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How data from personal monitoring devices could lower health care costs
Data that originates far from the doctor's office or lab can be vital to understanding how healthy someone truly is. While integrating this data—from fitness trackers and other health monitoring devices—into clinical records has proved difficult so far, successfully doing so could significantly reduce employers’ health costs while improving workers’ health and well-being.
New research shows the potential for using fitness data to uncover health risk factors, and why doing so can provide more accurate health profiles. For example, researchers at Johns Hopkins Medicine have discovered that an individual’s fitness as determined by a treadmill test is the single greatest factor in predicting that person’s risk of dying within the next 10 years. Meanwhile, clinicians at Kaiser Permanente have concluded that one of the most widely accepted lab-based risk calculators for cardiovascular disease overestimates true risk in the general population by five- to six-fold.
The ramifications for controlling health premiums—not least by uncovering possible overtreatment in people who are actually healthy—could be profound, yet clinical pathways have been slow to take up data generated outside lab tests and doctor’s visits.
“There are a lot of things that go into estimating risk,” said Seth Martin, a cardiologist at Johns Hopkins Medicine in Baltimore. “But interestingly, physical activity hasn't been well-measured or well-captured. When someone reports their physical activity subjectively, we know that's not particularly accurate, so it hasn't been part of risk assessment for cardiovascular diseases.”
However, the days of excluding extra-clinical data from employee health and wellness delivery may be numbered, and the ever-increasing popularity of wearable fitness trackers could help move that along. Not surprisingly, hospitals are on the cutting edge of using fitness data to improve the health of their workforce—and if these efforts are successful, they could, and should, be adopted by all types of employers.
What Might Such a Program Look Like?
A case in point: Lebanon, N.H.-based Dartmouth-Hitchcock (D-H) Medical Center is pioneering the formal integration of data from the Microsoft Band—an electronic wrist band that records steps taken, sleep quality and heart rate—along with other devices such as blood pressure monitors, in its new ImagineCare health and wellness platform. The voluntary program, which debuted with round-the-clock care team support, is being offered to D-H employees (regardless of their health status) and to their adult dependents diagnosed with one or more of the covered conditions (hypertension, diabetes, congestive heart failure, and chronic obstructive pulmonary disease). The program also is being marketed by D-H to other employers, with three external customers signed up to date.
Nate Larson, director of remote medical sensing at D-H, said the Microsoft device was chosen for ImagineCare because it was “definitely more than a fitness tracker,” with greater potential for health applications. ImagineCare staff will receive data from the band, allowing a care program to be tailored to each individual.
“Heart rate for us is the ultimate litmus test,” Larson said. “We have some congestive heart failure patients for whom walking to the mailbox and back is a great way to add activity points. Someone who’s active will have a different bar and the system optimizes to your trend. If you’re already trending to an elevated heart rate from an exercise standpoint, the goals and feedback we give you will be optimized to you—you won't get cookie-cutter, vanilla feedback.”
As Larson noted, “You can't just throw activity trackers and apps at people. You have to provide an end-to-end solution for their health.”
John Malanowski, D-H's chief HR officer, has experienced ImagineCare as both an administrator and a patient. “I monitor my blood pressure every day, and after a particularly stressful day at the office I went home, took my blood pressure, and five minutes later one of the nurses called and talked me through an immediate care protocol,” Malanowski said.
“This gives people the ability to actively manage a chronically ill employee population and in addition to helping people get healthier, reduces health care expenses. From a CHRO [chief human resources officer] perspective, this can change the conversation.”
Tracker adoption within corporate wellness programs is gaining in popularity: A 2015 survey by the nonprofit Health Enhancement Research Organization found that:
• 46 percent of 188 responding employers offered or sponsored some type of tracker as part of a wellness program.
• The Fitbit tracker was the dominant sponsored tracking device, with a 77 percent market share.
• From the list of fitness trackers named on the survey, 24 percent of respondents answered “other” when asked which devices they used, and, surprisingly, the standard pedometer dominated that category.
San Francisco-based Fitbit just launched its own Fitbit Group Health unit, which brings together the offerings Fitbit provides to corporate wellness partners, weight management leaders, insurers and clinical researchers. The launch “positions the company to integrate more deeply into the population health space,” said Woody Scal, Fitbit’s chief business officer, in a release. “We’ve already begun expanding the reach of our technology through other channels, such as health plans” to develop condition-care programs for health plan members.
And yet, several obstacles regularly crop up when integrating wearable tracker data into clinical health and wellness pathways. Perhaps foremost is the traditionally conservative attitude the clinical community has toward data that has not been granted Food and Drug Administration approval as being accurate within clinical requirements. Another hurdle is the existing limit of what wellness-oriented clinicians see in trackers' capabilities.
“The game changer in this area will be if you get a biometric that relates to either blood sugar or inflammation levels that patients can see themselves,” said Michael Roizen, chief wellness officer at Cleveland Clinic in Ohio.
There are signs this is now happening, particularly for employee safety monitoring. Baker Hughes, an oil and gas drilling services contractor based in Texas, is developing smart helmet technology with sensors to track a rig worker’s vital statistics (heart rate, oxygen levels, blood sugar levels), as noted in a 2016 report on The Evolution of Work from the ADP Research Institute. “This type of technology could be used in many different jobs to help ensure workers are at their best and help people learn how to improve their well-being,” the report states.
While Roizen says that data trackers add some value to the Cleveland Clinic’s wellness program, they are not its nucleus. “There are some people who clearly respond to the numbers in trackers,” he said, “but a whole bunch of other things—food choices and portion size, your inflammation numbers, your blood glucose, and the amount of stress you have and how you manage it—overwhelm the physical activity numbers. So a combined program has to coach all of those. Is there a value to the trackers? Absolutely, for the percent that will buy trackers and live by them.”
Gaining Access to the Data
One issue with tracker data in the Cleveland Clinic program, Roizen said, is that the participant controls who can see the data. ImagineCare, conversely, clearly stipulates that end-user data from the Microsoft Band and other devices may be shared with the D-H wellness program coaches and care team, and that de-identified and aggregated data may be used for population health analytics.
“We wanted to be very transparent about where your data is going and also make it very easy to understand what you can and can't turn on and off around your data being shared,” Larson said. “People are very sensitive and savvy about this subject, so we try to be very clear and upfront why your data is being shared with us and what we do with it to try and improve your health.”
He also alluded to “a fear of a data avalanche coming back to providers, which is hard for them to filter through.” But when they receive data that’s been structured to reveal patterns, “they can say, ‘The trend in your hypertension between visits has been x, y and z, and let’s talk a little bit about what's impacting that.’”
Thus far, the reception for ImagineCare at D-H has been positive, Larson said. About 3,000 of the organization's 9,000 employees requested to be enrolled after the first e-mail invitation about the program went out.
Greg Goth is a freelance health and technology writer based in Oakville, Conn.
Related SHRM Article:
Does Use of Wearables Increase HR's Responsibility?, HR Magazine, June 2016
Incorporating Fitness Trackers into Workplace Wellness, HR Magazine, September 2014
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