Once considered the health plan for privileged people, concierge medicine is enjoying a rebirth, using technology and data to create 'personalized, proactive, and preventive' care for anyone who needs it.
The evolution of personalized healthcare is giving new meaning to concierge services. What once was a platform for the rich and famous now offers precision healthcare, including chronic care management and health and wellness services, for anyone.
"We're optimizing health for everyone," says Rakesh Suri, MD, D.Phil., president and chief medical officer of Fountain Life, a Florida-based provider of "predictive, preventative, and personalized" care services that aims to create an international chain of healthcare centers. "We're focusing on the healthy years of life."
Concierge medicine encompasses a variety of terms, like boutique medicine, retainer-based medicine, platinum practice, and direct primary care. Generally, the organization contracts with a consumer or group, such as a company or health plan, for a fee to provide healthcare services.
Some health systems are launching their own concierge medicine programs. Tampa General Hospital recently opened TGH Concierge Health to offer residents of Florida's Palm Beach County and Treasure Coast personalized access to primary care services.
“If someone isn’t feeling well, they don’t want to wait for the next available appointment,” Laurie P. Rothman, MD, the first doctor to join the new program, said in a press release. “In addition to more time, my patients will also have increased access. If there is an emergency or they are sick, and it’s 9 o’clock at night, they can call me or text me and we’ll be able to talk it through and make a plan.”
But while some see this popular trend as paying for access to healthcare, others see the opportunity to create programs for personalized care that go beyond what a doctor or hospital can do.
Suri, who spent 12 years at The Mayo Clinic and seven years at The Cleveland Clinic, most recently as chief executive officer of its Abu Dhabi site, before joining Fountain Life in October 2022, says the concept of concierge care has undergone a make-over, so much so that he doesn't like that term. What Fountain Life and other sin this space are doing, he says, is developing "personalized, proactive, and preventive care."
Rakesh Suri, MD, D.Phil, president and chief medical officer at Fountain Life. Photo courtesy Fountain Life.
"We're taking concierge care and advancing it upstream," he says. Traditional health systems "focus more on care of the unwell. We start with the healthy person and use advanced diagnostics to focus on preventive health … [and] prevent catastrophic events."
Organizations like Fountain Life may very well fit into the health system of the future, where hospitals would evolve to focus on the most critical cases and medical practices, retail healthcare sites would take care of episodic, not-acute needs, and medical practices, specialists, and other clinics would focus more on ongoing health management.
Suri says Fountain Life fits into that ecosystem, and would form partnerships with health systems and other organizations to optimize a patient's healthcare journey. New technology, like digital health and AI, are being used not only to help people deal with ongoing health concerns, but identify and manage future issues.
"It's not the newest, brightest shiny object alone," he says, but an integrated and scalable platform that, much like the design of a value-based care system, focuses on overall health rather than periodic issues. In doing so, they're focusing on "the pre-symptomatic population."
"We are and will continue to be on the cutting edge of innovation," he says. "And it's all about the data. All of this is poured into a very sophisticated version of a data lake."
The company's business plan sounds very much like a concierge medicine organization, with high-tech, attractive centers now located in Naples, Florida; White Plains, New York; and Dallas. The company's website lists future centers in Lake Nona, Florida; Santa Monica, California; Toronto; Dubai; and New Delhi, India.
Suri says the company's plan is to create a network of clinics that collaborate with local health systems and providers.
"Mainstream health right now is reactive, and perhaps unsustainable," he says. "The escalating cost of healthcare is straining [traditional] health systems, who are operating on razor-thin margins. On top of that, insurance companies are asking providers to take on more risk, and corporate entities are seeing their employees ask to provide healthcare services for them."
The massive consumer electronics show returns to Las Vegas in January with a renewed focus on consumer-facing technology that personalizes and improves the healthcare journey.
CES 2023 kicks off next week in Las Vegas, shining a spotlight on the consumer electronic industry and bringing renewed attention to the growing influence of digital health.
What once was a small corner of one exhibit hall at the Las Vegas Convention Center exhibiting early smartwatches and fitness trackers will now be found throughout the massive conference. Digital health has been integrated into smart home devices that track daily activities alongside room temperature, lights and visitors at the front door; as well as in electronic games and home entertainment platforms. It's in TVs that can connect to the internet and enable connections with family, friends and caregivers, and new cars that can monitor a driver's health.
Virtual and augmented reality (VR and AR) will be featured prominently in Vegas this year, as will AI and robotics. And expect remote monitoring tools and platforms to make their presence known in wearables that track a wide range of vital signs and activities and the aforementioned smart home technology. In short, while healthcare was once a side benefit or add-on to consumer electronics, it's now part of the form and functionality.
The event, one of the largest in the world, is becoming increasingly popular to healthcare organizations as well.
Consumer-facing technology was once kept at a distance from healthcare providers who felt that the technology wasn't reliable or accurate enough to be used in clinical situations. But as forward-thinking organizations began using smartwatches and other wearables to track activity and trends, and as the technology becomes more sophisticated, with some achieving clinical-grade status, the landscape is now crowded with health systems and providers looking for new opportunities to connect with and manage care for patients outsider the hospital, clinic, or doctor's office.
Expect that trend to continue, as the healthcare industry looks to become more consumer-centric and providers of all sorts look to establish new connected health experiences.
Among the special events scheduled at CES 2023 is "The Future of Care in America: A New Hybrid Model," featuring Carlos Nunez, MD, chief medical officer for ResMed as the moderator and panelists Anne Docimo, MD, UnitedHealthcare's chief medical officer, Susan Turney, MD, MS, FACP, FACPME, CEO of Wisconsin's Marshfield Clinic Health System, Vidya Raman-Tangella, MD, chief medical officer of Teladoc Health, and Stephen Klasko, MD, MBA, former president and CEO of Thomas Jefferson University and Jefferson Health and now an executive in residence at General Catalyst.
Other panels of note will address virtual care and independent living, healthcare technology for seniors, sports technology, AI and digital health, self-tracking, hybrid care, bridging gaps in care, the future of at-home testing and diagnosis, and smart cities in health.
Also of note: HealthLeaders Senior Editor of Innovation and Technology Eric Wicklund will moderate a panel on "Data in the Age of Public Health Emergencies," featuring Alexander Garza, MD, chief community health officer at the St. Louis-based SSM Health System, Deven McGraw, former deputy director of health information policy for the HHS Office of Civil Rights and co-founder and chief regulatory officer for consumer health tech company Ciitizen, and Lee Schwamm, MD, vice president of patient experience at Mass General Brigham.
Maine's 'Libraries Health Connect Program' was launched in 10 rural libraries earlier this year, offering healthcare services to residents who may have access issues. The state is one of several using libraries as telehealth sites to improve access for underserved populations.
A telehealth program launched earlier this year in 10 rural Maine libraries is expanding, one of several such programs across the country that aims to improve healthcare access in communities where access can be difficult.
The Maine State Library's "Libraries Health Connect Program" was launched in April, using $50,000 from the 2021 American Rescue Plan Act (ARPA) to equip selected libraries with telemedicine technology and links to healthcare providers for such services as wellness visits, prescription requests, follow-up care, specialist consults, nutritional counseling, behavioral health services, and other non-urgent care.
"Maines libraries are committed to ensuring their communities have access to equitable services," Jamie Ritter, Maine State Librarian, in a press release issued earlier this year. "This means offering programs that you might not associate with your library, like telehealth. We strongly believe that where you live should not dictate the quality of your healthcare. These libraries are leading the way for establishing libraries as another way Mainers can connect with a healthcare provider."
The program is designed to help underserved residents in rural locations access services, and the libraries were chosen for the program based on what officials called "endemic community health issues and a lack of ready access to healthcare."
Libraries chosen for the program are located in Islesboro, Caribou, Houlton, Fryeburg, Steuben, Paris, Jonesport, Pittsfield, Skowhegan, and Dover-Foxcroft.
Officials are now looking to expand the program, either by adding more libraries or expanding the services offered.
"Living in Maine and rural areas you might have to drive a long way to get to see a specialist, and certainly in the wintertime, like the storm we just had, but in the wintertime that can be an extra challenge," Marijke Visser, the Maine State Library's director of library development, said in a recent TV news story.
Maine isn't the only state brining telehealth to libraries. Several see libraries as an ideal location for telehealth, serving as a community meeting place and having the necessary broadband availability to support the technology.
"Access to telehealth is essential for people to get the care they need when traveling to an in-person visit isn't possible,” Ken Zambos, program manager for workforce and economic development in Pima County, Arizona, said in a story posted by the Southwest Telehealth Resource Center (SWTRC). “By providing this service, the library is providing access to equipment that transforms healthcare delivery and positively affects healthcare outcomes."
In many cases, libraries need only dedicate a small, private space within the building for the service, with a booth or table that includes a laptop, audio-visual connections, assorted connected medical devices, and a virtual link to healthcare providers.
"By facilitating telehealth appointments and routine screening for members of under-served communities, libraries can deliver healthcare to those in need," John Chrastka, executive director of EveryLibrary and the EveryLibrary Institute, said in a white-paper released in 2021. "Many libraries have never considered this approach to helping their patrons, but it's possible. Some libraries are already doing it."
A new survey by PYMNTS and Lynx finds that consumers are very interested in accessing and managing their healthcare and insurance services via digital health, but they don't want to use several different portals or apps to get there.
The key to consumer digital health adoption is ease of use, whether it's for clinical care or paying for that care.
That's the take-away from Healthcare In The Digital Age: Consumers See Unified Platforms as Key To Better Health, a survey of more than 2,500 consumers by PYMNTS and financial technology company Lynx. It found that roughly 80% of those surveyed want to use a digital health platform to manage both care and insurance benefits, but half have had problems accessing what they want. With that in mind, about 80% want that access to come on a single digital platform.
"The synergy of one unified platform is clear," the report states. "Better access to information about insurance coverage, medical care, and financial details — when combined with improved information about providers, prescription medications, and pharmacy benefits as well as upgraded channels to share information with providers — can ultimately help consumers manage all tasks related to their care and well-being as well as facilitate coordination among insurers, financial services providers, care providers, and pharmacies."
Consumers have been demanding more digital health options for years, based on the success they've had with these platforms in the travel, hospitality, and retail industries. And while the healthcare industry has acknowledged the need to move toward consumer-directed healthcare, the transition has been slow and often painful.
The pandemic may have helped that process along, as health systems saw the value in shifting services from in-person to online to combat the spread of the virus and help overcrowded hospitals and worn-out providers. But while many healthcare organizations place high value on a digital health strategy, few have managed to bridge the gap to a mature platform.
The PYMNTS/Lynx study finds that consumers are demanding – and encountering roadblocks with – digital health access for their financial needs as much as their clinical needs. Only about 40%, the survey indicates, are extremely familiar with their health insurance benefits, yet 82% of consumers who do use the platform say it's time-saving and convenient, and a little more than half cite digital health access as the most important feature from an insurer, provider, or health and wellness app.
But consumers want one point of access, not multiple apps or platforms.
"Although consumers know that online access to healthcare information can save them time, increase their control when dealing with providers and help them access their insurance benefits, decentralizing and scattering this information among many portals can add to their frustrations," the survey reported. "Eleven percent of consumers say it is hard to remember login credentials for all their online accounts, and 9% of consumers say they have too many websites, portals or apps to use."
Some 92% of those surveyed who had problems while paying online for healthcare services said they're interested in using a unified digital platform, and 91% of those who had problems using the platform for healthcare services and insurance benefits said the same. More than 70% said a digital health platform would also improve their knowledge and management of services and insurance.
But they're also aware of the drawbacks. More than 40% of those not interested in a unified digital health platform said they're worried about security, with 28% saying it would affect the security of their health records. Some 38%, in fact, said they don’t want all their data in one place.
As for who would manage that platform, those surveyed are mixed on their preferences. About half say they would want their insurance provider to manage that platform, while 31% would prefer that their provider manage the platform and 39% want a healthcare technology company to take that job.
Research by the Health Management Academy (The Academy) and Teladoc Health finds that many leading health systems place high value on a digital health strategy, but they haven't reached a point where that strategy is sustainable.
Many healthcare organizations have launched virtual care programs as a result of the pandemic, but how many have programs that are sustainable? A new report offers four recommendations for bridging that gap.
According to a survey of healthcare executives from 38 health systems across the country conducted by the Health Management Academy (The Academy) and Teladoc Health, there's a large gap between where health systems want to be with virtual care and where they are now. The executives rated overall performance of their programs at only 2.9 on a scale of 1 to 5, with the lowest marks focused on care model design, workforce readiness, clinician satisfaction, consistency of experience, and patient satisfaction.
"The problem is that technology alone won’t solve integrated virtual care," the report, prepared by Victoria Stelfox and Anne Herleth of The Academy, states. "Health systems need the wrap-around functions that support virtual care technologies. But because health systems haven’t migrated toward organized, system-wide virtual care programs, they haven’t yet mastered the critical workforce and organizational inputs required to succeed."
Health system executives see a mature virtual care program as being integrated, consumer-focused, and scalable, but are having problems reaching that point. Many jumped on the bandwagon over the past few years to deal with the COVID crisis, helped in part by federal and state waivers aimed at boosting access to and coverage of telehealth and digital health during the public health emergency. But they did so without a long-range strategy, or a plan to continue after the PHE ends.
To reach that level, the report lists four imperatives:
Develop a realistic and actionable digital health strategy. According to the report, many organizations say they have a strategy, but when pressed, they can't define or articulate it. In many cases they've used digital health to enable a strategy but haven't made that strategy a priority.
"Health systems leaders are quick to recognize that a clear digital strategy is needed to push forward on integrated care delivery (among many other strategic imperatives)," the report states. "But to do it, LHS [leading health systems] need to decide who they want to be as an organization—and for virtual care delivery, what markets they want to play in. These may not be quick or easy decisions, but it’s a critical step in moving from disjointed decisions to a scaled, system-wide investment plan."
Look beyond vendor contracts and focus on partnerships. A consumer-focused digital strategy is one of the top priorities for many health systems, and more than three-quarters of those surveyed are joining forces with outside organizations to reach their digital health goals. But many are contracting with vendors or other organizations in purely business terms.
"What is needed is skin in the game on both sides," the report notes. "For both health systems and industry organizations, a good partner is not based on metrics like pricing or contract terms. [Healthcare leaders] describe productive partnerships with terms like flexibility, ongoing communication, culture and values alignment, willingness to hear feedback, and long-term delivery on promises. Industry partners echoed similar sentiments, adding the value of long-term partnerships and aligned incentives."
Make sure everyone is on the same page and supportive. The biggest mistake that health systems make in launching a digital health program is forgetting to include (or ignoring) key participants, such as nurses, or failing to secure support from everyone involved.
"Our data shows that it’s uncommon for operational leaders to be involved in virtual health strategy, despite often being held responsible for the performance of the tools," the report notes. "The result is that projects end up floundering and leaders wonder why the implementation hasn’t been successful. CMIOs and population health leaders observe that they are often brought into implementation conversations during the later stages of virtual health investments, negating the chance for them to provide early and actionable feedback."
"Virtual health implementations today can avoid mistakes of the past by involving key stakeholders early and selectively choosing solutions that make clinicians’ lives easier—not more complicated," the report concludes.
Proceed cautiously with scaling. Many digital health programs start small, addressing a specific pain point or population to prove that they work, and then branch upwards and outwards. But scaling a program or strategy, while critical to long-term growth and sustainability, is challenging. Only about half of those health systems surveyed have achieved mid-stage virtual health maturity.
"To beat this catch-22 and scale well, LHS must conduct an honest assessment of their virtual health maturity by looking at key indicator performance such as governance, data and technology management, financial sustainability, and clinical integration—each of which represents a critical component to scale," the report says. "Organizational self-assessment across these maturity indicators can help health systems determine their readiness for scaling virtual health solutions. However, most LHS still have a long way to go before they will be ready to scale. They will need to focus on solidifying and planning for the governance, sustainable financing and more of their virtual health programs before attempting to scale across the organization."
A bill before Congress would, if passed, continue COVID-era Medicare telehealth waivers until the end of 2024, while also extending the CMS Acute Hospital Care at Home program for two years.
Congress is expected to pass an omnibus spending bill this week that would extend pandemic-era Medicare telehealth waivers until the end of 2024. The bill would also keep in place the Centers for Medicare & Medicaid Services' (CMS) innovative Hospital at Home program, and continue several other programs aimed at boosting connected health access and coverage.
Among several organizations praising the news is the American Telemedicine Association, which had long warned that the elimination of these waivers and programs would seriously hinder telehealth and digital health adoption.
“The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients," Kyle Zebley, senior vice president of public policy for the ATA and executive director of ATA Action, said in a press release. "Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future.”
"The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans," The Alliance for Connected Care said in a separate press release. "The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both."
Generally, the bill, if passed, would:
Remove geographic requirements and expand the list of originating sites for telehealth services;
Expand the list of providers eligible to furnish telehealth services;
Expand telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs);
Delay in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology;
Permit audio-only telehealth services, such as phone calls;
Allow the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care during the emergency period; and
Mandate a study on telehealth and Medicare program integrity.
The inclusion of audio-only telehealth services is a nice surprise for telehealth advocates. Federal and state regulators have long mandated that telehealth services be audio-visual, and have severely restricted any use of the telephone or an audio-only telemedicine platform for care delivery. But during the pandemic the telephone became a popular tool in regions where access to either telemedicine equipment or reliable broadband is limited. CMS has indicated it will return to those restrictions after the PHE ends, saying the platform isn't reliable enough for care delivery.
The bill would also extend for two years the waiver for the CMS Acute Hospital Care at Home program, an innovative service launched by CMS that allows health systems to shift more care for acute patients from the hospital setting to the home, through a platform that includes remote patient monitoring, telehealth services and in-person care. More than 200 health systems have signed up to take part in the program, and many had said they would be forced to curtail, drastically change, or even cancel the program once CMS support for the program ends.
“We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services," Zebley said in the ATA press release. "Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction."
Not all the news was good, however. While the omnibus bill includes several measures aimed at addressing the nation's substance abuse epidemic, it does not include an extension for a waiver that currently allows healthcare providers to prescribe controlled substances via telehealth for substance abuse treatment.
Federal law bans are severely restricts prescriptions of controlled substances through telemedicine. Federal regulation is channeled primarily through the Ryan Haight Act, passed in 2008, which prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.
The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment. Congress has been considering bills that would, if passed, create a special registration through the US Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.
The bill does direct the DEA to implement that special registration process, but the DEA has been asked to start that process for several years and has yet to do so.
While the omnibus bill, if passed as expected, would extend all of these freedoms for another two years, the ATA and others are lobbying to make many of the provisions permanent, rather than just pushing the finish line farther down the road.
“The hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff,’" Zebley said. "Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.”
Researchers at the University of Illinois and OSF HealthCar are working on a digital health app that would enable providers to better combat false rumors and malicious reports that hinder public health efforts.
Researchers at the University of Illinois are working on a digital health app that would alert providers to healthcare misinformation circulating on social media.
Kevin Leicht, PhD, a sociology professor at UI, and Mary Stapel, MD, community care lead physician for OSF HealthCare Saint Francis Medical Center and assistant program director for the combined Internal Medicine-Pediatrics Residency at the University of Illinois College of Medicine Peoria (UICOMP), are using a $100,000 grant to develop the resource, which would give users real-time alerts about rumors and malicious reports that impact public health efforts.
"What our project actually does is take not only the pre-existing fact-checked data and query it all in one place, it brings it forward in a user-friendly fashion," Leicht said in a press release from OSF Healthcare. "But then it's also trying to come up with a way of adding to this data in a way that's faster than having a human fact checker just scan the web all the time, looking for what the new piece of misinformation is."
Leicht, the science team lead at the Chicago-based Discovery Partners Institute (DPI), and Stapel are using a grant from OSF Healthcare's Jump ARCHES (Applied Research for Community Health through Engineering and Simulation) program, and building on past work, supported by the National Science Foundation, to identify the spread of misinformation about COVID-19 and other debunked medical research.
"If we can even get ahead of that – know what information is circulating and start feeding out more accurate information ahead of time through our community partners; that really could be a game changer when we're thinking about things like pandemics and infectious disease," Stapel said in the press release.
Stapel said the app would help healthcare workers, especially those in community health, to better inform patients and gain their trust at a time when public healthcare workers are struggling against false information that affects their credibility.
"Having humans curate that a little bit … you have content experts that look at that and say, 'Is this dangerous or is it not? Is this trending, is it not?' And then figuring out a way to deliver that to the final customer in a way that requires as little inner interface by them as we can possibly get away with," she added.
A start-up from the Mayo Clinic orbit is partnering with Pfizer to develop an AI-enhanced ECG that can detect cardiac amyloidosis, a progressive disease that's difficult to diagnose early.
A startup launched out of the Mayo Clinic Platform is partnering with Pfizer to develop AI software that can detect cardiac amyloidosis in an electrocardiogram.
Anumana, which was launched in 2021 and is part of the nference software company's portfolio, intends to develop the AI-ECG tool as a software-as-a-medical-device (SaMD) and market the algorithm in the US, Europe, and Japan.
This isn't the first time Anumana has created software addressing cardiac issues. The company has developed AI-ECG algorithms in the past through the Mayo Clinic for detection of low ejection fraction, pulmonary hypertension, and hyperkalemia, all of which have received Breakthrough Device designation from the US Food and Drug Administration (FDA).
The latest software takes aim at cardiac amyloidosis, an often undiagnosed and progressive disease characterized by the stiffening of the walls of the heart, interfering with the function of the left ventricle. Symptoms include shortness of breath, knee pain, bilateral carpal tunnel syndrome, kidney disease, and gastrointestinal issues.
Because the symptoms are so diverse, the condition is hard to diagnose. Earlier detection would give clinicians time to develop more effective treatment plans that would improve clinical outcomes over time.
“The challenge in diagnosing cardiac amyloidosis can prevent patients from getting treatment while the disease continues to progress,” David McMullin, Anumana's chief business officer, said in a press release. “We believe this collaboration [with Pfizer] will demonstrate the power of Anumana’s AI-ECG algorithms to help clinicians intervene earlier, giving them greater ability to improve patient outcomes and prolong lives.”
The project is the latest of many that aim to use AI to spot infinitesimal trends in data that might not be picked up by manual data review until much later.
“AI-ECG solutions alert clinicians to humanly imperceptible patterns in ECG signals, providing an early warning for serious occult or impending disease,” added Paul Friedman, MD, chair of the Mayo Clinic's Department of Cardiovascular Medicine and chair of Anumana’s Mayo Clinic Board of Advisors. “This stands to improve the lives of people with cardiac amyloidosis by improving the speed of triage and care of this group.”
The Medicaid and CHIP Access to Prescription Digital Therapeutics Act, introduced this week in Congress, would create standardized coverage in Medicaid and CHIP plans for approved digital health tools and platforms.
A new bill introduced to Congress aims to improve coverage for digital therapeutics in Medicaid and state Children's Health Insurance Programs (CHIPs).
“Digital therapeutics hold particular value for Medicaid populations with convenient, accessible, and personalized treatment options to address many unmet medical needs,” Andy Molnar, chief executive officer of the Digital Therapeutics Alliance (DTA), said in a press release announcing the DTA's support for the bill. “This legislation would establish more clarity and uniformity in how prescription digital therapeutics are covered by public programs from state to state and is a critical step toward ensuring that these evidence-based treatments get into the hands of those who need them most.”
While the text of the bill wasn't yet available, supporters said it would, if passed, define 'prescription digital therapeutic' for Medicaid coverage, create standardized coverage for digital therapeutics treatments approved or cleared by the US Food and Drug Administration (FDA) in Medicaid and CHIP programs and give the Health and Human Services Secretary the ability to provide technical assistance to states considering such coverage.
The bill represents a growing interest in the use of digital health tools and platforms to treat chronic conditions and other health concerns, giving healthcare providers new options that don’t necessarily include drugs or in-patient treatments.
It also tackles one of the biggest barriers to adoption: payer coverage. Unless payers support these new treatments, providers have little incentive to prescribe them. Some health plans and private insurers have shown support for digital therapeutics, but the industry needs the backing of Medicare and Medicaid plans, who cover many of the populations that would greatly benefit from their use.
In its 2023 Standards of Care, the American Diabetes Association says technology is now a vital part of care management, and all people living with diabates should have access to those tools and platforms.
The American Diabetes Association is emphasizing the value of healthcare technology in diabetes care management in its 2023 Standards of Care.
The revised standards, issued this week, include a section devoted to technology, including continuous glucose monitoring (CGM) devices that allow people living with diabetes to check their blood glucose levels at any time, automated insulin delivery systems and digital health tools that offer coaching and access to resources.
The guidelines recommend that anyone living with diabetes have access to FDA-approved technology to manage their chronic condition, especially seniors and underserved populations. The ADA also points out that technology can be used to improve access to care and care management for those dealing with health inequity, or barriers to care caused by social determinants of health.
“ADA’s mission is to prevent and cure diabetes, a chronic illness that requires continuous medical care, and the release of ADA’s Standards of Care is a critical part of that mission,” Chuck Henderson, the organization's chief executive officer, said in a press release. “This year’s annual report provides necessary guidance that considers the role health inequities play in the development of diabetes, particularly for vulnerable communities and communities of color disproportionately impacted by the disease. This guidance will ensure healthcare teams, clinicians and researchers treat the whole person.”
Digital health technology has been a part of care management for people living with diabetes for years, though the ADA and other organizations, such as the Centers for Medicare & Medicaid Services (CMS) and US Food and Drug Administration (FDA), have been careful to support only technology that passes strict protocols and has proven to improve clinical outcomes.
The ADA's acknowledgement of the value of technology may mark an import step in the value-based care movement.
Earlier this year Kevin Sayer, CEO of digital health company Dexcom, one of the leaders in the diabetes technology space, said the industry is moving on from highlighting the next big thing and focusing more on integration and interoperability.
"Everybody wants everybody to be interoperable and talk to everybody else," he said. "The only way that these platforms are going to be successful going forward is if all the technology works with each other and people using it are engaged."
"It isn't even technological any more," he added. "What people are looking for is access."
Sayer says the diabetes care industry is now transitioning to overall health and wellness, not just tools and platforms that solely address diabetes. That's why a company like Livongo, which was launched by former Allscripts executive Glenn Tullman to help people living with diabetes like his son, has since evolved to address other chronic diseases, as well as integrating with primary care and behavioral healthcare services.
"We've come to understand that the patient's healthcare journey starts long before they were diagnosed with diabetes," Sayer said. "And it involves a lot more than just [diabetes tools and platforms]. It's all about access now, and that can be complex. We have to learn how to make access easier."
