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Leverage technology to improve patient health and engagement

There are apps for that

By Jeffrey M. Bullard, MD

While most would agree that resistance to change is normal, there seems to be a consensus that when it comes to the state of health care in America, change is necessary and inevitable. In response to the high cost of care, there has been an unrelenting shift in the design of care delivered in the United States. Most notably, there’s a shift to value-based care with the recognized need to create care teams, address the needs of the whole patient, increase communication with patients, and focus more on health than illness. In other words, we need to keep patients healthy instead of spending our time and money trying to reverse ill health.

Some doctors are fully on board with this. They are aware of the necessity to adapt. Many are turning over the business reins so they can focus all their energy on care coordination. Others are joining forces and taking a more active role in the business. They are forming accountable care organizations and clinically integrated networks representing large groups of physicians whose purpose is to provide better quality care at lower costs. These physicians look at the pressures from the market as a potential opportunity for improvement, not as a devastatingly negative situation. Their hope is that by increasing physician engagement in the rapidly evolving business of medicine, there will be opportunities for significant improvements in care delivery, population wellness, and the cost of care.

As a member of the board of governors for a clinically integrated network, Catalyst Health Network, which represents 300 primary care providers and over 150,000 patients in the Dallas-Fort Worth area, I have had an opportunity to experience this process firsthand. By banding together, we now have an opportunity to capitalize on each physician’s unique understanding of the requirements of care delivery and use that information to drive business decisions and shape the way care is delivered.

The tech undercurrent

In the midst of the chaotic and rapidly changing world of the business of health care, something else has been silently brewing. Application designers and technology vendors have been cranking out a plethora of health-related apps that are designed to improve patient health. These apps do everything from track blood pressure to differentiate depression from anxiety. Micro-technology is being designed that can be inserted into the circulatory system and provide constant feedback about a diabetic’s blood sugar or the presence of cancer cells. Amazing, right? But there are some obstacles to adoption of these devices.

I have had the opportunity to be involved in the creation of two health-related apps. As a result of this work, I have spent a great deal of time talking with providers across the country and gained a greater understanding of challenges providers face when dealing with these technologies.

Most of these apps are stand alone, single-purpose applications that the majority of health care providers view as just another source of information they have to somehow fit in and manage. It may be cool but … it produces DATA! Now, we providers have more data to deal with. These technologies generate questions like what to do with the data now that it’s available, where to store the data, how to talk to patients about the data generated, and how to incorporate the data collection into the current office workflow. A real downside is that most insurance companies don’t have a mechanism for paying for the use or interpretation of the data that many of these apps and devices produce. At the end of the day, we do what we are paid to do.

If we examine this a bit more, we see other obstacles in addition to the data. As doctors, we have been trained to treat the patient in front of us. As a result of the changing world of health care, we are experiencing change overload. We must dedicate time to interpret and address the external knowledge patients bring to consultations about their care and learn new, complicated technologies required to meet government regulations. We must control the cost of care, comply with reporting requirements, and deal with payer pressure to change the way we deliver and document care or we will face decreased reimbursements. When asked to consider using new apps that can improve patient health or improve patient engagement in wellness efforts but not get paid for it, many of us simply do not have the head space or motivation to tackle one more thing.

Clinical decision support

My second app, Vault, was designed to tackle some of the challenges providers face in the complicated world of value-based reimbursement. What doctors desperately need are tools that allow them to leverage the onslaught of data, not just provide them with more. At heart, health care providers all want the same thing: to be effective in helping their patients get healthy. They need tools that assist them, speed their workflow, and leverage the data collected to positively impact patient care, not ones that just flood them with more information.

We refer to these tools as “clinical decision support tools,” and they basically take data and intelligently assimilate it in a way that doctors can use it quickly and easily to steer treatments successfully. In other words, the doctors don’t just get raw data, they get data that already has a set of treatment rules applied to it. The results can then be used to make treatment decisions. Now increased data becomes a meaningful win for both patient and provider. See the difference?

Let’s use Vault as an example. Vault assesses patients for mental health issues. In addition, it collects data from patients about issues like obesity, hormone imbalances, allergies, cancer risk, and pain that all affect overall wellness. Once that data is collected, a rules engine sorts through the data and looks for opportunities to move the patient towards wellness or to address obstacles that might be preventing this move. The data is processed intelligently and the results are presented to the doctor – not just the basic raw results. Vault also allows doctors to push the testing to the patient’s smartphone, computer, or tablet so they can complete tests anywhere and at any time.

With these types of clinical decision support apps that engage the patient, doctors can follow patients between appointments, monitor treatment progress, track symptoms, and affect patient behaviors all from the same data. Like some of the newer tools, Vault can interact with other clinical decision support tools, sharing data, and supporting care delivery. That’s a powerful use of data. That’s the kind of support providers need if they are to squeeze value out of the data in which they are drowning. Unlike many other apps, the testing and interpreting of the data from Vault is reimbursed by most insurance payers, including Medicare. That’s a big plus for doctors as they try to pay for the ever-increasing overhead costs associated with the transition to value-based reimbursement.

Technology win

Change is uncomfortable and energy consuming, but it is inevitable and necessary in health care today, driven by obvious needs and potential benefits. We all need to be looking at what will result in the best outcomes, one where we have happier, healthier patients and providers, and significantly improved results from the care provided.

In many cases, the answer is technology. I’m not talking about more tests, more drugs, and more intricate surgery, although they can also play a part. I am talking about using the technology we already have and are creating to transform the face of medicine into the caring, personalized, interactive, outcomes-driven model we are striving for it to be. That future involves using your smart phone, tablet, or laptop to connect With patients. There are countless opportunities to impact the quality, accessibility, and cost of care but we have to embrace the options available. We have the tools at our disposal to marry ancient wisdom and traditional medicine with cutting-edge science to create a whole new medical paradigm – good medicine that takes the best of both worlds. The future is here.

Over the last 25 years we have seen:

  • The addition of a myriad of new imaging technologies, lab tests, and medications;
  • The explosion of the Internet with an abundance of readily available medical information once held only by those in medical fields;
  • A change in the patient’s expectations of the doctor-patient relationship from a paternalistic to an interactive cooperative one;
  • A rapidly growing interest in alternative medicine and an onslaught of products and programs to support that interest;
  • A transition to employer-led health insurance decisions;
  • Several failed attempts at ‘managed care’ delivery as well as other health care delivery overhauls;
  • A transition from fee-for-service to a rapid increase in value-based reimbursement;
  • The introduction of Obamacare, its increased administrative intricacies, and now a transition to MACRA;
  • Growing doctor frustration and burnout;
  • Patients looking for alternatives to traditional care;
  • Doctors exiting the field of patient care to escape the chaos; and
  • The awareness that despite claims that the United States has the best health care in the world, our system is broken and not delivering the value or outcomes it should or could.

Jeffrey M. Bullard, MD, is CEO for the behavioral health assessment and tracking tool, Vault, and is a member of the board of governors for Catalyst Health Network, a Dallas-Fort Worth based clinically integrated network. Bullard is the founder and serves as CMO of MaxHealth Medical Associates, a community-based primary care center and is founder and medical director of Acuity Brain Center and MaxFitness Peak Performance and Personal Training. He is the current president of the Academy of Allergy and Asthma in Primary Care and serves as a medical advisory board member for multiple health care entities. For more on Vault, visit

This article was originally published in the 2016 third-quarter edition of Texas Family Physician.