Connected Health Approaches to Improve the Health of Veterans

Nov 12, 2014, 1:00 PM, Posted by Mitesh Patel

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

The Patient Aligned Care Team (PACT) initiative has helped to facilitate much of this technology expansion. While these efforts significantly improved care coordination and reduced unnecessary health care utilization, little is known about using connected health approaches to change individual health behaviors such as those related to cardiovascular disease.

Behavioral economics is a promising field of study that leverages individuals’ tendencies to be “predictably irrational” to design interventions that change behavior. This means that the design of the incentive may often be more important than the magnitude of the incentive. For example, evidence suggests that when compared to a fixed payment with the same expected value, a lottery-based incentive is often more effective.

Connected health approaches that leverage concepts from behavioral economics could significantly improve the health of veterans through current and new VHA initiatives. A Culture of Health that effectively serves veterans would embrace connected health approaches and design interventions to test how they might best be utilized among this population.

There may be factors relating to variation in veterans’ adoption of connected health devices and the impact of these technology-based interventions on their health behaviors. For example, veterans have had prior experiences in service working as teams. They may be more accustomed than the general population to team-based support that builds upon accountability, trust, and unity toward a common goal.

Therefore, veterans may be more likely to participate in connected health approaches that embrace team-based designs. Future research could be designed to evaluate veterans’ adoption and engagement with connected health devices when participating as individuals or as part of a larger team.

Creating a Culture of Health among the veteran population requires that health systems are better designed to offer services focused on veterans’ everyday behaviors and build upon their existing support networks. Connected health approaches that leverage concepts from behavioral economics are a promising opportunity to improve the health of veterans on a national scale. Increased support and evaluation of such interventions will help develop new insights toward creating a Culture of Health among veterans.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.