How a personal digital coach can support chronically ill people in everyday life

A doctor cannot be there every day for all his patients. This goes without saying, but for chronically ill people this often means that they do not receive continuous support in their daily lives. In such cases, the digital coach from Pathmate Technologies, a startup with offices in Zurich and the Mannheim MAFINEX. In an interview with 5-HT, co-founder and CEO Dirk Volland explains how Pathmate's digital coach individually supports chronically ill people in their everyday lives and how health insurance companies can thus become active health promoters..

Why is the classical treatment by the doctor not sufficient for chronically ill patients?

Although patients with chronic diseases receive highly professional support in our health care system, this support is limited in time and expensive. The physician cannot provide support in managing the disease in everyday life and in implementing necessary behavioural changes. We do not want to replace the doctor with our digital coach, but rather to complement him or her and offer support where today there is often none. The question behind a digital coach is: What would a doctor do if he could support me every day based on my individual everyday life, as a sympathetic, personal companion?

Why is a digital coach particularly useful for chronic illnesses - and what specific illnesses does Pathmate have in mind?

Currently, our digital coach is aimed at patients with high blood pressure. However, we also plan to integrate other chronic diseases such as type 2 diabetes in the future. For chronic diseases such as these, so-called therapy adherence, i.e. how well patients adhere to the recognized medical recommendations for their disease, is particularly important. For example, I should know how correct blood pressure measurement works, what I should pay attention to in my daily diet and exercise, and how much my lifestyle can influence my disease and thus my quality of life. However, the information alone is usually of little help. People affected need individual motivation, feedback and active support.

How does your digital coach help users to integrate recommendations like these into their daily lives?

The core element of the smartphone application is a fully automated chatbot that informs, motivates and tries to coach me as personally as possible. In the conversations conducted via the chat, the user receives information, for example on nutrition or exercise, and can set daily goals. In addition, the digital coach has access to various disease-related tools. Here, for example, the so-called heart age is calculated, measured how much the user moves in everyday life, or the user is instructed to keep a digital blood pressure diary for one week. On the basis of this data, the digital coach can give more specific health tips. By the end of the year, the coach should be registered as a medical device, so that we can then make even more specific recommendations.

How do you make sure that your customers use your app regularly and actually follow the recommendations?

There are now many apps on the market for many different clinical pictures. However, most of them are only used for a few days and then not anymore, which is a problem especially with chronic diseases. Through proactive and individual coaching that adapts to the everyday life and habits of the users, we want to ensure that a broad target group uses the app in the long term. We want our users to be able to build a relationship with their digital coach, similar to a real personal coach. This also includes that the digital coach continuously develops on the basis of the data. If he behaves the same on the hundredth day as on the first day, the user thinks: "Why does he tell me the same thing again? In the beginning, the customer receives a lot of basic information, for example, how to measure blood pressure correctly or what a healthy diet looks like. They are also regularly reminded to take their medication. After a while, however, he will know his way around well enough and will be able to do this on his own. The challenge for the coach is to recognize what kind of interaction and how often the customer wants to have at the current time. At an advanced stage, the coach will then only call in less frequently, for example when he realises that the user has been moving less recently than usual in order to steer him back in the right direction.

How does your digital coach adjust to the individually different needs of the users?

No two users get the same coaching, because the behaviour of the coach depends on the measured data and the user input. When we give general information about nutrition or exercise, we also try to pick up the clients at their respective information levels so that we only tell them what is really relevant to them. In the future, we will also try to use activity times to better understand our customers' everyday lives. Certain interactions only make sense when the user is at home - when I'm on my way to work, I can't measure my blood pressure, and when I'm in a meeting, I don't want to receive notifications. So Pathmate is not a standard program, but is personalized to as many individual situations as possible.

What makes Pathmate different from other health tips on the market?

Many existing health apps require a high level of personal initiative and are suitable for people who take a very proactive and disciplined approach to treating their disease. However, these are the people who already have their disease under control better than others. Our app, on the other hand, is aimed at the many others who need more support and guidance. This makes the app also useful for older people, for example. Our coach guides customers through the program very closely, similar to a doctor's consultation. The coach asks something, the user answers, the coach gives a recommendation - these are very simple interactions for which no special preparation is necessary.

How did Pathmate Technologies come into being?

Our startup was founded in 2017 from ETH Zurich and the University of St. Gallen. Besides myself, Andreas Filler and Michelle Heppler were the operational founders. Andreas and I did research on digital health interventions in various projects at the Center for Digital Health Interventions, Michelle joined from another startup. Our goal was to create the technological basis for personalized, yet scalable health coaching. Basically, coaching is always similar. This refers to the behavioural psychological methods and the type of interaction between digital coach and user, but also to the content, as many chronic diseases depend on the same risk factors, for example unbalanced nutrition, stress, too little exercise and overweight. This is how we came up with the idea of offering a multi-coach solution: a single solution that can be used to treat several chronic diseases. This enables health insurance companies that sell the solution to their customers to offer scalable chronic care management.

How does your cooperation with health insurance companies work?

We sell our product to health insurance companies that make the digital coach available to their customers as a co-branded product. In Switzerland, for example, Sanitas Krankenversicherung sells our solution as "Sanitas Coach App. Our next goal is to find a health insurance company in Germany that wants to build a sustainable and long-term partnership with us. The goal is to enable a positioning as an active health promoter. This can only be achieved by actively accompanying people in relevant situations and offering support.

What advantages do health insurance companies have from using your digital coach?

A change is currently taking place within the health insurance companies: They do not regard their customers primarily as premium payers, but want to actively promote their health. With Pathmate, the health situation of chronically ill clients can be improved sustainably, which ultimately results in long-term cost reductions. In addition, health insurance companies can use our digital coach to offer their customers an attractive service and thus increase customer loyalty. We also provide aggregated, non-personal statistics and key figures that can give health insurance companies an overview of the complete risk profile of their customers. The app also includes a service channel through which health insurers can offer their customers products and services directly relevant to their chronic illness in a personalized way.

What other chronic diseases besides hypertension should be integrated into your digital coach next?

By May 2020 we also want to integrate type 2 diabetes and sleep disorders. After that, we plan to integrate other mental illnesses. Our technology enables us to treat a wide range of topics in a single application, and we intend to exploit this potential even further. Chronic diseases are strongly correlated, and people often have several chronic conditions, especially in advanced age. As a patient, I don't want to use several apps, but rather a coach who adapts to my individual health status and needs.