Healthcare Systems Aren’t Always Set Up to Efficiently Manage Chronic Diseases. How Can We Help?
July 16, 2018
Dr. Atul Gawande was recently announced as the new CEO of the yet-to-be named JPMorgan, Amazon, and Berkshire Hathaway joint venture. Gawande, a surgeon at Brigham and Women's Hospital in Boston, writer and professor, has long been an advocate for making healthcare systems smarter and more efficient. In a recent interview, he shared a story about his mother’s knee replacement surgery in the United States. In the course of three days, 66 different specialists or caretakers came into her hospital room – many giving contradictory advice.
As an industry, while technological and scientific innovation have surpassed our wildest dreams, our systems for healthcare delivery have lagged behind. Although to varying degrees, our experience has shown us that this is the case in most countries around the world.
Gawande has spent a large part of his career looking at how to improve healthcare facilities, and we are eager to hear what will come out of his most recent venture. However, as we look at the growing incidence of chronic diseases, which currently accounts for 71% of global deaths, we can’t forget a critical part of the puzzle.
Patients with chronic diseases require specialized care, costly long-term treatment and close follow-up, but what happens to patients once they leave the hospital?
Patients are on their own. Most receive limited to no follow-up to ensure that they are adhering to their prescribed care and treatment, and physicians are left without knowledge of what’s happening with their patient.
Patients diagnosed with the increasingly prevalent hepatitis C are a prime example of this. In 2016, only 13% of the 14 million people who were diagnosed with hepatitis C globally were able to start their prescribed treatment after diagnosis. We also see this with patients diagnosed with diabetes. At least 45% of patients with type 2 diabetes fail to achieve adequate glycemic control, with poor medication adherence being one of the major contributing factors. In developed countries, adherence to long-term treatment for chronic illnesses averages 50%. In developing countries, the rates are even lower.
This in turn limits the cost effectiveness of treatment (for patients and payers), and minimizes, if not nulls, its intended medical benefit.
How can we help health systems not only cope, but evolve to meet the needs of patients with chronic diseases most effectively?
From a systematic perspective, adherence and disease management support is the common denominator. Whether a patient is reimbursed for the cost of their treatment, pays out of pocket, or receives financial support to cover some of the cost, our experience has shown us that all types of patients need help adhering to their care and treatment. We’ve seen first-hand just how much adherence support makes a difference. In one of our currently active programs, we’ve addressed an issue where 12% of patients were scared of receiving an injection, which resulted in missed appointments and doses. After one-on-one meetings with the program nurse, and detailed training on how to inject themselves, 100% of the patients offered the service no longer faced this challenge.
Treatment affordability is often seen as the be-all, end-all when it comes to access to healthcare. But regardless of drug price cuts and other affordability solutions, if patients aren’t following their care and treatment regimens, how much are we really helping?
Our ultimate goal is to maximize care and treatment benefits for patients. To do so, we must acknowledge that what happens outside healthcare facilities is often just as important in meeting that goal as what happens inside, especially for non-communicable diseases and chronic illnesses. If we can provide personalized adherence and disease management support beyond the hospital-setting, as well as technology that allow patients to monitor their progress themselves and feed information automatically to their doctors, we can help bridge the gap between the time the patient walks out the hospital and their follow-up appointment. Such interventions help simultaneously overcome shortcomings in the health system by helping patients stay on treatment while improving systems in the long-term by enabling physicians and patients to make more informed decisions.
We also have to start thinking about Real World Data (RWD) differently. Traditionally, we collect the data, analyze it, and make the data available to inform decision making and help systems improve. While RWD studies play a major role in complementing clinical trial data, and we are seeing new tools to analyze large RWD sets quicker than ever before, they are still mostly retroactive. In addition, and perhaps most importantly, healthcare practitioners, who are the ones that can most directly benefit from this information, often don’t have the time to interpret this data. We need to put in place better technology that allows not just real-time data capture and analysis, but Real-Time Feedback (RTF). In other words, we need more investment in interactive and interconnected platforms that provide data to physicians in ways that are practical and relevant to daily clinical practice and patient interactions.
When it comes to helping healthcare systems work smarter, this is by no means an exhaustive list. There are many things we can do, but we see stronger adherence and disease management mechanisms and real-time RWD feedback as critical areas where we can play an important role to improve healthcare delivery.