Healthcare is Fixed! (Don’t Believe Everything You Read)

We’ve all seen advertisements with outlandish claims in our lives:

“Eat this every day and you’ll have six-pack abs.”

“Use our service and you’ll be 20% happier.”

“Make one wager and receive $1,000 in free credits!”*
*FINE PRINT: If you agree to lose $1,200 within a month. Restrictions apply. The house never loses.

You get the point. But in healthcare, making such claims can be dangerous due to the high stakes of patient care.

I get it, marketing is supposed to be creative, and it is supposed to entice us to act / buy / do something. With more digital startups and investors entering the industry with their Silicon Valley style exaggerations about incredible outcomes, they have the potential to harm companies and individuals who use these services. Some of the claims I’m seeing aren’t credible, to the point that if you were to believe the full accumulation of their marketing, you would assume they had not only solved healthcare for 350 million Americans, but also cured cancer, ended world hunger, and forged world peace.

That last sentence is facetious on my part, of course, but it boggles my mind as a physician when I read some of these white papers, slick one-page marketing documents, and ever-so-lightly-vetted publications. The results being claimed are rarely peer-reviewed, or only reviewed by people who also happen to work for (or are paid by) the company putting out the materials. Because I’m a nerdy doctor who always researches rigorously (as someone who used to crank out peer-reviewed publications and grants in a prior academic life), I can typically see through these claims, but I suspect many people without a science or research background may not have the time or training necessary to understand the spurious nature of these companies’ marketing collateral.

To give an example, I recently saw a venture capitalist on LinkedIn promoting that a portfolio company delivers employers a whopping 60% reduction in total medical costs.  This piqued my curiosity, since short of getting hit by an asteroid, not much reduces per-employer-per-month (PEPM) costs by that much.  The authoritative source that validated and published these outcomes?  It’s a large, publicly-traded benefits management firm that most likely serves as a channel partner – that is, they make money when they consummate a relationship between company and employer.

Because I use my spare time differently than most, I requested the report and read it. The results are for a small cohort of patients which were people at one employer who self-enrolled and received digital behavioral health services, compared to a “control sample” of employees who did not.   This method of analyzing data is notorious for introducing selection bias (i.e., people who volunteer are far more likely to report being engaged compared to those that don’t).  If I was a reviewer for a peer-reviewed journal, I would have rejected this study outright. (For the record, my reputation as a peer reviewer is not exactly as a hard ass.) To their credit, the company lists numerous peer- review papers, but almost all are written exclusively by employees and/or equity holders the company; the conflicts are not always disclosed, and most are online journals with low impact factors and questionable publication standards. Ultimately, my BS detector was blaring loudly on this particular report once I dug into the fine print of their data analysis.

The other thing that tipped me off was that even the most innovative health systems in the world do not produce these types of results.  The integration of behavioral with physical health care has been carefully studied.  One of the seminal peer-reviewed studies on this topic (from Intermountain Healthcare, where I served as Chief Medical Officer) saw a 5% reduction in costs.  In its Collaborative Care Model, Kaiser found that an integrated care model reduces costs by up to 13%.

I don’t mean to pick on this company since they are not alone.  This is a common issue throughout the industry.   Another clinical area that is receiving significant venture investment is musculoskeletal care.  I briefly reviewed some of the better-known companies in this space- one says they have saved $600 million+ (and counting), another claims to reduce costs by 80% (according to the for-profit “Validation Institute”), and yet another improves access by >15X.  Anyone who has ever spent time in a delivery system (or trying to consume health care) knows these results are not believable.

But it doesn’t have to be this way. There are models in other industries where for-profit companies and researchers collaborate to advance science and business innovation.  For example, the Duke Clinical Research Institute, now the world’s largest independent academic research organization (where I completed a research fellowship), was created to help pharmaceutical companies design, conduct, and analyze data from clinical trials.  They use established mechanisms for management, review, and publication of scientific data - this research has now been cited in over 760,000 peer-reviewed articles and led to the approval and widespread use of many drugs.

Specific to digital health, The University of California-San Francisco (UCSF) launched a digital incubator called UCSF S.O.L.V.E Health Tech, to advance partnerships between business and academia.   They partner with digital health companies to adapt, test, and evaluate products to better reach and meet the needs of diverse populations.   After successful validation of these technologies, CDHI collaborates with partners to commercialize and implement these solutions and report on results.

If you are a prospective customer or investor who is evaluating a digital health company, there are some simple steps you can follow to ensure you do appropriate diligence and not get swindled (I’ll be sharing more in an upcoming article).

In the meantime, my best advice is: if it sounds too good to be true, it probably is.  And if you’ve made it this far, 65% of you who read this blog will win the lottery by next year.**

**This is not real. Be sure to analyze this claim for yourself and don’t believe random percentages thrown out in blogs.