Digital Therapeutics—the Road to Health Equity?

Health Disparities are Costing Americans

The US spends $4.3 trillion a year on healthcare, predicted to reach $6.8 trillion by 2030. Yet the outcomes do not reflect this—certainly not for all Americans.

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In a Commonwealth Fund study of 11 high-income OECD countries, the US ranked last in health equity, as well as outcomes and overall health system performance, with the biggest range in income-based disparities.

This is not new: other analyses have also shown a clear lack of progress in health equity.

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This is despite yearslong commitment—at least a verbal commitment, lip service—to health equity… Yet we’re not getting where we want to be, and we’re going backwards.Frank Zimmerman, professor and health economics expert at UCLA, and lead author of a study examining trends in health equity in the US in 1993–2017.

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The estimated yearly cost of health disparities in the US is $320 billion, expected to reach $1 trillion in 2040 if left unaddressed. This will likely fall harder on historically under-served groups, costing the average American at least $3,000 annually up from today’s $1,000.

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Without universal health coverage and a primary care system, achieving health equity in the US is more challenging than in other high-income countries. A change needs to come fast. At Sidekick Health, we think the answer might lie in the fast-growing world of digital therapeutics.

Digital Health and Equity

Accessibility

By their nature, DTx can be made accessible to a wider range of people than traditional means. DTx allow individuals to get clinically-validated treatments at a time and place convenient for them. It can bridge the gap between urban and rural areas and, with access through patient-owned devices, it’s easily scalable. 85% of American adults have a smartphone, vs. just 35% in 2011. The stats are similar for Black and Hispanic populations, though fall to 61% for over 65s.

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Inclusivity

DTx solutions can be customized for a particular group that may find current methods inaccessible. They can help treat conditions in a more personalized way, provide a more discreet option for stigmatized diseases, and offer targeted messages, experiences, or programs. For example, Health in Her Hue matches women of color with culturally sensitive healthcare providers.

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What About the Digital Divide?

Digital literacy, as well as health literacy, heavily impacts how a patient can find information about their symptoms and ultimately what treatment they will choose and receive. It determines how well they can distinguish between helpful and unhelpful information. Those with lower literacy levels are less likely to use digital health solutions as they might struggle to understand or navigate technology, may not trust it, or feel it is too impersonal.

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With a digital divide shown to exist across different groups such as age, race, and gender, could DTx end up exacerbating health disparities even further?

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Not if we are smart about it.

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The Job for Digital Health Companies

A tool—even a super, AI powered one—is just a tool. We need to know how to use it.

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Digital therapeutic platforms have the potential to improve outcomes across various indications, as well as help optimize current treatments, but it’s not just about digitizing the tools we have today. We need to understand the needs and goals of people who are currently under-served, and the reasons why they aren’t getting the right care. How can a digital tool get around that?

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We can’t really make progress on health equity unless we’re serious about measuring it.
Frank Zimmerman

A Focus on Outcomes

To truly improve health equity, there needs to be a shift in perspective from volume to value. It’s moving beyond asking how to create more healthcare (more volume) to asking how to achieve better health outcomes for the money spent (more value). Digital health interventions are not simply about enabling more appointments, instead their focus is making a genuine improvement on health outcomes through incremental lifestyle modification and behavior change.

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The Solution Lies in the Method Itself

Fortunately, digital tools not only provide information, they can collect it too. Companies can see who is, and who isn’t, using their products, and examine the outcomes for each group. They can do their research and make their products more inclusive and accessible. Data can even be combined with existing health and social information to help influence public policies.

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The Role for Health Organizations

Equity as a strategy, not a checkbox

So far, attempts to address health equity have largely failed due to a lack of sustained effort. To really get the right tools to the right people, the change needs to start from the top down. Health bodies and organizations, payers, providers and pharma must be willing to re-engineer their strategies and business models.

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Health equity as a check-in-the-box activity is doomed to fail.
Yele Aluko MD, MBA, EY Americas Chief Medical Officer

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Health equity must be part of an organization’s strategy from the very beginning, with digital strategy falling under it. This means restructuring plans and programs, and creating systems that financially reward equality, remove barriers and create opportunities. This way, digital health can be a road towards value-based care—whose aim is not to create more healthcare, but better outcomes for the money spent.

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Reaching more communities

With the sheer number of new DTx platforms available, doctors and patients alike are bound to struggle. A system, like this one seen in the UK, where doctors can search and receive recommendations for the most appropriate DTx can allow for easy navigation of DTx treatment options.

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Centralized incentives to train healthcare professionals, and even community and peer mentors, to closely support patients with DTx will certainly help. For example, in Australia, the Be Connected program uses a mentorship system to help older people build digital skills. These kinds of initiatives take time, but are worth it.

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Final Thoughts

With advances in AI, robotics, and machine learning, as well as big data, digital therapeutics really has the potential to change the game, providing people with smart, scientifically proven, and accessible tools, for a wide range of conditions and therapeutic areas.

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But technology alone can’t solve disparities. Digital companies, health organizations, regulators and payers need to start the work from the top down, embedding equity firmly in their strategies. It isn’t easy to reach everyone, but dedicated time, effort, and investment will be a great start. It will get us a lot closer to the outcomes we’re looking for.

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