Connecting patients to treatment on the COVID Care Journey

digital health

Global digital health company Ada Health and Pfizer have collaborated to launch the US nationwide digital COVID-19 Care Journey – operated by Ada – in order to help connect patients with timely treatment when experiencing symptoms, and with the aim of changing the course of the disease for millions of Americans.

Ada Health has been working to lower barriers to those patients who might be struggling to access COVID-19 care: the COVID-19 Care Journey is an online ‘test to treat’ platform, developed with support from Pfizer, that is meant to help individuals learn whether they meet the current criteria for high risk of progression to severe COVID-19. If test results are positive, the platform offers connectivity to an independent telehealth provider for evaluation and, if appropriate, treatment.

COVID-19 remains the third leading cause of death in the US, currently resulting in – on average – over 400 deaths each day. Ada Health’s Care Journey has been available in all states since 6th February, having launched initially in 26 states plus Washington DC. The reason for doing this two-step approach was so as to begin with those states that have asynchronous telehealth laws that are somewhat different because the legislation is different from state to state. Now, eligible individuals using the service who receive a positive COVID-19 test can access a consultation with a healthcare provider within two hours, for a low out-of-pocket cost.

As many as 60% of Americans possessing one or more risk factors – such as being 50 or older, being pregnant, a smoker, or suffering from certain common medical conditions, including chronic lung diseases, diabetes, or asthma. Given this, and given also the positive implications of Ada Health’s latest development, pharmaphorum spoke with Vanessa Lemarié, chief client officer and chief operating officer at the company, in order to discuss the finer details of this new digital self-assessment tool.

Addressing a major problem: education and equitability

Discussing the fast route to treatment that the Care Journey app provides, Lemarié remarked on the fundamental fact that people “need easier and quicker” treatment, both effectively and efficiently.

“Ada’s COVID-19 Care Journey is an online test-to-treatment platform. It’s fully owned and operated by Ada, developed in partnership with Pfizer. We have independent third-party providers [… and] we’re solving for the fact that COVID-19, while it may feel like a distant memory to some, is still around and will be for a while. It’s a major problem actually, for millions of people, and a lot of them don’t know that it is a major problem. It’s really quite traumatic because we still have a very high number [of deaths in the US].”

Is it, then, a question of education and equitability?

“Absolutely,” Lemarié agreed. “It is certainly a lack of awareness of what risk factors are for progression to severe COVID-19, but also who is affected and how many people are affected by those risk factors. To name just a few, smoking status, current but also former smoking status, diabetes, advanced age, obesity – these are just a few of those risk factors. In fact, more than 60% of the American population would have one or several of those risk factors.”

“This is not known to the population at large, and possibly only to some of the more aware populations, say people with a rare disease or a specific established diagnosis,” Lemarié noted. “If you think of very prevalent risk factors, such as advanced age, but also just advanced BMI, then these are factors that you and I wouldn't necessarily know about being a risk factor for progression to severe COVID-19.”

“There's a lot of room for education and also for awareness and self-screening,” Lemarié continued. And that’s where Ada’s Care Journey app comes in.

“Part of what we have built in our offering is this possibility to self-assess, to self-screen for your personal risk of progression to severe COVID-19. Then, on the back of that, your eligibility or not for a treatment to help mitigate against that risk because, of course, if you are at risk and you have a COVID-19 infection or a suspicion of COVID-19, or indeed are at risk of developing COVID-19 […] at one point you would want to know and you would want to be able to know what to do very quickly,” Lemarié explained. “This is additionally important, knowing that the treatments are very effective, but they need to be taken within five days of onset of symptoms.”

What the Care Journey app also permits is the ability to self-assess and take a preventative approach – all in the comfort of their own home.

“That is, I think, for equitable and easy access to appropriate care, essential,” Lemarié said. “If you think, again, of an acute setting, it becomes even more important because if you are infectious, you do not want to go anywhere else and possibly spread the virus. From a public health perspective, this is of course also one of the objectives to make sure that people can stay within the comfort of their own home services, but then also get the access to adequate treatment and even have it delivered all the way to their doorstep, if that's what they design. All of this is enabled by the COVID-19 Care Journey.”

Accessing treatment: from app to healthcare provider

Incorporated into available treatments after this self-assessment stage is access to an oral antiviral treatment, dependent upon the patient’s level of risk – and in strict adherence to the normal patient-HCP process of prescriptions.

“Any authorised antiviral or other treatment for COVID-19 can be prescribed,” Lemarié explained. “Whether a user/patient is eligible for any treatment and what treatment that would be is completely at the discretion of the qualified healthcare professional who would undertake the consultation and deliver the script. Ada does not at any moment interfere with any of this. This is and will remain always between a patient and a healthcare professional. We have, among other things, taken great care to ensure that any authorised treatment as prescribable and also deliverable to a user as needed.”

“Now, of course,” Lemarié continued, “depending on the assessment of risk of progression and then eligibility, people and also providers will follow guidelines. The important point to retain is that you can be prescribed with the most appropriate treatment for your personal situation, and that's what a healthcare professional will do also under the Ada COVID-19 Care Journey.”

Lemarié added: “There's a follow-up call to the users' end, but that still features under a time-delayed and asynchronous exchange because I do not directly access a video consultation from a user perspective.”

Pfizer and expanding partnerships

On the topic of Ada Health’s partnership with Pfizer, Lemarié was keen to share the broader ramifications of the Care Journey app’s development.

“We're super proud of the fact that Pfizer has identified us as the partner of choice to help develop this tool in the fight against COVID-19 and raise awareness among at-risk individuals,” Lemarié said. “We've been working with Pfizer for a longer time already on other engagements […] For example, I've been working for a couple of years already in the field of rare diseases. We know one another, but there's been a longer-term vetting and exchange progress process, as well, for Ada's capability of delivering this, first of all, integrated end-to-end journey. We do have a longer-term partnership with Pfizer to deliver this first condition-based end journey, but not only does it mark a major step in our expansion in the US market, but we also count on developing additional condition-based journeys on the back of this. This can be with Pfizer, but it's also open for other partners and other conditions going forward.”

Asked about those conditions, Lemarié stated: “This would be the realm of hypothetical. I would prefer not to comment at this point in time, but conditions that can be and should be digitally supported and where easy and equitable access to knowledge and thereafter, also consultation and treatment, is necessary – these would qualify.”

She continued: “I think I can safely say that there are many of those, not only in the US but, of course, we are currently also looking to expand further in the US and ensure that. We built on this first step to really make sure that we help democratise access to affordable healthcare for a population where there is a lot of need. We really want to work together, and we'll work together with Pfizer and with other partners, to make sure that we also reach the most vulnerable groups in society with what we can do.”

The journey of Ada Health itself

Begun by three very bright people – an entrepreneur, a neuroscientist, and an NHS doctor – Ada Health’s own journey has been equally exciting.

“Ada's actually been around for almost 12 years now,” Lemarié said. “I always say it's a company that was founded by doctors for doctors. Claire Novorol, our co-founder and chief medical officer is a doctor by training and profession, trained as a clinical paediatrician. Martin Hirsch, a neuroscientist and doctor and, actually, professor for artificial intelligence and medicine. In his primary job, he is still chief scientific advisor to Ada and one of the co-founders, but also a doctor. They'd originally built and trained our medical AI to help doctors identify diagnosis easier, then with available systems. The medical knowledge and reasoning engine that has been developed since, and also continuously improved, is still at the heart of all of the Ada products, including the consumer products.”

Daniel Nathrath is the third co-founder and Ada’s CEO and, since those first days, Ada has come a long way.

“The technology behind this is still the same as the one that was developed originally for clinical decision support,” Lemarié continued. “However, in 2016, and this was in earlier startup stages, we also realised two things. One being that it is a much longer-term engagement to work with and convince not only the doctors themselves, but also the people they work with for the institutions to actually change ways of working and systems. Two, that [the] same knowledge if made available in a, I would say, layperson understandable format could really benefit consumers, people, patients – possibly at large – to self-screen and identify whether they have a specific condition, be it acute or chronic or even rare.”

Digital health and the future COVID-19 journey

It is, at core, a matter of digitalisation.

“Digital tools can really play a role here,” Lemarié said. “We have the Ada app that is available in app stores worldwide. We have the Ada website where you can also self-screen and/or self-assess. We also have a technology module suite that is available for integration with enterprise partners. We can integrate, and we do integrate, into partners' own digital pathways. An example could be the website of Sutter Health in the US, where one can undertake an Ada symptom assessment to thereafter be directed to the next best step within the Sutter healthcare environment.”

Additional integration has involved the Novartis disease awareness websites and Bayer Consumer Health.

The Ada app works on multiple devices, and multiple generations of devices and operating systems.  Lemarié stated that it will always remain freely available to people who choose to download it.

“We're inclusive and really designing for equitable access to care,” Lemarié noted. “I do want to state that, while this is a very important step in our expansion into the US as a country and the US market, Ada is and will remain a globally operating company. We are available worldwide. We do have engagements, including a lot of social equity engagement by our global health initiative and our rare disease initiative for at-risk and lower-access populations with bigger projects also in areas of the world, such as South Africa, Romania, Tanzania. That's something that's very dear to our heart.”

“[But], going back to this US launch, there are a lot of people at risk, underserved, in the US alone. We're focusing on [this] with a first priority now in this launch of the journey and also joined in these efforts with our partners from Pfizer,” she concluded.