Dr. Trishan Panch, co-founder and chief innovation officer at digital health management company Wellframe, discusses how mobile technology aids can improve heart health outcomes for diverse populations.
What are the reasons for heart disease to be more deadly among Black Americans?
“In 2018, Black Americans were 30% more likely to die from heart disease than non-Hispanic whites. Black Americans are also 40% more likely to:
“This can be attributed to a variety of factors, from genetics to behavior to access to health care. There are also unique issues that affect Black Americans:
- The environment in which people live
- Socioeconomic status
“Discriminatory attitudes and behaviours by individuals in the health care system may contribute to suboptimal diagnosis and management of cardiovascular disease among Black patients. This institutional racism leads to inequities in access to and quality of health care.
“For example, one study of cardiologists found that only about one-third agreed that racial/ethnic disparities exist in cardiac care in the US. Only 12% felt that they were in existence at their own medical institution.
“These social determinants of health require that we acknowledge the corrosive influence of history and the deep structural inequalities that drive these disparities. There is a tremendous amount of work to be done to address the role that systemic racism plays in health disparities.”
How does Wellframe’s digital health management app inform the programme?
“Wellframe’s platform addresses the two biggest problems with American health insurance: The patient experience, and the rising cost of care.
“During the clinical trial, researchers ran a 12-week study testing the impact of Wellframe’s digital health management app on patient outcomes. In the cardiac rehabilitation (CR) program, all participants underwent supervised exercise training and nutritional counseling. Cigarette smokers were also enrolled in smoking cessation counseling.
“The digital test group used the Wellframe app for the duration of the CR program. Through the app, participants had access to:
- Standardised educational clinical content, written and video content to support CR and comorbidities
- Daily step counts through smartphone accelerometer integration
- A secure two-way messaging system between the patient and program staff
- Surveys that screened for functional capacity, nutrition, and depression
“While participants accessed Wellframe’s capabilities through a mobile app, program staff monitored patient progress through a web-based dashboard. The dashboard enabled research staff to see patient activity in real-time and respond to digital messages.
“The study determined that CR patients who used Wellframe’s app showed a significant increase in program adherence and session attendance, across a racially diverse population (42% of which were Black). Individuals who used Wellframe had an 80.2.% completion rate of the programme (nearly double the rate of the standard group), and experienced slightly greater weight loss. Women and minorities also responded more positively to Wellframe compared to the standard group.”
Why do you think women and minorities have better patient adherence with a digital tool like Wellframe’s?
“There’s a misconception that higher-risk populations won’t engage with a digital platform. In fact, they’re actually the population most receptive to it. Our recent impact report found that higher-risk pregnant members demonstrated the most engagement with Wellframe, and engagement corresponded with the number of diagnoses a member had (gestational diabetes, preeclampsia, prenatal depression, etc.).
“It’s possible that greater interaction, personalised guidance, communication, and feedback that women and minorities received during this trial may have led to increased well‐being and motivation to complete the programme. This empowers patients, particularly patients who know they are at-risk, to take a more active role in monitoring their health. Material used during the program was also designed to reinforce the education provided by staff, covering topics ranging from understanding the physiology of the heart to goal setting and habit formation, safe exercise, and healthy eating.
“Content materials and videos were provided in both English and Spanish, which would explain native Spanish speakers’ engagement with the programme. By meeting members where they are and engaging them on their terms, care teams can forge meaningful, ongoing relationships.”
How can mobile solutions like this one be made more accessible to populations?
“Digital health solutions can start by expanding their language offerings beyond English. The lack of accessible translated information makes it especially difficult for non-native English speakers to understand their health insurance plan.
“Mobile solutions should also work to improve health literacy, or an individual’s ability to access, process, and understand basic healthcare information so they can make appropriate health decisions. People with limited health literacy tend to have higher rates of hospitalisation, are more likely to suffer from chronic conditions, and often skip important preventive care that can help lower the expenses of subsequent treatments.
“Alternatively, when patients are informed about their health conditions and treatment options, they’re more likely to be proactive about their care and understand why certain appointments or medications are necessary. Digital care management programs can enhance their literacy by improving accessibility to digital resources (such as by having a mobile presence), using plain language principles when developing content, and taking readability to the next level (ex: using medical terms instead of layman’s terms and avoiding abbreviations).”
Do you think mobile solutions and remote care can become widely adopted, post-pandemic?
“We’ve seen a massive rise in digital health solutions and remote care spurred by the pandemic. At Wellframe, we’ve found that on average 35 digital health management touch points are happening, per member, per month. A touch point is defined as a single message sent, a completed item in a daily health checklist, or a checked-off reminder.
“Wellframe’s Q2 impact report found that members who were the most engaged and compliant with their mobile care programs experienced a 36% reduction of subsequent inpatient admissions to the hospital and a 32% reduction in ER utilisation.
“Post-pandemic, we expect to see this adoption only increase as digital health management becomes more available through health plans and consumer attitudes embrace the ease and convenience of virtual care.”