Invent Health with Dr. Archana Dubey and Bambi Francisco Roizen; Episode 1Read more...
Kaiser Ventures, Evidation Health, Doctor on Demand, Express Care weigh in
Doctors and VCs took a deep dive during a discussion about the role technology plays in the life of the doctor, and if their lives are actually becoming better because of it. The next logical question was: does that then translate into a better experience for the patient?
The topic was broached during the first panel of the night, moderated by Dr. Archana Dubey (Global Medical Director, HP), and Bambi Francisco Roizen (Founder and CEO, Vator), with panelists Michael D. Abramoff (CEO & Founder, IDx), Dr. Aswin Chandrakantan (Chief Medical Officer & SVP Corporate Development, Komodo Health), Liz Rockett (Partner, Kaiser Permanente Ventures), David McAughan (COO, Providence Express Care), Drew Oetting (Founding Partner, 8VC).
The event was the latest in the Invent Health series, hosted by Vator, UCSF Health Hub and HP. The topic: Reinventing the Doctor.
(Editor's Note: Join us for "Future of Healthcare" on November 14 at HP. REGISTER for Early Bird tickets)
At one point Francisco asked McAughan how he was trying to make it easier for patients to navigate through the healthcare system, which he said is "a tough problem."
System navigates patients to highest cost of care
"As clinical options expand significantly, whether that’s through formats of clinics or through technology solutions that are out there, it’s not making our lives easier, and it’s certainly not making it less expensive. We’re actually adding costs into the system because we haven't solved how to navigate patients to the lowest cost of care that meets the needs that patient has. So, they end up finding places that are higher cost or less convenient or certainly not the place where we want them. The worst place they land is in the emergency department," he said.
McAughan's background, he noted, is "largely in the idea of creating consumer services in a value positioning," and what he sees happening now in healthcare is "a real void in terms of educating patients to where the healthtech systems are actually moving to."
"They’re still behaving against a prior generation health system, and we’re really struggling to get them where we want them to be. So, I don’t know what the answer is around it but it’s hard to get patients self-navigating to the place that actually makes the most sense for them. They have a tendency to fall back on things that they know."
Another issue he called out is that "tools are not as simple and easy as they need to be to make the adoption level as high as it should be."
"Most of us, and I’m talking mostly about a largely healthy population, who needs episodic care versus someone who has real significant health issues, that health application, due to the fact that you’re not using it very often, it’s not something that has the utility value, necessarily, of all that period of time between when you need care. So, you don’t necessarily think of it top of mind when you go to my health app to navigate me to a doctor without increasing the utility value add and creating the incentives to actually let me in," he said.
Kaiser's Liz Rockett also addressed this topic, telling a story about when she first moved to the Bay Area and woke up with a swollen eye. What saved her from having to go to the emergency room was that Kaiser Permanente had a feature that allowed patients to email their doctor.
"The thing that I appreciated since then is that to email your doctor, and for Kaiser Permenente to offer that to me in the moment of, ‘Please don’t make me go to the emergency room,’ it required so much workflow and process change and that was from a leadership commitment level. Email is not difficult technology, right? My step-son can create an email. And the coding is not complicated," she said.
"The workflow is legitimately difficult and takes both agreement from all the practicing physicians, the care teams that work around them, thinking through how they’re going to create time and space and capacity for this. The leadership commitment to it, certainly we have the benefit of in-house payment mechanisms that, even within our own walls, that can get complicated and figuring all that out can be quite challenging. But that workflow piece is real; it’s not just that, the access is not ever just about technology, it’s more of the figuring out network flow."
There's a tendency, however, to dismiss new technologies because of difficult it is to get that workflow right, she said, and also because it's so difficult to get patients to use it. The trick, she noted, is to make it as simple as possible for the patient. In Colorado, for example, members would go to the Kaiser Permanente website and see a little icon that says, "Chat with a doctor."
"Where we had banner ads everywhere for video visits with physicians and all the rest of it and very low traction, we had also 'chat with a doctor,' and the amount of traffic that instantly came through. Nobody had the question of what’s about to happen. ‘I click the button, I’m at some point going to be connected with a doctor. And if it’s fast I’m really going to like it.’ There’s not a lot of questioning and I think that that has been another interesting lesson for our organization, that when it comes to some of these reinventing the medical practice, you have to also think about just putting out little tests to watch for the desire, because patients will show you what they like to do if you can just give them that opportunity," Rockett said.
The topic of how technology is affecting patients came up in our second panel of the night as well. Called, "When will robots be our doctors?," it was again moderated by Dubey and Francisco, and featured Abramoff, as well as Ali Tamaseb (Partner, Data Collective), Dr. Ian Tong (Chief Medical Officer, Doctor on Demand), Dr. Hiroomi Tada (Chief Medical Officer, Notable Labs), Malay Gandhi (SVP, Business Operations, Evidation Health) and Unity Stoakes (Co-founder, President & Managing Partner, Startup Health).
Dubey addressed a question to Gandhi about how his company is "helping the end user, which is the provider, and helping them reinvent the workflow on the patient outcome experience?"
Doctor-patient imbalance with information
Gandhi answered the question by bringing up the Apple Watch, its irregular rhythm notification setting, and what that means for physicians.
"Dr. Gottlieb, who was running the FDA at the time that they received their clearance, he tweeted out and said, ‘We’re getting a lot of questions about but just to be clear, they followed the rules, they got a 510k clearance. We didn’t do anything, nothing was special here, 510k rules have been on the books forever, and, as a doctor, you need to figure out how to practice medicine in this world, because consumers decide to buy the device and they get notification then you, as a doctor, need to figure out how to practice that,'" Ghandi said.
Evidation Health, he noted, has its own consumer app called Achievement, which over three million people have signed up for, and it takes the same view: that the company's role is to give information to consumers, and it's up to the physicians to figure out what to do with it.
"Our view is we’re going to empower people, it’s not really our job to figure out how that works with physicians. I can see a future where we work with them and figuring out how to incorporate what we’re doing in the practice of medicine, but I think a lot of these things are so early, our focus is 100 percent with the individuals and helping them better understand their data and how it can be useful within the context of their health. Not speaking for the company, on a personal level, I’m kind of a Dr. Gottlieb. The world’s changing, you’ve got to adapt and figure it out. People are going to make the choices they’re going to make," he said.
The other thing that Gandhi brought up in terms of the increased knowledge on the patient side is how it helps create better balance between them and their doctor.
"I don't know that the ground has always been level in having a true shared decision making conversation. I think it’s still been the idea that the physician brings the information and that we together work. I think our question is, how does the information come together? We have to accept the premise, and a world that’s coming, where the patient knows more about their doctor. I would argue many patients living with conditions their whole life, chronic conditions, know way more than their doctor who’s been training for 10 years, 12 years. They’ve been living with it their whole life so there are things that they know more about their own health, their own condition, than their doctor does with this data," he said.
"The interesting part of that is what does shared decision making look like when it’s totally asymmetric? One person with the information saying, ‘Hey, let’s have this shared decision making, but I know a lot more than you do,' versus, ‘Both people might have something to bring to the table.’”
Doctor on Demand's Tong agreed with Ghandi that there's an imbalance between physician and doctor, and said that, "As a doctor, I actually do want to know that information that’s happening when they’re outside of my office."
"I get 20 minutes with you, and I think someone was making that 20 minutes sound like it’s a lot of time, it’s actually not quite a lot of time, depending on how many conditions or comorbidities your patient is actually dealing with. That’s one area that I’m allowed to ask a lot of questions about, and that patient expects me to ask questions about. They don’t know that I’m going to ask questions maybe about their social determinants of health and all the other issues that I think are really happening to them outside of the doctor’s office," he said.
"Having a tool that allows me to know which patients are going to need downstream caregivers, and are going to need transportation, I can see both medical crises being able to be avoided but I can also see indirect costs being minimized just by being able to put things in place at the right time."
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The Permanente Medical Group, Inc. (TPMG) is a physician-led medical group in Northern and Central California with over 8,000 dedicated and exceptional physicians working together across specialties. TPMG is the largest medical group in the country with over 65 years of providing quality medical care. Kaiser Permanente and The Permanente Medical Group work together to serve over 3.5 million members in Northern California. Many organizations have a mission statement; we have a calling: to lead the way to a better future for health care. Through our leadership in the use of advanced technology, our creation of innovative solutions, and our influence on health policy and reform efforts, we are shaping the future of health care.
Joined Vator onVenture investor for Kaiser Permanente Ventures focused on healthcare IT, digital health and tech-enabled services in healthcare. Board director at Big Health, Chrono Therapeutics, board observer to Omada, Vapotherm, LP advisor to Rock Health.