M-health

Archive for M-health

2016: The Year of Telehealth

Judging by the freezing rain hitting my window pane and the darkness that comes at 430 pm, it is evident we are coming to the year’s end here in Seattle. As always the approach of a new year brings a great number of predictions and I don’t mean the kind that are derived just out of hope, but out of reality. A quick Internet search produces many real 2016 telehealth predictions; some are witty, honest and steadfast, others more conservative. However one common thread not to ignore is the ever increasing benefits of telehealth and the great strives by the US Congress to regulate and support such. For instance there are 17 telehealth bills pending in the Senate and 21 in the House; from excise tax on medical devices to the “VETS Act to improve the ability of health care professionals to treat veterans via telehealth…” The 114th Congress ends in January 2017 so the progressive reality of telehealth to have a presence in your healthcare entity is undeniable and if such already exists it will be more palatable.

Another common thread in my searches is the statement: 2016 will be the Year of Telehealth. It is easy to believe this statement without any gullibility especially after experiencing first hand the steadfast innovation of telehealth over the last few months of 2015. Coupled with the readmission penalties, competitive advantage, telehealth parity laws, quality reporting outcomes incentives, and transformation of rural care it is no surprise that this statement is used liberally. Furthermore every year it is becoming increasingly more difficult to find skeptics of telehealth, the list of benefits are always increasing and scrutiny of our healthcare system forces many to find solutions. Telehealth is on that strong progression towards not just being an added bonus to way we provide care to our patients, but in some cases the only way we provide care.

I would never claim to be an elite expert in the field of healthcare innovation and policy, so I do not want to go into what I think will happen in 2016, but one cannot help feel the buzz in our Wellpepper office in Fremont, Seattle, WA. Our group serves has an example of what is going on in the mhealth field; we have grown in leaps and bounds just over the last 6 months in order to keep up with the demands of the industry. I cannot believe how incredibly lucky I am to be part of such great innovative team of professionals that have one goal of many in mind that brings my sentiment home, to make healthcare better for all of us.

Happy New Year!

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health, Seattle, Telemedicine

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Digital Health and the Influence on Healthcare: Wearables, Telehealth, & Treatment

Things are looking up in the world of digital health at least this was the view from “Digital Health and the Influence on Healthcare: Wearables, Telehealth, & Treatment.” The WBBA held their last event of the season with a panel on digital health, hosted by Russell Benaroya, CEO of Everymove, and featuring Dr. John Scott, Director of Telemedicine at UW Medicine, Davide Vigano CEO and co-founder of Sensoria, Mike Blume, independent healthcare consultant, and myself. I’d characterize the overall event as being optimistic and realistic, both from the panel and the attendees.

Digital health event

It was a dark and stormy night

No one said that the road to digital health was easy or fast, but the consensus that things like moving to the cloud, and the acceptance and adoption of patient-driven digital care is reaching a turning point.

Both Sensoria and Wellpepper’s business models are made possible by the cloud. For Sensoria this was the ability to process millions of datapoints coming from their wearable technology. For Wellpepper, this is our ability to rapidly implement solutions working with department heads facing a particular challenge in patient engagement and outcome tracking and improvement. Dr. Scott remarked on the dramatic drop in the cost of telemedicine solutions over the years he’s been an advocate and solutions due to both Moore’s Law and cloud computing over his tenure running telemedicine at UW.

Sensoria's Quantified Socks

Sensoria’s Quantified Socks

As well, although Dr. Scott highlighted how telemedicine was limited by arcane reimbursement models that did not allow for patients to receive telemedicine consults in their homes, he and other panelists discussed that they were not waiting for billing codes to do the right things in using technology to deliver better care. As usual, the Affordable Care Act was seen as a big driver as patient-centered and digital care.

Possibly because there were two ex-Microsoftees on the panel (Davide and me) a cloud-based platform approach was touted as the best way to both collect, analyze, and sort the data that came in directly from patients. In the case of Sensoria and Davide, this was to look for trends and patterns coming from sensor-integrated clothing, and in the case of Wellpepper it was to collect patient outcomes in the context of care and compare these across patients, procedures, and healthcare organizations.

This view led to a discussion about the proliferation of data, and everyone agreed that digital health has the ability to overwhelm health systems with data that they are currently not prepared for. EMRs are not set up to include sensor or patient-reported data, and as Dr. Scott pointed out, physicians are not looking for every data point on a patient, only the anomalies, like glucose out of range.

One audience member asked about whether healthcare organizations had an overall data strategy, and whether digital health data should be collected as part of that. It’s an interesting idea to consider but it seems like it’s still a long way off in healthcare. Does your organization or CIO have an overall data strategy? It seems that quality measures and the need for patient reported outcomes are introducing new requirements for data, but this is at the departmental or initiative level. Grappling with questions like this will be important as connected devices, digital, health, and patient reported outcomes enter the mainstream.

Posted in: Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Outcomes, Telemedicine

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Reverse Innovation: What We Can Learn From Global M-Health

Whenever possible at conferences, I try to attend at least one session that is outside my particular area of focus and expertise. While almost everything at the recent HIMSS M-Health was relevant, global health is a bit outside the target for Wellpepper right now. Attending a few sessions on M-Health got me thinking about similarities between some of these initiatives and the situation at home.

Global M-HealthWhen we started Wellpepper, we got a lot of feedback on our mobile first strategy, not all of it positive. We believe that people have an emotional connection with their mobile devices and that when people’s mobile devices ask them to do something they generally do it which is why we optimize our patient experience for mobile. Concerns were that people of lower socio-economic backgrounds or older people would not be able to use the technology.

We and other startups have found this to be untrue, and given the success of mobile programs in the developing world, it seems that this is a red herring of an argument as m-health initiatives are successful with people with widely varying literacy levels and for whom this is often their only connection with technology. Basically if people with low tech literacy can engage in their health through mobile devices in the developing world, we’re pretty sure everyone can in the US as well. In the developing world, mobile infrastructure has leapt over landline infrastructure. A similar thing has happened for lower income people in the US: they are more likely to only have Internet access through a smart phone than through a computer and home Internet connection.

The session “Innovative Content & Mobile Delivery Tools: Driving Healthcare Utilization & Coordinating Care” covered a number of private and public partnerships to bring culturally relevant and timely information health issues related to childbirth to women, caregivers, and families in Africa. There were a number of similar initiatives involving different players in different countries both not-for-profits and telecommunications companies. Rather than recapping one initiative this post is a survey of some of the learning and best practices from a few different ones.

Most projects were either focused on preventing unwanted pregnancies and also reducing child mortality. Really two sides of the same coin: making sure women and families had the information and resources they needed to care for their children. Information needed to be localized to the needs of the audiences that included mothers, mothers-to-be, midwives, and others caring for pregnant women, and their spouses. Customized content was key, for example, nutrition advice needed to address what was available in each country, and medical advice for the types of caregivers that were in the area, not always licensed medical professionals.

While the projects were shown to work, sustainability was key. There needed to be benefits to the telecommunciations companies that were providing free texting between expectant and new mothers and providers, and access to video content. There are definitely benefits for the telecommunications companies, which included:

  • Customer loyalty. By supporting women and families in this crucial time, the telcos were able to let them know that they would be with them through thick and thin and supporting them in important life events.
  • While the phones were provided for this particular educational program, people started using them for other activities which provided a revenue stream for the telecommunication companies.
  • Lack of churn. Many women were repeat users of the program when they had their second child.

Content for Global M-HealthChallenges of the programs mostly revolved around content. Creating and managing content was a big cost for the non-profits involved. Video content was seen to be best as it didn’t require a high-level of literacy, but keeping content both culturally-relevant and up-to-date was a challenge. As a result, one organization provides a free content library for front-line health workers.

In addition to the similarities of access to information, the content problem is also one we see here. However, the difference is an abundance of content for patient treatment plans. Each organization has their own content and best practices. During the session, I thought that donating care plans and instructions to some of these not-for-profit might be an interesting way to solve this problem, collect more feedback on care plans and accessibility, as well as give back.

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

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Help Wellpepper! My headache is agonizing

I remember when I was a kid walking into my grandmothers bedroom while she was in bed tending to, what I know now was, a headache. It was the middle of a busy summer day, but yet the room was dark, cool and completely silent, well except for me gasping; she wore these thick black eye masks that always scared me. Now as an adult I frequent this same scenario, except I have more than just aspirin to help me cope with my migraines, and very soon a useful device, my smartphone.

If you suffer from migraines, the thought of getting in the car, driving to the doctor, sitting in a busy clinic and being away from your cool dark room, is daunting. Honestly I don’t go to the doctor until sometimes days after, and by then I tend to block out that terrible afternoon I spent in bed. As a patient being able to record the effects in real time and communicate remotely with a helathcare professional is so much better than considering that trip. The new Wellpepper app will enable migraine sufferers to connect with their neurologist in real time, noting the severity of their headache, side effects, triggers and any medication taken. I cannot express how awesome it would be to roll out of bed for a minute, answer a few simple questions on my smartphone and go back to bed. This would save me money, a trip to the doctor after the fact (because let’s face it I am not driving to the ER in that state) and yet another session with my doctor that entails just getting out the prescription pad.

I have used great apps like Migraine eDiary and My Migraine Triggers, but they always left something to be desired, that connection to a human being that can help. Doctors are nurturers and when you are in as much pain as some of these headaches can be it is so reassuring to know that your doctor is on the other side of the Wellpepper app doing whatever they can to help. I know apps will never replace our clinicans, that much is evident, but if apps can be used as a tool to help us function better especially in times of distress, I couldn’t be happier.

Posted in: Healthcare Technology, M-health, Patient Satisfaction, Telemedicine

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Press Release: Sentara Healthcare Chooses Wellpepper

Sentara Healthcare Chooses Wellpepper for Mobile Patient Engagement in Headache Care

SEATTLE, Nov. 19, 2015 /PRNewswire/ — Wellpepper, Inc. today announced that Norfolk, Va.-based Sentara Healthcare is partnering with Wellpepper to provide a mobile patient engagement solution for headache care. Wellpepper is a clinically validated patient engagement platform. Sentara is an integrated not-for-profit system of 12 hospitals and more than 100 sites of care, including a robust neurosciences program. Sentara patients who suffer from migraines and other severe headaches are able to use the Wellpepper mobile application to report their headache experiences in real time, including pain, triggers and use of over-the-counter or prescription medication. Sentara Neurologists are able to use the information collected to diagnose, treat and monitor the ongoing progress of headache patients with the goal of better outcomes, fewer office visits and lower healthcare costs.

“We believe Wellpepper can help us provide timely care for headache patients,” said Alexander Grunsfeld, MD, medical director for Sentara Neurosciences. “Sentara encourages patients to be partners with us in their care and the Wellpepper solution offers a new opportunity to achieve that goal.”

Currently, when patients are referred to a neurologist, they are asked to complete surveys and try to remember what triggered their headaches. Follow-up surveys are typically given every 3-6 months. The result is often multiple office visits and patient care is delayed until the root causes for headaches are eventually discovered.

Data collected through the Wellpepper application is presented to healthcare providers via a clinical dashboard. Neurologists can easily communicate with headache patients to alter treatment plans without the patient having to unnecessarily visit the office. Wellpepper also provides a way for patients to log pain levels using the visual analog pain scale and to record medication use and how much.

“Too often, data collection from patients is disconnected from their care plan,” said Anne Weiler, co-founder and CEO of Wellpepper. “Being able to use patients’ own smartphones and tablets to provide care plans and show results using Wellpepper is not only a way to help drive patient engagement, it is a way for healthcare providers to gather strong, real-time data and patient-reported outcomes in a way that after-the-fact surveys cannot.”

Approximately 18 percent of women and 6 percent of men between the ages of 12 and 80 suffer from migraines in the U.S. According to a study published in the Journal of General Internal Medicine, migraine cases require, on average, 2.3 more physician office visits than non-migraine controls (9.1 vs 6.8, respectively) and were significantly more likely to have been seen in an emergency department (20.7% vs 17.6%) or admitted to a hospital (4.5% vs 2.8%).

For more information about Wellpepper or to find out how the Wellpepper patient engagement solution can support value-based payment models, please visit wellpepper.wpengine.com or email info@wellpepper.com.

For information on the Sentara Neurosciences program, visit www.sentara.com/neuro

About Sentara Healthcare
Sentara Healthcare, based in Norfolk, VA, celebrates a 127 year history of innovation, compassion and community benefit.  Sentara is a not-for-profit family of 12 hospitals in Virginia and North Carolina, the Optima Health Plan, a full array of integrated services and a team 30,000 strong on a mission to improve health every day.  This mandate is pursued through a disciplined strategy to achieve Top 10% performance in key clinical measures through shared best practices, transformation of primary care and strategic growth that adds tangible value to the communities we serve. www.sentara.com

About Wellpepper
Wellpepper is a healthcare technology company that provides a clinically validated platform for digital treatment plans delivered via mobile devices. The Wellpepper patient engagement solution improves patient adherence and outcomes with its patent-pending adaptive notification system and just-in-time, task-based instructions and by fostering communication between healthcare providers and patients. Wellpepper is used by major health systems that are moving to an accountable care organization model and need to track and improve patient outcomes while lowering costs. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Posted in: Healthcare Technology, M-health, Press Release, Seattle, Telemedicine

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Postcards from HIMSS M-Health 2015

HIMSS M-HealthIt’s been a busy couple of weeks at Wellpepper with both the AAKHS annual conference and HIMSS M-Health Summit at the Gaylord Convention Center in National Harbor where Wellpepper was honored to have won the Venture+ Pitch along with CirrusMD. This was our second year attending the conference and we noticed that the hype for digital health is a bit lower and perhaps that represents market maturity. It could also be that organizations are in the thick of implementation and don’t have the success stories to tell yet. We believe in digital health and are rolling up our sleeves so will take this feeling that we are moving to incremental change as a positive sign.

Venture+: The Market Is Maturing

We participated in the Venture+ Pitch last year as well which was won by fellow our fellow Springboard Alumna Prima-Temp. Prima-Temp was the clear winner last year, already raising their Series B. However, there were a ton of startups with only an idea. This year the criteria was that startups have revenue before applying, and the competition was held in two parts, the first an invitation-only session where 11 startups pitched and panelists talked about the market opportunity in general, and then a final round with 4 excellent startups and really tough questions from the judges. We were a bit earlier on our journey than a couple of the other startups in the final pitch so were honored to be recognized along with CirrusMD.Clinic of the Past and Present

Interestingly the startup area on the tradeshow floor was almost entirely made up of a new class of startups. So, while the market for M-Health may be maturing somewhat, there are still new entrants attracted by the promise of disruption.

Incremental Progress and Show Me The Evidence

I was only able to attend Day 1 Keynotes, and I heard that the Day 2 keynotes were great, especially by Shahram Ebadollahi of IBM Watson Healthcare. On Day 1, with the exception of an excellent presentation from Dr. Wood from Mayo Center for Innovation (disclosure: as part of winning the Mayo ThinkBig challenge we have the opportunity to work with CFI for the next year), most of the presentations were quite low-key. The main problem was the voice of the patient was missing: the focus was on initiatives or technology. I timed it. 1.5 hours into the keynote and we heard the first end-user story, and it wasn’t really a patient, it was a blind runner who used FitBit.

Dr. Wood shook everyone out of complacency and called out for a faster adoption of healthcare innovation, pointing out how basic things like patient treatment rooms have not changed dramatically in the last 50 years. He asked the audience to consider going beyond patient-reported outcomes and consider the outcomes that matter to patients. What would the system look like if we paid for health rather than healthcare, and we paid based on people being able to reach their own self-defined goals? Digital health is an enabler of this new system, but really, it’s about taking a patient or people-centered approach to health and to care.

What Patients WantAgain, maybe it’s a sign of market maturity, but the conference this year seemed more evolutionary rather than revolutionary. Themes from previous years were expanded on. For example, Judy Murphy of IBM talked about how consumer expectations expectations are fueling demand for m-health. People expect the same level of transparent and always available technology to manage their healthcare as they get from any other consumer experience.

HoneyBee and IPSOs announced the launch of the Global M-Health Survey which also pointed to ubiquity and consumer expectations and desire for M-Health. (The final survey results will be available in Q1.)

In a number of sessions Apple Research Kit was heralded as a major breakthrough for clinical trials. While the speed with which Research Kit was able to sign up study participants is certainly turning traditional research recruits on its head, the same limitations are still there: no HIPAA-compliant server infrastructure and selection-bias for those with more expensive devices. Interestingly, one of the greatest benefits for researchers seems to be the standardization of the informed consent process. (Note that Duke University will be open-sourcing the platform infrastructure they built in recognition that not all organizations have the skills and resources to build something like that.)

Interesting, how what was deemed such a major innovation at the time of release (less than a year ago), also seems a bit incremental. Again, we will take the glass-half full approach and say that we are reaching a market maturity where the gains are more incremental, although at next year’s conference we would really like to see more clinically-validated mobile health applications, and also more patient stories, preferably told by the patients themselves.

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

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Value-Based Bundles for Total Joint: The Glass Is More Than Half-Full

The bundles are coming! The bundles are coming! While many health systems have been delivering care in value-based bundles for some time, the broad implementation of bundles was made a reality when the Centers for Medicare and Medicaid announced the Comprehensive Care for Total Joint proposal to go into effect in early 2016. Navigating this new world, was the focus of the session “The Business of Total Joint Replacement: Surviving and Thriving” at the American Association of Hip and Knee Surgeons annual meeting. This was one of the best sessions we’ve attended on this topic: both realistic and optimistic about the opportunity to impact patient-centered care and change. This is a long post because the session was jam-packed with information, and I was only able to attend the first part. Heads must have been reeling for those who were fortunate to attend the entire 5-hour session.

The session was kicked off by Mark I. Froimson, MD, MBA EVP and Chief Clinical Officer of Trinity Health who took questions from the audience to start the day to ensure that their needs were addressed. A survey of the room showed that roughly half of the attendees were surgeons or physicians and the rest of the audience was comprised of included administrators, nurses, and physical therapists involved in care. This was apropos as much of the theme of the conference was about how care teams will need to work together across settings in a new patient-centered model to deliver on care.

Questions fielded showed that the audience had done their homework and included concerns about business models and outcome tracking for revisions. The Baby Boomer’s desire to stay active has resulted in earlier joint replacements which means revision surgery in the future. Audience members were concerned that revisions wouldn’t have as strong outcomes and they would be penalized by that. Participants from smaller organizations asked whether there were other metric tracking schemes they could participate in to offset the Meaningful Use incentives if they weren’t able to participate. (We have an idea: how about reimbursement for engagement with digital patient treatment plans?) Complex cases were also of concern: the system needs to ensure that systems will not be penalized for complex case that may also have weaker outcomes. Without risk adjustment for complex cases which are more likely be done at large in-patient facilities rather than ambulatory surgery centers, some organizations could be unfairly penalized.

Risk-sharing

Dr. Fromison handed the session over to the extremely optimistic Kevin J. Bozic, MD, MBA, Chair of Surgery and Perioperative Care, Dell School of Medicine. While value-based the goal of bundled payments is to improve outcomes and lower costs, Dr. Bozic spoke directly to the audience about the value for them: in the current fee-for-service model, the best surgeon gets paid the same as the worst. There is no incentive for efficiency. In the new model, surgeons that can deliver better outcomes at lower costs will be rewarded accordingly.

Interestingly though, the team-based medicine approach and the focus on surgical prep and post-operative care, means that it’s not clear which physician in the team will see the benefits of performance bonus: the primary care or physiatrist, the anesthesiologist, or the surgeon. This will be interesting to watch play out. In the past some surgeons considered their work to be finished after the surgery and others stepped in for post-acute care. As well, there was discussion about how to get hourly workers in the care team on board and aligned with the new models. As we’ve talked to countless organizations and individuals about the move to value-based payments, the common theme is that the patient outcome driven approach is better for patients: perhaps this can be the rallying cry for alignment.

This team-based partnership is not just within an organization or care team. Since 40-50% of costs of a total joint replacement are in post-acute care, surgeons and health systems must partner with post-acute care facilities. We’ve observed this trend directly with both inpatient and outpatient rehabilitation joining health systems and creating new ACOs to share risk.

Dr. Bozic handily turned the negative connotations of risk-sharing on their heads, when he was asked whether these new models were just a measure to shift risk to the providers. His answer was a positive “Yes” and encouraged the audience that providers were really the only ones who could manage performance and appropriateness of care. Note that payers still bear the risk of who gets a disease (although with more health systems focusing on wellness this could change), while providers bear the risk for the outcomes. Because of this, Bozic recommended that a strong physician needed to lead the change and own the bundle implementation within a health system.

Outcomes, Outcomes, Outcomes

Today with the focus on outcomes it’s hard to believe that a surgeon from Massachusetts General, largely seen as the father of outcome tracking, was run out of town and eventually lost his license for suggesting that physicians should track and be accountable for the outcomes of the interventions they performed.

Refreshingly, Dr. Bozic asked the audience to go beyond standardized outcome tracking as it relates to reimbursement, and consider which outcomes matter most to patients. We’re excited about this idea as we track outcomes both based on standardized outcome measures like the HOOS and KOOS (and soon the Hoos Jr & Koos Jr) but also at the task level and soon based on the patient’s own goal.Outcomes-mobile.screen4.jpg Outcomes-mobile.screen5.jpg

Without data transparency and sharing, improvement can’t happen. Finding out where the waste is in the 100-300% variation in inpatient total joint cost is key. Dr. Bozic is suspicious of organizations that boast that they are better than average on all measures: he believes that they are actually are unaware of their flaws and not driving a culture of continuous improvement.

We’ve been at surgeon-focused conferences before, and the booths that were busiest were those promoting joints and surgical instruments. Dr. Bozic told the audience they needed to be evaluating vendors that could help them collect, measure, and act on outcomes, which was music to our ears.

Patients and Prevention

The third speaker was Dr. David Halsey, MD from Vermont, who echoed many of the themes of the previous speakers, especially in the need for outcomes, but also posited a question we haven’t heard before, Dr. Halsey asked who better to do population health for arthritis than orthopedic surgeons? In our travels, we think that both physiatrists and physical therapists might want to join in that population health management, however, if it starts with the surgeons then they would be more incented to try other approaches before surgery, which can be accomplished through preventative care. Preventative care includes patient education and shared decision making and requires new tools to involve and engage patients in their care. It also includes making the patient’s goals front and center to improve care, and understanding and managing their expectations. Today’s patients have higher expectations to have a high level of mobility post surgery, and a low level of pain. Physicians need to engage with patients both to understand and to manage their expectations.

Moving Forward

While we’ve heard some people grousing about the squeeze that is being put on orthopedics through the CCJR, this glass-half-full group sees this as an opportunity for orthopedists to lead the way and actively engage with CMS. Data collection and transparency are the way to do this, and the current tools (aka EMRs) don’t cut it. (While this is our message at Wellpepper, it came directly from the speakers: times are changing!) Expectations are that other specialties will follow the total joint guidelines, spinal surgery is considered to be next, so orthopedists have the opportunity to set the standard for how value-based bundles are implemented in their organizations, while collecting and analyzing real-time data and leading an interdisciplinary team of course. Onwards! We’re ready!

Posted in: Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health, Outcomes

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Press Release: Wellpepper Venture+ Forum Winner

CirrusMD And Wellpepper Named Venture+ Forum Pitch Competition Winners At 7th Annual mHealth Summit

WASHINGTON, Nov. 11, 2015 /PRNewswire/ — CirrusMD Inc., and Wellpepper were named the winners of the 2015 Venture+ Forum Pitch competition for startups at the mHealth Summit. They were among four companies selected to deliver live pitch presentations during the ‘final four’ competition Tuesday evening. The finalists were selected from a field of eleven digital health startups who presented during the first round of live competition held on Sunday at the Summit.

The 2015 Presenting Companies were chosen based on criteria for demonstrated impact and quantifiable results for improving health care delivery and outcomes.  The Venture+ Forum provides a recognized platform for health entrepreneurs, fostering commercialization of innovative health technology solutions to advance healthcare delivery.

“The Venture+ Forum has become an anticipated event for health technology startups, with tangible results for pitch competition winners,” said Richard Scarfo, Director, mHealth Summit, and Vice President, Personal Connected Health Alliance (PCHA). “Venture+ Forum is designed to support the startup community, investors and entrepreneurs, and advance innovation in health technology. Congratulations to CirrusMD, Wellpepper and each of the finalists.”

CirrusMD develops “closed loop” virtual care solutions for value-based healthcare, with a unique telemedicine methodology that ensures continuity of patient care and enables full data integration over multiple communications channels – text messaging, phone and video chat.

Wellpepper is a clinically-validated mobile patient engagement platform, and is used in orthopedics, rehabilitation, trauma and burns, pain management and neurology at hospitals and clinics. It enables healthcare professionals to create and prescribe custom treatment plans based on their own best practices and protocols, and personalize them for each patient.

The first Venture+ Forum event of 2016 will be held at the HIMSS Annual Conference taking place February 29-March 4 in Las Vegas, as part of its mission to promote innovation in health technology. PCHA will also host the 2nd annual HX360 event at HIMSS16, inviting health system executive leaders, innovation teams, entrepreneurs, investors and technologists to explore technology-based solutions to challenges in healthcare delivery and operations, as well as new business models, novel partnerships and approaches to sustaining innovation.

About the mHealth Summit
The mHealth Summit is the global convener of the expanding mobile health ecosystem, exploring the disruptions, challenges and opportunities of the integration of mobile and wireless technologies into the healthcare system, and in consumer and patient engagement, for the delivery of better health outcomes. The 7th Annual mHealth Summit will take place November 8-11, 2015, in Washington, D.C. Focusing on four fundamental platforms – technology, business, research and policy – the mHealth Summit is presented by HIMSS, in partnership with Continua, the Foundation for the NIH and the mHealth Working Group. mHealth Summit is part of the Personal Connected Health Alliance (PCHA), an international non-profit organization established by Continua, mHealth Summit and HIMSS to represent the consumer voice in personal connected health. Visit the mHealth Summit for more information; and follow at @mhealthsummit.

 

Posted in: Healthcare Technology, M-health, Press Release

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You Could Get Well Here: Touring Mayo Clinic

Mayo Clinic Center for InnovationDuring the recent Mayo Clinic Center for Innovation Transform Conference, attendees had the opportunity to take tours of various Mayo facilities.

I was able to tour the Center For Innovation, where we will be working periodically over the next year as part of our prize for winning the Mayo and Avia Think Big Innovation challenge, and the Center for Healthy Living. A third tour, of the new Well Living Lab was sold out before we could get tickets.

Spirituality is part of health at Mayo

Spirituality is part of health at Mayo

The Well Living Lab is a research center where the health impacts of daily living can be tested. For example, researchers expect to study the impacts of air quality or lighting in office buildings on employee health. Tour organizers told me that the paint was still drying on the center as they start the tours so I’m sure we’ll be hearing more about this innovative center in the future.

Mayo Clinic Center for Innovation Tour

The Center For Innovation houses two main areas, one a clinical space where real patients and care teams can test different types of exam room configurations and equipment, and the other more like a typical software or design office. Pictures were limited in this area, so you’ll have to imagine from my descriptions.

All the walls in the clinical space are magnetic, enabling different types of room configurations on the fly. Even the artwork is affixed with magnets, so I suppose it’s possible to also test the effect of different artists as well. When medical teams work out of the CFI space, they are testing not just the patient experience but whether these new configurations make teams more productive or collaborative. The CFI has found a number of improvements to care are possible with better room configuration, and noted that clinics and exam rooms have changed very little since the 1950s.Human Centered Design

A few innovative examples include:

  • A kidney-shaped table encourages more collaboration and communication between doctors and patients
  • Separate consultation and exam rooms offer many benefits in both communication and efficiency. Patients are less stressed, more able to absorb information, and ask questions in a consultation room rather than sitting on a table in an exam room. Two physicians can share one exam room when there are two consultation rooms and therefore they can see more patients in only 1.5 times the space of a normal exam room.
  • An open plan office where all of the care team, nurses, medical assistants, schedulers can work encourages team collaboration and also empathy as each member has much better insight into what the others are doing.
    How Patients Experience Services

    How Patients Experience Services

At the CFI, we learned about projects that have recently been completed (although they were mum on work in progress), like a project to overhaul post-discharge instructions for total joint replacement. This is a hot topic lately as CMS moves to value-based bundles for reimbursing these procedures it’s even more important to manage care outside the clinic, and do to that patients need to understand what they need to do. This is a topic near and dear to our hearts at Wellpepper.

Other projects included exer-gaming for seniors, and Project Mars named as a challenge to completely reimagining the Mayo Clinic experience as though they were building a new Mayo on Mars. This experience spans pre-visit to post visit and includes patient care and the patient’s experience in the physical space.

Mayo Clinic Center for Healthy Living

The Center for Healthy Living is an impressive new facility in the middle of Mayo campus. The Center is focused on proactive and preventative experiences for people who want to take action managing their health.

IMG_2373

Yoga studio with a view

This may include executives who believe health and fitness is a competitive business advantage to people diagnosed as pre-diabetes who are motivated not to become diabetic, to people wanting to regain health and strength after cancer treatment. The Center takes a wholistic approach, and guests (as visitors are called) frequently book a week-long package that includes physical assessment, diet, and stress and spirituality consultations.

The living wall

The living wall

Consultations on diet include cooking classes and nutritional information including how to read labels and understand what’s really in your food.

The Center also houses a spa, which is apparently a best kept secret in Rochester. Throughout the center the design is calming, including floor to ceiling windows and a living wall, and it really feels like a place you can get well.

Clients are sent home with specialized treatment programs and recommendations to support their lifestyle changes permanently. The Center has only been open for a year, and ideally will seen clients coming back year over year for a tune up. It’s definitely a place I’d visit again.

More pictures of the Center for Healthy Living.

IMG_2370

The Nutrition Pantry

Guests learn to prepare healthy meals in this kitchen

Guests learn to prepare healthy meals in this kitchen

Rest with a view

Rest with a view

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

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Falls Prevention Awareness Day September 23rd

Last year my 80 year old grandmother fell walking back from my cousins wedding reception, luckily she grabbed onto my sister and broke her fall. Nevertheless as we studied the sidewalk for several minutes only to discover its perfectly flat surface and our tremendous worry… my dear grandmother could think of nothing other than her embarrassment. We later learned from my grandfather that she has fallen several times over the last few months; she shook it off with laughing commentary in the background saying he was exaggerating. Whereas I appreciate her humor, it is no laughing matter. 2.5 million elderly adults are treated in the ER for fall injuries, with one out of five falls result in broken bones. With those statistics I continue to worry about the next time she falls and my sister isn’t there.

Pick up your cars, grandma is coming over!

With that said, today being Falls Prevention Awareness day I cannot help but think of everyone in my life that is prone to falling… which I am sure you are now pondering yourself. So we should all take a minute (or longer depending on how caught up you are on house chores!) and look around our environment for fall hazards and think about prevention. I have a two year old son that contributes a lot to fall hazards with his hotwheels toys strewn all over the house, which makes my house a high risk zone no doubt! I have to ask what’s on my grandmothers floor?! We need to encourage our elderly loved ones to remove fall risk factors in their homes too; broken steps, faulty handrails, uneven pavement, clutter, throw rugs, poor lighting… grandchildren toys! However most of all we need to make sure they are still getting out of the house and do NOT let the fear of falling limit their mobility. Lower mobility is a major fall risk factor due to deteriorating body strength, which in return also influences balance. It is argued strengthening your balance is the single most important factor in avoiding falls. Senior centers across the country teach classes to elderly adults called “Matter of Balance” (I have taught a few in the past!), they are a great way to teach folks about balance strengthening through exercise and awareness of ‘fall-ty’ habits.

Working for Wellpepper and learning more each day about how it is helping patients, I cannot help but think about how mHealth technology could also help with fall prevention. There are several balance strengthening exercises that we do in our ‘Matter of Balance’ classes at the senior center that could be very easily translated onto the mHealth platform. Honestly now that I think about it the whole class could be taught this way, and might even have better results since a lot of elderly adults express interest in the class, but don’t show up because they are too embarrassed about admitting to of fallen, just like my poor grandmother.

Such thoughts of mine have been expressed officially (to say the least!) by Harvard researchers, because today it was announced on Falls Prevention Awareness Day no less, in a press release, that they are utilizing Wellpepper as an patient engagement solution to lower the costs of care and to improve patient mobility skills as well as muscle strength, endurance and power and to decrease the risk for fall-related injuries such as hip fracture. I cannot wait to see how this study plays out, because it could mean a whole world of good for our lovely elderly family members. I cannot help but visualize how cute my grandmother would be practicing her muscle strengthening exercises on an iPad and the great peace of mind my family would have.

Congratulations team Wellpepper for your involvement in making this Falls Prevention Awareness Day a big notch in your ongoing achievement index!

Posted in: Aging, Behavior Change, Healthcare Research, M-health

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This month [July] in Telemedicine

American Telemedicine Association: This month [July] in Telemedicine
July 28th, 2015

Presenters:
Gary Capistrant, Chief Policy Officer, American Telemedicine Association
Jonathan Linkous, CEO, American Telemedicine Association

The theme of this Month in Telemedicine webcast was progress; progression from telemedicine not being just an alternative to doctor office visits, but more as a replacement to them. The large amount of funds now being circulated through the market is worthy of making note of in your memory storage box. Here are a few.

Last week SHL telemedicine, an Israel based company, was bought by Shanghai Jiuchuan Investment (Group) Co., Ltd. for $116.34 Million. This event signifies the seriousness of China’s increasing interest in Telemedicine. Also in Asia it was reported that there was a 40% reduction of patients being transferred to Vietnam city hospitals for treatment from satellite provincial hospitals due to telemedicine. Chúng ta nên nhìn vào thị trường Việt Nam Wellpepper?

Station developed by HealthSpot… if you are in Ohio you might see one in your neighborhood Rite Aid.

Also in July Rite Aid launched a pilot project utilizing HealthSpot walk-in stations in throughout the state of Ohio. “HealthSpot stations offer customers convenient access to high-quality, medical care from board certified medical providers using high-definition videoconferencing and interactive medical devices”. Because I am a curious creature, I had to look up where the stations are. Doing a quick search in my sister’s zip code in Florida, I found one in a casino! I will not start with the jokes, but let your imagination ride!

Another Telemedicine company to keep an eye on is Teladoc. On the first of July stocks went from $19 a share to nearly $30 a share. They had predicted the stock would be between $15-17 a share! If that came as a little bit of a shock, this announcement really grabbed me… $570 million investment dollars is now breaking the ground harder in telemedicine (and related entities) than HIT. Specifically mhealth companies raised 214 million, personal health raised 209 million and telehealth raised 152 million, making it 570 million dollars raised in 2nd quarter alone of this year.

Another interesting ‘progression’ tidbit is what John mentioned; the ATA accreditation has 330 registrations in hand, mainly consisting of Healthcare orgs, instead of companies that provided standalone independent telemedicine services. The increase is believed due to the huge gap in services that healthcare orgs provide patients; telemedicine services are frankly quicker to utilize vs. the old way of: calling your docs office, making an appointment that is 2 months away, etc. etc. How often is your smartphone, tablet or computer right next to you a day? It’s okay to admit the truth; we know you sleep next to it! With that said, obviously healthcare orgs are losing patients (literally in their sleep!), so there is a huge spike in healthcare orgs wanting to create their own telehealth services. I ask why? Use an already created wonderful app like Wellpepper! J

To access this videocast recording:
http://services.choruscall.com/links/ata150728

Next Month in Telemedicine [August] webcast will be mentioned here.

Posted in: Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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MobiHealth News: Digital Health 2015 Midyear Review

Digital Health 2015 Midyear Review

Speakers:

Brian Dolan
Editor-in-Chief MobiHealthNews
brian.dolan@mobihealthnews.com

Ryan Beckland
CEO Validic
ryan@validic.com

Fitbit wearable- price tag $250.

This trend webinar presented by MobiHealthNews was packed full of information, information that many of us have already heard about individually from bigger news reporting agencies, but Brian did an excellent job in a 20 minute recap of the latest market trends. Since as we all know whenever you hear about a market (even your local farmers market!), the mention of money is never far behind, the HIT market is not any different except by the number of zeros, the very many! A whopping quarter million dollar funding increase from last year; $741 million to 1 Billion. If that wasn’t a big enough highlight, get a load of this, FitBit a wearable camera company, debuted its initial public offering (IPO) on the NYSE, raised 732 Million, making it the biggest EVER consumer electronics IPO in history. That is a very BIG deal indeed! With all this money rolling around in the form of connected health devices, therefore all the personal health data in return being generated, the Federal Trade Commission is nervous that HIPPA is not enough. It will be interesting to see what additional training employees, caregivers, etc. will have to do to appease FTC and well patients like myself!

Ryan Beckland, CEO and co-founder of Validic, a “…cloud-based technology platform that connects patient-recorded data from digital health applications, devices and wearables to key healthcare companies”. Validic works with the largest healthcare systems in the world, reaching 160 million individuals in 47 countries. Validic is continuously evolving their services to the accelerated demand and innovation of HIT, and has profited by the ‘recent’ wave of patient generated health information. The focus of Ryan’s presentation was on the behaviorism’s of patients and providers and how they have been changing due to the HIT market trends. Increase options for care has helped patients be more in charge of their care more than ever before, stating that in the not so distant future devices are going to replace the role doctors have in diagnosis and initial doctor appointment. Ryan very clearly laid out the benefits of telehealth, it doesn’t take a rocket scientist to see that telehealth empowers patients, prevents hospital readmissions, reaches patients in rural locations etc. and it can address doctor shortages.

Another noteworthy point that Ryan made is that by 2020 it is expected that the Pharma market will be entirely reshaped by digital health; dubbed Pharma 2020: The vision. Three major trends driving shift is patients expect technology to provide convenient and regular access to their providers, regulatory environment of data access and speed of competition requires more technology enabled solutions. Pharma is pressured to increase patient adherence to drug therapy (currently at 50% adherence!) and seeing how telehealth has been successful in other factors (lower readmissions, etc.) it’s time Pharma takes the reins on their patients’ health as well. I am extremely interested to see what new technologies this market develops/adapts since this is a very wealthy sector in the realm of healthcare.

You watch and listen to the webinar here, where you can also access the slides presented.

 

 

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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The Case for Patient Video in Doctors Visits: Take a Selfie and Call Me In the Morning

The selfie culture and our desire to photo-document every aspect of our lives has started to influence healthcare as well, and patients want to be able to record their doctors visits. The concept is so prevalent that it’s making headlines in the mainstream media.

Patients Press the Record Button, Making Doctors Squirm” from the Washington Post

Why You Should Record Your Doctor’s Visits” from Forbes.

Having a recording of a visit ensures that you don’t miss any information, and you can review it when you get home and are able to provide more attention to the topic. Much of what is said in a doctors visit is missed by patients, by some accounts between 40 and 80% is missed, and an additional half of that information is remembered incorrectly. As we learned during a course from the Institute for Healthcare Improvement, often healthcare providers are not trained in making sure the message is received.

When we ask patients about their experiences, they tell us that they thought they understood the instructions but realized when they got home they really didn’t retain enough or understand enough to comply with the instructions. Patients are often intimidated by healthcare personnel, worried about wasting valuable visit time with questions, or worrying about how what their being told will impact their lives, for example, who will walk my dog when I have my hip replaced? Is it any wonder that the information isn’t landing?

Patient Record on Parking

Patient record in parking garage of major health system

When handout instructions are available, they are often forgotten by patients, or confusing. One healthcare organization we work with conducted an audit of all their patient handouts and discovered that they were at an 18th grade reading level. The recommended reading level for health information is fifth grade, and yet these instructions required a graduate degree!

Patients have a seemingly simple solution to this: record their doctors. Doctors on the other hand have been warned about PHI and HIPAA, so a common ‘workaround’ is to record patients on their own phones. Legal departments hate this because then the patient has a copy of their prescribed instructions but the health system does not. Liability aside, it doesn’t result in good care if everyone is not working off the same information.

Including patient video as part of a HIPAA compliant digital treatment plan is a great way to solve this problem. Patients have a better experience and the health system is able to keep good records.

Patient video can cueing or instructions that is unique to that patient, and they show the patient’s actual experience whether that’s in wound care, using a medical device, or physical therapy. Patients feel a greater sense of connection and accountability to care plans when they are personalized and customized.

For complex instructions like wound care, using medical devices and durable medical equipment, and physical and occupational therapy, patients feel more confident that they can repeat the exercise or instructions at home when they see video of themselves doing it.

There are so many benefits to including custom video as part of a patient’s care plan. The technology is here today, it can be delivered in a HIPAA compliant manner, and it can be stored and easily retrieved. The challenge is that while patients are ready for this, health systems aren’t and the answer is often ‘no’. The risks to the health system, if video is delivered as part of an overall digital patient treatment plan solution are low, but the potential benefits to care are large.

We’ve tracked the evolution of the ‘consumerization of IT’ through other industries. Some have said it can never happen in healthcare, but this is a great example where patients starting to push the envelope and use technology in their care. Let’s hope they are able to convince their doctors as well.

Posted in: Adherence, Health Regulations, Healthcare Disruption, Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health

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Personal or Population Health? Big Data or Small Data?

Seattle Health Innovator's meetupJune’s Seattle Health Innovator’s Meetup topic was on Innovations in Population Health Management. Interestingly much of the discussion from panelists circled back to the individual patient. It seems that much of this was because the great promise of big data analytics in healthcare and automation and economies of scale through electronic medical records have not been realized. The audience consisted of entrepreneurs building solutions in this area, and innovative and entrepreneurial people within health systems.

The event, at the sleek new Cambia Grove healthcare meeting space, was kicked off by Dr. Wellesley Chapman, Medical Director Innovation and Development at Group Health. Dr Chapman set the stage by defining population health in a highly inspirational manner by referring to The Gates Foundation mission that everyone deserves to live a healthy and productive life. Narrowing in a bit more Dr. Chapman talked about the influences of good health on a population. Interestingly, although population health is largely thought of as a health system problem, the formal medical system only has a 20% influence on the health of a population and a person. Socio-economic factors have a much bigger influence, things like building walkable cities that encourage activity and community, access to healthful foods, and education. Unfortunately with healthcare representing 18% of the US GDP, there is a misallocation of funds to the clean up of problems versus infrastructure that will affect the well-being of the whole population. However, even though care delivery is a small part of the overall picture and influencers of health, Dr. Chapman enthusiastically encouraged the audience to do what they could to affect change.

The meet up continued with a panel discussion moderated by former Group Health VP of Marketing and now patient engagement consultant, Randy Wise and featuring:

When considering a population health strategy, key factors the panel felt were important were lead time to implement, expected outcomes, costs to patient and payer, and the overall patient experience. Patients are concerned about the quality of their lives, and this needs to be addressed at the primary care level, however, most health systems do not have a primary care strategy. Primary care is reactive rather than preventative, and reactive care is not usually focused on patient goals. Since the health of a population is so varied, at the primary care level, panelist thought “everything could be considered population health” making it difficult to pinpoint specific solutions for care.

When asked about whether big data was improving population health, panelists were negative to neutral, citing Excel spreadsheets used to review data, and the opportunity to know a lot more about patients. However this again came back to the specific saying that the intervention is all about the relationship between patient and provider and asking whether we are enabling patients to follow through with recommendations. (At Wellpepper, we would say there’s a great opportunity to improve here based on many of the care plans and instructions we’ve seen.)

Seattle Health Innovator's MeetupDr. Levine from Iora talked about his experiences training residents in listening skills and the payoff. Compared to a common approach of telling the patient they have limited time and to focus on the top issue, Dr. Levine advocated listening first, ask the patient to recount all their concerns, make a commitment to truly listen and hold the information the patient provided, and then follow up on the most pressing issues. Although the residents were skeptical, this approach yielded significantly faster follow-up as key information wasn’t being uncovered at a later date.

Events like this provide a great opportunity for those enthusiastic about changing healthcare to exchange ideas, and especially for entrepreneurs to learn practical advice from those in the trenches delivering care and trying new models. The big takeaways are that the promise of big data in healthcare is yet to be realized, and because of that population health tools may not be as effective as they could be. While the focus on patient personalization, customization, and meeting the needs of the individual are key, we need to figure out new ways to scale to solve this great problems in health.

Posted in: Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health, Seattle

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Session Picks for 2015 American Telemedicine Meeting

We can’t promise to get to all these sessions and blog about them for you, but here are a few that caught our attention at the American Telemedicine Association Annual meeting coming up in Los Angeles next week.

Monday May 4th

Establishing a Program to Reduce Readmissions and Costs in the Ambulatory Setting: A California Success Story

Telehealth is proven to decrease costs without sacrificing quality for many scenarios.

Learning Opportunities from Large Scale Telemedicine Initiatives

An interesting mix of private and public sector initiatives across disciplines including pediatrics and psychiatry.

Improving Commitment, Quality, and Outcomes

We love outcomes, and this session also feature’s Seattle’s own Carena.

It’s a Small World After All: Approaches in Neonatal ICU Care

Cute title, serious results with examples across pediatric care.

A New Model for Remote Diabetes Care Best Practices

One of the biggest issues facing our healthcare system so new models welcome!

Expanding Telehealth to Improve Hospital-wide Readmission Rates

Readmissions and care transitions, so important.

Mainstream Medicine Moves into Direct to Consumer Health

Mercy, a Catholic Health System from St. Louis, is a quiet leader in telehealth. Find out why they dedicated an entire new building to for their telehealth practice. Plus a case study from Cleveland Clinic. Whew, that’s a lot of great content.

Tuesday May 5th

Utilizing Interactive Voice Response (IVR) and Telemonitoring to Reduce Hospital Admissions and Readmissions for Heart Failure Patients

Heart failure is a patient group where readmissions can be prevented with better communications, which telemedicine and remote monitoring can provide.

A Large Provider Focuses on Consumers: The Experience at Kaiser Permanente

With large deductibles, patients are increasingly making decisions as consumers.

Implementing Successful Clinical Specialty Programs: Burns, Infectious Diseases, and Genetics

Telemedicine helps scale specialists, especially from centers of excellence and to rural areas.

Using Community Health Models to Enhance Patient Performance and Outcomes

Another great benefit of telemedicine is to empower community health workers through remote support from specialists.

Posted in: Behavior Change, Health Regulations, Healthcare Technology, Healthcare transformation, M-health, Telemedicine

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Something old, something new, something borrowed, something blue

As someone, (most likely French philosopher Blaise Pascal ) once said, “I would have written a shorter letter but I didn’t have time.” Stanford Professor Dr. Arnold Milstean started his talk for the Health Innovator’s Collaborative on “Providing Better Care With Less.” with a variation of this, saying that if he knew his topic better he would only have 4 slides instead of the 8. Those 8 slides represented so much practical data-driven advice and highly quotable and provocative statements like

“1/3 of healthcare spending could be cut without affecting anything except the quality of life of the providers.”

that it’s hard to imagine how rapid fire the content would have been with only 4 slides. Mistean took us along a path to define goals in healthcare transformation and then apply some simple formulas to affecting that change.

To determine some generally agreed upon principles for healthcare improvement, Milstean and team reviewed policy, research reports, and employer and payer surveys. The team found that getting to a 1% annual increase in quality, with a 30% reduction in costs, and a 2.5 percentage point long term increase in spend (less than GDP) would suit most policy recommendations and were therefore to be considered reasonable goals. To bring about this level of change, Milstean recommended implementing an “Old, New, Borrowed, Blue” strategy, which has nothing to do with marriage: it’s just a catchy and easy way to categorize some common sense thinking.

Old: Take a methodical review of existing evidence. As anyone who’s spent much time in healthcare research will tell you, there are a wealth of studies and best practices out there. Given that it takes 17 years to get from research to clinical practice, rather than starting a new study, reviewing what’s been done and implementing best practices is a better way to go.

New: Use technology to automate assessment, help with decision support, and improve workflow. Being at Stanford and working on multi-disciplinary teams lead Milstean to believe that the area healthcare could benefit most from “new” is in healthcare IT. In other industries the move to electronic records produced 2-6 percentage points in productivity improvement after 10 years. Healthcare, with only recent moves to electronic medical records, is just at the beginning of this and hasn’t seen the rewards yet. As well they have just scratched the surface of the digital opportunities.

Finding Outlier Physicians

Finding Outlier Physicians

Borrowed: Look at examples from other countries best practices and figure out how to implement locally. Milstean gave the example of a city in Finland where the time from stroke identification to tPA injection at an ER was 17 minutes. With each minute of time after the onset of stroke representing the death of 1.9 million braincells, emulating the Finnish model can have real impact on quality of patient life and long-term costs. (The average “door to needle” time in the US today is 60-75 minutes.)

Blue: Focus on human-centered design. Too much of healthcare is not working at the most basic human level, which as it turns out is the place where better and cheaper care resides. Here, Mistean showed a chart of “outliers” physicians who delivered a high-level of care at lower costs than their peers. It turns out what these physicians did differently was at the human level. They truly cared for their patients and looked at the whole patient, not the disease or not the specific incident. These primary care physicians acted as quarterbacks when their patients were managing complex issues with specialists. They cared, caught issues, and also motivated patients to participate in their own care.

The Impact of Blood Sugar on Parole Hearings

The Impact of Blood Sugar on Parole Hearings

While the formula is simple, it takes a lot of effort to change the system. Some are organization issues like the number of people involved in making any decision. One hospital, trying to implement a new program, took 3 months to get to the kick-off meeting due to the number of people involved in scheduling. The other issue is the human factor in creating repeatable systems. Here, Milstean used an example from the legal world, where judges were less likely to grant early release when their blood sugar was low. Comparing this to medicine, is remembering that everyone thinks that they are delivering high-quality care, but you often need data to convince them otherwise, and that you need to repeat, repeat, repeat to get to a precision that can cancel out the human factor. As a result, Milstean believes that computer science and behavioral science are two keys to making the big changes we need to improve quality and lower costs in healthcare.

 

 

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

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This Month in Telemedicine: February 2015

Speakers: Johnathan Linkous & Gary Capistrant of American Telemedicine Association.

This month in Telemedicine is hosted at the end of each month by the American Telemedicine Association (ATA) and is free to the public. Archived videocasts are available on their website. I highly recommend checking out their wiki website where you will find information on legislative state issues to general definitions.
62.5 million individuals were on Medicaid last year with a spending of $505 billion in 2013. These high numbers reflect the importance of legislative involvement to determine payment rates for Medicaid healthcare services. For those of us that do not know, Sustainable Growth Rate (SGR) is a system that was put in place in 1997 by the Centers for Medicare and Medicaid (CMS) to control Medicaid spending. Telehealth makes it possible for health services not to end with the clinical visit. However, the system is over 20 years old and pressure is being put on congress to come up with solutions that are in line with the need to move from fee for service to more innovative service models to support new solutions.

With the March deadline of Medicare physician fee payment schedule fast approaching, there is understandably a lot of federal activity. Medicare cuts are again being delayed because the budget estimates on cost of repeal have gone up and there is much difficulty coming up with a way to offset savings. It’s a case of poor budge planning, again. With that said Congress will be applying a ‘patch’ instead of a fix, a common ritual that has been occurring for 15 years. Last year they applied the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 bill as a ‘patch’. It is important to ATA because part of the SGR package is to put in place payment reforms, pressure to move reimbursement from fee for service to various payment innovations and because one provision in particular is set to waive Medicare restrictions for alternative payment methods (APMs). The big deal is this and there is no way around it: “Congress has to act by the end of March in order to avoid Medicare docs from taking a one quarter cut in payment rates.”

The Energy and Commerce Committee, an unlikely participant in the healthcare realm, developed the 21st Century Cures Act launched last April and is considered by Mr. Capistrant the “best single effort by any congressional committee ever on telehealth.” This is exemplified in the many committees on goings, the most resent being their efforts to open up discussions on Children’s chronic health Issues and how telehealth can network healthcare system entities (i.e. The nations Children’s Hospitals, etc.). Mr. Capistrant believes much of the committee push and interest in telehealth are in place because the chairman, that has spearheaded the momentum in congress to build better payment innovations and remote monitoring, will be leaving after this congress.

On a state level there have been over 100 telemedicine bills introduced, 15 states have introduced Provider standards in dealing with telehealth. However there are still eight states that do not provide some form of Mediciad telehealth reimbursement. Regarding State Licensing compacts, the question still looms: to require state by state licensure or move to the nurse’s model of reciprocity? Stay tuned.

Posted in: Healthcare Policy, Healthcare Technology, M-health, Telemedicine

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