A Digital Health Platform Without Engagement is Worthless

Despite the promise of digital innovation in Big Pharma, only a shocking 4% of pharma digital product launches regularly succeed, according to a 2022 report by Graphite and Reuters.?

Why? It's because without engagement, digital products are worthless. Without engagement, the expected spend on a project balloons 5-10x more, good money is thrown after bad, until it is considered a failure and shut down. This happens despite a clear understanding in Big Pharma that their products are not well designed to provide long-term engagement for patients and HCPs.?

So if the problem is known, then why do we continue to see these failures.?

It is because patient engagement is really difficult and costly to develop and deploy

We have had several Big Pharma companies offer to sell us their digital products they have developed over years and at high expense (many millions of dollars). They want us to buy these assets because they:?

1. Have found that no one uses them - no engagement?
2. Have found them too costly to update and maintain - one-off products?
3. Have found a lack of clinician enthusiasm for them - no clinical support?
4. Have not found a business model that would deliver value to Big Pharma - no ROI
5. Have not developed them using best digital practices - no value to users

Often the approach? by? Big Pharma is to license a regulatory compliant digital platform to build? new digital products. But such platforms do not address any of the above? problems: the lack of? regulatory compliance was not the reason they failed, and adding one won’t yield success.??

In our experience, having an FDA regulated platform is a necessary, but not sufficient condition for success, and is actually the easiest part of the solution to stitch together. The hard part is creating digital solutions that patients and clinicians like, will use more than once, will trust, and will come back to again and again to obtain benefit: this is what we call digital patient engagement, and it is a science that few in the pharmaceutical and healthcare industry understand, and fewer still know how to design, develop and deliver.??

How to design for optimal patient engagement

?When you look at what you must design, develop and deliver with a digital product to ensure engagement, there are a million decisions that impact engagement levels. For example, here are just a few:?

• Font
• Color
• Shapes
• Length of text blocks
• Word selection
• Reading level and difficulty
• Cultural sensitivity?
• Difficulty of activity
• Use of gaming principles and mechanics
• Use of behavioral economics
• Use of assessment tools
• Frequency of interaction
• Length of interaction
• Relationship of trust
• Data interoperability?
• Device interoperability?

And the list goes on and on and on.?

And for each one of these variables listed above, there are sometimes scores of underlying variables to play with in hundreds of different ways. For example, we use over 40 different gaming mechanics and principles in all of our applications, and 12 different behavioral economic approaches. We have? A/B tested all of these many variations to see which ones actually yield the highest levels of activation, engagement and desired behavior change. And then we continually tweak these to optimize engagement.?

We have summarized these many variables into 10 critical factors that are part of the Secret Sauce of Engagement:?

1. UI/UX
2. Outreach optimization
3. Intrinsic motivators
4. Clinical relevance?
5. Activity variety?
6. Personalization of activities?
7. Social interaction
8. Accountability anchors
9. Effective storytelling
10. Immersive experiences

After applying these 10 factors, we then optimize the patient experience to continually improve and? yield higher engagement over time by applying these five levers to deliver better outcomes:

Activation Rate (What % of the audience has started interacting?)

x

Visit Frequency (What is the average number of weekly sessions performed?_

x

Session Length (How many minutes are spent per session?)

x

Adherence Fidelity (How well are users performing their intended task?)

x

Retention Rate (How long do users keep coming back?)

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Outcomes - How does the app change user behaviors and demonstrate improvement

To develop and optimize digital products using this approach takes years of experience, millions of users, hundreds of millions of dollars and an agile, iterative approach that leads to daily, weekly, monthly, and annual software updates. It is impossible to design and create engaging digital products with very small data sets and small numbers of users.?

Without robust engagement levels, you don’t have patients, you don’t deliver outcomes, you can’t get paid, and you will never deliver value to your shareholders, patients, providers, or payers. But when you do, here are the benefits:?

• Widespread awareness and education
• Habit formation
• De-stigmatization
• Optimal clinical outcomes
• Big data collection & mining
• Large-scale triaging
• Early detection & referral
• Improved and sustained behavior change

It is for all these reasons that Twill does not purport to be a SaMD platform. We are a Patient Engagement platform that also happens to have SaMD compliance. This is a nuanced, yet highly complex, difference and is why we continue to be the partner of choice for those that are looking to truly transform patient engagement, not just build another digital solution that simply adds to the 96% failure rate.