Digital therapeutics are changing healthcare and letting patients be their best selves

Steven Loeb · December 20, 2018 · Short URL:

Entrepreneurs at SplashX spoke about how to best implement digital therapies

Last Thursday, Vator and HP held their holiday salon gathering, called SplashX Invent Health - Vitality: Lifestyle as a drug, where a group of innovators, adopters and financiers got together to take a deep dive into new innovations and frameworks that could get people to be more proactive about lifestyle modifications. 

One of the key themes throughout the night revolved around how traditional medicine is becoming passe; instead of the old fashioned way of doing things, where someone goes to a doctor, get a diagnosis and a pill, now there are are alternative solutions that are enabling us to be better versions of ourselves.

Halo Neuroscience, for example, basically replaces medication because pills carpet bomb the body, whereas Halo Neuroscience's tech targets the brain without any side effects. The company's first product, Halo Sports, uses neurostimulation or bioelectronic medicine to enable the motor cortex to absorb muscle memory faster from training.

This topic was brought up during the second panel of the night, made up of entrepreneurs in the healthtech space. Panelists included Esther Dyson, Executive Founder at Wellville;  Hemalee Patel, Lifestyle Medicine Physician at Crossover Health/Facebook; Munjal Shah, CEO & Co-founder of Health IQ; Seth Serxner, Chief Health Officer and Senior Vice President of Population Health at UnitedHealthcare Optum; Pankaj Vij, Kaiser Lifestyle Medicine, President at American College of Lifestyle Medicine; and Daniel Chao, CEO of Halo Neuroscience. The panel was co-moderated by Archana Dubey, Global Medical Director at HP, and Frances A. Ayalasomayajula, Senior Manager, Worldwide Healthcare at HP.

Ayalasomayajula began by asking about digital therapeutics, and how they are being implemented today, noting that only 10 percent of physicians have adopted them today, but that it's projected that 25 percent will have within the next five years. 

"I’m curious to know how are you today adopting digital therapies within your practices and what kind of process do you go through in the decision making of onboarding such types of solutions?" she asked. 

Patel spoke first, and said that the implementation of these technologies, "depends on the patient."

"If you have a young patient who’s very technologically savvy then I think you can do more. They tend to be a little bit more into gamifying healthcare. I always notice that it goes back to bringing the science behind it. So, it may be fun for a little bit but they’ll get bored, or they want to move onto something else. Something like Headspace is actually a great example of how you can actually explain the science behind the motivation to want to meditate. It’s more just getting into the mindset of being present and slowing your brain down a little bit to allow for chronic stress to start to slow down, which we’re seeing so much more of," she said.

In some cases, Patel pointed out, technology can be too much. For example, trying to get patients to use iPads in a hospital can be an overwhelming experience that is actually detrimental. 

"In the hospital I remember we tried to adopt iPads for patients and there’s so much going on; you’re losing your identity as a patient in the hospital, and I sat on the patient experience committee and it was almost too much. It was overwhelming for a lot of patients to come in and have to deal with their medical condition, which they don’t know about, five different doctors coming into the room and now, ‘Here’s an iPad, figure it out.’ It’s interesting and, ultimately, the goal is the same in decreasing delirium but it almost actually increased it, and increased confusion," she said.

"You really need to know your audience, so to speak, and the physicians needed to onboarded because there’s so much out there. That physician component is really important when you are adopting these types of modalities for patients."

Dyson then brought up a company that uses gamification to help people who have just been released from jail and who are now on parole.  

"Who knows better than me than what it is I’m susceptible to? Friday Night, 7 o’clock, I just need a drink, and I know that. So, on Wednesday, I can interact with the app and have my long term self know what to do to the short term self. At 6:30 on a Friday, get movie tickets or make sure I’ve got a meeting with some friends. There’s a lot of interplay between the long term and short term self," she said.

"Second, there’s the whole framing effect. If you want someone to do the right thing, again, you need to do the precision motivation. Are they doing it for their kids? Are they doing it to be better than the guy next door? Are they doing it to show their dad? Are they doing it because they’re scared of getting sick? Putting that context around it make that behavior easier."

When Vij spoke, he brought up the fact that technology is not the only answer to getting people to change their behavior.

"As we think about lifestyle as a drug, there’s many ways where digital health can be applied and it actually already being applied. But we need to keep in mind that motivating somebody to change the way they live cannot just be solved by high tech, it also needs high touch. The digital solution to that might be that your health coach, your physician, your mindfulness coach, your dietitian, your exercise coach, is available to you remotely on your screen or on your iPad, regardless of whether you’re a Millennial or someone in their 60s," he noted.

"That’s one place where it’s being used very well, probably with some hybrid of high touch contact as well. So it could be avatars or live person interacting in a digital manner, but then, somehow, combining that with contact with someone that they trust and know. That combination can help motivate and move someone and keep them in the right direction, keep them from the bars and dessert tray, and instead eating broccoli."

According to Shah, though, digital therapies have so far not been successful because they are trying too hard to change people. 

"How many people do you know who still wear their Fitbit? Not very many. And the rest of us wear it by accident. Because we have this technology we’ve tried to say, ‘We have this hammer and now tech has a nail.’ We’ve taken a bunch of approaches that are just wrong," he said.

"One of the insights we had quite a while ago was that we shouldn’t focus on behavior change, which is a crazy thing. Everybody in here is so paternalistic, ‘We’ve got to change them, we’ve got to save them!’ We believe in a behavior acceleration focus, not behavior change. The person has to flip on their own. There has to be some self responsibility left in this system, not everybody’s a victim. That’s one big paradigm shift."

The problem that he sees is that they have been focusing on the wrong way to change behavior, focusing on self control instead of environment.

"Anybody who has lost weight knows you do not lose weight just by having self control. You’ve got to get all the sugar out of your house if you want to lose weight. Nobody has perfect self control; you’ve got to get it all out of your office because everybody’s going to have a bad meeting at some point during the week. ‘Well, maybe I will just have half that cookie.’ So that’s the second part which is, in every environment we have to be willing to take things out, but we’re unwilling to take things out out of the environment so therefor we focus on self control."

The better way that Shah sees for getting people to change is to focus on big actions rather than small actions, as the small steps never really wind up changing things. 

"We keep focusing on small actions when actually a lot of the science shows high intensity is way better in almost every dimension. So, ‘Yeah, let’s just take our 10,000 steps.’ We have treadmill desks in our office where there’s days I’ve walked six hours, because I had six hours worth of meetings, day after day. You know how many pounds I lost from that? Zero. But a little bit of really fast sprinting made a much bigger difference. Heavy lifting made a bigger different," he said. "Even dietary extreme stuff, like intermittent fasting or fasting totally, if you’ve never done it, I strongly recommend trying fasting. It seems these highly intense things trigger something different but we keep encouraging people, ‘Take a few steps because that’s easy.’ It’s hard to tell them to do the other stuff."

Shah's idea for how to really motivate people: get them to wear a continuous glucose meter for a month.

"It is the most educational, nutritional thing you can do in your entire life. I’ve done this numerous times in a row now and I am constantly surprise at how high my blood sugar spikes from things I did not think were going to spike my blood sugar. Sushi, six pieces of a California roll, spiked my blood sugar as much as ice cream with chocolate on it. We keep focusing on the things that are easy, that in our Fitbit, instead of the things that are more important, and some of those things can make a bigger nutritional thing and teach people faster and give them the feedback loop they actually need," he said.

Dyson agreed, saying that every second grader should wear one for a month or two.

Serxner then spoke about the problem with digital health products: many don't use actual science to get people to use them. 

"While it’s great to work with people who are motivated today to do things, it is also really helpful to talk to those people about what might motivate them. What’s their sense of purpose? Why would they care? Why would they bother to be adherent? So, using a model behavior change that talks about the first step of self awareness, the second step of scale building and the third step of maintenance versus sustainability," he said. 

"Many of the products that are being developed focus on skill building, don’t even use the best science for that, don’t even bother talking about maintenance. We know a lot about maintenance, we know a lot about self identity, we know a lot about designing for failure. As you think about, and as we vet the services, the applications, we see the technologies, we ask, ‘What’s the behavioral science behind it? What’s the data driving personalized recommendations? How simple is it? What is the consumer experience behind all of this? And how does it integrate across the ecosystem?’ For a provider it’s got to be just part of your deal."

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