Something comes along every few years that promises to transform healthcare. The newest darling appears to be telehealth, which stepped into the limelight to address a crucial need during the COVID-19 pandemic. But a recent tweet by SCAN Group and SCAN Health Plan CEO Dr. Sachin Jain takes a sobering look at telehealth's effects with this meaningful invitation:

"Like" if you are exhausted by the "innovation" crowd that is perpetually hyping the notion that "tele-health" (a.k.a. Video visits) will save American healthcare from itself.

— Sachin H. Jain, MD, MBA (@sacjai) September 14, 2021

The responses to this tweet from insiders expose deep cynicism about telehealth's transformative capability. And this skepticism is not new. In a 2017 article in the San Francisco Business Times, Dr. Davis Liu said, "If the evolution of medicine in the next 5 to 10 years is still doctors on video, then we have failed." 

To be sure, telehealth was absolutely indispensable during pandemic lockdowns. It can often improve healthcare by making access to providers simpler and more convenient. However, telehealth can't truly transform healthcare because it merely represents incremental improvement rather than innovation.

No matter how you define it, real innovation requires a brand-new way of thinking. So, consider this: While telehealth modernizes the provider visit, what if we looked to digital health to change the very nature of care from "visit" to "continuous support"?

Think outside the visit

Provider visits — whether in-person or virtual — will always be a key component of good healthcare. Yet if one asks doctors the secret to better patient outcomes, most will respond with something like, "If only people would adopt healthier behaviors."

That's the biggest challenge we face in healthcare — and the reason why we can’t afford to conflate telehealth and digital health.

Providers can offer all the best advice, recommendations and resources to help patients. Still, even the most well-intentioned patients find it hard to change their habits once their doctor's visit is over and they return to all the vagaries of their everyday lives. Simply changing the site of care from a brick-and-mortar office to video does not solve this fundamental problem.

At the end of the day, telehealth is still a doctor's visit. It is still a periodic, synchronous, often quite brief, one-on-one event. Furthermore, it frequently lacks needed context.

People seldom develop diabetes, heart disease or any other condition solely because they don't have enough visits with their doctor. Health often happens as a result of numerous daily actions people take. Healthcare providers can guide those decisions, but ultimately, patient behaviors must change before outcomes will change. And the tools to influence those behaviors are, unfortunately, usually not available to providers. 

Digital health has the power to redefine how we think about care delivery within the context of people's everyday lives and choices. It can do more than alter the site of care; it can evolve the very nature of care by making it ongoing, scalable, personalized and multicondition. Digital health allows us to utilize a portion of healthcare value that cannot be accessed by either in-person or video visits alone.

Reimagine the nature of care

Most people acknowledge that the U.S. healthcare system accomplishes lackluster outcomes given its enormous expenditures. And most would agree that the answer to healthcare's rising costs and worse health isn't just more providers' visits. Instead, we must reimagine how to support patients in a way that unlocks high-value clinical care.

Embedding digital health into the patient experience can completely transform the nature of care by enabling something many providers have desired for decades: a way to support people in the kinds of daily decisions that impact outcomes. When digital health technologies deliver specific interventions to drive improvements in health, they are sometimes referred to as digital therapeutics.

As with most innovations, there is not yet broad consensus on how to define these concepts. But the Digital Therapeutics Alliance offers a useful working definition: "Digital therapeutics deliver medical interventions directly to patients using evidence-based, clinically evaluated software to treat, manage and prevent a broad spectrum of diseases and disorders."

In other words, care can occur continuously, or at the times that matter most in the lives of the people receiving it. As a result, these technologies can play driving roles in helping people make better choices where life is lived — such as when they decide whether to exercise or binge-watch TV, buy produce or pastries, meditate or pick up a cigarette. That is what generates potential value and elevates digital health above "creeping incrementalism" to true "innovation" status. 

There is no analog correlate for digital health. There is no "face-to-face version" of it. Rather than one doctor assisting one patient during one unit of time, digital tools allow the deployment of supportive relationships at scale. A single provider or coach can help thousands of people, and the users of these services can get the right, most helpful mix of digital and human support when and where they most prefer it.

For example, what if a digital therapeutics platform could identify which patients had previously set a goal to eat healthier at breakfast, but ended up making carb-heavy choices at breakfast this morning and now have high blood sugar levels? Within this group, what if there is a subset that prefers brief messages with a gentle-but-prescriptive tone, delivered in a specific channel with five or fewer alternative options?

Imagine the influence of a personalized message to each of them the following morning that says, in essence, "I see you had a hard time meeting your breakfast goal yesterday, so I thought I'd offer some healthful options you could try today. How else can I support you?" Although that is a very simple example, it quickly becomes clear that these interventions go far beyond what is possible in a discrete provider visit.

Fake 'platforms' abound 

As with all innovations, there is a significant caveat to keep in mind.

Dr. Jain accurately notes that telehealth is not going to revolutionize healthcare despite its benefits. In truth, digital health will not revolutionize healthcare either — unless it learns to integrate and become multi-condition to the point that it drives value for every stakeholder it touches. That includes patients, providers, payers and employers, as well as competitive digital therapeutic solutions.

These days, if everyone likes calling technologies "innovations," then they love calling their favorite technologies "platforms." Everywhere you look you encounter this or that "platform." But true platforms drive value for all participants — and by that simple standard, nearly every one of them fails to meet the threshold.

Platforms drive value for everyone. It's the reason you can download the Google Maps app on an Apple iPhone, for instance. Apple knows that the value of having a competitor's app on their phone outweighs the value of a totally closed ecosystem. Digital health can promote the same type of platform effect — but only if solutions work together to create value for everyone rather than their current approach of proprietary walled gardens.

If they can natively deliver data and intelligence to all stakeholders, even competitors, then compounding value emerges. Patients have information, health coaches and other tools right in their hands to adopt healthier behaviors in the moment. Providers have the data and intelligence necessary to help their patients become healthier and get reimbursed for doing so. Health plans can prevent high-cost services through lower-cost, proactive interventions. Employers can gain more productive and engaged employees at a lower cost. Other digital health companies can even grow faster by accessing shared value.

That's the real potential of integrated, multi-condition digital health.

Transformation through digital health 

There is ample room for more value within healthcare. Indeed, doctors are often as frustrated as their patients because they know it's hard to change all the daily habits that add up to good — or bad — outcomes. Telehealth is sometimes an incremental improvement over in-person visits alone, but it is still another form of synchronous doctor's visits.

Therefore, to unlock more value, we must re-evaluate the visit construct itself. We need to think about how to offer whole healthcare within the context of people's everyday lives.

Digital health and digital therapeutics take a radically different approach to care. Instead of one provider helping a few people with part of their health, digital therapeutics allow one person to help thousands of people in the ways that matter most to them.

No one solution has all the answers. In-person provider visits afford distinct benefits, as do telehealth visits. But highly integrated multicondition digital health can produce unparalleled value because it is scalable, can be delivered without regard to schedules, and relies on the devices people already use in the places they live and work. Constructed correctly, it can be integrated into existing care workflows. It enables personalized solutions to achieve superior outcomes at scale. 

If Dr. Jain is right about American healthcare needing to be saved from itself — and I think he is — it stands to reason that we can't do it by changing the site of care. We need to transform the nature of care, and digital health will be a key component of that transformation.

About the author

Dr. Omar Manejwala is chief medical officer at DarioHealth, a digital therapeutics company that offers solutions covering multiple chronic conditions including diabetes, hypertension, weight management, musculoskeletal and behavioral health within one integrated technology platform. He has an MBA from the University of Virginia's Darden School of Business, and an M.D. from the University of Maryland School of Medicine. Dr. Manejwala is board-certified in psychiatry, addiction medicine and medical management.