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POSTED March 21, 2018

Power User Spotlight: Rita Hall and Kelly McCrone at University Hospitals

Here at Force we are lucky to work with some pretty incredible healthcare professionals. This spotlight series serves to celebrate some of the fantastic users of the Force platform. It's a chance to learn from Force pros about favorite features, tips and tricks and learn more about them in the process.

Kelly McCrone and Rita Hall work closely together at University Hospitals in Cleveland, Ohio. Rita is the Total Joint Replacement Program Coordinator and Kelly is the Total Joint Replacement Patient Navigator. With over 30 years of patient care experience between them, we were excited to get their take on Force’s impact and where they think healthcare is headed. 

1. How has your day to day changed since using Force?

Rita: Playing “phone tag” with patients was tremendously time consuming prior to Force. Now we can message a patient anytime, anywhere. 

Kelly: Less phone calls overall and less time playing phone tag with patients.

2. What features do you find most useful?

Rita: Outcomes collection is a huge help, especially in my role as TJR program coordinator. PROs are a major component of the requirements for accreditation. Efficient PROs collection allows University Hospitals to maintain the Advanced Certification from The Joint Commission and submit data to the American Joint Replacement Registry. 

Kelly: I love the mass messaging. I used to call all the patients 2-3 weeks prior to surgery asking them the same set of questions: Do they have a care partner? did they take class?…etc.  Now I can send a mass message with those questions, which frees up time.

3. Do you find that Force makes you more efficient? 

Rita: Yes, the screen has all the information needed, surgery date, etc.

Kelly: Absolutely! It allows me to spend time with the patients that really need my attention and I have more time to dedicate to other responsibilities. 

4. How do you think about technology’s role on a Care Team now and in the future?

Rita:  I think technology will be at the forefront of Care Team workflows in the future. Force provides patients with a real-time connection to our team. 

Kelly: Technology is the way of the future!  We are only going to see more of these innovations in health care. I love the prompt response of the tech support when we have questions or when patients have questions.

5. What’s a fun fact about you?

Rita: I volunteer at the Kids Book bank to promote literacy in young children

Kelly:  I have been married for 15 years and am a mother of three. I swam in college at Edinboro University. 


POSTED March 20, 2018

The Opioid Epidemic in Orthopaedics

The opioid epidemic in the United States is nothing new. It has been a persistent problem that we failed to address for many decades. At this point,the US accounts for less than 5% of the world’s population, and consumes 80% of world’s opioid supply.

Orthopaedic surgeons are the third-highest opioid prescribers among all physicians, making orthopaedic surgery a major contributor to the current epidemic. With all the media coverage over the years, there has been a rising awareness in the orthopeadics community and many surgeons have started prescribing less opioids to their patients. Despite the efforts, however, the decline in opioid use has not been fast enough to bring meaningful impacts. So what have been the roadblocks?

The first is derived from the current trend towards value-based care and its emphasis on patient satisfaction. Since hospitals are financially incentivized to obtain high scores on the HCAHPS survey, which captures key elements of patient satisfaction -- including treatment and management of pain-- providers are naturally inclined to prescribe opioids. Jena et al. have reported a significant correlation between a hospital’s rate of post-discharge opioid prescriptions and patients’ reporting of “well-managed pain” via HCAHPS.

Second, a large portion of opioids are being prescribed to patients who actually need opioids. According to Bob Twillman, PhD, executive director of the Academy of Integrative Pain Management, a large share of the opioid consumption in the US could be attributed to chronic high-pain patients. Many of these patients have already developed opioid-induced hyperalgesia and resistance to low-dose opiate therapies prior to their orthopedic surgeries, making it unethical to dramatically limit their access to their opioid medications.

So what can we do? The complexity of the opioid crisis requires a collaborative, systematic approach. Everyone, from medical professionals to legislators to educators, has a role to play in order for these systematic changes to come to fruition. We must strive to establish interventions that prevent new patients from developing opioid dependence while continuing to support those who are already dependent on opioids. Here are some key approaches:

  • Implementing new evidence-based prescribing practices

Physicians must consider all other non-opioid treatment options prior to any opioid prescription. Every physician should be under a strict yet easy-to-follow opioid prescribing protocol like that of Kaiser Permanente where physicians encounter a series of decision support prompts within their prescription systems before they can assign any opioid medication. In addition, there needs to be a continued effort to validate long-term efficacy of opioids at varying dose ranges. Implementing evidence-based insights would allow physicians to prescribe the right dose, at the right time, in the right way.

  • Developing predictive tools

Care teams should identify patients who are at greater risk for opioid addiction based on their baseline characteristics and medical histories. For example, patients with a history of alcohol or drug abuse and who had been on high doses of controlled substances for extended periods of time, require more attention and education.

  • Fostering clear communication

Providers should fully explain the risks of opioids to patients and their families during their visits. Also, it is crucial to understand their attitudes and concerns about postoperative pain as setting reasonable expectations would allow patients to better cope with pain, without relying too much on their opioid prescriptions. Lastly, practicing on-going and more empathetic communication, especially with patients who are at higher risks of becoming opioid dependent, is key. Patients feel more comfortable taking fewer opioids when they know their providers better. Using an online messaging platform, such as Force Therapeutics, could be an effective way for both inbound and outbound communication.

The opioid epidemic has been decades in the making. Addressing this crisis will obviously require a lot of resources and efforts from everyone involved. It will be a long, slow process requiring much patience and consistency, but we need to remind ourselves that every step counts and we need to keep going.


POSTED March 9, 2018

Building a Culture For Innovation

Claire manages people operations at Force. 

There is no question that healthcare is about people -- and we’re smack bang in the middle of a shifting value landscape where providers are forced to do more with less. Traditionally, the approach to care has led to overutilization of costly services that sacrifice patient well-being and satisfaction. Technology is emerging as a clear solution, but making technology successful in the healthcare space is a unique challenge. It requires an empathetic and all-hands-on-deck approach. 

Que Force. We understand that successful healthcare technology is about the people who use it and the processes it can scale. Our team is dedicated to the idea that technology can connect and empower people to deliver and experience better care, at more accessible costs. In a field known for its wariness of technology, it’s critical that we form and foster a culture that is curious, determined and ready to tackle obstacles head-on. And that’s what we’ve done. 

Our culture is defined by the positive energy our team brings to their work -- we truly value the way in which things get done. When you walk off the elevator into our open office, you can feel the momentum and optimism in the air. I see it in our interactions with coworkers and the attitude with which our team responds to challenges as they arise. 

We come from many different backgrounds. We have people who bring with them formal healthcare experience, and those who bring experience from other industries, but no matter which route we’ve taken we all have a mutual respect for the knowledge our team members bring to the table. Bronwyn, our co-founder and CEO, brought other strong leaders on early. And we continue to grow with a firm belief that the best teams hire smart people who share in their mission and give them room to do what they do best. 

What I love most about Force is the genuine passion on our team. We support each other when pushing new ideas forward, and we show up for each other so we can get one step closer to achieving our goals. We have high expectations for what we can achieve and where we’re headed and we all hold each other accountable for doing what it takes to get there. 

A culture you want to be a part of, creates a company people want to work with -- a company that gets things done and has fun doing it. We are only able to produce such a dynamic platform and service because of the people who work here. Innovation is difficult. Any team looking to take on the status quo needs to be solution-oriented, aligned and optimistic. 

Our foundational values are what align us. I’m excited to kick-off a series of team spotlights over the next few months -- individual team members will share their insights into how our values drive their work. 


POSTED February 8, 2018

How to Make BPCI-A Work For You

BPCI Advanced is coming fast.

Given the success of many organizations in BPCI 1.0, surgeons and hospitals are eager to capitalize on the financial perks of quarterbacking the entire episode of care.

The basic idea of BPCI-A -- included as an Advanced Alternative Payment Model (AAPM) under MACRA -- is similar to BPCI 1.0 -- i.e. incentivize providers to reduce unnecessary variation across the holistic episode of care.

From our work with leading centers across the country, three themes have emerged as mission-critical to drive bundled payment success:

  • Optimize patients
  • Standardize and manage post-op care
  • Continuously monitor outcomes

Optimize Patients

In the new bundle model- retrospective reconciliation will play a large roll in what your organization can get back from CMS. While we don't yet know specifics of this biannual calculation, we do know that quality performance can alter your reconciliation amount by up to 10%. So focusing on improving this metric is key, as it can have significant impact on your CMS reimbursement.

Patient optimization is a critical part of cost & quality improvement. There are a wide-range of validated risk assessment tools and research on the hard stops for surgery (e.g. A1C levels, BMI, smoking, etc.). It’s imperative that all physicians buy into and leverage these tools to ensure the right patients are being operated on. For patients who are not optimized, there must be resources to support them in the changes that can be made to get them to be a safe and successful surgical candidate.

Standardize and manage post-op care

For joint replacement, the variation in cost occurs after discharge (30-50% of total episode cost is post-acute). The hospital stay is micromanaged, but when patients return home, Care Teams lose complete control of the outcomes. Patients are on their own, and without ongoing education, communication or monitoring, problems arise.

Historically, Care Teams relied on traditional post-acute services (e.g. SNF, Home Health, Outpatient PT) to manage their patients’ recovery, but these services are costly and cannot be sustained. Many top centers have begun to digitize recovery with tele-rehab and remote navigation, proven to enable control for a lower cost, and this trend will only continue to grow.

Continuously Monitor Outcomes

You can’t improve what you can’t measure. In order to build a culture of ongoing improvement, you must track outcomes (e.g. PROs, patient satisfaction, etc.), episode costs and complications in as close to real-time as possible. Teams must have analytic capabilities to understand unnecessary physician and facility variation. Evidence will not only expose current opportunities, but can point to and validate future solutions.

The only way to achieve this efficiently is to increase connectivity with the patient, so data can be collected wherever they go. Implementing real-time monitoring that consistently engages patients is the best way to capture valuable data that can guide system-wide decision-making.

Even the most efficient providers are committing to care redesign in the face of BPCI-A. They will need to overhaul their service lines quickly and thoughtfully, in order to get the most bang for the healthcare buck with this new model. It’s time to embrace the change.

Applications are due March 12th. For information on how to apply, click here


POSTED January 17, 2018

Creating a Valuable Patient-Provider Relationship

Ange Delgado leads the product team at Force

Implementing value-based care means improving or maintaining quality while reducing costs and variation. Given that many unnecessary costs occur when the patient is in the hospital, (and that shorter hospital stays decrease risk of infection) reducing length of stay is a priority. However, the less time patients spend in the hospital and around the care team, the more important it becomes to extend patient - provider communication outside the hospital.

The transfer of information from provider to patient is a critical element of successful care. Traditionally, that transfer occurs through in-person visits, hours of phone calls, and a paper packet of information that gets sent home with the patient. Providers remain a key source of patient instruction and direction, but intermittent phone calls and few in person office visits are not sufficient across an episode of care.

Many organizations are looking to technology to help them keep in touch with patients outside the hospital. The obvious solution is to use messaging tools to bridge the gap between patient and provider. While this is a good first step, simply opening up more access to 1:1 conversation might actually add work for providers rather than decrease it.

Building a messenger alone doesn’t replace the large educational paper packet that patients are sent home with and told to read. And it doesn’t help provider have better context for patients’ questions. Tech platforms have a unique ability to effectively answer questions before they need to be asked. Here are some important features for scaling communication:

Asynchronous messaging and telecommunication

Telehealth has been a buzzword for strategies in implementing value based care. While real-time video visits give providers a great sense of a patient’s progress, they are criticized for not actually saving providers much time. A solution to that problem is asynchronous video. Patients can send video updates demonstrating wound healing, range of motion, gait -- all without the need for the patient and provider to be sitting down at their computers at the same time. With asynchronous video, providers can review videos on their own time.

Real time data collection

Responding to patient concerns and questions about their progress can be difficult and inefficient without insight into their progress. Collecting and displaying data points including step count and pain level helps care team members understand the context for their patients concerns. This reduces the need for follow up questions and allows for swift, thorough responses.

Phased, digestible education

While it’s important to manage patient expectations and explain the care plan well ahead of the surgery, attempting to understand every detail at once can be overwhelming. Paper packets can be long and confusing, and long conversations during in-office visits can vary and be forgotten. Standardizing and delivering the details at the right time, and in the right medium, makes a big difference.

If the goal is truly to scale the most important and underutilized member of the Care Team -- the patient -- then care delivery itself has to change. Innovating around the way clinical information is shared is part of that shift. As care continues to move online, there is opportunity to create a new transparency and connectivity within the patient-provider relationship. Providers who adopt the right technology, can offer unprecedented levels of clarity to patients and Care Teams.


POSTED January 4, 2018

Power User Spotlight: Katie at Muve Health

Here at Force we are lucky to work with some pretty incredible healthcare professionals. This spotlight series serves to celebrate some of the fantastic users of the Force platform. It's a chance to learn from Force pros about favorite features, tips and tricks and learn more about them in the process.

Katie is a navigator at Muve Health. With over 10 years of orthopaedic nursing experience, Katie is no stranger to the changing tides of healthcare and rolling with the punches to ensure the best outcomes for her patients.

Compared to your prior nursing experience, how has now using Force changed your day to day?

I’ve had the fortunate opportunity to practice in a similar role that I’m doing now in the past with trying to manage patients preoperatively and postoperatively. Being able to communicate with all of my patients via 1 seamless platform has made my life so much easier as well as having the opportunity to ensure that patients are being compliant with what has been prescribed for them.

What features do you find most useful?

Having a view of who is all caught up on their forms has been super useful. It gives me a quick glance of who I need to follow up with. I also really enjoy being able to receive pictures through the messaging system. This allows the patients and me to have a safe environment to check on them.

Do you find that Force makes you more efficient? If so, what do you do with the added time?

It absolutely makes me more efficient!! I am now able to spend time talking with the patients about their emotional needs for the procedure they are about to have and create a deeper connection with them. This in turn I have found, creates a bigger accountability to complete their surveys/forms. It’s a win/win for everyone!

How do you think about technology’s role on a care team now and in the future?

I don’t know what I would do without technology being a part of my care for a patient. It’s how we all communicate these days and allows us to track outcomes and most importantly reach patients that may not have easy access to healthcare with the exercises. I’m sure it will only increasingly become part of the way healthcare is delivered in the future.

What other challenges are you facing that technology could address?

I think we still have a lot of opportunity in the way we integrate with other health care services. There seems to be a gap in what happens at the doctor's office, hospital, therapy services and whatever else the patient may utilize to have a successful surgical outcome.

What's a fun fact about you?

I have participated in 7 Spartan Races!!


POSTED December 13, 2017

Charlie Martin and the New Business Mindset

In a recent episode of A Healthy Dose podcast, interviewee Charlie Martin shared his thoughts on the future of healthcare. The founder of the Vanguard Health Systems, who entered the industry quite literally from the ground up with his work in construction, is now planning on tearing it down. In his own bio, he presents himself as a man on a new mission. “As a former hospital operator, Charlie Martin is well aware that he was part of the problem with healthcare and healthcare delivery. Now, he wants to be part of the solution.”

While some of his thoughts on the issue were a bit radical -- his ideal scenario involves cutting in-hospital care in half, and doing “the half that’s left...for half the price.” -- his line of thinking speaks to the coming trends and changes.

The issue is, the entire healthcare system costs too much, and changes must be made to maximize efficiency. The question then becomes, what are the leaders doing now to position themselves in a way that prepares them for this future ultimately leading them to greater success than those that don't?

Adopt a Commercial Business Plan and Mindest:

Going digital to go global

Uber is a leading taxi service without owning cars, AirBnB is a major hotel competitor without owning buildings. Software and digital platforms are gaining serious traction in every other industry, and it will in healthcare too.

Physical hospitals are massive cost drivers, so moving recovery into the home, which has positive impacts on outcomes anyway, will keep costs down. Many health systems are already doing this, but without fully rectifying the miscommunication that comes with distance. Technology can help bridge that gap with communication and education while preventing unnecessary post-acute costs.

Right now, physicians have to increase their patient volumes astronomically to maintain a profit. But, in current systems, more patients means harder to manage. Going digital expands reach to any patient no matter how far, while physicians better manage the high volumes of care.

Create an Experience

In a commercialized market, inundated with choice, healthcare systems will need to find new ways to captivate the “consumer patient” by meeting them where they are -- they way every other business does. Offering a stellar product isn’t enough anymore. You have to frame your product to fit into a holistic experience.

The first step is to understand that your entire episode of care is the “product”. Each step in the care process must then be treated as equal parts of the whole, from the moment surgery is scheduled, through recovery. How patients experience that product is clinical, administrative, and emotional. Health systems are becoming responsible for all of it.

Transparency with Cost and Effectiveness of the Product

As it stands, patients are only presented the final cost of a given procedure after the fact, when the explanation of benefits comes in the mail. That’s like picking out a pair of socks at the store, only to find out after the credit card swipe that they cost $100, and there's no return policy. But in a consumer-centered market, that may not always be the case.

Heightened healthcare competition requires key differentiators, on which patients can base their consumer decisions. As patients increasingly become major players in the payor game, they will actively seek out the best bang for their buck. This shift will put pressure on systems to prove excellence in both quality and price.

To do this, you have to collect valuable data and use it. By implementing actionable metrics you can gain insight into how to make your already great product even better in the eyes of the consumer. Then, when you’ve created an episode of care with evidence of quality, you can market the product effectively. Consumer-patients do their research, they want proof they are making the best purchase.

Health organizations that capitalize this business-mindset strategy will earn their spot as a Center of Excellence thus earning the high volumes that equate to profit. The leaders in this new market of healthcare will see astronomic payoffs when the transition is all said and done.


POSTED December 8, 2017

Commercialization of Healthcare: Impacts and Future Trends

The days of neighborhood doctors you stick with for a lifetime are declining. We are entering an era of pick-and-choose physicians where the customers can analyze their available options and weigh differences to make a decision. Are their outcomes good? Have previous patients been satisfied with the level of care? Is the price right?

Advances in medicine have allowed us to tackle diseases and increase life expectancies enormously. But just as Dr. Arthur Barkley found back in 1988, “although the collective health of the nation has improved dramatically... surveys reveal declining satisfaction with personal health.” And similar trends exist today, 30 years later. This is more relevant to Healthcare now than ever before as uninvolved patients shift to active consumers.

The gap between healthcare and retail markets grows ever smaller. Dr. Barkley suggested, even in the late 80s, that it is the commercialization of healthcare that is leading this shift and causing a “climate of apprehension, insecurity and alarm about disease.” As patients increasingly play a consumer role in healthcare, it becomes increasingly important that physician leaders apply traditional business insights to their patient relationships. Emotive branding, targeted marketing and strategic communication will need to be used to gain the attention and trust of the consumer patient.

Clearly this idea isn't new, and has been a long time coming. But it is now progressing to a point that can no longer be ignored. We are reaching a breaking point. With cost of care on the rise, patients are now players in the medical financial game and, with new metric-driven technology, can actively seek out the best bang for their buck.

With the Center for Medicare & Medicaid Service (CMS) pushing for an increase in data collection as part of their Meaningful Use program, we will begin to see more transparency into outcomes and provider effectiveness. Patients, now inundated with choice, can and will use this information to make decisions about which centers of care or providers best fit with their needs.

This need for lower prices has driven the rise of alternate payment models, pushing care and recovery to the home, and the need for patient engagement. Healthcare organizations must adapt and restructure to fit this new medical landscape in a way that will benefit both patient and provider.

Capitalism has been at work within the healthcare system but has really only lead to inflated costs. Health care is expensive. Employers can’t afford it anymore, and neither can patients. Instead we must put a commercialized system to work in a way that will benefit the consumer patient. The time for reducing costs must be now.


POSTED November 28, 2017

Same Day Discharge Total Joint Arthroplasty on the Rise

Total Joint Arthroplasty (TJA) is one of the most reliable and in-demand orthopaedic procedures with over 1 million cases performed annually in the United States alone. By 2030, this number is expected to reach 2-4 million. This sharp upward trend is primarily driven by an aging of the population with longer life expectancies.

Sg2 Analysis TJA Projections

Luckily, clinical advancements are keeping up with the demand. Since its introduction in the 1960’s, TJA has become safer, more efficient, and more cost effective. In particular, minimally invasive and anterior approaches have shown to minimize postoperative pain and help patients recover faster.

With the development of new surgical techniques and rapid recovery protocols as well as the CMS’s proposal to provide coverage for TJA in outpatient settings, there has been an increasing trend towards same-day discharge TJA. According to the Ambulatory Surgery Center Association, more than 200 ambulatory surgical centers (ASC) across the US perform outpatient TJAs. Hospitals are also shifting toward outpatient TJA in order to compete with the growing number of ASCs.

There are three main drivers contributing to the shift towards the outpatient delivery model:

1) Reduced costs for both patients and providers

Performing TJA in outpatient settings reduces the overall costs by as much as 50%. Richter et al. have shown that outpatient total knee arthroplasty (TKA), on average, led to $20,500 savings per patient. Aynardi et al. reported similar findings in total hip arthroplasty (THA) population.

2) Increased convenience and psychological benefits

According to Dr. Roy Davidovitch, Director of Hip Center at NYU Langone Medical Center, recovering at home not only adds convenience but also brings physical and psychological benefits that can boost patient’s recovery. Dr. William Hozack, Director of Joint Replacement at Thomas Jefferson University Hospital, shares this view in his recent study about in-home recovery, commenting that, “Patients were generally happy and content in the comfort of their own home during recovery.”

3) Lower risk of hospital-acquired infections after surgery.

Outpatient TJA offers reduced risk for hospital-acquired infection, which is one of the top causes of arthroplasty failure and need for revision. Currently, peri-prosthetic joint infection (PJI) rates for TKA and THA are approximately 0.3-0.6% and 1%, respectively. Although it may not seem high, it is still considered one of the most challenging complications following TJA, resulting in a burden on both patients and providers. According to Solarino et al., prevention should be the first and best strategy. Minimizing the duration of hospitalization would significantly reduce the risk of infection and further hospitalization.

While the future of outpatient TJA seems promising, there are still concerns regarding its safety and pain management. One of the biggest criticisms is the possibility of uncommon yet fetal postoperative conditions including deep vein thrombosis (DVT) and pulmonary embolism (PE).

However, these side effects could be avoided if high risk patients are properly identified preoperatively. At NYU Langone, Dr. Davidovitch and his team are using a comprehensive protocol that they developed with the anesthesiology, nursing and physical therapy departments. His team is also using technology to track patient progress and stay connected throughout patient recovery.

This migration will continue. It’s something of a no-brainer, for qualified patients same-day discharge provides quality care at lower costs.

*Projection Graph data from Sg2 Analytics*