In December 2019, the University of North Carolina at Chapel Hill (UNC) Center for the Business of Health (CBOH) began a research partnership with Sharecare, a leading digital health company founded by technology entrepreneur, Jeff Arnold, to assess the economic value of changing various health behaviors via mobile health (mHealth) interventions. The purpose of the research is to understand the efficacy and feasibility of mHealth interventions to change individual behaviors, promote health awareness and positive lifestyle choices, and lower direct medical costs through disease prevention and management. Both the CBOH and Sharecare identified a common interest in addressing the gaps in the current academic literature to support a better understanding of the economic impact(s) of targeted well-being interventions.
Sharecare and the CBOH bring unique and complementary skills and capabilities to this partnership. Sharecare is an innovative health IT company that seeks to promote health transformation by empowering individuals, communities, and organizations through engagement with a comprehensive technology platform which includes a mHealth application and online services as well as programs to assess specific health behaviors. They bring a wealth of experience and knowledge about digital health platform utilization, adoption, retention, and efficacy. Additionally, through various academic and private partnerships, Sharecare has incorporated its access to nationwide data on social determinants of health (SDOH) and community well-being to develop several proprietary indices for measuring these concepts. Since launching the CBOH in 2018, Professor Brad Staats, Associate Dean of M.B.A. Programs at the Kenan-Flagler Business School and Faculty Director for the CBOH, has worked to engage corporate partners and collaborate with health care experts across UNC Chapel Hill to drive insights around health, healthcare, and well-being in North Carolina. Aligning with the CBOH’s mission to bring together expertise from across UNC to create new knowledge, build business capabilities for healthcare leaders, and convene important conversations on the business of healthcare, Professor Staats and Dr. Katrina Donahue, the Charles B. Wilkerson Senior Distinguished Professor and Vice Chair of Research at the UNC Department of Family Medicine, developed an interdisciplinary, multi-phased research plan to advance the current medical and economic knowledge.
The overall goal of the research is to understand the value of implementing mHealth interventions to improve and manage health. The current academic literature identifies positive correlations between mHealth interventions and behavior change. However, the actual economic value of these individual and/or collective interventions across diverse populations is unclear due to the proprietary nature of this data and economic evaluation techniques such as Return on Investment (ROI) analysis failing to capture the fullness of application-based lifestyle intervention programs by focusing exclusively on medical claims data. As a result, the CBOH and Sharecare decided to use a Value on Investment (VOI) evaluation model to understand the financial and non-financial impacts of mHealth interventions through the full lifecycle of a direct-to-consumer application-based product which includes onboarding, messaging, engagement, and activation. VOI models have grown in popularity as evaluation tools, particularly in the well-being space, due to their ability to assess and quantify the value of investments beyond traditional financial instruments to capture intangible assets or benefits of a product.
Through multiple conversations with Dr. Michael Rickles, Sharecare’s Executive Director of Research Strategy, and Elizabeth Colyer, Senior Vice President of the Community Well-Being Index, the research team began by focusing on common lifestyle, biometric, and screening indicators (Figure 1).
Figure 1. CBOH’s Initial Research Categories and Metrics for Evaluation
The team identified definitions for each of the metrics using the latest medical guidance and developed an innovative research design that incorporated skills and knowledge from across various academic disciplines. The UNC Department of Family Medicine research team began by examining the existing literature to understand the value and impact of mHealth interventions, while the UNC Kenan-Flagler researchers used micro-simulation techniques to model the impact of intervening on these metrics.