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The Evolution of Connected Health

December 21, 2010

My assistant is spending a few hard-earned weeks of R and R in the Galapagos Islands with family. So my mind keeps thinking of Charles Darwin these days…

When we chose to rebrand our group from Partners Telemedicine to the Center for Connected Health (CCH), four years ago, we had a general idea that gathering objective data from program participants would create value in health care delivery. Our experience has taught us a lot since and we keep on learning by doing.

It was about that time (four years ago) that we began our discussions with Delia Vetter and company at EMC. The clinical trial we did with them eventuated in the launch of a new company, Healthrageous, in June of 2010. I have written elsewhere about the details of that experience. At the six-month mark, it is easy to look at their progress and see two very distinct brands of connected health implementation developing, when I compare Healthrageous to CCH. Simply put, Healthrageous is developing programs that engage employees by using their biometric information as a substrate for automated coaching. Their value proposition is to the employer and largely to commercial health plans. CCH continues to develop programs that are usable by patients and provide health care providers with tools that enable them to provide just-in-time care and coaching. The value proposition is to providers and more to government payers.

The Table below illustrates these differences and the following narrative explains them in greater detail. At the end, there is an illustrative example of how the two organizations are handling an overlap condition, hypertension.

Attribute Center for Connected Health Healthrageous
Market/customer Healthcare provider Health plan/employer
End user Patient Employee
Technology changes, last 6 months Focus on text messaging Added smartphone interface
Technology direction LMR/Pt. Gateway Integration Rules engine, machine learning, analytics
Participant accountability Via nurse, doctor or other health professional Via automated machine-generated messaging

Difference #1 – the customer

Starting with the customer focus, CCH concentrates on solutions that will enable provider organizations, such as Partners HealthCare, achieve higher quality, more efficient care using connected health. Healthrageous is interested in supplying personalized connected health solutions to employers, ultimately via health plans. The end users of the solutions overlap only slightly. Health care providers care for patients. These individuals are generally sicker and older than employees. The target conditions are different.

For instance, CCH has developed a robust heart failure telemonitoring program, which is helpful to Partners in their quest to improve care and avoid costly hospital readmissions. The incidence of heart failure in the employee population is so small that Healthrageous has no market for this program.

In contrast, Healthrageous’ launch program was a product to encourage walking and activity. Though CCH has this core program built, there has been no interest in scaling it in the provider setting. The two user groups adopt technology in different ways.

Recent data from the Pew Internet Project show that individuals with two or more chronic illnesses (i.e., patients) have adopted smart phones at a rate of ~ 16%, while adoption in the general employee population is closer to 75%. This difference has led to different choices for technology focus in the past six months, with Healthrageous focusing on its smartphone platform and the Center refining its text-messaging program.

Difference #2 – the technology platform

The other core difference is how the two organizations are refining the very same technology platform on which our connected health programs are built.

In addition to the smartphone capabilities noted above, Healthrageous has focused on developing automated coaching capabilities. Their goal is to automate health advice and caring in the same way that Amazon has automated predicting which books you will want to buy.

In contrast, CCH focuses on creating user interface changes to better enable clinicians to interact with patient data coming from the patient’s home and will soon begin integration of our programs into Partners electronic medical record and patient portal.

Hypertension Case Study:

The Blood Pressure Connect Program from CCH recruits patients from primary care practices within the Partners HealthCare system.  Patients are trained on how to use the equipment either in the MD office or in a group enrollment.  They regularly upload blood pressure from their home using a cuff and a phone modem as a transmission tool.  Participants have the option of reviewing their blood pressure trends on a website.  A monitoring nurse, typically in the primary care practice, logs into the system and sees a dashboard view of all of the participants under the practice’s care. Based on the data, and using his/her clinical judgment, the nurse will proactively contact patients who are having difficulty managing their blood pressure.  The blood pressure readings are also used as a tool to help the primary care doctor manage blood pressure.  CCH has put emphasis on the provider experience and relying on the provider to coach the patient to achieve improved blood pressure management.

Healthrageous’ blood pressure application is quite different. Participants are identified through either claims data or health risk appraisal data. Equipment is shipped to them. Their interaction is with either the website or the smart phone interface. A human being is only involved when the employee is not participating or to solve technical problems. The core value is around interpreting blood pressure readings in context of other inputs such as lifestyle, stress information and eventually lab data, etc. A powerful computer program analyzes all these inputs and customizes interactivity with the employee in a way that is predicted to motivate him or her to achieve improved blood pressure control.

So, as we continue to learn more, generate new data and better understand the specific needs of various patient populations and consumers, we are able to evolve our thinking and create more targeted and effective connected health solutions. There is clearly a role for customized online support to aid in patient self-management, as well as more robust and interactive interventions for sicker patients requiring more complex monitoring and care.

Following Darwin’s ‘common ancestry’ theory, CCH and Healthrageous have created two approaches, although quite different, that add great value, improve health and wellness and empower patients and providers.

Wherever your travels take you, my you have a happy and healthy holiday season and a prosperous New Year ahead. I look forward to continuing our dialogue in 2011 and hope you continue to join in our discussion.

5 Comments leave one →
  1. December 22, 2010 4:47 am

    As ever a thoughtful and reflective piece. I was wondering to what extent the health workforce and their employers had enthusiastically embraced the healthrageous proposition to increase their general wellness and productivity. With the London 2012 Olympics on the horizon there is an initiative to get 2012 NHS employees in local communities to get actively involved in physical exercise – an ambitious 300,000 people in total. There has been some innovation and dedicated support for individuals co-ordinated through their employers and individual role modelling by “heroic” leaders preparing for marathons and mountain climbs. I suspect there has been less attention to the personalised scientific approach and no/little predictive or automated personalised components. Have US healthcare employers more readily seen the potential for improved physical and mental wellbeing within their workforce?
    Best wishes for the festive season. Paul

    • December 22, 2010 9:30 am

      Paul,

      You have innocently conflated the responses to Healthrageous’ programs of two very different groups: employers and workforces. What has been evident in the literature for some time is that change imposed by a third party, falls far short of change that is inspired from within (think revolutions vs takeovers). When employees sign on and “embrace” Healthrageous programs, the majority are doing it for their own improved well being, not because their employer insisted on it. Smart employers are attempting to fund self improvement programs without them appearing to be employer-sponsored initiatives. All of the nuanced messaging deployed by Healthrageous targets the narcissism that most of us own up to; e.g., if I receive health inspiring messages that are all about me and my data, I will be much more likely to keep aspiring to achieve my self-imposed health goals. The really smart US employers strive to garner the enhanced productivity that comes from improving the physical and mental well being of their workforces; yet they also appreciate how it won’t sell if it sounds like Big Brother insisting on or incentivizing the improvement.

  2. December 26, 2010 7:30 pm

    Fascinating post, Joe. I love the (all too rare) common-sense, pragmatic, person-centered business thinking revealed here, made that much clearer by the evolutionary split you discuss. Great mix of the interacting forces that drive behavior change and adoption by the people with money.

    Here’s to a productive 2011!

    • December 27, 2010 8:21 am

      Thank you, Dave. I appreciate your thoughtful comment

  3. January 7, 2011 7:59 am

    While searching for e-health & usability literature, I’d fund a S.Fox article that talked about the future of e-health, in wich I’m happily stumbled across a video on technology’s fear applied to health. A lucid presentation on new and creative opportunities provided from automation to respond to medical needs. Also by reading this last article I have further confirmation(not needed) of your prospective vision. I can now go back writing my little article with much more inspiration.

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