This week, I participated in a panel discussion at the National Alliance of Healthcare Purchasers’ annual forum about defining and assessing value in healthcare. There was vibrant discussion about what constitutes value and who should get to decide.

At the Peterson Health Technology Institute (PHTI), we believe that when a company sells a digital health product, solution, or care model that is meant to improve the health of a patient, it should deliver measurable clinical benefits. While individual patients and purchasers have many priorities, delivering clinical benefit over the status quo should be table stakes for a broader discussion about value. 

To those outside the healthcare industry, a focus on clinical benefits may seem obvious.  Unfortunately, it’s not always core to decisions about care, and that’s what we’re working to change at PHTI.   
 
Since our launch in 2023, we have released independent evaluations of digital health technologies in three important areas: diabetes, musculoskeletal care, and hypertension.  We have received a lot of valuable feedback. Decision makers including employers, health plans, and health systems who select and pay for digital health solutions, have told us how PHTI’s evaluations inform their purchasing processes. Clinical experts compare our findings to their own intuition and experience. Investors are eager to incorporate our insights into their due diligence processes.  
 
We also have critics who have suggested that our assessment approach is too narrowly focused on clinical outcomes, without enough emphasis on patient experience and satisfaction. For instance, following our hypertension report, some stakeholders questioned PHTI’s focus on blood pressure reduction and control as the core outcome measure. It’s a great question, and the answer is because we believe it’s the most meaningful indicator of clinical benefits. Put another way, we believe it’s the best way of determining whether these hypertension products “work” or not.

We recognize that there are multiple measures of clinical impact for any given condition. That’s why we analyze over a dozen outcomes in each report, including patient-centric measures. It’s also why we look at which solutions are reporting on and measuring health equity impacts. 
 
Then, we prioritize. For hypertension, our primary focus was on changes in systolic blood pressure and blood pressure control. For hypertension, systolic blood pressure (the top number when you get your blood pressure reading) is widely considered a core indicator that predicts risk factors for heart disease. It is the number that clinicians focus on lowering when treating patients with hypertension. 
 
When we looked at the evidence for digital hypertension solutions that include medication management, we found that these solutions decrease patients’ systolic blood pressure by an average of 13 mmHg (e.g. top number goes from 150 to 137). That’s more than double the improvement that patients achieved in usual care in the studies reviewed in PHTI’s evaluation, which found that usual care decreases systolic blood pressure by 6 mmHg. So, a key finding of PHTI’s evaluation was that the incremental clinical benefit of digital medication management solutions over usual care is 7 mmHg. That’s a big increase in efficacy and will save lives in the long-term.

Other approaches to digital hypertension management solutions that we reviewed had more limited clinical benefits. While patients may enjoy using these solutions, they simply did not offer meaningful health benefits.

Of course, it’s also important to understand what matters most to patients and their doctors. Perhaps unsurprisingly, patients are primarily concerned with achieving the best health outcomes. When we talked to patients who live with hypertension as part of our evaluation process, they told us that their priority is to get their blood pressure down or to stay in a range. They expect that the extra effort they put into using a digital solution will pay off in better health.

Once patients know that a digital solution is clinically effective, they also value other aspects, including a good user experience, positive interactions with coaches and clinical teams, and the ability to share data with their primary provider.

Here’s our bottom line: If a solution or care model doesn’t work better than the status quo, it should not be in the game. If it does, that merits a deeper discussion on what it’s worth for a purchaser or to a patient. These are the conversations and discussions we are trying to facilitate and inform at PHTI, because we would love to see multiple clinically effective solutions competing for business on other dimensions of value. 
 
Patients and providers want straight talk about healthcare more than ever. That’s what PHTI aims to provide.