Healthcare Insider — Where are the real opportunities?
At Kaiser Permanente Ventures, we have the privilege of sitting inside a large integrated payer and provider system while supporting the healthcare innovation ecosystem. In that role, we are investing in and helping to build companies that address the biggest challenges facing US healthcare.
Armed with this insight, we look to align our fund’s investments with the burning needs because we believe that strategic impact and financial success are both tied to solving significant unmet needs.
In the course of doing this work, we conduct needs assessments — seeking to identify and better understand the true needs across our health system. Armed with this insight, we look to align our fund’s investments with the burning needs because we believe that strategic impact and financial success are both tied to solving significant unmet needs. While we never link our investments to vendor contracts, we see it as a sign of success that over 2/3 of KP Ventures portfolio companies have operational partnerships with Kaiser Permanente.
These needs assessments also give us the opportunity to impact the healthcare beyond capital, by sharing these insights with the broader innovation ecosystem. We share them in the hopes that these needs, drivers, and success factors that may not be as apparent from the outside help innovative solutions focus and grow more quickly. We have organized our insights into several key themes that we understand to be ripe for innovation.
The first theme that we are tackling is Access.
Access
Healthcare begins with access. It is fundamental to being able to provide quality care and achieve meaningful patient outcomes. It has become a key topic for innovation for two main reasons:
1. The “Amazon Effect.” Access to goods and services in the consumer world and other industries have changed dramatically. This has impacted patients’ expectations for convenience and connectivity.
2. Technology advances. New technologies create new opportunities for access, enabling us to solve challenges in new ways.
The opportunity in access is that technology and connectivity can simultaneously be a patient satisfier by shortening wait times and creating convenience while also solving for scarcity of clinical expertise by using resources the most efficiently, removing mismatches in supply and demand and scaling expertise by embedding some of it into the technology itself.
As an organization unencumbered by the fee-for-service model of reimbursement, KP is ahead of the curve in pursuing new methods of access which gives us a strong view into what the future of healthcare delivery can look like. Examples of that innovation include:
- KP has invested heavily in a telemedicine infrastructure and remote monitoring
- 52% of visits are done through telemedicine modalities
- Created new models of access like regional Physician Telephonic Call Centers
- Initiating chat to resolve patient questions quickly
Drivers of Innovation in Access
- High Demand
Implementing innovative access solutions takes time and money. With already busy practices, the bandwidth for and opportunity cost of doing something new is often prohibitive, even if the solution is valuable and more efficient once it is implemented. However, where there is rapid, significant growth in demand, we see more of these access innovations take hold. Areas like genomics, mental health and primary care — where the needs are growing faster than the workforce can keep up with. Leveraging technology is a way to solve where supply is limited or costly to grow.
2. 24 Hour Needs
Not all clinical needs adhere to the 9 to 5 appointment schedule but are also not well suited for the ER. Technology often creates new opportunities to fulfill needs by creating scalable and just-in-time access to information and clinical expertise. The maternity journey, behavioral health and urgent care are all prime examples. Waiting for an appointment in the middle of a workday to bring in a baby who is not latching for breastfeeding doesn’t solve the problem in the way an on-demand, telemedicine appointment would.
3. Geographic Constraints
Matching supply and demand of clinicians, especially more specialized ones, becomes a real challenge in the brick and mortar world. Recruiting and staffing create real costs and barriers. You need to either recruit clinicians to your area, potentially have them travel to multiple sites, overstaff the volume you have or have long wait times. Technology enables access to resources that aren’t constrained by geography which means you can meet the demand more efficiently. An overabundance of expertise in one area and scarcity in another can be equalized without moving clinicians around. This can be attractive to health systems to load balance, and for clinicians who can choose to live or remain where they would like.
4. Patient Convenience
Per the aforementioned “Amazon Effect”, our consumer experience is bleeding over to our expectations in healthcare. We are all becoming used to same day delivery, on-line scheduling, text and chat. There are also real costs to the patient from taking time off from work, traveling to appointments and being in the waiting room, especially in rural or very dense urban settings. This need for convenience may be the difference between taking time off work or not, which become even more acute for working caregivers.
5. Clinician Flexibility
We were initially surprised by this feedback since our going assumption was that technology in general and telemedicine specifically complicated clinicians’ lives by turning easy, in-person appointments where patients are ushered into your office efficiently into a telemedicine appointments that may have technology glitches or other logistical issues to contend with. However, clinicians are people too and benefit from flexible working schedules. Telemedicine offers the opportunity to work from home, something clinicians are not afforded in the traditional brick and mortar world, which enables clinicians to avoid commutes, pick up kids and better match the work schedule with the demands of their lives.
Non-Obvious Barriers to Access Innovations
1. Workflow Changes
People focus on the cost of the technology itself, but the real costs of new technology come from the workflow changes that must accompany the technology.
We think of this as the iceberg below the water line. People focus on the cost of the technology itself, but the real costs of new technology come from the workflow changes that must accompany the technology. Just adding telemedicine to the traditional workflow often complicates rather than optimizes the delivery of care. The best technology can’t overcome that. Workflows must be optimized for the new access models including staffing, scheduling, training, and information exchange. This is a barrier to adoption that is often unforeseen by emerging technologies that are hoping to plug into the existing model of care. It’s not that it can’t be overcome, but it does need time, attention, and the return must be sufficiently high to justify the up-front investment. It also means that the driver of access innovation must be big enough to justify the investment of time and energy.
2. Patient Navigation
Traditionally, there is a single “front door” to your clinician. You call the office and schedule an appointment or, in the case of an acute problem, go to the ER. Now that there are call centers, website portals, email, chat, urgent cares, apps, telemedicine and other tools.
The other non-obvious insight we have come across is that adding more access channels can create confusion. Traditionally, there is a single “front door” to your clinician. You call the office and schedule an appointment or, in the case of an acute problem, go to the ER. Now that there are call centers, website portals, email, chat, urgent cares, apps, telemedicine and other tools.
It’s not obvious to patients which access point is their best option. This in made even more meaningful to patients in the era of the high deductible health plans, as there are often cost implications tied to which “door” you enter. Being able to guide the patient successfully through a right door will be more than half the battle for start-ups looking to help innovate around access.
Our Investments in Access
KP Ventures has made several investments in companies that reflect these insights. All our investments in access share a common theme of leveraging connectivity and technology to create access to care that enhances outcomes, patient satisfaction and scales scarce expertise.
All our investments in access share a common theme of leveraging connectivity and technology to create access to care that enhances outcomes, patient satisfaction and scales scarce expertise.
Omada is a digital coaching platform for diabetes prevention that combines proven methods of diabetes prevention with a technology platform that enables scalable access to those proven methods.
Big Health is a digital therapeutics company that leverages proven methods of cognitive behavioral therapy and makes them scalable with a fully digital intervention to addresses insomnia and anxiety.
Genome Medical is a telemedicine platform that enables the “last mile” of precision medicine by creating efficient, scalable and convenient access to scarce genetic expertise so that the new wave of genomic tests and therapies can be appropriately applied to clinical care.
Ginger.io is a licensed tele-behavioral health company with on-demand coaching, teletherapy and telepsychiatry. Combining a world-class clinical network, artificial intelligence, and smart phone platform to provide high-quality, cost-effective on demand support.
Promising Areas for Future Investment
Areas that we think have promise to address access needs include:
- Patient self-service tools: Enable patients to access needed information on their own time in a scalable way that results in greater satisfaction and better outcomes.
- Care setting navigation: Engage and direct patients to the right care and setting at the right time in efficient manner for both patients and providers.
- Patient intake tools: Automate components of the patient intake process that addresses patients’ needs and directs them to the right care.
- Telemedicine and digital coaching platforms: Connecting patients to care in ways and times that aren’t possible or scalable in a brick & mortar world.
Our hope is that these insights start a conversation with entrepreneurs, other health system and plans, and others working advance meaningful innovations. Please reply to this article or reach out and share your comments, questions and insights!
This article was written by Amy Belt Raimundo and Shruti Kothari from Kaiser Permanente Ventures (bios below).
Amy Belt Raimundo is a Managing Director with Kaiser Permanente Ventures and focuses on the adoption of technology that meaningfully improves the quality, accessibility and affordability of healthcare. She has 12 years of investing experience and 10 years of operating experience. She graduated from Yale and Berkeley. She is a Kaufman Venture Fellow and the founder of MedtechWomen. Reach out by LinkedIn or Twitter @amyraimundo.
Shruti Kothari is a health care innovation advocate living in San Francisco. She is passionate about creating meaningful health care experiences for patients, families, and providers. She’s worked as a health educator, community mobilizer, quality improvement leader, early stage startup operator, and a conduit between large systems and the innovation ecosystem. Get in touch on LinkedIn or Tweet at @shrutiko to say hello ✌