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Health2047 Spin-Off Focuses on Prediabetes Coaching

October 9, 2018
by David Raths, Contributing Editor
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First Mile Care seeks to scale up CDC’s proven National Diabetes Prevention Program
First Mile Care CEO Karl Ronn

Health2047 Inc., a Silicon Valley-based innovation company founded by the American Medical Association (AMA), has spun out its second startup, First Mile Care, a preventive chronic care company focused on prediabetes.

Health2047 previously launched Akiri, a San Francisco-based company developing a blockchain-based network-as-a-service platform for the healthcare industry.

There are an estimated 84 million people living with pre-diabetes (higher-than-normal blood sugar level), according to the company. With $2 million in seed funding, First Mile Care is building a platform that will offer people coaching to make lifestyle decisions that can reverse prediabetes and reduce the risk that their condition will develop into type 2 diabetes.

The First Mile Care platform is based on the proven National Diabetes Prevention Program (DPP) method developed by the Centers for Disease Control and Prevention (CDC). The coaching program has been shown to reduce the incidence of type 2 diabetes by 58 percent compared to placebo.

In an interview with Healthcare Informatics, First Mile Care Founder and CEO Karl P. Ronn described First Mile’s approach. “The CDC developed an approved diabetes prevention coaching program that works, but it just hasn’t scaled,” he said. “Approximately 200,000 people have taken the program in the seven years it has been available. That leaves 84 million who haven’t. The question is: can we scale it?”

First Mile has set an ambitious goal of getting half of prediabetic population into a coaching program in the next 10 years. “That scale of intervention would change the chronic disease landscape in the United States, said Ronn, a former Procter & Gamble executive.

To accomplish that goal, Ronn said First Mile will have to make the coaching intervention as convenient as possible. “If I want you to do something weekly for 16 weeks and monthly or bimonthly for six months after that, it better be easy to do or you are going to drop out,” he said. “It has to be within 10 minutes of your home. The reason we are called First Mile Care is that rather than trying to figure out how we are going to get the last mile from our hospital or doctor’s office to your home, we are more interested in that first mile, and we need to be able to make it possible for you to get that coaching in that first mile from your home.”

An easy way to model that is ZIP codes, he said. There are 42,000 U.S. ZIP codes. “It has to be as convenient as regular weekly shopping trips and that means showing up in all those ZIP codes,” he said. “I could need 40,000 to 100,000 coaches to handle 84 million people.”

First Mile is building a technology platform to build a matching system between individuals and coaches much like Uber does between drivers and riders. The platform will also track progress and provide feedback to users and use analytics to discover best coaching practices. “The tech platform tis important in matching people and tracking progress,” Ronn said, “but really I am trying to build a relationship between you and your coach so you can get done what you need to do. I don’t want the technology to get in the way of that; I want it to support it.”

Another reason the timing is right for the company’s launch, he said, is that Medicare has recently started to pay for this type of coaching program and other insurers are starting to follow suit.

So what is next for First Mile? “Our seed funding will enable us to prove we can do what we said we could do in terms of develop this coaching process in the wild,” Ronn said, “and create the on-demand system. In the process of doing it, we want it to be effortless and delightful for the coach and for the person. We are in a learning model to prove we can do it. Within 18 months, we will be scaling it up. “

 

 


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N.Y. Hospital Conducts Digital Assessments of Patient Interactions

November 13, 2018
by David Raths, Contributing Editor
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Upstate University Hospital uses Vocera Rounds mobile app to gather data, provide feedback
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Physicians at Upstate University Hospital in Syracuse, N.Y., are using a mobile app to collect data about hospitalists’ behaviors during patient interactions in order to provide real-time feedback.

Amit Dhamoon, M.D., Ph.D., internist at Upstate University Hospital and associate professor of medicine at SUNY Upstate Medical University, said he was looking for a way to improve physician-patient communications.

“It is still unclear why some physicians really connect with patients and some just are not able to,” he said. “It is unclear why certain patients trust certain doctors more than others. We want to look at some basic behaviors.”

His team decided to do the digital assessment using a customized version of Vocera Rounds, a mobile application that enables clinicians to collaborate in responding to patient feedback and closing care gaps. “We needed a way to collect the data, relay it, and analyze it,” he said.

Fourth-year medical students who are going into internal medicine join the team of hospitalists on their rounds and serve as “silent shoppers,” Dhamoon said. They focus on the communication aspects of each interaction, and enter their observations into an iPad.  Residents and physicians also use the app to conduct a brief patient survey after the encounter. 

Among other things, they assess:

• how much time the provider was in the room;
• whether the provider introduced themselves;
• whether they sat down at eye level with patient; and
• At the end of conversation, did they ask if there were any questions?

Dhamoon said patients may pick up on body language or other things that physicians are not even cognizant of. “We are focusing on how to treat gall bladder disease or make their pneumonia better. We are focusing on the medicine,” he said. “We have to do that, but we also have to communicate what we are thinking.”

In an academic medical center, it is not unusual for teams of eight to nine doctors, residents and students enter a patient’s room. “Sometimes they don’t know what to do with their hands, so they stand with their arms crossed in front of them,” Dhamoon said. “For the patient, who is lying down with an ailment, it can almost feel like an inquisition.”

Dhamoon says hospital rooms are sometimes cramped and there is not a chair available. “I can say that it should be the gold standard that we are at eye level, so it doesn’t send a message to the patient that we have one foot out the door. But if we don’t have the basic tools in place, like a chair, then it is not going to work.”

Dhamoon and his colleagues are studying the effectiveness of this training approach and its impact on patient satisfaction measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.  “My colleagues are incredible people. I want our patients to see how incredible they are. We get in our own way sometimes.”

 

 


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GetWellNetwork Acquires HealthLoop

November 9, 2018
by David Raths, Contributing Editor
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Company seeks to provide comprehensive digital patient and family engagement platform

GetWellNetwork, a Bethesda, Md.-based company offering a platform for improving patient engagement, has acquired Silicon Valley startup HealthLoop.

The acquisition expands 280-employee GetWellNetwork’s reach into nearly 700 healthcare providers. Mountain View-Calif.-based HealthLoop’s platform enables care teams to engage patients before and after admission through automated, daily check-ins. Customers include Advocate Aurora Health, UCSF Health and LifeBridge

GetWellNetwork said it is combining its nearly two decades of experience implementing patient engagement solutions with 30-employee HealthLoop’s expertise in mobile technologies and digital care management. The move is designed to catalyze growth in the ambulatory space and signals its plans for more investment in cross-continuum tools to connect patients, families and providers.

GetWellNetwork was named one of Healthcare Informatics’ “Up and Comer” companies back in 2014. In an interview then, CEO Michael O’Neil described how the company uses the TV set in a hospital room to enhance patient engagement. To deal with pain management, GetWellNetwork has a workflow called the pain assessment pathway. If a patient is on a morphine pill, the system interrupts the TV show every hour to ask the patient to rate their pain on a scale. "If I report a certain threshold or below, it is simply going to document that in Epic, Cerner or Allscripts," O'Neil said. "If I report a five or above, it will document but also, through a Vocera badge, signal a nurse to go to the room. That is one pathway we help deploy, where pain management is a service or quality metric that a particular organization is trying to move the needle on. We are working with healthcare systems with the courage to take the 'patient-centered mission' off the poster in their office and bring it to the point of care."

In a prepared statement about the most recent acquisition, O’Neil said:  “Adding HealthLoop to our portfolio advances our strategy to provide the most comprehensive, end-to-end digital patient and family engagement platform. The changing nature of the how and where care is delivered requires dynamic solutions to meet modern engagement challenges. With HealthLoop as part of the GetWell portfolio, we’re excited to help health care organizations rethink and accelerate their digital strategies.”

 

 

 

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Dr. Mark Smith’s Five Tasks for the Healthcare Sector

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Founding CEO of California Health Care Foundation challenges industry to allow laypeople to do some tasks now done by professionals
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A good keynote address gets us to challenge our assumptions and consider some new possibilities in our field, often bringing in ideas from other disciplines or markets. That is what Mark Smith, M.D., M.B.A. founding president and CEO of the California Health Care Foundation, did last week at the annual meeting of the Patient Centered Outcomes Research Institute (PCORI) in Washington, D.C.

Dr. Smith is a professor of clinical medicine at the University of California, San Francisco, and a visiting professor at the University of California, Berkeley. As a clinician, served on the front line of the HIV/AIDS epidemic in San Francisco. From 1996 to 2013, he led the California Health Care Foundation, where he helped build the organization into a leader in delivery system innovation, public reporting of care quality, and applications of new technology in healthcare. In his PCORI talk he laid out five tasks for the field, which I will paraphrase here:

1. Continue to work with providers and patients to develop robust clinically specific measures of quality.

2. Accelerate the integration and automation of quality measures into the work flow of care delivery as opposed to separate flow of funds, personnel and work.

3. Develop instruments to measure and improve self-care capability and work with industry on enabling technology that would allow laypeople to do tasks now done by professionals.

4. Think about non-creepy ways to use social media, search, shopping and other non-health data to inform care of patients.

5. Develop, promote and deploy nimble, adaptive research methodologies.

I want to touch on a few of these in detail because I think he made interesting points, some of which are counter-intuitive or go against the grain of current thinking. For instance, Task No. 1 involves quality measures, and Smith acknowledged that there are legitimate complaints from clinicians about the terrible burden in our current system of measurement. “But the answer to that is not a search for five magic measures” useful in all settings, he said. Smith added that the call for fewer measures is a false path.

The current measures are imprecise and often not compelling to patients and professionals, he stressed. The key is to develop measures that are relevant to patients and clinically significant. “We have all sorts of things important to hospitals, doctors and CFOs and CMOs,” he said. “We are just now learning how to create robust measures that are important to patients. I believe those will only be compelling to patients and their doctors if they are clinically specific. When I hear people say we need fewer, better measures, I say no, we need more better measures.”

Smith went into a few reasons why measurement is so challenging in healthcare. “Our IT systems are so primitive that the burden of collection, analysis, and reporting is substantial,” he said. “The answer is more clinically specific measures with greater integration into workflow.” In no other sector of the economy, he pointed out, are the systems for monitoring the quality of the process different from the established and funded system to do the process itself. “We have to Integrate the process of measuring quality and collecting information from patients with the view toward the ergonomic and economic integration into the work flow,” he said.

Smith turned to the concept of patient engagement, noting that everyone has a different definition. “In the early part of 21st century, patients should be engaged in the co-production of healthcare services. It is an extreme notion, but I have been known for being extreme sometimes,” he said.

In fact, Smith focused a good deal of his talk on the idea of co-production. He pointed to the fact that other industries have taken advantage of technology to allow customers to co-produce a service. For instance, people book their own travel now instead of using a travel agent; they use an ATM or bank online instead of getting money from a teller. “Those industries have economic incentive to involve us in the transaction that used to be one way from the professional to us,” he said.

Smith stressed healthcare could do more of that, citing examples such as patients in Great Britain taking their own blood pressure and managing hypertension with medications based on the results. Or patients being trained to test coagulation. Some patient cohorts are doing self-dialysis.

“We have a system that does not take advantage of modern IT,” he added, “because our payment system is based on early 20th century notion of healthcare and how it should be delivered. The only way the practitioner gets paid is if you go somewhere to get information.”

Health systems are starting to move toward involving patients in scheduling decision making, and reporting outcomes. The Open Notes movement is a big improvement in the co-production of information about patient health, but clearly Smith is envisioning more revolutionary changes.

Perhaps the most controversial topic he touched on was No. 4, finding non-creepy ways to use social media, search, shopping and other non-health data to inform care of patients. He asked the audience to imagine clinicians having access to what Google Amazon, and Facebook know about you. “I know that is creepy,” he stressed. “I get there are privacy concerns. We need to think of non-creepy ways to do it. Social media is like nuclear energy,” he added. “It can be used for good or ill. We need to try to integrate that profound deep knowledge about you into the management of your care.”

How you respond to that suggestion may reflect in part which generation you come from. Personally, I recoil from the idea of my primary care doctor reviewing my social media streams or my shopping bill from Whole Foods. But Smith said the search is for a non-creepy way to do that, so I will withhold judgement until I hear an idea that doesn’t sound creepy or Big Brother-ish to me.

But overall, Smith left the PCORI audience with a lot of ideas to consider, and he applauded PCORI researchers for “trying to figure out what is important to patients and get the right instruments to measure it.”

PCORI, he said, “is on the cutting edge of the most important thing we can do: spend time and effort and money on things that are important to patients rather than to professionals. We are just at the beginning of that process.”

 

 

 

 

 

 

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