Healthcare in the United States is a complex maze that is difficult to navigate for both patients and clinicians alike. While there are plenty of challenges, there are just as many opportunities to improve the healthcare experience. Startup companies play an important role in changing the way we think about health and the delivery of healthcare. We will explore some of these new ideas and innovative solutions by means of a hypothetical scenario in the life of a patient Mr. Joe Smith.
Joe is in his late 60s and lives in a low income neighborhood. He is fortunate enough have a wonderful primary care physician via Oak Street Health which operates on a globally capitated, at risk model with full financial responsibility for its patients across the spectrum of primary, specialty, acute, and post-acute care. As a result, Joe doesn’t have to worry about unexpected out-of-pocket costs when he visits his physician or if he is admitted to a hospital. Oak Street Health utilizes a data-driven approach to population health using certain parameters to identify high-risk patients and allocate resources based on the same. Joe can be assured that he will have preventive visits at frequent intervals in accordance with the severity of his illnesses while having enough time at each visit to address his concerns with his doctor. With a team based model and focus on preventive care, Oak Street Health has been able to achieve excellent patient satisfaction scores and a 5 star rating in HEDIS measures while reducing hospital admissions by over 40% for its patients. Joe truly feels well cared for.
(For the rest of the article, we will assume Joe sees a primary care physician in a non-capitated care model).
At his routine follow-up appointment, Joe takes a digital assessment by BrainCheck while waiting to see his doctor. It takes less than 10 minutes for him to complete and it generates a report for his provider regarding any early cognitive or behavioral changes and recommendations for further steps to address them if they are detected. This screening by BrainCheck is reimbursable and can be administered remotely as well.
Joe has also been using Cliexa’s COPD and Rheumatoid Arthritis tool for chronic disease management. It keeps his doctor updated on his symptoms and enables timely changes to medications based on the disease severity. This prevents uncontrolled/worsening symptoms and avoids hospital admissions. It also helps his doctor spend more time discussing Joe’s COPD rather than asking questions about the COPD and Rheumatoid Arthritis symptoms. This can be achieved due to the customizable Cliexa assessments and questionnaires that enable seamless data integration into his doctor’s EMR system.
At one point, Joe is admitted to the hospital with what seems to be a congestive heart failure exacerbation. The Hospitalist caring for Joe calls his cardiologist who is able to send over the records he has using Medsender. As a result, the Hospitalist gets all the required information immediately. Even better, because the records were sent with Medsender, they are indexed and searchable. So the Hospitalist doesn’t have to go through a hundred odd pages to see the last echocardiogram and stress test results. The cardiologist is able to track who viewed, downloaded and printed the records. Likewise, at time of discharge, the hospital is able to send Joe’s primary care physician and the cardiologist the hospital stay records without needing to waste resources in terms of fax machines/toner cartridges/paper and staff time.
Prior to Joe’s discharge, the staff at the hospital has him view educational videos about his new medications generated near instantaneously by Telesofia Medical. Joe is able to get personalized videos for the new medications he has been prescribed, with instructions on the dose, how to take the medications and what they will help with. Joe has a better understanding of these medications and his Hospitalist is able to clarify the few questions he has.
While doing Joe’s discharge, the Hospitalist needs to prescribe him certain brand medications that do not have generic options. Since Joe has limited income, the Hospitalist is concerned about medication compliance. Fortunately, the Hospital has OptimizeRx seamlessly integrated with the EMR. As a result, the Hospitalist is able to see the potential savings on brand name medications for Joe right in the EMR itself and is able to send the prescriptions and the savings vouchers electronically to a pharmacy of Joe’s choice. The Hospitalist is also able to print the vouchers as well as text/email them to Joe using OptimizeRx.
Following his discharge from the Hospital, Joe receives notifications in his email and on his phone via text message to access a chat with Conversa’s chatbot regarding his heart failure symptoms. Conversa’s conversational A.I. technology covers chronic care, pre and post-surgical care, post-acute and prevention as well as wellness scenarios. The chatbot talks to Joe about his symptoms while providing information and guidance on things to monitor before he follows up with his doctor. If there is any concern, the chatbot can trigger a phone call from a nurse or a physician enabling a timely intervention and preventing readmission.
While this is a hypothetical scenario, it envisions some of the ways we can change and perhaps improve the healthcare experience for both patients and providers. Although these innovations and technologies are currently available and in use at some facilities, their use is not widespread. The reasons are myriad, including the less-than-satisfactory experience with EMR systems as well as the initial cost and time investment involved with use of new technology. The ideas mentioned in this article do seem to improve the physician/clinician efficiencies. At the same time, they provide better patient experience and reduce overall costs associated with complications of inadequate preventive care and those associated with non compliance as well as hospital readmissions. The use of the right technology for the right purposes seems to be the key to a successful integration into the mainstream.