This is the second blog in our series regarding strategic insights about the key-methodological aspects concerning the introduction of new digital solutions.
In this second blog, we address the issue of selecting the right solution in the basket of options. In comparison to traditional drugs and devices, we would suggest that in many instances the digital solutions and diagnostics should be reviewed as a basket of options within a specific disease. You can see in our prior analysis how there are many solutions addressing a similar issue:
- Alzheimer / Dementia
- Heart Failure
- Mental Health
- Rheumatoid Arthritis
- Oncology apps engaging the patient
We will use our most current analysis on heart failure to illustrate this issue. In our research, we have found more than 30 companies with over 50 different functions that provide digital solutions to support the management of heart failure. If you go to this blog, you can find more details about the different solutions. How would you select the solution that will provide the most optimal value for a health care system?
What is the optimized non-digital comparison?
In the assessment of new solutions, the starting point is to understand what best-practices apply in the non-digital world. In the ESC guidelines for heart failure, the recommendation for best practice is as follows: “It is recommended that patients with HF are enrolled in a multidisciplinary care management programme to reduce the risk of HF hospitalization and mortality” (1) with a class I recommendation supported by level A evidence. Still, there are few disease management programs implemented.
The study included below from France, demonstrates the financial saving that can be accomplished from the implementation of a traditional disease management program:
Agrinier, Nelly, Christelle Altieri, François Alla, Nicolas Jay, Daniela Dobre, Nathalie Thilly, and Faiez Zannad. ‘Effectiveness of a Multidimensional Home Nurse Led Heart Failure Disease Management Program--a French Nationwide Time-Series Comparison’. International Journal of Cardiology 168, no. 4 (9 October 2013): 3652–58. https://doi.org/10.1016/j.ijcard.2013.05.090.
Unfortunately, there was no funding/reimbursement provided for this in France so the programme was not continued at the time.
Selecting the right option(-s) in the basket of options
In many instances, there is an overlap between the functionalities of different solutions which will use different approaches to achieve the same purpose. From a healthcare system perspective, one needs to consider which solution(s) will provide the most relevant value in the context.
Summarising the core-functions of the digital disease management tools (excluding the interventions) there are two core functions that one is looking to establish:
- To support the patient to gain awareness about their disease in order to make lifestyle adjustments, to reduce the symptoms. This can be done either through training or by feedback to the patient, based on collected data.
- Information to the caregiver to initiate treatment changes or apply an intervention to avoid predicted deterioration. This can be done either at scheduled intervals or with an alert function to inform of any changes in the condition that requires specific action.
To provoke the thought process, one could consider how far it would be possible to develop a solution based on the below simple components. The functions included would be to capture data from a weight scale (to detect the accumulation of water as early signs of deterioration), blood pressure data from a cuff and activity data from a smartphone to trigger signals to a health care professional when there is a need to react.
Note: We are not working with any client who has such a solution or similar.
If such a ‘simple solution’ would work, do we need all the other bells and whistles to establish the essential functions of a disease management program?
There are important developments with new biomarkers, implanted automatic recording systems, self-monitoring equipment to help tracking data, as well as advanced algorithm techniques to better predict and prevent worsening that will help improve the process and outcome of the disease management. But what is the relative benefit they can offer compared to a smart simple solution?
Here is an overview of the solutions we have found in heart failure so far: Disease Management tools in Heart Failure.
- For further updates on this blog-series, please join the LinkedIn group (Digital Health Market Access) where we look forward to your feedback as we share more insights.
- Feel free to also comment on the LinkedIn post.