Digital disease management program – A responsive approach to manage chronic diseases during a pandemic

Disease Management Programmes

The need for expensive chronic care is growing and exerting considerable pressure on health systems across the world

Chronic diseases like diabetes and cardiovascular diseases are inarguably one of the major drivers of health care utilization due to their high burden of morbidity and mortality. The prevalence of chronic diseases is on the rise worldwide and has assumed an epidemic proportion. The scale of the problem is evident, as the number of deaths attributable to chronic diseases is projected to rise from 3.78 million in 1990 (40.4% of all deaths) to 7.63 million in 2020 (66.7% of all deaths) as per the World Health Organization.

Contrary to the popular belief that chronic, lifestyle-related diseases are a bane of the rich, 80% of chronic disease deaths occur in low and middle-income countries, where most of the world’s population resides and only 20% occur in high-income countries.

Amongst the chronic diseases, each year 1.6 million deaths are directly attributed to diabetes. Approximately 463 million adults in the age group of 20-79 years were living with diabetes in 2019 and this number is expected to rise to 700 million by 2045, as per the International Diabetes Federation (IDF). It is estimated that nearly USD 760 billion or 10% of the overall healthcare spending for adults is attributed to diabetes and its complications. India is at the top of the global league table for the number of diabetics, projected to be 57.2 million by 2025. As population growth is anticipated to be most significant in developing nations, emerging markets will be the hardest hit in the future with an increase in demand for healthcare systems as these numbers continue to rise in these regions.

Pandemics have proven to be a double whammy for persons with chronic diseases

Global pandemics are another rising health concern after chronic diseases. Infections are now easy to spread fast across the world due to globalization, as has been seen in past pandemics like SARS, H1N1, and now COVID-19. Sudden, fast-spreading infectious diseases create disruptive pressure on the health systems due to their sudden and widespread nature. Consequently, a huge chunk of healthcare resources is spent in containing such outbreaks quickly as and when they occur.

Pandemics of such a nature can have a twofold effect on persons with chronic diseases.

Firstly, persons with pre-existing medical conditions like diabetes, cardiac diseases, and asthma and those in advanced age-groups are believed to be highly vulnerable to becoming seriously ill with COVID-19. Viral infections in diabetics can become more difficult to treat due to the presence of comorbidities, diabetic complications, and fluctuations in blood glucose levels. Secondly, disruption in healthcare services during a pandemic situation can lead to poor clinical outcomes in persons with chronic diseases due to a break in the continuity of care.

On this note, in Aug’20 the WHO released interim results of a survey which showed that the prevention and treatment services for chronic diseases have been severely disrupted across 155 participating countries since the COVID-19 pandemic started. The survey revealed that low-income countries have been the worst affected during the pandemic, a situation of grave concern as people with chronic diseases are at a higher risk of severe COVID-19-related illness and death and have a high prevalence in these countries.

Some of the significant findings of the survey include partial or complete disruption of services in the treatment of:
  • Hypertension by 53%
  • Diabetes and diabetes-related complications by 49%
  • Cancer by 42%
  • Cardiovascular emergencies by 31%

Patients with chronic illnesses are more vulnerable to some of COVID-19’s most significant threats. As the global health crisis continues to present new challenges in treating patients with long-term conditions, it also has opened up new opportunities. It is exciting to be part of the evolution of solutions that will serve patients well beyond the pandemic – showing us all the next level of smarter, better, faster healthcare.

COVID-19 is a moment of inflection for healthcare towards innovative service delivery models

Postponement/ cancellation of planned treatments, difficulties in commuting to healthcare facilities due to halted public transport, and diversion of healthcare staff resources for COVID-19 management were cited to be the main causes for discontinuity of services for patients with chronic conditions in the WHO interim report cited above. These challenges are likely to persist for a long time to come as the global health crisis continues and the possibility of any new pandemics in the future can’t be ruled out. Consequently, governments, healthcare service providers, and payers across the world need to revisit the traditional service delivery models of chronic disease management that they offer or pay for.

Technology will have a key role to play in facilitating the care continuum as the world gets used to the new norm of social distancing in times to come. Fortunately, the healthcare industry globally has been quick in adopting digital technology and innovative solutions to address some of the unique challenges posed by the COVID crisis. With the emergence of innovative delivery models, the healthcare market is reshaping itself, placing greater emphasis on preventive health solutions and patient-centric care. The pandemic has opened the doors of new opportunities for industries such as telecommunications, logistics, technology, and wellness to bring innovative solutions to chronic disease management challenges. 

A preventive disease management approach will be the blueprint for positive health outcomes and claims cost management for insurers

One of the most significant opportunities in addressing the challenge of poor clinical outcomes due to disruptions in continuity of care for persons with chronic diseases is to reduce the risk factors associated with disease progression and the onset of comorbid conditions. People with “uncontrolled” chronic conditions tend to utilize more health care services that include the likes of frequent physician visits, hospital care, diagnostic tests, and prescription drugs. Provision of better care while reducing the costs of caring for persons with chronic diseases can be achieved by a methodological approach of “disease management”.

For example, diabetes can be managed well,  and its consequences can be avoided or delayed with a personalized and holistic approach to the lifestyle of a person including diet and physical activity apart from medication management. Health care service use and costs associated with claims for avoidable complications and acute events stemming out of chronic conditions such as emergency room visits and hospitalizations can thus be reduced with good disease management outside the physician’s office. 

Digital disease management solutions will pave the way for insurers towards smarter, better, faster healthcare for policyholders

There is no doubt that large-scale disease management programs have the potential to generate savings over the long-term by reducing events of the hospitalization. However, in the past, conventional disease management programs like one-to-one coaching, physician counselling, etc faced challenges of scalability, resource and cost constraints, and reproducibility of results.

Over the past few years, an increasing number of digital health solutions that can address the challenges of conventional large scale disease management have emerged. These solutions, termed as Digital Therapeutics (DTx) a mobile application-based technology can encourage adherence to the prescribed diet, exercise programs, or drug prescriptions. DTx has the ability to be tailored to specific ailments like diabetes, heart disease, hypertension, etc. One of the most significant advantages of the DTx is that it can be implemented by employers and insurers to provide holistic and longitudinal interventions that use “low-cost, high-tech touchpoints” to help their members achieve sustained lifestyle behavior change that can slow down disease progression or complications.

For example, using a digital app, members in a disease management program can log their blood glucose and insulin levels with activity data of exercise and diet. This data can be used to generate insights on the effects of physical activity, medication, and carbohy­drate intake on the blood glucose levels of the person. A digital coach can also provide real-time feedback on corrective actions when required. This can enhance user experience and consequently increase engagement with their own disease management, yielding better clinical outcomes for policyholders and cost savings for insurers.

 

Reference
  1. Who.int. 2020. Diabetes. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/diabetes> [Accessed 24 December 2020].
  2. in Who.int, , 2020, <https://www.who.int/chp/chronic_disease_report/full_report.pdf> [accessed 24 December 2020].
  3. “Pulse survey on continuity of essential health services during the COVID-19 pandemic: interim report, 27 August 2020”. in , , 2020, <https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1> [accessed 24 December 2020].
  4. .diabetes, A, W diabetes, & C diabetes, “COVID-19 and diabetes.”. in Idf.org, , 2020, <https://www.idf.org/aboutdiabetes/what-is-diabetes/covid-19-and-diabetes/1-covid-19-and-diabetes.html> [accessed 24 December 2020].