Entries in personalization for health and wellness (20)
Dartmouth- Hitchcock’s ImagineCare Platform Leverages Wearables, Connected Health & Analytics for Personalized Patient Care
Dartmouth-Hitchcock (D-H), an innovative New England healthcare system with 1,000+ providers is committed to creating a “sustainable health system”, which proactively engages patients through new care models to achieve the triple aim.
Over the years, D-H has invested in technologies that empower patients to collaborate with providers through shared decision tools and Telehealth, treating “patients and their families as partners in care”.
D-H has been a pioneer in innovative payment models with both the government and commercial payers.
In early 2015, D-H’s leadership team committed to create a truly patient-centric healthcare organization, which delivers high quality proactive personalized care to the patient beyond the hospital walls.
“Dartmouth-Hitchcock purposefully set out to assemble a team of employees with backgrounds from other consumer industries like hospitality and retail that would augment the world-class capabilities of our clinical staff, to improve the health care delivery experience”, explains Vin Fusca, COO, ImagineCare.
With their consumer- centric “healthcare without boundaries” vision, D-H management has designed a truly “care- driven” solution. ImagineCare, a cloud- based platform, enables providers to closely collaborate with each patient to meet her care goals at any time and from anywhere.
ImagineCare treats the patient holistically through the active and passive collection of a comprehensive set of patient data. In addition to condition specific evidence-based care pathways (i.e. ImagineCare Hypertension Pathway, COPD Pathway, CHF Pathway, Diabetes Pathway), D-H incorporates a “Core Health Pathway” to capture steps, heart-rate activity, sleep, and stress (Behavioral Health), providing contextual insight into the patient’s health.
With ImagineCare, the Provider and patient have a window into the latest health status for insight and action. In the background, ImagineCare collects information from the patient (i.e. sensor- based devices, apps), combines it with EMR data (i.e. patient visits, labs, meds) and processes it through complex clinical care algorithms with machine intelligence to pinpoint when the patient is at risk. High tech meets high touch when ImagineCare notifies the RN or Health Navigator to reach out to the patient for real-time support and intervention.
“ImagineCare leverages the best available technologies to assist with care, but does not replace the importance of the human touch to drive behavior change. ImagineCare seamlessly combines these components to help patients achieve their health goals”, shares Dr. Ethan Berke, Chief Medical Officer, ImagineCare.
During her recent doctor’s visit, (patient) Pam decides to participate in D-H’s new ImagineCare Program to help her lose weight and proactively manage her hypertension.
Within 48 hours, Pam receives an email to quickly enroll in ImagineCare and a welcome call to discuss her personal health goals. Two days later a personalized ImagineCare Kit (box) is delivered to her door containing a program overview, a wireless blood pressure cuff and an activity band, devices which fit her selected health goals. Pam follows the instructions to connect her devices to the ImagineCare app.
During enrollment, Pam’s shares her profile information such as personal health goals, challenges, communication preferences, family support, and defines her “medical neighborhood” (i.e. Providers, pharmacy, caregivers). She adds more information when responding to daily questions to create a rich picture about her health needs and resources required to tackle care plan activities.
Anxious about her attempts to lose weight, Pam indicates in the mobile app that she only wants to receive texts to help her stay on track with her weight-management goal.
Through the ImagineCare mobile app, Pam answers daily questions about how she is really doing, while her wireless blood pressure cuff and activity band retrieve and send real-time measures. Pam receives nudges, encouraging messages and digital check-ins to ensure she stays on track with her care plan. Yesterday’s text asked Pam if she was okay since she hadn’t provided her blood pressure as expected.
D-H’s RNs and Health Navigators continuously monitor Pam’s health status, review her trends, and respond to risk warnings by reaching out via text which is her communication preference. Since Pam designates her daughter as a personal health representative within the mobile app, ImagineCare’s RNs are permitted to speak with her about Pam’s health.
ImagineCare Success Measurement
ImagineCare is designed to empower a health care organization to right-size provider visits, lower ED utilization and decrease admission and re-admissions. ImagineCare provides a more engaging solution to help health care delivery systems increase quality of care, decrease cost and improve patient experience.
In addition to these quantitative measures, D-H actively gathers qualitative patient feedback to understand the patient experience. Comments from patients about engaging in the ImagineCare program include:
“I monitor my blood pressure every day, and after a particularly stressful day at the office I went home, took my blood pressure, and five minutes later one of the nurses called and talked me through an immediate care protocol.”
“It has improved my ability to manage my health…The ability to connect with people for support and also send information to my healthcare providers, makes it easier.”
"I am extremely impressed with the ImagineCare phone app. It is very easy to use and seems very intuitive”.
ImagineCare is constantly updating its services and products based on patience engagement data, clinical data, and new technological capabilities coming to market. In a digital health landscape that is becoming more fragmented, ImagineCare will continually create holistic, customer-centered health services to better care for patient populations.
D-H’s team has packaged up the ImagineCare platform for other providers, payers and (self- insured) employers to deliver personalized patient care for better outcomes.
Virtua Navigates Orthopedic Patients Pre- & Post-Surgery with Improved Patient Engagement and Care Coordination
With 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”.
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.
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.”
Vidya 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.
During the last eighteen months, the Ochsner Health System has moved into new territory, meeting consumers where they are, from their OBar, a retail genius format to patient hypertension pilots with the Apple Watch to drive behavior change.
As an innovative healthcare organization, Ochsner, a large Louisiana- based health network with 12 hospitals, 40 clinicians and an a 1,000+ Physician Group Practice, is committed to helping consumers use mobile and wearable connected health tools for self- management and care collaboration
It all started back in late 2013 when Dr. Richard Milani, now Chief Clinical Transformation Officer and Vice Chair of Cardiology at Ochsner, observed what was going on nationally, a tremendous growth of mobile phone and smart apps. “At the time, I noticed that a lot of people didn’t know much about the health apps and wearables or were fearful about how to use them. My background is in preventive medicine”, explains Dr. Milani. “I saw a powerful opportunity for Ochsner to empower consumers to use mobile technology to enhance their health, opening the door to favorable behavior change.”
OBar, Retail Genuis Bar with Apps & Devices
After more than nine months of planning, Ochsner launched their OBar in early 2014 at the new Ochsner Center for Primary Care and Wellness. The OBar is located in the lobby to attract people walking by as well as patients. The retail store is welcoming with digital tablets loaded with vetted mobile apps to support consumer health, “non-clinical” genius types to answer questions, provide guidance and sell discounted devices (i.e. Activity Tracker, wireless scale, blood pressure cuff and glucometer). “We created this retail setting to show people how to make themselves healthier on their own, independent of their health system. We also felt that as a health system, we could show you which health apps were good and can help you get the app loaded on your phone to begin using it.”
Ochsner wanted to go further, tying the OBar into their primary care services. Dr. Milani and his team created a prescription pad for their PCP offices, which lists the types of available apps and devices. The doctor simply checks off, hands the patient a prescription pad sheet and directs him downstairs to the OBar. Since this extension into primary care, clinicians have heard back from their patients about how the apps and devices have helped them make better health choices around activity, diet and their disease. Patient feedback has motivated these clinicians to tell others about the OBar.
Dr. Milani went on to explain that the OBar initiative is not designed to be a profit center. As a non-profit, Ochsner is most interested in helping people stay healthy and has invested in a retail format as a way to be sticky to attract and keep consumers coming back. As with any retail store, visitors walk in and out which makes it challenging to capture and measure the value that consumers have gained from using these apps and devices. Through anecdotes, however, Ochsner has heard about the weight loss, the knowledge about “buying the right foods” and the ability to better “understand my disease”, which has helped many consumers visiting the OBar.
Apple HealthKit & Epic Integration for Connected Health
Ochsner was the first hospital to integrate the Apple HealthKit with their Epic system. This integration powers their Connected Health programs. While the patient is still in the hospital, she is given a tablet to answer a detailed questionnaire. Hypertensive patients, for example, are asked sodium consumption, medication adherence and affordability, social situations, depression, physical activity, BMI, sleep, Health literacy, Patient activation and more. Ochsner believes that patients respond more truthfully to the tablet.
“We are phenotyping patients based on their specific disease and psycho- social measures that are fed into algorithms to personalize the care plan and decision support tools”, Dr. Milani explains. “Ochsner started with Heart Failure in early 2014, with a program for CHF patients to avoid readmissions through weight monitoring. In February 2015, we launched our Hypertension Digital Medicine Program, monitoring blood pressure and heart rate. “With the HealthKit/Epic integration, we are able to use the patient’s unique responses to the survey combined with the monitoring data to tailor the intervention to the individual”, adds Dr. Milani. Ochsner care providers monitor the dashboard to determine which patients are the priority today and to see the task check list for action.
The national data reflects that currently, only 50% of individuals diagnosed with hypertension (high blood pressure) have their blood pressure under control, or at goal. Lack of achieving goal blood pressure means that these individuals have significantly higher rates of stroke, heart disease and kidney failure. Ochsner has enrolled only patients that have failed to meet control blood pressure goals, and using this integrative approach, has achieved more than 60% control rates within 2 months.
Dr. Milani and his team wanted the patient to see his progress in the program and designed an insightful report, which visually displays results and progress, quantifies risk and describes how the patient can reduce that risk. This program report is available in the patient portal and is also mailed monthly to the patient. “We decided to mail the report because we wanted the patient to have the opportunity to share the report with their family and to have the discussion about how they are doing in controlling their blood pressure in order to strengthen every day support”, admits Dr. Milani.
In addition to the program report, program participants receive ongoing mobile texts for motivation and encouragement.
Ochsner closely tracks, monitors and has presented very positive patient outcomes of their Integrated & Connected Health programs. One interesting insight that Dr. Milani has shared is that these participants are more successful in the beginning when they have the OBar support. “A Hypertensive patient can go to our OBar, get the program app downloaded on her phone and a demonstration about how to use the devices. This is especially important with older patients who may not feel comfortable getting set up over the phone. We realize the importance of providing this face to face technology support for our Connected Health program and are adding OBars to our other regions”, confirms Dr. Milani. Ochsner is planning to launch three more retail OBars by the end of the year.
Apple Watch for Patient Pilot
Dr. Milani views the Apple Watch as a behavioral change tool. As a foundation, this is a wearable, with many non-health features which captures the consumer’s attention and motivates consumer engagement. It takes the consumer’s focus off the phone and onto the wrist to communicate time as well as personal and professional messages.
Ochsner is designing a study to understand the potential for changing the consumer’s behavior around health. They will be enrolling hundreds of hypertensive patients with the goal of increasing physician activity and improving medication adherence.
Dr. Milani mentioned two of the health related Apple Watch apps which he plans to incorporate to help patients achieve the pilot goals. “There is a WebMD app which is a great medication reminder. It taps you on your wrist and shows you the picture of the pill that you need to take at that time. This is important because 50% of patients with chronic disease do not take their medications as prescribed. The second built-in app is for physical activity which can be used to set goals. It will tap me and remind me to stand up every 50 minutes. I can also see how I am doing against my activity goals”, shares Dr. Milani.
For the Apple Watch pilot, Ochsner will compare the outcomes and behavior change for patients in their Hypertension Digital Medicine Program with a subset of patients who also have the Apple Watch medication and activity reminders and tracking. Throughout the pilot, Dr. Milani and his team will be closely monitoring whether and how these apps impact positive patient behavior change.
Carolinas HealthCare’s Diabetes Patients Collaborate with Coaches Using Data from Smartphones and Devices
Carolinas Healthcare System, the second largest public, not-for-profit healthcare system in the U.S. (39 hospitals, 900 care locations) based in the Southeast, is committed to using technology to engage patients for better care. Last Fall, Carolinas HealthCare launched their Virtual Visit initiative to bring convenience to patients. Like other innovative healthcare systems, Carolinas HealthCare also launched a mobile app for patients to access their portal (MyCarolinas), inform about the closest urgent care location with wait times as well as offer a provider search.
“This was just the beginning,” explains Pamela Landis, AVP Information Services at Carolinas HealthCare System. “We wanted to go beyond supporting patients when they needed care to becoming part of our patients’ every day health.”
Based on the market trends showing consumer’s increasing use of both mobile and social media, Carolinas HealthCare System decided to invest in technology to provide ongoing information and support. While conducting marketing research, Carolinas HealthCare learned about consumers use of different wearables and tools to track activity, fitness, nutrition, sleep and health issues and heard about their frustrations having information housed into various apps. For instance, a person could be tracking their activity in Runkeeper and using a Bluetooth-enabled scale and blood pressure cuff. All that data is being stored in separate apps.
“We wanted to address their needs, giving them a holistic view of their health by bringing together information from all of their trackers. We leverage the health kits from the major smartphone platforms for the information aggregation,” shares Landis.
“The first app, Carolinas Tracker, available in both the Apple and Android stores, enables consumers in the community to aggregate their health data from apps and devices into one place and view a dashboard to see where they need to focus their attention (i.e. be more active and manage their health conditions).” Carolinas Tracker gives people an easy way to track their health and provides clinical context around how they are doing. Consumers can not only see how many steps they have done through their Fitbit data but also whether that is enough to reach their goals through their Carolinas Tracker dashboard.
The second app, MyCarolinas Tracker for Carolinas patients, will enable patients to bring together the same tracking information as the consumer app but will also integrate with their lab data in their patient portal. This patient app will also have goal setting capabilities and enable some patients to collaborate with their health coaches.
New Tool for Diabetes Patient & Coach Care Collaboration
Carolinas HealthCare System is planning a program to provide this new mobile app to diabetes patients, given the size of the diabetes patient population at Carolinas (90k patients), significant rise in Type 2 diabetics, the impact on other diseases and long term impact on a patient’s health.
“We are envisioning an ongoing program (i.e. not a pilot) and want to learn from the early adopters. We plan to invite patients through their physician practice and through our coaching program,” Landis adds.
Success Measures for Diabetes Coaching App Program
After launching the Diabetes program, Carolinas HealthCare System will look at “adoption metrics” since this type of technology is still in the early stage of use in the market. With many health apps today downloaded and not used, Carolinas HealthCare is interested in seeing app usage such as when and how the app is being used.
“We want to see if patients will integrate the app into their life to live better by taking ownership of their health,” explains Landis.
Carolinas HealthCare is planning to collect qualitative feedback from consumers and patients through surveys and focus groups to see if/how the app has helped the patient better understand their health and whether it has made the patient feel more in charge of their health.
“We are very interested to hear about the patient’s motivation to use the app and understand triggers, actions and rewards. We want to explore social influence. For example, do the social capabilities with family/friends/care circle help the patient stay more engaged and does this make her more motivated to use the app? Carolinas Healthcare will also look at hard core usage stats – usage/how often,” Landis explains.
"When thoughtfully designed and deployed, technology can enhance the relationship of patients with their health and their healthcare team. The solutions we are building will promote empowered patients and collaborative care delivery," explains Dr. Gregory Weidner, an internist at Carolinas Healthcare System in Charlotte, N.C. . Dr. Weidner is also the medical director for Primary Care Innovation and Proactive Health and brings vision and leadership to ambulatory care redesign and digital patient engagement initiatives.