November 15, 2016


Simple Digital Technologies Can Reduce Health Care Costs (Alexander L. Fogel & Joseph C. Kvedar, NOVEMBER 14, 2016, Harvard Business Review)

Digital therapeutics are being increasingly validated in clinical trials published in peer-reviewed medical journals and are available or are being developed for most chronic diseases. They include diabetes, hypertension, hyperlipidemia, obesity, smoking and chronic respiratory disease, and chronic pain. The Centers for Medicare and Medicaid Services (CMS) now reimburses for digital therapeutics for diabetes prevention and management. Enrollment in digital therapeutic programs is growing: A digital therapeutic is now the largest diabetes-prevention program in the United States recognized by the Centers for Disease Control and Prevention (CDC), and millions of people have downloaded digital therapeutics apps for medication adherence.

Here are just a few examples of the scale of the problem and the possibilities offered by digital therapeutics:

Diabetes prevention. Diabetes affects 9.5% of the U.S. population, and a diabetic employee costs his or her employer $4,500 more per year in lost productivity and higher medical costs. An additional 32% of the population has "pre-diabetes" - meaning that they are at high risk of developing diabetes.

The best treatment for diabetes is prevention, which requires many continuous behavioral interventions, support, and education. Digital therapeutics are now offering these solutions. One example is Omada Health, which modeled its product after the landmark Diabetes Prevention Program study. Omada offers a 16-week, online, interactive, behavioral-intervention program that combines health coaches, social networks, and personalized plans to reduce the development of diabetes in pre-diabetic patients through weight loss and increased physical activity. Studies show that the average participant loses nearly 5% of his or her body weight, keeps it off, and is less likely to develop diabetes. Omada's programs are now recognized by the CDC and CMS.

Smoking cessation. Seventeen percent of U.S. adults smoke, and they cost their employers nearly $6,000 more per year in direct and indirect medical costs. Smoking cessation is difficult, requiring minute-to-minute support and behavioral change. Digital therapeutics are being developed and clinically validated for smoking cessation. One is 2Morrow's SmartQuit, a smartphone, app-based, smoking-cessation therapy that has demonstrated effectiveness in randomized clinical trials and is two to three times more effective than unaided smoking cessation.

Medication adherence. More than 83% of all prescriptions are filled by patients with chronic diseases, and the average patient with one or more chronic diseases fills more than 20 prescriptions per year. More than half of medications prescribed for chronic disease are not taken as directed, and between 20% to 30% of all prescriptions are never filled. This problem contributes to worse health outcomes and greater spending. Digital therapeutics are emerging to combat this problem.

One example is MediSafe's cloud-synced smartphone app that sends patients reminders to take medications at their scheduled time, along with a "virtual pillbox" with images of the size and shape of the patient's pills. MediSafe can then send summary reports to patients and doctors. Users report substantially greater medication adherence across a number of chronic conditions.

Posted by at November 15, 2016 5:35 PM