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.

In January 2015, Stanford Medicine launched ClickWell Care, a new type of Primary Care clinic which leverages technology to allow patients to virtually connect with their own Stanford primary care clinicians and wellness coaches via video or phone visits.  Patients use the MyHealth mobile app to schedule and conduct a video visit and share home health device data with the care team. Through this model, patients can choose to receive all of their primary care including integrated wellness coaching virtually, unless the physician indicates the need to come into the clinic for vaccinations, pap smears, procedures, or other physical exam needs.

“Initially we created this virtual model for our ACO. We knew that 18-30 year olds were not interacting with primary care and were choosing to go to the Emergency Department or urgent care for their needs. During focus groups with this patient population, we learned they were so busy and didn’t have time to come into the office but really valued the relationship with their doctor. They wanted to receive care from their doctor but it wasn’t available in a way that was convenient to them.  We knew that we needed to use technology to help support this relationship and not replace it”, explains Sumbul Desai, Medical Director ClickWell Care and Vice Chair of Strategy and Innovation in the Department of Medicine at Stanford University School of Medicine.

ClickWell clinicians and coaches support healthy patients and the ‘rising risk’ (e.g. up to 2 conditions), who are employees of Stanford University, Stanford Adult and Children’s Hospitals. With this highly educated, tech savvy patient population, there is a tremendous opportunity to leverage mobile tools to enhance the patient experience.

Patients see a doctor for primary care visits and engage with a wellness coach on health goals (i.e. weight loss, stress, activity, and nutrition) and to receive support for chronic conditions (i.e. diabetes, hypertension and hyperlipidemia).  “The average age of a ClickWell patient is 36 years old.  However, we have a growing group of 40-65 year olds, part of the ‘rising risk’ population, who prefer to do the majority of their visits virtually. These patients feel comfortable interacting by phone or video because they have a better understanding of the healthcare system and their health goals than our younger patients”, Desai shares.

The ClickWell Care program is designed to give patients complete control over how they want to access and interact with their doctor/coach and convenience of extended hours. Although patients have the option of scheduling a face to face appointment, they are incentivized to participate in a “no fee” virtual phone or video visit. Patients simply log into the MyHealth portal for their virtual appointment. 

To date in the ClickWell program, there have been 2,142 visits; 43% conducted in-person, 32% through phone visits and 25% via video visits. ClickWell staff have seen 1,223 patients. Although 30% of new patients start off with a virtual visit, most prefer to meet their doctor first in-person. After an initial face to face visit, 60% opt to see their doctor virtually for their return visits via phone or video.

MyHealth Mobile AppAll patient information from the virtual visit is transmitted to the Epic EMR and is accessible through the MyHealth portal. Patients can ask follow up questions through the portal.  When patients need to have blood work done, they are directed to the lab without having to come into the doctor’s office, and lab results are incorporated into the EMR with portal access. “Stanford was the first to use Epic’s integrated telemedicine service because we wanted this visit information available to patients in the portal and clinicians in their daily workflow”, confirms Lauren Cheung, Physician, ClickWell Care, and Medical Director, Strategic Innovations at Stanford University School of Medicine.

“One myth about telemedicine is that many patients choose to do video visits over phone visits. The truth is that it is an extra effort for the patient to participate in a video visit since the patient needs to be in front of a computer or mobile screen versus the phone visit which can be done while walking around”,  Cheung adds.

“Back in 2013, we rolled out video visits as part of our primary care practice but we didn’t see a strong uptake. When we conceived the ClickWell Care program, we knew that we needed to introduce wellness coaching to provide a complete overall healthcare experience and deliver a higher level of healthcare service to our patients”, describes Desai.

Strong collaboration with IT and Operations have been pivotal in implementing this new care model. Through this collaboration, ClickWell has been able to leverage the new MyHealth app developed internally and has worked closely with IT to improve the platform and video visit capabilities to provide an excellent patient experience.

As part of the ClickWell Care program, the MyHealth mobile app helps strengthen care collaboration. The doctor/coach prescribes the health tracking app to the patient as a way to monitor key measures which may include steps, weight and blood pressure. The patient uses the MyHealth app to upload tracking data from Withings, Fitbit and Apple HealthKit to the EMR, sharing health status between visits. “When I see a patient with blood pressure trending higher, I ask the patient to schedule an online visit so that we can discuss how to address this through diet or medication changes”, Cheung explains.

ClickWell Lessons Learned

The Stanford Medicine team has gained insight into ClickWell Care program usage, the telehealth platform and mobile app to bring the most value to primary care patients and providers. They understand that it is not about the technology but instead about how the technology is put into the care model through a program.

Patients have shared many positive comments about the ClickWell Care program:

“Video visits allowed me to continue with pressing work concerns, instead of taking time off work to travel to a clinic. Video visits allowed me to chat with a Doctor late in the evening, and appointments were very easy to get.  I felt that my virtual care was more personalized and provided a better experience.”

“I have not had many medical issues until recently. It is such a relief being able to ask questions and get answers quickly. My wellness appointments have me watching my diet and exercise regimen. Everything is done efficiently. I cannot say enough about the whole team that has been watching over me.”

“My experience with the ClickWell Clinic has been extremely informative and remarkably efficient. The flexibility they offer works perfect for people with busy schedules, without sacrificing the quality of care. The model of the Clinic makes other forms of healthcare communication feel outdated.”  

“I have never had better communication and quicker responses than I have since becoming part of this program. I travel a lot and therefore keeping up via phone calls is not that practical. Being able to send messages electronically and to have an appointment via video chat is ideal.”

Doctors and wellness coaches have provided mostly positive feedback as well:

“Overall my experience with virtual visits in the clinic has been very positive. Compared to my previous experience with only in-person visits, it seems like the virtual option may make wellness patients more likely to continue with follow-ups. The integration with the doctors is also helpful in learning more about the patients and providing well-rounded care. It is a unique experience to be able to discuss treatments so closely with the patient’s doctors and in such a timely manner.”

“The integration of clinical care with wellness coaching has been phenomenal. I couldn’t imagine going back to health coaching without it. I am able to provide more targeted, individualized, and thorough care to my patients since I have full access to their medical records, provider notes, and work directly with their primary care physicians. Working directly alongside physicians has helped me to expand my knowledge on chronic disease management, stay up to date on clinical guidelines and recommendations.”

“As a provider, the technologies we use in this clinic allow us to quickly connect with our patients and address concerns for our patients proactively. The extended hours also allow for expanded patient access, as well as a flexible schedule for providers who staff the clinic who may desire alternative hours outside of the usual 9-5 business day.” 

“Through our discussions with patients, we have also heard some suggestions for change. In the beginning, we were contacting patients to convince them to switch from in person to virtual visits. This frustrated some patients and most wanted to stay with the modality that they had initially chosen”, Desai shares. 

Future ClickWell Care

As with other healthcare systems across the country, Stanford Medicine sees what is happening with the retail pharmacies increasing care access to patients. However, they believe this only fragments care because the visits are outside of the patient/doctor relationship. ClickWell Care is designed to be “longitudinal” and not episodic.

In 2016, Stanford Medicine is looking to extend into specialty care. “We are interested in integrating preventative cardiology for our patients since care entails discussing and improving risk factors for cardiovascular disease, which can be done virtually. Preventative cardiology patients would also benefit from wellness coaching to improve their risk factors for disease.

We also want to expand the use of connected health devices. Currently, very few patients upload and share their data with our care team. We are planning to incorporate this health tracking into a program for a  patient population (e.g. specific chronic conditions) and integrate this information into clinical workflow to ensure that these patients receive excellent care. With our Precision Health initiative, we are not just interested in treating illness but rather finding tools to deliver a personalized health and wellness experience to ensure the best outcomes”, Desai concludes.

Dr. Eugenia Chan sat patiently waiting for her fidgety first grade patient and her frustrated mother to answer her question. "How was the new medication working to help Janie with her ADHD"? Janie's mom hadn’t had a chance to fill out an ADHD behavior questionnaire in the chaotic waiting area, so she tried to summarize her impressions since their last doctor’s appointment a few months ago.  She hadn’t heard specific feedback from Janie’s teacher, and had also forgotten to give the ADHD questionnaire to her teacher so that they would understand how she was doing in school.

In 2011, Dr. Chan, MD, MPH, a developmental-behavioral pediatrician and health services researcher in the Division of Developmental Medicine at Boston Children’s Hospital, felt that she needed a better way to monitor her patients and gather insight into how they were doing with their medications and treatment plans.  With a grant from the Croll Family Foundation, Dr. Chan collaborated with Dr. Eric Fleegler, MD, MPH, a pediatric emergency medicine physician and health services researcher in the Division of Emergency Medicine at Boston Children’s Hospital, on the development of a new software tool, eDMC (electronic Developmental Medicine Center).

Their goal was to gather and interpret the information from parents and teachers more effectively and gain a more comprehensive view into patient behavior between visits. The doctor determines when the system will email the parents, typically a week or two before the appointment. When the parent receives the email with a link into the software platform, she logs in and answers a set of questions about symptoms, school performance, quality of life, global functioning and improvement since the beginning of the treatment. The parent gives the email addresses of the patient’s teachers and other important observers of the child (e.g., sports coaches, behavioral therapists, tutors) to the clinician to get them set up in the system so they can answer similar questions.

Clinicial InterfaceWith this information, Dr. Chan is able to determine how her patient is doing throughout the day, week and over time. During the visit, she shares this information with her patient and family, points out trends and discusses what has transpired. On the graphs, each line shows data from a different caregiver; parent, teacher and coach. The clinician can also drill down to see specific symptoms and their ratings that are incorporated into a score. With the treatment plan in mind, the clinician evaluates the data and focuses in on any discrepancies to determine what is really happening. This exchange supports her clinical decisions and enables her to participate in shared decision making with her patient and his family.

“I’ve already started using the system to work with my adolescent patients who want to go off their medications. When I agree to let them try coming off meds, I suggest that we use the questionnaires to monitor results. At the next appointment, patients are often surprised to view parent and teacher ratings and comments, that she was ‘disruptive’ or was ‘unable to pay attention’”, describes Dr. Chan.

Another feature of the platform is the ability to notify the clinician when there is a “red flag” patient problem that may require action (i.e. severe depression). Even though parents are made aware that this is not a real time monitoring system, there is someone responsible for ensuring that clinicians have seen the red flag alert.

Parent InterfaceSince the program started, over 3,000 pediatric patients have participated.  One parent comments on the value that she sees with the system, “it is very easy to use and I like that we save the time at the doctor’s appointment and all of the information is there”. Dr. Fleeger adds that the system “transforms how patients are interacting with their clinicians. At the appointment, the clinician can show them the graphs and tables on the computer to understand where they are and have a fruitful conversation”.   Dr. Leonard Rappaport, Chief of the Division of Developmental Medicine at Boston Children’s, says that the platform “is the first major improvement we have made in individualized care for developmental disorders in the past two decades.”

Currently the clinician can copy patient level summary information from the system into the EMR. Although the platform is web- based, Dr. Chan mentioned they were creating a mobile interface for access through smartphones and tablets.

Expanding ICISS Health; More Patients & Populations

In 2012, Dr. Chan and Dr. Fleeger renamed the platform the Integrated Clinical Information Sharing System (ICISS Health) to be more generalized for expansion into other pediatric patient populations.

 “We have extended the ICISS Health platform to additional clinics at Boston Children’s that treat patients with ADHD, as well as private practices affiliated with Boston Children’s, and we are expanding into new conditions such as autism, asthma, depression and epilepsy”.

For each new condition, they have convened a cross disciplinary team to define the data that need to be collected to support decisions. “For example, we are working closely with clinicians from the Boston Children’s Autism Center to devise a questionnaire for patients, since there is no standardized set of questions for this patient population” explains Dr. Chan. “For asthma, we would like to invite the school nurse to participate and provide insight into frequency of nurse office visits and rescue medication use by the patient, and whether they used the patient’s asthma action plan.”

The team at Boston Children’s is in the process of collecting information to evaluate the ICISS Health platform impact on patient health outcomes and healthcare utilization and costs. Dr. Chan also mentioned their interest in calculating potential cost savings from the platform by identifying problems early and intervening in time to prevent emergency department visits and hospitalizations.

“As we think about the future of the platform, we are interested in going beyond the electronic questionnaires to capturing and integrating information from devices and mobile applications”, Dr. Chan concludes.

Pinnacle Health Social

mHealth + Telehealth World 2013- World Congress

July 24- 26, 2013 in Boston

Join our 2- hour Workshop to explore Social Engagement Strategies that activate consumers to participate in their health; sharing and tapping into peer lifestyle experiences and gaining expert guidance. You will see what healthcare leaders are investing in today, explore social eHealth opportunities for consumer engagement in the future and discuss how to launch a social strategy within your organization.

During the Workshop,

• Learn about key Social Engagement trends including social segmentation, social connect (programs & experts) and social data
• See examples of Social Engagement Approaches used by Healthcare Innovators; Payers & Providers
• Hear a Case Study of a Provider solution that “meaningfully” engages consumers with a private social community integrated with personalized content and communications
• Participate in a Social Engagement Planning Discussion; Considerations, Approaches and Mobile & Tele-health tie-in Opportunities
• Participate in a Group Innovation Exercise: Collectively define a specific social engagement initiative to positively impact consumer health (Workshop participants shape exercise)

Workshop Leaders:

Sherri Dorfman, MBA, Chief Executive Officer & Consumer eHealth Engagement Specialist, Stepping Stone Partners

Lucy Reynales, Director, Wellness Layers

Shelley Marshall, Web Marketing Manager, PinnacleHealth

mHealth + Telehealth World 2013- World Congress

July 24- 26, 2013 in Boston

Innovative healthcare organizations are developing comprehensive engagement strategies to support consumers across the care continuum. They are aggressively testing and learning about how to effectively use mobile technology to guide, motivate and support consumers for better health outcomes. 

During this session, you will learn about: 

• Evolving Consumer Engagement Landscape & Trends
• Engagement in Action and Insights from Innovative Providers & Payers  
• NeHC Patient Engagement Framework & Examples at Each Step
• NeHC Consumer eHealth Readiness Tool powered by HealthCAWS- Assessment & Path Forward 

Speakers:

Sherri Dorfman, MBA, CEO & Consumer eHealth Engagement Specialist, Stepping Stone Partners

Rose Maljanian, MBA, Chairman & CEO, HealthCAWS