By Ed Booty, reach52 CEO
It’s that time of the year when our social feeds and inboxes are full of the latest trend predictions for the year ahead. This is certainly the case in healthcare, an industry experiencing disruption in multiple ways. While I love learning about new trends and ideas, I get even more excited by delivering impact on the ground and translating concepts into action. So, here’s some practical ways to translate three key healthcare trends into action to deliver affordable, accessible healthcare in lower income countries.
It’s always been obvious that keeping people healthy and well in the first place rather than treating them when they become unhealthy should be the priority. The difference now is we can achieve this with far greater precision and accuracy. By building and applying predictive analytics models to relevant data, we can predict which groups of patients will be most at risk of certain conditions and make earlier interventions to prevent or manage them. For example, in developed systems, the La Fe Health Department in La Valencia used a predictive model to identify the multi-chronic patients with an increased risk of hospitalisation over the next 12 months, delivering a reduction of up to 79% of hospitalisation and emergency room visits1. The application of predictive and preventative healthcare approaches is more nascent in low- and middle-income settings but growing as we saw with the launch of the Rockefeller Foundation’s $100 million Precision Public Health Initiative last year.
It’s essential that predictive and preventative models include quality data from low- and middle-income communities currently outside of care. If the data is only from people who currently access care, the models won’t be applicable to these disadvantaged populations, further increasing health inequity. It’s also wrong to rely on the data analytics alone. This data must incorporate social histories as well as demographics and clinical histories. Preventative models of care must be equally based on insights into the real lives of people within the communities. Using the data we’ve captured through our reach52 access platform, we developed an algorithm to identify community residents in the Philippines at most risk of hypertension. Our Access Managers conducted house to house blood pressure checks over 3 weeks to monitor the blood pressure for ‘at risk’ residents, but also conducted interviews to understand the emotional and financial barriers to adopting healthier lifestyles (e.g. if I feel healthy, I must be healthy). This was a low-cost intervention covering about 10% of the village’s population. Of these, almost 70% completed their personal, home-based interactions with us, and 40% were severely at risk of or diagnosed with hypertension. We also understood medicine needs, helping us source suitable partnerships to fill the gaps in local care delivery.
‘Consumerisation of healthcare’ is a major trend across developed health systems, with patients as consumers demanding more personalised, convenient and relevant healthcare experiences. Patients are increasingly empowered to self-diagnose, track and manage their health through mobile applications, wearables or even digestibles such as Abilify MyCite’s digital pill.
Whilst the healthcare systems where reach52 works may be less evolved, the personalisation of healthcare experiences is no less important in these low- and middle-income areas. People have to make choices with their time and want to feel valued, so the experience matters. We will only change behaviour (e.g. adopting healthier lifestyles, seeking treatment, staying on treatment) by delivering access to care where, when and how individuals want it. Digital applications (in particular mobile) provide the means to achieve to this. However, just as in developed systems, applications must be designed to address the patient experience in the most relevant and convenient way. A common pitfall is trying to ‘lift and shift’ approaches from developed systems that are just too complex for low- and middle-income settings – simplicity is key.
We launched a new reach52 medicine ordering and delivery service in the Philippines in 2019 in partnership with Novartis Social Business, Zuellig Pharma and MedExpress. We have built into this service, simple mobile reminders for patients to pick up, take and re-order their medicines at the right time. In 2020, we plan to expand our use of personalised digital engagement and chatbots through Facebook Messenger – a platform which already has huge penetration in the communities, and often is the primary form of chat app due to ‘free data’ bundles with most telecoms’ companies.
The logic of personalised and relevant interventions is also staggeringly logical in my view. As we look to the hyper-targeting of ads by Google and Facebook, the notion that standardised, group-based lectures or events will have an impact alone is false. Instead, interventions need to be contextual and relevant to be impactful. So we actively use our granular datasets when developing community health programmes, adapting our programmes for individual villages based on their local needs and engaging residents at an individual level with relevant content (e.g. talking head video clips of doctors). This allows us to create a personal and authoritative visual experience with clear explanations about why a person has been selected, or why they and their broader community are at risk. I am of the personal view that we hold a ‘it won’t happen to me’ ego about our own health, somehow rationalising that we are not the highest risk (especially for silent killer diseases, such as NCDs). Data and personalised messaging can start to help people understand why they are at risk and engage them in essential first steps towards prevention.
Delivering health care via digital and telecommunication technologies, to both complement or as a substitute for face-to-face interactions, has become an increasing focus for developed health systems. Virtual health includes telehealth activities, virtual and augmented reality, and AI powered virtual assistants such as Sensely’s virtual nurse Molly used by the UK’s National Health System. Intermountain Healthcare have used telehealth for rural areas in the US where there is a lack of specialists. Video-assisted resuscitations for distressed infants in community hospitals reduced neo-natal transfers to level 3 traumas by nearly 30%.2
In rural areas of low and middle-income countries, there is still much work to do to realise the potential of virtual health. Low or no internet connectivity when most telemedicine applications require reliable internet bandwidth is clearly a challenge, so establishing telehealth access points in communities with an acceptable level of connectivity is important. However, often the failure to deliver impact is a failure of planning and engagement. Firstly, there is the failure of the private sector to engage government officials in developing new regulations and protocols to enable effective telemedicine systems, limiting efficiencies. For example, creating prescriptions without a physical consultation isn’t allowed in the Philippines, seriously limiting any potential telemedicine innovations in a country made up of 7,500 islands and severe shortage of health workers in the more rural areas. Secondly, there is the failure of the private sector to engage sceptical healthcare professionals around the benefits of telehealth for them and their patients. In my experience, there is often a reluctance to shift from face-to-face to virtual interactions as the latter isn’t perceived a ‘proper consultation’, affecting confidence in patient outcomes. The evidence for cost savings is there (e.g. it’s estimated if telemedicine replaced 30 to 40% of in-person outpatient consultations, India could save up to $10 billion3). We need to track quality of care outcomes better to drive change and integrate telehealth into healthcare delivery systems. The reliance upon telco’s can also not be understated. Without the reliable infrastructure, a quality service will be impossible for patients and clinicians and remain a barrier to the needed shift in healthcare service delivery.
We also need to think more broadly than telehealth and make the most of emerging technologies such as virtual and augmented reality. There is a much publicised, global shortage of health workers, with an urgent need to re-organise and upskill workforces (especially community health workers, who are often decentralised and more difficult to train) to address the rising prevalence of non-communicable diseases in low- and middle-income countries. One of the great benefits of virtual and augmented reality is its ability to remove barriers of distance. AR/VR enabled scenarios could be used by leading experts to remotely upskill new workers in lower income countries or even bring specialist care to patients through immersive experiences wherever they are on earth.
So, as we kick off an exciting 2020, let’s all commit and work together to translate trends into impact on the ground. 52% of the world still lack essential health services, let’s change this. As Abraham Lincoln once said, ‘If you want to predict the future, create it’.