Opportunity

Hypertension is high blood pressure over time, a condition that causes heart disease, stroke, kidney disease, and other severe health conditions. 

One in three Americans are diagnosed with hypertension, and although it can be easily controlled with medication, about 50 percent of people with hypertension are uncontrolled. This means they are aware of their condition but have not adopted the lifestyle changes or daily medications necessary to achieve controlled blood pressure. For employers in the United States, hypertension is one of the most expensive health conditions, mainly because of complications that result when left untreated.  

The traditional care model for hypertension requires patients to receive treatment for high blood pressure at a doctor's office, attend multiple visits to adjust medications, conduct repeat blood pressure readings, and participate in counseling. This process requires frequent travel and missing time from work to achieve blood pressure goals. Because of this intensive process, many patients struggle to remain engaged in treatment and ultimately don't gain control. 

In 2015, when this work began, we estimated that of Penn Medicine's 26,000 employees, 2,700 had uncontrolled hypertension.

Intervention

Penn Medicine's Employee Hypertension Program blends innovative care delivery with new technology and behavioral economics to help employees with uncontrolled hypertension achieve and sustain controlled blood pressure. 

Penn Medicine employees diagnosed with uncontrolled hypertension are referred to visit one of several convenient locations to enroll in the Employee Hypertension Program. During the initial visit, patients receive a treatment plan, prescriptions, an automated blood pressure cuff for at-home readings, and access to a dedicated hypertension nurse. After the appointment, a custom program supported by Way to Health enables patients to track blood pressure over time and receive counseling remotely.

In May 2021, the team introduced an automated chatbot to request and log blood pressure readings, triage measurements and participant messages, and provide scripted responses. When necessary, high blood pressure readings and messages requiring review are escalated to clinicians.

Impact

The Employee Hypertension Program drives better outcomes and improved patient experience. In year one, 94 percent of patients enrolled in the program achieved their target blood pressure within three months. And the program saved patients hours of time that would have been spent traveling to and participating in clinic appointments to manage their condition. The integrated chatbot, which accurately triages 99 percent of messages, has also reduced the burden on clinicians by escalating only the portion needing review – about one-quarter of all messages. 

A team of researchers from the University of Pennsylvania extended this work with a program called BP Pal to explore whether a similar program can improve blood pressure monitoring among primary care patients at Penn Medicine.