ViVE 2024: Included Health embeds CDC 'Healthy Days' measure in navigation service following successful pilot

LOS ANGELES — "How are you doing?"

Those four words can have a big impact on getting people healthier by addressing unmet medical needs, says Ami Parekh, M.D., Included Health's chief health officer.

For the past two years, the virtual care and health navigation company has been reaching out to thousands of its members, in partnership with some of its employer clients, to identify individuals in need of clinical intervention or additional support. Included Health provides healthcare benefits and insurance navigation along with virtual primary care, behavioral health, specialty care and all-hour urgent care appointments.

Included Health's patient outreach program uses a patient-centered measure developed by the U.S. Centers for Disease Control and Prevention, called Healthy Days, that tracks mental or physical health.

The premise for the program was a simple question: How do you measure if you are improving the health of a population?

"We wake up every day thinking about, 'How do we improve outcomes?' With the cost of healthcare outcomes, we have a True North metric as a community in healthcare. We all get excited when products and services can reduce the total cost of care, that's easy to quantify. That standard metric doesn't exist for clinical outcomes," Parekh told Fierce Healthcare during an interview on the sidelines of the ViVE 2024 conference on Wednesday.

"We're all here to make healthcare better, but what does that really mean from a quantifiable perspective?" she said.

While there are ways to measure individual health indicators, such as blood pressure control for patients with hypertension or hemoglobin a1c levels for individuals with diabetes, there is currently no standardized, universal way to measure whether a population's health is improving, Parekh said.

"We went out to say, 'What would a metric look like that we can track over time, at the individual level and at the population level, that can give us confidence that the products and services that we're offering for our members are actually making them better?'"

The pilot, which began in 2022 and involved over 23,000 individuals across all 50 states, combined SMS/text message surveys with clinical outreach based on a simple measure of self-reported health by asking individuals, 'How are you doing?' 

As part of the pilot, people were asked every 90 days to list the number of days in the past month when their physical or mental health was "not good" or interfered with work and daily activities. Individuals were asked to rate their general health, from 1 for Excellent to 5 for Poor. They were also asked to rate their physical and mental health and how many days of limited activity.

Based on data from 23,000 individuals, one key finding was surprising — one-third of respondents reported an average of 15 or more unhealthy days per month.

"That's half the month when they aren't feeling great," Parekh said. "And, 50% of them didn't have a usual source of care. They didn't have a primary care doctor, despite having so many unhealthy days."

If a person’s assessment of unhealthy days exceeded a certain threshold, they were offered an opportunity to connect with a clinician. 

The Healthy Days pilot showed strong results, which Parekh unveiled at the ViVE conference on Wednesday.

Among those offered the opportunity to connect with a clinician, 40% of individuals requested a clinician callback. Among those individuals, they reported an average of 17 unhealthy days for mental health.

In response, Included Health clinicians can then connect patients with follow-up care, both in-person and virtual, referrals or other support, such as financial or legal services. During the pilot, clinicians connected individuals to virtual therapy or psychiatry visits 53% of the time, according to results of the pilot program.

The Included Health team also offered individuals education on relevant benefits and connected them to high-quality primary care providers (41% of the time). The company also referred individuals to case management or coordination services for longitudinal care, offering them access to help with things like coordinating appointments and managing treatment for chronic.

As a result of these clinician check-ins, people who engaged with an Included Health clinician experienced an average of two additional Healthy Days per month, the pilot showed.

"This is the mic drop moment that I get very excited about. We give people back a weekend a month," Parekh said. "That's almost a month over the course of a year of days that they didn't have before."

Based on those results, Included Health is now embedding the CDC's Healthy Days measure as core to its navigation offering.

"At Included Health, we're proud to be adding more healthy days to our members’ lives — by connecting them with resources and guidance, and to primary care and mental health services," she noted.

By this summer, 80% of Included Healht's clients that utilize its navigation services will be live with the Healthy Days feature embedded in the solution. 

Looking at it through a broader lens, as a physician, Parekh believes Included Health's approach to standardize and embed Healthy Days as a measurement tool provides a blueprint for other organizations to use.

Research has shown that unhealthy days are a leading indicator for emergency room visits and hospital stays, and that each additional healthy day is associated with a reduction in annual health care spend of approximately $200 per individual

A standardized 'Healthy Days' measurement could become equivalent to a vital sign for patients and their clinicians, she noted.

Included Health decided to leverage the Healthy Days metrics as a measurement tool. But the company soon recognized that it's also an effective engagement tool as well, Parekh said.

"It's a great way to engage people who are otherwise not engaging in their own healthcare, because when you ask someone to reflect on, 'How many healthy days have you had in the last three days? They have a moment of, 'Well, actually not that many. Yeah, maybe I should do something about this.' It turns out, it's an incredible engagement tool, as well as a metric, so I hope many more healthcare companies start to hold themselves to it because we don't have anything like that."

Parekh believes that the check-ins and follow-up from clinicians, outside of a scheduled doctor's appointment, helped to drive strong engagement. During a typical doctor-patient visit, there is a set agenda, to discuss lab results or a particular health condition. During these calls, Included Health clinicians take the time to list and build trust, according to the company.

"I'm not coming in here to talk to you about a mammogram and pap smear. It's more like, 'Tell me what's going on? Let's have a conversation.' Sometimes it's very obvious why somebody has unhealthy days, but sometimes it's not as obvious and it takes a little bit of probing and discovery to say, 'Let's do a PHQ to see if it's depression, let's talk about your diabetes control and not getting your meds on time.' And then that clinician takes that information and makes some recommendations," she noted.

Included Health clinicians also already know all the patient's health benefits and can navigate them to care.

Parekh would like to see a standardized Healthy Days measurement too become a fundamental aspect of care engagement and navigation.

"I envision a world where, when you open your EHR and I'm talking to a patient, and this is how old she is, this is her gender and here's where her healthy days are at during this visit. That should hopefully guide the doctor to change their care. And what are the protocols that we then develop? Right now, we've relied on our clinician judgment but over time, you can imagine that becoming more standardized. When you see a drop of two days, what are the five or six things you want to make sure you hit to drive that and make it more predictive over time," she said. "I definitely can see this continuing to evolve in virtual care and in-person care as we take care of our patients.".