Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

TangramCare

Name of Innovative Program: 
Using mobile technology to integrate behavioral health into preventative health evaluations and planning
Sponsoring Organization
TangramCare
Name of Innovative Program Lead: 
Abby Smith
E-mail Address of Innovative Program Lead: 
abby@ownedoutcomes.com
Physical Address of Innovative Program: 
18302 Irvine Blvd Ste 250, Tustin CA 92780
Project Description: 

Using mobile technology to integrate behavioral health into preventative health evaluations and planning. 

In 2012, Medicare created its first ever reimbursement for 55 million beneficiaries to receive preventative visits called Annual Wellness Visits (AWV). TangramCare has productized the assessment and five-year care plan creation for AWV. The software personalizes questions to capture behavioral “vital signs” along with with physical wellness elements to create a “whole” person view of an individual.

Symptoms of behavioral issues in older adults (prevalence is 15% in 60+ population per WHO) are often overlooked and untreated because they coincide with other late life problems.

Therefore, the AWV software allows the patient to take their wellbeing into their own hands by providing them with the findings of the visit and a five-year roadmap for being well. This de-stigmatizes the behavioral health elements and helps them be evaluated within the context of overall well-being. TangramCare’s solution removes the two most frequently cited barriers to beneficiaries receiving their preventative wellness exam – (i) takes too long (ii) has sensitive questions that are uncomfortable.

We ask, we listen and we implicitly accept – we strive to make the annual evaluation of behavioral health within AWV an integral part of aging.

Creativity and Innovation: 

By creating a user interface that requires no previous computer experience, the TangramCare AWV screener allows the patient to self-administer the first part of the visit, freeing up the doctors, nurses, and office staff to focus on patients with a more immediate need of their attention. Allowing the patient to self-administer electronically also de-stigmatizes the behavioral/mental health aspect of the wellness evaluation. Patients are more likely to answer sensitive questions on a device (than verbally a human being), which leads to a more contextual decision making by the provider and better outcomes overall. The AWV software has also uniquely integrated both the physical and mental health aspects of wellness into one succinct overview that profiles the patient’s overall wellbeing and what behaviors or circumstances may be affecting health. TangramCare makes the AWV process efficient, personalized and allows psychological vital signs to be positioned in mainstream health evaluations.  

Leadership: 

TangramCare is leading the charge in engaging the neediest of patients – seniors burdened with multiple behavioral and clinical challenges. The AWV solution is delivered ubiquitously. The assessments are setting agnostic, IT platform agnostic, and support personnel agnostic so that they can be accessed at the patient’s convenience. Clinical and business leaders at prominent health organizations are now engaged with TangramCare’ AWV to leverage the high completion rates to:

- Expand data capture to get a “whole view” of the patients’ circumstances, behavioral status and physical health

- Integrate behavioral health into primary care for the entire senior population; use it as critical inputs into risk stratification

- Design and deliver behavioral interventions as a means for broader chronic disease management amongst seniors and,

- Develop sophisticated behavioral status driven predictive models for individual and population wellness roadmaps.

Sustainability: 

The healthcare industry is plagued with the challenge of creating extremely high value at very little cost today, while also innovating and planning for the problems of tomorrow. Medicare has voted with its “check book” in setting attractive reimbursement rates for the first-time (~$190) and subsequent AWVs (~$130). This allows individual physicians, group practices and integrated health systems to financially afford allocating time and resources to this endeavor. Commercial insurers and other such population risk owners are following suit by allowing quality credits for many aspects of AWV and therefore are paving the way for integrating behavioral health into primary care.

Financially, TangramCare is self-funded, commercially viable, and therefore able to dedicate itself to realizing a very high bar in influencing patient and provider behavior by marrying proven behavioral science and world-class user experience.

Replicability: 

TangramCare’s solutions have been successfully deployed in community, ambulatory and inpatient settings across multiple geographies and patient segments. The solution is cloud-based, HIPAA compliant, and delivered via any mobile devices and computing platforms (not locked into specific operating systems or hardware). Similarly, the design assumes that the senior user might be computer illiterate and computer phobic – therefore, leverages touch screen technology and is intuitive to seniors with no prior computer knowledge.

We have architected it for flexibility / nimbleness and successfully implemented large scale roll outs in a matter of hours and days as opposed to weeks and months. We have helped physicians “go-live” in an hour for zero set-up fees. With the lessons from such progressive early adoption engineered into product improvements, the solution set is ready to be scaled nationwide and globally.

Results/Outcomes: 

Patients: Awareness and positive patient acceptance are critical early indicators and evidenced by completion rates > 95% and net promoter scores (NPS) > 80%. In time, we hope to track and influence adherence on follow-ups (pursuing referrals, compliance with medical regimen etc.) through behaviorally informed primary care.

Family Members: As evidenced by their high NPS, are able to develop an awareness of the overall circumstances, receive resources to support behavioral and physical needs of their loved ones.

 

Physicians: Are able to zero in on the behavioral and physical issues that constitute the patient’s circumstances and able to plan their roadmap in a “shared decision making” mode. At UCLA Health and at Hoag Presbyterian systems, physicians are able to complete this in ~15 minutes which is spent entirely with the patient (as opposed to in data entry) compared to the previous process that took ~45 minutes and was therefore a deterrent.

 
Nomination Tags: 
Integration of Behavioral Health and Physical Health
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