Finding Digital Solutions for Multiple Sclerosis and Fatigue

This interview with Pablo Villoslada, MD, is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board. 

Dr. Pablo Villoslada is an accomplished neurologist with over 20 years of experience in translational medicine, bridging academia, biotech, and pharmaceuticals to pioneer treatments for neurological diseases. As a member of the Adhera Health Board of Advisors, Dr. Villoslada brings with him comprehensive expertise in drug development, from discovery through clinical trials to regulatory processes with bodies like the FDA and EMA. Dr. Villoslada’s experience extends to medical devices, including neurostimulation, bioinformatics, and machine learning. Beyond medical practice, Dr. Villoslada is a serial entrepreneur, founding and advising numerous biotech and MedTech startups in CNS and ophthalmology (Bionure/Accure, QMenta, SpiralTx, Attune Neurosciences, CLight, Adhera Health, NeuroPrex). 

What made you specialize in neurology? 

After finishing medical school, Dr. Villoslada was interested in surgery and medical conditions. “I was very passionate about science and trying to understand how the brain works, what is the basis of brain disease, and how to cure brain diseases,” says Dr. Villoslada. “This is the reason why I decided I chose neurology because I was interested in doing research and care for diseases of the brain. This was my main interest.” 

How has the field of neurology changed over the past 10 years? What areas have you seen the most change as far as treatments are concerned?  

Dr. Villoslada explains how the brain is more complicated and less understood than any other system in body. "For this reason, in the past centuries we have only made some progress." Now, he explains, advances in fields such as immunology and cardiology, have ushered in a golden era for therapeutics with respect to neurology. 

“For the last five years, we have seen a new revolution in neurology. And this is due to genetics, meaning the ability to genotype everybody, identify all the mutations now, now all the RNA technology that has been a revolution for vaccines and now is becoming a revolution for therapeutics for these genetic diseases, and to the level that we are seeing impressive improvements, even patients being cured with some of these genetic diseases; this is unique. We believed it was far away and now it's here. And finally, we are seeing now the beginning of a new therapeutic area for neurodegenerative diseases, meaning there is the first approval for Alzheimer disease, and there is a lot of research on new therapeutics for Parkinson’s, ALS, and all the others – in the next 10-20 years we are going to see a complete change in how we manage and treat patients with brain diseases.” 

What are the main differences between neurological and psychiatric disorders?   

“From my perspective, nothing. And I think that many of my colleagues agree, not everybody, because there is a tradition of psychiatry and neurology. The difference, in practical terms,” explains Dr. Villoslada, “is that psychiatry is mainly about positive symptoms of brain diseases, meaning abnormal behaviors happens, imposed ideation, delusion, hallucinations, these kinds of things. Neurology is about negative symptoms. You lose motor, sensory, speech, and other functions. If you see the damage to the brain, this is neurology. If you see nothing because of the technology, this is psychiatry.” Neurology relies on psychiatry; psychiatry can become more precise with neurological advancements. “Now, when technology is advancing, we have a better resolution, and we can see more things; for this reason, we are changing definitions of decisions.” 

As digital health technology and the use of digital health technology to promote and deliver post-diagnostic care and neurological conditions are becoming increasingly common, what technology and approaches are you seeing that help improve the efficiency and efficacy of neurological disease management? 

Dr. Villoslada believes applications that aid in disease diagnosis and monitoring are effective at improving neurological disease management. “Education, coaching, these are two activities that can be delivered through, let's say, apps, websites, and maybe other systems – digital health system – that are beneficial for the patient because patients are desperate to have information, especially to personalize the information for their own case. Otherwise, you know, you may see information about very severe cases, and your case, maybe it's not so severe.”

Says Dr. Villoslada. “In terms of diagnosis or monitoring the disease course? Yes. In some cases, data health can help to monitor decisions in which you have a readout. For example, you can, let's say have an EEG recorder: you can monitor EEG in the same way that you record glucose in your Apple Watch. Or motor symptom monitoring during Parkinson's disease: how fast you move, the tremors you have, these kinds of things. Or fatigue and ambulation, meaning based on the level of your activity and to some extent your mood, and pain based on physical and cognitive activity.”   

How important is it to address fatigue in neurological conditions and how can tools that support both mental and physical fatigue and self-management help? 

“Fatigue is very important in multiple sclerosis, in chronic fatigue syndrome, which is now called Myalgic Encephalomyelitis, post-Covid, which more or less is the same thing. And in some other diseases it's important, but not as important.”

Dr. Villoslada gives greater context. Someone might be experiencing increased fatigue “after a stroke” or due to Parkinson’s, but because of their severe disabilities, fatigue isn’t a prominent issue. “But in the case of MS, it is so important because people may suffer severe fatigue, meanwhile they don't have an obvious disability, meaning they're able to walk and to play sports. But the main complaint is fatigue, and they're usually younger than other patients with brain diseases, meaning that yes, fatigue is pervasive among many neurological conditions in some of them. Because of the population and because the level of activity or the quality of life impact maybe is more prominent. In terms of how to address that, we don't have any treatment that works for fatigue. Meaning the only thing that we can do is provide some information, advise, and train people to self-manage their own energy to live with fatigue.” 

Have you worked with patients with MS or other neurological diseases who have used tools for self-management? And what is your experience with how that helped with fatigue for some of the conditions you’ve talked about?   

“You know, in the case of fatigue, most of the time I always refer patients to the National MS Society, or any MS society in each country because they provide information and advice. This information includes some PDFs or some other material that explains to them how to self-manage fatigue. Whether they're using apps or digital solutions, for that, I haven't seen this too much.” As Dr. Villoslada explains, people with MS are generally “more active on the internet or searching for solutions, meaning that if something is there, they’re going to be the first ones trying it. But I haven’t seen a single solution that everybody’s extremely pleased taking.” 

In clinical care, how important is it to have greater precision and more personalization of neurological disease treatment?  

“The first thing is efficacy in neurology because we in general don't have treatments. You know, in the case of MS or in the case of stroke, efficacy now has increased quite a lot. Meaning this is the time to discuss personalization and accuracy. But because we are talking mainly about MS. Yes, in this case, the treatment we use – some of them have adverse events, side effects, maybe they're expensive. With most of the drugs, they are not personalized, meaning you provide the same doses to everybody's therapy regimen. And we cannot predict these side effects, meaning that in this sense, any personalization is going to be very welcome by the patients, because this is going to help to improve their quality of life.” 

How important is it to support the family caregivers of individuals with neurological conditions like MS and especially caregivers of children with these conditions?  

“First, I will divide between pediatrics and adults. Of course, in pediatrics, the parents are everything, meaning you need to truly work with the patients and the caregivers altogether at the same time, at the very beginning.” Dr. Villoslada continues. “In the case of adults, caregivers are important because most of the disease produced disability, and so later the patient, is going to be depending on the caregiver… But this is something that you need to do early, meaning don't wait until your fifties.” Managing MS causes a lot of strain on relationships and is an extremely difficult road to try to take alone. “In the past, they used to say that 40% of patients are alone and they don’t have a caregiver anymore. Ok. We’ll have somebody help, meaning social services or MS societies, or something. This is the reason why working with the caregiver, with the partner in this case, for adults is important.” 

Why did you choose to be a member of the Adhera Health Board of Advisors?  

“Because I was very interested in digital health. Because I believe this is a technology that can provide useful solutions for my patients to improve their quality of life. And especially because of the level of personalization: the fact that Adhera Health uses this artificial intelligence system to develop these recommendation systems is something that I think is unique, and I haven't seen with other data solutions. I think it will be perceived highly by patients with MS.” 

Why Evidence-based, Integrated Digital Companions are the Future of Mental Healthcare

This interview with Rosa Baños, Ph.D, is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board. 

Rosa Baños, Ph.D., is the most recent addition to Adhera Health's esteemed Advisory Board. A full professor of psychology at the University of Valencia, Rosa acts as the Director of the master’s program, “Multidisciplinary Intervention in Eating Disorders, Personality Disorders, and Emotional Disorders.” She has dedicated her career to the study of human psychology & disorders; her expertise is invaluable at Adhera Health as we address the bio-psychosocial factors that affect individuals afflicted with chronic conditions. 

What are some of the most pressing global mental health challenges that you see happening today? 

“There are really many, many challenges for this century,” says Rosa, “but if I have to choose two, I would highlight two that I think are very important. The first one is the access to psychological treatment.” Everyone deserves access to psychological treatment. “That one is a very important challenge. And the other is the prevention of mental disorders and the promotion of mental health.” As she explains, access to mental health care is a significant problem for people in both underdeveloped and developed countries. The barriers that exist are not only financial; a lack of healthcare infrastructure, limited numbers of health professionals, and “stigma” are all factors that limit an individual’s ability to get the care they need. 

“I think that another important problem is the increasing prevalence of some mental health disorders, especially depression, anxiety, substance abuse; the figures are really very alarming… the all-around stigma surrounding mental health sometimes prevents people from seeking help and hinders their ability to receive the appropriate care.” 

“And also, I think that treatments must be accessible, but also, we need treatments to be more available.” As Rosa explains, “That means we need greater integration between mental healthcare and primary healthcare, and also not only in the healthcare system but also into the daily life of the individual.” 

You mentioned access, could you talk about that a little bit more, is it a lack of access? Is that what you're referring to? 

“Yes, I say that because at least in Europe, more than 60% of the people with mental conditions don’t receive the appropriate treatment – we are talking about the first world, and we are talking about almost two-thirds of the population.” 

“I always say in conferences or even to my students, imagine that if we are talking about another problem, imagine we're talking about oncological problems, for instance, saying that we have evidence-based treatments. We have effaceable treatments for this medical condition, for instance, diabetes or cancer – but almost two-thirds of the population are not receiving this kind of treatment. Within that, what is happening? It is really a very big problem.” 

“And of course, sometimes it's because individuals don't know it is possible to recede this kind of problem. Sometimes people think that mental problems are something you must live with. You think that it's something about your weakness, it's not something that you can cope with in a successful way. This is one reason, of course. And of course, stigma is also another reason.” 

As for the solution, Rosa points to the need for a more flexible mental health care system and suggests a critical reevaluation of our current treatment delivery methods. She cited a paper from 2011 that echoes her belief, explaining that even if we increase the number of mental health professionals fivefold, we still won't reach all the people in need. 

 “And they say that this is because our mental healthcare system is based on a one-to-one system. You know, one professional, one patient. Maybe one family, maybe one couple, maybe one group, but not more than that. So, we need another kind of treatment delivery because only one-by-one, it is impossible to achieve and to reach all the people in need.” 

You've mentioned the difficulty of the one-to-one approach in mental health treatment. With the rapid advancements in artificial intelligence, do you think AI could potentially play a role in scaling individual mental health care? 

“It's a very complex question,” Rosa notes that AI can perform certain tasks with great efficiency. “If you need some [specific] information for instance… artificial intelligence can be a very good answer.” But to Rosa, AI is a tool, and updating systems doesn’t mean replacing human beings. “The answer is not technologies substituting psychologists, psychotherapists, or psychiatrists. The answer is complimenting both. That's the point.” Nowadays, as Rosa explains, when you’ve got an issue with your phone bill and you call the phone company, “you want a human on the other side of the conversation.” What seems uncertain is if there will come a day when we won’t mind asking a robot for help, and how long that might take. “I don’t know how artificial intelligence will develop in the next five years; I think it’s very difficult to envision how the future will be in this aspect.” Fortunately for us all, Rosa still has faith in human beings, at least for now, “I think at this very moment we still need humans.” She laughs. 

What do you think about the ways in which digital technologies (i.e., Calm or Headspace) are currently used in clinical practice to understand the mechanisms underlying mental health disorders? Are they providing meaningful mental wellbeing support? 

One of the advantages of digital technologies is their ability to promote accessibility, “for instance, with mobile technologies,” which have the potential to “make mental health resources more accessible to a wider population.” Practically all it takes these days to receive up-to-date health education is an internet connection, says Rosa. “The interconnection of treatments in daily life is very important; at this moment we have the model that if you have a problem, you have to go to a doctor's office or a hospital to seek help.” Rosa believes that emerging technologies have the potential to shift this model to one that provides individuals with greater context for their health. “This care model will change,” says Rosa, “we are in that moment.” 

These sorts of digital technologies have the advantage of “reaching many people and they are able to collect a large amount of data,” says Rosa. The bank of data helps clinicians and researchers to “gain insights regarding the underlying mechanisms of mental conditions. At this moment, we can monitor our patients in real time. We can track their moods, their behavior, and their physiological responses in real time. All this data contributes to a better understanding of the factors that influence mental health and wellbeing.” 

One problem that Rosa sees with many of the current mental health applications on the market is that they aren’t necessarily evidence-based – “they cannot fulfill the things they promise,” she says. “Most of them are designed by a well-intentioned engineer, but one with not a lot of knowledge about psychology because sometimes people think that psychology is common sense.” Rosa thinks these sorts of applications can be damaging. “Many of these apps or digital interventions don't have research data evidence behind them. And that is very dangerous.” These sorts of applications lacking proper evidence can break people’s trust, says Rosa. “The market, it’s very quick… even the digital advances are quick.” It’s true that it can take time for regulations to catch up to the science, Rosa explains. “It’s not easy.”  

Adhera Health hasn’t developed mental health-specific applications unlike other similar companies; we embed mental interventions within interventions for certain specific conditions. Do you think it would be more effective to have a separate application that would function solely as a mental health application? 

“I am more in line with integrated care,” says Rosa. “We cannot consider health without mental health. So, from this perspective, care must also be holistic and integrated. It's not, this is for my physical wellbeing, this is for my mental wellbeing, and this is for my social wellbeing. No, I think the social aspect, the psychological aspect, and the medical aspects must be integrated and interconnected.” Because their condition varies over a long period of time, individuals afflicted with chronic conditions must follow an adaptable program. Psychological support, Rosa notes, is an important aspect of such a program. Rosa understands the perspective of the physician; that they may feel they are only responsible for the department that they are an expert in. However, as Rosa explains. “It’s the same department. I am one person, and everything is impacting me.” Holistic care requires a level of integration. 

How would we engage in this integration in a way that would be more supported by clinicians, as they are ultimately the ones familiarizing patients with these new technologies? 

We need to hear from clinicians, explains Rosa. “They also have their own needs, worries, concerns, and limitations. Sometimes it’s a problem of training… I, a psychologist, always say that we work from a biopsychosocial perspective. I can't understand inner illness without taking into account the social factors, the psychological factors, and the biological factors.” As Rosa explains, an integration of different disciplines is necessary and challenging, but emerging technologies pose an interesting solution. 

How would you describe the difference between mental health and mental wellbeing, how are they interlinked? 

“Well, mental health is a broader concept that includes mental wellbeing. Currently, in clinical psychology and psychiatry, we recognize that mental health has two dimensions: one refers more to the pathological aspects, including mental disorders; the other refers to wellbeing in terms of flourishing and personal growth. And these are two different dimensions, two distinct dimensions. Just not feeling well does not necessarily imply having a mental disorder. Of course, these are two dimensions that are closely related and correlated, but they should be promoted separately.” Understanding the difference in these terms can offer us a “more comprehensive” understanding of our own psychological state. “It’s recognized that mental health is not the absence of illness, but also the presence of positive factors that contribute to our optimal functioning. We need to prevent mental conditions. And this means to identify and to cope with risk factors, and also to have access to appropriate treatment and intervention.” 

Rosa explains that we must be “fostering environments that support and care for people with mental conditions.” We must be promoting mental wellbeing, focusing “more on cultivating positive emotions” and building resilience through “positive relationships.” It isn’t just about avoiding risk factors, explains Rosa, it’s about creating a space to harbor sustainable personal growth, accountability, and commitment. 

Why did you choose to be a member of the Adhera Health Board of Advisors? 

“Why am I an advisor? Well because you were so kind.” Rosa laughs, speaking to the CEO of Adhera Health, Ricardo Berrios. “But really, I know the work you have done, and especially your sensibility to research.” For Rosa, an evidence-based approach is absolutely crucial. “I know a lot of digital companies that are developing apps very quickly for different things, and they're not interested in evidence. They're not interested in research.” As Rosa explained earlier, this can be dangerous. “For me, it's very great to work with people that are so responsible and so committed to ethics... this is a very important field,” says Rosa. As we all age, and as the average lifespan increases, addressing the chronic condition problem will become increasingly important. Rosa is proud that Adhera Health is addressing the problem with due diligence and passion. “I think it will be a successful future.” 

Building Around the Individual, Not the Disease – Part 2

This interview with Jonathan Anscombe is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board.

Jonathan Anscombe is the newest addition to Adhera Health's advisory board. Jonathan spent an impressive 30-year career at Kearney, the leading global management consultancy firm. As the former head of the Europe and Middle East healthcare practice at Kearney, he guided major healthcare and global pharmaceutical companies on topics related to digital transformation, digital solutions, product launches, and service redesign.

Jonathan's expertise further extends to areas including population health management, healthcare payment and delivery, system reform, and the social determinants of health.

In this second part of the interview, we continue where we left off in Part 1 and explore the importance of digital health personalization and evidence-based solutions. 

True Personalization and Differentiating Between Existing Digital Health Solutions

“One thing that I think virtually all of these [digital health] applications have struggled with is true personalization.” In the past, Jonathan had done research on compliance and whether people miss their medications. “Somebody who forgets to take their Atorvastatin on Saturday morning will also forget to take their cancer medications on Saturday morning. It's not a function of pill, it's a function of person.” Medical non-adherence for patients with chronic conditions is well-documented; studies indicate that a high rate of non-adherence (~40-60%) exists among patients with chronic conditions.

“Adhera has a particular capability around fatigue… which virtually nobody’s talking about, yet it is a function of many of these [chronic] diseases, particularly the more acute ones, cancer and some of the autoimmune diseases, and a major driver of non-adherence.”

As Jonathan says, a comprehensive approach across multiple conditions is necessary for these applications to find success. However, he feels that a lot of the current digital health applications miss the mark. “I think quite a lot of the applications are very focused on the clinician interaction, and that's great, but they miss out on the carer. And those carers can be parents when the patient is a child or young adult, they can be children when patients are older, they can be spouses, they can be colleagues or other health professionals.”

There is great importance in engaging those “nearest and dearest in the care of that individual. It becomes absolutely central that the caregivers and loved ones are engaged in that process. And I will speak about this from a very personal experience with both my parents.” Jonathan has seen firsthand that there are no current technologies that focus on caregivers, “I mean nothing…The only time I've ever felt myself starting to struggle with mental health issues is when both my parents had dementia, and sometimes the pressure on me and my family was unbearable.”

Adhera Health’s focus on supporting caregivers is a piece of the comprehensive approach that is excites Jonathan. The “ability to handle complex comorbidities as well as issues related to the patient’s specific context comes out naturally because with Adhera we are building around the individual, not the disease.” The evidence is there,” explains Jonathan, “there are numerous studies that you could refer to in terms of the importance of these relationship factors, yet there isn't any kind of solution that is able to address them head on.”

Breaking From Traditional Models

“We know that we can reverse diabetes, even those who have progressed to requiring insulin, with behavioral change, with increasing exercises supplemented with a protein-rich diet, with the right mental health support. Type two diabetes is recognized as a disease of inappropriate behavior and addressing that behavior can resolve the disease.” What is less known, explains Jonathan, is “the fact that you can have much better outcomes across a wide range of diseases, cancer for example, if people have the right mindset and mental resources.” Most leading clinicians will accept that certain diseases are behaviorally based, “what is not yet been so clearly understood is the importance of those same factors around other diseases.”

Jonathan references the microbiome research of ZOE, a UK company that analyzes an individual’s gut microbiome, blood fat, and blood sugar responses to generate a dietary plan that is ‘tailored to your biology.’  Regulating microbiomes has a huge impact on a wide range of diseases. “There are these emerging areas of science, but still much of the medical profession is quite traditional, focused on the apparent problem and not taking account of more holistic issues”.

“I'm not sure that every clinician is convinced that engaging people in their own healthcare is really important for a health outcome. You're always going to have skepticism because with limited resources there is a huge pressure to process people as quickly as possible to move on the next patient.”

This is why it’s so important to provide incontrovertible evidence that a solution is both clinically tested and cost-effective. “I did a little work some time ago for the mobile phone industry,” says Jonathan, “it was called mobile health: ‘Who Pays?’, and the basic essence of it was: look, if we can prove that better patient engagement, leads to better health outcomes, leads to lower costs, then what you need to do is talk to the person who pays the bill. That is not usually the clinician.”

“The relationship between the patient and clinician is often quite transactional. The person does not exist before they walk into their consulting room. And [they] no longer exist the moment once the intervention and follow-up is complete. Now, for diabetes, it’s different because they are going to have the patient for the next 15 years.  In contrast, “for an orthopedic surgeon repairing a knee, the treatment process lasts for a few weeks, and that's the entirety of the relationship.”

“So, there's a real different mindset here, you know, and if you're going to have a successful business, it's well worthwhile not predicating that on changing the medical mindset because it's kind of going to take quite a long time.” Jonathan says, laughing. “But, what you can do is you can think about ‘what evidence do I have that this is effective, and over what timescale?’ Who ultimately has the financial interest in this being effective? So the question is: am I selling to an insurance company or to a hospital? And I'm probably selling to the insurance because they're the people with the long-term interest.”

“However, probably the most important actor in the long term is the patient. If the patients like a solution so much that they prepared to take that into account in their choice of health plan or health provider”.

“So, anybody providing solutions to address these longer-term health outcomes needs to work at multiple levels. They need to persuade the treating health professional that the solution delivers better health outcomes without unduly increasing their workload. The solution needs to make commercial sense to the person who's got a financial interest in keeping this person healthy for a long period of time, which is generally the insurer; though I said, the problem with an insurance system when you move around is they often don't have a long-term view. And finally, you need to have a solution that is valuable to the patient who will then say, look, this has been helpful to me, and I'm not particularly interested in working with somebody who doesn't continue to provide that to me.”

Building Around the Individual, Not the Disease – Part 1

This interview with Jonathan Anscombe is part of a larger series of interviews where we discuss the intersection of healthcare and technology with subject matter experts from Adhera Health’s Advisory Board.

Jonathan Anscombe is the newest addition to Adhera Health's advisory board. Jonathan spent an impressive 30-year career at Kearney, the leading global management consultancy firm. As the former head of the Europe and Middle East healthcare practice at Kearney, he guided major healthcare and global pharmaceutical companies on topics related to digital transformation, digital solutions, product launches, and service redesign.

Jonathan's expertise further extends to areas including population health management, healthcare payment and delivery, system reform, and the social determinants of health.

In Part 1 of this interview, we explore global healthcare system challenges, the management of chronic diseases, and the role of digital health solutions as a bridge between patients, payers, and providers.

What do you think are some of the most pressing global health challenges that you see happening today?

“Global health challenges vary somewhat depending on the wealth of the country. The majority of the world's population doesn't even have access to what we in the developed world would regard as any kind of basic healthcare. Infectious diseases is still a huge problem and a quarter of the world’s population still does not have access to clean drinking water. Tuberculosis is endemic in much of the developing world.”

“In the developed world…. the biggest burden is chronic disease, particularly associated with obesity.”

In the U.S., the CDC has found that chronic disease accounts for seven out of ten deaths each year; chronic care treatment represents a massive expenditure of health care costs. Looking to the future, Jonathan believes Alzheimer’s and Dementia pose a great burden to global healthcare systems. “I don't think I have seen any country really come up with a view about how it's going to deal with that.”

“Things like cancer and heart disease maintain a big share of mindset and a huge amount of expenditure, particularly in the U.S. And rather surprisingly, there seems to be more progress being made on cancer, particularly with RNA vaccines, potentially than dementia, though some of the latest drugs are promising.”

What technologies have you seen over the years that truly address the health challenges you mentioned?

“The technologies in the developing world, I think, are probably in many ways more interesting than in the developed world.” Because of a shortage of healthcare professionals in the developing world, “simple applications, for example, basic health information around preventing infant mortality, the leading cause of mortality in poor countries, can have a dramatic impact on the lives of people.”

“In terms of the developed world, I think most of the big technology-driven breakthroughs have been in diagnostics. Scanning technologies and genomic profiling of cancers for example. Diagnostic AI is starting to have an impact. Obviously, we've got really interesting stuff about gene editing coming through, but it's still massively expensive and a long way from mass deployment.”

“What we haven't really seen yet is the widespread use of technologies for remote monitoring and patient support, despite solutions being available for a long time. There are all sorts of reasons for that; difficulty in proving effectiveness, reimbursement and payment systems, patient attitudes, and vested interests. So although there are a lot of technologies around that [remote monitoring], their uptake is probably not as high as you would've thought given the technology base we have.”

What are some of the common mistakes health insurance organizations made when they were trying to transition to digital health technologies?

“There are similar challenges in virtually every healthcare system. One of the most significant barriers has been the nature of proof. Do technologies actually work? And I did quite a lot of work for a variety of different parties looking at that.”

“The way health systems look at proof is rooted in pharmaceuticals. I have a chemical agent and I have a disease and I show that this particular agent has this impact on the disease within a controlled environment.” When you’re talking about remote management for chronic disease, “it’s not as straightforward… you have multiple variables, and the environment is uncontrolled. The performance of that technology is very highly varied between individuals and contexts and companies really struggle to get proof that it works consistently.”

 “If you can't get proof that it works, you can't get reimbursement; if you can't get proof that it works, doctors won't prescribe it.” Jonathan continues.

Another big area of concern is incentives.  “I think one really, really critical question with these technologies is: who do they financially benefit?”

One of the problems with an insurance-based system where patients can change between providers, Jonathan says, is that “virtually all of the kinds of really interesting technologies around chronic disease only manifest their outcome over many, many years.”

“In a traditional insurance-based system the focus is on controlling cost: I've got a sick person, so I have to try and find the cheapest way of treating them. Now, in European-style social healthcare, or if you are an integrated system like Kaiser who also has the provision as well as their healthcare plan, and [who] tends to have people for a long time, the economics can work a bit better.”

What is the interaction between Adhera Health and pharmaceutical companies?

“I was doing a lot of work around digital patient solutions… the most active players in this are actually the pharmaceutical companies because virtually all of the treatments they have require some kind of behavioral change on behalf of the patient, even if it's just to try to get them to take their medications on time.” says Jonathan. “The biggest mistake for pharma is very clear, it is that they tend to create solutions around the drugs they're selling at that moment in time. That is pretty useless from the perspective of a healthcare system.”

“If I'm a healthcare system, I'll say ‘I'm not interested’, because I've got thousands of patients and they're on hundreds of different therapeutic combinations. Why would I be interested in taking an application which only works with one particular drug?”

 Jonathan believes these solutions struggle to be successful because they don’t “apply to all the patients in the cohort.” Not only that, “they don't really have any way of getting that information into the patient record where it's going to be stored and be useful over a long period of time.”

“I was helping to develop products for pharma companies and healthcare systems would not take them for free. They're just more trouble than they're worth.” He continues, “the idea that a healthcare provider would have 20 different apps from different pharma companies: what a complete nightmare! There is a real fundamental issue here for pharma companies as they create ‘beyond the pill’ solutions.” 

“If they are dominant leaders and they've got a small, controlled population like a specific cancer, it's fine. But as soon as you get into COPD, heart disease, and diabetes, most of the people are co-morbid, and can shift between therapies, these kind of very therapy focused apps just don't really work.”

Jonathan says that essentially all supportive digital applications, in the context of pharmaceutical interventions, are associated with behavior change. “If you have tried to recover from a cancer operation, or you've got diabetes, or you've got COPD or indeed most other serious conditions, you actually have pretty much the same types of interventions that you need to do with the individual… they need to eat well, they need to exercise, they need to be informed about the disease. They need to be mentally engaged. They need to not be depressed. And, all of those things apply, but all of those are not features of the disease, they're features the person.”

“ The reason why Adhera Health is such an interesting platform and the reason why I agreed to come on the advisory board is that there is no reason to produce multiple different apps to support multiple different diseases… what you really need to do is have a single platform that is patient-focused, where you can tailor the kind of interventions you’re doing to the particular disease or set of diseases.”

— Jonathan Anscombe

 “I think that's where the interest in someone like Adhera Health comes; you can use the same platform regardless of the disease or set of diseases that the individual is suffering and regardless of the specific pharmaceutical intervention you are using at that time. The patient can become familiar with the system, and you only have to do one integration with the healthcare record.” This simplification and unification of data creates transparency between payers and providers; “the neutrality of the platform, the transparency of the platform over a long period of time, that potential makes Adhera so interesting.”

 “One consistent set of notations – the ability to review  patient data over a long period of time and take some sensible decisions on that basis… if you can move between insurance companies as well, you're seeing something that is much more like the integrated care record that you might some find, for example, in the U.K, which is neutral to provider, to individual, to therapy, and everything else.”

“By partnering with healthcare providers, Jonathan says Adhera Health provides “a neutral source of useful, consistent interrogatable and analyzable data on the individual that can be used by that individual, by their carers to try and generate some good long-term health outcomes.”

Ultimately, the data “has to reside with either the healthcare provider or the healthcare insurer or the health plan, or preferably in some format that's accessible by all of the above plus carers.” By partnering with healthcare providers, Jonathan says Adhera Health provides “a neutral source of useful, consistent interrogatable and analyzable data on the individual that can be used by that individual, by their carers to try and generate some good long-term health outcomes.”

Click here for Part 2 of this interview.