ImagineCare: Empowering Patients with Behavior Change Science and Advanced Technology

Dartmouth-Hitchcock sought a truly proactive and patient-centric digital solution that allows clinicians to monitor and care for patients remotely and continuously, without a visit to the hospital.

  • Imagine a hospital that doesn't want you to visit.
  • 20% reduction in the total cost of care
  • 23% reduction in emergency room costs
  • 95% patient satisfaction rating
  • $298 reduction PMPM (per-member-per-month) in total care

Creating a Hospital That Doesn't Want You to Visit

Nate Larson hit the nail on the head when he said, “Imagine this, creating a hospital that doesn’t want you to visit. Not because we don’t care, but because we do.” Larson is chief experience officer at Dartmouth-Hitchcock and was instrumental in the ImagineCare project – a bold, new 24/7 digital-enabled health center and integrated mobile health solution. As a world-class leader in population health management, renowned for providing value-driven, evidence-based care in accessible ways, Dartmouth-Hitchcock sought a truly proactive and patient-centric platform to provide mobile-enabled patient services. Larson turned to Mad*Pow to help conceive, design, and develop a revolutionary set of mobile and web applications to support ImagineCare and disrupt healthcare as we know it.

In its simplest description, ImagineCare is a virtual solution that allows clinicians to monitor and care for patients remotely and continuously, without a visit to the hospital. The solution was shaped by Mad*Pow’s classic research, design, and development process, all informed by our world-class behavior change team. ImagineCare harnesses and analyzes data to inform clinicians. In tandem, solid experience design work set out to “delight” both patients and the medical professionals staffing the virtual clinic. As one user put it:  ”This is not a technology solution, but really a human solution enabled by technology to help people self-manage.”

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M*P: ImagineCare would combine mobile devices, Bluetooth sensors, and a 24/7 telehealth clinic.

Refining the Vision

ImagineCare kicked off with an abundance of passion, with Mad*Pow pulled in to translate passion to product. Central to the project: Making the customer's health goals the core requirement. The ImagineCare team had lots of great ideas and strong clinical expertise, but they needed help determining how customers and clinicians would interact via the service. Mad*Pow conducted extensive stakeholder interviews, then a design workshop with clinicians, product managers, and executive leadership, to help get everyone on the same page and start visualizing their ideas as tangible.

“ImagineCare had a lot of wonderful ideas when we first started about what we thought the design experience should be,” Larson said. “Through (Mad*Pow’s) testing and listening to consumers we realized they didn’t need those things.”

Someone to Watch Over Me

The customer iOS app provides patients a quick overview of what they need to do each day and how they are progressing, using Bluetooth to connect customers’ phones with ImagineCare-provided sensors like blood pressure cuffs and weight scales. These remote sensing tools provide support for activity, steps, sleep, and behavioral health, as well as management of hypertension, CHF, COPD, and diabetes. Data is transmitted securely to the cloud, where it is analyzed by clinical pathway algorithms. If any serious trends emerge, ImagineCare clinicians are alerted and reach out to the customer via their preferred method of contact. While the initial pilot targeted a specific set of conditions, the ImagineCare solution can be expanded to monitor almost anything that a patient can measure.

A Direct Line to Care

Through the app, customers have an open line of communication to the ImagineCare clinical team 24/7 via chat, video call, or phone call. A trained team of health navigators provide technical support, health coaching, motivational interviewing, and general customer assistance. On-staff registered nurses provide professional care to resolve customers' needs over the phone, or to help find external support.

This ease of access allows small touchpoints to accrue to a strong relationship with the ImagineCare team, which leads to better overall care. This platform presents care teams with unprecedented access to new information as they make decisions on engagement and care. By mapping health data through custom-designed, evidence-based care pathways, with EHR integration capabilities, ImagineCare leverages automation and predictive analysis to enhance the overall care experience – without letting them take the place of human support.

Again, according to a user: “ImagineCare divides the labor smartly. Letting machines do what machines are good at and letting people do what people are good at.”

Seeing the Whole Person

“The real-time interaction with the ImagineCare team makes me feel like someone is looking out for my health and best interest.” – an ImagineCare patient

The app’s robust profile section and daily questionnaires help ImagineCare gather a wide variety of information from patients and enhance it gradually over time. The focus isn’t just on medical data – the ImagineCare team builds an understanding of the patient as a whole person, from their main stressors to their favorite sports teams. Mad*Pow worked closely with clinicians to prioritize the information they wanted to see, resulting in an innovative dual-screen web app that enables a robust view of data with minimal clicks.

It works well. An isolated example of the power of one small feature of the app: While in the production environment one day, one of the Mad*Pow employees quickly filled out a questionnaire just to test the app. Upon reaching the end, they realized they were taking the PHQ (which measures depression) and had unknowingly tapped through answers indicating formation of suicidal thoughts. This threw up an alarm at the ImagineCare clinic, setting off a flurry of calls until they were convinced someone was just testing random functions. Truly, the questionnaires are a powerful tool.

Project Highlights

ImagineCare leveraged Mad*Pow’s expertise in patient- and clinician-facing systems. That background helped clarify and crystallize the ImagineCare vision to support conversations with executive leadership and back-end technology vendors. Mad*Pow’s development team implemented and delivered the native iOS app and Angular-based dual-screen clinician web app, integrating against an Azure-based server-side solution that it helped define. The clinician app is designed to help clinicians efficiently manage alerts and priorities in one screen, while using the other to drill into the details of each patient’s condition and background – putting patient histories and personal details easily within reach and facilitating the real-time voice, video and, text chats that clinicians conduct with the people in their care.

Product Impact

The first beta tests of ImagineCare resulted in almost immediate measurable results, starting with a 50% improvement in blood pressure management in six weeks, with an incredible 95% satisfaction rate.

View Outcomes in JMIR


  • 15%+ reduction in total cost of care
  • $298+ per-member-per-month (PMPM) reduction in total cost of care
  • 23% reduction in emergency room costs
  • 6% reduction in avoidable emergency room visits
  • 4x the patient engagement when compared nationally to other health and wellness programs

A Long-Term Partnership

After the successful launch of ImagineCare, Dartmouth-Hitchcock spun it off as a stand-alone venture. More than a dozen entities bid for ImagineCare. It was purchased by a Swedish entity that will continue its development. Mad*Pow continues to support the design and development of the solution as it advances to its next pilot test.

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M*P: ImagineCare CXO Nate Larson presents his sketches during the design workshop.

“The real-time interaction with the ImagineCare team makes me feel like someone is looking out for my health and best interest.”

an ImagineCare Patient