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At some point in the not-so-distant future, if a patient takes a prescription only half the time and the outcome is poor, the physician won't get paid in full. When that day comes, healthcare organizations will start to ask who is responsible.
And there might be some finger-pointing, with payers glaring at pharmaceutical companies, pharma pointing to providers and so on. Payers and providers, in the meantime, are struggling to ratchet up patient adherence for a variety of reasons, not least of which is that various interventions work for different people at different times.
Is a new breed of exchanges the answer?
While the players work together and, to be sure, against each other to iron out these issues, a new crop of exchanges is sprouting up to pull the various pieces together then present them to patients and caregivers.
Set to make its U.S. launch this month at the American Telemedicine Association conference in Baltimore, Paris-based Be Patient Solutions is targeting payers and providers, especially hospital departments that are focused on using mobile technologies to further patient health.
Be Patient will be offering a similar concept as ActivityExchange, which helps coordinate care by taking information generated via consumer applications, sensors and monitoring devices and giving back targeted individual guidance to the patient, along with analytics to the healthcare team, so that they might gain more insight into a patient’s behavioral trends.
The companies' plans are similar in many ways to the kind of research being done on very large populations by companies like Google, who are trying to better understand how consumers use search terms on a large scale to give back more appropriate content to individuals.
Activity Exchange designers, for instance, believe that by understanding the community at the data level, they will know the right moment to intervene. “It takes a while to know the routine so you know when someone is out of routine,” said Mikki Nasch, CEO and co-founder of ActivityExchange.
Meanwhile, Be Patient’s "hospital-to-home" Web-based platform links the care team, including general practitioners, surgeons, specialists and nurses, to patients outside hospital walls. The coordinated healthcare management strategy for the patient taps into remote monitoring with wireless devices, such as blood pressure readers, wireless scales and oximeters from other vendors. All data is sent to the care team.
First proposed in the 1990s by the automotive industry, the idea of an exchange was to provide a neutral infrastructure for companies, including competitors, to pool and share non-competitive information.
ActivityExchange, in a similar manner, is a single infrastructure that pools a wide range of health data from mobile wellness applications, sensors and devices that patients are using, as well as data from insurance claims and existing interventions. By analyzing the data, AE works to coordinate and optimize content delivery through multiple provider channels.
AE connects to applications and devices used by patients through open APIs (Application Programming Interfaces). That access allows companies to build value for their own services on top of another platform, while in the background AE runs a digital sandbox dubbed AchieveMint for research purposes. AchieveMint is an opt-in program that continuously monitors behavior – not just healthcare – among large populations. Volunteers are paid for allowing AchieveMint to monitor all of their activities.
BePatient, for its part, offers application components appropriate for all the players in the healthcare circle – including payers, healthcare providers and patients – and coordinates the interactions between each group. Caregivers can pick and choose from a plethora of e-learning tools, depending on patient needs, and address those educational tools to the patient. For example, these might include Web TV accessed via YouTube videos that explain cardiac decease. Patients who complete various e-learning tasks are given points toward rewards such as a free activity tracker. Typically, appropriate rewards are developed by the individual hospitals.
By integrating remote patient monitoring, disease management, therapeutic compliance and risk management, the aim of "hospital-to-home" technology is to reduce hospital length-of-stay, costs and rehospitalization by giving the patient and team a management pathway from the hospital to the home — where the care team can connect to the patient by video conferencing or secure e-mail messaging.
Getting to the end point of coordinated care, wherein all parties take responsibility for patient adherence, isn't going to be easy.
Nasch anticipates payers leaning on pharma to shoulder more of the burden than they do today.
That argument: The content and services that pharma provides ultimately must be there to make a consumer more conscientious. Payers, otherwise, might suggest that if they are reimbursing for medicine that patients only take 30 percent of the time, perhaps payers should only be accountable for 30 percent of that cost.
“The laggards are going to be pharma,” Nasch predicted, “but they will come around because providers and payers will force them to take some responsibility for total care.”