- Offline patient care for chronic health conditions stem from patients’ unhealthy diet, exercise, and other habits
- Programs that use digital platforms to juggle care from doctors and coaches can create behavior change
- With reminders, nudges, and rewards, the programs keep patients engaged and feeling in control of their progress
Chronic medical conditions are painful to patients and costly to their healthcare providers. But mobile apps and other digital tools, including platforms that integrate frustratingly siloed data that can impede efficient care, offer a promising set of solutions for patients and providers.
Patients with chronic pain typically face an expensive and frustrating gauntlet of office visits, testing, and referrals—which are often followed by surgery, medication, and multiple (and frequently missed) appointments with a physical therapist. That frustration is often shared by hospitals and health systems, whose revenue models are increasingly based on outcomes rather than fees for service.
But an emerging model of care may help improve the patient experience for the 1 in 3 people globally who suffer from multiple chronic health conditions like heart disease, diabetes, and obesity. Mobile apps, portals, and other digital tools can connect patients with coaches and therapists around the clock and provide a means to conduct physical therapy sessions remotely, online.
Such programs, based on principles of behavior science, help patients make better progress toward their health goals, and at a fraction of the cost.
Creating better customer experiences is a near-universal business priority, of course; in healthcare, however, it’s absolutely critical. Pairing digital technologies with human coaching and clinical care can offer a dramatically better patient experience through personalized attention, on-demand access to support, and automated reminders.
Using these digital tools can mitigate the debilitating effects of chronic disease and avoid more costly treatments by motivating participants to improve their diets, exercise more, and more closely monitor their health.
“We’d much rather pay for this benefit for preventive care than to pay for the chronic condition for the next 20 years,” says Nicole Henry, director of health benefits for the Self-Insured Schools of California, a purchasing cooperative that insures more than 350,000 school workers and family members.
For healthcare providers that often rely on outdated or fragmented data systems, a digital health platform can allow them to respond quickly, via secure apps, to address patient needs more thoroughly and efficiently, improving patient outcomes and, not coincidentally, providers’ bottom lines.
Making healthy behavior more rewarding and repeatable
Treating chronic conditions is prohibitively expensive. They cost the American healthcare system an estimated $3.4 trillion a year and account for 90% of total healthcare spending, according to the Centers for Disease Control and Prevention. A recent survey by the Rand Corporation showed 60% of Americans suffer from at least one chronic condition.
While chronic conditions have several causes, including accidents and genetic history, many are spawned by daily habits like smoking, poor diet, or a lack of exercise. Experts have long recognized that, for many patients, bad habits are notoriously hard to break, while good habits that can lead to healthier outcomes are difficult to maintain.
“What you want to do is make the desired behavior, the healthy behavior, easier for people to repeat and make it more rewarding, so that people have a reason to repeat the behavior,” says Wendy Wood, a professor of psychology and business at the University of Southern California and author of “Good Habits, Bad Habits: The Science of Making Positive Changes That Stick.”
The value of virtual care
Programs that combine human clinical care and coaching—but make those services available on-demand through digital platforms—can provide the reward and repetition necessary to success, says Chris Mosunic, a psychoanalyst and chief clinical officer for Vida Health, a San Francisco–based company that offers habit-changing tools for chronic disease.
Such “virtual care” programs, proponents say, can do a better job getting patients to stick with their treatment and change behaviors than a traditional behavioral-management approach, which requires regular visits to a care center or professional’s office.
For example, diabetes sufferers typically manage their disease with insulin, often taken by injection or a pump placed under the patient’s skin, in most cases for life. In a recent study by Vida, participants were taught how to manage their diabetes without medication. They had regular one-on-one remote sessions with a caregiver and learned, through online tools and lessons, how to anticipate their bodies’ reactions to food and physical activity.
Over a four-month period, the study found, diabetics in the program experienced a larger decline in glucose levels than a control group taking conventional medication.
San Francisco–based Hinge Health helps treat patients with musculoskeletal disease, a leading cause of chronic pain, with a program based on building new habits, says Valerie Black, the company’s director of behavior change.
To avoid opioids, a common default treatment for chronic pain, Hinge Health uses a tablet-based app to pair patients with a physical therapist or a coach who assists with exercises. The app provides prompts, such as the fact the patient drinks coffee at the same time, to provide reminders when it’s time to exercise.
Keeping patients engaged and connected
Patients using digital-care apps on their own tend to be more receptive to exercising or taking medications than if they had to depend on office visits, Black says.
In a 2020 study of more than 10,000 people with knee and back pain, almost three-quarters of patients participating in digital care programs maintained their exercises after three months, compared with 30% to 50% of patients in conventional physical therapy programs. Likewise, patients who completed the exercises on the Hinge app also showed a significantly greater reduction in pain than those who followed a conventional physical therapy regimen.
If you allow the patient to have more of a self-health management journey, they become more aware, more educated.
“For employers that’s a significant savings in money and time by avoiding surgeries and reducing pain among employees,” says Black.
Patients—aka customers—expect healthcare apps to have consumer-grade tools and ease of use to keep them engaged in the treatment and provide a greater sense of control over their own health. Creating sophisticated healthcare apps is more achievable than ever in the age of low-code digital workflows.
“If you allow the patient to have more of a self-health management journey, rather than putting the onus on the provider, they become more aware, more educated,” says Vishakha Sant, global head for healthcare providers at ServiceNow, “and that kind of engagement with the patient leads to better clinical outcomes.”
Some health-policy experts are skeptical of the long-term value of such programs, and of studies that support their effectiveness, because the programs, they say, may disproportionately help patients who are already motivated to change their behavior.
“The people who do well with these apps are the kind of people who are already going to be monitoring themselves and going to therapy,” says Peter Muennig, a professor of health policy and management at Columbia University’s Mailman School of Public Health.
Still, if the programs can give patients a way to maintain the long-term process of changing unhealthy behaviors, they are more likely to have a significant effect on mitigating the damage caused by chronic diseases.
“People will engage and disengage, and then re-engage, and maybe that’s just fine,” says Robert Gabbay, chief medical officer of the American Diabetes Association and a paid advisor to Vida and other health programs. “That doesn’t negate their efforts.”