Related Experiment Video
Updated: Aug 16, 2026
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
Published on: April 12, 2021
Health System- and Payer-Level Decision-Making Processes Influencing the Adoption and Sustainability of
Mallory Herzog1, Linda S Park1, Andrew Quanbeck1
1Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N Whitney Way, STE 200, Madison, WI, 53705, United States.
Background:
Patient-facing digital health tools such as mobile health apps, wearables, and digital therapeutics have expanded rapidly and show promise for improving chronic disease management. Despite increasing evidence of effectiveness, health systems and payers continue to face challenges integrating these tools into routine care.
Objective:
This study examined the decision-making processes of health system and payer leaders regarding the adoption and sustainability of patient-facing digital health tools within their organizations.
Methods:
We conducted semistructured interviews between August 2025 and December 2025 with nine senior leaders from a large Midwestern academic health system and affiliated payer organizations, including a provider-owned health plan and a state Medicaid program. Interviews explored digital health adoption decisions, perceived value and fit, barriers, and sustainability considerations, focusing on the adoption of an evidence-based mobile health intervention for alcohol use disorder as a use case. Transcripts were analyzed using thematic analysis with inductive and deductive coding.
Results:
Four decision-making mechanisms shaped adoption and sustainability decisions: prioritization under organizational constraint, risk mitigation, operational fit, and value determination. These mechanisms describe how leaders navigate limited organizational capacity, reduce uncertainty, and protect against clinical, financial, and operational risks, assess whether tools can integrate within existing clinical and technical systems, and determine whether anticipated and measurable benefits justify adoption and continued organizational support.
Conclusions:
Adoption and sustainability of patient-facing digital health tools are shaped by dynamic organizational decision-making processes that often remain invisible to patients, clinicians, researchers, and developers. Making these processes visible may help better align digital health tools with the realities of the health care system to support implementation.
Related Concept Videos
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:13Patient-centered Care
01:25Ethical Standards I
The Code of Ethics provisions outline the nurse's duty to the patient, the healthcare team, the profession, and society. The Code's fundamental principles include advocacy,...