Chronic Disease Management: The Next Goldmine for Mobile Health?

According to WHO data, chronic diseases have become the leading cause of death globally. In China, chronic diseases, led by cardiovascular disease and diabetes, account for 85% of all deaths annually, and their share of the national disease burden exceeds 70%, imposing a substantial economic burden. Between 2010 and 2040, reducing the mortality rate from cardiovascular disease by 1% per year would generate economic value equivalent to 68% of China’s 2010 gross domestic product (GDP), amounting to more than $10.7 trillion (World Bank Report, 2011). China has now entered a period of high burden from chronic diseases, characterized by a large number of patients, high medical costs, long disease duration, and significant demand for healthcare services.

For patients with chronic diseases, while pharmacological therapy can alleviate symptoms and slow disease progression to some extent, it is even more critical to modify unhealthy lifestyle habits by reasonably planning and controlling diet, physical activity, and daily routines. The hallmark of chronic diseases is their long duration; patients often require continuous care, long-term medication, and frequent follow-up examinations. Moreover, the patient’s level of active participation, self-management ability, and adherence significantly influence disease outcomes. Therefore, relying solely on patient conscientiousness is not a sustainable strategy for managing chronic conditions. Patients need appropriate chronic disease management models to help them adhere to treatment plans and strengthen self-management. Such prolonged and intensive monitoring and management are not well-suited for delivery by centralized hospitals.

The high medical costs of chronic diseases place a heavy burden on patients’ families. As an effective tool for alleviating this burden and reducing the risk of poverty caused by illness, health insurance plays a crucial role in the management of chronic conditions. To date, several common chronic diseases have been incorporated into the health insurance system. For health insurance providers, the largest expenditure related to chronic diseases is the treatment of complications resulting from poor disease management, such as diabetic foot and renal failure. If a relatively low-cost management approach could help patients improve their prognosis and reduce the incidence of complications, it would save medical expenses and lower costs for the health insurance system.

Poor patient adherence to treatment has long been a major concern for many pharmaceutical companies. Due to a lack of medical knowledge, many patients fail to understand or agree with their treatment plans, leading them to refuse medication. Chronic disease management requires long-term treatment, and the burden of prolonged medication use can cause inconvenience in patients’ daily lives. Some patients often forget to take their medications due to busy work schedules, while others, driven by inertia, discontinue therapy against medical advice once their symptoms improve. These behaviors significantly worsen the prognosis of chronic diseases. For example, following percutaneous coronary intervention (PCI), clinical guidelines recommend anticoagulation therapy for a specified number of months; however, many patients prematurely discontinue treatment due to fears of bleeding. One physician shared that a patient stopped taking his medication midway, claiming he had heard it could “damage the liver.” Although the doctor assured him this was not the case, the patient remained unconvinced. The doctor then explained that discontinuing the medication could reduce life expectancy by three years, asking, “Do you consider your liver more important, or is living three additional years more important?” The patient subsequently resumed adherence to the prescribed regimen. This illustrates that appropriate reminders and supervision during chronic disease management can effectively improve patient adherence.

I have had a similar experience myself, albeit with my pet cat. In early 2012, I adopted a kitten and took her to the veterinary clinic downstairs for her first vaccination. However, due to a busy schedule, I forgot to bring her back for the subsequent doses. One day, I received a phone call from the clinic reminding me that the kitten still had pending vaccinations and inviting me to bring her in over the weekend. This simple call significantly improved my adherence; I felt valued and happily took the cat to complete the remaining vaccinations. Whether it involves disease treatment or trivial matters in daily life, having someone provide timely reminders and follow-ups is highly appreciated.

In summary, the substantial demand for chronic disease management services in China, coupled with their numerous benefits, offers broad development opportunities for the chronic disease health management industry. So, is the field of chronic disease management suitable for mobile health startups to enter? The answer is affirmative. The challenges posed by chronic diseases undoubtedly present significant opportunities for mobile health.

The Core of Chronic Disease Management Is Effective Patient Education and Adherence ManagementAs previously mentioned, the onset and progression of chronic diseases are often associated with patients’ unhealthy lifestyles. However, helping patients modify their established lifestyle habits is no easy task, necessitating comprehensive patient education and adherence management. Patient education shares similarities with primary school education: both require timely reminders, continuous reinforcement and supervision, trust in the educators, and the establishment of effective interactive feedback mechanisms. Delivering patient education that is scientific, easily understandable, and individually tailored is itself a highly specialized endeavor. Patient adherence is frequently built upon high-quality patient education, embodying the integration of “knowledge, action, and intention.”

Traditional chronic disease management relies on face-to-face consultations or telephone communication. U.S. health insurance companies often maintain large call centers, employing nurses and disease management algorithms to manage a vast population of patients with chronic conditions, which incurs significant costs. However, mobile internet has introduced new possibilities for chronic disease management. Leveraging mobile internet technologies, new platforms such as wearable devices and medical big data systems can continuously record and analyze individual health data, aiding in the prevention of chronic diseases. Furthermore, these technologies enhance the accessibility of healthcare services; for instance, real-time connectivity via smartphones and mobile high-definition video enables clear and prompt remote guidance from physicians, thereby facilitating the treatment of chronic conditions.

Currently, WellDoc’s diabetes management system in the United States has received FDA approval, and its clinical utility and economic value have been validated in clinical trials. Within 12 months of using the WellDoc system, patients with diabetes experienced a 58% reduction in the likelihood of emergency department visits and hospitalizations. Patient feedback has been highly positive, with 100% of users reporting that the system helped them better monitor their blood glucose levels. Additionally, CardioNet, a cardiac monitoring service provider, has successfully diagnosed more than 200,000 patients with its flagship product, MCOT™ (Mobile Cardiac Outpatient Telemetry), helping 41% of these patients identify previously undiagnosed serious cardiac conditions. These examples demonstrate that mobile health holds significant promise and offers broad prospects in the field of chronic disease management.

However, we must also recognize that significant challenges remain in mobile chronic disease management. How to educate and influence the behavior of users—including both patients and healthcare providers—regarding this new service delivery model of mobile health and their experience with wearable devices, while sustaining long-term user engagement, remains an unresolved issue.

First, since most patients with chronic diseases are older and have relatively lower acceptance of emerging technologies, it is essential to fully consider the simplicity and convenience of use for middle-aged and elderly individuals. Second, addressing the lack of motivation among physicians to participate in disease management poses a significant challenge. Physicians at tertiary hospitals possess both the expertise and patient trust but lack time; whereas primary care physicians have more time but enjoy relatively lower levels of patient trust. If physicians from tertiary hospitals are engaged in management, support from physician assistants may be necessary. Furthermore, unlike diagnosis and treatment, chronic disease management is not an immediate necessity for patients, making the barrier to downloading and installing a new application relatively high. To address this challenge, WeChat Official Accounts could be used initially on the patient side. In terms of disease selection, it may be advisable to start with chronic conditions common among pediatric or young-to-middle-aged adult populations, such as asthma. Once patients are satisfied with the effectiveness of chronic disease management and the user experience, a gradual transition to a dedicated chronic disease management app can be implemented.

 

This article is republished by VCBeat with authorization from Zhang Yusheng. The views expressed are solely those of the author and do not represent the position of VCBeat. Zhang Yusheng, M.D., is the founder of Xingshulin.