Q&A: Ensuring digital health programs work for the Medicaid population

Health & Wellbeing

Louisiana-based Ochsner Health embarked on its digital medicine program for monitoring chronic conditions several years ago, before the COVID-19 pandemic upended the healthcare system and pushed more patients and providers to consider virtual care.

Amid the pandemic, Ochsner launched a pilot focused on remotely monitoring Medicaid patients in Louisiana with conditions like hypertension and Type 2 diabetes. 

The health system recently released results after the first year of the pilot, noting half of out-of-control hypertension patients had the condition under control after 90 days, while 59% of patients with poorly controlled diabetes were able to get the disease under control.

Dr. Denise Basow, Ochsner’s chief digital officer, sat down with MobiHealthNews to discuss how the health system onboards and engages patients as well as what’s next for the program.

MobiHealthNews: Could you tell me a little bit about how the digital medicine program works, and how the pilot has gone so far?

Dr. Denise Basow: So Ochsner has been doing this for many years. It had been successful in most of our populations, but [we had the idea about two years ago] to really make a push in Medicaid to see whether this could work for these patients. It’s a patient population with a lot of chronic disease. It’s a patient population that has been traditionally difficult to engage in care. And it’s also a patient population where taking time off to come to the doctor’s office is not always convenient or likely to happen. So it seemed like a prime population for that.

Obviously, we get paid to care for patients on Medicaid, but there isn’t specific financial support for these types of programs. So we were able to secure a grant from the FCC to pay for devices, and then, we decided to fund the rest of the program, taking care of the patients, our care team, etc. We initially thought that we would have a thousand patients. I think we’re up to 4,400 at the moment. 

We’ve had very good outcomes in terms of improvements in control of blood pressure and control of diabetes, as well as lowering the cost of care by reducing visits to the emergency department and reducing hospital admissions. And that reduced cost of care even includes the fact that, in some cases, pharmacy costs go up because patients are actually more compliant with their medication.

MHN: How do you onboard patients with the program? I imagine it’s probably a new thing for a lot of patients.

Basow: We have a pretty simple enrollment portal that is a combination of making sure patients are eligible, making sure they understand the program, and then trying to engage them early in why they might be interested in participating. We do a lot of work digitally trying to engage these patients. If we see that they get partway through the enrollment but don’t quite finish it, we reach out to them. 

So we really do a lot on that front end. We try to do most of it without people as much as possible. But we know that we need to sometimes engage patients in other ways. We’ve learned a lot over the years about where in the process they tend to get stuck or fall out. And we’ve done a lot of work to try to smooth that out and make it as frictionless as possible for them to enroll. 

Once they enroll, we feel really good about keeping them. So we focus a lot on, what are those friction points in their roadmap process where they tend to drop out, so that we can reduce those.

MHN: What are some of the friction points that you found where people get stuck?

Basow: It’s most of the things you would think about. Basically, any clicks, any actions you take. The more you ask them to do, the more opportunities they have to not do them. There’s some basic information that we need that we can’t eliminate, but it’s really about reducing as many steps as possible.

What we’re really trying to do is get them to that first point of contact with our care team because once we get them to the first point of contact with our care team, then we have a very high success rate. So it’s trying to take as many obstacles, as many steps, out of the way to get them there.

MHN: Now that you’ve had the pilot with Medicaid patients going for approximately two years, are there any areas of expansion? Things you’re thinking of changing or adding?

Basow: Similar to what we’re doing with the rest of our digital programs, one thing that we’re doing is adding more diseases because we’ve now proven that we can do this successfully. And the number of things that we can monitor at home is only increasing. 

So for example, right now, we are doing diabetes, high blood pressure and hyperlipidemia — high cholesterol — but we also are looking at programs around maintaining a healthy back for people with back pain, which is another important chronic condition. We’re looking at heart failure and atrial fibrillation, which is the most common abnormal heart rhythm.

MHN: What are some of the challenges you faced during the pilot?

Basow: I think there definitely are some issues around health equity. Patients have to have some kind of smartphone that they can engage with. Although that’s getting to be more and more common, we definitely see disparities within some of our most at-need populations. 

Also, there are disparities in ease of use of technology. Probably just about half of our program is above [the age of 65], which makes sense because that’s where we see more common chronic conditions. While they definitely have some facility with technology, most of them report needing some kind of help or preferring some kind of help. So getting patients onboarded with their devices, making sure they’ve got the devices that they need, and then helping them with the technology – that’s always a heavy lift. 

Other than that, I think we’ve been pleasantly surprised at our ability to keep pace once we get them up and running and our ability to keep them engaged. We measure Net Promoter Scores, and the highest net score we get has been in this Medicaid population. I think some of that is because, again, it’s a population that traditionally has been difficult to engage, and now we’re giving them more attention than they may have received previously.

MHN: How have you seen digital health more broadly expand and change over the past couple of years?

Basow: It’s been pretty remarkable, honestly. The pandemic has definitely gotten people more comfortable with traditional telemedicine. These kinds of synchronous, in-real-time visits have gotten people more comfortable with the notion that we can do more in the home than we’ve been able to do previously. 

The other thing that’s happened is that there’s been just a proliferation of investment from the venture capital community, largely in digital businesses. I think it’s been disruptive, which I think is a good thing. There are probably too many companies now, which is not good because sometimes it’s hard to differentiate. But in general, it’s causing a lot of disruption, which I’m generally in favor of because it forces us to think about how we do things and do things differently. The combination of the pandemic and the investment that’s gone into digital businesses and healthcare has really caused the landscape to change quite a bit. 

I think it’s putting an emphasis on a few areas. One is just really looking at our care models. What can we do virtually first, versus traditionally having patients come into an office? Becoming really good at home monitoring is going to be important. So care models, home monitoring — which are related to each other — and then, the third thing is just around AI. We’ve been talking about AI in medicine for 15 plus years, but we’re now really beginning to see some practical application of that in a variety of ways. So those few areas have really changed things in the last couple of years.

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