Akili’s Vision for Equitable Benefit in Digital Therapeutics

When evaluating health equity and overcoming social determinants, progress is typically measured by access to high quality healthcare. However, we believe that access alone - while an important first step - is not enough. At Akili, we are constantly exploring new ways to improve healthcare access while also ensuring that the treatments patients receive are effective.

As part of this vision, Akili recently launched Equitable Benefit (EB), a new program which will evaluate all Akili products and services based on their accessibility, use and benefit. The goal: to provide equitable benefit to all patients and caregivers using our products, regardless of their demographic background. We sat down with Carl Gottlieb, Chief Technology Officer and Andy Heusser, Senior Data Science Manager, to explore the EB program and Akili’s vision for equitable care. 

Q. What is Akili’s Equitable Benefit program? 

Equitable Benefit is a program that helps us create products and services that are equally beneficial to all patients, regardless of their demographic background or socioeconomic status. 

Under the hood, EB is powered by advanced statistical software we built from the ground up to give us visibility into who has access to our products, who uses them, and who ultimately benefits from them. 

This visibility allows us to understand how our decisions impact the equity of those using our products, and helps us prioritize choices that will have the largest positive impact for patients. 

Q. How is equitable benefit different from equitable access?

Picture a student with access to best-in-class online course materials. Without the proper guidance, support and resources, they may never complete the course and consequently may never benefit from having access to these resources. 

To truly unleash the potential of our most powerful digital technologies, we must actively invest in addressing inequalities. It is well known that health outcomes can depend on social determinants, like race, gender or income. The COVID-19 pandemic clearly highlights these inequities: Black and Latinx Americans are ~4x more likely to be hospitalized with complications from COVID-19 than non-Hispanic white people.1 To truly unleash the potential of our most powerful digital technologies, we must actively invest in addressing inequities. The goal of manufacturers should not be just to facilitate access, but should be to enable everyone to equitably benefit from the latest innovations.

The goal of manufacturers should not be just to facilitate access, but should be to  enable everyone to equitably benefit from the latest innovations. 

To accomplish this, we use EB to evaluate whether the demographics of those using our product are aligned with the populations we intend to serve. For example, our product EndeavorRx is indicated to improve attention in 8-12 year old children with primarily inattentive or combined type ADHD. (Please see endeavorrx.com for full indication information.) EB enables us to compare the demographics of the patients benefiting from our treatment with the broader population of children aged 8-12 with ADHD in the US with the goal of ensuring benefits are as equitable as possible across that population.

Q. How can the equitable benefit assessment work for others?

The first step is collecting demographic data from those using the product, with their voluntary consent of course. We have an optional form when a caregiver and patient register for EndeavorRx after receiving a prescription that asks them to provide their demographic information. 

The second step is to define your “target” audience: who is this product meant for? Without knowing the populations you’re trying to serve and support, it will be hard to determine who is benefiting from a product, and how.

The last step is to define the criteria for access, use and benefit. These definitions are completely up to the company. For Akili, “access” means anyone who activates a prescription for our product, “use” is the cohort that adheres to the treatment, and “benefit” is the group that has - hopefully - realized the attentional improvements based on the treatment. Benefit, for us, will always be a work in progress. As new patients begin using our product and others age into and out of our indication range, we always want to make sure that everyone is benefiting in the most equitable way.

Once these three pieces are in place, the software tools handle the rest using our proprietary framework. We generate internal quarterly reports on equitable access, use and benefit of our products and confidentially share them with internal business leaders to help them identify investment opportunities to improve equity in our patient base. 

We’re excited to one day be able to share our learnings with other organizations who may be able to benefit from them as well, of course with proper consent and privacy protections in place for our users and customers.

Q. How has the program been put into practice to date? 

It’s best to answer this question with an example. Over the years, Akili has expanded from using iPadsⓇ exclusively to deliver treatment in our clinical trials, to expanding support to iPhonesⓇ, and then to the most commonly used AndroidTM devices in our commercial products. 

We hypothesized that giving patients the option to “play their medicine” on less expensive, more generally-used devices would enable a more diverse population to benefit from our treatment. It turned out, however, that our hypothesis was only partially true. Patients accessing EndeavorRx from an iPhone were more diverse than those using an iPad (9% improvement in Equitable Access Score). However, the story is a little more complicated for Android patients. While Android enabled lower income families to access EndeavorRx, those patients tended to be disproportionately male. In other words, income equity increased but gender equity decreased which resulted in no change in our overall Equitable Access score (relative to iPad patients).

[Infographic] Case Study: Impact of Device Type on Equitable Access

This plot represents the diversity of patients who are accessing EndeavorRx with an iPad, iPhone or Android device. The higher the bar, the more similar the patient demographics are to our target population, children 8-12 with inattentive or combined-type ADHD in the U.S. This score is an average across gender, race, ethnicity and income demographics. *p<.05, n.s. = not significant

In addition to analyzing how our business decisions affect the equity of our patient base, we’ve also  integrated EB into our corporate goals and company DE&I initiatives to ensure that equitable benefit remains at the forefront of everyone’s minds as we look to the future. 

Q. What’s your future vision for the program?

One of our big goals this year is to find other organizations we align with, to further validate our EB program outside of Akili. We hope to eventually establish the methodology as a standard for measuring equity across different types of industries beyond digital therapeutics 

If you are interested in exploring the use of EB in your organization, please reach out: equitablebenefit@akiliinteractive.com

1 Katella, K. (2021, February 2). Health Equity: What It Means and Why It Matters. YaleMedicine.com. https://www.yalemedicine.org/news/health-equity