Transforming episode of care delivery

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POSTED August 7, 2018

Buyer's Guide: How to Evaluate Episode of Care Technology

With value on the rise, healthcare is reaching a tipping point. Patients and paying stakeholders are demanding more for less, putting pressure on providers to cut costs. Outpatient procedures and shortened time in the hospital require greater control of the home. And initiatives for strategic improvement are not possible without useful cost and quality metrics.

 

Technology is the answer. Leading organizations understand the opportunity digital solutions have to offer and are acting quickly to future-proof their service lines and stay ahead of curve.

 

But with tremendous opportunity comes a scrambled vortex of products and platforms, all with seemingly the same message. Until the market thins out, and the best solutions become clear, below are evaluation tactics and questions to guide you in finding the right technology to support your organization.

 

Is it comprehensive? 

Is your organization using five different platforms or portals to solve one challenge? You’re not alone. Instead, find one that creates a complete care continuum by asking-

  • Which organizations have used the platform to augment or replace traditional post-acute rehab services?
  • Are average PROs collection rates greater than 80%? If so, does this include one-, three-, and five-year outcomes?
  • Which product features will help virtually navigate patients? Is there evidence showing positive impacts on care team efficiency?
  • Are there additional fees associated with any features or services?

The whole is greater than the sum of the parts -- by finding one solution that meets these requirements, you’ve probably found a solution better than any combination of point solutions.

 

Is it validated?

Too often, we’re drawn to the ‘latest and greatest’ technology (bells and whistles included). With patients at risk, it’s important to look past the virtual reality goggles and motion tracking hardware and simply ask-

  • Who uses this? [i.e. tell me about five of your clients]
  • Which clients have had 1000+ patients use the technology?
  • Have any clients expanded use of the technology based on results? If so, which ones, and what was the scope of expansion?
  • Do research studies exist that show efficacy of this product?

Essentially, you do not want to be the lone runner ahead of the pack. Be risk-averse by letting your peers do the talking. You get what you pay for, so be wary of free trials or strategic partnerships.

 

Will this technology fit the specific needs of my organization?

Don’t spend tons of time and money changing your existing infrastructure to fit your purchase. Your organization is unique, which your bolt-on solutions should reflect. Adding or subtracting responsibility or workflow disrupts what you’ve already worked hard to build. Optimize and streamline what you have by asking-

  • How are Care Team workflows and pathways configured, and what is the post-go-live support model?
  • How is patient onboarding and ongoing support handled?
  • Will I be forced to integrate it with my EMR? Do I have the option to integrate?
  • Are reports catered for my use cases (registries, business analytics, etc.)?
  • What is required on my end from a technical standpoint?

 

Evidence-based change is only possible when you’ve reached a certain level of efficiency. Without customizable tech and ongoing customer support, it’s nearly impossible to move past the inevitable growing pains.

 

Is it substantive?
“Digital health” is a buzzword, and until we’re comfortable enough asking the hard questions, it will remain so. At the end of the day, your purchasing decisions reflect your business, so be curious to no end, and passionate about what matters most to your organization. Check every box, then check them again. The clinical and financial outcomes are worth the investment.


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POSTED August 2, 2018

Webinar: Future-Proofing Orthopedic Service Line Through Virtual Care

Watch this 15 minute webinar, with Force Therapeutics' Head of Bundled Payment Strategy, Bill Porter to hear about:

  • The strategic focuses of leading orthopedic centers
  • How leaders are future proofing their service lines in response
  • What it takes to build a care continuum outside the hospital

About the Speaker: 

Bill Porter is a member of the founding team at Force Therapeutics. As Head of Bundled Payment Strategy, he has helped some of the largest hospitals in the country adapt to healthcare's changing business models and save millions of dollars on care delivery.

Bill began his career in the financial sector at Capital IQ, a market intelligence company. When he transitioned to healthcare as a strategic sales leader at ZocDoc, he brought his interest in data-based strategy with him. Here at Force, Bill's passion for smart, effective solutions is a key driver in our mission to provide orthopedic patients with better care for less.


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POSTED July 31, 2018

Interview with an Intern: Max


Max Rothman is a rising senior at Cornell University, majoring in biology. He spent his summer interning at Force, working on research with the Clinical Integration team, and captaining our volleyball team. 

Why did you choose this internship at Force? 

Research has been a passion of mine since high school because I have always enjoyed asking questions and problem-solving. The opportunity to conduct research at a health-tech startup was very intriguing to me because it bridges my love for research and entrepreneurship. During my interview process, I also really liked my interviewers and the company values, which were akin to my values - grit, collaboration, and lifelong learning, just to name a few. I envisioned myself developing at Force professionally and personally and forming lasting bonds with my co-workers. Force has exceeded all of these expectations! 

What do you do in your role? 

My day-to-day responsibilities are always changing depending on the needs of the team, but most of my work is focused on assisting with data analysis for research studies validating the Force platform, improving company forms/materials, and pursuing my own research questions/topics. For instance, "do patients who login and watch a certain number of videos have better outcomes?" 

Some days, I might sit in on user interviews and a sales pitch, while other days I might be attending a conference or film shoot. It ultimately depends on the day but I have never not had interesting projects or things to do at Force. 

What does your team do at Force? 

My team (Clinical Integration and Research team) works with medical professionals to help them get accustomed to the Force platform, creates digital content for users and assists with research submissions. Furthermore, my team works cross-functionally on bigger company initiatives. Two examples of cross-functional initiatives that I have helped with are redesigning the Force website (I made suggestions that were implemented into the newest edition of the site) and optimizing the pre-op experience on Force for patients (I ran statistical tests to determine the correlation between different predictor and outcome variables). 

How does that play into Force’s larger mission? 

Force’s mission is to improve care by reducing costs, reducing readmissions and optimizing care. Medical professionals need the Clinical Integration team to help them standardize, and transition to, evidence-based care. Without the team’s constant provision of platform support, content and data, users would neither recover as quickly nor enjoy the platform as much as they do.  

What role do you think research and digital technology will play in the future?

I think research and digital technology is the future. Healthcare is a rapidly growing field that is in need of new technologies to sustain the growing population. Research is also crucial because disseminating clinical findings drives innovation and validates the inventions of the future. Force is constantly pushing the envelope to find new ways to improve care outcomes and help more people. 



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POSTED July 24, 2018

Accountability in Delivering Great Patient Outcomes

Accountability across the healthcare ecosystem is imperative to its inhabitants. As a member of the Client Success team at Force, I am accountable for ensuring a positive and productive Force experience for our clients. Our team has processes in place to listen to and understand our customers' workflows and needs - and then to be responsive, resourceful, and accountable in finding strategic [people/software/system] solutions to their challenges. The follow-through is foundational and necessary for our role. Force is a strong and effective product -- as well as a knowledgeable and proven service.

Being able to prove ourselves and our efficacy is core to Force’s mission. Every team member is accountable to our stakeholders -Patients, Providers, and Executives. We all play a key and measurable role in our mission to provide an evidence-based platform and implementation plan that will enable healthcare systems to deliver quality care to their patients while reducing costs and inefficiencies.

Force collects a massive amount of data, which we funnel into features for our clients, such as Patient Progress, Surgeons Stats, Executive Dash & Reporting, Force Research, & Hospital Scorecards. This helps our clients be accountable to their patients. We also use this data to measure patient connectivity internally. This holds us accountable to our clients and to partnership goals.

Data on the quality and cost of health care services is becoming more transparent across the landscape. New medicare payment models increasingly hold providers accountable for patient care, using hospital experience surveys (HCAHPS) as metrics for reimbursement. This, along with the increasing role that patients play as a consumer of healthcare, make the ability to create and collect stellar outcomes critical, while making providers more accountable to their patients than ever before.

The  “Wear the Cost” initiative in Maryland is an example we love. Through this program, the Maryland Health Care Commission is providing their cost and quality information publicly so that patients and providers are aware of how cost and quality differ among hospitals. As they state on their site: “With this information, everyone in Maryland can join a statewide conversation to better understand the differences in cost and quality that exist, work together to find solutions to reduce those differences, and help patients make the best choices for their care”  

Knowledge is power. I love being part of a team that can empower its clients and itself through evidence -- holding us all more accountable to delivering great patient outcomes.  


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POSTED July 18, 2018

PRESS RELEASE: University Hospitals embraces new technology to extend physical therapy reach

“This video platform and series allow our orthopedic department to extend far beyond traditional geographical borders. We are enhancing patient engagement and communication with care providers with this telehealth tool throughout the episode of care for total joint replacement.” 

-- Matthew Kraay, MD, Director, Joint Reconstruction and Arthritis Surgery, UH Cleveland Medical Center


Earlier this week University Hospitals announced that they are expanding Force across their 18 hospital system. This decision is the result of a successful pilot with seven surgeons and 200 patients in which 90% of the patients who were offered the platform logged in and readmissions were reduced by 28%. Read the full press release below or click here to view the original document. 

PRESS RELEASE: University Hospitals embraces new technology to extend physical therapy reach

Surgery patients can rehab from home with instructional videos

CLEVELAND – University Hospitals Cleveland Medical Center recently announced a new collaboration with Force Therapeutics to aid in the rehabilitation for orthopedic surgery patients. 

Though there can be challenges in managing care for patients who come from greater distances, particularly those who require post-operative physical therapy, UH is empowering patients with information and communication wherever they are. 

The New York-based company is a surgeon-prescribed video platform that guides patients throughout their rehabilitation through video, episode-based education and rehab, automated navigation, and digital communication.

As patients engage in their prescribed care plan, physicians are able to collect patient-reported outcomes and discrete data and analytics throughout the entire process. This platform not only scales navigation teams, but allows clinicians to more closely monitor patient progress throughout their recovery.

University Hospitals conducted a successful three month pilot of the program and is now expanding the use of this program across the 18 hospital system. The initial pilot program included seven surgeons with 200 patients who had an average age of 64.

Almost 90 percent of the patients who were offered the program logged in and completed the entire video set of physical therapy tutorials with positive outcome. Most importantly, a 28 percent reduction in readmission rates was experienced as a result of the virtual therapy sessions.

“This video platform and series allows our orthopedic department to extend far beyond traditional geographical borders,” said Matthew Kraay, MD, Director, Joint Reconstruction and Arthritis Surgery - UH Cleveland Medical Center. “We are enhancing patient engagement and communication with care providers with this telehealth tool throughout the episode of care for total joint replacement. 

The technological solution solves a multitude of problems for orthopedic surgery patients including reductions of complications and readmission rates, and serves as improved options and value for patients. 

The agreements UH recently formalized with Walmart and General Electric to provide their employees with orthopedic care is especially important for patients who would seek treatment with the hospital as the telehealth option would bridge distance and ease the rehabilitation process.

Force Therapeutics presently provides video rehab instruction for over 50,000 patients in 50 hospitals across the country with 155 surgeons participating in the programs.

Join us us for a 20 minute webinar on creating successful virtual care continuums. Learn more here. 


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POSTED June 26, 2018

Employers Partnering with Orthopedic Leaders for Bundled Payment Success

Join us for a 20-minute webinar on solutions for future-proofing orthopedic service line. Learn more here. 

Increasing healthcare costs pose major challenges for employers seeking to create and sustain a healthy and productive workforce. In 2014, Walmart was forced to terminate healthcare coverage for up to 30,000 part-time workers due to $500 MM spent that year on health insurance.

Facing the pressure to cut healthcare costs, progressive employers are strategically aligning with highly selective Centers of Excellence, who are establishing hospitals with highly efficient service lines to act as a destination for specialized care attracting patients and employers. Walmart recently announcing their latest bundled payment partnership with New England Baptist Hospital further demonstrates the identification of financial incentives translated through these models.

Maximizing financial opportunities to coincide with improving health outcomes for employees are driving the rapid expansion to adopt employer-provider relationships including GE, Walmart, Jet Blue, and Lowe’s. With value-based care at the center of focus, proactively pursuing an alignment with Centers of Excellence are proving to be a priority for successful growth.

Employers aren’t the only ones proactively pursuing partnerships. Recognizing the opportunity to attract larger volumes of patients, providers are deliberately establishing themselves as Centers of Excellence by implementing new methods of care delivery that demonstrate better quality outcomes and reduce variation.

Failing to meet certain benchmarks in the bundled payment model is a financial risk for providers, which increases the stakes in improving outcomes while and reducing healthcare cost. In response, providers are concentrating on high-cost areas and incorporating new online technologies that further develop their communication and patient engagement beyond the hospital.

As a solution to trim healthcare costs, providers are implementing digital solutions to reduce usage of post-acute home health and therapy services. Digitally extending the communication and control outside the hospital allows providers to deliver high-quality care to higher volumes of patients.

Several studies with leading Centers of Excellence now show that providers who deliver remote rehab through digital platforms can successfully manage patients and improve outcomes. As employers pursue leading providers for potential partnerships, providers must find ways to demonstrate their ability to deliver value. Establishing a Center of Excellence to employers requires innovative solutions and adoption of technologies such as episode-of-care platforms for bundled-payment success.

 












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POSTED June 22, 2018

Force-enabled Research at AOA

Next week, the American Orthopaedic Association (AOA) meeting in Boston will gather leaders from the orthopaedic community pursuing advancement in the future of musculoskeletal care.

As orthopaedics shifts to value, the growth of Medicare (e.g. BPCI, CJR), Commercial and Employer bundled payment models for joint replacement are requiring providers to innovate and approach care delivery differently.  Considering the broad and rapidly transitioning landscape, the AOA meeting will presumably cover the proliferation of digital health solutions, and the impact these solutions are having in helping providers execute the shift.

Leading centers across the country (e.g. Geisinger, Northwell, Scripps, University Hospitals, etc) are incorporating digital care solutions into their care delivery strategy to minimize the reliance on, and cost of traditional post-acute care services (e.g. Home Care, PT, SNF) and embed virtual care into the continuum, enabling self-care and scalable digital patient navigation outside the hospital. 

Digital care solutions not only drive value by improving cost and resource efficiencies but are a powerful data engine capturing never before seen patient data.  Organizations are using big data gathered from patient engagement platforms to more efficiently and effectively run their business, redesigning care backed with evidence.

The Force platform collects outcomes and discrete data points as patients move through their care, providing organizations with new insights and access to information. The insights Force gathers is being used by clients to further measure, standardize and differentiate their care episode. With the help of Force’s research team, Force’s clients have been continuously publishing innovative research that is challenging the status quo.

The Force team has two research studies being presented at the AOA conference with partners from NYU and The Rothman Institute, both of which validate the efficacy of the Force platform impacting post-acute care reduction and enhanced patient-reported outcomes (PROs) collection capabilities, compared to traditional methodologies.  

Below are the two Force studies being presented at AOA:

“Successful Outcomes Can Be Achieved With a Web-based, Home Therapy Program after TSA” 

The Rothman Institute: Daniel E. Davis, MD, MS; Ryan COx, BS; Mark Lazarus, MD; Matthew Ramsey, MD; and Surena Namdari, MD, MS

“Improved Patient Reported Outcome Collection Through Integrated Online Patient Portals”

NYU Langone Orthopedic Hospital: Chen KK, Feng JE, Anoushiravani AA, Kim KY, Novikov D, Spira B, Davidovitch RI, Iorio R


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POSTED June 18, 2018

HIPAA Compliance and the Cloud

Stephen Johnston is the VP of Engineering at Force

Traditionally hospitals and other large healthcare institutions managed their own physical servers and IT infrastructure in-house. Today, most of these organizations have either already moved their entire infrastructure to the cloud, are running in a hybrid configuration, or have plans to move to the cloud very soon for a variety of reasons.

Most cloud platforms, including Amazon Web Services (AWS), recognize that their clients are diverse and require that their infrastructure enable a multitude of different compliance programs to be met and they have already gone through the processes of certification to enable this for their customers. Healthcare organizations require that their infrastructure be HIPAA compliant, and other organizations that process payments require that their infrastructure is PCI compliant. There are many different compliance programs and you can see the full list which AWS supports here.

The short answer to “May a HIPAA covered entity or business associate use a cloud service to store or process protected health information?” is "yes", but there are many details to this question that have to be considered.  We will cover some of those considerations in this blog.

How does AWS enable HIPAA compliance? 

In order to run sensitive workloads in AWS regulated under HIPAA the service provider must first accept the AWS Business Associate Addendum (BAA).  The AWS BAA covers the use of a set of HIPAA Eligible Services which can be used to store, process, and transmit PHI.  In addition, AWS offers the "Creating HIPAA-Compliant Medical Data Applications with AWS" whitepaper which outlines how companies can leverage AWS services that facilitate HIPAA and HITECH compliance.

The HIPAA Security Rule includes specifications for the encryption of PHI in transmission (“in transit”) and in storage (“at rest”).  AWS offers a comprehensive set of features and services to make key management and encryption of PHI easy to manage and simple to audit. Service providers with HIPAA compliance requirements have a great deal of flexibility in how they meet encryption requirements for PHI.

What is the Shared Responsibility Model?

It is not enough that AWS itself is secure.  The service providers building the SaaS applications on top of AWS also have a responsibility to configure and use those services in a way which is secure and compliant.  This is called the “Shared Responsibility Model”. 

AWS is responsible for the Security “of” the Cloud.  The service providers have no physical access to the data centers so the security of the infrastructure falls on AWS.  AWS operates, manages, and controls all the components from the host operating system and virtualization layer down the physical servers themselves.  The infrastructure also is composed of all the hardware, networking, and facilities that run AWS Cloud services.

The service provider is responsible for Security “in” the Cloud.  The service provider’s responsibility will be determined by the AWS Cloud services that a customer uses to build out their applications. This determines the amount of configuration work the customer must perform as part of their security responsibilities.  The selected AWS services all have various different aspects which must be configured correctly by the service provider in order to ensure that their service is HIPAA compliant.

Conclusion

Security and compliance is an important, ongoing and evolving process, but AWS customers have the tools available to them to run secure HIPAA compliant workloads in the cloud.  In some cases one would argue even more secure and cost efficient than running their own on premises data centers.  There are very large reputable private organizations and government institutions who entrust their data to the AWS cloud and given the breadth and depth of the security accreditations they stand on they are second to none.


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POSTED June 8, 2018

The Importance of Creating a Virtual Care Continuum

Bill Porter is the head of bundled payment strategy at Force

Join us for a 20-minute webinar on solutions for future-proofing orthopedic service line. Learn more here. 

As we’ve written about before, stakeholders who pay for healthcare in the US (the government, employers and now traditional consumers themselves) are demanding better care for less money.  

Orthopaedics has been a focus area given Musculoskeletal diseases’ prevalence and cost burden.  New reimbursement models (e.g. outpatient joint replacement, surgical bundled payments, condition-state bundles, etc.) are being rapidly adopted to incentivize behavior change and reduce costs. These reimbursement models give providers opportunities to share in savings and revenue by developing more efficient, evidence-based pathways.

In order to clinically and financially succeed in these opportunities, leaders are fundamentally rethinking care delivery -- working to find ways to wrap their arms around patients when they’re outside the hospital. Providers have traditionally micromanaged what happens inside the hospital, now they need to figure out how to micromanage what happens outside of it.  

Timeline of touch points across a traditional episode of care.

Managing care beyond the hospital depends on continuous care in the pre- and post-op period.  In order to create a care continuum, leaders are aiming to create a connected set of providers centered around the patient who can ensure care transitions are seamless, efficient and evidence-based.

Many organizations have leveraged analog tactics to accomplish this -- i.e. hiring care navigators, acquiring or building traditional post-acute care like SNFs, home care agencies, or PT clinics, or partnering with these post-acute providers in the community through a preferred (or narrow) network.

These methods aren’t achieving the ultimate goal of the value shift. They’re high cost and struggle to reach patients in between traditional encounters, where 99% of recovery takes place. 

As other industries are increasingly scaling through digital technology, Healthcare is the only field in the US that has added employee headcount over the last 10 years.  It’s one of the only industries who is still building traditional brick & mortar every chance it gets. 

It’s now been proven in myriad research studies that providers can successfully use technology to navigate patients, deliver rehab virtually in the home and track progress in real-time.  Digital platforms are the most efficient and effective model for creating access and continuity of care required for success in the rapidly changing healthcare landscape.

Timeline of touch points across a digital episode of care.


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