Cool Startup: RubiconMD

RubiconMD team sitting 2

Primary care practice stands on the precipice of radical transformation as emphasis shifts from offering volume-based to value-based care. Look no further than the recent Supreme Court ruling to see that the ACA and its mission are becoming further cemented into the U.S. healthcare system. The goals are lofty: higher quality and greater access to healthcare at a lower cost. For most, it’s hard to imagine what this healthcare landscape will look like in the future.

But Gil Addo, the CEO and founder of the NYC- and Boston-based healthcare startup RubiconMD, seems to know. His novel vision of the future involves shaking up the traditional model of primary and specialty care practice in medicine.

A Yale and Harvard Business School graduate, Addo’s experience as a consultant and in commercializing innovation has included industry stints at both large and small tech and biotech companies. In early 2013 he met co-founders Dr. Julien Pham, a physician formerly on faculty at Harvard Medical School, and Carlos Reines, another Harvard MBA.

As of December 2014, they have raised over $1.4 million funding and support from major investors, including athenahealth and Waterline Ventures.

We sat down with Addo recently to talk about this innovative company and discuss his plans for the future.

Tell us about what you do at RubiconMD.

RubiconMD is meant to enhance access and bring appropriate specialist expertise into the primary care setting. The patients will see their primary care providers and whatever the issue is–if it is outside the PCP’s expertise and results in a referral—the physician can upload any relevant information, such as images, labs, and studies, and ask questions. We figure out who the most appropriate specialist is and then route the case to them so that they can respond within a few hours.

That’s the crux of the entire interaction. It’s a clinician-to-clinician electronic consult.

How did you get the inspiration to start RubiconMD?

I was very interested in this problem of enhancing access and wanted to find a way to solve it. I had a personal experience that motivated me to take this on. I had a grandmother who had to travel thousands of miles to Boston for treatment of a brain tumor, and then back and forth for all the follow-up. Why couldn’t her local provider oversee her care with appropriate support? There had to be a better way.

I traveled to India and looked at different healthcare delivery models and found that better way. There they have an extreme version of what you see everywhere: the appropriate expertise is in a concentrated area and people are everywhere else, so they bring the appropriate expertise into community health centers.

I started iterating on that model and borrowed things from other settings until I arrived at a solution that fit the U.S. healthcare market. RubiconMD allows increased access to the right specialist and brings that expertise into the primary care setting, to the front line.

How did you figure out if this might be something that primary care physicians would actually be interested in?

Once we figured out that the idea made sense at a system level, we had to figure out if this was a solution that physicians would use. Julien brought his clinical expertise and introduced the idea of “curbside” interaction, an informal and natural way that physicians interact with each other. We were able to validate the model on a small scale and see that physicians would actually use it and find value.

We ran a larger scale pilot to see if this would save people money. We used two large clinics with a panel of specialists and ran it across 15 or so specialties. The findings have been remarkably consistent.

  • In a third of the time, this support avoids a specialist visit. This has been consistent across all deployments and different populations.
  • Another third of the time this process improves the referral. You’re able, even though you’re referring, to send along the appropriate labs and studies and waste less time. And you make sure the patient goes to the right specialist.
  • For the remaining third of the time, it’s peace of mind. It validates what you were going to do.

The cost savings is from improving care outcomes and avoiding duplicate and inefficient use of resources. Almost $300/per opinion is saved, aside from other benefits such us reducing wait time and avoiding ancillary costs to patients.

Is this billable to insurance?

It is not. Right now, we work with value-based organizations incented to provide high quality primary care in the most affordable way possible who see this as a way to extend their capabilities, provide better and more timely care in the primary care setting and avoid unnecessary services.

Payers show interest, as this is a great tool to enhance outcomes and reduce costs while improving patient satisfaction.

What are the challenges that you’re having? 

No shortage of challenges. We focus on the sphere of healthcare that is value-based and incented to provide high quality care at the lowest cost. But U.S. healthcare still has a very large fee-for-service component and the biggest challenge is that we’re dealing with so many groups fighting themselves. It’s a system in transition. We’re trying to bring this into that environment and show them how we help them transition. It’s tough but enough of the market has moved and enough changes in primary care have happened that we have been able to gain momentum quickly.

What are your next goals, short-term and long-term?

Short term, we want to continue better servicing our customers, provide better tools to meet their needs and fit even better into workflow. We’re obsessed with enhancing workflow and not making additional work — providing a tool that syncs with the way physicians want to practice medicine.

Long term, we’re focused on the idea of democratizing medical expertise. As our longer-term vision, we want this to be the default. We want people to think of RubiconMD as the way to get high quality consults more efficiently and locally so that there’s no barrier for clinical expertise.

This article was originally published at MedTechBoston.com.

A Peek Inside the Harvard Forum on Health Care Innovation

Prof. John Quelch discussing the Bloodbuy case study.

The Harvard Forum on Health Care Innovation, a joint collaboration between Harvard Business School and Harvard Medical School, was recently held in Cambridge, Mass, on April 15-16, 2015. This private, invitation-only event assembled an elite group that included HBS and HMS alumni and faculty, as well as other key opinion leaders in healthcare. Cara Sterling, Director of HBS’s Health Care Initiative, who organized the event, shared that the goal for the event was to provide an opportunity for “people from different sectors to come together and talk freely” in order to “spur innovation in healthcare.”

One key aspect of the event was the introduction of the finalists of the HBS-HMS Health Acceleration Challenge, a contest that was launched to seek innovative, early-stage healthcare ventures that have great potential for transforming healthcare.

Out of a total of 478 applicants, 18 were selected as semi-finalists; from those, four of the brightest were chosen as finalists to share a $150,000 Cox Prize. They’ve also had an HBS case study written about them, and each team presented and received feedback at this year’s Forum. The final winner will be decided in a year’s time, by identifying the startup venture that is most successful in disseminating and scaling their healthcare solution.

Look out for the great work of these four finalists in the coming year:

  • Bloodbuy is a startup that aims to improve the efficiency and price transparency of the blood supply market by matching blood centers and hospitals through an online, cloud-based platform. In a pilot program, this system was found to decrease hospital costs by 23% while also decreasing the risk of blood shortages and the waste of blood products.
  • The I-Pass Patient Handoff Program is a training curriculum developed by six clinicians to improve the exchange of patient information between providers that occurs at the change of a shift. A research study of this intervention, published in the New England Journal of Medicine, found that use of I-Pass led to an impressive 30% reduction in medical errors.
  • Medalogix is a predictive analytics company that has created a product to that can assist those in the post-acute care sector to better identify hospice-eligible patients. Through working with Medalogix, clients have been able to successfully increase transfers to hospice from home health care and decrease the number of live discharges from hospice.
  • Twine Health is a startup that has created a cloud-based, collaborative care platform of the same name that enables providers to partner with their patients through coaches to provide seamless care and support for the management of chronic disease. In a recent clinical trial, Twine more efficiently helped patients achieve blood pressure control, which resulted in cost-savings (versus the traditional model of care).

***

In addition to the Health Acceleration Challenge finalists, there was also an impressive line-up of healthcare experts that shared their thoughts throughout the two days in keynotes and panel discussions. Below are some of the highlights:

Value in Healthcare

Speaker Peter Orszag, Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup, discussed three major structural forces that he feels will have a major affect on healthcare quality and spending, including the shift to value based payments, digitization of healthcare, and the increased role of the consumer in healthcare spending. He also discussed three big unknowns and their future impact on the heathcare cost curve, namely: future policy changes, increasing consolidation of the healthcare market, and emerging healthcare innovation.

A Blueprint for the Future

Mark Bertolini, Chairman and CEO of Aetna, gave a keynote speech entitled “A Blueprint for a 21st Century Health Care System” in which he highlighted five key measures that hold promise to improve healthcare:

  • System re-design that enables lower cost, higher quality care with increased access
  • Sophisticated health IT systems
  • Care optimization, especially to coordinate care for the 5 percent for whom most healthcare dollars are spent
  • Aligning economic incentives with healthcare goals
  • Increasing patient engagement.

Employers as Innovators

In an engaging panel discussion, moderator Bryan Roberts, Partner at Venrock, discussed the growing role of “employers as innovators” with expert panel members Ellen Exum, Director of Benefits/Global Design and Strategy at IBM; Adam Jackson, CEO and Cofounder of Doctor on Demand; Brian Marcotte, CEO and President of the National Business Group on Health; and Derek Newell, CEO of Jiff.

There was a robust discussion regarding the use of wearables and other tools as part of wellness programs to increase engagement and compliance, and to hopefully improve outcomes. One example was Adam Jackson’s Doctor on Demand which, for $40 per telehealth visit, has been found to decrease costs, decrease absenteeism, and increase productivity and morale.

Focus on Neurologic Disease

In a discussion with William Sahlman, Professor of Business Administration at HBS, Deborah Dunsire, MD, President and CEO of FORUM Pharmaceuticals shared her company’s mission of tackling neurological disease. Costs to society due to neurologic disease are great, she argued, not just in terms of direct costs, but also indirect costs – and there should be increased focus in developing treatments for these disorders. One significant challenge is the lack of mental health advocacy, which is an obstacle to obtaining funding for research.

The “Retail-ization” of Healthcare

Speaker Helena Foulkes, President of CVS/Pharmacy and Executive VP of CVS Health, shared the key factors that she feels are driving the “retail-ization” of healthcare:

  • Excessive spending on chronic disease
  • Increasing number of baby boomers on Medicare
  • Rising use of the internet to research health information online
  • Growing numbers of employers with high deductible plans.

She also shared the initiatives that CVS has begun to help tackle these problems, which include drug adherence programs, a focus on patients with the greatest needs, and integrating digital tools.

Dr. Watson Will See You Now

Speaker Mark Megerian, Senior Tech Staff Member at IBM Watson Solutions, shared the exciting (and for some, frightening) prospect of using machine learning and predictive analytics to make clinical recommendations via IBM’s Watson program.

Trained at Memorial Sloan Kettering (MSK), Watson has been shown to be capable of making recommendations similar to MSK oncologists, with 97 percent accuracy, for breast, colon, rectal, and lung cancers. They are now scaling to include other types of cancers and also to involve other organizations.

***

Closing remarks were given by Dr. Jeffrey Flier, Dean of HMS, who shared that he feels healthcare delivery innovation has been sorely lacking, and that HMS and HBS are now deeply committed to medicine and entrepreneurship. Harvard hopes to lead healthcare innovation in the future. From the look of this year’s very promising Health Acceleration Challenge finalists, it seems his wish is likely to come true.

This article was originally published on MedTechBoston.com.

Electronic Health Records: Opportunities

EMR2

As discussed in the previous article in this series, the broad adoption of electronic health records (EHRs) has presented healthcare professionals with numerous challenges. It’s not surprising that many of us are left wondering: Will all of this effort to rapidly adopt EHRs even be worth it in the end?

Where We Are Now

To better understand this, it’s helpful to first take a closer look at the current state of the U.S. healthcare system. In 2000, the Institute of Medicine released their landmark report, To Err is Human, which exposed the alarming number of deaths that occur as a result of medical errors in the U.S. This was a big shock to many who assumed that the American healthcare system was the best in the world. To add insult to injury, we also discovered around that same time that healthcare costs were skyrocketing – in fact, they had doubled from 1993 to 2004.

According to the Commonwealth Fund, the United States today has the most expensive healthcare system in the world, spending about $8,500 per capita, or nearly 18% of our GDP, while also consistently ranking dead last in overall performance and quality compared to all other industrialized nations. One can’t help but wonder: What are other countries doing that we’re not? Well, two things in particular stand out when we compare our healthcare system to theirs: 1. A lack of universal healthcare coverage; and 2. A lack of high-functioning, fully-integrated health information systems. It turns out that our international counterparts have surpassed us when it comes to providing high quality, affordable, and accessible healthcare. One of the key elements of their success has been harnessing health IT.

Opportunities to Consider

Considering all of this, it’s no surprise that we have had bipartisan support for the expansion of EHRs from both Presidents Bush and Obama and that we continue to invest in creating a fully interoperable, nationwide network for health information. If EHRs can be harnessed properly, they promise to deliver lowered healthcare costs, improved quality, increased access, and improved population health. Let’s take another look at those challenges presented in the last part of this series. Where are the opportunities in these challenges?

1. Cost

Despite the high costs of implementing new EHR systems, there are also numerous studies that report that high-functioning EHR systems can help to decrease costs in the long run. One study found a 12.9 to 14.7% reduction of duplicative testing with the use of computerized provider order entry (CPOE) and clinical decision support (CDS) in an outpatient setting. Overhead costs may also be decreased through the reduction of chart pulls and from reduced paper, supplies, and storage costs, as well as via decreased transcription costs. Efficiencies can also be gained in billing processes with improved and complete documentation, improvements in the charge and capture process, and through decreases in billing errors. A study from Massachusetts found that paid malpractice claims may also be minimized with use of EHRs vs. paper records (6.1% vs. 10.8% paid claims).

It remains to be seen if EHR-induced savings will be favorable versus the cost expenditures required to operate them. But these studies show that there’s reason to be hopeful.

2. Quality & Communication

Investing in a high-quality EHR system has also been shown, in some studies, to result in higher overall quality, improvements in safety, and decreases in delayed medical decision-making. A study of hospitals in Florida found that those with greater investments in health information technology scored higher in quality measures. A similar study found that those hospitals with greater investments had lower patient complications and lower mortality rates as well. Other research has demonstrated that high-quality EHR systems improved prescribing patterns, too. In these ways, EHRs may support improved outcomes and thereby reduce malpractice and liability risks.

Highly interoperable EHR systems have also been credited with improving the communication and coordination of care between providers, and with decreasing delays in medical decision-making that can result from having to wait for the transfer of medical records. A strong health IT system can also enhance communication between providers and patients and help to foster increased patient engagement through the use of applications such as patient portals and interfaces with radiology, laboratory, and medical devices. Patients may be more apt to become actively involved in managing their health and participating in shared decision-making as a result of having easier access to their health information. 

3. Access 

Another advantage of EHRs is that they can help to provide convenient and timely access to a patient’s health record. We’re still a far way away from a fully transparent nationwide (or global) healthcare network, but these advances are coming. In addition, as the telehealth and mHealth market grows, and as we see better integration of other platforms with EHRs, we will likely see a huge revolution in access to personal health information. This need is especially urgent in light of the dire shortage of primary care physicians. Telehealth capabilities of EHRs may very well be the solution to providing access to medical care for patients in underserved or remote regions.

4. Population Health

As we succeed in integrating systems and improving interoperability, we will have the ability to aggregate huge amounts of health data for entire populations of patients. This “big data” can be used to conduct population health research, which can help identify patterns such as risk factors for diseases. With this, physicians will be better able to recommend preventative measures and evidence-based best practices. This information can also be harnessed to change practice patterns and hopefully, to affect positive healthcare outcomes on a broader scale. EHRs can also help to enhance reporting capabilities, which may help identify potentially dangerous outbreaks or treatment-related risks quickly, so that they can be managed in a more timely and effective manner.

***

The Bottom Line

EHRs hold a great deal of promise to truly transform our ailing healthcare system. How well we succeed will depend in large part on how we can overcome and manage key challenges affecting cost, interoperability, safety, and patient-centered care. It remains to be seen if the cost-to-benefit will be ultimately favorable, but these preliminary findings and evidence of international success give us reasons to be hopeful.

This article was originally published on MedTech Boston.