A Plea to Doctors...

As a family, we struggle to manage a very rare disease that has its grips on two of my daughter’s and my wife.? Right now, my youngest daughter and wife are the most afflicted.? Our family journey has always been defined by the current health crisis we battle.? Like all families that battle rare and severe chronic illnesses, we wake up for battle everyday with faith and determination to just win the day.

?I’ve had a blessed career in software technology.? I’ve run a few companies.? Exited a few.? I’ve been start-up entrepreneur and the typical corporate executive.? It’s been a fun ride.? But what has always weighed on my mind is the?complicated patient experience “complex patients” go through in trying to navigate healthcare.?A few years ago, I decided to enter the Healthtech scene to improve patient experiences and help ease the burden for these patients?and their caregivers.

?Although I lacked “healthcare experience” (as told to me many times), I countered with the fact that as a caregiver for rare disease patients, I have a truly unique understanding of the system.? Here’s what we have experienced, and I believe similar family’s experience, in trying to navigate our healthcare system:?

• Payers / Insurers are not trusted.? Prior authorizations and unnecessary red tape stand in the way of healthcare needs.? Cutting costs and uncovering waste is the mission.? Patients are not the problem, but they become the victims.
• Rare disease medications are extremely expensive and?getting them approved by insurance can take years.? Time is a precious commodity for these patients.? If you change insurers, the approval process starts all over again.
• Employers are not trusted.? Many employers are self-insured today, which means they “take the risk” on healthcare costs.? Chronically ill patients are bad for business, especially small to medium sized?self-insured companies.? This leads to discrimination against these plan members and the employee, intended or not.
• Doctors are the most trusted, but they lack the technology, the know-how,?and in some cases, the empathy?to understand the plight of these patients.? For example:

1. Ownership and care coordination are lacking.??Rare disease patients see lots of doctors and different specialists.? No doctor wants to really own the entire patient’s journey.? Complex patients have many different treatment protocols; many different medications; comorbidities that are treated as new issues as opposed to related effects of medications or existing diseases.? Many additional?tests and procedures may be avoided if Primary Care or Rare Disease Specialists?owned the whole patient experience.
2. Fragmentation is widespread and doctors don’t communicate well with one another.? Clinical records and medications are disconnected.?One doctor is reluctant to question another’s approach.??It becomes a patient's burden to pass on current clinical updates, medication updates and opinions of other doctors.
3. Many doctors do not understand the mental health toll that these patients go through.? 100% of these patients suffer from mental health challenges. Depression, isolation, and despair are common feelings.
4. The medical establishment lacks?“home” knowledge of the patient.? For chronically ill patients, their everyday life is all about dealing with their affliction.? They have unique social determinants of health (“SDoH”).? They have specific diets, they try many alternative/natural treatments, they live with life modifications just to walk, sleep, or even breathe.? They need specialized transportation, and they are ALWAYS battling symptoms that can send them back to the hospital.? What happens outside of the doctor’s office really matters.?

I spend a lot of time with doctors and most want to improve their patient treatment protocols.? Unfortunately, many lack the technology and business vision to transform their practices. ?It’s hard to believe but despite their prominent role within the healthcare system,?some medical doctors are becoming “the most underutilized resource in healthcare”.? Now more than ever, the future belongs to physicians who embrace and shape change, not resist it.

To be fair, doctors face many challenges into today’s healthcare environment.? Insurance reimburses less and less?for?in-office services.? Today, roughly 65% of reimbursements DO NOT cover the cost of their service.? It’s hard to hire and keep office staff, especially nurses.? To keep “afloat” the practice must see a lot more patients.??Office workflow has become a huge nightmare.? Margins have become so thin that many doctors are giving up?or?selling out.??Some are?just paralyzed.? These factors, combined with the move to value-based care (VBC),?have brought doctors to a crossroads.

Rare and chronic disease patients are pleading for their doctors to co-captain.? These patients and caregivers know they need to own their own health outcomes, but doctors need to transform their practices to help lead.? The good news is that COVID has greatly accelerated the acceptance of digital health and more importantly, the reimbursements available for digital services.??

Digital health services can be a game changer for doctors, but they must truly embrace the transformation required in their practice.? And these remote healthcare services will?dramatically improve the patient/doctor relationship.? Yes, reimbursement codes and rules can be hard to navigate, but the number of reimbursement codes?continues?to grow.? CMS and the commercial payers are embracing codes for video consultations, preventative health monitoring, behavioral health visits, physical therapy, medication adherence, chronic care management, chronic pain management, etc.? Payers are reimbursing for these services because remote health works.? Truly understanding a patient’s 24x7 health indicators and intervening when necessary, improves outcomes, reduces costs, provides valuable treatment data, and keeps patients out of the hospital.?Digital health solutions help doctors get to know their patients better and enhance the doctor-patient relationship in a way not previously possible.? In a shifting reimbursement environment, remote health tools support the adoption of VBC and provide appropriate financial reward for better, more comprehensive care.

Because of these reimbursements, there are hundreds of companies trying to own the patient and thus, earn the reimbursements.? There’s big tech, there’s big-box retail, there are massive digital health companies with multi-billion-dollar valuations.??Every day,?there are more health technology start-up companies trying to innovate.? To get paid, these digital health companies?target?payers, employers, health systems and individual practices.? There is a race to own the patient at home.? Patients have accepted digital health?--?but with so many voices trying to get their attention, they?become overwhelmed and resist engagement.??But most digital health companies don’t start from a position of trust, the single most critical component of driving patient engagement.

In this battle to own the patient, there is one party with a clear advantage.? Patients ultimately trust their doctors and will listen to them over most all other voices.? Unfortunately,?doctors are?ill-equipped?to take advantage of the opportunity.? Too few are?technology innovators and frankly,?most?have not embraced digital health and all the real-time data insights derived.??Their patients are at a disadvantage as a result.??Medicine 3.0 is about digital health, capturing the home, using AI to improve outcomes,?enhancing the patient experience, and of course, reducing?costs.

The good news is, there is roadmap for success for doctors.? Medicine 3.0 means:

1. Embrace?digital transformation, automate?your patient operations, and expand your own digital presence.? Do not allow 3rd?parties to own your patients!? You need to drive your patients to your brand.
2. Engage?your patients remotely.? Drive?digital communication through your?digital presence.? This includes ALL facets on doctor / patient communication.
3. Digitize your treatment protocols and?patient instructions.? Track your patients’ compliance and?challenges?and adjust your treatment plans as needed.
4. Use AI to your benefit.? AI will not replace you, but it will greatly advance your ability to diagnose and treat.
5. Use the data you?collect?to advise, educate, treat, and even compliment your patients.? When patients understand that you are using?data to improve their treatment, they will gladly continue to engage.
6. Collect patient reported outcomes (PROMs) data and SDoH data.? Use this data to improve your treatment plan.
7. Listen?to your patients.? Communicate with other doctors. Be mental health aware. And?most importantly?be available.

Medicine 3.0 is a new frontier for all of healthcare, but especially doctors.? There is a pathway to significantly increase per patient revenue, patient satisfaction, patient loyalty and most importantly, patient outcomes.? But doctors must be willing to transform their current models and think differently.?

I spent most of my career in telecom and wireless communications.? When the streaming companies like Netflix and Amazon started to offer video, the telecom companies decided those new models would fail and consumers would continue to watch broadcast TV.? They were wrong.? Today, video and entertainment markets are completely owned by “the new guys”.? Doctors, don’t lose your patients to big box retail, to big tech, to the Pharmacist, etc.? Embrace digital healthcare and AI but own your patients.? Patients are rooting for you.

By the way, there are many doctors and health systems that inspire us. Just a few include Cincinnati Children's , Daniel Dunham MD, MPH , Benjamin Schwartz, MD, MBA , Scott Kolbaba, MD , Lalit Puri MD,MBA , Lisa Larkin MD FACP MSCP , Andy Collins , Carol Palackdharry MD, MS, FACP , Azlan Tariq, D.O. FAAPMR CIME , and many more I did not tag.

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