Saving lives through a digital nudge

Recently while mentoring a digital health start up that I invested in, the founder asked me a very interesting question. He was curious about the potential role/interest for pharma in the use of digital tools to hand-hold patients through their chronic diseases.

This is a very important question and one that fundamentally displays the difference between treatment protocols in the western world versus India and the way clinicians believe patients must behave in these two very different worlds.

In countries where there is a heavy burden of healthcare (cant think of one where there isn’t), doctors tend to adopt methods whereby patients of chronic diseases are guided and made capable of taking care of themselves outside the hospital/clinic where they spend a majority of their time.

While in the western world, patients are comfortable in a DIY (Do It Yourself) situation, in India probably they aren’t as much and expect the doctor to see them or talk to them or guide them frequently which is why doctors ask them to come over to clinics every fortnight or so.

Doctors in India also fear losing patients to other doctors if frequent face-to-face contact isn’t maintained. As a younger and more digitally-savvy generation grows up, this trend must surely shift. We get a whiff of such a change in preference, as more DIY apps and tech tools are increasingly being accepted. However, the shift is slow and gradual.

Now for pharma’s interest in the area.

In the western world, product differentiation isn’t an immediate problem given the monopoly that patents provide, but as patients engage well with digital tools Big Pharma sees a couple of benefits:

  1. RWE (real world evidence) data that streams in which allows deeper insights into disease prevalence, treatment and outcomes. This allows for identifying unmet medical needs which is very good info for R&D depts. Remote clinical trials have long been a major focus of pharma’s digital health efforts. These days, pharma companies are also increasingly eyeing artificial intelligence as another clinical trial game changer. Roche’s acquisition of Flatiron comes to mind as they get access to its real-world data across a range of tumours for research and development. While AI may be the future of clinical trials, mobile apps and wearables are rapidly becoming the present.
  2. The long view of pharma and digital is better tracking of patient outcomes to demonstrate the long-term value of therapies. As an industry, pharma has been under attack for the cost of drugs, especially for new classes of drugs such as gene and cell therapies and other breakthrough innovations. These treatments offer value to patients, but often come with a high upfront cost – or even a one-time cost in the form of a cure (Sovaldi, Zolgensma) – that payers are reluctant to cover. Many healthcare stakeholders do not yet understand how valuable these therapies are and cannot measure the costs avoided in the rest of the healthcare system.

In India, well, the lesser said the better.

Then, what would trigger behavior change and digital adoption for patients in their chronic disease management journey?

I think it has a lot to do with two things – awareness and convenience.

  • Awareness – Patients probably don’t take remote care seriously (except in extreme cases such as diseases that restrict movement or cause one to be bed-ridden). They still want a doctor’s guidance every step of the way as they see tech as impersonal. Hence helping patients / caregivers understand how to use the digital tool can lead to higher adoption. We have seen a certain degree of success in preventive healthcare as increased awareness has led to higher adoption. How willing are doctors to share medical information with patients or to empower them? We have seen signs outside clinics that dissuade patients from even Googling their symptoms!
  • Convenience – Digital tools must be convenient to use. The success of most tech company products is a direct consequence of how those products help to make a person’s life better and doesn’t do much to radically change behavior. Anything that slows down a patient or caregiver will be avoided. Also, people won’t pay for technology.

I think providing solutions that use currently available technology to solve patient’s problems in the simplest and least expensive ways are a good way to trigger adoption.

While these behavior choices, preferences and the nudge provided by digital tools towards a better and well-managed lifestyle may be valuable to patients, the question is, does pharma see value in them? Or is it still “my brand, my prescription and my share”? In India, that question is still a rhetorical one.


3 thoughts on “Saving lives through a digital nudge

  1. Salil, Thanks for bringing out some extremely important points. I couldn’t agree more. As times are changing, patients (and care-givers) would have to ‘take charge’ of their treatments. Technology (including digitisation of records) would help them immensely. As you said, some onus lies with physicians, too, to empower patients..
    And, the change has already started – I have experienced this, personally to a great extent, in medical implants field, especially for premium implants. The decision-making is shifting towards patients, so much, that it is believed that many therapies, in near future, would expand owing largely to self-referral. I am certain, this trend would catch up in the pharmaceutical field, as well, fast

    And the point about ‘nudge’!! Modern pharma-healthcare marketers, I am sure, are learning (and would learn from your wisdom as well 🙂 )


  2. Salil

    That’s well put. But I think we also look at why startups are failing in this regard
    1. They don’t talk about benefit story to patients
    2. They push product and heavy terminology with no personalisation or empathy for patient
    3. Outcomes are not promised as lot of these startups start pushing discounted medicines and tests eroding doctor and consumer trust.

    Technology will come and Indian people will adopt it when a startup works from patient perspective with only two goals in mind – outcomes and engagement. Sadly, most of them get attracted to large patient populations and try to solve it primarily from only tech perspective without understanding that it is healthcare business enabled by technology not vice versa.


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