Healthcare motivation

Archive for Healthcare motivation

Supporting Patient Motivation

What motivates people to improve their health and stay on the right track over time?

This question is on the mind of every practitioner, whether it’s a physician sending someone home with a wound care plan, a nutritionist giving dietary advice to help manage diabetes or a physical therapist providing exercises to get a frozen shoulder moving again. They’re thinking: “Will the patient do it?” To a great extent, the answer to this question determines how successful their treatment plans will be.

Some of this blog’s most popular posts have explored the issue of motivation because it is a major underpinning of patient engagement technology – will the patient use, and stick with, the technology that in turn helps them adhere to their care plans?

The subject of motivation usually starts with a discussion about goal-setting. This process, at least in the medical context, typically begins when the practitioner sets goals for the patient and provides a care plan that tells the patient what they need to do in order to get there. Some practitioners feel this should be motivation enough for a patient. In reality, they know it’s not.

So what is motivation? A great deal of research has gone into the subject, particularly with regard to behavior change. It is most often described as being either extrinsic (outside the individual) or intrinsic (inside the individual). With extrinsic motivation, we engage in a behavior or activity either to gain some sort of external reward or avoid a negative consequence. With intrinsic motivation, we engage in something because we find it personally fun or rewarding.

While these are the two areas most often discussed, there are other, deeper dimensions to motivation, including fear-based and development-based motivators – and these can be either extrinsic or intrinsic. Understanding the interplay among these different forms of motivation is an important element in successful health coaching and in the creation of successful, supportive technologies that assist people in reaching their health goals.

Fear-based motivation comes in two basic flavors: deficiency-based and threat-based. Deficiency-based motivations come from the sense you are lacking in some way. These can have an external, socio-cultural source (just watch any personal care product advertisement: you smell bad, your hair is the wrong color and your teeth aren’t nearly white enough) or an intrinsic source (e.g. internal pressure “shoulds,” self-imposed discipline or overcoming the deficiency of lost health). Threat-based motivations tap into fear at a deeper level. In the world of medicine, this might be a medical incident that serves as a wake-up call, and the threat of disability or death propels a person to make serious lifestyle changes.

Development-based motivation tends to come from the desire for personal growth or self-actualization. It can also be externally sourced (e.g. from positive peer health norms or positive environmental conditions like smoke-free public spaces) or intrinsic – from the satisfaction, pleasure or joy we derive from doing something.

Research has shown that while fear can be a great motivator for getting people started on something, the positive, development-based motivators tend to be more powerful in keeping people engaged and active in behavior change over the longer term.

I believe one of the reasons the Wellpepper patient engagement platform is so successful at driving patient engagement with care plans (70% engagement compared to an average of 20% engagement with portals) is because the Wellpepper team understands this complex motivation dynamic very well and they have incorporated some of the most successful elements from it into their platform. They call it the “3rd approach” and here’s why I think it works.

Wellpepper takes a very obvious extrinsic motivator – the practitioner’s care plan – and turns it into an application that incorporates both intrinsic and extrinsic development-based motivators that keep people engaged over time. There are many layers we could explore here, but we’ll start with a few of the big ones.

Setting aspirational goals: In addition to the functional goals set by the practitioner, Wellpepper provides the ability for patients to set their own personally meaningful, aspirational goals that can support and reinforce their motivation to heal. For example, someone recovering from a total joint replacement operation might set a future vision of wanting to hike to their favorite fishing spot with a grandchild. They can use Wellpepper to set interim goals that lead them toward that vision and can rate their own progress on a Likert scale.

Research in positive psychology has shown that this kind of personal vision and goal setting is highly successful at sustaining motivation over time. In this case the patient is more likely to complete their prescribed exercises because it leads them toward goals that are personally meaningful about their own healing and about doing something special with someone they love.

Personalized experience: Wellpepper also provides a personalized experience for the patient. Using the same joint replacement example, instead of getting a piece of paper with a series of exercise diagrams or a generic video, the practitioner can record the patient doing their own exercises. Seeing yourself, and hearing the personal comments of the physician or physical therapist as you do it, is not only easier to follow, it feels personal. And, as you begin to improve, when you watch yourself then and now, seeing your own progress can be very satisfying (a powerful development-based motivator).

Adaptive notification: Wellpepper’s patented adaptive notification system means the patient doesn’t get the same generic reminder every day – it changes the notification based on the patient’s progress and level of engagement, keeping the extrinsic motivator relevant, fresh and focused on personal development.

Tracking progress: By enabling people to track progress on their goals and sharing that information with their practitioners, patients tap into positive, extrinsic motivation. Also tracking progress on personal, aspirational goals helps people feel a greater sense of accomplishment and direction over their own developmental outcomes.

While motivation for any one individual can be elusive, the way Wellpepper weaves together the positive extrinsic and intrinsic development-based motivators may be the key to its success in helping patients stay motivated and helping practitioners answer the age-old question: “Will the patient do it?”

If they’re using Wellpepper, chances are, they will.

Jennifer Allen Newton is Wellpepper’s PR lead, and also a Functional Medicine Certified Health Coach. 

Posted in: Adherence, Healthcare motivation, Healthcare Technology, Healthcare transformation, patient engagement, Physical Therapy

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Your Cupcakes Are Not My Goals

This year Google Maps tried out a short-lived motivational technique of showing how many cupcakes you would burn off or ostensibly could eat if you chose to walk to your destination. Not surprisingly this backfired, and they quickly retracted the feature. The reasons ranged from users expressing feelings of shame for not walking, to those with eating disorders saying it would encourage more obsessive behavior. Beyond that, many questioned how Google was even calculating both caloric expenditure and the actual calories in the cupcakes.

Regardless of the myriad of criticisms the experiment illustrated a key point: motivation and goal setting is best left to the individual, and understanding someone’s personal context is extremely important if you want to help them set goals.

One of our most read blog posts of 2017 was a 2015 post on whether setting SMART or MEANINGFUL goals was most effective for patients. I’m not sure why this bubbled to the top this year but the post provides an overview of two thoughtful frameworks for helping patients set goals.

At Wellpepper, we’d like to propose a third methodology: let people figure out what’s important to them. This year we expanded a capability we’ve had since V.1 that enables patients to set their own goals. This is a free-form, 140 character text box where patients write about what’s important to them. Over the years, we’ve had some clinicians express concern about whether patients could set their own goals. Functional goals are best left to the experts, but these are life goals, things that are important to people and why they are even bothering to use this app which helps them through healthcare activities to manage chronic diseases or recover from acute events.

Since we already knew that setting patient-generated goals is motivating, we also got to wondering whether you could track progress in a generic way based on patient-generated goals. After analyzing thousands of patient-generated goals, we figured out that asking a question about the patient’s perception progress on a Likert scale would work, and so this year we expanded the patient goal task type to include tracking.

It looks like this.

In case you’re skeptical that this works, here are a few examples of patient-generated goals.

Spend more time with family.

Get outside more frequently.

Walk more.

Be ready for vacation.

Now ask the question. See, it’s entirely possible for patients to set their own goals, unaided, and track progress against those goals. We’re pretty excited about the possibilities of this for improving motivation, and also for further analysis of patient adherence and outcomes. If you’d like to know more, or see a demo, we’d love to hear from you.

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, Healthcare transformation, patient engagement, patient-generated data

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May You Live In Interesting Times: Wellpepper’s Most Interesting Blog Posts of 2017

Who would have predicted 2017? As soon as the election results were in, we knew there would be trouble for the Affordable Care Act no one could have predicted the path through repeal with no replacement to claw backs in a tax bill that no one has read. It’s been a crazy ride in healthcare and otherwise. As we look ahead to 2018, we’ve found that a good place to start is by looking back at what was popular in 2017.

Looking back over the past year’s top blog posts, we also believe trends that started in 2017, but will even stronger in 2018. These four themes bubbled up to the top in our most-read blog posts of 2017:

Shift to the cloud

We’ve noticed a much wider spread acceptance of cloud technologies in healthcare, and the big cloud platform vendors have definitely taken an interest in the space. Wellpepper CTO Mike Van Snellenberg’s comprehensive primer on using AWS with HIPAA protected data was one of our most read posts. Since he wrote it, even more AWS services have become HIPAA-eligible.

Using AWS with HIPAA-Protected Data – A Practical Primer

Consumerization of healthcare

Consumer expectations for efficient online interactions have been driven by high-deductible plans and an expectation from consumer technology and industries like retail and banking that customer service should be personalized, interactive, and real-time. These two posts about the consumerization of healthcare were among the most popular.

The Disneyfication or Consumerization of Healthcare

Consumerization Is Not A Bad Word

Value of patient-generated data

In 2017 we saw a real acceptance of patient-generated data. Our customers started asking about putting certain data in the EMR, and our analysis of the data we collect showed interesting trends in patient adherence and predictors of readmission. This was reflected in the large readership of these two blog posts focused on the clinical and business value of collecting and analyzing patient-generated data.

In Defense of Patient-Generated Data

Realizing Value In Patient Engagement

Power of voice technology

Voice technology definitely had a moment this year. Okay Google, and Alexa were asked to play music, turn on lights, and more importantly questions about healthcare. As winners of the Alexa Diabetes Challenge, we saw the power of voice firsthand when testing voice with people newly diagnosed with Type 2 diabetes. The emotional connection to voice is stronger than mobile, and it’s such a natural interaction in people-powered healthcare. Our blog posts on the Alexa Diabetes Challenge, and developing a voice solution were definitely in the top 10 most read.

Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

Building a Voice Experience for People with Type 2 Diabetes

Ready When You Are: Voice Interfaces for Patient Engagement

Since these themes are still evolving we think 2018 will present a shift from investigation to action, from consideration to deployment and possibly insights. Machine-learning and AI will probably remain high in the hype cycle, and certainly the trends of horizontal and vertical healthcare mergers will continue. We also expect a big move from one of the large technology companies who have all been increasing their focus in healthcare, which in turn will accelerate the shift to a consumer-focus in healthcare.

There’s a saying “may you live in interesting times.” We expect 2018 to be at least as interesting as 2017. Onwards!

Note: There was one additional post that hit the most popular list. Interestingly, it was a post from 2014 on whether SMART or MEANINGFUL goals are better for patients. We’re not sure why it resurfaced, but based on analysis we’ve done of patient-directed goals, we think there’s a third approach.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, HIPAA, patient engagement, patient-generated data, Voice

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What Motivates You, May Not Motivate Me

At Wellpepper our goal is to empower people to be able to follow their care plans and possibly change their behavior, so we think a lot about how to motivate people. Early on when working with Terry Ellis, Director of the Boston University Center for Neurorehabilitation, wanted to make sure that our messages to patients that may struggle with adherence were positive. She works with people who have Parkinson’s disease, and stressed that while they may improve symptoms they would not “get better.”

Last week I had a similar conversation with an endocrinologist about diabetes care plans. People with chronic diseases are often overwhelmed and may take a defeatist attitude to their health. Feedback and tools need to be non-judgmental and encouraging. Ideas like “compliance” and “adherence” may not be the way to look at it. Sometimes the approach should be “something is better than nothing.” And humans, not just algorithms need to decide what “good” is.

Am I good or great?

Here’s an example, non-healthcare related of algorithmic evaluation gone wrong. Rather than applauding me for being in the top tier of energy efficient homes, the City of Seattle, says I’m merely “good.” There’s no context on my “excellent” neighbors, for example are they in a newly built home compared to my 112 year old one, and no suggestions on what I might want to do to become “excellent. (Is it the 30-year old fridge?) I’m left with a feeling of hopelessness, rather than a resolve to try to get rid of that extra 2KW. Also, what does that even mean? Is 2KW a big deal?

Now imagine you’re struggling with a chronic disease. You’ve done your best, but a poorly tuned algorithm says you’re merely good, not excellent. Well, maybe what you’ve done is your excellent. This is why we enable people to set their own goals and track progress against them, and why care plans need to be personalized for each patient. It’s also why we don’t publish stats on overall adherence. Adherence for me might be 3 out of 5 days. For someone else it might be 7 days a week. It might depend on the care plan or the person.

As part of every care plan in Wellpepper, patients can set their own goals. Sometimes clinicians worry about the patient’s ability to do this. These are not functional goals, they represent what’s important to patients, like family time or events, enjoying life, and so on. We did an analysis of thousands of these patient-entered goals, and determined that it’s possible to track progress against these goals, so we rolled out a new feature that enables patients to do this.

Patient progress against patient-defined goal

Success should be defined by the patient, and outcome goals by clinicians. Motivation and measures need to be appropriate to what the patient is being treated for and their abilities. Personalization, customization, and a patient-centered approach can achieve this. To learn more, get in touch.

Posted in: Behavior Change, chronic disease, Healthcare motivation, Healthcare Technology, Healthcare transformation, Outcomes, patient engagement, patient-generated data

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Who Defines Value?

Pharma companies have recently jumped on the value bandwagon with proposals for value-based drug pricing based on outcomes and effectiveness. They have started to enter contracts with payers for specific drugs based on the impact the drug has on the condition the drug is treating.

This is a step in the right direction, and much better than pricing based on maximizing shareholder value, but value is in the eye of the beholder, and the patient is a key stakeholder. Shared decision making does a good job defining what’s important to a patient. The goal of shared decision making is to choose courses of care that offer the best outcome to the patient, and can consider some of the following:

  • Is this procedure my only option? What are alternative types of treatment?
  • What are the possible outcomes and side effects of each option, including the option of doing nothing?
  • What is the estimated cost of the procedure and any related follow-up care or medication?

Source: Center for American Progress

Simply, value can be defined by the following.

The challenge of the equation is in the definitions of acceptable outcomes and costs. Here are a few things that people might consider when evaluating a drug or a course of care.

  • Inconvenience or effort: How much does this disrupt their life? Does it prevent the person from doing other things?
  • Cost: How much does it cost? This could be in monetary terms, time, side effects, or quality of life.
  • Outcome: What is the expected outcome and how closely does it align with the outcome that’s important to me?

You can see that based on these factors, that healthcare can be a market of one. My idea of value and acceptable outcomes could be very different from yours. And, unfortunately, the patient is not a consumer in a free and transparent market. That said, it is possible to make consumer-like decisions in healthcare.

Let’s look at the value decision I tried to make this past weekend. I fractured and dislocated a finger while playing Ultimate Frisbee. I was pretty sure the finger was dislocated, which shouldn’t be a big deal, so tried to go to urgent care where I expected value based on time, outcome, and cost. Well guess what? Urgent care is not open on a Saturday night. I had a feeling that emergency care would not meet my value criteria of effort, since I expected a long wait, and I got it. On the cost, I did know that the provider I went to was in-network so that wasn’t a big issue, but I still don’t know the total cost if I’d had to pay out of pocket.

Waiting in ED

Waiting

Outcome was great, and the level of care was great. What was not great is that it took 4 hours to get x-rays, pop my finger back in, and splint it. If I had been choosing as a consumer, I’d never have chosen this. With higher deductibles and co-pays, people are making decisions as consumers which is why hospitals advertise wait times, and some are looking at how to completely overhaul the ER, both of which would get us closer to value.

Let’s look at an example on value-based drug pricing. Back when I had the Cadillac of US healthcare plans when I was working at Microsoft, I was prescribed a topical psoriasis drug. The expected outcome was no psoriasis lesions. The cost was $800 for a 60g tube. Since I didn’t have to pay anything out of pocket, I got the prescription. Did it work? Yes. Was it worth it to me? No. I had other creams that cost much less, and worked almost as well. I didn’t end up getting it again—I wouldn’t have paid $800 for it myself, so why should my employer? If cost is not part of the equation, people are making decisions with only partial information, and can’t possibly judge value. Co-pays and transparency can help guide people to consumer-like behavior in healthcare, even in an imperfect market.

What’s the upside? The upside is that we’re having these discussions, and that we can see a shift to value and consumer focus, even without legislation, which is really how it needs to happen. The other thing to remember is that people want to deliver excellent and quality care. Everyone I met during my finger ordeal, from the admitting staff to the x-ray tech, to the resident who was excited to see a dislocation he’d never seen before was excellent, and that defines quality in my mind. Maybe we have less far to go than we thought.

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Outcomes

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Exposure at a digital health startup

Physicians typically endure years of training by being put in a pressure cooker with no safety valve. They persist through sheer brute force and discipline within a highly regulated, high barrier to entry industry. The high stakes culture of medicine often lends to emotional immaturity and an inability to relate to most of the world around. Ironic and sad, given that one of the core principles in patient care is to demonstrate empathy towards the human condition. The information asymmetry that exists between patient and provider further puts more onus on the physician to have character and compassion. In addition to being out of touch with reality, physicians also grapple with the changing times. Technological advancements and accessibility of information through technology has influenced the way physicians learn and practice medicine. Physicians who are uncomfortable with technology tend to find it harder to keep up with the latest innovations and research that affects patient care.

I chose to do a rotation at a digital health startup because of the fear of being disconnected and clueless. Plus there are a few other beliefs of mine that I wanted to more fully explore during my time at Wellpepper:

  • Understanding patients in the aggregate is important. Understanding what patients want, feel, and expect is not just an interesting data set, but is essential for me in providing optimal care. While a physician still deals with a patient one on one and the experience is influenced by patient characteristics, knowing the context in where the patient is coming from provides the best chance for an optimal encounter.
  • Technology that enhances the patient-physician relationship is a top priority. The physicians I have respected the most have tier 1 communication skills and relationships with their patients. A good relationship can literally bend the physics of the situation (e.g. that’s why doctors who have good bedside manner don’t get sued).
  • Technology that promotes value based care is the current landscape. It is no longer around the corner. Every stakeholder in healthcare is interested in improvement of care from an outcomes and cost perspective. Current practices in medicine are rapidly adapting in order to keep up.
  • Betting against yourself is a great strategy for growth. Based on the culture of medicine, it has always been more important for me to implement care that is standardized and in service of saving a patient’s life rather than considering how he/she feels. Something as simple as a patient having to give five histories within the same hospital admission is normal to me and also has value due to the difficulties in eliciting accurate information. But what if I considered that a patient doesn’t want to hear the same question repeatedly and that ultimately effects his/her perception of care? What if their lives were saved but they didn’t believe that anyone truly cared for them in the hospitalization? Would this be a meaningful experience, or a shallow one sided win? Challenging the way I think, the way I was indoctrinated into thinking and behaving, is something I look forward to in this process.

In summary, I chose to do a rotation at Wellpepper because I have a growth mindset. I want to consciously be a part of the most exciting time in medicine, where the hard work of innovative and creative minds improve patient lives.

Posted in: Behavior Change, Healthcare motivation, patient engagement, Patient Satisfaction

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Home Sweet Home

Our goal at Wellpepper has always been to make sure patients have a top-notch experience with our Partners. What better experience can patients have than being in the comfort of their own home while rehabilitating from a joint replacement? An article was recently published in the New York Times that really hits home for us. Not only is in-home therapy more cost-effective than inpatient rehabilitation, but it significantly decreases the risk for adverse events.

More and more studies are showing that patients are generally happier and actually prefer being at home during their recovery from a joint replacement. A study published earlier this year in Australia found that inpatient rehabilitation did not provide an increase in mobility when compared to patients participating in a monitored home-based program.

Don’t get me wrong, inpatient rehabilitation is extremely valuable to have. In fact, we are starting to see more patients interact with their Wellpepper digital treatment plans in an inpatient setting and then continuing once discharged home.

Rehabilitation is not a one size fits all solution and much depends on a patient’s general health and attitude. The ability to be flexible and innovative in providing treatment is crucial when evaluating a patient’s needs for rehabilitation. With Wellpepper digital treatment plans, we enable health systems to bring the expertise and personalization of inpatient rehabilitation to their patient’s mobile devices, so that they may recover from their surgery in the comfort of their own homes.

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, patient engagement, Patient Satisfaction, Physical Therapy

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T2 Telehealth aka ATA 2017 aka ATA 23: Part 2, How Did We Get Here and Where Are We Going?

This was my second trip to Orange County Convention Center this year, so it was hard not to compare and contrast the annual American Telemedicine conference to HIMSS, the biggest health IT conference. As well, it was my third time at the ATA conference, back after skipping in 2016, and the gap made it easier to reflect on previous years as well.

The ATA annual is almost 10 times smaller than HIMSS, which makes it a lot less exhausting and easier to focus. There’s not a feeling that for every second you’re talking to someone you’re missing out on talking to someone else equally as interesting and valuable. (There is no shortage of interesting people, just a more manageable group.) The size also makes it a bit easier to talk to people as they’re not rushing off to walk a few miles across the convention center to the next session.

The first year I attended, 2014, the tradeshow floor was full of integrated hardware and software solutions, and Rubbermaid was even a vendor selling telemedicine carts. It was almost as though the iPad hadn’t been invented.  It was the year that Mercy Virtual launched their services as a provider of telestroke and telemonitoring for other health systems. A provider as a vendor caused a bit of a stir on the tradeshow floor.

By the next year, the integrated hardware and software vendors were dwindling, but talks were largely still given by academics and were focused on pilot projects that while showed success, talks often ended with a plea for thoughts on how to scale the program.

ATA evolved out of an academic conference and that’s still quite prevalent in the presenters who are often from academic medical centers, and reporting on studies rather than implementation. Data was important in all sessions, but measurement of value was inconsistent. In addition to academic medical centers, most leaders in telehealth seemed to be faith-based not-for-profits, like Mercy and Dignity, and as well as rural organizations where the value was clear.

That said, a welcome addition to this year’s content was two new tracks on Transformation and Value. I spoke in the Value track at ATA, along with Reflexion Health and Hartford Healthcare about the value of telerehab in total joint replacement, and we were able to share data points from real patient implementations, in addition to clinical studies. (If you’re interested, in the Wellpepper segment, get in touch.)

Although, harkening back to the day 1 keynote, the definition of value depended on the business model of the telemedicine platform being implemented. There’s no question that telestroke and neurology programs, and telebehavior programs deliver value especially in rural areas without direct access. At Wellpepper, we’ve seen definite results in post-acute care, both in recovery speed and readmissions.

In other sessions the value was not as clear and no one was able to fully refute the study that when offered the choice, patients used telemedicine in addition to in-person visits, thus driving up costs. In fact, the director of telemedicine for a prominent healthcare organization confirmed that patients were using televisits for surgical prep when they could have just read the instructions given to them. (Or interacted with a digital care plan like Wellpepper.)

As with every technology conference the voice of the patient was absent, with the exception of head of Mercy Virtual Randall Moore, MD who started all his presentations by introducing us to patient Naomi who was able to live out her life at home, attend bingo, and enjoy herself due to the benefits of the wrap-around telemedicine program that Mercy put In place. Oh, and it cost a lot less than the path of hospital admissions she’d been on previously. Sounds like triple aim, and what we all need to aspire to.

So, based on the keynotes, the sessions, and the show floor, I’d characterize this year’s conference as a world in flux, like what’s going on elsewhere. There was a sense of relief that the ACA had not been repealed. HIMSS took place before the proposed repeal and replace plan died, and there was a lot more fear and uncertainty. Vendors and providers alike are looking to strengthen the value chain. Unlike HIMSS, there was a lot less hype. Machine learning and AI were barely mentioned except in keynotes possibly because telemedicine is still largely a world of real-time visits, and extracting meaning from video is a lot harder than from records. We see promise, people want to do the right thing, but it’s not clear which direction will help us ride out the storm.

 

Still trying to figure out what this has to do with Telemedicine. Look better on realtime visits?

Posted in: Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare Policy, Healthcare Technology, M-health, Prehabilitation, Rehabilitation Business, Telemedicine

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Wellpepper Top Healthcare Blog Posts of 2016

We had a terrific year at Wellpepper and are anticipating great things in 2017. We’re looking forward to further improvement in the efficacy and effectiveness of mobile health and telehealth as well as advancement of new business models, value-based care, and interoperability between EMRs.

As we move forward, we’d like to take a moment to reflect and recap some of our most popular blog posts of 2016. In order of popularity they are:

Wellpepper Healthcare Christmas Wish List

Given the rush of the holiday season, it was a pleasant surprise to have gotten so many viewers (other than Santa) looking over our healthcare wish list, making it our most popular post of the year.

Not Patient Engagement with Jan Oldenburg

Unsurprisingly, our second most popular blog post happens to discuss a variety of topics ranging from shifting the healthcare mindset to utilizing digital tools to assist physicians, with nationally recognized consumer health information strategy leader Jan Oldenburg in this lively podcast that has listeners eagerly tuning in.

What’s True Now

With the uneasy condition of health systems and polices following the recent changes in leadership after the election, we are glad to see many turning to our blog post for some clarity. Will these factors remain true for the following years to come? We certainly hope so.

Better Living Through Big Data

We love sharing with our readers what we’ve gathered from panels and talks. This summary of our CEO discussing the benefits of collecting big data with the Seattle Health Innovator’s panel made this blog post our fourth most popular.

What Keeps Healthcare CEOs Up at Night

Last but not least, this recap of MATTER’s study about Accenture made our Top 5 by addressing the important values and actions that need to be implemented by healthcare CEOs in order to take a more patient-centered approach.

This next year, we are looking forward to sharing our new discoveries as we continue to tackle the challenges in healthcare and find more ways to improve mobile health and patient-centered technology.

Posted in: Healthcare motivation, Healthcare transformation

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Wellpepper’s Healthcare Christmas Wish List

santa

Dear Santa,

This year for Christmas we would like:

  • Real interoperability between EMRs and other systems so that data flows smoothly from patient to provider applications and between organizations. Make sure it comes with APIs and real reference architectures.
  • Modern, scalable, and reliable healthcare technology so CIOs and IT teams can spend more time innovating and bringing new ideas for patients and providers, and less time keeping systems up and running.
  • Patient-centered care where the goals of the patient are the most important outcomes considered. Make sure patients and providers can communicate about these goals and consider their impact on care.
  • Value-based care where cost and outcomes are evaluated to determine the right course of action. Let’s lower costs of care AND improve outcomes.
  • All people to have affordable healthcare regardless of pre-existing conditions. No one should go without healthcare.
  • When you deliver all the presents, please take away all the fax machines!

 

Thanks, Santa!

Good luck on your travels around the world on Christmas Eve.

 

Love, Wellpepper

 

PS We care about your health, so we’re leaving you an apple and some carrots for the reindeer rather than cookies this year.

Posted in: Healthcare motivation, Healthcare transformation, patient engagement

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What Keeps Healthcare CEOs Up At Night?

This week I had a double whammy of healthcare value from the comfort of my desk when MATTER Chicago live-streamed their event “What Keeps Healthcare CEOs Up At Night.” In addition to participating online with 40 others and engaging on Twitter on the topic, I’m pretty sure that Accenture charges big bucks to healthcare organizations to present these findings from interviews with over 50 healthcare CEOs. I got great info, some online networking, and no traffic!

So what does keep healthcare CEOs up at night? It seems that there are differing levels of awareness regarding the health of one’s own organization, changes in population health, as well as changes in healthcare in general. Perhaps the only thing keeping them all up at night is the delicate balance in shifting to outcome and value based payments without disrupting today’s revenue streams. It’s a classic innovator’s dilemma, but nonetheless, interviews and research with over 50 healthcare CEOs have shown that only some are effectively straddling these two worlds. Michael Main, managing director at Accenture Strategy, walked the full-house crowd at Matter and 40 of us on the live stream through the research, looking at winners and losers as well as making a few predictions for how the change would happen.

According to presenter Michael Main and the Accenture team’s analysis, only 5 out of these 50 CEOs were actually successfully making the shift to value based care, and of the rest, only 15 were capable of making that shift.

screen-shot

See full report on Accenture here

To make the shift, Main identified some key criteria:

  • The CEO must have a strong passion for what healthcare can be, not what it is today. He or she must have vision and be motivated to make his or her system the #1 or #2 in their area.
  • The shift from volume to value needs to also include a shift back to volume but with the volume being serving a larger population base, not doing more to each patient. The only way to do this is to really understand a health system’s catchment area and the population. Main used the example of the 1,500 data points that Experian, the credit check company, has on each person and compared that to how few data points health systems have.
  • Care must move from being physician-centered to patient centered, but there must be strong physician leaders on board.

Main also identified barriers to change today:

  • Perverse incentives that reward for doing more to a patient rather than what’s actually best for the patient. Here, Main provided a couple of personal examples, including his father who was admitted to the hospital for 48 hours because of protocol when he would have been better at home waiting for test results.
  • People being worried about their own jobs. Main mentioned working with a nurse’s union on a patient-centered medical home project. Everything was positive until they realized the model would require fewer nurses than first expected. Demonstrating the basic adage that you can’t get someone to believe in something if their own livelihood depends on them not believing it.
  • Too much gray hair in the C-suite. Main believes that many hospital CEOs are too close to retirement to want to tackle the risk. They are looking to ride out the current fee for service world, and hand over the reins when the real change needs to be implemented. Most CEOs estimated the change will take another 7-10 years so they had time to wrap up their retirement packages. (Shades of physicians retiring around the deadlines for implementing electronic medical records.)

As you can imagine, there will be winners and losers in this new world of capitated and value-based payments. Basically, aside from the 20 CEOs that Main identified as either already changing or capable of it, the rest he felt were in the loser category. As care is pushed to the lowest cost delivery, hospitals could lose out if they don’t build integrated networks with primary care and urgent care in addition to emergency and inpatient. Smart CEOs are looking at consolidation by buying the best systems or smaller organizations instead of looking for bargains. They know that those bargain competitors will end up out of business. Winners will figure out how to incubate models that will cannibalize their own business rather that fending off upstarts who are looking to do it to them.

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Winners will have the right leaders who can take a patient-centered approach: both in aggregate and for individuals. In aggregate, they will better understand the patient base they serve in their geography and they will look at treatments that are outcome-driven and patient centered as well as looking at treatments that will impact each individual rather than the standard protocols like what Main described with his father’s treatment.

The Accenture research definitely pointed to answers in the transformation. Unfortunately, it seems like a number of CEOs today aren’t even asking the right questions. And of course, as with every healthcare event for the next while, with the looming threat to repeal the ACA, there are even more questions we need to be asking.

Posted in: Healthcare motivation, Healthcare transformation, Patient Advocacy

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MHealth and Big Data Are Catalysts for Personalized Patient Care

Although there are many complexities wrapped around our healthcare system, Stanford University’s 2016 Medicine X Conference starts finding solutions to improving patient care by focusing on increasing patient engagement and transforming how patients are treated in the system.

Wellpepper CTO Mike Van Snellenberg, who spoke at MedX in September with digital health entrepreneur and physician Dr. Ravi Komatireddy, addressed several important aspects of big data collection.

“Collecting big data is like planting trees. You need to plant the seed of the process or tooling,” says Van Snelleberg. “Over time, this matures and produces data.”

Mr. Van Snellenberg, who has collected and analyzed patient data at Wellpepper, discovered several key aspects of data collection that could improve care continuity for both patient and providers. He shared this to his MedX audience.

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“Wellpepper has already uncovered new understandings about which patients are most adherent as well as indicators of readmissions,” says Van Snellenberg. “That’s very valuable information.”

“We’ve discovered that, as you collect patient-generated data, these types of insights as well indications about the effectiveness of certain clinical protocols will be available to you. This will help allow for providers to encourage positive patient behavior,” he stated.

Mr. Van Snellenberg spoke further at an interview in October about collecting and using patient-generated data.

 

Question: What groups can benefit off the collecting of big data?

Snellenberg: Collecting patient-generated data can ultimately produce better outcomes and patient care for hospital and clinics as well as the patients themselves. The more in quantity and detail, the better it is to help produce good results. Data collection has tremendous value that can allow hospitals and clinics to learn more about their patients in between hospital visits, thereby filling in missing gaps in patient information. We also realized that collecting big data can potentially prevent complications or readmissions by identifying warning flags before the patient needs to return to the clinic.

And as mentioned, analyzing big data has provided us insights about which patients are most adherent. For example, we have found that patients with 5-7 tasks are adherent while patients with 8-10 tasks are not.

 

Q: What are some things you have discovered using patient-generated data?

MS: We were able to make observations on the patterns. We also discovered a strong linear correlation between the level of pain and difficulty of patients.

Traditionally, patient data remained in the hospital. This often left big gaps in knowledge about the patient in between hospital visits. By collecting and data in between visits to the hospital, you can discover important correlations that would not have been discoverable without data.

 

Q: What are some possible methods to collect patient data?

MS: Dr. Ravi Komatireddy, who worked in digital health, suggested several programs such as Storyvine and AugMedix.

Usually, data is collected by patients recording symptoms and experiences on a daily basis in a consistent manner and then managed afterwards. For example, patients themselves tend to keep track of their progress in diaries or using the FitBit to record the number of steps and heart rate.

 

Q: What are some of the most unique aspects about this year’s MedX?

MS: One unique aspect about the MedX Conference is that it provided more opportunities for diverse voices to be heard in addition to health professionals – including a mix of health patients, providers, and educators.

The mindset was also encouraged to change. Some of the convention’s most progressive talks on stage happened when phrases such as “How might we…” and “Everybody included” are brought up in the discussion.

The term “Everyone included” came up most often, pushing for more perspectives outside of JUST the physicians. MedX’s solution-oriented focus proves to be heading down a successful route to improving patient care in the healthcare system as well as acting as the initiative to open doors for new voices to be heard.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare Technology, Outcomes, patient engagement, Research, Seattle

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A CJR Primer

Recently, I had the opportunity to attend a CJR Bootcamp put on by the Healthcare Education Associates in Miami, Florida. The boot camp setting was intimate, collegial, and well targeted. With the exception of a trio of cardio folks who wanted to get ahead of their bundles, all attendees were directly responsible for implementing bundles at their health systems . The two days were jam-packed with information ranging from understanding the legislation to influencing surgeon behavior to assembling a great team to implement CJR. I recommend that if you’re on the hook for bundles in your organization that you check out this or a similar training yourself.

There is too much to recap in a single blog post, so I’ll share some high-level takeaways:

Bundles Are Complex

Even advanced organizations had gaps in their knowledge and understanding when it comes to the complexity associated with bundles. CMS continues to evolve the requirements and guidelines, causing some implementation approaches to have to rely on predicting what’s going to stick.

For example, the original PRO guidelines were for HOOS and KOOS, which have now been changed to HOOSJR and KOOSJR. If you’re concerned about requirements changing, consider adopting requirements that will benefit you even if they change. Organizations that started tracking HOOS and KOOS have a leg (or knee or hip) up because they have historical outcome data and have hopefully streamlined their processes.

Bundles Require Multi-Disciplinary and Multi-Organizational Teams

Within an organization, you’ll need a multi-disciplinary team that includes clinical, administrative, operational and finance, technology, procurement and so on. You’ll also require an executive sponsor who will make sure senior leadership is aware of and supporting your initiative.

A recommended working group looks like this:

  1. Executive Sponsor(s)
  2. Physician Lead
  3. Project Manager(s)
  4. Care Navigator/Care Coordination Lead
  5. HER/IT Lead
  6. Data Analytics & Quality Leads
  7. Compliance Lead
  8. Legal Lead
  9. Communications Lead
  10. Gainsharing Program Support

You’ll need to be skilled in both project management as well as the ability to influence change. Consider all the stakeholders that need to be influenced – who are the best people to influence them and how?

Think about the rhythm of communication to different stakeholders. Too much and you overwhelm. Too little and people aren’t part of the process.

 Influencing Surgeons

One of the sessions focused on how to change behavior of surgeons. It was presented by Claudette Lajam, M.D. Assistant Professor of Orthopedic Surgery Chief Safety Officer at NYU Langone Orthopedics, who had the task of decreasing costs for implants and improving quality by getting Langone’s to use the right selection criteria. Dr. Lajam studied behavior change theory to implement the change, but it came down to understanding surgeon behavior. She presented them with data, and encouraged competition: each surgeon was able to see in a weekly report where they stood with respect to costs and quality against everyone else in the department.

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In the new model, hospitals are responsible for gain sharing with both upstream and downstream partners where they have less influence and insight. Understanding your top performing orthopedic and skilled nursing partners is key to a successful bundle. In some areas, this risk-and-gain sharing is causing consolidation where orthopedic groups are joining hospitals.

Note that with CJR, different from BPCI, conveners are not allowed. That is, hospitals can only share risk with orthopedic groups and skilled nursing facilities. Organizations that offer to manage your program and share the risk are not allowed to participate in any gain sharing.

Bundles Need Data: But People Don’t Have It

If you need to improve outcomes and lower costs, you need to know where you’re starting from.  To know where you’re starting from, you will need lots of data so that the impact of outliers is harmonized. Not many organizations have this level of detail across their entire pathway, either from organizational challenges or challenges of the system.

Sometimes, this is from a variation of care. For example, one surgeon has most of the complex cases, or another surgeon uses a different combination of implants and auxiliary materials.

Sometimes this is from the challenges of inter-organizational communication. For example, the handoffs between hospital and skilled nursing are notoriously bad – usually with hospitals not knowing where their patients ended up and skilled nursing not knowing why they are there.

Add to this that you can’tthis on top of not being able to find out if a patient is even in the CJR bundle for a period until the CMS data comes back.

So, you’ve got a complex challenge, with large and heterogeneous teams and organizations, and a lack of data. What do you do? Give up? Of course not.

First, attend a boot camp like this one.

Then, treat every patient like they are in a bundle and work on improving outcomes.

Finally, take a look at your position, risk, and low hanging fruit. Even if you only have a few patients in the bundle today, the private payers and self-insured employers are monitoring this closely.

There is Low Hanging Fruit

There are a few areas that have been identified as opportunities to lower costs without impacting quality:

  • Inpatient rehab has been targeted, and often cut. Patients need to get moving soon after surgery, but they may not need as many sessions with a PT directly. We have patients who are following their PT care plan through Wellpepper even in an inpatient setting.
  • Standardization and optimization of implants. Often the implant companies charge separately for each component for the implant and try to upsell on items like screws. Negotiating a standardized bundle can decrease costs here, as can evaluating patients for the best joint for their situation rather than using the surgeon’s favorite. (This was the project undertaken at NYU Langone.)
  • Decreasing the length of inpatient and skilled nursing stay. Equipping patients to be more self-sufficient with joint camps, educational materials, and mobile care plans can enable them to go home faster.

You are Here

Possibly because it’s early days and people are still figuring this out, there isn’t a consistent, phased approach to rolling out the CJR bundle. In fact, you can start anywhere. Or maybe you don’t have to.

First off, make sure you’re in one of the X areas where the bundle is being rolled out. If you are, find out who else is in your region. Your cost accountability is for the average for your region. If there are big spenders in your region, you may already be delivering total joints more effectively than others and may not need to change much besides starting to collect PROs.

Also, take a look at your Medicare population for joint replacement. If it’s low, you may only have a few patients that qualify for the bundle each year – which doesn’t mean that you shouldn’t strive to improve, but it may impact the amount of effort you put in initially.

Figure out where you are today and plan your efforts accordingly. Don’t try to do everything at once and understand that both your process and the information available will continue to improve.

Good luck!

Posted in: Behavior Change, Clinical Research, Healthcare Legislation, Healthcare motivation, Healthcare Research

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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Mayo Transform 2016: Change

There was method to the madness, but the feedback for John Hockenberry, host and moderator of this year’s Mayo Clinic Center for Innovation Transform Conference at the first night reception was that the keynote was a bummer.

And it was. This year’s theme was change, and the keynote highlighted three key areas where we need fast and effective change: climate, diet, and early childhood education.Mayo Transform logo

Will Steger, a lifetime adventure and outdoorsperson and founder of Climate Generation, kicked things off with a dire warning that it was no longer possible to make a living running sled dog tours because the Arctic is melting. This was followed by Karen Watson who talked about the successful DrinkUp campaign to combat the challenge that 75% of Americans are chronically dehydrated from consuming sugared beverages instead of water. The campaign was focused on driving people to reach for bottled water instead of soda, and while this seemed counter to the first session on climate change, she cited that 22 million Americans have no access to potable water so bottled water is a good choice for them. Next up George Halvorson from First 5 California and former CEO of Kaiser Permanente talked about programs the state of California and KP have created for early childhood health and education, noting that the years from 0-3 were crucial for childhood development, and that a child of a working mother is read to for 1,500 hours during this period while the child of a typical Medicaid mother (who could be working) is read to for 30 hours during this period. This year 51% of children will be born to Medicaid mothers.

DrinkUpWhile both DrinkUp and First 5 provided solutions to the problems they raised, the overall impact of the keynote was depressing. While the intention was to catalyze people to change the schedule left us had the tools for making change delivered in sessions on days 2 and 3, which left us to drink our sorrows at the opening night reception (and not with bottled water).

Moving into days 2 and 3 of the conference, we did get tools for thinking differently, and the first session on day 2 provided richly in this area with Roger Martin, former dean of the Rotman School making the case for using both scientific method and rhetoric, and in particularly pointing out the short comings of scientific method if you want to innovate, in particular that it only looks at past data and does not imagine a future. Denny Royal of Azul 7 asked us to get out in nature for creativity, inspiration, pattern matching, by using biomimicry to use nature’s solutions for pressing problems, like how Sharklet used the natural antibiotic properties of sharkskin as inspiration to create a substance that naturally repels bacteria, or considering how to create adhesives that work better when wet, like the silk of the Cadis Fly, and could be used internally during surgery instead of our crude methods today like stiches or stapling. Teri Pipe, of ASU led us on a meditative path by asking us to notice what was happening in this moment, and apply these skills to build compassion and reduce stress in delivering care.img_0055

The day 2 keynote provided us with tools for imagining things that don’t exist, have the courage to quiet our own cleverness and learn from nature, and be resilient and empathetic. Given the day 1 keynote, this was just the antidote to embark on the rest of the conference.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health

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Cardiac rehab is effective, but patient-centered care needs to actually be patient-centered

With CMS’s new Cardiac Bundle, cardiac care (especially post-acute care), is the next service line to go under the microscope. As with total joint, variations in outcomes and costs are often seen in post-acute care so looking at how that care is delivered is key. For any bundle to be successful, engaging patients and ensuring their participation in follow up is a driver of success.

I have to admit, I haven’t read the bundle specs yet, just the news on the bundle. According to Becker’s Hospital Review’s “10 things to know about CMS’ new mandatory cardiac bundle”, the bundle includes provisions to test cardiac rehabilitation services, with 36 sessions available over 36 weeks. However, according to this article from NPR, although cardiac rehabilitation is proven to be effective, most people don’t participate. If you read through the comments on the NPR article (ignoring the trolls of course), you’ll start to see the reasons: cardiac rehabilitation care is built around the needs of the people providing the rehabilitation, not the patients.

From our experiences delivering post-acute care plans, as well as talking to payers and providers we’ve learned a few reasons why patients don’t follow up with their outpatient care:

  • Distance: In cardiac cases, patients are taken to the closest hospital, but this may not be the closest to their home or work. In other post-acute scenarios, they may have gone to a center of excellence that is also at distance.
  • Time commitment: These programs often require multiple days of treatment a week. Not everyone has the flexibility to take off work.
  • Timing: Programs are usually offered during 9 to 5, to accommodate the needs of the providers. Patients might prefer evening or weekend programs. We talked to one provider that focuses on lower income patients. People in hourly wage jobs don’t get to choose when they take breaks and their breaks are usually 15 minutes, and maybe 30 minutes for lunch. It’s next to impossible for them to attend in-person sessions.
Francis Ying/Kaiser Health News

Francis Ying/Kaiser Health News

The NPR article keyed in on these within the one example of Kathryn Shiflett (a healthcare worker herself!) whose distance and work hours (4:30 AM – 3:00 PM) pose a significant barrier: “She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.”

While the bundles are definitely driving the right behavior in focusing on patient outcomes rather than procedures, they need to go further to promote patient-centered care. In this case, that should be testing new models like mobile health or community-based rehab programs that are adaptable to the unique needs of different patient groups.

Posted in: Adherence, Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare transformation, Occupational Therapy, patient engagement, Patient Satisfaction, Rehabilitation Business, Uncategorized

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Different System, Same Challenges: Long-Term Care Perspective From Canada

Kristin Helps, our Director of Client Operations, and I had the opportunity to speak about delivering Empathetic Care for Seniors Through Technology at the annual BC Caregiver’s Association Conference in Whistler, BC. The BCCPA is the representative body for long-term care, skilled nursing, homecare and retirement facilities in the province of British Columbia in Canada. These types of facilities are mostly privately run, by both for-profit, and charity organizations, as opposed to acute care which is run by provincial and regional authorities. While this was a BC organization and conference, delegates came from across the country, and ranged from individual home care works, to facility owners, to university professors and researchers.

For the most part we heard similar challenges to those encountered in the health system in the US:

  • Communication between care settings
  • The struggle to deliver patient-centered care
  • Decreasing reimbursement for homecare
  • Enabling staff to operate at the top of their license

At the same time, people expressed a desire to age in place, and the health system wanted to be able to support this. While 80% of Canadians cited wanting to die at home, only 40% actually do.

One of the big differences we noted at this conference was that speakers and participants were calling on the Federal government to step in and fix many of the problems in a way that we don’t often see in the US. Another difference was that participants were looking globally for solutions to challenges, particularly in dementia care.

Looking Globally for Dementia Care

This was our first time at this conference and veterans told us that the previous year was quite focused on analytics, while this year the focus was on dementia care. While not primarily our area of expertise at Wellpepper, we heard about a number of innovative initiatives to improve care, including a novel approach by the government of Japan. Japan decided to characterize dementia as a social problem rather than a medical problem and trained bank tellers and grocery store clerks to recognize the signs of dementia. It was thought that these people were most likely to see problems, for example if someone was unable to understand how to pay bills or buy groceries. Considering that many with early onset dementia are quite successful at hiding changes from their loved ones, this idea is quite interesting. It also puts the responsibility for care back into society rather than relying on medical facilities that often distance the rest of us from the challenges of aging.

Basketball courts at Aegis Living Seattle

Basketball courts at Aegis Living Seattle

The Butterfly Household Model of Care, which was initiated in the UK, but has been implemented in Alberta with some success, is another novel idea. People with dementia often don’t know what day it is or what they had for lunch, but they do have vivid internal experiences, often remembering happier times of their lives. Butterfly Households are designed to stimulate people with dementia with bright colors, and also to stimulate memories with areas designed to invoke feelings of the past, for example an ice cream shop or an area with old photographs. The idea in a Butterfly home is to meet patients where they are, and caregivers report much joy in delivering care and significantly fewer of the violent behaviors often associated with dementia.

While not a designated Butterfly Home, you can see some of these techniques in action at Aegis Living in Capitol Hill, Seattle. Here are a couple of pictures from when I visited last fall. In an outdoor area they have a car and a garden shed designed to stimulate conversation and fond memories, and an old-gym styled basketball court, where you can shoot hoops sitting down.

Invoking memories at Aegis Living Seattle

Invoking memories at Aegis Living Seattle

To find out more about the topics in this post:

Bank Tellers Act Serve as Caregivers in Aging Japan

BC Caregivers Association

Butterfly Household Model of Care

Aegis Living Capitol Hill Seattle

If you’re interested in learning more about our talk on delivering empathy through technology, contact us.

Posted in: Aging, Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Managing Chronic Disease, Seattle, Uncategorized

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