The March PHTI Report and What It Underscores About Digital Health Design

By Byron Crowe, MD Chief Medical Officer

A couple weeks ago, the Peterson Health Technology Institute (PHTI) released its report on digital diabetes solutions. Many media outlets picked up on its findings – and many digital diabetes tools contributed concerns with the findings. It’s a great reminder that strong academic debate rooted in evidence-based medicine remains a vital part of creating and refining any healthcare solution – particularly in the relatively new arena of health tech.

Like any good academic discussion, there are honorable people who disagree (sometimes strongly) with the methods and conclusions put forward by the report. A different approach might very well have drawn different conclusions, and the Peterson team rightly acknowledges the sensitivity of their analysis to reductions in A1c score and underlying assumptions about cost savings from changes in that score. All that’s to say – it’s wrong to view Peterson’s report (or any other singular work) as the last word in a complex and nuanced area like diabetes care.

However, I was struck by a few other observations in the report that didn’t come through in the subsequent news coverage – but which I think the Peterson authors really get right. These are not universally adopted truths across digital diabetes platforms – but they are central tenets of Solera’s approach to our platform design – one which spans eight conditions and applies the same logic to our curated networks of solutions for each.

Matching Patients to Solutions

This report underscores the fact that intentional patient selection is paramount to getting the most value – and best outcomes – from digital health tools. Solera has a unique methodology of matching patients to their best-fit solution based on clinical acuity. This allows us to carefully recommend programs only for those who stand to benefit most. In terms of diabetes care, Peterson’s report highlighted that by targeting patients with A1cs above 9 or those on insulin, value could be improved. What’s not captured in the report – but is reasonable based on experience – would be to also engage individuals with a new diagnosis or who struggle to understand their diabetes care plan. All of these are options on which patients can be better matched into programs.

Paying for Utilization (or Outcomes)

In addition, the PHTI report highlighted that payment models which reimburse for actual customer usage are higher value to payers. Solera couldn’t agree more. Our unique model uses milestone-based (pay-for-outcomes) billing across its programs, only reimbursing for services as they create value. We are currently the only value-based omni-condition platform – providing unprecedented accountability for both us  and our network of point solutions. This is a core element of how our customers know we partner with only clinically vetted, quality point solutions – and incentive to ensure consistent, class leading engagement initiatives.

Transparency in Outcomes

Finally, real-world, rigorous technology assessment is key to its refinement and/or elimination. Solera’s commitment to transparency of outcomes is reflected in both our reporting and payment models. Performance is tracked using a measurable biometric or psychometric outcome, and achievement of that outcome is collected and reported at the individual level. With full visibility into engagement and clinical outcomes, new approaches can be used to test and learn what works best in a given category.

The Peterson report ruffled a lot of feathers by taking aim at diabetes self-management tools. Frankly, those provide a somewhat easy target. Any clinician who has treated diabetic patients could predict that these tools were never panaceas and that maintaining good diabetes care is one of their most challenging endeavors. There are other areas of medicine where digital and virtual-first interventions are clearly demonstrating high levels of improvements in outcomes and cost savings, so the report shouldn’t be read as a hit piece on digital health writ large (although some are misinterpreting it that way).

It’s evident that this report is anything but a condemnation of well-designed, thoughtfully implemented digital health tools. It’s actually reinforcement that the approach we’ve taken as Solera is the right one – matching patients to solutions that provide the most value, paying for meaningful engagement and outcomes, and transparency in reporting that makes it unambiguous how any tool is performing among patients.

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