By Juan Pablo Segura, president and co-founder, Babyscripts.
In a crisis, finding the “right” solution is much less important than finding the “right now” solution. During the COVID-19 pandemic, clinical practices scrambled to quickly transition care out of the office, with some practices fully turning over to virtual strategies in the course of a single weekend — and they used whatever means available to do so.
Relaxed HIPAA restrictions and expanded CPT codes made it easier for practices to leverage the tools at hand to help with remote delivery of care — whether it was using the EMR to patch together messaging or collect vitals or Facetime and Zoom to get video visits off the ground — the boomerang went out to the market to capture a solution simply to plug the hole in the dike.
But now that the crisis has abated, leaders are turning their attention away from quick fixes to think about the long-term sustainability of pandemic solutions.
Physician buy-in is no longer the challenge that it was — the urgency for virtual solutions in the face of the pandemic leapt that barrier, and the success of remote care for managing patients through the crisis proved its value. Covid-19 has accelerated a massive behavioral change around digital health — providers are more willing to prescribe it, and patients even more receptive to using it.
In order not to lose these massive gains in digital adoption and changing mindsets, though, leaders need to think more holistically about digital health and virtual care. They need to consider and address questions of scale and ease of use. Makeshift solutions like drive-through blood pressure measurements worked in a pinch, but how do they function when the weather changes? When people can’t take off work?
Leaders know that efficiency and optimization is crucial to clawing back margin and to transition away from massive losses. So, in response to these changes, a few thoughts:
By Juan Pablo Segura, president and co-founder, Babyscripts
In the past several months, novel coronavirus 2019 (COVID-19) has risen from humble beginnings in a Wuhan farmer’s market to international status: dominating the news cycle, exhausting the world’s hand sanitizer resources, and generally monopolizing the mental real estate of the developed world.
As new cases continue to be identified in the U.S., politicians are giving coronavirus the attention it deserves, responding to initial accusations of inadequacy with proposals for funding and reimbursements for testing and other precautionary measures.
One of the primary targets of this emergency funding is telehealth. New York’s Governor Cuomo and the NY Department of Financial services released a directive encouraging insurers to develop telehealth programs with participating providers.
Arizona Rep. Ruben Gallego announced he was introducing a bill that would allow Medicaid to cover all COVID-19-related charges, including virtual appointments.
Major health industry groups like the Connected Health Initiative and the American Medical Association advocated for the Department of Health and Human Services to expand access to telehealth and offer Medicaid reimbursements for telemedicine in emergency situations.
Many have cited this pandemic as the “put me in coach” moment for telehealth — digital innovation that has lagged in adoption because of cumbersome restrictions, red tape, and lack of funding, among other things. And it’s obvious why telehealth is the tool for this moment.
At its most basic level, telehealth can provide accurate information about the virus — what it is, what the symptoms are, and how to protect against it. It’s low-hanging fruit in the rank of benefits, as disinformation seems to be spreading faster than the virus itself.
A local Costco suffered a run on toilet paper and paper towels, while the soap aisle remained surprisingly undisturbed: “Are we prepping for a snowstorm or a virus?” one shopper wondered.
A viral (no pun intended) tweet from CNN stated that “38% of Americans wouldn’t buy Corona beer ‘under any circumstances’ because of the coronavirus.” The tweet sparked a rash of sardonic responses. “Thirty-eight percent of Americans shouldn’t be allowed to roam free,” wrote one Twitter user.
The statistic was later debunked in a statement by the CEO of Corona, but it proves how quickly and easily even the most ridiculous rumors can take hold in panic mode.
The simple security of receiving information from a trusted care provider through a mobile app or text notification can dramatically reduce the panic that rises from disinformation, and clear up confusion around prevention and precautions (and what beer you should be avoiding).
Last month saw the rollout of the latest upgrades to Amazon’s Echo speaker line: earbuds, glasses, and a ring that connect to Amazon’s personal assistant Alexa. These new products are just three examples of a growing trend to incorporate technology seamlessly into our human experience, representing the ever-expanding frontiers for technology that have moved far past the smartphone.
These trends and others are going to make a big impact in the healthcare space, especially as providers, payers and consumers alike slowly but surely recognize the need to incorporate tech into their workflows to meet the growing consumer demand for digital health tools. At the same time, the data-hungry nature of these innovations is creating its own problems, driving a discussion around privacy and security that is louder and more urgent than ever.
Here are three trends to look out for in the coming year:
Artificial Intelligence (AI) and Machine Learning are growing into themselves
In 2020, we will continue to see AI and machine learning push boundaries, while at the same time mature and settle into more defined patterns.
With the adoption of technologies like FaceID, facial recognition technology will be an important player in privacy and security. It can be leveraged to simplify the security requirements that make multi-factor authentication a time-consuming process for healthcare professionals — on average, doctors spend fifty-two hours a year just logging in to EHR systems. On the patient end, this same technology has the ability to detect emotional states of patients and anticipate needs based upon them, and the success of startups like Affectiva, the brainchild of MIT graduates, shows its tremendous promise..
Meanwhile, FDA-approved innovations from Microsoft and others claim the ability of computer vision for assisting radiologists and pathologists in identifying tumors and abnormalities in the heart. While robotic primary care is a long way off, some view AI as a rival to more niche clinical positions.
At first glance, the healthcare field seems to be a goldmine for digital innovation. An overextended workforce, outdated protocols, hundreds of wasted hours in administrative tasks, a patient population that is wide open to digital solutions, a multitude of inefficiencies and redundancies — the opportunities for digital overhaul in healthcare are myriad. Yet every year the graveyard of digital health tools gets more crowded as innovators fail to overcome healthcare’s uniquely complex barriers to their adoption.
Goldmine and graveyard, the tremendous opportunities for digital transformation in healthcare and the seemingly insurmountable barriers to its adoption are two sides of a coin. They spring from the same root causes: the lack of financial incentives to implement digital solutions; the high stakes that necessitate a cautious approach; and most significantly, providers’ seeming unwillingness to abandon proven workflows or sunk costs to take a chance on a disruptive solution.
This last cause is often the greatest barrier to getting innovation through the door. Clinicians are the primary end-users of digital health, and a clinical champion can make all the difference in whether a solution is adopted. But in the face of the physician shortage in the United States, doctors don’t have time to trade out their proven workflows to take a risk on a solution that may or may not be successful, and will almost certainly take time to learn and implement into their practice. The majority of providers are already at capacity — eighty percent have no time to see more patients or take on more duties. Thus what seems like an unwillingness to change is often an inability to find the time to change.
Because of their packed schedules, physicians often default to the status quo for sanity’s sake: forty percent of physicians see up to 20 patients per day, with another 40% seeing more (anywhere from 21 to over 70); and all spend almost a quarter of their day on administrative duties like inputting data into EHRs. If physicians do have a chance to sit down with innovators, it’s in the margins of their day — instead of an exciting opportunity for change, a pitch-meeting with an innovator represents another 15 minutes they have to take from their family at the end of a long day, an extra 10 minutes of sleep lost in the morning to get into the office early, the interruption of the small respite of a lunch break.
It’s no surprise that in a 2018 survey conducted by the Physician’s Foundation, eighty-nine percent of physicians polled felt that they had somewhat to very little influence on changes in healthcare — they have no time to research chances to optimize their practice, and thus essentially no voice in its improvement. Yet only a physician has the kind of intimate knowledge of his or her needs and workflow that can drive effective innovations. Perhaps digital innovations have failed to take hold because the people making decisions around tools to help doctors are not doctors.
If we are going to break the barriers to digital transformation in healthcare, we need to expect physicians to think critically about how their job needs to evolve. And no one can do this without time to reflect on and evaluate the status quo. In the corporate world, executives and other employees are encouraged to do research, to take time in their schedules for professional development. Many tech giants — most famously Google, but also Facebook, Linkedin, Apple, and others — employ the 20 percent time model, where roughly one-fifth of an employee’s schedule is focused on personal side projects (those side projects have turned into Gmail, Google Maps, Twitter, Slack, and Groupon, to name a few). This is the model that we need to embrace in the healthcare system.
Collaboration is at the heart of successes over history — in Darwin’s words, “those who learn to collaborate and improvise most effectively have prevailed.”
Yet the healthcare space has been slow to learn that lesson. Far from functioning as a team focused on a single goal, healthcare stakeholders operate on a fractured playing field, each one trying to get to the goal on their own. From that perspective, everyone becomes a competitor — and the ability to reach the goal line becomes nearly impossible.
Nowhere is the tension more obvious than in the struggle to integrate technology and healthcare.
On the surface, they are unlikely partners. Healthcare isn’t exactly a profession for risk-taking, and rightfully so — in every decision, the safety of a patient is at stake. A new drug or tool has to run the gamut of regulatory burdens and clinical validation before it gets anywhere close to adoption. Adoption and implementation is arguably even more challenging, including everything from integrating new solutions into legacy systems, convincing practices to abandon the sunk cost of preexisting solutions, or overcoming the lack of financial incentives — without practice reimbursement, the challenge of adoption becomes that much more daunting.
Technology, on the other hand, is a high-risk, high-reward market (there’s a reason that billion dollar-valuation startups are called “unicorns”). Many tech startups achieve their success by delivering direct-to-consumer solutions, cutting out the middleman and individualizing experiences for the user. It’s a formula that doesn’t map well onto the healthcare field where the success of patient care and outcomes relies on a web of relationships.
And tech companies that have tried to take these formulas from Silicon Valley and apply them to healthcare learn that really quickly. The graveyard of digital health tools is littered with companies trying to sidestep the problems of the healthcare system by dealing with the patient directly, and removing the care provider from the equation.
Babyscripts is a virtual care platform for prenatal care powered by mobile apps that drive better patient decision making, IOT devices for remote monitoring, and a host of population health tools to give providers access to patient data in real time.
It seems unlikely that two childless bachelors, with no healthcare experience, would start a pregnancy company, but Juan Pablo Segura and Anish Sebastian founded Babyscripts, now the most impactful digital health tool in the obstetrical market. In 2014, with a passion to improve the current healthcare system due to family health struggles, business savvy, and the tenacity to succeed, these two former Deloitte consultants found themselves in front of the Chair of Obstetrics at George Washington School of Medicine & Health Sciences, Dr. Nancy Gaba, which started the journey of Babyscripts.
Babyscripts sells to health systems, private practices, and payers to support women’s health initiatives in pregnancy care. Babyscripts is then delivered by a care provider to an expectant mother at the beginning of her pregnancy. It is deployed through risk-specific modules that are tied to the clinical/social risk of a patient at the point of care.
Each year, 4 million babies are born in the United States. Babyscripts works with the providers of care for these pregnancies – health systems and private practices – to support better access to care and better quality of care. Currently, nearly half of the counties in the United States don’t have access to an OB-GYN, according to the American College of Nurse-Midwives. The American Congress of Obstetricians and Gynecologists estimated that in 2020, there will be between 6,000 and 8,000 fewer OB-GYNs in the country than needed. Babyscripts is the only clinically validated tool that allows doctors to automate aspects of care, enabling there to be greater efficiency in the workflow, enabling doctors to touch more patients in a meaningful way.
Who are your competitors?
Our competition can be categorized in a few areas:
There are Consumer Maternity Apps in the market (ex. What to Expect, BabyCenter, The Bump)
Payer focused apps and programs for maternity (Wildflower Health, Ovia Pregnancy)
Non-Obstetric based clinical apps (ex. Wellpass, Vivify Health, Conversa Health)
How your company differentiates itself from the competition and what differentiates Babyscripts?
Babyscripts is the only platform that connects the clinical provider and patients together using technology, while at the same time lowering the cost of care. By including the provider and all of their guidance, specific information and advice into the equation, it ensures that a patient is getting information that aligns with her provider’s care plan, while keeping engagement high. Additionally, Babyscripts is the only clinical tool that is singularly focused on solving obstetrical problems.
Yet effective January of this year, CMS instituted important changes to their reimbursement policies that encourage the use of digital health tools. Most significant among these changes is the un-bundling of the Medicare/Medicaid CPT code 99091, a decision that specifically affects the adoption and deployment of remote patient monitoring (RPM) devices. In the past, CMS has only offered financial incentives for live, audiovisual virtual visits, excluding RPM—and thus excluding a major demographic from the possibility of affordable and accessible care. With the un-bundling, financial incentives for RPM are not only available, but also are deployed across multiple providers, allowing nurses and care managers as well as physicians to analyze and monitor data, creating efficiencies and lowering costs.
But while the CPT un-bundling represents an important victory for RPM, it also serves to highlight the policy’s inadequacies and the large margin for growth. With the update, care providers no longer have to worry about fully funding RPM from their original operating budgets, but the reimbursement rate ($60 per patient per month) is still far too low to be effective in most cases. Other requirements, such as a prior wellness visit with the patient and a limit of one charge to the code per month, further restrict its effectiveness.
Perhaps most problematic, while the un-bundling will have an immediate positive impact on patients over the age of 65, a large patient demographic could be outside the bounds of its effects. Commercial plans are under no requirement to follow the updated CPT guidelines, and more importantly, neither is Medicaid. And while Medicaid is the smaller of the two government run-healthcare plans (compare Medicaid’s revenue of $565.5 billion to Medicare’s $672.1 billion), it is outpacing Medicare by 10 percent in rates of spending (increasing by 3.9 percent in 2016 compared to Medicare’s 3.3 percent).