Healthcare Providers Use New Strategies, Technology to Make Meaningful Connections

New York City's Mount Sinai Health System is launching a digital health program aimed at relaying teenager-friendly messaging for teenagers at risk of type 2 diabetes.

It's never easy to communicate with a teenager—just ask any parent. But care providers at the Mount Sinai Health System are making that connection with a new digital health platform aimed at young adult at risk of developing type 2 diabetes.

The New York City-based health system is partnering with digital health company mPulse Mobile on a digital health engagement platform that meets teens where they want to be met and gives them access to resources focused on education and prevention.

The key to engagement, say researchers, is involving teens in the planning process.

"We did a lot of the buy-in work early on," says Nita Vangeepuram, MD, MPH, a pediatrician, clinical researcher, and assistant professor at Mount Sinai's Icahn School of Medicine. "We turned the program on its head a little bit and decided, why not ask them for their thoughts and how to make this work? I don't know if that's been done before."

Type 2 diabetes was once thought to be an older person's disease, while Type 1 diabetes was called pediatric diabetes. Type 1 is genetic, while type 2 develops over time, often due to a predisposition toward diabetes combined with bad diet and exercise habits. More and more teens and young adults, however, are becoming type 2 diabetic. According to the National Health and Nutrition Examination Survey (NHANES), one in every five teens and one in every four young adults can now be classified as  prediabetic.

Put those teens and young adults in an underserved population, such as East Harlem, and the risk increases. Between one-third and one-half of the teens in that area are prediabetic. Access to health resources, including digital literacy education, telehealth technology, and even in-person primary care services, is more complicated.

"We actually don’t know what's going to work," says Vangeepuram, who's been working on the program for the past few years and is eager to start collecting and analyzing engagement data. "We know that what's been tried in the past hasn't worked, and pediatricians are struggling. It's time to recognize that the patients here are the experts."

Making the Message Matter

Those experts are telling Mount Sinai's care teams how they want to communicate. For example, Vangeepuram says the teens involved in the early part of the program prefer texts, rather than either an mHealth app or social media. And while automated messages are good to get certain points across, they still want to talk to real, live care providers, either in person or virtually.

"We're seeing that there's some balance that needs to happen," she says. "Not all of the interactions can be automated; there has to be some interaction."

Vangeepuram and her colleagues are being specific in how they tailor the program. Choose the wrong medium or message, and teens won’t be interested in collaborating with the care providers on better lifestyle choices, and the advice will fall on deaf ears. They also won’t be interested in a generic, cookie-cutter approach that uses the same message for everyone.

"This is why research and behavioral science are important," Vangeepuram says. "You have to understand what works and what doesn't. And you do it by telling a story … that engages them."

Teens helping to develop this platform preferring texting over social media and apps surprised her in a way. So much of today's teen culture is wrapped around social media and apps that it just seemed natural to follow that route. They weren't interested in sharing photos, either.

"They prefer messaging, and goal-setting is extremely important," she says. "They want to be involved in the process."

Making Prevention a Priority

Programs like Mount Sinai's hold significant promise for value-based care because they target chronic disease prevention, alongside health and wellness. According to the Centers for Disease Control and Prevention's National Diabetes Statistics Report, some 37.3 million Americans, or more than 11% of the population, have been diagnosed with diabetes, while another 96 million people aged 18 and older are classified as prediabetic.

The American Diabetes Association, meanwhile, notes 1.4 million Americans are diagnosed with diabetes each year, and that number is going up. Also increasing are the costs to treat people living with diabetes: $327 billion in 2017, with $237 billion tied to direct medical costs. This means a person living with diabetes spends 2.3 times more on healthcare than someone without diabetes.

Due to the nature of type 2 diabetes, which can be avoided through better diet and exercise, healthcare organizations are planning and launching diabetes prevention programs (DPPs), which funnel in-person and group counseling with targeted resources aimed at helping people live a healthier lifestyle.

Federal officials have also gotten involved. The National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Disease (NIDDK) developed a DPP model in the 1990s. The Centers for Medicare & Medicaid Services (CMS) used that model to create the Medicare Diabetes Prevention Program (MDPP) in 2018, enabling care providers to qualify for Medicare reimbursement for diabetes prevention services.

The program has been met with skepticism, with critics arguing that it isn't reducing costs or keeping a measurable amount of the prediabetic population from developing diabetes. The main problem is that few health systems are launching or supporting DPP programs, and despite intense lobbying, CMS has not expanded coverage to include virtual programs.

Proving the Program's Value

Vangeepuram says Mount Sinai will be looking at engagement metrics with this program. She wants to see that teens are getting these messages and responding to them and interacting with their care providers, and she wants to see that these actions help teens improve their health and reduce the chances of developing diabetes.

For now, they'll be rolling out the digital health platform, looking for engagement, and making any tweaks necessary to improve the process. They'll be working closely with not only primary care providers and diabetes educators, but with the teens, themselves.

Eventually, Vangeepuram says, they'll launch a clinical study, which will look to tie engagement into clinical outcomes. Those numbers might help state and federal payers, like CMS, to show more support for the program. They could also be the catalyst to scale the program out to other populations and target other chronic disease or health concerns.

After all, if you can connect with a teenager, you've made quite an accomplishment.

"It's better to teach them to be healthy, and that part isn't really complicated," she says. "You have to make sure that they're listening. That's the hard part."