Category Archives: Patients

TytoCare: Comprehensive telehealth exam platform

TytoCare hopes to take telehealth to the next level by providing a solution that allows clinicians to conduct remote examinations. Patients (or caregivers) will use a TytoCare device to conduct an exam that can be interpreted by a physician over a cloud-based platform with video conferencing.

The company took a step forward recently by obtaining FDA clearance for its digital stethoscope. The approach looks pretty cool, but clearly it will be a challenge to get the devices out to patients ahead of need and to do so cost effectively.

CEO & Co-Founder Dedi Gilad answered my questions via email:

1. What was the inspiration for Tyto?

I founded TytoCare along with Ofer Tzadik, another lifelong leader in Healthcare IT, in 2012. The story is similar to that experienced by most families when at a young age, my daughter suffered from a series of earaches requiring constant medical treatment. With two working parents, it became increasingly difficult to travel in and out of the local physician’s office on a regular basis. The experience was not easy for my daughter either, waiting for hours in the crowded doctor’s office in considerable pain and discomfort. 

After consulting with my pediatrician, I recognized the strong need for change in the way primary care is delivered today. I collaborated with Ofer Tzadik to design a new medical experience, one that would not only mutually benefit both the doctor and the patient, but also serve to strengthen this vital relationship. The result of this endeavor is TytoCare, a company prepared to lower the load and cost of U.S. healthcare services, improve accessibility to healthcare services even from the comfort of home, and reshape day-to-day healthcare as we know it.

2.      Why a dedicated device instead of using a tool everyone already has, i.e., a smartphone?

 TytoCare’s examination tools and complete telehealth platform work with a smartphone or tablet and include a stethoscope, otoscope, tongue depressor, camera, and thermometer. While a smartphone can only offer video and audio technology, Tyto enables the patient to conduct actual exams of the heart, lungs, heart rate, temperature, throat, skin and ears. This cannot be done with video alone and more importantly, it requires an interface and technological infrastructure that simply wouldn’t be cost effective in a smartphone.

 3.    How will distribution to end users work? It seems like logistics will be difficult. For example, do you expect everyone to have a device in place before they need it?

 To begin, distribution will start with health institutions though a full consumer product is coming in 2017. We expect that consumers will see the value in being able to perform live, remote medical examinations at home, in place of rushing back and forth to the doctor’s office. 

 4.  What is the cost of the home and pro solutions?

 TytoPro will cost $999.00 plus a monthly fee based on usage, and TytoHome will cost $299.00.

5.  More broadly, what are the overall economics of the solution? Is there a financial return on investment? How do you think about calculating that? Is it more appropriate for certain segments of patients or providers?

Certainly, and our work with leading financial institutions has reinforced the financial ROI.

 The incredible benefit of the product is that its applications are endless because it simultaneously empowers doctors and clinicians while unlocking the full benefits of telehealth for patients. TytoHome can be beneficial in many different scenarios – for geographically isolated patients and those who lack easy access to medical facilities; those who are turning to urgent care because they cannot get an appointment in time at their regular establishment; patients with chronic illnesses or other conditions that require monitoring and frequent, tiresome trips to the doctor or hospital; school or traveling nurses; and of course, parents at home with kids.

 6. What is the lifecycle for this solution? Do you expect to upgrade the devices over time? Can that be done through software or will it require hardware to be replaced?

We will likely add additional examination capabilities over time, but the majority of upgrades can be made through software updates.

 7. What else should readers know?

TytoCare is a complete end-to-end telehealth platform that provides a telehealth experience comparable to in-person visits. It truly fills the missing link in telehealth between the in-office professional and the at-home patient by delivering comprehensive exam results – of the ear, nose, throat, heart, lung, stomach, skin – as part of a complete telehealth visit. The exam data can be delivered to a clinician via “live telehealth exams” or through the “exam and forward” function – sending the exam results on to be examined by the clinician later.

 TytoCare can be used anytime, anywhere and by anyone. Patented guidance technology directs and enables anyone to collect the right data so a clinician can make the proper diagnosis. The advanced digital exam tools use clinic-grade technology to capture high resolution images and sounds, allowing for more kinds of remote diagnoses and increased accuracy.

The secure cloud-based platform enables integration with existing HER systems and provides analytics for decision support with health alerts. TytoCare offers HIPAA compliance, and the modular product design also supports open APIs so other examination devices can be integrated within TytoCare.

——-

By healthcare business consultant David E. Williams, president of Health Business Group.

Mass Health Quality Partners: 21 years young

barbra-rabson-2

Barbra Rabson, MHQP President and CEO

Health Business Group is a sponsor of the upcoming anniversary party for Massachusetts Health Quality Partners (MHQP). I asked MHQP’s President, Barbra Rabson to reflect on the first couple decades.

MHQP is about to celebrate its 21st anniversary. What are you celebrating?

We are celebrating the courage and vision it took 21 years ago to found MHQP, and the amazing two decades of progress we’ve made since our inception. Our 21st anniversary is symbolic of our coming of age and reaching a level of maturity. MHQP has become an important part of the Massachusetts healthcare landscape over the decades thanks to the commitment and hard work of our diverse stakeholders – including patients, physicians, hospitals and payers.  More than 40 sponsors and over 300 people are gathering on November 2 to celebrate MHQP’s unwavering commitment to reliable healthcare measurement and transparency and our pioneering work in the Commonwealth and the nation to systematically capture the patient voice and integrate it into care improvements.

At our anniversary celebration we will be honoring the vision of MHQP’s Founding Circle –Blue Cross Blue Shield of MA, Fallon Health Plan, MA Business Roundtable, MA Hospital Association (MHA), MA Medical Society (MMS), Harvard Pilgrim Health Care (HPHC), Tufts Health Plan and the State (Governor Charlie Baker was a founding member of MHQP when he was Secretary of Administration and Finance).

We will also be awarding MHQP’s first award in honor of the late Richard Nesson, MD, a founding visionary of MHQP when he was the Chair of the MHA Board in 1995 when MHQP was established.  We are delighted that Susan Edgman-Levitan, the executive director of the John D. Stoeckle Center for Primary Care Innovation at Massachusetts General Hospital and the founding president of the Picker Institute will be the first recipient of MHQP’s H. Richard Nesson Award.

How has the environment changed in MA over the past 21 years? What role has MHQP played in that?

The healthcare environment is drastically different than it was when MHQP was founded in 1995.  When MHQP first started collecting and reporting comparative statewide performance information, we were the only game in town.  For example, MHQP’s first in the nation statewide patient experience survey of acute care hospitals and public release came a full decade before CMS developed the hospital H-CAHPs survey! Likewise, when MHQP began collecting and reporting statewide clinical and patient experiences measures for ambulatory care, MHQP’s data was the only reliable source for quality benchmarks for our provider organizations.  Before MHQP’s comparative quality reports, Massachusetts provider organizations only knew their own performance scores, they had no comparative benchmarks or best practices to drive performance improvements.  Physician leaders  (Barbara Spivak, Tom Lee and others) have told us MHQP’s performance reports were invaluable to them because our reports became the writing on the wall that they needed to make significant investments in their organization in the form of electronic health records and quality improvement infrastructure to advance their performance to the level they aspired to.

Another big change is that our reimbursement systems now provide millions of dollars of incentives for provider organizations to improve performance.  When MHQP first started the term ‘pay-for-performance’ had not yet been coined.  MHQP has always [encouraged] improvements through public reporting of reliable and trusted comparative performance information – relying on physicians’ intrinsic motivation to perform as well as they can. Now that provider compensation depends heavily on measurement we need to work harder to make sure we have accurate and fair measurements of quality care.

Finally, back in 1998 when MHQP first started reporting on patient experiences of care, patient experience was not considered a core measure of quality.  MHQP’s statewide collection and reporting of patient experience helped draw national attention to the importance of listening to patients, and in 2001 the IOM introduced the concept of patient centered care as a key element of quality care in the Crossing the Quality Chasm Report.

Kindred organizations to MHQP have arisen around the country over the last couple decades. How do you relate to them?

MHQP was one of the first regional health improvement collaboratives (RHICs) to be founded in the country. Gordon Mosser (founding CEO of ICSI in Minnesota) and I organized the first meeting of regional collaboratives in 2004.  As a founding member and past Board chair of NRHI (the Network for Regional Healthcare Improvement), it has been very gratifying to see so many new RHICs being established.  There are now more than 40 across the country.  I have been told by many of the younger RHICs that MHQP was a role model for them when they were first starting out, and I take great pride in that.

What does the future hold?

Great question, and one I have been reflecting on as we have been looking back on our first 21 years. One of the biggest challenges (and one of our greatest failures as a health care system) has been that we have not done a good job engaging our patients as a resource to help us improve outcomes. In many cases we have actively refused to seek input from patients, and when given feedback we have ignored it.  We are now trying to make a 180 degree shift on this, to better engage patients in the co-production of solutions, and it is not easy because it requires a shift in mindset.  I believe that MHQP’s two decades of experience capturing the patient voice and integrating that voice into care improvements positions us extremely well to support our practices and healthcare systems as they embark on this journey.

——-

By healthcare business consultant David E. Williams, president of Health Business Group.

MedSentry: Adherence for complex drug regimens (podcast)

front-red-logo-1

Medication adherence is a tough challenge, especially for high-risk patients, whose complex drug regimens often feature more than a dozen pills. MedSentry is rolling out an end-to-end closed loop adherence system for this population. Although it’s not a large group, it is responsible for a disproportionate share of medical costs.

In this podcast interview, CEO Adam Wallen and I discuss the following:

    1. (0:11) Adherence is a big problem in healthcare. What does it mean? What’s the nature of the problem?
    2. (0:57) Are there multiple reasons for lack of adherence?
    3. (4:05) There are a number of adherence solutions in the market. How well do they work?
    4. (7:46) What is the MedSentry approach? How is it different?
    5. (11:57) What evidence is there that this approach is effective?
    6. (13:17) You have focused on the most complicated patients. Will that continue to be your niche as your commercialize?
    7. (14:55) Do you have a scale-up plan?

——-

By healthcare business consultant David E. Williams, president of Health Business Group.

Dr. Joshua Newman, GM for Healthcare at Salesforce, discusses telehealth solution

Dr. Joshua Newman, MD, MDHS, Chief Medical Officer, Salesforce

Joshua Newman, MD –Salesforce’s Chief Medical Officer

I really like Salesforce’s Health Cloud approach to patient engagement and am excited to see the company add telehealth to the platform. I caught up recently with Dr. Joshua Newman, who is Chief Medical Officer for Salesforce and also General Manager of Healthcare and Life Sciences.

In this podcast interview we discussed the following:

  1. (0:12) How has the rollout of Health Cloud gone since our last discussion about a year ago?
  2. (2:03) There are other telehealth offerings on the market already. Is the new Health Cloud offering different or better?
  3. (4:21) Who is the target user? Is the telehealth solution aimed at particular types of providers or patients?
  4. (6:55) Is there a return on investment? What drives it?
  5. (9:02) Is this mainly a mobile solution?
  6. (9:55) How does the telehealth solution fit with other Health Cloud offerings?
  7. (12:38) What else can we expect from Health Cloud over the next year?

I came away with the conviction that there is the potential for significant impact as the platform matures, health care-specific partners are brought on board, and as customer/patient engagement practices in healthcare catch up with the rest of the economy.

I’m looking forward to hearing more, especially with the big Dreamforce conference coming up in October.

By healthcare business consultant David E. Williams, president of Health Business Group.

Are men comfortable with female physicians? Other factors to consider

female-doctor-with-stethoscope-around-her-neck-100147037

Nuzzel showed me that my friends have been sharing a new athenainsight: Are male patients comfortable with women doctors?  The post uses athenahealth billing data to demonstrate that male patients are less likely to return to female physicians than they are to male physicians, but for female patients the sex of their doctor doesn’t make a difference.

Athena’s conclusion is that men may be “less enthusiastic than women about seeing physicians of the opposite” sex. The article links to a Quora exchange, where all the respondents indicate that as patients they are equally comfortable with women as they are with men.

These findings are interesting, but I don’t think they tell the whole story.

When my long-time primary care physician retired I looked for a new doctor. I believe in the value of long-term relationships so wanted to pick someone I could be with for 15 years or more. I wanted someone affiliated with my preferred health system, with excellent clinical and at least decent communications skills, and around my age (late 40s).

My retiring physician recommended a female colleague in a practice close to where I live, who fit the bill. He had been involved in her training and had worked with her.

Like the Quora respondents, I was comfortable with being examined by a female physician. As I’ve written, I’m also comfortable being examined by a physician who is a friend.

But, although it was further down my list of criteria, I did have the sex of the physician somewhere on my list of factors. Why? Because at least on average, men work more hours and retire at an older age, making them more likely to be available to patients when needed.  One survey showed that 44 percent of female physicians worked part time, compared with 22 percent of men. Another showed 25 percent of women compared to 12 percent of men.

My personal experience reinforces those statistics. The recommended primary care doctor works part-time. Other  female physicians my family sees have taken time off to care for sick family members and attend to other family issues. One retired in her 40s to take care of sick parents. Working less or taking time off doesn’t make them bad doctors or bad people –quite the contrary, it may even keep them fresh or help them stay connected with patient needs– but it does have an impact on availability and longevity of the relationship.

In the end I chose the female primary care physician my retiring doctor recommended, and I plan to stay with her. But I’m also adjusting my expectations about primary care. For one thing I’m focused more on the relationship with the overall practice, rather than just with my personal doctor.

The practice seems to do a reasonable job of working together as a team, and I hope this will serve its patients as well or better in the long term than the more traditional and familiar one-on-one doctor/patient relationship. If it doesn’t turn out that way then my likely next step is to switch to a concierge practice rather than seek out a male physician.

Image courtesy of stockimages at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Smoking and the ACA

ID-100160543

The Affordable Care Act (ACA) has created a wonderful laboratory for studying the impact of changes in healthcare policy. One of the more interesting papers on the topic appears in the latest Health Affairs (Evidence suggests that the ACA’s tobacco surcharges reduce insurance take-up and did not increase smoking cessation). (You’ll need a subscription to read the full article.)

Health plans can’t charge higher prices to people who are sicker, but they can tack on surcharges of up to 50 percent for tobacco users. States can limit or ban the surcharges, and some do. Not surprisingly, people subjected to high surcharges are a lot less likely to purchase insurance, especially because the way the surcharges work has a very significant impact on their out of pocket costs.

Beyond the headlines, there were several additional findings:

  • When smokers faced no, moderate or high surcharges rates of smoking cessation were unaffected
  • Low surcharges significantly reduced the degree of smoking cessation
  • Young smokers were much more likely than older smokers to be deterred from health insurance coverage by the imposition of surcharges
  • Surcharges were typically higher than the extra medical costs incurred by smokers

These findings have some interesting implications:

  • If the goal of the surcharge policy is to get people to quit smoking, then it doesn’t seem to be working very well. The least effective approach of all is to impose low surcharges. The authors speculate that the low surcharge smokers may feel they are being fairly charged and therefore don’t have an incentive to change. This is like the parents who are more likely to pick up their kids late from day care when a small fine is imposed
  • Surcharges knock younger people out of coverage disproportionately, which may destabilize the risk pools since younger people are generally more profitable than older people
  • The rising penalties for not purchasing insurance may not have much effect on smokers who face surcharges. Many low or moderate income smokers will be exempt from the penalties because the premiums –with surcharges– are deemed unaffordable
  • Patients with mental health problems are being discriminated against because they have much higher smoking rates than the general population. (I have been making similar arguments since 2007)

The authors mention in passing that high surcharges may encourage people to quit in order to obtain affordable coverage. They also note that the smoking surcharge isn’t always apparent on the exchanges, so smokers may not understand that they are paying more or how much.

I’d like to see the law tweaked to make the financial consequences of smoking more apparent to smokers. Surcharges could be displayed more explicitly, and the bar for being exempt from the insurance coverage requirement could be raised. Exceptions could be made for those with a mental health diagnosis.

These changes won’t necessarily be easy to achieve. Congress so far shows no signs of being willing to improve the law –though that may change if the Democrats retake Congress. Another issue is that tobacco use is generally self-reported for exchange customers, so we don’t know how many people are classifying themselves as non-users when in fact they are not.

By healthcare business consultant David E. Williams, president of Health Business Group.

Uber the ambulance chaser

ID-100263676

Uber and to a lesser degree Lyft have decimated the taxi industry with a disruptive model that lowers costs, improves service, and identifies the few bad apples among drivers and passengers. Now both companies are venturing into a niche market that’s in need of serious reform: medical transportation.

Some patients need help to get to their medical appointments and Medicaid and Medicare step in as needed to pay for transportation. However, too often a patient is transported in an expensive limo or even an ambulance when a regular car would have been fine. The government recognizes the problem and has taken some steps to clean up the business, but it’s tough going.

I’m not exactly sure how Uber and Lyft will tackle the intricacies of the business, but they are diving in:

  • Boston Children’s John Brownstein has helped form Circulation, which will use the Uber network to provide rides to medical visits to seniors and those with disabilities. Medicaid will provide coverage
  • In New York, Lyft has been working with the National Medtrans Network on a pilot program

These services will be valuable in their own right because they are likely to reduce costs and improve service. But the downstream value to the healthcare system is even greater: if patients can get to and from appointments more reliably it may well reduce overall medical costs and improve outcomes.

Finally, it’s helpful for patients to have their medical appointments bracketed by state-of-the-art service experiences, since it will encourage patients and maybe medical offices to strive for the same service levels in their medical care. Kind of like how Disney pulls up all customer service in the Orlando area.

Image courtesy of vectorolie at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.