Several issues arise as the baby boomer generation (born between 1946 and 1964) reaches retirement age.

• Age-related health issues and associated costs (chronic conditions such as hypertension, cholesterol, diabetes, cancers, obesity, etc.) have begun to burden the healthcare system.
• This increased cost burden is depleting the Medicare funding which will eventually go bankrupt. There will be difficulty in funding the tax-funded Medicare program. So there will inevitably be an imbalance in the Medicare funding inflow vs. expenses, affecting the healthcare system severely in the coming years.
• Many healthcare providers and payors have begun to adopt digital transformation to reduce healthcare costs.

The triple aim framework, developed by the Institute for Healthcare Improvement, has been the core of many of these digital transformation initiatives. The three aims are:

1. Better healthcare outcomes

A successful digital health transformation initiative should result in better healthcare outcomes, such as a reduction in the need for emergency room visits, readmissions, and unnecessary surgical procedures and tests. Other outcomes could be reduced medication errors and provider-side errors. By providing preventative care and wellness education to the population and also by providing care teams for specific chronic conditions, the initiative should improve the specific measures of chronic ailments such as reduction in blood pressure, cholesterol, blood sugar, seizures, early detection of cancers, and other communicable and infectious diseases.

2. Improved patient experience/ better care

The initiative should improve the patient experience by providing coordinated and continued care via remote patient monitoring, telehealth, care teams, social workers, etc. The initiative should also consider the population’s social determinants of health to provide tailored care to better improve the cohort’s health outcomes.

3. Lowered costs

The initiative should demonstrate increased savings to the provider. For example, the initiative could use data and analytics to project cost savings of an effort before the actual implementation of the program. Another example is using population health data to provide need-based care to specific population cohorts, saving money. Other cost savings could be achieved by negotiating value-based care contracts with payers. Improved patient experiences and better healthcare outcomes will lead to more patient referrals and patients trying to stay within the network, which is cost-effective for the provider.

A fourth factor could very much indicate the success of a population health initiative – improved provider well-being. Addressing provider burnout and ensuring that physicians only practice what they are licensed for and not take up other duties could help physician adherence and acceptance of initiatives.

But what are the challenges in implementing these digital health initiatives and solutions? Here are a few:

GETTING BUY-IN FROM THE PROVIDER

The UI/UX of the solution should be such that it is easily usable by the clinical staff and should also fit seamlessly into the standard workflow.

DATA

In the case of predictive model-based digital health solutions, high-quality data is needed to train the models to reduce false positives and negatives and develop more accurate models. Efforts should be taken to conduct clinical trials or use real-world evidence or data to establish the validity of these digital health solutions.

ALGORITHMIC BIAS

There is a lot of algorithmic bias in designing and developing predictive models used in digital health solutions. Health equity parameters (Social Determinants of Health) should be a critical element in designing these systems so that everyone can benefit equally from their use.

FAST-PACED TECHNOLOGICAL ADVANCEMENTS

Some solutions, such as early warning systems, should be adaptable to fast-paced technological advancements. By the time a hospital has installed and familiarized with these systems, the system could go obsolete, and newer and much better methods could be available. This puts pressure on the hospital admin team and the rapid response team to be more adaptable to change.

LACK OF REGULATION AND REGULATORY GUIDELINES

Regulatory hurdles can delay the implementation and effective use of such solutions.

PRIVACY AND DATA SECURITY ISSUES

Healthcare data is subject to privacy laws, and the lack of following these laws well could lead to privacy and data security issues. Providers have the additional burden of ensuring these solutions follow regulatory, data privacy, and security guidelines.

If you are a consumer or a healthcare provider or a payor, which of the above challenges resonate with you?