Quantified Health

Let’s Bring “Quantified Health” to Populations That Need It

Wearable fitness trackers and their complementary smartphone apps are taking the world by storm. There is breathless media coverage and a growing army of gadgets ranging from glorified pedometers to glucose-monitoring contact lenses. While at least one in five Americans now has a wearable device and two thirds intend to use digital tools to track some aspect of their health, and the trend shows no sign of slowing with 68.1 million wearable devices estimated to be produced in 2015, the actual health benefits of these tools have not materialized for everyone.

Along those lines, The Washington Post detailed the “revolution” in a lengthy feature earlier this year, and quoted Deborah Estrin, a professor of computer science and public health at Cornell: “Getting the data is much easier than making it useful. […] It’s unclear how important and meaningful it is for the everyday person.”

Part of those underwhelming results might be due to human nature rather than because of the devices themselves. In early July, Megan Garber wrote in The Atlantic about the Ennui of the Fitbit: research indicates that a third of trackers are abandoned within six months and that more than half of people who purchase trackers will ultimately abandon them. With the case of Fitbit, which commands more than three-quarters of the market for wearable health technology in terms of revenue, just 10 million of the company’s 20 million registered users are still active.

People stick to habits and use devices that add some kind of value to their lives. For a young and relatively healthy person, Fitbits and similar gadgets might be alluring and nice to have, but can quickly lose their luster. For a few people, having an up-to-the-minute accounting of steps taken, calories consumed, weight recorded, and hours slept would inspire positive behavior change. For most others, it might become annoying and perhaps create more stress.

Mobile technology has long become mainstream, and people from all walks of life are on board, but the tech industry appears to be designing wearable health gadgets almost exclusively for the folks described as “young invincibles” or “worried well.” As such, the actual health-improving mechanism is sometimes given less attention than the development of attractive user interfaces and slick marketing campaigns.

How might we move past seeing these devices as mere entertainment value or social capital and increase adoption among people who are elderly, low-resource or have poor health status – and especially for those who check all three boxes? Making cool and informative devices that people enjoy using is undoubtedly a good thing, and such business should continue to thrive as long as the free market rewards these products, but we are not taking advantage of a major opportunity to invest in bringing wearable devices and other personal health technology to the populations that are often not included in the “target market” section of startup pitch decks. These inspired startups and their investors could make a real impact with populations that have the most “health to gain.”

How could these current leaders of innovation in healthcare spread their services to populations that are more in need of support? Rachel Davis, a senior program officer at the Center for Health Care Strategies (CHCS), explored the idea in a Health Affairs post in 2014. She cited research that found high adoption of smartphones among people making less than $30,000 per year, and CHCS focus groups suggested that lower-income populations would be receptive to increased use of digital health technology to track and manage chronic conditions.

Davis identified five principles issues that impact healthcare access for these populations: lack of consistent contact with health providers and technology, fragmented health care across settings, difficulty managing complex medication regimens, managing health needs reactively instead of proactively, and difficulty accessing transportation to and from appointments.

The exploding world of digital health startups is showing an interest in solving these problems of low-income, complex patients. The Robert Wood Johnson Foundation (RWJF) granted $500,000 to accelerator StartupHealth, which has more than 100 startup companies in its portfolio, to “make it easier for digital health entrepreneurs to develop […] products and services to meet the unique needs of [underserved] communities.”

One startup called Health ELT is building its entire value proposition on bringing “engagement, logistics and technology services” to Medicaid populations. The organization’s pilot study last year in Texas, involving 1,000 patients covered under a Medicaid managed care organization, nearly doubled engagement rates, cut emergency department admissions in half, and reduced hospital admissions by more than 35 percent. “Technology is transformative and critical to progress,” said Amanda Havard, Chief Innovations Officer at Health ELT, in an email. “We can’t keep affording that progress only to healthy and resourced populations.”

Havard has some advice for entrepreneurs who are new to healthcare and want to make an impact on elderly or low-resource populations: “Get to know the population. Get to know the system. Learn the obnoxious routes of red tape. Log time with people who know infinitely more about the industry than you do. Too often technologists roll their eyes at that. They think if they build a good enough product, then it will do what it’s meant to. This is a fallacy if you want to innovate in regulated industries. You must be willing to spend the time, energy, money, and intellectual space to learn about the industry you want to change so that the change you make is a relevant one.”

Public-private partnerships could combine private-sector ingenuity with the public-sector reach into disadvantaged communities. For one, the new Center for Medicare and Medicaid Innovation (CMMI), which wields immense influence over the finance and delivery of healthcare services to the elderly, poor and disabled, could serve as a translational intermediary between the innovative companies and the communities where need is high but access to good-quality care is low.

Apple, which is now becoming a power player in the quantified and mobile health space with its new Health app, has demonstrated a commitment to using its resources and broad user base for meaningful ends with ResearchKit, a software platform that allows medical research subjects to submit data that is collected by their iPhones. The program launched several months ago, and since then more than 75,000 subjects have enrolled in mobile health studies related to asthma, Parkinson’s Disease, diabetes, breast cancer, and heart disease. In some cases, a smartphone enables a level of precision and convenience that patient testing within a facility cannot offer. Consider one diagnostic used in the Parkinson’s Study and described by the lead researcher, Dr. Ray Dorsey, of the University of Rochester Medical Center: “One test […] measures the speed at which participants tap their fingers in a particular sequence on the iPhone’s touchscreen. [That’s] more objective than a process still used in clinics, where doctors watch patients tap their fingers and assign them a numerical score.”

The ResearchKit concept is powerful because it enables patients to contribute to medical research in a more convenient way. The barriers to participation in research studies – inability to take time off work or travel long distances – are significantly diminished. For lower-income and sicker people, who experience these barriers most often, such technology could facilitate more representation in important medical research studies.

Healthcare technology, and the mobile and wearable health space in particular, is receiving an enormous amount of attention and funding. The excitement is warranted – our ability to collect and analyze data is advancing alongside our understanding of biomedical diseases, treatments, and the social and economic factors that influence them. While the free market should reward those who invent the next cool thing, we also should not discount the potential of this technology to make a different in places where it is needed most.

NOTE: The views expressed here are those of the authors and do not necessarily represent or reflect the views of Healthcare, Inc. and HealthCare.com

Imran Cronk

About Imran Cronk

Imran is a contributing writer for HealthCare.com and has covered healthcare topics for The Atlantic, the Wharton Public Policy Initiative, and the Leonard Davis Institute of Health Economics. He is a research assistant at the University of Pennsylvania examining health economics, with a focus on health policy research and quality/safety improvement.

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