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    a16z Bio + Health #16: Digital Health for Complex Care

    enJune 17, 2021

    Podcast Summary

    • Revolutionizing Complex Care with Digital Health ToolsDigital health tools can transform care coordination and delivery for complex cases, focusing beyond primary care and wellness, and emphasizing disagreement and debate for valuable insights.

      Digital health tools and platforms have the potential to revolutionize complex care coordination and delivery for our sickest patients, particularly those with chronic conditions like heart failure, cancer, COPD, poorly controlled diabetes, and renal failure. The panel, consisting of healthcare leaders and experts, acknowledged the importance of digital health solutions in managing these complex cases and reducing reliance on emergency departments. They discussed the need to move beyond virtual first primary care and wellness care, and instead focus on how digital health can address the challenges of complex care coordination and delivery. The group also emphasized the importance of disagreement and debate to draw out the most interesting insights. The panelists represented various perspectives, from the president and co-founder of a prominent healthcare CEO organization to the founder and CEO of a health tech start-up, all emphasizing the significant role of technology in this segment of healthcare. The debate also touched upon the potential of EHR features and the possibility of realizing the full potential of digital health in complex care delivery.

    • Recognizing the difference between consumers and patients in digital healthSuccessful digital tools meet people where they are in their health journey and augment clinician involvement, integrating into traditional care settings for improved outcomes and cost savings.

      When it comes to using digital technologies for complex health conditions, it's important to recognize the difference between consumers and patients, and where they are in their journey. Digital tools can provide convenience and relationships, but they need to be deployed differently. The nuanced approach requires thoughtful consideration and integration into traditional care settings. Otherwise, the digitization of care can create more confusion and complexity rather than solving it. The most successful digital tools are those that can meet people where they are in their health journey and augment clinician involvement. From a payer perspective, it's crucial that digital tools and solutions integrate into the care settings where patients receive care to ensure they move outcomes and bend the cost curve.

    • Digital health tools bridge gaps in patient careDigital health tools optimize care coordination, enhance communication, and support patients by connecting them with various provider access points, becoming part of the care continuum.

      Digital health tools play a crucial role in connecting various aspects of patient care, acting as a fabric that stitches together information from different points of the healthcare spectrum. Hospitals, especially during the COVID-19 pandemic, have highlighted the need for more effective coordination of care and the potential for digital health tools to streamline the process. These tools help manage patients outside the hospital, allowing for more comprehensive understanding of their health journey. They also facilitate better communication and trust between patients and healthcare providers. While the intention is not to replace hospital care for critically ill patients, digital health tools can help optimize care coordination and support consumers by connecting them with various provider access points. By integrating into traditional workflows and becoming part of the care continuum, digital health tools can significantly enhance the overall healthcare experience.

    • Digital solutions for non-clinical healthcare needsDigital health solutions can improve healthcare efficiency and patient experience by addressing non-clinical needs like care coordination, patient navigation, and socioeconomic support, leading to better outcomes and a more streamlined healthcare experience overall.

      Digital health solutions have a significant role to play in improving healthcare efficiency and patient experience, particularly in areas beyond core clinical care. While clinical applications like digital diagnostics and clinical decision support are crucial, addressing non-clinical needs such as care coordination, patient navigation, and socioeconomic support can be equally impactful. The administrative burdens and complexities of the healthcare system can significantly hinder clinical progress, and addressing these challenges through digital means can lead to better outcomes and a more streamlined healthcare experience overall. Furthermore, focusing on non-clinical areas could offer unique opportunities for tech companies to make a difference, particularly in leveraging logistics and social determinants to improve patient care.

    • Digital health tools for underserved communities: More than just access to careDigital health tools like telehealth and remote patient monitoring can improve outcomes, but access to healthcare is just one factor in population health. Ease of use, intelligent medical knowledge, and human judgment are also crucial.

      While digital health tools like telehealth and remote patient monitoring have the potential to improve health outcomes for underserved communities, they are only one piece of the puzzle. Access to healthcare is just one factor influencing population health, and the ease of use and intelligent combing of medical knowledge are also crucial aspects of digital health's evolution. However, it's important to remember that there is still a significant role for human judgment and empathy in healthcare, especially when it comes to diagnosing and managing complex conditions. The ongoing debate is about how digital health tools will enable and enhance the work of healthcare professionals rather than replacing them entirely. As for the impact on physician training, there may be a shift in focus towards administrative automation and access to care, but the core care delivery skills will remain essential.

    • Integrating digital and clinical aspects in healthcareDigital tools support clinicians in making informed decisions, managing patient panels, and learning from past experiences, while improving patient access and experience.

      The future of healthcare lies in the integration of digital and clinical aspects. Both aspects are interconnected and essential in improving patient access, reducing administrative burden, and enhancing clinical decision-making. The clinical side of digital health tools offers significant opportunities for doctors to become more effective and efficient, while the non-clinical side focuses on improving patient access and experience. The ideal solution is a digitally integrated healthcare system where digital tools support clinicians in making informed decisions, managing patient panels, and learning from past experiences. The ongoing challenge is to strike the right balance between the two and minimize the analog workload on clinicians. As Tarun pointed out, the physician inbox is an often overlooked aspect that prevents physicians from doing great work. The future of healthcare is about understanding how to integrate digital and analog elements effectively and efficiently.

    • Revolutionizing healthcare administration with digital toolsDigital health tools can streamline workflows, filter data from EMRs, and provide AI-driven decision support, but their implementation requires a focus on workflow adaptation and a long-term, scalable strategy to address the unique challenges of different healthcare providers.

      Digital health tools have the potential to revolutionize healthcare administration, but their integration into clinical workflows is complex and challenging. The speaker shared an example of the overwhelming amount of data from electronic medical records, which highlighted the need for digital tools to help filter and analyze information. However, he noted that most attempts to build digital health tools for clinical use have failed due to the difficulty of adapting to the unique workflows of different healthcare providers. The speaker also emphasized the importance of addressing clinician burnout as a significant issue in healthcare and how digital health tools can help alleviate it by streamlining workflows and providing AI-driven decision support. Despite the challenges, there have been successful implementations of digital health tools, particularly in rural health and telehealth. Overall, the speaker encouraged the audience to consider the potential of digital health tools to improve healthcare, but to approach their implementation with a focus on workflow adaptation and a long-term, scalable strategy.

    • Digital health tools: Beyond the hype cycleWhile digital health tools show promise, it's crucial to focus on real-world outcomes and ask fundamental questions, recognizing that existing tools like smartphones can make a difference in healthcare.

      While there is excitement around digital health tools and their potential to revolutionize healthcare, it's important to keep a critical perspective and focus on real-world outcomes. The comparison to traditional analog tools may not be fair, as digital tools are still in their early stages and face unique challenges. However, there are examples of digital health tools making a meaningful impact on clinical outcomes, particularly in areas like telehealth and remote patient monitoring. The hype cycle for digital health may be ahead of the delivery cycle, so it's crucial for clinicians and practitioners to stay grounded in reality and ask fundamental questions. Additionally, there are already existing tools and technologies, such as smartphones, that are making a difference in healthcare without the need for large startups. Overall, it's essential to approach digital health with a healthy dose of skepticism and a focus on tangible results.

    • Digital health tools improve health outcomes with simple tasks and proactive guidanceDigital health tools can enhance healthcare delivery by automating tasks and offering guidance, but for complex chronic care, predictive analytics may be required. Investment in technology depends on organizational needs and resources, and process improvements are crucial for optimal results.

      Digital health tools can significantly improve health outcomes by automating simple yet crucial tasks, such as medication reminders, and providing proactive guidance to patients. These tools don't need to be complex or expensive to make a difference. In fact, even a small increase in operational efficiencies could mean the difference between life and death for an integrated delivery network. However, to truly move the needle on chronic complex care, more advanced technology like predictive analytics may be necessary. The decision on where to invest in technology depends on the specific needs of the organization and the resources available. It's important to remember that every system is designed to give the results it gives, and digitizing an inefficient process will only result in incremental improvements. To unlock the full potential of digital health, we need to redesign the way we deliver healthcare and combine digitization with process improvements.

    • Basic challenges in healthcare logistics despite interest in advanced techDespite interest in advanced tech for healthcare logistics, basic challenges persist such as lack of action on existing data and analytics, and the need for organizations to develop capabilities to address insights gained. Balancing basic and advanced solutions is necessary, focusing on simple front-end technologies and complex back-ends.

      While there is a growing interest and potential for advanced predictive analytics and AI in healthcare logistics, particularly in the transition of care from clinician's office to pharmacy, the industry still faces basic challenges. These challenges include the lack of action on existing data and analytics, and the need for organizations to develop capabilities to address the insights gained. The role of venture capital firms in funding and developing these areas is valuable, but it's important to acknowledge what has and hasn't been accomplished yet. A balance between basic and advanced solutions is necessary, focusing on simple front-end technologies that meet end-user needs while having complex back-ends that truly understand patients. Solving basic problems with technology is a crucial step before tackling more complex predictive analytics and patient outcomes.

    • Balancing advanced tech and basic solutionsInvest in both basic solutions and advanced tech for digital health, focusing on end-to-end platforms and care coordination for effective healthcare solutions.

      While advanced technology in digital health is important, it's equally crucial to address "basic" problems with straightforward and understandable solutions. The industry risks overfunding commoditized tech that doesn't deserve such high investment. However, high-impact solutions may require advanced technology to achieve significant impact. A more comprehensive approach, focusing on end-to-end digital platforms, is essential to address complex healthcare needs effectively. Care coordination plays a pivotal role in ensuring these solutions are accessible and navigable for patients.

    • Coordinated approach to healthcare transformation through technologyEffective healthcare transformation through technology requires a coordinated approach, engaging patients uniquely, using a command center approach, and focusing on provider strengths.

      Effective transformation in healthcare through technology requires a coordinated approach that combines the right algorithms for change with good patient engagement. Unique companies excel in this area by engaging patients uniquely, reaching different subsegments. A command center approach can help orchestrate this change, but it's crucial to avoid sending people in multiple directions. From a physician's perspective, it's essential to identify problems and use technology to improve experiences. Providers should focus on what they can do well and partner with others for areas outside their expertise. As technology advances and specialization deepens, there will be opportunities for provider organizations to focus on their strengths and collaborate within the healthcare ecosystem.

    • Shifting towards end-to-end solutions through partnerships and outsourcingHealthcare organizations may focus on their core competencies and partner with tech companies and specialists for digital health solutions, interoperability, AI risk stratification, and non-clinical tasks automation.

      The healthcare industry is shifting towards end-to-end solutions, but not every organization will handle every part of the continuum of care. Instead, partnerships and outsourcing to tech companies and other specialists may become common. Digital health, particularly in multidisciplinary care, shows great potential, with opportunities for interoperability, AI risk stratification, and non-clinical tasks automation. However, complex care populations, who often don't trust the healthcare system, require alternative models focusing on building trust from the outside in. These are some of the key areas of growth and innovation in the healthcare sector.

    • Building trust in healthcare with digital toolsEffective communication and prioritization by leadership are crucial in implementing digital tools in healthcare to reach underserved populations, build trust, and improve patient engagement and satisfaction.

      Trust is the most important element in merging humanistic elements with digital tools and technology in healthcare. While digital tools can help reach those not in the system, identifying them through analytics is only the first step. The real challenge lies in creating the necessary bandwidth within the system to bring them in. Leadership plays a crucial role in prioritizing and actualizing these tools, as they have existed in lesser forms in previous generations but failed to make a significant impact due to lack of focus and specialized effort. Effective communication, especially in large organizations where trust is often lacking, is essential in building trust and enabling the use of more advanced interventions. A simple example is the use of basic tools like translator services to help patients understand their care and build trust. From the patient's perspective, basic communication tools can go a long way in earning trust and setting the foundation for more advanced interventions. Additionally, asking patients for their language preference and preferred communication channel is a simple yet effective way to improve patient engagement and satisfaction.

    • Understanding patient preferences for effective healthcare deliveryEffective communication in a patient's preferred language and method can significantly impact their perception of care and ultimately, their health outcomes. Healthcare leaders should consider implementing tools to accurately identify these preferences.

      Effectively delivering healthcare to patients requires understanding their unique preferences and needs. This includes factors like language preference and communication method. Leaders in healthcare systems should consider implementing tools that can accurately identify these preferences to ensure clinical interventions are effective. The ability to communicate in a patient's preferred way can significantly impact their perception of care and ultimately, their health outcomes. This is not a binary issue, and there is a vast amount of nuance to explore as we continue these discussions in the coming weeks and months. Thank you to all our guests and audience members for joining us today. We appreciate your time and insights.

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