Chronic cardiometabolic conditions like hypertension, diabetes and high cholesterol drive a major share of healthcare costs and, more importantly, long-term health risks. As a clinical pharmacist, I’ve paid attention to the past decade’s rapid rise in digital health solutions designed to address these challenges. Many offer promising technology and engaging apps. Yet, a digital health product is only going to work if it’s built around true clinical care.  

At Ochsner Digital Medicine, we’ve taken that approach, and the outcomes show that our program consistently delivers results for patients, as well as measurable value for health systems.  

A pharmacist-physician collaboration

One of the most common misconceptions I encounter is the role of pharmacists in care delivery. Many people associate pharmacists primarily with those dispensing medications at the local drugstore. But clinical pharmacists, like me, have received advanced training in chronic disease management and medication optimization. In Digital Medicine, we work directly with physicians and professional health coaches to actively manage the care of patients, not just educate or monitor them.

You see, chronic disease management isn’t static. Medications need to be adjusted. Side effects must be addressed. Risk factors are reassessed as our patients’ conditions evolve. Many digital solutions out there stop at reminders, lifestyle nudges or logging readings without clinical interventions. Ochsner Digital Medicine goes further by delivering ongoing clinical management supported by much more data than what is collected in traditional care settings.  

Going beyond the primary diagnosis of hypertension or Type 2 diabetes, our team branches out care to related areas that could drive negative outcomes and higher costs, including high cholesterol, excess weight, heart failure and kidney disease. We practice a holistic approach in an attempt to stop disease progression and prevent further complications.

Clinical and lifestyle care, from home

Traditional care relies heavily on sporadic office visits and in-office data points. But a blood pressure reading taken once or twice a year doesn’t tell the full story. Neither does an A1c checked twice a year.

Digital Medicine fills that gap by using Bluetooth-connected blood pressure cuffs and glucose monitors that let patients send in readings from home. Home readings are the best readings. Not only do they tend to be more accurate than readings at the doctor’s office, but they also give the care team a longer view of how the patient’s medications, diet, activity and daily habits are impacting their health.  

Further, engagement increases when patients see their own data regularly. They begin to understand the connection between daily choices and long-term health. We have found that this awareness drives meaningful behavioral changes.

With Digital Medicine, while a clinical pharmacist (or advanced practice practitioner) focuses on the patients’ medication management and risk reduction, patients also have access to a panel of health coaches. These professional coaches help patients set small, realistic goals that fit into their life.  

This model works

One of the ways Digital Medicine differs from many solutions on the market is our focus on risk reduction, not just numeric improvement.

Eighty percent of Digital Medicine members achieve blood pressure and A1c control within six months, a rate significantly higher than traditional care alone. But this is about more than just the numbers; these gains represent reduced risk of stroke, heart attack, kidney failure or other high-cost complications. Even modest improvements — such as a 5mmHg reduction in systolic blood pressure or a 0.5% reduction in A1C — are associated with a 10% decreased risk of cardiovascular events.

Let me give you an example that ties into the pharmacist’s role in the program: many people don’t realize that patients with diabetes should be on cholesterol-lowering therapy, regardless of baseline LDL levels. That recommendation isn’t about today’s lab result but about reducing future cardiovascular events. Similarly, long-standing hypertension and diabetes significantly increase the risk of kidney disease and heart failure, often before symptoms appear.

Digital Medicine proactively addresses these risks. We ensure patients are on appropriate, evidence-based therapies and monitor their response over time. When needed, we coordinate referrals or escalate care. This preventive approach helps avoid downstream complications that drive the highest costs in healthcare.

For health systems — particularly those in value-based arrangements — slowing chronic disease progression reduces department visits and hospitalizations, positively impacting your bottom line.  

Easy to implement

Digital Medicine was designed to be easy to adopt and scale. We partner with external health systems to implement these evidence-based programs by fully integrating into Epic and provider workflows. 

The program is fully remote, eliminating the need to build new clinical infrastructure and enabling care delivery to patients wherever they are. Enrollment is straightforward, and once patients are engaged, they tend to stay in the program. Our attrition rate is less than 2%.  

Because the program was built by an 80+-year-old academic health system, the program offers health systems a true partner, not just a vendor. The workflows, technology and care model were built within our real-world practice.

The future of care

There is a Digital Medicine difference.  Solutions that rely solely on monitoring or coaching often struggle to deliver sustained outcomes. Digital Medicine succeeds because it combines technology with clinical expertise and a focus on long-term impact on patient care.

As a clinician, I believe that’s why this model works and how cardiometabolic conditions should be treated. Not only for patients, but for the organizations that support their care.  

What can we do for you?  

If you’re evaluating digital health solutions and looking for a program that is proven, scalable and clinically grounded, please connect with our team to see how Ochsner Digital Medicine can support your patients, improve outcomes and reduce the total cost of care.

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