Connected health as a therapeutic

(Editor's note: This post first appeared in The cHealth Blog.)

I heard the other day that by 2017, 50 percent of the pharmacy spend in the U.S. will be on specialty pharmacy. It seems this is driven by two phenomena.

The first is the growing crop of new molecules that are in the class ‘biologics’ - developed via biotechnology and which are complex to manufacture and require special handling and care coordination. They are incredibly expensive but have given us new hope for such conditions such as Hepatitis C and a variety of cancers. These are classified as specialty pharmacy drugs. The second phenomenon is that just about everything else will be generics. Specialty drugs in this one burgeoning expense class seem to be taking over the pharmaceutical industry and bucking the trend in healthcare -- to succeed by being more efficient.

This brings to mind two opportunities for connected health. One is surrounding these expensive therapeutics with connected health applications in order to improve outcomes and reduce costs. The second is that connected health interventions, because of their demonstrated improvements in adherence, can improve the care experience, patient satisfaction and quality of life and themselves prove to be therapeutic.

(I am not going to speak to the first opportunity, but we are working on a real-life example of this at CCH now. We are under non-disclosure with the research sponsor, but I promise you it will be an exciting result when we can publicly discuss it.)

The latter opportunity is intriguing and a bit of a sleeper. Traditionally, the introduction of new technologies into healthcare has been assumed by a knee-jerk reaction to add costs. Yet we’ve accumulated evidence to the contrary. I have two stories to demonstrate this.

The first example is a clinical research program we have under way with adolescents who have asthma. We’ve created a private Facebook group for them to be part of - and that's about it, really. No fancy bells and whistles. Just old-fashioned social networking. This is a study in progress, but to date we’ve already seen a positive effect, as measured by an instrument called the Asthma Control Test (ACT). Typically, the success rate of teenagers filling out this survey is 18 percent. Just putting kids in a Facebook group improved their participation to 80 percent. More importantly, the improvement in the score on the ACT measuring how well these teens are controlling their asthma was, on average, 1.47. Compared to the introduction of a new inhaler, which typically gives a response, at a population level, of ~0.5, and it seems that Facebook is three times as therapeutic as a drug. I’m being provocative here, but you get the idea.

The second example is in type II diabetes, using connected health to improve activity.  We randomized patients with type II diabetes into two groups. One received an activity tracker and nothing more; a second group received a tracker and were sent automated motivational messages every day.



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