Digital Health has experienced a glorious boom in the last decade and is expected to reach $379.3 Billion by 2024 with 25% of the growth occurring between 2016 and 2024. Patient management can now be done on user-friendly platforms; physicians can remotely monitor their patients with mobile devices and telemedicine; and personal trackers and genetic testing are allowing patients easier access to their own health data. Clearly, we understand the kind of power technology has on improving the delivery of care and management of disease.
But what Public Health professionals have known for decades and what Healthcare is now catching onto, is that the real story behind who is healthy and who is not has little or nothing to do with the doctor’s office at all—the real story starts in the place you lay your head (if you have a place to lay it at all). The bigger picture and, therefore, the truly transformative opportunity is in the social, physical, political, and economic situation of each person—the social determinants of health. Leveraging tech for this more comprehensive approach to health is what we are calling Public Health Tech.
So what is Public Health Tech exactly?
Public Health Tech, as we define it, is any tech product or tech-enabled service that prevents the onset of disease or addresses the needs of medically vulnerable populations. It is a subset of digital health and sits at the intersection of Public Health and Tech.
In 2016, my co-founder Vanessa Mason and I founded P2Health Ventures, the first venture fund supporting Public Health Tech companies. We invest in early-stage startups innovating solutions for population and/or preventative health. We also look for companies who are addressing health inequities, are committed to diversity within their teams and among the populations they serve, and who are implementing evidence-based product development. Through our work, three key observations about Public Health Tech convinced us this was the future of healthcare.
1. An opportunity for more cost-effective, sustainable healthcare delivery
Public health spending had increased significantly from $39 per capita (inflation adjusted) to $275 per capita from 1960 to 2002, but a recent study has found that it has since been declining. Most of the increase in funding (approximately 80-90%) was a result of federal or local government spending. While the ACA in 2010 had originally committed $15 Billion in public health funding, it reduced that commitment by $6.25 Billion in 2012 and even further via sequestrations in 2013. Now with the new Trump administration, it is unclear how that spending will change, but if recent efforts to repeal the ACA are any indication, it is unlikely public health spending will see any relief in the near future.
We, therefore, find ourselves in a challenging position and simultaneously at an opportune moment. Traditional funding streams for population and preventative health interventions are more difficult to access. As payers seek better methods to manage patient populations without support from the public sector, many of these interventions are finding a home in the commercial market. Omada Health is one startup that has developed such an offering. Prevent, is a digital therapeutic modeled off of the CDC’s National Diabetes Prevention Program—a program that is proven to reduce the risk of developing type 2 diabetes from pre-diabetes by 58%. Its digitization allows for greater scalability and patient monitoring compared to conventional methods, making Prevent a cost-effective program for payers and health systems.
2. An opportunity to support a value-based healthcare system
Our healthcare system is changing. The shift toward value-based care has offered glimmers of the benefits of population and preventative health outcomes. However, most of the health technology on the market is still rooted in the fee-for-service model. While organizations like Medicaid ACOs, CBOs, and Medicaid Advantage Plans that serve vulnerable populations search for methods to improve the health of communities, proven population health programs are becoming a top priority.
Healthify, an early stage Public Health Tech startup, tackles population health by addressing the social determinants of health. Healthify enables caseworkers and social workers to refer patients to social services in their neighborhood. For many vulnerable populations, fulfilling a treatment plan can be challenging with unmet non-clinical needs (e.g. access to fresh produce, transportation, emotional and social support). Healthify’s platform connects providers to community resources that were difficult to access with traditional methods and addresses interoperability of health systems by integrating with Epic. More social support means lower readmissions, better treatment outcomes, and greater overall health.
3. The opportunity to address the right problems
As with any intervention, ensuring that the right question is being addressed is essential. The inability to identify meaningful problems within a target population’s social, physical, and political environment can render any intervention and its resources useless. Often in tech, the tendency is to develop the technology first and then attempt to fit it to a problem or create a problem altogether.
When wearables debuted on the market, the concept was easy to grasp. Wear the device daily to capture activity data to become more informed about your personal behavior in order to make healthier, more productive decisions. Awesome. Got the data—now what? Herein lies the problem. What do we do with the data and more importantly, why? How is this better than a $5 pedometer: Why does a user really want his or her personal activity data collected and analyzed in this manner? What is the user’s real psychological itch motivating them to keep wearing the device? How will it significantly impact their everyday life? How does it enable them to make better decisions, and sustain these positive habits over time?
Enter the public health professional, the healthcare professional, the healthcare economist, the clinician, and on and on. Much of the problem within health tech is that the people asking the questions were never trained on HOW to ask the right question. They are former engineers, business development professionals, or consumers turned health enthusiasts. While their skill sets are invaluable to operating a company and breathing fresh air into an industry as slow moving as healthcare, they can lack the behavioral science research training necessary to develop the right theses, or in other words, to define the right problem. What digital health and Public Health Tech needs now more than ever, are more healthcare and public health professionals building their lived experience into the product development process and guiding transformational innovation. Public Health Tech training should be built into academic curricula, professional training, and career development so that professionals feel prepared and empowered to seek new solutions. Tech has so much power to simplify and scale—let’s use it to fix the healthcare system.
Marquesa Finch, MPH
Marquesa is Co-Founder and Managing Director of P2Health and was previously at the Kapor Center for Social Impact and Kapor Capital, working on improving diversity and inclusion in tech through entrepreneurship.
Marquesa’s introduction into tech began after graduate school while working with a global health organization in the Middle East to leverage technology in the refugee crisis—a milestone experience solidified her dedication to digital health for social impact. Upon returning from the Middle East, she continued to work in digital health at Kaiser Permanente building their first mobile analytics program and, subsequently, at various digital health early-stage startups. She is an active member of the tech community, especially within groups for women and underrepresented persons, and in 2012, co-founded Movement50, a new leaders group promoting diversity and social good in Oakland and San Francisco.
Marquesa studied Art History and Biology at the University of California, Santa Barbara and earned her Masters in Public Health (MPH) in Global Health at The George Washington University Milken Institute School of Public Health in Washington, D.C. Marquesa is a Bay Area native, a classical pianist, and a former ballerina.
Public health officials have focused more attention on prevention than general practitioners have, and GPs more than specialists. That’s because these public health officials have seen differences in average longevity of more than 20 years between poor and affluent neighborhoods on opposite sides of the same city, according to the HBO documentary, “The Weight of the Nation.”
While the documentary mostly covers the obesity epidemic, it also shows poverty as a primary cause. So, part of curing our broken healthcare system must be to address poverty and the widening wealth gap, because that’s where the cancer grows. (See httpss://www.mhealthtalk.com/us-healthcare-system-has-cancer/)
Fixing the core social problems and providing universal healthcare will be difficult in today’s political climate, so I ask, “What is REALLY behind universal healthcare opposition? It’s the fear of helping ‘LOSERS’.” (See httpss://www.mhealthtalk.com/universal-healthcare-opposition/)
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