By Frank Cunningham, Senior Vice President: Global Value and Access, Eli Lilly and Company and Sam Marwaha, Chief Commercial Officer, Evidation
The pandemic has accelerated patient, provider, and pharma adoption of remote health tools and capabilities, which can and will fundamentally change the patient experience and improve outcomes, enabling the next generation of value-based arrangements (VBAs). The focal point of care delivery and management since March has been telehealth, providing patients access to healthcare providers via the nearest screen or phone. The increase in use of telehealth in the pandemic is a result of efforts from providers, plans, and technology companies to establish telehealth capabilities, aided and encouraged by federal legislative and regulatory flexibilities, as well as individuals’ willingness to try this treatment avenue.
This accelerated adoption of telehealth demonstrates the opportunity for using remote health tools and methods that facilitate patient engagement outside of the clinic to improve patient outcomes. In a feasibility study conducted by Lilly, Evidation, and Apple, personal devices and apps were used to determine whether they could differentiate participants with mild cognitive impairment (MCI) and mild Alzheimer’s disease. This study demonstrated that connected devices could potentially be used to predict disease onset and track disease progression remotely, thereby providing the ability to route patients to the right treatment sooner.
This study is an illustration of the broader ability to use remote health to predict disease progression in patients faster and engage patients earlier, improving experience at an individual level and reducing medical cost at the population level. Taken together it allows the capture of value in VBAs for all stakeholders.
The Shift to Remote Health, Including Telehealth, Is Encouraged by Both Congress and the Administration
The use of telehealth has increased dramatically since the start of the pandemic, with virtual doctors’ visits predicted far exceeding prior years. Over the next 5 years, telemedicine demand is expected to grow annually by approximately 38%. To further the adoption of telemedicine, the federal government and lawmakers have incentivized unprecedented flexibilities for stakeholders.
The telehealth industry is responding aggressively as evidenced by the large-scale acquisitions to advance the remote health space. Teladoc’s $18 billion deal with Livongo, Amwell’s planned IPO primed by Google’s $100 million investment, Zocdoc’s roll-out of free telemedicine capability in record time for its thousands of physicians all point to the rapid pace of innovations and progress.
While Telemedicine Adapts to Growing Demand, there Are Challenges within Evolving Landscape
Advancements in technology have greatly facilitated remote care delivery, but some constraints have impeded its utility, limited uptake, and posed challenges for other forms of telemedicine:
- Some providers lack the infrastructure or funds to accommodate a shift to telehealth, leaving vulnerable patients at risk of foregone care and other telehealth benefits.
- Transfers of data can make information susceptible to breaches, jeopardizing the security of patients, especially when data is shared across multiple stakeholders and platforms. It is critical that technology vendors and health systems focus on privacy and establish appropriate guardrails to ensure patient information is protected.
- In some cases, in-person visits cannot be replaced by telehealth, especially if the condition is complex or a procedure must be performed in an office setting. Additionally, cultural and language barriers can be exacerbated in a telehealth setting.
Implementing robust and vigilant IT departments to oversee security and partnering with doctor’s offices, remote monitoring providers, and patients to encourage participation and widespread adoption are ways in which the telehealth industry is confronting challenges to make telehealth more accessible and secure. However, payment parity is an important issue to be addressed beyond the public health emergency, because without confidence in reimbursement, it would be challenging to make some of the technology investments necessary to enhance telehealth capacities, ensure resilience and remain financially viable.
These Advancements in Healthcare Technology Can Incorporate the Patient Experience and Lead to Innovative Value-Based Arrangements
Remote-health is more than just replacing an in-person visit to the doctor’s office with a virtual interaction. It includes the tools to monitor patients in natural settings in real time, learn the predictive ‘markers’ of disease progression, and make timely intervention possible. Implemented effectively this would speed up the pace of innovation within biopharma, improve patient experiences, and drive down disease burden dramatically. The industry now has both the means and the motive to change not only how evidence is generated but also how it is deployed and paid for. Potential changes include:
- Learning what biomarkers indicate disease progression from a continuous stream of person-generated data, in addition to the snapshot data from clinic/lab visits such as claims and EHR data. (Patient-generated health data (PGHD) is data created, recorded or gathered by or from patients, family members or caregivers and includes treatment history, biometric data, symptoms and lifestyle choices. Data from blood glucose monitoring or blood pressure readings using home health equipment or exercise and diet tracking using a mobile app or wearable device are examples of PGHD.)
- Expanding the definition of evidence to have a more inclusive, patient-focused definition. Through effective digital monitoring and self-reported metrics, a more holistic picture can be captured of a patient’s health, and more emphasis can be placed on long-term outcomes.
- Reducing latency between evidence generation and action by embedding actionable evidence in software (sometimes as a medical device). While the biopharma industry is already effective at driving the adoption of best evidence in clinical practice, data sharing among stakeholders is inefficient. The ability for manufacturers and digital health companies to offer tools that health systems can use on data about their specific patients could dramatically improve effectiveness and dramatically shorten time to adoption of new evidence by physicians and patients.
Data leveraged from advanced use of technology, as described above, can inform treatment and value assessments to provide meaningful therapies to patients, make healthcare more efficient, and reduce costs to the system, supporting agreements among providers, payers, and pharmaceutical manufacturers. One such possible application of these new technologies is with VBAs that act as the vehicle that ties value to a therapy based on outcomes, rather than its monetary cost. Value-based arrangements are ideal conduits to take advantage of these new technologies, especially if regulatory flexibilities are extended beyond the current public health emergency. Using patient-specific metrics, data sharing, and incorporating digital devices could advance VBAs to a holistic, elevated level. Policymakers and healthcare stakeholders should not focus solely on how remote health will continue to evolve post-pandemic but should look toward broader changes that embrace a larger role for healthcare technology that ultimately provides value to patients and their families.