Vince Kuraitis, advisor and strategic healthcare consultant, connected with PatientPing’s founder Jay Desai on the potential for healthcare to transform into a platform industry: Think Facebook, Google or Amazon. To Vince, healthcare desperately needs to capitalize on the network effect, but this can’t happen until healthcare embraces platform companies to support this business model.
Vince’s deep knowledge of the healthcare industry combined with his big-picture approach to consulting provide the foundation for his approach to the evolution of healthcare. I recently chatted with Vince about the future of care coordination, value-based care and more for the next Four Questions Blog. Thanks, Vince!
1. Do you expect investments in care coordination to increase or decrease over the next 10 years?
I expect investments to increase, however I expect the composition of the investments to change in at least three different ways:
The first way is in the care coordination model and how it supports the clinicians using the system. Over the last 15 years or so, in many communities we’ve had more of what I would describe as a “carve out” model of care coordination. The system’s clinicians are asked to work with independent 3rd party care coordination approaches that have run side-by-side to their workflow– and they’re upset. Healthcare providers see care coordination as intruding on their turf as opposed to supporting what the care managers and clinicians are trying to accomplish..
Over the next ten years, we can expect to see a “carve-in” care coordination process become increasingly dominant. What PatientPing is doing defines that well. Instead of setting up a separate parallel system, or one that is duplicative, care coordination systems will support what the front-line providers are currently doing. For example, health plans 10 years ago set up their own nurse call centers to assist patients with diabetes. Doctors felt like these centers competed with their work and they were no longer “quarterbacking” care. The call centers were not designed to work in harmony with the PCP’s workflow and did not support the model of the PCP at the center of care coordination.
Going forward, the mindset and the types of investments that we’ll see in care coordination are much more accepting of the premise that the quarterbacks of care are truly the care providers – in particular the PCP – and the infrastructure that is going to be built is much more geared toward supporting the care provider instead of competing with or setting up the parallel system.
The second way is that the dollars invested in care coordination might not actually be labeled as care coordination. But, the investments will support care coordination efforts that can build off common IT and workflow infrastructure. A lot of this infrastructure still needs to be built. The investments could be in machine learning, artificial intelligence (AI) remote patient monitoring, or many other areas. These are not necessarily under the label of care coordination, but are technologies that will be supportive of a much broader care coordination process. Investments will build out the care coordination ecosystem.
The third way in which the composition could change is in refining and defining the role of the care coach. There is a lot of potential to explore here, especially as it relates to the top 5% of patients that incur the highest costs.
From my view - 30 years in the industry - the whole phenomenon of care coaches is just 10-15 years old. These coaches start with highest cost patients, but we are seeing it trickle its way down to patients that will potentially be high cost in the future. Health coaches will go beyond the 5% of patients and will provide more support to the top 10-20% of patients that are costly to the healthcare system.
2. What challenges are value-based care programs facing today?
The first big challenge is that it is still not in the economic interest of care providers to support these kinds of programs and develop value-based initiatives. This is changing, but we’re not there yet.
Value-based care really challenges the culture of healthcare providers. I personally spent the first 15 years of my career in the hospital industry and what I saw is an industry that has spent the last 100 years following the model that more patients in beds is good and contributes to economic health. So, the 100-year-old infrastructure of systems, procedures, policies and mindsets that support the idea that fee-for-service is a good thing – is now trying to build a system that goes 180 degrees against that.
3. What are some of the biggest challenges or hurdles for healthcare providers?
The first challenge falls under generic financial pressures and government relations. There is still uncertainty around what the Trump administration will be doing in this area. There are also financial pressures. Is Medicaid going to be chopped? There are really big unknowns still.
Hospitals are high fixed-cost organizations and to be able to reduce their costs is difficult in the short run. They’ve invested a lot of money in plant, equipment, 24-hour staff, etc. and it’s very difficult to respond to reductions in patient volume in the short term.
The second challenge I would label generally as value-based reimbursement and how providers will cope with it. This refers back to the notion that value-based healthcare is a very different game than fee-for-service, which they have been playing over the last century.
The whole challenge is also building up the infrastructure for population health and how to do that as a hospital. There are hospitals and delivery systems that are in very different stages in this process.
4. What technologies or companies have you seen making an impact across the healthcare landscape?
This is really getting into the area where Jay Desai and I spend most of our time talking. The future of healthcare needs to look a lot different. Healthcare is an industry that should be populated with strong networks and platforms, but to date we haven’t seen a lot of successful business models and operational models built around this.
There are some exceptions to this and there are some examples of where I’ve seen successful platforms emerging. One example is e-prescribing, where Surescripts is a dominant platform in the industry. Another example is Validic. Validic is a private company where you can essentially leverage their remote monitoring technology network – they have done the integrations and work for you.
The third company I’d point to as a success is Qualcomm Life. It’s similar in the sense of they’ve developed some standards for medical and patient devices and have hundreds of clients that have decided to use their platform and plug into their technology.
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