From the Extra Mile to the Last Mile — Scaling the best of Care Management
The term “frequent flyer” means a very different thing in medicine, referring to patients who are frequently in and out of the hospital. Most of these patients suffer from heart disease, kidney disease, diabetes, or other long-term conditions that leave them anxious and frustrated. While these patients receive top-notch care in hospitals, they often go home to an environment that makes it difficult to take care of themselves.
Some of the top health care institutions in the country realized that to manage many of these chronic conditions — congestive heart failure, type II diabetes, sleep apnea, anxiety — required additional touchpoints beyond the traditional hospital or clinic visit. Along with their grandiose reputations came equally-sized budgets to hire additional nurses, medical assistants, care managers, lifestyle health coaches, social workers, and home health aides to provide support, encouragement, and continuous feedback to patients working hard to manage chronic disease. Intensive chronic disease management units with one-on-one health coaching have popped up within large academic medical centers to manage their most complex patients, with excellent results to boot [e.g. below diagram showing larger reductions in HbA1c among patients with diabetes in a collaborative care program (orange) vs. control group (blue)].
As a result, hospital budgets for care managers have nearly doubled in the last two years. Remote monitoring has similarly exploded as progressive health systems began to send patients home with wireless, internet-connected scales, glucose monitors, inhalers, and blood pressure cuffs. Others changed their financial model altogether, and were rewarded for improvements in markers of patient health, such as blood pressure and blood glucose, rather than the sheer number of clinic visits.
While these initiatives show promise and, in some cases, have yielded excellent results, they remain limited to few patients at few medical centers. With more touchpoints comes more expenses, relegating novel models of chronic disease management largely to those patients with the means to access and afford high-quality health care. Unfortunately, this has left rural hospitals with worse mortality and health outcomes for patients relative to their urban counterparts.
Why can’t we take what has worked in health care and spread it to the masses? Could we standardize elements of high-quality disease management and bring the same models to clinics that otherwise didn’t have the staff to serve all the patients that needed this level of care?
This gap in health care equity is why our team at Memora Health is aiming to create a new standard for care management, where clinically-validated models for follow-up, health coaching, and post-discharge instructions can be scaled to reach any patient that needs them, with as many touchpoints as necessary.
As medicine broadly adopts innovative models of care management to manage its most at-risk patients, we believe it is essential to harness the speed and flexibility of technology solutions to extend their reach. In particular, SMS offers accessibility unmatched by any other medium.
While mobile interventions introduce a natural selection bias, using SMS as a mode of communication is inclusionary of all demographics relative to other technological solutions. In 2013, mobile phone penetration had been estimated at 86% among American households earning less than $30,000 per year, 93% of which regularly send text messages. In the same demographic, only 59% have access to a desktop or laptop, while just 47% have broadband at home, supporting text messaging as the best method for automated interventions. SMS interventions have a 98% read rate, better than any smartphone app on the market.
By digitizing these care management programs and delivering them automatically in a simple-to-use medium, we hope to democratize and scale the best of what the world’s best physicians, nurses, and support staff have already figured out.
Memora Health is building the operating system for care delivery that implements intelligent, streamlined workflows and revolutionizes the patient experience outside the care setting. We offer a smart end-to-end platform that unifies fragmented health care data to enable providers, payors, and life science companies to automate care delivery operations — from patient communication to documentation to reimbursement. We uniquely use artificial intelligence to digitize existing care delivery workflows, giving clinicians infrastructure that learns from every encounter they have. Memora supports a full suite of virtual care systems from automated patient intake and scheduling to remote monitoring and care pathways to billing and documentation. Memora is backed by Andreessen Horowitz, SV Angel, Kevin Durant, Martin Ventures, and several healthcare strategic groups.
