Geisinger Chief Innovation Officer Karen Murphy

Remote Care

The Future of Home and Community Care

A bit of a slow news week gave us a chance to circle back on a recent NEJM commentary by Optum’s leadership, which laid out the key components of a futuristic home care model and the steps that Optum is taking to make it a reality.

“The vision is to unite modular point solutions around the patient to enable timely interventions and care coordination that is supported by data and technology for a seamless experience and optimized care delivery across providers and care settings.”

Sounds great, maybe a little boilerplate-ish, but the individual solutions tie it all together:

• Patient Assessments – The “pivotal first step” to identifying, engaging, and stratifying patient populations through annual in-home comprehensive clinical examinations of medical, behavioral, and social needs. Ex. Optum HouseCalls

• Care Transitions – Appropriately managing a patient’s transition from acute care facilities is essential to keeping recoveries on track, and comprehensive programs should include post-discharge engagement and 90-day follow-ups. Ex. naviHealth

• At-Home Emergent Care – At-home emergent care is convenient for patients while helping avoid readmissions, and the authors cite a 2018 hospital-at-home study demonstrating better outcomes than inpatient care. Ex. DispatchHealth   

• Home-Based Medical Groups – The cherry on top of the proposed model is a call for more home-based medical groups to treat patients with chronic conditions. Services might include primary care, therapy, and dialysis. Ex. Landmark Health

The Takeaway

Although the article was mainly intended to provide a framework for successful home care, it also gave us a great peek at Optum’s priorities. It was interesting to see the companies that the authors held up as prime examples for each solution, and it’s easy to picture each of them as potential acquisition targets considering how active Optum’s been in the M&A space.

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The Wire

• UHG Change Full Opinion: The judge’s full opinion on UnitedHealth Group’s acquisition of Change Healthcare apparently didn’t have to stay sealed for very long. Although it reportedly contained “competitively sensitive information,” the now-unsealed opinion revealed that Judge Carl Nichols felt there was “zero real-world evidence” that the acquisition would reduce innovation from other payors. He also agreed the acquisition would give UHG control of over 90% of the claims processing market, but was satisfied with UHG’s plans to divest Change’s ClaimsXten unit to maintain competition.

• Bicycle Health Raises $5M: Bicycle Health is extending its recent $53M Series B with $5M in fresh funding to support the growth of its opioid use disorder platform and generate further research on the efficacy of its unique care model. The Bicycle Health model includes psychotherapy and chronic condition management delivered via telehealth to reduce barriers to care for the large portion of OUD patients who are either struggling to attend in-person appointments or seeking to maintain anonymity.

• EHR Satisfaction By Specialty: A KLAS Arch Collaborative report details how physician satisfaction of EHRs varies by speciality, with hospital medicine and pediatrics having the highest satisfaction scores (39%, 31%), while orthopedics and ophthalmology have the lowest (11%, 8%). The authors found that the top factors improving satisfaction were proper functionality and system efficiency, while the biggest frustrations were improper functionality and poor vendor quality.

• Intermountain Pediatric Telehealth: Intermountain Healthcare is launching pediatric telehealth services that allow physicians across the health system to connect with Primary Children’s Hospital’s ED, trauma, and pediatric ICU specialists through 24/7 telehealth consults. The new service is designed to avoid unnecessary transfers to Primary Children’s, after a successful six month pilot enabled nearly half of pediatric ED patients to stay in their local communities without having to transfer.

• Lyra Expands Youth Services: Elsewhere in pediatric telehealth land, Lyra Health is expanding its services for kids and teens amid the growing childhood mental health crisis. The new initiatives will roll out in 2023 and include the addition of 3.9k providers to Lyra’s behavioral health network, comprehensive therapy for teens, coaching programs for parents, and personalized care navigation for children with autism.

• Cancer Deaths Decline: The latest AACR Cancer Progress report shows that cancer deaths in the US have been rapidly declining, with a 2.3% annual decrease every year between 2016 and 2019. The report outlines how improved treatments, diagnostics, and screening are making a significant difference in the fight against cancer, as there are now more than 18M cancer survivors in the US (~5% of the population), up from 3M in 1971 (~1.5% of the population).

• Vori & Firefly Team Up: Virtual MSK startup Vori Health is partnering with Firefly Health to bring value-based care to patients with musculoskeletal conditions. The agreement will combine Vori’s virtual MSK platform with Firefly’s risk-based health plan to lower financial barriers to treatment for patients, while giving them access to an integrated care team that incorporates personalized physician medical care, physical therapy, and lifestyle coaching.

• Zócalo Health Seed Funding: Zócalo Health scored $5M in seed funding to launch its membership-based virtual primary care service for the Latino community. The company is led by former Amazon Care founding members Erik Cardenas and Mariza Hardin, who are now focusing on improving the patient experience for Latinos by hiring care teams from the communities they work in and connecting patients with local health workers. The service is available in California, but plans to expand to Texas and Washington later this year.

• EHR Meaningful Use: A large University of Missouri study of 5M patients across 300 US hospitals found that health systems following CMS meaningful use guidelines for EHRs have been able to improve outcomes and reduce patient mortality rates. Compliant hospitals saw an 8% mortality rate decrease for selected procedures (measured with IQI 90) and an 18% mortality rate decrease for selected conditions (IQI 91).

• New York’s Unused Med Tech: The state of New York has $250M in medical supplies acquired during the pandemic that’s currently going unused, including 8,555 ventilators ($166M), 1,179 X-ray machines ($86M), and 700k gallons of expired hand sanitizer. That’s from a Politico report that also revealed that the National Guard is managing NY’s medical technology stockpile in warehouses, and there are no current plans to distribute them or put them to immediate use.

• Moving Away from BMI: Medscape published a thinkpiece in which Dr. Sylvia Gonsahn-Bollie argues that BMI is a flawed reference for health status. She notes that weight bias continues to prevent people living with obesity from receiving life-enhancing obesity therapies, because once their BMI is “normal,” many patients lose coverage for their obesity medication, despite needing long-term metabolic support. She contends that if BMI must be used, then the reference chart should be an adjusted chart based on age, race, ethnicity, biological sex, and obesity-related conditions.

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