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Kamal Jethwani, MD, MPH Corporate Manager - Research and Innovation Partners Healthcare Center for Connected Health iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health
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Kamal Jethwani MD MPH
Patient Engagement
in the age of Accountable Care
Our World is being turned Upside Down
The Increasing Burden of Chronic Diseases
Physician Supply & Demand Projections through 2025
Connected Health Goal
Integrate care into the
day-to-day lives of our patients
Components of Self Care
Social Networking Gamification Incentives Coaching
Feedback
Loop
© 2013 Center for Connected Health – All Rights Reserved
Content Confidential – DO NOT DUPLICATE.
Slide developed by ProPoint Graphics for CCH
Uploads, viewing &
coaching
Uploads, viewing &
provider engaged Patient uploads
& views
GOOD
BETTER BEST!
Engagement = Better Outcomes
© 2013 Center for Connected Health – All Rights Reserved
Content Confidential – DO NOT DUPLICATE.
Patient sends blood pressure, blood glucose, step counts or weight readings to a secure website. Patients provide contextual information.
Providers access data & information to manage patient’s care. Automated rules & alerts also help patients understand their health.
Connected Health Platform Overview
© 2013 Center for Connected Health – All Rights Reserved
Content Confidential – DO NOT DUPLICATE.
“This program gave me a great sense of support and comfort. It taught me discipline to watch my weight and my blood pressure, and to make changes before I end up in the hospital.”
George Ruboy Connected Cardiac Care patient
Connected Cardiac Care Program (CCCP)
A Patient’s Perspective
Data Includes 332 CCCP enrollments among 301 unique patients discharged from the CCCP program prior
to July 1, 2009. Results are similar within more recent cohorts of enrollees discharged from the program
prior October 1, 2009 and prior to January 1, 2010.
Proportion of CCCP Enrollees with >1 Hospitalizations
39.80
13.30
58.10
100
1 yr prior to CCCP
enrollment (point
estimate & 95% C.I.)
1 yr following CCCP
disenrollment (point
estimate & 95% C.I.)
% o
f C
CC
P E
nro
lle
s
50% Drop in
Readmissions
Average drop of HbA1c: 1.5
69% achieved a drop in BP
Diabetes & Blood Pressure Connect
Greater Engagement associated w/ Greater Pre-post HbA1c Change
Practice engagement correlates strongly w/ better patient outcomes
Patients w/ >15 uploads had average 1.5 pre-post HbA1c change
P< 0.03 between no uploads vs. uploads groups
0.43
1.34
1.53
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
no uploads 1 - 15 uploads > 15 uploads
Dro
p i
n H
bA
1c
Average drop HbA1c by # of uploads
Engaged Providers = Engaged Patients
6 28
+ 0.9 + 0.4
- 0.7 - 1.8
- 0.8 - 1.5
PRACTICE 2 PRACTICE 1
Avg. change A1c - Total
Avg. change A1c – Active patients only
Avg. change A1c – Non-active patients only
Provider logins / month
n = 91 patients
Medication reminders, encourage pre-natal care, etc.
Instant messaging ‘in path’ – reach patients where they are
Lower barrier to adoption, higher engagement
Weekly Adherence Rates (mean +/- SEM)
0%
10%
20%
30%
40%
50%
60%
70%
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6
Study Period
% A
dh
ere
nc
eReminder group
No Reminder Group
The Power of Simple Messaging
Customized
Program Design
Readiness
To Change
Connected
Health Data
Practice
Location
Analytic
Engine
The Value of Personalization
© 2013 Center for Connected Health – All Rights Reserved
Content Confidential – DO NOT DUPLICATE.
Rise of the Consumer-Patient
Patients are Online:
78% of U.S. adults use the Internet
80% of Internet users look online for health info
20% of adults have tracked their weight, diet, exercise
routine or some other health indicators / symptoms online
Self-service Health:
73% want online access to their physician
47% would consider switching doctors to
one whose office offered online access
Sources:
Pew Internet & American Life Project, 2011
Intuit Health Survey by Decipher Research, 2011
PatientsLikeMe
CureTogether
1
9
Model for Patient Collaboration
19
Current (Paternalistic) Future (Collaborative)
Patient Physician Patient Physician
Passivity-Activity Passive ACTIVE ACTIVE ACTIVE
Decision making ---- Primary Shared Shared
Non-personal health info
access (e.g., research) None/little Full Full Full
Personal health info
access (e.g., lab results) None/little Full Full Full
Knowledge/Info symmetry Asymmetric Symmetric
Liability/Accountability None/little Full Shared Shared
Empowerment None/little Full Shared Shared
Use of tools No Yes Yes Yes
Awareness of costs No Sometimes Yes Yes
Skills needed No Yes Yes Yes
Roles ----- Data collector,
decision maker,
treatment
provider,
gatekeeper
Data collector,
information
seeker, shared
decision maker
Guide for
non-routine
problems
Accountable Care Organizations
Improve efficiency & patient satisfaction
Improve patient care, support self-care
Quality of care & Costs
Lower Overhead
Maintain infrastructure
& remain flexible
Shared vision &
commitment
Improve data collection, integration, & exchange
Adapted from: http://www.med3000.com/Portals/46580/images/healthcare_it_chartfinal1(2).png
Role of mHealth in Patient-Centered Medical Home
Track &
coordinate care? Measure & improve
performance?
PATIENT
Identify & manage
patient population?
Enhance access & continuity?
Plan &
manage care?
Provide self-care
support & community
resources?
PCMH
AIM: Better Health for Populations
All or Nothing Scoring:
Hemoglobin A1c Control
Low Density Lipoprotein
Blood Pressure
Tobacco Non Use
Aspirin Use
Patients whose most recent
hemoglobin A1c level >9.0%
Patients aged 18-75 with
diagnosis of diabetes
“It keeps me aware of what I’m doing and gives me a better frame of mind about my condition.”
Leo Jabotte Diabetes Connect patient
ACO #22-27 At-Risk Population: Diabetes
Take-Aways
Remote monitoring & self-management strategies can
drastically impact quality of care and cost of delivery
Patient engagement in these programs can be
improved by:
improving provider engagement
appropriate use of technology
personalization tactics
Many ACO metrics can be achieved by engaging
patients in their care & leveraging data collected from
outside the hospital
Kamal Jethwani, MD MPH Corporate Manager, Research and Innovation
Partners HealthCare Center for Connected Health
Thank you! Regina Holliday, “Silos”