As the digital health field matures, there’s growing evidence that virtual tools are effective in managing chronic diseases. For instance, in the world of diabetes, digital intervention for this complex disease has been shown to lower A1c levels such that prediabetes patients don’t progress to full-blown type 2 diabetes.
In late January, Hello Heart announced that an independent validation showed that its machine-learning-powered digital cardiac app saved employers money because employees avoided surgeries and invasive procedures.
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And earlier this week, more evidence emerged — this time through a study published in Mayo Clinic Proceedings — that showed that a digital-first approach is very effective in managing hypertension. The peer-reviewed study co-authored by Included Health and Stanford Healthcare found that a large majority of the patient population — 77% of 569 patients — experienced an improvement in either systolic or diastolic blood pressure. Specifically, patients had mean reductions of -9.7 mm Hg and -6.8 mm Hg in systolic and diastolic blood pressures, respectively.
“With recent reports that rates of adequately controlling hypertension in the U.S. have declined over the last decade, virtual care has demonstrated to be an effective model to provide improved hypertension care,” said Dr. Shriram Nallamshetty, clinical assistant professor (affiliated) at Stanford Medicine and co-author of the study, in an Included Health news release. “For chronic conditions like hypertension, we must consider the impact of the virtual care model in raising the standards of care for all patients.”
A full 416 of the 569 patients came to the study with systolic blood pressure above the 140/90 mm Hg threshold defined as blood pressure that is under control. For this latter group, 55.7 percent achieved an optimal blood pressure by the end of the study period, which followed patients between March 2020 and February 2021. Average reductions in systolic and diastolic blood pressures were -17.9 mm Hg and -12.8 mm Hg, translating to improvements of 11.2% and 12.4% respectively.
Other than improved blood pressure levels, patients also reported high satisfaction rates, scoring the virtual experience 4.94 on a 5-point scale.
“With this latest data, we’ve shown that virtual care can offer an alternative solution for hypertension management when in-person visits may not be convenient or possible,” said Ian Tong, chief medical officer at Included Health in a statement. “New approaches to chronic disease management broadly are crucial to improving access to quality healthcare for those who need it most.”
This is the new approach that San Francisco-based Included Health is purportedly building. In a recent interview, Robin Glass, president of the company formed by the merger of Grand Rounds and Doctor on Demand, said that Included Health is redefining the whole patient experience and journey. The company not only provides a resource when people need a second opinion but also allows them to meet a virtual primary care physician, as well as the option to have virtual urgent care visit. People can also speak can with therapists online in addition to having the ability to be matched with a care provider if a diagnosis calls for an intervention or follow up.
And when virtual options are not appropriate, Included Health can facilitate in-person visits as well.
“That’s one of the powers of bringing the two companies, Grand Rounds and Doctor On Demand together, is that we have the virtual care experience, but then we also have all of the quality algorithms and other resources that we’ve built to navigate that member to the right place for care in the brick and mortar settings and then to bring them in and out of our platform as it relates to their health care journey,” Glass said. “We actually really do believe in the power of the multiple settings of care.”
However, multiple points of care also mean disparate areas where patient data can be dispersed and siloed. But Glass said that Included Health is building an interoperable infrastructure that to prevent further data fragmentation.
“There’s an app that you can go to to have a care experience with us, and you can see all of the experiences that you’ve had with Included Health. And then you can also just within the app, you can request that something, say, be sent to your primary care physician or something like that. So that data from our app can be shared out with your provider in the community,” she said.
In other words, Included Health has built APIs such that patient data can move from its platform out into other systems where the patient might be getting care and then also allow integration of that external data back on to the company’s platform. And all in an automated fashion.
Where the infrastructure of APIs is not there, the company also has a care team where if required, they can go and get hold of patient’s records.
“All of us who’ve been at this for a while know that data connectivity and interoperability is probably the single biggest challenge in our health care system and so we absolutely are of the belief and the mindset that we must ensure that the contribution that we make to the healthcare system is not to further fragment it but to bring this great integration together and so that’s why we set out at the beginning of our merger to build a fully integrated care experience,” she said.
Glass explained that the company has more than a 1,000 clinicians on staff to virtually assist people, and relationships with providers and systems should they need in-person care. Included Health’s customers are payers and large, self-insured employers and the business model is charging visit fees for online visits in addition to a per user per month fee it charges employer and insurance customers.
While companies like Included Health have seen their fortunes rise over the pandemic as demand for virtual care services soared, it will be interesting to see who ultimately stands out in terms of marketshare. A veritable army of companies — be it virtual care companies like Amwell or Teladoc, care navigation companies like Accolade, or a mixture of the two that is Included Health or scores of other smaller startups and other disease-specific startups new, old and older, — are trying to get the attention of either large self insured employers or payers or both. They all have the same message — traditional healthcare is broken; buy our products and services to give your employees/members an exceptional experience and achieve substantial savings on healthcare coverage costs to boot.
Add to this motley mix of companies, the online retail juggernaut Amazon. , It’s two-year old Amazon Care care business — billed as combining the “best of virtual care and in-person services” — targets employers has just expanded. Virtual care services are now available nationwide and in-person services to be launched in 20 U.S. cities this year.
Who will win the hearts of minds of employers?
Only time will tell though it is very clear that large employers do not want point solutions, nor do they want to have multiple offerings for their employees. They are looking for a one-stop shop.
Photo credit: Andrey Suslov, Getty
