The connected care horizon in 2023
At the beginning of each year, setting expectations for the road ahead is always a somewhat risky endeavour. Some paths are brand new, affording us the unique excitement and opportunity of being a trailblazer. Other paths are more familiar, and our previous experience helps refine both our expectations as well as our plans for navigating them once again.
The paths my team and I travel in the world of connected care solutions are no different. And as we continue to forge ahead within 2023, here’s a view to some of the connected care trends we expect to see on the road ahead, from digital therapeutics to remote patient monitoring and clinical trial management.
Precision engagement: an emerging development in digital therapeutics
Digital therapeutics (DTx) is a fast-growing category of medicine that delivers evidence-based treatment through digital solutions that help prevent, manage, or treat a disorder or disease. One estimate of the global DTx market valued the category at $1.8 billion in 2018 and projected it to reach $7.1 billion by 2025, with other estimates projecting even faster growth.
A development within DTx that holds great promise is the emergence of precision engagement, especially for chronic conditions like diabetes, obesity, and hypertension, where day-to-day choices and behaviours significantly impact outcomes.
Remote patient monitoring is clearly important for connecting patients and care teams and giving visibility into a patient’s condition management to enable vital clinical interventions. But patients living with conditions that are significantly impacted by individual behaviours must independently make what often amounts to dozens of additional daily decisions requiring action. With diabetes, for example, these can range from food and exercise choices to decisions around medications and using medical devices, like glucose monitors and insulin delivery devices.
With the help of AI and machine learning, developers of digital health solutions are increasingly building in the ability for physicians to program digital interventions or “nudges.” Digital nudges prompt patients to take necessary actions throughout the day, but in ways that are tailored specifically to the patient and, ultimately, can lead them to better outcomes. In behavioural medicine, these digital interventions are known as just-in-time adaptive interventions (JITAI), and they are enabling healthcare professionals to use software to precisely engage the right patients with the right interventions at the right time.
Once in use, this type of precision engagement solution can learn about individual preferences from a patient’s responses to questions, as well as the daily decisions they make, helping the software personalise future interventions for the patient.
As such, precision engagement software might be used to help identify the right moment of the day to generate a digital nudge, suggesting the patient eat an apple or take a walk because that specific time is when the patient is most receptive to that suggestion.
A precision engagement intervention might involve time- or activity-triggered reminders to take medication or check blood glucose, or send an encouraging message prompted by the patient achieving a daily goal, like walking a certain number of steps.
Precision engagement can even tailor the nature of communication used for nudges, from utilising email, text, or a mobile app message to the use of an empathetic voice, an authoritative directive, or even humour.
Precision engagement is one of the most exciting new developments on the horizon within digital therapeutics, aiming to build highly personalised, time-adaptive interventions into patient-facing digital health tools in ways that drive positive behaviour change, provide great patient experiences, and produce improved health outcomes.
A measured pace of adoption: Growing remote patient monitoring awareness and education
Despite broad adoption of telehealth during the pandemic, a Stat poll of 586 healthcare leaders taken by the Medical Group Management Association last June found that remote patient monitoring (RPM) “is one component of telehealth that has lagged,” with 75% of medical practices having yet to offer it.
This deliberate pace of RPM adoption seems to defy a number of the factors already in place that would predict a more rapid uptake, including positive patient perspectives of RPM, demonstrated outcomes, payor recognition of RPM’s value, and reimbursement opportunities established by CMS and private payors.
Nevertheless, preparing providers to make the actual leap to RPM is not easy.
One thing we’re finding among some providers is that they just haven’t gotten word yet that reimbursement for RPM exists. It’s simply a matter of awareness, so we continue educating our provider partners to ensure they have the latest information.
Another challenge we’ve found among some providers is the misconception that only Medicare reimburses for RPM. In reality, there are dozens of private payors covering RPM, and some reimburse at an even higher level than Medicare.
An additional obstacle we sometimes encounter is the misconception that a provider must implement everything in RPM at once - setting up patients, having them sync their data, analysing the data, and providing consults. But that’s just not the case, and in fact it’s why CMS has assigned unique CPT codes for discrete RPM activities. Providers are learning that starting small may actually be the best approach, so they begin by simply getting patients to perform their monthly data sync, submitting for reimbursement, then building from there.
One of the most helpful steps for providers uncertain where to start can be finding a reliable vendor specialising in RPM planning and implementation. Resources like the 12-step RPM Playbook published last year by the AMA can help, as it covers every stage of establishing a fully operational RPM program.
Decentralised clinical trial usage: Stimulated by the pandemic, increasing due to efficiencies
Decentralised clinical trials (DCTs) are trials in which some or all study assessments are conducted at locations other than the investigator site via either tele-visits, mobile or local healthcare providers, local labs and imaging centres, home-delivered investigational products, and/or mobile technologies. During the pandemic, when thousands of non-COVID trials were interrupted (an estimated 80%), the popularity of DCTs skyrocketed.
In addition to virtual trial companies suddenly experiencing an explosion of requests, there was a significant increase in deal-making activity. In 2020, there were nine mergers and acquisitions related to virtual trial capabilities, compared to just one in 2018 and two in 2019, and the number of virtual trial-related venture capital funding deals rose from six in 2018 to 18 in 2020.
Demand doesn’t seem to be slowing any time soon, with one market analysis issued this year already projecting the global DCT market to grow from $6.1 billion in 2020 to nearly $16.3 billion in 2027.
As the need for social distancing that precipitated the sharp uptick in DCT demand has subsided from its peak early in the pandemic, it’s clear that continued demand is, and will continue to be, driven by the efficiencies of DCTs that researchers experienced first-hand during the pandemic.
DCTs are especially valuable for enrolment efforts, as patients can often be signed up at home and remotely monitored. This broadens the number and diversity of eligible participants, as trials and their benefits are no longer limited to those living near key urban centres, where traditional trial visits usually happen.
DCTs can reduce patient dropout rates and speed up study timelines, two of the biggest challenges in life sciences R&D. And researchers can also realise significant cost efficiencies from decreases in the number of physical trial sites and reductions in research staff and travel.
We expect to see the demand for DCTs continue to ramp this year and into the future, driven by this wide range of efficiencies benefitting study subjects, researchers, and sponsors alike.
Overall, we expect 2023 to be a year where we continue to make exciting advancements in the abilities of connected care to support patients living with chronic conditions, and the physicians and care teams that support them.
About the author
With 30+ years of healthcare and technology experience, Russ Johannesson is chief executive officer at Glooko, where he leads the company’s corporate strategy, global expansion, and day-to-day operations. He is also a member of the company’s board of directors. Johannesson is passionate about Glooko’s mission to improve the lives of people with chronic conditions by connecting them with their caregivers and equipping both with digital health technology for improved outcomes. He holds an MBA from the University of Chicago Booth School of Business.