Innovation in Chronic Disease Management Is a Marathon and Requires Organizational Endurance

Chronic diseases have been a challenge in the United States and globally for a long time, and as the population ages, they are becoming more prevalent. During a session at the HIMSS21 Digital Program, speakers from Highmark Health and Geisinger discussed innovative strategies that their organizations implemented, as well as the challenges while rolling these strategies out.

In addition to chronic diseases being prevalent, it has been well established that 30% of healthcare in the United States is considered waste, said Tony G. Farah-Stapleton, executive vice president, chief medical officer and clinical transformation officer at Highmark Health. The waste is part of the broader ecosystem, which includes the financing system, the lack of interoperability among records and systems, and communication challenges. Given these challenges, physicians, health systems and hospitals face a steep hill when trying to improve outcomes and reduce costs.

Farah-Stapleton said this waste was seen an opportunity. One of the ways Highmark saw to reduce waste was to improve the health of its population, which also brings total cost of care down. While it won’t remove the entire 30% of waste, it will make a significant dent in it.

“What better way to address the healthcare cost crisis than by moving people’s health?” he asked. “That sounds simple, and why wouldn’t we do it? But it’s not easy.”

He pointed to larger organizations that have tried and failed, such as Haven—the collaboration between Berkshire Hathaway, JPMorgan and Amazon that disbanded less than 3 years after forming—and IBM’s Watson—which partnered with some medical schools and cancer centers to little success.

“This is not for the faint of heart,” he said.

Highmark started its journey several years ago to prove the concept that improving the health of the population reduces costs. As an integrated system, Highmark can track costs because it has visibility into claims. Highmark took a series of patient populations and large-scale pilots to plot the current and future states of conditions. Patients and clinical teams were involved to identify what was wrong with the current state, and Highmark set out to improve clinical outcomes.

“Without any exception we were able to improve clinical outcomes, patient experience, clinician experience…and guess what? The total cost of care came down precipitously,” Farah-Stapleton said.

To do it at scale, Highmark is working with Google Cloud and Verily in order to reach broader populations. While many organizations are interested in improving patient outcomes at scale, they often fix a small slice of the problem, he explained. Highmark is moving all clinical and claims data to the cloud. Without a single platform, it is difficult to curate data for actionable information to be delivered to patients and clinicians in real time, he said.

Geisinger has been tackling chronic disease management for decades, but it has been a very labor-intensive approach offering case management and education on a one-to-one basis, said Karen Murphy, executive vice president and chief innovation officer at the Geisinger Steele Institute for Health Innovation.

Similar to Highmark, Geisinger first took stock of what it was currently doing to address chronic disease and then took a 6-month deep dive to get a snapshot.

“We decided that using a fundamentally different approach to chronic disease we may be able to come out with some strong quantifiable outcomes in cost and quality and then, more certainly and most importantly, patient experience and slowing the disease,” she said.

The result was Connected Care 365, which leverages remote patient monitoring, patient-reported outcomes (PROs), and artificial intelligence (AI) and machine learning. The program engages patients to monitor themselves and boost their self-management capabilities. The PROs are used to learn more about what patients were feeling as their disease progressed and the AI provided insights into disease progression and exacerbation that requires a high level of care and intervention.

She noted that the technology is not just an enabling strategy, but the strategy. “Our strategy is a new approach to caring for patients that’s enabled by technology,” she said.

Geisinger discovered that no vendors had anything that met its needs, so it looked for companies that wanted to go on the journey with them and codevelop something.

“We’re not just trying to codevelop for Geisinger,” she said. Past experience has shown that single solutions for a health system are not effective for the industry. Instead, Geisinger wanted to focus on “what we can build that can be generalizable throughout the nation and…globally.”

Both Murphy and Farah-Stapleton noted there are challenges when using technology-based programs, particularly that broadband access can be a limitation in some communities. Farah-Stapleton pointed out that community analytics are necessary because Highmark found that some communities with transportation and housing issues actually had smartphones.

Murphy added that the age of the population is a challenge. Patients with chronic diseases tend to be older and might not be as digitally adept, she said. When answering a problem with digital tools, the organization needs to be sure the patient can engage with the solution.

She added that the patient voice needs to be included when creating strategies, and Farah-Stapleton similarly highlighted the importance of convening community organizations that can help work with the population.

Another barrier is internally: change management. Often, people feel comfortable where they are and doing what they do, which makes change difficult. The sort of innovations Highmark and Geisinger were implementing were complex and required iteration.

“Many times, we are asking them to do what turns out to be double the work while we refine these models,” Murphy said.

Keeping up the momentum is difficult, as well. “People get fatigued,” she said. While everyone is initially excited by the vision, that excitement fades when it becomes apparent the amount of work it will require. Farah-Stapleton agreed, adding that getting people excited is important, but the organization needs to make the final vision real.

Murphy said it is important to set realistic expectations from the start, but also to develop an evaluation plan to show early results. These results don’t need to be earth shattering, but they can help to show progress is being made while shooting for the stars.

“It’s a marathon, truly, with no finish line,” Murphy said. “If it’s a good innovation and it’s solid, we’ll be able to iterate as we continue.”