- Alaska’s largest primary care group is prescribing mHealth technology to thousands of residents living with diabetes in a unique remote monitoring program designed to improve care management outcomes and drive down costs.
Anchorage-based Medical Park Family Care is issuing the Livongo for Diabetes digital health package, which includes mHealth devices and an online care management platform, to some 3,000 to 4,000 residents diagnosed with type 1 diabetes. The tools and technology will allow Medical Park’s patients to access 24/7 care support and guidance, while giving the practice’s 21 clinicians real-time access to each patient’s health data in between visits.
“In Alaska, the support for people with chronic conditions is very, very limited,” says Brandon Ousley, chief executive officer of the 21-provider practice. “We’ve got, maybe, 15 minutes of time (when patients visit their doctor) to cram all this stuff in, and then hope it works.”
Access to healthcare – especially chronic care and specialist services – is a particular problem in Alaska, the nation’s largest and most remote state. Specialists are few and far between (there’s only one cardiology practice in the state), forcing residents to wait several months and travel long distances – by car, bus, plane, ferry, even snowmobile and dogsled – to see a doctor in person.
In that environment, a digital health platform that can provide patients and doctors with a virtual link to collaborate on healthcare management would hold a lot of value.
Ousley says the Livongo platform gives their patients round-the-clock access to support, education and coaching, while enabling Medical Park practitioners to check in at any time, review a patient’s health data and make adjustments to the care plan when necessary.
“That backup support for us is huge,” he says. “Our providers want to be able to give patients the care they need. That means giving them the tools they need to manage their care. Now we have the resources.”
Digital health tools and platforms have proven their value time and again in helping those with diabetes manage and coordinate their care at home, but providers are reluctant to embrace the technology due to reimbursement issues.
In this case, Premera, Alaska’s Blue Cross and Blue Shield plan, is supporting the new program. It's part of an emerging trend of payers and providers getting together to negotiate new mHealth and telehealth programs.
“We’ve had a lot of discussions about care gaps, and we know there’s a big problem with diabetes in Alaska,” says Jennifer Dahline, Premera’s director of provider network management. “There’s not a lot of tools out there that are available for our members, so when we see a program like this, we’re telling providers to do it and we’ll pay for it.”
“This is an investment for us,” she adds. “Medical Park is very innovative, and we see this as providing an important service for our members and improving their experience. So we just carved this into Medical Park’s existing contract.”
Livongo, one of a growing number of mHealth-based care management platforms on the market, sells itself as a patient-centered platform, giving the patient the tools and coaching necessary to help manage his/her chronic condition and connecting the care provider on the back end for clinical support. It was launched several years ago by Glenn Tullman, a former Allscripts executive and the father of a diabetic son who sees patient empowerment as a key to improving outcomes.
Livongo’s partnership with Medical Park is a new venture, says Jennifer J. Schneider, MD, MS, the company’s chief medical officer. The company recognizes that the healthcare provider has to play a more active role in empowering the patient, she says.
“We need to be relevant to the provider,” she says. “Doctors want to know when their patients are in trouble, and when they should or shouldn’t intervene. We have to give them the data they need to make those decisions.”
Schneider says care management platforms like Livongo for Diabetes enable providers to coordinate care for populations within their normal workflows, giving them access to data when and where they need it. They’ll then use that data to determine which patients need help and which are managing just fine on their own.
mHealth “works best when it’s directed to the patients who need the care,” she adds.
Likewise, Ousley says his physicians aren’t as reluctant to call their patients when they have data in front of them that indicates the patient needs some help. This adds value to the encounter, he says, and fives both doctor and patient a chance to collaborate on better care and improved outcomes.
Ousley’s reason for launching the Livongo program is personal. His young daughter was diagnosed with diabetes roughly three years ago, and he experienced firsthand the challenges in finding information and support. There are only a handful of endocrinologists in Alaska, most of them focused on dealing with adult patients, so Ousley had to book regular visits with a pediatric endocrinologist in Salt Lake City – some 3,000 miles distant.
Ousley said Premera executives suggested contacting Livongo after his daughter was diagnosed, and in looking at the company he saw potential for the platform in Alaska, where almost 8 percent of the state’s 800,000 residents have diabetes and another 60,000 to 90,000 are pre-diabetic.
“We just kind of started barnstorming this idea,” he says. “In a state where we have real issues with access, this seemed like a perfect fit.”
Ousley, who’s seeing patients sign up every day for the Livongo program since it was launched in November, hopes to have as many as 6,000 people signed up within a couple of years. He’s not ready yet to say how he’ll measure the program’s value, and wonders if A1c levels, blood sugar readings or some other measurable data point will present itself as proof that the program is working.
He also hopes to attract other payers to the program, and to expand the mHealth platform to serve people with other chronic conditions.
A remote monitoring program, he says, could give a doctor who spots disturbing trends in a patient’s health data a chance to intervene and make corrections. And in a state where a medical emergency in remote Dillingham might result in a $60,000 bill just for a Medevac transport, the potential is enormous.
“I think it’s going to be a huge costs savings to the system,” he says.