By David Shulkin, M.D.
If you are doing something innovative in healthcare you probably already know that your biggest competitor is not another company, but rather it’s the status quo in healthcare.
Change in healthcare moves at glacial speed. The reason is complicated. Often it’s the alignment needed to make change among various parts of the ecosystem— payers, providers, supplies, employers, and government. It’s almost as if each needs to decide that they want to move forward at the same time for something to occur. But maybe it’s just that people are used to doing things that they have figured out how to make a living at and there is not a compelling reason to change.
We all know the healthcare system is in need of improvement and must change if we are to improve people’s lives. Yet even the most common sense changes sometimes seem hard to get done. That’s why I developed this list of “Healthcare No Brainers”. These are things that frankly it’s hard to argue with, but still struggle to find traction in our system of care. But these are things leaders should be looking at and asking why we can’t make more progress. So here is my list:
1. Interdisciplinary Team Based Delivery Models
Let’s face it healthcare is pretty siloed. Providers tend to feel comfortable in their own fields of study and don’t often play well with others. Yet particularly when it comes to chronic disease people often respond best to an interdisciplinary team based approach. In addition, payers don’t tend to reimburse well for interdisciplinary care, but continue to pay for individual providers that too often don’t work with one another. Providers that work together, and work to share their knowledge towards an integrated patient treatment plan, often achieve superior results than the current standard of care.
Examples of Healthcare “No-Brainer” #1 — Override (Override.Health) — this is interdisciplinary team based care for people with chronic pain. Override a team of pain-trained professionals working together on an individualized pain plan. The US Department of Veteran Affairs is the largest system that promotes team based approaches to care and has numerous research studies demonstrating the effectiveness of these models of care.
2. Non-surgical Alternatives to Care
When someone is suffering from a chronic problem, sometimes it just seems easier to get it “fixed” right away. Yet too often people can rush into surgery when there are effective non-surgical options. Given the cost of surgery, and the potential for surgical complications, you would think that adoption of these alternative would be prevalent. Yet companies with effective solutions often fight the status quo.
Example of Healthcare “No Brainer” #2 — Apos (AposHealth.com) – Wearable technology that adjust gait function to reduce the need for knee replacements for osteoarthritis by over 80%.
3. Reduced Documentation Systems
With increased work related stress, burnout and worsening labor shortages in healthcare, allowing providers to focus on patients and less than on paperwork is more important than ever before. For example, nurses spend almost half of their time on documentation on only one third of their time in the patient’s room providing clinical care.
Examples of Healthcare “No Brainer” #3 — Eleos (Eleos.Health) — utilized natural language processing and clinical AI to reduce documentation for behavioral healthcare providers by 36%. In addition this technology provides new insights into how clinicians spend time and how they can be more effective in helping patients. Companies like Nant Health (NantHealth.com) and Valorant Health (Valoranthealth.com) are using information technology platforms to better integrate exchange of clinical information to provide clinicians with needed information and reduce time needed in searching for and documenting what is needed for patient care. Nant has particular expertise in
4. Care in the Home
This is an easy one—or at least you would think it would be that way. I mean, who wouldn’t rather get care in the comfort of their own home than in a facility with people you don’t know. But yet, the challenges of getting care set up for remain significant for many. Here there are lots of companies bringing innovation to make care in the home a reality, but the rate of adoption sure seems slow. These companies have the technology and now we need the rest of healthcare to catch up.
Examples of Healthcare “No Brainer” #4 — When it comes to lab testing in the home, companies like Orasure (www.Orasure.com) are bringing new home testing to the market and Emed (www.Emed.com) is providing the ability to do proctored testing right at home. Companies like Cadence (Cadence.care) and Phillips (usa.phillips.com) are allowing Healthsystems to bring remote monitoring to their patients and connect providers with data from the home. Tytocare (Tytocare.com) has consumer ready telehealth devices to allow consumers to perform examinations at home and transmit clinical findings to providers on line. Nuvo (NuvoCares.com) is bringing new capabilities in fetal monitoring to make complex maternal care once only thought to be available in the hospital, to the home as well. Strive (StriveMedtech.com) is bringing post surgical care into the home with medical expertise, monitoring, and rehabilitation treatments. Compassus (Compassus.com) is a leading hospice and home health provider bringing needed services such as palliative care and infusion services into the home.
5. Improved Diagnosis
Artificial Intelligence may not replace doctors anytime soon, but they sure can help make more accurate diagnosis today and allow doctors to start the appropriate treatments sooner.
Examples of Healthcare “No Brainer” #5 — Ibex (Ibex,ai.com) is an AI powered diagnostic system to improve the accuracy of identifying biopsies from prostate, breast, and gastric tissue. It can help pathologists focus on abnormalities quicker and pick up missed diagnoses in approximately 7 percent of cases. Aidoc (aidoc.com) enhances medical imaging to help identify acute abnormalities that allows clinicians to prioritize care and start appropriate treatments. Theator (Theator.io) has created a surgical intelligence system to enable surgeons to better identify issues in the operating room using video capture to improve skills and improve on surgical best practices.
6. Digital First
We’ve learned a lot about virtual care in the past few years and many of us are still digesting these lessons that will steer us towards future strategies. However, it’s safe to say that a hybrid approach, combining virtual and physical care, may make the most sense. In this hybrid approach, the order of care appears to make a big difference. With a digital first approach, it looks like patients can achieve good results with easy access, affordability, and outcomes.
Examples of Healthcare “No Brainer #6 — Galileo (Galileo.io) is a digital first primary care team that has been shown to manage over 90% of clinical issues without a referral. Twill (Twill.Health) provides digital first tools to numerous medical conditions, including behavioral health, and has demonstrated significant improvements in outcomes and reduced costs. SafetyNet Connect (safetynetconnect.com) provides e-consult technology that connects primary care physicians with specialists. Safety Net Connect has demonstrated the ability to resolve 66.8 percent of specialty care needs at the primary care and a 89 percent reduction in specialty care wait times.
7. Medication Adherence
It seems pretty obvious that medications work best when people take them and use then as instructed. Yet overall adherence to medications in chronic conditions is about 50%. When medications are prescribed and administered appropriately both costs and quality improve.
Examples of Healthcare “No Brainer” #7 — Medminder (Medminder.com) is an internet connected medication dispenser in the home that ensures that patients are taking their medications at the right time and right dose. Medminder’s device is particularly important for patients with multiple medications (polypharmacy) or for those with cognitive disorders that may be challenged with taking medications at the right time and dose.
8. Data Integration
To better understand how to manage individual patients and populations of patients, it is essential to have an accurate understanding of clinical and financial outcomes of care. Yet because of barriers in data sharing, it is too often difficult to get a full picture of the physical care, behavioral care, pharmacologic care, and administrative and financial data especially across different care settings. Yet with new government regulations from the Office of the National Coordinator and other agencies, and with technologic advances, there are real world examples where this is being done.
Examples of Healthcare “No Brainer #8) — Few companies understand large data sets and have mastered analytics like CareJourney (CareJourney.com). Care Journey uses a variety of data sources to create an integrated clinical and financial source of information to drive network and clinical performance improvements. Other companies are enabling this type of data sharing to become a reality. Datavant (Datavant.com) is using tokenization to connect data sources from around the healthcare ecosystem including 2000 hospitals, 25000 clinical, 120 HealthPlans and 500 real world evidence partners. Trinetx (www.Trinetx.com) has created a large ecosystem of real-world data to answer questions about safety, efficacy, and value and to increase the speed of future discoveries. They partner with Healthsystems and others to integrate data sets. MDClone (MDClone.com) creates synthetic data to enable unique data analytics capabilities to get at big issues without compromising patient privacy. Companies like Amida (Amida.com) have the technologic sophistication to help enable organizations to enable their data interoperability and data security issues.
9. Prevention of Illness and Injury
It makes sense to try to prevent illness or injury before it occurs, and the costs and suffering are much greater. Yet it still remains challenging to get proven prevention strategies paid for. The system’s “status quo” seems stuck in a model that finds it easier to pay for illness rather than prevent it.
Examples of Healthcare No-Brainer #9 — Sparta Science (SpartaScience.com) uses a high-fidelity force plate and advanced machine learning to capture gait analysis and other movement metrics that can predict and prevent injury from occurring. Companies like DayTwo (DayTwo.com) are using microbiome-based precision nutrition to prevent and treat conditions like diabetes often without the need for medications or other medical interventions. Somalogic (Somalogic.com) is a leader in proteonomics that can measure proteins that are key indicators of health status and risk to identify patients at risk before they develop medical conditions that require intensive treatments. Companies such as Exact Sciences (ExactSciences.com) have developed innovative solutions for detecting and treating cancer early in their course where preventive or early intervention is possible. Cormedix (Cormedix.com) is working on a new solution to preventing infection in patients with indwelling catheters. Of course bloodstream infections when they occur are serious and expensive yet are preventable. Legacy (GiveLeagacy.com) stores sperm samples for men to ensure the ability to have children before cancer treatments or other illnesses or even before military service.
10. Health Equity
Solving health disparities to ensure health equity and addressing the social determinants of health is not an easy endeavor. But making progress, even one step at a time, is possible. Barriers to healthcare can be many and include socioeconomic issues, racial disparities, and people with disabilities such as sight, speech, cognitive disorders, and those with limited physical abilities. Increasingly government and private companies together are recognizing the important of health equity in improving the overall health and well being of populations and communities.
Examples of Healthcare “No Brainer” #10 — Voiceitt (Voiceitt.com) is bringing speech recognition technology to help people with speech disorders communicate effectively with others. Using machine learning, Voiceitt identifies and learns unique speech patterns and then give people the ability to clearly communicate and connect with others.
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