Flattening the Curve of Care with At-Home Diagnostics

This article was originally published in Patient Safety & Quality Healthcare (PSQH).

While talk of at-home diagnostics is not new, the conversation around the concept is evolving, particularly in the face of challenges the healthcare industry must overcome in 2024 and beyond: staffing shortages, rising costs, and providing care to patients who may not have access to the kind of care they need for any number of geographic, economic, or social reasons.

Programs involving at-home diagnostics are becoming more prevalent in the area of biopharma. According to one study, the at-home testing industry is projected to be worth over $2 billion by 2025. But beyond the economic impact, at-home testing can also help drive adherence for at-risk patients lacking access to the necessary healthcare facilities or testing centers.

“It’s felt as though several macro things are coming together in a whole new way,” says Jeff Davis, general manager of biopharma for ixlayer. “COVID was a massive forcing function for at-home testing. We all got acquainted with and comfortable with this notion of not necessarily going to a doctor but rather taking a test at home before seeing a doctor.”

COVID forced a very rapid evolution in testing into a very compressed timeline—what might have taken 12 or 15 years had to change in 18 months.

“Now, post-lockdown, one of the things I think is really picking up steam: if COVID was the forcing function, what about remote diagnostics across a variety of conditions?” says Davis.

There are other macro elements at play ushering in this new development, he notes, such as PCP shortages. Studies have shown that interacting with the American healthcare system is not a good experience in general, Davis points out, and things continue to change and evolve at this new, rapid pace.

“Everything from the physical experience of testing to what device is used to the digital experience is all moving fast. The physical act of sample collection has transformed. For certain tests, you no longer have to prick your finger and drain the sample into a microcontainer or smear it on a card,” he says. “All of those things feel like they’re going through an evolution.”

The other external pressure: there simply are not enough staff to meet demand. And without sufficient staffing, the industry can’t test at a high enough volume to keep pace.

“Even in the prior cycle, virtually every condition we look at and talk to prospective customers about, without exception, is grossly undiagnosed,” says Davis. “If 70% of all diagnostics rely on a lab test, I think that’s part of the opportunity.”

Better access, more convenience

A challenge for healthcare across the board is the reasonable, if sometimes unfair, comparison to the consumer experience in every other industry. Most other activities have become far more convenient than ever before, whether through websites, apps, or other ways to interact with those industries that don’t involve face to face interaction.

“There’s a pretty high bar there in terms of what we expect from an experience, and it just doesn’t exist in healthcare,” says Davis. “Healthcare can be fragmented, it’s hard, and it looks like nothing else in the rest of our lives.”

For testing, striving for a better patient experience is part of the opportunity before the industry, Davis notes.

“There’s a chance for biopharma companies to make their campaigns more effective by delivering a tailored, premium physical and digital experience across the patient journey to make it more seamless and reduce friction,” he says. “We can go to a portal and see our lab results, send them to the treating clinician…We’re starting to bridge the gap with testing in connection to care, creating more of an experience that maps with what we expect from the rest of our lives.”

Healthcare is built differently than other industries, so a perfect one-to-one comparison isn’t always possible. For the digital experience, healthcare has unique privacy need, for example. There’s also the challenge of connecting disparate systems, particularly in the U.S. where different stakeholders often have misaligned interests with what they need to get out of the experience. But Davis says there is “positive pressure in the right direction” here.

“There’s a comfort level for the patient that builds over time. My generation is digitally fluent but my children are digitally native, while for older generations there’s a bit of a drop-off. But overall, we have all become much more comfortable with using technology in our everyday lives,” he says. “So how do we not overcomplicate things to deliver results online, optimized for mobile devices but super easy to log in, find your results, and understand them?”

But what steps can the industry take to create that seamless, great experience for patients using at-home diagnostics to help democratize access to care?

“What we’re doing is putting the patient in the center and giving them the ability to get really relevant information from a test or screening,” says Davis.

If everything is firing on all cylinders, Davis says, it’s possible to move the needle for these under-tested conditions—and the needle has plenty of room to move, he says.

“Take type-2 diabetes, for example. There was a massive awareness campaign and there are really advanced treatments now, and on the awareness side it’s considered one of the success stories,” says Davis. “The industry has reduced the number to about 23% of type-2 diabetics as undiagnosed, but that’s still almost a quarter of a massive population. The true north is seeing the top of that curve stat flatten where we can increase diagnoses and treatment rates in a way that’s measurable.”

One of the reasons ixlayer has chosen to partner with biopharma organizations is because, Davis says, these organizations are uniquely well suited to understand and tackle the underdiagnosis issue.

“They’ve invested enormous resources in understanding the patient population, raising awareness, and understanding the patient experience,” he says.

Barriers do exist for improving the overall availability and impact of at-home testing, Davis notes.

“Many of the barriers are structural. In healthcare, you’ve got innovation creating new things and you’ve got structural bureaucracy, so policy adoption is always lagging,” he says.

For example, right now if you go to buy a direct-to-consumer health test, these tests are often not reimbursable or covered by payors. This means out-of-pocket testing inherently has an access problem as not everyone has $99 to spend on an at home test kit, and so the numbers are skewed toward people who can afford to do so and are likely more engaged with their health.

The other structural challenge is EHR integration at scale. If the lab tests results don’t flow into the patient’s EHR seamlessly, it creates friction.

“Looking at health inequality, making remote testing and connection to care more available has massive potential to help solve those issues,” says Davis. “How do we put this together in a way that is tailored to combat health inequality so it can help underserved communities? If you can fully subsidize and make available a remote test, then you’re maximizing the number of people who can take advantage of that.”

The spectrum of the market is simple but wide, Davis notes. On one end of the spectrum, there is complete subsidization for qualified patients, seamless on the financial side. On the other end of the spectrum, it’s 100% the patient’s responsibility. The middle is a gray area of partial responsibilities.

Innovation is already occurring to bring testing to the home for improved access, Davis notes.

“I think in the broadest strokes, remote diagnostic testing moves from the periphery of      healthcare into the core,” he says. “As a patient, I should be able to control the flow of remote testing right into my EHR, and I should be able to have insurance cover it as appropriate. I also want to see the continued innovation about what conditions it’s possible to test for from home.”

This move toward home testing is one of those rare instances, Davis notes, where all the stakeholders can benefit from innovation.

“If we’re able to raise the bar so that more patients are diagnosed and treated faster, then because they’re tested earlier the cure or treatment starts sooner. Healthcare costs from earlier diagnosis is a win for the payors. The patient wins with earlier intervention and treatment,” Davis says. “And then we have better outcomes. I don’t see how the continued acceleration of home diagnostic testing doesn’t benefit every single stakeholder.”