Introducing Sutter Sync, a digital care program designed to help patients monitor and manage health conditions at home.

It’s difficult to imagine a medical condition more common or more dangerous than high blood pressure. And yet, it is more responsive to treatment than most. So, why hasn’t more progress been made?

With fewer than 25% of hypertensive patients achieving blood pressure control nationwide, a new approach is necessary says Dr. Richard Milani, chief clinical innovation officer for Sutter Health.

“As we look at results, we’re increasingly confronted with the reality that good medical care is not just defined by what treatments or recommendations we provide, but also how we provide them,” he says. “The traditional healthcare model has asked patients to navigate a complex system, characterized by mostly in-person touchpoints, and little coordination or patient engagement between episodes of care. With new approaches to care we can offer something better.”

A New Approach to Chronic Disease Management

Sutter Sync is a new digital care program designed to offer patients an effortless healthcare experience — providing convenient tools and proactive support to manage their chronic conditions from anywhere — while ensuring connected, coordinated care with their primary care team. The program’s first focus is high blood pressure, or hypertension, initially providing a select group of eligible Medicare patients personalized guidance and real-time tracking of their blood pressure.

This is the first phase of a scalable program. Future expansions will extend Sutter Sync’s support to more patients and a wider range of health needs like diabetes and high cholesterol.

Digital Tools, Personalized Guidance

The Sutter Sync program for hypertension provides eligible patients with a top-quality digital blood pressure monitor. It automatically sends readings directly to the patient’s electronic health record. By taking regular, proactive blood pressure readings at home, patients can track their progress and receive insights tailored to their health journey.

“Patients can access Sutter’s My Health Online secure patient portal, from a smartphone or tablet, and see monthly summaries of their personal progress toward better blood pressure control, powered by data they helped collect,” said John Evans, vice president of digital care for Sutter Health. “They’ll also receive customized health guidance tailored to their needs, providing insights and tips to support healthier habits.”

Providers can access and act on the wealth of data, too.

A Smarter Way to Monitor and Act on Blood Pressure Data

Everyone’s blood pressure varies from day-to-day and from morning to night. It’s always been recommended that providers use multiple readings to establish a patient’s baseline and current level of control. But this was burdensome to do in the past.

“Having patients come into the clinic for a blood pressure reading is inefficient for both patients and providers,” says Evans. “Sutter Sync helps bridge the gaps between visits, ensuring that patients are engaged in their health while still maintaining an ongoing relationship with their primary care provider. This doesn’t replace in-person care, but rather provides additional insights and support that help primary care providers make informed decisions.”

In-fact, studies show that home blood pressure readings are more reproducible and better predictors of cardiovascular risk than those taken during in-person visits.

By capturing multiple real-world readings over time, the Sutter Sync team can determine whether a patient’s condition is stable, improving or deteriorating, allowing for better-informed treatment decisions. This also enables timely medication adjustments, without requiring an office visit.

Proactive Support with a Personalized Approach

While patients remain connected to their primary care provider, Sutter Sync serves as an extension of the care team. It offers additional support to help patients stay on track between visits. Primary care clinicians remain central to the patient’s care, with program insights seamlessly integrated into the electronic health record to inform discussions during in-person visits.

• If a patient’s readings shift outside of their normal range, they receive a personalized messages with guidance on next steps.

• When needed, the care team follows up to help manage medications or provide additional support.

“When providers are able to view the full picture of their patient’s condition, they’re empowered to deliver more data-driven, proactive care, which improves patient health outcomes and makes care more efficient,” said Dr. Milani.