Latest Project Plan: Connectivity for California Consumers (c-cubed)

Issue & Focus

  1. The California Healthcare Foundation is dedicated to the improvement of the lives of Californians managing chronic illnesses.
  2. There are many community stakeholders involved in supporting this goal; their work could be improved by making connections to each other that are meaningful for patients.
  3. This is part of a broader strategic plan to support the objective of involving patients and families in all aspects of their care. This is the identified gap to be closed through this work.
  4. California Healthcare Foundation is seen as catalyst and partner for patient engagement in California. It’s scope is 36,000,000 Californians

Current Condition

  1. All chronic conditions can benefit from better patient engagement
  2. Hypertension is a good example of one – recently published studies demonstrate both the gap and the opportunity with non-office-based approaches

Problem Analysis

  1. Divided into three areas : Clinical Gap, Technology Gap, Partnership Gap, that California Healthcare Foundation can connect partners to assist with
  2. Clinical Gap: Patient role in recognizing blood pressure out of control; currently this rests with the physician, in an office-based setting
  3. Technological Gap: Chronic disease assessment is typically performed in the office or medical setting
  4. Partnership Gap: Stakeholders (patients, payers, providers, connectivity providers) are not connected to patients and one another at the same time
  5. The societal costs of inadequate management are spread diffusely; few organizations are able to to see the total harm from this perspective

Target Condition

This pilot seeks to create a functioning ecosystem that supports chronic disease management across the lifecycle, with the best candidate being hypertension

Action Plan

We began by interviewing example employers, health care providers, and technology providers to understand which approaches and components appeared most promising. At this time, it seems most reasonable to approach this first from the employer perspective.

Next step will be to convene a group of potential partners in July, 2008, at California Healthcare Foundation, to discuss how pieces would fit together.

A presentation would be made to the CHCF Board in the fall, with funding and activity to begin in 2009.

Cost / Cost-Benefit / Waste Recognition

There are recognized wastes, which include unnecessary visits for blood pressure monitoring, inadequate medication therapy, and inadequate use of the health system, for patients who have not been seen in the past 12 months.

There are costs including, technology costs (although the goal is not to build anything new), and realignment of incentives to support non-visit-based care.

Followup / Unresolved Issues

Points of concern and planned countermeasures

  1. What is the metric for patient access? (Pacific Business Group on Health is working on an employee engagement survey; metrics for patient access to their health data may need to be developed)
  2. How can this complement the launch of both a P4P measure for blood pressure management, and a HEDIS “Relative Resource Use for Uncomplicated Hypertension” measure for 2008?
  3. Data for presenteeism and productivity loss does not seem intuitive (I have reviewed this in depth and we can bring in clinical champions to verify)
  4. Partners and aligned interests (will do due diligence to support cooperative business models of partners)
  5. How to engage patients in things like biometric monitoring and blood pressure control (there is data supporting patient interest in this monitoring, but most importantly will go to the factory floor, and will bring an employee/patient advisor on to the team)

That’s the latest script that goes with the story, more or less. Comment away, and keep in mind that each comment will change the A3 a little every time.


Hi Ted,

Just curious regarding Action Plan ("We began by interviewing example employers, health care providers, and technology providers"): What was the reason for not including consumers in the initial round of interviews?


Hi Josh,

Thanks for the clarification request. This refers to technology setups that were "consumer derived," "employer derived," "health care provider derived." As you can probably guess, looking at examples from each stakeholder produced a different product.

As you can see from successive posts, we're working hard to include patients as designers as well as users of the product, we wouldn't have it any other way,


Ted Eytan, MD