I had the opportunity to sit down with Dr. David Wennberg (Chief Science & Product Officer, Health Dialog) at the 8th Annual World Healthcare Congress (Twitter hashtag #WHCC11). David is a fascinating and engaging speaker. He has lots of publications, works with the Dartmouth Atlas, and leads the Health Dialog Analytic Solutions group.
David and I began our time talking about “informed choice”.
In this environment, doctors need tools that identify patients lacking evidence-based care. They also need to ensure that patients undergoing surgery have been exposed to informed choice, not just informed consent, when there is more than one legitimate treatment path. With these resources in place, physician groups can ensure that they are in control of their own destiny when it comes to performance evaluations. (source)
This is an important issue in healthcare. Giving patients (1) complete information in (2) language that they can understand and helping them (3) frame their options relative to their preferences is at the core of this issue.
Health Dialog calls this Shared Decision Making and focuses on how to engage targeted consumers and help them make their best decision. Their customer support personnel go through a certification process and use decision aids to enable the process.
This led us into a discussion about “trust” (see prior post) and then into a discussion about “embodied conversational agents“. Obviously, if you’re going to help consumers make decisions, they need to trust you. We talked about the need to have transparency, the need to for disclosure, and the importance of using clinicians in the engagement and discussion process. In many cases, nurses and the empathy that they have are critical to this process.
But, I know from prior exposure to Health Dialog that they have figured out ways to blend technology and agents. They do a lot with data and analytics to really understand the popluation. They’ve worked hard to avoid the traps that “disease management” has fallen into over the years. He shared with me some amazing engagement statistics.
We talked about the value of peer-to-peer videos for people to understand their condition and talked about some recent studies around storytelling and distributing that information via DVD to patients (see more on study). We went on to talk about how engaging the consumer in the decisions about their care increase success, but that many models have been a challenge to scale. Health Dialog just published an article in the NEJM called A Randomized Trial of a Telephone Care-Management Strategy which demonstrated an ability to scale the solution and get results.
At baseline, medical costs and resource utilization were similar in the two groups. After 12 months, 10.4% of the enhanced-support group and 3.7% of the usual-support group received the telephone intervention. The average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% ($7.96) lower than those in the usual-support group ($213.82 vs. $221.78, P=0.05); a 10.1% reduction in annual hospital admissions (P<0.001) accounted for the majority of savings. The cost of this intervention program was less than $2.00 per person per month.
Before I could even jump to my next question about ACOs, he made the natural transition to the fact that the new ACO regulations mention shared decision making 8 times. I believe we both agreed that whatever actual form these new practice settings take that they will accelerate the importance of leveraging technology and things like shared decision making to engage the consumer. The key is to leverage the PCP setting whether it’s the MD or someone on their staff as the foundation for engagement.
This led me to ask him about physician acceptance of technology as part of their practice (more on this later). He felt that they had moved from resistance to understanding the technology and “guides” can enable them to practice better medicine.