The app as a remedy for health care’s inbetweenies

Use apps to keep patients connected to the health care system during transitions and in between visits.

At the oft-brittle point of contact between health insurer and patient, Harvard Pilgrim Health Plan places an app. Launched at the end of June, it allows patients—most of whom have been recently discharged from the hospital—to connect with the health plan’s nurse care managers, and vice versa. The app, which includes an IT dashboard that allows patients to review their care history, was created by Wellframe, a digital health care technology company in Boston.

“Initially, we’re focused on transitions of care from the inpatient hospital setting,” says April Greene, Harvard Pilgrim’s vice president of population health and clinical operations.

The health plan has a nurse or social worker contact members whom it feels would benefit from the app. Harvard Pilgrim also sends out letters. But other members who may want to use the tool can also contact the insurer, says Greene. “They can call one of our nurses at any time and ask for support and help.”

The app offers personalized health education, medication and appointment reminders, surveys, and lifestyle goals in the form of a daily checklist. “We send patients short questionnaires and surveys about how their health is doing,” says Greene. “We also send them health education-specific content.”

Jacob Sattelmair, Wellframe’s CEO, says that a lot of what drives variance in health outcomes and costs doesn’t happen when patients and doctors interact face-to-face. “It happens in all those moments in between. Historically, it’s been very hard for the health care system to understand how and what people are doing day to day, let alone influence it.”

The app is not a 24/7 connection at the moment; the interaction can happen only during business hours. But members can send questions to care managers in the off hours and receive a response the next day, says Sattelmair. Harvard Pilgrim will give the app about a year before deciding on a broader rollout, although Greene is hopeful. (She declined to say how much they are paying for the service.)

“We expect to expand sig­nificantly the number of members we’re able to conduct outreach to,” says Greene. Harvard Pilgrim contracts with hospitals in Massachusetts, New Hampshire, Connecticut, and Maine. The rollout won’t target hospitals, however, “just the members we think could benefit from a nurse intervention, regardless of what facility they’re being discharged from.”

The health plan employs about 50 nurse care managers, and the initial team for the app launch was about 10. Participating nurses received training, much of it involving how to integrate the new approach into their workday, says Greene. “What we’ve seen from the other health plans that have deployed this technology is that the nurse care managers’ satisfaction with their day-to-day increases significantly because they can have much more frequent contact with the member,” says Greene.

Sattelmair says that the idea is for one nurse to develop a rapport with a patient as much possible. But the nurse is part of a team. “For instance, we might have a nurse, a social worker, and a dietician, and what we call a health advocate, which could be a peer patient who is helping you and empathizing with you on a day-in, day-out basis.”

The app seems tailor-made for patients with chronic conditions, but it can be applied to just about almost everything a person might need to go to the hospital for, says Sattelmair.

“So people going through chemotherapy, for instance, or people with chronic kidney disease,” he says. “We have programs for people with mental health or behavioral health challenges, programs for high-risk maternity.”