Prevention versus treatment: how technology can help drive change
from Zuellig Pharma
In traditional Chinese Medicine, a doctor was paid a retainer to keep patients healthy. If a patient became sick, the doctor would not be paid until the patient’s health returned to normal. Emphasizing prevention over treatment seems like a no brainer: why not spend more resources on keeping people from being sick as opposed to giving them expensive, sometimes painful and/or lifelong treatments (including drugs, exams, procedures, hospital stays…)? Not only would it save costs but it would surely prolong their life and increase its quality as well. As simple and straightforward as the concept may sound, it is actually quite hard to translate into real life.
A textbook example is type II diabetes, a devastating lifestyle-related disease that is spreading fast in our part of the world. An estimated 70% of diabetics live in Asia and studies have shown that Asians are at higher risk of developing type II diabetes, when compared with people of European ancestry. Diabetes is sometimes called a silent killer as it strongly increases the risk of cardiovascular diseases, renal diseases, stroke… A very effective way to stay away from this killer (or to keep it in check if it’s already around) is actually just to live a healthy lifestyle i.e. balanced diet, some exercise, moderate alcohol consumption… But if we look at the prevalence of obesity (itself linked to diabetes, heart disease and even some types of cancers), we can see it rising rapidly in Asia. A 2014 article in the Lancet showed that almost half of Malaysian adults are overweight or obese—possibly the highest rate in Asia. The problem isn’t just in Malaysia though: according to the study, similar rates can be found in Singapore.
To start understanding why we don’t do more to stay disease-free, we have to look at the whole healthcare ecosystem. Indeed, it is geared towards providing care to patients when they are ill. Physicians diagnose illnesses and prescribe treatments, pharmaceutical companies develop drugs to treat those illnesses, payers reimburse drugs and surgeries and even patients oftentimes prefer to trust pharmacological or surgical intervention over any other form of intervention. One fundamental issue is that we see prevention as a bet on potential positive effects in the future, whereas treatment happens now with (supposedly) visible effects. Preventive interventions need to demonstrate their value just as any intervention within the realm of evidence-based medicine. Actually they probably need to demonstrate even more value, in order to shake off the perception that they are the snake oil of the 21st century.
Technology is playing a key part in the quest to deliver scalable and effective prevention to the population. Thanks to the developments in wearables and connected devices, from pen-sized glucose meters to activity-tracking watches, we can now remotely monitor dozens of parameters and detect potentially harmful behaviour or risk, without sacrificing patient convenience. However, more of these devices need to get proper regulatory approval in order to be fully relied upon by healthcare professionals. Understanding how to use this mine of data to drive better clinical outcomes is another issue that hasn’t been fully resolved. But we are getting closer every day!
With more than a billion smartphone users, mobile penetration in the Asia-Pacific region is exceptional. Mobile devices are thus a great tool to keep people connected with their HCPs (physician, nutritionist, psychologist…), while staying in the comfort of their home environment. Phone-mediated telemedicine represents a huge progress for people living in areas where physical access to care is limited, whether remote islands or super-congested urban centres. But the tremendous challenge of making someone change their lifestyle remains, regardless of how much connected that someone is. For that matter, mobile health is enabling new ways for patients or not-yet-patients to receive daily coaching and tips on nutrition, exercising or even mindfulness to relieve stress. In order to foster long-term engagement and sustained behaviour changes, several types of incentives have been tested. The most obvious one, the financial incentive, has yielded mixed results so far, especially in the long run. An increasingly popular approach has been to use social networks and game-centred incentives. For example, the patient may be asked to complete a quiz on nutrition, in order to get points that can be converted into tangible rewards like coupons or eCards. An element of competition can also be introduced to spice up the challenge!
Lack of reimbursement remains a major hurdle for preventive interventions to really take off, in societies where people are reluctant to spend out-of-pocket money on healthcare. A case is therefore being built to show that investing in such interventions also makes sense on a financial level. Corporates in particular are starting to realize that keeping their employees healthy can lead to significant increases in productivity, reduced absenteeism and lower medical spending. Zuellig Pharma has actually been pioneering this approach in Asia. A great example is the 12-month wellness program delivered by our MiCare subsidiary to one of its corporate client in Malaysia, which led to a more than 14% reduction in medical expenses incurred for major chronic illnesses. The program offered a range of education and fitness activities to motivate employees to adopt healthy lifestyle habits. In particular, the MiCare MyMed application was integrated in the program for employees to be able to monitor their personal exercise information, access online health seminars and manage wellness rewards on their mobile phones (more information on https://www.zuelligpharma.com/news/micare-wellness-program-improves-employee-health-reduces-corporate-healthcare-costs).
About the Author:
Benjamin Belot is a Project Manager at Zuellig Pharma, working on innovative service models. He is particularly interested in the ways technology can help improve access to healthcare
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