CLINICAL INNOVATORS
kinds of things they were doing to drive those
outcomes, and your approach could become more
personalized as you collected more data. Think
Google for health.
Were people given a financial incentive to use it?
How were you able to fund it?
We really were in the right place at the right
time after developing this technology. In 2014
Medicare came out with a new code around
chronic care management. The largest payer in
the world started an initiative to pay providers
$42 to message patients for 20 minutes per
month. This was big as it was a great validation
of our initial vision; we now had the biggest
payor in the world to fund our business model
and data acquisition strategy. Out of 600 billion
Medicare dollars, 93% is spent on chronic
disease, and Medicare recognized the importance
of touching patients between visits. Our software
was secure and this was the perfect opportunity.
Doctors do not have the additional time to spend
successful. It doesn’t really add cost to the system
and it bridges providers as we move from volume to
value-based care.
To date, we’ve signed up over 50 provider
groups, representing 750 providers and 300,000+
lives across 17 states. We’re adding between 2,000
and 3,000 new patients per month to our platform,
so it’s an exciting time.
Have you looked at outcomes data for patients
enrolled in your program?
We’ve gathered early outcomes data on diabetics
and hypertensive patients (on the scale of 100’s
so far), and it looks quite promising. We are
seeing 20-point average drops that are statistically
significant in blood glucose readings in our
uncontrolled diabetic population. We are also
seeing an 8 mm drop in BP in our uncontrolled
hypertensives. Accordingly, we know the platform
works, but ultimately it’s about constantly
changing our solution and approach via incoming
dat a on our patients.
I believe to fundamentally influence
patient behavior outside of the clinic,
you must have human interaction.
messaging each of their patients 20 minutes per
month—they’d have to hire a whole staff for that.
We help them with that by using nurses to reach
out to their patients. On top of that, we aggregate
the data in a way that doctors can learn from
it and tailor care accordingly. Imagine doctors
knowing in the last 30 seconds of their visit how
exactly to encourage their patient based on their
personality characteristics and what they have or
haven’t done in the last month. It really enriches
the patient-doctor relationship.
We have a web application and mobile
application that push the data collected (BP, logged
meals, pain, sleep, mood, glucose readings) and
messages sent to the patient to the electronic health
record (EHR) so the doctors can bill Medicare at
the end of the month. Out of the 35 million patients
who qualify for this new code, only 275,000 claims
were submitted last year, so doctors are really
trying to figure out how to do this cost effectively.
We’ve been able to help here.
We do still have a lot of room to grow, and
we are interfacing directly with Medicare to help
increase patient access to this code. This was a
Medicare initiated code, so they really want it to be
40 CardioSource WorldNews
What have been the barriers to getting this up
and running?
The first thing we had to figure out was what
kind of clinicians we should hire to deliver
this service, since nothing like this had been
done before. For 4 years, I was refining the
prototype of the kind of nurse or care manager
we needed. Then it was the software, where
the goal was building a user interface and a
clinical interface that can engage seniors and
be user-friendly for the care manager. Now the
challenge is integrating with a variety of EHRs.
We’ve succeeded in integrating on a limited basis
with the top 10 EHRs. We are now focusing on
distribution partnerships with EHRs that can
allow for a deeper level of integration with our
patient engagement app: RevUp.
The final frontier is scaling the enrollment
process across the country. Onboarding
thousands of patients a month with a staff of
about 100 is a challenge that requires a lot of
human and technological ingenuity. The good
news is that the response from both providers
and patients is better than we anticipated—more
than 50% of patients presented with the option
of enrolling in our solution are doing so, and
physicians have found our services very helpful
in extending their reach between visits.
What technology do you anticipate coming
out in future years that will drive better care
delivery?
It’s not about technology—the technology is a
vehicle. It’s about the data that we garner and how
we are using that data to care for patients better.
The ability to use data from sensors that are
already out there and personalize care for patients
is what the future holds. Once the data is part of
a network, that data can be crunched and be used
by clinicians and care managers to take better care
of patients. Thus, interoperability of EHR’s with
web services platforms like ours is going to be
critical. It is great that the government is forcing
software vendors to be interoperable, so we can
start leveraging data to care for very large groups
with chronic disease.
I also believe to fundamentally influence
patient behavior outside of the clinic, you must
have human interaction. People who think you
can take human interaction out of the equation
are laboring under a false notion of what is
going to improve health. At the end of the day,
technology and data are about scaling that
human interaction. Enabling the technology
to make use of high-touch care models is
going to be esssential if the U.S. expects to be
economically viable in the future. Not only do
patients need this, our society does as well. ■
Katlyn Nemani, MD, is a physician
at New York University.
April 2016