Less Hospitals, More Homes

Current Health, who raised a $43m Series B in April to expand it’s remote care management platform, has now done just that. 

Newly announced partnerships with Workpath (a Ro company) and ScriptDrop enable Current Health’s service to begin offering both in-home blood draws as well as medication delivery.

  • Workpath – Current Health’s clinical dashboard now allows physicians to determine what blood tests are needed for remote patients before using Workpath’s integrated tool to dispatch a certified phlebotomist. 
  • ScriptDrop – Physicians can now access ScriptDrop’s on-demand and same-day prescription delivery tool within Current Health’s platform, a feature that could improve patient adherence to needed medications.
  • Benefits – The fully-integrated remote care platform greatly simplifies physician workflows when ordering in-home tests or medications, with the added benefit of further reducing the need for patients to visit a lab or pharmacy.

The Takeaway

Current Health’s latest partnerships are centered around improving access for patients and finding efficiencies for physicians. The company is aiming to build a world where doctors can develop a diagnosis and provide a treatment without ever having a face-to-face interaction with a patient, and this latest expansion gets them at least two steps closer to reaching that goal.

Fixing Problems Before They Happen

While the acceleration of digital health adoption has created many positive outcomes, adding “tech support” to the job description of clinicians was probably not one of them.

A Possible Solution: Johns Hopkins Medicine recently unveiled an EHR-embedded calculator that assigns telehealth patients a technical risk score so that IT support teams can proactively address tech challenges prior to an appointment. 

The calculator works by assigning a 0-4 score based on the following factors:

  • Two points for the patient not having an active account in MyChart
  • One point for the patient not having completed the eCheck-in process
  • One point for the patient not attending a telehealth visit in the past three months 

Pilot Program: Johns Hopkins created a two-stage pilot program to test the efficacy of the technical risk score. Phase 1 involved text-only outreach and found that 7 of 384 patients contacted via text proceeded to seek IT support. Phase 2 involved text plus phone outreach and had 44 of 98 patients successfully reached via telephone, but found preemptive IT support difficult to schedule.

The Takeaway

Despite the inconclusive pilot program, Johns Hopkins found that its calculator anecdotally eased the burden on IT support staff while creating more equitable telehealth visits for patients.

Digital Health Wire Q&A: Zoom’s Healthcare Transformation

With Heidi West
Zoom, Head of Healthcare

As the role of digital health continues to grow, new use cases are emerging and enabling communication between patients and physicians. The rapid adoption of telehealth solutions over the past year and a half has led to a boom in innovation that has expanded the scope of the technology well beyond the “virtual visit.”

In this Digital Health Wire Q&A we sat down with Zoom’s Head of Healthcare, Heidi West, to discuss the role of telehealth today and how the technology is evolving to meet the needs of consumers in a post-pandemic world.

Since the start of the pandemic, Zoom has enabled everything from remote schooling to virtual healthcare visits. How has Zoom’s healthcare business changed over the course of the past two years?

When the pandemic happened, there was a very abrupt shift from in-person visits to telehealth. At the beginning of the pandemic, telehealth was all about the virtual visit, and figuring out ways to engage the patient and provider. Throughout the course of the last year and a half, through the creativity and innovation of nurses and doctors and administrators, it started to focus more on all the ways that we can break down the communication barriers throughout healthcare.

It also served as a family connection point in many ways, helping patients that were isolated and vulnerable during the pandemic. As Zoom for Healthcare’s platform continues to evolve, the focus will be on augmenting or enhancing the communication experience along the entire continuum.

What are Zoom for Healthcare’s top priorities in this space?

Our number one goal is to continue to provide a simple and frictionless experience within healthcare communication. Whether it’s virtual visits, telehealth, or even internal communication between the business and the clinical side, we are looking at all of those strategic communication points and finding ways to simplify and tie more of a ubiquitous familiar experience across healthcare.

There’s a lot of passion in what we do, and a tremendous responsibility to clients and patients. A patient’s health and wellness conversations with their doctor are some of their most private communications, and that’s not lost on us.

A recent survey listed Zoom as the the most used telehealth platform, with 34% of physicians using the service. Why are so many physicians already choosing Zoom over other healthcare-focused platforms?

There’s a couple of reasons. It’s the simplicity, quality, and you’re not becoming tech support when you engage in a telehealth visit. There are niche products that are just telehealth, but many miss the business-to-consumer piece of the puzzle. Zoom is really uniquely positioned to bridge that gap.

It’s the same solution that their kids are using in school. It’s the same solution and look and feel as their trivia nights, or parent-teacher conferences. Zoom serves as a familiar connectedness that we’ve all really needed over the past year and a half.

Many telehealth offerings include services such as text and email notification, payments, and file transfers. Is this indicative of the direction that telehealth is heading?

Telehealth is in no way done with just a virtual visit. With Zoom Apps, any number of those needs that you mentioned can now reside within the Zoom meeting and serve different purposes. We’ll also begin to see more functionality leveraging biometrics and enabling live vital sign monitoring during telehealth visits.

Zoom will always remain simple and easy to use, but simple does not mean non-innovative. The mobile web client is a perfect example of that. Our clients asked for it, and within a quarter we’re already in beta. I’m really proud of the fact that we are customer-driven in the way we’re building the platform.

In the same survey, top physician concerns regarding telemedicine were “technology challenges for patients”, “poor integration with other technologies”, and “new telehealth specific workflows.” How can telehealth technology be improved to address these concerns?

This goes back to the reasons why so many physicians are already using Zoom, and that’s that we have an integrated workflow. Our goal is not to create parallel workflows, but to work within the workflows that clinicians are already sitting in today.

The beauty of our open platform is that it allows our clients to build within their own workflows. Providing that level of flexibility in the way people can develop with Zoom sets us apart significantly in solving a lot of these problems. From a patient perspective, I think addressing any friction point should be the goal, which is why we launched the mobile web client to help anyone struggling with the app.

Safety and data privacy concerns are always a priority with sensitive interactions like a telemedicine visit. How does Zoom ensure patient privacy is protected and that sensitive data is never vulnerable?

First and foremost, Zoom holds privacy and security to the highest level of responsibility. We enable HIPAA compliance throughout our entire platform. We have safeguards spanning everything from end-to-end encryption data to data-at-rest, but it’s important to remember that technology only enables HIPAA compliance. It’s the responsibility of everyone involved in the conversation to protect the information.

So it’s safe to say that patients don’t have to worry about someone “zoombombing” their doctor visit?

They don’t have to worry. Protecting user privacy is Zoom’s top responsibility and something we take very seriously.

Outside of doctor/patient visits utilizing telemedicine, where else is there a role for the technology that might not be as obvious?

I look at the entire healthcare continuum, and telemedicine has a role anywhere from a well-visit, to primary care, to an acute care setting, as well as in the home. There are dozens of communication points along this continuum, and our goal is to look at them and ask if there’s a way that Zoom can improve them or remove friction. For each communication component, we ask questions like: Do you augment this with video? Do you leverage Zoom Phone? Can Zoom Rooms tie different pieces together? The entire healthcare journey needs to be the focus, not just the virtual visit.

I would almost flip the question and ask: Where wouldn’t telehealth fit? Even in just the patient’s room, there’s entertainment, education, food services. All of these can be improved through technology, but so can things like care coordination and family engagement. We’re looking at the patient room as a source of digital transformation that revolves around putting the patient at the center of all of the different communication that goes on within the room.

How do you see the telehealth space evolving over the next few years and where does Zoom fit into this picture?

The biggest thing to remember is that the landscape has changed following the pandemic. Patients have choice. Patients have flexibility. There’s a lot of competition in delivering care today. Never underestimate the consumer’s wants and needs from healthcare.

Look at all of the four hour blocks of care and say, how do I augment in-person with virtual? Do I leverage nurse practitioners? Do I leverage medical assistants? Then augment to provide that flexibility and convenience to patients. Healthcare still uses pagers and fax machines, so the chance to upgrade to a more strategic communication strategy will only continue to evolve.

The healthcare industry just saw 10 years of innovation in six months, and I think it’s made people aware that the consumers and the communities they serve will follow the innovation – and I’ll say it again: never underestimate the consumer.

WellSky Invests in Community Care

Sometimes having a great community impact is as simple as a corporate mega-buyout. Health-tech company WellSky is acquiring Healthify for an undisclosed amount to expand access to its healthcare networks while addressing the social determinants of health (SDOH).

  • What’s SDOH? All of the socio-economic conditions that affect health outcomes or quality-of-life, including: access to healthcare, education, economic stability, and community.
  • What’s Healthify? Healthify connects healthcare providers with community-based organizations, then allows them to track the success of interventions with an interoperable technology platform. 
  • Why does WellSky want it? Instead of building its SDOH offerings from the ground up, WellSky can leverage Healthify’s network of community organizations (and its closed-loop referral platform) to help payers and providers effectively coordinate care.

The Takeaway

Adding Healthify’s community-based SDOH referral platform to WellSky’s existing technology suite creates one of the largest social services networks in the US. The scale of the combined solution should allow for better ROI analysis and clinical data, which might mean improved patient outcomes and health equity over the long run.

Telehealth’s Payoff

A new study from MITRE Corporation and Mayo Clinic of over 2 billion claims (plus thousands of patient and provider surveys) found that telehealth was effective at delivering care across a wide variety of specialties, but providers are still worried about its limitations in the post-COVID era.

Claims Results

  • Telehealth claims represented less than 2% of total claims before the pandemic, peaking at 49% in April 2020
  • Every clinical discipline saw usage rise, with the largest spike seen in behavioral health
  • Out of state providers were responsible for 6.5% of telehealth visit claims

Provider Survey

  • 79% of providers offered telehealth following the pandemic (16% prior)
  • Highest quality of care ratings were for chronic disease mgmt (89%) and mental health (83%)
  • Lowest quality of care ratings were for acute care (62%) and perioperative care (59%)
  • Biggest telehealth barriers were low reimbursement (~80%) and patient tech challenges (~70%)
  • Zoom (34%), audio-only (29%), and Doxy.me (28%) were the most cited technologies

Patient Survey

  • An impressive 74% of patients plan to use telehealth services in the future
  • 55% of patients reported that they would have delayed care without telehealth
  • Telehealth drove patient satisfaction by removing transportation barriers (76%), removing need to take time off work (65%), and reducing costs (67%)

The Takeaway

Telehealth studies aren’t exactly hard to come by, but this one is unique given its size and intent. Mayo Clinic’s goal behind the study was to encourage more telehealth research with the hope of influencing permanent regulatory change and reimbursement approaches. The study does a great job of showcasing telehealth’s positive impact on patients and providers, highlighting the need to better understand how the technology can be improved moving forward.

The Wire – Americans Want Data

  • Americans Want Data: A new survey from The Pew Charitable Trusts found that over half of US adults want to use apps on smartphones, tablets, and computers to access their healthcare data. However, when told that federal privacy protections do not cover data stored on apps, respondents expressing serious privacy concerns nearly doubled from 35% to 62%.
  • Zoom Interpreters: Voyce recently announced the launch of its live language interpreter app for Zoom Meetings, enabling an embedded interpretation experience for non-English speaking patients. The app makes professional interpreters accessible within the video platform, helping to ensure that language is not an obstacle for diagnosis and care.
  • A Brutal Commute: The Wall Street Journal recently shared the story of an Ithaca College biology professor living in upstate New York who found herself skipping postoperative oncology appointments due to outdated interstate telehealth coverage policies. Dana-Farber Cancer Institute in Boston informed her that recent post-pandemic waivers for out-of-state patients had expired, and that she’d have to drive 3.5 hours and cross the Massachusetts border before she could hold any further video calls with her doctors.
  • Making Telehealth Permanent: In a move that’s sure to please at least one Ithaca College biology professor, a coalition of 430 advocacy groups recently sent a letter to Congress expressing an urgent need to permanently adopt the relaxed telehealth policies that followed the onset of the pandemic. These measures include the lifting of patient/provider geographic barriers and the need for an in-person visit prior to telehealth, both of which could abruptly expire following the public health emergency.
  • Telehealth for Headaches: A survey of American Headache Society clinicians found that nearly all of the 225 respondents were “comfortable/very comfortable” treating via telehealth, citing patient convenience (97%) and reducing patient travel stress (91%) as key benefits. Providers were also “interested/very interested” in adopting new digital health technologies (prescribing headache apps, remote symptom monitors) to address remote care’s shortcomings.
  • Front End Funding: b.well Connected Health secured a $32m Series B round ($58.7m total post-round funding) that it will use to further develop its digital platform that helps organizations manage their population health initiatives. End users of the b.well app can access all of their health data from a single source and receive proactive health guidance, while also taking advantage of provider incentive programs deployed directly through the app.
  • Telemedicine Saves the World: A new 5-year study (2015 – 2020) of Kaiser Permanente’s 600k members found that digital health platforms are healthy for the environment as well as patients, with healthcare visit greenhouse gas emissions falling 46% following the pandemic. The researchers pointed out that the reduction in emissions was not tied to a decline in appointments, but from the shift to telemedicine solutions.
  • Inaccurate Symptom Checkers: A recent PLOS study of 12 online symptom checkers revealed that many aren’t accurate, with the correct diagnosis listed in the top five tools only 51% of the time (Range 22.2% to 84.0%). The online symptom checkers’ wide diagnostic variation and poor overall performance would be unacceptable in most other medical fields, suggesting more validation is required to ensure these public facing tools are safe.
  • Amwell’s Shopping Spree: Amwell recently acquired a duo of digital health startups to expand its longitudinal care offerings and grow in new markets. The telemedicine company acquired SilverCloud (digital mental health platform) and Conversa (automated virtual care) for a combined $320m, which is quite an investment considering that Amwell generated $245m in revenue last year.
  • Satisfaction Survey: A Catholic University of Korea study found that South Korean patients were far more satisfied than clinicians with telephone-based remote care during the COVID shutdown. Although nearly 80% of patients were satisfied with all five of the study’s evaluation criteria, the same share of clinicians expressed worries about their inability to perform complete medical assessments over the phone.
  • Physical Meets Digital: LifeScan (glucose monitoring hardware) and Noom (behavior change platform) recently signed a multi-year partnership that integrates both companies’ diabetes management solutions. Users of LifeScan’s OneTouch monitors will be able to access Noom’s behavior change programs through a new combined platform set to debut in fall 2021.
  • Deep Brain Stimulation: A new Parkinsonism & Related Disorders study found that telemedicine improves patient satisfaction in the management of chronic neurological conditions. Although telemedicine is effective for movement disorders, the study showed that utilization for patients with device-aided therapies like deep brain stimulation is limited due to the challenge of adjusting the devices remotely, highlighting the need for more care guidelines for this patient population.

The Telehealth Boom Continues

New McKinsey analysis suggests that telehealth will maintain most of its pandemic-driven usage gains, which stabilized at 38X its pre-COVID baseline and 17% of all outpatient/office visit claims.

McKinsey’s findings highlight three primary driving factors:

Adoption

  • 40% of surveyed consumers believe they will continue to use telehealth, up from 11% before COVID-19
  • 84% of physicians are now offering virtual visits, while 57% wish to continue

Regulation

  • CMS made telehealth coverage for a number of CPT codes permanent in the 2021 physician fee schedule

Investment

  • Total digital health VC funding in 1H 2021 reached $14.7B, eclipsing 2020’s total ($14.6B)
  • Investment surge pressuring companies to innovate and find viable models
  • Top 60 digital health players had combined revenue of $5.5B in 2020, vs. $3B in 2019

The Takeaway

It may have been reasonable to expect telehealth usage to decline given the unique circumstances behind its massive growth. However, the combination of patient, clinician, and business momentum suggests that most of telehealth’s share gains could persist.

The Health App Scorecard

A recent study in Nature provided a new scorecard approach for evaluating which digital health applications actually produce meaningful clinical results, using a sample of oncology apps to demonstrate the need for standardized evaluation criteria.

The Problem – Low entry barriers have created a confusing digital health landscape, with the growth of apps outpacing digital health stakeholders’ ability to validate their quality.

The Solution – The study evaluated 22 popular oncology mobile apps using a digital health scorecard with 5 evaluation criteria (technical, clinical, usability, end user requirements, cost).

The Results – Although usability was adequate, the oncology apps carried significant technical limitations, were of limited clinical value, and “generally did not do what end users wanted.”

Across all 22 apps, the average score (100% max) for each criteria was:

  • Cost – 100% (all apps were free)
  • Usability – 56.7%
  • Technical – 37.3%
  • End-User Requirements – 37.2%
  • Clinical – 15.9%

The Takeaway

Healthcare apps are here to stay, but the shortcomings of highly downloaded oncology apps highlights the need for standardized frameworks like this scorecard to evaluate their clinical appropriateness. We’ll also need far more healthcare apps that satisfy these criteria.

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