Trends in Digital Health: Headwinds and Opportunities to Reinvigorate Chronic Condition Management Through TEFCA and GenAI

The 2010s experienced an explosion of digital health solutions. By 2021, health management apps accounted for 47% of all apps in 2021—a sharp increase from 28% in 2015. The vision that many of the products’ creators had was for a companion app that could provide education and constant support and would be cheaper and more effective than going repeatedly to physicians.   

Some of the popular products included: 

• Livongo for diabetes
• Propeller for asthma
• Noom for weight loss
• Omada for hypertension
• Cricket Health for care of kidney disease (CKD)

These products had a lot in common. They were usually point solutions on a single condition. They tended to focus on education and tracking, and they catered to large employers as a complement to enterprise wellness programs and insurance benefits. Now, another trait they share is that they’re not working. 

While there were a lot of innovative ideas that came with digital health management for chronic conditions, the industry had flaws. The space is now collapsing on two levels. 

The first front where telehealth is experiencing challenges is employer burnout. For the past decade, many chronic condition management solutions sold to the market by going directly to employers. The HR leaders or employers who made purchasing essentially become mini health plan executives. In addition to their many other duties, they decided which digital solutions to roll out to their employees. Now around 81% of HR leaders are feeling burnout and don’t have extra energy to do deep research on which digital health programs work best. While these leaders are often talented and capable, they don’t usually have a clinical health background to make optimal decisions about healthcare on an enterprise level. 

When we look at what HR leaders want, we’re seeing the pendulum swing from customized detail back toward simplicity. They’re looking for simplicity of employee usage, simplicity of product administration, and simplicity of product pricing. The multitude of products and their complicated pricing structures are too disparate and complicated for HR leaders to wedge into their existing plans. Especially if the solution is only for a single condition, HR probably won’t deem it worth the time. Christina Farr has an excellent article that explains why HR leaders are feeling acute point-solution fatigue when it comes to health-tech solutions. 

From a trend perspective, the era of the point solution is over. The majority of companies in the chronic condition and wellness spaces are consolidating into a few big players. There used to be many different companies each offering a point solution; now, there are fewer companies, but they are offering management for multiple chronic conditions. Now, the era of the chronic condition management platform is here. When it comes to regional payers, HR leaders’ and employers’ new expectation is that insurance companies act as their single platform partner, providing optionality for bespoke offerings for multiple chronic conditions, not just one, while shouldering the burden of complexity.

Additionally, big players are starting to have their own homegrown or white-labeled programs. For example, United Healthcare’s clinical and disease management support programs or Aetna’s chronic disease management program. This fits in with the trend mentioned above with HR leaders experiencing burnout: HR leaders want to collapse vendors and work with fewer companies. A single vendor across chronic condition management is much easier for HR leaders to manage. 

The second level where the telehealth and chronic condition space is consolidating is in functionality. Pure-play digital health didn’t work. The model of “educate users and track data” wasn’t enough; patients needed more nuanced support. Many apps don’t effectively measure usage, and patients may not correctly interpret results. If a patient needs medication or needs dosage adjustments, an app focused purely on education and tracking can’t help. 

Many of the digital health products oversimplified treatment for chronic health conditions into a small checklist of educational modules and data tracking. To remedy the issues and bring up compliance rates, products in this space started offering expanded services beyond education and tracking to include elements such as:

• Social influencing
• Rewards
• Health coaches
• Wearables
• RNs who can do telehealth

Basically, digital health platforms have started turning into a medical practice that’s tech-enabled rather than software that’s supporting health services. At 3Pillar, we speculate that the services that digital health apps and traditional doctors’ offices will converge at a similar end-state. The most effective combination of services to help patients manage chronic conditions with digital health support needs to include human connections, a qualified physician, digital education, and habit tracking all together. 

Another trend that’s already shaping the future of digital health management is the Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA is a set of terms outlined by the US government that helps facilitate the sharing of patient information between entities. For example, TEFCA legislation facilitates data-sharing between doctors’ offices and insurance companies. Previously, you had to be a physician directly providing care to access patient health information. Now, with TEFCA, more entities can access patient data (as long as they have patient permission). 

This means that health apps and health insurance companies can get raw clinical data from health systems. The next-gen chronic condition management platforms could be able to access patients’ blood work labs and medical history. 

“Companies have had a reactive approach to digital health apps. For example, if a health insurance company offers a diabetes management program, a user might not know about it. However, the company also doesn’t know that the user has diabetes. Halfway through the year, the company sees a bill from an endocrinologist, diagnosing the patient with diabetes. Only then are insurance companies directly reaching out to patients about the diabetes management program,” said Steve Rowe, Industry Leader, Healthcare Portfolio at 3Pillar. “TEFCA could change that and enable health insurance companies to be proactive about offering support to patient groups, saving money for both the company and the patient.” 

In addition to TEFCA, another factor that will shape the future of digital health is AI. As AI continues to change the way companies work, a chatbot could be foundational to the future of chronic condition management. A chatbot could suggest and remind employees about digital health apps that are available or relevant to them that are covered by health insurance. To complement TEFCA data access, digital health apps could use AI to summarize a patient’s clinical notes and pull out relevant data to customize the app flow to a person’s individual needs. 

3Pillar sees developments in AI and TEFCA regulations reviving digital health platforms for chronic condition management, both in terms of adoption as well as compliance. 

At 3Pillar, we help healthcare clients manage, plan for, and optimize their digital healthcare solutions. To work through challenges you’re currently facing as well as future-proofing your business, work with 3Pillar. We offer application technology strategy, digital product engineering, and AI implementation guidance specifically for the healthcare industry. To learn more about how we can build a future for your platform, contact us today.