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Lessons Learned: SDOH & Chronic Conditions- The HSB Blog 7/12/22


Given we have written approximately 75 Our Takes over the last two years we thought it might be helpful over the course of the summer to look at “Lessons Learned” from our posts. As such, this summer we will be looking at our lessons learned on the broad range of digital health on topics we’ve written about including Artificial Intelligence; RPM and Virtual Care; Value-Based Care, and Mental Health (among others). This week we look at Social Determinants of Health (SDOH) and chronic conditions with a focus on how digital health can make a difference.

The Backdrop:

Chronic Health conditions are one of the leading causes of death and illness worldwide. According to the CDC, approximately 85% of adults over 55 have at least one chronic health condition, and 60% have at least two chronic conditions. As we age, naturally we are increasingly prone to falling ill and are more susceptible to chronic illness resulting in increased spending on healthcare treatments. Chronic conditions can have major impacts on healthcare, patient livelihood, employee productivity, mental health outcomes, and much more. Chronic illnesses like diabetes and obesity could lead to absenteeism and missed work days over long periods of time causing economic strain on employers. Unfortunately, due to uneven distribution of care among certain socio-economic, and geographic groups, certain racial and ethnic groups are at higher risk for certain chronic conditions.

However, recent advances in digital health may enable chronic conditions to be dealt with early in the patients' journey by deploying tools that empower patients to monitor and act on or change certain behaviors thereby impacting health conditions. For example, remote patient monitoring (RPM) technology has become increasingly popular and is being used to help treat patients with heart conditions, high blood pressure, cancer, and respiratory diseases. During the Pandemic, digital tools like telehealth measures allowed clinicians to continue to monitor and track patients who were either unable or unwilling to come into the office. Wearable devices such as smart watches or smart apps can aid in monitoring chronic conditions such as hypertension and provide patients with useful and actionable information about their personal health indicators without ever having to leave the comfort of their homes. These technologies can be particularly helpful with certain chronic conditions like cardiovascular disease, where lifestyle modification and self-management can be critical to improving outcomes. These are some of the very many ways in which chronic health conditions can be mitigated by digital health. What follows below are our insights, we hope you enjoy them.

Lessons Learned:

That said, what were some of the “lessons learned” on chronic health from some of our prior Our Take’s?

While digital tools can help the elderly remain independent and age in place, close attention has to be paid to the technology gap and specific, age-appropriate training is required.

  • For example, according to AARP’s “Home and Community Preference Survey” conducted in 2021, “77 percent of adults 50 and older want to remain in their homes for the long term — a number that has been consistent for more than a decade.”

  • In addition, according to a recent article in Mobi entitled “Seniors aren't tech-averse. We're just not designing for their needs.”. The article noted, “Digital health companies that design user-friendly services or products for the elderly could mitigate adverse health-related outcomes and worsened chronic conditions linked to usage barriers by addressing the age-related barriers. These technologies can be particularly helpful with certain chronic conditions like cardiovascular disease, where lifestyle modification and self-management of chronic conditions are critical to improving outcomes.

Age Related Barriers to Digital Health Remain-The HSB Blog 5/24/22

The Digital Divide and Broadband Access Must Be Addressed to Make Broad-Based RPM a Reality.

  • A 2020 study in the Journal of the American Medical Informatics Association found that “areas with limited broadband access also had higher rates of chronic diseases such as obesity and diabetes, resulting in a double burden where those with the lowest connectivity have the highest need”.

  • Data from the National Telecommunications and Information Administration indicate that only 12% of those with an annual household income of $25,000 or less used the internet to communicate with their healthcare provider compared to 40% of those making $100,000 or more in 2019. Hispanic, American Native/Alaska Native, and African Americans had the lowest rate of internet use for health-related activities, trailing White and Asian Americans.

Digital Tools Could Significantly Increase Engagement, Utilization, and Compliance

  • A 2019 JAMA article found, that chronic health conditions lower employees’ productivity and increase the number of missed workdays. Employee absenteeism caused by high blood pressure, diabetes, smoking, physical inactivity, and obesity, incur an annual cost for employers of $36.4 billion.

  • A study by NCQA found that “telehealth facilitates access to healthcare for individuals who might otherwise skip or avoid important services. It also allows care delivery more quickly and efficiently in lower-cost settings. [The report] also found evidence that telehealth can help reduce more costly urgent and emergency department (ED) care, as well as the use of costly and often overused services such as imaging.”

Digital Wellness Programs Could Be Key to Engagement and Utilization-The HSB Blog 10/18/21

Healthtech Could Meaningfully Address Disparities in Health for the Underserved (assuming broadband access is addressed).

  • For example, data from the CDC indicates that “integrating community health workers (CHW) into the healthcare system [who are often empowered by digital technology] will reduce the burden placed on strained resources and overworked clinicians. It will also help improve health outcomes when used for addressing chronic health conditions [many of which disproportionately impact people of color and are preventable].

  • In 2021 HealthcareITNews reported, “studies have shown that minority patients routinely receive inferior care because they may be bouncing between hospitals and clinics and also have higher rates of chronic illnesses like diabetes and hypertension, which research indicates can be better addressed by digital technologies.”

  • A 2021 article in the Central European Journal of Medicine entitled, the “Role of new digital technologies and telemedicine in pulmonary rehabilitation” noted that “the continuous monitoring for chronic respiratory conditions can produce the expected efficacy needed for the lower occurrence of systemic side effects and effectively determine the appropriate number of doses for inhalation therapy."

Community Health Workers Will Reduce Disparities & Improve Outcomes-The HSB Blog 4/19/21

Enhancing Telemedicine Can Close The Infant and Maternal Mortality Gap-The HSB Blog 3/8/21

Digital Tools Can Improve Efficiency & Effectiveness of Respiratory Therapy-The HSB Blog 6/7/22

Final Thoughts:

Given all the dramatic change we’ve seen in the past 2 years, in large part as a result of COVID and the near-instantaneous embrace of digital care, our lessons learned focus on these factors: chronic care is moving from discrete, point-in-time monitoring to real-time continuous monitoring but is not yet there, at a minimum the pandemic has demonstrated that digital tools will serve as a significant adjunct to in-person care for many underserved communities and may in fact open new avenues for access; providers and payers must pay attention to and design plans to deal with technological issues, cultural barriers and issues around health literacy; remote-patient monitoring, virtual care, and even hospital-at-home models should be designed by disease state and therapeutic category, not one size fits all.


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