Study Shows Empathy-Focused Interventions Can Improve Diabetes Control

A recent clinical trial by researchers from the Texas-based Dell Medical School has demonstrated that empathy-focused phone call interventions can drive clinically relevant health improvements for health plan members.  Maninder “Mini” Kahlon, Ph.D., an associate professor in the Department of Population Health at Dell, leads this research and has co-founded a company called Beheld Health to scale up this work. She recently spoke with Healthcare Innovation. 

The study, published in JAMA Network Open, found that consistent, empathy-focused phone calls led to significant improvement in mental health and blood sugar control for adults with diabetes. Kahlon says this research highlights a cost-effective model for managing various conditions, especially for individuals with limited access to traditional mental health and support services.

Kahlon's medical school lab, Factor Health, identifies opportunities to rapidly improve health through programs embedded in people’s lives, outside the clinic, testing them through community-based trials. Solutions address chronic conditions such as diabetes, depression and loneliness, and they incorporate innovations in the workforce, systems design, and nutritional and behavioral health science.

“In my lab we were asking whether we could create clinically relevant outcomes outside of the healthcare system, but in a way big enough and quickly enough that the healthcare system might actually pay. We are not doing this work in a vacuum,” Kahlon explained. “From the beginning, we were bringing payers in. Specifically in Texas we were looking at Medicaid managed care organizations as well as the county health districts, which basically take taxpayer dollars and fund some of the uninsured in the cities in Texas. We worked with them directly and asked: What are the populations and conditions that you are having such a challenge with that, were we to do something unorthodox and get results, you might consider paying?”

The answer that came back was that they wanted help with people with low incomes who have uncontrolled diabetes.  Kahlon’s team thought that was promising because diabetes is associated with a lot of emotional distress, she said. “It was a perfect condition to take our empathetic connection program, and apply it to people who had a chronic condition, where our goal was no longer just to get the mental health improvement, but to see it translate into people feeling so much better and hopefully changing their behaviors in such a way that actually their glycemic control improved, and that's what the paper was about.”

During a six-month clinical trial, 260 patients of the Federally Qualified Health Center Lone Star Circle Care with uncontrolled diabetes were split randomly into two groups—one receiving standard care and the other receiving both standard care and consistent phone calls. Referred to as Sunshine Connections, these calls were made by non-medical staff, creating opportunities for participants to share their experiences and day-to-day challenges in living with diabetes. This human-centered approach empowered trial participants to receive support at their own pace, fostering a strong personal connection and ongoing engagement with their callers beyond the clinical setting, Kahlon explained. 

At the end of six months, the participants receiving Sunshine Connections saw:
• Improved blood sugar control: Patients saw an average HbA1c reduction of 0.7%, compared with no significant change in the control group.
• Greater impact for patients with mild or greater depressive symptoms: Patients reporting mild depressive symptoms saw even larger reductions, with average HbA1c improvements of 1.1%.
• High satisfaction: Nearly all participants receiving Sunshine Connections rated them as very or extremely beneficial to their well-being.

Kahlon explained that it is important that the callers learn how to listen and be empathetic and are not perceived as nagging patients to eat differently or exercise. In most care coordination protocols that are currently done, they're still anchored in clinical needs, Kahlon noted. “You call because you want something done, right? And we are literally the opposite. When you start with the person you can't be there with an agenda. We just have to be there and be trusted, so that when the need comes up, we're there. That's what converts this from just engagement to eventually achieving clinical outcomes”  

The key, she added, is in the kind of person that they recruit. Authenticity is very important. “That's actually what we select for, and part of our secret sauce, and then also empathetic talent.”

Several factors made Kahlon and colleagues think that there was a business opportunity to scale up this type of intervention. “We knew the results were looking positive, and then we were contacted by a health plan focused on maternal health that asked us to work with their Medicaid population,” she said. “I knew that we could publish in JAMA until the cows come home, and it would not change how things happened. You would not be able to scale it. So at this stage, I was not willing to just publish and work around the edges. Also, execution truly is 90% of getting results — taking care in every aspect of what you're doing to make sure it's not lost in the shuffle. So the fact that we had somebody come to us straight away for the first contract, and my belief that the only way to get this out into the world at some scale was to push it myself. That's what resulted in us making this into a company.”

The FQHC Lone Star Circle Care is interested in continuing this work but is still working with Beheld to figure out if there are ways that they could propose some kind of value-based payment mechanism. “They can't take this on until they are in a payment scenario where they actually benefit from improving outcomes,” Kahlon said.