Digital Health Innovation Beyond the Clinic

Your income and zip code are a better predictor of your health outcome than the clinician you see or the genetics you inherited. Yet, up until recently, a patient’s socioeconomic status was really only paid attention to by the U.S. healthcare system when it interfered with the patient’s ability to pay. Medication and treatment was dispensed without any research of whether the patient could get to the pharmacy to fill the prescription or was able to afford it. Even if clinicians were aware of the hurdles their patients faced in adhering to their treatment, few had the tools or insights to do much about it. Today, though, the changing reimbursement landscape is forcing health organizations to recognize these impediments, and entrepreneurs are stepping up to solve one of the biggest problems clinicians currently face: understanding their patient’s lives outside of the clinic, specifically the social determinants of health.

This shift to focusing on the factors patients experience outside of the clinic wouldn’t have happened without several key pieces of legislation that, over time, implemented the digitalization of health records and new payment models. In 2001, the number of physicians using electronic medical records (EMRs) was only 18-percent, but by 2011, that number jumped to 57-percent. One of the reasons behind this jump in EMR use is the American Recovery and Reinvestment Act of 2009 (AARA), which stipulated the health industry’s necessary adoption of electronic records. The AARA established an incentive program for providers to implement electronic records, while also implementing penalties in the near future for provider organizations that failed to comply.

The Affordable Care Act is the second key piece of legislation that not only brought millions of individuals into the insurance market, but is also changing the way doctors get paid. Instead of health organizations being paid based on the service they provide, the Center for Medicare / Medicaid Services (CMS) will now tie a percentage of reimbursements to the quality of care given, known as bundled payments. The first bundled payment was rolled out on April 1st, 2016, for hip and knee replacements. Instead of being charged for each piece of service delivered; i.e., the MRI, the physician visit, pre-operation screening, follow-up appointment, etc…, provider organizations will receive one sum per procedure, regardless of follow-up care required for complications. This way of assessing reimbursements is one of the new payment structures being rolled out under value-based care and will impact the way healthcare providers generate revenue and do business. While these payment structures will be phased in, by 2018, 50-percent of CMS reimbursements will be done through alternative payment models, like bundled payments.

One of the reasons why policy and the U.S. government play such a driving role in changing the business of healthcare is simply because they are the largest customer of healthcare services. Between Medicare, Medicaid, the Affordable Care Act (ACA) subsidies, and the Children’s Health Insurance Program (CHIP), the U.S. government spent $938 billion on healthcare in 2015. Medicare, government-provided health insurance for citizens over 65-years old, cost the government $546 billion. The penalties for not complying with the ACA are typically administered through a reduction in the organization’s Medicare reimbursements. Given the sheer volume of Medicare patients in the U.S., almost every organization touches these patients and relies on these reimbursements for payments; thus, it creates a strong incentive for organizations to comply. With the government having the largest purchasing power of any organization in healthcare, health policy inevitably reverberates across the entire industry.

Entrepreneurs have long recognized the slow-coming tide of value-based care and have developed a slew of solutions, but most have focused on clinical improvements. There is huge potential to leverage technology to capture and handle the factors that inhibit patients’ health, yet can’t be assessed or treated clinically. While it’s still early for this particular niche within health IT, three broad trends are emerging:

• Transportation: Access to transportation affects all areas of a patient’s life and determines where a patient can grocery shop, whether they can pick up their medication, and if they’re able to make it to medical appointments. While Uber and Lyft have dominated the market, their services are typically out of reach for most low-income patients. Fortunately, there are multiple startups cropping up to handle the need to get patients to the most critical places.
• Remote care: Tying in with transportation hurdles is the ability to monitor patients in their own home, eliminating the need for the patient to physically go to the clinic. Through innovative data collection techniques and analytics, clinicians can now track the progress of their patients at home. In some instances, algorithms can be used to guide patients through a tailored treatment program, like in the case of physical rehabilitation.
• Data and assessments: Physical and basic demographic assessments are nothing new to medicine. Most of these, though, are only focused on clinical symptoms and a couple of high-risk behavior questions related to smoking and substance abuse. This and related clinical data, though, is a very small window into the patient as a whole and new technologies are being developed to get data from different, currently disparate, sources to create a more holistic view of the patient. It’s important to note that these new data sources aren’t meant to medicalize non-medical problems, but meant to arm those within the care continuum, such as social workers, with the best knowledge of the impediments of a particular patient.

Village Capital Health: US, in partnership with The Kresge Foundation, is excited to work with the following thirteen companies, representing the best solutions both within the above outlined trends and within the subsector of health IT for the social determinants:

bosWell leverages community-based organizations to forecast risk of hospitalization among the most vulnerable Medicaid beneficiaries.

care.coach improves care of at-risk patients via 24x7 social support, health coaching & risk assessment, provided by avatars that fuse human + software.

Certintell’s patient-centered medical home virtual care solution lets low-income Americans text, send pictures, and video chat with their care team.

Heudia Health matches Medicaid Beneficiaries with the goods and services they need to live a healthier, more productive life.

Kaizen Health connects health systems with the rideshare community while taking down technology barriers.

Kangaroo Health is a patient-risk big data analytics & intervention platform-as-a-service to help providers reduce costs & improve outcomes.

KNOX is working to prevent asthma attacks before they begin.

LivWell offers a cloud-based, services management solution for post-acute providers to manage home and community based services.

PatientToc uses IT to help low-income & non-English speakers communicate to healthcare teams, and helps providers use the information to improve care.

PHRQL improves access to preventive healthcare for people with food insecurity, by bringing services to them in food pantries.

Play-it Health delivers platforms that track, report, and intervene to improve adherence to prescribed health regimens.

Senosis uses built-in sensors on the iPhone to perform diagnostics, making primary care faster & cheaper and telemedicine more powerful.

THINKMD is a mobile medical assessment, triage and treatment platform that guides minimally skilled users through a clinical assessment of a child using the same evidence-based logic utilized by pediatricians.

Social determinants have a disproportionate outcomes on an individual’s health. Through addressing some of these non-clinical impediments, Village Capital believes all people in the U.S., regardless of wealth, will have a greater chance of experiencing better health.