Making Better Connections via Mobile-enabled Care Management

Achieving true patient engagement usually means trying new processes that might make your staff uncomfortable and those you care for unsure of whether it is worth their time and effort.

That was definitely the case for Blue Cross and Blue Shield of Nebraska (BCBSNE), one of the state’s largest health plans, when it rolled out a new mobile care management approach three years ago to engage its members. In the project, care managers work with patients through a mobile application on their devices to facilitate asynchronous communication as well as a personalized daily care plan.

At this year’s Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Norine Domenge, manager of case management and care coordination for BCBSNE, detailed some of the challenges facing her nursing staff, beginning with hospital discharge follow up. The previous system relied mainly on telephonic care management which presented obstacles ranging from missing or dated patient phone numbers to the inability to sustain patient relationships past a few brief phone conversations.

“As a result,” Domenge said, “patient engagement in self-care and care management was limited. It would be great to send a nurse home with every person, but we can’t afford that.”

So the health plan partnered with Wellframe, a Boston-based health technology firm that specializes in combining mobile devices and artificial intelligence to optimize care management. In the previous telephone-based system, most patients spoke with a care manager twice, on average, over the course of the month following hospital discharge.

Wellframe helped replace that system with a mobile model put in place a series of sustained mobile messages, reminders, patient education, and even surveys to create several touchpoints and data opportunities to assist in care management. After 12 months of use, the new system started showing dividends, including a 63 percent average weekly engagement mark among members, with a higher average in the post-discharge program.

“Those patients were very motivated,” said Domenge. “They did not want to go back to the hospital.”

There was also a 400 percent increase in touchpoints between care managers and patients. This came through the continuum of mobile messaging and increased opportunity to gather patient data and further steer next steps. This may have meant increasing patient education or deploying surveys to gather more answers from patients on what was working and what wasn’t in their care plan. Nurses could follow up and help close the gaps via phone or text message.

And patients were reacting to the new technology. Fifty-three percent of patients achieved medication adherence, 67 percent of members reviewed educational content, and 62 percent were completing surveys directed to their own unique cases one year after rollout.

And equally important, noted Domenge, was that care managers were gaining time back in their days (an average of 5.5 minutes per patient interaction with more targeted discussions) and the health plan saved an additional 35 percent to 49 percent in medical costs by moving to the mobile platform of care management. Sharing that data with nursing staff helped convert those that were really slow to come along, said Domenge.

“The nurses really sat up and paid attention when we showed them [one patient story] about a member who was really hard to manage [but saw improvement via the mobile platform],” she said. “When they saw how the app helped, they bought into it and we saw our rates of onboarding [nurses] grow.”

And with an engaged nursing base, patients soon followed. “If you ‘hope’ patients will use this, they won’t,” Domenge said. “Care manager behavior influences patient behavior and it became really apparent to us how nurses felt about [the mobile system] was very, very important because it influenced how they talked to our members about it.”