Addressing Quality in an Ocean of Healthcare Apps

By Matt Phillion

We’ve witnessed a digital health tool explosion over the past few years. Sped up by the emerging needs of the pandemic, a universe of tools has become available, and this has introduced a new problem: there are over 350,000 health apps available today, and that number is growing.

Consumers not only have a dizzying array of choices to make but are often shepherded into unique digital tools based on their interaction with healthcare—and reaching a breaking point where too much choice leads consumers to decision paralysis and the choice to not interact with those tools at all.

These applications can help with many pain points the industry is facing now, including worker shortages and burnout as well as patient access, engagement, and utilization of care. How does the industry address this point-solution fatigue to ensure patients are getting the best experience from their provider and their technology?

Consider the origin of the issue.

“There was a massive influx of capital, with a lot of attentive eyes at home on apps looking for non-physical, facility-bound ways to do things,” says Dave Dookeeram, chief operating officer at Pager. “As consumers, we looked to recreate that experience we had with every other industry into healthcare. And when you have a lot of capital you have a lot of ideas, good and bad, that come to fruition.”

Technology plus services needs to be intentional, Dookeeram says. With digital-only, you lack the ability to intervene and get meaningful return on your investment unless it’s connected to a meaningful ecosystem, he explains.

“Not only do we have 350,000 apps, we’ve got them with cute names that mean nothing, mostly disconnected from each other,” he says. “The same challenge the consumer has in the physical world has been replicated and made worse. The applications are immediately accessible, and think about the amplified confusion that creates, and the fact that you have to share your [protected health information] with another app, adding another layer of risk. And also, that app doesn’t have a complete picture of you.”

There’s a need to look to the payors and stitch together those wide-ranging pieces to create an environment that helps them understand their members, and helps those members navigate through the right programs and interventions.

“We need to tee up the right digital apps,” Dookeeram says. “It’s not just a page of logos the consumer sees.”

A page of logos for apps doesn’t tell the patient enough, Dookeeram explains. A colorful square with a clever name doesn’t explain the functionality and, with enough volume of options, can be a barrier rather than a help for consumers to navigate their healthcare journey.

“We need to think about a much more curated experience, where the plan knows about you and serves up a single platform that’s clinically curated,” says Dookeeram. “It’s about meeting the members where they are—where you can have a conversation and have it clinically validated. If you get a call from a patient in distress you can walk them through staying calm, get help to them and make an early assessment.”

The signal to noise ratio

There are parallels with what’s happening in healthcare and in other industries.

“If you think about what happened in the physical world, we made a lot of resources and endpoints available and that resulted in massive overregulation—and massive utilization and over-utilization. The pendulum swung back in to the point where there were significant restrictions on how can use what when. We’re doomed to repeat that if we continue to make 350,000-plus apps if we don’t start rationalizing and understanding the value,” says Dookeeram. “We really should be curating them in ways that are clinically appropriate, just like we do in traditional healthcare. We need to set meaningful use standards: for this technology, you must be this tall to ride the ride.”

Ensuring meaningful use can be a strong way to create guardrails during the proliferation of healthcare apps to avoid confusion, overutilization, and possibly wrong utilization.

The issue now is that we’re not seeing value, and healthcare costs are not going down with utilization.

“We’re seeing some niches. With one organization I worked with, we knew we had a return if we saw the patient in the home and prevented an ER visit. This would reduce cost and was validated by studies,” says Dookeeram. “We have utilization data that tells us when we ask: where would you have gone if you didn’t call us today? In my opinion we can wait around for the utilization hammer to drop, or we can think about it intentionally and curate an ecosystem that works with the member and doesn’t require 15 apps to manage their health so that it meets them where they are and provides the service they need in the moment.”

These apps don’t always have to connect with a clinician to be effective, he notes. A CPAP machine might connect to a health app or platform, or a Fitbit might note what time you are usually awake and active and note when there’s a change.

“What it comes down to in my mind is how do you create this digital wraparound without having a sitter following the patient around. I think that’s the path we have to intentionally take,” he says. “It has to be a combination of technology and services. If we attempt to do this direct-to-consumer or claw in through Amazon or Walmart, I think you’re going to have different outcomes. I like keeping it centered on doctors and nurses. We know how to measure safety and quality.”

Moving the needle in the right direction

To move this merging of technology and service in the right direction, the industry will need good public sentiment, says Dookeeram.

“Healthcare is too costly and confusing,” he says. “The framework through which consumers assess quality is compromised.”

Dookeeram points to the way patient satisfaction scores are often impacted by things outside of actual patient care because these are the things patients understand most.

“I remember in the hospital our patient satisfaction scores would get dinged because their toast was cold,” he says. “So we added toasters closer to the rooms and our scores went up. They didn’t care if their doctor came from Mayo or the nurses were all Magnet-certified. But they did understand what hot food tasted like, and that was their proxy for quality and they transposed that quality onto everything else.”

Patients are more and more voting with their feet, and this means that if they are not engaging with apps that are difficult to use, they’re not connected and less likely to be active users.

“Solutions are not powerful if they aren’t deployed right,” says Dookeeram. “Payors want it simple, and risk-bearing providers are trying to draw patients in and want to make it easy.”

On the regulatory side, there’s a push for plans to disclose which supplemental benefits are available and for plans to intentionally reach out to members who haven’t used those supplemental benefits.

“With all the spending on new shiny things out there, we’re starting to see the regulatory sphere motioning toward the right direction,” he says.

The future of healthcare apps

All indications are that capital is going to be come cheap very quickly, with a lot of pent-up capital on the sidelines, and this increases the likelihood things will get worse before they get better, Dookeeram says.

“I think we’ll see another proliferation in the digital health space. Add another 10% to that number as we see increasing pressure from the buyers of those solutions. The pressure to show use of offered solutions also means that if a solution is not demonstrating value, organizations won’t use them.

“There’s two opposing forces. New capital driving new companies coming off the conveyor belt, and some won’t be able to pull back. Then we’ll see the regulatory environment and the labor environment really impose limits,” says Dookeeram.

There are many areas where digital tools still have plenty of room to expand access to services—behavioral health, for example.

“The provider shortage is such that even if we want to reach the same network of providers, there are any number of apps going into that same network of providers,” says Dookeeram. “There are different front doors and we need to get them to go to the right door.”

Dookeeram foresees more confusion in the near term but great opportunity for simplifiers in this space.

“There’s a lot of fragmentation that needs to be addressed,” he says. “Without the right framework to evaluate performance we’re always going to go for the shiniest solution. I’m not saying we’re going to have a Joint Commission for digital health, but it wouldn’t surprise me. We could use the same utilization hammer we use for brick and mortar, but ultimately, this is a real opportunity to do something different.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.