Family Medicine Vital Signs

By Dr. Christopher Wasden

The biggest failure in healthcare is that no one has ever considered the consumer (aka the patient) the customer. Consequently, all stakeholders such as governments, private payers, medtech and pharma companies, and providers almost always ignore consumer-oriented value propositions, and instead focus on creating and delivering their value propositions to one another. This has resulted in healthcare systems around the world failing to deliver on the triple aim of affordable, accessible, and effective healthcare, with the most pronounced failures occurring in the United States.

Four digital technologies I call SMAC (Social, Mobile, Analytic and Cloud) are now putting the consumer at the center of healthcare and beginning to radically disrupt healthcare as they already have retail, travel, and media. This disruption is now creating powerful tensions that are now creating the “end of healthcare as we know it” and ushering in the Digital Health Revolution.

So what’s the problem?

Healthcare firms have not yet figured out how to harness 10 tensions created by these new Digital Health technologies to validate, package and promote their solutions as effectively as drug companies do to drive mass adoption.

1. Money Tension – clinicians and health systems will only adopt Digital Health if they can make more money; yet the primary value of Digital Health is to improve the triple aim: better outcomes, greater access, affordable care (lower costs). Digital Health has the power to decrease costs by 50% or more.

2. Practice Tension – Digital Health must drive creative destruction of medicine and transform the practice of healthcare to one that uses fewer clinicians; pharma and medtech are leading this transformation. Digital Health eliminates all physician and nurse shortages around the world.

3. Engagement Tension – consumers/patients need to be more engaged in making healthy decisions but less engaged in the health system; Digital Health provides the platforms to enable this. Consumers want the same type and quality of digital engagement in healthcare they get in all other aspects of their lives.

4. Adoption Tension – those that need Digital Healthcare the least are those most likely and willing to adopt it the fastest, while those that need it the most will be slow adopters; early adopters provide great tests cases to drive innovation. We must learn from the successes of companies like Fitbit to see how to get the same adoption in other aspects of health.

5. Technology Tension – we have an over abundance of technologies but an unwillingness and inability of clinicians to use them; technology adoption must become as simple as writing a drug script and require no more thinking and effort from clinicians. We must create a Digital Health app formulary to make adoption by clinicians simple and easy.

6. Satisfaction Tension – nearly every study and survey on Digital Health shows 85%+ consumer/patient satisfaction due to significantly better outcomes (shorter hospitalization, fewer admissions and readmissions, happy people); consumers must become the outspoken revolutionaries demanding Digital Health solutions. We must eliminate paternalism in healthcare and put the consumer in charge.

7. Feedback Tension – there currently is virtually no feedback loop in healthcare for the vast majority of consumers/patients; Digital Health enables real time feedback, but not by the human physician. We have to create feedback loops that don’t require the physician.

8. Utilization Tension – nearly all studies of Digital Health show 20-40% reductions in health system utilization yet health systems in developed countries can’t figure out how to turn that into economic value; emerging markets and consumer driven systems are creating new Digital Health systems to leapfrog developed markets. We must penalize waste and incentivize value so we are not afraid to keep people out of the healthcare system.

9. Validation Tension – despite a plethora of pilots and studies of Digital Health applications and use cases, we lack a systemic way to evaluate and validate which ones work and how effective they are; we need social and crowd sourced mechanisms to rapidly test and share Digital Health solutions. Peer reviewed articles that take three to five years to produce published papers will never keep up with the pace of Digital Health innovation and can’t be the standard for validation.

10. Behavior Change Tension – Digital Health’s value only really accrues by changing consumer/patient and clinician behaviors, yet clinicians lack any training in behavioral psychology, economics and change; Digital Health vendors must incorporate behavior change science into their solutions just as Google, Amazon, Facebook and Apple do in digital technology solutions. We must embed behavior change into gamified apps and devices so that we don’t require clinicians to figure out how to change behavior on a one-by-one basis.

Those healthcare organizations that harness these 10 tensions will decrease costs, improve efficacy, increase safety, and deliver better outcomes by harnessing these tensions to create successful blockbuster digital health technologies through new business models to consumers (aka patients) in the market.

Dr. Chris Wasden is the Executive Director for the Sorenson Center for Discovery & Innovation in the David Eccles School of Business at the University of Utah.