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Transforming the Sleep Industry

These days, there is no shortage of voices heralding the transformation of healthcare and the technology that will help drive that change. Often overlooked in such statements, however, is a fundamental truth: at its core, healthcare is a business of people. To transform healthcare you need to change the way people behave. Whether you're implementing a new technology or aiming to encourage a major process change, a change in behavior is necessary.

Here in the U.S., the healthcare industry has historically spent the lion's share of resources on the diagnosis and treatment of disease, rather than on prevention and follow-up care. Yet we know that investing in disease prevention can pay huge dividends, both socially and financially. Shifting the emphasis to prevention will require fundamental changes in behavior - for patients, for providers and for payers. Unfortunately, most healthcare organizations aren't prepared or equipped to inspire behavioral change on the scale necessary to have a significant impact on population health.

Waking up: Motivating Change in Sleep
The recent changes to healthcare have been dramatic and more are on the way. Much of the focus is shifting to providing the best healthcare at the lowest cost, with a particular attention to outcomes. Any efforts in healthcare are more meaningful if they achieve better overall outcomes for our patients, but it has to be done in the right way. So far, practitioners are being reimbursed for the outcomes they achieve. One example lies in the treatment of sleep apnea. Patients who do not reach a certain level of adherence within the first 90 days of treatment do not get reimbursement for their treatment device. The DMEs in particular feel the financial loss, while the physicians are left unable to address a serious disorder that requires long-term treatment. The problem with this reimbursement approach to the treatment of sleep apnea is that it assumes that practitioners create change in their patients. But patients have to create change in themselves. Outcomes are the direct result of patient behavior. Without an understanding of patient engagement, motivation, and behavior change, we will not effectively transform healthcare.

Glimmers of Hope
Some forward-looking healthcare organizations have achieved positive, sustainable improvements in health by employing a deep understanding of what motivates people to change their behavior and exploiting that insight with appropriate use of technology.

One such example in the sleep area can be found in a recent study performed by Philips Respironics and independently replicated by researchers at Walter Reed National Military Medical Center.1,2 Both studies focused on the role of patient engagement in positive airway pressure (PAP) therapy in the treatment of patients with obstructive sleep apnea (OSA). While PAP therapy is effective for treating patients with this serious sleep disorder, adherence to treatment has traditionally been low, leading to under-treated patients (and, as a consequence, refusal by payers to pay for therapy). Patient motivation is a key factor in adherence. How can we boost that motivation?

The studies looked at patients using a mobile, interactive smartphone app and related website developed by Philips Respironics that provide patients with information on their own individual adherence to therapy, along with tools and techniques to help improve compliance. Designed based on the latest behavioral science, the app automatically reports individual adherence information to the patient, creating a "progress feedback loop," keeping patients engaged and interested in their treatment through positive reinforcement. This feedback loop, however, is not simple. To be effective, it has to deliver the right information, to the right people, at the right time. It's not the quantity of information that initiates change, but rather the quality of that information.

Does such feedback improve patient compliance with treatment? The studies suggest that the answer is a resounding yes. In the Philips study, a retrospective study of approximately 15,000 OSA patients, those using the mobile app achieved a 78% adherence rate, compared to a 56% adherence rate among patients not using the app. The Walter Reed study, which included just 61 patients, achieved similar results and concluded that use of the interactive app was associated with improved treatment adherence. A 22% improvement in adherence to any therapy gets your attention.

These results demonstrate that technology can shape how patients respond to therapy by improving engagement and motivation and ultimately leading them to a better course of treatment for their condition.

It's About People
It's important to remember that technology by itself is just one piece of the behavior change puzzle. Simple apps alone are not enough. Meaningful, sustainable behavior change requires that we continue to expand our knowledge and understanding of the behavioral drivers behind patient engagement.

I'm fortunate to work with behavioral experts who have studied and published in this field for more than 15 years. They know what patients need to create change in their lives, which is the first step in preventing the progression of many diseases. Yet much of the healthcare ecosystem is still behind the curve.

Certainly, moving healthcare transformation toward a focus on prevention requires new thinking on everything from public health policy to reimbursement. But if we don't focus our efforts on understanding, inspiring and sustaining behavioral change, then we're not doing enough.


Mark Aloia is senior director, Global Clinical Research, Philips Healthcare.


References
1. Hardy W., et al, A Mobile Application and Website to Engage Sleep Apnea Patients in PAP Therapy and Improve Adherence to Treatment, Philips Respironics, 2014.
2.Hostler J., et al, An Educational Smart Phone Application improves CPAP adherence, SLEEP, Vol 37, 2014.

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