Guest post by Grant Kohler, vice president, Innovation and co-founder, REACH Health.
I began my healthcare career in the hospital setting. While working at Georgia Regents University (formally the Medical College of Georgia), my colleagues and I developed one of the nation’s first telestroke systems. It was rudimentary at first, literally pieced together on an IV pole from existing equipment: web-enabled video cameras, flatbed scanners for CT scans and spare CPUs, with a landline telephone to provide audio. Since then, I’ve worked with many facilities across the country to set up telemedicine platforms. Over that time, I’ve witnessed a variety of approaches to telemedicine.
One major transformation I’ve witnessed more recently: Many hospital systems are now choosing software-based platforms over hardware-based technologies. As I’ll explain shortly, this shift in thinking has important implications worth considering.
Core Technology: Software vs. Hardware
Telemedicine platforms are evolving rapidly with no signs of slowing. It is prudent to ensure that your hospital is in a position to take advantage of the rapid pace of improvements without being locked into a solution that hinders or prevents future technological enhancements or program expansion.
To appreciate the difference between focusing on software vs. hardware, consider the evolution of mobile phones. In 2007, the first smartphone was introduced. At the time, flip phones were considered leading edge. Less than five years later, flip phones were deemed antiquated by most. Why? The cell phone is a hardware-centric device and the smartphone is a software-centric device.
In the telemedicine industry, first-generation solutions such as tele-presence carts and robots began as single-function, hardware-centric devices. Even if they work satisfactorily for their narrow purpose, they lack the flexibility needed to support cost-effective upgrades and expansion for multiple service lines. Also, because the hardware is proprietary, it often isn’t subject to commoditization and is priced at a premium. As telemedicine technologies have evolved, software-centric platforms have become available and offer increased flexibility, including new capabilities and multiple endpoint options.
Support for Creating a Telemedicine Network – Thinking about the Subscribers
The literal goal of telemedicine is to create networks where provider hospitals offer specialty care or expertise to subscribing hospitals. Successful execution produces improved outcomes and patient satisfaction for a larger number of patients and creates economic benefits for both the provider and subscriber hospitals.
Your telemedicine platform can impact your ability to recruit hospitals into your network. In competitive markets where other provider hospitals are vying for the same potential subscribers, a well-designed telemedicine platform provides a recruiting advantage. If a large hospital balks at expensive hardware investments that easily become dated, a smaller hospital will have similar concerns but a tinier budget. Hospitals of all sizes seek to leverage maximum utility out of all investments with a minimal disruption to existing processes and workflows. With hardware-centric platforms, the inherent focus is often on the technology itself rather than the patient. This is unpalatable for most hospitals considering telemedicine, as their primary objective is better patient care.
Deb Dahl, vice president of patient care and innovation at Banner Health, discusses her experiences managing the telehealth program for the health system. Banner Health is a nonprofit health system based in Phoenix operating more than 20 hospitals and specialized facilities. It is the second largest employer in Arizona, providing emergency care, hospital care, hospice, long-term care, outpatient surgery centers, labs, rehab services, pharmacies, and ambulatory clinics, which include Banner Arizona Medical Clinic and Banner Medical Group.
The health system is a long-time user of telehealth technology, which has had a profound positive impact on providing patient care and is seen as a major benefit to the organization.
Have you used telehealth services in your practice to provide care?
Yes, we have had a long standing relationship with Philips collaborating on telehealth programs, using a “technology, people and process” approach to healthcare. We started with a single facility in 2007, and our telehealth program now reaches more than 400 beds at 18 facilities in Arizona, Colorado, Wyoming and Nebraska with plans to cover our Fairbanks, Alaska, facility and Nevada site some time in 2015. Across these facilities we utilize telehealth in the intensive care unit, acute care, skilled nursing facility, and ambulatory space (patients at home). We use a command center approach, which allows a dedicated team of physicians, nurse practitioners, nurses, pharmacists and social workers. We provide coverage to more than 400 ICU beds in five states, more than 200 medical/surgical patients, neuro and behavioral health ED coverage, 500 complex chronic members at home, as well as simple low acuity on demand home visits.
What’s it like? Is it all it’s cracked up to be?
Yes, we went live with our first 50 ICU beds in 2006. With our program growth, we’ve experienced great results: in 2013 our ICU results were among the top three in the U.S. Using APACHE as the actual to predictive model Banner saved more than 33,000 ICU days, 47,000 hospital days and 1,890 lives in 2013. We are expecting similar results for 2014.
A Baton Rouge, La.-based data company has set its sights on Jackson, Mississippi, announcing it will build a technology center that, in part, will house one of the University of Mississippi Medical Center’s fastest growing services – telehealth.
UMMC has entered into a lease agreement with Venyu Solutions, LLC, which will construct a stand-alone, 16,000-square-foot facility to accommodate the increase in the services UMMC’s Center for Telehealth provides to hospitals, clinics, corporations and patients across the state. The lease will begin on or around July 1, 2016.
The Venyu Technology Center will be constructed at the site of the former McRae’s department store on the corner of Meadowbrook Road and State Street in the Fondren neighborhood. In addition to the new building, existing structures such as the former McRae’s building will be renovated to host a data center for Venyu, with plans for other businesses in the future.
“Throughout the years, Venyu has provided data center services and other critical services to many health-care organizations, but few have embarked upon such an innovative approach to delivering medical advice and care,” said Scott Thompson, founder and CEO of Venyu. “We are proud the University of Mississippi Medical Center has selected our new Technology Center in Jackson to help host their telehealth operations. We greatly look forward to the positive impact these new services will have within the community.”
The technology center site falls in line with a health-care corridor that’s been lauded by state leaders.
“Mississippi is a national leader in telehealth, and today’s announcement marks an important step toward even more innovation and development,” Gov. Phil Bryant said. “We are not only growing the medical corridor in the Jackson metro area, we are ensuring we have the infrastructure in place to develop new health-care solutions that can improve the lives of Mississippians.”
Girish Navani is CEO and co-founder of eClinicalWorks, an electronic health record company exceeding in the B2B field since 1999. Under the leadership and foresight of Navani, the company is expanding its services to B2C with the launch of healow – an app for patients to easily find new doctors, schedule appointments online and access their personal health records.
Here, Navani speaks about his path to eClinicalWorks, he offers his expert insight on EHRs and their benefits to healthcare, and he speak of likely trends that will continue to change the healthcare landscape.
Tell me your story. About how you got here, how you developed your technology and the reasoning for a private company set up?
We wanted to use technology as a way to completely transform the healthcare delivery model to streamline processes, prevent errors and provide easily accessible information to both providers and patients. Not only was our primary goal to make doctors’ jobs easier by providing them with a way to operate more efficiently, but we also wanted to improve the patient experience.
I’m a strong believer in keeping my company private and concentrating on building a solid product. Selling shares and depending on investors means that they will always have a say in how we conduct our business. We use our profits to continue building our company and our products.
What about the leadership inside the company? Is it true the no employees have titles? What’s the reasoning?
I have an open-door policy, which allows the opportunity for anybody to approach me to ask questions and brainstorm ideas. Over time, I’ve learned to listen more. I’m okay with second guessing my own decisions and receiving feedback from my colleagues, even if what they say is “no.”
Yes, our employees do not have titles, but instead, the whole company is team-based with team leaders being the only leadership position. Employees’ careers grow with bigger projects. I think titles are self-fulfilling and short-term objectives that people quickly get tired of. With a team-based structure, employees can work together to achieve successful results instead of individuals striving for the next title.
What drew you to healthcare? Why does it stand out for you?
I have always worked in technology, and in 1999, I heard a lecture in Geneva about using wireless computing in healthcare and the idea of “connected healthcare” really stuck with me. I loved the idea of a doctor and patient sitting in the doctor’s office reviewing charts on a tablet instead of pieces of paper, so I wanted to build a technology that connects all parties involved in healthcare, including the doctor, patient and insurance company.
Prior to launching Webbed Marketing (the previous name of Fathom Columbus), founder Bill Balderaz worked with some of the largest publishers in the world to plan, execute and measure Internet marketing programs. He began working on search engine optimization, pay-per-click advertising and link-building in 1998, prior to the launch of Google. He has spoken on Internet marketing topics at events sponsored by the Public Relations Society of America, the American Marketing Association and the National Fuel Funds Network. Bill holds a bachelor’s degree in public relations journalism from Bowling Green State University and an MBA from Franklin University.
Here, he discusses health IT trends, the future of wearables as he sees them and the consumerization of healthcare.
What are the biggest changes we will see in 2015 in terms of healthcare technology?
Hospitals and health systems across the country will be adopting or upgrading EHRs, telehealth capabilities, and mobile tools. Look for increased reliance on and more sophisticated use of data analytics, as well as individualized medicine, ‘doctor-less’ patient models, and quantification of population health via social media. Patients will take more control of their health.
Also look for integration. Patients have so many inputs: lab results, wearable data, fitness plans. Then they have outputs, newsletters, emails, patient portals. The smart money is on the technology to connect and simplify.
What is driving these changes?
At the consumer level, where patients are more informed and involved than ever, what some call the ‘democratized future’ of healthcare is bringing more accountability and transparency to both the methods and costs of care. The parallel needs to cut skyrocketing costs, increase access to care, improve quality of service, and encourage patient engagement are all factors contributing to the growing potential of health IT to transform the delivery and experience of healthcare at fundamental levels.
You work with healthcare systems across the country in a variety of markets. What trends are common to all hospitals and healthcare systems? What differences do you see?
eVisit is the telemedicine software platform for physician’s offices. Its cloud-based SaaS application allows physicians, PAs and NPs to evaluate and treat their existing patient population remotely, via webcam interaction. Unlike competitors, eVisit is the only platform for providers, designed to allow telemedicine reimbursement from third party payers. eVisit can increase patient flow up to 300 percent; and can decrease “no shows” by 80 percent, allowing a practice to recover up to $120,000 a year.
eVisit is telehealth software that enables providers to increase patient flow and revenue, while providing convenience to their patients with online treatment.
Bret Larsen, Co-Founder, CEO. Glen McCracken, MD, Co-founder, president.
We are actively marketing through strategic channel partnerships and product integrations.
The Primary Care Market generates $135B/year in revenue with a CAGR of 2.6 percent. It employs 745,642 (246,090 physicians) over 130,526 medical practices; 90 percent of primary care physicians operate in SMB medical practices, our target segment (IBISWorld). This segment represents a $9.99B/year addressable market (221,481 buyers x $1,200) + ($121.5B x 8 percent billing fee).
How your company differentiates itself from the competition
Competitors offerings include B2B models with value propositions of lowering costs, B2C models offering convenience or enterprise hardware and software (none offer physicians ability to bill a patient’s insurance, the doctor-patient relationship is non-existent and patients are being asked to pay more).
Healthcare practice sign up on a subscription that is charged on a per user, per month fee of $99.
We are currently raising our seed round of investment ($1M) and actively looking to hire talented developers.
As a concept, telehealth has always impressed physicians with its potential. The ability to capture time-critical health information regardless of a patient’s location empowers a level of preventive care and early diagnosis never before possible. A physician can only observe the symptoms exhibited by a patient during a visit, but what of the symptoms exhibited in the course of the hours, days, weeks and months between visits? Each day, patients are subject to changes in their health as a result of lifestyle choices, treatment compliance decisions and physiological processes. Telehealth makes it possible to continually monitor these changes and take immediate remediation measures rather than waiting until the disease has progressed to a point of no return.
The advent of wireless devices that may be unobtrusively worn or placed in the home to track everything from pulse rate to frequency of night-time bathroom usage has made the real-time collection of a broad range of biometric data a reality. Moreover, the cost of such devices has dropped significantly over the past several years while their convenience and capabilities have grown. Despite this progress, the healthcare industry has yet to fully adopt telehealth or realize its enormous potential.
Some point to the lack of reimbursement as the culprit. Although device costs may have dropped, the overall expense of initiating and maintaining a telehealth program, including the associated device, data, personnel and training costs, is significant. However, two trends are chipping away at the economic side of the equation. First, state Medicaid programs are continually increasing the scope of reimbursement for tele-visits and remote monitoring, and both Medicare and private insurers have also started to move in the same direction. Second, the shift from fee-for-service to capitation models are providing compelling financial incentives for managed care organizations to fund telehealth programs.
Arguably a more critical obstacle to the mainstream adoption of telehealth is the challenge of data integration. Telehealth systems have developed along a separate track from electronic medical record systems. As a result, the telehealth data resides in a separate, landlocked silo from the patient’s medical history. Thus, even though data is being captured regarding the patient between physician visits, the physician still only sees and records the data accessible during the visit. At the same time, the telehealth program nurse is only seeing the biometric data without the context of the patient’s overall health profile that is accessible to the physician. With the data in landlocked silos, different members of the patient’s care team are unable to see the entire picture or effectively collaborate.
Guest post by Scott Zimmerman, president, TeleVox.
If you caught Maria Bartiromo’sinterview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:
“Telehealth is going to be a booming industry.”
Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.
Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”
The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.
One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.
It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.
Progress Is Underway
Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.
Mercom Capital Group, a global communications and consulting firm, releases a new report depicting VC funding and mergers and acquisitions activity in the healthcare IT third quarter 2014. According to the report, venture capital funding in the sector came to $956 million raised in 212 deals globally, a decline of 46 percent in terms of dollars compared to the massive $1.8 billion in 161 deals raised in Q2 2014, a rare quarter. Q3 2014 was still the second highest quarter for VC funding since 2010, though, and total VC funding year-to-date is $3.6 billion.
The quarter was dominated by more than 100 funding deals of less than $2 million. There were 252 investors that participated in the quarter including angels, VCs, private equity and corporate VCs. The quarter also included 12 accelerators/incubators.
“Healthcare IT saw another big fundraising quarter in Q3 with almost $1 billion raised. Companies from countries outside of the United States, accounted for a record 21 percent share of the funding. While consumer-centric companies attracted the majority of the funding this quarter, M&A has been a different story with the majority of the deals involving practice-focused companies,” said Raj Prabhu, CEO and co-founder of Mercom Capital Group.
Consumer-focused technologies received 65 percent of all VC investments, with $623 million in 140 deals compared to $678 million in 100 deals in Q2 2014. Areas that received the most funding under this category were mobile health with $345 million in 82 deals followed by telehealth, which had its best quarter, with $101 million in 16 deals; personal health with $85 million in 24 deals; social with $70 million in three deals; and scheduling, rating and shopping with $23 million in 15 deals.
Practice-centric companies received $333 million in 72 deals in the third quarter of 2014, compared to $1.1 billion in 61 deals in Q2. Under this category, the areas that received the most funding were revenue cycle management with $75 million in eight deals, and data analytics with $71 million in 19 deals.
The top five VC funding deals in Q3 2014 were the $70 million raise by DXY (Ting Ting Group), an online healthcare community for medical institutions and healthcare providers in China, from Tencent Holdings Limited, a provider of comprehensive internet services in China, followed by the $52 million raise by Proteus Digital Health, a developer of products and services integrating medicines with ingestible sensors, wearable sensors, mobile and cloud computing.
Guest post by Cliff Bleustein, M.D., M.B.A., chief medical officer, Dell Services.
For decades, reimbursement for the time spent coordinating care and keeping people healthy has been mostly non-existent. But the tide is turning, as government and private payers see that coordinated care and the time spent keeping people healthy can lower the amount of money they spend treating illness.
Primary care physicians are even seeing higher reimbursements in some areas. For example, beginning in 2011, CareFirst BlueCross BlueShield, the largest insurer in the Washington, D.C., area, substantially raised reimbursement rates for general internists and family practitioners who adopted the medical home model, which emphasizes care coordination. They also rewarded them with significant bonuses if they met quality standards and reduced costs. They also provided the physicians with round-the-clock nursing assistance to help with their sickest and riskiest patients.
CareFirst CEO Chet Burrell said in news reports that the program is saving “hundreds of millions of dollars in accumulated, avoided costs.”
That’s good news for everyone. Coordinated care requires an upfront-investment in people and technology that is often beyond the resources of a primary care practice, but it is far less expensive than the business-as-usual, uncoordinated care that has seen costs rise at double the rate of inflation for most of the past two decades. If public and private health plans make that upfront investment, paying for the time and the needed resources, they can reap the financial benefits while patients reap the benefit of better health.