Consumer eHealth Engagement - Data-Driven Health Solution & Experience

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Sherri Dorfman, CEO, Stepping Stone Partners, Health Technology Innovation & Patient Experience Strategist

My blog is designed to spotlight healthcare organizations with innovative uses of technology & data to drive Care Coordination, Collaboration, Patient Engagement & Experience.

These patient centric approaches may influence your product & service roadmap, experiences, partnerships and marketing strategies.

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Entries in family ehealth engagement (8)

UnitedHealthcare Rewards Medicaid Moms for Healthy Behaviors; Baby Blocks & Community Rewards Programs

February 11, 2013

Baby Blocks Rewards

UnitedHealthcare has a track record of leveraging technologies to engage their members in their health through their OptimizeMe and Health4Me mobile initiatives. In addition to these broad based offerings, UnitedHealthcare has launched two programs targeting Medicaid moms, rewarding them for healthy choices throughout pregnancy and with their children.

“Over 40% of U.S. births are to women on Medicaid. We wanted to use technology to empower these women to improve access to appointment information and provide incentives to motivate them to stay engaged”, explains Brett Edelson, VP, Product Strategy & Management, UnitedHealthcare Community & State (Medicaid). “We specially developed the Baby Blocks program to ensure that babies have a healthy start to life.”

"More and more Medicaid programs are looking to financial incentives to encourage Medicaid recipients to complete preventive screenings. These financial incentives have proven effective in the short term but longitudinal studies of other such programs show decreasing effectiveness over time. We created Community Rewards to build a relationship with the member beyond simply rewarding individual actions but encouraged life-long habits", describes Andrew Mackenzie, Chief Marketing Officer, UnitedHealthcare Community & State.

Although these programs target different life stages, both are designed to define a healthy path which informs and incentivizes the member to complete healthy actions over time. This creates awareness for these behaviors and reinforces them with rewards. “Our research shows that these moms feel more connected to the program when they earn points and then pick out an award because it creates an emotional bond. We decided to structure our program this way instead of just rewarding with money,” explains Mackenzie. “Unlike many other wellness programs which give gift cards to patients for going to appointments, we’ve decided to design our programs for ongoing engagement with cumulative points and continuous education.”

The initial awareness and invitation for each program is through a direct mailing which explains how the program works and encourages them to enroll using their computer or smart phone. Additionally, Baby Blocks engages members through Ob/Gyn offices and outreach calls.

Baby Blocks Program

“The idea for Baby Blocks came from our focus groups with pregnant women who were overwhelmed with the 20+ doctor appointments they needed to keep track of during their pregnancy and the first 15 months of their baby’s life. We thought about our communication channels to support this group when one teen said ‘I never read my mail but I sleep with my cell phone’ ”, Edelson explains.

The Baby Blocks Program guides the expectant mother throughout her pregnancy, providing educational information and reminders for essential doctor visits pre and post-delivery. On the program website, the expectant mom sees pregnancy milestones with the number of weeks (i.e. 24 weeks, 28 weeks, 30 weeks, etc) on a baby block and can unlock the educational information as well as track her doctor appointments. She actually earns rewards from enrollment through her baby’s 15 month post pregnancy wellness visit.

Throughout her pregnancy, she sees health tips on her computer or mobile phone, for example: “It can be hard to wait for your baby to be born. It’s best to give birth after at least 39 weeks. Your baby’s brain and lungs are still growing!” After birth, mom receives tips such as “Place your baby on its back to sleep. Don’t put a pillow in the crib until baby is over one year old. Ask your doctor about the shots your baby needs to prevent serious illness.”

“When we were developing this program for the Medicaid audience, we expected most moms would use their smart phones to access the Baby Blocks website based on consumer research. Currently, about 40% of all visits to the Baby Blocks website are from smart phones", shares Edelson.

UnitedHealthcare continues to hear very positive feedback from the program participants:

No matter how many children you have, you can learn something new; each child is different and each pregnancy is different.

Expectant mom actively using Baby Blocks program during her second pregnancy

Life is so hectic with a 4 month old and a 3 year old. I like that the Baby Blocks program is so easy to use and I love the incentives that they offer. I have already picked out new books and toys for Athena

Since the initial launch November 2011, the Baby Blocks program has enrolled 3,000+ members in Maryland, Ohio, Pennsylvania, and Rhode Island. The program expanded into additional states October 2012 (AZ, FL, TN, MI) increasing the program reach to new and expectant moms dependent on Medicaid from 12,000 to 50,000.

“We were excited to see over a 30% response rate across all markets. Our program results to date have been strong with 10,000+ doctor appointments recorded and over 1,500 births to Baby Blocks participants, representing a 63% member engagement rate through baby’s birth”, explains Edelson. “We are working on motivating the mother to get her post pregnancy care which typically falls off since she is focused on the care for her baby. We’ve heard some mothers say that with previous pregnancies they only attended some of their prenatal appointments but with Baby Blocks, they are attending more of them”.

Community Rewards Program

Community Rewards is designed to educate and motivate a group of consumers with similar health needs. For their first pilot in August 2012, UnitedHealthcare selected Medicaid moms, incentivizing them to follow healthy habits with their children under 13 years old, such as eating a healthy breakfast, getting 8-10 hours of sleep or simply washing their hands. On the program website, mom can see the checkups and vaccine reward opportunities, learn what to expect at each appointment and can track where (i.e. doctor’s office or clinic) and when this was done. This tracking is especially important for this patient segment who may need another option outside of their doctor’s office to get vaccines.

The program also rewards moms for “Knowing their Health Plan” (i.e. listening to a welcome call, reading newsletters and speaking with the Nurseline). Community Rewards “households” the points so mom can shop with the accumulated points that she and her child(ren) have earned.

“We have received encouraging results to date. Typically with incentive programs, 15% are engaged after 6 months. We are seeing double that, 30% sustained engagement”, explains Mackenzie. Here is a comment from a program participant:

Dear UHC Community Rewards, I want to say that I am appreciative of this program and the incentive it provides to make sure my child is consistent with healthy habits.

“As we review program participation metrics, one big surprise for us is that 30% of the moms enrolled in the program were not invited. Through word of mouth, moms came to our Community Rewards program website and joined which shows us the tremendous value of talk for referrals”, emphasizes Mackenzie.

Expanding Engagement with Rewards Programs

UnitedHealthcare is evaluating potential ways to enhance both programs to reach and motivate members to engage in healthy behaviors on an ongoing basis.

“The Baby Blocks Program will be rolled out to more states this year. We’re also considering extending the program to include well baby visits through age two”, Edelson shares.

“For Community Rewards, we see an opportunity to extend the program on the social front where moms can post their accomplishments to friends and family on Facebook. On the health side, we are considering ways to customize our Community Rewards Program to support high risk populations such as patients with diabetes or asthma”, explains Mackenzie. “By educating and reminding them about what they need to do every day and providing an easy way for them to use our resources as support, we believe that we can see better outcomes.”

Engagement Opportunities

Healthcare Technology and Health Plans are quickly learning about the benefits of creating “programs” to drive technology platform usage.

Based on my review of UnitedHealthcare’s Baby Blocks & Community Rewards Programs, I see two key engagement drivers:

Segment Specific: UnitedHealthcare has packaged educational content, health actions and incentives that are tailored to the needs of their target consumer segments. They’ve designed Community Rewards to address a set of consumers with similar needs, which gives them many opportunities to extend this motivational program to other segments of members.

Health Rewards Program: Although many rewards programs are focused on wellness, UnitedHealthcare is working on developing a program to support self-management and care management with incentives for engagement. Their approach will proactively lay out the care path instead of reactively delivering one off ‘gaps in care’ communications. Could this be the next frontier in population management?

Mayo Pilots myCare iPad App for Cardiac Surgery Support, Engaging Patients & Families

February 5, 2013

A team of clinicians at Mayo Clinic designed an iPad app to help cardiac surgery patients and their families participate in the pre and post surgery process, creating a patient-sided driver of successful recovery.

Dr. David J. Cook, a Mayo Clinic anesthesiologist leading the Discovery Project team had personal inspiration for this application. “My mother had cardiac surgery and shared her experiences. As a patient gets ready for surgery, there is a tremendous amount of anxiety and uncertainty. We ran focus groups with patients and heard about the frequent disconnect between patients and providers about what to they can expect during the hospital stay. Patients may be poorly informed about what will happen over the course of a hospitalization or what they can expect any given day and it is difficult for patients to manage information and learn when they are under stress. With this iPad application, we clearly communicate what is happening today, what to expect during your stay, what patients need to know, and what a normal recovery looks like.”

The Mayo myCare iPad application displays a personalized “Plan of Stay” showing patients and their families what is planned each day. Specifically, the patient’s Plan of Stay is organized into four sections each day; “Clinical Milestones, “Gaining strength”, “Education” and “Planning my Recovery”. “In 'To Do' Lists, we give patients knowledge, self-assessments (i.e. pain level) and self reporting tools to facilitate and document their participation in their recovery plan. We can tell them how much to walk each day, ask them how much they walked and measure it remotely”, explains Dr. Cook. “We want to help our patients feel more in control and part of the process, as a partner with their care team. This significantly shifts the nature of the medical relationship as patients become more educated. They can now ask questions about any step in the surgery process because they are better informed”.

While in surgery, the myCare iPad is used by the patient’s spouse, child or other family member to better understand what to expect that day, thru surgery and upon discharge. “We worked closely with our discharge planners, social workers and therapists to recognize the barriers that patients and families face and developed modules to help drive critical conversations, such as the who, how and when of preparing for the patient’s needs when they leave the hospital. We identify barriers such as driving limitations or need for support with other daily activities. These are critical conversations to have and yet they often fly under the radar screen for physicians who typically focus on the specifics of surgical recovery,” emphasizes Dr. Cook.

The myCare iPad application presents clinicians with a care population and an “individual recovery dashboard” to monitor the patient’s progress through recovery. It aggregates data on the patient’s use of the education, recovery planning and self-assessment tools and provides alerts when patients did not, or were predicted to not, meet recovery expectations. The direct patient input and data aggregation enables providers to get an earlier look at progress and allows for rapid mobilization of resources to address patient needs. This was an important factor in reducing hospital length of stay in the patients using the program.

Pilot Success Measures & Evaluation

The Mayo Clinic iPad Pilot was conducted with 149 cardiac surgery patients from early February 2012 and through mid-November. Pilot patients ranged in age from 52 to 85 years old, with an average age of 69 years old.

One important success measure for Mayo is patient and family satisfaction. Mayo sent separate surveys to patients and their families and received an over 90% satisfaction rate. Questions were asked about the overall hospital experience, satisfaction with their care, but also how well informed they were and how easy it was for them to use the technology they were provided with. Even though this was an older population more than 80% of patients said felt very comfortable using the program after a day or two. Here are some of their comments:

The IPad was a valuable addition to overall patient care and provided a more confident “going home” feeling for us.

I would strongly recommend the MyCare IPad, it helped me to understand each day what to expect instead of the high anxiety of wondering if what my husband was going through was normal.

..is was very nice to see day to day what my Dad should be doing to recover from surgery so I can help him improve, also the knowledge that we had helped us figure out what step to take next

In addition to patient and family satisfaction, Mayo is measuring care quality, care cost and length of stay. “A principal driver in the care cost are the people resources required to support the patient. Acquiring and managing data in this way allows for the more appropriate and targeted use of personnel resources. One of our patient participants was a physician hospital administrator who indicated that his ability to do his own discharge planning assessment before surgery had the potential to more wisely use hospital resources and direct those valuable resources to other patients who needed them more. In fact he completed and scored his discharge planning assessment (with what is typically a provider tool) before he was ever seen by a discharge planner. This and other patient self-assessment tools such as daily mobility accomplishments, have implications about how we assign resources to patients based on their needs. With this app, we can now focus our personnel on patients with more need”, shares Cook.

Future Engagement Opportunities with iPad App

The Mayo iPad application currently supports the patient while in the hospital. Mayo has not moved this outside of the hospital because they are “proceeding carefully” and working through the privacy and security issues that come with moving data outside their firewalls. “Over the year, we are planning to address those issues so we can extend the iPad recovery support program 30 days post discharge to prevent readmission and in two years we are looking to support longer term care management.

We developed this iPad solution with patient education, self assessment and reporting and we are planning to extend this solutions into 5 or 6 different care areas in the near term”, explains Cook.” On the tracking side, we have already built in FitBit integration so that we know how much our patients are moving. In the future, we will enable the solution to be configured with remote monitoring devices for patients who are obese or have diabetes for example”.

Dr. Cook feels that this represents a new model for health care delivery. “Making patients knowledgeable, giving them the tools for self-assessment and setting expectations that they participate in their care is the model for managing health care in this country and bending the cost and quality curve.”

Cisco’s LifeConnections Medical Home Program Drives Employee and Family Engagement

July 16, 2012

In 2008, Cisco launched their LifeConnection’s onsite health center which uses a Patient- Centered Medical Home model. Today, it supports over 42,000 employees and their families at Cisco’s corporate campus in San Jose, CA.

Cisco’s LifeConnections' Center offers primary and pediatric care integrated with care services including disease/condition management, health coaching, mental health, pharmacy, physical therapy and chiropractic as well as acupuncture services.

Cisco now has two physical LifeConnections' Health Centers, one at their headquarters and a second location at the Cisco Bangalore, India campus. In addition, they operate a telehealth location in the Raleigh-Durham area of North Carolina.

Employees access LifeConnections’ services online for health management. “Within our Cisco LifeConnections' portal, our employees and their families can schedule appointments in real-time, view their medical records, communicate securely with their physicians and even send their doctor an attached document such as a food or exercise log”, explains Katelyn Johnson, Manager, Integrated Health at Cisco Systems.

Cisco’s approach supports the findings from a recent Accenture Connected Health Pulse Survey which found that most patients (90%) want to use technology to self-manage which includes accessing their medical information, booking their doctor’s appointments and refilling their medications. The survey also revealed that patients do not want to give up the interaction with their doctor.

Technology Transforms the Patient Experience

Working closely with employees and families, Cisco designed the LifeConnections’ Health Center to bring convenience, better care and transparency to the consumer.

Through ongoing interviews with patients, Cisco has heard feedback from consumers who:

“Do not want to be burdened by the administration of healthcare”

“Want technology to take away what I don’t like to do (i.e. clip board,

discharge payment)”

“Want to spend more time with my physician”

Cisco has used this insight to determine ways to leverage technology within the LifeConnections’ Health Center to increase patient satisfaction including:

Kiosk: Patients come into the Health Center and use a tablet to have a “paperless, self-service, check in” including verifying demographic information, paying co-pays and signing consent forms, taking less than five minutes of their time.

Flat Screen Monitors in Care Suite: Within the patient-centric care suites, the patient and physician sit side by side to view and discuss health information projected on the flat screen such as the medical record with the latest vitals and lab results, x-rays and educational content about the patient’s condition. Cisco emphasizes the importance of providing transparency to the patient by showing them their medical record, in real time, during the visit.

HealthPresence in Care Suite: Cisco has recently partnered with Stanford Hospital and Clinics to enable patients to access specialty care (tele-dermatology) through the use of Cisco’s own telemedicine solution called HealthPresence. A nurse assists the patient in the LifeConnections’ Health Center while the Dermatologist connects from the Stanford Outpatient center. Cisco has found that connecting specialists with patients using this solution offers greater access to specialty care, reduces appointment wait times, and improves patient satisfaction.

Matching Technology to the Employee Profile

Cisco has put healthcare technology in place to meet the needs and profile of their employees and families.

“We are a high technology company and our many of our employees are engineers who literally live on-line. Their average age is 42 years. Our employees expect our healthcare experience to mirror the way they work – which is surrounded by technology. Specifically, they want technology to help enable care, remove access barriers and overall enhance their experience as a patient.” shares Sharon M. Gibson, Director Healthcare Business Transformation at Cisco. “Not only do they want to see more information about their health status but they want to see trending data for themselves to better understand how their health stats change over time and how their behavior impacts those results.”

“Our employees are busy and always on the move. They want to take care of their health in an efficient way. Soon, we will also offer patients the option of e-visits with their doctors through WebEx, for example”, explains Sharon. “Online or e-visits would help engage employees in their health, whether from home or even remote sites, and bring the convenience that they demand”.