Personalized Digital Telehealth Coaching for Hypertension Management

Hypertension affects 46% of American adults and is a risk factor for stroke, cardiovascular disease, and other vascular disease [1]. Annually, hypertension costs about $68.4 billion in medical and $42.2 billion in indirect costs. Patient lifestyle choices affect blood pressure, but only about half of patients with high blood pressure have it under control due to factors including not making healthy behavior choices and lack of support for making healthy choices.

Telehealth can address the needs of this population by increasing access to care and reducing the burden on the healthcare system. Lark for Hypertension is a proven digital program that leverages artificial intelligence (AI) to coach patients to make healthy behavior changes. It is infinitely scalable and has shown effectiveness.

Lack of Control

In general, optimal blood pressure management depends on patient self-management. Behaviors such as adhering to prescription medications, losing weight for patients who are obese, consuming a healthy dietary pattern consistent with Dietary Approaches to Stop Hypertension (DASH), and achieving physical activity goals for aerobic and resistance training can have significan effects on blood pressure [2]. 

However, most patients fail to meet one or more of these behaviors. Only about half of patients with hypertension are adherent to their medications long-term [3], fewer than 1 in 4 American adults meet recommendation for both aerobic and muscle-strengthening activity [4], and fewer than 1 in 3 American adults are not considered overweight or obese, for example [5]. 

A shortage of healthcare providers may contribute to lack of support for patients to make lifestyle changes to lower blood pressure. For example, doctor's appointments often only allow a total of 15 minutes for everything [6], including discussing lifestyle changes and hypertension management. By 2032, the American Association of Medical Colleges (AAMC) projects a nationwide shortfall of 21,200 to 55,200 primary care physicians and 24,800 to 65,800 specialists [7]. 

Especially underserved areas include healthcare provider shortage areas (HPSAs), which are defined by a high ratio of patients to providers and which include over 80 million patients [8]. Nearly two-thirds of designated HPSAs are rural, with potential additional challenges to getting healthcare such as distance to clinics and lack of specialty care.

A solution is needed to reduce the proportion of patients with uncontrolled blood pressure, increase the amount of counseling they receive on self-management and associated behaviors, and mitigate the effects of provider shortages. 

Telehealth to Meet Needs

Telehealth offers solutions for addressing unmet needs. Having phone and video appointments, ordering prescriptions and blood pressure monitors online, and using online portals and apps for education and tracking can reduce or eliminate barriers, such as distance, to getting care. Providers who see patients remotely can also handle more patients and, at the same time, benefit financially.

Though telehealth has been used for decades and has been gaining traction, the COVID-19 pandemic may have sped the process along. As the dramatic rise in the number of patients threatened to overwhelm the healthcare system, telehealth helped to keep patients at home instead of in hospitals or other in-person facilities. 

Lark is a telehealth solution that goes further. Powered by AI, Lark is a fully digital health coach with 24/7 support. It coaches patients on prevention and management of chronic conditions such as hypertension. Lark for Hypertension helps patients make positive choices that can help control blood pressure. Areas of focus include medication, weight loss, achieving the recommended amount of aerobic activity of 150 minutes per week, and shifts towards a more nutritious diet for blood pressure.  

 Use of Lark for Hypertension could help relieve healthcare systems in a few ways.

• Helping patients lower blood pressure and associated health risks, thus helping keep more patients out of hospitals and emergency rooms, which lowers costs and frees up resources.
• Connecting patients to remote healthcare providers when necessary, thus reducing unnecessary visits to and phone calls with live providers, which also frees up resources.
• Reducing trips to hospitals and emergency rooms helps patients with hypertension, who are considered high-risk, avoid contact with COVID-19 patients.

For physicians, Lark can potentially increase patient load and improve health, therefore increasing profitability in a managed care model. In addition, Lark can facilitate remote patient monitoring (RPM) as it can collect patient blood pressure and weight measurements through bluetooth connected devices. Now reimbursable through CPT Code 99091, RPM can increase revenues when it is done efficiently.

Programs that depend on live providers may have limited hours, require appointments or waiting times, or have different nurses answering the phone each time. They may also limit the number of interactions patients can have with these providers. Lark patients can count on always talking to their same Lark coach at any time, without worrying about wait times or limits on numbers of interactions. Due to AI, Lark learns more about individual patients the more they use the app, enabling a more personalized coaching experience.

Proven Outcomes with Lark

Lark has already demonstrated its ability to reach vulnerable and underserved populations. In one analysis among over 25,000 patients using Lark, over half were in a designated HPSA and identified as having lower access to doctors. Lark eliminates possible barriers such as lack of transportation to appointments, inability to take time off work to get to appointments, and perceived stigma associated with talking to live providers.

An analysis of patients using Lark for Hypertension for six months found that blood pressure decreased from the beginning to the end of the time period [9]. Participants were also provided a bluetooth-connected home blood pressure monitor. The analysis included 76 participants. Average decrease in systolic blood pressure (SBP) was 8.4 mm Hg, and diastolic blood pressure (DBP) decreased by 6.4 mm Hg.

In previous research, results of this magnitude have been linked to positive health and economic outcomes. For example, on a population level, a decrease in SBP of 5 mm Hg was associated with a decrease in stroke mortality, 9 percent decrease in coronary heart disease mortality, and a 7 percent decrease in all-cause mortality [10]. On a population level, a 5-mm Hg decrease in SBP is estimated to lower stroke and myocardial infarction risk by 34% [11].

Ability to Meet Increasing Needs

As widespread and costly as hypertension is now, its impact is only expected to increase in coming years, according to a technical report for the American Heart Association [12]. By 2035, 42.1% of Americans are expected to have hypertension, up from 38.8% in 2015.  Annual costs attributed to hypertension are projected to leap from $111 billion in 2015 to $221 billion in 2035. Hospital visits account for 45% of these estimates.

Lark can help address the increased demands of hypertension. Powered by AI and backed with seamless integration and delivery, Lark is infinitely scalable. Lark for Hypertension can deliver personalized coaching to a rapidly growing population quickly, at cost, and without any loss of quality.

Self-management of hypertension can help lower blood pressure, but there is a lack of support for establishing healthy habits that are known to be effective. Doctors are in short supply, and many other barriers exist for patients to get the care and support they may need for making long-lasting changes. Lark for Hypertension has already shown its effectiveness and it is equipped to handle the growing numbers of patients that may need hypertension self-management support now and in coming decades.

References

1.  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-e248 
2. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127-e248 
3. Health and Human Services. Improving medication adherence among patients with hypertension: A tip sheet for health care professionals. Updated February 2017. 
4. National Center for Health Statistics. Exercise or Physical Activity. Reviewed January 20, 2017. https://www.cdc.gov/nchs/fastats/exercise.htm
5. National Center for Health Statistics. Obesity and Overweight. Reviewed June 13, 2016. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm
6. Tai-Seale M, McGuire TG, Zhang W. Time allocation in primary care office visits. Health Serv Res. 2007;42(5):1871–1894. doi:10.1111/j.1475-6773.2006.00689.
7. IHS Markit Ltd. The Complexities of Physician Supply and Demand: Projections from 2017 to 2032. Association of American Medical Colleges. April 2019.
8. Bureau of Health Workforce, Health Resources and Services Administration (HRSA), U.S. Department of Health & Human Services, Designated Health Professional Shortage Areas Statistics: Designated HPSA Quarterly Summary, as of March 31, 2020. Available at https://data.hrsa.gov/topics/health-workforce/shortage-areas.
9. Lark. Analysis shows personalized health coaching, blood pressure monitoring leads to control. 
10. Chobanian et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252. 
11. Geleijnse JM. Habitual coffee consumption and blood pressure: an epidemiological perspective. Vasc Health Risk Manag. 2008;4(5):963‚Äê970. doi:10.2147/vhrm.s3055
12. Projections of cardiovascular disease prevalence and costs: 2015-2035. Technical report. November 2016. Prepared for American Heart Association. Available at https://heart.org/