Building the Future of Health Care for Patients Left Behind.

Joey kept forgetting to take his metformin on time. Mrs. Lin was having trouble sticking to an exercise program that worked with her arthritis. Mr. Johnson just wasn’t sure how to improve his diet.*

Throughout my first year at Harvard Medical School, nothing felt more heartbreaking than listening to patients recount the difficulty of managing their health.

“I really want to do better doc,” many would confess. “It’s just not easy.”

Their medication schedules were complicated as it was, not to mention their side effects and instructions, all on top of strict diets and new exercises. How was it that we could leave physiology lecture in the morning fascinated about cutting-edge advances in biomedical science and therapeutics, but see much of the potential of these novel treatments left unharnessed in the clinic during the afternoon?

Track your blood sugar, eat better, be more active. Rinse. Repeat.

It wasn’t entirely a surprise that many of these patients would end up back in the hospital, or return to clinic with an ever-rising HbA1c. “There’s only so much you can do in a short visit,” the attendings would say.

It wasn’t just the patients I saw. More than half of the patients in the United States either forget to take their medication or take the wrong dose, in some instances landing them in the emergency room. 1 in every 7 patients discharged from a hospital is readmitted in less than a week, but two-thirds of those readmissions could be prevented with better follow up and care at home.

The financial impact is another tragedy — poor care at home costs our health care system $290 billion each year, 13% of all U.S. health spending combined.

In the last few years, hospitals have made a push towards value-based care and prevention, hoping to motivate efforts to improve the long-term health of patients over the number of services provided. But restructuring care teams and incentives can only go so far when patients go home to the same environments and triggers and continue to struggle with lifestyle change. The principal question remains:

How can we improve disease management in a cost-effective, scalable manner for the patients that need it most?

The “Digital Health Revolution”.

Physicians are increasingly realizing that we can leverage technology to reach more patients, more often, and for a fraction of the cost. This has led to a recent explosion of wearables that track patient data, smarter pill-delivering technologies, self-monitoring apps that help patients manage their disease, and “connected” platforms that help connect patients with their care teams.

And yet, although many of these interventions have shown early promise, none have really been able to stake a claim into the incredible need that remains for patient care. Appealing to the goals of patients, providers, health systems, and insurance companies all at once is daunting and complicated. Those in charge of buying health technology–hospital CFOs, CIOs, Chief Quality Officers–are rarely the ones using the product every day.

Most importantly, patients that need innovations in care delivery the most are the last ones to have access to them, if at all. Patients like Joey, Mrs. Lin, and Mr. Johnson aren’t exactly jumping at the chance to wear fitness trackers and configure health apps on their smartphones. Many of these patients tend to be older and less tech-savvy, and digital solutions, for all their ingenuity, sometimes just make things even more difficult.

A smartphone app that tracks your medication adherence and vital signs over time is hardly the coaching needed to make meaningful lifestyle changes. Patients need someone they can talk to, that can answer their questions, that can work with them day by day, one step at a time.

That’s why we built Felix, a virtual health care coach in your pocket.

Felix is an artificial intelligence-backed health coach that engages with patients with pre-diabetes and Type II Diabetes over text message, helping educate them about their condition, provide interactive health coaching, and improve their overall self-care.

Past SMS interventions in health care tend to be static, one-way messages; hardly sufficient to target larger changes in lifestyle required to improve chronic disease management. When we first built Felix, it was simply that.

But as we continued to alpha test our product and learn from patients, physicians, and friends we realized how much folks were willing to engage in their health once they found a friendly, personable agent to confide in. They had questions about their medications and side effects, the healthiest kinds of food to eat and where to find them, and the best exercise for their schedule and health goals, among others.

By no means has the journey been smooth.

Innovation within health care is hard, and we have certainly dealt with our own share of understaffed clinics, medical record systems that were nearly impossible to navigate, hesitance from doctors about even the thought of seeing another piece of information about their patients, and ultimately, institutional resistance to change. Sounds like another app doomed to fail, many would say. What about physician liability? What if the patients stop talking to their doctors? What about patient privacy? What if Felix gives the wrong advice?

And for all the reasons about patients having difficulty benefiting from these interventions, it’s not any easier on the provider end. Clinicians already have too much on their plate; they simply don’t have the time to collaborate on and integrate new interventions into their workflow. Thus the digital divide between consumer technology and health care only continues to grow.

Indeed, many are quick to dismiss the plethora of recent technologies that seek to digitize and virtualize healthcare. And we don’t blame them. Many tools entering the market are well-motivated and sophisticated, but fail to gain traction due to a neglect of patient and provider experience.

We realized that we had to think about innovating in health care differently.

AI won’t replace physicians, but no AI will even be good enough to come close unless it’s in the trenches; until it fails and learns to be better. Any successful product in health care needs to achieve user accessibility on both sides of the care landscape — with patients and with their physicians.

We went back to the drawing board and redesigned our product. We worked tirelessly with each and every clinic to figure out which metrics they wanted, what their workflow was, and how they’d be able to use Felix without losing time that they didn’t have.

Our mission is to make it as easy for patients to feel comforted about their care and concerns at home as it is to text their family. Through our new platform, patients receive handcrafted chronic illness support and coaching, proactive medication and appointment reminders, treatment and drug information, and personalized follow-up questions to track patient-reported health outcomes (.e. blood sugar, drug side effects), all personalized to their condition and treatments via text message (SMS). Patient SMS responses are parsed and displayed on a browser dashboard as easy-to-read visualizations of key health outcomes.

The platform’s core is an artificial intelligence engine that allowed us to build a nuanced level of personalization and a conversational interface to simplify the patient user experience. Patients can use the SMS interface on any cell phone to talk to Felix, our intelligent clinical assistant, to receive information and care support, ask questions about their treatment, mention challenges they’re facing, and report symptoms and side effects.

Our analytics engine identifies potentially dangerous symptoms from patient responses and can alert the patient, caregivers, and clinicians in the event of an emergency. Felix is active 24/7 and immediately responds to patient questions and concerns to help them feel cared for at anytime, anywhere. Best of all, Felix gets smarter as he talks to and learns from more patients.

Our team does all the heavy lifting for you. There’s no installation or setup required for physicians, caregivers, or patients. Open a browser, login, and you’re ready to go.

Now, our users love Felix.

100% (every single one!) of our users reported finding the platform easy-to-use and over 85% of them continuing to engage with Felix over a long period of time.

Felix talks to patients day and night so that clinicians don’t have to spend time figuring out why patients weren’t sticking to their regimen, including their medications, diet, and exercise routine. Felix answers their basic questions so that their doctors truly focus on providing transformative care. Felix can talk to thousands of patients at a time, reaching the patients that otherwise didn’t imagine receiving support anywhere beyond the four walls of the hospital.

Change in health care is hard, and occasionally even feels impossible. At these junctions, it has helped to remember that at the end of the day, behind the budgets and time constraints, we all share the same goal. Patients want to be healthier — they just need a little help. Clinicians want to take better care of their patients — they’re just over-committed all the time. And as we continue to make reforms, payers are getting on board as well.

So many health care companies focus on moonshots and visions of health care from 30,000 feet, but somewhere in the pitch decks, projections, and products, the patient and the patient experience is lost. Joey, Mrs. Lin and Mr. Johnson aren’t rare instances of patients lost within our convoluted health care system; they’re everyday people that just want to know that someone is looking out for them.

As we gather users, and accumulate invaluable data, we hope not only to continue to improve Felix, but design what we envision to be the operating system for value-based health care.

Because this is the future of medicine.

Visit and reach out to let us know how we can help your practice and patients!

If you believe that everyone deserves the opportunity to receive the best possible health care, please recommend us below and share our story to help us reach the patients who might otherwise be left behind in the future of medicine.

*For their privacy, I’ve changed Joey, Mrs. Lin, and Mr. Johnson’s real names and identifying details.