In this episode of the MGMA Insights podcast, we're joined by Omar Manejwala, MD, chief medical officer, DarioHealth.
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Addressing the chronic conditions of patients across America remains a top priority for healthcare leaders hoping to improve outcomes and control costs.
Omar Manejwala, MD, chief medical officer, DarioHealth, joined the MGMA Insights podcast recently to explain more about how the COVID-19 pandemic has prompted medical groups to update their workflows to continue providing care.
“If you want to reduce your ER visits, if you want to improve health, if you want to reduce hospitalizations and help people, you've got to help people change behavior,” Manejwala said. “Because at the end of the day, if you change 50, 100 or 200 things a person does, it can have a very dramatic impact on outcomes.”
In the past year, Manejwala has focused on finding new solutions for employer health plan markets to better address patients dealing with chronic illnesses and comorbidities. “We've seen where people with chronic conditions are maybe not getting their needed maintenance care, their preventive care that they need to manage those conditions,” Manejwala said. “Chronic conditions really are the primary problem in healthcare, and a lot of that could be changed if we focused on supporting people with digital tools to engage them and really get that behavior change.”
Manejwala noted that chronic conditions have always been very difficult to manage, and the effects of the pandemic — “people are moving less, you know, they're not leaving their homes as much,” he added — are worsening underlying conditions. He also cautions about those increases in weight and lower activity levels further being complicated by increasing mental health diagnoses and substance use. “All these factors are really conspiring to make chronic conditions worse and really become a greater burden to everybody — to providers, patients and employers.
“A major focus needs to be managing people beyond the physician visit,” Manejwala said.
Digital lives require digital engagement
The solution to engaging patients with chronic conditions in a time of social distancing and the increasing digitization of everyday life is finding the right technology to make the process convenient.
“People have a digital life,” he said. ‘They're using their phones more and they're engaging with technology more. … We've expected an acceleration into digital health, and we knew that was coming over time. I think it has been a tremendous surprise to everybody just how much this has accelerated” in recent years.
The surprise also includes the extent to which different patients engage via digital health tools. The common myth that older patients don’t use technology or would not be interested in digital health tools has not been true in Manejwala’s experience at DarioHealth. “Somewhere between 26% and 28% of our users are over the age of 65,” Manejwala said. “They use tech … and they're using it more than I think anybody expected.”
Not all telehealth is created equal
The expansion of telehealth was vital for providers and patients at the height of the pandemic, but some elements of care delivery can be addressed in other methods, Manejwala said. For managing elements of chronic conditions, he argues there is a litmus test for digital health tools:
- Is it simple?
- Is it intuitive?
- Does it create value?
While a diabetic patient can understand avoiding sugar-dense foods and getting more exercise, that education does not go far without a tool to make those goals more easily attainable. If a patient portal for accessing test results or accessing wellness education is cumbersome or awkward, it’s “asking people to do a lot of work” and might result in them not following through, Manjewala said.
Similarly, healthcare providers are unlikely to adopt or recommend digital tools unless they boost clinical outcomes and have “low friction” with existing systems, such as the EHR.
For healthcare organizations looking to expand in an area such as telehealth, the key consideration should be to identify tools that can take some of the pressure off providers to drive desired outcomes.
“Sure, you can counsel people on moving more and exercising more. … You have a few minutes to do that” during a patient visit, Manjewala said. “But what's really needed to deliver on that is to give people access to tools that they can use for self-management. That's a win-win … especially if the providers can be reimbursed for using those tools.”
The science of behavior change
Changing patient behavior to adopt new digital tools that can help make significant improvements in chronic conditions is not merely about understanding of behavioral science, Manjewala said. While you do need to understand what motivates people, it also requires a degree of personalization.
“In healthcare, we’ve talked forever about one size doesn’t fit all. … But then we keep selling and deploying one-size-fits-all solutions,” Manjewala said. He noted that successful solutions for the future of digital health will have an element of adaptive or dynamic personalization that can personalize timing, tone, content and interventions for users to have the most impact. Those factors can make the difference between a user engaging and finding value in the tool versus thinking it is annoying or a waste of time, leading to deleting an app.
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The MGMA Insights podcast is produced by Daniel Williams, Rob Ketcham and Decklan McGee.