I was privileged to be invited to an interesting meeting earlier this week, participating in an advisory board for some work done by a prominent policy institute. The topic of the project and the meeting was focused on bundling of care model innovations. The room was filled with notable, experienced individuals, all who have had experience disseminating care delivery innovations.
We met for a full day and I am sorry to say the amount of time allocated to connected health was only about five minutes. We discussed innovations that send care providers to the home, innovations that moved the hospital into the home, innovations in palliative care in the home and innovations involving the restructuring of the medical practice. All were chosen because there was high quality scientific literature demonstrating that these strategies could lower costs. I can't say the innovations we discussed didn't involve connected health, but my favorite type of care model innovation was, at best, a footnote in the discussion.
I meet with a lot of early stage entrepreneurs. Among the questions I always ask is, "Who is your competition?" How they answer tells me a lot about how they are viewing the market. Some say, "We really don't have any competition." That tells me that they either have an innovation that the market really doesn't appreciate the need for yet (like the original iPad) or more likely, they are focused on what they perceive to be different about their product or technology, not the problem they are trying to solve. One rule of thumb I always remind entrepreneurs is that, when disseminating a new innovation, if people perceive a problem and pay for products to solve it, that is what forms a market. So, rather than focus on what makes an innovation unique, it is more productive to focus on what problem the innovation is solving and how others are solving it presently. This can be very helpful in crafting a communications and marketing strategy.
But getting back to the care model innovations meeting, I was struck by how ingrained the use of human interaction is in solving healthcare challenges. To wit, at Partners Connected Health, we recently queried a group of hospital presidents about increasing their use of telemonitoring for congestive heart failure (CHF). We knew each hospital's CMS readmission penalty and devised our sales pitch around how telemonitoring is an efficient tool enabling a one-to-many care model, leveraging each nurse across 100 patients (or thereabouts) and predictably lowering readmissions, as well as achieving an overall decrease in total medical expenses. These audience members had a significant interest in efficient care, as their payment is at risk depending on outcomes and efficiency for this CHF patient pool. We perceived our logic to be air tight and expected everyone to sign on to adopt more telemonitoring.
Perhaps you won't be as surprised as I was about the relative lack of enthusiasm. We heard a number of different reasons why to not invest in telemedicine further. Among the most salient (from the perspective of this post) was the comment by one executive that her hospital has a robust cardiac management program that bringing patients into the clinic for follow up. Another cited the use of care managers visiting the home to do medication reconciliation.
I expect the picture I'm trying to paint is coming into focus for you now. In healthcare, our biggest sunken costs are in facilities and labor, so we build financial models around making use of those resources. For instance, if you're a bit overstaffed in nursing, it may make sense to deploy nurses to patients' homes. Likewise, bringing patients in to your facility helps offset the cost of depreciation on that asset.
We started the journey of connected heath adoption 20 years ago. The first barrier we had to overcome was skepticism about quality. Then came the cry of "How do we get paid?" (This is why there has been an uptick of interest directly proportional to the adoption of value-based reimbursement and overutilization penalties.) Then providers implored, "But it needs to be part of my workflow." Today, almost all EMR vendors have integrated telehealth or a roadmap to offer those integrations.
So, the next phase of our journey will be integrating connected health into the deconstruction of facility-based care as we know it. Consumers now have many options for receiving their care, including at the local pharmacy or via a virtual video visit. Providers will come on board with these new care delivery models. And, it is imperative that those of us who advocate for connected health be at all of the meetings and involved in the key decisions so that connected health is presented as a viable option to solving today's healthcare challenges.
Our competition, at this point, is the business-as-usual approach: "the way we've always done it, by one-to-one human interaction." Overcoming inertia is harder than presenting an airtight sales pitch.
This explains the lineup of care bundle innovations from the advisory board meeting I referred to above. They are innovative in that they move the locus of care, in most cases, to the home. Perhaps that's the state of progress at this time. We take the one-to-one interaction and move it out of the facility and into the home. That only disrupts one of our major fixed costs.
I expect you can tell I'm puzzled. I'd love your thoughts on the matter.