How Health Economists Add Value to Digital Health

Bringing innovation to the clinic

MDisrupt: Why did you choose to study health economics?

Ragan Hart: I was an exercise science major doing lab work in the genetics of diabetes, and I wanted to better understand genomics tools and sequencing. That led to an interdisciplinary graduate program in public health genetics. I was very interested in biostatistics and how to get these technologies to the clinic.

With colleagues who were physicians, research scientists, genetic counselors and others in an academic medical center focused on genetic testing, I kept hearing, “Payers don’t want to pay for this.” And so I asked, “What type of evidence do the payers need? Are we having conversations with payers?” And the response was, “No, we haven’t been engaging payers.”

That was pivotal. I said, I need to train in applied health economics to understand payer decision making. Economics and business are two things I wish had been introduced to sooner.

MDisrupt: What did you envision for yourself in terms of a career?  

Ragan Hart: I definitely knew I wanted to work in industry. I didn’t know the term commercialization at that point, but I was absolutely trying to find my way into commercialization. I knew I had an understanding of startups in the genomics diagnostics space. So I started following the market of early stage venture capital into a set of these companies. I really started to understand the different levers at play for health tech adoption.

MDisrupt: Why did you decide to join MDisrupt?  

Ragan Hart: Because I absolutely understood the mission that MDisrupt was founded to serve—getting the most impactful health products to market faster and more responsibly—and I wanted to be part of that. I wanted to have a role in connecting scientists and health experts to digital health founders. I pride myself on being able to appreciate new ideas; I value a lot of lessons learned from the tech sector and I want to be part of figuring out how we can bring this into health care.

How health economists add value 

MDisrupt: How do you see health economists as helpful to digital health companies?

Ragan Hart: Health economists can help digital health companies by identifying:

• Who are the stakeholders?
• What are their economic incentives?
• How do we build a product that can meet those incentives?
• What evidence do we need to generate?
• How do we assess how well the product performs in a clinical setting?
• What’s the added value? For example, is this improving quality of life? Are cost savings being generated?

From a value proposition perspective, the digital health companies may have a really awesome product. But it’s also critical to their success to be able to articulate why their product should displace standard of care. Applied health economists can support economic evaluation for cost effectiveness studies—evaluating the new health technology against whatever is currently being used and comparing cost effectiveness.

Often, costs are going to be increased by investing in new health technology. But we’re getting this gain in the quality outcome or the health outcomes. The next step of data that needs to be generated is, can the purchaser who’s evaluating this technology afford it?

And so applied health economists can generate budget impact data, honing in on the financial consequences for adopting the new health technology. These are things that a health system needs to know, and in an ideal world, maybe the health system would do that kind of analysis. But they don’t necessarily put resources into doing it, so it really has to be done by the digital health company themselves. However, in the healthcare industry’s transition to value-based care, we may start to see more health systems identifying gaps from a cost-benefit perspective.

Integrity as the North Star

MDisrupt: Can you describe a challenge you’ve faced that’s been formative to the way you work now? 

Ragan Hart: In the academic space, something came up where a senior individual was operating without scientific integrity. The challenge was a dilemma for whether or not to say, yes, we’re willing to accept your lack of scientific integrity. There would have been limited consequences for everyone involved. I was really fortunate that my advisor said, look, here are the two options. And this one—to accept the lack of scientific integrity—is not an option. And that forever changed my ability to be able to navigate situations from that perspective. 

MDisrupt: Can you say more about that? 

Ragan Hart: It allowed me to anchor myself in thinking through the competing incentives, and, going back to my economic roots, that everything is about tradeoffs. It was a valuable lesson in what’s the North Star, and, when are we allowing ourselves to veer away from that? At what cost?

Health startups need scientists

MDisrupt: What advice would you give other scientists who might be thinking about working with a health startup?

Ragan Hart: Do it! Startups building health products need individuals who have critical thinking skills and subject matter expertise. They also need to generate data and evidence that their products work and are safe, effective and clinically useful.

Oftentimes, scientists are conflicted and wonder, Well, am I still going to be in an environment that maintains the academic rigor, intellectual curiosity, and stimulation of the academic environment? The answer is yes, tenfold in a startup environment. Because you’re also getting to cultivate new skills on top of contributing domain expertise you already have. It’s incredibly enriching.

Fresh ways to work

MDisrupt: What have you discovered in your role at MDisrupt that’s been fresh and surprising for you? 

Ragan Hart: I’ve been exposed to the value of marketing. And building trust with colleagues and working in a team. Previous environments have been quite siloed and building that bridge and rapport hasn’t been valued as much. It’s so valuable, because we’re trying to build and execute on the same mission. And I’ve learned that it’s OK to depend on others. Necessary, in fact.

MDisrupt: Can you say more about that? 

Ragan Hart: Building off of that trust piece, there are too many critical things that need to be completed to meet the goal, and not one of us can complete them on our own.

MDisrupt: What would you say to scientists who might be interested in joining MDisrupt?

Ragan Hart: It’s an easy way to work with digital health innovators. It’s about being able to apply your scientific skills in a new environment. And the energy and pace are invigorating! You are able to contribute to getting your science placed in the hands of patients or providers or health systems or whoever the intended user is, faster and more responsibly with data. Scientists don’t often have that opportunity.