While acknowledging the pivotal role of technology in enhancing health, we are still in the early innings for digital health as it relates to the transformative impact many had expected to come to fruition. Although there remains ample opportunity, technology adoption has not yet meaningfully scaled to a level where alternative models, such as care in the home, are dominating. At the same time, we face an unparalleled crisis in access: constrained labor supply, hospital closures, and margin constriction in ambulatory settings are all contributing to worsening access to care. It is our belief that digital health can play a key role in solving this problem but only if resources are channeled towards solutions that yield tangible returns. These returns should be measured not only through improvements in outcomes but also by addressing inefficiencies. However, only those solutions that have an acute focus on demonstrating meaningful and sustainable levels of engagement, a comprehensive approach to health management, and prolonged impact on patient relevant clinical outcomes and financial impact will prevail.
It is no surprise that consumers encounter significant barriers when trying to access timely and appropriate healthcare services. Wait times to see a doctor have increased egregiously. In 2022, new patients faced an average wait time of 26 days — a rise of 8% since 2017 and 24% since 2004. Moreso, access barriers span beyond simple wait times. Today, over two million elderly and disabled adults encounter barriers in visiting provider offices due to transportation and cost constraints. At the same time, as our nation’s population grows and ages, the demand for healthcare services will continue to sharply rise. Currently, the senior population drives 34% of physician demand, a number expected to climb to 42% by 2034.
In conjunction, our healthcare system is witnessing an unprecedented rise in costs, with one out of every three dollars spent on hospital care. It is expected that as much as $47B of healthcare costs can be avoided, largely due to unnecessary ER visits driven by low health system literacy by consumers. The prevailing, and sadly accurate, perception of healthcare as extremely expensive has led to nearly 40% of consumer’s forgoing medical care due to cost. As these barriers and costs continue to persist, there will be a growing urgency for alternative solutions that support consumers where they are. This is where the promise of digital health can be transformative.
Scalability requires greater connectivity
While the healthcare industry has taken steps toward enhancing accessibility, leveraging digital health services spurred by the Covid-19 pandemic and expanding care beyond conventional facilities into people’s homes, there exists untapped potential to establish scalable healthcare solutions that transcend the limitations of the four walls of the traditional healthcare system. Connecting these services to entities that already have trusted relationships with patients rather than creating disconnected parallel structures is essential. Digital health can both improve access and augment experience in a sustainable and scalable approach with greater connectivity with providers and trusted institutions.
Digital health solutions can avoid the exacerbation of silos and point solutions and emphasize effective communication, an aspect where the traditional healthcare system frequently falls short. This entails not only conveying information to the patient but also ensuring proper communication with relevant caregivers and providers. Current approaches to payer sent eligibility files and “cold calling” patients are arcane, do not generally yield sustainably high engagement, and often fail to interject at critical moments of influence. If companies are disconnected from the care experience, it will be almost impossible to demonstrate meaningful engagement and impact on the total cost of care. Creating an experience where patients can navigate both their in-person interactions and digital engagements will be important to accelerate greater adoption and scale.
As the number of polychronic Americans rises, the era of a fragmented, point solution digital health ecosystem will fall in favor of a more interconnected and integrated landscape. Consumers, across all aspects of their life, desire solutions that address all their needs. This expectation holds true when they are engaging with their health and care. However, when launching with health plans, healthcare solutions are tested independently. As we move towards a more interconnected environment, there will be a greater need to test solutions as a bundle of services rather than in silos. Ultimately, digital health organizations that are unable to play well in the sandbox with other solutions and incumbent systems will not stand the test of time.
Payer reimbursement for a non-traditional clinical care model
Establishing sustained engagement as a lever to be able to impact medical cost continues to be a challenge for payers. If digital health interventions are unsuccessful, it is not because of their clinical programs but because they (along with their payer partner) are unable to keep the members engaged for a long enough period of time to be able to impact total cost of care. When an intervention is directly provided from a payer as opposed to one that is deployed in partnership with both a payer and provider, the engagement is meaningfully different. In deploying interventions primarily only through a payer channel, many digital health interventions might not be operating in an environment set up for success given the underlying disruption to the patient-provider relationship.
While payers will continue to seek solutions that can drive engagement and impact total cost of care, it would be judicious for digital health companies to think through what the upfront partnership model should look like to create the right environment for success and how that model may need to be different based on geographic variabilities, condition-specific variances, or other important considerations. It is also important to keep in mind that consumers are ultimately seeking convenience and quality and payers are seeking to impact medical cost. If what the member is seeking is not addressed, the impact on cost will never be achieved. Scaling these solutions then requires moving beyond only payer driven eligibility files to a more nuanced approach in order to drive the most impactful care.
What the future holds and how do we get there?
Looking forward, successful scaling requires meeting consumers and providers where they are by providing care in the home, enabling improved services through technology, and devising creative and accessible alternatives to ED or hospital visits. Consumers are searching for this as 69% of consumers are interested in at home check-ins with their doctors, 73% of consumers prefer to recover at home versus a medical facility following a major medical event, and 64% of adults regularly use a mobile application to measure their health metrics. For consumers, receiving care at home through technology enablement offers immense potential for convenient, high-quality, and affordable healthcare. Given the delicate balance to ensure the profitability of in-home care, technology serves as a valuable augmentation through remote monitoring and virtual services, especially when in-person visits are not required. Regardless of the delivery mechanism, solutions must be connected to providers, especially those taking on risk, to improve upfront engagement, and demonstrate improved clinical outcomes and decrease in medical costs.
Another avenue to explore is delivering services at locations where consumers naturally congregate, such as community-based organizations and on-site clinics, leveraging trust and accessibility. Noteworthy examples of companies embracing this approach include GroundGame Health, LiveChair, Local Connections for Health and Waymark. GroundGame Health links community based organizations (CBOs) with health plans and providers to address SDOH needs of the most difficult to engage healthcare populations. The company has successfully powered the flow of $26M from MCOs to CBOs, helping provide sustainable funding to local organizations best positioned to meet the needs. Live Chair Health started by reaching members in salons and barbershops and expanded its reach to faith-based institutions and housing developments. The company has now rebranded as Local Connections for Health and includes local community health workers who are certified in advanced chronic disease management. Waymark offers local care teams comprised of community health workers, licensed therapists, care coordinators, and pharmacists that help providers expand their reach to better serve patients on Medicaid.
The landscape has also seen the emergence of organizations streamlining service delivery; for instance, NOCD provides virtual therapy for those with severe mental illness but also seamlessly directs members to in-person care when necessary. Similarly, Author Health, extends virtual care to Medicare Advantage populations dealing with serious mental health concerns and substance use disorders, averting unnecessary and costly ED visits. Jasper, a virtual oncology navigation solution, offers personalized guidance and digital planning tools, empowering individuals throughout the cancer journey. These instances highlight the tangible and innovative opportunities for more efficient and accessible healthcare services. (Editors note: co-author Alyssa Jaffee is an investor in NOCD, GroundGame, and Jasper.)
Conclusion
The future of digital health scalability relies on a multifaceted approach. Leveraging tech-enabled services is essential in facilitating alternative methods of care like home and community-based options. It also entails aligning with consumer preferences and engaging with them at critical moments of influence. Creating flexibility in how consumers choose to access care (both in-person and tech enabled) will lead to greater use of digital solutions that can be seen as part of their health care experience rather than outside the traditional ecosystem. Consumer interest in at-home check-ins, a preference for recovery at home, and the surge in health-centric mobile app usage are just part of the equation. Success requires a synergy between technology, healthcare providers, and payers to provide guidance and education, ensuring individuals make informed decisions about their healthcare options
Photo: FG Trade, Getty Images
Mona Siddiqui has spent over 20 years in health care at the intersection of data, operations and technology launching and scaling programs and products to deliver value. She most recently served as Senior Vice President of Clinical Operations for Humana’s Home Segment with responsibility for scaling its value-based care offering. Prior to this, she led Strategy and Quality across Humana’s Insurance division and had accountability to drive measurable improvements in total cost of care. Before coming to Humana, she served as Chief Data Officer for HHS where she led the Department’s first AI strategy. In addition to this, she has held senior roles at CMMI, at the White House and at the Johns Hopkins Hospital. She has a medical degree from Johns Hopkins, a degree in Quantitative Methods from Harvard and in Management/Engineering from Stanford.
Alyssa Jaffee is a Partner at 7wireVentures where she invests in companies that empower everyone to be better stewards of their health. She holds board roles at Caraway Health, NOCD, MedArrive, Brightline, Zerigo Health, Jasper Health, and Summer Health. Previously, Alyssa was an investor at Pritzker Group Venture Capital and Hyde Park Angels. Alyssa is also a cofounder of TransparentCareer, a NVC winning company helping people make more data-driven career decisions. Alyssa spent time at the Advisory Board Company where she launched new technologies and consulted hundreds of hospital executives to understand their needs and recommend solutions. Alyssa attended the University of Wisconsin-Madison and received an MBA from the University of Chicago’s Booth School of Business. Her work and accomplishments have been featured in Fortune, Stat News, MedCity News, Crain’s, and more.