Thursday, November 8, 2012

Finding and Assembling the Building Blocks to Improve Chronic Care and Reduce Costs

Erik Strout, solutions architect at SilverTech and Type 1 Diabetic (T1D) for twenty-seven years, presented the complexities of managing his chronic condition.  Erik framed the conversation in the context of a typical day as a busy business person, family man, philanthropist and individual.  Then he added to that “all the things” a T1D life support system requires of the individual in order to delay (hopefully avoid) complications or even death.

Knowledge of T1D, as well as medical device and insulin technology for managing the condition, has advanced greatly through the years.  Those advancements have created an incredibly complex life support system that the T1D must integrate into everyday life.  Successful execution requires the individual to collect, correlate and act on a wide variety of constant data streams and share that information with the care team. 

Erik focused on two key challenges he faces in managing T1D.  First, those various data sets are separate silos.  Managing and correlating that data is complex and time consuming.  Currently, there is no comprehensive technology solution available to diabetic patients to help with what equates to a full time job. 

Second, the condition assaults the individual with constant negative reinforcement, returning negative results despite 24 X 7 efforts to do “all of the things”.  This daily bombardment exists within the reality that T1D is forever and the over arching negative reinforcement that everything a T1D does is to avoid complications such as blindness, kidney failure, amputation or even death, among other things.

Dr. David Harlan, Director for Diabetes Center of Excellence and Division Chief of Diabetes, The University of Massachusetts Medical School agreed and tells his patients that once you are diagnosed as a diabetic, it will be part of your life.  He understands how the overwhelming negative reinforcement can undermine patient motivation and execution on the constant demands of the condition.

Dr. Harlan is working closely with Jim Mingle, CEO of MyCareTeam.  In collaboration with Dr. Harlan and UMASS Medical Center, MyCareTeam has created a platform that helps diabetics share their glucose readings with their care team.  The care team can review the patient’s glucose levels at any time, looking for concerning glucose readings and patterns.  Having this steady stream of data enables the care team to reach out to patients when they are struggling; offering support, guidance and positive reinforcement of their efforts. 

This approach differs dramatically from the traditional scenario where patients are supposed to bring all of the information they have collected to an appointment that might occur every three months.  Reviewing three months of data (which patients all too frequently show up without), identifying opportunities for improvement and connecting with the patient to motivate them and help them understand, all in the course of fifteen or twenty minutes is far less than optimal.  Dr. Harlan’s approach accomplishes all of these things far more effectively and efficiently.  Actionable information and support is provided when it is needed, not long after the fact.

The MyCareTeam platform and Dr. Harlan’s approach also helps to address other serious chronic healthcare challenges.  There are 26 million diabetic patients (T1, T1.5 and T2) in the U.S. but only 3,000 endocrinologists.  This equates to roughly twelve minutes per year to devote to each patient.  Reducing the number of in person visits and delivering more effective and efficient care through Dr. Harlan’s model could address this. 

However, the question of who will pay for care delivered in this way was poised.  The current system is designed to reimburse the traditional model of quarterly in-person visits.  The future of reimbursement could help to promote a shift towards the Dr. Harlan / MyCareTeam model.  Jim Mingle reports that significant improvement in A1C results is achieved when care is delivered using the MyCareTeam platform.  If reimbursement becomes dependent upon results, this model could be the future.

The aforementioned shortage of endocrinologists prompted a T1D in the audience to ask how Joslin is addressing the shortage of endocrinologists as well as how they keep their endocrinologists current in their understanding of the different varieties of the condition.  Dr. Nandan Padukone, Office of Commercialization and Ventures at Joslin Diabetes Center, spoke of Joslin’s ongoing training for physicians.  He also discussed that improving chronic care is all about innovation.  Putting the building blocks together can help to improve care.  In addition to engaging physicians and patients Joslin is focusing on key issues such as weight management, tele-medicine, data analytics for the management of costs, centralizing and managing costs.
Erik believes that a solution to make data management and correlation easier combined with popular forms of positive reinforcement and motivation found in online media are the key.  He also feels that patient motivations and perceptions must be factored heavily in the solution. “Working in digital marketing at SilverTech I have learned that you must engage the patient on their terms.  We work with hospitals to strategize and build their websites.  We structure the sites based on how the patient looks for care, not on how the healthcare provider thinks patient should look for care.” 

It’s a fact that if the patient isn’t willing to engage then none of this is going to help.  But, Dr. Harlan agrees that positive reinforcement is a key ingredient that can help with many patients.   He recommends starting with small goals.  As those goals are achieved, the patient starts to feel better and you can set bigger goals.  The positive reinforcement of achievement combined with feeling better can put the patient on a path to better health and control of their diabetes.

Erik’s presentation will be posted for review, with narration, in the coming week. More information about Erik and Silvertech can be found here.

Thanks for joining us!  Thanks to UKTI, Cambridge for hosting the event and thanks to IBM and Partners Healthcare for sponsoring MassTLC’s healthcare community.

- posted by Christine Nolan, MassTLC

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