Imagine this: A patient is prompted to take their weight at home. The patient steps on the scale. The scale transmits via Bluetooth to a device that texts the clinician, informing the clinician that the patient has gained five pounds. The clinician, remotely, directs a medication dispensing device to provide the patient with a dose of medication to treat the weight gain and avoid exacerbation of their congestive heart failure. The result is a perfect combination of a medical and technological care plan. It also meets the Institute for Healthcare Improvement (IHI) quadruple aim: high-quality, patient-centered care that is efficient and allows providers to provide the care that they aspire to each day.
"With one setup, a clinician’s care plan can be communicated effectively to the patient and easily modified when clinically indicated"
Not long ago, this scenario seemed like a distant goal, but today, it is a real possibility. It is also the vision that Commonwealth Care Alliance® (CCA) and its subsidiary, Winter Street Ventures, had in mind three years ago when they began exploring several innovative technologies that had the potential to positively impact members’ lives, fulfilling the promise of leveraging technology to improve care. CCA is a community-based healthcare organization that is nationally recognized for its innovative care model that serves individuals with complex medical, behavioral health, and social needs. Its two health plans serve over 30,000 members who are dually eligible for Medicaid and Medicare, a population considered to be high-cost, high-utilization healthcare participants.
The innovations CCA has explored are technologies that augment the ability of CCA’s clinicians to care for our patients in the environment, which is most effective: their home. These have included medication adherence devices, seamless Bluetooth aggregators to connect to home monitoring devices such as scales, blood pressure cuffs, oximeters, and telemedicine platforms. By testing these innovations, CCA anticipates that when clinicians have accurate and actionable data, the vast majority of both acute and chronic medical issues can, and should, be triaged, then appropriately treated at a patient’s home. And when we treat patients at home, there is tremendous potential for improved care and lower costs.
The most exciting development for CCA and Winter Street so far has been the adoption of voice-first caretaking technology. Why? Voice is everywhere. It is the preferred way that humans choose to communicate and it is enabling innovation across industries. The adoption of smart speakers such as Amazon Echo and Google Home have skyrocketed. Yet, barriers to effective use of voice-first technology remain, and engaging with such devices can be difficult. Wake words are not intuitive and hard to remember. This is especially true for those with cognitive or other disabilities. At CCA, we found this out early on. This helped us seek proactive voice-first technology that utilizes a programmed structure to engage with patients multiple times a day. We also wanted a programmed structure that was or could be developed with patients and providers.
This innovation journey led us to LifePod – a voice-first caregiving solution. LifePod allows patients and providers to create an individualized journey throughout the day that blends medical reminders with activities of daily living. Theoretically, LifePod can engage with patients thousands of times a day. Once programmed, it offers patients reminders about mediations, movement, diet, hydration, news updates, weather, and sports, and the ability to contact friends, families, and caregivers – both professional and non professional. The decision of how, when, and why LifePod interacts with patients is up to those who know the patient the best: the patient, the patient’s family, and the patient’s medical providers who work together to create the best “voice plan” for the patient.
For example, LifePod greets CCA patients in the morning with a simple engagement: “Hi, Helen, this is LifePod, how did you sleep last night?” The patient’s response to LifePod’s morning greeting provides remote access to and knowledge of a patient’s condition. If the response is negative, LifePod has the capability of contacting a family member, caretaker, or provider. If all is well, LifePod can quickly provide the news of the day. Mid-morning, to help Helen with her goal of increased exercise, LifePod can ask Helen if she would like to hear some of her favorite musical selections to inspire her to dance. Later at dinner, LifePod can remind Helen to take her medications before she eats. At bedtime, LifePod can offer a reminder that it is time for bed and then play relaxing sounds from the sea.
What does this mean for CCA as both a healthcare provider and payer? With one setup, a clinician’s care plan can be communicated effectively to the patient and easily modified when clinically indicated. Our clinicians can “touch” the patient 10, 20, or 30 times a day without having to call or visit the patient. This is powerful and supports important behavior modifications that improve patient engagement in medication regimens, home monitoring, exercise, and diet. In addition, LifePod can be a valuable source of data to help guide clinical decisions. It can even provide an early warning for a possible clinical decompensation. In other words, using voice technology in this way may help prevent dreaded ER or inpatient admissions.Patients, clinicians, and payers alike all want to avoid ER and hospital admissions whenever possible. For payers, preventing costly ER or inpatient admissions helps reduce costs, but LifePod can also contact patients with important insurance updates and send reminders about transportation, upcoming appointments, and other tasks that are traditionally done by phone.
Yet, one of the biggest, not initially anticipated impacts of our LifePod pilot has been on member isolation. We have found that LifePod has become a source of social connection, of obtaining important information, and simply a vehicle to improve their engagement in the world. It is an antidote to loneliness, which is a social determinant of health (SDOH) that permeates our world and has the negative health impact of tobacco use. As one patient commented, “I wouldn’t want to trade LifePod for all the money in the world.”