As has been widely noted, the COVID-19 pandemic has prompted countless people to rely on telehealth and virtual monitoring for their healthcare needs. This dramatic pivot is catalyzing a demand for digital health tools that will persist post-pandemic, as providers, payers and patients alike grow accustomed to the benefits of digital care.
To turn that demand into sustained healthcare delivery excellence, all stakeholders in the digital health ecosystem—providers, patients, regulators and technology developers—will need to reimagine healthcare. As healthcare reform, healthcare coverage, and healthcare disparities remain pressing public policy and public health topics, there are opportunities for a forward-thinking federal policy that takes concrete steps to integrate digital health tools into day-to-day healthcare delivery—and fundamentally changes how we think about healthcare delivery.
But it’s not up to government alone. At the outset of the pandemic, many people were new to telehealth and may not have had a point of comparison to assess and evaluate (and thus, critique) the remote care they received. Further, many people simply felt grateful for the telehealth options that were available to them in a time of uncertainty and recognized that the healthcare system rapidly scaled its synchronous telehealth capabilities under enormous pressure. As we begin to move from a crisis response into a sustained new normal, however, people’s expectations for versatility, excellence and a patient-centered approach will increase, and the deserved halo of gratitude currently affixed to the healthcare system and healthcare providers may no longer compensate. The challenge for the digital health community will be to bring the same high standards for care in the physical world to their digital interactions.
To meet this challenge, regulators, digital health technology developers and providers will need to consider a post-pandemic delivery system that works differently than the system we had in February 2020. A key element in doing so will be integrating in-person and digital care, considering the patient experience and anticipating challenges such as patient accessibility, reimbursement and data access. Digital health technologies should not just be added to the current system as bells and whistles; they should be an integral part of transforming the current system into a delivery model that addresses many of the systemic and ingrained deficiencies of our current models.
What might this new system look like? As a starting point, expanded, reimbursable access to synchronous telehealth encounters with a provider will be critical and the benefits to patients and the healthcare system as a whole are obvious. But synchronous care is just one building block to a healthcare system that effectively leverages digital healthcare. Comprehensive digital care means moving from the episodic to the enterprise—essentially, deploying a range of tools, technologies and support beyond episodic care to create a continuum of care that engages and empowers patients; provides real-time advice, intervention and support; and identifies gaps in care or adherence failures that can be addressed before they become acute or chronic.
This shift to a continuum of digital care delivery presents its own benefits and its own challenges. For providers, patients and payers that are accustomed to episodic care, the on-going monitoring and engagement of virtual care technologies and the incorporation of smart phones, the Internet of Things and other devices can be a welcome source of support and a powerful tool for managing chronic conditions. But they can also present novel issues related to patient comfort level and adherence; provider satisfaction and provider responsibility; data management, curation and privacy; and reimbursement and value-based pricing.
Let’s take a closer look at specific steps that digital health technology developers and providers can take to integrate digital health into our care delivery system.
Build Trust. For all of the flaws in our current healthcare delivery system, patients still seek a trusting, personal relationship with their providers. A care model built around episodic care necessarily builds in communication models that create a specific, personal connection. For digital health to reach its full potential, the patient needs to see the company delivering the virtual care tool as an integrated and seamless part of the care experience—not just as an app or a piece of technology, but as a provider in its own right working in concert with non-digital healthcare providers. In addition, patients need to understand and even feel a sense of enthusiasm for how their data is leveraged for research, product improvement and other innovations. Complying with the law is not enough; stakeholders need to foster a sense of transparency, trust and buy-in.
Invest in the Provider Partnership to Integrate Care. One way to earn trust and adherence is for the digital health provider to work in tandem with the patient’s existing providers. Care recommendations, digital reminders and actionable insights, care coordination, real-time data delivery and review by providers—all of these need to be integrated into a consensus plan of care between the patient and providers, including providers that are not part of the digital solution. Patients shouldn’t feel ping-ponged between digital and non-digital caregivers.
Create Patient Buy-In and Adherence. Patients often struggle with complying with medication and other healthcare regimes. Seeing this as a healthcare need, rather than as a patient failure, create opportunities for improving our healthcare delivery system. Digital health tools, with their continual monitoring and real-time actionable insights and support, may offer new means to encourage and track patient adherence, and even mitigate a lack of it. But monitoring patient adherence must be balanced with potential patient concerns about being overly scrutinized or surveilled, which could prompt them to disengage from the digital health tool.
Shift from Digital First to Simply Delivery. Right now, digital healthcare is the novel newcomer. Over time, however, we can imagine a digital-default model where digital health is the first line approach when true, in-person, episodic care is not an essential part of the healthcare encounter at that particular moment. In time, we will no longer distinguish between digital and non-digital care—both will simply be the delivery of care. Companies that are able to begin building now toward a model in which digital and non-digital tools are developed to seamlessly complement each other will be well positioned. Right now, stakeholders can have systematic digital health governance frameworks that make sure that the right tools are onboarded for specific patient challenges and that these tools are operationalized in a way that is maximally effective. Given the plethora of digital tool options available to providers, and the pressure CTOs and CIOs are already under to meeting existing tech challenges, having a framework to make smart, strategic choices is essential.
Pivot to Outcomes-Based Reimbursement and Value. Digital health (and healthcare delivery more generally) needs to align to savvier healthcare incentives. A reimbursement system that privileges episodic encounters but does not reimburse for the on-going care coordination and digital monitoring that is at the heart of digital healthcare will continue to hamper the development and economic viability of new technologies and slow efforts to flatten the cost curve. Digital health companies currently can be successful if they enter into alternative, value-based pricing arrangements with large insurers—typically, self-funded health plans—but that will constrain the reach of these technologies, to the disadvantage, in many cases, of the neediest Americans.
Reimagine the Patient Experience. We all expect what we are used to. Patients, especially those with chronic conditions, may come to think of the limitations and gaps in our current healthcare system as unavoidable. As a result, without adequate onboarding and training, patients may be skeptical about a different kind of healthcare experience, which could depress interest in adherence to new digital modes. Digital health will be more successful if patients understand the possibilities for their care and why their active participation with the digital health company works to their benefit.
Anticipate and Understand the Patient Journey. Technology and actionable insights are critical, but so is stepping through the patient experience to understand what care delivery looks like for the recipients. For digital healthcare to work, we need anticipate and optimize the delivery of that care. Episodic care is easier to predict, is time-bound, and has certain normative rules and predictable inconveniences. Digital health is a different package, and helping patients become familiar with it will accelerate adoption. This effort ranges from straightforward considerations (i.e., counseling patients through privacy settings on their phones if they use medical apps) to the more complex (i.e., determining the optimal cadence for prescription reminders to balance patient adherence, provider liability and patient frustration). A superior product is not enough—it must also be a superior clinical experience.
Engage in Data Curation and Actionable Insights. Our data ecology is fractured and interoperable. For digital health to be optimally effective, data from different applications and different providers must be integrated to create a more holistic picture of a patient’s care. Federal rulemaking on information blocking and interoperability may help create a national data infrastructure, but more work is necessary to incentivize data sharing while addressing legitimate intellectual property and proprietary concerns.
Secondary Data Rights and Research. Digital tools capture significant information all the time. This information has tremendous potential to be used to understand patients better and to contribute to generalizable knowledge about illnesses, chronic disease, social determinants of health and many other pressing scientific questions. Research regulations and human subject safety norms provide guidance for how to de-identify data, mine identifiable health information to refine research questions and protocols, screen and recruitment subjects, and conduct research. Integrating a secondary data use strategy to leverage data received as part of clinical care and care coordination for secondary research enables our digital tools to contribute in multiple ways to keeping people healthy. In addition, digital health tools can help facilitate research by improving the informed consent process, helping with remote monitoring in between subject visits, and reducing in-person encounters, especially for subjects whose underlying health conditions make them more vulnerable.
Pursue Data Strategies and Privacy Controls. Drawing on many of the themes above, digital health depends on digital privacy, which further fosters trust, adherence, buy-in, adoption and smart data practices. Comprehensive digital governance and updated regulatory privacy standards that take seriously both privacy and data utility will be instrumental in making sure that data can be collected, maintained and shared in responsible ways.