How Enabled Health Plans to Use Virtual Care to Help Seniors Age in Place

In her two-plus decades in healthcare, Bethany Doran, MD, has observed how the traditional model for chronic disease management is falling short, especially for seniors.

As a medical student in New York City and later as a cardiology fellow at Duke University, Doran found numerous gaps in chronic care resulting from a lack of access to technology and an inability to reach patients in time to change the trajectory of their disease. 

"[I] was feeling like we really weren't serving patients…in our current model of healthcare, both because we were reaching them so late, but also because even the technologies that I started seeing, whether it was apps in the hands of patients, or all these novel things coming out, weren't actually being used by the older patients I was seeing, or patients who had chronic disease," she said in a phone interview.

This issue was further exacerbated in rural areas, where specialty-trained physicians are in short supply and primary care providers may not be equipped with knowledge of the new care options for chronic disease patients, Doran added.

Following her cardiology fellowship, Doran completed a bioinformatics fellowship, further cementing her view of the broad potential of digital health technologies in chronic disease care. But the challenge of getting the right technology to the right patient remained.

And then, the COVID-19 pandemic hit. Suddenly, the very technologies that could most benefit chronic care patients, like telehealth and remote patient monitoring (RPM), became more widely available.

"I just started thinking about what a new model of healthcare would be, especially with more telemedicine and telemonitoring being offered, and realized that there are so few seniors, or people with chronic disability, that are able to take part in telemonitoring and health monitoring in their homes because they don't really have access," she said.

It was then that the idea of Enabled Health took shape. Founded by Doran, Enabled Health officially launched in Washington last week. The company offers a hybrid care model to patients, combining in-person visits, telehealth, and RPM technology to enhance chronic disease management and support seniors as they age in place.

The company is currently enrolling Medicare, Medicaid, and self-pay patients in assisted living and residential care facilities and working with home health agencies in Washington. 

"We usually go to the location of the patient at least once per month in person, but then we set them up with both the monitoring service as well as [the ability] to participate in telemedicine by providing them the equipment for telemedicine and telemonitoring," said Doran.

The equipment includes a tablet that supports virtual visits and connects to various devices, such as blood pressure cuffs and weight scales. The company leverages proprietary software to collect and analyze the data.

"I'm a bioinformaticist, so the goal is to have usable data so that we can keep generating insights and learning from different outcomes that have happened to our patients to prevent them in other patients," Doran said.

The company mines the data for patient care insights and works closely with patients' existing primary care doctors and caregivers to develop personalized care plans for chronic conditions. This data is made available to assisted living and home healthcare partners through a hybrid EHR. Patients and their family caregivers can also access the vitals and medication data to track metrics over time.

Further, Enabled Health offers the services of virtual wellness coaches who can provide mindfulness and adaptive yoga techniques.

There are many ways in which RPM can provide benefits for chronic disease patients as it enables longitudinal care management based on real-time tracking of patient health metrics. Enabled Health aims to leverage the advantages provided by RPM to reduce hospitalizations among seniors, thus helping them age in place.

"In rural areas, it might take somebody two or three hours to get to their local doctor," Doran noted. "And that usually really prevents them from being able to see their doctor except in kind of emergent situations, and they may not get the type of preventative care around their chronic disease that they need to keep them out of the hospital."

For example, one of Enabled Health's pilot programs aims to reduce hospitalizations among hypertension patients. The company tracks metrics like medication adherence and blood pressure readings to gauge whether a patient needs extra support. This can help mitigate the need for urgent care or emergency department visits that could lead to hospital stays.

But there are some challenges to the company's care model. One of the biggest is the ever-changing reimbursement landscape.

"Our goal is, during this period, to show dramatic outcome benefits, and really be able to quantify what those are in the cost savings, and then move towards working with Medicare Advantage plans to be able to have more risk-bearing contracts, because by then we'll know what we do really well," Doran said.

Another hurdle is maintaining patient data privacy while also using the data to advance research and develop new treatment options. Doran believes that data-driven companies can overcome this issue by prioritizing patient privacy protection from the get-go and ensuring that all parties are aligned on what the data will be used for.

The company has big plans for growth. While only open to patients in Washington at the moment, the company's services will open to assisted living facility patients in Hawaii in June. The company also eventually plans to work directly with patients rather than through assisted living, residential care, and home health organizations.

Not only that, but the company is also in talks with state agencies to support efforts surrounding medication adherence and with health systems to bolster recovery care efforts and help free up inpatient beds.

"We're definitely kind of starting to talk to health systems in different areas because we think we could also really get their patients out of the hospital a lot earlier and do a better job of basically monitoring them and making sure they don't bounce back in a month," Doran said.

In terms of technology, Enabled Health plans to expand its digital health offerings by incorporating new analytics, artificial intelligence approaches, and novel devices.

But amid its growth plans, Enabled Health aims to keep focused on its mission: to leverage enterprise software to boost care management in traditionally underserved communities. 

"We want to be able to expand [access to telehealth and RPM] and basically improve the health of populations in more remote areas or [for] people who have a harder time accessing physicians or high-quality healthcare…Our care model is basically that we go and [reach] patients wherever they are," Doran said.