Health ICT’s approach to accomplishing its mission of preventing and combating diabetes, obesity, heart attack and stroke is a multifaceted one. One of those facets focuses on the clinical care side and has involved using a mix of technology and collaboration to target diabetes and other metabolic conditions.
Dr. Justin Moore, medical consultant for the grant-funded Health ICT, said efforts involving data mining and app-based monitoring of diabetes are in synch with the national shift from volume-based fee for service to an outcomes-based model that rewards prevention and chronic disease management. Health ICT is interesting in doing even more along those lines, and would be glad to hear from doctors and practices with ideas.
So far, Health ICT has helped bring the software app Twine to Dr. Steve Davis’ practice at Wichita Family Medicine Specialists, where the messaging program was used to track blood sugar and other vitals and put the information into a digestible format. Health ICT’s work in that case involved arranging for medical students in Dr. Bob Badgett’s Population Health in Practice class to study work flows and help with implementation.
The technology “allows, probably a nurse or health coach, and in some cases the doctor, to make changes to the patient’s therapy without actually seeing the patient in the office,” Dr. Moore said. “Our goal isn’t to go into offices and ask doctors to do more for less money. Our goal is to make this at the very least a break-even proposition for providing slightly better care or, if it really goes well, improves the care and makes some money.”
“As long as you can capture 20 minutes per month of interaction with the patient outside of your office, and as long as that care applies to a couple of chronic conditions, then the provider is eligible for chronic care management reimbursement. It isn’t a huge amount of money, $40-$45 a month depending on the region, but if you have substantial chronically ill Medicare population it can really add up,” Dr. Moore said.
It is also a good use of time for doctor and patient. “I have long felt kind of guilty about the hoops we make patients jump through in order to receive care that ought to be almost automatic or routine, like having them miss half a day of work for a 15-minute office visit,” said Dr. Moore, an endocrinologist. “For a lot of these, it’s mostly about asking a couple of questions and checking the numbers.”
Another Health ICT initiative utilizes the resources of KHIN/WHIE and KaMMCo Health Solutions, with the former supplying patient data and the latter a way to make that information more understandable and usable.
In the project, Health ICT worked with KHIN to develop criteria to identify patients at high risk of metabolic issues such as high blood pressure or pre-diabetes. They then zoomed in on data from six clinics to find patients who might be pre-diabetic. “So now it’s getting really exciting because now we can go into the six pilot offices and show them the data and they can actually filter it to find the people they think ought to be proactively contacted rather than waiting for the patient to show up in the clinic and just notice these things by happenstance.”
“They can really narrow the focus of their search and contact these people and get some intervention going, whether it is getting them in to check their blood pressure more often or organizing a work flow that gets the patient into the Diabetes Prevention Program because their blood sugars are starting to creep up,” he said.
“The capabilities extend beyond the metabolic diseases we are interested in. There is a fair amount of data that’s growing every day in KHIN about some cancer screening things — colon cancer screenings, mammography, cervical cancer screening. There’s data in there on immunizations as well,” he said.
With the technology, there are plenty of options to explore.
“If there are any doctor’s offices out there that are interested in improving or even analyzing their care of some aspect of chronic metabolic diseases, we would love to talk with them, because they probably have better ideas than we have, in a lot of ways we haven’t thought of,” he said.