Using digital health tools to enhance digestive disease care

Disorders of gut-brain interaction, like irritable bowel syndrome, functional diarrhea, and functional constipation, can severely limit an individual's quality of life. DGBI conditions not only manifest physically, but they also have psychological repercussions. Thus, this population requires nutrition counseling and stress management alongside medications.

To provide this comprehensive care, Cleveland Clinic is offering its DGBI patients access to Ayble Health's AI-enabled digital care platform, which offers virtual behavioral healthcare and personalized nutrition support.

DGBI are widespread in the United States. According to a study published in 2023, four out of 10 U.S. adults have a DGBI, and it is more common among women and people under 65. Additionally, DGBI adversely affects an individual's quality of life and emotional well-being, resulting in elevated anxiety, depression and somatization symptoms.

Addressing the psychological effects of DGBI is critical to improving patient outcomes, noted Stephen Lupe, Psy.D., gastrointestinal (GI) psychologist and director of behavioral medicine in the department of gastroenterology, hepatology, and nutrition at Cleveland Clinic.

"What we found was, as you work with people, and you start teaching people to do some kind of relaxation, it changes the nervous system, and it changes the inflammation levels within the body, and the medications start working better, and patients feel better," he said in an interview.

Through its collaboration with Ayble Health, Cleveland Clinic aims to expand access to behavioral healthcare for digestive disease patients through digital care modalities.

What we found was, as you work with people, and you start teaching people to do some kind of relaxation, it changes the nervous system, and it changes the inflammation levels within the body, and the medications start working better, and patients feel better.

A look into the digital health app's behavioral health features

Ayble Health, launched in 2020, offers various resources to help DGBI patients manage their diet and psychological health. The company was born from the founder's own decade-long experience as a gastroenterology patient.

"During that time, I struggled to manage my condition without adequate support beyond clinic visits and medication -- in particular, how to manage my symptoms through diet and address the psychological components to my condition," said Sam Jactel, founder and CEO of Ayble Health, in an interview.

To close this care gap, Jactel founded Ayble Health, which offers mental health programs, nutrition support, wellness tools and access to a virtual care team via a mobile app. Patients enrolled in the Ayble Health app first undergo a health assessment. Based on the results of the assessment, the care team creates a customized treatment plan for the patient.

The mental health programs include guided audio content on mindfulness, hypnosis, meditation, cognitive behavioral therapy and breathing techniques, as well as AI-based wellness tools to manage and track symptom progress. The nutrition support offers guidance on identifying and managing trigger foods.

"It's not huge swabs of elimination," Lupe explained. "It's more like, we're going to eliminate apples and gluten out of your diet, and then we're going to track your symptoms and try to add back in as much as we can. So, we can get to a granular level [and tell patients things] like you can have a fourth of an apple before your symptoms are likely to show up."

The app includes a food barcode scanner that patients can use at the grocery store to determine whether a particular item could worsen their symptoms and educational resources on grocery stores and products nationwide.

As part of the collaboration, Cleveland Clinic and Ayble Health have co-developed care pathways, behavioral health content on the platform and patient engagement approaches. The multidisciplinary Ayble Health virtual care team, which includes health coaches, coordinates the patient's care plan with their Cleveland Clinic providers.

"By combining our virtual care platform with Cleveland Clinic's model, we aim to create an effective and holistic approach to GI care that I wish I had when I was diagnosed," Jactel said.

Virtual care platform enhances DGBI care, but change management is needed

Providing DGBI patients with virtual behavioral health support in addition to traditional, in-person care provides numerous benefits, including enhanced symptom management.

According to Lupe, the data shows that mental health support helps DGBI patients relax their minds and bodies, reducing symptoms and decreasing inflammation. Managing symptoms effectively could, in turn, reduce the need for more invasive treatment, like surgery.

Further, because the behavioral health resources and the virtual care team are available 24/7, the app offers expanded access to DGBI care.

"So, if you're sitting up in the middle of the night worried about your stomach hurting, you can communicate at least with your health coach, who is supervised by a gastroenterologist," Lupe said.

Not only that but since the app augments the DGBI care provided by brick-and-mortar facilities like Cleveland Clinic, it can help mitigate hurdles stemming from specialist shortages.

According to data from the Health Resources and Services Administration, GI physician supply will fall short of demand for the next decade. Lupe explained that the gap is also persistent among GI-focused mental health providers.

"There's a complete mismatch of providers and patients," he said. "If you look at people in the mental health field, and this is everybody in the mental health field who identifies as having a GI specialty in some form, there's about 240 providers in the U.S. If you look at doctorate-level trained providers, it's probably about 50 ... I've told our chair multiple times, I think I could fill a building with psychologists, and we would still have patients to see."

Ayble Health thus performs the critical task of supplementing the GI care provided in the clinic by Cleveland Clinic providers.

Notably, the agreement between the two organizations ensures that patients can move between in-person and virtual care in accordance with their needs. It includes bidirectional referrals, which means that if a patient's symptoms worsen despite using the programs and resources available on the app, their Cleveland Clinic care team can take over.

"Digital care and in-person care, appropriately matched to what a patient needs at any given time, is what we believe to be the most effective use of clinical resources and generates better outcomes," said Jactel.

Though the platform could help alleviate workflow burdens for physicians, Lupe noted that they might find it difficult to adapt to a new model of care, one that involves a care team from outside the hospital.

Accepting hesitancy and working to understand and mitigate their concerns is critical to addressing physician resistance to new technologies and ensuring a successful deployment.

"I think that the way you deal with [hesitancy] is education," Lupe said. "You show them what [the technology] is, you show them how it works, [and] you walk them through the implementation side."

Cleveland Clinic is also working to solidify the evidence base of digital health utilization within the GI arena. The health system and Ayble Health are collecting data on various metrics among those using the app, including symptom reduction and patient experience. They plan to analyze the data and publish their findings.

Providing whole-person care is an increasingly important goal among healthcare stakeholders. Collaborations like the one between Cleveland Clinic and Ayble Health show that combining in-person and digital healthcare is an innovative approach to achieving this goal without adding to existing healthcare workforce burdens.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.