Do we need a new approach to value in digital health and care?

Do we need a new approach to value in digital health and care?

Leo
Do we need a new approach to value in digital health and care?

Healthcare systems around the world, including the NHS, have seen a substantial increase in the deployment and use of digital health and care tools in recent years. A host of innovations, including in the areas of digital therapeutics and virtual care, are now more commonly used. But behind digital health’s move from the niche to the mainstream lies the need to clearly define and evaluate the value solutions could bring to patients, staff and the wider health and care system, and in turn drive sustainable procurement. 

During the COVID-19 pandemic, when traditional face-to-face access to healthcare became extremely difficult, many digital solutions that provided an alternative were rapidly adopted. Although we may not face the same constraints now, with growing demand on services, the need to improve access is still there. According to the BMA, 7.75 million people are currently waiting for treatment in England, with approximately 400,000 of those patients waiting for over a year.

In recent months, we have seen a wave of announcements boosting investment in digital technology to tackle some of the biggest healthcare challenges. However, questions around the sustainability of the sector continue, including whether we have the right financial structures in place to generate the value needed for the system. 

An exciting panel of speakers bringing a range of perspectives and expertise tackled these exact questions at our second Lunch & Learn webinar earlier this month. We were pleased to be joined for this discussion by:  

  • Dr Penny Kechagioglou, CCIO and Deputy CMO at University Hospitals Coventry and Warwickshire NHS Trust; Vice Chair, CCIO Advisory Panel, Digital Health
  • Professor Paul Corrigan CBE, Chair of Care City UK and former adviser to Tony Blair
  • Jim McDonald, Senior Programme Manager, Midlands and Lancashire Commissioning Support Unit; West Midlands Remote Monitoring Collaborative
  • Professor Ann-Marie Cannaby, Pro-Vice Chancellor of Health and Life Sciences, Coventry University
  • Dr Saira Ghafur, Digital Health Lead, Imperial College London; Cofounder, Prova Health. 

Here are our some of our key takeaways from the panel.   

1.    Prioritising evidence-based outcomes and viewing value as multi-dimensional.

Longevity and success in the market for digital health and care companies depend on demonstrable outcomes, Dr Ghafur stressed. However, one of the challenges is ensuring consistency in our understanding of value across the system, reducing duplication and ensuring innovators don’t have to go through the same process from start to finish with all 42 Integrated Care Boards (ICBs). 

“Compared to pharma, you’ve got a very clear utility there (…). For digital, what is the comparator? Is it the incumbent system that you already have, is it another drug, is it a piece of equipment? There’s a lot of different comparators. And to try and work out that economic evidence behind it is somewhat trickier, because it may well not lead to better clinical outcomes, but it will enable a smoother pathway, it will help you see more patients,” Dr Ghafur explained.  

“But while it’s trickier to work out what the kind of economic evidence is going to look like, at the same time, it’s got to be done. Because if you are the payer, you’ve got to make sure that you’ve got return on investment for anything that you’re spending X amount of money on and making sure that it’s relevant to the patient population as well.” 

Accessing such evidence will boost clinicians’ confidence in recommending these tools, fostering wider adoption. Additionally, we must consider impacts beyond economic outcomes, such as reducing inequalities or pressure on services, the panel noted, with the audience adding dimensions including staff and patient adoption and experience (Mentimeter wordcloud added above). Although funding for robust studies in these areas remains challenging for smaller digital health companies to access, attendees heard that innovators are working on exciting tools to assess the impact of their solutions on things like meeting the net zero agenda. Support from the NHS in developing and testing these initiatives will be key in realising value on the ground. 

2.    Aligning financial flows to allow innovation to flourish.

The panel stressed that the current financial system operates in siloes, making it challenging to recognise the holistic value derived from certain projects. To drive change, financial flows need to be aligned with patient pathways and incentivise use of proven technology. 

Professor Corrigan explained: “What we need is a financial system that flows. At the moment, if we invest in one part of the system, it’s likely that there’ll be savings in a completely different part of the system, and therefore those savings cannot be realised. But if you had a flow that made that work, then it’d be totally different.” 

The Hewitt Review, published earlier his year, called on NHS England to work with the Department of Health and Social Care, the Treasury and some of the most mature ICBs to identify more effective payment models that “incentivise and enable better outcomes and significantly improve productivity”. It highlighted:

“Many health systems in other parts of the world, including those that are entirely or largely taxpayer-funded, are developing payment models that support and incentivise a focus on health. Meanwhile, NHS funding remains over-focused on treatment of illness or injury rather than prevention of them and ICS partners struggle to work around over-complex, uncoordinated funding systems and rules in order to shift resource to where it is most needed. There are lessons from other systems that we should draw on.”

3.    Demystifying the role of digital technology to support adoption. 

“We make it really tricky for clinicians to use things,” Dr Ghafur noted. “If you work in the digital health sphere, you see all these tools, you’re more confident recommending them to patients or using them yourself in your own clinical practice. But there are so many things out there, how do you even know where to start and how do you recommend them?”

Mr McDonald highlighted that there is a huge role for demystifying the concept of digital health and raising awareness for colleagues that may not be as familiar with it. “Their imagination sort of builds it up in their heads, this is going to be terribly complicated, I’ve heard something but don’t know much about it, I fear the worst. And, therefore, even before they come into the room, they’ve got mental barriers in place. Demystifying and doing a lot more awareness work where we can are absolutely necessary.” 

Professor Cannaby stressed: “There are a lot of things, a lot of technologies that we use in our daily life that just haven't been translated into health. If we actually concentrated on some of that in the adoption curve, or on the familiarity of staff, or the win-win, that would resonate in people's minds differently because they do it somewhere else.” As a leader of an institution training the next generation of the healthcare workforce, Professor Cannaby emphasised that young people coming into the workforce now already have the expectation that technology used at work should live up to the usability and functionality standards seen in other areas of their lives. 

4.    Fostering innovative partnerships between the NHS, patients and suppliers.

Finally, all panellists agreed that closer collaboration between frontline clinicians, patients and industry is key to ensuring that the solutions created match real needs and therefore drive value. 

“It’s important that clinicians and relevant stakeholders such as patients work with suppliers to identify what the pain points are, and what the problems that we’re actually trying to solve are. How technology will enable us to do that, and how we are going to measure it in the short, medium and long term. We have done this in our organisation, I'm sure others have done this, but I'm not sure whether that is happening consistently,” Dr Kechagioglou noted. “Clinicians on the frontline work with patients day in and day out, they understand what the problems are and what the possible solutions are, so we need to enable our frontline clinicians and our patients to work closely with suppliers to drive that innovation.”

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Don’t miss the last webinar before the end of the year, taking place next Tuesday, 5 December, looking at how we can build winter resilience with virtual care. Get in touch with our team at leo@feebris.com to join us for this session.

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