Patient engagement offers opportunities for shared decision making between visits, when those with diabetes or obesity make choices about food, exercise, or medication that affect health outcomes.
More and more, health plans and practices alike are trying to improve patient engagement for those with diabetes or obesity. This means improving connections between visits to the doctor—and impacting patients’ decisions about what to eat, whether to exercise, or trying to remember to take medication.
Real-time patient data—and clinical interventions—can uncover a medication problem or a dip in blood glucose, perhaps heading off an expensive trip to the hospital. In today’s value-based reimbursement calculus, it can affect the bottom line not just for health plans, but for practices as well.
Enter WellDoc, creator of the BlueStar digital diabetes management app, which has been running a pilot study to integrate patient data into the practice workflow as part of a population health intervention.
“BlueStar looks and acts like an app, but it has the connection to the care team,” said Malinda Peeples, RN, MS, CDE, vice president for Clinical Advocacy at WellDoc, in an interview with The American Journal of Managed Care®. Combining data generation with personalized clinical intervention makes BlueStar “unlike any apps that are out there,” she said.
Besides information for the individual patient, there is the opportunity to collect and evaluate data at the population level as well, Peeples said. BlueStar offers real-time feedback, trending data to help with problem solving, and weekly summaries that tell patients if they need diet or exercise adjustments, or whether they should contact a doctor or diabetes educator. “They can do problem solving or outreach to their team as needed,” she said.
In the pilot study, a lead diabetes educator mentored health coaches to evaluate basic patient data sent in with a smartphone. Janice MacLeod, MA, RDN, LDN, CDE, director of Clinical Innovation for WellDoc, said BlueStar allows patients to quickly generate a report “that allows the healthcare team to quickly glance at the data.” The clinician knows very quickly what the interaction with the health coach has been, “so we can see what has to happen next,” MacLeod said.
At last month’s meeting of the American Diabetes Association, WellDoc presented a year’s worth of data from the pilot study at 8 practices; patients who had diabetes or obesity received the app, along with education and a support program, and the study evaluated whether patients would share health data in way that would move seamlessly into the workflow of the practices, giving the clinicians insight into ways they could make adjustments.
Early results were promising. Data showed that half the patients were engaged with the app for at least 60 days, and more than half of a core group of active users (52%) stayed engaged past 90 days. Overall, 42% of all users were engaged beyond 90 days. The patients in the study included 12.8% who had diabetes and 72.6% who were overweight or obese. (The mean age was 45; and the mean body mass index was 38.6 kg/m2.)
The core group of 87 active users logged 15,872 entries for self-monitoring, 4401 for medication, 79 for exercise, 3436 for food, and 1439 for note entries.
Digital health—and mobile health in particular—is a useful management tool for those who are living with chronic conditions for the simple reason that smartphones have become ubiquitous. Smartphones are also cheaper than waiting for patients to progress to the point of needing a continuous glucose monitor, which experts say will be more common among patients with type 2 diabetes.
But despite the enormous potential of mobile health for real-time assessment and feedback from a healthcare team, using technology for disease management is still relatively new, and some health plans don’t know where it fits in.
Evaluating the patient engagement results offers a good “first step,” the study concluded, “to exploring the potential of patient-generated data for impacting the value-based goals of improving outcomes in a cost-effective way.”
Peeples M, MacLeod J, Taylor S, Shomali M. Population health diabetes education: the role of digital health and patient-centered health data. Presented at the 77th Scientific Sessions of the American Diabetes Association, June 9-13, 2017, San Diego, California. Abstract 1341-P.