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25% Reduction in Rheumatoid Arthritis bDMARD Cost Possible With Avatar Assistance

A rheumatoid arthritis—focused Virtual Health Assistant (aka avatar) could help save US health plans over $1 billion per year by providing the data needed to pursue an evidence-based dose reduction/discontinuation strategy for biologic DMARDs (bDMARDs). The science is strong, but is the will equally strong?
A Virtual Health Assistant Can Produce Data to Allow Discontinuation of bDMARDs in RA Patients Through Intelligent Engagement
A recent article reflected on how an avatar, more properly called a virtual health assistant (VHA), could collect this data from patients. 
A VHA, using advanced artificial intelligence and natural language procession and residing on a smartphone, could easily engage in a conversation with a person with rheumatoid arthritis. An earlier AJMC series of articles described how a VHA can literally talk to a person. This capability is already possible and is where the human-computer interface is rapidly heading.
A VHA could first and foremost inquire whether the prescribed medication was taken as directed. A VHA can enter into a dialogue about barriers to adherence (ie, financial issues, adverse events, treatment expectations, prior authorization issues, etc) and actually assist in solving the issue. A VHA can contact the pharmacy for a refill, and remind the patient of an upcoming appointment—the capabilities are virtually endless.
The VHA could, on a prescheduled basis, ask the patient to record each painful and swollen joint by touching the smart phone (or tablet) screen at the appropriate joint on an anatomic diagram. In addition it could perform a clinical assessment such as the RAPID3 scale (recommended by the American College of Rheumatology guidelines); a score that asks questions about limitations in performing activities of daily living, sleep difficulties, and overall health.
The device can also be programmed to answer literally tens of thousands of questions a person might ask concerning rheumatoid arthritis, allowing the person to make sense of his or her disease as well as help the person deal with ambivalence and resistance. 
A VHA can also be programmed to monitor overall health and encourage healthy lifestyle choices such as smoking cessation, weight control, healthy diet, and recommended exercise. A VHA could also pop up with videos of stretching and strengthening exercises, especially important for those with joint disease.
Health plans have entered the era of big data. But they have to find a way to create a return on investment for collecting and analyzing big data. A VHA can easily create this return on investment with just one drug class: the bDMARDs for RA. Think about what it would mean to your health plan to shave 25% or more from the bDMARD drug class. For a regional health plan, it could mean tens of millions in savings. For our entire country, the savings could be measured in billions!
In addition, patients would be exposed to fewer side effects and physicians could use VHA generated data for clinical decisions instead of relying on lab tests and MRIs as Dr Wei earlier stated. In summary, everyone would benefit.
RA is the perfect case study for using a VHA as a data collection tool because the data is currently not available. The data can provide incredible insight into the lives of those suffering with this terrible disease. The data can lead to actionable decisions by physicians, and the savings could be enormous. The science is strong, but is the will equally strong?

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