Post COVID-19: Opportunities for Companies to Restructure the Healthcare Future
Published on : Monday 17-08-2020
There are expectations that the areas that will require the most adaptation are in value-based care payment models, digitally integrated and tailored care delivery and automation. The novel coronavirus pandemic has upended the world as we know it, taking an unprecedented toll on health and human life. The healthcare ecosystem has quickly mobilized to mitigate the crisis by modifying care access points and modalities while producing financing mechanisms to sustain patient care amidst dire circumstances.
As the scale of the pandemic grows and downstream impacts persist, healthcare organizations are recognizing they must shift from a reactive stance to a more proactive new normal. Operating in this environment will require new capabilities, forcing many organizations to look externally for innovative solutions to guide this transformation.
In this piece, we examine the macro ramifications of the pandemic and potential reverberations across the healthcare industry. Through this analysis, we’ve identified five opportunities that harness these disruptive forces into tailwinds, and we cite examples of the venture and PE-backed companies getting traction. We believe nimble, fast-moving early-stage companies are best positioned to maneuver and create lasting impact in these unprecedented and challenging times.
Few Emerging Opportunities for Innovations in Healthcare Post COVID-19
1. Automate the Healthcare Enterprise
It is well-documented that repetitive manual processes and human inefficiency are drivers of unnecessary hospital administrative spending. Yet these challenges persist due to the low adoption of automation technology. As health systems seek operating efficiency and quick value creation, they are likely to embrace enterprise automation strategies like robotic process automation (RPA) and artificial intelligence (AI) to enhance productivity and free staff up to practice at the top of their license.
Across industries, these technologies have demonstrated the most value automating repetitive, high-volume, and rules-based activities such as scraping web data and filling in forms. There are a number of similar automation opportunities scattered across the hospital enterprise, such as claim status checks during the revenue cycle process, insurance verification efforts in the contact center, or inventory management as part of supply chain and ordering. While implementing automation seems prudent, scalability and enduring ROI have been elusive for some hospitals. This is due to the challenge of finding alignment between these technologies, the nuanced and unstructured nature of hospital processes and the staff supporting these processes. Therefore, automation platforms capable of facilitating process discovery and standardization, supporting human-in-the-loop synchronization, and enabling self-governance have the most utility.
Several companies are helping hospitals automate enterprise processes, targeting the end-to-end automation of specific functional areas as part of a broader enterprise automation strategy. Syllable AI is an intelligent automation platform for the healthcare contact center, capable of processing live web, mobile, and phone requests from patients and either resolving them or triaging to human staff appropriately. Suki AI, a Flare Capital portfolio company, and Alpha Health are focused on automating revenue cycle processes. Suki offers a voice-enabled and AI-powered platform that automates clinical note documentation as well as coding and billing related administrative tasks, while Alpha Health leverages people, data, and machine learning technology to automate reimbursement tasks.
2. Synchronize Virtual Primary Care through a Longitudinal Offering
The in-person nature of primary care, rooted in the relationship between patient and “PCP,” has been hallowed ground. Despite this tradition, studies suggest as many as 80% of primary care services (validating symptoms, triaging care, and developing treatment plans) can be delivered virtually. The fallout from the pandemic has created a unique opportunity to realize this potential as patients have gravitated to virtual solutions to access care. However, the rapid surge in virtual care options has been overwhelming for some patients, leading to mixed experiences. This suggests an opportunity to streamline the virtual care experience through a longitudinal offering to support the continuous patient journey.
In order to “create” a longitudinal virtual primary care offering, risk-bearing entities (payers, employers, and provider groups) have experimented with aggregating point solutions into a cohesive offering. As new solutions rapidly come to market and delegated entities to include virtual care as a medical benefit, the challenge of aggregating these offerings will grow. Therefore, there is a growing need for natively integrated products that leverage provider scale and power longitudinal (engage, treat, and close) care experiences.
Three companies that are innovating the longitudinal, virtual primary care experience are 98point6, K Health and Eden Health, a Flare Capital portfolio company. 98point6 offers an on-demand, virtual care experience that resolves basic care needs by sequencing both technology and chat-based primary care consults to screen and treat patients. K Health has quickly evolved from a symptom-checking solution to a platform capable of connecting members directly to a range of contracted physicians for electronic live chat-based care for as low as $9/month. Meanwhile, Eden Health has built a virtual-first NCQA accredited patient-centered medical home model for employers that virtualizes the experience of a best practice traditional primary care clinic. Eden deploys multidisciplinary care teams including behavioral health and navigation assistance interconnected with the healthcare system to help employees navigate their healthcare journey at their office work site or virtually.
3. Develop Dynamic, Community-Centered Home Care Models for Vulnerable Populations
The pandemic is hastening the ongoing transition of care away from acute care settings (ED, inpatient) to the lowest cost, and now “safest” site of care, the home. Medically complex patients, many of whom are particularly vulnerable to coronavirus, unable to leave home and in need of higher-touch care, are accelerating this transition. Healthcare claims outcomes data suggests providing care in the home for certain populations is worth the required upfront investment for additional services. Recognizing these benefits, payors are incentivizing home and community-based care, taking a lead in catalyzing this shift. As this shift accelerates, however, health systems risk falling behind unless they actively participate in shaping the change.
The inpatient model has been designed and staffed to accommodate high capacity and treat broad care needs at a central site. As care grows decentralized, this model will have to be reconstructed. Health systems will need to ensure that their workforces and equipment are mobile, dynamic, and organized around individual patient needs. For higher-acuity patients, hospital-at-home models will also need to package care delivery, remote monitoring, and supply chain into a more cohesive and flexible offering.
Several companies are assisting health plan and health system efforts to extend their care reach into the home, allowing providers to treat a wide range of clinical needs. Dispatch Health and Ready Responders are two on-demand and mobile care providers. Both companies partner with health plans and health systems by bringing on-demand, mobile care teams to patients’ homes and providing in-home care for non-emergency needs. Contessa Health, meanwhile, helps health systems deliver hospital-at-home programs and enables health plans to effectively contract for this new model of care.
For higher-need patients, home-based primary care, as well as Program of All-Inclusive Care for the Elderly (PACE) models, have proven to be uniquely effective at improving outcomes and reducing costs. Concerto Health and Landmark Health are two home-based primary care providers that contract with health plans to address more complex member needs, by providing longitudinal home-based primary care and care coordination amongst multiple specialist clinicians. PACE models, characterized by their interdisciplinary staffing, dynamic site-of-care synchronization, and community orientation, have been particularly adaptive and effective at caring for elderly and complex patients during the pandemic. WelbeHealth’s recent expansion and remote home-based care innovations lend further credence to the adaptive nature of this model of care.
4. Integrate Primary Medical and Behavioral Healthcare
If the “first mile” in fixing the Behavioral Health system in the U.S. was increasing access to care, the “last mile” will surely be improving outcomes of that care. A critical next step in improving treatment efficacy involves better integrating behavioral health with the rest of the patient’s medical journey. Integrated models have demonstrated better outcomes for both adult and adolescent populations.
An emerging class of companies is developing solutions to better enable integrated care for adult populations, including Quartet Health, Concert Health, and Mindoula. Quartet Health offers healthcare providers both technology and access to a network of behavioral health providers to facilitate better collaborative care and has most recently signed a large national collaboration with Centene. Concert Health works closely with primary care providers and deploys a full-stack collaborative care solution including remotely delivered behavioral health care. Finally, Mindoula partners with both health systems and health plans, providing virtual care teams and technology-enabled support services to help its partners engage and treat their patient’s acute needs.
The unique needs of the adolescent and pediatric populations are often overlooked in the broader discussion about behavioral health. As rates of anxiety, depression, suicidal ideation, and autism spectrum disorder rise, so do the need for better care options. Effectively managing the behavioral health needs of this population requires integrated care with additional wraparound capabilities, especially family-centered engagement, but also school and community-based support. Brightline and Opya are two companies that have set out to address this need, creating collaborative, multi-specialty clinics that engage care teams, families, and communities in providing care while leveraging a digital platform to ensure overall continuity.
As the Covid-19 pandemic rages on, it’s clear the ramifications of the pandemic are likely to permanently reshape the healthcare industry. Targeted evolution around key areas of change will be required to successfully navigate the healthcare world beyond Covid-19. We believe the areas that will require the most adaptation is in value-based care payment models, digitally integrated and tailored care delivery and automation. As the healthcare industry begins this dynamic journey, we believe early-stage companies have a once-in-a-generation opportunity to shape the future ahead.
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