Brave New World of Health Care Consumerism, N-of-1, and Character of Health Type
Author: Browning Rockwell, WeWa.life
The ICN is a noncommercial entity that receives no funding and is run by volunteers. The ICN Executive Committee have no commercial interest in WeWa.life. WeWa.life has been invited by the ICN to write this blog and share an update about WeWa.life.
In 1990 Dr. Richard Lam stated that “health care costs in the United States are making our economy sick”. 30 years later, our economy is even sicker. Relative to the size of the economy, healthcare costs have increased over the past few decades, from 5 percent of gross domestic product (GDP) in 1960 to 18 percent in 2018. High healthcare spending is not necessarily a bad thing, especially if it leads to better health outcomes. However, that is not the case in the United States. The COVID19 pandemic will change the way we view our personal health and reshape health care as we know it. There are numerous social, public policy, economic, and technology changes that will impact how we address our personal health and how payors and providers in this space will be realigned or forced to not simply transform (reimagine), but recreate themselves. The innovation health care really needs is to help people manage their own health.
The long tail of the brave new world post-COVID19 will bring immediate and long-term changes that will accelerate the consumerization of healthcare, expansion of Smart Health Communities (SHCs) and the adoption of P4 Medicine (predictive, preventive, personalized, and participatory). On-demand service will be the new normal. We will meet health consumers where they are and when they want. Consumer first health reforms will ensure safe, secure, standardized access to health information and services. As concern for coronavirus grows among the consumer and provider base, both stakeholders are turning to largely consumer-oriented patient engagement technology to take control of their own health. In the near term, healthcare organizations will accelerate innovation to respond to the crisis. These investments will enable healthcare organizations post-COVID19 to rethink care delivery and financing.
The traditional medical model of treating patients after they become ill gives us no path for reducing or controlling healthcare costs. The consumer health experience does not begin when the physician walks into the room or even when the patient enters the care setting. Rather, the experience starts when consumers open a browser or an app on their smartphone, if not sooner. A consumer’s impression of care providers is shaped as they seek health information, evaluate services and actively seek care. The impressions persist well after they leave care facilities and return home. Health systems must digitize consumer-facing workflows and support personalized interactions anytime, anywhere to meet the expectations of a growing population of “digital native” consumers.
We are now poised to transition to a new medical paradigm that is predictive, preventive, personalized, and participatory (P4). P4 Medicine aims to improve the quality of care delivered to patients through better diagnosis and targeted therapies. These advances facilitate new forms of active participation by patients and consumers in collecting personal health data that will accelerate discovery science. There will be two significant challenges to achieving P4 medicine—technical and societal barriers—and the societal barriers will prove the most challenging. How do we bring patients, physicians, and members of the health-care community into alignment with the enormous opportunities of P4 medicine? In part, this will be done by the creation of new types of strategic partnerships—between patients, large clinical centres, consortia of clinical centres, and patient-advocate groups. Medicine has always focused on treating disease after it occurs. Treatment and diagnosis has been based largely on population averages.
Envision a holistic approach to healthcare, where all relevant data shapes decisions in real-time
Using segmentation, we can influence consumer health behavior with insights into why and how people make decisions—essential data as the industry continues to move toward a more individual-centered approach. Grouping health consumers in this way can provide a more refined approach to understanding them as they move through different stages of their health and wellness journey. We can look at risk stratification, predictive analytics, and proactively address the future instead of reacting to the past to begin seeing rewards from participating in value-based health & wellness initiatives.
The combination of segmentation that adds accurate behavioral segmentation and intervention response segmentation assessments (N-of-1) for individual and sub-group level provides a hyper-personalized approach to population wellness and prevention, in addition to active chronic condition management. Segmentation needs to be dynamic, not static—how does a person move through life stages, and across care events, over time?
With the cost of health care rapidly outstripping corresponding improvements in public health, the health care landscape is undergoing a necessary paradigm shift toward a reimbursement model. This shift will create a need to monitor individual health performance systematically. Simultaneously, technological advances in mobile health are making it possible to remotely, unobtrusively, and objectively measure many health behaviors, which should facilitate the implementation of many more N-of-1 randomised controlled trials (RCT) designs. To date, our ability to provide objective information about which therapy or intervention is best for any given patient by relying on clinical intuition, or extensive conventional group-based RCT results has remained modest at best. A sound N-of-1 RCT methodology could change that.
Patient nonadherence to healthy lifestyle behaviors and medical treatments (like medication adherence) accounts for a significant portion of the chronic disease burden. Despite the plethora of behavioral interventions to overcome key modifiable/non-modifiable barriers and enable facilitators to adherence, short- and long-term adherence to healthy lifestyle behaviors and medical treatments is still poor. To optimize adherence, WeWa.life aims to provide a novel mobile health solution steeped in precision and personalized population health and a pan theoretical approach that increases the likelihood of adherence. We will include the stages of a pan theoretical approach utilizing tailoring, clustering/profiling, personalizing, and optimizing interventions/strategies to obtain adherence and highlight the minimal engineering needed to build such a solution.
We are combining the power of “All” (population communities) with the power of overtime “Individual” data (N-of-1) to better engage patients and care teams in the best personalized pharmaceutical and non-pharmaceutical treatments for pre-chronic and chronic disease and mental health disorders. We will provide accurate personalized care that helps providers, caregivers, and consumer-patients by applying the Science of ALL (Group Average Science-GAS) and Individual Science (N-of-1) for complex chronic disease and mental health disorders. Our individualized treatment approach improves health and quality of life outcomes faster and with increased accuracy over current standard medical care through health analytics and personalized precision medicine dashboard.
The burgeoning use of mobile technologies to deliver health, lifestyle, and wellness interventions has shown initial signs of improving adherence to primary prevention and management of chronic health conditions. The purpose of the pan theoretical study undertaken by Dr. Azizi Seixas and his team was to explore (1) modifiable and nonmodifiable barriers and facilitators of adherence to primary prevention and management of chronic health conditions, especially in mobile health (mHealth) solutions; (2) precision and personalized population health framework that overcomes barriers and enables facilitators to adherence in primary prevention and management of chronic health, noncommunicable, and infectious health conditions; and (3) how to implement a precision and personalized population health approach in eHealth/digital health solutions. With consumers exercising choice over where, when, and how much care to receive, understanding the character of health type and the interplay of these different kinds of segments is fast becoming an essential skill for caregivers and health systems.
WeWa.life was recently approved to submit for a National Science Foundation SBIR Phase 1 funding under the American Seed Fund program. We will use the Pan Theoretical Framework developed by team member Dr. Azizi Seixas and the Digital Twins model for digital health developed by Dr. Steven Schwartz as a foundation for the NSF/SBIR proposal. We propose to design a system architecture and algorithm to undertake a study to validate these hypotheses with real-world evidence and real-world data. Our project will embrace a pan theoretical approach, one that incorporates nomothetic and idiographic approaches to engender precise, personalized, and optimized (contextualized) solutions to increase adherence to primary prevention and management of chronic health conditions. WeWa.life was selected by the Agency for Health Research & Quality ( AHRQ ) as First Runner-Up for its Digital Solutions to Support Care Transitions challenge. The AHRQ Challenge focused on the process of medication reconciliation, medication adherence, and care transition tools.
About the Author
Browning Rockwell - WeWa.life Founder and ICN Industry Representative
WeWa.life is a personal health navigator platform designed to address underserved individual and virtual health community needs. An intuitive phone app and digital voice assistant enables health consumers to be in control, informed, entertained, engaged, and activated around the most essential thing in their life — their health. The WeWa.life Cloud platform provides a single point of integration with existing health consumer systems using open APIs and interoperable system architecture. The core of the WeWa.life platform and app is the ability to download and manage your Electronic Health Record (EHR) and Personal Health Data (PGHD) in one location. Health consumers can leverage this data to create actionable insights that can be incorporated into individual and caregiver workflows.
The ICN is a noncommercial entity that receives no funding and is run by volunteers. The ICN Executive Committee have no commercial interest in WeWa.life. WeWa.life has been invited by the ICN to write this blog and share an update.