Healthcare delivery is increasingly moving away from the hospital and clinic and returning to community-based settings. But instead of the house calls and home births of generations past, patients are accessing a new type of community care: smart health communities.

Smart health communities, a term coined in a recent report published by Deloitte, lean on a set of smart technologies to foster a sense of community among patients with similar health goals or needs. These communities work to drive patient motivation and, in many cases, support chronic disease management or prevention.

“A smart health community is an entity that operates largely outside of the traditional health care system and encourages disease prevention and overall well-being in a geographic or virtual community setting,” the Deloitte researchers wrote. “The basics of SHCs have been around for many years but have evolved because of technological advances and a greater understanding of health behavior change derived from the behavioral sciences.”

Health communities have, in fact, been successful since before healthcare’s digital revolution. Community groups have launched different programs to support individuals who are working to achieve a health goal and who need to work toward that goal in between doctor’s visits.

At the YMCA, for example, the National Diabetes Prevention Program (DPP) has brought together different members of the diabetic community to encourage one another, provide support and motivation, and to help check and manage health metrics.

But in an increasingly digital age, these types of programs are no longer cutting it, the Deloitte researchers said. Patients are demanding a more digital support system, which has brought about the idea of a smart health community, according to Asif Dhar, MD, chief health informatics officer and principle at Deloitte, as well as one of the report’s authors.

“People's communities and their social interactions have migrated from physical settings to digital ones by their very definition,” Dhar said in an interview with PatientEngagementHIT.com. “The vast majority of our lives are now migrating to a digital experience and that is a reality of a community basis. And it has clear impact to consumer patterns and we've known that in the consumer industry.”

The advent of smart health communities has been propelled by the sheer power digital technology now has, Dhar noted. Take Metcalfe’s Law, which Dhar explained describes how a network’s value increases as more individuals participate, and Moore’s Law, which outlines how computing power has doubled every two years for several decades.

“In tandem, these two phenomena will likely allow SHCs to grow and become more sophisticated, interconnected, and influential over time,” Dhar and his colleagues wrote in the report. “As this happens, the impact of community-based health interventions could be brought to scale, while becoming more personalized.”

Growth in consumer technology use has been tangible, Dhar added. About 86 percent of the Medicaid population has a smartphone, and 69 percent of patients without any insurance can say the same. Smartphone adoption is nearly ubiquitous among those with employer-sponsored health plans.

“So the capacity for health, communities, and consumers to all start reorganizing behavior is incredibly profound,” Dhar noted.

And thus, smart health communities have established themselves as mainstays in the medical industry.

Specifically, smart health communities accomplish five things:

Drive patient empowerment and self-management
Foster a sense of community
Use health IT and behavioral science
Leverage health data to improve health outcomes
Create and improve health ecosystems

A prime example of the smart health community is the Weight Watchers program, Dhar offered as an example. What once was set up in brick-and-mortar locations for meetings now exists on a member’s smartphone.

“With the digital solution with Freestyle, wherever I eat, wherever I'm at, I'm being influenced by a social community around it with individuals,” Dhar said.

This approach beats traditional chronic disease management inside the doctor’s office. Previously, a patient working to manage or lose weight might be encouraged by his doctor to eat better. And while that patient may adhere to an improved diet for a week or so, it is difficult for them to wholly change behavior with limited health touchpoints.

The smart health community of Weight Watchers combats that situation by providing a space for continuous patient motivation.

And this high-touch, continuous model is poised to take over healthcare.

“Those things are now pushing people to move from a physical place to a completely digital place,” Dhar said. “These networks and organized services on networks are creating a revolution where communities can fight back against disease, where poor health and illness start.”

But smart health communities have hit a quagmire when integrating the provider. There is plenty of room for patients to integrate themselves into smart health communities. This can be as simple as joining a Facebook group for cancer survivors or downloading a fitness group app.

But doctors and other clinicians need to integrate these tools into their pre-existing workflows, something that has always been a tall order in the healthcare industry.

“A doctor absolutely wants their patient to be better and healthier,” Dhar asserted. “They want more people helping their patients become healthier and better. They will certainly have a reimagined experience with patients now that virtual health is becoming common.”

But integrating a new healthcare paradigm complete with an entirely different set of technologies is disruptive.

While high-touch technologies may not be disruptive in the way other health IT – think of EHRs or other digital reporting tools that have contributed more to physician burnout than eased it – technology is going to have a learning curve and take some getting used to.

“Physicians have this real opportunity at resetting the nature of their relationship with their patients by leveraging both virtual technologies and having the communities be an active role,” Dhar pointed out. “But now the community is one of the most powerful tools for a physician. They just need to learn how to use them.”

Specifically, doctors will have to adjust to a quarterbacking role, integrating into a team of community members. Doctors will still play a big role directing patients’ health goals, but they must also allow the team to do its own work.

Additionally, it will require clinicians to accept the role technology will play in their practices. Technology will require providers to reconfigure workflows, but that adoption will be inevitable.

True to what many in the health IT space have said, consumer demand will push technology adoption, Dhar explained.

Smart communities have been established in multiple walks of life, not just healthcare. And as patients come to rely on them – think of the number of Instagram, Facebook, or Twitter users – they are going to build health offshoots with or without their providers.

“It's true a doctor could say, ‘I'm not going to be in this space. I'm going to resist it,’” Dhar acknowledged. “But the behavior is completely disruptive in nature and people will start demanding a set of services that if you're unable to perform, they may not want to see you.”

Providers that do adapt to these changes will see positive returns, the Deloitte report added. Consumer loyalty, improved treatment adherence, increased access to care, and value-based care successes may follow integration of smart health communities.

“This is a real opportunity for state and local governments and federal governments to team with their counterparts across government, industry, and healthcare players all together to reinvent how we live and work and exist in health,” Dhar concluded. “If history is a good indicator, smart health communities will arise very quickly and be highly disruptive.”

Originally published in Patient Engagement by Sarah Heath on June 24, 2019

Tech Watch