Home Sweet Home: The Three Ps Underpinning Care in the Home
The secular trend of moving care into the home aligns nicely with the Triple Aim of Healthcare:
- Improving the individual experience of care,
- Improving the health of populations, and
- Reducing the per capita costs of care.
The late Bernard Tyson said it best in terms of his vision for healthcare delivery:
“Providing care where the member is, virtually and at home, with interventions taking place at super hubs across the country.”
— Bernard Tyson, Former CEO and Chair, Kaiser Permanente
Technology enabled super hubs will drive top notch interventional care. In the arena of stroke interventions, where I spent over a decade, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) developed a Comprehensive Stroke Center designation where to date, only 197 high volume centers in the US have satisfied the requirements, including offering 24/7 emergent stroke intervention capabilities. The goal is to concentrate care in centers with the most experience, tackling the toughest procedures with a collaborative interdisciplinary approach to drive the highest level of clinical care.
But we know that the surgical intervention is just one piece of the care continuum. In a value based care world, the focus has expanded to the “bookends” of the care continuum: Awareness/Prevention and Recovery/Rehab.
Awareness — Prevention — Diagnosis — Treatment — Recovery — Rehab
The care bookends can (and should) be best performed virtually and at home. The days of inconvenient and expensive monitoring in the hospital bed are on its way out. Below I outline 3 key tenants around intelligent virtual care in the home: Personalization, Prediction, and Prevention.
- Personalization: Tailored Care Journeys and Personalized Medicines
It’s the difference between wearing a suit off the rack from a department store versus having a tailored suit that fits you perfectly. Beyond that, it’s like having a suit that continues to conform to your body, even after that big Thanksgiving meal or that new low carb diet and Peloton exercise regimen! Out goes the generic recovery plan printed on a piece of paper post-surgery that instructs you to perform a set of exercises that you may or may not be physically able to do. In comes a series of smart wearables (e.g., Apple Watch, Nanowear) that provide continuous, simultaneous, and even synchronous monitoring of your vitals, key organ function, movement and range of motion, to name a few. Add visualization and an analytics engine for both the patient and the care team to drive smart, tailored care journeys for recovery and rehab in the comfort of your home.
A couple of examples: MyMobility is a great example of ZimmerBiomet and Apple teaming up to provide a personalized rehab and recovery plan for orthopedic patients. Tempus has the world’s largest library of clinical and molecular data, and an operating system to make that data accessible and useful, to enable physicians to make real-time, data-driven decisions to deliver personalized patient care.
2. Prediction: Anticipating the Next Event
With the plethora of data through wearables, the potential for predicting the next big event holds so much promise. With continuous, simultaneous, and synchronous data coming in, big data companies can distill this data to start making predictions on disease progression, such as the progression in kidney failure in the US:
1 of 3 are at risk for chronic kidney disease → 1 out of 6 adults who are affected by it (but 90% don’t know they have it) →120,000 people annually who develop end stage kidney disease (ESKD). Or when the next heart attack may occur? Or when the next blood glucose may spike? Anticipating the next event will drive the associated actions to prevent them.
Prevention: Next Best Actions to Avoid or Mitigate Disease
Armed with predictive capabilities, the focus then can shift to the proverbial “how to avoid spilling the milk in the first place”, vs the best way to clean it up after it’s already spilled. If a patient knows that he is at higher risk for certain conditions, he can act today to mitigate or delay its onset.
Preventative actions in cardiovascular disease alone have huge impact: Clinical preventive services could save tens of thousands of lives each year. Blood pressure screening and control is one of the most effective ways to prevent heart disease and stroke. Among people with diabetes, blood pressure control reduces the risk of cardiovascular disease by 33 to 50%.
The same sensor that collects the data can also be a tool to empower you to lose weight, control the factors impacting blood pressure, blood sugar level, and cut back on tobacco products. Importantly, the ability to do so in a seamlessly integrated way with your daily lifestyle. I’ve found this list helpful on the top 5 preventative care healthcare start ups.
For those of us in tech, we hear the terms ‘personalization’ and ‘prediction’ quite a bit, but when they are applied in healthcare, it takes on a new, and deeper meaning, as we tackle some of the toughest health challenges and do so in an innovative patient-centered way. The time is now for intelligent virtual care in the comfort of our own homes!
Question:
What innovative models in virtual and home based care have you seen that makes you excited? What are the keys to success and pitfalls to avoid?
