Natalie Hodge is a board-certified pediatrician and has been serving children for more than 20 years in St. Louis and Paducah, Kentucky. Her experience has given her insight into the difficulties of behavior change and the importance of maintaining a simple strategy to improve health. Along with public health advocate Brandi Harless and tech entrepreneur Jay Campbell, she founded Personal Medicine Plus to help patients create “a personal health feedback loop for real behavior change.” From their headquarters in rural western Kentucky, CMO Hodge shares more about their digital health innovation:


What is the mission of Personal Medicine Plus? What problem are you working to solve?
Our mission is to end lifestyle diseaseWe are trying to delay onset of diabetes and hypertension in underserved and at-risk populations by changing the behavior of our patients—both teenagers and adults—on an hour-to-hour basis as they go about their day. We are talking about a group of people who rarely have a glass of water, who have never had any veggies to eat aside from French fries, and who are completely sedentary, taking less than 1,000 steps daily.

What is your solution and how does it work?
We use iOS and Android platforms to deliver our software to patients. Physicians or care managers “prescribe” the software and help patients download the software in their offices at the point of care. Once the software is on the phone, this simplifies the conversation and counseling around behavior change. Behaviors are clearly tracked on a dashboard with a gamified interface that’s engaging and fun for patients to use. The goal is to “get your screen to green” by the end of the day. Three health behaviors can affect 80 percent of healthcare costs: Water intake, fruit and veggies intake, and daily steps. Three simple behaviors. Our software flows data from connected health devices to simplify use and reduce user data inputs. It gathers data from home scales, blood pressure cuffs, and blood sugar monitors.

What resonates most with patients?
I tell patients the first step in improving your health behavior is to track your health behavior. Then, I tell them this is health industry software, not a consumer application. I give them my coupon code that identifies my population. And I tell them their use of the software connects to a population health dashboard that I can see, tracking the entire patient group’s every step and their every weight—as well as their nonuse of the software. Patients’ eyes get really big at that point, and I like to use the analogy of the Wizard of Oz behind the curtain, or even “big brother” for parents. This adds in the piece of accountability for patients that is missing when consumers use a pure consumer software play. The messages are: “My doctor daily wants me to do this” and “This is how I’m going to accomplish these goals.”

What are the pros and cons of being based outside Silicon Valley?
We come from a deep understanding of this population’s daily lives and routines. We are not a Silicon Valley consumer app which started and iterated with the needs of the affluent millennial or educated PhD researcher. Our intensive user facing design work that went into the development of the software started here. A 12-year-old from my practice said, “Make it work like Candy Crush, and I’ll use it.” So that’s how we started. Android is the clear winner among this population, and we understand how they use their phones, and what it takes to get our software on it. The implementation within this population is absolutely the hardest part. This is what makes the physician implementation so key. Here people would otherwise never download a consumer app. But they will do what we tell them. However, we are at a clear disadvantage when it comes to raising capital. Hundreds of millions of dollars are being raised on the coasts, and we need investors who can bring both expertise and capital to the table. Also we are a two-woman founder company, which brings its own bias in and of itself. A rural two-woman founder company is at an even deeper disadvantage.

Where are you in the development process? What are your immediate goals and challenges?
We have bootstrapped and self-funded all the way through to complete iOS and Android versions, with internal research showing increases in health activation and patient engagement through use of our program. We have iOS and Android versions available for piloting and clinical research by health systems and integrated physician practices. Our current focus is development and iteration of the population health version of the software, which enables visualization, data, and outcomes reporting to CMS and other stakeholders. Implementing clinical decision support intervention software in the underserved population requires a special clinical approach, understanding of these folks as consumers, and technical knowledge. We have spent the last year learning about and overcoming the many barriers to both getting the software on patients’ Android phones and getting patients to use it on a daily basis. This learning is the key to a true prevention approach—and to the greatest cost savings.

What projects and partnerships are you working on now?
We have a number of clinical research projects in progress with academic centers and health systems. We are finalizing 12-week pilots with our Pioneer Physician groups, which have been implementing our solution in their prediabetic and prehypertensive at-risk patients over the past 12 weeks. We have a great cross section of pioneers, including cardiologists, family practitioners, OB’s and even ER physicians piloting our software and writing up case studies on their patients. We are thrilled to see such deep interest in prevention and reversal of early disease among our physician leaders. We are also excited to be a part of the StartUp Health ecosystem and to have connected with XLerateHealth for strategy, implementation, finance, and technical expertise.

What are your next steps?
We are in the early stages of certifying with ONC as an EMR module for clinical decision support intervention. Certifying agencies are on standby for the final reporting period to be over at the end of this May. ONC will finalize testing criteria by the end of the second quarter. We expect full certification by fall. Actually, I am tracking several of the testers now remotely, and they are just waiting for the green light from CMS. So we will actually meet criteria for meaningful use phase 3 by the 2016 deadline.

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