Actionable Insights

In our first article, we discussed how COVID-19 preys upon those with an underlying chronic condition and how the virus has highlighted a real need to overhaul chronic disease management.  In the last article, we explored four burdens associated with chronic disease – physical, emotional, financial and cognitive burden – and ways in which a needs-based framework can serve as a guide in the identification and development of new technologies, services and/or solutions.

In this addition, I’d like to focus on one of these burdens in particular - cognitive burden – and how by focusing on not only decision support but also by engaging the patient through actionable insights, an enterprise can unlock real value for the patient and for the healthcare system.

Before I jump into it, imagine talking to a stockbroker and he/she tells you one of the stocks in your portfolio – one in which you have a significant position – has been declining rapidly and just hit an all-time low.  After hearing the devastating news, you ask the next set of logical questions: “Why?  What happened?” and “What should I do about it?”  Now, imagine if the broker’s answer to each of your questions is “I don’t know.”  I would venture to guess for most, this would likely be the end of your relationship with this particular broker.

Now, let’s say you have diabetes.  There are some amazing technologies out there to help manage the disease.  For example, continuous glucose monitors (CGM) measure a person’s glucose levels every 5 minutes!  Let’s also say you have access to some of these wonderful technologies and, with their help, you check your blood sugar levels regularly.  As you do, you see some interesting patterns emerge.  When you wake up, your glucose levels are on the high side, averaging around 220 mg/DL (for a patient with diabetes, ideal glucose level targets are between 70 – 180 mg/DL).  After your morning run, you see your glucose levels surprisingly rise, on average, an additional 50-60 mg/DL.  In the late afternoon, especially on Thursday’s and Friday’s, your glucose levels fall rapidly to a value of around 65 mg/DL.  Imagine observing these patterns and, like the investor, asking “Why?  What’s happening?” and, most importantly, “What should I be doing about it?”

One of the challenges facing healthcare is despite all the amazing technology out in the marketplace today, very few can actually help patients answer these basic questions.  They are essentially a digital version of the helpless stockbroker.  They give you data, but they cannot offer any meaningful, actionable insights.  And data without actionable insights is essentially useless.

This dynamic doesn’t just apply to a patient with diabetes.  Think about what you see on display near the pharmacy counter at a Walgreens or CVS:  digital scales, SPO2 monitors, home blood pressure cuffs, CPAP machines, etc.  All sorts of devices intended to help people manage an array of chronic diseases ranging from obesity, to hypertension, to COPD.  There are also activity trackers and smart watches which track your every step, your pulse, your body temperature, the variability of your heart rate, the length of your sleep cycle, and even your ECG.

Yet, with this explosion of devices and data, many of these wonderful technologies can’t tell you “Why is my blood pressure high” or “What should I do to better manage my blood pressure?” beyond some very generic suggestions.  One reason for this is the companies developing these technologies are more focused on delivering the next hardware feature and less focused on mining the treasure trove of data within these devices in order to deliver information that could trigger meaningful action by the patient.  Instead, they want to give you a color screen, new biometrics to track, or perhaps a smaller device to wear.  While some of these features certainly do add value, this singular focus on hardware largely misses the point, particularly when it comes to relieving some of the cognitive burden associated with chronic disease.  

For healthcare, particularly chronic care, to take full advantage of the existing technologies in the marketplace, more thoughtful investment is needed in data science, decision support and action initiation.  Companies need to think about using the data in a way to help the patient make sense of what is happening and, ultimately, spur the patient to act in ways to better manage their disease.  Said another way, creating actionable insights needs the same rigor, focus and thought process as introducing the next cool, new hardware feature.

A good example actually comes from the health & wellness space.  It is an activity tracker called Whoop.  Whoop is interesting because it’s different from the minute you put it on.  You see, Whoop doesn’t have a fancy screen.  In fact, it has no screen at all.  You follow Whoop from your phone.  Why?  Because rather than focusing on hardware features, the company has decided to prioritize data and insights.  The device is tracking a few key biometric parameters – actually, the same parameters as an Apple Watch or a Fitbit – namely, heart rate, heart rate variability (HRV) and sleep. However, Whoop takes this further and uses these parameters to provide two key personalized insights:  Strain and Recovery.  Strain is a measure of your cardiovascular exertion while Recovery measures your body’s state of preparedness for such exertion.  In other words, every morning Whoop scores how ready your body is to take on a cardiovascular load.  A higher Recovery score:  go hard.  A lower score:  take it easy.  Each day, Whoop also recommends a level of Strain based on your level of Recovery.  It recommends numerically how hard you should exert yourself and the app tracks your Strain on your phone in real time so you can ensure you match the recommended level of exertion each day.  This is a good example of not just providing data, but also providing meaningful insights in an effort to initiate action.

Ultimately, the more companies are willing to invest in this kind of effort, the more we can actually empower patients to take control of their health.  In chronic diseases, where the patient plays a pivotal role in the management of their disease, this is essential.  If more companies can focus their R&D on these types of insights for chronic care, we will see health outcomes improve, quality of life increase and the cost of healthcare decrease.

Afterward:

While this article focuses on what healthcare companies can do, there is clearly a role for healthcare regulatory authorities.  Although this is very slowly starting to change, healthcare agencies have not broadly embraced the use of actionable insights to help manage chronic disease.  Clearly an insight intended to generate action by the patient needs to be grounded clinically and therefore needs strong oversight to ensure the recommended action is both safe and effective.  There are, however, ways to do this – from sending the data and the recommended action to a physician before passing it to the patient, all the way to ensuring the appropriate clinical protocols and standards of care are embedded in the product’s software.  Regardless of the approach, for the use of actionable insights to take hold, we also need our government agencies to be willing to embrace a more digital approach.  Failure to do so will only aggravate two of today’s fundamental challenges:  first, that there are far more chronic care patients than there are physicians who can effectively care for them, and second, that the vast majority of today’s chronic care patients are not achieving the desired outcomes.