How HealthTech can improve clinical outcomes and reduce cost
Healthcare systems around the world are under pressure to deliver better care at lower cost. The pressures differ in different parts of the world – some such as the US are struggling with the complexities of streamlining insurance-based systems bloated by administrative costs. Others in emerging markets are struggling to design the best systems to meet rapidly growing needs from a starting point of inadequate resources and rapidly rising demand from growing and ageing populations with shifting disease patterns.
The holy grail of health system design is the delivery of better clinical outcomes in more cost-effective ways. As physicians, we seek to do the best for our patients individually – we need to now shift our mindset to think about how the systems in which we work can do the best for our patients collectively.
HealthTech, and the variety of approaches offered by connectivity and clinical data flows between patients and care providers, offers an opportunity to radically disrupt healthcare delivery through changing the nature of interactions between patients and physicians (and other caregivers). This is particularly valuable for chronic disease management (which represents around 75% of healthcare spending in the US according to CDC).
Diabetes probably represents the greatest burden on healthcare resources of any single disease, in view of its prevalence (around 12% in Singapore) and the high cost of management of its long-term complications (e.g. renal failure, blindness, heart disease) – which can be catastrophic.
There are a number of emerging best practice principles guiding management of chronic diseases such as diabetes, which will be well known to those involved in delivering care to this group of patients:
- Monitoring of the disease and advice to patients needs to be frequent and informed in order to generate the best clinical outcomes (in the case of diabetes, level of blood sugar control as measured by the marker HbA1c)
- Patients need to be engaged in self-management of their disease, including receiving motivation to make lifestyle changes, which are another predictor of long-term disease outcome
- Multidisciplinary care by a team including physician, diabetic nurse/health coach, dietician and others also drives better outcomes through closer patient monitoring and engagement
These approaches are hard to achieve in traditional clinical practice, where the delivery of care in many countries is handled by solo GPs who may not have advanced training in the management of chronic diseases such as diabetes, and who see patients perhaps once every 3 months – leaving patients to fend for themselves with little or no support between consultations.
It is not surprising that long term clinical outcomes for diabetes (as measured by the level of progression to end-stage complications such as renal failure) are poor in many countries. Good clinical management throughout the lifespan of the disease is a determinant of long term clinical outcomes and current healthcare systems in many countries are not set up to provide this.
This is where HealthTech provides a major disruptive opportunity to reengineer how our healthcare systems manage chronic disease. HealthTech companies around the world are implementing systems to monitor patient clinical data remotely (for diabetes: blood sugar, weight, blood pressure, activity levels) and to make this data available to clinicians (which can comprise members of a broader care team such as dieticians and health coaches in addition to physicians) on a timely basis between consultations so that patients can receive feedback and advice on how to manage their disease. This reduces immediate problems such as hypoglycaemia (in the case of diabetes) and results in better outcomes. (For diabetes several trails involving such systems have shown statistically-significant reductions in HbA1C).
The cost of implementing such systems is relatively low compared to their potential long-term benefits in terms of catastrophic complication reduction. Since these types of systems have only been introduced in recent years there are as yet no long-term health economics studies relating to use of HealthTech in this way. However, given the accepted link between HbA1c control and reduction of long term complications in the case of diabetes, it is logical to reason that rollout of these approaches can result in very significant savings to health systems over time.
The same approaches apply to a variety of chronic diseases, illustrating the vast potential impact of HealthTech when applied in this way. Many barriers still exist in terms of realizing this opportunity. In particular Asia still needs systems which are well designed, engaging and based on clinical best practice. Doctors need to be involved and engaged in the design and development of such systems.
These approaches also need to be built around business models which will support rollout/adoption: notably they may need to be funded by governments or insurance companies and they must align interests across the entire care team to deliver the multidisciplinary care needed.
There is much thought and innovation now being applied to such solutions around the world, including in Asia. I am highly optimistic that we are about to enter a new era when tech-enabled healthcare systems will allow us to make significant steps towards that holy grail in the near future.
Authored by: Dr Ronald Ling
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