Online patient groups -- where, for example, people with diabetes meet to support each other's efforts to maintain their proper insulin levels and overall health,
The current model of care just doesn't allow us to focus on what really seems to be changing the cost dynamic -- behavior change.
medical director, West County Health Centers
Some are sponsored by pharmaceutical companies or other profit-motivated vendors, who may drop marketing materials into the feed. Some independent groups, such as PatientsLikeMe, offer social network-like user experiences, but they can be a little more public-facing than some patients wish. And sometimes they share data with pharmas, too, as per its user agreement and general mission to affect new clinical treatments via crowd-sourcing of symptom data more nimbly than traditional clinical trials.
Another problem is there aren't any outcomes research on the effectiveness of these online wellness communities, Jeff Benabio, M.D., Kaiser Permanente dermatologist and physician director of health innovation told SearchHealthIT. He argued against the online groups in a debate session during Partners HealthCare Connected Health Symposium 2012.
"There's significant harm that's harbored within these communities in misformation -- well-meaning, but misinformation, and conflicts of interest," Benabio said. "So there's no protection for the patients ... no one's watching the store; we can't endorse them."
New model: Provider-hosted online wellness groups
A new model of online patient groups is emerging, however; one that hopes to counter the patient protection argument. In this model, the group is hosted by an outside vendor and moderated by a patient's care provider, which can set the agenda, exclude advertising and sketchy health information, as well as lock down privacy and security for HIPAA compliance. Patients can appear as anonymous (or pseudonymous) to their group peers, but the provider knows who's who in the back end for treatment purposes, and for documenting education material a patient consumes and course completion.
These groups aren't free, however. The provider must pay for them, since commercial sponsors don't. Because they're in their infancy, the outcomes still aren't well-known. But one resource-strapped federally qualified health center (FQHC), the West County Health Centers network of Guerneville, Calif., is wagering some of its chips on online patient groups.
The idea is that the groups, hosted by vendor WellFX, will work as a de facto population health management tool by inspiring West County's patients with diabetes, substance abuse and obesity problems, and behavioral health diagnoses to check with each other. Greater communication and improved home care tactics might keep patients healthier between what the provider hopes ultimately will be less-frequent episodes of care. That could quickly translate to cost savings, considering 40% of the clinic group's 13,000 patients are either completely unfunded or underinsured.
"We are, like everybody else is, rethinking our care delivery model in a significant way," said Jason Cunningham, D.O., West County medical director, who is overseeing the rollout of the first WellFX groups. "The current model of reimbursement, the current model of care, just doesn't allow us to focus on what really seems to be changing the cost dynamic -- behavior change. In primary care, with diabetes and heart failure and addiction and depression and mental illness, the 15- or 20-minute visit where we're dictating the conversation ... it's just not the right model for patient care."
WellFX activity isn't yet connected to the provider's electronic health record (EHR) system, and Cunningham said it can't yet be directly used to document any particular accountable care organization (ACO) or meaningful use measure, yet. But he believes the investment will ultimately pay off in fewer unfunded visits and Medicaid claims by helping create an overall healthier patient base. The groups may also contribute to better outcomes in several Medicare and Medicaid medical home pilot projects in which West County is enrolled.
So far the health centers have created patient groups for diabetes, chronic pain, anxiety and overall wellness. They serve as online continuations of in-person groups at West County when those have concluded. For example, patients show up from 8 weeks to 10 weeks for addiction groups at the clinic in person, and continue it online afterwards in WellFX. Providers don't address patients within WellFX; West County so far has confined those communications to its online patient portal.
"A lot of groups where we recognize that the secret sauce is patients engaging with each other -- we do a little bit of educating, but the patients engage with each other very candidly about what they need to be doing and lessons learned," Cunningham said.