MANAGING RISK WITHOUT ACTIVATION IS CHAOS HOW CONE HEALTH IS USING DIGITAL HEALTH TO MANAGE RISK - JOHN JENKINS, MD MICHAEL MCGARRY - HFMA ANNUAL ...
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Managing Risk without Activation Is Chaos How Cone Health is using Digital Health to Manage Risk John Jenkins, MD Michael McGarry
Session Speakers
John Jenkins, MD
Chief Clinical Officer of Connected Care, Cone Health
• Oversees Cone Health’s Connected Care Division, utilizing virtual care technology to explore new
approaches to delivering exceptional care
• Developed Cone Health’s asynchronous and live telehealth visit enterprise and competencies
• Board certified in internal medicine, earning his medical degree and completing his residency at the
Medical University of South Carolina in Charleston
Michael McGarry
Vice President of Growth and Partnerships, Wellsmith
• Collaborates closely with health systems and organizations to deliver programs that meet the specific
clinical and financial needs of each customer
• Has over 20 years of experience in the healthcare industry designing innovative population health
programs and developing medical devices from prototype through FDA approval with both small start-
up organizations and Fortune 500 companies
• Has a bachelor of science degree in biomedical engineering from Northwestern University and a
master of business administration degree from Indiana University Keller School of Business.
Session Agenda • Key Learning Objectives • Cone Health’s Patient Activation Case Study • Small Group Discussion and Patient Activation Assessment
Key Learning Objectives
• Define Interactions: Demonstrate the different types, intent, and impact of daily interactions on
medication adherence, daily activity, weight management, glucose, and utilization.
• Understand Relationship-Based Risk Management: Outline the key differences between
traditional risk management and risk management through deep relationships and patient
activation. Demonstrate how digital health tools can be leveraged to reach these goals
• Share Learning Methodology: Review the unique learning methodology to collect, compare,
and analyze the proposed correlation between patient activation and improved clinical, financial,
and operational outcomes.
Upon review of the three learning objectives, we will
facilitate a group workshop that assesses
opportunities for patient activation at your
organization.
Cone Health Today Cone Health is an integrated not-for-profit network of health care providers serving central North Carolina in over 100 locations, 6 hospitals and 3 Med Centers. Triad Healthcare Network in 2017 led all Next Generation ACO’s in percentage savings. Through THN Cone Health engages 1400 providers in more than 150 practice sites to manage over 100,000 attributed lives in a variety of at-risk contracts.
Cone Health’s Digital Health Ecosystem
Reselling to
Business
Acute and Scheduled Care Digital health activation
Ecosystem
Infrastructure and
In Patient Services, E-ICU, optimizations of patient portal
Tele-specialty experiences
Underserved
Populations
Insanity is doing the same thing over and over and expecting different results. -- Albert Einstein A system’s Digital Health Strategy must address more than delivering access to care. To get different results we must be able to guide patients (customers) to make better health choices that lead to better health outcomes. Exercise and nutrition are the primary interventions for over 35 chronic conditions. CDC.gov
So how did Cone Health do something differently
to avoid getting the same results?
Patient-Facing
Care Plan
Management Tool
Facilitated Social
Interactions
Cone Health’s Patient Activation Case Study
The common thread in Cone’s patient activation journey is the use of digital activation tools as a foundation for
transforming episodic care into continuous interaction between patients and their care team. The tool is a
digital health assistance platform that connects with Bluetooth devices to help patients better understand their
care and self-motivate to a state of patient activation.
Episodic Care (Nest) Continuous Engagement (Wild) Activated Patients
• Stand-alone ERs and clinics
• Daily continuous engagement • Close monitoring and tracking of medications,
• Expanded clinic and practice hours
• Provision of help with critical glucose, diet, and exercise with minimal
• Telehealth and e-visits
decision-making guidance
• Retail clinics and spaces
• Understanding of goals and metrics • Empowerment with information and human
• Limited by time and locations
• Connection to “people like me” connection so that change feels natural
• Intrinsic motivation to make positive changeCone Health’s Patient Activation Case Study
In October 2017, after two smaller proof of concept trials, Cone Health began a patient activation study with over
350 employee health plan members with type 2 diabetes. The heavy lift is to understand how the platform can
be used to activate patients and what are the health system benefits of patient activation.
Expanded Centralized Care Team Model
• >350 patients
• Type 2 diabetes managed by centralized (RN) care team
• Demonstration of greater scale and understanding of factors that move patients
from engagement to activation
PATIENT ACTIVATION STUDY
Initial Trials Practice-Prescribed and -Managed Model
•Cone Health’s Patient Activation Case Study (continued)
Cone’s hypothesis is that patients can develop accountability and awareness through initial platform use, and
become activated in self care through continuous touches. The idea is for the activated patient: “healthy living
becomes a habit”.
• Build a digital version of the care plan • Create a valuable and memorable first • Introduce a coach-like resource to the • Connect the actions of participation with
negotiated between the provider and experience by facilitating seamless device care team who communicates with specific health outcomes for the patient.
patient. connection and staging the patient’s first patients through motivational interviewing • Assist and validate that the patient is self-
• Create measurement nodes (glucose, communications on the platform. to understand current status and any motivated to change and understands the
weight, activity, nutrition) for the patient to • Confirm the patient’s mental, technical, barriers to participation. value of consistent participation and
track against. and clinical readiness for the journey. • Analyze participation and performance communication with their care team.
data to identify trends and provide
appropriate content and education.So now its time for you to get involved:
The majority of health systems
believe that investment in telemedicine
(digital health) should be a priority. Do
you agree?
Now we are going to split into groups
of 4-5 with the persons next to you
Share with each other the nature of
your investments and how you measure
the return on investment.
Are you using a digital health strategy to
manage any “at risk” populations?
Select one of your group to report outLive Content Slide
When playing as a slideshow, this slide will display live content
Poll: Are you using a digital health strategy to manage any “at risk”
populations?Remain in your small groups for the next few activities…
Our hypothesis is that patient activation has the highest probability of demonstrating both clinical and financial
outcomes. Lets do a group activity to manage a population for which your organization has a high degree of
financial risk.
For the next 15 minutes complete the worksheet in your small groups. We will ask for report outs from each team.
Identify the opportunity Understand Existing How would a digital, high-touch system
that “activated” patients to adopt
Delivery Models healthy lifestyles play a role in achieving
» Identify an at risk population within your » List some interventions you currently your desired outcomes?
organization are using.
» Describe the risk and quantify the » Estimate the frequency at which this
population to the extent possible. Which specific features or offerings
population interacts (in person or (social motivation, clinical reminders,
» Describe any current or prior barriers to remotely) with resources from your
addressing this risk-based population. .
specialized messages, etc. ) would
organization.
motivate a patient that fits your
» What are the outcomes you need to
organization’s risk profile to move
achieve to demonstrate value?
toward activation?
Clinical Proof for Activation
1) Am J Manage Care. 2017 Feb;23(2):123-128. An examination of the relationship between care management with coaching for activation and patient outcomes
2) J Gen Intern Med. 2012 May; 27(5): 520–526. Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related
Outcomes
3) Health Affairs, 32, no.2 (2013):207-214 What the Evidence Shows About Patient Activation: Better Health Outcomes and Care ExperiencesSmall Group Discussion and Patient Activation Assessment (continued)
• What were the most challenging components of the
assessment to complete? Why?
• What positive characteristics (clinical, financial, and
Q & D operational outcomes) do you see in a population of
activated patients?
• What are some specific financial measures that
may demonstrate the short- and long-term upside of
an activated patient population?Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: What were the most challenging components of the assessment to
complete? Why?Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: What positive characteristics (clinical, financial, and operational
outcomes) do you see in a population of activated patients?Live Content Slide
When playing as a slideshow, this slide will display live content
Poll: What are some specific financial measures that may demonstrate
the short- and long-term upside of an activated patient population?You can also read
