It all started with a simple question one day, and grew into a trusted health relationship a few short months later. Sarah was very busy at work that crisp fall morning and had only a few minutes to log in and ask about her daughter’s diabetes medication. Sarah was comforted by the response and a bit intrigued when her Health Assistant Harriet introduced herself and explained that she is a resource to help her and her family with any of her health questions or concerns. They began a conversation about her daughter’s condition and a trusted relationship began.

Later that week Harriet made a follow up call to see if Sarah was able to pick up her daughter’s medication and asked how everything was going. Sarah mentioned that she finally got her daughter’s pills and confided that she was completely overwhelmed. Sarah shared that she was recently diagnosed with breast cancer and that her husband was often unavailable as he traveled constantly for work. She explained that she had a hard time getting to her treatments. After their call, Harriet explored and evaluated resources, and scheduled transportation to help Sarah get to her next appointment. Harriet put the appointment confirmation into Sarah’s patient portal and set up a reminder, including date and time, about the ride to her next treatment.

This may sound like fiction in the current healthcare environment, where services are siloed and patients are burdened with making their own decisions around healthcare – often complex and costly. Sarah is relieved to have this service today. She first learned from her employer about the Accolade platform and health advisor service last summer. It wasn’t until she reached out with a simple question to her health assistant that Sarah experienced the true value of having a healthcare advisor on her side.

A 2016 Harris Poll reveals that 84% of working families placed a value on having a single, trusted resource to help support their healthcare needs. Busy families have limited time and resources so they appreciate having one place to go to help them understand their options and sort through their healthcare decisions. 

Personalized Patient Experience

With the Accolade Health Assistant as the single point of contact for her family, Sarah is able to reach out to Harriet for guidance all along her and her family’s healthcare journeys.  Accolade integrates high tech and high touch to deliver a superior patient experience with lower healthcare costs. 

Accolade Health Assistant Harriet accesses the Accolade platform to interact with and personalize her support for Sarah:

Preferred Communication: Harriet engages with Sarah and her family based on their communication preferences. Sarah likes phone calls and email through the Accolade online portal. Sarah’s husband Sam prefers secure text messages since he can send quick messages and follow up later during his business trips.  

Personalized & Proactive Experience: Harriet’s interactions with Sarah are driven by rich patient profile information, which contains contextual information, social determinants of health and service utilization. Sarah and her family’s profiles are updated with data collected over time and more than 150 data feeds integrated into the Accolade platform. The HIPAA-certified approach creates profiles that are continuously analyzed through sophisticated algorithms and health assistant reviews, which allow for personalized conversations around individual health needs, care gaps and obstacles.

A recent Accolade platform trigger prompts Harriet to reach out to Sarah’s husband Sam when she notices that he is still refilling this pain medication many weeks after his knee surgery.  Harriet sent a text to Sam to inquire about his knee surgery. After a text exchange, Harriett suggested that he see his doctor to discuss his persistent pain.

Patient Education & Connected Health: Sarah and her family can access educational information and recommended health apps. Before Sarah’s husband knee operation, Health Assistant Harriet texted Sam with a link to a video and suggested questions to prepare for his surgery and provider discussion. 

When Harriett spoke with Sarah about her daughter’s diabetes appointment and care plan, Harriet informed Sarah about the Livongo mobile diabetes application available through her employer’s health plan. Together, they review the Livongo app, which can help Sarah and her daughter better track and manage her diabetes. With Accolade and Livongo, Sarah is able to share information from the mobile app with her daughter’s doctor, giving him insight into her problems with controlling her A1C levels.

Continuous Connection to Clinical Resources and Support:  Harriett asked Sarah if she would like to speak with an oncology nurse to help prepare her for her upcoming oncologist appointment. Margaret, an Accolade Clinical Health Assistant and RN, joined them on the line and offered empathetic support by asking more about Sarah’s diagnosis, where she was in her care plan with her doctor, whether she had a support network and what was planned for her next appointment. Margaret provided Sarah with questions to ask her oncologist and recommended a follow-up discussion.

Intelligent Engagement: Harriet and her Health Assistant team are continuously alerted by the Accolade platform. On an ongoing basis Accolade gathers, aggregates and models de-identified data to trigger alerts and guide Health Assistants in further personalizing their interactions with their clients.  Health Assistants are prompted to ask questions about health behaviors and emerging symptoms, applying specialized training and skillset. 

Patient Experience Success Measures:

Paul Csigi, Director of Benefits at Philadelphia- based Temple University Health System (TUHS), rolled out the Accolade solution in 2015 and has over 7,000 employees on the platform today.  “So much of healthcare is getting people to the right place at the right time. Accolade has created an experience where our employees build a relationship with an assistant that gives them what they need, when they need it. Accolade takes a single problem that the patient has called in about and creates a relationship to support the family on an ongoing basis. With all of the information about our employees, Accolade addresses the whole person, connects the patient with clinical resources, and continues to reach out. This helps treat our employees sooner, which is less expensive for our organization.”

In addition to financial measures, TUHS monitors qualitative feedback from employees. With the Accolade platform outreach (phone or online), TUHS is able to capture the patient’s experience engaging with their Accolade Health Assistant:

“I'd like to thank Temple for the Accolade program. We have been going through some really tough times…..my health assistants have been a big support and a big help to my family in helping to guide us to the right doctors to help with family issues and illnesses. I really appreciate this program. Without it, I'd really be lost.”

With two years of the Accolade solution under their belt, Paul Csigi and his team are considering new ways to support TUHS employees. “I have an employee population with diabetes and heart disease. I am interested in learning more about Accolade’s partnerships to bring patient data into the platform to support these populations.”  Csigi sees the benefit of bringing in data from patient devices and smart applications. Integrating this data with the patient’s medical record gives new insights to Accolade Health Assistants, empowering them to deliver even better support and drive improved outcomes.

Dartmouth-Hitchcock (D-H), an innovative New England healthcare system with 1,000+ providers is committed to creating a “sustainable health system”, which proactively engages patients through new care models to achieve the triple aim.

Over the years, D-H has invested in technologies that empower patients to collaborate with providers through shared decision tools and Telehealth, treating “patients and their families as partners in care”.

D-H has been a pioneer in innovative payment models with both the government and commercial payers.

In early 2015, D-H’s leadership team committed to create a truly patient-centric healthcare organization, which delivers high quality proactive personalized care to the patient beyond the hospital walls.

“Dartmouth-Hitchcock purposefully set out to assemble a team of employees with backgrounds from other consumer industries like hospitality and retail that would augment the world-class capabilities of our clinical staff, to improve the health care delivery experience”, explains Vin Fusca, COO, ImagineCare.

With their consumer- centric “healthcare without boundaries” vision, D-H management has designed a truly “care- driven” solution.  ImagineCare, a cloud- based platform, enables providers to closely collaborate with each patient to meet her care goals at any time and from anywhere.

ImagineCare treats the patient holistically through the active and passive collection of a comprehensive set of patient data. In addition to condition specific evidence-based care pathways (i.e. ImagineCare Hypertension Pathway, COPD Pathway, CHF Pathway, Diabetes Pathway), D-H incorporates a “Core Health Pathway” to capture steps, heart-rate activity, sleep, and stress (Behavioral Health), providing contextual insight into the patient’s health.  

With ImagineCare, the Provider and patient have a window into the latest health status for insight and action. In the background, ImagineCare collects information from the patient (i.e. sensor- based devices, apps), combines it with EMR data (i.e. patient visits, labs, meds) and processes it through complex clinical care algorithms with machine intelligence to pinpoint when the patient is at risk. High tech meets high touch when ImagineCare notifies the RN or Health Navigator to reach out to the patient for real-time support and intervention. 

“ImagineCare leverages the best available technologies to assist with care, but does not replace the importance of the human touch to drive behavior change. ImagineCare seamlessly combines these components to help patients achieve their health goals”, shares Dr. Ethan Berke, Chief Medical Officer, ImagineCare.

 Patient Experience

During her recent doctor’s visit, (patient) Pam decides to participate in D-H’s new ImagineCare Program to help her lose weight and proactively manage her hypertension.

Within 48 hours, Pam receives an email to quickly enroll in ImagineCare and a welcome call to discuss her personal health goals. Two days later a personalized ImagineCare Kit (box) is delivered to her door containing a program overview, a wireless blood pressure cuff and an activity band, devices which fit her selected health goals. Pam follows the instructions to connect her devices to the ImagineCare app.

During enrollment, Pam’s shares her profile information such as personal health goals, challenges, communication preferences, family support, and defines her “medical neighborhood” (i.e. Providers, pharmacy, caregivers). She adds more information when responding to daily questions to create a rich picture about her health needs and resources required to tackle care plan activities.

Anxious about her attempts to lose weight, Pam indicates in the mobile app that she only wants to receive texts to help her stay on track with her weight-management goal.

Through the ImagineCare mobile app, Pam answers daily questions about how she is really doing, while her wireless blood pressure cuff and activity band retrieve and send real-time measures. Pam receives nudges, encouraging messages and digital check-ins to ensure she stays on track with her care plan. Yesterday’s text asked Pam if she was okay since she hadn’t provided her blood pressure as expected.

D-H’s RNs and Health Navigators continuously monitor Pam’s health status, review her trends, and respond to risk warnings by reaching out via text which is her communication preference. Since Pam designates her daughter as a personal health representative within the mobile app, ImagineCare’s RNs are permitted to speak with her about Pam’s health.

ImagineCare Success Measurement

ImagineCare is designed to empower a health care organization to right-size provider visits, lower ED utilization and decrease admission and re-admissions. ImagineCare provides a more engaging solution to help health care delivery systems increase quality of care, decrease cost and improve patient experience.  

In addition to these quantitative measures, D-H actively gathers qualitative patient feedback to understand the patient experience. Comments from patients about engaging in the ImagineCare program include:

“I monitor my blood pressure every day, and after a particularly stressful day at the office I went home, took my blood pressure, and five minutes later one of the nurses called and talked me through an immediate care protocol.”

“It has improved my ability to manage my health…The ability to connect with people for support and also send information to my healthcare providers, makes it easier.”

"I am extremely impressed with the ImagineCare phone app. It is very easy to use and seems very intuitive”.

ImagineCare Future

ImagineCare is constantly updating its services and products based on patience engagement data, clinical data, and new technological capabilities coming to market. In a digital health landscape that is becoming more fragmented, ImagineCare will continually create holistic, customer-centered health services to better care for patient populations.

D-H’s team has packaged up the ImagineCare platform for other providers, payers and (self- insured) employers to deliver personalized patient care for better outcomes.  

With the shift to value- based care, health systems are investing in mobile technologies to increase patient engagement and care quality while reducing the cost of care delivery.

Geisinger, an award winning healthcare system based in the Mid-Atlantic with 12 hospitals and a 510K+ health plan, is a leader in patient engagement. Within their organization, the Geisinger in Motion team focuses on strategic initiatives to drive patient engagement by co-creating with patients on digital technology solution design, capabilities and efficacy.

Geisinger’s digital patient engagement initiatives are designed to support three key strategies 1) “understand my health”, 2) “manage my stay or visit” and 3) “control my condition (or specific acute episode)”.

Last fall, the Geisinger in Motion team embarked on a project to enhance their patient education resources, which spans all three patient engagement strategies. Although they already offered a comprehensive set of patient education materials (i.e. handouts, online resources, targeted classes, individual conversations), Geisinger was looking to expand the reach of these resources for patients and their families. 

“The genesis of the idea came from a pilot for patients that were having Lumbar Spine surgery”, explains Chanin Wendling, AVP, Geisinger in Motion. Geisinger focused on this patient population because of the prevalence back pain problems across the nation, the volume of surgeries done annually (approximately 2,000) and high patient co-pays for the surgery.

“For this pilot, we loaded 10 iPads with educational content and loaned them to patients for about 4 months during the time before and after surgery”, Wendling shares. “After the pilot, we realized that we needed to come up with a different approach. CMS prevented us from giving the iPads to their patients, a critical population that we didn’t want to exclude.  In addition, it was very expensive to have enough iPads for all patients and took a lot of work to get the iPads back.”

From the pilot, Geisinger also learned that patients wanted to use a device with everything on it. After evaluating different mobile tools, Geisinger elected to use Apple’s iBook and iTunes University to conveniently package a set of patient resources in one place and enable patients and their families to easily access and consume education content when needed, pre and post- surgery.

Geisinger began by bringing together existing components into the iBook.  ”We had built a number of tools over time and were trying to leverage what we had to deliver a full ‘patient engagement package’ solution”,  adds Wendling.

The Lumbar Spine patient education solution encompasses:  

• Comprehensive set of interactive videos, animations, images  
• MyGeisinger Patient Portal- 350k+ users with access to their patient record, visit notes and pre-visit prep
• MySurgery: Lumbar Spine reminder mobile app – Developed for the iPad loan pilot, this app reminds the patient of activities that need to be done pre and post- surgery
• Health (electronic) questionnaires for Lumbar Spine outcomes & medication reconciliation – These have been in place for a several years

Patient Education Experience & Engagement

When Geisinger patient Lisa decides to have lumbar spine surgery, she receives a handout explaining how to use her mobile device (iPhone, iPad) to access a suite of patient engagement tools through iTunes University or to download an iBook. Lisa’s friends and family can also access the educational materials to help her throughout surgery prep and recovery. The handout instructs Lisa to contact the Nurse Navigators listed with any questions.

Patient Lisa engages electronically with these educational resources which contain animations, videos and interactive components. She moves through the chapters covering “meeting the care team”, “learning about the surgery”, “diet and medication guidelines”, “what to do before surgery”, “what to expect day of and after surgery” and even ”Navigating the Geisinger Medical Center”.  

Within the course, patient Lisa is encouraged to download the Lumbar Spine App to receive reminders about pre and post- surgery activities such as diet and medication requirements, what to expect during the hospital stay, things to watch for post- surgery (e.g. fever), how to address pain, exercise and sexual activity. Three and twelve months after surgery, Lisa receives a notification and logs into her patient portal to complete health questionnaires about her Lumbar Spine recovery outcomes and medication. All of the information that Lisa enters flows into the EMR so that the care team can monitor her recovery.

“We have received very positive response from our patients who like accessing these resources all in one place. It helps by setting expectations, reinforces materials discussed at clinic visits, reminds them of important steps and gives them a reference to share with family and friends.  Since the 3 month visit tends to be difficult to schedule and not all providers feel it is necessary, the questionnaire responses let the team check in with the patient and follow-up if there is a need”, describes Wendling.

Geisinger has expanded this education offering beyond Lumber Spine with iBooks for Pediatric Concussion and NICU (for parents).  “Pediatrics was the initial area for our IPS project (iPads while patients are in the hospital). We learned about the high-volume of print materials that are handed out in the NICU and realized that we needed to give parents a better tool”, Wendling explains.  

The Geisinger in Motion & IT teams continue to tackle resource issues and have "more ideas than we can execute”. Currently, they are working through a set of operational issues for tracking and measurement: 

Activity Tracking-Fitbit/Withings: Although it was part of iPad pilot (e.g. 10 patients were given a Fitbit), it is not currently in iTunes University. “We are waiting on a project where the ability to get patient generated health data from wearables will be available in the patient portal and then can automatically be uploaded into the EMR”, Wendling shares.

Measurement: “We completed and posted the Lumbar Spine course in December with an access code but then had to work with Apple to get qualified as an education institution in order to make it available publicly. From iTunes University, there have been about 30 downloads of the Lumbar Spine, 20 downloads of each of the NICU books and 16 of the Concussion. This is a public system so it is really hard to determine who is downloading. We are using survey data to better understand the profile of our users”, Wendling adds.  

In the future, Geisinger plans to bring out bariatric surgery education through iBook and iTunes University. “Obesity is a significant health issue in Pennsylvania and the components around healthy weight and eating can also be used for other conditions such as diabetes, heart failure and hypertension. We hope this will be a building block as we expand our education resources to support patients and families”, concludes Wendling.

WELLBE PLATFORM FOR PATIENT ENGAGEMENTWith an aging population and increase in chronic conditions including obesity, the demand for hip and knee operation is increasing dramatically. A study in the Journal of Bone & Joint Surgery estimates by 2030 “demand for total hip arthroplasties to grow by 174% to 572,000 and demand for primary total knee arthroplasties by 673% to 3.48 million procedures”.

PATIENT CREATES CARECIRCLE ON WELLBEDuring the initial visit to the surgeon’s office, patient Patty is given information about Wellbe, a personalized care plan for her pre-and post-surgical journey. She signs up with the Nurse Navigator and receives a Welcome email. Patty shares this information and invites her family ‘Care Partner’ to join her CareCircle to access her resources.

At the 2016 Consumer Electronics Show (CES) in January, UnitedHealthcare launched Solutions for Caregivers, an online program that provides resources for caregivers and their family; personalized information, a discounted marketplace of products and services and care circle community for ongoing support.

UnitedHealthcare is addressing the evolving needs of a large population of caregivers. According to the Caregiving in the U.S. 2015 report by the National Alliance for Caregiving (NAC) and AARP Public Policy Institute, an estimated 43.5 million adults have provided unpaid care during the prior 12 months,  34.2 million (79%) offering care for an adult age 50+.

“Many caregivers are searching for relevant resources but often don’t know where to start. Solutions for Caregivers addresses the needs of family caregivers through case management services and online resources that help caregivers more effectively care for their loved ones,” shares Dr. Richard Migliori, EVP and Chief Medical Officer, UnitedHealth Group.

Caregiving Burden

According to the Caregiving in the U.S. 2015 report, caregivers spend an average of 24 hours each week helping their loved ones. Many caregivers experience their own physical, emotional and financial strain as a result of their caregiving role. Half of the caregivers indicated “they had no choice in taking on their caregiving responsibilities,” and 40% report being in high-burden situations. When asked about their health, 17% said ”it is fair or poor”, compared with 10% of the general adult population.

Many caregivers (60%) admit they had to make a workplace accommodation, such as taking time off or reducing work hours. On average, caregivers assist with “4.2 out of 7 Instrumental Activities of Daily Living (IADLs),” including transportation, grocery/other shopping, or housework. Most caregivers (84%) report an interest in receiving more information such as “keeping their loved one safe at home” and “managing their own stress.”  

UnitedHealthcare has conducted extensive research with family caregivers to understand their challenges around caring for a loved one. Vidya Raman-Tangella, M.D., head of UnitedHealthcare’s Innovation Center of Excellence, explains, “We heard that each journey is a ‘unique’ and ‘personal’ experience. Family caregivers are often not prepared and do not know where to begin, which causes anxiety. Some caregivers need support recognizing ‘what is good’ when making decisions for their loved one. Finally, UnitedHealthcare heard that the family caregivers did not want to feel alone and wanted to work together with others in their care circle.”

CAREGIVERS MARKETPLACEVidya and her innovation team set out to define a solution based on these caregiver needs. The team started with a portal front end to house a set of tools to help caregivers:

Personalized Information – educational articles and videos that are tailored to the specific medical issues and needs of the care recipient and caregiver. UnitedHealthcare’s articles support the topics requested by caregivers (i.e. safety, stress). Users can save an article for future reference or share with others (i.e. siblings, health coach and clinician).

Marketplace – set of vetted discounted products and services to support the caregiver and care recipient’s conditions and challenges. Product categories include “assistive products”, “home monitoring”, “home safety” and “medication management.” Service categories span “financial”, “in-home care”, “nutrition” and “transportation”. Regarding “nutrition,” caregivers can order meals that are tailored to the care recipient’s health condition (i.e. low salt, low sugar). UnitedHealthcare’s marketplace is designed to support caregivers for activities they undertake on a regular basis, including transportation, shopping and house work. 

One service option is for a “Care Manager” who can help the family plan or respond to care recipient/caregiver needs, via online, phone or consult (secure messaging). Some caregivers may have a health plan benefit that covers the care manager service, while others have the option of paying the hourly fee.

Currently, UnitedHealthcare has mostly national companies and a growing number of regional and local offerings in the marketplace. Based on the care recipient’s zip code, there may be a national service provider such as CareLinx, which offers services in the specified geography.

Community Support – centralized place where caregivers and friends of a loved one can connect, share insights and concerns (i.e. how does mom look today), add and view medical appointments & meetings on a daily/weekly/monthly calendar, post and assign tasks (i.e. a ride to the doctor’s appointment) and access a library of documents such as medication lists, doctors list, health records and a living will. The solution serves as a repository of this information, however there is no integration with the EMR or any clinical information 

Caregivers can also invite others, such as clinicians and in-home caregivers, and enable them to securely access information and communicate on a common platform.

Although other companies promote online caregiver offerings today, UnitedHealthcare has designed a 'personalized caregiver solution'. During the sign-up process, the caregiver creates a profile by responding to set of questions about the care recipient; relationship, age, zip code, conditions and challenges. The caregiver also indicates their own health conditions and challenges. 

For example, when family caregiver Carla responds that her 86-year-old mother has hypertension and diabetes and is dealing with mobility issues, and she (the caregiver) is experiencing depression, Carla will see articles, videos, products and services that are relevant to both of their needs.

Caregiver Solution Pilot

UnitedHealthcare is providing the Solutions for Caregivers program to large employers at no additional cost for employees to access the online services. As of January 2016, Solutions for Caregivers is being promoted to over 1 million employees. Currently, Solutions for Caregivers is also accessible to the public. For people using the employer-sponsored version, the company can cover the costs associated with care management services, enabling caregivers to access more holistic support. In comparison, people accessing the consumer site, or instances where the employer has not purchased the additional care management services, can pay out of pocket for these resources. In both versions, caregivers can access customized content, shop from the marketplace, and use the myCommunity resources.

UnitedHealthcare has received positive comments about their Caregiver solution, that it “saves time” and they would “recommend it to other caregivers”.  To date, UnitedHealthcare has also noticed that many users are in the early stages of caregiving.

Future Solutions for Caregivers

“While it will take the rest of 2016 to build the volume of users, we will continue to grow our marketplace through strategic partnerships with product and service companies. We are especially interested in technology solutions for caregivers”, shares Dr. Vidya Raman-Tangella.

UnitedHealthcare is planning to leverage all customer service touch points to identify caregivers who are currently moving along the care journey or will be on the journey soon as potential users of the solution.

“Throughout the year, we will learn how this program is delivering value to caregivers and care recipients. With Boomers turning 70, we will be particularly interested to see how our offering will be used to support the boomers as they retire as well care for their loved ones”, explains Dr. Raman-Tangella.

“This program and others from UnitedHealthcare are making it easier and more convenient to people to take charge of their health and the health of their loved ones. By using technology and personalized resources, we are helping people to live healthier lives”, Dr. Migliori concludes.