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The need for leveraging digital health tools to create more flexible care models across non-traditional settings, including the home, is clear. Yet, the persistent challenge continues to be scaling novel and successful pilots across the broader enterprise.

“It’s really a problem that a lot of these pilots are one-offs, a digital thing here, a home-based care pilot there and it isn’t seamless integrated care,” said Steve Udvarhelyi, MD, President & CEO, Blue Cross and Blue Shield of Louisiana.

To share their viewpoints on the critical elements of scaling digital health tools and home-based care models, Fellows of the Health Evolution Work Group on Digital Health and App Experience and the Work Group on Advancing Innovative Home-Based Care Models convened during an invitation-only discussion. Udvarhelyi facilitated the conversation, titled From Pilot to Scale: Defining the Business Model for Digital Health & Home-Based Care Models, which also included Nancy Howell Agee, President & CEO, Carilion Clinic; Aaron Martin, VP Health, Amazon; Hal Paz, MD, EVP for Health Sciences, Stony Brook University & CEO, Stony Brook University Medicine; and Mona Siddiqui, MD, SVP, Clinical Strategy and Quality, Enterprise Clinical Management, Humana.

The executives outlined critical elements of successfully scaling pilot projects:

  • Understanding how to effectively engage patients
  • Identifying why scaling the pilot is valuable
  • Establishing trust with clinicians, consumers, members
  • Maintaining the ability to pivot as needs evolve

Understanding how to effectively engage patients
When planning how to engage with health care consumers, executives leading health systems and health plans would be wise to consider the way millennials and so-called digital natives interact with other industries, notably retail and banking.

“Their experience in retail is they don’t go into big box stores, the UPS person comes to their home. They haven’t been inside a bank in 20 years. They use their phone for banking,” Paz said. “Why are their expectations for health care going to be any different? They’re not. We know that. So organizations that can scale up and start to provide these services in a similar fashion will be well positioned to have a continuum of care across the individual experience.”

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Investing in modalities that engage patients where they are — digitally and outside the brick-and-mortar clinic setting — also enables organizations to better capture other relevant data points, such as community factors and patients’ preferences. This information sets the foundation for establishing a more personalized approach to health care that consumers are increasingly demanding.

“We have to take incremental steps today and figure out the capabilities we need in a way that is sustainable and scalable so we’re not in pilot mode forever,” Siddiqui said.

Identifying why scaling the pilot is valuable
Prior to rejoining Amazon, Martin served as the Chief Digital Officer at Providence, where the team focused on identifying which pilot projects should be a top strategic priority for the organization.

“That sounds super simple but there can be a lot of things, a million points of light, and no real support behind any one specific project,” Martin said. Ranking priorities can help the workforce understand the clinical or financial benefit to the organization. Specific to clinicians, explaining the upside is important because they are already overburdened and asking them to perform yet another task is straining.

Martin pointed to Providence using a pregnancy app as an example of how communicating the benefits to clinicians can drive engagement. Because the app is for OBGYNs, most of whom were not employed by Providence, the health system could not mandate that the doctors use it. But the functionality, which delivers timely content related to the pregnancy week a woman is in, was more effective than handing patients a book about what to expect.

“The reason doctors liked the app is because it reduces the number of questions coming in by providing answers through content,” Martin said.

Establishing trust with clinicians, consumers, members
Whether leading a health system, medical practice or health plan, executives will need to build trust among the people being asked to adopt a new technology. Understanding patients and clinicians and communication are necessary initial elements of such trust.

“A key ingredient for providers is trust, and figuring out ways for physicians and nurses to convey that trust becomes exceptionally important. Building trust-based relationships requires interactions that are both genuinely personalized and actionable,” Paz said.

In addition to trust between clinicians and consumers, trust also needs to be extended between health systems and health plans. “Sometimes there is a divide between providers and the health plans,” Agee said. “But we’re both interested in the same thing and that’s the health of the patient.” Leaders should identify opportunities for health systems and health plans to find common ground and work together.

Maintaining the ability to pivot as needs evolve
The executives agreed that the ultimate goal is to create a seamless, integrated and flexible health care system that is capable of extending to meet patients where they are without further burdening clinicians — yet no chassis exists on which to achieve that.

That means leaders driving digital health and home-based models of care should enter pilot programs with the recognition that being able to scale those will require measuring progress and, when necessary, adjusting accordingly.

“We need a capability to test rapidly and then pivot messaging, channel strategy, engagement approach or other factors based on what we are learning in real time,” Siddiqui said. “That’s where health care overall has to move if we want to be providing new models of care in new ways. That’s a muscle we need to build.”

And, of course, leaders will need to manage scaling or pivoting pilots against competing priorities and under already stressful circumstances.

“Let’s face it. People are exhausted and change is hard,” Agee said. “We have to pay attention to that right now because all the things that we’ve been discussing are about change management and that’s not easy, even when you’re making things better.”

Tom Sullivan

Tom Sullivan brings more than two decades in editing and journalism experience to Health Evolution. Sullivan most recently served as Editor-in-Chief at HIMSS, leading Healthcare IT News, Health Finance, MobiHealthNews. Prior to HIMSS Media, Sullivan was News Editor of IDG’s InfoWorld, directing a dozen reporters’ coverage for the weekly print publication and daily website.