One third of adults in the U.S. live with one or more chronic illnesses. Conditions they need to take care of themselves.
Approximately 71% of U.S. healthcare dollars is spent on people who have more than one chronic condition.
As people acquire more chronic conditions their risk of dying prematurely, being hospitalized and/or receiving conflicting information that leads to negative consequences increases.
The power of the internet to upend this scenario is immense. We have the power to educate tens of millions of people how to take care of themselves and give them much needed support.
That would mean: 1) Improving people's quality of life, more years of productivity and longer lifespans, and healthier families 2) Enabling people who live in remote areas and smaller cities and towns, without ample health professionals, to stay well and/or avoid heart-breaking, unnecessary decline and 3) Reduce our nation’s skyrocketing healthcare costs.
We value education for our children, yet not our adults who live with illness. Can we shift, societally, to appreciate the value of health education and invest in it?
To better understand the power and potential of health education off-line and on, I spoke with an academic pioneer in the field and a CEO working to bring digital disease-management to the masses.
Stanford University’s Ground-Breaking Programs
Three decades ago Kate Lorig, DrPH, while at Stanford University, designed the first-of-its-kind health education program, the Chronic Disease Self Management Program (CDSMP). Its uniqueness lay in the fact that it doesn’t cover a single condition, it covers five: arthritis, diabetes, heart disease, depression and pain. Lorig saw what was beginning: people living with more than one chronic condition.
Today three out of four Americans over sixty-five manage multiple conditions
Lorig then created the Diabetes Self-Management Program for people with type two diabetes. Both programs’ main feature - the interaction of participants in small group, community-based classes - was always thought to be a primary reason why the programs work. Today the programs are offered through the Self-Management Resource Center (SMRC).
Bringing education online
After years of work by Lorig and the Stanford team to develop an initial online version, Adam Kaufman, CEO of Canary Health, brought the programs to scale through Better Choices, Better Health - keeping the success factors of the small group classes in the foreground and the technology in the background.
This distinguishes Canary Health’s disease- and lifestyle-management courses from other digital programs. It’s also already made Kaufman’s young company a leader in digital health education and self-management support.
In America more than 100 million people have diabetes or pre-diabetes and more than 133 million people have one or more chronic illnesses. That’s 40 percent of the country in need of health education and support.
Canary Health wants to fill that need. Kaufman shared the results of a Stanford-led twelve month, peer-review study conducted last year. The study showed Better Choices, Better Health - Diabetes lowered blood sugar, A1c values and hypoglycemia, increased medication adherence and exercise participation and improved depression - similar to that of the offline classes.
This largest study of its kind, with 1300 diverse individuals, showed the diabetes program works online as well as it does face-to-face.
Lorig, who led the study admitted, “Frankly I was surprised. We really didn’t know what the outcome would be taking the classes online.”
The science and art of health education
Multiple studies show online health education is beneficial, and, that it’s also a future we are slow to embrace. Medscape’s, “Patients Learn Chronic Disease Self-Management Online" cites the future of medicine is management of chronic disease... and... internet-based social support makes even novice internet users feel more supported and able than programs without a chat room.
Better Choices, Better Health programs, like the face-to-face classes, are six weeks long and share the same content through guided lessons with two peer-coaches. Participants create action plans based on what’s important to them and receive support from their coaches and fellow participants. People also benefit from the group support experience participants in classes enjoy by actively posting questions, concerns, experiences, feelings and advice on discussion boards and in group chats.
A look at how the programs work
As to why the programs work so well Kaufman insists, “It’s because Kate Lorig is a magician at patient activation.”
The magic according to Lorig is not that complex. If people believe they can do something, they probably will. If they don’t, they probably won’t. “So,” said Lorig, “we get people to believe they can do something, by getting them to do something right away.” The magic also comes from the power of social persuasion and people interacting with, and helping, others like themselves, which Lorig says is crucial.
As for covering five conditions in one program, Lorig credits her public health training which taught her to look at whole people and whole systems. Also, patients involved in her early work in arthritis were telling her, “This is a great (arthritis) program, but my cardiologist is telling me something else, or my diabetologist and cardiologist don’t agree! Help me!” Lorig says, “Putting health education into disease silos just doesn’t make sense.”
An investigation by Stanford and the University of Michigan revealed 80% of health behaviors are the same across most chronic conditions. Grouping diseases in one program makes enormous sense.
Tending to chronic illness means investing in people, not just pills
Oddly, or maybe not, Kaufman and Lorig share their biggest obstacle - getting companies to value and fund health education, both offline and on.
Only fifty to seventy-five thousand people a year attend the community-based classes which are available across the country. The programs are drastically underfunded. Lorig reflected, “We don’t yet have the collective will to trust something as simple as the power of education and community to create health. Meanwhile we don’t think twice about giving people medication for the rest of their lives which may or may not help.”
Kaufman shared insurance companies think in terms of health silos which makes sense for them from a market perspective, “But it’s not how people live.”
It’s been documented that health education and support lead to fewer doctor visits, fewer hospitalizations and trips to the ER, and fewer days in the hospital. ”That works out to several hundred dollars saved per person in health care utilization,” says Lorig.
Personally, I believe not everything works for everyone. Canary Health’s success rate is high: seventy percent of people who begin the program finish. That also means about thirty percent do not. Digital learning may not work best for them, whereas others may prefer its convenience or anonymity.
Either way, the case for digital health education is clear and compelling. The scalability and benefits of online programs, done well, are enormous - cutting runaway healthcare spending, lowering insurance costs, supporting and putting health back into the hands of millions of individuals and their families. With all this at our fingertips, my question is: What are we waiting for?
Note: Canary Health programs are available to employees through Kaiser Permanente, Blue Cross Blue Shield, Providence, the Veterans Administration, GEHA and New Mexico Department of Health. If you’re interested in offering program(s) to your employees, contact Adam Kaufman at firstname.lastname@example.org.
If you’d like to attend a group class that meets in your local area, check here. Programs are offered across the U.S. at low or no cost to individuals.
Disclaimer: I was not asked by Canary Heath or Kate Lorig to write this article nor am I being compensated.