Investing in the Future of Healthcare: The Advent of a Connected Care Continuum
Value-based care (VBC) is a force to be reckoned with. What is so fascinating about the VBC transformation is that it is permeating every facet of the care continuum. Nowhere on the care continuum has the need for transformation been more pronounced than in non-acute care settings.
Rising Demand for Care Outside of Acute Settings
There has been an increasing directive among payers/providers to shift care delivery from higher-cost (acute) to lower-cost (non-acute) care sites as a cost-control mechanism. However it’s care consumers who are accelerating the pace of change. An aging population (by 2030, one in five Americans will be 65+, up from one in seven today) and increased rates of chronic disease (by 2025, chronic disease will affect nearly 50% of the US population) suggest that a higher volume of sicker patients will continue to interact with the healthcare system. Many of these future patients (7 in 10 patients), meanwhile, have indicated a preference to receive this care either in the home or closer to home. There is real demand for better care options outside of the acute setting, but the challenge lies in the ability of payers and providers to consistently meet this demand.
Variation in Clinical Outcomes between Care Settings
Until now, providers and payers have not had their reimbursement tied to the treatment of an entire care episode and as a result, outside of acute care settings, patient clinical outcomes and accompanying reimbursement were mostly the responsibility of geographically fragmented and often siloed non-acute care sites. There was no real incentive for continuity, communication or coordination between these two care settings and therefore there was (and often still is) significant variation in care delivered between the two settings. Nowhere is that more apparent than the post-acute care setting (a category of non-acute care that deals with patient recovery and rehabilitation from an acute episode), which often treats some of the highest acuity patients in the care ecosystem. Using post-acute care as a proxy for the non-acute care ecosystem helps to emphasize just how much variation exists between care settings.
What’s really surprising is that post–acute care is not only a major contributor to the cost of a hospitalization episode (42% of Medicare beneficiaries are discharged from hospitals to post–acute care) but also one of the most inconsistent care settings in terms of clinical effectiveness (post-acute care makes up 73% of the variation in Medicare spending). Part of the reason for this inconsistency is that many post-acute care settings are not as well equipped (e.g., technology, data, clinical innovation, communication with acute care providers) as acute care settings and can not always ensure continuity of the patient’s care regimen. Patient engagement rates also tend to drop off outside of the acute setting, leading to incomplete care regimens and readmission within 30 days. What this suggests is that technology to enable communication between acute and non-acute care providers and increase patient engagement, are lacking.
Change is coming though, driven by a number of regulatory directives spurred by the macro shift to value-based care (e.g., the increased CMS emphasis to penalize hospitals that exceed defined readmission rates). The path ahead will likely see acute and non-acute (especially post-acute) sites sharing more data as well as integrating/collaborating to improve the clinical effectiveness of care delivered remotely.
In the future healthcare landscape, tools and technologies that enrich the “connectedness” and clinical effectiveness of non-acute and remote care solutions will gain traction in the market.
Vision for the Future: Connected Care Continuum
Pilot trials of several new innovations show promise in the ability of technology to enable more continuity in the patient experience through a care episode. Some interesting models leverage a primary care team as the “quarterback” of patient care, feeding them clinical data from multiple patient care settings so that they have a holistic view of the patient’s care episode. This can be extremely helpful in ensuring care continuity (timely intervention when there is an aberrancy in the patient’s clinical status, consistent medication adherence). Other models even aggregate patient data across a variety of care settings and use it to predict clinical tendencies or inform enhancements to the individual patient’s care protocols.
These technological innovations have shown potential in both improving the care being delivered outside of the acute setting and also in facilitating transition/coordination between acute and non-acute settings. Perhaps they’ll help usher in the advent of the connected care continuum.
Careport Health: Careport Health is a company dedicated to connecting patients with helpful post-acute care treatments. The company helps direct patients and family to learn about what type of care they may need, and what to expect during recovery, after filling in basic patient information. Patients can then search for post-hospital care providers and book care through Careport Health’s software. Hospitals can link into Careport Health’s network to help evaluate and manage patients, and connect them with the post-hospital care they will need. Finally, post-hospital care providers can connect with Careport Health to track patient progress as well as make themselves available to the company’s network and increase their own visibility.
Catalia Health: Catalia Health’s patient engagement platform pairs with the company’s intelligent personalized healthcare companion, Mabu, an AI-enabled robot that combines the efficacy of conversations tailored to individual patients with the cost efficiency of scalable technology. Catalia Health combines proprietary artificial intelligence algorithms for generating conversations with the patented advantage of social robots to effectively engage patients. The patient-robot interactions make possible the collection and analysis of data critical to providing the highest level of care in any remote care setting. Mabu’s main purpose is to prevent chronically ill patients with conditions like congestive heart failure or kidney disease from having to go back to the hospital. The goal is to help patients better manage their diseases and in turn reduce the readmissions penalties many hospitals incur when patients’ clinical conditions do not improve after an acute stay.
ClearCare: As care delivery shifts to lower costs settings, such as the home, technologies in remote monitoring, telemedicine, remote diagnostics, and medication compliance will improve clinical outcomes in these settings. ClearCare is well-positioned to address the unique care needs of the complex, high-cost patients in these settings. The company’s platform enables home care facilities to manage caregivers and patients. Features include matching clients with nearby caregivers and filling shifts if a caregiver cancels, texting and emailing caregivers to remind them of shift duties, and creating care plans for caregivers to use. The platform also provides home care facilities with administrative features, like billing and payroll management. Lastly, ClearCare is using a $60M Series D round of funding to add new features to its platform, including telehealth and remote patient monitoring.
Iora Health: Iora Health is transforming the connectedness of the healthcare ecosystem by offering a relationship-based care model available at the patient’s site of employment. The company works with self-insured employers and unions to create primary care clinics for high-risk, high-cost populations (which include post-acute care patients). Each patient has a care team that includes a health coach (the patient’s primary point of contact), a behavioral health specialist, a nurse and a doctor. This care team proactively manages the patient’s clinical / non-clinical needs both in the community and home setting, to improve clinical outcomes in lower-cost care settings. Underpinning the success of this care model is the Chirp Platform, a patient and provider-facing portal that integrates with mobile devices and offers continuous communication and medical record sharing functionality. Iora Health has achieved a 12.3% decrease in total spending for patients enrolled in the dedicated high-risk clinics since 2009.
