Phreesia CEO Chaim Indig in an interview with Founders Workbench.

Patient Engagement

Phreesia Acquires Insignia Health

Patient engagement company Phreesia recently announced its acquisition of Insignia Health to help patients become more active participants in their care journeys.

• Phreesia provides services focused on “putting tools in the hands of patients to take on tasks,” ranging from scheduling to self-reporting social determinants of health. Each service is designed to make care more efficient through patient activation.

• Insignia Health holds the worldwide license for the PAM patient activation measure, which allows clinicians to quickly understand a patient’s ability to self-manage their healthcare. PAM is backed by over 700 peer-review studies and is the only measure of patient activation used by the NHS and CMS.

• PAM levels include “disengaged and overwhelmed,” “becoming aware but still struggling,” “taking action and gaining control,” and “maintaining behaviors and pushing forward.” Knowing a patient’s level allows care teams to cater treatment plans to individual needs.

• The acquisition expands PAM’s reach through Phreesia’s existing partner network. Insignia Health founder Chris Delaney stated that “the number of patients we can reach in a single week through Phreesia’s platform would otherwise take us months.”  

The Takeaway

Improving outcomes through individualized care is a top priority for any patient engagement company, and the Insignia Health acquisition gives Phreesia the license to the “gold-standard” of patient activation measures.

Owning PAM could generate additional revenue for Phreesia through licensing, but might also lead to Phreesia cutting back on the number of competitors that have access to PAM in order to strengthen its competitive positioning.

Remote Care

Oxygen Saturation Monitoring for COVID-19 Patients

A new study published in Sage Digital Health found that at-home oxygen saturation monitoring helps identify early signs of clinical deterioration in COVID-19 patients, enabling them to seek appropriate care before the disease escalates.

• Methods – Stanford researchers recruited 49 patients with a recently positive COVID-19 test in the outpatient setting, preferentially selecting for those with underlying comorbidities. Participants were mailed pulse oximeters and enrolled in a symptom-monitoring app (AIRx), which provided a daily questionnaire for clinicians to review.

• Results – Of the six patients who required hospitalization, five sought care as a result of low pulse oximeter readings. Nearly all patients found the pulse oximeter useful, with 96% of those who did not require hospitalization reporting that the device gave them the confidence to stay at home. 

• Impact – Keeping COVID-positive patients at home has the potential to reduce the spread of disease while preventing unnecessary strain on the healthcare system. The researchers recommend targeting this intervention at patients with a high risk for deterioration given the difficulty of obtaining and mailing pulse oximeters.

The Takeaway
While there have been several studies on the effectiveness of remote patient monitoring for COVID-19, few have assessed the patient experience. Although this study is limited by its small sample size and selection bias, the high levels of engagement and patient satisfaction suggest that pulse oximeters could be a simple intervention for COVID-19 monitoring if implemented on a larger scale.

Explore Nuance’s Personalized Patient Experience

Personalized digital experiences drive better outcomes for patients and providers. Explore how Nuance is using AI automation to advance the quality of service across the care journey here.

The Wire

• Oracle In Talks to Acquire Cerner: The Wall Street Journal recently reported that Oracle is exploring the acquisition of healthcare IT giant Cerner in a transaction expected to be worth over $30B. The acquisition would expand Oracle’s enterprise software operations deeper into the healthcare market and would be among the largest healthcare M&A moves since Microsoft’s $19.7B acquisition of Nuance earlier this year.

• Emails Improve Wearables: A study published in JMIR found that adding behavioral support emails to a wearable activity tracker interventions increased physical activity levels among obese women compared to  activity tracker–only interventions. Over a six week period, the email + tracker group received weekly emails to enhance motivation for physical activity, which led to a mean weekly walking minute measure of nearly 1.4k minutes (vs ~700 for the tracker-only group).

• UpLift Funding: Behavioral health startup UpLift closed an $8M funding round to integrate psychiatry into its platform that connects patients with in-network therapists and mental health providers. UpLift’s approach to digital mental health focuses on working directly with payors as opposed to employers, reducing the friction associated with finding a new provider when a patient switches jobs.

• Obesity Telerehabilitation: New research out of France compared telerehabilitation (TR) to standard care for 49 patients with obesity, finding that TR significantly improved body composition and quality of life, but was not statistically superior to standard care. Despite similar results across both cohorts, the TR group had an abnormally high 95% adherence (compared to standard dropouts of 43%-62%), indicating that telerehabilitation should be considered when developing obesity programs.

• Clover Launches Kidney Care: Clover Health is partnering with Cricket Health to launch a new clinical program targeting chronic kidney disease (CKD) within the Clover Assistant, a CDS tool that aggregates health data to drive earlier disease detection. Clinicians using the Clover Assistant can now access Cricket Health’s comprehensive services for patients with CKD, which often goes undiagnosed within the Medicare Advantage population that Clover serves.

• Digital Depression Treatments: The American Psychological Association conducted a systematic review of 83 randomized controlled trials of digital interventions, finding that while computer- and smartphone- based treatments were generally effective, the largest positive outcomes were for tools that incorporated human guidance (feedback on assignments, exercises), rather than self-directed care. The APA recommends that digital mental health apps keep patient attrition as a top priority, given that nearly 50% of participants across all studies failed to complete the full intervention.

• Pear Acquires Depression Assets: Pear Therapeutics announced that it completed the acquisition of two digital therapeutics targeting depression, which will be incorporated into Pear’s own depression product ahead of clinical evaluation. Pear is hoping that the new assets will help expedite the FDA clearance for its Pear-015 depression solution, allowing it to join its roster of approved treatments that includes reSET (substance use disorder), reSET-O (opioid use disorder), and Somryst (chronic insomnia).

• Rural Telehealth: The share of rural households interacting with providers online reached 54% in 2021 (up from 34% in 2019), according to a Connected Nation survey. Of the 360 head of household respondents from rural Michigan, 75% plan to continue using telehealth as much as they do now in the next year, with another 6% planning on using it more frequently, suggesting that telehealth adoption within this population will persist for the near term.

• Wheel + GoodRx: Virtual care technology company Wheel is partnering with GoodRx to improve access to medication and help patients adhere to their treatment plans. Companies using Wheel’s white-labeled virtual care platform will be able to take advantage of GoodRx’s integrated service, which processes over 200B data points every day to find ways to reduce medication expenses.

• Believing in Black Boxes: A University of Toronto editorial argued that healthcare machine learning tools don’t need to be explainable to be evidence-based, noting medicine’s long list of treatments / procedures that are not fully understood (e.g. acetaminophen or gastric bypass surgery). Instead of holding ML to unnecessarily high standards, the authors suggest that we should focus on improving how we evaluate ML, an approach that aligns with another recent paper that calls for the rigorous validation of AI models until suitable explainability methods emerge.