Over the last decade, the dawn of digital health has accelerated biopharmaceutical innovation, the pace of which has only quickened since the start of the Covid-19 pandemic. Yet within this tech-enabled health ecosystem, a glaring inequity exists in access to digital health tools. Technology applications of the biopharmaceutical industry, including sensors, wearables, and digital therapeutics, are largely inaccessible to disadvantaged segments of the population who stand to benefit from these tools the most.
While biopharma companies are increasingly relying on digital technologies to accelerate discovery, optimize clinical operations, and enhance real-world patient engagement, their adoption and access among the general population remains inequitable. These companies must play a leading role in reducing these inequities so more people can access the digital tools designed to better their health. How? By ensuring collaboration among stakeholders across sectors at various levels to address these barriers holistically.
Designing a multi-level systems framework
Social determinants of health are now widely recognized to contribute more significantly to health outcomes than health care and medicine. Health disparities across diverse populations related to social determinants are made worse by differential access to digital health innovations — and the adoption of these innovations — due to both historical and contemporary structural barriers. These range from financial constraints, like lack of insurance, to infrastructural limitations such as lack of access to broadband internet. Such barriers exist at multiple levels of the health care system — including individual, community, and institutional levels.
A multi-level systems framework is useful for conceptualizing and identifying barriers to the adoption of digital therapeutics at each of these levels. Such a framework can support biopharmaceutical companies in capitalizing on emerging trends in the industry, such as the applications of data science and digital health tools, and to intervene where possible to increase equitable access and adoption of digital therapeutics. This proposed framework is adapted from the National Institute on Minority Health and Health Disparities Research.
At the institutional level, the lack of collaboration between biopharma companies and community partners can hinder equitable access and adoption of digital health tools. As such, biopharma companies need to make changes in how they lead and organize their internal operations to dismantle institutional barriers. For example, companies should identify and establish leadership roles in their organizations that are specifically tasked with engaging stakeholders from diverse and disadvantaged populations. This is particularly important to ensure that the creators of digital therapeutics are aware of patient barriers to adoption from the start, so they can be accounted for and addressed appropriately.
Community based participatory research is one means of advancing such engagement. It entails identifying and establishing relationships with members of a target population, supporting the dissemination of information and the implementation of findings. For instance, researchers at the University of Michigan and the REACH Detroit Partnership, a group of health care and academic collaborators, implemented iDecide.Decido in Southwest and East Detroit. This web-based tool, available in both English and Spanish, was used to educate and inform treatment decisions made by Black and Latinx individuals with diabetes who had limited access to health information. Community health workers used iPads to present essential, tailored health details to patients in order to improve their health literacy so they could make educated decisions towards their diabetes management and treatment.
Such an example can serve as a model for how biopharma companies can partner with local entities to either test or promote adoption of digital therapeutics in populations that otherwise would not have access.
Similarly, collaborations with technology companies, academia, and local health care players forged by biopharma leadership can catalyze positive change in the health ecosystem.
Community-level data can highlight broader barriers that prevent people from having consistent access to medical innovation. Such data can be drawn from the racial and ethnic composition of neighborhoods, the distribution of poverty within a given population, and even the spatial distribution of pharmacies within a given community.
For instance, evidence from a meta-analysis indicates that digital wearables designed to improve physical activity are not as effective among those of low socioeconomic status compared to those of high socioeconomic status. This barrier to access could be caused by a multitude of factors, including a lack of broadband internet access. These barriers can decrease the effectiveness of digital interventions meant to improve patient outcomes.
It is essential for biopharma companies to invest in the collection of data and development of infrastructure to understand the lived experiences of their patient populations so they can be incorporated into real-world studies. This will help biopharma companies assess drug benefits and risks in distinct patient populations and subsequently equip communities with the necessary infrastructure that advances the adoption of desired therapeutics.
Mistrust of the medical system is an individual-level barrier to access that biopharma companies need to evaluate and address. Leveraging new technologies that deliver better health outcomes is meaningless if lack of trust among target populations inhibits their adoption. Although digital health tools have taken the pharmaceutical industry by storm, a trend amplified by the pandemic, some segments of the population remain hesitant to adopt them. This hesitancy persists even though data-driven, transparent, and privacy-protected engagement could significantly improve health outcomes across all factions of society.
Transparent communication on the collection, storage, protection, and use of patient data is essential. Stories such as that of Henrietta Lacks, a Black woman whose cells were cultured and used for research in labs across the U.S. after her death from terminal cancer in 1951 without the knowledge of her or her family underscore persistent mistrust in the U.S. health care system.
This grave, historical incident also highlights the importance of transparency when collecting information via sensors and wearable devices, and in using novel therapeutics that rely on genetic information. Engaging patients in health literacy campaigns so they understand how digital tools and genetic data will be used to improve their health could help alleviate mistrust.
Despite public criticism of the biopharmaceutical industry, its companies generate substantial clinical and humanistic value with their products and services. While these companies are increasingly investing in digital technologies, a multitude of barriers at the individual, community, and institutional level have led to the disparate adoption across populations. By applying a multi-level approach to identifying barriers to therapeutic development, biopharma companies can ensure more equitable access to their digital therapeutics, a key reason their business plans should consider barriers to access.
To maximize the value of their digital health innovations for all stakeholders, biopharma companies must identify and engage in more cross-sector, systems-wide collaboration. This will help them better account for social factors that prevent people from becoming or staying healthy. Partnering with public and private entities to acutely address these barriers will improve access, adoption, and outcomes of digital therapeutics.
The need to modernize health care management models beyond traditional health care settings with emerging technologies is long overdue. Multi-level systems thinking can help get us there. The digital health revolution presents a golden opportunity for biopharma to reset access and outcomes goals based on health equity.
John J. Doyle is an epidemiologist, group vice president of health sciences at Exponent, an engineering and scientific consulting firm, and adjunct assistant professor at Columbia University’s Mailman School of Public Health. Anam M. Khan is a scientist, epidemiologist and health services researcher in Exponent’s health sciences practice. Jowanna R. Malone is a scientist and epidemiologist in Exponent’s health sciences practice.
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