We know the 80/20 rule — majority of consequences result from a few causes. Examples include how a big portion of wealth is concentrated in fewer individuals, how a small portion of population contributes to majority of healthcare spending, how bulk of company revenues come from a minority of customers etc.

US national healthcare expense has surpassed $4 trillion. Per-capita spend is over $12,000 per year. Talking about health expenses and our healthcare system beats flogging a dead horse.

Does the 80/20 rule, the Pareto principle, apply to how we spend money for our overall wellbeing? Is the bulk of our spending targeted towards where the impact is highest? Do we spend $4 trillion to solve a 10 percent problem.

Let’s examine this through four lenses:

1. Our system of care
2. Comparative health outcomes vs. spend — US vs. similar countries
3. Health of our populations
4. Impact of clinical care on our overall wellbeing

Our System — Complexity is Our Pride

We’ve a healthcare system that has elements of every other system in the world buried inside — from single payer to private insurance to employer-financed sub-systems.

The myriad ways we get our care and pay for it requires a complex dance of providers, administrators, insurers, employers, and technology makers.

One would think we’ve purposely designed a complex system to care for a complex system — our body.

The system ingests $4T a year and spits it out. For an infographic on how it happens, see the X-ray of a tapeworm.

The Outcomes — Not Getting our Money’s Worth

Comparisons of US health care system and spending with other economically advanced countries galore. It can be summed up as “ not getting our money’s worth”.

Measured by the ultimate metric — life expectancy at birth — vs. per-capita spending, US is an outlier. We’re the run-away train when it comes to spending as shown above over nearly 50-years. Other non-financial measures such as DALYs and QALYs — disability-adjusted life years and quality-adjusted life years — or detailed disease burden data tells the same story of poorer outcomes.

Population Health — We Have Issues!

The answer to the simple question “how are you doing?” can be answered at the population-level: We have issues.

We are a crucible of chronic conditions. Nearly 3 out of 4 of us are obese or overweight. And the bad news gets worse from there as health conditions pile on top of each other.

About 1 in 3 of us live with co-morbidities and are deemed polychronic.

All this makes one wonder if the state of our population is the product of our system or if the state of our system the product of our state of health?

Yes, we’ve heard these facts ad nauseam, and the rhetorical questions that accompany them! What does all this have to do with the Pareto principle?

Beyond Clinical Care

This picture shows NEJM research from 2017 — only 10% of our wellbeing is attributable to clinical care. 60% is due to our behaviors, social circumstances, and the environment.

In other words, we spend $4T to solve a 10% problem.

This needs to be restated, perhaps perversely, to conform to the Pareto principle — most of our health spending is concentrated on solving a few of our problems.

This still leaves the question of impactful spending unresolved.

Summary

Depicting the state of our health care would look as shown below and would read as follows:

We spend $4 trillion via a complex system to care for an unhealthy population without getting our money’s worth while solving for a 10% problem.

Be assured that enough smart people are working on pieces of this problem. CDC’s Healthy People 2030 initiative should help. The increased awareness post-pandemic will help. However, it remains to be seen how fundamentally our system of care will change to focus on the 60% problem — those driven by social, behavioral, and environmental factors.

Hope springs eternal!

Originally published at https://www.linkedin.com.

The post How to Spend $4 Trillion on a 10% Problem? Pareto Principle And US Healthcare appeared first on Hari Harikrishnan.

We hear about technology-enabled healthcare innovations constantly. Peloton’s camera for better strength training using vision AI; Microsoft’s acquisition of Nuance for conversational AI; Google using AI for drug-discovery; Amazon’s Amazon Care for employee health benefits; The list goes on.

When technology meets healthcare — arguably the most complex industry — some of us think of the status quo and regulations stifling innovation. We hear about an industry that adopts technological innovations such as digital technologies slowly compared to others. All this until a pandemic arrives, perhaps?

How do we connect the dots across all these technologies? It is more than just medical innovations and digital technologies. Keeping in mind that there is more to innovation than just technology, let’s explore how various technology innovations are reshaping healthcare.

This is a straightforward guide to making navigating technologies in healthcare easier so that the next time you hear about an innovation, you will know where to place it in the landscape of technology innovations in healthcare. This is not meant to be exhaustive, but directional.

Read on to see the infographic that puts multidimensional technological innovations in perspective.

A Top-Down View

We know innovation comes in many shapes and forms. To understand technological innovations in health care, we must look at the innovations from the vantage point of healthcare services we receive as consumers or patients.

Let me categorize the innovations into three broad areas as shown here:

1. Health Services: Primary care to specialty care, hospital care, diagnostics, and health insurance fall into this category

2. Products — Medical Devices and Drugs: Complex implants, surgical devices, wearables, vaccines, and even the common tongue-depressor that the clinician uses to examine us fall into this category of products.

3. Technologies: They fall into three categories — A) molecular technologies (chemical or biological), B) digital technologies (information & communication technologies), and C) materials (chemicals, plastics, metals, etc.)

Even simple health care services require the use of devices or drugs powered by these technologies. Think of the technologies inside the products used for routine medical care — blood pressure monitors, thermometers, x-ray machines, and medications.

We will use this hierarchy of services, products, and technologies to put in context the slew of technologies we will look at next.

1. Technology-enabled Services

Let us look at the type of innovations in each category of services, products, and technologies.

New and Existing Services Improved

How we think of innovations as fast or slow is relative to each of our baseline assumptions. Regardless, rest assured that the march of innovation is relentless.

Health Services Portfolio and Underlying Workflows

Some highlights from the services innovation include:

• Telemedicine: Covid unleashed a level of creativity and innovation in delivering care remotely, enabled by digital technologies
• Digital insurance: We are still in the early stages of ways to provide health insurance services using our individual data
• Surgery: Robot-assisted surgeries that augment clinicians are becoming more widespread.
• Rehabilitation: Services using apps abound. Exoskeletons and prosthetics driven by robotic technologies or new materials are proliferating.

Workflows and Processes

Service innovations require process changes and underlying workflows. These processes and workflows undergo dramatic change anytime a new medical device, drug, or technology is introduced.

Examples include:

• Clinical trials are made more accessible by mobile technologies to recruit participants and keep them engaged
• Drug discovery enabled by artificial intelligence (AI).
• Patient and clinician education using mobile, videos, augmented/virtual reality (AR/VR)

2. Products: Medical Devices and Drugs

Medical devices and drugs comprise about 15% of US healthcare spending. Within these two markets, innovation continues, enabled by digital, molecular, and materials technologies.

Products powering health services

A classic blood pressure monitor becomes smart and connected, enabling a telehealth service. Wearable medical devices blur the lines between classic medical devices and consumer electronics. Diagnostic devices such as ultrasound machines become smaller and portable, making their use at points-of-care more prevalent.

COVID accelerated the journey from research to trials to productizing new therapies on the drug front. mRNA vaccines being the prime example. The trend of acceleration of development is slated to continue, taking advantage of the change in global collaboration, regulatory environment, and process digitization.

3. The Technologies

Depending on our industry perspectives, we may think of medical technologies as falling into “medical” vs. “digital”. Here, I have classified the technologies into three categories — molecular, digital, and material technologies.

All Tech in Healthcare

This article aims not to describe each technology exhaustively but to provide a sampling of what is brewing in each category.

There are exciting innovations in each category. Molecular technologies boast mRNA and genomics; digital holds promise with robotics and AI while materials maybe the unsung heroes in this group.

Select examples in material technologies include:

• Titanium or platinum in implants
• Nano-scale materials in batteries, sensors, or molecular technologies
• Polymers that makeup contact lenses
• Plastics in catheters used in minimally invasive surgeries
• Carbon in replacement heart valves

Just as drug discovery is being accelerated by AI, material discovery and testing are being boosted by AI. 3D printing offers exciting possibilities to create biomaterials for exoskeletons.

The convergence of these three technology realms — molecular, digital, and materials — with each reinforcing the other will be a tremendous boost for new health services and therapies in the next decade.

Applying the Guide as a Compass

This infographic puts together into one view the health care services, the products (drugs and devices), and the technologies.

Health Services, Products, Technologies

Here is how to use this guide to make sense of the innovations we discussed earlier -Peloton, Google, Amazon, or many others that will surely make headlines:

• Peloton is integrating digital technologies (vision AI) with their smart exercise equipment to offer wellness services
• Google uses digital technologies (AI and Cloud) to discover new drugs or enable others to discover drugs faster. Pharmaceutical companies are using digital and molecular technologies to find new therapies.
• Amazon is starting to offer services (employee benefits/insurance, pharmacy) using digital technologies, including Amazon Web Services.

This graphic also lets us see the alternative ways a medical solution can be introduced in the future using a one or more of these technologies.

For example, will we solve an orthopaedic issue on our knee using a 3D-printed metallic knee implant, an exoskeleton, or regenerative therapy?

The actual intervention would really depend on our specific condition and the availability of the technology when we need it.

In short, we are integrating technologies from molecular, digital, and materials categories to build new drugs and devices to deliver new health care services.

Summary

It may seem challenging to keep up with the pace of technological innovation unleashed in healthcare by combining technologies from molecular to digital to materials. Mapping these technologies to the wide portfolio of health services — insurance, primary care, surgery, etc. and their underlying workflows — clinical decision making, scheduling, drug discovery, etc. — will make it easy to apply innovations to improve our health care system and health outcomes.

Originally published at cxotechmagazine.com

The post The Really Simple Guide to Navigating Health Care Technology Innovations appeared first on Hari Harikrishnan.

Warren Buffet memorably termed the healthcare industry the tapeworm of the US economy, referring to the apparent crowding out of investment in other industries as healthcare costs exceed 17% of US GDP — $3.8T in 2019.

See below on how $100 flows in and out of the “tapeworm”.

The inflow (shown with ‘+’ sign) is the funding originating from various participants in the system.

Inflow = Consumer contributions and direct spending + Govt spending + Employer contributions;
Outflow = Provider spending + Drugs/Device Makers revenues + Insurance Costs + Govt Admin cost;

Every large bucket of funding and spending is shown as % of total expenditure, so that we can see the elephant (or rather the “tapeworm”), at a glance. When one player says the problem is with another, we know the size of the pie each player represents, if not their influence in the industry.

Are our passionate debates on US healthcare spending — the highest in OECD countries in absolute terms and per-capita — calibrated to the size of each participant’s funding or spending?

For example:

• Pharmaceuticals is 10% of the pie, but hearing the debates on big pharma would make one think that we can solve our cost problem by reining in Pharma.
• We hear about the middlemen problem. The middlemen — insurers and PBMs (pharmacy benefit managers, these days part of insurers) is a 6% problem.
• Private sector employers fund 19% of spend, but the portion of consumer spend tethered to private plans adds clout to them since 50% of the population is enrolled in employer plans.
• Consumers fund 28% ($1T) in taxes, premiums, and out-of-pocket expenses. The high portion of spend doesn’t seem to translate to influence
• Provider spending is 70%. Before we get excited about that tranche, reflect that this is a highly labor-intensive industry. We know wages aren’t sky-rocketing here or in the economy as a whole. Do we think more utilization reviews and prior authorizations by insurers and more optimization on how we price each service (via relative value units or RVUs) will help?

Where are the possible hundreds of billions in cost-savings hidden? Yes, we have room to tighten this all around in the many layers below these buckets. Still, how can large swathes of costs be drained from this system?

Does the answer lies outside this frame, in non-clinical approaches to health and wellbeing? Is this “X-Ray” a mere reflection of how much it costs to care for our population? Are we too focused on cost of disease and not on the whole persons in our populations?

The old quote from Dr.William Osler springs to mind:

It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.

The post The X-Ray of a Tapeworm: Visualizing Money Flow in US Healthcare appeared first on Hari Harikrishnan.

New headlines loom large every day about investments and initiatives from Microsoft, Apple, Google, Amazon (MAGA, for short if you can’t remember them) in healthcare. Some of the initiatives promise miraculous cure to the ills of the state of healthcare, some promise disruption, some are more of the same. Often we hear of their high-profile attempts and equally high-profile exits.

Getting a summary view into their forays by tallying up their inventions and investments can be found here. For a quick distillation of Big Tech in healthcare, read on.

All of them have their clouds whether for B2B or B2C businesses. They all have their AI — embedded in their products or for others to develop and to enhance their products. You can find something even more specific like “voice-enabled AI healthcare solution” or “vision AI for radiology”?

Rather than itemize their trophies to quantify their place in the health-tech race, here is an at-a-glance view on how much disruptive threat they pose to large healthcare incumbents in the US.

At a Glance — Big Four Tech in Health

The graphic below is a look at the posture of Big Four Tech in healthcare innovation & the threat they pose to incumbents — device makers, healthcare providers, and insurers. The threat-level follows the arrow based on the capabilities and investments each firm is making.

1. Microsoft: So far, Microsoft remains a provider of innovative technology to the industry — a classic stance of tech players towards most industries. Not threatening incumbents, but providing infotech solutions for industries to leverage.
2. Apple: Apple’s posture is similar to Microsoft’s. Apple too remains rooted in being a technology provider while making advances into new class of digitized medical devices — like the Apple Watch or SaMDs (Software-as-a-Medical-Device) and services enabled by them.
3. Google: The similarities between Apple and Google in healthcare starts and ends with devices (phones, and FitBit, for example). Google’s ambitions range from life sciences — genome projects, enabling drug discovery — to health insurance and care delivery. Investments in new-age health insurer Oscar Health, in telehealth provider Amwell etc are examples. In addition, Google invests more in technology for imaging and diagnostics.
4. Amazon: Based on available offerings and ambition, Amazon looks the most threatening to status-quo healthcare. No other player in the Big Four has direct-to-consumer service offerings such as pharmacy (Amazon Pharmacy) or planned care delivery like Amazon Care. Amazon’s appetite for wide range of business models makes them a threat in many aspects of healthcare. We’ll set aside their failed joint venture “Haven” for this discussion.

How will this shape healthcare industry partnerships with the big four? How will this threat evolve as these new entrants gain experience in health? Will their investments wax and wane as they shift priorities?

The post Big 4 Tech Players and Threat to Healthcare Incumbents appeared first on Hari Harikrishnan.

Why women report more Covid-19 side effects — Three Bs: Biology, Behavior, and Bias.

By early Jan 2021, almost 80% of Covid-19 vaccine side effects reported in the US came from women. This article from USA Today from April 2021, covers the possible reasons.

Here’s a graphical summary of the findings.

1. Biology

Women show greater immune response to vaccines — almost twice as much as men. Having more “ T helper cells” that activate the immune system one reason attributed to this.

Women’s immune cells having more estrogen receptors also makes the immune response, “adaptive”.

2. Behaviour

So, women are prone to higher side-effects. Are they also more inclined to report adverse effects more than men? Do men report less?

It would appear so on both counts. Women are more engaged than men in health care, per this WHO study. Women seek care more actively unlike men. Women being in charge of care for children and the family makes them more engaged than men.

3. Bias

Dosage of vaccines and meds not adjusted for women. Unlike pediatric care where dosage is adjusted by weight, men and women get the same adult dose. Trials and studies have started to include women only recently.

Women were not included in clinical trials until 30 years ago (“for their own good”). The National Institute of Health Revitalization act of 1993 in the US established new norms for clinical research equity for women and minorities. However, research for most drugs in the market pre-dates these reforms.

Combine this bias with the biological response and we get findings that suggest half the typical dose of flu vaccine is enough for women, as compared to men.

Epilogue

In an era when we talk about precision medicine and personalized health care delivery eloquently, it is sobering to realize that gender equity in health care is far from reality.

In case we walk away thinking that men are in better shape, sadly not so.

Historical clinical research emphasizing white males of certain types and men’s lack of engagement, puts them at a higher risk. The extent of the risk is manifest in the life expectancy gains men have not achieved, when compared to women.

That’s a story for another time.

The post 3 Reasons for Women Reporting More Vaccine Side Effects Than Men appeared first on Hari Harikrishnan.

2020. Annus horribilis. The year when considerations of health outweighed those of wealth globally, though we found them inseparably intertwined as millions lost their livelihoods.

The debate about how the pandemic transformed healthcare globally and in the US will go on for eons — everything from vaccine development to regulatory pathways, health policy, continuum of care delivery, and our response — individually and collectively.

I am sure we each have our unique takeaways based on the lens with which we view society, industry, and our own personal health or economic situation. Here’s my lens.

3E’s Shaping US Healthcare

In a year of turmoil not just in public health and its economic fallout, but also in social justice, 3 areas jumped out for me as shaping the future of our healthcare — 1. Expectation of patients, 2. Equity for populations, and 3. Existence of care providers.

Expectations of Patients

Before the Internet era, health information was hard to access. Several decades of information access via Internet has empowered us to do symptom checks before we show up for a doctor’s appointment. The pandemic has made it necessary for patients and providers to adopt Telehealth.

Patient empowerment has taken on a new dimension with the remote care

Trust barrier that existed around care from far has been shattered — both from patient’s acceptance of remote care and the provider’s existential imperative to offer it (or go out of business), along with policy changes to get compensated for it.

This is an irrevocable change in consumer behavior that is not going to go away once we get past this pandemic. How we build on this new foundation of behavior and receive care in different care settings and modalities — face-to-face, virtually, live, or offline — and how this affects efficacy and economics of care will be interesting to observe.

[ Related: Thoughts on whether great expectations beget better outcomes in this article on patient experience].

Equity for Populations

The awareness about inequities in social justice has reached a level we have not seen before. 2020 saw global repudiation of long-standing artifacts of racial and social injustice. Against this backdrop, unrelated to the pandemic though coinciding it, we saw how virus devastates certain groups.

Virus maybe an equal-opportunity parasite, but it is not a great leveler.

We will discuss at length the color of covid in the broad context of social equity.

For the healthcare industry, the pandemic throws more spotlight on the social determinants of health (SDOH) and how we should bring more accessible care to groups across the spectrum of colors in our society.

Existence of Providers

During the pandemic we cancelled our screenings, our routine visits, our dental care; postponed our surgeries or elective surgeries were suspended. To providers of non-urgent, non-critical care, their patients vanished overnight (some came back on camera).

Pandemic seen from some providers’ view is ironically akin to entire patient populations becoming healthy overnight.

We joke about our healthcare being really about sick-care. It isn’t anything to laugh at when small and big provider business models, built on sick-care, are threatened by no-shows induced by the pandemic. At the peak of a health contagion, we were laying off people or shutting down clinics.

Independent physician practices to hospitals are in various stages of financial distress. The existence of providers, especially the small businesses who can’t absorb the economic shock, is threatened.

About a 100 years ago, health insurance came into existence to prevent surprise medical bills that bankrupted people by stabilizing patients’ monthly expenses.

On the other hand, bulk of the physicians are paid by fee-for-service reimbursements for service rendered per visit or incident. There is no stability in their income. In 2020 most practices will see diminished revenues and a majority of primary care practices will lose money per this McKinsey survey.

More than ever, the fragility of providers’ existence, founded on sick-care, is exposed.

How will the provider’s payor-mix (sources of income from medicare/medicaid reimbursements, private insurance, patient-paid etc.) change? Will we see an accelerated shift to concierge-care where providers move to a patient-paid model? Will we finally move away from the fee-for-service model with its perverse incentives to a new payment model to stabilize healthcare provider incomes to ensure their financial health?

Our Response

How will the healthcare industry and policy-makers respond — from makers of drugs and devices to providers and payers? We have many balls to juggle and many large jugglers.

Will improving access to care and patient experience outweigh singular focus on cost? The push towards value-based care in the last decade saw us trying to balance quality and costs via accountable care and bundled payment initiatives. What incentives exist in the system today to improve access and experience for the long-run at scale?

Whatever we do to improve quality, access, costs, and experience, the 3Es of expectations, equity, and existence need to be factored in.

Do share your thoughts on key post-pandemic drivers for healthcare reforms in the US or in your country.

Originally published at https://www.linkedin.com.

The post Beyond the Pandemic: 3 Es Shaping US Healthcare appeared first on Hari Harikrishnan.

This is the finale of this series on Patient eXperience — series on moving from “Rx to Px” (prescription to experience).

1. Part I of this series on “Rx to Px” (Prescription to Patient eXperience), discussed how telemedicine and remote care delivery is transforming our day-to-day experience at doctors’ offices.
2. Part II of “Rx to Px” (Going Beyond the Surgery for Better Outcomes) we looked at patient experience from surgical procedure to recovery — on how our health system can go beyond surgery, improve patient experience, and consequently ensure better recoveries.
3. Part III of “Rx to Px” (Reimagining Our Medicine Cabinet Experience) considered improving the Px (Patient eXperience) for classic prescription meds (“scripts”).

Encounters Shaping Us

In this series, we’ve looked at how office visits, surgeries, and our own experience at our personal medicine cabinets could be different. These some of our main touchpoints to the healthcare we get and affect our experience and outcomes.

A quick look at the volume of these interactions in the US:

This series looked at how we could reimagine these “encounters” using a combination of:

A summary infographic on the possibilities to reimagine the voluminous encounters we have with our healthcare is below — clearly an optimistic look how our millions of yearly touchpoints can be experientially-enhanced.

Quality of Experience vs. Quality of Care

Our historical approaches to caring has centered on safety and efficacy — the design-center of utility.

Lately a slow march towards experience-centric design has begun.

This will demand us to look the services we deliver with a view to longer-term outcome measues that go beyond the simplistic ones. Such as:

“person walks pain free in 90 days”, “person is alive after 30 days”. Metrics such as DALY (disabilty-adjusted-life-years), or specifics on functional recovery years after a major surgery like a knee replacement.

Does that mean we’ll design healthcare services with an ExperienceFirst mindset like product-firms that excel at delivering experiences? Perhaps, as we rethink how we achieve outcomes across the various dimensions shown below.

We could bridge the chasm between cures, care delivery, and outcomes by merging Rx and Px.

Great Expectations Beget Better Outcomes?

An unfortunate public health emergency has “broken through the trust barrier between patients and providers…for remote care delivery”. Telemedicine acceptance and policy push behind it are real for patients and the ecosystem of care delivery.

More than anything — more than technologies, more than data — we are dealing with new expectations. Those expectations from us as patients will impact how we design programs, deliver them, and get paid.

Will public policies drive how we distribute money across services? E.g. Visits (physical, virtual, synchronous, asynchronous), surgery vs. recovery management, meds bundled in programs vs. provided standalone?

At Plethy, we are looking forward to seizing the moment with the industry and our customers and partners.

— — * — — * — —

Checkout Plethy for how empowered, continuous care can be delivered for surgical episodes of care.

Published By Cerebrus

Originally published at https://www.linkedin.com.

The post Rx to Px — Series Finale: Will an Experience-First Approach Lead to Better Outcomes? appeared first on Hari Harikrishnan.

In part I of this series on “Rx to Px” (Prescription to Patient eXperience), I discussed how telemedicine and remote care delivery is transforming our day-to-day experience at doctors’ offices. In part II of “Rx to Px” (Going Beyond the Surgery for Better Outcomes) we looked at patient experience from surgical procedure to recovery — on how our health system can go beyond surgery, improve patient experience, and consequently ensure better recoveries.

In this post, let’s examine if we can improve the Px (Patient eXperience) for classic prescription meds (“scripts”).

Lack of Med Adherence — Tale as Old as Time

Half of us do not take medications as prescribed. Hence this ancient message to all physicians:

“..not only be prepared to do what is right himself, but also to make the patient…cooperate”. — Hippocrates.

Reasons range from our perception about meds (worry, fear, mistrust) to cost and lack of awareness. Areas that are constantly being improved for better adherence include the stages of prescription, pharmacy-dispensing, and ongoing education.

But, are we going farther upstream in making the drugs themselves?

Meds: A Classic UX Design Problem

We know meds are designed for safety and efficacy first. If we were to argue for changing the design center of Rx to Px, one might get laughed out of the room, unless it was tied to safety or efficacy.

However, if Rx is not filled and taken by us, outcomes won’t be achieved.

Shouldn’t experience be a consideration on its own merit?

An Example — A Great Inhaler

I came across this novel inhaler that is a great delivery system for asthma/COPD patients to inhale multiple drugs in one puff.

The instructions that came with it were a bit IKEA-esque — a DIY-feel requiring a routine of assembly, priming, and finally puffing — as shown below.

I didn’t doubt the ingenuity of the drug delivery in the least, but wondered if patients with less dexterous hands could perform the assembly.

I was pleasantly surprised to find this:

The COMBIVENT RESPIMAT inhaler has been certified by the Arthritis Foundation for Ease of Use.

Kudos to its maker Boehringer Ingelheim for making the balance between drug delivery and usability a priority in design! That’s design-thinking.

More Approaches? Molecular and Digital?

Emphasis on usability and Px may find us look for alternative options beyond just education and diplomatic encouragement.

More user-friendly formulations that affect taste and solubility (why does it always have to be some cliched bitter pill?)

How about digital companions for support beyond the caring human?

The Medicine Cabinet — Reimagined

Can we bring Rx and Px into the same medicine cabinet to drive better outcomes? Can utility and usability be blended at design?

At Plethy, we believe that digital platforms like Plethy Recupe should serve up the entire treatment plan to patients and contextualize the medication plan for patients, to drive engagement, experience, and better outcomes.

Therein lies our vision of bridging the chasm between Rx and Px. No doubt, it will take a village to achieve it.

— — * — — * — —

Stay tuned for more posts in this series on the evolution in healthcare from Rx to Px. Checkout Plethy for how continuous care can be delivered in Orthopaedics and surgical recovery journeys can be made impactful.

Published By Cerebrus

Originally published at https://www.linkedin.com.

The post Rx to Px — Part III: Reimagining Our Medicine Cabinet Experience appeared first on Hari Harikrishnan.

In part I of this series on “Rx to Px” (Prescription to Patient eXperience), I discussed how telemedicine and remote care delivery is transforming our day-to-day experience at doctors’ offices.

In this article, let’s examine patient experience from surgical procedure to recovery — on how our health system can go beyond surgery, improve patient experience, and consequently ensure better recoveries.

A typical person who gets a knee or hip replacement surgery — like my uncle — would’ve waited for over 10 years to get that procedure. During that time their mobility has deteriorated, along with their quality of life. They live with pain, have falls. They research, get referrals, find a surgeon, and finally get their procedure done.

Their arduous journey to recovery, of restoring their mobility, begins.

The Lonely Road to Recovery

When patients get discharged after surgery, some may end up in a skilled nursing facility (SNF) — a halfway-house between the surgery facility and their home. Others may get discharged directly to home where they may get a few weeks of home healthcare, with a nurse and/or physical therapist visiting them for delivering care. Some may get outpatient physical therapy after home care or in lieu of it. Post-operative visits to the surgeon occur during the first few months.

Care pathways and delivery modalities vary by individual. However, the only constant is the patient.

Can the patient be empowered to care for themselves post-surgery and discharge? Can we equip them to be in control of their recovery? After all, we know that engaged patients get better outcomes.

Can the surgeon and team stay connected with that patient while they’re out-of-sight and are being managed by the ecosystem of providers in the post-discharge phase? (PAC or post-acute care providers). Can the PAC providers and the surgeon coordinate care better to ensure timely care transitions as the patient navigates the road to recovery?

The answer to all these questions is ‘yes’. Doing those improves Patient eXperience (Px) as well as raises the standard of care by going beyond the surgery.

What else can we do to ensure better outcomes and Px?

Recovery Begins Before Surgery

Pre-operative preparation is now part of enhanced recovery protocols. Prehabilitation — any intervention administered before surgery to reduce surgery-related morbidity, decrease the length of hospital stay, and facilitate the patient’s return to normal life — is shown to enable better surgical outcomes.

Could we apply Enhanced Recovery After Surgery (ERAS) pathways to patients’ journey from pre-operative to post-operative stages of care?

After all, the aftermath of surgery shouldn’t be an afterthought.

Go Beyond Surgery — Improve Px and Outcomes

Research shows that evidence-based best-practices such as ERAS makes for better outcomes by focusing on the entire patient journey.

At Plethy, our focus is to transform the patient journey in orthopaedic recovery by applying these best-practices to surgery preparation and recovery.

We hope that focusing on Px throughout the patient journey and key provider partnership with patient will make the lonely road to recovery a tolerable one.

Digital platforms like Plethy Recupe for Orthopedics will enable such empowered surgical journeys by keeping the patients engaged and empowered while providing visibility to clinicians on patient preparedness, progress, and recovery.

— — * — — * — —

Stay tuned for more posts in this series on the evolution in healthcare from Rx to Px. Checkout Plethy for how continuous care can be delivered in Orthopaedics.

Published By Cerebrus

Originally published at https://www.linkedin.com.

The post Rx to Px — Part II: Going Beyond the Surgery for Better Outcomes appeared first on Hari Harikrishnan.

Much has been written about how we moved from the Age of Information to the Age of Experience. Customer Experience (CX) was deemed the winning strategy for this era, with many technology-enabled businesses winning customers over with digitized experiences (DX). Underlying that view is the secular trend to improving User Experience (UX) — popularized by the world of new technology and human-computer-interfaces.

What does all this mean for the healthcare industry? In this age of experience, there’s a lot of discussion about patient experience.

What constitutes the dimensions of Patient Experience (Px) and how to improve Px?

Are we really moving from the realm of prescriptions and procedures (“ Rx World”) to one where Px is a winning strategy, as other industries seem to think?

Can we bridge the worlds between cures (drugs, devices, and procedures) and care delivery to improve Px?

Efforts to evaluate and enhance Px at the healthcare-sector level will need us to consider not just healthcare delivery, but also medical devices, medical procedures, drugs, and our access to affordable care.

We’ll take a look at Px in care delivery in this post. Many fundamental shifts are afoot in this area alone. We’ll look at Px in other aspects of the healthcare industry in future posts.

Patient or Impatient?

When we visit a clinic, wait-times weigh heavily in influencing our experience. The scheduling gymnastics that physician’s offices do to accommodate patients and keep themselves afloat evokes images of airlines overbooking flights. More data on this aspect of Px (e.g Healthgrades and even Yelp), has thrown the spotlight on this issue and perhaps re-calibrated our expectations in the last decade.

Enter Covid-19! Our notion of Px is now thrown in disarray. But Covid may well be the (unfortunate) medicine that the doctor ordered that makes us rethink care delivery and adjust our expectations. As shown below, how we access health services has changed dramatically.

Typical office visits in a brick-and-mortar clinic took a nosedive with Covid-19. Our cars became our waiting rooms, should we needed to make trip. Telehealth visits, which were until now an afterthought and had restrictions for use, are expected to reach 200 million in 2020, from a previously expected 36 million.

This is despite the fact that countless technology challenges await the hapless patient on their pathway to a video call with their physician (e.g. devices used, video software used, browser cookies!). The physician and their staff in-turn navigate a host of challenges from scheduling video calls, solving technical issues, while adapting to care delivery remotely.

Anecdotal evidence suggests that all that maybe worth it to avoid the hassle of wading through traffic and bypassing waiting rooms to receive care from the comfort of your home.

Caring: In-Person to Virtual

The transitions in care delivery are not limited to a physical visit to a clinic turning into a video or phone-based Telehealth visit. New communication technology-based services (CTBS) are enabling care to be delivered non face-to-face. i.e. based on a virtual interaction between the patient and the clinician where neither party is face-to-face norareinteracting in real-time, as shown below in scenario 3.

These virtual visits — Telehealth and other emerging Telemedicine services — are expected to exceed a billion visits in 2020.

Virtual Care — Complementing Classic Care

The market forces behind this evolution of care is just gathering momentum — from patient expectations to provider operations to policy-making.

Telemedicine services are not a one-for-one replacement for classic office visits. They have the potential to dramatically improve access to care and healthcare economics.

Real-time Telehealth visits combined with other asynchronous care may have an as-yet-unquantified effect on the way we get health services and how we manage population health.

Healthcare delivery may have been irrevocably altered by an unfortunate public health emergency. We have likely crossed an inflection point between face-to-face care and non-face-to-face care.

Patient expectations have changed. That in itself may drive more changes in this decade. Let us at least hope it has provided a boost to much-needed innovations in healthcare, starting with how we get access to care from the comfort of our homes.

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Stay tuned for more posts in this series on the evolution in healthcare from Rx to Px. Checkout Plethy for how non face-to-face care can be delivered in Orthopaedics.

Published By Cerebrus

Originally published at https://www.linkedin.com.

The post Rx to Px — Part I : Has the Age of Customer Experience Arrived in Healthcare? appeared first on Hari Harikrishnan.