1. Patient Engagement
in the age of Accountable Care
Kamal Jethwani MD MPH

2. Our World is being turned Upside Down

3. The Increasing Burden of Chronic Diseases

4. Physician Supply & Demand Projections through 2025

5. Connected Health Goal
Integrate care into the
day-to-day lives of our patients

6. Components of Self Care
Social
Networking
Gamification
Incentives
Coaching
Feedback
Loop
Slide developed by ProPoint Graphics for CCH
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Content Confidential – DO NOT DUPLICATE.

7. Engagement = Better Outcomes
Patient uploads
& views
Uploads, viewing &
provider engaged
Uploads, viewing &
coaching
GOOD
BETTER
BEST!
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Content Confidential – DO NOT DUPLICATE.

8. Connected Health Platform Overview
Patient sends blood
Providers access data &
pressure, blood glucose, step
counts or weight readings to
a secure website.
information to manage
patient’s care.
Patients provide contextual
information.
Automated rules & alerts also
help patients understand their
health.
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Content Confidential – DO NOT DUPLICATE.

9. Connected Cardiac Care Program (CCCP)
A Patient’s Perspective
“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

10. Proportion of CCCP Enrollees with >1 Hospitalizations
% of CCCP Enrolles
100
58.10
39.80
13.30
1 yr prior to CCCP
enrollment (point
estimate & 95% C.I.)
1 yr following CCCP
disenrollment (point
estimate & 95% C.I.)
50% Drop in
Readmissions
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.

11. Diabetes & Blood Pressure Connect
Average drop of HbA1c: 1.5
69% achieved a drop in BP

12. Greater Engagement associated w/ Greater Pre-post HbA1c Change
Average drop HbA1c by # of uploads
1.8
1.53
Drop in HbA1c
1.6
1.34
1.4
1.2
1
0.8
0.6
0.43
0.4
0.2
0
no uploads
1 - 15 uploads
> 15 uploads
 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

13. Engaged Providers = Engaged Patients
n = 91 patients
PRACTICE 1
PRACTICE 2
Avg. change A1c - Total
- 0.8
- 1.5
Avg. change A1c – Active patients only
- 0.7
- 1.8
Avg. change A1c – Non-active patients only
+ 0.9
+ 0.4
6
28
Provider logins / month

14. The Power of Simple Messaging
Medication reminders, encourage pre-natal care, etc.
Instant messaging ‘in path’ – reach patients where they are
Lower barrier to adoption, higher engagement
70%
Weekly Adherence Rates (mean +/- SEM)
Reminder group
60%
No Reminder Group
% Adherence
50%
40%
30%
20%
10%
0%
Week 1
Week 2
Week 3
Study Period
Week 4
Week 5
Week 6

15. The Value of Personalization
Readiness
To Change
Connected
Health Data
Customized
Program Design
Analytic
Engine
Practice
Location
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Content Confidential – DO NOT DUPLICATE.

16. 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

17. PatientsLikeMe

18. CureTogether

19. Model for Patient Collaboration
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
Asymmetric
Knowledge/Info symmetry
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
19
1

20. Accountable Care Organizations
Improve
efficiency &
patient
satisfaction
Improve
patient care,
support
self-care
Shared vision
&
commitment
Improve data
collection,
integration,
& exchange
Quality of
care & Costs
Lower
Overhead
Maintain
infrastructure
& remain
flexible
Adapted from:
http://www.med3000.com/Por
tals/46580/images/healthcare
_it_chartfinal1(2).png

21. Role of mHealth in Patient-Centered Medical Home
Enhance access & continuity?
Plan &
manage care?
PCMH
Identify & manage
patient population?
PATIENT
Provide self-care
support & community
resources?
Track &
coordinate care?
Measure & improve
performance?

22. AIM: Better Health for Populations
ACO #22-27 At-Risk Population: Diabetes
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

23. 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

24. Regina Holliday, “Silos”
Thank you!
Kamal Jethwani, MD MPH
Corporate Manager, Research and Innovation
Partners HealthCare Center for Connected Health
kjethwani@partners.org