By Luci DeHaan
Meaningful patient engagement has become a critical component of care as our healthcare system moves from a volume based, fee-for-service model to a value-based, capitation model.
Last year, half of smartphone or tablet users nationally had a health and wellness app, according to the federal government’s Office of the National Coordinator for Health Information Technology (ONC). Three-quarters of those users tracked their progress on health-related goals and about half used their apps to make treatment-related decisions.
It’s no wonder that health providers are embracing technology as a tool to engage patients in their health.
Here in our borough, Bronx Partners for Healthy Communities (BPHC), the SBH-led DSRIP Performing Provider System (PPS), has been looking closely at how the use of mobile applications can drive engagement among our communities’ most complex and vulnerable patients.
Through BPHC’s Innovation Fund, a mobile app piloted by Montefiore Medical Center with patients who have behavioral health conditions, including those with serious mental illness (SMI) and involvement with the criminal justice system, is showing successful results.
The app allows care managers to communicate with and engage their patients in their own care through features that facilitate two-way secure messaging (video and chat), appointment reminders, tailored and interactive educational content, and automated symptom self-assessments. The platform can also alert care managers to changes in a patient’s condition that might suggest the need for timely clinical intervention.
Working with the technology vendor, Valera Health, Montefiore first piloted the app in July 2016 through an Innovation grant from the Centers for Medicare and Medicaid Services (CMS). The app was introduced to adults with behavioral health conditions that commonly presented in primary care such as depression and anxiety.
Over the course of a year, those patients had faster time to improvement while showing similar clinical improvement and remission rates as those not using the app. This was the case even though app-enrolled patients on average had higher baseline depression and anxiety scores and more prior treatment episodes, indicating they may have been more clinically severe. Patient engagement rose considerably for those enrolled in the app with care managers interacting with patients two times more than usual and having a shorter time to first follow-up (11 vs. 19 days).
In April 2018, BPHC’s Innovation Fund allowed the pilot to expand to patients with SMI and substance use disorders, including those with a history of justice system involvement.
“Montefiore had initially piloted a platform that was successful with patients identified as needing behavioral health services through primary care,” says Dr. J. Robin Moon, BPHC Senior Director of System Integration. “We wanted to see if we could apply it to our hard-to-reach, high-burdened patients who need more intensive care coordination.”
Through each phase of implementation, Montefiore worked closely with behavioral health team leadership, clinicians and care managers using the app to closely monitor patient feedback, address workflow challenges, and capitalize on best practices. App customizations were made throughout the project to best meet patient and care manager needs. Once more, results were very positive. Patients more engaged in the app had fewer no-show appointments and more completed appointments with their behavioral health team than those who did not use the app.
Patient engagement and satisfaction were also high: two-thirds of enrolled patients completed one or more depression and anxiety symptom measures, such as the PHQ-9 and GAD-7, and almost three-quarters read informative materials, viewed educational videos delivered through the app, and engaged in secure chats with their care manager or therapist. Users overwhelmingly said the app was easy to use (86%) and more than two-thirds said they felt more connected to their care team.
“We are pleased with how this technology helps improve patient engagement in their care, especially for our low literacy, socioeconomically challenged patients who experience significant barriers to accessing health care,” says Dr. Henry Chung, Senior Medical Director of Behavioral Health Strategy at Montefiore Medical Center, Care Management Organization. “With the app, our teams are able to provide high-quality, patient-centered care to more people in a more timely and cost effective way.”
Coordinated Behavioral Care (CBC) IPA, a provider-led organization, is also using technology to increase patient engagement and treatment adherence. Through its newly created Innovations Hub, CBC actively partners with companies to explore and test mobile technologies that can meet their patients’ needs.
Recently, BPHC supported the CBC’s launch of a behavioral health app that uses cognitive behavioral therapy-based strategies and meditation to help people manage chronic health conditions. The technology also allows providers to monitor patients remotely, administer assessments, and access quality measures related reporting.
Consumer input was critical to this project from the start, according to Dr. Jorge Petit, CBC President and CEO. CBC surveyed patients and providers and led patient focus groups to understand their needs. Patients were even invited to meet with the final group of vendors under consideration to participate in demonstrations and literally vote on which technology CBC should select to pilot.
CBC is currently piloting the app with Bronx clients and assessing it for replicability and scalability.
“CBC collaborated with providers in our PPS to take a patient-centered approach to identifying and launching a mobile app platform that would best serve their patients,” says Dr. Moon. “This is what makes the potential of these technologies so exciting. The focus is on the patient. The care team is driving the care; the technology is the tool.”