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Telehealth Gains Favor as a Coaching Platform for Chronic Care

A 12-week digital health program for patients with rheumatoid arthritis saw strong increases in clinical outcomes. It's further proof that telehealth can assist providers with chronic care management.

Source: ThinkStock

By Eric Wicklund

- Healthcare providers who use telehealth or mHealth tools to coach patients with chronic conditions are seeing marked improvements in clinical outcomes.

The latest to report this is Pack Health, a Birmingham, Ala.-based digital health coaching company, whose 12-week program helped patients with rheumatoid arthritis improve their activity levels, sleep and medication adherence. As reported at the American College of Rheumatology annual meeting earlier this month in San Diego, It offers proof that a digital health platform can improve the health and wellness of the estimated 1.3 million Americans living with this chronic condition.

“Often, patients with RA are overwhelmed, and they require both coaching and care coordination to improve their well-being. However, rheumatologists often lack the time, tools and training required to effectively coach patients in the office environment,” Uma Srivastava, Associate Director of Strategic Partnerships at Pack Health, said in a statement following her presentation at the conference. “This study shows that incorporating tools such as digital remote patient coaching into the workflow of clinicians can support better outcomes, patient experience and healthcare utilization. In turn, clinicians are able to overcome barriers such as time, cost and patient non-adherence to recommended care.”

The program adds to the growing library of evidence that these programs can help people with chronic conditions like arthritis, diabetes and heart disease manage their care at home in between doctor’s visits.

The Pack Health study involved some 127 patients diagnosed with RA, who were paired with a non-clinical health coach. The coaches contacted the patients once a week, often by telephone, to discuss physical and behavioral health and lifestyle changes.

The patients were also surveyed by their healthcare providers before and after the 12-week program, using the PROMIS Global Health-10 survey, and were asked to self-report any flare-ups during each month.

According to Srivastava, study participants reported a decrease in body-mass index over the course of the 12 weeks, along with an increase in sleep of .3 hours per night and a 76 percent increase in weekly physical activity. In addition, she said, the patients reduced by half the number of medication doses they missed per week, and their flare-ups dropped in frequency by 50 percent after the program.

Srivastava said the study proved that a digital health coaching program can compel patients to improve their health and wellness at home.

“The hope was that when armed with the right information and tools and dedicated, one-on-one support on their schedule, participants would be able to improve key heath behaviors as well as key measures of disease management and overall health,” she said.

The concept is especially popular in helping people with diabetes, where companies like Canary Health, Omada and Fruit Street are pushing telehealth services designed to improve care management for people with the disease and help those at risk of developing type 2 diabetes avoid the diagnosis.

For them, the news has been both good and bad lately.

Those programs took a hit earlier this month when the Centers for Medicare & Medicaid Services declined to cover virtual coaching for weight management in its Medicare Diabetes Prevention Program, which will become a reimbursable Medicare service in 2018. CMS has hinted, though, that it could include the program in a Center for Medicare & Medicaid Innovation (CMMI) demonstration project.

Meanwhile, the American Medical Association gave a nod to digital health coaching in announcing a multi-state effort last week to help doctors screen and support patients at risk of developing type 2 diabetes.

Building off a similar effort in three states, the AMA announced it would expand its outreach to eight more states to “help galvanize more physicians throughout the country to screen their at-risk patients for prediabetes and refer those at high risk to evidenced-based National Diabetes Prevention Programs (National DPPs) that have been shown to cut in half the risk of progressing to type 2 diabetes.”

“With 90 percent of the people living with prediabetes in this country unaware they have the condition and at high risk for developing type 2 diabetes, we are excited to now be working with eight new states to help reach thousands more patients with prediabetes,” AMA President David O. Barbe, MD, said in a press release. “Using what we’ve learned through our ongoing work, we will have more opportunities to get more patients into proven programs that can help prevent or delay the onset of type 2 diabetes.”

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