Today I’m in New York City visiting Oscar Health, on my continuing quest to determine how best to integrate digital platforms, patient-family engagement, and care coordination in preparation for MACRA/MIPS and the transformation from fee for service to alternative payment models.
At the moment, there is no single magic bullet, but there are early innovations that hold promise.
At BIDMC we’ve thought the best approach to care management is to identify a cohort with a disease, then enroll that cohort in a program which involves tracking progress against guidelines/protocols, deploying telemedicine/visiting nurses, and measuring data from home-based devices.
Oscar’s approach incorporates similar ideas by providing a unique mobile app and web resources for patients, providers and care managers, reducing total medical expense through informed care navigation. For example, you are given a choice of options based on your signs/symptoms that aligns the intensity of the service with the intensity of the illness. Care is coordinated via sharing of clinical and claims data among care teams. Episodes of care are tracked to ensure patients follow a coherent path. The technology is superb and the staff is creative. I hope their startup phase evolves into a long term sustainable business model.
Other interesting technologies to watch are the Salesforce Health Cloud which brings customer relationship management techniques to the caregiver/patient relationship. Isn’t it ironic that the Ritz Carlton can remember your pillow preferences but your clinician’s office hands you a clip board at each visit to answer the same questions over and over? Today’s EHRs were designed for documenting episodes of sickness, not encouraging wellness. The concept of customer relationship management in healthcare is what I call “Care Traffic Control” - setting goals for the patient then ensuring those goals are tracked, reviewed and discussed.
Apple's CareKit is another technology to follow since it enables care planning, care team communications, and care progress monitoring all on your phone. BIDMC is launching its first CareKit app when iOS10 is released this Fall. The app - a version of BIDMC@Home that includes HealthKit, CareKit and BIDMC Patientsite features all in one platform, is something I believe will bring true value to patients and families.
The next two years in healthcare will be rocky - the end of Meaningful Use, the transition of presidential administrations and the release of final rules from CMS that will shape reimbursement for the next 5 years. The winners will be those health systems that respond to these disruptions with agility. The time to begin selecting the tools you’ll need to manage wellness, control medical expenses, and treat patients as customers is now.
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