Getting to the Future with Integrated Care
The fragmented virtual health industry is repeating history. How do we move forward?
So much has changed in the last year and a half, and certainly in the digital health industry as a whole. It's changed at this incredibly fast breakneck speed, and the implications have been hard to comprehend for all of us —even those like myself who are actually within the industry. When I think about the profound nature of the changes in healthcare, to all of us in society, and specifically virtual health, this quote sums it up:
“More and more, I tend to read history. I often find it more up to date than the daily newspapers.”
- Joe Murray
This quote resonates with me because the evolution of technology and its impact follows what I consider to be a repeatable arc. We actually don't need to look farther back than the 1990s to understand what might be happening next in virtual healthcare.
The Fractured Technology of the ‘90s and Early Aughts
I grew up in the ‘90s. I remember reading newspapers back then and trying not to get the black ink on my fingers. Classics like Back to the Future, believe it or not, were raging at the box office, and although I could never really afford a Trapper Keeper, I did always want one.
All joking aside, the ‘90s were the start of the handheld mobile technology revolution. It was incredible, at that particular time, as antiquated as these devices look today. These innovations were actually game-changing. They were easy to take with you, made tasks easier to organize, and life became more convenient in real time. However, each device was good at doing one thing, and only one thing. Though I could take my cell phone anywhere, it only made calls; I could take my Palm Pilot to all my business appointments and meetings, but it only organized my schedule. My digital camera was also portable, and at the time took pretty decent pictures, but that’s all it did. Needless to say, the mobile technology experience of the ‘90s and early aughts was fractured. Devices didn’t talk to each other, and every experience was on an island, until January 9, 2007 when our worlds changed with the iPhone.
The Birth of the Integrated Mobile Experience
What was once a fragmented experience became seamless (for the time) and integrated with the introduction of the iPhone. We found that bringing multiple functions together in one place created synergistic exponential value. The iPhone was a generational step change, not only for myself, but probably for you, and certainly for the global economy and communities all over the world. It was engaging, it was magical and beautiful, it was a tipping point in history. What happened with the iPhone launch on that day in 2007 is what we are seeking today with virtual healthcare.
We know that unilaterally across the United States, people crave a care experience that works in sync with their lives 24/7. People with multiple health conditions find their lives to be incredibly complex, and the traditional healthcare system further complicates that complexity.
Designing Healthcare Through the Patient Lens
Patients find it incredibly frustrating that the burden falls on them to make sure the system has the right information. Lots of errors occur when this happens, and we know that patients shouldn’t be taking on these tasks. At the end of the day, things need to change across the board.
That’s why Omada is reinventing the care experience to meet the growing concerns and needs of both our members and the healthcare system. It starts with moving access to care from a doctor's office into, literally, the hands of our members — actually moving care to a member’s mobile phone. It’s the virtual-first approach to healthcare, and it allows us to solve three challenges:
Virtual-First Care Increases Patient Engagement
Leveraging technology that creates a magical, beautiful and, thus, engaging experience increases the likelihood that patients will make progress on their health goals. We've seen this time and time again in publications, as well as our own data.
For instance, Omada Insights Lab found that members who engage with their Omada care team and community in the first week of the program are ~94% more likely to achieve their target health outcomes in the Omada program.
Frequent digital interactions between members and care teams are more affordable than sparse in-person appointments, because when people engage in their health, long-term costs actually come down.
In April 2021, Cigna reported improved health by Omada program members, with an average savings net of program fees of $348 per member in year one and $989 through year two, with Omada for Prevention.
Enables Timely Care for Better Outcomes
Technology like continuous glucose monitoring (CGM) allows for the observation of real-time health data, which unleashes extraordinary power when coupled with an available specialist or clinician. Decisions and interventions can happen near real-time, versus waiting three months for the next in-person visit.
Each of the above three elements work together to create a flywheel effect, and this virtual-first approach to healthcare is within our grasp.
The Virtual-First Patient Experience
Here’s what a virtual-first patient experience looks like:
*Nina has type 2 diabetes. As an Omada member, she is seamlessly connected to a doctor virtually, who provides an assessment and determines that a CGM is appropriate for her care, and subsequently receives a CGM shipped straight to her front door for convenience. She’s then assigned a care team, which includes a coach and certified diabetes educator. Once Nina activates her CGM and connects it with her Omada profile, she can see how her blood sugar responds to her meals and activities in real time. Her Omada care team is concurrently tracking that data so they can provide meal recommendations and create SMART goals specifically for Nina and her lifestyle to effectively manage her diabetes through behavior change.
The integration doesn’t stop there. While Nina sleeps, her CGM tracks when she experiences overnight hyperglycemia — blood sugars that are dangerously high while sleeping. The next morning her care team sees the alert and is prompted for immediate action.
Behind all of this is a clinical care system utilized by Nina’s care team, which is absolutely essential. This continuous collection of health data paints a clearer picture for Nina’s entire care team, both virtual and in-person, enabling them to implement treatment plans for her individual situation. No other off-the-shelf electronic medical record (EMR) system can deliver this type of care experience.
What happens next for Nina? Nina’s Omada specialist reaches out to her and suggests she schedule an in-person visit with her doctor —but her visit actually isn't for the next few weeks, a common problem in today's healthcare system. Nina’s specialist then offers a telehealth option so she can speak with a doctor online and that visit is available within minutes, thus seizing the opportunity to take immediate action.
Nina’s health data is then sent to her virtual doctor for review via the Omada platform, freeing her of the burden of describing her condition, collecting her patient records and sending them to her primary care physician, whether electronically or via snail mail. It’s all done near real-time through the integrated backend of our platform.
After a brief workup, Nina's virtual doctor changes the dosage of her diabetes medication and recommends she take it right before bedtime instead of at lunch. During the visit, her virtual doctor also asks how she's progressing on her weight loss, because we know that weight loss favorably impacts diabetes. Nina then shares that she has knee pain, which is preventing her from being as active as she'd like and reaching her health goals via exercise. After her appointment, the virtual doctor connects Nina to Omada’s musculoskeletal (MSK) program, giving her access to a licensed virtual physical therapist within 24 hours.
Isn’t this the way healthcare should be? If we peel apart what people love about this experience, we'll find four core principles:
Treat the person, not the disease
Nina has multiple conditions, so only treating one condition only gets us so far.
The war against chronic disease is not won in the doctor’s office
It's won or lost in the time between doctor's visits.
Connected devices complete the picture
Without data collection from devices like CGMs and connected blood pressure cuffs, it's like looking into a keyhole trying to guess what's on the other side of a door.
The right care at the right time
The right time is defined by what works for the patient, not by when it's convenient for the doctor or the healthcare system.
This is what we want, but also what's holding us back.
Today’s Virtual Care is Repeating History
Believe it or not, virtual health itself is the barrier to achieving a virtual-first future. The mobile experience of the ‘90s is actually how I see digital health today, specifically with point solutions, which is what Omada used to offer. We pioneered the first flagship digital diabetes prevention program over a decade ago, and quickly after that, other companies followed suit, developing their ownpoint solutions in diabetes, MSK, fertility, cancer —the list goes on.
In Q1 of 2021 alone, $6.7 billion was spent on virtual health funding in the United States, adding to the thousands of virtual health programs that exist today. Why is this happening? Why do we need thousands of digital health care options? Why aren't we getting smarter, faster? This is happening in every single condition area.
The virtual health industry, as we're seeing right now, is repeating history. The great irony here is that fragmented healthcare is getting worse. While technology is supposed to bring fragmented experiences together, instead we're making 293 new mental health applications, similar to creating 293 different kinds of Palm Pilots. What we need is the iPhone. We need to start moving in a different direction and start doing it quickly. Patients, customers, health plans, employers —everybody is giving clear signals that integration is what we want and what we need, and the payoff in doing so successfully is profound.
The Omada Insights Lab has found that across conditions, when we put data together including care team goals and on-demand access, engagement and outcomes improve:
- Members who complete goals are 50% more likely to achieve positive outcomes.
- Members who complete goals with a human care team on the other side are 250% more likely to achieve outcome targets.
- Members who engage in the first week of the program are 24% more likely to be engaged later on.
- Omada coaches with that human touch and personalization are 10% more effective than automated machine learning and artificial intelligence-generated nudges.
Where Do We Go From Here?
How do we scale these kinds of results, so we can make history instead of repeat it? We can start by committing to the following five principles, which are currently underway at Omada:
The platform needs to be able to integrate data and have APIs that enable interoperability. It connects devices and facilitates in-person and telehealth visits. At Omada, we've spent the better part of a decade building this platform, and in early 2021 added telehealth visits with a doctor, or as we call it, physician-guided care.
Secure Patient Record Storage
The platform needs to store patient records as privately and securely as each and every one of us have come to expect at a doctor's office or a hospital.
Coordinated Care Across Platforms
Once a secure platform is in place, care needs to be coordinated and accessible across multiple channels when it is needed most. We need to be able to connect coaches to specialists, nurses, doctors, healthcare professionals, both in person and virtually, and it needs to occur whether a person has one condition, or multiple conditions like we talked about with Nina.
Treatment Grounded in Data and Affordability
To achieve desired outcomes at both the individual and population levels, every intervention, treatment or care plan needs to be grounded in what I call a data mosaic. This data mosaic reveals fact patterns and insights that can be used to create a care plan that results in measurable outcomes. And if you achieve outcomes, it has to be affordable — the cost of care has to be less than the savings.
Trust Between Patients and Care Teams
A trusting relationship between a member or patient and their healthcare professional is sacrosanct. Trust is the catalyst that gets a member like Nina to make a change, and that’s the ultimate sign of success.