Successful virtual healthcare services must not simply “engineer” the drawbacks of legacy care models. To truly succeed, they must deliver digital innovation that dramatically lowers costs, eases the burden on legacy care providers and infrastructure, and delights patients. But where does healthcare quality appear in the context of virtual healthcare, and how should healthcare innovators, investors, and providers address questions about quality in this paradigm? For a doctor’s point of view, we turned to Simon Mathews, chief medical officer at Rock Health’s portfolio company, Vivante Health, to share a perspective on how digital health can play a role in advancing quality of care. attention in four dimensions.
By Dr. Simon C. Mathews, MD
Medical Director, Vivante Health
Assistant Professor of Medicine and Gastroenterologist, Johns Hopkins Medicine
Not so long ago, quality of care was synonymous with clinical outcomes. In 1999, the Institute of Medicine reported that nearly 100,000 deaths a year were due to medical errors (the most recent estimates are closer to 250,000). These statistics changed the narrative about quality and highlighted that clinical metrics alone do not adequately characterize the overall healthcare experience. As a result, the health care community has made efforts to broaden the definition of quality, promoting a systems thinking approach that proactively recognizes the complex interrelationships that affect care.
In my role as a gastroenterologist at Johns Hopkins, I have seen firsthand this shift to a more holistic approach. During quality improvement meetings, doctors and team members speculate, “How could our next patient be harmed?” Instead of focusing on strengthening clinical metrics, we typically look at the entire care delivery system and a patient’s unique challenges that interact with that system. Fortunately, digital tools can enable this more comprehensive, systems-level view of quality, but what does that actually look like in practice?
A broader definition of quality
Let’s first consider how the current and expanded view of quality can be broken down into four main components, along with how digital health solutions can play a role in improving quality along these dimensions.
- Patient safety: How do we proactively prevent preventable harm to patients? A classic example here is the use of EHR-based decision support tools to ensure that the appropriate prophylaxis is selected to prevent blood clots in high-risk patients admitted to hospital. A more recent and not yet widely adopted example is the application of wearable devices to detect cardiac arrhythmias, allowing earlier detection of risks that were previously not easily identifiable.
- Clinical results: Are we providing excellent clinical care? Historically, this question has been answered in the form of structural metrics (eg, 24/7 coverage by advanced endoscopists for emergency procedures), process metrics (eg, colorectal cancer screening rate in outpatient clinics ) and actual outcome metrics (eg, colorectal cancer mortality ). However, as technological capabilities advance, we have the ability to create novel digital outcome measures that offer a more complete and continuous understanding of health and disease.
- Patient experience: How does the sum of all patient interactions impact a patient’s perception of their care? Digital health solutions offer a number of ways to address overlapping facets of the experience, including enhanced hospital navigation, online patient support tools and communities, and crowdsourced ratings and reviews. These resources are being driven by the broader trend of consumerism in health care.
- Worth: Are we able to reduce healthcare costs and excel in the above categories? Decision support tools that help select the most appropriate diagnostic test for a specific clinical situation, algorithms that use EHR and claims data to identify at-risk patients, and text-based reminders that improve clinic attendance and medication adherence are just a few examples of how technologies can improve care and the patient experience while reducing unnecessary costs.
Digital solutions can identify and bridge the gaps
Traditional healthcare settings are constrained by your episodic personal interaction with the patient. Digital platforms, by contrast, can connect with an individual in different ways, in different places, and at different times. While the digital solutions market can still benefit from further validation, the ability of digital health to connect with patients in novel ways should also be recognized as a unique opportunity to improve all four dimensions of healthcare quality.
At Vivante Health, we provide a comprehensive digital solution for self-insured employers and health plans to better manage the digestive health of their populations by improving the quality of care they receive. We combine a digital platform with the personal touch of a care team to deliver a personalized, clinic-focused experience. Our primary approach to optimizing quality and reducing costs is to develop disease- and symptom-specific clinical pathways.
This means recognizing that clinical medicine is complex. One size definitely doesn’t fit all when it comes to digestive diseases, which account for almost 800 ICD-10 codes. We found that by asking clinically relevant questions that are individually tailored to our members, we are able to identify gaps in each person’s care. We then develop and implement a customized “action plan,” sharing specific tools from our platform to address patient needs. Tools and recommended actions vary by member and may include: dietary counseling with a registered dietitian, personalized education modules, food and symptom log, mobile medication reminders, health coaching sessions, and shareable risk summaries with their doctors.
We use our digital platform to deliver proven, evidence-based interventions in a dynamic, personalized format. And most importantly, these interventions ensure that the Vivante solution is improving quality for patients and the system in all four dimensions described above. Some interventions take the form of risk factors unknown to the individual that prompt more urgent evaluation (patient safety). In other cases, intervention means regularly measuring validated patient-reported metrics (clinical results) and proactively intercept a downward trajectory to avoid an unnecessary ER visit (worth). Vivante also uncovers the biggest factors at play, such as healthcare literacy and affordability, caregiver burden, or work-related anxiety and stress that affect an individual’s ability to navigate their illness and complex environment. health care (patient experience). Additionally, we are incorporating new biometric data (eg, microbiome and breath tests) to see if we can increase the personalization we provide. We were lucky to get promising early results in the real world and look forward to sharing additional analysis soon.
For physicians, there is an intuitive link between improving outcomes and reducing costs, as they see the direct consequences of those who stay on track and those who don’t. Unfortunately, the latter group experiences more frequent acute care visits, more expensive hospitalizations, and a greater need for complex drug therapies and interventional procedures. The first step in getting patients on the path to health is to individually understand what gaps exist. This degree of personalization is truly possible with digital solutions.
Instead of having a rushed, limited annual opportunity to intervene in a traditional clinical setting, digital platforms can act as a near-continuous virtual safety net, catching those who stray from the appropriate clinical path. More importantly, they provide people with innovative tools and interactive support to get back on track and get back on a positive trajectory. The narrative surrounding digital health is often focused on technology when it should be focused on delivering quality healthcare in all its dimensions. As the capabilities of digital platforms continue to grow, there is reason to be optimistic that the quality of healthcare will improve as well. While technology is an incredible vehicle for digital health, the destination is high-quality healthcare.