Key Considerations for Adopting a Digital Health Platform

Omar Manejwala, MD, chief medical officer, DarioHealth, breaks down key considerations for health care executives choosing a digital health platform, and discusses how DarioHealth’s technology may be integrated alongside other digital solutions while retaining patient engagement over time.

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Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network, where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we're joined by Dr Omar Manejwala, chief medical officer for DarioHealth. He breaks down key considerations for health care executives choosing a digital health platform and discusses how DarioHealth's platform may be integrated alongside other digital solutions while retaining patient engagement over time. Omar?

Thanks, Julie. Yeah, I'm Omar Manejwala. I'm the chief medical officer for DarioHealth. I'm a psychiatrist by training, and previously, I was chief medical officer for Catasys, where I owned product and built strategic relationships that grew that from zero to commercial success and widespread adoption by many of the nation's largest payers.

I joined Dario just over a year ago. DarioHealth is a leading global digital therapeutics company that's really revolutionizing how people with chronic conditions manage their health.

Dario's next generation AI-powered digital therapeutics solutions provide adaptive, personalized experiences that drive much needed behavior change through evidence-based interventions, intuitive, clinically-proven digital tools, high quality software, and coaching to help people improve health, sustain meaningful outcomes in chronic disease.

At Dario, personally, I'm responsible for all things clinical. So things like providing visible external-internal leadership, supporting commercial relationships with health plans and employers, consultants, provider organizations, and other strategic partners.

I conduct the clinical research that clinical partnerships. I set clinical product and sales strategy to drive clinical and financial outcomes. Julie, I'm very passionate about this space, because I think we really can and we should be doing so much more to help people who are suffering from these chronic conditions.

What are some of the benefits of adopting a digital platform that create sustained behavior change to mitigate some of the high costs of chronic condition management?

Yeah, that's a great question. Generally speaking, chronic health conditions are those that persist for at least six months. Diabetes, high blood pressure, musculoskeletal conditions, chronic pain, behavioral health conditions.

These are very common examples. Not only do most people who have conditions have more than one, but the conditions tend to interact with each other, along with sedentary lifestyle, stress, diet, other factors, all of which have gotten much worse in the last year.

A major focus really needs to be on managing patients beyond the visit. When digital therapeutics combine with human support, what you're really doing is you're influencing the other 99.9% of the time in a person's life that they're not in a provider's office or on a telehealth visit.

Most of the decisions that a person makes about their life, about their health, those things are made outside the provider visit. For example, whether or not a person will actually take their medicines, what they eat, when they sleep, and when they wake up, what kind of social interactions they have.

All those decisions are made outside of the doctor's visit. Julie, think about the choices you make every day in your life. The ones that are easy, the ones that are hard, the ones that have become habits, the ones you wish would become habits. I certainly have many of those.

We really need to make it much easier for people to do the right things for their health, despite all those everyday obstacles that invariably get in the way. Then, if you look on the other side, to answer your question, beyond just the ease of use for members, we're seeing health care professionals looking to adopt digital solutions.

They tend to have a common theme, which is they're looking for value-based solutions that improve clinical outcomes with the lowest friction possible, with the lowest lift possible, because they're already overwhelmed, in many cases.

Solutions that are configurable, that adopt seamlessly to our customers’ evolving digital strategies and care models. That's what they're looking for.

Can you discuss how DarioHealth's hyper-personalized platform and consumer DNA make it easier for patients to adopt the tool as part of their daily habit?

Sure, yeah. Solutions that have customers, consumers, in their DNA, those are the ones that are winning, and those are the ones that are executing clinical outcomes with the highest engagement, the highest value, the lowest friction, the lowest lift.

DarioHealth's direct-to-consumer experience, that offers a unique opportunity to evolve user experience in response to longitudinal consumer data, over 10 years, and analyze how these habits are formed over time, and how that differs from person to person.

If you have a solution that's skipping that vital direct-to-consumer step and going straight to health plans, going straight to employers or providers, they're missing that key requirement. What you usually end up with is a stale, very flat user experience that's much more like the boring online portals that you tend to see everywhere. The ones that you never, ever use, unless you absolutely have to.

Then, on the other hand, if something is adaptive to you, if it's personalized for timing, for tone, channel, content, frequency, intervention, like Dario's solution is, if it applies behavioral science to support your habit change, then you're far more likely to stick with it.

Dario continuously maps these user journey exit nodes and adapts solutions to respond to those exit nodes. That drives increasing participation, better outcomes. You know, Julie, providers are under a lot of pressure to drive clinical outcomes.

They're inundated with all these various approaches that are out there in the market. One simple litmus test for folks who are evaluating in this space would be to say, "Do people love it? Do they use it, and do they keep using it?" especially in the direct-to-consumer space.

If a solution doesn't have sustained engagement, I think you can pretty much skip all your other questions in your RFP, because they're all irrelevant. People have to use it for it to get better. In a sense, I guess what we're doing at Dario is listening.

The people who are using these digital health tools, they have a ton of feedback that we can benefit from. As a digital health solution, partners should be utilizing engagement to allow people who are using the solution to be their teachers. That's really important.

A lot of our audience listening in are those that are executives in health systems and organizations making key decisions. What are key questions health care leaders should ask when evaluating an effective digital health tool?

This, I think, is maybe the most important question you've asked, which is what should we be looking for? What do we need to know, and what are the red flags? People will gravitate towards tools that are simple, that are convenient.

Sustained behavior change requires technology that offers what consumers want, when and how they want it. Health care leaders should be looking for solutions that, number one, that people like, that consumers like, that they're using with little or no friction, high engagement.

Number two, should be clinically validated, extensive published research. Number three, they should have low operational lift. It shouldn't be hard to launch them. Fourth, I would say highly interoperable with their other solutions. That's really important. You've got to play well in the sandbox.

Fifth, I would say align on risk. Really important to have risk-based contracting. Then it's also important to be clear on how engagement is defined. What is the billable unit? What is the proof that that unit occurred?

Solutions, of course, have to be secure. That's table stakes. It's really important that these solutions provide real-time, member-level data visibility. You need that visibility to be able to partner and really deliver solutions.

When you go through that list of, I don't know what it was, like seven or eight items that I listed there, you've basically knocked out most first-generation digital health solutions, because they just don't rise to that bar.

Dario's proud to be leading in that next-gen space in these areas. If I were advising health care executives, your audience, what specifically should we be asking and why, I would say number one, ask these solutions, "What's your direct-to-consumer experience?"

Consumer products only survive if people have loved them and used them enough to buy them, keep buying them, and keep renewing them. They have to deliver sustained value. In general, health care has missed this point.

Health care portals aren't exactly known for being a well-loved place where you love to spend your time. There are exceptions, but generally, you go there, because you have to go there, not because you want to go there, not because it's actually making the rest of your life easier.

If you just look at the app store reviews for these other digital experiences, you'll quickly see what I'm talking about. Platforms that have successful track record in the direct-to-consumer space, they've already solved the toughest problem first: creating a valuable, engaging experience that people want to use.

I'll mention this, too, Julie. This is something people don't often think about. There's really not a lot of lift, if you have a technology, to sell it directly to consumers, even if you've already targeted to the employer market.

I would caution executives, be highly skeptical if the product they are selling you is not available to consumers. Usually, it's because the company knows people won't pay for it themselves, because it isn't all that valuable to them. That's a red flag.

Then, next question I would ask is, "How does the solution apply behavioral science principles?" Scientists know a lot about what makes people change, what makes them try new things, what makes habits form and stick, but that knowledge is rarely applied.

There's a lot of technologies that claim to leverage behavioral science, but if you look under the hood, most of them really don't, or they just offer so-called PBL, points, badges, leaderboards, which is really the most basic gamification.

In this area, I think you can ask a few further questions, like what behavioral science principles is the application relying on and why? What research does the application follow and why? Who are the development team's behavioral science advisers? How does the solution tie behavioral science into its various components?

I think behavioral science would be the second specific question that your executives could ask. Third up, I would say, "Does the solution leverage dynamic or adaptive kinds of personalizations for their interventions, or is it really just static personalizations like cohort matching and nudges?"

You see a lot of first-generation solutions focused on the nudge. The nudge is really important, but it's not enough, because health care is more than communication. We've known for a long time that one size doesn't fit all in health care, yet most solutions are still not personalized in any meaningful way.

Those digital health products that use fingerprinting, where they're matching you to somebody else, that's good. That's important. The problem is people themselves change over time. If you've matched me to somebody else, but what I was willing to do last month doesn't work anymore this month, then you're going to lose engagement.

That's really important. You have to have an adaptive experience that drives engagement, behavior change over time. That requires adaptive in those six dimensions I talked about, timing, tone, channel, content, frequency, intervention.

If you don't engage, if you're a first-generation solution, of you're not getting that kind of engagement, then you end up making up for it in some other ways, like trying some multi-month blocks of pricing, or population-based pricing that obscures low engagement. There should be a big red flag on that as well.

Next up, I would say, "What clinical outcomes has it delivered, and are they proven?" You need to prove that the solution will improve the health of the members. The best way to make sure of that is to ask whether the outcomes have been tested and validated through research studies.

I would say make sure you ask if studies have been peer-reviewed. Look at whether they were long- or short-term studies. Most of your members aren't sticking around for three months, so what's the value of a three or a six-month study? Not as great.

Look for long-term, one-year, two-year outcomes. How large was the user pool? There should be at least 50,000 or more users in the largest study, is really important. Have the studies been replicated? Look for improvements in clinical metrics tied to health and costs, and for specific populations.

For example, at Dario, we have over 20 clinical studies in both peer-reviewed journals, as well as in posters. Some of them have nearly 60,000 users. Some are two years long. That's the sort of thing you really want to be looking for.

Then finally, I would say, "How interoperable is it?" Too many solutions don't share member-level data. They aren't built with open APIs. They generally don't play well in the sandbox with other partners. At Dario, we know that we're not going to set your digital strategy. You're going to set your digital strategy.

There's an arrogance in coming in and saying, "Hey, do it our way." That's not right. The question is how configurable are we? Can we play well in the sandbox with everybody else? Can we deploy this with minimal lift, minimal friction for the members?

Are members going to be enjoying this experience, loving it? This is important. Minimal disruption to your existing workflows. Workflow is very complex. You don't want to have to disrupt all of those just to sign up with a partner to help you with these.

Julie, that's a great question. Those are some of the questions I would say they should ask.

We're moving obviously more into this digital age, so on a more broad scale, what do you think the future of care looks like?

I would say accessible, equitable, effective, valuable. We've already seen a real acceleration in digital. That's going to continue postCOVID. We know that. We're seeing health systems, health plans, really investing in infrastructure, in digital, and a recognition that telehealth alone isn't enough.

They need to add digital. They are adding digital. From the start of the pandemic, there's been an increased demand for digital as people were avoiding physicians, doctor's offices, and also, as they discovered the convenience of being able to manage their conditions from wherever and whenever works for them, in their pocket, as they say.

Throughout retail, throughout all commercial environments, technologies are most disruptive when they make things easier by at least one order of magnitude. That's what we're seeing here with digital health. We're going to see that digital health solutions are being—and I think this is good—they are being held more accountable for driving outcomes that ensure a very seamless user experience, centered around engagement.

At the end of the day, engagement is number one on the scorecard. You want to look at who's actually using the solution. How many people are actually using this, and what clinical and financial results have been achieved?

Finally, Omar, just overall, is there anything else you would like to add to this conversation today?

Yeah. We need to be talking more about access to care. We need to be talking more about health equity. We need to be talking about solutions that seniors can easily use. Almost 30% of Dario users are over age 65. Many are over age 80.

We need to be talking about asynchronous solutions, so people who don't have continuous cellular or Internet access. That's a social determinant of health. People who don't have that kind of continuous access can still use it.

We need to be talking about backwards compatibility, so solutions can work with the older phones that many folks who are impoverished may be using. I think many, many other topics. Digital solutions are going to be essential in solving these problems, both in the near term and beyond, but I think all of that will have to be a topic for another day, Julie, maybe the next time you have me on.

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