We explore a personal healthcare system with mobile and social networking components.
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In Part One of this article, we discussed Sana, a volunteer organization that has created an open source, end-to-end telehealth system (with mobile capabilities playing a central role) targeted to improving healthcare delivery in the developing world. In part two of this article, we will look at Healthrageous, a new innovation in managing disease and promoting wellness.
Personal Responsibility and Motivation
The U.S. has gone through some vigorous debates about how to lower healthcare costs. Most people know that improving the health habits of the citizens can make a huge difference in the nation’s healthcare costs. The Affordable Care Act that passed this year includes some support for preventative care, such as establishment of the National Prevention, Health Promotion and Public Health Council within HHS. And starting next year, all new individual insurance and group health plans must offer preventative services (e.g. diagnostic tests) for no additional out-of-pocket charges to consumers. But gosh darn it, the new law doesn’t force all us citizens to improve our diets, start exercising, and take our meds. Hmmm, maybe that’s not the government’s responsibility. But it is something that Healthrageous is trying to tackle.
Doug McClure, the CTO and VP of Operations for Healthrageous spoke at the recent MIT Forum on mobile healthcare. Healthrageous is a recently launched company, based on work done at the Center for Connected Health, a division of Partners HealthCare in Boston that researches and develops patient care solutions outside of the traditional medical setting. The Healthrageous solution gathers data from biometric and health sensor devices (such as data about physical activity, blood pressure, blood glucose levels etc.) That is combined with information directly input by the member about their personal preferences and health habits, to create a personalized health plan for the individual and then monitor progress against the plan.
Putting the “Personal” in Personal Healthcare
Users can see their personalized dashboard on their laptop or smart phone. For example, a subscriber who was focused on a weight loss and fitness program might see information like the number of steps walked each day, calories burned, and so forth.
There is also an interview process “My Health Assessment” which asks questions on a regular basis. For some questions, like “How much do you weigh?” people are not so honest. For other questions, like questions about diet and sleep, people are more honest. So they gather data from the devices and marry it with the subjective data from the questions and create “coaching messages” to guide the user’s health regimen.
Motivation and Change Management
The people at the Center for Connected Health have been studying for years what motivates people. They and others have found that extrinsic rewards work well for about 3-6 months, but then their effectiveness drops off and most people will “fall off the wagon.” People have events in their lives that can disrupt good health programs: parents get sick, kids leave, we all get “too busy,” and we lose the good habits. The platform is designed to watch for these lapses. If the system is “watching” and people have some motivation, the system giving a very gentle nudge works for many people.
There is no magic bullet. Different things work for different people. Healthrageous has tried to figure out the best “weapon of influence” that will help each person change and become motivated again. These can be social contracts or simple feedback loops. The platform does a synthesis of a bunch of behavior change models. McClure says “the power of social networks” is a strong tool.
One big challenge is how to help the very poor. They usually have too many things going on in their lives. McClure said helping them is one of Healthrageous’ biggest challenges.
Device Agnostic Approach
McClure looked at existing remote monitoring of patients and concluded that it was way too expensive. For example, congestive heart failure monitoring cost about $350/month per patient. In the past, the people creating those solutions had to build the entire stack—all of the hardware, software, and communications. In contrast, Healthrageous takes advantage of new existing devices and services. By leveraging what others have already built, they can lower costs. They are user interface agnostic and work with any phone or laptop to get the right message to the user, wherever they are.
Results and ROI
Healthrageous was launched from Partners Healthcare and is based on technology developed there. It is about how to get individuals to take better care of themselves. At Partners' Center for Connected Health, they did a randomized controlled trial around reducing blood pressure with about 400 people (half controls). The average disease management program adherence rate is about 10%. The Healthrageous program achieved about 90%. They don’t yet know all the reasons why, but this is a “very sticky program.” Over 30% had a clinically significant reduction in blood pressure. This leads directly to a reduction in the number of strokes and heart attacks. The ROI on these types of behavior changes is huge – a $1.5M savings for every 1,000 employees, according to McClure. (See video below.)
Self-insured employers own the risk of their healthcare costs. So they are highly incented to improve the wellness of employees. He said EMC has been a strong partner with the Center for Connected Healthcare throughout the development of the Healthrageous system. According to McClure, EMC tells their employees, “It’s not just about how well you work, but also about how well you are,” and has an honest discussion about the cost of healthcare. But progressive companies like EMC are few and far between. Healthrageous is looking to insurance companies and other channels to roll out to a broader range of companies.
Helping the Healthcare System to Manage Disease and Encourage Wellness
One question asked during the MIT session was, “Doctors are overworked and overbooked already. How will doctors find any time to look at all this new data being generated by the mobile devices?” The answer for Healthrageous is that this is more about arming the patient with information and guidance. Let the system collect the data, analyze it, and based on clinical practices, guide the patient. This actually may reduce some of the burden on doctors. There is a huge need for tools that the patients can use themselves.
McClure talked about how wellness, disease management, and healthcare are separate industries in this country. Most doctors want you to be well and take care of your health, but they don’t get paid for that. Healthrageous’ focus is on disease management and wellness, and they believe that they have a business model that can be profitable. Apparently, North Bridge Venture Partners, Egan Managed Capital, and Long River Ventures agree, as they recently invested $6M in Healthrageous. If they can succeed in a big way, perhaps it will become one more piece of the solution to the healthcare challenges that we are facing as a society.