Though we seldom see their use in our modern world and, even then, only in fiction, there was a time when it was common for people to actually use things like crystal balls and divining rods to try to uncover unknown yet valuable information. As unbelievable as it may seem, soothsayers peered into crystal balls aiming to help seekers look into the future for guidance, while prospectors would rely earnestly on divining rods as they attempted to locate underground riches of water or oil.
While we may still entertain such images in some of the literature, TV, and movie fantasies we enjoy, in our modern professional world, we tend to entrust industry predictions to those with real, practical knowledge of the business landscape, because they trek, mine, and drill there regularly.
The world of medtech is no different, and for me and my team, connected care is the ground we travel, excavate, and explore on a daily basis. As we venture further into 2023, here’s our perspective on some of the connected care trends we expect to see on the road ahead, from digital therapeutics to remote patient monitoring and clinical trial management.
Precision engagement is an emerging development within digital therapeutics
One of the fast-growing categories within medicine today is digital therapeutics (DTx), which is the delivery of evidence-based treatment through digital solutions that help prevent, manage, or treat a disorder or disease. One recent report valued the global DTx market at $4.2 billion in 2021 and predicted it would expand at a compound annual growth rate of 26.1% between 2022 and 2030, with other estimates projecting even faster growth.
Within DTx, the emergence of precision engagement is a development that holds great promise, especially for chronic conditions where day-to-day choices and behaviors have a significant impact on health outcomes—conditions like diabetes, obesity, and hypertension.
While remote patient monitoring is clearly important for giving care teams visibility into the management of a patient’s condition in order to facilitate vital provider interventions, those living with chronic conditions requiring day-to-day management must also make dozens of additional decisions every day. But initiating provider interventions for all of these would simply not be possible nor even desirable. With diabetes, for example, these can range from food and exercise choices to the need to take medications or interact with a medical device, like a glucose monitor or an insulin pen or pump.
Enter precision engagement. Just as precision medicine can utilize a patient’s genetics or metabolic profile to uniquely fine-tune the dosing of a drug to an individual, precision engagement—with the help of AI and machine learning—can be used by digital health developers and physicians to program connected care platforms to issue electronic interventions or “nudges” that are uniquely tailored and helpful to the individual patient.
These digital nudges prompt a patient to take necessary actions throughout the day that are not only personalized to their needs but delivered in a way that is consistent with their lifestyle and preferences, leading to a better likelihood of engaging the patient and, ultimately, guiding them to better health outcomes. These digital interventions are known in behavioral medicine as just-in-time adaptive interventions or JITAI, and they are helping healthcare professionals use software to precisely engage the right patients with the right interventions at the right time.
With precision engagement, these solutions programmed into connected care platforms are able to digitally “learn” about an individual patient’s preferences from their responses to questions and from the daily decisions they make in their self-management as they engage with the platform’s corresponding app. This learning enables the software to personalize future digital nudges for the patient.
Precision engagement software might be used, then, to help identify the right moment of the day to generate a nudge, like suggesting the patient eat an apple or take a walk at a specific time of day because that’s when the individual is most receptive to such a suggestion.
Or, a digital nudge might involve time- or activity-triggered reminders, such as the need to take medication or to sync the patient’s medical device to the connected-care platform. It might even send the patient an encouraging message prompted by their reaching of a daily target, such as meeting a specific exercise goal.
Precision engagement can even tailor the type of communication used for nudges, from the use of a pop-up message or the suggestion of a video or article to the kind of voice used—maybe through empathy or even humor—to deliver the nudge.
Precision engagement is one of the most exciting new developments within digital therapeutics, using digital health tools to deliver highly personalized, time-adaptive interventions in ways that lead to positive behavior change, extraordinary patient experiences, and improved health outcomes.
The need for greater RPM awareness is resulting in a measured pace of adoption
While necessity may have forced the issue for care teams during the pandemic regarding the adoption of telemedicine appointments, it turns out that remote patient monitoring (RPM) is still “one component of telehealth that has lagged,” according to the Medical Group Management Association (MGMA). In a Stat poll of 586 healthcare leaders taken by MGMA last year, the association found that 75% of medical practices had yet to offer RPM services.
Despite patients’ positive perspectives of RPM, demonstrated outcomes, payor recognition of RPM’s value, and the establishment of reimbursement mechanisms, the actual pace of RPM adoption has turned out to be more deliberate than these factors had originally led many to predict. In fact, in our work, we’ve found that a large part of preparing providers to make the actual leap to RPM adoption has really been a challenge of growing awareness.
For one thing, we’ve found that in the busy world of providing clinical care, some providers simply haven’t gotten a complete understanding of what RPM reimbursement looks like. So, we continue to chip away at the task of making sure our provider partners have the latest information.
And while some may have caught wind of RPM reimbursement, we’re coming across other providers who have the misconception that only Medicare reimburses for RPM. In reality, there are dozens of private payors covering RPM, with some reimbursing at even higher levels than Medicare.
Another misconception we encounter among some providers is the mistaken belief that, to get reimbursement for RPM, they must implement every piece of it all at once, from getting patients set up and syncing their data to analyzing the data and providing patient consults. Not only is that not true, but the idea of such a weighty burden is partly why CMS has assigned unique CPT codes for discrete RPM activities. For many providers, implementing RPM is such a significant change management challenge that it actually makes the most sense for them to start small, which they can do by getting patients set up and focusing them on simply sharing their data remotely on a monthly basis. With that, providers can begin submitting for reimbursement, then build from there.
One of the most useful steps for providers unsure of where to begin is to find a reliable partner who specializes in RPM planning and implementation. Resources like AMA’s recently published 12-step RPM Playbook can help, as it covers every stage of establishing a fully operational RPM program.
Pandemic-induced use of decentralized clinical trials provided an up-close view of their efficiencies and is leading to increased adoption
Decentralized clinical trials (DCTs) are trials in which some or all study assessments are conducted at locations other than the investigator site via either tele-visits, mobile or local healthcare providers, local labs and imaging centers, home-delivered investigational products and/or mobile technologies. During the pandemic, when thousands of non-COVID trials—some 80%—were interrupted, virtual trial companies experienced an explosion in demand.
And if market projections are any indicator, demand for DCTs will continue to increase, with an analysis issued earlier this year projecting the global DCT market will grow from $6.1 billion in 2020 to nearly $16.3 billion in 2027.
While the need for social distancing that precipitated the sharp uptick in DCT demand may have subsided from its peak during the pandemic, it’s clear that continued demand for DCTs will be driven primarily by the efficiencies of the model that researchers witnessed first-hand during the pandemic.
One of the biggest advantages of DCTs is how they boost trial enrollment, as they often allow for patients to sign up and participate from home via remote monitoring. Remote participation opens trials and the benefits they provide to those living outside urban centers, which means the trend toward DCTs is also broadening the number and diversity of eligible enrollees.
DCTs can also reduce patient dropout rates and speed up study timelines, two of biggest challenges in life sciences R&D. And they help researchers realize significant cost savings from decreases in the number of physical trial sites and reductions in research staff and travel.
Driven by this wide range of efficiencies benefiting subjects, researchers, and study sponsors, it’s expected the demand for DCTs will continue to ramp this year and in the future.
Overall, we expect 2023 to be a year where our prospecting and development efforts in the connected care landscape will continue producing exciting advancements that will enable us to better support patients living with chronic conditions as well as the physicians and teams who care for them.
About Russ Johannesson
Russ Johannesson is Chief Executive Officer at Glooko, a leading provider of connected care, patient engagement, digital therapeutics, and clinical trial optimization. Deployed in over 30 countries and 8,000 clinical locations, Glooko’s mission is to improve the lives of people with chronic conditions by connecting them with their caregivers and equipping both with digital health technology for improved outcomes.
