Link­ing per­son­al­ity, treat­ment com­pli­ance

Modern Healthcare - - INNOVATIONS - By Bar­bara Feder Ostrov Bar­bara Feder Ostrov is a free­lance writer based in San Jose, Calif.

Could a pa­tient per­son­al­ity test help clin­i­cians im­prove med­i­ca­tion and treat­ment com­pli­ance? Los An­ge­les-based startup Frame Health is test­ing that ap­proach at Kaiser Per­ma­nente.

Bruce Et­tinger, Frame Health’s founder and CEO, said he started the com­pany to help solve a long-stand­ing chal­lenge faced by healthcare providers and in­sur­ers: how to man­age pa­tients who don’t stick to med­i­ca­tion or treat­ment reg­i­mens and are more likely to be read­mit­ted to the hos­pi­tal. He be­came in­ter­ested in the link be­tween health and per­son­al­ity while work­ing as a be­hav­ioral health ex­ec­u­tive.

Frame Health has de­vel­oped a per­son­al­ity as­sess­ment to iden­tify po­ten­tially non­com­pli­ant pa­tients and tools that help clin­i­cians bet­ter com­mu­ni­cate with pa­tients based on their per­son­al­ity pro­files. Re­search link­ing per­son­al­ity types to health be­hav­iors and mor­tal­ity lends cre­dence to its ap­proach.

Stud­ies show that nearly half of med­i­ca­tions for chronic dis­eases are not taken as pre­scribed, and another 20% to 30% of pre­scrip­tions are never filled. The re­sult is pre­ventable deaths and hos­pi­tal read­mis­sions that cost the healthcare sys­tem be­tween $100 bil­lion and $289 bil­lion an­nu­ally.

Of­ten, clin­i­cians “feel they’re in­ef­fec­tive, not be­cause they don’t know what to do, but be­cause they’re un­able to get the re­sults from pa­tients that they’re look­ing for,” Et­tinger said. “We pro­vide a tool that of­fers care providers the op­por­tu­nity to have a bet­ter un­der­stand­ing of their pa­tients.”

Frame Health has won or been a fi­nal­ist in sev­eral dig­i­tal health com­pe­ti­tions. With fi­nan­cial sup­port from Kaiser Per­ma­nente’s In­no­va­tion Fund, the com­pany has joined a bur­geon­ing in­dus­try of ven­dors us­ing dig­i­tal tools and be­hav­ioral health ap­proaches to im­prove pa­tient en­gage­ment and com­pli­ance.

Frame Health is test­ing its tools in a pi­lot pro­ject at Kaiser Per­ma­nente in Cal­i­for­nia. Start­ing in July 2014, af­ter their first ap­point­ment, pa­tients with chronic con­di­tions such as di­a­betes and hy­per­ten­sion who pre­vi­ously were iden­ti­fied as non­com­pli­ant re­ceive a vol­un­tary 70-ques­tion as­sess­ment, which takes about eight min­utes to com­plete. With ques­tions that delve into mood and how the pa­tient re­lates to tasks and in­ter­acts with peo­ple, the as­sess­ment is pre­sented to pa­tients as a way to help them com­mu­ni­cate bet­ter with their provider.

The re­sult­ing in­sights are used to cre­ate in­di­vid­u­al­ized pa­tient-care guides for providers to help pa­tients com­ply with their treat­ments. Frame Health and Kaiser are study­ing how the assess­ments af­fect pa­tient sat­is­fac­tion and health out­comes, Et­tinger said. Kaiser Per­ma­nente de­clined to com­ment.

To cre­ate the as­sess­ment tool, Frame Health part­nered with Tulsa, Okla.-based Ho­gan As­sess­ment Sys­tems, a work­place per­son­al­ity test­ing firm. The firm re­vamped its busi­ness-ori­ented per­son­al­ity as­sess­ment to fo­cus on traits that re­searchers have linked to health be­hav­iors.

One trait the as­sess­ment tool looks at is neu­roti­cism, which has been linked to car­dio­vas­cu­lar dis­ease, smok­ing and drug de­pen­dence. Another is con­sci­en­tious­ness, which has been linked with higher rates of ex­er­cise and bet­ter com­pli­ance with med­i­ca­tion reg­i­mens.

There’s a large body of per­son­al­ity re­search that makes Frame Health’s ap­proach po­ten­tially use­ful, said Howard Fried­man, a Univer­sity of Cal­i­for­nia at River­side health psy­chol­o­gist. “There’s no doubt that if you have a bet­ter doc­tor-pa­tient re­la­tion­ship, you can im­prove co­op­er­a­tion,” he said. “But whether you can do it the quick and dirty way with a short per­son­al­ity test is another ques­tion.”

Dave DeBronkart, a pa­tient-en­gage­ment ad­vo­cate known as e-Pa­tient Dave be­cause of his work in dig­i­tal health, said he finds Frame Health’s ap­proach in­trigu­ing. But he cau­tioned that “the con­text makes all the dif­fer­ence. If my physi­cian with whom I have a great re­la­tion­ship asked me to take a test like that for a good rea­son, I’d gladly do that. But it must not be viewed as a sub­sti­tute for get­ting to know each other.”

Et­tinger and his team are work­ing on a mo­bile plat­form for the as­sess­ment so that pa­tients can com­plete it on their smart­phones. They’re also work­ing on tools for clin­i­cians such as per­son­al­ized pa­tient com­mu­ni­ca­tion rec­om­men­da­tions. Frame Health is work­ing on in­te­grat­ing its tools into lead­ing elec­tronic health-record sys­tems.

Pa­tients “have em­braced the tool and com­pleted the as­sess­ment in num­bers that sur­prised us,” he said. “There’s a huge la­tent de­sire by pa­tients to want to be bet­ter un­der­stood.”

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