Health Technology, Digital Healthcare
Article | August 21, 2023
The COVID-19 virus (C19) pandemic is turning out to be the event of the century. Even World War seems timid in comparison. We are in the 4th month of the virus (in non-China countries) and have gone past the lockdown in many places. Isn’t it time we re-think the approach? What if there is another wave of C19 coming soon? What if C19 is the first of many such events in the future?
Before we get into analysis and solution design, summarizing the C19 quirks:
While a large section of the affected population is asymptomatic, for some it can be lethal
There isn’t clarity on all the ways C19 spreads
It’s known to affect the lungs, heart, and kidneys in patients with weak immunity
It has been hard to identify a definitive pattern of the virus. Some observations in managing the C19 situation are:
With no vaccine in sight, the end of this epidemic looks months or years away
Health care personnel in hospitals need additional protection to treat patients
Lockdowns lead to severe economic hardship and its repeated application can be damaging
Quarantining people has an economic cost, especially in the weaker sections of society
If one takes a step back to re-think about this, we are primarily solving 2 problems:
Minimise deaths: Minimise the death of C19 and non-C19 patients in this period
Maximise economic growth: The GDP output/growth should equal or higher than pre-C19 levels
One needs to achieve the 2 goals in an environment of rising number of C19 cases.
Minimise deaths
An approach that can be applied to achieve this is:
Data driven health care capacity planning
Build a health repository of all the citizens with details like pre-existing diseases, comorbidity, health status, etc. The repository needs to be updated quarterly to account for patient data changes
This health repository data is combined with the C19 profile (disease susceptibility) and/or other seasonal diseases to determine the healthcare capacity (medicines, doctors, etc.) needed
The healthcare capacity deficit/excess needs to be analysed in categories (beds, equipment, medicine, personnel, etc.) and regions (city, state, etc.) and actions taken accordingly
Regular capacity management will ensure patients aren’t deprived of timely treatment. In addition, such planning helps in the equitable distribution of healthcare across regions and optimising health care costs. Healthcare sector is better prepared to scale-up/down their operations
Based on the analysis citizens can be informed about their probability of needing hospitalisation on contracting C19. Citizens with a higher health risk on C19 infection should be personally trained on prevention and tips to manage the disease on occurrence
The diagram below explains the process
Mechanism to increase hospital capacity without cost escalation
Due to the nature of C19, health personnel are prone to infection and their safety is a big issue. There is also a shortage of hospitable beds available. Even non-C19 patients aren’t getting the required treatment because health personnel seek it as a risk. This resulted in, healthcare costs going up and availability reducing.
To mitigate such issues, hospital layouts may need to be altered (as shown in the diagram below). The altered layout improves hospital capacity and availability of health care personnel. It also reduces the need for the arduous C19 protection procedures. Such procedures reduce the patient treatment capacity and puts a toll on hospital management.
Over a period, the number of recovered C19 persons are going to increase significantly. We need to start tapping into their services to reduce the burden on the system. The hospitals need to be divided into 3 zones. The hospital zoning illustration shown below explains how this could be done. In the diagram, patients are shown in green and health care personnel are in light red.
**Assumption: Infected and recovered C19 patients are immune to the disease. This is not clearly established
Better enforcement of social factors
The other reason for high number of infections in countries like India is a glaring disregard in following C19 rules in public places and the laxity in enforcement. Enforcement covers 2 parts, tracking incidents of violation and penalising the behaviour. Government should use modern mechanisms like crowd sourcing to track incidents and ride on the growing public fear to ensure penalty enforcement succeeds. The C19 pandemic has exposed governance limitations in not just following C19 rules, but also in other areas of public safety like road travel, sanitation, dietary habits, etc.
Maximise economic growth
The earlier lockdown has strained the economy. Adequate measures need to be taken to get the economy back on track. Some of the areas that need to be addressed are:
One needs to evaluate the development needs of the country in different categories like growth impetus factors (e.g. building roads, electricity capacity increase), social factors (e.g. waste water treatment plants, health care capacity), and environmental factors (e.g. solar energy generation, EV charging stations). Governments need to accelerate funding in such projects so that that large numbers of unemployed people are hired and trained. Besides giving an immediate boost to the ailing economy such projects have a future payback. The governments should not get bogged down by the huge fiscal deficit such measures can create. Such a mechanism to get money out in the economy is far than better measures like QE (Quantitative Easing) or free money transfer into people’s bank accounts
Certain items like smartphone, internet, masks, etc. have become critical (for work, education, critical government announcements). It’s essential to subsidise or reduce taxes so that these items are affordable and accessible to everyone without a financial impact
The government shouldn’t put too many C19 related controls on service offerings (e.g. shops, schools, restaurants, cabs). Putting many controls increases the cost of the service which neither the seller not buyer is willing or able to pay. Where controls are put, the Govt should bear the costs or reduce taxes or figure out a mechanism so that the cost can be absorbed.
An event like the C19 pandemic is a great opportunity to rationalise development imbalances in the country. Government funding should be channelized more to under-developed regions. This drives growth in regions that need it most. It also prevents excess migration that has resulted in uncontrolled and bad urbanisation that has made C19 management hard (guidelines like social distance are impossible to follow)
Post-C19 lockdown, the business environment (need for sanitizers, masks, home furniture) has changed. To make people employable in new flourishing businesses there could be a need to re-skill people. Such an initiative can be taken up by the public/private sector
The number of C19 infected asymptomatic patients is going to keep increasing. Building an economy around them (existing, recovered C19 patients) may not be a far-fetched idea. E.g. jobs for C19 infected daily wage earners, C19 infected taxi drivers to transport C19 patients, etc.
In the last 100 years, mankind has conquered the destructive aspects of many a disease and natural mishap (hurricanes, floods, etc.). Human lives lost in such events has dramatically dropped over the years and our preparedness has never been this good. Nature seems to have caught up with mankind’s big strides in science and technology. C19 has been hard to reign in with no breakthrough yet. The C19 pandemic is here to stay for the near future. The more we accept this reality and change ourselves to live with it amidst us, the faster we can return to a new normal. A quote from Edward Jenner (inventor of Small Pox) seems apt in the situation – “The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases”.
Read More
Health Technology, Digital Healthcare
Article | September 8, 2023
As consumers, we crave convenience and simplicity, and across an array of industries, technology has made it increasingly easy to search for and purchase products and services. From getting a pizza delivered to buying a car online, the process often involves entering a few pieces of information, hitting send, and waiting for a confirmation email.
A Changing Landscape
Unsurprisingly, people want this same level of convenience and simplicitywhen they're seeking care. This change in consumer demand for convenience is further compounded by fundamental shifts in the healthcare ecosystem. Among these shifts are cost-sharing models that have increased patient out-of-pocket expenses, healthcare systems that are increasingly shifting toward delivering value-based care, and innovations in digital health solutions.
While patients want to play an active role in managing their well-being, that is often easier said than done in a system that uses a combination of manual processes and non-integrated point solutions to try and meet consumer demand. Disparate and burdensome methods of managing patient engagement often lead to inefficiencies within provider organizations, resulting in missed appointments, increased registration and eligibility-based denials, incomplete payments, higher collections and write-offs, and low patient satisfaction.
Consumer Dissatisfaction
Healthcare consumers today feel like they're fighting an uphill battle. According to Change Healthcare's 2020 Harris Poll Consumer Experience Index, 67% of respondents agreed that it “feels like every step of the healthcare process is a chore.” A similar percentage, 62%, agreed that “the healthcare system feels like it is set up to be confusing.”
Furthermore, if consumers don’t receive the level of convenience and digitization they want from their current provider, they’re more than willing to seek it out elsewhere. In a recent Black Book survey, 80% of respondents indicated they would be willing to change providers for more convenience even if they were receiving good care from their current provider. An even higher percentage of patients,90%, do not think they have to continue seeing a provider if that provider does not “deliver an overall satisfactory digital experience.”
A Patient-Centric Approach
Improving the patient experiencestarts with humanizing revenue cycle management(RCM) —the administrative process that takes the patient from registration and appointment scheduling to the final payment of a balance. Simply making administrative touchpoints self-service and easy to understand throughout the patient’s financial journey can help humanize revenue cycle management for providers.
How is that possible? By thinking about the patients’ side of the administrative process and leveraging innovative technologies like artificial intelligence, robotic process automation (RPA), natural language processing (NLP), and machine learning. The more that providers’ staffs are able to automate repetitive tasks, the more time they're able to spend helping provide a seamless patient engagement journey that is focused on a patient’s specific needs. In other words, reducing human intervention throughout our technologies allows providers to infuse more human interaction with each patient as they navigate their healthcare journey.
According to Change Healthcare’s 2020 Harris Poll Consumer Experience Index, what patients really want is a retail-like shopping experience with modern, streamlined communication, as thevast majority (81%) agreed that “shopping for healthcare should be as easy as shopping for other common services” via a streamlined access point online. A clear majority (71%) also said they want their health insurance and healthcare providers (68%) to communicate with them using more-modern platforms.
Simplified Scheduling and Payment
The entire clinical-care journey is focused on the specific needs of the patient rather than the provider, so why shouldn’t the patient’s financial journey be handled the exact same way? From a patient-satisfaction perspective, patients are not separating their clinical journey from their financial journey, so providers should start viewing it the same way.
It should be easy to schedule an appointment and modify that appointment if needed. Patients should have to (securely) provide their personal and insurance information only once (digitally and in advance), then be squared away when they show up for their appointment with their provider. In addition, because of COVID-19 and the heightened awareness surrounding personal interaction, it’s important to provide patients with no-contact check-in and waiting room options.
By humanizing RCM, providers can achieve a cohesive end-to-end journey that allows patients to quickly and easily get the care they need complete with clear communication, price transparency , and a provider who truly takes the time to understand their unique situations. By putting the patient back at the center of their care journey, providers can improve care outcomes while also driving maximized business outcomes for their organizations.
Read More
Health Technology, Digital Healthcare
Article | July 14, 2023
While many United States healthcare providers are returning to their in-person offices, many others are digging in to offer hybrid telehealth or exclusive telehealth practices moving forward. Understanding the future of telehealth reimbursement is then a pivotal issue. As a hub for telehealth consultants and trainers, the Telebehavioral Health Institute (TBHI) is receiving daily requests for assistance from behavioral health groups and independent practitioners seeking to position themselves for telehealth expansion optimally.
Read More
Health Technology, Medical Devices
Article | November 2, 2022
Smoking has a lot of consequences to one’s health. It can lead to cancer, heart disease, and chronic obstructive pulmonary disease—all of which are chronic diseases. This is part of the reason why the Health and Human Services agency reports that 70% of adult smokers want to quit. As a medical provider, adults looking to stop smoking will come to you for advice and treatment. One alternative smoking product you might want to recommend is an e-cigarette, given their prevalence in recent years.
In this article, let’s take a deeper look at whether e-cigarettes’ should be recommended for smoking cessation and what other treatment options to endorse to patients.
Are e-cigarettes approved for smoking cessation?
Electronic cigarettes, more commonly known as e-cigarettes, are devices that vaporize nicotine-based liquid to be inhaled by its user. It almost replicates the experience of smoking a cigarette due to the device’s shape and the vapor it produces. However, the FDA has yet to approve e-cigarettes for smoking cessation because there is currently limited research on their effectiveness, benefits, and risks for the human body.
Additionally, scientists at the University of California found harmful metals in the vapor from tank-style e-cigarettes. These e-cigarettes are equipped with high-power batteries and atomizers to store more liquid. These result in high concentrations of metals like iron, lead, and nickel in the vapor. Exposure to and inhaling metallic particles may impair lung function and cause chronic respiratory diseases. As such, medical providers should not recommend e-cigarettes for smoking cessation.
What can medical providers recommend for smoking cessation?
Smoking cessation medication
Presently, two FDA-approved prescription medicines for smoking cessation are Bupropion and Varenicline. Bupropion is an antidepressant that decreases tobacco cravings and withdrawal symptoms. It does this by increasing the brain chemicals dopamine and noradrenaline. This comes in a pill and can be used alongside other smoking cessation aids.
Varenicline also reduces cravings and nicotine withdrawal symptoms. It blocks nicotine receptors in the brain, decreasing the amount of enjoyment one gets from smoking. One thing to note about this is that it will take several days for Varenicline's effects to take place. Therefore, it's best to prescribe these pills 1-2 weeks before the patient quits smoking. Like Bupropion, Varenicline may be used simultaneously with other quit-smoking products.
Nicotine Replacement Therapy
Nicotine replacement therapy (NRT) is a treatment involving nicotine consumption at gradually decreasing levels. This reduces the patient’s desire to smoke without them having to quit cold turkey. NRT involves using nicotine alternatives that don’t produce smoke, such as nicotine pouches and nicotine gum.
Nicotine pouches are oral products containing ingredients like nicotine, flavoring, and plant-based fibers. These are placed between the lip and gum, where nicotine is absorbed into the bloodstream. Different variations have different strengths. On! pouches come in different strengths: 2mg, 4mg, and 8mg. Patients may start from 8mg variants and gradually decrease this dosage as their NRT progresses. Pouches also come in a wide range of flavors—including citrus, mint, and berry—to entice users.
Meanwhile, nicotine gum is chewing gum that contains nicotine. It is chewed a few times before being parked between the gums and cheek for nicotine absorption. The nicotine gums by Lucy are a significantly better alternative for tobacco users. Like pouches, this gum comes in several flavors, such as cinnamon, mango, and wintergreen, and different strengths ranging from 2mg to 6mg.
Counseling
The recommendations mentioned above—medication and NRT—are more effective when coupled with counseling. A Primary Care Respiratory Medicine study revealed that successful smoking cessation is best attained through pharmacological treatment and counseling. Sessions typically involve a patient meeting with a counselor and they discuss their smoking habits, possible causes, and how to mitigate them. Medical providers should include counseling in addition to medication and NRT.
E-cigarettes have yet to be approved by the FDA as smoking cessation aids. For now, medical providers should provide medication, NRT, and counseling to patients who want to quit smoking.
Read More