So far in 2018, the two most common themes we’ve heard from guests on the podcast are the importance of change management and care coordination. This conversation deals with the latter. We’re hearing more and more how significant of a chokepoint care team handoffs and care coordination between and across facilities really are. As patients move from provider to provider for different forms of care, fragmented medical records lead to significant waste (through, for example, redundant tests) and the potential for poor outcomes (e.g., drug-drug interactions)
Jay Desai is Co-founder and CEO of PatientPing, a care coordination platform that brings an individual’s medical records together to eliminate these problems. The service is built on network effects, sending providers alerts when the patient receives care at other facilities and also compiles their history into “stories” at the point of care. The goal, says Desai, is to reduce costs through fewer redundant tests and treatments, as well as provide insight that will improve care based on past events and reduce adverse outcomes or readmissions.
Explain the problem of care coordination
patients get care from a lot of providers and if those providers don’t coordinate, care is a lot more dangerous and inefficient. For the 80 million Americans who have a chronic condition and the hundreds of millions of acute encounters that require complex care, pre and post that particular procedure, coordination of care is really relevant. So for Medicare patients […] they see on average of seven doctors a year across four different unaffiliated practices. And when those providers don’t talk to each other – they’re all on different medical records in different systems – care can be very inefficient in a dangerous if that information is not flowing back and forth.
What is the cost of lack of care coordination?
[JAMA published] a study a probably about five to ten years ago that broke down the categories of waste in healthcare. They came up with something like a third of what we spend in the healthcare system is waste. And they attributed that waste to several categories. Two of the categories have to do with failures of coordination of care. One is specifically failures and care delivery and coordination, and they cited $165 billion dollars of waste as a result of that. That’s redundant procedures. That’s mistakes that are made, that’s drug-drug interactions that happen because of failures of information sharing between providers to be able to make a complete decision. The other category where disconnected care results in huge amounts of extra spend is overdiagnosis […] And that’s been cited at about $190 billion.
Does the consolidation we’re seeing across healthcare have an effect in the area of care coordination?
At a very high level, there’s logic to the notion that if a primary care practice gets subsumed by a large healthcare system, [the] electronic medical record system and coordination of care between that primary care practice and that health system will improve. Now, the truth is though, healthcare is not delivered only between primary care and health systems. There’s a wide range of providers that serve any given patient that oftentimes even extend out beyond the community, beyond the medical setting […] So if there is a world where any given community fully vertically integrates across all of those different sites of care then theoretically we can have a coordinated system across there. But I think that’s the right thing to do for efficiency because they are wildly different businesses.
But I’ll add one more point to that, which is when you get more consolidation, there tends to not be a single monopoly within the region. So as the competitive nature of healthcare increases, as you get two or three major health systems as opposed to five or ten, those that remain have a greater need to share because patients now are just going to be shifting back and forth between a few settings and if they don’t share them, you know, major gaps in care can and do occur.
How much of a role does technology play in solving the problem of care coordination?
Incentives are, call it, 40 percent of the reason for failure here […] The other part of it is the health system not making enough investment in the human resources to be able to support [care coordination]. So let’s call that another 40 percent. Technology is a major enabler, but I wouldn’t put it at more than 20 percent. We’re a technology company and we think that we are adding really important value to the world. But the vast majority of that work is being done by the front line, by the clinicians. And the processes that they’re setting up. So, technology can be a very profound enabler, but it’s only as good as the incentives and system design and the processes and the human capital that’s being put to work.