Date: Wednesday, November 22, 2023

Time: 12:00 PM Eastern Standard Time

Duration: 30 minutes

Register here

By PARV SONDHI

As the digital health world continues to expand, more and more people are turning to apps to manage everything from diabetes and obesity to depression and anxiety. People rely on these apps for their physical and mental health, so it’s crucial that product developers ensure a safe, effective, and engaging experience for them. Healthcare experts agree.

A team of researchers and health system leaders recently introduced a new framework called “Evidence DEFINED” for evaluating digital health products. This framework offers hospitals, payers, and trade organizations a precise set of guidelines to assess the validity and safety of a digital health product. It also gives digital health companies good benchmarks to work from.

As digital health companies create new products in the space, they should keep specific points in mind — from user experience design to considerations for data privacy. While clinical outcomes will always reign supreme, the framework suggests that patient experience, provider experience, product design, and cost effectiveness can’t be discounted.

Here are a few critical considerations that product delivery teams should plan for when creating digital health apps.

Clear navigation

First things first: a user won’t use an app that’s hard to navigate. To help people stick to their health goals, developers need to create apps that are intuitive and easy-to-use. When a user logs onto an app, they want to find the content they need immediately and be guided through the experience step by step.

A lot of different people use health apps, and not all of them are tech-savvy. Health apps need to be accessible to all demographics, including people of various ages who speak different languages. It’s also important to remember that digital health apps can be used across multiple platforms, so the navigation should remain clear when switching between devices.

While navigation might seem like a no-brainer, it’s often overlooked when designing for digital health.

But clear navigation benefits the app as a whole since it can help reduce the time users spend searching for what they need and increase overall engagement.

Simple user interface

Digital health apps need to have a simple, straightforward design so that users can use the product to do what they came to do: work on achieving their health goals. For example, all user interface elements should be visible simultaneously, and interactive elements should be easily recognizable as buttons, tabs, or links. Additionally, task completion instructions should be clearly explained and simple enough for users at a fifth-grade reading level to understand.

The goal should be to create an app that allows users to focus on their health needs without getting bogged down by complex features or design elements. After all, the app aims to help users in their journey to better health, not to be a distraction.

Personalization

Giving users the ability to create a customized experience within the app can help keep them engaged over time. This could involve allowing users to customize their dashboard with widgets, change the color scheme or background of the app and tailor their interactions.

In addition, consider enabling users to set up personalized reminders for activities such as taking medication, logging their moods, or completing specific tasks.

Depending on the specifics of the app, users should also be able to access and update their personal information, such as contact details, health history, etc. This ensures all data is accurate and up-to-date.

Positive reinforcement

An intuitive app gets the user started, but to keep them coming back you need positive reinforcement. A well-designed app should make achieving health goals easy and even pleasant, helping users through each step and celebrating their wins.

Developers can create apps that send users encouraging messages when they complete tasks, or awards users points or badges when they reach milestones. These things might seem small, but they can motivate users to keep using the app regularly and inspire confidence in their ability to take control of their mental health.

This might seem like an added expense or extra effort, but it goes a long way in improving user experience and engagement — which helps define whether or not an app succeeds in the digital health space.

Access to support

Integrating support in the app helps users feel like there’s always someone to turn to and provides an added layer of safety. Consider adding a feature that quickly connects users to the necessary support services in their broader health network, whether in the form of an in-app 24/7 chat or email.

It’s also helpful to provide FAQs and community support articles to allow users to opt for a self-service option. And, as always, make sure to enable robust privacy settings so users can control who they speak with and what information they share.

Education

People who use digital health apps want an action plan, but they also want to educate themselves on their health issues. Providing an education section engages users on issues that are important to them, enhancing their experience and encouraging them to keep using the app. Plus, it’s a great way to distinguish your app from others.

You can also display educational content to users as they go, offering definitions, or statistics, or links to research that they can access as they move through the stages of the program, as well as a separate education section that users can explore more on their own time.

Designing with this relevant and actionable content in mind can enhance user experience and motivate users to stick to their health goals and  continue to use the app.

Gamification

Gamification is a tool that encourages users to achieve their health goals by visualizing their progress and rewarding their persistence. Developers can use devices like leaderboards to show how a user is performing compared to other users, or streak trackers to encourage users to keep moving. Finally, developers can allow users to unlock achievements when they pass certain markers, rewarding them for their hard work.

By making health-related activities more fun and interactive, users are more likely to stick with them in the long run – which can positively impact their health. Gamifying the app experience can also help keep users engaged, motivated, and connected, creating a more positive user experience.

Integrated Care

While we’ve been talking about the digital experience, sometimes, one of the most vital pieces of the experience is the human in the loop. Teams can provide that experience by bringing in health coaches, dietitians, or therapists who can offer support right from the app. These experts engage users far more than a basic app can, and experts can offer tailored support and care for the user’s progress and suggest improvements to the member’s care plan.

Giving users access to this in-app can help them feel supported and encourage them to move the needle on their health goals and keep returning to the app.

Final Thoughts

As frameworks like Evidence DEFINED become more widely shared and developed, companies creating digital health products should consider not only whether the product is evidence-based and suitable for adoption, but also the user experience for their products.

When designing apps for digital health, it’s essential to create an experience tailored to users’ individual needs. By taking the time to understand user needs and preferences and integrating these considerations into an app’s design, developers can create products that are both accessible and effective for those struggling with health issues. With the right approach, such apps can be valuable resources in helping people manage their health and lead more fulfilling lives.

Parv Sondhi is a Group Product Manager at Vida Health

“If last year was EUPHORIA…‘We made it! Digital health is relevant!’ This year, it’s a little more panic. More, ‘Are we okay???’” SVB Securities’ Senior Managing Director Stephanie Davis says that she’s been getting asked for a lot of advice this year, so we jump on the bandwagon. Should digital health and health tech be worried? What about exits? What areas of health innovation are still hot? Which are not? And, what the heck is “creative destruction” and why is it her favorite buzz phrase from HLTH 2022?

Stephanie answers all our questions, reassures us of the healthcare market’s resiliency, and offers up some high-level perspective on which “wallet” (payer, pharma, or provider) startups will want to align with to weather the short-term.

Our rural health care system has suffered badly during the COVID-19 pandemic. It entered the pandemic with severe structural weaknesses, including magnified health disparities and inequities, lower rates of vaccination in the general population, and high risk of rural hospital closures. Beginning with these challenges, rural providers have been harder hit by the pandemic than just about any other health care sector. 

Juxtaposed against this struggle is the optimism for digital health – one of the few bright spots of the pandemic. We have witnessed a veritable digital health revolution – record capital infusions of $37.9 billion to digital health companies in 2021, a proliferation of digital health companies (11,000 by some estimates), a wave of healthtech IPOs (29), and an unprecedented talent migration of Silicon Valley programmers, technologists, and engineers into health care. With this investment and talent boom comes staggering growth in new digital health tools. From telemedicine to remote diagnostics to the delivery of medications directly to a patient’s home, it seems that for every health care access need there is a digital solution.

We – a health care strategist and rural health system CEO – think digital health entrepreneurs and these severely challenged health systems need each other to achieve their respective missions. Put simply, new digital modalities will be key to resolving many of today’s rural health care issues.

Bassett Healthcare Network in central New York state is showing how this can be done.

Why rural providers and rural communities need help

Rural providers are under siege. They face tough demographic challenges. Rural Americans on average are poorer, older, sicker, and less digitally-savvy than urban and suburban Americans. The vast majority of persistently poor counties (defined by having a >20 percent poverty rate over time) are rural. Poverty rates among rural Black and Native American populations almost triple the rate of rural white populations. 

These factors lead to corresponding health care and health status disparities. Rural areas perform worse on evaluations of risky lifestyle behaviors such as smoking and excessive drinking, and exceed urban counterparts in mortality rate across each of the ten leading causes of death in the U.S. The largest gaps are seen in mortality due to heart disease (21 percent), cancer (15 percent), and chronic lower respiratory disease (48 percent). 

Making matters worse, the nationwide shortage of health care professionals – from nurses and doctors to hospital security staff – is worse in rural markets. Sixty percent of federally designated health professional shortage areas are rural counties; rural areas average 13 primary care providers and 30 specialists per 100,000 people compared to 31.2 and 263 per 100,000, respectively, in non-rural areas. 

Between 2010 and 2021, 138 rural hospitals closed their doors altogether, leaving those impacted communities stranded for services and damaging their economic base.  

The explosion of telehealth in the past year is a promising way for rural health care providers to bridge workforce-and transportation-related access gaps.

However, a major hurdle to telehealth is that more than 18 million Americans – predominantly rural – lack access to high-speed Internet networks; 26% of rural households and more than 50 percent of tribal lands don’t have access to broadband connections reliable enough to support virtual health care visits.  

The dark side of digital health’s success story

In dramatic contrast to rural health care, digital health is a fast-growing sector. The amount of capital flowing into the space is more than 20 times the digital health investments of a decade ago. 

A more sober assessment reveals significant structural challenges facing these innovators. We see myriad factors impeding the successful adoption of these solutions. These include a proliferation of overlapping and imitative solutions in spaces like diabetes, musculoskeletal conditions, and behavioral health care; slow adoption of solutions by providers and consumers (the estimated average time for hospitals to deploy and scale a digital solution is 23 months); lack of interoperability between platforms; confusing and quickly-shifting regulatory requirements; and payer and provider technology bureaucracies that are slow to embrace digital solutions. 

Partnering with large, bureaucratic health systems has been a particular challenge for digital health companies. While some health systems like Stanford, Ochsner, and Rush have been more agile, the typical health system has been slow to welcome these breakthroughs. 

Bassett shows potential for a win-win partnership

So how do these two narratives come together? 

Unlike urban and suburban health systems, rural hospitals aren’t focused on building lavish new facilities. They can be less bureaucratic and faster-moving, with fewer constituencies and stakeholders to get in the way. Thus, they may prove more open to digital health technologies that advance home care and virtual care, enable professionals to practice at the top of their license, and create significant value for patients and providers in these communities. At the same time, they aren’t supported by the same level of funding as their urban and suburban counterparts, so they must take a more discerning approach to innovation. Since they can’t afford to invest in tools they may not use fully, each new digital prospect must be vetted to ensure it’s the right fit for workflows and patient needs. That scrutiny can lead hospitals to the best solutions.

In other words, the perceived weaknesses of rural health care may be strategic opportunities. 

Bassett Healthcare Network in central New York illustrates the potential for rural health system partnerships with digital health companies. Founded over a century ago, it serves an eight-county, 5600 square-mile geography roughly the size of Connecticut. It operates five acute care hospitals, a large multispecialty employed medical group, and a full-service post-acute care division comprising two subacute nursing home facilities, home care services, a durable medical equipment company, and a population health services organization. It also offers a medical school program focused on rural health training and research.

While unique in many ways, Bassett’s organizational challenges are starkly similar to those of other rural health systems. Its struggles include a disproportionate share of patients in lower-paying governmental insurance programs, compressed margins, and inflationary cost pressures exacerbated by stagnating population growth and an increasingly aging patient demographic. 

The combination of these factors limits Bassett’s ability to invest in workforce, infrastructure, and growth, translating into recruitment difficulties, aging facilities and equipment, and market vulnerabilities relative to regional competitors. 

But Bassett has identified digital innovation as a key strategy to improve operations, advance patient quality, access, and the patient experience, create financial stability, maintain independence, and position for future growth. 

In mid-2021, Bassett announced a plan to implement a partnership with Optum, a national health services provider, to install state-of-the-art information technology and cybersecurity infrastructure and end-to-end revenue cycle management that will advance a data-driven culture through a full suite of analytics tools and capabilities. Bassett executives worked closely with the provider’s board of directors to complete a thorough analysis of the transaction, and the partnership deal was finalized within a nine-month timeframe. This partnership has freed Bassett leaders to focus more time and energy on the organization’s evolving transformation and essential patient care needs. 

Viewing itself as an innovation center, Bassett’s partnerships with technology and digital health start-ups create an opportunity to co-develop solutions that meet the specific needs of rural health care across the country, and to test specific hypotheses through the Bassett Research Institute.

There are countless examples of how digital solutions can and should be expeditiously adopted by rural providers. 

Digital and hybrid companies offering “hospital at home,” remote patient monitoring (RPM) and integrated continuous monitoring (ICM), and remote laboratory services could solve the challenges in addressing geographic and access issues. Behavioral telehealth modalities – including synchronous/asynchronous, artificial intelligence-enabled cognitive behavioral therapy, “game-ification,” and other advances in behavioral care provision – could be deployed. Virtual-first primary care could mitigate the shortage of physicians and geographic distance barriers to care. Automation of operational and clinical systems promise to augment staff where shortages exist. Partnerships with providers and technology companies, several of which Bassett is actively pursuing, will be essential for implementing these systemic innovations.

Digital health is an area of innovation and invention that has advanced over the past two years, both in spite of and because of the COVID-19 pandemic. But digital health’s future is not assured, given the pullback in the public and private markets, the reversal of the Federal Reserve’s quantitative easing which was key to providing the liquidity for the digital health surge, and the delays and complexities in deploying digital health solutions.

The convergence of rural health challenges and the digital health care revolution create a prime opportunity for rural communities. Health care leaders, digital innovators, and federal and state policymakers could finally address the critical issue of improving health care and well-being in rural communities across the country. The digital health sector is in need of an agile ally, and the same is true for rural health care providers. We think leaders in the two sectors should chart a collaborative path forward together. 

Eric Larsen is President of The Advisory Board Company. Tommy Ibrahim, MD, MHA is President & CEO of Bassett Healthcare Network

For today’s health care tidbits, the elephant in the room has truely come home to roost, and now it’s landed on the phone wire, it’s close to breaking it. OK, I have stretched that metaphor to death but you’ll get my point. Writing on THCB earlier this month Jeff Goldsmith and Eric Larsen picked up on something I’ve been saying for a while –the fall in valuation of publicly traded digital health companies will have a knock effect on private companies. 

It took a while–those public companies stock prices started falling from their heights 14 months ago–but in the last month the venture capital scene has gone quiet. The days of sub $20m ARR companies getting mutli-hundred million dollar valuations are over for now. They will be back at some point in the future, as that’s how Silicon Valley has always worked, but it’ll be a while and in the meantime everyone is going to have to figure out what to do in the new world.

The “What to do?” question is getting harder as the data starts to come in, and it’s getting ugly. On the one hand the two fastest growing digital health companies ever have both had their comeuppance. Livongo was a tremendous exit for its investors and ended up trading at 20 times future revenue before it got acquired by Teladoc for $18bn mostly in stock. This quarter Teladoc wrote off much of its investment in Livongo and the whole company is now only worth $5bn. Clearly those “synergies” between telehealth and chronic care management didn’t work. The other rocket ship was Cerebral, which went from nothing in Jan 2020 to by Jan 2022 having over 100,000 patients and thousands of providers on its system as it raised over $300m from Softbank et al. Its aggressive & expensive customer acquisition costs, with its controversial controlled medication prescribing patterns, brought it way too much controversy. Its young CEO is gone, and it’ll be a slow climb back with bankruptcy and collapse the likeliest of outcomes.

But the part of digital health that’s trying to replace the incumbents is not the only place showing ugliness. The technologies and services being rolled out are often not working. Exhibit A is a randomized controlled trial conducted a Univ of Pennsylvania. One set of heart patients was set up with connected blood pressure cuffs, a pillbox that tracked their Rx adherence and lots of coaching help. The others were sent home with the proverbial leaflet and told to call if they had problems. You’d assume many more deaths and hospital readmissions in the second group. You’d be wrong. There were no differences.

So digital health needs to see if it can produce services companies that move the needle on costs and outcomes. The advantage is that they are eventually competing with hospital systems whose DNA doesn’t allow them the ability to let them cross the chasm to the new world. The bad news is that those systems have huge reserves which they can use to subsidize their old world activities.

I’m hoping digital health’s impact in the next 2 years will be as big as it was in the past 2, It’s by no means dead or over, but I am pessimistic.

What does digital transformation look like at a global healthcare giant like Pfizer? Lidia Fonseca, Pfizer’s Chief Digital & Technology Officer, shares her strategy for building the life sciences company’s digital data and technology solutions, including her thinking about digital therapeutics, digital diagnostics, and digital biomarkers. As Lidia puts it, this is not about trying to simply implement a “digital strategy,” but is, instead, about building a “business strategy for digital world.”

There’s probably no better story that illustrates how that “business strategy for a digital world” is playing out than the fascinating example of how Pfizer’s Digital team helped accelerate the development of the Covid19 vaccine and oral treatment. Lidia takes us inside and talks through how her team used tech to safely speed-up everything from development timelines to clinical trials and even go-to-market in areas around the globe that were experiencing outbreaks.

Beyond the tech team’s ability to effectively wield data that changed the game when it came to Covid, Lidia also shares what’s next for the pharma co when it comes to digital health and digital medicines. Beyond the pill? Around the pill? Instead of the pill? What’s Pfizer’s position on digital therapeutics as it continues to work to bring new breakthrough medicines to patients? We get into all the ways digital and technology are manifesting themselves within an organization like Pfizer AND get Lidia’s best advice for other healthcare organizations who are redefining their businesses with technology.

Big news coming out of Vida Health today as the chronic condition care startup announces that it will now be able to prescribe meds, med devices, lab tests, and more to its members. This puts Vida Health among the first of the digital health chronic care companies to evolve its offerings beyond apps-and-coaching, leading on this trend to take digital health chronic care into a more full expression of virtual care.

Vida Health’s Chief Medical Officer, Dr. Patrick Carroll, introduces us to the new offering which he tipped us off about when we met him a few months ago, new to his role at Vida and coming in hot from Hims & Hers where he built similar services as he took that company public as CMO.

The new prescribing services will cover both sides of Vida Health’s integrated model: mental health and cardiometabolic health, but in different ways. On the mental health side, Pat says members will be able to receive prescription meds for anxiety and depression ONLY at this time; on the cardiometabolic side, members working with Vida Health will NOT be able to get prescription drugs to help with diabetes or heart health, but would instead be able to get continuous glucose monitors (CGMs) prescribed, specialized diets, and labs, like A1C testing, that require a script.

Do these prescribing services begin to turn Vida Health into a primary care provider? If not, how do these new prescribing and medication management roles integrate with whatever other primary care offering is in place through a member’s plan or employer without adding cost or confusion to the patient experience? We talk through the evolution of both care model and business model as Vida Health adds another layer to its full-stack chronic condition management platform.