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

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

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Slide developed by ProPoint Graphics for CCH

Uploads, viewing &

coaching

Uploads, viewing &

provider engaged Patient uploads

& views

GOOD

BETTER BEST!

Engagement = Better Outcomes

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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

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“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

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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

[email protected]

Thank you! Regina Holliday, “Silos”