Can personalized and actionable feedback get you to put down that doughnut and go for a walk?

My Take

Can personalized and actionable feedback get you to put down that doughnut and go for a walk?

By Doug Beaudoin, vice chairman, US Life Sciences & Health Care leader, Deloitte LLP

I have three kids under the age of 12. As a parent, I pay close attention to their well-being. I limit their screen-time and get them to bed at a reasonable hour (usually). I make sure they eat well-balanced meals and have access to healthy snacks. I also try to sign them up for sports teams and camps to make sure they stay active. Unlike my kids, no one is constantly monitoring the choices I make that could affect my health. I know I don’t get enough sleep. When I’m on the road, I tend to skip the gym more often than I’d like.

We have been writing extensively about our vision for health in the year 2040 when we expect always-on sensors, multi-omics profiling, and highly personalized health data will empower individuals to take steps to improve their health condition or prevent illness in the first place.

And speaking of taking steps…nearly 600 of my Deloitte colleagues recently completed a 36-week randomized clinical study that looked into the impact wearable devices can have on physical activity. Researchers from the Perelman School of Medicine at the University of Pennsylvania concluded that wearable activity trackers paired with an element of gamification are much more effective at boosting activity levels than wearable devices alone. Even 12 weeks after the study concluded, the participants who had a fitness tracker paired with competitive gamification were far more physically active than the control group that used a fitness tracker alone. The results of this study were published yesterday in the September 9 issue of the American Medical Association’s Internal Medicine publication.

Another recent article (this one in the journal Nature Medicine), backs up our thesis that patients will become more engaged in their health as they gain insight into the preclinical conditions that impact their well-being. In this study, participants who were at risk for developing diabetes were evaluated over a period of up to eight years. Tests included profiling of the genome and gut microbes, and participants used wearable devices to continuously monitor their glucose levels. Regular feedback related to their health prompted a majority of participants to alter their diets and to exercise more frequently. Participants said their wearable devices kept them accountable for exercising and made them more aware of the need for occasional walking breaks.

We are heartened by the results of these studies, which challenge the orthodoxies about human behavior. Twenty years from now, or maybe much sooner, a smart wearable device might continually track activity as well as blood-sugar levels, electrolytes, and hydration.

Immediate feedback can change behaviors

To effectively change behaviors, health data provided to consumers should be highly personalized, immediate, measurable, and actionable. Here are two more examples of how feedback is being used today to change behaviors, and what it might look like in the future:

Facial-image scans: Last year, Walgreens teamed up with the Skin Cancer Foundation to encourage consumers to be more proactive in protecting their skin. Participants were invited to receive a high-tech facial scan that shows sub-surface sun damage that has occurred over years. The imager system provides visual proof of a potential health risk. An estimated one out of five people will develop skin cancer by the age of 70.

• In the future of health, such devices might be imbedded in our bathroom mirrors to illustrate the importance of sunscreen before we head out of the house.
  

Pictorial warning labels: Graphic photos on the front and back of cigarette packs have been highly effective at getting people to quit or to smoke less, according to a 2016 study.² Researchers in Australia, Canada, and the United Kingdom looked at changes to smoking rates after pictures were added to cigarette packages. In the eight years since Canada added pictures, for example, smoking prevalence has fallen between 12 and 20 percent.

• In the future of health, a wearable device might tell a person what is taking place in their lungs immediately after a cigarette.

Are stakeholders ready to change?

At a personal level, most everyone who works in the health care industry understands that helping consumers make better health choices can improve their well-being and reduce long-term care costs. But the antibodies that exist within many organizations can be highly effective in maintaining the status quo of engaging with people only after they become sick. There is also a fair amount of skepticism among stakeholders that patient/consumer behavior can be changed. But there is a growing body of evidence that highly personalized, immediate, measurable, and actionable data can be effective in changing behaviors.

We all know we should eat more dark-green leafy vegetables, avoid saturated fats and sugary drinks, and we need to exercise regularly. Most people understand that some of the choices they make today could have a negative impact on their health in the future. However, many of us will still reach for a doughnut instead of a piece of fruit if given the choice. Rather than doubling down on existing products and services, health care and life sciences stakeholders should consider investing in diagnostic and visualization technologies that encourage consumers to make healthier choices.

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¹ A longitudinal big data approach for precision health, Nature Medicine, May 2019 VOL 25 792-804.

² Graphic Pictures on Cigarette Packs Would Significantly Reduce Smoking Death Rate, Georgetown University Medical Center, November 3, 2016

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In the News

CMS issues final rule targeting health care fraud

On September 5, the US Centers for Medicare and Medicaid Services (CMS) finalized a program-integrity rule to block health care providers from participating in Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) if they are affiliated with entities that pose a potential fraud risk. According to CMS Administrator Seema Verma, the final rule, called the Program Integrity Enhancements to the Provider Enrollment Process, allows the agency to block potentially fraudulent providers from initially enrolling in federal health insurance programs. This enhances the agency’s existing efforts to recover fraudulent payments after they are made.

The final rule, which is scheduled to begin November 4, will require health providers and suppliers that participate in Medicare, Medicaid, and CHIP to disclose “any current or previous direct or indirect affiliation” with an organization that has uncollected debt, was previously excluded from these health programs, or received similar sanctions. CMS will use this information to block or revoke enrollment of a provider or supplier for up to 10 years—an increase from the current three-year enrollment ban. CMS estimates the rule could save the government $47 billion over 10 years.

(Source: CMS, CMS Announces New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid, and CHIP, September 5, 2019)

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CMS overhauls Medicare Plan Finder tool to improve functionality

On August 27, CMS launched an updated version of its Medicare Plan Finder tool—the first update in a decade. The new, mobile-friendly version is meant to improve usability and provide a more personalized experience for Medicare beneficiaries. The decision to update Medicare Plan Finder was prompted by a report from the Government Accountability Office (GAO) that said many users had difficulty navigating the tool. Key features of the updated tool include:

• An account log-in option that loads personal details upon signing in. This allows beneficiaries to access data such as Medicare coverage status and medications.
• A browsing feature that lets beneficiaries compare important aspects of Medicare plans, including costs and coverage options.

While the updated tool allows consumers to compare plan options, it does not include all of the information about Medicare Advantage (MA) plans and their network providers. CMS Administrator Seema Verma said improvements to the tool will be ongoing to ensure all essential data are incorporated. The original version of the tool will continue to run alongside the updated version through September to ensure a smooth transition for beneficiaries adjusting to the tool’s new design and features.

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Employee health, wellness benefits have more than doubled over 10 years

More than 80 percent of recently surveyed employers intend to increase their health and wellness budgets, which is more than double the percentage reported in 2009, according to Optum’s annual Wellness in the Workplace study. Optum, a health services innovation company, is part of UnitedHealth Group. As noted in a recent My Take, a growing number of large employers are doing more to address the physical, mental, and financial well-being of their workers. The study also found:

• Many employers are embracing telemedicine services: The number of employers who reported using telemedicine has increased 171 percent since 2014. According to a recent survey from Deloitte’s Center for Health Solutions, consumers have a strong interest in receiving care virtually.
• Mobile devices and apps are important for employee wellness: The number of employers that offer health-related mobile apps has increased by 46 percent since 2016. Moreover, close to three-quarters of respondents said apps helped increase employee participation. During the same period, the number of employers reporting that their employee wellness programs include activity or fitness devices increased by nearly 40 percent, with 71 percent of employers indicating successful employee engagement.
• Employers are increasingly showing interest in mental and behavioral health care: In this year’s study, 88 percent of employers said they intend to address the stigma around behavioral health within a year. Nearly 90 percent of employers said they are concerned about the ability of employees to access behavioral health services, and 61 percent of employers are planning to implement digital tools to improve employee access to those services.
• Women’s program offerings have increased: The percentage of employers offering maternity care rose from 59 percent in 2016 to 74 percent in 2018. Additionally, 84 percent of employers said they plan to increase investments in women’s health services over the next three years.

(Source: Optum, 10 Years of Health and Well-being at Work: Learning from our past and reimagining the future, August 21, 2019)

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State health news roundup

• Maine to join other states in launching state-based insurance exchange: Maine Governor Janet Mills (D) recently submitted a letter of intent to CMS indicating that the state will transition to a state-based insurance exchange for the 2021 plan year. With this move, Maine will join a small group of states that have opted to move away from participating in the federally run HealthCare.gov exchange. Key drivers behind the decision include the state’s desire to have better access to consumer data. The potential cost-saving benefits for consumers was another factor. Several states that have pursued this model are already seeing lower premiums. Maine will continue to use the federal enrollment platform and call center before fully transitioning to a state-run exchange in 2022.
  
  (Source: Office of Governor Janet T. Mills, Governor Mills Announces Maine Will Pursue a State-Based Health Insurance Marketplace Under the Affordable Care Act, August 29, 2019)
  
• California's rate-setting model reduced surprise bills: The number of in-network providers in California has increased by 16 percent since the state’s 2016 legislation to end surprise medical bills, according to a recent study from America’s Health Insurance Plans (AHIP). The trade group analyzed data from 11 health plans serving 96 percent of Californians. The legislation (AB 72) established a benchmark payment rate for out-of-network care.
  
  (Source: AHIP, State’s approach can be a model for federal legislation, August 22, 2019)
• CMS approves Rhode Island reinsurance program: CMS has approved Rhode Island’s request to use a 1332 waiver to establish a reinsurance program, which will begin in 2020 and run through 2024. The program, which is expected to cost $14.7 million, will be partially funded by federal pass-through dollars and penalties from people who do not comply with the state’s individual-mandate policy. HealthSource RI, the state’s insurance exchange, will administer the program. The state predicts the new program will result in a 5.9 percent drop in average premium rates compared to last year.

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HHS releases $1.8B to help states combat opioid crisis

On September 4, the US Department of Health and Human Services (HHS) released $1.8 billion to help states address the nationwide opioid crisis. This amount includes $932 million from the Substance Abuse and Mental Health Services Administration (SAMHSA)—in State Opioid Response Grants—to all 50 states. These grants require recipients to give patients access to medication-assisted treatment (MAT) services.

The US Centers for Disease Control and Prevention (CDC) announced more than $900 million in new funding to launch the Overdose Data to Action initiative, a three-year collaborative effort with states, territories, and city health departments. According to CDC, the initiative seeks to more effectively calculate rates for overprescribing, addiction, and overdoses. The data will be used to improve prevention and surveillance efforts.

By the end of 2019, HHS will have awarded more than $9 billion in grants to states and communities to improve treatment and prevention services.

(Sources: CDC, Overdose Data to Action, September 2019; HHS, Trump Administration Announces $1.8 Billion in Funding to States to Continue Combating Opioid Crisis, September 4, 2019)

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FDA approves two new antibiotics

On August 19, the US Food and Drug Administration (FDA) approved a first-in-class antibiotic to treat adults with “community-acquired” pneumonia, meaning pneumonia acquired outside of a hospital. This drug, which can be administered orally or intravenously, received FDA’s Qualified Infectious Disease Product (QIDP) designation because it can be used to treat a serious or life-threatening infection. According to the CDC, one million people in the US are hospitalized with community-acquired pneumonia each year, and 50,000 people die from the disease.

This approval was announced four days after FDA approved a new antibiotic for treating resistant forms of tuberculosis. The tuberculosis drug is the therapy drug to be approved using FDA’s Limited Population Pathway for Antibacterial and Antifungal Drugs, which Congress established in 2016. The tuberculosis drug also qualified for QIDP designation and priority review, in addition to Orphan Drug Designation.

(Sources: FDA, FDA approves new drug for treatment-resistant forms of tuberculosis that affects the lungs, August 14, 2019; FDA, FDA approves new antibiotic to treat community-acquired bacterial pneumonia, August 19, 2019; US Centers for Disease Control and Prevention, Pneumonia Can Be Prevented—Vaccines Can Help)

RELATED: On August 16, FDA announced its first-ever approval of a spinal tether designed to treat idiopathic scoliosis, which is the most common form of scoliosis found in children and adolescents. The spinal tether’s manufacturer will also develop a patient registry to assess the device’s long-term performance and track real-world evidence (RWE) of its safety and effectiveness. As noted in Deloitte’s most recent annual RWE benchmarking survey, FDA has taken steps to provide guidelines around RWE and is collaborating with the biopharma industry to explore its uses.

(Source: FDA, FDA approves first of its kind device to treat pediatric patients with progressive idiopathic scoliosis, August 16, 2019)

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Breaking Boundaries

A glimpse into the future of biosensing wearables

A team of researchers from Stanford University have designed a wireless wearable device that sticks to skin like a bandage and can track movement, heart rate, and breathing. The device has a tiny antenna made of metallic ink, and it uses radiofrequency identification (RFID)—the same technology used in keyless access systems and key cards.

While our skin helps to protect us, the various layers of skin help control body temperature and water loss, while nerve endings allow us to detect pressure, vibration, touch, and pain. Stanford researchers developed a way to harness those skin signals with a device that does not require batteries, wires, or chips. The device measures how the skin stretches and contracts, and it sends these readings wirelessly to a receiver attached to the wearer’s clothes. From these readings, researchers were able to monitor the subject’s breathing and heart rate, as well as arm and leg movements.

Researchers named their device "body area sensor network" or BodyNET. The team recently published its findings in the journal Nature Electronics. In the paper, the researchers describe how they stuck the sensors to the wrist and abdomen of participants to detect their pulse and breathing. Sensors were also placed on their elbows and knees to determine movement. The device detected the stretching and contracting of the skin in the areas that corresponded to the muscles flexed.

The device could eventually be used to help health care professionals monitor people who have sleeping problems or heart conditions. In future studies, the researchers want to figure out how the patch could detect sweat and temperature. They conclude that one day, it might be possible to create a full-body skin sensor that can collect physiological data seamlessly, without interfering in a person’s daily life.

(Source: Simiao Niu, “A wireless body area sensor network based on stretchable passive tags,” Nature Electronics, August 15, 2019)

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