In 2022, Kannact decided to align with HEDIS to measure performance. We selected a cohort of 694 active participants for which we were able to measure their health state over 2 consecutive years. We evaluated 1344 goals from those 694 participants. We give our coaches 12 months to achieve these goals with the participants. 72% of those goals were met.

Measuring Outcomes: HEDIS

During 2022, we decided to align our way of measuring outcomes with the Healthcare Effectiveness Data and Information Set (HEDIS) created by the NCQA. HEDIS is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service. HEDIS is the national standard applied by hospital systems, clinics, Medicare, and private insurers for measuring healthcare outcomes.

Why did we pick HEDIS? Standardization makes comparisons easier so picking a national standard was important to us. Picking a strong standard helps guide who we coach and what our coaches focus on. It is updated yearly, combining the latest scientific evidence with the gaps in care in the US.

The Cohort

We selected 694 participants with chronic conditions to evaluate the progression in their health state. The criteria were:

• Had the biometric data to be evaluated on any HEDIS measure for two consecutive years.
• Active in 2022.

What did the cohort look like? The typical participant within this cohort:

• Had 4.5 chronic conditions
• Has done 19 coaching sessions.
• Has taken 609 readings since they joined the program.
• Has been actively coached for almost 3 years.

It's also inspiring to see how engaged this cohort was, in particular:

• In any month, 2/3 of them chose to have a coaching session.
• In any month, 2/3 of them had an upcoming appointment.
• 80% of those appointments ended up in a coaching session.

Goals for this case study

For this case study, we look at the following key outcome goals for our chronic population:

• HbA1c control:
  • Eligible: participants with diabetes
  • Goal: HbA1c under 8%.
• Blood pressure control:
  • Eligible: participants with diabetes and/or hypertension
  • Goal: blood pressure under 140/90
• Adherence to statin medication:
  • Eligible: participants with cardiovascular disease, hyperlipidemia and/or diabetes
  • Goal: adherence (Proportion Days Covered) over 80%

For each goal, we split participants into two categories:

• Maintain. Participants who were already adherent to the goal in 2021, are put into the Maintain category.
• Improve. Participants who were not adherent to the goal in 2021, are put into the Improve category.

Given our changing population of active users, we report goal completion by category (improve/maintain). That way, our performance can be compared across different cohorts, which might have a different proportion of more and less severe cases.

Outcomes

78% of people with HbA1c goals and 81% of people with blood pressure goals succeeded in passing their goal. However, only 44% of people with statin adherence goals passed. Poor performance on medication adherence is not surprising and we will talk in future posts about the improvements we have since made in data quality in order to both better track and achieve medication adherence goals.

Thinking in terms of goals is very helpful, as it makes it easy to compare across outcomes and cohorts, but it does not give us all the information. In particular, for those that had an elevated HbA1c score and did not bring it down under 8.0, what happened? Examining the trends in the biometrics themselves helps us see the impact we had.

In the trends, we can see that HbA1c decreased by 1 point on average for participants that needed to decrease it significantly (over 9). HbA1c decreased by 0.5 points on average for participants that needed to decrease it (over 8, under 9). Participants that needed to maintain their HbA1c score, maintained it under 7, on average.

In these trends, we can see that Blood pressure decreased by 16 points on average for participants that needed to decrease it. Participants that needed to maintain their blood pressure did so, on average.

Participant Feedback

After every call participants have the option to provide feedback on their coaching session. Participants can grade their coaches on a scale of 1-thru-5 and have the option to expand / provide written feedback. Kannact introduced this survey at the beginning of August and received 1047 responses by the end of the year with an average satisfaction score of 4.85 out of 5. And the comments that our participants left in response to the survey?

• 8.31.22 “I love Celeste! She’s really helpful!”
• 8.31.22 “My coach was very helpful getting me set up. I appreciated her help, she truly does a great job.”
• 9.1.22 “Richard is always great to help get me taken care of.”
• 9.2.22 “My coach is knowledgeable and she has helpful options for me. I enjoy my visits with her.”
• 10.6.22 “Very kind, knowledgeable, and not judgmental.”
• 11.12.22 “Celeste is always positive and helpful with ideas to help me with my concerns.”
• 12.9.22 “I am so excited to read the information that Richard gave to me. I appreciate his help.”
• 09.26.22 “I love the feedback and interaction I receive with Rayanna, I look forward to our calls.”

Conclusions

Good reporting is not about getting good grades, it's about revealing the truth. As a coach-led health program backed by a team of technologists, we have the benefit of being able to rapidly evolve both our coach training and the technology platform, our in-house EHR that our coaches use. This allows us to constantly improve our care delivery and the speed can sometimes be a bit dizzying. Data from a year before can already feel obsolete. We've integrated all new data sources (prescription fulfillment networks) to better monitor medication adherence and we've revamped the way coaches view that information. What was a gap just one year ago is rapidly becoming a strength.

That being said, we are extremely proud of the impact we made in 2022 and in particular of the impact shown in this study. Bringing our at-risk cohort down from an average HbA1c of 10.2 to 9.1 has made a dramatic impact on the health of those individuals. Reducing the average blood pressure from 149 to 133 for those with high blood pressure is also a job well done. Equally important, however, if not more so in the long run, is those who stayed healthy. Maintaining HbA1c and blood pressure under control for 87% of our participants, participants that have been with us for several years, is an accomplishment that we are also extremely proud of. Long-term health depends both on improving scores and maintaining that improvement for years.

Which is why we're so excited to see how all these participants do in 2023 and, with their health coach by their side every step of the way, why we're so confident the results will be even better.