Banner Health Deploys App-Based Loneliness Interventions
Reprinted with AIS Health permission from the June 4, 2020, issue of RADAR on Medicare Advantage
When Banner Health Network (BHN) was vying for a spot in Arizona’s revamped $14 billion managed Medicaid program, the integrated health care system knew it needed something innovative to meet the state’s expectations for merging physical and behavioral health services. In late 2017, it synced up with emerging mobile technology provider Pyx Health, which focuses on social isolation and loneliness, and has found the tools provided by Pyx to be useful in triggering real-time interventions and providing the outcomes the state was seeking.
The Arizona Health Care Cost Containment System (AHCCCS) in 2017 issued a request for proposals from managed care organizations that would coordinate the physical and behavioral health care needs of 1.5 million Medicaid members. BHN was chosen as one of seven MCOs to integrate services for the new Complete Care program, which replaced the state’s Acute Care managed Medicaid program on Oct. 1, 2018. BHN, which is a clinically integrated network and accountable care organization that merged with University Health Plans in 2015, has a separate contract to serve the state’s long-term care program and operates a Dual Eligible Special Needs Plan (D-SNP).
“We were very focused on looking at overall health care and how we could innovate, but we really knew that we needed to go beyond just innovative clinical solutions and utilize technology to drive the outcomes associated” with the state’s vision of whole person care and reduced costs, recalls Sandra Stein, M.D., medical director for care integration with BHN. “We did a lot of research as we were planning for the RFP and one of the things that came to light is there’s a lot of information out there that is focused on social isolation and loneliness, and there’s a very significant cost associated with [those factors].”
Loneliness Can Be Costly Risk Factor
AARP, for one, released a study in 2017 estimating that costs associated with social isolation and loneliness in the Medicare population were $6.7 billion annually and observing that loneliness can be a risk factor for chronic conditions such as high blood pressure, cardiovascular disease and diabetes. Stein says BHN recognized that such factors play into care for the vulnerable populations whose behavioral health care had been siloed for many years in the legacy Arizona Medicaid program. And the organization wanted to focus on anxiety and depression as part of its overall integrated approach to health care “because we know anxiety and depression profoundly impact overall health care and physical health conditions.”
But the “traditional approach” to screening and providing supports for loneliness and other social determinants of health — which can include physician interviews and care management — doesn’t always result in the full picture of what’s happening with a patient, especially leading up to a catastrophic event, observes Stein. Partnering with Pyx Health provided the opportunity for “ongoing interaction with members through screening, through identifying risk, through providing us information…so that we can interact between those events” (i.e., a primary care visit and a catastrophic event), she says.
Pyx Health CEO Cindy Jordan tells AIS Health that she founded the technology provider with the most vulnerable Medicare and Medicaid members in mind. Through a “super funny, empathetic chatbot,” the Pyx Health app uses artificial intelligence to engage a member, create a connection and “empower people to take control of their chronic loneliness through sustained behavioral changes,” she explains. She describes the chatbot as similar to a “friend in a coffee shop,” engaging around sentiment and “softly introducing self-management.”
Through these interactions, Pyx Health can collect data on loneliness and other social determinants of health and connect members with additional resources through outbound calls from real people. Users can also reach an inbound call center to ask additional questions of a live person, and it’s that human-AI combination that Jordan says has been very attractive to potential clients. With BHN, “they have an entire [care management] department, so we send this data we get in the moment directly over to them and that department intervenes,” explains Jordan.
According to Stein, BHN rolled out the Pyx Health app at the start of Complete Care, focusing on Medicaid members who were at the highest risk for anxiety, depression, social isolation and loneliness, and within that population segmenting them by, for example, members transitioning out of hospitals, skilled nursing facilities or behavioral health residential settings. “We know that during those transitional periods of time, those supports are absolutely critical,” asserts Stein. The plan also focused on “high needs, high cost” members via its care management team that is working with Pyx to gain insight from its evidence-based screening tools and make real-time interventions.
Call Center Can Also Intervene
“When [a screening] becomes positive, the Pyx compassionate call center can reach out to a member, certainly to our care management team who gets really proactive information or ‘Pyx pals,’” says Stein. Regarding the latter, she explains that “an individual who is utilizing the Pyx app can select the individuals in the community who are closest to them to be able to support them in real time. It’s a very different intervention than is used with other social media or a text.…When the individual is starting to have a hard time, the Pyx app can communicate with that support circle and give them an outreach to say, ‘Janet is having a hard time, maybe you want to reach out to her.’ It even gives that support circle some basic recommendations about how to intervene, and at the same time if they’re feeling anxious or socially isolated, it will give some recommendations and humor to interact with her, so she’s not feeling as lonely.”
Stein says BHN has done a couple of small studies on its population and found “very positive outcomes associated with reducing cost” and lowering hospitalizations among its members, and plans to do more analysis with its broader population. It’s also begun using the tool with its D-SNP members and talking about rolling it out more broadly through its value-based contracts for Medicare and commercial populations.