About This Blog

 

Sherri Dorfman, CEO, Stepping Stone Partners

Connected & Digital Health Innovation Specialist

My blog is designed to spotlight healthcare organizations with innovative uses of technology & data to drive Care Coordination, Collaboration & Patient Engagement.

These new approaches may influence your product & service roadmap, partnership and marketing strategies.

My Expertise: 

Over 17 years ago, I moved my focus from consumer-centric technologies in other industries (i.e. financial services, retail) to healthcare technology.  

While consulting, I leverage my extensive experience, knowledge and professional network to help companies make the right strategic product and marketing decisions. Services include: 

> Strategic Planning Market Review: Competitive Assessments, Partnership Evaluations. Workshop facilitation. Insight drives product, partnership and marketing strategies 

> Product Roadmap Planning: Product conceptualization, definition and validation through Marketing Research. Work Sessions for product suite planning with solutions from mergers, acquisitions, partnerships and purchases

> Product Marketing/Messaging: Differentiated value proposition story incorporated into marketing & sales assets
Find out how I can help you. Call me at 508-655-6585. Email me at SDorfman@Stepping-Stone.net to set up an exploratory discussion. 

Follow me on Twitter @SherriDorfman

Learn more about Me and my expertise

Read about the unique perspective shared through this blog

 

 

 

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    Geisinger Drives Mobile Patient Engagement with Education through iBooks & iTunes University

    With the shift to value- based care, health systems are investing in mobile technologies to increase patient engagement and care quality while reducing the cost of care delivery.

    Geisinger, an award winning healthcare system based in the Mid-Atlantic with 12 hospitals and a 510K+ health plan, is a leader in patient engagement. Within their organization, the Geisinger in Motion team focuses on strategic initiatives to drive patient engagement by co-creating with patients on digital technology solution design, capabilities and efficacy.

    Geisinger’s digital patient engagement initiatives are designed to support three key strategies 1) “understand my health”, 2) “manage my stay or visit” and 3) “control my condition (or specific acute episode)”.

    Last fall, the Geisinger in Motion team embarked on a project to enhance their patient education resources, which spans all three patient engagement strategies. Although they already offered a comprehensive set of patient education materials (i.e. handouts, online resources, targeted classes, individual conversations), Geisinger was looking to expand the reach of these resources for patients and their families. 

    “The genesis of the idea came from a pilot for patients that were having Lumbar Spine surgery”, explains Chanin Wendling, AVP, Geisinger in Motion. Geisinger focused on this patient population because of the prevalence back pain problems across the nation, the volume of surgeries done annually (approximately 2,000) and high patient co-pays for the surgery.

    “For this pilot, we loaded 10 iPads with educational content and loaned them to patients for about 4 months during the time before and after surgery”, Wendling shares. “After the pilot, we realized that we needed to come up with a different approach. CMS prevented us from giving the iPads to their patients, a critical population that we didn’t want to exclude.  In addition, it was very expensive to have enough iPads for all patients and took a lot of work to get the iPads back.”

    From the pilot, Geisinger also learned that patients wanted to use a device with everything on it. After evaluating different mobile tools, Geisinger elected to use Apple’s iBook and iTunes University to conveniently package a set of patient resources in one place and enable patients and their families to easily access and consume education content when needed, pre and post- surgery.

    Geisinger began by bringing together existing components into the iBook.  ”We had built a number of tools over time and were trying to leverage what we had to deliver a full ‘patient engagement package’ solution”,  adds Wendling.

    The Lumbar Spine patient education solution encompasses:  

    • Comprehensive set of interactive videos, animations, images  
    • MyGeisinger Patient Portal- 350k+ users with access to their patient record, visit notes and pre-visit prep
    • MySurgery: Lumbar Spine reminder mobile app – Developed for the iPad loan pilot, this app reminds the patient of activities that need to be done pre and post- surgery
    • Health (electronic) questionnaires for Lumbar Spine outcomes & medication reconciliation – These have been in place for a several years

    Patient Education Experience & Engagement

    When Geisinger patient Lisa decides to have lumbar spine surgery, she receives a handout explaining how to use her mobile device (iPhone, iPad) to access a suite of patient engagement tools through iTunes University or to download an iBook. Lisa’s friends and family can also access the educational materials to help her throughout surgery prep and recovery. The handout instructs Lisa to contact the Nurse Navigators listed with any questions.

    Patient Lisa engages electronically with these educational resources which contain animations, videos and interactive components. She moves through the chapters covering “meeting the care team”, “learning about the surgery”, “diet and medication guidelines”, “what to do before surgery”, “what to expect day of and after surgery” and even ”Navigating the Geisinger Medical Center”.  

    Within the course, patient Lisa is encouraged to download the Lumbar Spine App to receive reminders about pre and post- surgery activities such as diet and medication requirements, what to expect during the hospital stay, things to watch for post- surgery (e.g. fever), how to address pain, exercise and sexual activity. Three and twelve months after surgery, Lisa receives a notification and logs into her patient portal to complete health questionnaires about her Lumbar Spine recovery outcomes and medication. All of the information that Lisa enters flows into the EMR so that the care team can monitor her recovery.

    “We have received very positive response from our patients who like accessing these resources all in one place. It helps by setting expectations, reinforces materials discussed at clinic visits, reminds them of important steps and gives them a reference to share with family and friends.  Since the 3 month visit tends to be difficult to schedule and not all providers feel it is necessary, the questionnaire responses let the team check in with the patient and follow-up if there is a need”, describes Wendling.

    Geisinger has expanded this education offering beyond Lumber Spine with iBooks for Pediatric Concussion and NICU (for parents).  “Pediatrics was the initial area for our IPS project (iPads while patients are in the hospital). We learned about the high-volume of print materials that are handed out in the NICU and realized that we needed to give parents a better tool”, Wendling explains.  

    The Geisinger in Motion & IT teams continue to tackle resource issues and have "more ideas than we can execute”. Currently, they are working through a set of operational issues for tracking and measurement: 

    Activity Tracking-Fitbit/Withings: Although it was part of iPad pilot (e.g. 10 patients were given a Fitbit), it is not currently in iTunes University. “We are waiting on a project where the ability to get patient generated health data from wearables will be available in the patient portal and then can automatically be uploaded into the EMR”, Wendling shares.

    Measurement: “We completed and posted the Lumbar Spine course in December with an access code but then had to work with Apple to get qualified as an education institution in order to make it available publicly. From iTunes University, there have been about 30 downloads of the Lumbar Spine, 20 downloads of each of the NICU books and 16 of the Concussion. This is a public system so it is really hard to determine who is downloading. We are using survey data to better understand the profile of our users”, Wendling adds.  

    In the future, Geisinger plans to bring out bariatric surgery education through iBook and iTunes University. “Obesity is a significant health issue in Pennsylvania and the components around healthy weight and eating can also be used for other conditions such as diabetes, heart failure and hypertension. We hope this will be a building block as we expand our education resources to support patients and families”, concludes Wendling.

    Virtua Navigates Orthopedic Patients Pre- & Post-Surgery with Improved Patient Engagement and Care Coordination

    WELLBE PLATFORM FOR PATIENT ENGAGEMENTWith an aging population and increase in chronic conditions including obesity, the demand for hip and knee operation is increasing dramatically. A study in the Journal of Bone & Joint Surgery estimates by 2030 “demand for total hip arthroplasties to grow by 174% to 572,000 and demand for primary total knee arthroplasties by 673% to 3.48 million procedures”.

    Responding to this strong demand and high procedure expense, CMS launched the Comprehensive Care for Joint Replacement (CJR) payment bundle April 1st, focusing on cost and quality over a 90-day period beginning with the hospital admission. The CMS CJR Payment bundle is initially for about 800 selected hospitals across the country. 

    Although Virtua, one of New Jersey’s largest health systems with hospitals, surgical and rehabilitation centers, is voluntarily participating in the BPCI payment bundle, their investment in the orthopedic patient experience at their Joint Replacement Institute (JRI) started long before the payment model changes. 

    Virtua Health’s Orthopedic Patient Care Journey 

    Back in 2000, Virtua adopted the Six Sigma methodology and launched the STAR initiative to deliver an "outstanding patient experience”.

    “When we look at how we can change and improve a process, we focus on the patient and understand what they need, not what we think they need,” explains Kate Gillespie, AVP of Virtua’s Orthopedic Service Line. 

    With a commitment to enhancing the orthopedic (hip, knee) surgery experience, Virtua listened to patients discuss their challenges and needs. Through focus group research (Spring 2015), Virtua learned:
    • Orthopedic patients need a lot of information to get ready for their surgery but are overwhelmed when inundated with too much at one time.
    • Patients place a high value on their doctor’s suggestions to achieve best results.
    • Patients that are prepared are more confident and will participate in the process leading to improved outcomes.
      
    “We learned that as patients prepared for surgery, they were asked many of the same questions by different members of our care team,” said Gillespie. “We needed to improve the patient experience and ensure the consistency of information shared along the patient journey. We also wanted to engage the family to support the patient before and after surgery and decided to require that each patient has a ‘care partner’.” 

    The Virtua JRI team looked for technology to continuously engage patients and families, from on-boarding before surgery, to educating and guiding them from discharge through recovery.  The tool needed to be actionable, collecting essential information from the patient (i.e. concerns, pain levels) and informing Nurse Navigators when patients fall off track.

    Virtua JRI chose to implement a Connected CarePath for Total Joint Replacement from Wellbe, a solution provider in Madison, Wisconsin. Working closely with Wellbe, Virtua customized their CarePath with their own health history and sleep apnea surveys, scheduling and care plan content (delivered via “CareCards”). 

    Patient Journey 

    PATIENT CREATES CARECIRCLE ON WELLBEDuring the initial visit to the surgeon’s office, patient Patty is given information about Wellbe, a personalized care plan for her pre-and post-surgical journey. She signs up with the Nurse Navigator and receives a Welcome email. Patty shares this information and invites her family ‘Care Partner’ to join her CareCircle to access her resources.
     
    Pre- Surgery: Beginning 4-6 weeks prior to surgery, Patty views a care plan with a personalized set of “CareCards” explaining the operation and process to successfully prepare including preadmissions testing and health clearance forms. She receives a “CareCard” introduction to her Nurse Navigator. Every CareCard is delivered “from” her doctor or another member of her care team to motivate compliance. Patty receives reminder messages and checklist items leading up to the surgery and can refer to any completed CareCards in the “library” such as “How to prepare for the day of surgery.”  

    “Our patients really like the library feature. Before we launched the Wellbe platform, patients were given a Joint Replacement booklet. Now patients and families have all the surgery information at their fingertips.  Patients traveling to our Institute can prepare for their surgery by viewing videos instead of attending an in-person class,” adds Gillespie.  

    Post –Surgery: Within Wellbe, Patty views discharge information such as symptoms to watch for and completes surveys so that her care team can manage her recovery. Patty’s Nurse Navigator monitors her “Progress Report” with required actions and contacts her with any concerns. 

    “We believe this post-surgery engagement is important to prevent readmissions by ensuring the patient understands how to take medications, manage pain and follow outpatient physical therapy,” Gillespie shares.
     
    Patient Engagement Results

    Since launching the Wellbe platform in December 2015, Virtua JRI has enrolled 700 patients.  Patients span every socio-economic level and range from 40- 90 years old, with the majority in their 70s. 

    “We are signing up 86% of our surgery patients which is much higher than we expected. The remaining patients either did not have an email address or didn’t have a friend or family member to help them,” explains Gillespie.
     
    Virtua is evaluating success based on a few factors. Through a Wellbe survey, they are measuring how prepared the patient feels using the platform. With Wellbe reporting, Virtua is also measuring the patient’s engagement and compliance with required CareCards.

    Patients have shared positive comments about their experience using the tool - “grateful for the support received”. Nurse Navigators have also provided feedback - the Wellbe platform has helped them be more efficient in their patient care. Through “one tool”, nurses are able to “organize and track patient progress and communicate with the rest of the team” (i.e. physician office, pre-admission testing department). 

    Virtua has received suggested enhancements such as “defining an end time for a patient to be on the platform” and removing the medication form since patients “already gave the medication list to my surgeon.” Virtua has also added a link to the “Virtua Orthopedic Endowment”, giving patients an opportunity to give back. 

    Future Opportunities 

    Virtua initially launched the Wellbe platform without tying it into their Electronic Medical Record. “We are considering integrating Wellbe into our EMR so that the patient’s surgical chart will be easily available on one site for our Nurse Navigator.”   

    “Wellbe provides a key to patient engagement by keeping them engaged and participating towards a successful surgical journey. Virtua is determining where we can use this tool in other service lines such as Spine, Bariatric, Oncology and Maternity, which are all education-intensive clinical episodes.” 

    “This program aligns with our vision in keeping our focus on the patient /family experience, and provides us with an opportunities to participate in their surgical journey”, Gillespie concludes.  

     

    UnitedHealthcare Empowers Caregivers with Personalized Tools for Guidance, eCommerce & Connection

    At the 2016 Consumer Electronics Show (CES) in January, UnitedHealthcare launched Solutions for Caregivers, an online program that provides resources for caregivers and their family; personalized information, a discounted marketplace of products and services and care circle community for ongoing support.

    UnitedHealthcare is addressing the evolving needs of a large population of caregivers. According to the Caregiving in the U.S. 2015 report by the National Alliance for Caregiving (NAC) and AARP Public Policy Institute, an estimated 43.5 million adults have provided unpaid care during the prior 12 months,  34.2 million (79%) offering care for an adult age 50+.

    “Many caregivers are searching for relevant resources but often don’t know where to start. Solutions for Caregivers addresses the needs of family caregivers through case management services and online resources that help caregivers more effectively care for their loved ones,” shares Dr. Richard Migliori, EVP and Chief Medical Officer, UnitedHealth Group.

    Caregiving Burden

    According to the Caregiving in the U.S. 2015 report, caregivers spend an average of 24 hours each week helping their loved ones. Many caregivers experience their own physical, emotional and financial strain as a result of their caregiving role. Half of the caregivers indicated “they had no choice in taking on their caregiving responsibilities,” and 40% report being in high-burden situations. When asked about their health, 17% said ”it is fair or poor”, compared with 10% of the general adult population.

    Many caregivers (60%) admit they had to make a workplace accommodation, such as taking time off or reducing work hours. On average, caregivers assist with “4.2 out of 7 Instrumental Activities of Daily Living (IADLs),” including transportation, grocery/other shopping, or housework. Most caregivers (84%) report an interest in receiving more information such as “keeping their loved one safe at home” and “managing their own stress.”  

    UnitedHealthcare has conducted extensive research with family caregivers to understand their challenges around caring for a loved one. Vidya Raman-Tangella, M.D., head of UnitedHealthcare’s Innovation Center of Excellence, explains, “We heard that each journey is a ‘unique’ and ‘personal’ experience. Family caregivers are often not prepared and do not know where to begin, which causes anxiety. Some caregivers need support recognizing ‘what is good’ when making decisions for their loved one. Finally, UnitedHealthcare heard that the family caregivers did not want to feel alone and wanted to work together with others in their care circle.”

    CAREGIVERS MARKETPLACEVidya and her innovation team set out to define a solution based on these caregiver needs. The team started with a portal front end to house a set of tools to help caregivers:

    Personalized Information – educational articles and videos that are tailored to the specific medical issues and needs of the care recipient and caregiver. UnitedHealthcare’s articles support the topics requested by caregivers (i.e. safety, stress). Users can save an article for future reference or share with others (i.e. siblings, health coach and clinician).

    Marketplace – set of vetted discounted products and services to support the caregiver and care recipient’s conditions and challenges. Product categories include “assistive products”, “home monitoring”, “home safety” and “medication management.” Service categories span “financial”, “in-home care”, “nutrition” and “transportation”. Regarding “nutrition,” caregivers can order meals that are tailored to the care recipient’s health condition (i.e. low salt, low sugar). UnitedHealthcare’s marketplace is designed to support caregivers for activities they undertake on a regular basis, including transportation, shopping and house work. 

    One service option is for a “Care Manager” who can help the family plan or respond to care recipient/caregiver needs, via online, phone or consult (secure messaging). Some caregivers may have a health plan benefit that covers the care manager service, while others have the option of paying the hourly fee.

    Currently, UnitedHealthcare has mostly national companies and a growing number of regional and local offerings in the marketplace. Based on the care recipient’s zip code, there may be a national service provider such as CareLinx, which offers services in the specified geography.

    Community Support – centralized place where caregivers and friends of a loved one can connect, share insights and concerns (i.e. how does mom look today), add and view medical appointments & meetings on a daily/weekly/monthly calendar, post and assign tasks (i.e. a ride to the doctor’s appointment) and access a library of documents such as medication lists, doctors list, health records and a living will. The solution serves as a repository of this information, however there is no integration with the EMR or any clinical information 

    Caregivers can also invite others, such as clinicians and in-home caregivers, and enable them to securely access information and communicate on a common platform.

    Although other companies promote online caregiver offerings today, UnitedHealthcare has designed a 'personalized caregiver solution'. During the sign-up process, the caregiver creates a profile by responding to set of questions about the care recipient; relationship, age, zip code, conditions and challenges. The caregiver also indicates their own health conditions and challenges. 

    For example, when family caregiver Carla responds that her 86-year-old mother has hypertension and diabetes and is dealing with mobility issues, and she (the caregiver) is experiencing depression, Carla will see articles, videos, products and services that are relevant to both of their needs.

    Caregiver Solution Pilot

    UnitedHealthcare is providing the Solutions for Caregivers program to large employers at no additional cost for employees to access the online services. As of January 2016, Solutions for Caregivers is being promoted to over 1 million employees. Currently, Solutions for Caregivers is also accessible to the public. For people using the employer-sponsored version, the company can cover the costs associated with care management services, enabling caregivers to access more holistic support. In comparison, people accessing the consumer site, or instances where the employer has not purchased the additional care management services, can pay out of pocket for these resources. In both versions, caregivers can access customized content, shop from the marketplace, and use the myCommunity resources.

    UnitedHealthcare has received positive comments about their Caregiver solution, that it “saves time” and they would “recommend it to other caregivers”.  To date, UnitedHealthcare has also noticed that many users are in the early stages of caregiving.

    Future Solutions for Caregivers

    “While it will take the rest of 2016 to build the volume of users, we will continue to grow our marketplace through strategic partnerships with product and service companies. We are especially interested in technology solutions for caregivers”, shares Dr. Vidya Raman-Tangella.

    UnitedHealthcare is planning to leverage all customer service touch points to identify caregivers who are currently moving along the care journey or will be on the journey soon as potential users of the solution.

    “Throughout the year, we will learn how this program is delivering value to caregivers and care recipients. With Boomers turning 70, we will be particularly interested to see how our offering will be used to support the boomers as they retire as well care for their loved ones”, explains Dr. Raman-Tangella.

    “This program and others from UnitedHealthcare are making it easier and more convenient to people to take charge of their health and the health of their loved ones. By using technology and personalized resources, we are helping people to live healthier lives”, Dr. Migliori concludes.

    Carolinas HealthCare System Pilots Prevent PreDiabetes Program via Virtual Group Coaching

    OMADA HEALTH CONSUMER VIEW

    The Centers for Disease Control and Prevention (CDC) has revealed that 86 million, 1 in 3 Americans now have prediabetes, and 9 out of 10 of them don’t even know they have the condition. Unless there is an intervention, 15% to 30% of people with prediabetes will develop type 2 diabetes within 5 years. The CDC predicts that if current trends continue, 1 in 3 Americans will have diabetes by 2040.  On average, diabetes patients cost approximately $10,000 more every year than those without the condition. Like many chronic conditions, risk for type 2 diabetes can be reduced through lifestyle changes.

    “We knew that we needed a way to leverage technology to assist our employees who have prediabetes. With our employees spread across 900 locations in North and South Carolina, one huge challenge was figuring out how to motivate employees to participate in a prediabetes program that required them to go to a defined place (building) at a defined time, every week, and do this for 16 weeks.” explains Dr. Zeev Neuwirth, Senior Medical Director of Primary Care at Carolinas HealthCare System.

    Carolinas HealthCare System (CHS) was approached by Omada Health with a solution. Omada's online Prevent platform delivers a 16- week National Diabetes Prevention Program recognized by the CDC, with two years of peer-reviewed published data demonstrating effectiveness.

    Neuwirth explains further, “We were very interested in the Omada solution.  First, it had some really sophisticated and elegant behavior change mechanisms making it much easier for people to create and maintain healthier habits.  Second, it was online and asynchronous – meaning that people did not have to show up at a certain time,or certain place. They could use the program from the comfort of their home, and at any time of day or night which makes it much easier for people to sign up and stay with the program. Third, Prevent is based on a proven 16-week program. The Omada platform provides the social connection with a health coach and other participants to sustain behavior change, continuous real-time feedback and daily tasks for habit formation."

    “When I participated in the program, I looked at my weight on the Omada scale daily. This led me to be much more aware of my eating and exercise habits. But even more than that, having the bluetooth enabled scale in my house, connected to the coach, I felt like I was part of a larger community, all focused on becoming healthier. Stepping onto that scale almost felt like being transported – the social connectivity factor was much more powerful than I anticipated”, Neuwirth shares. 

    In early 2015, CHS began offering this solution to employees (called teammates) at risk for developing type 2 diabetes. To promote this new program, CHS leveraged their LiveWell Team which had trusted relationships with teammates across different locations for a “boots on the ground” approach. CHS teammates were emailed a complete Prevent program description, with their participation responsibilities clearly communicated.  

         Prevent Program includes:
    • Short online health assessment to determine if you are a candidate
    • Wireless scale provided to you, for daily weigh-ins
    • Group of peers who will be your online “team”
    • Online interactions with a dedicated, professional health coach
    • Daily and weekly tracking of your progress with your coach and team
    Interested teammates clicked on the email link to answer the Prevent screening questions. Qualified teammates enrolled into a cohort of 10-12 anonymous teammates, were assigned to a coach from Omada Health and received a Welcome package with a bluetooth scale.

    During the 16-week Prevent “Core” phase, participants complete one interactive health lesson each week, covering physiological, social and psychological aspects for change reinforced with interactive games. After the Core phase, teammates move into the “Sustain” phase with access to more education and a broader peer group for ongoing support.

    OMADA HEALTH COACH VIEWTeammates and their coach collaborate via the Omada Health platform. The coach monitors progress and gives real-time feedback via private messaging, group discussion board, text messaging or by phone. Teammates use food and activity trackers to capture high level daily eating, drinking and movement and engage in “healthy competition” messaging with other group members. Cohorts keep them motivated and accountable. Teammates can see the cohort member’s progress towards the weight goal displayed on the group dashboard by a green circle around their profile picture. Only the coach can view each teammate’s detailed progress page with tracked weight, food and activity information.

    Prevent Program Positive Response

    To date, over 400 teammates have participated in the Prevent program, with 245 completing the 16-week program. 

    “Teammates have found it beneficial to participate in the program”, explains Kati Davis, Director Benefit Planning and Wellness at Carolinas HealthCare System. “They are guided by trained coaches, supported by cohorts and can participate when it is convenient for them, from wherever they are.. at home or the work.”

    CHS is evaluating the program success through quantitative measures (i.e. weight loss, program engagement) and qualitative feedback.

    “Although the primary goal was to engage teammates in the program, we have been very happy with the results - 40% of our Prevent participants have lost more than 5% of their weight.  When you are considering the risk for prediabetes, this weight loss has a big impact on the health of the teammate.”

    “Our teammates are engaging with the Prevent platform an average of 12+ times each week, completing educational lessons, weigh-ins, tracking food/activity, participating in discussions and exchanging private messages with their coach”, Davis adds.

         Teammate comments:
    • The information has been helpful. I know that if I do what it says, I can avoid diabetes. If I don't, I am almost sure to be a diabetic.
    • Nice to have others going through the same struggles and working together for improvement
    • Currently in the 9th week of the program and I have lost 17 pounds. I love the app. I hope that at the end of the 16 weeks my scale will continue to work with the app and the tools I have been using will still be there.

    Future Direction for Carolinas HealthCare

    “We're working to move away from self-reported health activities to activities that require additional accountability and social support”, describes Davis. “We feel the support from the coach and cohort is very powerful to rejoice in the teammate’s success”.  

    CHS is currently considering to offer the Prevent program to a wider population at risk for Metabolic Syndrome, where weight is an important factor to monitor and manage.

    Neuwirth concludes, “From the perspective of a forward-thinking healthcare provider organization, we are excited about the potential of making significant improvements in the health of the multiple populations we care for – our employees, our much larger patient population, and the communities that we serve in the Carolinas.  Reducing the number of people who transition from PreDiabetes to Diabetes is one of the largest levers we have to improve the health of populations and communities. What makes this particular Omada Prevent Program attractive to providers and employers is that it makes it a lot easier and much more doable for the people we are trying to help.”

    Note: The Omada Health screen shots above do not display real health data. 

    Stanford’s ClickWell: Virtual Model for Primary Care

    In January 2015, Stanford Medicine launched ClickWell Care, a new type of Primary Care clinic which leverages technology to allow patients to virtually connect with their own Stanford primary care clinicians and wellness coaches via video or phone visits.  Patients use the MyHealth mobile app to schedule and conduct a video visit and share home health device data with the care team. Through this model, patients can choose to receive all of their primary care including integrated wellness coaching virtually, unless the physician indicates the need to come into the clinic for vaccinations, pap smears, procedures, or other physical exam needs.

    “Initially we created this virtual model for our ACO. We knew that 18-30 year olds were not interacting with primary care and were choosing to go to the Emergency Department or urgent care for their needs. During focus groups with this patient population, we learned they were so busy and didn’t have time to come into the office but really valued the relationship with their doctor. They wanted to receive care from their doctor but it wasn’t available in a way that was convenient to them.  We knew that we needed to use technology to help support this relationship and not replace it”, explains Sumbul Desai, Medical Director ClickWell Care and Vice Chair of Strategy and Innovation in the Department of Medicine at Stanford University School of Medicine.

    ClickWell clinicians and coaches support healthy patients and the ‘rising risk’ (e.g. up to 2 conditions), who are employees of Stanford University, Stanford Adult and Children’s Hospitals. With this highly educated, tech savvy patient population, there is a tremendous opportunity to leverage mobile tools to enhance the patient experience.

    Patients see a doctor for primary care visits and engage with a wellness coach on health goals (i.e. weight loss, stress, activity, and nutrition) and to receive support for chronic conditions (i.e. diabetes, hypertension and hyperlipidemia).  “The average age of a ClickWell patient is 36 years old.  However, we have a growing group of 40-65 year olds, part of the ‘rising risk’ population, who prefer to do the majority of their visits virtually. These patients feel comfortable interacting by phone or video because they have a better understanding of the healthcare system and their health goals than our younger patients”, Desai shares.

    The ClickWell Care program is designed to give patients complete control over how they want to access and interact with their doctor/coach and convenience of extended hours. Although patients have the option of scheduling a face to face appointment, they are incentivized to participate in a “no fee” virtual phone or video visit. Patients simply log into the MyHealth portal for their virtual appointment. 

    To date in the ClickWell program, there have been 2,142 visits; 43% conducted in-person, 32% through phone visits and 25% via video visits. ClickWell staff have seen 1,223 patients. Although 30% of new patients start off with a virtual visit, most prefer to meet their doctor first in-person. After an initial face to face visit, 60% opt to see their doctor virtually for their return visits via phone or video.

    MyHealth Mobile AppAll patient information from the virtual visit is transmitted to the Epic EMR and is accessible through the MyHealth portal. Patients can ask follow up questions through the portal.  When patients need to have blood work done, they are directed to the lab without having to come into the doctor’s office, and lab results are incorporated into the EMR with portal access. “Stanford was the first to use Epic’s integrated telemedicine service because we wanted this visit information available to patients in the portal and clinicians in their daily workflow”, confirms Lauren Cheung, Physician, ClickWell Care, and Medical Director, Strategic Innovations at Stanford University School of Medicine.

    “One myth about telemedicine is that many patients choose to do video visits over phone visits. The truth is that it is an extra effort for the patient to participate in a video visit since the patient needs to be in front of a computer or mobile screen versus the phone visit which can be done while walking around”,  Cheung adds.

    “Back in 2013, we rolled out video visits as part of our primary care practice but we didn’t see a strong uptake. When we conceived the ClickWell Care program, we knew that we needed to introduce wellness coaching to provide a complete overall healthcare experience and deliver a higher level of healthcare service to our patients”, describes Desai.

    Strong collaboration with IT and Operations have been pivotal in implementing this new care model. Through this collaboration, ClickWell has been able to leverage the new MyHealth app developed internally and has worked closely with IT to improve the platform and video visit capabilities to provide an excellent patient experience.

    As part of the ClickWell Care program, the MyHealth mobile app helps strengthen care collaboration. The doctor/coach prescribes the health tracking app to the patient as a way to monitor key measures which may include steps, weight and blood pressure. The patient uses the MyHealth app to upload tracking data from Withings, Fitbit and Apple HealthKit to the EMR, sharing health status between visits. “When I see a patient with blood pressure trending higher, I ask the patient to schedule an online visit so that we can discuss how to address this through diet or medication changes”, Cheung explains.

    ClickWell Lessons Learned

    The Stanford Medicine team has gained insight into ClickWell Care program usage, the telehealth platform and mobile app to bring the most value to primary care patients and providers. They understand that it is not about the technology but instead about how the technology is put into the care model through a program.

    Patients have shared many positive comments about the ClickWell Care program:

    “Video visits allowed me to continue with pressing work concerns, instead of taking time off work to travel to a clinic. Video visits allowed me to chat with a Doctor late in the evening, and appointments were very easy to get.  I felt that my virtual care was more personalized and provided a better experience.

    “I have not had many medical issues until recently. It is such a relief being able to ask questions and get answers quickly. My wellness appointments have me watching my diet and exercise regimen. Everything is done efficiently. I cannot say enough about the whole team that has been watching over me.”

    “My experience with the ClickWell Clinic has been extremely informative and remarkably efficient. The flexibility they offer works perfect for people with busy schedules, without sacrificing the quality of care. The model of the Clinic makes other forms of healthcare communication feel outdated.”  

    “I have never had better communication and quicker responses than I have since becoming part of this program. I travel a lot and therefore keeping up via phone calls is not that practical. Being able to send messages electronically and to have an appointment via video chat is ideal.”

    Doctors and wellness coaches have provided mostly positive feedback as well:

    “Overall my experience with virtual visits in the clinic has been very positive. Compared to my previous experience with only in-person visits, it seems like the virtual option may make wellness patients more likely to continue with follow-ups. The integration with the doctors is also helpful in learning more about the patients and providing well-rounded care. It is a unique experience to be able to discuss treatments so closely with the patient’s doctors and in such a timely manner.”

    “The integration of clinical care with wellness coaching has been phenomenal. I couldn’t imagine going back to health coaching without it. I am able to provide more targeted, individualized, and thorough care to my patients since I have full access to their medical records, provider notes, and work directly with their primary care physicians. Working directly alongside physicians has helped me to expand my knowledge on chronic disease management, stay up to date on clinical guidelines and recommendations.”

    “As a provider, the technologies we use in this clinic allow us to quickly connect with our patients and address concerns for our patients proactively. The extended hours also allow for expanded patient access, as well as a flexible schedule for providers who staff the clinic who may desire alternative hours outside of the usual 9-5 business day.” 

    “Through our discussions with patients, we have also heard some suggestions for change. In the beginning, we were contacting patients to convince them to switch from in person to virtual visits. This frustrated some patients and most wanted to stay with the modality that they had initially chosen”, Desai shares. 

    Future ClickWell Care

    As with other healthcare systems across the country, Stanford Medicine sees what is happening with the retail pharmacies increasing care access to patients. However, they believe this only fragments care because the visits are outside of the patient/doctor relationship. ClickWell Care is designed to be “longitudinal” and not episodic.

    In 2016, Stanford Medicine is looking to extend into specialty care. “We are interested in integrating preventative cardiology for our patients since care entails discussing and improving risk factors for cardiovascular disease, which can be done virtually. Preventative cardiology patients would also benefit from wellness coaching to improve their risk factors for disease.

    We also want to expand the use of connected health devices. Currently, very few patients upload and share their data with our care team. We are planning to incorporate this health tracking into a program for a  patient population (e.g. specific chronic conditions) and integrate this information into clinical workflow to ensure that these patients receive excellent care. With our Precision Health initiative, we are not just interested in treating illness but rather finding tools to deliver a personalized health and wellness experience to ensure the best outcomes”, Desai concludes.