0
Patient Engagement
in the age of Accountable Care
Kamal Jethwani MD MPH
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

Slide developed by ProPoint...
Engagement = Better Outcomes

Patient uploads
& views

Uploads, viewing &
provider engaged

Uploads, viewing &
coaching

G...
Connected Health Platform Overview
Patient sends blood

Providers access data &

pressure, blood glucose, step
counts or w...
Connected Cardiac Care Program (CCCP)
A Patient’s Perspective

“This program gave me a great sense
of support and comfort....
Proportion of CCCP Enrollees with >1 Hospitalizations

% of CCCP Enrolles

100

58.10
39.80

13.30
1 yr prior to CCCP
enro...
Diabetes & Blood Pressure Connect

Average drop of HbA1c: 1.5
69% achieved a drop in BP
Greater Engagement associated w/ Greater Pre-post HbA1c Change
Average drop HbA1c by # of uploads
1.8

1.53

Drop in HbA1c...
Engaged Providers = Engaged Patients

n = 91 patients
PRACTICE 1

PRACTICE 2

Avg. change A1c - Total

- 0.8

- 1.5

Avg. ...
The Power of Simple Messaging
Medication reminders, encourage pre-natal care, etc.
Instant messaging ‘in path’ – reach pat...
The Value of Personalization

Readiness
To Change

Connected
Health Data

Customized
Program Design

Analytic
Engine

Prac...
Rise of the Consumer-Patient
Patients are Online:
 78% of U.S. adults use the Internet
 80% of Internet users look onlin...
PatientsLikeMe
CureTogether
Model for Patient Collaboration
Current (Paternalistic)

Future (Collaborative)

Patient

Physician

Patient

Physician

P...
Accountable Care Organizations

Improve
efficiency &
patient
satisfaction

Improve
patient care,
support
self-care

Shared...
Role of mHealth in Patient-Centered Medical Home
Enhance access & continuity?

Plan &
manage care?

PCMH

Identify & manag...
AIM: Better Health for Populations
ACO #22-27 At-Risk Population: Diabetes
All or Nothing Scoring:
 Hemoglobin A1c Contro...
Take-Aways

 Remote monitoring & self-management strategies can
drastically impact quality of care and cost of delivery
...
Regina Holliday, “Silos”

Thank you!

Kamal Jethwani, MD MPH
Corporate Manager, Research and Innovation
Partners HealthCar...
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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
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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Transcript of "iHT² CMIO Symposium Beverly Hills – Opening Keynote: Kamal Jethwani, MD, MPH, Corporate Manager – Research and Innovation, Partners Healthcare Center for Connected Health "

  1. 1. Patient Engagement in the age of Accountable Care Kamal Jethwani MD MPH
  2. 2. Our World is being turned Upside Down
  3. 3. The Increasing Burden of Chronic Diseases
  4. 4. Physician Supply & Demand Projections through 2025
  5. 5. Connected Health Goal Integrate care into the day-to-day lives of our patients
  6. 6. Components of Self Care Social Networking Gamification Incentives Coaching Feedback Loop Slide developed by ProPoint Graphics for CCH © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  7. 7. Engagement = Better Outcomes Patient uploads & views Uploads, viewing & provider engaged Uploads, viewing & coaching GOOD BETTER BEST! © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  8. 8. Connected Health Platform Overview Patient sends blood Providers access data & pressure, blood glucose, step counts or weight readings to a secure website. information to manage patient’s care. Patients provide contextual information. Automated rules & alerts also help patients understand their health. © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  9. 9. Connected Cardiac Care Program (CCCP) A Patient’s Perspective “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
  10. 10. Proportion of CCCP Enrollees with >1 Hospitalizations % of CCCP Enrolles 100 58.10 39.80 13.30 1 yr prior to CCCP enrollment (point estimate & 95% C.I.) 1 yr following CCCP disenrollment (point estimate & 95% C.I.) 50% Drop in Readmissions 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.
  11. 11. Diabetes & Blood Pressure Connect Average drop of HbA1c: 1.5 69% achieved a drop in BP
  12. 12. Greater Engagement associated w/ Greater Pre-post HbA1c Change Average drop HbA1c by # of uploads 1.8 1.53 Drop in HbA1c 1.6 1.34 1.4 1.2 1 0.8 0.6 0.43 0.4 0.2 0 no uploads 1 - 15 uploads > 15 uploads  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
  13. 13. Engaged Providers = Engaged Patients n = 91 patients PRACTICE 1 PRACTICE 2 Avg. change A1c - Total - 0.8 - 1.5 Avg. change A1c – Active patients only - 0.7 - 1.8 Avg. change A1c – Non-active patients only + 0.9 + 0.4 6 28 Provider logins / month
  14. 14. The Power of Simple Messaging Medication reminders, encourage pre-natal care, etc. Instant messaging ‘in path’ – reach patients where they are Lower barrier to adoption, higher engagement 70% Weekly Adherence Rates (mean +/- SEM) Reminder group 60% No Reminder Group % Adherence 50% 40% 30% 20% 10% 0% Week 1 Week 2 Week 3 Study Period Week 4 Week 5 Week 6
  15. 15. The Value of Personalization Readiness To Change Connected Health Data Customized Program Design Analytic Engine Practice Location © 2013 Center for Connected Health – All Rights Reserved Content Confidential – DO NOT DUPLICATE.
  16. 16. 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
  17. 17. PatientsLikeMe
  18. 18. CureTogether
  19. 19. Model for Patient Collaboration 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 Asymmetric Knowledge/Info symmetry 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 19 1
  20. 20. Accountable Care Organizations Improve efficiency & patient satisfaction Improve patient care, support self-care Shared vision & commitment Improve data collection, integration, & exchange Quality of care & Costs Lower Overhead Maintain infrastructure & remain flexible Adapted from: http://www.med3000.com/Por tals/46580/images/healthcare _it_chartfinal1(2).png
  21. 21. Role of mHealth in Patient-Centered Medical Home Enhance access & continuity? Plan & manage care? PCMH Identify & manage patient population? PATIENT Provide self-care support & community resources? Track & coordinate care? Measure & improve performance?
  22. 22. AIM: Better Health for Populations ACO #22-27 At-Risk Population: Diabetes 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
  23. 23. 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
  24. 24. Regina Holliday, “Silos” Thank you! Kamal Jethwani, MD MPH Corporate Manager, Research and Innovation Partners HealthCare Center for Connected Health kjethwani@partners.org
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