Robin Miller:This is Joanne Rohde who is the Founder and CEO of Axial Exchange a company that’s busily working to make it easier for healthcare providers to share healthcare records, that is your patient records safely, securely and quickly. She was recently quoted as saying “patients are the key to reducing readmissions” How is that? What does that mean?
Joanne Rohde:Well, I think that we are moving from what I call the myth of the Dr. Welby healthcare system, and I think it was always a myth that there is this all-knowing physician that’s going to take care of you and your family to the reality that we are a nation of chronic disease. As we jokingly say sometimes ‘no one gets well in the hospital’, what do we mean? You might be diagnosed in the hospital, you might get patched up in the hospital, you might get your tests taken, but you get well once you leave. If you get well. And healthcare really hasn’t recognized that yet. And so they don’t really meet the patients where they live and where they improve
The second thing in this parochial view of patients is this idea that patients really can’t understand what they need to take care of their health. And that is just a myth, because any sick person I’ve ever talked to wants nothing more than to get better. And they are much more vested in that than the healthcare provider, I don’t care what economic incentives we change in this country, your physician is not living your life.
And then thirdly, I think the healthcare organizations have not done the minimal job of trying to see the world through the lens of the patient. So even though we’re starting to make progress in selling to healthcare organizations I often hear the patient relationship referred to as the last mile. So what’s their view of the world? Their view of the world is: Here is the hospital, we are theheartof the world, you’re going to come in here and we’re going to fix you up. First we’re going to fix what’s going on that’s wrong in our hospital, then we’re going to fix what’s going wrong between the hospital and the other docs.
And then when we think we’ve got that, we’re going to talk to you, the patient.” Instead of going the other way around and going, “Well, wait a minute, this just isn’t working, it isn’t working where we are first place in costs, we are37th place inresults—how are we going to really check this? We are a nation of chronic diseases, there’s nothing anybody can do in my care that’s going to change that. That’s the question that we got to be able to answer as a country. And it is with the patient.
But where it is supposed to be a relationship between the healthcare providers and the patient gets to I think three different things: Teach me, engage me, and track me. And what that means is essentially is starting with the teaching, ‘tell me what I need to know about my disease, let me learn, I might not have been reading it before I got sick, probably not, but now that I am sick, if you give it to me in a way that I can understand it I will learn it. ’So the big phrase there is ‘in a way that I can understand it’. Everybody has had that experience of standing in a doctor’s office with them going through the language of Grey’s Anatomy and you go ‘What?’, that’s why part of the reason why we only maintain 8% of what we hear in a hospital situation when we get home.
The second is we don’t do normal teaching even if we have the ability to get the phrases we don’t teach that, we don’t use testing, we don’t use any of the things that we know get people to learn, so we don’t employ any of those techniques. So it is not surprising that people don’t really understand about their illnesses because they do not really talk about them when it comes right down to it.
The second in terms of engage me, comes to the, ‘how are we going to work together’, and that has everything to do with building a care team. So it’s not just the doctor you see, but do I have a physical therapist, do I have a mental health professional, have I seen a nutritionist—all the pieces that you’re going to need to get engaged in taking care of your own health and how do they share information.
And then finally track me, and I think there is a lot of proof coming that’s not just for triathletes, I think that whether we like it or not anytime you ever written down everything you eat all day long, and it’s a pain to do so, anytime you’ve ever tracked how many steps you take, it really teaches you about yourself. And normally you can just ignore it, but if you’re sick you might want to change it. So the measurement is very key. So those are really the three buckets, I think that we have to address if we are going to get patients to take responsibility in a way removed from a lose-lose situation, which is where I think healthcare is today, to a win-win situation where there’s something in it for both the patients and the providers.
Robin Miller:Okay. So let me just talk about money for a second. Costs—will a more engaged patient, pay less, help say the continuous rises in healthcare costs. Can that happen?
Joanne Rohde:Well, I think it’s the only way we’re going to get rid of the rise in healthcare costs. But, here’s the rub that it is only now, I think last year will go back in history as a bellwether year, as the first year that we actually sort of flattened out the expense for patients forever. But I think that up until now the reason that’s been the case is there’s been no incentives to rein in costs—in fact the opposite is true. And when I first got into this business, I thought that was a very cynical view of the world.
Surely people get into this business to save people. And they do , they get into this business to save people. But if you start looking at where your healthcare dollars go and how little of it that actually ends up lining the pockets of the doctor you’re having the relationship with, you’ll see that there are a lot of vested interests between you and your wallet. And the sad truth is at the hospital level and so a few years ago, maybe, say 18 months ago, if you went for a heart attack and then you went out and went to Kentucky Fried Chicken and then the next day you’re in a for a heart attack, that was a good event for your hospital. And so that’s what’s changed. So I think the first thing is, that’s where incentives make a difference and payment model make a difference. And I think we’re already beginning to really address the key aspect of that and I think at a macro level you’re beginning to see that information and I personally don’t believe last year was a fluke, as some people suggest, I think that’s the beginning of changing the cost per head, so that’s first.
So the second is to the heart of what you asked me, I think really at the end of the day, what everyone is looking for that I talked to in the healthcare provider spaces, is show me the ROI, show me that if I invest more money in my patient, I will make more money. And so really that comes down to three things for a healthcare provider. To have a win-win, everybody has to win, you got to get your health back at a reasonable cost, they have to be able to make money. And so, let’s look at their side, not your side, individual side. So there’s basically three ways that they start to make money.
The first is affinity and loyalty. As we move from a society of chronic disease into where I think we’ll hopefully move to a society of ‘get me well, keep me well’, are you going to pick all your downstream providers be it a physical therapist, be it a nutritionist, are you going to pick it with a health system? Or are you going to out and be on your own? So there is going to be a dollar shift from this acute care setting to chronic care to long-term health. And if they want to capture your wallet they have to make that move. So you have to as a health system not just have a good doctor, you have to have all the offerings all the service. That’s a tall order given what healthcare is today, but we believe that they’re ways to help with that. But the hard ROI really comes from reduced admissions and increased patient satisfaction today.
And then down the road it comes from lower utilization of the healthcare system in total. So today a healthcare system can make more money by increasing what is known as their age cap or patient’s satisfaction score. Patients have proven time and time again to be more satisfied when they are taught, when there are ways to interface with their physicians when they are not with them, thanks to electronic. And that in turn translates into hard dollars today for healthcare systems. Because if they see any Medicare patients, and who doesn’t? Everybody sees Medicare patients, they drive most of our care costs in this country, they get more from our federal government per patient if they have higher age cap scores, another positive incentive. The second thing is more of a stick than a carrot, which is you may have heard a lot of talk about reducing readmissions.
Joanne Rohde:So the conversation is, if you’re in the bottom third, the penalties are still increasing but the way they are going to level off in the next year or two, is that you can end up losing up to 3% of your total Medicare billings, if you end up in the bottom third.
Robin Miller:Well, by you , you mean the hospital, right?
Joanne Rohde:The hospital. Yeah, I’m sorry, the hospital, the hospital. And that a several years ago when I first started in this business and the law was sort of coming down, down, they could see it from the distance, the conversations in hospitals often run, ‘how can they do that to us, I can’t control what the patient eats, I can’t help if they don’t do any of the things I tell them to do’. And I think there’s a lot of that reaction still, but there’s a recognition from the leading hospitals that the model isn’t working. Thatthere needs to be an exchange of information—that’s our name, AxialExchange—on an ongoing basis, and that outcomes matter, and that the healthcare system has to have a stake in the ground, and that only the winners in the long term are going to exist because they have good results.