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.
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.
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.
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.