Among the challenges of chronic disease management is the lack of interoperability between different medical records and inability to communicate effectively between patients and their physicians and social workers.

In a recent HIMSS21 Digital session, Frank Cutitta, CEO of HealthTech Decisions Lab led a panel comprising of Karen Murphy, chief innovation officer at Geisinger, and Tony Farah, chief medical and clinical transformation officer at Highmark Health, who noted innovations in cardiac and cancer treatment leaves healthcare faced with a growing population where chronic diseases are quite prevalent.

"We're up against a steep hill to climb," Farah said. "We have enough of the capabilities that would allow us to move in the right direction, and we know we can't do this on our own."

The key is to improve the health outcomes of populations at large, which allows you to lower costs and track those cost savings, which Farah did through large scale pilots targeting populations with chronic conditions.

To push through these programs at scale, Farah looked to public cloud providers like Google that have the processing power and can be combined with provider expertise to reach populations with chronic diseases.

"We need to make sure we're 100 percent synchronized on what our goals are, which is providing better clinical outcomes for the population at scale," he said. "Without a high level of interoperability, it's just hard to achieve those outcomes."

Murphy noted with chronic disease management, it's important to focus on innovation not for innovation's sake, but to solve problems.

"We did a six-month deep dive to get a snapshot of who's doing what, how are we communicating to patients, and what are the clinical outcomes," she said. "We determined that using a completely different approach would lead to quantifiable improvements in patient outcomes in cost and quality."

The initiative leveraged remote patient monitoring, and AI and ML to engage patients to monitor themselves and boost self-management, as well as patient-reported outcomes, and look for insights that would signal progression of the disease.

Karan also noted it's important that in the design of these digital strategies you include the patient's voice to help overcome barriers, though change management is a specific challenge for providers, particularly when it comes to innovation.

"These are big steps we are taking which are very complex," Karen said. "Clinicians have a job to do, so many times we are asking them to what turns out to be double the work as we refine these models. This work is not easy."