Digital health: seeing the forest and the trees

Forest at eye level

Originally presented at HLTH 2021

By Dave Neuman |
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HLTH Tech Talk transcript

Slide 1 (Introduction)

Thank you for coming to the 4:05 Tech Talk session.

My name is Dave Neuman. I’m the chief technology officer for Milliman HealthIO.

We’re on a mission to curb the rising risks and costs of chronic conditions for our clients and help individuals along their journey to stay healthy longer and minimize the effects of chronic conditions.

We’ve all worked with people who get caught in the details. Many times we will say, “they can’t see the forest from the trees.” They get lost amongst the data and the challenges of today and lose sight of the bigger context.

I like to use that as the basis for this presentation because I think many times when we talk about chronic condition management and trying to affect population health, we get lost in the details and forget the higher level context.

Slide 2

So let me start with a little visual.

Imagine you’re on a nature walk. You might even be an arborist or a nature fanatic. You look at these trees and they all look healthy. You don’t see any issues, but the forestry department who is managing that public park knows something you don’t know.

Slide 3

They know that there’s sickness amongst the forest. They have a different perspective than those that are on the ground. They also have a different job. Their job is to look out for the betterment of the forest as a whole and call in the experts when sickness needs to be eradicated.

Have we heard that before?

Slide 4

We transition that metaphor to regular life.

We have populations. We’re all part of different populations.

It could be a population of employees at work for a self insured employer. It could be a member of a health plan. Or I could be a life insurance carrier with a population of members.

Within each population, we’ve seen the statistics. The numbers are staggering of how many are living with and dealing with chronic conditions. Being able to identify who has a chronic condition is the first step at being able to help them mitigate and even control and minimize the impact or the progression of those diseases.

Those diseases may include hypertension, diabetes, COPD, obesity. The list goes on and on.

Slide 5

However, once we identify who has a condition, we typically talk about interventions. We talk about getting them on a program. Providers will prescribe medication.

What about those that don’t have a chronic condition? They should be put into a prevention program if they are healthy or they are below the set norms of disease.

How are we helping them maintain that level? That’s the challenge we have in curbing the onslaught of chronic conditions.

Slide 6

Digital health empowers everyone. Organizations, individuals…look around. There’s solutions, there’s technologies, there’s services all over. There’s a lot of smart people developing new solutions every day.

For organizations, we’re helping them identify risk. Identify and manage the unknown.

What’s going to be coming up next? What is going to be the cost of healthcare for my organization as a self- insured employer in the future?

Is it a 10% increase? Is it a 25% increase? That may be millions of dollars on my bottom line.

So helping them plan for the future is important. And engaging and empowering their workforce and wellness and health programs is important.

Flipping to the individual side, empowering individuals with the ability to collect data on their own, to interpret that data and see what it means for them in an individualized context.

Who knows? The technologies are there today to potentially predict and alert to an impending event coming up.

Slide 7

So how do we do this? At Milliman HealthIO we developed a digital solution that combines population health intelligence and chronic condition management in an easy to use, mobile-first digital environment.

We’ll take those that are healthy, not managing a chronic disease, and we will enroll them in a program.

We provide them a kit of Bluetooth-enabled devices, blood pressure cuff, weight scale, glucometer, etc., along with a mobile app, to collect and check in on their vitals at home on an ongoing basis.

We allow them to connect to friends and family through an advocacy network.

Predictive analytics, algorithms run in the background to predict the rising risk and impending health events coming up in the future.

Those trends can generate alerts and notifications that can then be forwarded on through their advocacy network or to providers and caregivers as needed.

Slide 8

From a chronic care management standpoint, the capabilities to manage a condition aren’t that different than prevention.

Once they are enrolled in the program, we allow them to check in and measure their vitals, track their medication, check in, and wellness parameters.

The biggest difference between prevention and chronic condition management is the protocol. It’s going to be tighter, it’s going to be more frequent check-ins. The analytics will be dialed in a little bit more specific to controlling a set condition.

Support network is even more important.

If an individual continues to be challenged to keep their diabetes under control, they continue to eat poorly or not exercise or adhere to their program, their sugar levels are going to continue to spike.

We need to alert others that surround them to give them the support they need on a daily basis. It doesn’t require going back to a provider. It’s someone close to them that can help them manage that condition better.

Algorithms, trend analysis, statistical process control, all these fancy terms can give a provider, care organization, better insight into the challenges an individual is facing on a day- to-day basis with their condition.

It isn’t a set-and-forget scenario. This is a set and remember and check in frequently scenario.

Slide 9

Data. Digital Health Tools. Integration, interoperability enables a whole new level of population health intelligence.

Deploying digital health tools into a population, collecting real time data from at home, provides organizations real-time visibility to current state of health.

We’re no longer waiting for a three month delay and claims data through a TPA to be able to do some kind of risk analysis.

We’ve got data today. We can see the change in the organization every day. We can monitor for risk at a population level. We can understand whether population health initiatives that we have deployed are working or not.

Is weight and obesity changing within the organization, or is that program not working effectively?

Adherence is critical to managing chronic conditions. Because we’re using tools to track day-to-day, we get adherence information. We understand the risk of not adhering to protocols and its effect on the effectiveness of those programs that are being deployed.

Engagement. I’ve heard a number of sessions here talk about patient engagement as being one of the biggest challenges.

Again, digital health tools, personal assistants in your pocket, devices that are used on a daily, weekly, monthly basis, gives us very in-depth engagement information related to health.

Slide 10 (Closing)

As a result, Milliman HealthIO is combining the power of population health with digital solutions for chronic condition management at home and providing a new set of tools for, as an ode to Bob Ross, creating “happy little trees” within our populations.

Thank you for your time and enjoy the rest of the conference.

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