7 ways one health system hacked primary care for better patient outcomes

Hacking is rarely a positive word. When used in healthcare, its negative connotation brings to mind thoughts of breached patient records and HIPAA penalties. But with help from Cambridge, Mass.-based Twine Health, Philadelphia-based University of Pennsylvania Health System employed hacking to help patients achieve better outcomes.

Led by David Asch, MD, the Penn Medicine Center for Health Care Innovation has multiple goals, including making people healthier, bringing care into people's lives, reducing the cost of healthcare, enabling and accelerating innovation and encouraging and catalyzing patients. In 2015, it launched a pilot program specifically geared toward its employees with hypertension. Penn Medicine estimated that of its 26,000 employees, 2,700 have uncontrolled hypertension. The pilot, which became an official program called the Employee Hypertension Program this year, currently has 105 patients enrolled.

The Center for Health Care Innovation didn't use traditional methods to reach its goal. It brought in Twine Health, a cloud-based collaborative care platform that blends the capabilities of a patient engagement portal, a peer support network, a care management solution and an outcomes analytics tool. Through the Employee Hypertension Program, Penn Medicine employees diagnosed with uncontrolled hypertension can visit one of several locations for a free screening. They then receive a treatment plan, prescription, automated blood pressure cuff for at-home readings and access to a coaching plan on Twine's app. After the initial appointment, patients use the Twine app to track their progress and connect with the Center's clinical team.

In essence, the Center "hacked" primary care; it "changed the existing network — in this case, primary care — to achieve a more favorable outcome," Megan Mariotti, assistant director of operations for the Center for Health Care Innovation, said during a webinar hosted by Becker's Hospital Review.

The Center attributes its success to seven major hacks:

1. Empowering patients to be leaders in their healthcare. "Patients are often underutilized members of the care team," Ms. Mariotti said. The Center for Health Care Innovation wanted to put patients in charge of their care.

Through Twine Health's involvement in the Employee Hypertension Program, patients truly can have control in the palm of their hand. "What we do at Twine is put the patient at the center of their care," Twine Health CEO John Moore, MD, PhD, said during the webinar. "We ask, 'How can they really be driving the agenda and feel they're controlling the situation?'"

2. A modern, collaborative care team. Because the model for the Employee Hypertension Program is non-traditional, the Center deliberately selected a varied team, which includes a physician, nurse, medical assistant and staff from the University of Pennsylvania Health System, to care for each patient. The Center wanted its team to step outside its comfort zones and think outside the box. The result? "Each member of the team brings their expertise, and as a team, we've created a successful program," said Ms. Mariotti.

3. Meet and enroll patients where they are. Since the program's inception, the Center has tried various techniques to enroll patients. At first, it tried getting the word out through email blasts and posters. After discovering these methods weren't highly effective, the Center tried something new and found speaking to patients directly resulted in more enrollees. Tactics such as advertising at biometric screenings, utilizing health fairs and walking around and meeting people on the University of Pennsylvania Health System's campuses have proven to be the most effective ways of engaging patients in the program.

4. Engage patients and remove barriers. The Center strives to build a longstanding relationship with its employees through the program versus episodic treatment. At their first appointment, patients discuss their medical history and various factors that may contribute to their hypertension and affect their health goals. In addition, by providing medications, an at-home blood pressure machine and remote monitoring via Twine the Center removes potential barriers to each patient's care. Dr. Moore believes this hack is crucial. "It's about convenience. Patients have a lot of priorities to manage, and healthcare falls at the bottom of that many times," he said.

5. Collaborative goal setting and action planning. Nicole McHenry, RN, a health coach at University of Pennsylvania Health System, sets each patient up on the Twine app at the end of their appointments. Each patient has a personalized set of goals, all of which are visible in the app. But Ms. McHenry's connection with the patients doesn't end there — she continues to regularly follow up with them. "Our overall goal is to lower their blood pressure, but we use goals and words that the patient is passionate about," she said. For example, if a certain patient wants to get in shape for a 5k, Ms. McHenry and the team will help create an action plan to help him or her reach that goal.

6. Use real-time data to drive outreach and interventions. Ms. McHenry interacts with patients and helps them create an action plan. Through the Twine app, she's able to track patients' progress and reach out to congratulate and motivate them in real-time. "It's not just about technology," said Dr. Moore. "It's really about this new relationship. Now it feels like it's under your thumb and you have someone there to support you."

7. Drive self-efficacy between visits. Within a few weeks, patients begin seeing improvement in their blood pressure. In fact, one-third of patients at the Center for Health Care Innovation reached their target blood pressure within one month. Patients can use the Twine app to better visualize their progress. "Patients aren't just learning about hypertension; they're seeing how their body responds to various things in real-time," said Ms. McHenry.

The Center for Health Care Innovation has seen tremendous results within just one year of the Employee Hypertension Program's launch. Each person who started with program had blood pressure greater than 140 over 90. Patients who have been in the program the longest — 14 months — have seen their blood pressure drop to 113 over 74, on average. Overall, 94 percent of patients have hit their target blood pressure within three months of starting the program

The Employee Hypertension Program couldn't have achieved the success it did without the help of Twine. "Twine has really been an essential tool to making this program successful," said Ms. Mariotti. "It's about accelerating behavior change with technology."

Twine isn't limited to programs focused on hypertension; health systems across the country have used it for diabetes, chronic obstructive pulmonary disease, prenatal care and more. "Health is challenging no matter what the issue is," said Dr. Moore. "Most of the time, it's the social challenges, social support and timely medical support that gets lost. What we find is that this kind of supporting approach gives very similar results across all the conditions and optimization situations."

To listen to the webinar, click here.

To view the webinar's slides, click here.

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