Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

TangramCare

Name of Innovative Program: 
Using mobile technology to address the gap between prevalence, diagnosis, and care in behavioral health
Sponsoring Organization
TangramCare
Name of Innovative Program Lead: 
Anita Pramoda
E-mail Address of Innovative Program Lead: 
Anita@tangramcare.com
Project Description: 
TangramCare asks and seeks answers to the "WHY" question behind patient choices, behaviors and circumstances. They address the gap between prevalence, diagnosis and care in behavioral health. Behavioral issues like sleep, cognition, depression, abuse, pain etc. are at the root of many patients' decisions and non-compliance issues that exacerbate chronic disease management. Based on prominent medical advisories, their mobile screening platform uses branching logic to streamline and personalize screeners to an individual patient. Delivered in an IT, setting, and personnel agnostic format, our intuitive and engaging interface de-stigmatizes behavioral assessments to go beyond mental illness to include assessment of emotional wellness and resiliency. Using this low cost screening tool, it presents a comprehensive behavioral snapshot to the care team for evaluation, medical decision-making, and care. They ask, listen, and implicitly accept. Ultimately, they are working towards designing behaviorally informed care plans that lead to better outcomes and lower costs.
Creativity and Innovation: 
Research shows that integrating behaviorally informed care improves overall outcomes, especially with the chronically ill. But behavioral screening is difficult - it's time consuming and not standardized. TangramCare has responded with interactive questionnaires that are delivered through touch screen technology and friendly screens that require no prior computer skills. Such an engaging user-experience de-stigmatizes behavioral screening and patients have demonstrated a higher degree of comfort in confiding sensitive information electronically. With completion rates > 96%, the patient feels recognized and appreciated as an individual (as opposed to a disease), is eager to receive support, and therefore more apt to comply. TangramCare delivers the scored behavioral snapshot into the health system’s EMR. So, the care team receives a complete look highlighting what needs attention along with specific actions to take. Therefore, behavioral screening is efficient, care is personalized and ultimately, outcomes are superior.
Leadership: 
TangramCare is leading the charge in engaging the neediest of patients – those with low health literacy that are economically disadvantaged and burdened with multiple behavioral and clinical challenges. Solutions are 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 to leverage the high completion rates to:
  • Expand outstanding data capture
  • Aggregate population wide behavioral assessment information
  • Demonstrate health plan / sponsor’s “population illness burden”, supporting optimized Risk Adjustment calculation
  • Design and deliver more targeted case management interventions which occur further upstream in the patient care process and before individual deterioration and,
  • Develop sophisticated behavioral status driven predictive models.
TangramCare strives to push the frontiers of behavioral health by realizing the new standard of “behaviorally informed care.”
Sustainability: 
Commercially, sponsors in various health organizations are eagerly pursuing creative ways to touch, engage, and influence large populations with assessments and ongoing monitoring with an aspiration to bend the cost curve. With its ease of use, relevance, integration with care workflows, and interoperability with existing IT systems, TangramCare is eagerly adopted by various members of the inter- disciplinary care team and therefore entrenched in broader population health initiatives.Technologically, the system in engineered with considerable elasticity to scale in load and functionality. There is significant intelligence built into the algorithms to machine learn from user behaviors to improve their experience – deliver relevant and timely advice, crowd-source peer support, and adapt to the individual’s usage patterns.Financially, the company 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 and hardware). Therefore, sponsoring payors and health systems are not required to make upfront capital investments to adopt these tools. Similarly, the patients are not required to own or have knowledge of specific computing systems to benefit from these tools. The product set is evolving to provide foreign language support with culturally sensitive delivery formats.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. 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: 
Ambulatory physicians at Hoag Presbyterian Hospital use TangramCare to understand the behavioral status of the patient and to deliver immediate, clear, individually targeted interventions. These include self-management activities and ultimately results decreased hospitalizations and improved outcomes. The format’s high user engagement is evidenced by >96% questionnaire completion rates.Scripps Health has successfully leveraged TangramCare to screen patients in the inpatient setting - as a hospitalized patient nears discharge, they assess for, address behavioral issues that could result in readmission and design post discharge care coordination steps, with the ultimate outcome of readmission reduction. New Mexico Health Connections (COOP plan in New Mexico) is designing a behavioral screening and intervention backbone to their overall chronic disease management programs.We study and continuously strive to improve awareness of disease prevalence, identify gaps in care, fill such gaps with personalized care plans, generate targeted referrals, and follow through on therapy completion.
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