Introducing InquisitHealth: the proven power of peer-to-peer mentoring

My father has been serving the 10456 zip code in the South Bronx as a primary care physician for almost two decades. Forty percent of the people living in this zip code are below the poverty line.

Not surprisingly, he often sees his patients struggling with the pervasive, negative impact of the ‘social and behavioral determinants of health’(SBDoH) as he cares for their chronic medical conditions.

For his patients, taking care of their health is not always their highest priority.

For example, one patient with diabetes worries more about finding his next meal than that meal’s carbohydrate content. One mom is more stressed about her child’s custody battle than keeping up with her thyroid medications. Another worries more about not being able to pay his rent than missing a cardiology follow-up appointment (because he can’t afford the copay).

Lifestyle changes are key to successful chronic disease self-management.

But making and sustaining those changes isn’t easy— especially if complicated by any of the social and behavioral determinants of health.

Life expectancy is driven by zip code.

In fact, if you live in some zip codes, you may live over 20 years LESS than people living in other zip codes. And this variation exists right here in the US.

This is super concerning.

An individual zip code can represent a myriad of potential constraints and challenges, suggesting a compelling case for why people might experience poor health — regardless of the skill, compassion and dedication of their physicians and nurses.

Fortunately, this is all correlation. Not causation. Not deterministic. And definitely not the way it needs to be.

Importantly, not everyone in a zip code with a chronic disease struggles with managing their health. There are many positive outliers — patients who have also faced similar challenges and found a way to be successful.

Can these ‘positive outliers’ help guide others to the same success?

Peer-to-peer mentoring: the evidence base

In 2012, the Annals of Internal Medicine published impressive results from a peer-to-peer mentoring randomized clinical trial.

Researchers from the University of Pennsylvania (UPenn) identified patients who had poorly-controlled diabetes, as evidenced by an HbA1c>9%.

Some patients with poorly-controlled diabetes were randomized to the control group where they continued to receive (1) their ‘usual care’ from their physicians and nurses. Others with poorly-controlled diabetes were randomly assigned to the intervention arm where they received (2) 1-on-1 coaching from ‘peer mentors’ in addition to their usual care.

These peer mentors were not professionals. They lived with diabetes, too. In addition, they shared the same race, gender, ethnicity and geography as the patients (or, more appropriately, the peers) they were paired with.

Peer mentors developed trusting, empathetic relationships with their peers through regular 1-on-1 telephonic interactions. They truly understood the challenges their peers were facing (since they experienced them too) and helped them set goals towards better diabetes self-management.

After 6 months in the study, the control group experienced only a 0.1-point reduction in HbA1c from baseline; clinically and statistically insignificant.

However, the patients receiving peer mentoring experienced a 1.1-point reduction in HbA1c; this was both clinically and statistically very significant since a 1-point reduction in HbA1c translates into a 40% reduction in costly complications — e.g., prevention of amputations, heart attacks, etc.

This was huge.

This talented team of physicians and researchers at UPenn had proven via randomized clinical trial — the gold standard of medical research — a compelling solution to a very thorny driver of health care cost in our country. This approach improved patient outcomes by inspiring sustainable lifestyle changes while addressing the underlying social and behavioral determinants of health (SBDoH).

A year later, there was another compelling study at the University of California San Francisco (UCSF) — also a randomized clinical trial — that found the same amazing result: 1.1-point reduction in HbA1c for patients in the peer mentoring group vs. just 0.3-point reduction in the control group.

I had the great fortune of being an MD-PhD student at the UPenn during this time. As part of my thesis, I was analyzing how patients made important decisions about their own health — the interplay of motivation, knowledge, literacy, beliefs, data, access, and stigma.

This was a vexing problem to untangle. And literally in my backyard was a groundbreaking trial with a very real, practical solution that worked.

My immediate thought: this is going to change the entire paradigm of how we tackle chronic diseases in our country — and the world!

I am a bit of an idealist 🙂

These amazing studies did garner great press, but the buzz did not last.

Once the grant money was done, and the papers were published (albeit in top peer-reviewed journals), everyone went back to their day jobs. Even the trained network of dedicated peer mentors was disbanded.

As far as research was concerned, the job was done.

This was frustrating. This worked— proven by 2 independently-conducted randomized clinical trials led by incredibly talented clinicians and researchers with results published in top-tier peer-reviewed journals!

This gap between research and implementation needed to be filled!

InquisitHealth was born.

We assembled a great team of clinicians, operators, and technologists to translate these evidence-based peer mentoring protocols into turnkey, technology-enabled peer mentoring programs that delivered results.

We raised over $4.2M in funding from the National Institutes of Health (NIH) and many great investors.

And we closely collaborated with the incredible researchers and clinicians at UCSF, UPenn, UMich, UNC, WashU, and other great universities who led many of the original peer mentoring studies — not only for diabetes, but also asthma, cancer, hypertension and more!

Together, we built (1) robust training programs for peer mentors — designed to provide chronic disease knowledge and develop coaching skills — to help them channel their own success managing a chronic disease to help others empathetically; (2) technology platforms to allow this ‘distributed workforce’ of peer mentors to match and work with patients and deliver 1-on-1 structured, yet personalized, interventions through HIPAA-compliant phone-, text-, and smartphone-based mentoring; (3) administrative tools to manage outreach, provide mentor oversight, and ensure that each interaction is delivered with fidelity and optimized to improve clinical outcomes.

Technology helped us scale a high-touch, human-powered, empathy-first intervention to deliver consistent, sustained real-world results.

Back to the South Bronx

In 2014, we launched our first commercial diabetes peer-to-peer mentoring program in the South Bronx — zip code 10456.

My father recommended our first cohort of peer mentors from his practice, e.g., a 62-year old African American part-time filmmaker, 42-year old electronics store clerk from the Dominican Republic, and a 78-year old retired school teacher from Puerto Rico.

Each mentor had overcome their own personal battles with diabetes and had figured out — for example, what (ethnic) foods to eat and how to prepare them to avoid spiking their blood sugars yet having them still taste good; how to get medications easily and regularly (home delivery, discounts, etc.); where to exercise (in safe parts of their neighborhood), and more!

Peer mentors figured out “self-management” in the context of their own micro- socio-economic environment and cultural realities, and were then able to share these insights with their peers.

And it worked, even better than the original trials!

Recent analysis of our diabetes peer mentoring program across all commercial, Medicare and Medicaid populations demonstrated an average 1.5-point reduction, across patient populations, ethnicities, and geographies!

Zip codes are no longer driving health.