Written by Gali Weinreb, Translated by Danielle Amir-Lobel
Miscommunications between doctors, patients, and healthcare apps characterize the “last mile challenge” in medicine – a concept which describes the gap between the health system’s ability to treat and the ability and desire to follow through of the person receiving the treatment. Well-Beat has developed an AI solution which identifies an individualized, appropriate psychological approach and treatment program for each patient, helping them to overcome adherence challenge.
Medicine is advancing at a rapid pace and becoming increasingly more complex and digitized, exacerbating the “last mile challenge” – a concept which originates in the communication world. It describes a reality in which companies build communication networks with the most advanced technologies but fail to connect to customers’ homes.
In the world of medicine, this term describes how the health care system can provide medical treatments or recommendations but cannot force patients to implement them. Sometimes, patients avoid adhering to their treatments out of conscious and rational decisions, but, other times, the reasons for avoidance are hidden and necessitate diving deep into patient’s world to understand the source of a particular behavior.
The “last mile challenge” is one of the most difficult in the world of medicine today. It hinders not only treatments of lifestyle diseases (such as smoking and obesity) but also harms management of disease such as diabetes, heart complications, cancer, AIDS, autoimmune diseases, mental illnesses, and more. For example, patients often take their medications at irregular intervals or avoid medical check-ups.
When organizations first started discussing this challenge, doctors asserted that they are not psychologists, so adhering to treatments is the patient’s responsibility. Today, the approach has been completely reversed. The phenomenon has become too widespread, and its price has become too high.
Well-Beat seeks to connect insights into patient behavior with AI technology to motivate patient to stick with care plans. The company was founded by Keren Aharon, a consumer behavior researcher, David Voschina, an experienced high-tech worker, and the CEO of the company, Ravit Ram Bar-Dea who has a strong background in business & marketing.
Well-Beat Co-Founders: (from left to right) Keren Aharon, Ravit Ram
Bar-Dea and David Voschina
Who wants to manage their disease?
We tend to talk about a “lack of motivation” in treatment, but it would be difficult to find anyone who lacks the desire to be healthier. In that case, why do patients often still avoid properly following their treatment plan? A key part of the discussion to answer this question is anxiety, which may lead to denial or avoidance. “Denial is a strong and healthy mechanism from a psychological standpoint,” explains Aharon. “It is impossible to completely prevent a person from repression or denial. It would not be helpful for the overall quality of life of a chronic patient.”
This means that it is impossible to motivate people to action solely through intimidation or even through advertisers’ favorite three-step strategy: intimidation, providing a solution, and assuring that everything will be alright if we stick to the solution. This tactic is almost worthless in regards to people who were diagnosed with a chronic disease. We can even see this phenomenon to a certain level on a national scale in terms of how people dealt with the COVID-19 pandemic.
Is it actually the fear of medical situations that causes inaction from patients?
“Yes. It is true across countries, diseases, origins, genders, and ages. In previous studies, along with the recent study conducted by Well-Beat in October 2020 on 646 chronic patients aged 45-85, we found that 23% of the patients were at an anxiety level that made it difficult for them to function.”
Another widespread alleged truth is that patients want to manage their own diseases, which is why the world of medicine is transitioning towards sharing and consents between care teams and patients. However, in some cases, the pendulum swings too far. For example, when a doctor informs a patient and their family members about an abdominal aneurism, a phenomenon they are only hearing about for the first time, it seems like a nearly impossible task to expect a patient to choose their treatment method while they are still in shock of the diagnosis. The resulting feeling for the patient is not one of sharing responsibility but rather of throwing it directly at them.
Pilots conducted by Well-Beat showed that only 29% of chronic patients want to hear about additional treatment methods (beyond the first one the doctor prescribed) and only 18% want to manage their disease. “I don’t want the doctor to ask me what I decide to do, but rather I want them to tell me exactly what to do. I understand that they’re trying to provide good service, but, to me, it seems like they are trying to give me all of the responsibility,” a pilot participant explained. A young manager interviewed in the pilot shared, “In other aspects of life I like to be in control and not have others ‘decide for me’. In health matters, it is different. I’m not the one who spent 10 years studying and specializing in the field – the doctor did.”
Similar responses have been given not only by elderly or uneducated people, but rather by young people who possess the ability to manage their disease, Aharon emphasizes. She adds that the flood of new technologies and apps designed to assist in managing diseases do not really ease matters for patients because they require “hard work” of continuous inputting information and data. “Approximately a quarter of patients receive value from these types of apps. The others begin inserting their data and then give up due to a lack of motivation or energy. Sometimes, patients are ashamed to tell their doctors that they don’t want to manage their own disease.”
Detect sensitivities ahead of time
Even when you tell patients exactly what to do, it does not always mean that they will follow through. Sometimes they will avoid following instructions partially or fully, and then they will not always report to their doctors that they did not follow instructions in order to avoid dealing with negative feedback. This is a challenge with extreme repercussions.
In recent years, professionals have often adopted programs which include commitment from the patient to act in a certain way by setting goals and providing incentives for them to overcome “the last mile.”
Well-Beat uses AI to figure out which program to tailor for each patient. “It isn’t just a question of personality,” says Aharon. “There are different stages to coping with a diagnosis, which are similar to the five stages of mourning, and how a patient is approached should align with each stage. The disease itself also has different stages during which a patient’s behavior varies. And there is also the personal element. Did your parent die of the same disease, or did they live with it in peace? Are you retired and free logistically but at an emotional crossroads, or are you busy and need treatment to be ‘woven’ into your life on the road? Do you have family or friends with you? For example, if a patient does not want to worry their family, he may refrain from asking them to take him to further testing or may try not to take medicine around them.”
“We see this phenomenon a lot in matters of diet or quitting smoking. There are people who get angry or shut themselves off if you raise the subject around their family while others need their family to support them in the process. It is hard for doctors to know which type of person a patient is. There are people who feel at a loss of control when their family members take responsibility for their care process, which then means we actually damaged their motivation.”
Well-Beat detects these sensitivities ahead of time. “Determining when the family should be included in the dialogue, who is embarrassed in front of the doctor and feels more comfortable talking to a nutritionist or health coach, and other such preferences. This decision alone, of when a doctor is needed or not, can save a lot of resources and make them accessible to those who need them.”
These are nuances that can only be discovered on the level of an in-depth psychological review. Which doctors have time to dive into this?
“This is one of the things we learned from a pilot conducted with care teams. It seems that a psychological approach threatens many therapists. They say it is an extra task that is not part of their job description. Therefore, we don’t send the care teams off to conduct their own personality research on patients, but rather we tell them what should be said and what to avoid doing during the interactions. According to the feedback we received, this type of instruction does not burden the system. Moreover, a therapist who wants to dive deeper can simply click on a button and receive further explanation. In a similar manner to the patient, not all care providers are identical. In the future, we intend to provide a tool to match patients with care providers.”
In recent years, an attempt has been made to transfer the sensitive and demanding process of the “last mile” from the human care provider to apps that should, among other things, provide us with practice and experience to improve our motivation. Yet, according to Aharon, this only fits in some cases while in others there is bound to be another minefield in the way.
If the app says, “Take control over your life,” there are people who would be scared because they feel out of control,” Aharon describes. “If it says, ‘Fulfill your dreams’ or ‘Every day will be better than the last,’ this message alienates those who were diagnosed with a disease that is expected to deteriorate their health condition gradually and hurt their chances to fulfill their dreams. For some people, the phrase ‘Think about your loved ones’ is the pinnacle of motivation whereas, for others, their loved ones got on their nerves that morning, so the phrase is not the best thing to hear.”
“Sometimes the patients have to let each day pass in its time and simply have someone tell them what to do that day, without looking forward. They need to turn this into a habit. The challenge is to know how to identify each patient and to tailor the approach automatically.”
A tool for predicting the abandonment of health plans
Well-Beat has developed a tool for predicting abandonment of treatments. “There are people where, if you manage to motivate them from the onset, they will be with you. Others start out very strong but become worn out at certain intersections,” Aharon says. “Sometimes a person does not want accompaniment at the beginning, but, later on, when they begin to ask questions, you can again ask them if they are interested in receiving support. If we direct our intervention resources to the stage when the abandonment is expected, we will save a lot of resources and intervention will become more effective.”
Pilot results at the Sheba Rehabilitation Center
In a pilot performed at the Cardiac Rehabilitation Center at Sheba, a program that used Well-Beat’s system succeeded in increasing the number of patients who persisted by 300%. The reasons for abandoning the rehabilitation plan in the past were numerous: the center is far away, there’s no parking, I’ve already learned enough tools, and I already take medications, so why do I also need to exercise? Others missed a number of sessions and then felt embarrassed to return, Aharon describes. Instead of dealing with these objections and finding them solutions, Well-Beat identified the appropriate communication approach with each patient. All patients received customized tailored messages, according to their actual behavior and profile identified by the Well-Beat dynamic solution. “In this way, we improved patients’ perseverance and hardly put any extra load on the system,” Aharon concludes.
For the original article as published on Globes click here