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Patient Engagement: From Idea to Proof

In the last year, patient engagement has gone from buzzword to a clinically proven solution to rising healthcare costs. A study published in 2013 in Health Affairs found that engaged patients in the first year of the study were 8% less expensive that non-engaged patients in the base year. As the years progressed and the impact of some of the behaviors of non-engaged patients like diet, exercise, and smoking had a bigger impact, the gap was expected to widen.  Cost drivers were use of emergency room services and hospitalization of these non-engaged patients.medicalperson

“Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores”http://content.healthaffairs.org/content/32/2/216.full?sid=bd3de9e3-8393-4553-bf75-ebb537b75905

At the same time, technology has been heralded as the solution for engaging patients, and the quantified self-movement was the poster child for tracking health metrics. The problem is that the people who were doing all this tracking were pretty engaged to begin with and therefore not representative of the population as a whole. Other solutions used rewards for behavior change, like gift cards or donations to favorite charities. Unfortunately, recent studies have shown that these types of rewards systems are good at enrolling patients in health engagement programs but not good at helping them sustain good habits. http://mobihealthnews.com/35244/study-rewards-boost-enrollment-but-not-sustained-engagement/

personA combination of extrinsic and intrinsic rewards is seen to be much more motivating. Intrinsic rewards are the ones that are built directly into an experience, for example Facebook likes or Twitter retweets. We know from our experience at Wellpepper that a combination of intrinsic rewards coupled with the accountability through a connection with the healthcare provider creates more adherent patients and better outcomes. Our patient engagement rates hover around 70% (compared to 2-3% for some EHR portals), and we have some providers with patients who are 100% adherent to their treatment plans. Look for more news on this topic in the fall of 2014 when we release the results of some clinical studies that use Wellpepper.

Technology for health-related behavior change is still in its infancy. However, with the right combinations of factors that motivate patients, the benefits are clear: better engagement and better outcomes. For patients, using technology for health engagement provides them with convenient and cost effective solutions. There are also benefits across the health system.

Using technology for patient engagement can enable:

  • Remote care and monitoring. This covers both outpatient discharge and aging in place. Enabling people to recover or live at home longer improves their experience and lowers overall healthcare costs. New models of care are also possible as remote communication can employ specialists in different areas of the country or the world.

“There is a nationwide shortage of such critical-care specialists, known as “intensivists,” so the idea is that these doctors can monitor more patients remotely than if they were on-site at a single hospital.” USA Today

  • medical bldgOperating at the top of your license. Predicted shortages of primary care physicians due to an increased demand from more coverage and an aging population are not overstated. Technology that enables physicians to scale their abilities to cover patients by offloading some care and monitoring to other disciplines like nurse practitioners can help ease this burden.

“We use what we call Teamlettes. A group of people assigned to every patient. Administrative, clinical, psychiatric, all of us working at the top of our license, because there’s a lot of stuff done in medicine that can be done at other levels.” Mike Witte, Medical Director Coastal Health Alliance

  • Patient-reported data. Patient-data is already in our systems, from patient interviews, however it’s inputted by healthcare professionals and relies on patient memory of previous events. Enabling patients to enter health data as they experience it can result in more accurate information and also a more efficient in-person visit as the healthcare professional and patient can review what’s been entered rather than trying to remember what happened over the course of several days or weeks between in-person visits.

“Patient-created, and patient-curated information is the key to the future. We need to build tools that are based on this assumption. They need to be in line with what consumers are accustomed to in other aspects of their lives – they need to work on mobile devices as well as the web.” Robert Rowley, MD 

  • Community support. Engaging community organizations in helping patients, is both beneficial and cost-effective. Community organizations and centers can play an active role in helping people manage their health. Enabling patients to have key health-related information with them outside the clinic can help professionals like fitness or diet coaches engage. Providing the patient with ways to engage around their health in a community setting can help encourage and foster new habits. Medicare is piloting a number of programs designed to increase community involvement and decrease readmissions.
  • Managing groups of people. Websites like “Patients Like Me” and “Ben’s Friends” started as grassroots patient support groups facilitated by the vast reach of the Internet. If patients can meet and discuss their health, healthcare organizations should also be able to facilitate the management of people with similar issues. Technology can facilitate the ability to send similar treatment plans, communication, and tips to groups of people.

This is just the beginning of what’s possible. Technology advances will facilitate new ways of monitoring, communicating, and engaging that we haven’t even considered. We’re pretty excited about how engaging patients can improve outcomes and ultimately result in major positive changes in the health of countries and the way care is delivered. It’s still early days and patients, providers, insurers, and technologists are all still learning but there is so much opportunity to have a real impact.

Posted in: Adherence, Healthcare Disruption, Healthcare motivation, Healthcare Technology, Healthcare transformation

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Healthcare Transformation Summer Reading List: 7 Thought-Provoking Recommendations

FeetHeading to the beach, lake, or forest soon? Looking for something that will stimulate your thinking and have you heading back to work with inspiration and new ideas? Interested in new ways of looking at the world and ways to improve your organization?

We’ve rounded up some books that have inspired and even entertained us on big topics like motivation, behavior change, and the challenges and solutions in healthcare today. In no particular order, here are some ideas for summer reading that will get you thinking differently. (And no, we’re not an Amazon affiliate so we don’t make money if you buy after clicking through.)

Behavioral Health, Habits, and Economics

Nudge: Improving Decisions About Health, Wealth, and Happiness

Richard H. Thaler  (Author), Cass R. Sunstein

calmSynopsis: Research-based with practical examples of how small ‘nudges’ can alter behavior in predictable ways. Great for both micro-changes in your own behavior and thinking about human behavior as a whole. Unfortunately, like many of the books in this section, you’ll learn from this one that we very often do not make choices that are in our best interests.

Quotable: “The nudge provided by asking people what they intend to do can be accentuated by asking them when and how they plan to do it.”

Why You Should Read It: Who doesn’t want to make better decisions about health, wealth, and happiness? 😉

The Power of Habit: Why We Do What We Do in Life and Business

Charles Duhigg

Synopsis: Examines human behavior by looking at scientific research on habits, and even addictions, and combines that with examples of how companies have exploited these traits to ‘help’ us create new habits that include their products. Helpful to understand your own behavior and think about how to influence others either individually or collectively.

Quotable: “Studies of people who have successfully started new exercise routines, for instance, show they are more likely to stick with a workout plan if they choose a specific cue, such as running as soon as they get home from work, and a clear reward, such as a beer or an evening of guilt-free television.”

Why You Should Read It: Clearly breaks down behaviors and gives real examples of where we have all formed habits even without knowing it. Uses case studies from the masters of habit influencing: consumer packaged goods companies, with a particularly interesting story about why Febreeze smells the way it does.

GameFrame: Using Games as a Strategy for Success

Synopsis: This book tackles game mechanics and explains them in a way to make them applicable to anything you’re doing. It explains why games are addictive, but more than that equates them to behaviors and habits that we can apply to business and life. Although game mechanics are the framework for the book, it’s really about human behavior and motivation and how games capitalize on it.

Quotable: “Seeing progress is motivation. We derive satisfaction not from the moment, but from looking back and seeing how far we’ve come.”

Why You Should Read It: If you like games, you’ll understand better what makes them so appealing. If you’re not a gamer you’ll learn that gaming techniques and intrinsic rewards are part of everyday experiences that are pleasurable or sticky.

Predictably Irrational: The Hidden Forces That Shape Our Decision

Dan Ariely

Synopsis: Master of behavioral economics Dan Ariely explains why although we think we are making rational decisions we are actually making irrational decisions and yet there is still a method to this madness. That is, you can actually predict in what circumstances people will make irrational decisions that are potentially against their best interests.

Quotable: “money, as it turns out, is the most expensive way to motivate people. Social norms are not only cheaper, but often more effective as well.”

Why You Should Read It: Unlike many other books on behavior that provide a summary of research from many sources, in this book Ariely summarizes his own research which makes his insights both deeper and funnier. For example, this Duke University professor impersonates a waiter and takes beer orders in a pub in one experiment.

Healthcare Transformation

The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare

Eric Topol, M.D.

Synopsis: Not afraid to be provocative, and pulling no punches, Dr Topol takes on the US healthcare system and what’s wrong with the way medicine is practiced today both as a system and in individual patient/provider relationships. Topol is an early evangelist of how big-data can be used to deliver personalized medicine. If you’re interested in what all the fuss is on big data, this is a great primer.

Quotable: “Many patients now trust their peers on social networks—online medical communities such as PatientsLikeMe—more than their physicians.”

Why You Should Read It: Some of the examples, especially in genomics, seem far out, but they’re closer that you can imagine.

The Innovator’s Prescription: A Disruptive Solution For Healthcare

Clayton Christensen, Jerome Grossman, MD, Jason Huang, MD

Synopsis: Clayton Christensen turns his “innovator’s dilemma” theory towards healthcare with the help of medical experts Dr. Jason Huang and Dr. Jerome Grossman to shine light on waste and mis-incentives in the current system and provides strong cases for how to change it.

Quotable: “There are more than 9,000 billing codes for individual procedures and units of care. But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”

Why You Should Read It: In comparing hospitals to mainframe computers the authors use an already played out technology industry scenario to foreshadow what could happen in healthcare.

Transforming Health Care: Virginia Mason Medical Center’s Pursuit of the Perfect Patient Experience

Charles Kenney

Synopsis: Virginia Mason Medical Center in Seattle is a leader in applying kaizen or lean manufacturing techniques to healthcare. This book chronicles how they went from near bankruptcy to becoming a model of efficiency. It provides real examples and pulls no punches on the bumps along the way.

Quotable: “Change or die”

Why You Should Read It: While the mechanics of how Virginia Mason improved processes with a lean model are fascinating, the culture and people change that had to happen for the new model is just as interesting.

If you don’t like any of these options, we’re also reading HL7/ASTM Implementation Guide for CDA® R2 -Continuity of Care Document (CCD®) Release 1 😉

Posted in: Behavior Change, Healthcare motivation, Healthcare Technology, Healthcare transformation

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Just Because You Can, Does That Mean You Should?

Facebook’s recent experiments in social media mood contagion got us thinking about user-based testing in general and especially how that applies in healthcare technology that is intended to influence behavior.

The Experiment

happyFor one week in January 2012, Facebook manipulated the feeds of users to show content that was either positive or negative and then looked at whether this had an influence on users. The main point of contention or dissention is that this was human subject research without consent from the subjects and without the oversight of a review board as would be expected for university research. If the research hadn’t been published in a scientific journal then there might not have been so much controversy. What is the difference between A/B testing and what Facebook did? In A/B testing, marketers test different landing pages or campaigns and see which one works the best for their desired goal. Consumers don’t know that they are part of an experiment to test messages. However, consumers did freely follow a link that brought them to the content. The difference with Facebook is probably first, that they have significant power due to the volume of users and more importantly what they know about those users, and second although Facebook lawyers will tell you their terms of use covered it, Facebook users probably did not sign up with the expectation that Facebook itself would actively attempt to make them happy or sad.

How Do You Test Behavior Change?

It’s an interesting question for those involved in healthcare, and in particular trying to help people modify their behavior. In our case, at Wellpepper we are helping people be more adherent to home treatment programs. To do that we use a number of motivating factors including personalization and notifications. As part of building our application we test which features are effective in motivating people. We continually improve and change the application based on what we learn. Is this testing on human subjects? Yes. Did we get permission? Yes. This is part of our terms of use and it is also an essential part of how the industry builds software that people will use: by testing that software with real users. When people start using our software they use it to help them with a specific problem and they are happy when we make improvements to make it more effective to solve that problem. We encourage user feedback and implement new features based on it. So while, we may test new features, it is part of the implicit agreement of delivering software to users. (If you’ve ever used software that was not tested with real end-users, you’ll know the difference.)

When we test and add features that help improve user experience and become more adherent to their treatment program users are happy because we have helped them with their goals for using our software and the implicit contract with them. If we started testing and adding features that made them less adherent or changed some other type of behavior that they weren’t trying to change using our application we would have broken that contract and they might vote with their feet or in this case fingers and stop using the application.

What’s Your Implied User Contract?

The same thing could happen with Facebook, and it stems back to what their intention is with this research. The unfortunate thing is that they probably have enough data to have figured out that positive newfeeds make you happy and negative newsfeeds make you unhappy without actually manipulating the feeds. The fact that they did this, and did this without consent, brings up a bigger question of what their intention is, and what exactly is the implicit contract you have with Facebook. What exactly is their motive in trying to manipulate your emotions? For marketing experiments of this type the motive is pretty clear: consume more of their product. For Facebook it might be the same, but the fact that they tested negative messages does cause some alarm. Let’s hope they use their power for good.

Wellpepper2-1216aFor software developers that aim at healthcare behavior change there is an additional challenge as we think about testing features with real users. In order to help someone change behavior you need to test what works and that does need to be with real users. In general software development there are industry best-practices, for example, where you test different designs to find out which is most effective. This may be considered “experimentation” as users will not see the same features and some of the features they do see may not make it into the final version of the product. When you are doing this type of testing, you are looking for what is most effective in helping users achieve their goals. However, this testing must be done while protecting personal health information and not providing any harmful impact to the patient. Software developers can partner with research organizations whose internal review board will ensure that research on human subjects is conducted in the right way. To prove out efficacy of an entire application, this is often the best way to go but not practical for feature testing.

Guidelines for User Testing in Consumer Healthcare Applications

While looking at specific feature testing, these guidelines can help make sure you respect your end-user testers:

  • Unless you have explicit consent, all user testing must be anonymous. This is because if you are dealing with PHI and have signed a HIPAA BAA you have agreed to only access PHI when absolutely necessary. If you need to know demographics of your users for user testing, then you should err on the side of getting their explicit consent. This could be either via a form, or simply a non-anonymous feedback form on your application or website. By providing you with direct feedback the user has agreed to not be anonymous. (The good thing here is that patients can do whatever they want with their own data, so if they give you consent, to look at it, you have it.) That said, if you are working with healthcare organizations you will also have an agreement with them about contacting their patients: you need to make sure they have agreed to this as well. When possible err on the side of making data anonymous before analyzing it.
  • Think about the implicit contract you have with the user. If you are providing them with an application that does one thing, but you discover it may have applications for something else, don’t test features for that something else without getting consent. That is breaking the contract you have with them. Let’s look purely hypothetical example: at Wellpepper we have an application that increases patient adherence to home treatment programs for those undergoing physical rehabilitation. Let’s say we found out that people in physical rehabilitation are also often fighting with their spouses and started adding features or asking questions about the user’s relationship with his or her spouse, users would find this both unnerving and intrusive because that was not their expectation that we would help them with marital issues when they signed up for the application. Obviously this is a bit far-fetched, but you get the point.
  • Don’t get in the middle of human-to-human communication. This is essentially where Facebook broke the implicit contract with users by dis-intermediating the newsfeed. Your expectation with Facebook is that it’s a way for you to communicate with people (and sometimes organizations) you like. By changing what showed up in your feed, Facebook got in the middle of this. In healthcare this is even more important: don’t get between healthcare professionals and their patients. Make sure it’s clear when it’s you (the application, the company) talking and when it’s the caregiver and patient.
  • Consider where you’d get more value by partnering with a research organization. Sure it will take longer and may require more effort, but you will be able learn a lot more about why or how people are using your features by getting explicit research consent. I am not sure if it’s a coincidence or not but about a month ago I noticed that my Facebook newsfeed was full of extremely depressing stories. I remember wondering what was going on both with Facebook and the world in general and I remember wanting to post something depressing but then thought, “No I don’t want to add to this. I will only post positive things.” It’s possible that I was part of another study by Facebook and if so, they didn’t get the full picture that they would have if they’d been upfront about it, got my consent, and were able to ask me questions later about my thought process.

There is no doubt that we will see more discussions of ethics and consent in the space of user testing, especially as it relates to consumer-facing health applications. Having no regulation or guidelines is not good for consumer. However, only doing research with IRB and third party researchers is also not good for the consumer as innovation that could really help them can be slowed dramatically. Most people, whether healthcare practitioners or entrepreneurs got into the space because they wanted to help people. If we remember this, and we consider the ethical implications of our actions, we should be able to balance the two worlds.

For more reading on this topic as it applies to the software industry, see:

http://en.wikipedia.org/wiki/A/B_testing

http://ai.stanford.edu/~ronnyk/2009controlledExperimentsOnTheWebSurvey.pdf

http://www.exp-platform.com/Pages/expMicrosoft.aspx

Posted in: Behavior Change, Data Protection, Health Regulations, Healthcare motivation, Healthcare Social Media, Healthcare Technology, M-health

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Big Distances Make the Case for Telemedicine: Recap from the Canadian E-Health Conference

Vancouver Convention CentreJust back from the American Telemedicine Conference, and we took a short trip over the border (and back to the motherland), to the Canadian E-Health Conference in Vancouver, BC. Due to the short timeframe between conferences, it’s hard not to compare and contrast the two, although the healthcare systems between Canada and the US could not be more different. The E-health conference had a broader scope than the ATA conference, with telehealth as a sub-topic and electronic records management featured more broadly, in fact, all the major EMR vendors were there, with the exception of Epic.

Know Me in Powerchart

Know Me in Powerchart

In a session sponsored by Cerner, Island Health CMIO and Acting Executive Medical Director, Dr. Mary-Lyn Fyfe shared their patient-centered approach to EMR implementation called “Know Me.” Island Health Authority has been a Cerner customer for 5 years, and have a robust implementation with plans to extend to patient recorded profiles. Dr. Fyfe talked about how what is most important to patients is not always evident or even apparent to healthcare providers, for example, a patient admitted for heart issues but who is more concerned about who will care for his spouse at home with dementia rather than his own condition. Only by treating the whole patient does Dr. Fyfe believe that healthcare providers can have real impact.

Although telehealth was not more advanced in Canada than what we’ve observed in the US, Canada has real financial incentives for telehealth. Vast distances and sparse populations make delivering a high-level of care in many parts of Canada very expensive. The more that can be done remotely, the better. One group covering First Nations groups boasted that they had delivered nine telebabies, that is babies delivered with the help of a doctor over telemedicine. Another doctor talked about how his being able to coach a medical assistant onsite through a video call prevented a $10,000 emergency helicopter flight. Others talked about the environmental benefits of thousands of car trips of 3-4 hours that were avoided by using telemedicine, not to mention the quality of life improvements for patients. Another benefit of telemedicine that we hadn’t seen cited before was doctor education, this is in the scenario where a local primary care physician calls a specialist and together they meet with a patient. In an in-person specialist care scenario the patient would not see these two physicians at the same time. Having both in the same patient visit enables knowledge sharing between the doctors, for the specialist more context on the patient, and for the primary care physician education about the specialist’s area of expertise and the patient’s condition. You could call this collaborative telemedicine.Hackathon

While telemedicine is well established in Northern Canada, it seemed that the benefits in parts of Canada closer to the US border where most of the population lives were not as well established, and a surprising number of telemedicine initiatives were still in pilot mode. Similarly there seemed to be a great disparity in electronic records management with some health authorities still entirely on paper.

Kicking off the Canadian Telehealth Forum, which was a pre-conference session and also an annual event, Joseph Cafazzo of the Center for Global E-Health Innovation showed examples of home monitoring technology that did not take into account the users, who are primarily seniors, and called on the audience to consider empathy in the design of products. One of the key reasons for this is that the only person capable of managing a chronic illness is the patient themselves, and yet many don’t want to identify with their illness or be reminded that they have it. Empathy to the patients experience can help in designing products that make it less intrusive for patients to manage their health. The Juvenile Diabetes Foundation has been putting pressure on manufacturers for this as teens in particular don’t want to take their blood sugar readings although it’s crucial to their health. The Center for E-Health developed an application that identified the times that teens really don’t want to take readings (at lunch when they are at school for example), and offered rewards like iTunes giftcards for doing so, a great example of a carrot that is attuned to the patient’s preferences.

Mobile health seemed in the same place as in the US: a lot of very interesting, patient-centered applications like the 30-day stroke assessment from the Center for E-Health and the Heart & Stroke Foundation of Canada, which used AirMiles rewards to entice a high-risk group of men to download and complete the assessment. Engagement was 12% across all groups, including seniors. One of they keys to the app was that it focused on a short-timeframe, although this does bring up the question of how to keep patients engaged over the long-run.

Not surprisingly a number of solutions were based on lowering costs of population health management. Because healthcare is government funded, unlike the US there are real incentives for decreasing costs as well as keeping the population out of long-term care. While many solutions addressing issues such as CHF and COPD are in early stages, we heard lofty goals of increasing the number of outpatients managed by one nurse to over 200, and also using wellness coaches to scale further.

Considering that unlike the US, all the economic and patient incentives are aligned for e-health, it was a bit surprising that so many of the solutions and presentations were about pilots rather than completely implemented systems. However, that might be a tradeoff of having government run programs. Regardless, the conference featured many passionate speakers who are using innovative solutions to both improve patient outcomes and experience while being cost-effective.

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare Technology, M-health, Telemedicine, Uncategorized

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IT Can Make a Big Difference in Healthcare, Why Hasn’t It?

The final in the excellent collaborative healthcare series from the University of Washington and the Washington Biotechnology and Biomedical association did not necessarily end the series on a high note: speaker Peter Neupert presented a view of the near-term realities of healthcare evolution that was sobering for technology vendors. Basically Neupert’s thesis (and investing thesis) is that technology alone cannot have an impact on healthcare process and outcome improvement, and that pure technical solutions are doomed in the current situation where there is a lack of symmetry between the recipient of service and the payer of the service.Determinants of Health

The benefit of technology historically has been to create efficiencies and economies of scale by reducing manual efforts and waste. In the current system, the payers are incented to decrease costs, however, the way many providers are paid (fee for service) result in no incentives for them to reduce cost. Also, we currently have a disjointed system where payers and employers are responsible for the health of people until age 65 and the government is responsible afterwards, which is not conducive to preventative medicine or efforts to help the long-term health of the population.  Changes in healthcare models as part of the Affordable Care Act will drive the need for providers to be concerned about both population and long-term health but right now, we are in transition, which is why Neupert is betting (at least in the mid-term) on services that are delivered with technology rather than technology on its own unlike other industries. Neupert believes the winners will be those who can deliver a healthcare service more efficiently with technology, for example, home care systems that are able to do remote monitoring with telehealth and sensors and find problems before they become major issues.

Another reason Neupert cited as a reason that Health IT has not made the impact it could have is that in the US in particular, 5% of the people represent 50% of the cost. The reasons for poor health in this 5% are heterogeneous, which also makes it hard for a pure technology solution to address and do what technology does best which is scale. Neupert gave the example of an outpatient care company that produced better outcomes by simply making sure that patients had a ride to their follow-up care, a decidedly low-tech solution. As we think about preventative health solutions, it’s not enough to consider the person in treatment, we also have to consider the environment, for example, if you want to change a person’s diet you also have to change the diet of their family. Technology could help here, for example visual food journals have proven to be effective, but step one is often making sure the family has access to fresh food and knows how to prepare it.

Big data is another lauded savior of healthcare. But if data is not used it is not accurate. Again, there needs to be incentive to use it and that will drive data accuracy and results. Neupert gave the example of New York Presbyterian who have over 100 hospital applications and consequently very good data and contrasted that with the statistic that cause of death is cited incorrectly 25% of the time. Applying analytics to that data would be futile as we’d be trying to prevent the wrong cause of death.

Healthcare IT is grappling with problems that other industries faced years ago, for example, moving to the cloud, bring your own devices, or single-sign on. The key is for both healthcare organizations and technology companies not to see IT or the implementation of an EMR as the savior of improved healthcare, but as a tool that can enhance human-based processes. At Wellpepper we know that a key driver of patient adherence to outpatient treatment plans is the connection and relationship patients feel with their healthcare provider and think that technology is a great tool to enhance and extend that relationship.

We’d like to thank the Health Innovator’s Collaborative, the University of Washington, and the WBBA for this series. It provided inspiration, innovation, and an important dose of reality to big thorny problems. We hope to see this continue.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Technology, Healthcare transformation, Seattle

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Dispatches from the 2014 American Telemedicine Association Conference

BaltimoreWe just returned from the 19th annual American Telemedicine Conference in Baltimore, MD. It was an amazing opportunity to network, meet telemedicine pioneers, and get energized about the opportunities to improve patient care. While there are still some major barriers to care, first in the way of billing codes and second in the way of cross-state licensing, speakers were confident that these legislative issues will be solved for a number of reasons: telemedicine is effective, it’s what patients want, and it can improve access to care and decrease costs.

Telehealth in Practice: Chronic Disease Management

Similar to what we’re seeing in all healthcare, a one-size fits all approach does not work when it comes to telehealth either. For some patients it works extremely well, and for some even the most rudimentary telehealth (i.e. phone calls) doesn’t work. We heard many discussions about green, yellow, and red patients. Green are those that are able to take care of themselves and their recovery. Yellow are those that have some risk, particularly of hospital readmissions. Red are those who are a definite readmissions risk. While Red patients often cost the most money, they may not be the best candidates for the cost savings of telehealth. One speaker pointed out that the most challenging of “red” patients often move without notice or have their phones cut off which makes even the simplest intervention, either a phone call or a house call impossible. This speaker suggested that while the healthcare system needs to figure out a solution for these patients, they are often used as examples of why telemedicine doesn’t work. Using this as the standard will definitely set us up for failure as the benefits for those green and yellow patients are real.

Congestive Heart Failure is the number 1 reason for hospital readmissions, and not-surprisingly a number of sessions dealt with follow-up care for this population. As well, repeated CHF readmissions also lead to long-term mortality. In practice ensuring follow-up visits reduced readmissions, however, in-person follow up visits are both expensive and inconvenient for patients. Carolinas Healthcare Systems started a telehealth follow-up program for CHF in June of last year, and are already seeing results for their Heart Success Virtual Clinic. First, patients have been saved over 3,900 miles and 380 hours of travel. Second, the follow-up rate for virtual visits is >95% compared to 70% at the in-person clinic, and the no-show rate is 3% compared to 10%. Telehealth visits are more convenient and as one speaker pointed out “it’s hard to miss a visit that’s in your house” so no-shows decreased as well. While the study hasn’t been completed yet, they are expecting a 50% decrease in readmissions for the patients that are participating in telehealth visits.photo 2

The University of Arkansas Center for Distance Health also saw positive results for CHF by using a call center to manage 30-day post-discharge follow-up coupled with an EMR. While on the phone with the patient, an RN verifies whether the patient has been seen by a nutritionist, is on a special diet, is managing fluid intake, has been in touch with a patient educator, and has scheduled a 1-week follow up appointment. Patients were instructed to call the hotline with any questions, concerns, or worsening symptoms. During the pilot from May-July of 2013 the program saw a 31% decline in readmissions resulting in $60,000 in cost savings to the organization (this did not include the costs of any Medicare fines). When the program was rolled-out to the entire patient population in Q1 of 2014, 34 readmissions were prevented with a total cost savings of $418,000.

Other examples from the conference involved care team and peer support for patients. A bariatric program run by DPS Health included patient discussion groups that were moderated by healthcare professionals. Moderators were present to guide the discussion and ensure that patient questions were answered, but they did this by prompting patients to answer each other’s questions rather than having the moderator jump in. This peer support helped participants achieve an average weight loss of 4-5%.

Sensors and Information Overload

It seems that the greatest promise for telemedicine though comes at the convergence of patient self-care, collaborative team care, and access to information, and patient provider communication. Patients can take more responsibility for their care outside the clinic using monitoring, apps, and sensors. However, the best results were seen when those patients were able to communicate remotely with healthcare professionals, and when those healthcare professionals also had access to information. However, none of this should come at the expense of care. While sensors were a hot topic, tools must be developed to help healthcare professionals deal with the influx of data. They need to be able to triage the information and get to the relevant and actionable information. One physician said that we don’t have a primary care physician shortage, but due to the extraordinary demands of documentation, we do have a shortage of physician time. Trackers and sensors should not increase this burden if they want to have an impact on care.

At the conference we saw sensors for just about everything, including a few questionable brain scanners. The sizes of scanners ranged from ankle bracelets to band-aids, and from flashy consumer designs to highly clinical. One speaker was adamant that disposable sensors are the future, citing the “razor/razor blade” model. While disposable are appealing in that they are usually designed to be worn under clothes and are small, we’re not sure about the analogy as the software that comes with sensors is usually free. However, given the number of FitBits we’ve had to replace at Wellpepper due to loss, the idea of a cheap disposable sensor is highly appealing.

What Patients Want

We’ve know since we founded Wellpepper that patients want information, convenience, and access to support from healthcare providers everywhere. It was heartening to see this echoed throughout the conference. Perhaps the most interesting was the data presented by Carena on what happened when a major employer in Seattle moved to a high deductible plan: the total number of PCP visits decreased 52% and the remaining shifted to telehealth. If this doesn’t prove without a doubt that patients are cost-conscious consumers, we’re not sure what does, especially since we happen to know that major employer pays pretty well. It also probably shows that if services are unlimited, people will overuse them.

This was really just a small glimpse of an extremely busy conference. On the one hand, it’s heartening to see all the passion about change, however, it’s also sobering to realize that this was the 19th year for this conference, and yet we still are debating the merits of telehealth, and some states do not allow telehealth. Hopefully though between patient demand, increased access to technology, and the need to reevaluate both the costs of care and how to support population health, this will change.

We will definitely see you next year at ATA 2015, and are looking forward to see how small the sensors have become and how much more ubiquitous telemedicine has become.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Technology, M-health, Telemedicine

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Good, Fast, and Cheap: Demonstrating Value in Health Innovation

The goal of Triple Aim is to say that, despite what any project manager will tell you, you can have all three.

Good, Fast, Cheap

Source: http://ollmann.cc/

This provocative statement, set the tone for this third installment in Seattle’s  Health Innovator’s Collaborative, a talk called “Demonstrating Value in Health Innovation: Lessons from Comparative Effectiveness Research” by Larry Kessler, Professor and Chair, Department of Health Services, UW School of Public Health and formerly of the FDA, NIH, and NIMH. Dr. Kessler believes that the new accountable care organizations are mandated to deliver on all three and used the example of the Institute for Healthcare Improvement which was founded in 1991 on this principle and brings together leading hospitals, policy people, and researchers who are finding the best ways to deliver triple aim across many specialties.

Changes in how healthcare systems deliver care will drive innovation; however, innovation for its own sake will not win. Innovation must show evidence, cost savings, and revenue drivers. At the same time, it must satisfy a much wider group of stakeholders than previously including patients, physicians and clinicians, payers and providers. Innovative approaches and technology will take the leap past simply showing evidence of clinical outcomes to delivering value. This is a dramatically different approach from how typical NIH or FDA studies are done today. Those studies are done with a small slice of the population that is homogeneous, for example, they only have one issue and no co-morbidities. This type of study may prove outcomes with this particular population, but it doesn’t show cost or revenue based value and is no indicator of how something would work in the population at large, where the sickest patients are usually struggling with more than one issue.

Quality needs to be redefined as the best service AND the best health outcomes AND the best cost outcomes. Dr. Kessler went on to show some clear examples where solutions needed to go to the next level to be adopted and show results.

The first example provided a model that showed over a 5 year period, gastric bypass surgery proved cost effective. However, insurance plans do not include this surgery and require copious paperwork to justify it. This may make sense though, as the determinates of whether surgery is actually cost effective include a number of additional factors like the population and especially whether they will be part of your problem in 5 years. This is where the new accountable care organizations that are charged with population health will have an easier time with the cost benefit analysis as they be responsible for these patients in 5 years.

Another similar example is the new drug Solvaldi for the treatment of Hepititis C. It’s recently been in the news for its staggering price tag: $84,000 for a 12-week course. However, the drug has proved to be extremely effective, and University of Washington health economist Sean Sullivan points out “the drug is far cheaper than the alternative, which is a liver transplant and a lifetime of immunosuppressant drugs.” Again, though, whether this is a bargain or not depends on how long the payer thinks they will be responsible for the patient.

Successful business outcomes based on cost savings were shown in the example of two diagnostic tests for whether breast cancer would reoccur. The FDA-approved test MammaPrint could predict the recurrence of breast cancer. The non-FDA approved test Oncotype DX could predict the recurrence of breast cancer AND whether chemotherapy would work for the patient. This test, while not FDA-approved became far more popular as it showed very clear cost savings and quality of life for patients who did not undertake unnecessary chemotherapy.

Another study, Back Pain Outcomes Using Longitudinal Data-Extension of Research (BOLDER) was able to consider the patient experience as part of treatment. This study looked at 5,239 patients over 65 with new primary care visits for back pain across 3 integrated systems: Kaiser Permanente of Northern California, Henry Ford Health System, Harvard Vanguard/Harvard Pilgrim. The study goal was to determine the impact of early imaging as an intervention. The results are not yet published, but a couple of observations were already apparent. First, patients sent for MRIs, delay getting physical therapy and if the MRI shows they need physical therapy rather than surgery they have delayed their recovery by the time they waited for the MRI. In this case, the intervention of imaging if it was not needed produced less positive results for patients.

This study used the Roland-Morris Disability Questionnaire and it was also noted that many of the standardized testing tools do not account for what the patient actually considers a good outcome, like whether they can sleep soundly or have sex. Again, this shows that studies need to go a step further into the real world application of the patient’s situation.

These examples showed that it’s not enough to show that an intervention or new technology worked in a study, they also need to work in the real world. For payers that means lowering costs, for providers that means lowering costs or generating revenue while improving outcomes, and for patients that means delivering outcomes that are important to them, not just clinically validated.

The final lecture in this series will be June 3rd with Peter Neupert of Health Innovation Partners. See you there!
“IT can make a big difference in health:  Why hasn’t it?”

Health Innovators Collaborative
4:30 PM, W.H. Foege Building, UW Campus
Seminar: Foege Auditorium (S060)
Reception: Foege North 1st Floor Lobby

 

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

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Transforming Healthcare Through IT in Washington State

It seems every week there’s another health IT event in Seattle these days and we’re pretty excited about that. The grassroots efforts to build a health community really seem to be starting to take hold.  This week we had the pleasure of attending and presenting about Wellpepper at a Technology Alliance and WBBA event called “Transforming Healthcare Through IT: Investment Opportunities in an Emerging Sector”  held at K&L Gates beautiful offices. The WBBA officially launched their new Innovative Health initiative at the event: they are adding a third focus area to their current biomedical and biotechnology pillars and taking up the mantle of healthcare IT. Given that the lines are blurring between medical devices and mobile devices and software in particular, and that the WBBA are experts in healthcare regulations, this is a welcome move.

The view from K&L Gates Seattle, copyright K&L Gates

The view from K&L Gates Seattle, it was that beautiful this week. Source: K&L Gates

The event was kicked off by Rob Arnold of VantagePoint Investments, who outlined why health IT is so hot right now with a review of a number of trends including patient-centered care and the new requirements of the Affordable Care Act. However, he pointed out that Seattle really didn’t register as a center of healthcare IT investment. San Francisco, New York, Chicago, and even Atlanta and Nashville were far ahead. And yet, as we’ve heard many times we have some of the best healthcare systems in the country and some of the best software developers in the world. What we don’t have is investment, but this event, by bringing together investors, startups, and providers was aiming to change this.

Next up was a panel focused on the landscape of and future of IT moderated by John Koster, MD and former CEO of Providence Health & Services, with panelists Todd Cozzens from Sequoia Capital, Mark Gargett, VP of Digital Integration, Providence Health & Services, and Ralph Sabin from Fortis Advisors. The current state of health IT is not great: 80% of health records are running on a 45-year old technology called MUMPS (ie Epic), and 65% of providers continue to look for cost savings instead of at the $1T opportunity to fundamentally change how we do healthcare.  The current systems were characterized as a “big calcified hairball.”

EMRs need to transform and unlock the data in them to change this system, to be able to be prescriptive rather than reactive, for example, imagine identifying asthma patients and telling them about environmental changes that might impact their health.

All the panelists agreed that the transformation needs to come from within the healthcare system, and cited Microsoft, Google, and GE’s entrance and exit from personal and electronic health records as examples of why technology alone without a keen understanding of the process and system will not effect change.

On the other hand, there are lots of opportunities to fix small problems, for example, patient workflow or outpatient care. However, these incremental changes are harder to predict: it’s easier to see the large scale changes necessary than to fully understand the steps on the road to get there. This may be why the venture money shies away.

The panel also agreed that healthcare is becoming a retail model with patients as consumers driven by both high-deductibles and also expectations from conveniences in other industries. Providence recognized that consumers are increasingly in control of their health decisions and “want to be delighted.” Todd Cozzens from Sequoia predicted the winners would be those who could deliver on a retail experience, and close to or possibly even in a patient’s home.

Similar to discussion we’ve heard at other conferences about the future of healthcare, there was a belief that the fundamental skillset of individual healthcare providers needed to change: in the past remembering a number of facts and applying them in a particular situation was important. With technological advances like IBM’s Watson, computers can do a much better job of diagnosis and the role of the doctor changes to a social role of translating diagnosis into an effective care plan. Or as we’ve heard it characterized: “putting the care back in caregiving.”

Next up Mary Haggard and Joe Piper from Point B Managing Consultants and Capital, showed their “Health IT Landscape Matrix” which was an attempt to characterize Washington’s health IT companies according to the big buckets of Triple Aim categorized as “Creating Efficiency,” “Unlocking the Data,” and “Improving the Delivery of Care.” At the same time they attempted to categorize by the buyer (consumer, employer, provider, or payer), which wasn’t quite as easy and probably reflects the changing landscape of healthcare. What was amazing about the exercise was to see the diversity and number of players in Washington State. This is a great start to hopefully what will become a definitive reference source for the local industry.

Next up were the startup pitches from Corengi, Owl Outcomes, Health123, MedaNext, Spiral Genetics, 2Morrow, CadenceMD, TransformativeMed, and Wellpepper, which ranged from patient engagement to unlocking data genomics to unlocking data in the EMR (not sure which is harder ;)). We’ve been at events with most of these companies before and it was great to hear how they have gained traction and how their businesses and stories are evolving. As a presenting startup, we were happy to be in such great company both with our fellow audience and with attendees.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Technology, Healthcare transformation, Lean Healthcare, M-health, Seattle

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UW Medicine’s Journey To Become An Accountable Care Organization

As part of the newly forming Health IT community in Seattle, the Unveristity of Washington and the Washington Biotechnology and Biomedical Association have partnered on the “Health Innovator’s Collaborative” which launched with a series of seminars on how the coming changes in US healthcare affect organizations and innovation.

Accountable Care OrganizationsThis past Tuesday, I attended a talk by Paul Ramsey, MD, and CEO of University of Washington Medicine entitled “The Transformation of Healthcare: Forces, Directions and Implications.” Despite this lofty title, Dr. Ramsey focused on the nuts and bolts of the new Affordable Care Act (ACA) with specific examples of how UW Medicine is becoming an Accountable Care Organization (ACO).

First off, Dr. Ramsey started with some definitions of the goals of the Affordable Care Act and Accountable Care Organizations. When asked if the ACA is having a profound effect, he stated that regardless of any other measures, the number of individuals who are now insured is significant. Harborview Medical Center, a member of the UW Medicine System that covers a diverse and often low-income population, has already seen a 2% decrease in patients without coverage.

What was striking about the session was Dr. Ramsey’s clear conviction that while the ACA is morally just (we need to stop pricing people out of healthcare) organizations becoming ACOs were currently doing it because it makes human sense, while not currently financial sense. The reason it doesn’t currently make financial sense is that the first ACO contracts between payers and providers are still in negotiation and in the switch between reimbursements for procedures to reimbursement for outcomes providers initially see lower revenues as they decrease the number of unnecessary procedures. In the long run, this is mitigated by getting the right care to patients and by managing population health in addition to individual health

The triple aim of the ACA is to improve experiences for individuals, improve overall population health, and reduce the cost of care: lofty but extremely important goals. While managed care and HMOs were supposed to do this in the 90s, their main failure was having the primary care physician as the gatekeeper to all other services. This did not guarantee that the patient received the best and most cost effective care. Dr. Ramsey contrasted this to the goals of an ACO, where a patient might call a nurse hotline and be referred to emergency, their primary care physician, or receives an e-care visit, depending on which was best for the patient and most cost effective in the long run.

When asked if this model was a capitated model, Dr. Ramsey said yes, but at a population level, and that is why the current negotiations between payers and providers are so important. Providers are choosing which measures they will be held accountable for in their first year as an ACO. UW Medicine is choosing seven disease management measures, three health status and screening measures, and number of caesarian sections, which is apparently a hot button measure for CMS. Because all measures will not be implemented immediately UW Medicine will spend some time transitioning between models, however, this does not mean they won’t continue to improve care in all areas. He cited his own recent experience as a cataract patient at UW Medicine as of an example where high quality outcomes, patient care, and cost-effectiveness were combined.

As a guide for these types of measures, and as an example of the medical profession taking on best practices regardless of financial incentives, Dr. Ramsey cited http://www.choosingwisely.org where each medical specialty association provides their own guidelines for reducing unnecessary procedures and promoting best practices. This is a great resource for patients as well to review whether costly procedures are actually recommended and effective.

Accountable Care OrganizationsThere was some discussion that the US medical system as a whole could decrease costs by 25% without reducing the quality of care. UW Medicine has been able to reduce costs by $90M annually which is only a 2-3% of their operating budget and remain a top hospital. UW Medicine will continue to improve on both costs and their overall ratings.

Interestingly, the most important factor in patient satisfaction, a key health system rating, is the communication with their healthcare provider, rather than the outcomes. Improving patient/provider communication is an extremely cost effective way to ensure great care.

This was a great talk, realistic yet optimistic about the challenges and opportunities inherent in this transition to the new models of care we so desperately need.

The two remaining talks are:

May 13, 2014: “Demonstrating Value in Health Innovation: Lessons from Comparative Effectiveness Research”

Larry Kessler, ScD, Chair of UW Department of Health Services and former Director, Center for Devices and Radiological Health, FDA, will consider the coming necessity for innovations to demonstrably provide value and how the experience with comparative effectiveness can help innovators gather the needed evidence.

June 3, 2014: “IT can make a big difference in health: Why hasn’t it?”

Peter Neupert, Operating Partner of Health Evolution Partners and former VP of the Health Solutions Group at Microsoft will draw on his extensive experience with both institutional and consumer aspects of health IT to consider the enormous potential and serious pitfalls that make this area of innovation so challenging.

Editor’s Note: The primary care physician as gatekeeper is a failure in the single payer system as well. It denies patients access to the care they need and also adds waste into the system. In Canada for example, a referral to a specialist must be done by a primary care physician and expires every 6 months. So, if a patient has a chronic disease that they need to see a specialist for, the patient cannot keep seeing that specialist without getting another referral, even if all parties agree the patient should keep seeing that specialist.

Posted in: Health Regulations, Healthcare Disruption, Lean Healthcare

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23 and Who? The results

This post is the 2nd in a 2-part series on our experiences with 23andMe.

Wellpepper: What made you want to try 23andMe?

Anne Weiler: I wanted to see what the customer experience was like. It seemed so simple. $99 and they promise to tell you about your ancestry and DNA.

Jacquie Scarlett: I was really interested in getting back the results and seeing if the information I received from 23andMe was consistent with what I already knew about myself and my family history.

Wellpepper: What did you think you would learn?

Anne: I was curious about my ancestry. I had a theory that somewhere in my family someone was Jewish. They weren’t.

Jacquie: I figured that I would get confirmation that I was mostly European and that arthritis ran deep in my history and would be a high risk for me.

Wellpepper: Were you surprised by the results?

Anne: Originally, I was surprised at being 99.9% European. People are always asking where I’m from and they aren’t satisfied with “Canada” as an answer. When I was travelling in Nepal people thought I was half Nepalese. However, since I originally received results, they have been refined, and I’m now only 99.5.% European. I am not sure if that explains anything though.Anne Weiler Ancestry from 23andMe

Jacquie: I wasn’t overly surprised by the results, but found some items very interesting. I knew that I would be mostly European, and I was – 99.7% (mostly British and Irish) – but it was fun to find out that I was .1% Jewish and .1% Native American.  It was also pretty cool to see 479 DNA relatives pop up in my results from all over North America and the UK.

Wellpepper: What was the most surprising result?

Anne: Most surprising were results that contradict my actual experience. For example, 23andMe says I’m at reduced risk for Psoriasis, a hereditary disease that runs in my family and that I do in fact have. This does make me question other results.

Jacquie: There were a few illnesses in the Elevated Risk section that took me back for a moment, but then when I dove into the results I realized that I was merely a few % points above the average for all people and I relaxed. It is a bit surprising to see those illnesses listed in front of you.

Wellpepper: What was the least surprising?

Anne: That I’m at risk for glaucoma. It’s hereditary and I’m familiar with my family history.

Jacquie: High risk for arthritis – very prevalent in my family history and I already have the illness.

Wellpepper: What is your understanding of the accuracy of this test?

Anne: I don’t know the statistical accuracy, but I know that 23andMe was trying to get to 1M DNA records sampled so that they could claim accuracy. I also saw the NY Times article showing the discrepancies between tests. Based on some of my results that are wrong it’s hard to know. The brain is funny though: I definitely want to believe that the results showing low risk for Parkinson’s or MS are correct even though I have other results that are incorrect based on my personal experience.

Jacquie:  I do not know. I have the understanding that the more DNA they receive from the population, the more accurate the results will be and the more information they will be able to find out. I took this as an opportunity to learn more about DNA and the possibilities of what you could learn versus that this is the absolute truth.

Wellpepper: What was it like to receive your results?

Anne: Anne Weiler Norovirus ResistanceIt was addictive. We all want to know about ourselves, and here it was, in great detail. I really loved the random things I found out, like I’m resistant to Norovirus (stomach flu) or that I am likely to sneeze in bright sunlight. I intuitively sensed those things, but had no idea they were genetic.

Jacquie: It was pretty fun and interesting. I love learning more about myself and family history. Even though there was a lot of information, I found myself wanting more and wanting to dive deeper. Every time there was an unknown listed – I wanted the answer – this is what keeps me coming back to the site.

Wellpepper: Since you have received your results how have you engaged with 23andMe?

Anne: They are very good at pulling you back in, either through relatives who want to connect or by releasing new test results. That’s the really interesting (and scary) part. Once your DNA is analyzed it remains on file and they run new tests or more accurate versions of previous tests on it. I didn’t realize that it was going to be such a sticky experience.Anne Weiler DNA Relatives

Jacquie: I have checked in from time to time to see if any of my results have been updated. I also really enjoy doing the surveys – I am very interested in the research that 23andMe is doing and want to help in any way I can.

Wellpepper: Have you shared your information with anyone? Who and how?

Anne: I’ve connected with two 2nd or 3rd cousins on the 23andMe website. I’m interested in finding my maternal grandmother’s family. We don’t know as much about them.

Jacquie: I have shared my results with close friends and family, mostly with family to entice them to do the test as well.

Wellpepper: Would you share it with your doctor?

Anne: If I thought it was relevant to symptoms I was experiencing yes, but otherwise not unless my doctor asked. Doctors are being overloaded with data these days.

Jacquie: I would share the results with them if they would find it helpful.

Wellpepper: Do you think 23andMe will continue to engage you?

Anne: I don’t seem myself using it all the time, but as I mentioned before they do a good job of bringing you back in, and maybe I’ll become more interested in genealogy as I get older.

Jacquie: I will check in here and there. I imagine that if I have a health situation, it will be helpful to be able to pull these results when needed.Anne Weiler Asparagus 23andMe

Wellpepper: Do you think people should have access to this type of personal health information? Is it dangerous?

Anne: They should definitely have access. I thought 23andMe did a good job of presenting potentially disturbing results with the appropriate cautions. For results for chronic and debilitating diseases they make everyone read information about the disease before they tell you if you have the marker for it. I think it could be dangerous if someone started to make changes before talking to their doctor, except for some basic things like avoiding tobacco or caffeine, which are good for you regardless of the markers you have.

Jacquie: Absolutely! I think it’s very beneficial for people to have the most information possible so that they know more about themselves and feel empowered to take care of themselves and their health.

Wellpepper: Based on receiving your results, will you make any personal changes?

Anne:  I will be more helpful to people with stomach flu since I know I can’t catch it, and I’ll be even more strict on my caffeine in the morning only policy.

Jacquie: The results weren’t surprising enough to cause any personal changes.

 

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare Technology

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Impressions from XX in Health

Last week I was fortunate to attend the XX in Health conference sponsored by Rock Health at Cavallo Point in Sausalito. It was an evening and full-day of networking for women at all stages of their careers and across many disciplines including large insurers, startups, consulting companies, government, and healthcare providers.

Lisa Suennen, venture capitalist and healthcare consultant provided commentary and kept the day running smoothly. Pat Salber of the Doctor Weighs In did a great job of summarizing the day, so I’ll stick to my impressions.

First, I can’t remember the last time I was at any event that was all women and the first thing that struck me was the color and diversity of appearances and the amount of buzz in the room before the event even started. I’m used to IT conferences where everyone is wearing the same uniform of khakis and polos, and where everyone looks at their shoes until the evening cocktail hour. (Joke: How can you tell an extroverted engineer? S/he looks at your shoes.)

Second, I was struck by the honesty of the personal stories that were told. It was refreshing to hear how people struggled. So often we only hear the ups, and miss all the trials that got a successful person to that place. What struck me is that it seemed unlikely that a group of men would share to this depth.

My favorite quote of the day was

Halle Tecco tweet
Third, women’s career paths while producing highly talented and well-rounded individuals do not fit the traditional “climbing the ladder.” During my 10 years at Microsoft, I saw people with calculated career paths. They did whatever it took to get to the next level, and they got there faster than I did. I looked for interesting experiences. Opening speaker, Colleen Reitan of Healthcare Services Corporation talked about a similar approach, but was questioned by an audience member if perhaps women take this route because they have no other choice or face roadblocks. At the break, my table talked about this a bit, and think that unfortunately there a lot of external factors, like not wanting to look too aggressive that make women take this path.

Another prevalent theme was that women are well suited to solve challenges in healthcare due to their natural empathy, and that healthcare problems can only be solved with human communication, spaces for healing, and spiritual connection.

Brainstorming at XXinHealth at Cavallo Point

Brainstorming at XX in Health at Cavallo Point

Many speakers talked about mentors who had challenged them, supported them, and sometimes bluntly said they couldn’t do things, which spurned greater action. Interestingly, I can’t remember a single person with a great female mentor. They were all senior men, most of these speakers were in later career so it might just be a product of the time they were starting.

Finally, one of my biggest takeaways was to look for the “underdog.” Vivek Wadwa, the only male speaker, talked about how while Silicon Valley was staffed by immigrants, he was told by every VC that “Indians don’t make good CEOs” so rather than fight this, he looked to CEOs of successful Indian companies for backing and advice, which might not have been a typical choice. I heard the same advice from other startup CEOs I talked to: you are different, find others who are different and help them.

The event this year had a waitlist of over 400 people, so if you’re interested in attending you will want to make sure you are following @xxinhealth.

If you’d like to get some great impressions of the event, you can see some of the best tweets here.

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Health 2.0 Seattle Meetup: How to Build Solutions in Healthcare

This was the second Seattle health meetup we attended in March, the previous was the Health Innovators Meetup. Health 2.0 is a global organization (we demoed at a Health 2.0 event in London back in November 2013) but the Seattle group is quite new. They are valiantly trying to help build a community of healthcare industry and startups, and those just interested in healthtech issues in Seattle.

The meetup was hosted and moderated by Tory Kelso of GenieMD, and formerly Microsoft HealthVault and Cerner, and panelists were:
Anand Gaddum, Director, Health & Life Sciences at iLink Systems.
Howard Mahran, CEO & Founder Deep Domain, Inc
Sailesh Chutan, CEO and co-Founder at Mobisante, Inc.

Each talked about the drivers for their participation in healthcare. For Howard Mahran, like many entrepreneurs we’ve met, ourselves included, it was frustration born from a personal experience. When Howard’s father was diagnosed with prostate cancer, he was amazed at the lack of information and data available about the diagnosis and prognosis. Sailesh Chutan was driven by a passion for accessibility to technology on a global basis. Anand Gadddum cited the opportunity for applying resources to the wealth of health data out there to make a difference.

When asked how to pinpoint the right problem to solve in healthcare, panelists discussed how to find the pain point by looking at something that doesn’t work today, and how to spot the disruption by seeing how a market or technology change could become amplified when applied to another industry. Sailesh used the example that the computing power in a smartphone today is more than enough to do complex image processing, and recalled his ‘aha’ moment when he realized to reduce cost and improve access, move access to services closest to the patient and find the lowest cost person to deliver the care. (We’ve written about this before. It’s often called “operating at the top of your license”, that is, making sure that if a lower licensed person can perform a task, enabling them to do it.)

Howard talked about the pain of trying to make sense of the “dumptruck” of data that the over 1100 non-standardized EMRs produce, an acute pain for smaller hospitals and clinics that do not have a large IT staff. Also related to the proliferation of non-standard EMRs, Anand talked about customers that are stuck with old technology that is siloed and not easily integrated. Services companies like iLink can help integrate and unlock this information.

Networking at Health 2.0 Seattle

Networking at Health 2.0 Seattle

At this point Tory pointed out that all three solutions had started with the technology, as technologists often do, and asked how to translate a technical solution to a customer focus. Howard readily agreed with the need to translate, saying that his customers don’t care about the technology at all, they care about the problem they have which is not being able to get information. He talked about how Deep Domain had completely changed their sales process to focus on customer pain rather than how great their technology is, and shared the enviable example of a sale that closed in 4 days after they took this approach.

Sailesh also talked about how they had adapted their sales strategy and focus based on what they’d learned in the field. In particular, they found that their mobile-phone based ultrasound offered new billing opportunities to small and particularly rural communities. Rather than providing a referral to a hospital for an ultrasound these clinics could perform ultrasounds themselves for a fraction of the cost resulting in a new revenue stream for the clinic and much higher convenience for the patient. He also realized in selling to these smaller customers, Mobisante had to provide a complete solution including training and image management.

The next topic was on healthcare’s slow embrace of platform, and perhaps the best quote of the night that the current crop of EMRs are why healthcare doesn’t understand platform. Certainly the lack of openness and data interoperability as well as the late adoption of many now standard enterprise IT practices pointed out by Anand are the key reasons behind this.
Some other reasons that healthcare has been slow to embrace platform and cloud technology is the very real fines for HIPAA breaches, although the panel pointed out that most breaches are not due to technology vendors but human error like losing laptops that have PHI on them.

Upcoming Health 2.0 Talks

Upcoming Health 2.0 Seattle Events

To conclude the session, Tory asked for some tips for anyone wanting to get into healthcare technology. Howard jokingly responded “don’t” but the underlying truth is that with long sales cycles, lack of standardization, and many regulations, health technology is not for the faint of heart. He also recommended to “look down not up”, that is don’t ignore the smaller hospitals that can implement more quickly or where your solution offers value they might not normally afford, like Deep Domain’s reporting or Mobisante’s ultrasound. Would-be entrepreneurs were also advised to seek out the early adopters in customers, those people who have passion, understand your value proposition, and are mission driven. These people will help you succeed.

Posted in: Data Protection, Health Regulations, Healthcare Disruption, Healthcare Technology, M-health

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Seattle Health Meetup: Focus on Consumer Health and Wellness Technology Sector

Less than a year ago, I was at an event sponsored by the Washington Biotechnology and Biomedical Association, where a room full of health IT and consumer health startup CEOs bemoaned the lack of a healthtech community in Seattle. We have all the elements here: talent, world-class healthcare facilities, and b2b or enterprise IT pedigree. Events like Seattle’s Health Innovators Forum Meetup and Health 2.0 are trying to change that by bringing together startups, investors, and general health enthusiasts for learning and sharing. This month’s Health Meetup, organized by Edmund Butler, was focused on Consumer Health and Wellness, and featured local startups in this space. Speakers were:

54824v1-max-250x250Marcelo Calbucci (@calbucci) is Co-Founder and CTO of Everymove, a company that automatically integrates data from various fitness trackers and provides consumer rewards from its partners.

 

 

 

Julie Kientz (@juliekientz) is the director of the Computing for Healthy Living and Learning Lab (CHiLL), a group of UW researchers interested in designing, developing, and evaluating apps that aim to promote healthy lifestyles and education.

 

 

Rebecca Norlander (@rebatwork) is the Co-Founder and CEO of Health123,  a consumer health company that helps people make decisions and track the small changes in their lives that can make a big difference in their health.

The three speakers shared a passion for designing person friendly applications for consumers to manage and improve their health. The three talks provided different perspectives on the topics of how to engage users and overcome their barriers or burdens to both application use and improving their health.

Marcelo kicked it off with his “8 Pet Peeves of Health Apps.” (I’m sensing an Everymove love of numbers as I also attended another talk by CEO Russell Benaroya called 25 Reasons You Suck At Sales. They also like to have provocative titles. 😉 )

Here they are in order:

    1. Calling people patients. Marcello pointed out that for all other applications they are users. He prefers people or member. (Later Rebecca noted that some industry conventions need to stay in order to communicate with your target customer. Patients is a tough one. People don’t like to be called patients, but the entire healthcare industry refers to them this way.)
    2. Trying to be all things to all people. This was a criticism of apps that try to track too many things. Figure out what behavior you’re trying to affect and do a great job of that.
    3. Putting the organization rather than the person at the center. This would be designing for the healthcare organization rather than the patient or worse yet for the insurance company rather than the patient.
    4. Misaligned or misguided incentives. Marcelo used the example of paying people to track something for example finding out their BMI rather than trying to incent them to change something, like become more active (and then lose weight). Historically there has been an idea in the health and wellness area that if you have information you will change. Information is really only one component (as Julie elaborated on in her session).
    5. Health Risk Assessments. Marcelo thought that these were particularly dangerous as people tend to associate these types of assessments with tests and then inflate their answers and then assume they are healthier than they thought.
    6. Bad UX and bad visual design. Marcelo showed an EMR screenshot saying “the 90s called, they want their interface back”.
EMR Screenshot

Source, Microwize.com.

  1. Treating a person as a condition. The person’s condition is not who they are and is only one component of the information a healthcare provider or application needs to understand to care for or help support that person.
  2. Making you change to fit the application or service. Wearables still fall into this category. You need to remember them, you need to wear them, and in the case of the new FitBit force, you need to get medical attention after wearing them.

Julie Kientz was up next, and her human-centered design approach provided practical advice to solve many of the pet peeves that Marcelo mentioned. The goal of Julie’s research is to understand and reduce the burdens in healthcare design. She described 8 key burdens that can impact adoption of healthcare technology.

Physical: Is the technology comfortable to use or to wear? Does it fit in with my surroundings or what I am doing? With wearables, physical is obvious, but physical could also be how you access the application, for example which tasks are better for a mobile device versus a PC?

Privacy: Where does the data go? Who is able to see it? For applications that have social sharing, are others able to track you? (Did you call in sick and then go for a 15K run?)

Mental: How do you feel about the technology? Julie said she feels sad when she forgets to put her FitBit on, and often goes back home to get it. As well, she is on her 6th FitBit in 3.5 years due to losing them, so is also feeling some guilt about the loss.

Access: Is the technology designed for diversity? For example, many nutrition trackers do not include foods that are popular with different ethnic groups.

Time: How much effort is required to enter or review data? Julie personally doesn’t look at her FitBit data online, just at the step count on the display. The online reporting is too much effort for her.

Emotional: What is the emotional impact of not meeting the goals the technology is tracking? Do you feel like a failure?

Financial: How much does it cost? Does it require expensive equipment like a smartphone? Are there added costs like a data plan?

Social: Does others use of tracking make you feel better or worse? Do you feel guilty when someone posts their runs online?

Because these burdens compete with each other it’s impossible to design to eliminate all of them at once, and so you have to understand which are the most important or provide the biggest barriers for the audience you’re designing for. Julie and her lab published a paper on this if you want to know more “Understanding the emotional burden of health technologies”. She also provided some practical examples of how her team has developed technologies and studies to accommodate these burdens.

ShutEye

One example is the ShutEye sleep tracker that’s designed for people who have some trouble sleeping but are not motivated enough to seek professional help. ShutEye is an Android app that displays on the homescreen with recommendations based on the time of day. For example, it will tell you whether it is too late to have caffeine if you want to get a good night’s sleep.

Another application, BabySteps deals with the emotional component of child development, by displaying development stages as trees in different stages of growth. This removes the stigma of clinical terms like delayed. BabySteps is designed to be used over the first 5 years of a child’s life so the team is also experimenting with different interactions to keep parents engaged for example, a Twitter feed that asks questions about child development. You can find links to all of Julie’s research here.

Julie then summarized with these words of advice:

  • Embed actions in activities people are already doing
  • Provide multiple options for tracking/achieving goals
  • Balance between manual and automated tracking
  • Priortize which burdens you will resolve based on your user’s desire and what your application is intended to accomplish
  • Match the burden to the motivation level of your user

Rebecca took the stage next and tied the two previous talks together with examples from how they built Health 1-2-3 to overcome barriers to engagement in health. While 85% of people say they want to feel better, a number of factors prevent them from reaching that goal. The absence of the following can be barriers to wellness:

Awareness: Not knowing what the actual situation is. (See Marcelo’s Pet Peeve # 5 on Health Risk Assessments.)

Knowledge: Once you have awareness, what can you actually do? Health information is often not delivered in a way that is actionable.

Self-efficacy: People cannot make big changes all at once. How do you make small and incremental changes towards health?

Personalized Solutions: Generic solutions don’t speak to the person or help them take personal responsibility for their health. Personalized solutions are customized based on information about that patient and provide options appropriate for that person’s health.

Time: Solutions need to integrate with people’s lives. Behavior change cannot take so much time as to be prohibitive. What small steps can be integrated?

Support: What types of social support does a person need to make a change? For example, there are many great fitness and health communities, like Strava for cyclists, where people support each other’s goals. On the other hand, social support needs to be in the control of the person. Applications shouldn’t be posting updates on the person’s behalf.

Rebecca walked through all of the above in the context of a Health 123 demo that showed how they simply address the issues. For example, awareness takes the form of a series of simple health questions. Knowledge is tailored health information based on the questions the patients answered. Self-efficacy is addressed by making health challenges reasonable to fit into a person’s day and week.

If you’re interested in or working in health technology in Seattle, I highly recommend these meetups. The content and discussions are packed with inspiration and information, and the burgeoning Seattle Health IT community needs your support.

You can find out about the next meetup here.

Posted in: Behavior Change, Healthcare Disruption, Healthcare motivation, Healthcare Technology, M-health

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APTA Session Recap: What We Say Feeds White and Grey

“Brain‐Enhancing  Strategies for Effective Therapeutic Communication”

Speaker: Karen Mueller, PT,DPT PhD

Therapeutic outcomes are as affected by the therapist’s ability to effect behavior change in their patients as by their clinical skills. However, many healthcare professionals don’t understand the basics. This session by Karen Mueller, PT, DPT, PhD focused on strategies to help improve patient care by examining principles from positive psychology and mindfulness to develop empathy for patients.

We know from research that feeling empathy from the healthcare provider is one of the key factors in patient satisfaction. We also know that a positive relationship between patient and provider is a key factor in improving patient adherence to treatment plans. How much do we think about the impact of the provider on the patient in daily care? Does a more positive and mindful healthcare provider get better results with patients?

The session started with some background research on positive psychology and mindfulness, with reference to renowned happiness researcher Martin Seligman, Director of the Positive Psychology Department at the University of Pennsylvania, in particular the impact of positive psychology in healthcare outcomes.  Unfortunately, our brains are naturally wired towards negativity, which may have been a primitive self-protection mechanism, and it takes a 3:1 ratio of positive thoughts to overcome negative thoughts so we need to actively cultivate positive thoughts to overcome this bias.

Why is this important? Positive emotions appear to create enduring personal resources including creativity, resilience, social relationships, and overall health and well-being.

“The way we choose our words can improve the neural functioning of the brain, in fact a single word has the power to influence the expression of genes that regulate physical and emotional stress” Andrew Newberg, MD

Next the session explored mindfulness, defined clinically as the “cognitive process of directing and redirecting focused attention on an internal physiologic process” and in layman’s terms of focusing and noticing the current experience without attachment, often by using the breath as a tool. Mindfulness has been studied for its impact in healthcare, particularly for managing chronic pain but patients using mindfulness techniques have also seen improvements in fatigue and depression.

Mindfulness has also been proven to be effective in therapeutic practice when used by healthcare providers. A study by Beach et all in 2013, showed that clinicians who practiced mindfulness had an easier time building patient rapport, more patient centered communication, and ultimately more satisfied patients.

Finally the session provided practical advice for people wanting to practice mindfulness when caring for patients:

  • Understand how you are feeling before you meet with a patient. Your negative emotions can have a big impact on them. If you are stressed or burned out, help yourself so you can better help your patients.
  • Speak wisely: express appreciation, speak slowly (slower speech enhances trust and reduces anxiety), speak briefly, check for understanding
  • Listen wisely: paraphrase, don’t interrupt, look at the patient, ask questions

The session provided a comprehensive high-level survey of the topic, and pointed to a wealth of information and research studies for those wishing to explore the topic further to improve their patient care.

Posted in: Aging, Behavior Change, Healthcare motivation, Occupational Therapy

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APTA 2014 Recap: Forging Ahead With Telehealth: A Roadmap for Physical Therapists

Presenters

Justin Elliott, NA

Matthew Elrod, PT, DPT, MEd, NCS

Alan Lee, PT, PhD, DPT, CWS, GCS

Christopher Peterson, DPT

Telehealth, which originated as a way to provide care to rural settings, has become an accepted way although not widely adopted method of delivering healthcare. Benefits include convenience for patients, the ability to access specialists in other locations, and being able to monitor chronic conditions at lower costs. Advances in technology, that have put powerful microcomputers in everyone’s pocket, have made telehealth significantly more in demand and more feasible than ever before and as a result the telehealth market is forecasted to grow to a 4.5B market by 2018.

The good news is that telerehabilitation is part of this growing market, and people are already practicing today. The bad news is there’s still a lot of confusion about reimbursement and regulation. A show of hands at the beginning of this session revealed that while 5 out of approximately 50 attendees were practicing telehealth, no one put their hand up when asked if they felt confident about the rules and regulations, and most people seemed to not be getting reimbursed.

The goal of the session was to provide some clarity on the definition of telehealth, examples of how it is used in physical therapy, a survey of the current regulatory and reimbursement situation, and a toolkit for those who are interested in moving forward with a telehealth practice.

Telehealth communication is used in two settings, between a healthcare provider in an office and a patient at home, or between two clinical settings where one healthcare provider wants to consult with or have the patient consult with a specialist in another clinical location.

Telehealth Scenarios

There are two types of telehealth:

  • Synchronous, or real-time where the two parties communicate directly via video conference.
  • Asynchronous, or store and forward where video, text, or voice communication is transmitted between the two parties but they do not respond to it in real time. Email, texting, and even voicemail are all forms of asynchronous communication. (Wellpepper is an example of asynchronous telehealth.)

Synchronous communication more closely resembles a typical clinic visit, as it is a dedicated and scheduled visit, with the difference being that the two parties are not in the same location. Asynchronous is better for remote patient monitoring, check-ins, and chronic disease management were the parties do not require constant face-to-face communications. In fact, one of the areas that telehealth has shown real promise is in chronic disease management, first because most of the management of chronic diseases occurs outside the clinic, and second because these patients often need access to specialists who are not local.

Telehealth should be considered a way to augment in person treatment but not replace it, especially in the musculoskeletal world where treatment is often hands-on. Follow-up treatment, home treatment plans, questions and answers, and consultations with specialists are all areas where telehealth can add value in treatment. Telehealth also provides more convenient options for patients, not just rural ones. With busy lives many patients find it difficult to get to a clinic to an in-person appointment. It can also help lower costs of care.

While telehealth has many benefits, there currently many potential blockers. For example, before embarking on a telehealth program, make sure you fully understand privacy laws. All communication needs to be encrypted, and tools like Skype, while very convenient, do not deliver the level of security required by healthcare law.

The elephant(s) in the room in the whole discussion are regulations and reimbursement. This session provided hope that these will be resolved: both the APTA and the The Federation of State Boards of Physical Therapy are working to define and eventually change the legislation to enable more widespread adoption of telehealth. Unfortunately, it seems that the change may be slower than consumer demand and certainly than innovations in technology.

Currently 21 states have private coverage legislation for telehealth billing and 11 states have Medicare billing with 6 more in proposal stage. This legislation applies to intra-state practice, that is the patient and the physical therapist are within the same state. Inter-state practice where the physical therapist and the patient are in different states is only possible if the physical therapist is licensed in the state where the patient resides. Note that Medicare does not include telehealth for PT, OT, Audiology, or Speech Therapy. Since some of the real power of telemedicine is being able to practice across state boundaries (and possible across country boundaries in the future), we need to solve this inter-state issue.

It’s not really feasible for physical therapists to get licensed in each state so that they can practice telemedicine regardless of patient location. There are two possible solutions to this problem. One is a “telemedicine license” which is a license to practice telemedicine in a particular state even if you don’t reside in that state. Louisiana is a state that has this license type. The other, and more practical long-term solution is to create an interstate licensure compact. This would enable the portability of licenses from one state to another. The most common example of this is the driver’s license. Your driver’s license may be granted by the state of Washington but it is recognized and honored in all the other states (as well as Canada). The Federation of State Boards of Physical Therapy is leading a committee to put forward a proposal for an interstate licensure compact, and there is some discussion at the global level as well. (Nurses are much further ahead in this area, 24 states have joined a nursing licensure compact that enables nurses to be licensed in their home state and practice in any of these states, which is great for both telehealth and for portability of nursing careers.)

With respect to billing, there are billing codes for telehealth for physical therapy but they vary depending on state and by insurer. Two state practice acts, Washington and Alaska, recognize telehealth. In California, physical therapists are covered under a general assembly bill that allows for telehealth. Arizona, Kentucky, Minnesota, Nebraska, and New Mexico, list physical therapy and/or telerehabilitation services in their Medicaid policies. Perhaps the most promising change that will move telehealth forward is the new “accountable care organization” and bundled payments. With bundled payments, the organization is paid based on patient diagnosis and outcome not by the number of procedures that are provided, so there is built-in incentive to focus on the most effective and cost effective way to get a great outcome.

If you’re interested in moving telehealth forward for the physical therapy profession, the APTA has a lot of great resources in their telehealth toolkit. At Wellpepper, we’re very excited about the prospects and look forward to working with you on these new ways of treatment.

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Rehabilitation Business

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APTA 2014 Session Recap: The Success of the Profession Lies in the Consumer: Who Are They?

This post is part of our recap from attending the American Physical Therapy Association Combined Sections Meeting in Las Vegas Feb. 3-6.

Speakers:

Andy Lodato, MPT

Jerry Durham, PT

This session from Jerry Durham, cofounder of San Francisco Spine and Sport and Andy Lodato, cofounder of PhysioCarePT in the Private Practice section explored how the business of physical therapy needs to consider patients as consumers first, even in states where patients do not have direct access to physical therapy. The patient as consumer is a popular theme in healthcare these days, as high-deductible plans increase out-of-pocket costs and make patients more discerning about the cost-value relationship in their care, and many of the ideas in the session were appropriate to both private practice and hospital outpatient settings.

The session began with Andy talking about how he and his business partners transformed their business from the early days when they “said yes to everyone”, that is they accepted every patient even if the terms of that patients insurance caused them to operate at a loss. While this may seem like a great thing to do for patients, they also weren’t discerning in whether they accepted patients that appreciated the value that PhysioCarePT provided. This devalued their brand promise. Now Andy and team target the “conscious consumer”: the patient that connects with the value that Physiocare provides. Andy also talked about how the profession is so focused on measuring patient outcomes but does not measure business outcomes. His business turned around when he started applying this same rigor to the business.

After taking this approach, Andy and his partners started actively targeting patients that would appreciate the value that Physiocare provided. He works in an extremely competitive market, however, also a market that has a well-educated, athletic, and well-insured patient base.

Andy outlined some of the ways in which he and his staff cultivate relationships with patients as consumers. All of the physical therapists at the clinic are expected to network and market the value of the services they offer. Here are some of the ways they do that:

  • They share infrequently on Facebook: only when they have something important to say, for example, the most successful Facebook campaign included a pair of Nike running shoes designed  with the custom colors of PhysioCare’s branding. This attracted the most likes and shares of any campaign.
  • Similar to other best practices we’ve written about, PhysioCare created a “Solemate’s Running Group” that meets weekly. This serves two purposes, it shows patients that you care about their goals, and also keeps you top of mind when injuries occur, as they do for the majority of runners.
  • PhysioCare offers community lectures on topics like whether young ballerinas are ready to dance on point, corporate fitness programs, the right way to carry a baby to prevent back injuries. These events are a pure community service but also establish PhysioCare PTs as experts in topics “conscious consumers” care about.

Andy talked a bit about referrals from doctors, often a contentious topic: should you market to the doctors or their patients? First off, Andy said he never buys lunch, referring to the practice of sending gifts to doctor’s offices, he works on establishing a mutually beneficial relationship. He works with a group of 7 surgeons who refer patients to him, while his team refers patients to them if they think they require surgery. Surgeons would rather spend their time with patients who require surgery, so this provides them with well-qualified leads. Andy considered the relationship a success as his team had not even met some of the surgeons who had been referring patients back and forth.

Next up was the eminently tweetable Jerry Durham. The person beside me said that the whole profession would be moved forward if you could bottle Jerry. Jerry also has a “no lunches” policy. He wants to place his business in the center of a healthcare team, including doctors, nurses, nutritionists, and physical therapists. Sending over lunch devalues his organization as part of the team. (Disclosure, I once bought Jerry lunch: won’t be doing that again. 😉 )

While Jerry thinks constantly about the patient experience from the first contact with his office through billing, he does admit to marketing to the providers for referrals. However, similar to Andy, he also thinks about targeting the right type of “provider consumer” that is, a referring doctor who understands the value that a physical therapist can offer to the patient’s recovery or in preventing injuries. He focuses on what’s most important to these providers and to their patients, and makes sure his team delivers on it, and surprisingly, outcomes are often not the most important thing for patients.

He cited some basic things that make the difference to the patient:

None of these things have anything to do with outcomes or how knowledgable the physical therapist is. As Jerry puts it “outcomes are not a value proposition.” Patients expect outcomes, how they value the care they receive is comprised of a myriad of other factors. Do you know what your patients value?

Here’s a selection of our tweets from the session.

Tweets from the APTA Conference

Posted in: Healthcare Disruption, Rehabilitation Business

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