Digital Health Holds the Promise of Serving the “Underserved”

By Peggy Salvatore

This is the eighth entry in a series of blogs for ePharma Summit 2016 to explore ways the pharmaceutical industry can maximize the promise of digital health.

A report put out by the California Health Care Foundation  last week chronicled the promise of digital health holding the key to holding down costs for low-income patients with chronic conditions. After all, it is the poor, those with poor literacy and health literacy, who are often the ones with the highest rate of chronic disease – and the highest cost – to the healthcare system.

Who pays? For patients who fit this description, it is often the states and federal government who end up footing the bill for medications, emergency department care (because they sometimes don’t have a home at all, let alone a medical home) and inpatient stays. The study states:

Some 90 million Americans have multiple chronic conditions (MCCs), with the prevalence of MCCs highest among people with the lowest incomes. Each additional chronic disease increases a person’s risk of adverse drug events, higher out-of-pocket expenses, impaired functional status, hospitalization, and mortality. Two-thirds of health spending is associated with patients managing MCCs. (p.3)

A series of pilot programs have shown that even the poorest of the poor in unstable living situations often have a cell phone or even a smart phone, and Internet access at a computer. With just those tools, a few low-cost, high-touch digital outreach programs have moved the needle with medication compliance, attending appointments and maintaining health regimens recommended by their providers.

Here are a few highlights from this February 2016 CHCF study which surveyed global healthcare leaders:

• Digital solutions use texting, customize language and communication style to the audience, uses portals, kiosks, video, telephone and cable, combines medical and social services, leverages a trusted human and collects data passively.
• One-half of low-income adults own a smartphone and 84% own a cell phone. Customized text messaging bolstered appointment adherence by 40% and medication adherence by 12%. One successful test program has been expanded to Medicaid care management programs in New York.
• Text4baby is a program in both English and Spanish that messages labor signs and symptoms, birth-defect prevention, prenatal care, urgent alerts, developmental milestones, immunizations, nutrition, safety and more. It also connects users to Medicaid and the CHIP program.
• Meducation targets community health centers and translates medication and discharge instructions into 18 languages as well as provides visual instructions.
• Kaiser Permanente implemented KP HealthConnect by mining retrospective data in the EHR and using HEDIS data sets to use electronic messaging to bolster outcomes for black patients managing diabetes and heart disease.
• In a North Philadelphia grocery store in a low-income area of the city, one kiosk with behavioral health information encourages people to get “a check-up from the neck up”.

Some programs leverage relationships with faith-based initiatives, federally qualified health centers and university programs. The promise of digital health to help, diagnose, treat and manage diseases and common conditions (like pregnancy!) are only limited to our imagination.

With the desire to serve those who cannot afford and do not have regular access to healthcare, and the limitations of state and federal budgets to do so, digital health solutions can bridge the gap between poor health outcomes and managing high-risk populations.