Mobile health (mHealth) apps and telemedicine have the potential to lower costs and improve patient care by allowing closer collaboration between patients and healthcare providers. The increasing adoption of health apps and other tools means not only healthier, more informed patients, but a more robust market: mHealth technology is expected to grow to $60 billion in 2020—an increase of 33%.
Is digital health the panacea it's made out to be, or are we just generating data for data's sake? Deneen Vojta, executive vice president of research and development for UnitedHealth Group, said it's too soon to say.
"Digital health is worth investigating," she said. "We've seen a lot of healthy people leveraging devices to understand fitness. And we do see growing evidence in healthcare of organizations leveraging similar technology to improve care. We have to better understand how patients engage and study the outcomes. There are the early adopters, and there's the rest of us."
Johnson & Johnson hopes patients of all technical persuasions will embrace Health Partner, a new connected digital platform that guides patients through all steps of surgery, from consideration to rehab. A website provides articles and tools for patients debating surgery (Health Partner currently focuses on weight loss, hip, and knee). A mobile app walks patients through surgery preparation and recovery. A care portal allows real-time interaction between physician and patient.
"All three digital tools put the patient at the center," said Amy Foley, vice president of product innovation and delivery for Johnson & Johnson. "Our behavior scientists and digital product experts put together what we think and know, based on research, will work with a particular population."
Through Health Partner, Johnson & Johnson collects, analyzes, and draws insights from patient data to further refine its capabilities and deliver a more tailored experience. "We might assume a certain set of behavior change techniques works well for a population based on experience and literature," Foley said. "But as users work with our tools, we might see a subset of those tools that are most effective."
Princeton HealthCare System's joint replacement program has grown from 800 procedures a few years ago to 1500 in 2017. Evaluating the program, Princeton Health System leaders found a gap in patient engagement. It brought in Health Partner to help boost engagement.
"Health Partner allowed us to close the gap from when patients commit to surgery, through preparation, a hospital stay and post op," said James Demetriades, Princeton HealthCare System's vice president of operations. "We have a goal to improve time from discharge to home, which we feel is an important indicator of prompt recovery."
Since implementing Health Partner, Princeton HealthCare System's joint replacement program has remained at or above the 90th percentile in patient satisfaction. Over the past 24 months, 80% of its patients either went home after surgery or went home with home care. Five years ago, it sent 80% of patients to skilled nursing or rehab facilities.
mHealth apps and other devices won't engage anyone if they don't get to market. FDA, which recently launched its Software Pre-Cert Pilot Program, wants to make that happen more efficiently. Johnson & Johnson joins Roche Holding AG, Verily Life Sciences, and six others, including startups Pear Therapeutics, Phosphorus, and Tidepool, as the first nine companies to participate in the program.
Foley said Johnson & Johnson is still discussing which product or platform it will focus on for the pilot program. "We will have a number of in-person opportunities with FDA over the next six weeks to help illuminate the approach," Foley said.
During these meetings, FDA will work closely with participating companies to "understand how we can apply systems related to security, privacy and patient safety in a rigorous and consistent manner, one which they could anticipate we would deliver time and time again," Foley said. "Our opportunity to improve speed-to-market and access because of the PreCert program is huge."
Patient Knows Best
Of all the new apps on the horizon, the tools consumers stick with will address their needs, varied as they may be. "Take glucose monitors," Vojta said. "Some have alarms, some don't. Which one's best? Whichever one the patient thinks is best."
In a study published this year in the American Journal of Managed Care, investigators found that among new adult insulin pump initiators, 8.5% had resumed regular refills of basal insulin and had no further evidence of pump-related supplies by the end of year one. By the end of year two, that number climbed to 13.9%.
Higher costs may contribute to patients' decision to return to basal insulin. It's also possible, Vojta said, that maintaining the catheter and having a device permanently attached to your abdomen made the pen seem not so bad.
"There is no one size fits all," Vojta said. "We need to figure out the best way to connect people when they really need it, automating what can be automated, and leverage patient data so people get the right care at the right time at the right place."