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Healthify

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We use technology to marry information that addresses the social determinants of health with mobile health tools focused on patient outreach to redefine preventative care in low-income and at-risk populations.

Imagine a primary care physician meeting with a family in Baltimore worried about their son's asthma, only to discover that the child is emaciated. Not equipped to deal with the food need, he sends the family home with a costly inhaler hoping they won't return. However, they do return a few months later since the root cause of the asthma was a moldy house. This scenario is a common occurrence in urban communities. Social determinants, like food security, lower health outcomes and negatively influence any form of proactive care in low-income populations. Sadly, they remain unaddressed in patient care. Social service resources are abstracted away from the healthcare equation when they should be under the same roof. Providers don't have context of a patient's environment; crucial information for care. Moreover, advice is given episodically due to no tools for patient outreach which leads to poor adherence of advice: a problem that is again exacerbated by the patient's environment. Clinics in urban communities have tried to address these concerns by way of case managers and non-profit organizations but there isn't enough help and the information is disjointed. In most clinics there are two case managers for every 500 patients. People are falling through the cracks. There needs to be a technological solution that distills crucial resource information for patients, gives providers insight into the environment of their patient, and allows for providers to easily conduct outreach.
The Healthify solution is built upon the synergy of a patient focused social services screener and a provider focused management platform. 1. Patient screener: Patients are screened with a quick questionnaire and subsequently given relevant information on need-based resources. The resources are built upon a scaleable resource database that can be modified by social workers. This allows patients to feel empowered with the information to address their environmental concerns. In addition, time savings are passed on to case managers and readmission rates will decrease (high readmission rates are linked to unmet environmental needs). 2. Provider management system: The information garnered from the screener is stored in a secure cloud platform to be accessed by a provider. Using open government data, we are developing algorithms which highlight the most at-risk patients based on their environment. Providers benefit from this by gaining better insight into a patient's environment to facilitate behavior change and tailor any future patient engagement. 3. Engagement platform: Using the same platform, providers will be able to flexibly reach out to their patients using SMS messaging and set parameters such as frequency. More reinforcement, along with environmental needs being met, means that there is much higher chance for advice to be heeded. No one else has combined outreach and social determinants like we have
1. The process begins when a patient enters relevant demographic and environmental information (age, income, food status, employment status) while in the waiting room and is then greeted with need-based information (food stamps, energy assistance) and tutorials on how to access resources to improve their environment/health. Most waiting rooms have computers that are unused; they will finally become useful again. Upon the next visit, the patient is asked a series of questions to validate the effectiveness of the screener and to check up on their progress on addressing the need. If we return to the family with the asthmatic son, if Healthify was being used in the clinic, the family would have received pertinent information on food stamps and local food pantries. 2. This information is then stored in a local management system to be accessed by the healthcare provider either during a patient appointment or afterwards. Providers can interact with this management system to see the environmental concerns of a patient, programs the patient qualifies for, and the patient's progress in addressing the needs. In addition, this patient gathered information is cross referenced with epidemiological public health data, census data, and other open government data sources so that each patient has an "environmental risk" score. This allows for providers to quickly see which patient is in the most environment and might need more targeted care. Going back to the previous example, with Healthify, the primary care physician would be better equipped to deal with the patient's food situation and therefore have a more effective patient appointment. 3. After the patient leaves, the provider can use the same management system to set up a reminder system for their patient to facilitate behavior change and/or any aspect related to preventative care. Healthify will also preemptively engage the patient with surveys to gauge the effectiveness of the outreach. An example of this would be to use the MAQ8 adherence survey if the provider is using the engagement platform to improve a patient's medication adherence. Now, the physician in the earlier example will be able to set up a weekly text message to check up on the patient and remind them to sign up for food stamps to receive nutritious food for their child. We believe this outreach will also strengthen the physician/patient relationship.
Healthify sits at the intersection of mHealth, preventative healthcare, and pubic health. Patient engagement continues to be a hot topic for innovation and companies, like ALRT, are honing in on texting tools for providers. But, they are focused on the singular problems like diabetes management. This leads to a fragmentation of services increasing the barriers to deployment and causing confusion for providers. Healthify gives providers flexibility in how they want to engage the patient, whether it be a reminder for medicine or a simple environmental checkup. Furthermore, the mHealth market is being inundated with smartphone apps that hope to change behavior. However, these apps don't involve the provider in the process, don't appreciate the fact that low-income populations can't benefit from smartphone applications, and don't factor in the environment into the healthcare equation. Behavior is not produced in a vacuum, it is molded by the environment. Healthify understands this and our success and growth is dependent upon how other companies approach the social determinants of health in the future. Websites like AuntBertha, a database website that compiles information on local resources, could expand to healthcare threatening our unique approach. But, even if they enter the clinical setting with their resource screener, they would still lack our vision of a synergistic management and engagement platform.

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