Q&A: Ensuring Digital Health Programs Work for Medicaid Populations

Based in Louisiana Ochsner Health began its digital medicine program for chronic disease monitoring several years ago, before the COVID-19 pandemic upended the health care system and prompted more patients and providers to consider virtual care.

Amid the pandemic, Ochsner launched a pilot project focused on remote monitoring of Medicaid patients in Louisiana with conditions such as hypertension and type 2 diabetes.

The health system recently published results after the first year of the pilot project, noting that half of patients with uncontrolled hypertension had the condition under control after 90 days, while 59% of patients with poorly controlled diabetes were able to bring the condition under control.

Dr. Dennis Bassow, Ochsner’s Chief Digital Officer, sat down with MobiHealthNews to discuss how the health system engages and engages patients, and 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. Dennis Bassow: So Ochsner has been doing this for many years. It has 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 if this could work for these patients. This is a group of patients with many chronic diseases. This is a patient group that has traditionally been difficult to engage in care. Additionally, this is a patient population where taking time off to come to the doctor’s office is not always convenient or likely to occur. So it seemed like a prime population for that.

Obviously, we are paid to care for Medicaid patients, but there is no 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 by taking care of the patients, our care team, and so on. At first we thought we would have a thousand patients. I think we’re up to 4400 right now.

We have achieved very good results in terms of improvements in blood pressure control and diabetes control, as well as reducing the cost of care by reducing emergency room visits 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 medications.

MHN: How do you get patients involved in the program? I guess it’s probably something new for a lot of patients.

Bassov: We have a fairly simple enrollment portal, which is a combination of making sure patients are eligible, making sure they understand the program, and then trying to engage them early on as to why they might be interested in participating . We do a lot of work digitally trying to engage these patients. If we see that they are going through part of the enrollment but not completing it completely, we reach out to them.

So we really do a lot on that front end. We try to do most of this without humans as much as possible. But we know that sometimes we need to 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 iron that out and make it as seamless as possible for them to sign up.

Once they sign up, we feel very good about keeping them. So we focus a lot on what are those friction points in their roadmap process where they tend to fall off so that we can reduce them.

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

Bassov: These are most things you would think of. Basically, any clicks, any actions you take. The more you ask them to do, the more options they have not to do. There is 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 he tries to clear as many obstacles as possible, as many steps to get there.

MHN: Now that the pilot with Medicaid patients has been going on for about two years, are there areas for expansion? Things you’re thinking of changing or adding?

Bassov: Like what we do with our other digital programs, one thing we’re doing is adding more diseases because we’ve already proven that we can do that successfully. And the number of things we can watch at home is only increasing.

So, for example, we’re currently dealing with diabetes, high blood pressure and hyperlipidemia – high cholesterol – but we’re also looking at back health programs for people with back pain, which is another important chronic condition. We look 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?

Bassov: I think there are definitely some issues around equity in health care. Patients need to have some kind of smartphone that they can engage with. While this is becoming more common, we definitely see disparities in some of our most needy populations.

There are also differences in the ease of use of the technology. Probably only about half of our program is above [the age of 65], which makes sense because we see more chronic diseases there. Although they definitely have some equipment with technology, most of them report that they need some kind of help or prefer some kind of help. So engaging patients with their devices, making sure they have the devices they need, and then helping them with the technology—that’s always hard work.

Also, I think we’ve been pleasantly surprised by our ability to keep up the pace once we’ve gotten them working and our ability to keep them engaged. We measure Net Promoter Scores and the highest Net Promoter Score we get is in this Medicaid population. I think part of it is because, again, this is a population that has traditionally been difficult to engage, and we’re now giving them more attention than maybe they’ve gotten before.

MHN: How do you see digital health expanding and changing more broadly over the past few years?

Bassov: It was pretty remarkable, to be honest. The pandemic has definitely made people more comfortable with traditional telemedicine. These types of real-time, synchronous visits have made people more comfortable with the idea that we can do more in the home than we were able to do before.

The other thing that happened is that there was just a proliferation of investment from the venture capital community, largely in digital businesses. I think it was disruptive, which I think is good. Now there are probably too many companies, which is not good because sometimes it is difficult to distinguish them. But overall, it causes a lot of disruption, which I’m generally in favor of because it forces us to think about how we do things and do them differently. The combination of the pandemic and the investments made in digital business and healthcare has really caused the landscape to change quite a bit.

I think it emphasizes several areas. One is just really looking at our models of care. What can we do first virtually, versus traditionally having patients come into the office? It will be important to get really good at home monitoring. So, models of care, home monitoring – which are interconnected – and then the third thing is just around AI. We’ve been talking about AI in medicine for over 15 years, but now we’re really starting to see some practical application of it in different ways. So these few areas have really changed things over the last few years.

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