Tuesday, February 17, 2015

Connected Health as a Therapeutic

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By 2017, 50% of the pharmacy spend in the U.S. is expected to be for specialty pharmacy. It seems this is driven by two phenomena. The first is the growing crop of new molecules that are biologics -- classified as specialty pharmacy drugs -- and require special handling and care coordination. They are expensive but have given us new hope for such conditions as Hepatitis C and a variety of cancers. The second phenomenon is that just about everything else will be generics.

This brings to mind two opportunities for connected health. One is surrounding these specialty therapeutics with connected health applications in order to improve outcomes and reduce costs. The second is that connected health interventions, because of their demonstrated improvements in adherence, can also improve the care experience, patient satisfaction and quality of life, and themselves prove to be therapeutic.

Without getting into too much detail here about the first opportunity, our team is working on a real-life example of this at Partners HealthCare right now. We recently signed a co-development agreement with Daiichi Sankyo, Inc. to create a mobile app to serve as a coaching platform for patients with atrial fibrillation who have been prescribed oral anticoagulation therapy. The goal of this mobile app will be to support patients living with atrial fibrillation by helping improve patient adherence and compliance to medication, as well as fostering feedback loops that connect the provider to the patient.

Let's focus on the latter opportunity, which I believe is intriguing and a bit of a sleeper. Traditionally, the introduction of new technologies in health care has been assumed by a knee-jerk reaction to add costs. Yet, we’ve accumulated evidence to the contrary. I have two stories to demonstrate this.

The first example is a clinical research program we have under way with adolescents who have asthma. We’ve created a private Facebook group for them to be part of, and that’s about it really. No fancy bells and whistles. Just old-fashioned social networking. This is a study in progress, but to date we’ve already seen a positive effect, as measured by an instrument called the Asthma Control Test (ACT). Typically, the success rate of teenagers filling out this survey is 18%. Although the results are still preliminary, it appears that just putting kids in a Facebook group increased their participation to 80%. More importantly, the improvement in the score on the ACT, measuring how well these teens are controlling their asthma, also appears to be significantly improved compared to the use of a new inhaler. So, it seems that Facebook can be more therapeutic than a drug. I’m being provocative here, but you get the idea.

The second example is in type II diabetes, using connected health to improve activity. We randomized patients with type II diabetes into two groups, one received an activity tracker and nothing more, versus a second group that received a tracker plus were sent automated motivational text messages every day.

The messages were algorithm-driven; they were not sent by a person. The algorithm took into account several variables, including self-reported information on how motivated the individual was to increase activity, data from the activity tracker, weather data and some electronic records data. This intervention was conducted over six months. Interim data suggests that patients receiving the automated messages had a significant drop in HbA1c, more robust than the effects of Metformin, a generic drug. Once again, we see the potential of connected health to be more therapeutic than a drug. This result is even more impressive when you take into account the fact that the messages were machine generated.

These data drive home the point that engagement is powerful and that engaged patients do better. In both cases, those patients who were engaged, measured by either participation in the Facebook group or frequency of opening messages, did even better than the intervention groups as a whole.

Here are two examples, then, where connected health competes with chemical therapeutics in terms of efficacy.

It suggests a future where connected health programs are widespread, either as adjuncts to or substitutes for chemical therapeutics. And, we haven’t even discussed how connected health strategies can be integrated into clinical trials, or deliver value-added programs to build brand loyalty and patient engagement.

Author: Joseph C. Kvedar, MD, Vice President, Connected Health; Partners HealthCare

Dr. Kvedar will be presenting Outcomes-Driven Marketing: How Daiichi Sankyo and the Partners Healthcare Center for Connected Health Are Leveraging Mobile Technologies to Improve Outcomes at ePharma on Thursday, February 26 with Greg Barrett, Vice President of Marketing, Daiichi Sankyo Pharmaceuticals.  As a reader of this blog, when you register to join us with priority code XP2006BL, you can save $100 off current rates.
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