In our previous post Learning from Three Integrated Care Strategies: A Care Team’s Perspective, we discussed the three types of integrated care that the UPMC Health Plan Community Team provided during the Integrated Care Study to allow us to compare the benefits of each type of care management delivery: high-touch, high-tech, and optimal discharge planning.

Health systems are learning and continuing to evolve their approach to virtual methods and digital tools for providing care, such as video care consults or remote patient monitoring. These learnings have become especially important in the last several years. During the Integrated Care Study, we conducted interviews with participants and care managers, reviewed usage data, and worked closely with patient partners to understand when and how virtual health tools can work best for patients. 

Participants who received high-tech care were sent special check-in messages through a secure text message link that asked them about their symptoms that day. This model of care is called remote patient monitoring. Participants from the high-tech group also connected with their care managers for monthly video visits or phone calls. In study interviews, care managers and study participants helped us better understand the value they saw in using digital health tools.

I liked that they would send them-a daily one. And, you know, it would have them like-and you would just go in that link, and enter your numbers in. You know. So, I really liked that. Because if you forgot, that-it reminded you every day to do it. And then after you knew, like, you know, the first two months, it might be like, "oh, I forgot to do that," but then after a while... So I, liked the texts.

–Participant

Sometimes when you just say, you know, “How are your blood sugars?” people say, “Fine.”—"How has your blood pressure been?”—"Fine.” This way, at least I have a number that I can discuss with them [participant], and we can have some goals based on those numbers … encouraging them to follow up appointments, talk to the doctor, that kind of stuff. 

–Care Manager

Having to look at my sugars every day ... it helped me realize just how important it is to keep my diet under control and to keep track of my sugars … She [care manager] helped make me more serious about the serious situation … in the beginning, my diabetes was just an annoyance to me. But, working with her made me realize that I’m the only one that can change that.

–Participant

When it came to using the digital tools, almost 60% of patients who received text message check-ins answered at least half of the messages they received either daily, weekly, or biweekly for 4 to 12 months of care management. By reviewing reports generated by the digital tools as well as care management records, we learned that use of the digital tools did not change across age groups and health conditions. In addition, these reports showed that members used the digital tools over many months to keep in touch with their care manager. We also learned that participants who received integrated care through a digital approach worked with their care manager on the same types of health goals as those who received in-person care.

 Our patient partners played an important role in making sure that participants were able to use the digital tools for their care management. Together, our team of patient partners, researchers, and care managers developed a high-tech user guide for participants that broke down basic features of smartphones used for the study and showed participants step-by-step how to navigate check-in messages and video calls. If a participant needed additional support, our team conducted one-on-one support visits to troubleshoot problems and provide personalized education.

 Overall, we learned that delivering integrated care through technology is a viable approach for supporting people with multiple chronic conditions. However, it is important that health care systems and health care providers take time to understand and address the challenges patients can face when using technology like smartphones and video visits. We found that engaging patients in developing solutions to common and unique challenges led to a better patient care experience for all involved.

For more information about how we worked with diverse stakeholders to better support our participants with technology engagement, please read our peer-reviewed article Addressing Implementation Challenges to Digital Care Delivery for Adults With Multiple Chronic Conditions: Stakeholder Feedback in a Randomized Controlled Trial.¹

Please check out our website to learn more about the Integrated Care Study. Stay tuned for our next installment of our Integrated Care Study Blog Series, which will focus on final results of the Integrated Care Study.