Health equity through value-based care: wishful thinking or digital health future?

If health equity is our desired destination, then value-based care must be our vehicle. At its core, value-based care is all about improving the quality of care for patients. Rather than seeing more patients, conducting more procedures and ordering more tests, healthcare systems and providers are pivoting toward proactive, targeted care approaches that aim to identify and prevent health problems before they have a chance to worsen. 

By investing in a deeper understanding of patients’ health and social risks, healthcare systems can better engage populations in upstream preventive care and social services, and providers are freed to dedicate more time and allied health services to patients with chronic conditions or comorbidities that require complex care. These actions can facilitate the identification and mitigation of the larger, more complex barriers known to directly impact patient outcomes, such as the social, behavioral and environmental determinants of health. In this way, value-based care acts as a pathway for pinpointing and addressing key barriers to equal health access, especially among more vulnerable or underserved patient populations. 

With value-based care in mind, health equity can be addressed in a way that is both sustainable and scalable, delivering better outcomes to entire populations of patients who have faced unjust barriers to good health. We can accomplish this by using digital health to support patient behavior change, identify unique patient motivators and personalize approaches to chronic care management. Here’s why:

Whether the stated goal is improving patient quality of life, promoting population health or reducing the cost of care, better outcomes are the foundation of the value-based care model and impact patients, providers and payers alike. Each wants patients to feel healthier and live better lives, while providers and payers also seek reduced hospitalizations and lower overall healthcare costs. Frameworks to implement value-based care typically include opportunities to intervene with each of the different stakeholders within the healthcare ecosystem, thus taking advantage of the natural alignment around improving outcomes.

For digital health companies focused on promoting healthy behaviors, patients become the primary focus of intervention, reasoning that improved patient outcomes will in turn reduce care-related costs for healthcare systems and payers.

So, how do we help patients achieve their healthcare goals through positive, sustainable behavior change? The answer is not simple. Every patient is unique – not only in their healthcare needs, but also in the context and environment in which they receive and manage their care. It’s difficult, for example, to expect patients to be successful with a digital health tool if the patient does not have reliable, affordable internet access or a smartphone that can support a self-management app. Consequently, understanding a patient’s unique motivations, goals, barriers, and social and economic environments in addition to their healthcare needs is essential to achieving desired behaviors and patient outcomes.  

To illustrate this concept, let’s consider two hypothetical patients: Jayson, a 32-year old male with uncontrolled asthma, high symptom burden and commercial insurance, and Shirley, a 66-year old female with frequent COPD exacerbations and comorbidities, on Medicare. Jayson loves to play soccer with his friends, but recently stopped when his asthma symptoms started worsening. He felt ashamed when he became winded during games. Shirley, on the other hand, has lived with COPD for the last 9 years and following a recent layoff, she lives on a tight budget and is in constant fear of overspending on medications. Given their distinct personal and socioeconomic differences, Jayson and Shirley will likely not be encouraged to change their behaviors if we attempt to engage them with the same intervention. In these examples, a common delivery method may also not be feasible – Jason may have the latest smartphone and reliable internet access, while Shirley may be more cost-conscious.

This holds true for all patients – we can’t expect that utilizing a single approach to promote patient outcomes will produce effective results for everyone. Tailored experiences are essential in motivating people to change behavior. Understanding key patient traits, current behaviors and environmental exposures can help create a more customizable experience and present opportunities to engage patients in ways not previously possible.   

Digital health is an immensely powerful tool for enabling personalized care and optimizing the right intervention, at the right time. Thoughtfully-collected data may allow for a more holistic patient experience, while also providing important insights to providers and payers. With higher quality objective insights, providers will be empowered to make more informed treatment decisions with patients, and payers can effectively evaluate care outcomes and apply learnings more broadly to a variety of patient populations, from pediatric to geriatric to those historically underserved. 

In fact, this is a principle already being explored in chronic respiratory condition management. Results from a study evaluating the effect of a comprehensive intervention that combined telehealth and digital technology in children with asthma showed improvement in controller medication adherence – 8% on average, with about one-third of children experiencing greater than 20% increase in adherence. The children in this study were from minority, low-income families in inner-city areas, where traditional approaches of healthcare may not have been able to adequately address certain barriers or risk factors. Although future research needs to be done, this is a promising study that demonstrates the feasibility and need for comprehensive approaches to healthcare. Among a growing body of research focused on the impact of digital health enabled clinical care for underserved populations, this is one example that highlights the importance of addressing socioeconomic barriers to care, such as access to technology. 

The road to health equity is a long one, but there is hope that it may not be as distant as we had initially envisioned. Value-based care is just one piece of the puzzle, and improved health outcomes will require systemic changes upstream in addition to quality care, such as safer living conditions or increased education and employment opportunities. However, as digital health adoption continues to grow among patients, providers and payers, there will be tremendous opportunity to deploy value-based approaches within patient care. If we can continue to approach chronic care management with a focus on quality outcomes and patient-centric interventions, particularly among those who have been historically left behind, we can inform healthcare stakeholders and policymakers to drive the systemic changes that will ensure health equity in access, affordability and health improvements at scale. 

About Propeller Health

At Propeller Health, our mission is to empower every person living with a chronic respiratory disease to take control of their health so they can live a better life. As a leader in digital health and therapeutics for asthma and COPD, we work to improve clinical outcomes, healthcare costs, and quality of life by supporting patients in managing their condition with their healthcare provider.  

Propeller’s platform includes FDA-cleared medical devices, consumer apps and access to clinical data for provider monitoring throughout the care journey, to create value to all stakeholders. We enable a personalized digital experience with a human touch used by patients, caregivers, providers, payers, pharmaceutical companies and other healthcare organizations across the US, Europe and Asia.

Propeller Health is a wholly owned subsidiary of ResMed. For more information, visit www.propellerhealth.com.