Employee Hypertension Program

Helping our employee population become normotensive

Opportunity

Hypertension is high blood pressure over time, a condition that causes heart disease, stroke, kidney disease, and other severe health conditions. Uncontrolled hypertension results in one in seven deaths each year or approximately 1,000 deaths per day. One in three Americans are diagnosed with hypertension, and although it can be easily controlled with medication, about 50 percent of people with hypertension are uncontrolled. This means they are aware of their condition but have not adopted the lifestyle changes or daily medications necessary to achieve controlled blood pressures.

For employers in the U.S., hypertension is one of the most expensive health conditions, mainly because of complications related to heart disease, stroke, and kidney disease that result when left untreated. The traditional care model for hypertension requires patients to receive treatment for high blood pressure at a doctor's office, attend multiple visits to adjust medications, conduct repeat blood pressure readings, and participate in counseling. This process requires frequent travel and missing time from work to achieve blood pressure goals. Because of this intensive process, many patients struggle to remain engaged in treatment and ultimately don't gain control.

In 2015, when this work began, we estimated that of Penn Medicine's 26,000 employees, 2,700 had uncontrolled hypertension.

Intervention

The Employee Hypertension Program blends innovative care delivery with new technology and behavioral economics to help Penn Medicine employees with uncontrolled hypertension achieve and sustain controlled blood pressure.

Penn Medicine employees diagnosed with uncontrolled hypertension can visit one of several locations for a free screening. They then receive a treatment plan, prescription, automated blood pressure cuff for at-home readings, and access to a dedicated hypertension nurse. After an initial appointment, patients communicate with their hypertension team through text messages - tracking blood pressure over time, discussing medications, and receiving counseling remotely. Additional provider access is available through the patient portal in the electronic medical record, over the phone, or video.

Impact

The Employee Hypertension Program is offered to all employees at Penn Medicine for free. In year one, 94% of patients enrolled in the program achieved their target blood pressure within three months.

The team is currently working to develop a conversational AI chatbot to support and replace many of the day-to-day tasks the hypertension nurse performs. Optimizing the program's efficiency would allow the intervention to be scaled to hundreds of thousands of Penn Medicine patients, including non-employee populations.

COVID-19

While new patient enrollment was stalled due to the COVID-19 pandemic, the Employee Hypertension Program's remote monitoring and titration approaches helped patients receive care without interruption. Because of these approaches, the program was able to sustain control for over 90 percent of employees in the program.

Phase 3: How we work
Collaborators

Mathew Rusk, MD
Aba Barden-Maja, MD, MS, FACP
David Aizenberg, MD, FACP
Nicole McHenry, RN
Christina Worst, CRNP
Donna Donia, CSA
Terren Drayton
Penn Medicine Wellfocused team
Penn Medicine Data Science team
Penn Institute for Bioinformatics
Penn Medicine Primary Care Service Line

Innovation leads

Krisda Chaiyachati, MD, MPH, MSHP
David Asch, MD, MBA
Megan Mariotti, BSN, MSN, MPH
Mike Serpa, MS
Ryan Schumacher

Platforms
Funding

Independence Blue Cross
The Penn-CMU Roybal Center on Behavioral Economics and Health

External partners

Fitbit Plus (formerly Twine)

Awards

HUP Clinical Effectiveness and Quality Improvements Initiative, 2015
Twine Health Coach Excellence Award, 2016

Innovation Methods

Design for delight
Delight is a great concept to utilize when you're striving to create a breakthrough user experience.
 
Delight expresses a situation in which you've created an experience so compelling and emotionally resonant that people tell others about it, generating active word of mouth. 
 
Key drivers of delight include positive surprises, including the elimination of work and effort. So, key questions to ask include "What would users not expect in this service?" "How do we want users to feel when using this service?" and "What work can we remove or do on behalf of users?"
 
Examples of designing for delight include Zappos surprising customers with free overnight shipping on their first order or an Airbnb host creating an itinerary for you based on previously identified interests. 
Design for delight

In 2017 and 2018, we hosted blood pressure screening events in high-traffic areas on campus that featured special guests - adoptable dogs from the Pennsylvania Society for the Prevention of Cruelty to Animals (PSPCA).

This delightful surprise got many employees' attention, causing them to stop and have their screening done. These events contributed to spikes in enrollment in the Employee Hypertension Program and an uptick in adoptions for the PSPCA.

Fake back end
It is essential to validate feasibility and understand user needs before investing in the design and development of a product or service.
 
A fake back end is a temporary, usually unsustainable, structure that presents as a real service to users but is not fully developed on the back end.
 
Fake back ends can help you answer the questions, "What happens if people use this?" and "Does this move the needle?"
 
As opposed to fake front ends, fake back ends can produce a real outcome for target users on a small scale. For example, suppose you pretend to be the automated back end of a two-way texting service during a pilot. In that case, the user will receive answers from the service, just ones generated by you instead of automation.
Fake back end

In 2019, many of the features of the Employee Hypertension Program were implemented within primary care practices that did not specialize in the care of employees.

The practice that achieved the highest control rates leveraged a human pretending to be a chatbot in their pilot. Patients were told they were chatting with a bot while a human responded to messages in a standardized, algorithmic fashion. The success of this fake back end motivated the program's development of an AI chatbot.