How Startups Are Filling in the Gaps

The issue of “access to healthcare” is at the heart of both Democratic and Republican resistance to the repeal the Affordable Care Act. The proposed plan, among other things, would roll back coverage for millions of people, including those with mental illness and addiction during a devastating opioid epidemic.

While the GOP plan would severely curtail access, trends in industry seek to expand access. Hospitals have begun to reevaluate the way they view this issue and to adopt new technologies to fill in gaps in a cost-effective manner. For purposes of political conversation, “access” tends to mean ‘access to insurance.’ Healthcare executives have expanded on that definition.

Access in Washington means insurance. Access when you’re sick means actually being able to see a provider. So, we have radically changed our approach to access. We feel that access ought to be anytime, anywhere.
— Toby Cosgrove, MD, CEO of the Cleveland Clinic

To better understand what access means, you should understand the factors that limit it. These include inequality, broadband access, affordable care, geographically accessible primary and urgent care, among many other things. Some of these issues may seem peripheral to the debate, but they can be the difference between life and death for hundreds of thousands of people in America. Inequality, for instance, can determine the types of hospitals, clinics, doctors’ offices, skilled professionals, medical technology, essential medicine, and proper procedures that a person can utilize to treat their medical problems.

The most innovative healthcare providers around the country are doing their part to expand access in local communities, but this effort must be complemented by technology developed outside of these organizational structures to make a broad impact across society.

We are diligently trying to apply expansion of primary care, expansion of school-based clinics, the expansion of our physical footprint. But that’s got to be conjoined with an expansion of the digital footprint. Otherwise, I don’t think the access problems can be solved.
— Dr. Steve Corwin, CEO of NY-Presbyterian

An example of this type of approach would be Children’s Hospital Colorado, where CEO Jena Hausman and her team have adopted a couple of schools in their local neighborhood to start pilots to try to figure out how to make schools a new care setting. These schools are overwhelmed with behavioral health issues, and Children’s Hospital can bring new personnel into the school or redefine the way nurses work within schools.

More ways providers and startups are filling in access gaps —

Virtual Patient Visits

Over the past few years, NY-Presbyterian has seen emergency room visits grow by 7–10% per year, even with the passage of the ACA. To help deal with this trend, the hospital began offering virtual visits in their emergency room. Patients with grade four or five conditions, i.e. conditions that are not deemed to be in immediate need for acute physical care, were directed to kiosks where they met with virtual doctors, lowering the total amount of time that people were in the emergency room and allowing staff to cover more serious emergency room visits.

Outside of the acute care setting, hospitals have also rolled out digital urgent care clinics that enable patients to connect through video with emergency room physicians for minor issues like sore throats, allergies, and flu like symptoms. This allows the doctor to assess whether that patient really needs to come in for an in person visit.

Recently, studies have suggested that virtual doctor visits are more expensive for providers than previously thought for the telemedicine industry as a whole. However, this does not apply to people who use telehealth in place of an emergency room visit, which costs on average an estimated $1,734 per visit. Providers and startups over the next few years will likely optimize telehealth to focus on on patients who are likely to opt for high cost care.

Engaging Non-English Speaking Populations

There is a large disconnect in supply and demand for doctors who can treat patients in Spanish, which often results in Spanish speaking patients waiting until they are very, very sick to seek medical help. Often, Spanish speakers put off care until they are forced to go to the emergency room, which is not an efficient or cost effective way to receive care on an ongoing basis.

Startups are helping these communities engage with the healthcare system. Telehealth startup ConsejoSano recently raised a $4.9M Series A to increase preventive care among Spanish-speaking patients, saving money for providers by improving health outcomes early on. HealthTap expanded their existing offering to the Spanish speaking population, offering 24/7 access to top U.S. doctors and their knowledge via video, text, or voice in Spanish via HealthTap Español mobile apps and website. Canopy Apps is the first mobile app that allows providers to access a library of routine medical terminology in any of 150 languages, all at the touch of a button.

Mental Health Tech

It has become obvious that we need to put much more resources into mental health in America. Around 19% of American adults suffer from some kind of mental illness. This is expensive both for employers and for the healthcare system. Employers face around $200billion in lost earnings each year due to mental health issues. If you add a mental health substance comorbidity to any diagnosis it doubles or triples the cost of caring for that patient.

In addition, there is a massive shortage of adolescent psychiatrists in America (less than 10k in the entire country).

We’re using a lot of the telehealth technologies to try to connect to emergency departments across the region so that they have immediate access to pediatric mental health providers, either psychologists or psychiatrists, so that we can help them do a triage, and assessment in their home community ED, manage that situation if appropriate, or do the appropriate referral.
— Jena Hausman, CEO of Children’s Hospital Colorado

This is a great example of how startups are stepping in to solve problems revolving around subspecialties that might be really rare in demand for one provider but an broad problem across the country. Startups in the mental health space are also helping to remove the stigma that has been associated with seeking out mental health assistance.

Many of these startups are working with benefits managers at large employers. Lantern Health raised $17M to launch a programs around improving and managing issues such as mood, stress, anxiety and body image. Silver Cloud Health raised $8.1M to Level Therapy works with benefits managers at large companies to enable employers to provide affordable mental health services to employees. Kip allows patients to record . Lyra and Joyable allows employers to provide behavioral health solutions to their workforce and increase productivity.

Startups are solving structural issues within the healthcare system. Mental health professionals often work in practice setting silos separate and apart from primary care physicians, making it difficult to collaborate with primary physicians. Google Ventures-backed Quartet solves this problem by allowing primary care to easy identify the appropriate mental health provider and then keep in touch with that provider to ensure better coordination of care.

Enabling Health Consumers to Comparison Shop for Care

Research has shown a relationship between increasing patient cost burden and health service utilization, suggesting that when patients pay more for their healthcare they are less likely to access treatment. While healthcare providers should be providing more efficient billing strategies and payment plans, consumers should also be doing more to comparison shop on their own.

Healthcare consumers are notoriously bad about comparison shopping, which makes sense since people do not need to think about their healthcare on a regular basis. Additionally, people also tend to trust their doctors’ referrals over comparison shopping engines.

Startups are empowering consumers by offering more transparency in healthcare. Castlight Health, built on the philosophy that the more information leads to better outcomes, uses proprietary software to analyze claims data to estimate the costs of common medical procedures. The reports also include performance data on various providers, enabling users to take into account both cost and quality. HealthWiz, which recently raised seed funding from Rough Draft Ventures, aggregates the best existing healthcare information across symptoms, conditions, doctors, and costs then leverages this information to understand a user’s symptoms and connect them directly with relevant physicians within their insurance provider network. CareDashVitals, and RateMDs allow users to rate their doctors, find specialists, and understand healthcare conditions.

Startups are also changing the way people buy drugs. GoodRx allows consumers to compare drug prices from pharmacies around the country, which can vary drastically. Consumers can then use coupons provided by the company to buy. Medicare patients are finding that GoodRx coupons or cash payment can be cheaper than their own copays. Blink Health utilizes a network of over 25 million people to negotiate lower prices with pharmacies for customers in its network. Customers order their drugs online then pick them up at their pharmacy. These two startups are basically allowing consumers to access drugs at prices typically only available to insurance companies.

Originally published on Medium by Charles LaCalle here

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