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Managing Repatha and Praluent Could Be a Walk in the Park for Health Plans

The PCSK9 drugs are stirring up a lot of attention, primarily around how to restrict access. But, no one is talking about how to best manage the patient's needs.
Modifying behavior is difficult, but, a recent article in Evidence-Based Diabetes Management discussed a remarkable clinician, Cheryl Marco, RD, LDN, CDE, from Jefferson Hospital in Philadelphia, (incidentally my alma mater). Cheryl has developed a very effective cognitive behavioral program that literally changes lives. And, of course, she is not alone. There are numerous programs popping up around the country that are focusing on our national scourge.
 
In a companion article, Joslin Diabetes Center’s Osama Hamdy, MD, PhD, provides follow up to an intensive behavioral modification program for diabetes that has exceeded expectations … for 5 years running!
 
But all of these efforts suffer from scalability. There is no way these efforts can handle the nearly one-third of Americans who currently need this counseling, behavior modification, and monitoring.
 
The Answer: Cognitive Technologies
A recent white paper by Deloitte outlined how health plans could start to use cognitive technologies—in particular, natural language processing. It is not a stretch to imagine how digital technologies in general and natural language specifically might work. A study in Obesity by Lora Burke, PhD, MPH, RN, FAAN, at the University of Pittsburg School of Nursing and colleagues, demonstrated that an earlier model of digital assistant could produce weight loss outcomes that exceeded those of traditional approaches.
 
Natural language processing, more accurately termed natural language understanding (NLU), is a giant leap in digital medicine. NLU combined with artificial intelligence is the foundation for the latest generation of a virtual health assistant (VHA)—one that can literally talk to people.
 
VHAs can perform the intensive behavioral counseling recommended by the CDC and measure the results. Not only can the VHA can educate, assist in motivation, track exercise and adherence, measure calories and content of food, coach, and answer tens of thousands of questions, but also perform the data gathering and other administrative tasks essential to the prior authorization process for the PCSK9 class of drugs. And, given the earlier discussion, the requirements health plans create will be (and should be) substantial.
 
If you believe the CDC, it is time to get serious about behavioral counseling. And this behavioral counseling can now be offered, at an affordable price, to the 1 in 3 Americans who need it to prevent illness.

 
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