Digital Solutions for Chronic Disease Prevention and Management: The Promise and Reality

By Dan Sheeran, CEO, HealthSlate

Dan Sheeran, CEO, HealthSlate

The Glass is Half Full

Over the past five years a tremendous amount of excitement has developed about the potential role that “digital therapeutics” can play in preventing and managing high-cost chronic conditions such as diabetes and heart disease. Digital therapeutic programs typically include a trained health coach, an educational program delivered through a mobile app, a social support component via a peer group, and digital tools for monitoring and logging biometrics such as weight, nutrition, physical activity, glucose and blood pressure.

"If the goal is to make it easier for patients to find and engage with a program, perhaps we should not actually ask them to install and use yet another app"

These programs provide a more convenient way for patients to access evidence-based behavior change programs, thereby greatly expanding the programs’ potential reach. Health plans have increasingly been willing to cover digital programs because of evidence they have seen from both clinical trials and their own deployments that these companies can deliver health gains similar to in-person programs while “meeting the patient where they are.” As a result of this easier attendance model and growing health plan coverage, the number of people who have enrolled in the national diabetes prevention program has increased more than threefold during the past five years over the prior period.

The Glass if Half Empty

However, even with this expanded access more than 90 percent of people who need an evidence-based program to prevent or manage a chronic condition have not enrolled, and most of those people are not even aware that free or low-cost proven programs exist for which they are eligible. In addition, people who do attend struggle to maintain their health gains once the program ends; for example, on average over half of the weight loss during a diabetes prevention program will have been regained 24 months after program completion. While the reasons for this are varied and complex, it seems increasingly clear that we need to make these behavior change modifications even easier and more compelling to learn about, participate in, and stay engaged with after the formal program ends.

Truly Meeting the Patient Where They Are

If the goal is to make it easier for patients to find and engage with a program, perhaps we should not actually ask them to install and use yet another app. Perhaps instead should truly meet them where they are. And where is that? It’s on social media and, most specifically, messaging apps. Consumers spend far more time on Facebook, WhatsApp and similar programs than anywhere else when online. Once their behavior change program ends they are still going to spend hours every week on those same messaging and social platforms.

Fortunately, artificial intelligence and chatbot capabilities now available on Facebook and other platforms make it possible to bring proven lifestyle change programs to converse with consumers the same way that they chat with their friends, and without asking them to install a new app and create a new account. Because the bot is just another one of the consumer’s “friends” in their contact list, it can stay part of that person’s life for months and years after the formal behavior change program has come to an end. We see several companies exploring this area with exciting potential, and expect it to impact the market significantly starting in 2019.