Use technology instead of waiting for your population to reach chronic disease.
I am a native of western Kentucky of the fifth generation, and I was told one of my great-grandfathers was the only person enlisted in the Civil War for the Union from Marshall County. I did my pediatrics training at the University of Washington at St. John’s Children’s Hospital. I was intrigued during the interview process with a children’s hospital as far away as Seattle Children’s. Finally, I connected with my program officer Jim P. Keating and decided to stick close to home around Paducah, Kentucky. This made me feel close to a large medical specialty group after residency, but after seven years I decided to do a solo house call practice in St. Concierge medicine is heating up, but I think the industry is a little weird. Back in 2009, I got a call from the Mayo Clinic asking me to present at the Transform Symposium on “customer experience.” Not long after that, Brian Dolan of MobiHealthNews called me “the first iPhone doctor” for apparently running my medical practice on my iPhone while pulling e-commerce payments.
Status quo medicine was never my thing.
I decided to try my hand at a solo rural practice in the very county my great-grandfather came from. Transferring back to Kentucky was a lot. I went from calling home in some of the most prosperous zip codes in the country, to treat the family in the least. The thing that impressed me the most about the area after being gone for a long time was the sudden death of a high school friend in their mid-40s. Obesity is rampant. All have some chronic disease. I don’t recognize my friends. Something horrible happened while I was gone.
The patients who came, wanted so much and were just so thrilled that I was there. I tell the teen and the family what to do during the hearing. A family that used to drink water. A family that doesn’t like vegetables. A year later, they will return only if they have gained 10 pounds instead of losing anything. Then, a patient comes in and loses weight using one of the consumer apps. I can see the value, but notice that I didn’t actually provide the value. Luckily, Doximity and Healthtap came calling with a consultant role and an offer of full-time telemedicine that I couldn’t refuse. Before I knew it, I was recruiting our team to solve this health care blind spot: the time between visits where patients progress from obesity, prediabetes, and pre-hypertension to full-blown chronic disease.
Today, there is an app for everything. Wearables are everywhere. Consumer health mobile programs, employer-led programs, and payer-led programs are available for patients to improve their health. But where are the primary care providers? We are drowning in problems and struggling with burnout. We are expected to take responsibility for results, but without prior training (or tools) in affecting health behavior change.
Robert Wilson, MD, put the problem succinctly on a recent episode of the Startup Health Now Podcast. Medical practice is inherently reactive, and the challenge of introducing proactivity into the system is a top priority:
“A lot of primary care providers don’t like the status quo. We don’t like the fact that we have to wait until someone is sick to really make our clinical decisions. So, we would like to find ways to integrate prevention and risk reduction with all of these things into daily practice. Especially family medicine. We take care of the whole family. When we give our advice, it takes care of the whole family. So, if we have an application or integration system that will allow us to give that information at a more appropriate time, it will be something which is more meaningful.
I attended a telehealth conference in 2022 led by Eric Thrailkill and his team at the Nashville Entrepreneur Center. I sat in the audience trying to drill down further on the problem of providers proved by the leaders of the medical school in Nashville. Several themes related to the patient-generated data emerged from the noise.
There is a firehose of patient-generated data, but:
- Not filtered.
- This is not actionable.
- It doesn’t fit in my workflow. (I not get this information on the right Time.)
And then there’s the patient problem, explained succinctly in this infographic from the US Centers for Disease Control and Prevention. Heart disease, cancer, chronic lung disease, stroke, Alzheimer’s, diabetes, and chronic kidney disease: These are the main drivers of our nation’s $4.1 trillion health care costs.
The challenge in primary care is to systematically study the entire population, educate the population about risk, quantify their motivation level, and then divide the patient population into groups. Everything must fall together at the right time. You need to get actionable data to the primary care physician before the patient leaves the office. Then, they can implement provider-led interventions that you work with to engage patients throughout these health care “blind spots” as the chronic disease progresses.
I am a pediatrician, so the solution to our chronic disease problem has been obvious to me and my fellow primary care colleagues for a long time. The Affordable Care Act works on capsize affects hospital costs:
- Waiting until a 74-year-old heart failure patient is on his way home from the hospital to enroll in chronic disease management or remote monitoring is waiting too long.
- Waiting until a 64-year-old patient has been diagnosed with diabetes and then focusing on his med compliance data and analytics is waiting too long.
- Waiting until a 59-year-old patient with obesity develops diabetes and hypertension and then “manages his condition” with medication and specialist visits is waiting too long.
- Waiting until an overweight 42-year-old developed a complete picture of metabolic syndrome and then discussed pharmacotherapy is waiting too long.
We need to embed prevention in the entire patient population and automate as many of those processes with algorithms and artificial intelligence to make our days easier, engage our patients, and show that we care.
Patients are now ready to live happy and healthy lives at home, free of metabolic disease. Now is the time for providers to lead the way by offering engagement programs and provider-led interventions that will drastically reduce costs. Beginning in the population our risk increases.
Natalie Davis, MD, is a pediatrician and chief medical officer of PreventScripts. He graduated from Murray State University, The University of Kentucky College of Medicine, and Washington University Pediatrics at St. Louis Children’s Hospital. She became obsessed with mobile technology and its potential to scale health across the population while serving on the advisory board at Healthtap and Doximity.
