Unlike like planning for retirement, a child’s education, or a wedding, planning for future healthcare has, until only recently., been pretty rare. Healthcare planning, known clinically as Advance Care Planning (ACP), has been shown to keep patients more in control of their healthcare, often resulting in better care, higher quality of life, reduced stress for the patient and their family, and, in some cases, even longer life.
A recent study showed that nine out of 10 people would be interested in having these discussions if available, yet less than two out of 10 had actually done any healthcare planning. That's where Iris Plans comes in: it tries to make those conversations and decisions smoother and easier for everyone involved.
The winner at the Vator Splash Health, Wellness & Wearables 2017 last month, the company delivers healthcare services via telehealth to people facing serious medical conditions. Iris facilitators meet people with serious medical conditions, along with their family members, through a videoconference platform, provide the education and support people need to create a plan to help guide their most important future healthcare decisions.
Iris Plans co-founder and CEO Steve Wardle spoke to me about why the lack of ACP is a problem he feels strongly about tackling, and how Iris Plans offers a solution that combines technology and people in a way that no other company currently does.
Wardle began his career in the corporate sector, doing investment banking, but felt a strong desire to help people and give people access things that were “fundamental to their health and livelihoods." So, he told me, he decided to dedicate himself, and his career, to that mission. He has spent time in Africa, Latin America and Asia, helping to provide people with access to healthcare and financial services. While living in Africa, Bill Gates visited his “mobile midwife” program, which delivered education to pregnant women and new mothers in rural Ghana, calling it the most promising mobile health solution he’d seen.
As rewarding as he told me this work was, though, he also began to realize how many issues there were with the healthcare system in the United States that needed to be tackled, and decided to refocus on technology-based innovation in the US healthcare sector.
"There's a situation in the healthcare system where the patient receives massive amounts of unnecessary care. It's unwanted and non-beneficial. There’s $210 billion spent on unnecessary care every year. It's the larger driver of waste in the system," Wardle told me.
"On a human level that creates suffering. Patients receive care they don't need, spending extra time in the hospital, rather than at home, and with more procedures comes more risk. It also puts extra stress on them physically, emotionally and financially."
Just one single procedure that isn't covered by insurance can cause big financial difficulties for both the patient and the system. Over half of all personal bankruptcies are driven by healthcare bills.
"We spend two and half times more than any other developed country on healthcare, and we don’t have better outcomes. Our healthcare system is actually ranked below other developed countries, and we're number 47 in the world. On a personal level, and an overall macro societal level, this is a huge issue to tackle," he said.
One of the areas in particular where he saw major inefficiencies in the system was in how people are given treatment for their serious illnesses, and how those people are able to plan for them.
"I was driven by what's happening with how we give medical treatment to serious illness. In my own family, I saw the negative impact of not planning ahead. My grandmother had dementia and lost her capacity to make these decisions, so our family didn't know what her wishes would have been. We wound up not agreeing, and it had a huge negative impact on our family. Everyone else on the Iris Plans team has had poor experiences trying to navigate the healthcare system with a family member, and it drives us to make things better," said Wardle.
"When we met, our stories were similar and they resonated. He had set up palliative care programs across the country, and time and again found that there was a workforce shortage. It's the newest specificity, and the one with the biggest shortage, so we saw a tremendous opportunity. If we could make the core of Advanced Care Planning available then we could solve some of these problems and dramatically improve the experience for families dealing with serious illness," said Wardle.
How Iris Plans Works
Iris Plans uses telehealth, and video conferencing, in order to make ACP a less stressful experience for its users and their loved ones.
The Iris Plans platform allows its facilitators to meet by video, or by phone, with patients and their families. The platform also customizes the ACP process to the patient’s medical conditions and unique circumstances, ultimately producing official healthcare directives and a plan to guide major healthcare decisions.
The company focuses solely on those with serious and chronic medical conditions, helping them live better despite their illness. The reason, Wardle said, is that there are the most at risk, and there is a huge unmet demand with this group. There are currently 8 million people with a serious illness who are in need of that kind of urgent planning, but they don’t have access.
"They are the focus for us because they need somebody who has a background in how their illness progresses and what to expect, so they can plan. We want to talk with them in advance, not in a moment of crisis. When you are out of crisis you make better decisions, and you can think it through and talk it over and come to decision about what you want," said Wardle.
"That process of being educated about conditions, then making decisions about preferences, that kind of Advanced Care Planning, is the solution that has been proven to be really effective in terms of getting people better care, offering higher quality of life, and taking the stress and burden off of family. It puts people more in control and that has big impacts. As a result, patients tend to spend a lot less. The cost of care is anywhere from 22 percent to 35 percent lower than if they don't do advance care planning."
Iris Plans is completely free for the patient. Instead, the company offers the service through health plans, so it’s covered by insurance. The doctors and health plans can share information with Iris Plans about which people have the conditions that the company is focused on, allowing Iris Plans to be more effective in reaching out to potential users.
"Physicians want Advanced Care Planning to happen, but there are a lot of barriers to them doing it themselves. It is time consuming; it can be several hours for several sessions with the patient and their family. Physicians don’t have that kind of time. Also, the reimbursement is poor or nonexistent, so it's not attractive enough to be a big motivator for them. Even if they had the time, they aren't trained. This is a specialized skill set," Wardle explained.
"On top of that, there are cultural barriers. There's a lot of concern on behalf of physicians that bringing up ACP is a signal that they've 'given up.' It's hard to have both conversations, so doctors will be supportive of ACP, but typically do not have these discussions directly with their patients. They're happy for us to have them instead, and then they can have a shorter follow-up. A five minute recap is easy enough for a doctor, while an unpredictable multi-hour conversation, including family members, is essentially impossible for them."
Iris Plans members are paired with a facilitator, someone who typically has experience practicing at hospital, either a nurse, social worker or a chaplain.
"These are people who have spent time working with people that have serious illness, who have real life experience. We also train them. Even if they have done Advanced Care Planning, they still go through training. They are then equipped to facilitate these discussions remotely, so they can stay in practice wherever they are," said Wardle.
Members can talk to their facilitator right away, but it is suggested that they schedule an appointment so that their friends and family can be involved as well in a group discussion via the Iris Plans video platform. The facilitator follows a discussion guide that is mapped out for that specific member, and is tailored to their medical conditions and state-specific requirements. The company currently has 25 different disease programs, with specific documents that need to be filled out, such as advanced directives or living wills, based on which state the user is currently living in.
Facilitators also help resolve conflict between family members who don’t see eye to eye and to point everyone back to the patient, so their choices are heard. In all cases, the patient comes first, said Wardle.
"An educated and empowered patient and family results in receiving higher quality care, and produces a higher quality of life. They are significantly less stressed and still in control.”
Once decisions are made and the documents are filled out, they will be distributed to the family, the hospital, and physicians.
Nobody else is doing advance care planning the same way that Iris Plans does, Wardle said, with video-based technology driving cost-effective human connections where facilitators provide (virtual) face-to-face support in completing advance directives.
There are tech-only solutions, such as MyDirectives, which offer a self-serve approach to education and documentation, but without having a facilitator to help them along the way.
"We believe this is a service where you cannot remove the human element. It is essential. Technology is important, but it is only part of the answer," said Wardle.
Another company called Vital Decisions provides telephonic ACP discussions, but it doesn't offer a face to face connection, involve the family or help complete the advance directives.
Aspire Health, though not a competitor to Iris Plans, offers advanced illness management service and has gained a lot of traction lately. It has the face to face aspect down, but does not leverage the technology to make the service completely virtual. The company rolls out in specific geographies, and has boots on the ground that can come into a person's home.
"ACP is part of Aspire’s advance illness management service, though it's not the main focus. It's integrated into a much broader solution," Wardle explained, while also mentioning the company as potentially a complimentary service to Iris Plans, and one that the company could potentially work with in the future.
The future of Iris Plans
In the next five years, Wardle wants Iris Plans to have rolled out access to ACP to the majority of people that need service, so at least half of the 8 million people that currently require it.
"I know that's highly ambitious, but it's too important to the healthcare system, and to the millions of patients that suffer every year, to not to have an ambitious goal. That's why we set up the service with telehealth technology, so that it is highly scalable," he said.
"The big industry players are hungry for solutions to this problem, and we are experiencing high demand, so I believe we can reach those targets. Right now, the market is wide open."
Currently, the company is seeing its biggest success on the west coast, which has moved more quickly to value based care from the traditional fee for service model.
"The payers and providers that have moved into value based care are the most receptive, and most interested, in new innovations such as telehealth-based ACP. There are seven states across the west where we're active. In the next couple of months, we will add a number of additional states and be operating from coast to coast."