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Better data integration: A key step toward the future of health care

Leah Briggs, Executive Director, Clinical Product Solutions

October 21, 2022

The evolution of electronic health records

Electronic health records (EHR) first appeared in the 1960s as an administrative tool to improve scheduling and billing in hospitals. In the 1990s the first studies were published arguing that EHRs could help improve patient records and reduce medication errors. Despite these studies, adoption of EHR technology was slow. They were costly to implement and mostly seen as an administrative tool rather than a clinical one.

In the early 2000s, the federal government tied Medicare and Medicaid reimbursement levels to the adoption and meaningful use of certified EHR technology. In theory, widespread use of EHR technology could create one centralized place for a person’s health information. This would foster better communication between providers, reduce medication errors and improve health outcomes.

Unrealized potential

As the market for certified EHR technology grew, the number of companies competing to provide the technology grew as well. As a result, about 96% of hospitals today have adopted EHR technology.1 However, even within a single health system, considering inpatient and outpatient facilities and affiliated providers, there can be as many as 18 different EHR platforms in place.2 And, they don’t necessarily communicate with each other.

Given privacy requirements for protected health information, without concerted effort to create interoperable data, we have been stalled, unable to do more than glimpse at what could be.

We know what’s possible

At ActiveHealth, taking in huge amounts of member data and turning it into meaningful opportunities for health improvement is core to what we do. As technology has advanced, we’ve been able to become more sophisticated in terms of sources for data and how we distribute meaningful insights from that data. We realized the power of integrating health records and we wanted to be part of the solution. So, we turned to Epic.

Epic is one of the largest EHR networks in the country, currently housing records of more than 250 million patients. To better serve our members, we have integrated our clinical platforms with Epic to give us direct access to those records, as allowed by applicable privacy regulations. With additional consent from the member, we now can create a bi-directional exchange of data with health care providers. Our services are enhanced by the ability to assess changes to the member’s clinical information almost as soon as they happen. Insights are now available from the EHR that has never before been available – like medication reconciliation in primary care visits and encounter notes from urgent care. The possibilities are astounding.

Efficient, effective health care

This close-to-real-time data sharing directly in the EHR offers an unprecedented opportunity to impact clinical efficacy at the point of care. Health care in America is complicated, exacerbated by an aging population rapidly acquiring multiple chronic conditions and often seeing more than one health care provider. ActiveHealth can help collate health data from multiple sources and assess it for gaps in care and opportunities to improve health. Delivering these insights into an EHR makes it easy for providers to review them as part of the existing patient care experience.

Another step toward the future of health care

By taking advantage of technology already in daily use, ActiveHealth is taking the natural next step toward achieving our mission to help people live healthier lives. We were founded on the notion that the right data in the hands of providers can help people achieve better health outcomes. Now, we can deliver that data to providers right at the point of care when it has the best chance for impact.

 

1 Definitive Healthcare. 10 most common inpatient EHR systems by market share. Available here. Accessed August 31, 2022.

2 Healthcare IT News. Why EHR data interoperability is such a mess in 3 charts. Available here. Accessed August 31, 2022.

Physical and social factors that affect health

Tobin Sebastian, Lead Director, Informatics

October 21, 2022

The who, what, where of your health

When you think about the kinds of things that impact your health, some are obvious, and some are hidden. Let’s use Marisol as an example. Marisol is a 30-something woman who eats a healthy diet but is rarely physically active.* Those choices can have a positive and negative effect on her health. To an outside observer, Marisol looks healthy. But her latest biometric results would paint a different picture. Her LDL cholesterol is on the higher end of normal and her HDL cholesterol is low. Those can indicate a rising risk for heart disease. What else might affect Marisol’s health?

Aside from risk for heart disease, Marisol has to be mindful of other things that impact her health that aren’t directly linked to her medical care.  Marisol works from home, and she’s chosen to live in a small town in the country that’s about an hour from the nearest large city. She sees a doctor in the only family practice in her town, but if she needs specialist care, she’ll need to travel to get it. Her town has a history of coming together to provide meals and do small errands for people in need. Transportation to receive care could be an issue should she become seriously ill, though.

The impact of where we live, work and play

Social determinants of health (SDOH), conditions that exist in the environments that surround us, are easy to discount when we think of what affects our health. They may be less obvious, but they can be more impactful than you might think. On a county-by-county basis, the availability and quality of clinical care may result in a 20% differential in health outcomes. In contrast, SDOH can create a 50% differential in outcomes, with poverty, education and employment having the largest impacts.1

What can we learn from SDOH?

SDOH aren’t inherently negative; they simply are. They also reflect our ability to understand our health, access health care, afford the care we need and the safety and support systems present in our communities. However, it’s important to understand the social and, to the degree that we can, the cultural context of the people we work with every day.

Understanding the conditions that surround our members can give us insight into trends around economic stability, education and family structures where they live. We can add this information to other established factors related to health – like age, biological sex and underlying medical and behavioral health conditions. Then, accounting for modifiable factors like adherence to prescriptions and lifestyle behaviors, we can assign a metric to a person’s health as it is today and identify opportunities for improvement. Taking it further, we can assess what the person’s best possible health could be if they act on those opportunities.

Looking to the future with respect for today

People will continue to make the unhealthy choice that feels comfortable over healthier choices that feel unfamiliar or irrelevant. We can use what we know about who our members are and where they live to guide our work together. Our goal is to deliver highly personal, relevant experiences that both respect our members’ values and traditions and address relevant SDOH factors.

 

 

1Department of Health and Human Services Office of Health Policy. Whitman A, De Lew N, et al. Addressing Social Determinants of Health: Examples of Successful Evidence-Based Strategies and Current Federal Efforts. April 1, 2022. Available here. Accessed August 16, 2022.

*This is a fictitious example.

Turning fun gadgets into helpful tools

Patrick Dall’Occhio, ActiveHealth Clinical Solutions

October 21, 2022

Technology has advanced in one generation

In late 1983, there was a revolutionary – for the time – ad for computers that said, “1984 won’t be like ‘1984’.” Technology, it suggested, would be the key to a brighter future. There was a healthy degree of skepticism for a lot of people when that ad aired. At the time, not every household had a computer. Most houses didn’t even have cordless phones.

As I write this there’s a pocket-sized supercomputer that doubles as my phone on my desk. Technology advances, and sometimes those advances turn nice-to-have gadgets into indispensable tools.

Be open to new technology

Our clinical product team integrates advances in technology into our clinical programs where possible. Wireless scales and fitness trackers seemed like a natural fit for a program providing intensive weight management support. Having had no previous experience with wireless scales, I got one. I wanted to experience what our members would experience when setting one up and connecting it to their ActiveHealth accounts.

With little effort I was able to set up the scale, download the app and connect the device. I also set a target weight for myself. As advertised, my daily weight started appearing in my ActiveHealth mobile app and my weight tracker showed movement. I went about my daily life and this device collected the data I wanted. My data was integrated into trackers that helped me watch my progress toward my goals.  Without any additional intervention from me.

Broaden the reach beyond early adopters

Working every day with coaches and clinicians, I know how closely connected weight can be to a host of health issues. The years are passing, and I’ve got a number in my mind that I don’t want to cross. The wireless scale definitely makes it easier for me to track my weight and see trends over time. That’s good news for people actively trying to manage their weight, but it’s even better news for some of our members managing a serious chronic condition.

Did you know that for people with congestive heart failure, weighing themselves every day is an important part of managing their condition? Because a sharp increase in weight can mean their hearts aren’t moving blood the way they should be. Connecting a wireless scale means their ActiveHealth clinicians can see their daily trends easily. If a clinician sees a sharp increase in weight, they can intervene quickly. This is literally life-changing information and it’s more readily available because of technology.

Technology can enhance our clinical impact

Impactful advances in health technology are quietly happening around us all the time. It’s those advances that ActiveHealth is watching for and bringing to our members to help them achieve their best health.

Finding the moments that matter

Kathy Filkins, Chief Operating Officer

October 21, 2022

The right data at the right time

The technology around data acquisition has become incredibly sophisticated. We can gather health and demographic data from myriad sources, but in spite of the volume we’re able to collect, the context around what we have still matters.   If you buy something online, like a travel guide for Australia, suddenly your social media feeds are full of ads for things to do in the country. But what if you had to cancel your trip to Australia and your feed is now full of reminders of the dream trip you’re not able to take?

For more than 20 years, ActiveHealth has been committed to the idea that the right piece of data can change the course of a person’s health. But a recommendation delivered at the wrong time, to the wrong person or in the wrong way isn’t just ineffective, it could be harmful.

We look for opportunities

If you put “health tips” into Google, you get more than 5 billion results in about a second and a half. Mixed in with articles from government agencies and world-renowned clinics are ads for newsletters and subscription services. Most look highly polished and professional, so it would be very difficult for anyone to immediately tell which sites to trust. However, someone searching for this information is actively thinking about their health, and this is a key opportunity to help them change their behavior.

A person’s perception of their health and their readiness to change are critical pieces of information to have as we work to help them understand their opportunities for improvement. There would be little point in trying to engage a smoker who has no desire to quit in a tobacco cessation program. We can make them aware of the support, but it’s unlikely that they will participate. A smoker who indicates they want to quit is another story.

Trust is critical

It’s important that our members know they can trust information they get from us, and that we’re their advocates and cheerleaders as they work on their health goals. However, some information is more effective when it’s delivered by their health care providers, especially information related to chronic conditions.

Advances in technology enable us to create a bi-directional exchange of data with health care providers and pharmacists. The ability to provide data-driven insights into clinical opportunities at the point of care is game-changing. Not only does the member receive the information from us directly, but it’s echoed by people they already trust to help them manage their health.

The art and science of delivering insights

Imagine a baseball player up at bat. They’re watching for a pitch coming in at the right height and speed and when they take the swing and hear the crack of the ball against the bat, they’re off and running. We experience hundreds of those moments in our lives – the moment that puts us in just the right place to achieve our goal. Reaching our members with data-driven health insights is similar. We have the technological ability to recognize an opportunity for health improvement. Just as important, though, is our experience with delivering the insight when it has the best chance for impact. Every day, we help people live healthier lives – and that’s a home run.

We’re ready for our close-ups

Beth Austin, RN, BSN, Clinical Services Director

October 21, 2022

What’s the number one thing people are looking for in a health care provider? Someone they can talk to, who will listen to their concerns and spend time as much time as it takes to explain what’s going on with their health. According to one survey, that’s even more important than getting evidence-based care.1

It’s a matter of trust

Why would that be? Because recognizing that we have a health issue or something we might want to change about our health isn’t easy. It makes us feel vulnerable, so we want to know that the person working with us is someone we can trust. ActiveHealth builds that trust through communication:

  • The words we choose
  • The tone of our voice and how fast we speak
  • Our body language

What we say and what we mean

A slight change in the way we say the same words can convey sincerity, sarcasm or humor. We’ve all received one of those emails or texts where we’re not quite sure how to take it. The words we choose matter too. Thoughtful conversations can help our members focus on their values and priorities and find the strength within themselves to make positive changes.

This is the benefit that telephonic coaching has offered. Experienced coaches, trained in motivational interviewing techniques connect live with people who are trying to make healthy changes, manage chronic conditions or navigate an acute episode of care.

It’s also why we offer group coaching sessions live. We can offer reliable, clinically sound information to our members and respond to their questions in real time.

Adding the missing piece

During the pandemic, many of us started to explore technology that let us be face to face with friends, family and colleagues. Being live on video in our daily lives has become more normal.

So, we started asking our coaches to be visible on screen during group coaching sessions – enhancing the coach-participant interactivity. Sessions now more fully convey the information using words, tone, inflection and body language.

We also started making telehealth-style video calls an option in our coaching programs. Now, instead of just talking with a coach on the phone, our members and coaches can see each other. As one of our coaches said, “You can see facial expressions and reactions on video that you can’t on phone calls. Members seem to like that, and I can use visual aids, which is helpful.”

Making a human connection

People really are at the heart of what we do at ActiveHealth. They’re our clients, our members and our colleagues. Including more video functionality in our programs is an incremental addition to the support we already provide in telephonic and online sessions. It’s an important one though – because nothing conveys how truly excited we are when our members achieve their health goals than returning their hard-won smiles with our own.

 

1Council of Accountable Physician Practices. 2017 Consumer Healthcare Priorities Study: What Patients and Doctors Want from the Health Care System. Available here. Accessed August 15, 2022.

Lifestyle & condition coaching program by the numbers

August 2, 2022

The Lifestyle and Condition Coaching program uses advanced analytics, digital tools and health coaching to provide an easy, personalized health experience for members.  See how we do it.

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A healthy workforce is good for business

August 2, 2022

Promoting healthier behaviors by supporting employee wellness programs can pay off. Healthy employees are more productive,  miss fewer days of work and help keep health care costs down.

Get infographic

The more you know

Scott D. Sobocinski, Pharm.D., Executive Director, Digital Product, Analytics & Behavior Change

August 2, 2022

Think about how you’d describe yourself to someone in a couple of sentences. I’m a 40-something person who works with data and analytics. I love swimming, a big bowl of mac and cheese, and I sing along with Bad Romance if it comes on the radio. If you knew me from work, you’d know the first two. If you know me casually in my personal life, you’d know the first and might know the second and third. You’d have to know me really well to know that last one.

Data builds a picture

We’re made up of slivers of information that we acquire about each other depending on the context of our relationship. The better you know someone, the more complete a picture you have. It’s the same with data. The more we have, the more we know – if you know what to do with it.

From medical and pharmacy claims, we can see that someone is seeing a health care provider, what kind of provider they are and whether they ordered any follow-up care or a prescription. From lab results and biometric data, we can get an idea of what kind of health risks might exist. From health assessment input, we learn about a person’s habits and how they perceive their health.

Turn data into action

It doesn’t matter that you can take in data if you’re not doing anything with it. We built our CareEngine® technology to do both. It ingests data from a myriad of sources and compiles it, analyzing it against thousands of evidence-based clinical rules until it has a full picture of a person. We call that the member’s health state and it lets us see everything that’s going on with someone clinically.

Data and analytics can help us understand what a person is doing right for their health as well as where they need support. Marie has diabetes. She is also seeing a health care provider regularly, taking a statin as prescribed and having annual eye and foot exams. But Marie skipped her annual kidney screening. All of this creates a picture of a person with well-managed diabetes at low risk for complications. She could still use a nudge from us because there’s a gap in her care.

See the same person from different angles

The member’s health state exists outside the boundaries of any program they’re enrolled in. We use it to identify programs the member may find valuable and to help clinicians understand what support the member needs. As the member engages with the program, their health state updates with new information that’s readily available to clinicians in other programs. Advances in electronic health record technology make it possible for us to share this updated information with the member’s health care providers at the point of care.

Expect an integrated experience

It’s possible to integrate data and to then use it deliberately and intentionally to improve health outcomes for ActiveHealth members. Once you fully understand the potential, it’s difficult to settle for less. Not just from our well-being solutions, but from our health care providers as well. As consumers of health care, we should all be asking our health care providers what they’re doing to assemble the slivers of our health care data and put it to use to improve health outcomes.

Data: Power and potential

Larry Siegel, Executive Vice President, Reporting & Informatics

August 2, 2022

For some, the idea of spending the day reviewing databases, reports and spreadsheets might leave them flat, but not me. I spend my days immersed in the data that is the lifeblood of ActiveHealth, and it’s so much more than numbers.

It’s the nudge that says, “Look at this – see this trend.” It’s the whispered, “Why is this happening?” It’s the exultant “Yes, it’s working!” ActiveHealth was founded on the idea that the right set of data given to providers could change the course of someone’s health, and we still fundamentally believe that.

What do you know and how are you using it?

Effective use of data and analytics is:

  • Descriptive – what happened
  • Predictive – what will happen
  • Prescriptive – how can we make something different happen

Let’s look at an example

In reviewing program performance and clinical metrics for one client, we spotted an emerging trend and responded to reverse it.

  • Descriptive: The number of members in one group who were complying with HbA1c testing was lower than we expected.  This trend is problematic because routine HbA1c tests help people with diabetes understand how effectively they are managing their conditions. They also help treating health care providers modify treatment plans as needed.
  • Predictive: We used predictive modeling to assess how this trend might evolve over time without intervention.
  • Prescriptive: With this information in hand, we set an objective to increase the number of members getting HbA1c testing at prescribed intervals. We proposed providing targeted clinical alerts and recommendations to members who weren’t getting their testing done, to increase awareness and promote the value of testing.  Later analysis showed a statistically significant increase in HbA1c testing for the targeted group.

Data turns into action

To bring what we’ve learned from the data to life, we need input and action from more than just the data science team. We trust our colleagues on the clinical team to apply their experience in motivational interviewing techniques to elicit the desired response from members. We turn to our colleagues in marketing to determine how best to raise awareness and spark action. We rely on our colleagues in account management to gain consensus with our clients as to what the challenge is and how to address it.

Coming full circle

Once we’ve set a strategy and executed it, we return to the data to determine how it worked. Ideally, we achieve one of those exultant moments I mentioned. However, a commitment to data-driven strategies requires flexibility and adaptation. If the strategy doesn’t work, we try again.

When you understand how much potential is there, just waiting to be uncovered, it’s awe-inspiring. Every new trend we uncover, every new plan we deploy, could be the first step toward changing someone’s health – and life – for the better.

What does healthy mean to you?

Dr. Jonathan Rubens, former Chief Medical Officer at ActiveHealth

June 29, 2022

Health literacy is a term prone to a wide range of interpretations. The U. S. Department of Health and Human Services Healthy People 2030 initiative provides an officially recognized definition of health literacy: “Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”1 It seems like a fairly simple concept, but it’s more complex than many realize. At ActiveHealth, we think of health literacy as the ability to find, understand and use health information, but also to apply it within the context of our familial and cultural traditions to define what health means to each of us individually.

Improving health literacy is fundamental to the work ActiveHealth does with our members in terms of empowering better health with everyone we touch. The Centers for Disease Control and Prevention reports that nearly 9 out of 10 adults struggle to understand health information when it’s presented in complex and unfamiliar terms.2 It can be difficult even for people who read well. Imagine how overwhelming it must seem to the 26.5 million Americans who are only able to read simple sentences and how impossible it is for the more than 8 million others who cannot even read at that level.3 It’s critical that we offer health information in clear, easy-to-understand terms.

Improving health literacy doesn’t end with committing to the use of plain language, though that does contribute to helping people find and understand health information. The next principle is the ability to use information to make health decisions for themselves and others. Not every health decision centers around choosing whether to receive health care or what kind. We all make multiple health decisions every day, though we don’t always think about them in that way. What you’re eating and how much, whether you’re active or not, whether you use tobacco or alcohol and whether you’re fostering healthy relationships are all health decisions.

How we take health information that’s readily available to us and apply it within our lives is the next, most important part of health literacy, and it’s different for everyone. Respecting long-standing familial and cultural traditions while making healthier choices can be a delicate balance. In our work, we don’t focus just on checking off a list of prioritized health actions. We relate the health action to what’s important to the person we’re working with in the context of their lives. We work to help each person affirm their sense of self and belonging to their family and community while ensuring they have the understanding and support to make choices that are beneficial to their health in the long term.

These beneficial choices at the individual level flow often into that person’s extended circle. Here’s how one member describes this effect: “I never realized how unhealthfully my family and I were eating. They have followed my lead with eating healthier, making healthier choices and being more physically active.” Health literacy can have real-world individual, familial and community impacts, one choice at a time. It all begins with understanding.

1 Centers for Disease Control and Prevention. What is Health Literacy? Available at https://www.cdc.gov/healthliteracy/learn/index.html. Accessed June 7, 2022.2 Centers for Disease Control and Prevention. Talking Points About Health Literacy. Available at https://www.cdc.gov/healthliteracy/shareinteract/TellOthers.html. Accessed June 7, 2022.3 U. S. Department of Education. Adult Literacy in the United States. Available at https://web.archive.org/web/20200730223012/https:/nces.ed.gov/datapoints/2019179.asp. Accessed June 7, 2022.