Designing an Employee Hypertension Program

Designing an Employee Hypertension Program

Client

Penn Medicine, Center for Health Care Innovation

Problem

Hypertension is high blood pressure over time. The disease leads to heart attacks, strokes, kidney failure, and other adverse outcomes. Surprisingly, high blood pressure is the most preventable treatable risk factor for cardiovascular disease. Treatment is an inexpensive, daily medication.

Nearly 67 million Americans — 1 in 3 adults — have uncontrolled hypertension. In our local Employee population of 26,000 at Penn Medicine, nearly half were hypertensive or pre-hypertensive, despite access to great care. Moreover, our Health System paid more than $3 million annually in claims related to hypertension.

Our Innovation Center was empowered by executive leadership to tackle this problem. How might we redesign effective care pathways for our employees — and then extend this learning to our patients?

Blood pressure ranges. Systolic (first number) is your pressure while your heart beats. Diastolic (second number) is your pressure at rest.

My Role

Innovation Design Lead:

  • Data analysis
  • User research (130 employees and clinicians)
  • Problem Definition
  • Root Cause Analysis
  • Inter-disciplinary discussions
  • Ideation of Solutions
  • Prototyping
  • Leading Program Design
  • Monitoring Outcomes
  • Executive Presentations

PROCESS

This year long-project was a partnership with the Innovation Center and an outstanding physician, Matt Rusk. As design lead on the project, I met with Matt weekly to create a new pathway model. 

The work began by reading the Joint National Committee guidelines on hypertension, looking at other hypertension models in other large employers (there were few effective programs), and sifting through large amounts of population data and de-identified claims data.

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 Analyzing target populations in our employee population

Analyzing target populations in our employee population

I then conducted user interviews with over 130 Employees and clinicians. I set up tables near the cafeteria and went to employee health fairs, speaking with employees who were both controlled and uncontrolled, asking them about their decisions, priorities, goals, and barriers to care.

User research outcome: the 3 main fall-off points to care, with employee quotes, root causes, and objectives of the antidote solution

Those discussions lead to understanding that there were 3 main fall-off points on the pathway to successful care. Employees either weren't getting a first check, weren't getting a follow-up check, or weren't practicing medication adherence. 

How could we design a plan to make these 3 steps easy for employees? Moreover, in looking at the pathways to successful care, how could we reduce the number of steps an employee had to take to get to the MD office, to the pharmacy, and home? Can we eliminate some of these steps completely?

Dr. Rusk and I co-created a new care delivery model where Employees could be evaluated and treated on site. Rather than having to go to a lab to get blood drawn, or a pharmacy for medication, we made the model a one-stop shop. Thereafter, we mailed patients their medication directly to their home. 

A flowchart created to show the user-journey through the program

Another key part of our model was using a remote chatting and blood pressure logging system. We gave each patient-employee their own blood pressure cuff to use at home, and trained them how to use it.

Then we piloted an app call Twine Health (which has now since been acquired by FitBit). This app allowed patients to message our nurse, Nicole, if they had questions. They also got reminders to logged their medication adherence and blood pressures as needed. On the provider side, they could see patient status at a glance, and drill down to see more details of each patient.

Employee-patients and the clinical staff reported high satisfaction with this platform. I managed the vendor on-boarding of this company at UPHS with our legal team and the Twine Health team.

The Twine Health app gave providers a look into blood pressures over time, and gave patients a way to log adherence and message providers

In this project, we also leveraged key findings from behavioral economics, like loss aversion and social belonging, to convey to employee-patients that they were making a wise, inclusive, and safe choice for their best future selves.

I wrote this list of strategies for enrollment to our program based on research from behavioral economics, a strength of our lab

I created this graphic with our data scientist to visualize our real employee population to see where we should strategize opportunities.

OUTCOME

The most exciting outcome of this project is that we significantly reduced blood pressure in the most vulnerable of our employee population. The pilot year has since grown to be a full-blown benefit of employees at Penn Medicine.

Exciting results of our pilot showing a reduction in blood pressure from first visit (purple dots) to 8-weeks later (green dots). The yellow zone was the target for controlled hypertension

This project won the Penn Medicine Clinical Effectiveness and Quality Improvement Award 

Additional Links:

Read my Report shared with the executive team at Penn Medicine

Read The Joint National Committee 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults (clinical paper)

Browse JAMA's  The 2014 JNC 8 and 2017 AHA/ACA Guidelines for Management of High Blood Pressure in Adults (clinical but lay-person friendly)

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