The Brightest Minds Speak Up

Dr. Hilary Hatch brings her background in clinical psychology to lead the development of clinical programs for an automated platform that manages 70 million patient intakes annually. Dr. Hatch is passionate about using every contact with patients to prime them to become partners in their own care. Prior to joining Phreesia, she founded and served as CEO of Vital Score, a digital health company that helps patients self-identify their health goals and barriers to care in order to drive their own care planning. Informed by Motivational Interviewing, an evidence-based therapeutic technique, Vital Score developed Motivational Indexing®, a method for anticipating patients’ motivations, needs and barriers to care. Phreesia acquired Vital Score in 2018.

Dr. Hatch holds a doctorate in clinical psychology from the City University of New York, a postdoctoral certificate in psychoanalysis from the Institute for Psychoanalytic Education at the NYU Langone School of Medicine and a B.A. from Columbia College. She is a nationally recognized speaker on patient engagement and an instructor at Johns Hopkins and NYU Langone School of Medicine. At HIMSS19, she spoke with thought leaders about ways to prove a return on investment for addressing social determinants of health.

HIMSS: How did you develop an interest in combining psychology with digital health innovation?

Hilary: I began my clinical psychology career in public health, working for the New York Board of Education on drop-out prevention among kindergartners and then with Bellevue Hospital in pediatrics and adolescent medicine. It was a very integrated model between behavioral and social behaviors and primary care.

These foundational experiences formed how I thought about psychology -- always in the context of medicine and education. After getting my PhD, then post-doctoral work in psychoanalysis and 15 years of private practice, I was working with doctors at Johns Hopkins and asked, “Can’t we find a way to work with patients in the waiting room?” That developed into Motivational Interviewing as a way to engage patients in becoming the author of their own treatment plan. We later developed that into an app with Vital Score, which was acquired by Phreesia.

HIMSS: What do you see as the most pressing needs on the healthcare horizon?

Hilary: Half of patients are non-adherent to their medications. We have to stop blaming patients and penalizing providers and take a systemic look at the problem.

Healthcare is still largely “medical care.” Yet patients present with an array of health needs, such as depression, housing or food insecurity, social isolation, addiction and family or neighborhood violence. These are problems medicine doesn’t solve, but hospitals, EDs and doctors’ offices are overrun with social and behavioral-health visits and admissions. Physicians are increasingly aware of how this interferes with the delivery of medicine.

As a psychologist, when my patient is “non-compliant,” I see it as a shortcoming of the treatment, not the patient, because engagement is the treatment. Non-adherence is often a misalignment between providers and patients about health goals, or a lack of awareness of the barriers the patient faces.

I am passionate about strengthening the humans in healthcare: priming patients to be partners in their care and easing the burden on providers to address the overwhelming unmet needs of patients with complex behavioral health and social needs.

HIMSS: How do you think digital health technology can address this problem?

Hilary: Studies show that medical care accounts for only about 10 to 20 percent of the modifiable contributors to healthy outcomes for a population. Genetics is also a substantial factor, but as much as 60 percent of outcomes are influenced by social determinants of health — the economic, social and environmental conditions that influence individual and group health outcomes.

With value-based care, we just can’t ignore the facts in healthcare anymore. Social determinants are getting attention now, but healthcare technology is lagging, not leading. We need scalable methods to understand patients better. How can we extend and improve people’s lives if we don’t know what they are living for?

Personalized medicine addresses patients’ medical needs in the context of their social and behavioral-health risks and prioritizes their personal health goals. Precision medicine aims treatment at the individual’s genetic code. But personalized, patient-driven medicine aims treatment at the person’s motivational or psychological code.

In our current healthcare environment, before a typical visit, a provider might see data like this, with no context:

May, 66 years old: A1C = 9; BP = 140/90; last mammogram = 3 years ago; BMI = 35. Reason for visit: twisted ankle.

But what if the provider’s questions revealed this context: May recently lost her job. She’s the breadwinner for her three adult children, so now their housing is at risk. She didn’t fill a recent prescription because she wasn’t sure it would be covered by insurance. She’s here today because she’s worried her twisted ankle will keep her from being able to look for work. In this case, May’s barriers to care are driving non-adherence.

Or what if the provider’s questions revealed these details: May lives with her husband. She doesn’t understand what some of her medicines are for and thinks she probably doesn’t need all of them. She’s really bothered by her lack of energy and has been skipping her neighborhood walking group. Her twisted ankle is another setback. In this case, May doesn’t think her medications are aligned with what matters most to her.

Digital technology can help us gather this kind of patient-reported data. Patients are the experts. No one knows better than the patient what matters most to them and what barriers they face to better health.

HIMSS:  What do you see as the most important new innovations in digital health?

Hilary: The patient is the ultimate silo of healthcare data. We need to break down those silos and capture that data individually and collectively, as we would any other piece of critical health information.

What if we could really learn to anticipate patients’ motivations, needs and barriers to health and incorporate those [factors] into personalized treatment plans? It might not only change adherence -- it would fundamentally transform “medical care” into “health care.”

I see organizations and thought leaders making much bigger bets on directly engaging with patients. They are ready to go for it. They have spent the last five years optimizing “provider-driven quality”— trying to improve quality and outcomes by changing provider behavior. They have hired armies of care managers and outreach teams. They’ve found success, but they’ve hit the limits of those models.

There is no specialty in medicine that isn’t grappling with the challenges of patient engagement. How do I get my patients to come in when they need to and not come in when they don’t need to? How do I get patients to follow their treatment plan? How do I predict when they are not going to follow their plan? How do I alter the plan to fit the patient? Patient engagement problems have become business problems.

We ask patients what matters most to them, what barriers they face and what outcomes they seek, and we help providers get that information so they can act on it.

HIMSS: How have you collaborated with HIMSS – and what value have you seen?

Hilary: The HIMSS Innovation Committee has given me the opportunity to create a dialogue with leaders around the country on the social determinants of health and the consumer healthcare experience. These conversations among medical leaders, payers, policymakers and technology companies are the basis for change.

HIMSS: Anything else to share with healthcare leaders or developers?

Hilary: I think that in the next 10 years, we’re going to see patients take a lot more control of defining the healthcare they need. This, in turn, will fundamentally change the healthcare offered.

This is a pivotal moment for healthcare leaders. They’ve come a long way in optimizing what providers can do to help change patients’ behavior (i.e., taking their medications, getting a mammogram, or whatever is deemed the standard of care). But they’ve focused on building a bigger workforce to address patients’ needs, rather than working directly with patients and engaging them in their care. 

For developers, we need a better user experience for both providers and patients. Going online to book a flight is so much easier than doing anything in healthcare. User experience is incredibly poor, and we just accept that, because healthcare is not a consumer-facing industry. That’s going to change. I’d also encourage developers to focus on improving the clinical team’s experience, just as they do with the patient experience.