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What Keeps Healthcare CEOs Up At Night?

This week I had a double whammy of healthcare value from the comfort of my desk when MATTER Chicago live-streamed their event “What Keeps Healthcare CEOs Up At Night.” In addition to participating online with 40 others and engaging on Twitter on the topic, I’m pretty sure that Accenture charges big bucks to healthcare organizations to present these findings from interviews with over 50 healthcare CEOs. I got great info, some online networking, and no traffic!

So what does keep healthcare CEOs up at night? It seems that there are differing levels of awareness regarding the health of one’s own organization, changes in population health, as well as changes in healthcare in general. Perhaps the only thing keeping them all up at night is the delicate balance in shifting to outcome and value based payments without disrupting today’s revenue streams. It’s a classic innovator’s dilemma, but nonetheless, interviews and research with over 50 healthcare CEOs have shown that only some are effectively straddling these two worlds. Michael Main, managing director at Accenture Strategy, walked the full-house crowd at Matter and 40 of us on the live stream through the research, looking at winners and losers as well as making a few predictions for how the change would happen.

According to presenter Michael Main and the Accenture team’s analysis, only 5 out of these 50 CEOs were actually successfully making the shift to value based care, and of the rest, only 15 were capable of making that shift.

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See full report on Accenture here

To make the shift, Main identified some key criteria:

  • The CEO must have a strong passion for what healthcare can be, not what it is today. He or she must have vision and be motivated to make his or her system the #1 or #2 in their area.
  • The shift from volume to value needs to also include a shift back to volume but with the volume being serving a larger population base, not doing more to each patient. The only way to do this is to really understand a health system’s catchment area and the population. Main used the example of the 1,500 data points that Experian, the credit check company, has on each person and compared that to how few data points health systems have.
  • Care must move from being physician-centered to patient centered, but there must be strong physician leaders on board.

Main also identified barriers to change today:

  • Perverse incentives that reward for doing more to a patient rather than what’s actually best for the patient. Here, Main provided a couple of personal examples, including his father who was admitted to the hospital for 48 hours because of protocol when he would have been better at home waiting for test results.
  • People being worried about their own jobs. Main mentioned working with a nurse’s union on a patient-centered medical home project. Everything was positive until they realized the model would require fewer nurses than first expected. Demonstrating the basic adage that you can’t get someone to believe in something if their own livelihood depends on them not believing it.
  • Too much gray hair in the C-suite. Main believes that many hospital CEOs are too close to retirement to want to tackle the risk. They are looking to ride out the current fee for service world, and hand over the reins when the real change needs to be implemented. Most CEOs estimated the change will take another 7-10 years so they had time to wrap up their retirement packages. (Shades of physicians retiring around the deadlines for implementing electronic medical records.)

As you can imagine, there will be winners and losers in this new world of capitated and value-based payments. Basically, aside from the 20 CEOs that Main identified as either already changing or capable of it, the rest he felt were in the loser category. As care is pushed to the lowest cost delivery, hospitals could lose out if they don’t build integrated networks with primary care and urgent care in addition to emergency and inpatient. Smart CEOs are looking at consolidation by buying the best systems or smaller organizations instead of looking for bargains. They know that those bargain competitors will end up out of business. Winners will figure out how to incubate models that will cannibalize their own business rather that fending off upstarts who are looking to do it to them.

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Winners will have the right leaders who can take a patient-centered approach: both in aggregate and for individuals. In aggregate, they will better understand the patient base they serve in their geography and they will look at treatments that are outcome-driven and patient centered as well as looking at treatments that will impact each individual rather than the standard protocols like what Main described with his father’s treatment.

The Accenture research definitely pointed to answers in the transformation. Unfortunately, it seems like a number of CEOs today aren’t even asking the right questions. And of course, as with every healthcare event for the next while, with the looming threat to repeal the ACA, there are even more questions we need to be asking.

Posted in: Healthcare motivation, Healthcare transformation, Patient Advocacy

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What’s True Now?

 

Health systems and payers alike are scrambling to figure out what the incoming administration means by repealing Obamacare. The payers admitted to having no contingency plans if Trump won. Trump doesn’t have a clear model, and the Republican party has a number of proposals. Some involve changing the names of programs or offering them in a different way. Some involve scrapping large sections of the affordable care act.

Rather than second-guessing what’s to come, at Wellpepper, we are focusing on what’s true now and what will remain true going forward.

We believe these things will continue to hold true:

  • Innovation will continue. If anything we hope that new innovation in healthcare, and technology innovation in particular is driven by market forces rather than legislation which created winners out of what was not always the best technology.
  • Consumer-focus is good. 20M newly insured individuals and high-deductibles helped create a market for new care organizations like local urgent care and patient-focused primary care. This consumer evolution will continue as patients demand that their healthcare dollars deliver good service.
  • Value and outcome focused approaches will be rewarded. Whether it’s traditional payers or self-insured employers, the light has been shone on areas to improve care AND reduce costs. Healthcare organizations have seen investments in outcomes pay off as well.

It’s time for a new patient experience that is real-time, connected, and based on the individual. We need to take advantage of the ability of technology to scale, analyze, and deliver personal experiences to leapfrog the current technology implementations in healthcare and deliver better outcomes and greater value in healthcare.

Posted in: Health Regulations, Healthcare Legislation, Healthcare Policy, Outcomes

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Not Patient Engagement with Jan Oldenburg

When it comes to talking about patient engagement, nationally recognized consumer health information strategy leader Jan Oldenburg of Participatory Health Consulting chooses to delve deeper into what it means to engage patients in healthcare. With her wide range of experience, she focuses on helping organizations create and implement strategies related to patient/provider engagement and activation with a focus on digital health technology.

In this podcast, Ms. Oldenburg addresses a variety of topics ranging from shifting the healthcare mindset to utilizing digital tools to assist physicians.

Also check out more of Jan Oldenburg’s webinars: “Patient Engagement: Creating Digital Programs that Work.”

Posted in: Behavior Change, Healthcare Technology, patient engagement, Patient Satisfaction

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Better Living Through Big Data

This week I had the opportunity to participate on a lively panel at General Assembly Seattle organized by Seattle Health Innovators, and moderated by Corinne Stroum of Caradigm. Fellow panelists included Randy Wise formerly of Group Health and now at EveryMove, Ang Sun of Regence/Cambia, Lifesprite founder Swatee Surve, and Daniel Newton of Accolade.

Corrine sent us a series of great questions in advance, and we had a rich discussion and so many questions from the audience that we didn’t even get to half of them. It’s a big topic, and with payers, providers, and technologists on the panel there was a lot of opportunity for broad perspectives. There’s a discussion of having a follow-up to this panel to continue the conversation—stay tuned for more on that. The general themes of the discussion included the value of big data to influence individual health with examples like the quantified-self movement, but more generally how our ability to collect and analyze can lead to more personalized and better healthcare. img_3265

At Wellpepper, we have a lot of data to analyze. As Wellpepper CTO Mike Van Snellenberg pointed out in his Stanford MedX talk and I’ve also talked about in this paper in The Journal of MHealth, having data provides an opportunity to get answers faster than using the traditional scientific method. Rather than formulating a hypothesis, setting up an experiment, collecting data, analyzing the data, and then going back to the drawing board if your hypothesis is not born out, data enables you to ask a series of questions and get immediate and sometimes surprising answers.

The panel kicked off with the sharing of some surprising things that we’ve found from the data,  ranging from which mental health tools were favored by different populations to the ability to predict hospital readmissions. In addition to finding trends from explicit patient input, we also discussed the ability to draw insight from activities including social media and mobile usage patterns. Swatee mentioned the Instagram analysis that showed color scheme on photos was a predictor of depression.

The ability to combine both passive and active patient-generated data, and draw conclusions from broad date sets these data sources can help to deliver better care – resulting in what Daniel Newton referred to as “small data.” That is, I’m going to learn as much as I can about you, and then tailor care to you, which is the approach Accolade takes.

As with any talk on tracking and data, questions of privacy came up. While all the panelists thought that there have become standard terms for people to opt-in to sharing health data, describing the use of that data was deemed important. At this point, Ang Sun from Cambia (who admitted that, as a healthcare plan, they had a heck of a lot of data on people), mused that he wished his physician knew as much about him as Google did. Generally, there was consensus that, if the purpose of the data sharing was for connecting people with the appropriate healthcare services, people would opt in.

Our panel was pretty aligned on the idea that there is big value in big data for healthcare, but that the general applications and usage are still in early days. First, there are the privacy concerns and even laws. Second, current healthcare organizations using this first generation of EMRs have limited ability to look at aggregate data for trends. However, with new technology and personalized approaches to care, we see great promise in big data and predictive analytics for healthcare.

Posted in: Clinical Research, Healthcare Research, Research, Seattle

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A CJR Primer

Recently, I had the opportunity to attend a CJR Bootcamp put on by the Healthcare Education Associates in Miami, Florida. The boot camp setting was intimate, collegial, and well targeted. With the exception of a trio of cardio folks who wanted to get ahead of their bundles, all attendees were directly responsible for implementing bundles at their health systems . The two days were jam-packed with information ranging from understanding the legislation to influencing surgeon behavior to assembling a great team to implement CJR. I recommend that if you’re on the hook for bundles in your organization that you check out this or a similar training yourself.

There is too much to recap in a single blog post, so I’ll share some high-level takeaways:

Bundles Are Complex

Even advanced organizations had gaps in their knowledge and understanding when it comes to the complexity associated with bundles. CMS continues to evolve the requirements and guidelines, causing some implementation approaches to have to rely on predicting what’s going to stick.

For example, the original PRO guidelines were for HOOS and KOOS, which have now been changed to HOOSJR and KOOSJR. If you’re concerned about requirements changing, consider adopting requirements that will benefit you even if they change. Organizations that started tracking HOOS and KOOS have a leg (or knee or hip) up because they have historical outcome data and have hopefully streamlined their processes.

Bundles Require Multi-Disciplinary and Multi-Organizational Teams

Within an organization, you’ll need a multi-disciplinary team that includes clinical, administrative, operational and finance, technology, procurement and so on. You’ll also require an executive sponsor who will make sure senior leadership is aware of and supporting your initiative.

A recommended working group looks like this:

  1. Executive Sponsor(s)
  2. Physician Lead
  3. Project Manager(s)
  4. Care Navigator/Care Coordination Lead
  5. HER/IT Lead
  6. Data Analytics & Quality Leads
  7. Compliance Lead
  8. Legal Lead
  9. Communications Lead
  10. Gainsharing Program Support

You’ll need to be skilled in both project management as well as the ability to influence change. Consider all the stakeholders that need to be influenced – who are the best people to influence them and how?

Think about the rhythm of communication to different stakeholders. Too much and you overwhelm. Too little and people aren’t part of the process.

 Influencing Surgeons

One of the sessions focused on how to change behavior of surgeons. It was presented by Claudette Lajam, M.D. Assistant Professor of Orthopedic Surgery Chief Safety Officer at NYU Langone Orthopedics, who had the task of decreasing costs for implants and improving quality by getting Langone’s to use the right selection criteria. Dr. Lajam studied behavior change theory to implement the change, but it came down to understanding surgeon behavior. She presented them with data, and encouraged competition: each surgeon was able to see in a weekly report where they stood with respect to costs and quality against everyone else in the department.

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In the new model, hospitals are responsible for gain sharing with both upstream and downstream partners where they have less influence and insight. Understanding your top performing orthopedic and skilled nursing partners is key to a successful bundle. In some areas, this risk-and-gain sharing is causing consolidation where orthopedic groups are joining hospitals.

Note that with CJR, different from BPCI, conveners are not allowed. That is, hospitals can only share risk with orthopedic groups and skilled nursing facilities. Organizations that offer to manage your program and share the risk are not allowed to participate in any gain sharing.

Bundles Need Data: But People Don’t Have It

If you need to improve outcomes and lower costs, you need to know where you’re starting from.  To know where you’re starting from, you will need lots of data so that the impact of outliers is harmonized. Not many organizations have this level of detail across their entire pathway, either from organizational challenges or challenges of the system.

Sometimes, this is from a variation of care. For example, one surgeon has most of the complex cases, or another surgeon uses a different combination of implants and auxiliary materials.

Sometimes this is from the challenges of inter-organizational communication. For example, the handoffs between hospital and skilled nursing are notoriously bad – usually with hospitals not knowing where their patients ended up and skilled nursing not knowing why they are there.

Add to this that you can’tthis on top of not being able to find out if a patient is even in the CJR bundle for a period until the CMS data comes back.

So, you’ve got a complex challenge, with large and heterogeneous teams and organizations, and a lack of data. What do you do? Give up? Of course not.

First, attend a boot camp like this one.

Then, treat every patient like they are in a bundle and work on improving outcomes.

Finally, take a look at your position, risk, and low hanging fruit. Even if you only have a few patients in the bundle today, the private payers and self-insured employers are monitoring this closely.

There is Low Hanging Fruit

There are a few areas that have been identified as opportunities to lower costs without impacting quality:

  • Inpatient rehab has been targeted, and often cut. Patients need to get moving soon after surgery, but they may not need as many sessions with a PT directly. We have patients who are following their PT care plan through Wellpepper even in an inpatient setting.
  • Standardization and optimization of implants. Often the implant companies charge separately for each component for the implant and try to upsell on items like screws. Negotiating a standardized bundle can decrease costs here, as can evaluating patients for the best joint for their situation rather than using the surgeon’s favorite. (This was the project undertaken at NYU Langone.)
  • Decreasing the length of inpatient and skilled nursing stay. Equipping patients to be more self-sufficient with joint camps, educational materials, and mobile care plans can enable them to go home faster.

You are Here

Possibly because it’s early days and people are still figuring this out, there isn’t a consistent, phased approach to rolling out the CJR bundle. In fact, you can start anywhere. Or maybe you don’t have to.

First off, make sure you’re in one of the X areas where the bundle is being rolled out. If you are, find out who else is in your region. Your cost accountability is for the average for your region. If there are big spenders in your region, you may already be delivering total joints more effectively than others and may not need to change much besides starting to collect PROs.

Also, take a look at your Medicare population for joint replacement. If it’s low, you may only have a few patients that qualify for the bundle each year – which doesn’t mean that you shouldn’t strive to improve, but it may impact the amount of effort you put in initially.

Figure out where you are today and plan your efforts accordingly. Don’t try to do everything at once and understand that both your process and the information available will continue to improve.

Good luck!

Posted in: Behavior Change, Clinical Research, Healthcare Legislation, Healthcare motivation, Healthcare Research

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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Health Care Innovators’ Uphill Climb

The Healthcare Innovators Collaborative and Cambia Grove have joined forces to present a series of talks on our evolving healthcare challenges.

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This series was run out of University of Washington last year, and this year’s sessions, subtitled “Under the Boughs” are held at Cambia Grove – where a new Sasquatch In Residence (SIR) ensures that the patient voice is present in the conversations.

September’s session took off with Dr. Carlos A. Pellegrini, Chief Medical Officer of UW Medicine, discussing the shift to value-based care. Pellegrini defined UW’s transformation as a process with 6 key goals:

  1.  Standardization

Standardization improves efficiency and is key to reducing cost and improving outcomes. Today, surgeons performing surgery at different hospitals may have varying tasks per hospital. Patients may receive different instructions depending on which physician or department they interact with. As a result, it is difficult to compare outcomes or optimize clinical workflow without a form of standardization.

      2. Population Health Management

Using system data to anticipate patient needs before they become major problems can both improve care and lower costs.

       3. Medical Home 

Implementing the medical home model can allow providers to be more aware of all of their patients and manage them proactively in measurable groups.

       4. Clinical Technology

Better use of clinical technical systems and of technology generally will enable more efficient and proactive patient care.

Dr. Pellegrini suggested they need to identify which patient was calling and suggesting the care they needed. For example “It’s Linda Smith, and she’s due for a mammogram.”

       5. Risk Management

“The Healthy You” – Sending better information to clinicians can help keep patients healthy, such as regarding activity level for obese patients.

        6. Smart Innovation

In contrast to standardization, consider opportunities to   customize experience/treatment for patients to deliver personalized and targeted care.

Understanding and measuring outcomes is also seen as key to approaching this evolution. Still, it was pointed out that providers, payers, and patients all understand a positive outcome differently. For example, for a provider the outcome is usually functional, for a payer or employer the outcome is financial, and for the patient it is often quality of life.

Only when these three outcomes are considered at once can we have true value-based experiences.

While Dr. Pellegrini and interview Lee Huntsman lamented the fact that US healthcare is ten times as expensive as other models, like the UK’s system, at present only 3% of UW Medicine’s revenue comes from value-based models, and it costs them $200M per year to maintain EPIC.

With numbers like this, the shift to value-based care has some big uphill battles. Keep fighting the good fight everyone, we know that the burgeoning health community in Seattle and the Cambia Sasquatch will!

Posted in: Healthcare Research, Healthcare transformation, Meaningful Use, Outcomes, Patient Advocacy, Seattle

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Let’s Talk About Poop

The ups and downs of the first two keynotes at the 2016 Mayo Transform Conference were mirrored in the session The Challenges of Change which highlighted the story of Cologuard. Cologuard is a joint venture between Mayo Clinic and Exact Sciences whose sole goal for the venture was to create a less invasive way for early detection of colon cancer. They succeeded in this goal and were also the first product to receive FDA clearance and CMS reimbursement on the first day. Cologuard launched to much fanfare on national news.

Did they knock it out of the park? Yes. Are they wildly successful today? No. Why? Keep reading and I’ll tell you.

First let’s start with the problem. Colonoscopies, while effective, are not favored by most people. The preparation is extremely uncomfortable, they require general or partial anesthesia, and people need to take time off work. In addition, in some remote communities, it is difficult to get access to care from specialists. As a result, people put off or skip getting colonoscopies and by the time cancer is detected it is often too late. A clinical challenge with colonoscopies is that they are good at detecting left-side tumors but not right side tumors, the incidence of which has been increasing since the 1980s.

CologuardCologuard solves all of these problems. The test is designed to be used at home and is basically a nicely-packaged stool collection kit combined with specialized testing at Cologuard’s lab. No time, and no procedure required for an individual. As well, Cologuard is more effective than colonoscopy at detecting right side tumors, and comparably effective at left-side tumors. Since it’s a home collection, and all tests are processed at Cologuard, access to care is not an issue either and it’s widely used in the Alaska Native Tribal Health Consortium, which was presented as a success story.

Sounds great, yes? Everyone (aka people who at some point will need a colonoscopy or have already had one) I talked to about it thought so. So what’s the problem? As usual, what’s preventing this innovation is an issue of reimbursement. Colonoscopies are a profit center for healthcare organizations, and they are effective, so this isn’t necessarily a case of a better technology losing. It’s the case of a more patient-friendly technology losing, except in Alaska where there really isn’t a viable option for delivering colonoscopies. As well in violation of CMS, some payers are refusing to cover Cologuard.

Cologuard CEO Kevin Conroy was evasive when asked about pricing, which is more expensive than other screenings but pales in comparison to the coimg_0060sts of a procedure that requires booking an operating room and an anesthesiologist.

Let’s hope that a shift to value-based care changes this. From a patient’s perspective it can’t come soon enough.

PS Apparently a lot of single Cologuard kits are being ordered by cardiologists and other specialists. Conroy thinks they’ve recognized the value and are using the kits on themselves. Harrumph.

Posted in: Clinical Research, Health Regulations, Healthcare Disruption, Healthcare Legislation, Outcomes, Patient Advocacy, patient engagement, Patient Satisfaction

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Mayo Transform 2016: Change

There was method to the madness, but the feedback for John Hockenberry, host and moderator of this year’s Mayo Clinic Center for Innovation Transform Conference at the first night reception was that the keynote was a bummer.

And it was. This year’s theme was change, and the keynote highlighted three key areas where we need fast and effective change: climate, diet, and early childhood education.Mayo Transform logo

Will Steger, a lifetime adventure and outdoorsperson and founder of Climate Generation, kicked things off with a dire warning that it was no longer possible to make a living running sled dog tours because the Arctic is melting. This was followed by Karen Watson who talked about the successful DrinkUp campaign to combat the challenge that 75% of Americans are chronically dehydrated from consuming sugared beverages instead of water. The campaign was focused on driving people to reach for bottled water instead of soda, and while this seemed counter to the first session on climate change, she cited that 22 million Americans have no access to potable water so bottled water is a good choice for them. Next up George Halvorson from First 5 California and former CEO of Kaiser Permanente talked about programs the state of California and KP have created for early childhood health and education, noting that the years from 0-3 were crucial for childhood development, and that a child of a working mother is read to for 1,500 hours during this period while the child of a typical Medicaid mother (who could be working) is read to for 30 hours during this period. This year 51% of children will be born to Medicaid mothers.

DrinkUpWhile both DrinkUp and First 5 provided solutions to the problems they raised, the overall impact of the keynote was depressing. While the intention was to catalyze people to change the schedule left us had the tools for making change delivered in sessions on days 2 and 3, which left us to drink our sorrows at the opening night reception (and not with bottled water).

Moving into days 2 and 3 of the conference, we did get tools for thinking differently, and the first session on day 2 provided richly in this area with Roger Martin, former dean of the Rotman School making the case for using both scientific method and rhetoric, and in particularly pointing out the short comings of scientific method if you want to innovate, in particular that it only looks at past data and does not imagine a future. Denny Royal of Azul 7 asked us to get out in nature for creativity, inspiration, pattern matching, by using biomimicry to use nature’s solutions for pressing problems, like how Sharklet used the natural antibiotic properties of sharkskin as inspiration to create a substance that naturally repels bacteria, or considering how to create adhesives that work better when wet, like the silk of the Cadis Fly, and could be used internally during surgery instead of our crude methods today like stiches or stapling. Teri Pipe, of ASU led us on a meditative path by asking us to notice what was happening in this moment, and apply these skills to build compassion and reduce stress in delivering care.img_0055

The day 2 keynote provided us with tools for imagining things that don’t exist, have the courage to quiet our own cleverness and learn from nature, and be resilient and empathetic. Given the day 1 keynote, this was just the antidote to embark on the rest of the conference.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health

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Is Connected Health Entering The Mainstream?

I’m just back from Parks Associates 3rd Annual Connected Health Summit. The summit, which began with a focus on consumer health and devices, is broadening to include the consumer experience in all digital health. Most attendees were from technology, payer, and device industries rather than healthcare organizations, and I was struck that a lot of the discussion of about the data from devices, predictive analytics, and natural language processing was beyond what we’re seeing in implementation in healthcare industries today.

Evolution of Digital Health

Evolution of Digital Health

Possibly because Parks Associates focuses on consumer data, and also that the conference has been consumer-device focused in the past, attendees and presenters included telecommunications companies, and even home security companies. This was my first time at the conference but from the data presented by Parks it seems as though digital health, and consumer focused health has become accepted as inevitable and mainstream. A few examples include ADT, the home security company talking about in-home sensing to enable seniors to stay in their homes longer, and Wal-mart talking about meeting healthcare consumers where they are. All of this is a far cry from traditional healthcare delivery. There was also a belief that digital health and the digital health consumer touches everyone from seniors, to the example that for many homeless people their most prized possession is their mobile phone.

Top takeaways:

  • There is no silver bullet for mobile health, digital health, or sensors.
    • Personalization is going to be key as the drivers for engaging in health are different for each person
  • There is no digital health consumer. Segmentation is very challenging in this market. Parks Associates Research identified 4 consumer groups, and 14 segments within those groups.

Digital Health Segments

  • Technology is currently out-pacing implementation possibly due to a slower transition to value-based care than the speed of consumer technology adoption.
  • People are sometimes consumers and sometimes patients, and this is not mutually exclusive.

From Fee For Service To Value-Based Payments

I had the pleasure of participating on a panel on moving to value-based care with Dr. Alexander Grunsfeld, Chief of Neurology from our customer Sentara Healthcare, and Angie Kalousek  from Blue Cross/Blue Shield of California. Too often value gets lumped into the idea of bundles versus fee for service, instead of considering the triple aim of healthcare and delivering the best patient experience and outcomes cost effectively. Fee for service remains the stumbling block to value-based care and organizations have to straddle two worlds when considering implementing two programs. Those who can effectively cross the chasm from fee-for-service to value-based care will be the ones who succeed in the long run, and especially those who consider options before they are legislated to do so.

Crossing the chasm from fee for service to value-based payments

Crossing the chasm from fee for service to value-based payments

Our headache management project with Sentara started from the need of one neurologist to manage his caseload. He had too many patients and not enough data, and needed a way to identify patients that needed the most help and also to enable patients to self-manage their headaches. Interestingly, though although the problem that he was trying to solve was focused on access, in a fee-for-service world, initial appointments are compensated at a higher rate that follow on appointments, so decreasing the need for follow on appointments could actually increase revenue. In an exact opposite scenario, this project has caught the attention of those in Sentara’s health plan, Optima, and they are looking to use this patient self-management to decrease ER costs by enabling patients to better self-manage.

Audience poll on in-home care

Audience poll on in-home care

Posted in: Adherence, Behavior Change, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient engagement

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Cardiac rehab is effective, but patient-centered care needs to actually be patient-centered

With CMS’s new Cardiac Bundle, cardiac care (especially post-acute care), is the next service line to go under the microscope. As with total joint, variations in outcomes and costs are often seen in post-acute care so looking at how that care is delivered is key. For any bundle to be successful, engaging patients and ensuring their participation in follow up is a driver of success.

I have to admit, I haven’t read the bundle specs yet, just the news on the bundle. According to Becker’s Hospital Review’s “10 things to know about CMS’ new mandatory cardiac bundle”, the bundle includes provisions to test cardiac rehabilitation services, with 36 sessions available over 36 weeks. However, according to this article from NPR, although cardiac rehabilitation is proven to be effective, most people don’t participate. If you read through the comments on the NPR article (ignoring the trolls of course), you’ll start to see the reasons: cardiac rehabilitation care is built around the needs of the people providing the rehabilitation, not the patients.

From our experiences delivering post-acute care plans, as well as talking to payers and providers we’ve learned a few reasons why patients don’t follow up with their outpatient care:

  • Distance: In cardiac cases, patients are taken to the closest hospital, but this may not be the closest to their home or work. In other post-acute scenarios, they may have gone to a center of excellence that is also at distance.
  • Time commitment: These programs often require multiple days of treatment a week. Not everyone has the flexibility to take off work.
  • Timing: Programs are usually offered during 9 to 5, to accommodate the needs of the providers. Patients might prefer evening or weekend programs. We talked to one provider that focuses on lower income patients. People in hourly wage jobs don’t get to choose when they take breaks and their breaks are usually 15 minutes, and maybe 30 minutes for lunch. It’s next to impossible for them to attend in-person sessions.
Francis Ying/Kaiser Health News

Francis Ying/Kaiser Health News

The NPR article keyed in on these within the one example of Kathryn Shiflett (a healthcare worker herself!) whose distance and work hours (4:30 AM – 3:00 PM) pose a significant barrier: “She lives an hour away and is about to start a new job. Cardiac rehab classes happen Mondays, Wednesdays and Fridays, with sessions at 8 a.m., 10 a.m. and 3 p.m.”

While the bundles are definitely driving the right behavior in focusing on patient outcomes rather than procedures, they need to go further to promote patient-centered care. In this case, that should be testing new models like mobile health or community-based rehab programs that are adaptable to the unique needs of different patient groups.

Posted in: Adherence, Healthcare Disruption, Healthcare Legislation, Healthcare motivation, Healthcare transformation, Occupational Therapy, patient engagement, Patient Satisfaction, Rehabilitation Business, Uncategorized

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Patients As Designers Of Their Own Health

Seattle’s grassroots healthcare community continues to gain traction with a new meetup for patient-centered design. Last week’s meeting was generously sponsored by MCG a subsidiary of Hearst Publications who are quite active in the healthcare world with content and education. The panel discussion featured Dana Lewis, a patient-maker who is active in the open source movement for diabetes care and built her own artificial pancreas, Christina Berry-White from the digital health group at Seattle Children’s, and Amy London, Innovation Specialist at Virginia Mason. The group talked about how to effectively get feedback from patients, and how patient hackers like Dana can take poor design into their own hands build tools they need, and ultimately influence large healthcare companies, in this case device manufacturers.

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Dana, Christina, and Amy, photo credit Alina Serebryany

The panel had great advice for understanding and developing products and improving processes for patients, as well as for soliciting feedback from patients. Here are a few of my takeaways.

Tips for developing products and process

  • Understand patient’s goals and desires. Often the goals of the hospital or health system are not the same as the patient’s. After meeting with a group of patient advocates one Virginia Mason surgeon realized that the only outcome that really mattered was whether the patient had a positive experience.
  • Let patients customize their views and experiences. Amy talked about a particular chart where she wanted to see the graph rising to show increasing blood sugar and another user she talked to wanted to see the graph lowering to show insulin lowering and a need for intervention. Amy was confused by this view but created her open source artificial pancreas interface to enables people to choose their own view, and the result was that people who had diabetes looked at it the same way Amy did and parent-caregivers of diabetic children wanted the second view. Which brings us to the next point–
  • Differentiate between users. Patients often have different requirements than their caregivers, whether that’s parents caring for a child or teen, or adult children caring for a parent. As well, the clinical workflow shouldn’t dictate the patient experience.
  • Get feedback early. Amy mentioned meeting with a device manufacturer who showed her an almost ready for release glucometer that was intended to fit in the pocket. She quipped “you obviously didn’t test this with women’s pockets.”

Tips for collecting feedback

  • Build it into the product. Christina from Children’s mentioned that when they switched from reams of paper to an iPad-based tool for patient on-boarding forms the physicians wanted to stop using it because it did not immediately integrate with the EMR. Luckily the tool had a feature to survey users on whether they preferred using it to paper, and the answer from parents was overwhelmingly yes. The digital health team showed these results to the physicians, and the tool stayed in place.
  • Be creative when soliciting feedback. Children’s knew from experience that parents and patients were reluctant to give them negative feedback after a lifesaving experience like an organ transplant, so they used techniques that are often used in brand market research: analogies. For example, they asked teens to describe a digital tool as a car, and found out that their tool was like a pick-up truck to them: useful but utilitarian.
  • Use patients to collect feedback. Patients are also often intimidated to provide direct feedback to healthcare professionals as they see them as authority figures. At Virginia Mason patients who have already had a successful joint replacement visit post-surgical patients to find out how they are doing, and talk about their own experiences. Patients are a lot more candid with each other, and Virginia Mason was able to benefit from understanding the questions they asked the peer ambassadors and incorporate that information into formal programs.
  • Ask the questions at the right time. If you want to understand post-operative experiences ask within a few weeks of the actual experience, not 6 months later.
  • Be aware of selection bias. Patients who volunteer for focus groups are often those who have the time and money to be able to do so. Your feedback may be skewed towards retired patients, and those who are not hourly workers. Consider how you will cast a wide net.

Lots of great advice at this event, much of which we already incorporate into our processes and products at Wellpepper, although I definitely got some new ideas and it’s great to see the community coming together to share best practices. My only disappointment with the event was that with a title of Patients as Designers, I expected to see more patients on the panel. While there was a last minute cancellation of a patient-maker, it would have been amazing to have Children’s and Virginia Mason bring one of their patient-designers to be on the panel. Maybe next time?

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Lean Healthcare, Research, Seattle

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Taking the Fear Out of Total Joint Replacement

I’m not quite ready for a joint replacement but many of our Wellpepper users are, so I found myself spending a recent Saturday morning at a session called “Taking The Fear Out of Total Joint Replacement.” This patient-focused half-day workshop was free to potential patients and sponsored by an organization called SwiftPath that specializes in minimally invasive outpatient total joint procedures. Total joint procedures are feeling the crunch of reimbursement changes in the Affordable Care Act, and one way to lower costs is to perform them in an outpatient facility. However, due to the minimized time an outpatient candidate would spend under the supervision of a doctor, they must be highly engaged in their self-care efforts, including losing weight or quitting smoking if necessary. With people having replacements at younger ages, and often having both knees and hips replaced, the need for engaged patients continues to grow.

I attended the workshop to get an idea of the patient’s perspective on the information and on the procedure. Health systems frequently offer Total Joint Bootcamp but this was intended as an introductory session for people who may be undecided about getting a replacement. The sessions included information about good candidates for minimally invasive total joint replacement, expectations of patients and their caregivers for participation, learning, and recovery, and an overview of the physical therapy involved. The host for the day was Dr. Craig McAllister who is one of the principals of the SwiftPath method. With the exception of the initial opening sequence of surgeons talking about the effictiveness of the methodology, the day was primarily patient focused, starting with risk stratification as a means to determining the best candidates for surgery, through tracking patient reported outcomes, and ensuring patients and caregivers were equal participants in care. There was also a session on determining how a patient pays. Dr. McAllister noted at one point that this entire patient-centered approach was completely different than what he was taught in medical school.

Two of the most powerful sessions were also patient-focused. The first was a patient panel consisting of an OR nurse who had a recent knee replacement and biked to the session, a few people who had experienced both in-patient and outpatient replacements, and one who was not originally a candidate for surgery because he was a smoker. While quitting is a requirement for the surgery, he initially didn’t want to until he realized that he would lose his opportunity to have Dr. McAllister perform the surgery, concluding that he needed the surgeon more than the surgeon needed him: “If I didn’t do what he said, the next patient in line would.” I thought this was a really interesting approach to motivating change: be inspiring and selective, not punitive or even threatening. All of the participants talked about having low pain levels, and some not using the prescribed opiates. As part of the program, Dr. McAllister closely tracked their post-surgical pain, nausea, and opiate usage. One patient disclosed that he drove himself to his first post-surgery physical therapy appointment, and although this was not encouraged, his PT actually gave him the all-clear to drive home.

The final session of the day was possibly the most striking. It featured a police officer and the founder of a drug addiction non-profit, Amber’s Hope talking about opiate addiction. This session was sobering, both from the impact of the drugs but also because measures to control these dangerous substances have actually exacerbated the problem. Since opiates cannot be prescribed by phone, and post-surgery patients are not mobile enough to visit a physician, get a prescription, and take it to a pharmacy, physicians need to prescribe what they believe will be enough pills prior to surgery, which can lead to leftover pills. Most non-prescribed usage of opiates comes from these leftover pills, which means that educating patients on how to dispose of them is key. In Kirkland, Washington where this session took place, for example, the only way to dispose of them is to take them to the local police station. (FDA recommendations for disposal of prescription drugs can be found here.) At Wellpepper, we track the use of both over-the-counter and prescribed painkillers as part of treatment plans. We do this for two reasons: first, it’s a valuable piece of information about a patient’s pain levels and recovery time, and second, too often these pills are prescribed as needed and usage isn’t monitored, leading to a nationwide opiate problem.

I attended this event so I could better understand the people who will eventually use our software. I learned a lot more about changes in care delivery, and got some great ideas for continuing to engage patients that you’ll see in future updates to our products.

Posted in: Behavior Change, Opioids, Outcomes, Patient Advocacy, patient engagement, Patient Satisfaction, Physical Therapy, Seattle

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Different System, Same Challenges: Long-Term Care Perspective From Canada

Kristin Helps, our Director of Client Operations, and I had the opportunity to speak about delivering Empathetic Care for Seniors Through Technology at the annual BC Caregiver’s Association Conference in Whistler, BC. The BCCPA is the representative body for long-term care, skilled nursing, homecare and retirement facilities in the province of British Columbia in Canada. These types of facilities are mostly privately run, by both for-profit, and charity organizations, as opposed to acute care which is run by provincial and regional authorities. While this was a BC organization and conference, delegates came from across the country, and ranged from individual home care works, to facility owners, to university professors and researchers.

For the most part we heard similar challenges to those encountered in the health system in the US:

  • Communication between care settings
  • The struggle to deliver patient-centered care
  • Decreasing reimbursement for homecare
  • Enabling staff to operate at the top of their license

At the same time, people expressed a desire to age in place, and the health system wanted to be able to support this. While 80% of Canadians cited wanting to die at home, only 40% actually do.

One of the big differences we noted at this conference was that speakers and participants were calling on the Federal government to step in and fix many of the problems in a way that we don’t often see in the US. Another difference was that participants were looking globally for solutions to challenges, particularly in dementia care.

Looking Globally for Dementia Care

This was our first time at this conference and veterans told us that the previous year was quite focused on analytics, while this year the focus was on dementia care. While not primarily our area of expertise at Wellpepper, we heard about a number of innovative initiatives to improve care, including a novel approach by the government of Japan. Japan decided to characterize dementia as a social problem rather than a medical problem and trained bank tellers and grocery store clerks to recognize the signs of dementia. It was thought that these people were most likely to see problems, for example if someone was unable to understand how to pay bills or buy groceries. Considering that many with early onset dementia are quite successful at hiding changes from their loved ones, this idea is quite interesting. It also puts the responsibility for care back into society rather than relying on medical facilities that often distance the rest of us from the challenges of aging.

Basketball courts at Aegis Living Seattle

Basketball courts at Aegis Living Seattle

The Butterfly Household Model of Care, which was initiated in the UK, but has been implemented in Alberta with some success, is another novel idea. People with dementia often don’t know what day it is or what they had for lunch, but they do have vivid internal experiences, often remembering happier times of their lives. Butterfly Households are designed to stimulate people with dementia with bright colors, and also to stimulate memories with areas designed to invoke feelings of the past, for example an ice cream shop or an area with old photographs. The idea in a Butterfly home is to meet patients where they are, and caregivers report much joy in delivering care and significantly fewer of the violent behaviors often associated with dementia.

While not a designated Butterfly Home, you can see some of these techniques in action at Aegis Living in Capitol Hill, Seattle. Here are a couple of pictures from when I visited last fall. In an outdoor area they have a car and a garden shed designed to stimulate conversation and fond memories, and an old-gym styled basketball court, where you can shoot hoops sitting down.

Invoking memories at Aegis Living Seattle

Invoking memories at Aegis Living Seattle

To find out more about the topics in this post:

Bank Tellers Act Serve as Caregivers in Aging Japan

BC Caregivers Association

Butterfly Household Model of Care

Aegis Living Capitol Hill Seattle

If you’re interested in learning more about our talk on delivering empathy through technology, contact us.

Posted in: Aging, Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Managing Chronic Disease, Seattle, Uncategorized

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The Consumerization of Healthcare

While Healthcare is sometimes criticized as being behind other industries when it comes to technology, being behind this can have advantages. The first is that early adopters in other industries have worked the kinks out of new models like Saas or not-new models like single-sign-on. The second is that you can understand how technology and usage might evolve by seeing what happened in other industries, and the third is that you can skip steps in technical evolution and potentially move faster. This is what’s happening with the Consumerization of Healthcare IT, as evidenced by the proliferation of mobile and consumer-facing health technologies, topics at a few key healthcare events I’ve attended lately, and conversations I’ve had with senior healthcare leaders.

The concept of consumerization is the idea that consumer perceptions, expectations, and consumer technology can have an impact on an industry. This sometimes results in direct applications, like “it’s Uber for ambulances” or “Netflix for CPE credits” but more frequently it’s a subtle shift in thinking.

When I was working at Microsoft preparing for the launch of Office 2010, the consumerization of IT was a major theme of the release. We talked about the influence of the expectations of end-users on the tools they used every day: users were always on and always connected and they expected the same of their companies. We talked about the impact of BYOD on security and also the expectations to be able to communicate and collaborate from anywhere. The same is happening in healthcare today. Patients and physicians alike want to be able to communicate in the ways they communicate elsewhere and wonder why they can’t. They want applications that are as easy to understand and interact with as those on their phones.

One health system CIO I spoke to recently envisioned providing a “productivity stipend” and enabling all his staff to use whatever type of computer and smartphone they wanted. He would make sure they kept patient-health information secure but they would be responsible for choosing and maintaining their devices. Where BYOD was seen as a threat back in 2010, it’s now an opportunity. (I checked in with some of my former colleagues and they are seeing BYOD for phones but not computers, so this CIO is ahead of the industry pack and could even be seen as an example of skipping a step.)

When we started Wellpepper a little over three years ago, people commented on how patient-friendly and patient-focused our software was, and how it was a shame because it didn’t really matter what patients thought or what the patient experience was. (Not everyone said this, but we did hear it more than you’d hope.) Today, leaders in the industry are laser-focused on the patient/consumer experience. There are a number of reasons for that, which are both carrots and sticks.

  • Meaningful Use, while not always driving the best technology, has put an emphasis on communicating electronically with patients
  • High-deductible plans have made patients into consumers, carefully evaluating the service and value they can get for their healthcare dollars
  • New technology players like ZocDoc with online scheduling and MDLive with telemedicine delivered at Walgreens have trained people to expect on-demand services
  • New care delivery players like Iora and Zoom+ have set expectations for wellness and preventative care, and have attracted healthcare professionals who want to practice differently
  • We are all consumers. These supercomputers in our pockets and the constant connection and sharing they provide, and the ease of use of the applications that run on them have trained us to expect the same in our healthcare whether we are patients or providers.

At two recent conferences, I participated in conversations about the consumerization of healthcare service and tools. At the annual Health Evolution Partners Summit in Laguna Beach I had the opportunity to participate in a workshop where we were asked to imagine what it would be like if healthcare were run by customer-focused brands like Nordstrom, Amazon, Apple, and Uber for example.

@griotsyeye draws the consumer revolution in healthcare

@griotsyeye draws the consumer revolution in healthcare

At a local Seattle event hosted by the University of Washington Foster School of Business and sponsored by Providence Healthcare and Premera, I participated on a panel with Bill Frerichs, VP of Clinic Operations from Zoom+ and Paul Stoddart, VP of Marketing for Providence, and hosted by Curtis Kopf, VP of Customer Experience, Premera Blue Cross. We had all joined healthcare from other industries: Bill from running Target’s Store Operations and Paul from Microsoft, like me. We had all had personal experiences that had moved us into healthcare to try to change the system from within. Similar to many that choose healthcare as a career from day 1, we had become vocation-driven.

While it’s easy to come up with ideas for how healthcare can improve by looking at the customer focus from other industries as we did in these two sessions, for example, taking a concierge model like Nordstrom’s personal shopper or pattern-matching what’s important to each patient like Amazon’s “people like you also bought”, or using data to predict pregnancy like Target, it’s important to remember two things. First, if history of adoption of technology is any indicator, healthcare will evolve like other industries and will move to the cloud and more end-user and patient-friendly tools. It’s already happening. And second, that we need to remember the goals of healthcare while transferring best practices from other industries, and emulate only what’s best in healthcare settings: compassion and care, not greed and a ‘gig-based’ economy that is sometimes the focus in other industries. As well, while patients want to share data with their care teams, they want this data protected and used appropriately. Those who question the status quo, embrace change, and yet do it while remaining true to the ideals of healthcare should be the winners in this new consumerized world.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, patient engagement, Patient Satisfaction

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Patient Engagement Goes Mainstream: 5 Observations from HIMSS 2016

A walk through the trade show floor, and a glance at some of the sessions at HIMSS, quickly indicates that patient engagement is everywhere, which is great because an empowered patient is key to improving outcomes and lowering costs of care. There is still a lot of noise in this space however, with anything from wayfinding applications to billing services being billed as patient engagement. Let me set the record straight: making sense of things that are very confusing and often poorly designed, like hospitals and healthcare billing is not patient engagement, it’s explanation. That said, there are many innovative companies and healthcare organizations who are taking patient engagement seriously.

Here are 5 impressions or things heard at HIMSS about patient engagement and the state of healthcare IT:

  1. There are a lot of solutions in this space/competition is good. While there may be companies that have joined the space because patient engagement is a hot topic, real competition shows a real need and market.
  2. Clinical workflow does not equal patient engagement. True patient engagement solutions are designed around the needs of the patient.
  3. Engagement does not equal alignment. While this was said about physicians it’s also applicable to patients. A surgical patient can’t help but be engaged, but are the patient and physician aligned on the patient’s goals.
  4. Healthcare IT is emerging from the EMR era. Meaningful use drove widespread adoption of EMRs and monopolized IT resources for the past X years. IT is now ready to take a seat at the table and proactively suggest solutions to the clinical side of the house.
  5. People are asking how a solution is different rather than why they need a solution. This is a huge shift: at our booth we spent a lot less time explaining what we do and how we do it.

We’re looking forward to what the next year will bring. It seems like we’re at the starting blocks for some real value-based implementations of patient engagement solutions.

Patient Engagement Hits The Mainstream

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Outcomes, patient engagement

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Flexible Care for Independent Aging: Don’t Dumb It Down!

I had the pleasure of participating on a panel on technology for aging, along with Honor founder Seth Sternberg and CareTicker founder Chiara Bell during the HX360 event at HIMSS 2016. (HX360 is a “conference within a conference” focused on innovation and C-suite leadership.) The panel was hosted by Jeff Makowka, Director of Market Innovation for AARP, and ranged from topics on entrepreneurship and whether there is a venture rush to technology for aging now to approaches for delivering care for aging in place.

Interestingly, all three panelists were inspired by personal experiences to found our companies. For me, it was poor discharge instructions and lack of continuity of care when my mom was released from 6 months in a long-term care facility. For Seth and Chiara, it was trying to figure out how to enable their parents to age at home. It’s a classic entrepreneurial model to experience a problem and try to find a solution to it, provided the market is big enough, and this market certainly is based only on demographics of the aging baby boomers. Seth and I both made the leap from technology, Seth from Google, and me from Microsoft, and Chiara from a long history in healthcare and homecare.

We were much sharper in real life.

We were much sharper in real life.

Honor’s $20M in funding lead by Andressen Horowitz is proof that Silicon Valley is paying attention to homecare, which can be viewed as important from two aspects: first we need innovative and new thinking to approach these challenges, and second these solutions could require a lot of money. (Although I would posit that we need patient capital in this space, something that Silicon Valley is not always known for. Interestingly, the same week as the panel Dave Chase and Andrey Ostrovsky posted a piece on why Silicon Valley does not belong in homecare. Maybe they should be on next year’s panel.)

The three panelist companies took similar approaches in using technology to scale and empower the people in the process, both patients and caregivers. For Wellpepper it’s about empowering the patient to follow their care plans and get remote support from the healthcare team. Honor and Careticker are more focused on the patient and their homecare team, whether that is professionals or family members. What was similar in the approach was providing information in real-time to the people who need it, and treating everyone in the process with respect. Honor does this by ensuring homecare workers are paid a living wage. Careticker does this by recognizing for people to age in place, the family caregivers need the right information and supports and Wellpepper does this with patient-centered and highly-usable software that is not dumbed down for the aging.

We were perhaps the outlier on this panel as our solution is not aimed specifically at the elderly. However, you could say we are the most representative of the way we need to approach the challenge: we need solutions that are designed with empathy, putting the patient first, and are not categorizing people into “young” and “old.” Well designed solutions and products should can address a broad spectrum of users, and we need to treat those aging in our population as another audience in this spectrum.

Posted in: Aging, Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, Patient Satisfaction

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