Health care providers and insurance companies want to get their customers healthier, and have customers record their wellness data to track their progress, with some health app developers eager to help out. Speakers on Friday, 26 July at the mHealth + Telehealth World Congress in Boston gave examples of recent health and wellness initiatives making use of customer-generated data, but questions still remain on integrating these data with patients’ electronic health records.
Adventist HealthCare, a network of five hospitals serving the Washington, D.C. region, offers a self-insured health plan for its nearly 6,300 employees, and thus is both a health care provider and a payer for health care services. Arumani Manisundaram, director of Adventist’s Center for Connected Health, reported on a pilot program to reduce the number of employees deemed to have high-risk health conditions.
Like many employers, Adventist HealthCare discovered a small number of its employees (6.3%) accounted for a majority (60%) of its health care costs. Further analysis identified 121 individuals considered high-risk users. These individuals saw, on average, some 15 health care providers and had nine different prescribing physicians.
As an immediate first step, said Manisundaram, Adventist assigned a primary care physician to each of these employees, to better manage their health care needs. In addition, Adventist coupled a personal health nurse from its third-party plan administrator with each primary care physician, to provide coaching on wellness, nutrition, and exercise, and followed-up on employees’ making and keeping their doctor appointments.
Adventist employees also receive discounts for good health behaviors, such as not smoking, and keeping their weight in check. Employees can receive as well discounts at a local fitness club, with a fitness coach provided.
To help employees keep track of their health care activities, Adventist established My HealthPlace, a portal for employees that captures claims data, but also allows employees to record their health goals, appointments, and wellness data. Manisundaram called it a “home-grown approach” befitting a small-scale pilot program to engage patients and reduce costs.
The results showed the pilot program was able to reduce the number of high-risk employees by nearly half (48%) to medium and low risk, saving some $1.2 million in that year. Adventist has since rolled out MyHealthPlace for its entire workforce and added the ability to enter data to the portal from employee smartphones.
The health insurance provider Aetna aims to capture data from user apps through its CarePass service, aggregating those data in a system that provides for those insured by Aetna, or any others, keep track of their health and wellness progress. Dan Conroy, who heads business development for the CarePass program, described the main features in CarePass, which began full-scale operations in June 2013.
CarePass, says Conroy, allows users to get an overall picture of their health and progress toward wellness goals in one place. For Aetna members, CarePass can integrate data from their wellness apps with their Aetna personal health records, making that picture a more comprehesive view.
The mobile apps supported by CarePass cover nutrition, sleep, and exercise tracking including BodyMedia, FitBug, LoseIt, and Up by Jawbone, which in some cases use accessories like wrist bands to capture the data. CarePass also supports data from iTriage, an app that helps users find a physician, make an appointment, and analyze symptoms.
In addition, CarePass offers an application program interface (API) for app and other software developers to interact with CarePass. CarePass also acts as a gateway other health-related APIs.
Dacadoo, in Zurich, Switzerland provides a health-data collection portal separate from health care providers and payers. Vishal Dubey, the company’s vice-president for technology delivery, described how the portal connects to traditional health-monitoring devices, such as blood-pressure cuffs, as well as connected bathroom scales and activity trackers. Users can import data from smartphone apps or by keyboard input.
Data collected from the Dacadoo portal — covering nutrition, sleep, exercise, and overall wellness — then are then uploaded to the cloud and crunched into a single overall health score from 1 to 1,000 that provides feedback for the user to track over time. Users can also share their progress with other Dacadoo participants in groups with common activity interests, such as hiking or rowing, or can form into competitive groups, called leagues, that run for three to four-month seasons.
Dubey explained how Dacadoo, like CarePass, also provides a platform for sharing and integrating data into personal or corporate systems. Dubey stressed that individuals subscribing to Dacadoo control who can access their data.
A later session that day discussed the emerging central role of electronic health records in collecting an individual’s data, but also as platform for further messaging and advanced services, such as telemedicine. Pramod Gaur, vice-president of telehealth at the insurance provider UnitedHealth, raised a number of cautions about integrating the data from personal wellness apps.
Gaur pointed out that the distinction between data collected by health professionals — clinicians, pharmacists, or from labs — and data collected by individuals. Data collected by professionals are more likely to be interoperable with electronic health records than those gathered by individuals.
In addition, Gaur noted personal data need to be verified before becoming part of the electronic health record. Even a reading by a professional-style device, such as blood-pressure cuffs, could be that of a different person. Data may need to be repeated or reviewed by professional before entered into an individual’s electronic record.
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