“It came out of the Great Recession…”
This line from the director of the Penn Center for Health Care Innovation, David Asch, MD, MBA, gives his signature product’s origin a mythical air, placing it at a time that was turbulent for the United States yet, ironically, a boon for health care innovation.
Perhaps that’s fitting for Way to Health, an online platform designed to provide automated tech infrastructure not just for research projects, but also clinical care. In the same way that CAR T cell therapy has transformed cancer immunotherapy, Asch believes Way to Health transforms patient engagement. The platform’s start 10 years ago resulted from a federal grant — awarded to Asch and Kevin Volpp, MD, PhD, the director of the Center for Health Incentives & Behavioral Economics (CHIBE) — that was aimed at stimulating the United States’ Recession-stunted economy by investing in scientific infrastructure.
“We knew that caring for patients with chronic illness can require hovering over them, because they often need help managing complex regimens,” Asch said. “We were using research staff to connect with them daily, offering rewards for healthy behaviors or following prescriptions, but that was expensive and couldn’t scale. So, Kevin and I thought, ‘let’s automate it so we can do clinical trials more quickly. If it works, we can use it to treat patients, too.’”
Way to Health was built around behavioral economics, the science of understanding and harnessing the irrational tendencies everyone has and using them to improve outcomes. A central insight was that for all the excitement of new technologies — like fitness trackers, wireless scales, and electronic pill bottles — none fundamentally change behavior on their own. They have to be paired with a behavioral strategy.
“Fitbits alone don’t make you walk more, just like electronic scales don’t make you lose weight,” Volpp said. “It takes a engagement to change behavior, such as through incentives or social considerations. The new scales and pedometers just make it easy to measure success remotely.
Volpp says many tech companies miss that point, as if allowing someone to measure their steps encourages them to walk more, or that all you need to do is port that information to their doctor.
“That doesn’t correspond to how people think or how doctors practice,” he said.
It’s also too narrow.
“A lot of companies say, ‘I’m going to tackle diabetes management.’ And then that’s all they do,” said Mohan Balachandran, MA, MS, the chief operating officer of Way to Health within the Penn Center for Health Care Innovation. He came from the world of start-ups about three years ago to help lead the further development of the platform. “We are here for diabetes management. And we are here for weight loss and hypertension and maternal health. Catering to leading edge researchers forced Way to Health to be flexible enough to do anything. And although it’s a tech platform, it’s true engine isn’t tech, but rather practical insight into human behavior.”
Way to Health was designed to be one-stop shopping. For example, in a fitness tracking intervention, Way to Health can not only record steps, it can also identify potential goals, automatically communicate them to the patient, notify the patient’s doctor of the goals and whether the patient is achieving them, automatically determine a new range of goals personal to the patient, and even digitally dispense financial incentives as a reward for goal attainment. This coverage of every aspect of an intervention makes it much easier to guide patients toward healthier decisions.
“Way to Health’s bread and butter is tailored patient messaging and device integrations,” said Christianne Sevinc, MPH, a product manager at the Penn Center for Health Care Innovation. “New devices are coming along daily, so it’s easy to tweak with whatever the market produces. And adjusting the design of interventions is simple and doesn’t require developers.”
This is a long way from where things began for Laurie Norton, assistant director of research operations at the Center for Health Incentives & Behavioral Economics. The behavioral interventions she worked on featured a lot more effort on the back end, and some equipment you wouldn’t expect a health care researcher to need.
“I used to have a safe in my office for a weight-loss study with financial incentives that I ran with veterans,” she laughed. “I’d have to come in and open it up, count out cash, and hand it out. And that was a full-time job – with help from a research assistant – for 57 participants.”
Then in 2011, Way to Health was used in a study that offered incentives for lowering cholesterol – with 1,500 participants.
“It completely changed the landscape,” Norton said.
Studies could be managed extremely efficiently – two or three times as fast as before, Norton estimated. And the large trials that used to require multi-center coordination could now run just out of Penn. Her office safe quickly became obsolete.
But Sevinc emphasized that while Way to Health cut its teeth as a research tool, it is just as usable and potent in the clinic.
As of today, 150 trials or clinical projects — in all 50 states — have been conducted using Way to Health, with between 65 and 70 currently running. More than 60,000 patients have been enrolled. And some of Penn Medicine’s most successful projects, such as Heart Safe Motherhood and ERAP, have been supported by Way to Health.
“The research is mission-critical, but we also want to move more and more into the clinical space so that doctors can quickly create interventions and easily interact with patients outside the traditional clinical setting,” Sevinc said. “Heart Safe Motherhood is a good example of how this can be successfully deployed across the entire health system.”
Moving forward, Balachandran knows that interventions backed by evidence will be increasingly valued within health care. Way to Health is uniquely positioned to facilitate those, so he’s hoping to continue its growth in the clinic. The team believes the easy monitoring and messaging capabilities native to Way to Health could eliminate the necessity of many follow-up appointments, opening up more time for clinicians.
Born in a time of great change in medicine, Balachandran views Way to Health as a catalyst for another change: automating support for chronic care.
“Advances in health care to date have been very focused on physicians and the science of medicine,” Balachandran said. “Some of the barriers to improving health are social determinants and our behaviors. Way to Health's intent is the focus on the patient and aid in changing their behavior for the better.”