There's one provision of the Affordable Care Act that hasn't gotten much attention outside the industry, but it's a significant one: providers face financial penalties when a patient is readmitted more than 30 days after treatment.
A young entrepreneurial company known as Pack Health--part of Birmingham's Innovation Depot--has created a range of services to help patients with chronic conditions stay healthy after they're discharged.
"The basis of the idea," says CEO and cofounder Will Wright, "was the realization that we need to monitor and manage chronic disease better in order to improve health care outcomes. Unfortunately there are just not enough doctors and nurses to do that."
The problem is in the numbers. "The average person might see a doctor for an hour or two a year, but you have to deal with your chronic illness every day," Wright says. "So our challenge was to find a way to help the care teams - who already work at full speed - manage these kinds of patients."
The name Pack Health derives from the goal of delivering the complete package of information on staying healthy by providing a customized health coach for each patient in between doctor visits.
One segment of the approach has been to create information packets, beginning with the most common areas of chronic disease, such as diabetes, asthma, pulmonology, cancer, arthritis, and cardio-metabolic issues. After the initial information, patients receive regular calls from health advisors to check on their progress and offer advice on the best ways to achieve their goals.
Mazi Rasulnia, PhD
Ironically, says cofounder Mazi Rasulnia, PhD, MBA, MPH one challenge is that there is "too much information, especially from the baby boomer standpoint. We wanted something simple for older patients to be able to use and it evolved from there to a prescription-based product."
"If you go to a library," Wright says, "and look for information on self-care for diabetes, there's probably a stack of books taller than I am. There is a lot of information out there but it's hard for people to understand what they really need to know.
"So our goal is to get patients the key messages they need to be focusing on, and provide them the personalization they need in order to do that. It's like a coach. You could teach yourself to play chess, but it's a lot easier if you have somebody showing you where you need to start, what your goals are, and the areas you most need to focus on."
That teaching and coaching is achieved by recruiting a group of advisors with advanced degrees in biology, public health, social work, and nutrition who undergo training in counseling techniques, coaching methods, and disease management. Whenever possible, patients are paired with advisors who have personal experience with their disease. A video on Pack Health's website, for instance, tells about the relationship between a breast cancer patient and an advisor who is a survivor of the disease.
"We put everyone through a rigorous program," Wright says, "to make sure they're trained in the basics of motivational techniques, plus condition-specific knowledge. Then the health advisors work in teams together under our clinical director, and they receive feedback.
"We talk to people a lot. Behavior change doesn't happen suddenly, but in increments, every day, so we find a way to have lots of short conversations with folks over time. It's up to the individual whether they want to have that conversation through a phone call, over email, or maybe a YouTube video sent to them, and then we walk them through it afterward.
Each week's focus is on what Pack Health calls a "tiny step."
"For example, say that someone with diabetes has a target of losing 10 pounds over three months, which comes out roughly to a pound a week. If we find that they drink five sodas each day, rather than going cold turkey we suggest that they replace just one of those sodas with water. If they're doing well the next week, they replace two. In the long run, it's gradual change that works better."
Besides the insurance incentive for physicians' bottom lines, Wright says, "It's frustrating for doctors to see patients coming back with the same problem rather than moving on. In the three years we've been operating, we hear stories time and time again of the doctor giving the patient a high-five because their numbers have improved.
"The quality of life, that's so important, shows that people are actually listening and following through."