Desert Oasis Healthcare provides medical care and wellness services to communities in California's Coachella Valley, as well as in Riverside and San Bernardino. The group serves more than 60,000 patients.

THE PROBLEM

Desert Oasis was facing a challenge many healthcare organizations must contend with: getting patients to follow their care plans. For clinicians, just telling their patients what they need them to do and how to behave is not enough.

"There are countless reasons why many patients don't adhere to their care plans: some don't fully understand their diagnosis, some don't want to believe they have a condition, others have behavioral health issues or simply choose not to participate," said Brian Hodgkins, executive vice president of clinical operations and the Heritage Provider Network ACO at Desert Oasis Healthcare. He holds a pharmacy doctorate.

"It was clear we needed an innovative turnkey solution to effectively connect with our hard-to-reach patients and ensure they were sticking to their care plans, which is essential to our goal of promoting cost-effective population health," he added.

Desert Oasis had made some progress on this issue, but it was not anywhere close to finding an answer. On a related note, half of its 60,000 patients are seniors without much disposable income.

"Consequently, many of our patients are hard to reach and do not adhere to their medication or care plans, often leading to expensive care interventions," Hodgkins explained. "Over the long term, regularly providing such care puts pressure on our organization and can impede our ability to provide quality care to our full range of patients.

"I like to say my team at Desert Oasis is in the business of testing technology," he continued. "I can't tell you how many technology, AI and remote patient monitoring companies have approached us. One of the central challenges of my current job is to find technology we can leverage to actually improve the patient and provider experience and reduce the cost and burden of care."

PROPOSAL

Health IT vendor Wellth presented data to Desert Oasis demonstrating the real-world efficacy of its technology and made a compelling case that patients activated on its platform would show improved medication and care plan adherence rates, resulting in reduced inpatient and ER utilization, Hodgkins said.

"The fundamentals of their approach – leveraging behavioral science and proprietary technology to motivate hard-to-reach members daily and create sustainable engagement – were very compelling for us as a way to help our members while also improving outcomes and reducing costs," he continued. "We were extremely impressed with their data and thought their proposal was in line with our approach to try and keep as many of our patients out of the hospital as possible.

"The technology leverages principles like loss aversion to incentivize patients to take their medication and complete their daily check-ins," he added. "By providing recurring, tangible incentives to patients, they are much more motivated to adhere to their medication."

The bottom line for Hodgkins was this: Even if patients were reluctant to adhere to their care plans, if Desert Oasis could get them to participate in such a simple program, they would become much more involved in their own care and the platform would be completely worth it.

"Anytime patients have a medication adherence rate of 80% or better, their lives improve substantially and we don't have to worry about disease progression and debilitating effects," he noted.

MEETING THE CHALLENGE

Whether it's addressing patients who need to monitor their blood glucose levels, have behavioral problems, or go to the emergency room at the drop of a hat, every time Desert Oasis has handed over a problem to Wellth, the team has delivered, Hodgkins reported.

"The process of working together has been extremely straightforward," he said. "We simply securely provided Wellth with our disease registry – our database of hard-to-reach patients with all their relevant conditions – and the number of patients we wanted to enroll in the program. After that, they did all the heavy lifting, including the patient outreach and activation on the vendor's mobile app.

"The technology also fits seamlessly with our existing systems and workflow," he continued. "No additional API or software integration was necessary. Our doctors can access case types for our patients, which allows them to quickly identify who uses the technology and check in on their experience."

If the technology shows up in a patient's case type, doctors know right away what condition the platform is helping to treat, that the patient is most likely compliant and taking their medications, and the kinds of outcomes they can expect to get from their engagement.

"Plus, whenever a patient is not compliant, the technology alerts us so we can proactively reach out to the patient and make sure they get back on track," Hodgkins noted.

"Anytime you turn over a segment of your healthcare delivery model to a contracted partner, you want to make sure you get accurate information from them in a timely manner and that your brand and mission are consistently communicated," he added. "Wellth's communication with us is direct, measured and frequent, so we're always on the same page."

Since Desert Oasis clinicians cannot be in the home with patients 24 hours a day, the technology is an extension of the clinicians' eyes and ears into the community, and it's proven extremely helpful.

"Currently, we are working on finding new ways to implement it for other patient populations and expanding on the potential of the impact," Hodgkins explained. "The technology really has been a gift to us and in return we are thrilled to be able to gift the technology to our patients. The platform has worked better than we ever could have expected."

RESULTS

That platform has helped Desert Oasis close several critical quality care gaps.

"Since 2022, we've enrolled 3,000 of our hard-to-reach patients – mostly seniors with multiple chronic conditions – in our program," Hodgkins reported. "To be eligible for activation on the platform, our patients must have extraordinarily poor medication adherence rates of around 40% to 50%. Many of our patients who had adherence rates in that range now take their medication 90% of the time since they've been on the platform.

"Among the 3,000 members we've enrolled, we've seen a 91% daily engagement rate, a 91% retention rate, a 29% reduction in inpatient utilization, a 24% reduction in emergency room utilization, and a 5% and 6% improvement in adherence to antidepressant and RAS medications, respectively," he continued.

The healthcare organization was able to achieve these results because the platform's daily check-in process is both extremely simple and rewarding for patients, he added.

"Anecdotally, I've had patients call me personally to tell me how much they enjoy using it and how proud they are of their daily check-in streaks," he reported.

"The platform promotes daily care motivation through a process where patients can benefit from both the incentives and the habits they develop," he continued. "Beyond that, our patients enjoy using it and view it as a real benefit, especially since its rewards go directly toward helping our patients purchase groceries, pay for transportation and pay the bills every month."

The reductions in inpatient and emergency room utilization demonstrate the technology's effectiveness in promoting preventive care, he added.

"Through their platform, patients are taking their medications much more regularly, improving their general well-being and changing the trajectory of their conditions for the better," he said. "This overall improvement in health is leading to fewer emergency room visits and hospitalizations."

ADVICE FOR OTHERS

If a healthcare organization wants to promote population health, investing in effective patient engagement technology is a no-brainer, Hodgkins said.

"There are very few partnerships that can yield such a high return on both cost and patient health outcomes," he continued. "Our own investment in patient engagement technology is one of five reliable and innovative partnerships that have really helped deliver on our mission of improving population health.

"Moving forward, healthcare providers will face even greater pressure to deliver better patient experiences and health outcomes, and a substantial component of that success will be contingent on the intelligent use of reliable patient engagement technology and partner relationships," he added.

The returns also clearly justify the costs for providers, he said.

"You just need to consider what will ultimately cost your organization more: a comprehensive patient engagement program or providing long-term, frequent inpatient and ER care for a large, aging population," he remarked.

"For us, the average ER visit costs $3,000," he said. "70% of those patients are admitted, ultimately costing us about $18,000 per hospitalization. In a patient population of 3,000, an organization only needs to prevent roughly 30 ER visits to pay for the entire patient engagement model. Our own investment in patient engagement technology has yielded a roughly 4x ROI."

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