Historically, clinicians have delivered care for chronic disease in a fragmented way. Treating conditions in isolation, however, ignores other important factors like social determinants of health, the cost of care or barriers to provider access.
During a February webinar hosted by Becker's Hospital Review and sponsored by Vida Health, Kevin Knight, Vida Health's chief marketing officer, facilitated a discussion with two colleagues about the future of healthcare and the need for a new, holistic model of disease management:
- Patrick Carroll, MD, chief medical officer, Vida Health
- Gretchen Zimmerman, head of cardiometabolic disease, Vida Health
Four key learnings:
- Siloed approaches are the default for chronic disease care, but they are ineffective. Medical schools train physicians to treat one specific condition, rather than promoting a team-based care philosophy. "You can't treat conditions in isolation. For example, in adult populations, patients with diabetes are four times more likely to be depressed. When individuals are depressed, they're 75 percent less adherent to their medications," Dr. Carroll said.
Although hospitals try to educate patients about their conditions, they are often discharged with no follow-up plan. "We know that readmission rates are incredibly high for people with chronic diseases," Ms. Zimmerman said. "There are many psychosocial factors that people are dealing with. Without behavioral change, it's hard to expect long-term improvements." - The key to patient engagement is combining human, high-touch relationships with technology solutions. Integration and high touch are critical. People don't just click on an app and automatically become engaged in their care. When patients come to Vida Health with a cardiometabolic condition, they are screened for social determinants of health, depression and anxiety. "We use motivational interviewing to identify what motivates and engages people. Patients establish strong relationships with coaches and counselors. Then they engage with our app and digital content. We see high engagement because patients feel like they are part of the team," Dr. Carroll said. If a barrier arises that Vida Health can't help with, the team triages patients to licensed care managers or pharmacists. "We see the person as a whole and understand the interventions that will be most impactful for them," Ms. Zimmerman said.
- Treating mental health and physical health in tandem leads to better outcomes. Vida Health has found that when patients with diabetes work with a therapist and a registered dietitian, they experience a 33 percent greater A1C improvement than patients who only focus on their physical health and work with a dietitian.
High-touch, tech-enabled care also results in lower costs. As Dr. Carroll noted, "We're working with two large health plans, one with an ACA population. For more complex patients, we are reducing costs by $100 per member per month. For higher-risk patients with more emergency room visits and hospitalizations, we are approaching $250 per member per month savings." - Vida Health is democratizing healthcare for all people. Everything Vida Health does is patient-centered. Individuals in remote areas who may not have smartphones can access Vida Health on a web-based version of the app or they can dial in by phone. The team is also sensitive to helping patients get care within their means. For instance, Vida Health's experts are skilled at guiding people to healthy food choices at food banks or dollar stores.
"We identify the root cause of what's holding people back and help them set realistic goals. Having human support is what moves people forward and over time, we see sustained change," Ms. Zimmerman said. Dr. Carroll echoed that sentiment. "You don't need 5G to impact patients. We're seeing incredible results with high levels of human touch backed by technology," he said.
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