Why Many Digital Health Solutions Fail to Engage the Patients Who Need Them the Most — And What to Do Instead

By Scott Taylor

Digital health is a rapidly growing market of over $75 billion in total spending in 2020. From EMRs to implantable devices and consumer wearables, companies are betting big that the future of healthcare is digital and connected.

However, too often a health plan or healthcare system will invest significant resources to build an app, device, or online portal that looks great but gets minimal traction with patients. If there’s one lesson to be learned from the first wave of Digital Health it’s that “digital” and “engagement” are not synonymous and patients don’t engage with new shiny technology just because we ask them to. In fact, the number one challenge cited by US health plans in delivering digital health programs is a lack of patient engagement. Why is this the case?

Digital health entrepreneurs are not your average patient 

Digital health innovators are usually highly technologically literate or highly health literate. They’re the people who are excited to trial the new Apple Watch’s ECG functionality, or read the latest clinical research on intermittent fasting in diabetes. And, when you see the solutions they build, it’s clear they often think everyone must be wired the same way! 

Unfortunately, we know this isn’t the case. It’s well-established that low levels of health literacy and complex social determinants correlate with worse outcomes and a higher burden of chronic conditions. The high-risk patients who could benefit the most from digital health programs are almost polar opposites to those who design them. They probably don’t find the offer of more health information particularly appealing and aren’t that excited by the latest medical device.

We need to accept patients are human, not hyper-rational superhumans

There’s much talk about patient-centric care— yet the term “patient” implies an acquiescent subject. This ignores the reality that the most important agent in managing long-term health is the individual themselves. People are managing their long-term health 24 hours a day, 365 days a year, by the decisions they make about food, exercise, medication, sleep, and the frequency they choose to access care.

Yet we often design healthcare on the presumption that patients are subjects to be “acted on” as opposed to the principal actors themselves. We expect patients to passively comply with every single, complex clinical instruction, simply because we tell them to. And we are in disbelief when they fail to behave as hyper-rational superhumans!

In digital health, we make the same mistake and expect that because we ask patients to download an app, use a device, read a lesson plan, take a call from a coach, that they will. We build behavior change programs that rely on information, even though behavioral scientists tell us information alone rarely leads to real behavior change. We build remote patient monitoring platforms with beautiful clinical dashboards and sophisticated EMR integrations, yet design the app we expect patients to engage with multiple times per day as an afterthought.

We don’t need to reinvent the (fly)wheel

The irony of the engagement problem in digital health is that driving digital engagement is a solved problem. The most successful companies in the world, the ominously-titled FAANG (Facebook, Apple, Amazon, Netflix, Google), are all built on the back of high-engagement digital products.

These companies have demonstrated that driving habitual digital engagement is possible at scale across a wide-range of demographics, literacy levels, and technology acceptance. Whilst we might begrudge how they use that engagement, it’s hard to argue they’re not highly effective. So how would FAANG design a high-engagement digital health program?

First, they wouldn’t rely on the promise information or long-term health alone to entice patients to engage – that would be like Facebook creating a news feed consisting solely of vetted educational facts!

Instead they would use a diverse selection of behavioral strategies to drive an emotional response, not a rational one. The reward of exclusive Amazon Prime deals, the gamification of Apple Watch rings, the validation of Instagram is what keeps users habitually buying, scrolling, and engaged.

These companies also recognize that what works to engage one person might not be successful in engaging another. Safe to say, your Netflix recommendations are very different from mine. There is no silver bullet for engagement or behavior change, and people are motivated to engage differently. 

Digital health can’t afford to leave people behind

The people who need the most help to manage their long-term health are neither early adopters nor have access to the latest technology. But this isn’t just a health equity issue but an issue that threatens the entire viability of digital health.

The healthcare cost curve is steep and unforgiving. As a rule of thumb, 5% of patients account for roughly 50% of healthcare costs. If digital health fails to reach and engage these highest-risk patients, we’ll never be able to deliver on promised returns.

As we look to 2022 and beyond, we must do more than create more sophisticated technology. We must also find ways to deliver digital health solutions that work, to the people who need it the most. If Facebook can routinely engage over 2 billion people worldwide, surely we as an industry can build better digital tools to help people develop better habits to manage their health.

Scott Taylor is the CEO and co-founder of Perx Health, a digital health company that uses personalized behavioral science to deliver daily engagement and motivation for people living with chronic conditions. Members engage with digital health programs 4-5 times per day, consistently for over 6 months.