There’s an App for That: Using Technology to Improve Behavioral Health

MHVC offers app and interactive voice system to partners. The future of health care is now being piloted with members of MHVC’s Behavioral Health/Primary Care Learning Collaborative in partnership with Montefiore Medical Center’s Care Management Organization (CMO).

“The project offers partners access to two telehealth platforms, a smartphone application and an interactive voice response system (IVR) — automated check in call — to enhance collaborative care for patients with common behavioral health conditions in primary care and behavioral health settings,” explained Michelle Blackmore, PhD, Project Director at the Montefiore Medical Center’s Care Management Organization, which leads the Behavioral Health Integration Learning Collaborative (BHLC) for MHVC. “MHVC will now offer this technology to partners who have established an integrated care foundation and are looking to improve patient symptom monitoring, engagement in care, and self-management, while maximizing provider and staff resources.”

“The preliminary results are impressive,” said Blackmore. “Patients using the smartphone application had a threefold increase in their number of contacts with their health care team per month compared to those patients not using the application. With IVR, over 50% of patients answering the calls completed symptom scales, allowing their health care team to more closely monitor progress throughout treatment. Most patients using the app or IVR also report that they feel more connected to their care team, contributing to the evidence that technology can help increase patient satisfaction in their health care experience.”

This technology was previously piloted as part of a Health Care Innovation Award from the Center for Medicare and Medicaid Innovation to Montefiore Medical Center for the Behavioral Health Integration Program. Eligible patients were offered treatment through the collaborative care model, including short-term, evidence-based behavioral health treatment and/or medication management, case supervision, and enhanced “between visit” care (e.g., psychoeducation, behavioral activation, motivational interviewing). Patients were given the option to enroll in their choice of the smartphone application or IVR system to assist in between-visit, patient-provider contact.

The smartphone application, by Valera Health, offers a comprehensive and interactive care management experience, including a secure chat and video capability to connect with providers off-site, automated appointment and medication reminders, symptom and function scales, goal setting features/reminders, and self-management education. Passive data can also be collected to inform treatment plan adherence and alert the health care team if a patient becomes behaviorally inactive (the app can track the steps a patient takes each day as well as map their geo-location) or demonstrates poor sleep hygiene (e.g., ambient light sensor). IVR can be used to collect information on patients’ depression and anxiety symptoms between visits, as well as provide educational tips on topics related to whole health (e.g., behavioral activation, sleep hygiene, nutrition, self-care, etc), and even offers a breathing relaxation exercise. During the call, patients also are asked if they have questions about their medication or health to help ensure more timely responses from the health care team when needed.

“With the smartphone application, patients are more comfortable letting us know through the chat feature when they are having difficulty adhering to their treatment goals or need to reschedule an appointment — patients can then get more timely feedback and coaching and stay engaged in their health care,” said Blackmore. “They can also access psychoeducational and mindfulness materials and videos, which they are able to read and use in the privacy of their home or when it is convenient for them.”

Montefiore’s partnering smartphone vendor assured patient accessibility to the app across a variety of devices, including any Android or iOS operating systems. Patients without a smartphone have the option of using the IVR automated check in calls on any type of cell phone or landline. “Not only does the technology automate a lot of patient follow-up without creating additional work for providers or patients, it also empowers patients to take a more active role in the management of their health,” said Blackmore.

The care team uses all aspects of the technology platforms and reports high satisfaction. Clinical Care Providers (PCPs and BH clinicians) can utilize the cloud-based dashboard to better manage and more closely monitor the patients in their caseload. Blackmore cites one example. “In one case, an alert notified a care manager that a patient had not left home in 72 hours, based on tracked geo-location activity. The care manager reached out to the patient and identified worsening depression. The technology allowed for more immediate intervention, rather than having to wait until the next face-to-face visit which may have taken a month or more. The care manager told us that she has a much better sense of what is happening with the patient and feels more connected.”

The success of this new direction for health care is countering the belief that all interactions have to be face-to-face. “Over 87% of patients find the technology easy to use and would recommend it to a friend, so if patients continue to use it, they likely will be more engaged with their care team and have better outcomes,” said Blackmore. “Even as providers identify more patients in need of services and continue to manage larger caseloads, this technology can help them provide a higher quality of care and stay better connected with their patients.”

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