Redefining Digital Health: The Keys to Patient Engagement

Dr. Kate Wolin is a behavioral epidemiologist, digital health entrepreneur, investor and professor. Following her academic medicine career at Washington University School of Medicine and Loyola University, Kate co-founded and served as CEO of ScaleDown, a digital health start-up that was acquired by Anthem, Inc. She then served as Chief Science Officer of a population health platform company and as head of product for Optum's direct-to-consumer business.

Dr. Wolin is an advisor to start-ups and enterprise organizations on bridging clinical and behavioral science with commercial product strategy and execution. Kate earned her doctorate at the Harvard School of Public Health and completed her fellowship training at Northwestern Feinberg School of Medicine. She is currently on the entrepreneurship faculty at the Kellogg School of Management at Northwestern. She has been named as a Forbes Healthcare Innovator That You Should Know and a Notable Woman in STEM by Crains. Dr. Wolin is a Fellow of the Society of Behavioral Medicine and the American College of Sports Medicine.

Sohum: Looking back to last year, what are your top three key takeaways on the healthcare landscape from 2023?

Dr. Wolin: I knew 2023 was going to be rough, but I was surprised by how difficult it was. We just hadn't seen the rebound we were hoping for – a little disappointing for both funds that are raising and the startups that they want to invest in. On the other hand, as someone committed to outcomes, the trend towards a bit more rigor in what we invest in is a good thing. Having worked with a lot of entrepreneurs and aspiring entrepreneurs, I can say that people in the healthcare space are committed to making an impact.

Impact of the Pandemic on Digital Health

Sohum: How has your view of digital health changed before and after the pandemic? What does the future hold?

Dr. Wolin: There’s an increased interest in outcomes. When we launched ScaleDown in 2014, we had a clinical trial behind our solution, and it was a nice to have, not a need to have. So many resources go into demonstrating outcomes in a real way, not a pseudoscience, white paper way. The market didn’t value that as much back then, but there’s a shift in how people are really evaluating company claims. And a lot of that is companies getting burned, putting dollars into something that doesn’t work. In the startup world, a unique pressure of the healthcare space is that first and foremost, we have to do no harm. ‘Move fast and break things’ and all those startup mantras only go so far.

Pioneering Digital Health - ScaleDown

Sohum: ScaleDown was sold to Anthem in 2017. What did the digital health environment look like at the time? What obstacles did you face?

Dr. Wolin: For the weight loss space, it was a totally different drug landscape. GLP medications work in a really different way and have launched a very different conversation. But back then, the idea of a behavioral wraparound was very new, and I think a lot of it was like we didn't know what we didn't know. In entrepreneurship, we talk about understanding the value proposition and the jobs to be done for your customer. And our pharma partners team not only understood the job for the consumer, but they really understood the job for the provider.

Our obstacles—I mean, we drank from a fire hose! They sent us 10,000 patients in the first three months. And as a startup, you're like, ‘Oh, my God, that's amazing!’ But we needed a lot of trust and communication to navigate that. Everyone kept saying, ‘This is a good problem to have, right?’ But as my counterpart said to me one day, ‘It's still a problem, we need to solve it.’

Another obstacle. One of the payers I talked to said, ‘Obesity is a huge problem, but it's not one of the three problems keeping my boss up at night.’ That's a big challenge in healthcare: there's no shortage of problems. And just because you're solving a real problem doesn't mean it's the problem your customer is losing sleep over.

Measuring Outcomes in Healthcare

Sohum: You talked about clinical outcomes a couple of times when discussing the pre-pandemic/post-pandemic transition. How do you define and measure these outcomes for digital health solutions? And how can purchasers start to evaluate these solutions as it relates to quality?

Dr. Wolin: I think about the buckets and the outcomes that people are measuring at different rates. For weight loss, clinically meaningful had already been defined as 3% to 6% body weight loss. I didn’t have to define it for the market. But that’s not always the case, it varies for different groups.

The other outcome that matters a lot in our space is engagement, and there’s no universal definition of what good engagement looks like. I think about causal pathways. If you never open my app, I don't have the opportunity to influence your behavior. I love that way of thinking because it pulls in a lot of other disciplines, like your user experience team. The bottom line is, to get to the clinically meaningful outcome, to change your diabetes risk or cancer risk or whatever it is, I have to get you to engage with my solution.

D2C Healthcare Model

Sohum: While one might assume that the healthcare industry is very consumer or patient centric, given the flow of dollars, it sometimes is not. And from your time as head of product at Optum's D2C business, how have you seen the healthcare industry embrace the D2C model? How is that impacting the product itself?

Dr. Wolin: You mentioned the flow of dollars around payers – there is no transparency. The healthcare system is opaque to most individuals. And if you're getting your health insurance through your employer is actually the one who makes plan decisions, and many of the people in that decision making process are not well informed. Of course, they're working with a benefits broker who's making a recommendation of how to structure your plan, but still, many of the people involved are not well informed. 

The real challenge is that there are a lot of entrenched interests that really don't want to bring consumerism to health care. So there's an interesting tension for me because I want to empower the consumer, but also the consumer is being bombarded with a lot of misinformation and it's only getting worse.

Patient Engagement Challenges

Sohum: As a behavioral epidemiologist, and with your focus on product, why is patient engagement so challenging?

Dr. Wolin: If you ask people, everyone will tell you that they care about the environment, right? But if you watch how people behave, they will not walk 10 feet further to put a soda can in the recycling bin. So we say things and then we do things – and that's the basis of a lot of design work.

One thing we get stuck on in patient engagement is that, say you're in the doctor's office. The doctor’s going to give you information, but do you really want that information right now? Especially bad news, things like risk factors. Not everyone wants to engage in that conversation because there’s a lot you're feeling in that moment of fear.

The healthcare system has historically been pretty condescending to a lot of people. We talk about wanting to meet people where they are, but we really don't. We don't approach people with curiosity and humility and validation that, yeah, sometimes it's totally fine to manage your feelings with Ben and Jerry. Not every day, but sometimes.

Implementing Digital Health Solutions

Sohum: You have experience working at the heart of digital health companies as well as health plans. What have you learned about implementing large scale digital health solutions? Are there any effective strategies to encourage payers to adopt and utilize digital health tools efficiently?

Dr. Wolin: Payers are very interested in digital health solutions, in anything that drives more effective and efficient utilization of healthcare. For all of the jokes we make about the payers, they are staffed by people deeply committed to improving health care for this country. But our healthcare system is the largest bureaucracy in existence. So there's only so much that those individuals can do. It’s hard. They're trying to reduce spending on healthcare, and recruit top talent.

Point Solution Fatigue

Sohum: The concept of point solution fatigue has been voiced repeatedly this year by employers, health plans, and even patients. Is there a right or wrong way to specialize care for targeted populations, without overwhelming them with solutions? 

Dr. Wolin: I don't think there is a right approach. And I think the other thing to remember is your employees don't always want you to know everything about their health. I don't think the benefits decision makers at a company know how many of the women at their organization experience symptoms of endometriosis or have an endometriosis diagnosis. It’s not top of mind, but it sure as heck is for the people who experience it. And that's a real tension because that employer is not necessarily going out to look for an endometriosis solution, to use that as an example.

So there's layers of that around trust in the decision maker. Is your employer the person you trust to get you navigated to the best healthcare solution? Healthcare moves at the pace of trust, and we need to acknowledge that.

Innovation in Digital Health

Sohum: What digital health companies are you most excited about?

Dr. Wolin: There's a lot that I'm excited about. I'm a science nerd. Sam Jactel of Ayble Health was a student of mine at Kellogg a number of years ago. He ran a clinical trial when he was an MBA student, because he was so committed to getting the data. That's really paid off. Now he has the data to back up what they're doing, and he can also use it to refine the product.

I'm really excited by what's happening in the women's health space. We have ignored the data and not paid attention to how women experience a lot of conditions, like heart disease. Understanding how solutions might need to be different for women is going to be interesting going forward.

I'm also excited to see where the behavioral health space goes. A lot of solutions coming out of that space are really fantastic. I work with a company that is really committed to great clinical outcomes, but also to addressing a problem we need to talk about more, which is how we treat our clinicians and providers, especially those that are experiencing burnout, and that some digital health companies are treating like commodities.

What’s Next for 2024?

Sohum: From an investor’s perspective, what are you looking forward to for the rest of 2024?

Dr. Wolin: I think we’re facing a value correction, and we just have to come to terms with it. Ultimately it's better for the market when that happens - we get the right valuations on companies. 

I remain excited about digital therapeutics. We haven't figured out the business model yet, but the commitment to outcomes in that space is really exciting to me, as is the philosophy that everything doesn't have to be solved with a drug, that we can actually engage people.

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