On the isle Jersey in the English Channel, postal workers are being trained to check up on the frail elderly and pick up and deliver prescriptions. The effort — called Call & Check — was conceived in 2010 as a way for the postal service to diversify its business while improving the health of the local community.
Postal workers make about two visits per week, lasting less than five minutes, at a cost of just $6 to $8, according to The Commonwealth Fund. The government, payers, or families pick up the cost.
Training includes a list of signs of physical or mental distress, such as confusion, irrational behavior, or dehydration. To ensure safety, postal workers don’t go inside people’s homes or provide formal care. There are plans to expand the program with a cloud-based program that will let postal workers access portions of customers’ medical records to remind them of upcoming healthcare appointments.
While such a program might not work in the U.S., there are a growing number of initiatives—tech and nontech—that are aimed at improving the health of populations.
The global population health management market is expected to reach $31.6 billion by 2020, growing at a compound annual growth rate of 23.2% from 2015, according to India-based MarketsandMarkets. The U.S. share of that market last year was about 77%, or $8.5 billion. The market research firm says McKesson, Verisk Health, Cerner, Allscripts, WellCentive, and IBM are among the largest players in the market.
Driving growth are changes mandated by the Affordable Care Act, such as Meaningful Use, the Hospital Readmissions Reduction Program, and the shift to patient-centric care, and an aging population.
Private institutions have been quick to adopt these changes, spurring initiatives that support a healthy community. “Going forward, providers are expected to deliver complete patient care solutions — at an individual level as well as at the population level,” says MarketsandMarkets consultant Siddharth Dutta.
Also, next year could see a number of IT companies, including Epic and “a multitude of out-of-the-box non-health care players,” enter the population health space, Dutta believes. “This increasing number of market players is a major factor driving the growth of the population health management market,” he says.
Among the areas getting most of the attention are chronic conditions and obesity, infant mortality, frail elders, and mental and behavioral health, The Commonwealth Fund reported.
Technology can play an important role in helping patients manage their health — for example, by helping them track their conditions, reminding them of treatment regiments and making it easier to connect with providers, says spokeswoman Martha Hostetter.
Social networking platforms — whether virtual or “real world” — show promise in enabling patients to connect with other patients to compare symptoms and treatment, she adds. For example, Big White Wall provides a range of behavioral health self-management services, blinded peer support, and quick access to evidence-based tools via a digital platform. It was introduced in the UK in 2007 and expanded to the U.S. in 2014.
They can also create demand for improvement, as in the case of the Food and Drug Administration’s Patient-Focused Drug Development initiative, in which patients are being asked to describe how their conditions and the available therapies affect their lives.
The field is still emergent, however. A Commonwealth Fund-supported study reviewed currently available digital health apps and found that only 6% of iOS apps and 16% of Android apps are useful in patient engagement.
Still, organizations are partnering with others to achieve healthier populations. In California, the Palo Alto Medical Foundation is working with local government, health systems, and faith-based, civic and neighborhood groups to provide social support to older adults who are living independently. By leveraging technology and social interactions across generations, the linkAges program seeks to combat isolation and loneliness and improve health.
Among the program’s features are a time bank that allows members to exchange needed services like driving or cooking, a list of senior-friendly resources and services, including community-generated reviews, and a personal profile with information seniors would like their doctors to know about. linkAges also monitors for changes in seniors’ well-being via utility data uploaded to and analyzed on the cloud.
Food security is another area that is getting attention. Since 2014, CareOregon’s FoodRx initiative partners with health clinics and food vendors to provide access to food and education on healthy eating. The program focuses on three different needs: curative nutrition, prenatal eating, and food for low-income citizens.
At Dartmouth-Hitchcock Medical Center, ImagineCare is bringing personalized, 24/7 care to patients based on their specific needs and preferences. The program, developed in a Dartmouth-Hitchcock innovation lab and now a wholly owned subsidiary, combines a custom-designed mobile app, remote sensing devices, smart-data processing capabilities and a round-the-clock care team to offer personalized health management support, explains Dartmouth-Hitchcock.
One of ImagineCare’s primary focuses is empowering people with chronic conditions, such as high-blood pressure, congestive heart failure and diabetes, to better manage their health, says spokesman Michael Barwell. Remote sensors provided by ImagineCare send routine health readings through the app and into a data cloud, enabling the care team to proactively engage with users and intervene immediately if needed.
ImagineCare engaged a number of technology companies to bring the best product to its customers, Barwell says. “Our goal is to provide as much care as a patient requires at any given time, and by reducing the need for them to visit their doctor for non-acute concerns, we effectively reduce the burden on the healthcare system and on the patient,” he says.