How digital health is powering population health strategies

The past two decades have seen the U.S. healthcare system shift from fee-for-service to value-based care models, which ties reimbursement to the quality of healthcare provided. Providing value-based care is no easy lift, requiring health systems to ensure that the unique medical needs of different patient populations are being met. Thus, effective population health strategies are critical to achieving value-based care goals.

Though the definition of population health has evolved over the past decade, Dan Shields, CEO of digital medicine at Ochsner Health, noted that the concept revolves around engaging patients in managing their health. But this is easier said than done.

"[Population health is] at its core getting people to do what they're supposed to do to manage their health," he said at the Payer + Provider 2024 virtual summit. "That sounds really simple, but there are so many factors that go into that, which is making population health more difficult. How do you reach the right people and get them to do what they're supposed to do to take care of their health?"

Digital health technology has proved vital in expanding care access and improving outcomes for various populations. During a panel discussion at the virtual summit, Shields and his fellow panelists detailed how digital health technology is helping healthcare providers reach patients and individualize population health efforts, bringing them closer to achieving value-based care. They also discussed some key considerations for technology integration and utilization.

Population health strategies that benefited from technology integration

Among the myriad areas in which technology is being used in healthcare today, certain areas stand out as especially effective in boosting population health.

For instance, at OSF Healthcare, digital health technology has played an important role in increasing disease screening rates. Brandi Clark, vice president of digital care at OSF OnCall, stated that the health system is using an automated tool that engages patients and drives them to a personalized landing page that provides education about the screening that their clinician is suggesting, how they would benefit from it and what their expected cost would be.

"Trying to meet the patients where they are through that digital experience and then feeding them directly into a self-scheduling workflow that then allows the patient to actually schedule that appointment at the time that's convenient for them is so much more efficient than sending letters in snail mail, than calling patients or waiting for them to call us to schedule those appointments," she said during the panel discussion.

As a result of the tool, the health system has seen a significant increase in patient response compared to legacy tactics for boosting patient engagement, she added.

Trying to meet the patients where they are through that digital experience and then feeding them directly into a self-scheduling workflow that then allows the patient to actually schedule that appointment at the time that's convenient for them is so much more efficient than sending letters in snail mail, than calling patients or waiting for them to call us to schedule those appointments.

Further, digital health technology can help improve outcomes for chronic disease patients who end up in the intensive care unit because their disease is not managed well. According to Kristina M. Kury, M.D., medical director of the Eden ICU at Sutter Health Hospital and regional medical director at Sound Critical Care East Bay, cutting down these ICU stays or preventing them altogether can significantly improve population health and reduce costs in the healthcare system.

"In my tiny little silo of the world, what I embraced recently is a new technology that will help guide our treatment for sepsis and hypotension in patients coming to the hospital," she said during the panel discussion.

The health system is using a wireless, wearable Doppler ultrasound device that helps clinicians with an essential aspect of sepsis treatment: fluid resuscitation. Fluid resuscitation involves administering fluids and electrolytes to maintain oxygen and nutrient delivery through blood flow in sepsis patients.

"You can attach [the device] to somebody's neck -- no pain, easy to do [and then it] takes a couple minutes to get real-time data about true cardiovascular performance in patients where you can say, 'Hey, if I give them more fluid, they're going to get better. This is going to get the outcome I'm hoping for. I will be able to correct that blood pressure and I will be able to move forward with their care. Or if I give them more fluid, I can put them in a heart failure and respiratory failure; they're coming to the ICU.' It really is a tool [to measure what] we don't have a good way of measuring right now, and it's relatively new."

Of course, the ideal scenario would be using digital health technology on the outpatient side to keep chronic disease patients out of the hospital and ICU. Ochsner Health is doing just that.

The health system is using remote patient monitoring technologies to manage type 2 diabetes and hypertension and improve outcomes for these populations. Patients participating in the digital care programs receive tools like wireless blood pressure cuffs and glucometers to track health metrics. The devices collect data that is automatically sent to the patient's care team via a smartphone application. Patients receive guidance from their care teams if their readings are not within the normal range. They can also use the app to connect with health coaches who help them make lifestyle changes.

We can make decisions based on three, four or five data points a week as opposed to one or maybe two a year if people are even going to see their provider [that often] ...We really think that this is the way these conditions should be treated nationally.

"We can monitor them," Shields said. "We can make decisions based on three, four or five data points a week as opposed to one or maybe two a year if people are even going to see their provider [that often] ...We really think that this is the way these conditions should be treated nationally. "

This real-time, continuous data allows clinicians to operate at the top of their license and make informed clinical decisions that result in better patient outcomes, he added.

Addressing challenges and misconceptions of technology adoption

Though the panelists agreed that digital health technology benefits patients and healthcare providers, they emphasized that various factors influence the success of technology adoption.

For OSF's Clark, data management is one of the most trenchant challenges of technology-enabled population health programs.

"A lot of times when we talk about data, we think about data as something that we collect along the way so that we can report something," she said. "But, in the case of our digital programs, we're talking about … the front end, the patient data that we're utilizing to drive that patient identification, to even understand which patients are appropriate for which programs to then, sort of, start the process of engaging and caring for them. So that has been a really complex endeavor."

Th data management process requires gathering data from various sources, including digital health tools, EMRs and billing systems, standardizing the multiple formats in which the data might be presented, and analyzing it to uncover insights that inform clinical decision-making.

Clark noted that the process was a massive undertaking that required collaboration between OSF's operations and data analytics teams. The data analytics team also created a subgroup called the data innovation development team, which focused on novel strategies for managing data to support digital transformation.

Once you introduce it and educate them, there are no more barriers. They love it, and they embrace it.

As healthcare providers establish technology-based population health programs, misconceptions about the populations they serve might skew their efforts. For instance, the digital divide is a well-documented social determinant of health that prevents certain populations from accessing the benefits of healthcare technology, but both Kury and Sheilds underscored the dangers of making assumptions about which populations might be averse to using technology.

Kury said that many in the healthcare industry are concerned that seniors are less willing or able to use digital health technologies. However, the Sutter teams involved in deploying technology have not found this to be true.

"Once you introduce it and educate them, there are no more barriers," she said. "They love it, and they embrace it. Nothing's going to be 100%, but the success and all the net promoter scores (NPSs) that we look at as far as satisfaction [is concerned] are through the roof, and they're far better than for the traditional legacy-type care."

Shields echoed Kury, stating, "In general, making assumptions is a bad idea. You have to kind of follow the data."

He added that healthcare stakeholders also make assumptions about other underserved groups, such as the Medicaid population. There is a misconception that this population would be noncompliant and uninterested in engaging with digital health tools. According to Shields, data from Ochsner's digital care programs showed the opposite.

"Not only were their compliance rates as high or higher, [but] we saw the same outcomes in that population that we saw in Medicare and in commercial [payer populations], but actually their NPS was a 91," he said. "It's the highest of any population we have."

Thus, keeping patients at the center of technology deployment and accounting for the needs of various populations is critical to the success of digital health programs.

Adopting digital health technology comes with wide-ranging considerations and challenges that must be addressed. However, these technologies remain among the most effective tools for improving population health and bringing healthcare stakeholders closer to achieving true value-based care.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.