Banner Health reduces generalized anxiety with digital therapies
Banner Health, based in Phoenix is one of the largest nonprofit health care systems in the U.S., serving more than eight million patients in six Southwest states. Like many other hospitals and health care systems, the country faces many behavioral health challenges.
THE PROBLEM
Behavioral health is an interesting story for several reasons: said Jeff Johnson, vice president of innovation and digital business at Banner Health.
“First, there is a significant unmet need for this type of care, which has been accelerated by the pandemic,” he explains. “Second, there is a lack of licensed clinical professionals in the markets we serve. In fact, research from the Kaiser Foundation shows that Arizona has one of the lowest levels of access to behavioral health specialists nationwide.
“Additionally, several studies have shown that Phoenix, Arizona experienced the greatest growth in behavioral health care needs of any major metropolitan area during the pandemic,” he continued. “Together, these factors created significant demand for services that could not be met by traditional approaches to hiring additional clinical capacity.”
This is where a digital therapeutic can step in to provide a new solution, he added. By making the digital layer available to patients with mild and moderate depression and anxiety, healthcare teams can have a new kind of tool to provide care to this population, he said.
‘Diabetes has a more complicated and broad impact on the network,” Johnson noted. “And honestly, we’re still working on finding the right solution for a digital therapeutic in space. What we hope to get out of a digital therapy for diabetes is really more staff and patient efficiency. In its current, unmanaged state, diabetes patients have their A1C readings in different ways.
“These range from paper-based to Excel spreadsheets to smartphone apps and ultimately proprietary continuous glucose monitoring via Bluetooth that collects software-hardware instances,” he continued. “This creates a fragmented experience for patients because depending on how they gather this information, the dynamic they have with their care team changes.”
And the care team must be able to absorb that information through all of those patient channels.
“This significantly reduces the amount of time patients and care teams have to focus on other health issues while working to effectively share chronic care tracking data,” he said. “Banner focuses not only on patients who are out of reach for better A1C control, but also on solving the fragmented healthcare experience, including the primarily analog data capture methods that leave our patients and providers without a good snapshot in time. of health so that they can make decisions.”
Johnson and associates view a better and more integrated experience as critical to differentiating Banner care for the diabetes population.
“That said, we are offering enhanced diabetes education pathways, in a similar release pattern to our digital therapeutics,” he explained. “Additionally, we educate specific types of patients about digital diabetes care tools available to them through their insurance benefits at the time of scheduling visits, to help match benefits to those who would get the most value from the solution.”
PROPOSAL
Banner prides itself on conducting in-depth evaluations of the features and capabilities of technology products before deploying them.
“Internally, we try to align a business need with a clinical need, and then we try to find a market solution that can meet those two needs,” Johnson noted. “We generally use market insights to select best-in-class vendors, we put together an evaluation group and then we do demos with that evaluation group and the products.
“We then compare the strengths of these tools and ensure they can meet our business and clinical objectives,” he continued. “Once these factors align, we take the vendor’s specific product through a governance group. This is no different than a traditional P&T committee, but for digital health tools. If that committee comes to an agreement that they feel comfortable when using the tool, it concerns contracting and implementation.”
Behavioral health This fit right in where Banner had a business need to expand healthcare capacity, and the company had a compelling clinical need for that expansion, reducing overall levels of anxiety and depression in the population.
“These were accompanied by a relatively mature market that provided quite a few different products to meet our use case,” Johnson said. “We specifically sought to reduce the number of patients with an unmet need for mild/moderate anxiety and depression treatment, providing our healthcare teams with a new tool to assist in patient care, and ultimately taking some of the burden off traditional behavioral health teams to focus more on patients with higher needs.
“And again, all of this had to be achieved in an environment where neither the capacity nor the resources to hire FTEs existed,” he added.
MEETING THE CHALLENGE
Banner viewed digital therapeutics as a way to use software to address capacity requirements for behavioral health. It also wanted to opt for a purely digital therapeutic tool where the software itself did the work.
“There are many ‘digitally enhanced referral platforms’ that are a way to transition patients to telehealth, wrapped in a digital platform,” Johnson explains. “That’s one approach, but we didn’t want to dilute the clinical experience for patients with external care teams. And we wanted to use the software ‘on top of the license,’ so to speak, by linking it together for the right type of patient.
“Banner currently uses SilverCloud, an Amwell product, which is delivered directly from our Oracle/Cerner workflows to patients through a third-party distribution tool called Xealth,” he continued. “This tool is distributed to healthcare teams based on their security role in the Oracle/Cerner system. In the outpatient setting, most of our end users have access to this distribution tool.”
Banner gave its healthcare teams broad discretion over who would use the digital therapeutic products. However, the clinical champions helped create guidelines on what types of patients would fit within the technology use guidelines. Banner considers these to be Rx indications.
“We then tested our approach with some of our combined specialty care clinics in Tucson, Arizona,” Johnson said. “These locations received training and support from the university chair psychiatry and psychology who was also our champion doctor. Together, our teams created training materials, handouts, and even a YouTube video series with recommendations for using the tool.
“Additionally, the team distributed monthly statistics on enrollments, orders, and patients to keep care teams engaged in the process,” he continued.
RESULTS
Patients who have used SilverCloud have seen a decrease in both generalized anxiety disorder and patient health questionnaire scores. Additionally, Banner has noted a long product lifespan (more than two hours per patient enrollment).
“We’re also hovering around 40% order-to-enrollment,” Johnson reported. “Additionally, we are conducting an analysis of whether patients who used digital therapeutics would be less likely to seek other care or reduce drug spending (SSRIs) to find a hard ROI on cost containment. We are trying to model that approach in a similar way to how the National Health Service used Sleepio as their first solution for insomnia.”
ADVICE FOR OTHERS
“An orchestration layer, or a way to place these types of orders into the healthcare team’s workflows, is critical,” Johnson advised. “This is why we started working with Xealth. We know that patients are much more likely to use a tool or product if it comes from their doctor than anywhere else in the network.
“Governance is also a crucial piece of the puzzle,” he continued. “There are a lot of ‘shiny objects’ that teams can go after that may seem like good digital therapeutics to use. However, it’s critical to have organizational clarity on which ones are useful and why.”
Finally, clearly defined success metrics and the ability to easily capture that data are necessary, he said.
“Many problems in measuring the value of Digital health tools come down to attribution,” Johnson concluded. “Are the results you are seeing due to the digital therapeutic intervention? Or despite the digital therapeutic intervention? Making sure you have strongly defined experimental boundaries and data capture techniques goes a long way toward capturing that value.”
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