Mayo Clinic and Verily, Alphabet’s life science division, recently announced a two-year strategic partnership to develop a clinical decision support (CDS) tool that caters to a patient’s individual needs.
Although physicians generally do not love their EHR flashing advice at them, the collaboration aims to sidestep the one-size-fits-all approach of traditional CDS tools with AI-generated recommendations relevant to the patient in the room.
- The Partnership – Mayo Clinic will provide curated clinical content and deidentified health record data while Verily will apply advanced analytics and user-centered design to deliver insights within existing point-of-care workflows.
- The Roadmap – The tool will initially focus on cardiovascular and cardiometabolic conditions at Mayo Clinic, but will use open standards to enable integration with multiple EHRs for possible expansion to other use cases for Verily’s health system partners.
While announcing the partnership, medical director of Mayo Clinic’s Center for Digital Health Bradley Leibovich MD stated that he hopes the tool can be used as “a GPS for patient care.”
The companies cited the exponential growth in medical discovery and knowledge as making it nearly impossible for caregivers to keep up with the latest advances in their fields, creating a need for a tool that offers clinical support.
Verily and Mayo Clinic are betting that their combined expertise in clinical informatics and data science will be the solution to creating a patient-relevant CDS that clinicians actually want to use.
New analysis from Sanjula Jain, chief research officer at Trilliant and faculty member at the Johns Hopkins School of Medicine, suggests that focusing on the wrong success metrics might be negatively impacting telehealth’s effectiveness as a digital front door.
- In theory, a digital front door is a consumer-friendly and low-acuity engagement, like telehealth, that provides a health system with an opportunity to earn a greater share of an individual’s downstream services.
- In practice, telehealth’s ability to serve as a digital front door is hampered by low switching costs between similar services, with many consumers willing to shift from their current provider to a more affordable new entrant, such as Amazon Care.
Jain analyzed the behavior of insured individuals within and outside one of the country’s largest health systems, referred to as Health System A, finding that downstream capture from telehealth services did not indicate strong consumer loyalty.
- The Findings – Roughly 13% of individuals within Health System A’s 2.7m consumer total addressable market accessed telehealth at least once in 2020, in line with the national average. Of those telehealth patients, Health System A captured a ~34% aggregate downstream share of care (based on revenue).
- The Impact – The low downstream share reflects the ability to capture an additional 65% of follow-up care prompted by the initial “front door” interaction. For comparison, Health System A’s service segment with the highest downstream capture was its Emergency Department (69%), indicating that telehealth might not be as effective of a digital front door as commonly perceived.
Telehealth is routinely serving as a digital front door, providing patients with their first exposure to a new health system, but more work is needed to validate its effectiveness. For telehealth to serve as a successful gateway to other services, health systems need better measurements of downstream care capture and consumer loyalty.
According to a new report from Business Insider, Apple is scaling back its internal HealthHabit app that let employees track their fitness, talk to clinicians, and manage hypertension.
HealthHabit was one of Apple’s largest projects resulting from a partnership with AC Wellness, a primary care provider for employers and families. Unnamed sources at Apple stated that HealthHabit was intended for a consumer launch if successful internally, which… it apparently wasn’t.
Although the project was the focus of more than 50 employees, it struggled with user engagement, a problem all too familiar to those working on digital health products.
- The Strategy – Apple’s healthcare ambitions are apparent in its products, with the company incorporating a medical-grade EKG in the Apple Watch and data-sharing for clinical trials through the iPhone Health app. HealthHabit’s roadmap likely resembled that of Amazon Care, which began as an employee-only primary care app before expanding nationwide earlier this year.
- The Trend – Apple’s news follows just days after Alphabet reported that it was dismantling Google Health and reorganizing its healthcare projects to be closer to their team-specific specialties (e.g. Health-AI moves within AI group). Sometimes taking a step back is the best way to move forward, and Apple’s recent moves are far from the end of its healthcare strategy.
The healthcare history books are filled with would-be disruptors who seemed to have everything they needed (excellent teams, funding, strong industry connections), but few if any have had the bottomless warchest of capital and talent commanded by Apple.
While the moat around healthcare is incredibly wide (entrenched tech/vendors, complex datasets, demanding users), the same could be said about the smartphone market circa 2008.
Despite this step back, if any industry needs a disruptor, it’s healthcare – and if any consumer brand is going to pull it off, it’s Apple.
At a time when mental health problems are rapidly escalating, Headspace and Ginger have a solution: mega-merger.
Meditation app Headspace is merging with teletherapy platform Ginger to create a combined company called Headspace Health. The agreement values the joint venture at $3b (10x this year’s expected revenue) and will give Headspace Health the ability to begin offering affordable mental health services to over 100 million people globally.
- Headspace – The company is best known as one of the first guided meditation apps and remains a leader in mindfulness training. Headspace has partnerships with many consumer-favorite brands such as Netflix and Spotify, giving many of those suffering from anxiety and depression their first exposure to accessible care.
- Ginger – Ginger offers its members access to mobile-first mental healthcare, including behavioral health coaching and telehealth therapy. It has an on-demand, team-based care model, giving users 24/7 access to therapists.
- Headspace Health – The newly formed company will blend Headspace’s 65m+ user base with Ginger’s evidence-based interventions, creating an easy way for patients to improve their well-being from a unified platform. Headspace Health will also have one of the world’s largest mental health data sets, which it will leverage to deliver highly personalized care.
Headspace Health plays at the intersection of the mental health crisis and telemedicine, two areas that have been attracting significant investor attention. With so much capital flowing into the space, consolidation was soon to follow, and this merger could kick off a wave of similar deals involving other popular meditation apps such as Calm.
Competing acquisitions aren’t the only change foreshadowed by the merger. Headspace Health was originally the name of Headspace’s 2018 digital therapeutic product that failed to receive FDA approval, and it’s now easier to see how federal clearance, and reimbursement, could be on the horizon.
According to a Current Health survey of 250 health system decision makers, 81% expect their organizations to increase investment in remote care technology over the next year.
While home care was once a nice-to-have option for forward thinking providers, it is now a necessity for those looking to effectively care for high risk patients amid the ongoing pandemic.
Many health systems have already begun to adopt new remote care technologies, with 89% of respondents expanding its use over the past year, but the study suggests that care-at-home programs have more room to grow.
- Investment Areas: Respondents indicated that they plan to increase investments in three main categories: home-based chronic care (64%), hospital at home (60%), and transitional care (58%). When asked about the key benefits of remote care in these areas, answers included reduced hospital admissions (69%), and improved patient (63%) and provider (62%) satisfaction.
- Barriers to Success: According to those surveyed, the key barriers to remote care’s success are patient and provider engagement, workflow integrations, and operational concerns. Additionally, over 50% of respondents reported patient adoption and adherence as a challenge they’ve faced with care-at-home.
As healthcare organizations transition from small remote care pilots to enterprise-wide strategies, new investments are addressing the long-term challenges of scaling to care for more patients with limited clinical staff. The technologies that are likely to find the most success are those that keep sight of patient engagement barriers without adding complicated workflows for providers.
New research from patient engagement services provider SymphonyRM explored the growing distrust patients have for their doctors in the wake of COVID-19.
A survey of 1,192 US healthcare consumers found that 41% had lost confidence in their doctor because of the pandemic, with a majority of mistrust stemming from preventable causes.
Reasons for Physician Mistrust
- Infrequent communication about COVID-19 (53%)
- Slow adoption of virtual care (29%)
- Under-utilization of digital communication tools (24%)
Reasons for Improved Physician Trust
- Quick transition to virtual care (61%)
- High communication frequency about COVID-19 (58%)
- Proactive use of digital communication (47%)
Patient Communication Needs
- 41% would like to receive information about preventive screenings
- 37% would like to receive information related to their chronic condition(s)
- 37% would like to receive information and updates about the COVID-19 vaccine
Learning From Leaders
When asked what companies are the best at sharing information with users, 40% of respondents cited Amazon as the “gold standard” of communication.
Amazon’s investments in real time shipping updates and 24/7 status monitoring have resonated with consumers, and it’s clear that patients are now looking for the same level of communication about their health.
The survey suggests that providers looking to meet these evolving communication needs should look to consumer-facing brands when it comes to creating convenient experiences and driving engagement.
Mayo Clinic recently published a new study of its remote patient monitoring (RPM) program for ambulatory care of COVID-19 patients (n = 7,074), aimed at reducing acute care utilization and hospital admissions.
The program included two care-delivery models based on patient risk, enabling RPM-registered nurses to respond to technology-generated alerts and deliver standardized care for clinical assessments and patient management.
Low-Intensity Care Model (n = 2,314)
- Patient had no risk factors for severe illness and low symptom burden
- Mayo provided thermometer and pulse oximeter
- Patient reported symptoms twice daily
- 1:50 nurse to patient ratio
High-Intensity Care Model (n = 4,760)
- Patient had 1+ risk factors for severe illness and moderate-to-high symptom burden
- Mayo provided LTE-enabled tablet, thermometer, pulse oximeter, blood pressure monitor
- Patient reported symptoms twice daily
- 1:30 nurse to patient ratio
Among all patients, ED visit and hospitalization rates within 30 days of enrollment were 11.4% (low-intensity) and 9.4% (high intensity), with a 30 day mortality rate of 0.4%. The RPM engagement rate was above-average at 78.9%, supporting recent changes to the CMS physician fee schedule to expand reimbursement for RPM services to patients with acute conditions.
The study suggests that RPM for management of COVID-19 is associated with “excellent clinical outcomes,” especially among patients at risk for severe illness.
Given that Mayo Clinic’s RPM program was part of a retrospective cohort study, it remains unknown how the results compare with “usual care,” but a matched case-control study is planned to evaluate the program.
Optum, a subsidiary of UnitedHealth, recently began selling prescription medications online directly to patients. The company also began offering telehealth services to provide prescriptions to treat depression, erectile dysfunction, and other common illnesses – directly challenging startups such as Ro and Hims that offer online access to drugs for many of the same ailments.
UnitedHealth is the most profitable US healthcare company, with net income totaling $15.8b in 2020, and Optum is its fastest growing business segment. The company has expanded far beyond its payer roots and now employs or contracts over 50k physicians.
Optum launched its online storefront in November 2020 before adding pharmacy and healthcare services in June. It’s recent redesign and cash payment options make it more friendly to digitally native consumers.
- The Strategy – More Americans are paying directly for healthcare, and by offering cash services to either uninsured or budget-constrained patients, Optum is increasing access to healthcare.
- The Real Strategy – Optum’s entrance into the direct-to-consumer world defends against rising competition from retail giants such as Amazon and Walmart, both of which have launched digital pharmacy options as membership incentives.
UnitedHealth’s largest competitive advantage is its vertical integration. It operates the largest US commercial insurance provider, a substantial pharmacy benefits manager, and is one of the biggest employers of physicians in the country. It’s recent expansion deepens this integration, while keeping patient money in-house amid a sea of new competition.
Accenture’s Health Strategy senior manager Dr. Darryl Gibbings-Isaac took to the HIMSS21 stage to discuss clinicians’ trust in the future of healthcare technology. The keynote addressed the findings of a new Accenture survey that asked physicians a series of true or false questions relating to their trust in technology’s growing clinical role.
1. Clinicians’ digital health adoption will not revert to pre-pandemic levels.
- 71% will continue to use digital tools to the same or greater extent
- 61% would invest in digital health tools if it improves their bottom line
- 76% believe that digital investments will increase in the next five years
- Verdict – True
2. Clinicians believe AI is a threat to their future prosperity.
- 80% are interested in AI for clinical uses
- 76% believe AI is not a threat to their job security
- 45% have received training or have upcoming training about AI and digital tools
- Verdict – False
3. Clinicians see value in investing in AI and digital health.
- 68% see digital health’s long-term impact as positive
- 61% believe that the investment required for digital health tools is a barrier
- 76% believe that digital health spending will increase in the next five years despite barriers
- Verdict – True
4. Clinicians trust in the security of healthcare technology.
- 76% are only somewhat confident in measures to protect patient data
- 41% have security concerns over patient data that hinders adoption
- 33% of those uninterested in AI-based solutions cite lack of trust
- Verdict – False
To answer Accenture’s original question of whether or not clinicians have trust in the future of healthcare technology, the response is a reserved “yes.” While clinicians believe digital health adoption is here to stay, more work is needed to ensure trust in its security – specifically work centered around improving the three T’s: tools, transparency, and training.
Although you’d be hard pressed to find a single product launch at HIMSS21 that did not address at least one of digital health’s quadruple aims (better health outcomes, improved patient / provider experience, lower costs), you’d have a similarly difficult time finding a solution that addresses all four. Philips HealthSuite is aiming to do just that.
Philips announced the expansion of its cloud-based HealthSuite platform to include two new solutions: Patient Flow Capacity Suite and Acute Care Telehealth. Both solutions address the quadruple aim not as individual products, but as pieces of a platform aspiring to be more than the sum of its parts.
- Patient Flow Capacity Suite – A patient logistics solution that combines clinical and operational data to improve patient flow decisions with visualization and AI-supported analytics. PFCS’s value lies in streamlining inefficiencies throughout the continuum, whether in demand prediction, patient transition decisions, or patient flow bottleneck detection.
- Acute Care Telehealth – A configurable solution that allows health systems to deploy a centralized command center, or a decentralized model of telehealth depending on their needs. By allowing customers to add additional hospitals or clinical units, the solution evolves alongside each organization’s telehealth strategy.
The Theme – Philips is seeking to establish HealthSuite as a future-proof solution, providing modularity for unique needs and a SaaS model that lowers ongoing resource strains. Although Philips’ size might raise questions about its agility in a fast moving digital health environment, its scale enables it to combine a platform infrastructure with its deep experience in clinical settings.
Big problems require big solutions, and solving resource management and interoperability in healthcare is a heavy burden for a collection of disparate products. Adding Patient Flow Capacity Suite and Acute Care Telehealth to the HealthSuite platform lays the foundation for Philips to grow into a value-based partner for providers, as opposed to a classic transactional based vendor.