Last month, Care at Hand‘s CEO, Andrey Ostrovsky, testified about digital health in Congress. He hoped to inform them about real ways to achieve the Triple Aim and policies that might be keeping us from reaching those goals. We sat down with Andrey to talk about his company, his vision for healthcare and the federal policies we should be working to change.
Q: First off, why take the time to testify in front of Congress?
I think that generally speaking, federal legislation around technology and healthcare isn’t always a net benefit – so much context is needed, especially when it comes to locality. So my goal wasn’t to go advocate for more federal policy. My goal was to advocate for a culture shift away from looking at healthcare and technology through a lens of medical care, and more toward looking at healthcare through a lens of a comprehensive approach to wellness.
When I was asked to offer input, I was saying ‘wearables are nice and apps and platforms and Glass are interesting – but how can we innovate to achieve more aspects of the triple aim for a population that can’t buy an app?’ We rely on patients to take action or purchase these things. But they might not have the ability to comply even if they wanted to. That’s what I wanted to share – other innovative, community-driven options.
Q: You were invited to speak based on your work at Care at Hand. We’ve written about CAH’s wonderful work here before, but can you tell us a little bit about what you’re up to now? What experience were you bringing to your conversation?
Here’s the big picture: there’s medical care (you go to a doctor or a nursing facility) and there’s support. Support is what happens when you go home. Say you can’t cook or clean – you may need a personal care attendant. What if you need help figuring out what resources are available to you? What about transport? This is all under the umbrella of “community based long-term care support and services.” Much of the funding for this comes through Medicaid dollars, which is why Congress cares.
At Care at Hand, we’ve hacked the fee-for-service delivery model with our clients. Often, community health workers like home aids or Meals on Wheels drivers get stuck doing things that patients could do themselves. They don’t know where to draw the line, so they spend more time with their patients. This causes companies to lose money and it’s more costly for patients, so Care at Hand provides a 2-minute survey for these workers. They take it and if they hear back from a nurse, they stay with their patient. If they don’t, they can go. These workers are able to see more people and bill more people, and the organizations get more revenue, plus they now know when people are at risk. We’re preventing re-admissions but increasing workflow.
Q: What were you hoping to teach the members of Congress based on your experiences?
My major observation was that even with (in theory) innovative funding incentives, our culture has a fee-for-service mentality. I’m hoping that we can innovate in a way that’s not fee-for-service, which is what we’ve done at Care at Hand.
I shared with them that our data tells us something amazing: non-clinical workers can predict whether or not someone will go to the hospital in 30-120 days. With the EMR, this is often a blind spot. But the community care workers are in the blind spots. They can prevent risks. We don’t have to be fee-for-service to find the Triple Aim.
Q: What else did you touch on during your presentation besides non- fee for service models?
If Congress is considering doing any kind of support for reimbursement design, they need to not perseverate on Medicare all the time. They also need to invest in Medicaid innovation. Guess where 40-50% of our spending is coming from?
I also discussed interoperability. Meaningful use was implemented quickly with good intent, but it is super inefficient. We need interoperability not just for doctors or hospitals, but also for long-term supports and services. Imagine that a Meals on Wheels driver delivers a meal and takes a survey that says the patient is at a high risk for readmission within 30 days. What if there was a high tech info highway? Now, doctors have no ability to intervene in that situation. But that kind of interoperability would connect stake holders.
Q: Last question – I recently saw data from a study you worked on with the IHI. It showed that many health startups aren’t actually achieving the Triple Aim. Can you tell us more about that?
We developed a framework for recommending new medical technology. We used the idea of the triple aim when we tested it (because Obamacare has invested $150 billion in the triple aim). But we discovered, using the framework, that most successful digital health startups have no evidence of achieving the triple aim. Is there really all this buzz about healthcare reform – and no one is actually investing in what healthcare reform is supposed to achieve? There’s a big fat zero when you look at patient-centered technologies that improve outcomes. This is a market failure and an investment opportunity.
Watch Andrey’s entire conversation with Congress below:
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