Health IT, Patient Engagement

Smartphone-based behavioral health program cuts ER use in Ind., Tenn. Medicaid populations

In a recent pilot at four sites in Indiana and Tennessee, a collaboration called CoactionHealth was able to cut visits to emergency rooms by 39 percent and inpatient hospital days by 53 percent among a targeted population of high-utilizing Medicaid patients with behavioral issues.

Combine case management, wellness coaching and smartphones with the proper apps and make a real difference in patient quality of life and hospital utilization. That was experience in coactionHealth, a collaboration between Nashville, Tenn.-based behavioral health services provider Centerstone, mental health app-maker Ginger.io and telecommunications giant Verizon.

In a recent pilot at four sites in Indiana and Tennessee, coactionHealth was able to cut visits to emergency rooms by 39 percent and inpatient hospital days by 53 percent among a targeted population of high-utilizing Medicaid patients with behavioral issues. The program also improved patient-provider communication and engagement, according to the partners.

“They use the ER basically as their primary care,” said Teresea Higham, a health coach at the Columbus, Ind., Centerpoint clinic, one of the participating sites.

The coactionHealth project gave iPhones with a selection of health apps, contact with a licensed practical nurse and health coaches to more than 100 disabled people, and then educated these patients on when to go to a primary care physician and when to visit the ER. The partners wanted to determine whether technology plus a health and wellness coach plus a little bit of money to better their lives could change healthcare utilization patterns.

Based on the results, the interventions did just that.

“We got them up and moving,” Higham said. Centerstone offered to spend up to $200 on each participant to help improve small areas of their lives. Some of this money went to installing grab bars in their bathtubs, while others received nicotine therapy to help them quit smoking, Higham said.

In one case, a pulse oximeter given to one pregnant woman helped Centerstone discover that she had abnormal oxygen levels in her blood, and they promptly got her the necessary medical attention. Another patient, a 35-year-old recovering drug addict with cerebral palsy and chronic obstructive pulmonary disorder who had lost manual dexterity in a car accident, was brought into regular physical therapy.

Patients who were comfortable with technology also received Fitbits. “They challenged themselves with that,” Higham said, though some did struggle to understand how to use the fitness tracker.

The centerpiece app, to monitor patient moods, was HipaaBridge, a texting and telemedicine app from communications technology vendor Everbridge. “I was able to reach out to [patients] very easily, daily, if they needed it,” said Higham, who personally monitored 13 specific patients from a dashboard on her computer screen.

CoactionHealth tracked each patient for 90 days. The program, run by Centerstone Research Institute, the research and technology division of Centerstone, started last November, and the last patient entered the program in late February. After the pilot period, the institute let participants keep their phones for an additional three months, and didn’t see the patients as often.

“We helped them be more independent,” Higham reported. “My clients made huge improvements in social aspects, in their living environments.”

Participants did have to turn in the iPhones after six months, but when they did, the coactionHealth program gave them gift cards. Some put the money toward buying their own smartphones, Higham reported, and they learned to use other apps.

Pandora, for example, came in handy for patients with schizophrenia. When they start hearing voices, they can turn their music up loud to help bring them back to reality, according to Higham.

Others listened to audio books as a coping mechanism. One user learned to enjoy drawing on her phone’s screen.

“We taught them how to have fun,” Higham said. “Being sick, you forget how to do fun things.”

Photo: Everbridge