Twine Health, which offers software to manage coaching programs for wellness and disease management, has had some pretty robust efficacy data over the years. For instance, a hypertension trial saw a decrease in systolic blood pressure from 26.3 mm Hg to 16.0 mm Hg, and a diabetes trial saw an average 3.2 drop in HbA1C with Twine’s coaching, compared to a 1.0 drop for a control group.

But even though – by all indications – Twine works, the company has stopped offering its coaching services to health systems for their patients. It now works exclusively with employer populations, though this does include some health systems that use the coaching with their own employees.

“It was not a sustainable business path,” Twine CEO John O. Moore told MobiHealthNews. “We were quite successful with a number of organizations at improving outcomes and decreasing costs and they did not have a desire to scale their implementations at all at that time. And it was mainly because they had challenges with getting it to mesh with their current business model. Their risk-based contracts are just not risky enough. They don’t have enough of an incentive to really do what, in parallel, we were seeing our workplace health providers do. So we said ‘there’s a dramatic difference in uptake here of Twine in these workplace health providers and ACOs, so we’re going to put all our effort into the workplace health providers’.”

At the Patient Engagement Symposium today in Boston, Chilmark analyst Brian Eastwood talked about the same issue in broader terms.

“Absent a shift to value-based care there are actually disincentives,” he said. “It’s still easier to present a short-term solution at the point of care rather than put the patient into a situation where there’s more ongoing longitudinal coordination.”

Moore says the company has been burned enough by ACOs  that they won’t work with hospitals in that way even when they ask.

“Right now what we do when they come to us — and sometimes they come to us and say ‘hey we want to focus on this population of non-employees’ — currently we say no,” he said. “We say if you want to learn to provide great value-based care, the environment where you can do it effectively is with your employees because you’re fully at risk for them. Anything less becomes incredibly complicated and many times perverse in terms of how you manage the economics of it. Because as long as you have some fee for service component there will always be a pull back towards high utilization, because it generates revenue.”

Plenty of organizations are taking them up on that offer to work with their employee populations, including St. Luke’s Boise Medical Center in Idaho. Twine recently released data about St. Luke’s implementation showing that the health system surpassed its annual goal for program participation for the year in just 45 days.

“Weight is our biggest category and right now our weight loss is tracking way ahead of what we planned,” Carmen Olderburg, wellness manager at St. Luke's Health System, told MobiHealthNews. “So that’s really exciting and the nice opportunity there is to continue to follow this group throughout the next year to see how they do in maintaining that weight loss.”

The data from St. Luke’s is encouraging, Moore said, because along with the company’s existing efficacy data, it will validate the program from start to finish. 

“That first stage of engagement that healthcare technology and similar programs really tend to struggle with is getting very, very low participation rates,” Twine Health Chief Marketing Officer Chris Storer told MobiHealthNews. “No matter what the outcomes, if the inflow isn’t what it’s supposed to be, programs like this can suffer before they even get off the ground. So we think that whatever outcomes are, utilizations and the ability to generate activity in the front end is just as important as the overall net result.”

With encouraging results across both outcomes and uptake, Moore says that in the future, they hope to be able to work with ACOs on their patient populations again. 

“Our approach is to always focus on the employee population with them, but it certainly is a path to help them understand and to operationalize value-based care so that when their next contract comes in and it reaches past that threshold where it’s really valuable to do value-based care, our intention is to be there to help them do that,” he said.