Bridging the healthcare gap with digital coaching

Employers want healthy employees.

That may be out of sheer benevolence or perhaps the desire to have a productive workforce, or maybe both.

No matter the reason, they're finding that achieving employee health requires more than just an annual physical—it requires near-constant engagement.

Enter companies like Twine Health, a so-called “health activation platform” that allows providers to track the health of large companies' workers, who are encouraged to use technology to engage in their own well-being. Those employers can track their workforces at the population level.

Twine targets providers that employers pay to deliver healthcare to employees, whether it's on-site, near-site or virtual. Those providers pay a monthly fee based on the size of their deployment for Twine, sometimes passing along the cost to employers and sometimes charging a premium for it, based on the size of deployment. The 56 providers and healthcare delivery systems who are Twine's customers have nearly 1 million patients.

Because 63% of U.S. employers are self-insured and 94% of companies with more than 5,000 employees self insure, employers are usually the ones paying out claims, Twine Health CEO John Moore said. “They're saying to themselves: If we wait until people end up in the ER and let the healthcare system go about its usual routine, our employees won't be as healthy, and it's going to be a lot more expensive.”

Moore believes Twine could help keep an eye on employees' health in between doctors' visits through coaching combined with a digital platform with health information about employees. A coach can be “an extender of the healthcare system who helps in the day-to-day aspects of becoming healthier,” Moore said. Most health coaches can simultaneously support about 100 people with chronic diseases. But with Twine, each can support about 300 people with chronic diseases.

Usually, a patient will encounter Twine and health coaching after a visit to a primary-care provider or health coach who's on-site at the patient's workplace. Patients with diabetes, for instance, might get advice on sticking to their medication regimens while other coaches behind the scenes see which patients might need more assistance in managing their condition. The coach and patients co-create an action plan and work together to make sure it's followed. The coaching takes place by phone, tablet or computer.

Penn Medicine in Philadelphia, for instance, runs a hypertension program for its employees. Patients in the program download the Twine app and enter their blood pressure readings. Meanwhile, the app reminds the patients every day to take their blood pressure medications. On the provider end, Nicole McHenry, a Penn Medicine nurse and health coach, can watch adherence levels. “Twine allows the patient to feel more involved in their care,” she said.

Provant, which provides workplace health programs, will soon use Twine to enable digital health coaching, allowing the company to get in touch with people who were previously unreachable.

“You may have people who really want to be part of the program, but they just don't have time to set up the phone call,” said Barbara Anketell, Provant's chief operating officer. “This lets them be involved. It's access, engagement, and year-over-year improvements in the health of the people who are engaging.”

Twine, which originally began as part of the MIT Media Lab, is developing artificial intelligence capabilities to flag the most urgent messages for the care teams. With machine learning, they'll be able to detect trends and predict changes in people's outcomes. They might, for example, be able to predict based on their medication adherence what will happen to a patient's blood pressure. Twine hopes to add some of these capabilities in 2018.

After that, the company will get into conversational AI, so coaches and patients could use voice and text to interact with the app. “That adds a bit of delight to it,” Moore said. “If you build a platform that processes the data and tells the coach who needs help and who's struggling, that becomes an incredibly scalable model.”