We sat down with Todd Cozzens, Co-Founder & Managing Partner at Leerink Transformation Partners, and PatientPing board member, for our next Four Questions blog. Todd’s vast experiences in the healthcare IT industry–from leading healthcare investments at Sequoia Capital, working as CEO of Accountable Care Solutions at Optum, to founding and developing healthcare solutions such as Picis and Marquette Medical Systems–lend amazing insights into the future of care coordination investments as well as some of the challenges seen in healthcare today.
1. Do you expect investments in care coordination to increase or decrease over the next 10 years?
I think investments will increase, but I think care coordination will morph from being something on its own to a platform of products and services around an integrated care approach to the patient. By that I mean that care coordination has to work across environments and care settings that aren’t naturally or financially connected to each other. That begs the question of interoperability. There will be an evolution from an EMR to a community electronic record, which encompasses not only when the patient is in the hospital, but when the patient is in the skilled nursing facility, pre-op clinic, at a stand-alone MRI center, or in a walk-in emergency room.
2. What challenges are value-based care programs facing today?
Value-based care programs are facing the complexity of who pays for what, and when. That stems from a lack of clarity and changing of the rules, the quasi-commitment of the government to value-based care, and a lot of other factors. For example, the difficult issue with ACOs has been patient attribution. This is one of the reasons that PatientPing is in existence: The ACO has attribution on numerous patients, but those same patients go outside of the system to get care and the ACO loses their shirts. Trying to weave value-based care into a fee-for-service system means you have to stitch together a lot of constituencies, including how bills get paid and processed. It’s very cumbersome and manual, and has got to change.
The same attribution issue happens with bundled payments. The patient gets their MRI done at a stand-alone center, goes to the pre-op clinic of the health system, and gets their surgery done in the hospital. Then they go to an outside physical therapy center. Under the bundled payment programs, the hospital only gets a rebate if they beat their historical average. They’ve got to keep track of all those components. Some are inside the hospital and some are not; it’s very complex to keep all of that together.
We’ve made it difficult to gravitate toward value-based payments. Some health systems are moving toward direct partnerships and at-risk contracts, and some are developing their own insurance plans. I think it’s a very risky strategy for hospitals to develop their own health plans because of scaling and getting that initiative off the ground–it’s not their expertise. However, these partnerships you see happening like Aetna and Banner have a lot of promise.
It’s still in its early days, but I think everyone realizes value-based care is the right way to go. Eventually we need to change the whole system and the whole currency of healthcare to tilt toward being over 50% value-based.
3. What are some of the biggest challenges or hurdles for healthcare providers?
Healthcare providers are facing a number of hurdles. We’ve got to fix the Affordable Care Act. There are parts providers like and there are other parts providers don’t like. It was negotiated as a give and take package, but providers came out in pretty good shape. Most of the health systems had some of their best years ever in terms of operating margin but that is changing.
Some aspects of the Affordable Care Act are in doubt right now and we’ve got to fix it; it can’t continue the way it is. The challenge that health systems face is that it’s much cheaper to provide services in an ambulatory setting and treat that patient closer to home. We’re now providing in the home what we used to do in the clinic, and providing in the clinic what we used to do in the hospital. Hospitals have been slow to react and make changes to their operating plans.
It’s not a good use of money to continue to add big glorified monuments to healthcare that you see going up in downtown campuses everywhere across America. It’s waking up and realizing where things are going and where to put investment dollars to build networks and systems. This is absolutely critical. Bringing care to the patient and starting to think of the patient as the consumer is what will separate the performers from the weaker players.
4. What technologies or companies have you seen making an impact across the healthcare landscape?
Well, I’ll start with PatientPing since it's made an incredible impact. The fact that doctors, nurses, and administrators in all different care settings don’t know where their patients come from before they’re admitted, and don’t know where they go after they are discharged, leads to huge incongruities in their care and a lot of waste. That’s why we repeat MRIs or fill out forms every time we go into a new care setting. I think PatientPing is putting an end to that madness. It’s a great service and the network effect that you’re building is tremendous.
Health Catalyst is doing something similar. They are taking all of the information coming out of the EMR and competing systems and putting it in one place as the single source of truth for a health system. Now, all of their systems are integrated and, more importantly, their data is integrated. You can start to look at things like clinical procedures, controlling sepsis, and doing activity-based costing which has never really been done in healthcare before. It needs to be done so now they’ve got the data and the applications toward it. I see Health Catalyst solving a big problem that health systems have: They spend $2 million to $5 million dollars on an EMR and can’t get a lick of data out of it. Health Catalyst not only helps them organize that data and consume it, but also offers them clinical, financial, and administrative performance tools all under one roof.
Docent Health is going after both customer acquisition and customer satisfaction in health systems which is an area that hasn’t been touched before. It’s about treating patients like a guest at a Ritz Carlton or Disneyland with the focus on customer retention. When it’s all said and done, we may end up with between 200 and 300 health systems. We may even end up with five with the way the consolidation trend is going. There will be super competitive networks in every urban area. Think Coca Cola v. Pepsi. Consumer retention and satisfaction is going to be key.
Another company is Kyruus. Managing referrals is the single biggest issue as these health systems consolidate and spend money buying physician groups that still refer patients in their old patterns. Kyruus helps health systems match the right patient to the right doctor at the right time. That’s a very valuable tool for hospitals.
Self-insured employers are looking to take on more tools directly. Vera Whole Health takes a whole new approach by providing comprehensive primary care at the worksite. It’s not just about the provider coming to the patient, it’s about working with the patient on lifestyle, nutrition, etc. and providing all the primary care needed. You may never need to go to a PCP since you can do it all at work. The trend is to put services in the work place – similar to laundry service, neck massages, or whatever. They’re clever – they want to keep people on campus – well this is another great way to provide a great service so they’ve been building that out. They have a whole new approach to that.
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