The high prevalence and cost of cardiometabolic disease and its direct link to lifestyle makes it a prime target of virtual health interventions because of the need for day-to-day support to stay healthy. To put it simply, what happens between your in-person visits is, arguably, just as important as what happens in your doctor’s office; and that’s where virtual health comes in. It’s a crucial supplement to in-person care.
Entrepreneurs, employers, venture capitalists, clinicians, and other key players have taken notice. Total corporate funding for virtual health reached $21.6 billion in 2020, up 103% compared to $10.6 billion in 2019. The attention paid to the virtual health space inspires excitement, support, and––in some cases––skepticism.
In Evidence and Efficacy in the Era of Digital Care, its authors identify the urgent need for rigorous clinical evidence and quality standards in virtual care. They correctly identify that the industry to date has not universally produced the scientific evidence or succumbed to the rigor of quality standards to assure patients, plans, and sponsors that the care improves health and reduces costs. As Omada Health’s Chief Medical Officer, I couldn't agree more.
But, before we critique virtual health interventions for a lack of evidence, we need to start by acknowledging that the status quo of traditional care is not working. Since 2005, well before the rise of virtual health, diabetes treatment goals––glycemic control, blood pressure control, and cholesterol control––have not improved significantly in the United States.
COVID-19 has only made matters worse.
Throughout the pandemic, roughly 25% of patients in the United States with chronic conditions have had trouble accessing their physician about their condition. In a World Health Organization study, more than half of countries (53%) surveyed either partially or completely disrupted services for hypertension treatment; 49% and 31% did the same for diabetes treatments and cardiovascular emergencies, respectively.
These are figures we've been evaluating since early fall at Omada. We expect that a global chronic condition complication wave is coming. Can traditional healthcare models realistically handle it? The aforementioned stagnation of target attainment metrics would seem to indicate that innovation shouldn’t just be welcome––it’s sorely needed.
But before we jump into a virtual-first health care world, we must return to the concerns raised by the “Evidence and Efficacy” authors. They argue that peer-reviewed literature, consensus-based guidelines, and approval from independent regulatory organizations which clinicians rely on to make informed treatment decisions are “comparatively weak or completely absent for most digital care products.” They go on to say “we should expect the demonstration of at least one measurable, statistically rigorous, and meaningful effect on a clinically relevant metric before a digital care program is adopted at scale.” We agree with the authors that time and again, enthusiasm for digital health solutions outpaces the evidence to back up the claims.
That’s precisely why Omada’s virtual care program development starts and ends with research. Our early insights study into the management of type 2 diabetes using our virtual platform demonstrated that individuals with uncontrolled type 2 diabetes are able to obtain, on average, a 1.4% decrease in their hemoglobin A1C. As a secondary outcome, our Omada for Diabetes program also improved medication adherence, reduced diabetes distress scores, and decreased cholesterol among those with an elevated baseline level. From our Hypertension program, our recently published early insights paper also demonstrated that a 13.4 mmHg and 7.7 mmHg decrease in systolic and diastolic blood pressure, respectively, was possible for individuals with stage 2 hypertension. Furthermore, in our most recent Musculoskeletal (MSK) publication, study participants significantly improved pain and function after digital physical therapy treatment, with meaningful reductions in pain (-2.69 points on a 0-10 point scale). Researchers also noted improvements in physical function (+2.67 points on a 0-10 point scale).
These meaningful chronic disease management outcomes are the result of Omada’s foundational commitment to clinical rigor and precision, which is at the core of building efficacious virtual chronic disease care programs.
Omada’s programs clearly are not “most digital care products.” We are a virtual healthcare provider with human-led––not AI––coaching services that draws on consensus-based data to build out our virtual care programs. In practice, that has involved publishing 23 studies in peer-reviewed literature that meet the standard of the scientific community writ large. Our research progresses through different levels, from early insights up to randomized controlled trials. We have published the largest randomized controlled trial on a virtual diabetes prevention program, as well as early insights for our Diabetes Program; and we are continuing to invest in clinical-grade research.
The “Evidence and Efficacy” authors recommend borrowing approaches and processes from accrediting institutions like the NCQA to push for standard-setting of evidence and clinically meaningful outcomes in virtual care. The implication is that virtual health’s growth is coming at the expense of clinical rigor. Healthcare is a very regulated space, but virtual health companies are generally not held to the same standard of producing certain metric outcomes prior to advertising the efficacy of their products; thus, virtual health could be viewed as an under-regulated space. However, as demonstrated, Omada doesn’t sacrifice clinical rigor to enable rapid innovation. We abide by our guiding principles as a healthcare provider to offer evidence-based programs.
We also have the NCQA Population Health Program accreditation for our Diabetes program and we’re an ADCES-accredited provider of diabetes self-management training.
While lesser quality data may potentially hamper some virtual care products from driving substantial health changes, Omada doesn’t suffer that fate. Many of our competitors lack the quality of data we have. Our clinical-grade metrics showcase how we demonstrably improve the health of our program participants; and it’s why we are trusted with the health of organizations ranging in size from small businesses to Fortune 500s across a wide variety of industries.
Virtual health products certainly aren’t all created equal. However, companies like Omada continue to validate the rapid innovation and high payer investment in the virtual health industry. Omada adopts clinical precision, produces high-quality scientific evidence, meets efficacy standards and drives meaningful outcomes demonstrating effectiveness in populations that should quell skepticism and inspire optimism. A new era of evidence, efficacy and effectiveness in virtual healthcare isn’t coming––it’s here.
And Omada is at the forefront, helping lead the way toward a healthier world. I encourage more active participation and thought sharing in this ongoing conversation, as I believe virtual healthcare’s future is our future.