In the past, healthcare and public health were considered parallel fields, with healthcare focused on the health of individuals and public health concentrated on the health of populations. But a transformation is underway. Healthcare is evolving to understand the importance of community-level factors in individual health and has started incorporating population health strategies. Still, more can be done, especially for Medicaid and Medicare plans tasked with improving the health of vulnerable populations. 

By embracing two strategies inspired by public health methodologies—video directly Observed Therapy (video DOT) and the Cascade of Care framework—Medicaid and Medicare health plans can move beyond a purely clinical focus, fostering a more holistic, proactive, and community-centered approach to healthcare.

In a recent presentation at the New York Health Plan Association Annual Conference & Expo, Sebastian Seiguer, CEO and Co-Founder of Scene Health, outlined how video DOT and the Cascade of Care framework are foundational to Medication Engagement. He detailed how Scene's solution can enable Medicaid and Medicare health plans to translate the success of these public health strategies to their member populations. Solving the problem of medication nonadherence is one of the most direct ways that health plans can improve member health.

Video Directly Observed Therapy

Sebastian began with an overview of Scene's first public health-based intervention, video DOT. Scene's video DOT uses asynchronous video technology to scale and enhance Directly Observed Therapy (DOT), a formal process in which a healthcare provider directly monitors a patient's receipt and use of medications in person.

DOT has been around since the 1960s and was formally recognized as the standard of care for tuberculosis treatment by the World Health Organization in 1994. Since then, the practice of DOT has gained significant traction among public health departments for treating tuberculosis despite high workforce demands and costs.

Scene's video DOT removes the workforce burdens of in-person DOT and allows for significant cost savings by enabling healthcare professionals to monitor adherence remotely and engage with patients despite distance and cellular service limitations.  

The Cascade of Care framework

Next, Sebastian covered the Cascade of Care framework. The framework is based on the HIV care continuum, a public health model that outlines the steps or stages that people with HIV go through, from diagnosis to achieving and maintaining viral suppression through care and treatment with antiretroviral therapy or ART. 

The Cascade of Care framework promotes adherence across sequential stages to achieve successful treatment outcomes. This approach helps members progress by delivering care and resources tailored to each person’s needs at each stage. The strategy underscores the importance of understanding and addressing the underlying social determinants of health influencing whether patients can adhere to their treatments. It also considers that improved outcomes rely on more than just adherence but an account of whether the treatments work for the patients.

In Scene's program, this framework encompasses outreach and education, linkages to care, and clinical interventions. This multi-level approach ensures that patients are educated about their conditions, connected to necessary resources, and supported through pharmacist-led comprehensive medication reviews and video DOT.

Translating public health strategies to health plans

Sebastian concluded the presentation by highlighting how health plans can benefit from adopting Scene's program for their members. With minimal investment, health plans can utilize video DOT and the Cascade of Care framework to enhance quality, clinical, and financial metrics, as well as the overall member experience. Scene's success in improving possession quality metrics, provider visits, lab and testing value capture, and overall clinical outcomes is valuable for health plans aiming to make a positive impact, improve member outcomes, and contribute to the well-being of the populations they serve.

Contact us to learn more about our approach to medication engagement and how we partner with organizations across the healthcare landscape to inspire better health.