By DAVID LEE SCHER, MD, FACP, FACC, FHRS
Sponsored by MedSpeaks
There are clear threads between consumer and healthcare delivery with regards to adoption of digital technologies. Many of these threads involve the consumer sides of healthcare. I will discuss below how the patient is a consumer (defined as a purchaser of goods and services for personal use) in the healthcare arena and how viewing a patient as a consumer is transforming healthcare.
Patients have choices. In an excellent article in the International Journal of Health Policy and Management Benjamin Ebert makes a key point: Although healthcare users have multiple identities (patients and consumers), the relative weight of these roles is dependent upon outside factors (users' personality, state of health, values and respective health care decisions to face). Patients have choices as to healthcare insurance plans and medical provider and treating facilities (albeit limited in many cases by the health insurance carrier's 'network'), assisted living facilities. One must note, however that the extent of choice is decreasing because of consolidations in healthcare. Patients have choices regarding the purchase of many digital health technologies. Awareness (on the part of patients as well as providers) and development of more robust, impactful, diversified and integrated technologies will increase those choices in the future. Fitbit, Apple, Samsung, Google, and others are bringing healthcare closer to the consumer side of society.
Patient satisfaction counts. Patient satisfaction is not a qualitative term equated with patient advocacy. It is a set of standardized questions (in limited language diversity) in the form of patient surveys to formulate metrics upon which payments to hospitals and physicians are based. Though patient higher satisfaction scores have been shown in one study to correspond to higher mortality rates and another to higher hospital readmission rates, they are still seen by some as surrogates of care quality. Nonetheless, the fact that the patient's perspective is considered at all is a step in the right direction for patient advocacy. Patients may have a choice of points of care and therefore these metrics are certainly playing heavily in marketing campaigns.
All stakeholders in healthcare are looking for market share. Whether speaking about payers, providers, other healthcare services or technologies, the rules of a free economy are in play. Market share rules and is the underlying cause of heavy consolidation in the payer and provider arenas. The number of 'covered lives' is the goal of payers, ACOs and healthcare enterprises alike. It is the reason for large companies like IBM, Apple, Samsung and others getting into healthcare. Technologies which appeal to patients as consumers will succeed. Those putting the most effort into user experience (UX) design translating into adherence and potentially outcomes will succeed in the marketplace. What is different about healthcare from the retail business market is that these efforts need to be driven by studies demonstrating good user experience, adherence, and better outcomes (which can be related to efficiency, clinical or other parameters). The days of walking into a C-Suite with the "I've got a technology to sell you" are over. Proof of concept is replaced by proof of efficacy. ROI is defined today as cost savings not revenue generation. As readmission penalties and other quality metrics determine fines and payment, this becomes a critical concept. Some see the need of proof of efficacy via trials (though not necessarily long ones) as a chicken or egg situation. However, a tool which makes a difference and the right development team will find its way into clinical trials which can involve minimal investment and even be performed totally via mobile technology. Investors specializing in digital health technologies (beyond the multitudes of local incubators) are going to become key players. Strategies in healthcare are different because the marketplace, margins, and effects on lives are different. Proof of the momentum of clinical trials is the1247 studies involving mobile health found on gov.
Mobile health technology success hinges on social engagement. Outcomes tied to patient engagement are directly dependent upon the ability of the technology to maintain contact with the patient or caregiver. A recent study found that just 36 health apps accounted for one half of all downloads of the estimated 165,000 health and fitness apps available via Apple and Google. Social engagement will be a significant driver of mobile health engagement. Having a mobile health tool with social will increase interactions and therefore the 'stickiness' of the tool. Social media began without a business model. It now makes billions of dollars for advertisers and other digital partners.
There are many reasons why physicians need to be on social media as professionals. Many of these same reasons hold true for mobile health technologies. Mobile health technologies need to harness the power of social to connect patients to each other via support communities, to hospitals, to Pharma and medical device companies, to non-profit and governmental agencies and to their own caregivers. Granted, it will take time for all these stakeholders in the slow-moving world of healthcare to get to social in a significant way. But it will happen and social engagement on mobile apps will be the forum. The excuses of regulatory constraints and lack of models by some stakeholders can be addressed with appropriate investment in internal infrastructure and education.
Most mobile health technologies are patient-facing. The fact that most mobile technologies are patient-facing only speaks to the consumer-oriented approach taken for the quickest adoption and financial success (which doesn't necessarily reflect long-term adherence or profitability). The emphasis on user experience is paramount. The purpose of the technology needs to be clearly stated and the expected level of patient and/or caregiver participation needs to be explicitly presented. Incentives in the form of gamification and/or healthcare financial incentives by a payer or employer might result in greater adherence.
This remains to be proven.
If the patient-facing tool is expected to share information with a provider, it is mandatory that the technology is easily integrated (interoperable) with the electronic health record and that only filtered clinically relevant, important, and actionable data reach the clinician.
In summary, digital technologies are only tools. They will be utilized only if they appeal to patients and caregivers. One might consider mimicking development and marketing strategies of some of the most successful retail and finance tools. Brand loyalty will be established based on the delivery of high quality, reliable, safe, and easy to use tools. There are considerations in healthcare that certainly differ from retail. However, patients are consumers of healthcare. Use of any technology is still a universal human experience. Technology offered to them needs to reflect this.
David Lee Scher, MD, is Founder and Director at DLS HEALTHCARE CONSULTING, LLC. To read more of Dr. Scher's work, go to davidleescher.com or email dlschermd@digitalhealthconsultants.com.
