Transformative Chronic Care Management in the Post-Pandemic Era
Today, roughly six in 10 Americans live with at least one chronic disease, such as heart disease, cancer or diabetes, according to the Centers for Disease Control and Prevention. As a leading driver of death and healthcare expenses in the U.S., preventing or actively managing chronic diseases is critical to improving health outcomes and reducing costs. This, we know; so how can we deliver care more effectively?
The Shift to Digital-First
Technology investments made during the pandemic have propelled almost every industry forward by at least a decade. As a result of improved online experiences, we now depend on digital services to support our entire existence: from the way we work, learn, shop and communicate to how we receive care.
Within healthcare, we already see that the majority of non-life-threatening visits can be done in a digital setting. Symptom assessments for non-emergency issues can be qualified remotely before coming in for an in-person visit. Likewise, many consultations and follow-up care – such as post-surgery visits, reviewing test results and prescription refills – are ideal for virtual visits. Many behavioral health services can be done remotely, as well. Even annual physicals can be completed virtually, to a certain extent.
Care Delivery in the New Normal
In the near future, digital health will play an even broader role in the delivery of care. As a result of increased capacity due to digital health’s effectiveness and efficiency, traditional care delivery models will evolve from scheduled- to event-based, enabling healthcare consumers to receive care when and where they need it. Data will play a significant role in that process, and we’ll see digital care delivery become foundational in the patient journey, especially for chronic disease patients.
Already, remote patient monitoring devices – such as a glucometer to measure blood sugar for people with diabetes – are empowering patients to take control of their health. During a routine, scheduled appointment, these patients will automatically share this data with their provider and discuss healthcare goals. This might be a satisfactory solution for active, engaged patients, but what about the disengaged or those struggling to get their disease under control?
Looking ahead, digital-first chronic care delivery models will enable real-time unobtrusive data flow between patients and providers via inconspicuous remote patient monitoring devices. Now, when a diabetic’s glucose level is outside of its normal range, a nurse practitioner will receive an automated alert and proactively reach out to the patient to help identify the cause in real-time. “What did you just eat? Did you take more insulin today than normal? I noticed that your insulin did the same thing at the same time last week; any correlation?” After an initial assessment, the provider will quickly assemble a team in a virtual setting – such as bringing in a nutritionist to help the patient better manage their diet.
Using artificial intelligence (AI) and historical data, healthcare providers will also now be able to predict interventions and proactively reach out to patients before an episode to support optimal health. These technological advancements will allow healthcare visits to be proactive rather than reactive or episodic. Consider proactive communication such as, “It’s October, you need to be on alert to the following trends that we’ve distilled from the last two years of data.” This may sound too good to be true but will be the standard of care in the not-so-distant future.
As we think of healthcare as a whole, blending digital health with in-person care will help drive significant value and benefit for the entire healthcare ecosystem, leading to increased patient engagement, reduced costs and improved population health. The key will be in guiding patients to the right provider in the right care setting at the right time.
David Nash, M.D., is founding dean emeritus of Jefferson College of Population Health; Puneet Maheshwari is co-founder and CEO of DocASAP.
