The program has led to improved outcomes for its 7,500 Medicaid participants, including better rates of medication adherence and blood pressure control, Ochsner said. About 79% of all participants achieved their blood pressure goals in six months, the health system reports. The digital medicine program also has saved money across the board—to the tune of $2,200 per enrollee, per year, according to information shared by Ochsner from third-party healthcare performance evaluation company Validation Institute.
Social determinants: Address or else
As part of the program, a health coach works with the patient to address social determinants of health. The coaches screen patients on which factors are preventing them from managing their chronic care. Clinicians can access further information regarding patients' social needs through the electronic health record.
“The health coach is all in with the patient. they create a personal relationship with them,” said Dr. David Houghton, Ochsner’s medical director of digital medicine. “The technology, plus the time spent with the coach, is the secret sauce."
Addressing social determinants of health is critical to the success of digital medicine's ability to reduce disparities in care, said Dr. Eboni Price-Haywood, medical director at Ochsner-Xavier Institute for Health Equity and Research.
“For us in Louisiana … there is a long-standing history of disparities in chronic conditions, as well as risk factors for heart disease and cancer, that have not been systematically addressed on the structural level,” Price-Haywood said.
Price-Haywood works with the digital medicine team to ensure it is assessing whether the program is narrowing disparities and addressing social issues. As with food, housing and transportation insecurity issues, she said it’s important to identify people at risk for a digital divide during screenings for the program—a lesson for organizations looking to spin up similar projects.
"Just because someone is not savvy with technology doesn't mean they can't benefit from it,” Price-Haywood said. “Take the extra step and find out who in their family helps them with [technology].”
For patients outside urban areas, high-speed connectivity can be a barrier to participation. While most people have a smartphone, Houghton said, video visits through the program can be difficult in some areas. Ochsner is working with the state of Louisiana and the federal government to expand broadband access and enable these kinds of digital programs.
Up-front cost is another potential barrier, both for patients and the providers. Ochsner contracts with payers and employers and has a self-pay monthly option. For the first three years, the health system took on the cost of managing Medicaid patients, Houghton said. It also has used COVID-19 grant funds through the Federal Communications Commission and worked with managed care organizations in the state to expand access.
The program is a larger part of Ochsner’s Healthy State Initiative, which the health system rolled out with Louisiana Gov. John Bel Edwards (D). The initiative has specific goals aimed at reducing the number of people with chronic conditions and improving health equity.
“We really have rewritten [the] narrative that there is a patient population that we can't reach," Houghton said.