In a recent interview with Healthcare Innovation, Kirk Garratt, M.D., medical director of the Center for Heart & Vascular Health at ChristianaCare, and Story Health CEO Tom Stanis spoke about their collaboration to improve health outcomes for patients living with hypertension and heart failure in Wilmington, Del.
The partnership uses Story Health’s digital hybrid platform that provides patients with a dedicated health coach to ensure their care plan is followed and treatment goals are achieved. Through this approach, ChristianaCare said it has been able to address some health disparities, with a significant improvement in the number of Black patients adhering to prescribed doses of guideline-directed medical therapy for heart failure.
ChristianaCare said Black patients in particular have made remarkable gains:
• 2.6x improvement on target doses of beta blockers (76 percent);
• 2.7x improvement on target doses ACE/ARB/ARNIs (54 percent); and
• 2.2x improvement on target doses of MRAs (57 percent).
ChristianaCare was also able to achieve improvement in Black patients taking SGLT2 inhibitors, rising from a 32 percent baseline to 74 percent.
Addressing the factors that lead to gaps in health equity is difficult, Garratt said. Marginalized populations having a more difficult time managing their medications or even just accessing them. “If you’re an African American living in downtown Wilmington, the poverty level is extremely high, unemployment is maybe 30 percent and health literacy is extremely poor. You have generations of under-education,” he said. “You have no meaningful generational wealth, which deprives you not just of material things, but other kinds of social connections that allow us to get quick answers to complex problems.”
Garratt said Story Health’s added layer of resources that serves as a connection between patients and their care providers wins the day. “It really solves a lot of problems. Not every problem, but a lot of the problems that hold people back from optimal medical care for their condition.”
Stanis, a former Google and Verily Life Sciences executive, described three parts to what Story Health offers. They built a technology platform and care planning tool that integrates with the electronic health record to help clinicians plan care for patients beyond the clinic visit, including managing medications for patients. Clinicians can see the clinical data from the EHR merged with data from the patient’s home about how they're doing.
The second part is focused on the patient experience to help guide them through all of this and remind them what they are supposed to be doing. “It works over SMS, over text-based communication with the patient so they don't need a fancy phone or anything like that,” Stanis said.
The third part is a care extension team with health coaches. These are nurses and lower-licensure professionals who are there to help the patient with any barriers they run into. “That could be understanding what their instructions are or dealing with the fact that maybe they get to the pharmacy and find out their meds cost $900 and they don't know how to pay for that," Stanis said. "Or figuring out that they get labs drawn to see whether these meds are working. How am I going to do that?”
Story Health has also worked with Utah-based Intermountain Health. Unlike the urban environment in which ChristianaCare is working, that is very much a rural situation in six or seven states all across the West. “They’ve got wonderful centers of excellence in Salt Lake City, where they do amazing life-saving work, and then they have places that are far afield of that,” Stanis said. “It can be in the middle of nowhere in Utah, so they really need an option to be able to bring this kind of care to those patients who are not going to drive two or three hours to come to this center of excellence every time they need treatment.”
Garratt said the impetus to get health systems to focus on this work is initially to avoid readmission penalties in government insurance programs, adding that the number of ChristianaCare patients covered by government plans has gradually increased to 66 percent.
Avoiding readmission penalties was the easy target, he said. “That was the low-hanging fruit — getting ahead of those readmission rates. That's how our model was crafted initially. We identify patients for enrollment in Story Health based on their having an acute hospitalization for heart failure,” Garratt said. “But our conversations now are starting to evolve past that and we're thinking about not just interfering with readmissions, but interfering with admissions. Can we implement a superior care plan leveraging partners like Story Health to keep people from landing in the hospital in the first place?
Impressed by the outcomes they have achieved, ChristianaCare executives are planning to expand and scale the program to include patients seeking care in its virtual primary care practice. “We think that this is going to be a three-legged stool approach where we lean into our primary care services, the Story Health partners, and our own resources through entities like the Center for Virtual Health to optimize care, Garratt said. “Many of us are convinced that's going to be the secret sauce to prevent those initial admissions out of the gate.”
Stanis noted that even advanced heart disease is often managed by primary care. “So I think it's most important to follow the patients wherever they may be, and realize that not everyone has access to very specialized or sub-specialized resources,” he said. “We’re going to take what we know works really well when it's in a sub-specialist’s hands and deploy it in the setting of primary care to be able to help patients who, frankly, could have benefited from specialty care but don't have access to it.”
