Category: Business

31 Dec 2018

Uber and Lyft ride into healthcare. What to expect (and what not to)

Here’s the premise.

36 million American patients miss their medical appointments. If only they had a ride waiting outside, they’d make it to the doctor’s office.

Uber and Lyft have both made announcements in healthcare this month. And why not? In recent months, Apple, Amazon, Google, Berkshire Hathaway have all plugged into healthcare.

Here are a few headlines that recap this ride-sharing story.

Uber wants your doctor to call you a ride to your next checkup

Know the Risks When Using Uber Health, Lyft

Whoa, Uber’s New Service Will Drive You to the Doctor for Free

New BCBS Institute working with Lyft, CVS, Walgreens to tackle social determinants

Lyft announces integration with Allscripts EHR system, allowing 180,000 doctors to hail rides for patients

Five Things to Know About the Uber and Lyft Provider Partnerships

Basically, the doctor’s office or the hospital would hail a ride. A patient would hop in, possibly share the ride with other patients. Helping providers not lose money in missed appointments ($150 billion per year). Helping patients not fall sicker by skipping those appointments. Further, sick patients end up in acute care burdening the system more and more.

I get the logic.

Just that I see a few bugs in it. More so because we are practically in the trenches with doctors everyday.

Why patients don’t show up (really)

JAMA just published findings from a clinical trial of 786 adults with Medicaid. This is what they found:

“Offering a rideshare-based transportation service may not decrease missed primary care appointments.”

The Annals of Family Medicine published this study in 2004. Why We Don’t Come: Patient Perceptions on No-Shows. Before Uber or Lyft existed.

Patient “no-shows” is a big problem for doctors. But you rarely hear that they didn’t show up because they couldn’t get a ride.

The 3 big reasons that the Annals of Family Medicine study found were:

  • Emotions
  • Perceived disrespect
  • Not understanding the scheduling system

Here’s quoting from the study:

“Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants’ lack of understanding of the scheduling system.”

This does sound right.

There’s another study, Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. The findings:

“Forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments.”

In our experience, this sounds perfectly reasonable. More than a quarter of them cited “no reason”!

There are also unexpressed financial reasons. By showing up, patients need to face up to deductibles and co-pays. It’s not always that they want to pay up.

Several articles talked about how the rides would help lower income populations.

The reality is doctors struggle to get paid by Medicaid (insurance that covers lower income). They never know if they’d get paid for the service they are about to provide. They do it anyways.

It seems unreasonable to expect that over-stretched doctors and staff would now hail a ride for patients via the EHR.

EVEN IF we do call Uber from the EHR

I was recently in a meeting at a large hospital in the east coast of US. It’s easily considered one of the world’s best. The doctors don’t really have a problem patients showing up. It’s what happens after they do.

Here’s where they are stuck.

They see a patient. Order a test. Or schedule a procedure. The billing office calls the insurance to get “prior authorization” for the procedure. Insurances make it difficult to provide prior auths. The game goes on for several days. The billing office is overwhelmed by the many prior auth requests. Finally after 30+ days (on average), the patient ends up on the procedure table. Getting the care she rode in for.

Now imagine in the above everyday scenario, the doctor or her staff does call Uber for their patient. Possibly via their EHR. Of course, the integration is cool (for tech folks, not necessarily for doctors). It won’t necessarily help the patient get care faster. It won’t help doctors get paid for that care or service.

In fact, what it is is this. It’s convenient. Like ordering food online. It may not really solve our clinical or economic burden in healthcare. It adds a layer of easy. And that’s a good thing too.

May be we should say just that.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Pexels

31 Dec 2018

4 Takeaways from Practice Fusion EHR’s $100M sale to Allscripts

Two years ago, Practice Fusion, an electronics health record company was rumored to be valued at more than a billion dollars.

Last month, the company sold for a fire sale price of $100 million.

Having raised $157 million, you can imagine that most people didn’t make any money. Apparently parachute deals help senior executives and the board make a few million (including $2million for the company lawyer).

But nothing really for employees who stayed on and ordinary shareholders. Few who exercised options earlier will even lose money via taxes.

Read: Employees at Practice Fusion expected IPO riches, but got nothing as execs pocketed millions (CNBC)

Apparently, the company has been looking for a buyer for 2+ years. And got offers ranging from $50-$250M. Allscripts, an EHR giant that recently acquired McKesson’s Health IT portfolio, initially offered $250M. But got nervous after a Department of Justice investigation last year (of another company – eClinicalworks which settled with prosecutors for $155million).

Read: Allscripts offered to buy Practice Fusion for $250M. A DOJ investigation changed everything

That’s the story. What does it all mean?

The evolving healthcare industry landscape will show what it eventually means. But here are a few takeaways.

1) A nod to the cloud

The EHR world’s market leaders are Cerner, Epic and Allscripts. All of them are client-server based. Epic is based on 52-year old MUMPS technology.

In a world of client-server dominance, Allscripts acquisition of Practice Fusion is a nod to the cloud. That’s clearly where the industry is going. Or, will be compelled to go.

Here’s what the company’s president Rick Poulton said: “Plus, Practice Fusion’s affordable EHR technology supports traditionally hard-to-reach independent physician practices, and its cloud-based infrastructure aligns with Allscripts forward vision for solution delivery.”

2) It’s tough to make ‘free’ a sustainable business model in healthcare

Practice Fusion started on the premise of offering a free EHR to physicians. And in turn, monetizing de-identified healthcare data. Supported by ads etc.

Investors bought into it. Including Peter Thiel (he wrote the founder a check of $1million in 2011 before leading that round).

Then the valuation game caught up with itself. Investors put in money assuming someone else is going to put in at a higher valuation. Later. But when the company isn’t making real cash, the valuation cycle eventually catches up.

Someone says, I can’t agree to that valuation – it makes no sense. And then everything goes down-hill. Down rounds begin. Terms change. Dilution for earlier investors happens. People get fired. CEOs get ousted.

The problem with healthcare is that regardless of how fast the world moves, the industry moves at its own pace. Like life and death, the industry whiffs of a certain permanence.

You can’t do a Google or Facebook here by offering free service and making money via ads or data. At least, not yet.

3) The landscape is freezing

Industry changes happen like lakes freezing and unfreezing.

Rules of the game shrink. Consolidate. Big boys dominate. They make it harder for each other and others to change rules.

In US, Meaningful Use incentive dollars that spurred the industry have dried up. Tech giants like Apple have made healthcare announcements (“effortless solution to bring health records to iPhone”).

Companies like Allscripts bought McKesson (to go after smaller markets), now Practice Fusion. They’ll keep looking for more deals to spread their reach.

Tired of their healthcare costs, Amazon, Berkshire Hathaway, and J.P. Morgan announced that they are teaming up to disrupt the industry.

When industry landscapes freeze, it’ll take time before it melts again. But because it’s healthcare, the freezing – while it’s definitely begun – will happen slowly, slowly.

This leaves doors open for specialty and niche opportunities that are small for the big boys to focus on. That means there’s no point building a new plain vanilla EHR. But there’ll be strong needs for EHRs and products that go a mile deep in specific areas. That naturally plug into the new rules that are bubbling to the surface.

4) Practice Fusion’s real asset is its data. But no one’s talking about it

Practice Fusion has a dataset of 81 million patient records. Imagine applying AI on that data. Creating newer products for the same target group based on their data.

It may be tough for Allscripts because market commands their vision to focus on getting bigger faster. Not develop cool technology tools.

Practice Fusion’s idea was a good one. To build a company around data. But their business couldn’t sustain itself until that point where the industry is mature enough to make that data useful.

What’s the moral of the story?

Practice Fusion’s founder Ryan Howard moved on to build a heart-activity wearable device called iBeat (after differences with the board).

Is there a lesson here? That the healthcare industry is trying to tell us. Perhaps it’s this.

It’ll be slow. You can disrupt but not quickly or suddenly. You’ll need stable, sustainable business models. The boring stuff makes money. Regulations can disrupt your life. And yes, it’ll all be up in the cloud. Eventually.

 

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Pixabay

06 Jul 2017

To survive (and thrive) in healthcare, you need a pipeline of ideas

 

There’s this myth that entrepreneurs take great risks. It may be true while starting out. But in reality, most long term entrepreneurs methodically de-risk. Do everything to reduce risk for their companies. Not increase it.

Several startups go belly up in risking too many eggs in one product or one investor or one client. Including some very large startups.

More times than not, market forces work against you. Not for you.

You already know this.

To survive (and thrive), you need a pipeline of ideas. Particularly in healthcare. A complicated, slow-moving beast.

Sometimes in this industry, the function of one product or service is to simply lead to the next. Or, the one after that.

In such a game, your ability to acutely focus on what clients want and will pay for is key. It’ll keep your lights on.

Then when something takes off, it’ll get the rest of your portfolio to take off.

A “page turner” that no one cared about

Entrepreneurs (like me) often obsess about things that no one cares about. We burn time and money on those obsessions.

When we first built our enki electronic health record (EHR), the mobile version excited us. One of the doctors we interviewed indicated that he’d love for the EHR to resemble his paper charts.

We took that feedback to heart. Spent inordinate amount of resources in building that feedback into a feature in our mobile app. Each section of the patient’s chart would flip like a real page. It looked great and we loved it!

But our clients really didn’t care much for that feature. All that mattered to doctors was the ability to complete a chart quickly. Move onto the next patient. Flipping a page was lower in the order of priorities.

This “page-turner” and other features delayed our launch endlessly. We spent our time making our creation more and more beautiful (not just “good enough” to move onto the next step). It left no money or time for marketing.

Thankfully we had other sources of revenue that kept us going. Even while we learnt from these mistakes and built our next product or service. And the next.

What we now observe is one service or product often triggers our clients to buy our other products. Because they already love us and what we do. Now many of our clients use everything we’ve built.

Allow them take complete advantage of you

Say you wish to start a smart footwear company for senior citizens. The sensors would alert an app when there are abnormalities in mobility.

Instead of running after funding first, spend $500 online. Buy sensors and strap it to footwear. Figure out how to send basic signals to your phone. Build a prototype that your potential buyers can use.

Then just give it to your customers to use it. And watch.

Your beta users will show you what they like and dislike.

If you listen keenly, they will exactly tell you what they will pay for.

Focus on what they want versus what you want.

Observe your users (senior citizens in this example) and their environment. So closely that you know them more than they know themselves.

Ask yourself this question: How can they take complete advantage of you?

You will be surprised with the number of ideas you would get when you answer that question. Because you would be bringing the focus to them.

May be there are caregivers and doctors who have certain needs in monitoring your customer. Or, may be there’s everyday furniture that can become smarter. Or, may be there’s a need for “smart” walking canes that sense movement.

May be, the footwear needs to connect with other devices giving richer analysis of data. Or, you could develop a subscription plan and offer the footwear free.

You’ll arrive at endless possibilities for growth. When you bring all your attention to your customers. They will tell you what you need to build next. You simply need to listen and respond. With everything you got.

Never run out of ideas

A tree with many roots doesn’t get blown away when the winds are strong.

Not only do the roots keep it grounded, they also provide renewed sources of water. If one root dries out, it can feed itself from another. Roots run long and source water from many different terrains.

Successful healthcare businesses are no different. Longevity helps in this industry. With experience, you will find many sources of revenues. One product leads to another. One service evolves into many branches.

All you have to do is listen. And respond to your sources of water.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

 

27 Jun 2017

How to grow your startup…even if VCs don’t love you

 

Big meeting rooms with shiny tables make me uncomfortable. Like that room inside the offices of that big-name VC firm.

Even as I waited, I lusted after the logos of many a known startup. They were displayed on plaques outside the room.

(Some of them are bust today. But back then it didn’t matter.)

Then he came. The investor. Eating something. Crumbs.

“Show me something that you have that no one else has!”

That was almost the opening line.

Right, I thought. Imagine hearing something like that on a first date.

My next thought was to recall the cost of the flight tickets that brought us to this meeting. Then my time. I could’ve met clients. Trained our people.

Or, I could’ve at least gone for a movie.

Ouch, I thought. But decided to go along since I was already there.

“Look,” he said midway through the demo. He was staring into his phone. “We would want you to get to a $500 million valuation. Or, go bust!”

Go bust? But what about our clients? And our people?

(Wasn’t it a 50 Cent movie? Get Rich or Die Tryin’)

Just valuation.

Not real money. Like profits. Or even revenues.

“But that’s our model,” the investor said. He was looking at me now.

“Oh,” I responded.

A day later, to close the loop I told him we weren’t a fit.

Well, he already knew that.

Thinking about growth differently

No meeting really is futile. Those kind of meetings (yes, there were a few) helped me discover the Healthcare Footprint Finder. A practical strategy to grow your business in healthcare.

Another VC-friend-of-a-friend told me this in confidence:

In reality, most of us don’t understand healthcare. Or, how to sell to businesses within healthcare. The industry is too complicated. That’s why we ask for traction. If there’s demand then it reduces the risk for us.

I know. Healthcare is complex.

Everything takes time. Your first product is often the means to your next one or the one after that.

If you can’t stay put, you’ll surely go bust.

In 2012, 2,000+ electronic health record (EHR) companies went through the gate of Meaningful Use Stage 1 (part of the erstwhile Obamacare). By 2015 the time of Stage 2, only 200+ companies passed through the gate.

It’s now time for Stage 3. The game gets narrower.

Healthcare requires staying power. Where you need to make real money. Not just play the valuation game.

Because even if you get an investor onboard, they will lose patience in trying fuel you again and again.

But how do you stay on in healthcare? By finding your next big idea.

And how do you find your next big idea? By looking around your existing footprint.

Observe your clients in action. You will discover many unmet needs. They may not be able to verbalize them for you. But if you work closely with them, those needs will begin to leap out at you.

Our company started by selling billing services to gastroenterologists. Today we sell sophisticated endoscopy report writing software to the same clients. We also sell MACRA compliance services and a cloud-based EHR platform. To the same clients.

We got the idea of creating software by looking around our existing footprint. Looking for newer ways to be useful to people who already love us and our work. Observing what was bothering them. Solving their problems.

That’s how it happens. We use the Healthcare Footprint Finder model to grow.

When you approach growth this way, you will have a pipeline of services and products to develop. Because client needs become the starting point. Not random ideas. This way, your new product is likely to sell from Day 1.

Without hankering for funding, you would focus on the right things for your company.

So, VCs or not?

There’s no right answer. It depends on what you want and what the business wants. At that point of time. It also depends on finding the right investor. Does the person getting on your board understand you and your vision?

There are many fine examples of entrepreneurs who’ve ditched the elevator pitch altogether. Built fantastic companies.

Jason Fried from Basecamp. Ramit Sethi from IWT. Ben Chestnut from Mailchimp. Steve Rayson from BuzzSumo.

It’s the market that sustains them. Their business models are regenerative. Always alive. In tune with client needs.

They focus on quality vs quantity. User success vs user acquisition. Sustainable growth vs quick exits.

Mara Zepada of Switchboard and Jennifer Brandel of Hearken call these companies Zebras. An alternative to the Unicorn fantasy.

But such a strategy seems counterintuitive.

At a time when everybody wants to Uber-this and Uber-that.

Even when it all comes Uber-ing down.

 

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Photo by Ashley Bean on Unsplash

21 Jun 2017

Global convergence in the future of healthcare. Are you ready?

 

This wasn’t the usual South African clinic.

We were inside a high security prison for illegal immigrants. On the outskirts of Johannesburg.

Stroking his beard the doctor told me, “Some of them get arrested for a free ride home. First, the authorities bring them here for a few days. Then they drop them at the border. Our clinic has to make sure they don’t get sick.”

Then he began sounding so much like doctors in America.

“We must digitize. But it mustn’t slow us down.”

“Patients don’t listen to instructions.”

“Nothing integrates here. We need our systems talking to this, this and this.”

Global like your local Starbucks

Healthcare issues are so local that we fail to realize how global we’ve actually become.

South America. Africa. Asia. Middle-East. Whichever part of the world you look. Healthcare is looking more similar than dissimilar.

With increased sanitation, communicable diseases like malaria are on the decline. With increased prosperity, non-communicable diseases like diabetes are on the rise.

In a city like Mumbai or Johannesburg, you’ll find that both disease conditions co-exist often within walking distance.

4 pillars of healthcare delivery

Observe these four essential pillars of healthcare. These are applicable wherever healthcare is delivered. Notice the convergence.

  1. Disease: Types of diseases are more common (e.g. hypertension). Reasons of disease are also more common (e.g. stress). Country after country, disease burden is on the rise.
  2. Diagnosis. Our approach to arrive at a diagnosis is getting similar (e.g. via lab tests, examinations and consultations).
  3. Cure. Therapies are common (e.g. procedures are similar, guidelines are more common).
  4. Pay. Sometimes it’s the government or the individual that pays. But today it’s more likely that you have an insurance company covering you.

You will notice that everyone is moving in the same direction. Everywhere.

Future of healthcare needs a global mindset

Extrapolate these trends of disease and healthcare delivery. What do you think is going to happen in the future? Yes, a lot more convergence.

You could delve into a specific area such as in Health IT. You will hear the same language. Technology standards. Interoperability issues. Burdensome complexity.

Healthcare administrators fret about the same issues from Manama to Miami. Productivity of doctors and staff. Expensive technology. Lack of available skills.

In global healthcare, the good and bad news is the same: Whether we sink or sail, everyone is in this together.

So where do you begin?

Today’s business environment is unpredictable. Technological changes are wiping out old business models faster.

A global mindset reduces risk for business. Particularly in healthcare because things are changing quickly.

But where do you begin?

1) Think differently about talent

Start by exploring new-age outsourcing tools like Fiverr or Freelancer or Upwork. From drawings of the anatomy to voice-overs, we’ve used these tools to reach global talent. It’s made our work richer.

A friend from a Fortune X company recently hired material science engineers in East Europe. These engineers reinvented a core product design for the company without really knowing who they were working for.

As head of R&D, my friend told his bosses only after he completed the pilot. It cost the company 1/20th the expense and brought about a shift in mindset.

Salim Ismael writes about this evolving exponential organizational mindset.

Today’s companies are built for a linear world – closed and topdown. They evolved more than a hundred years ago.

That world doesn’t exist anymore. Changes are exponential today.

2) Build partnerships with your global colleagues

Do this little experiment.

Go to LinkedIn and search for what you do in a completely different geography. Search for an industry-specific health IT standard like “HL7”. You’ll find people in UK, Australia, Egypt and elsewhere.

Reach out and build partnerships. You will find a need in the most unexpected places.

U.S. certifications are sought after in emerging markets. Like JCAHO, operated by Joint Commission, a non-profit body based in Chicago.

Brazil introduced ICD-10 in 1996. China in 2002. South Africa in 2005. U.S. shifted from ICD-9 to ICD-10 much later in 2015.

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Healthcare is changing.

To think differently, look beyond what you can see.

And ask this question: what’s not so different here?

Get healthcare insights more directly at redo/healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Facebook Connections by Michael Coghlan/Flickr

17 Jun 2017

4 steps to find your footprint in healthcare

 

Creating a business is fun. It’s also tedious.

It’s the tedious parts that are difficult. Because it takes patience to figure things out.

Building a product is fun. But when it doesn’t sell, do you add more features? Or, learn how to sell?

Like creating products, hiring is fun. When you are on the choosing end. But developing someone who’s not yet ready – that takes effort.

When new clients sign up, it’s fun. But when they complain about your support or when quality wobbles – that’s tedious.

It’s easy to gravitate towards the next shiny thing. And the next after that. But the magic lies in figuring the tedious things out.

To market and sell. To build stable operations. To develop people. To be responsive to clients. To manage cashflow. These take time and discipline.

How we found our focus in healthcare

There are more than 120 medical specialties and subspecialties in medicine. Each is an industry in its own right. But we found our center in the gut!

My company started by providing billing services. It so happened that one of our first clients was a gastroenterology practice.

We loved the David and Goliath fight with insurance reimbursements. In doing so, we learnt the business problems that GI doctors face.

When our clients struggled with old EHRs, we knew we could do something about it. With a lot of effort and of course money, we built our own cloud-based EHR called enki.

We didn’t stop there. We kept learning and digging the well of gastroenterology.

We noticed that clients had to deal with the complexity of compliance. We figured that out. Helped them win audits and incentive dollars.

We saw that our doctors lived with old endoscopy software. Expensive. Requiring frequent upgrades.

That prompted us to build endoscopy report writer software. We used our knowledge of building cloud-based products and compliance. Applied that to the endoscopy market.

Our clients continue to have many needs. Our company simply needs to make sure we meet those needs by being on top of the game.

That becomes our focus.

4 steps to find your healthcare footprint

If you are starting or growing your business in healthcare, find your footprint using these four steps. Here’s the Healthcare Footprint Finder.

Step 1: Find your market within the industry

Healthcare is too big. You need to find a market within the industry. Something with gaps and frustrations but also expanding. A specialty that’s branching into subspecialties.

Before you start developing anything, be clear (by testing) that someone is willing to pay you for it. How does it ultimately benefit a doctor or a patient?

(I’m not a fan of the user-volume game that certain startups play. It burns a lot of other people’s money. Doesn’t guarantee a method for profitability.)

Step 2: Find a footprint within your market

Once you know there’s a market need, find your footprint. If you can serve ONE client well enough for them to say, “We love what you do for us!” then you are in business. You can do this many times over.

If you can’t find even one to say so and pay you, then something is wrong.

Step 3: Learn how to sell your footprint

Several entrepreneurs abandon this step because it’s too difficult. Or they throw money on the problem by hiring more salespeople or paying for clicks.

Marketing forces you to deeply probe and ask yourself whom you wish to serve. Why? How? What differentiates you? How could you be better? What should you be doing to offer maximum value to your footprint?

Step 4: Look around your own footprint

Once you have a footprint and know how to sell, look around your footprint. What do your clients do before and after they use your product or service? How could you make their life better?

That becomes your next product or service. That’s how you grow.

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Get healthcare insights more directly at redo/healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Christopher Sardegna/Unsplash

08 Jun 2017

Here’s something that many healthcare entrepreneurs ignore

 

Despite innovation in medical science, healthcare is usually behind other industries. By 3-5 years or more.

The industry gets by with old technology and processes. People resist change. Regulations slow progress. Companies market and sell using traditional approaches.

Such an environment sets the stage for new healthcare businesses. Some startups succeed. Several fail.

These failures aren’t sudden or dramatic like in other sectors. You can’t really fail-fast in healthcare. They are slow deaths. Companies drag on. Then they die when the money dries up.

The healthcare mousetrap

You have an idea. With your passion, you raise money. Or, you invest your own.

You build a team. Spend many months building a product or service. After toiling for many nights, you finally produce something beautiful.

Now you want people to buy your creation. At least a handful of customers.

You push for sales. But it’s tough.

You spend money on website traffic. SEO. Facebook Likes. Twitter campaigns.

You think – may be if you offer it free, you can get users onboard.

You use the “users” number to show traction and raise more money. You use the money to “buy” more users.

But…

Doctors or hospitals aren’t buying. Sales people are too expensive. Google Adword clicks in healthcare are pricey.

You need sales to raise more money. You need more money for sales. With no money, your product will age. But you can’t spend more on product until you at least sell some.

You are trapped.

Finally, many founders end-up writing post-mortem essays on Medium.

CB Insights analyzed numbers from 101 of those essays. Here are two big reasons for startups going belly-up.

  1. No market need (42%)
  2. Ran out of cash (29%)

Something so obvious that we love to ignore

Healthcare has many layers of complexity. Entrepreneurs often lose sight of what to focus on in this maze.

You can be a new hospital or software product or device maker. It doesn’t matter. Your success depends on understanding two main players in healthcare. Build something that they really need.

#1: Patient – because of whom healthcare exists

#2: Doctor – without whom healthcare cannot exist

(I know some of you technologists are thinking – but AI will soon replace doctors. It’s a separate topic. But for now, let’s agree that we won’t be seeing Elysium-style medpods anytime soon.)

It’s not that entrepreneurs entirely ignore patients or doctors. They simply assume that they already know enough.

But then healthcare is peculiar.

Even if your product or service doesn’t directly serve patients or doctors (e.g. something for insurance companies). It will still need to finally serve patients or doctors.

Patient behavior changes depending on context. She may agree to something in front of the doctor. But may do something else at home.

Treatment patterns also vary. The same patient could be treated differently depending on place of service, her insurance plan and where she lives.

Entrepreneurs love focusing on better technology. Or a better looking website. Or an ideal notion of how healthcare must be. Or quality processes. Or marketing tactics.

All those are important. But could become meaningless. If patients or doctors ultimately have no pressing need for your product or service.

Instead of building what you want and finding buyers later. Build what they want.

Flip your thinking.

Talk to them. Ask them deep, probing questions. Observe them closely. At work and beyond. Know them more than they know themselves.

It might take you longer to get started. But it saves you from going down a tunnel with no end.

Patients and doctors. It’s where all healthcare begins. It’s also where it ends.

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Related: You have a healthcare product idea? Avoid these 5 dead-on-arrival mistakes

Get healthcare insights more directly at redo/healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: geralt/Pixabay

24 Jan 2017

Why Are Cat Videos Easier To Share Than Medical Records?

catvideoseasiertoshare

Since 2009, US spent $27 billion to digitize medical records. The cornerstone of digitization is to make health records available for patient care when needed.

In other words, the objective is to make electronic health records interoperable. This means, developing systems using common standards so that information can be exchanged without difficulty.

But as the now former President Obama remarked, “It’s proven to be harder than expected.”

HD videos of cats are easier to share than critical medical information

The reason we can share cat videos with ease is because the system creating them (say the camera on your phone), the system uploading them (your computer), the systems distributing them (example, YouTube) and the system accessing them (say your friend’s phone via an app or browser) – all of them talk to one another.

If you so wished, you could even share those videos using 256-bit encryption security.

The underlying systems here are interoperable. More importantly, the companies behind these systems want to talk to one another. They’ve figured out ways to do so.

The healthcare industry is an altogether different story.

The traditional EHR model wasn’t built for interoperability

Traditional EHR vendors built their businesses by becoming one-stop-shops for healthcare providers – billing, storing records, connecting to labs and pharmacies, capturing radiology images and so on. A few became mega one-stop-shops digitizing hundreds of millions of records.

Once in, you are never expected to get out. In fact, your systems and data are locked-in almost permanently.

Why would you get out after spending hundreds of millions of dollars and years in implementation? But for some reason if you do need out, you would have to pay a price.

Healthcare interoperability disrupts a business model that is built on holding onto data. It suddenly says, share your gold to anyone who needs it.

Of course, none of the vendors liked it. However, the big EHR vendors faced a lot of flak in the last 2-3 years. For not sharing. For making it expensive to share.

[Read this scathing article from Mother Jones: We’ve Spent Billions to Fix Our Medical Records, and They’re Still a Mess. Here’s Why.]

It was only in December 2016 that two major industry alliances Commonwell and Carequality (led by different groups) agreed to start talking.

[Read a longwinded but informative article from Healthcare Informatics: Healthcare’s Latest Interoperability Push]

This agreement sets the stage for locating medical records hidden in some system somewhere. That’s the I-know-there’s-a-cat-video-on-your-phone level.

A KLAS 2016 report on interoperability notes that only 6% of providers felt it significantly benefited patient care.

KLAS definition of a home run: information received that is easily available, easy to locate, within the workflow, and beneficial to patient care.

We are still way off before making any meaningful impact on patient care.

The other interoperability issue no one is talking about

Say your surgery center uses a really old anesthesia monitor, a new infusion system, an old endoscopy machine and a new patient vitals monitor. Perhaps, you can make them talk because the cables connecting them are more or less standard (but too many).

 

But how would you convert these semi-analog signals (think, your old TV) into digital (think, your phone) so that they can be transmitted as data via the Internet – so that eventually your doctor can access them on her mobile device?

It’s tough.

Making medical systems interoperable is like trying to stuff a floppy disk into your phone to send a document.

There are companies that are attempting to connect various medical devices and offer these signals via a HL7 data format. This allows for accessing medical device data via an EHR.

[Aside: Read about FHIR that’s taking HL7 standards further – What is FHIR and why should you care]

GE recently said that its health cloud will connect over 2 million imaging machines worldwide (500,000 of those are made by GE). But that’s just imaging.

We are dealing with a potpourri of medical systems. Some old, some new. Plus, there are several millions of them when you consider various medical specialties.

Add to the mix the lack of business incentives to talk. There you have the other big challenge for true healthcare interoperability.

In the mean time, let’s all drink our Kool-Aid

Almost everyone in the healthcare industry says that they are in it for patient care. That sharing medical information is critical for continuity of care. That they are doing their best to make interoperability happen. That data doesn’t become wisdom unless it’s shared. All the right things.

While our industry is figuring things out, do a simple test the next time you see a doctor at a hospital. Open your iPad and show the cat videos your family took last year. Ask if your doctor can do that with your medical records.

 

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 
Image: GIPHY

19 Jan 2017

A New Healthcare Law To Worry About [NOT SURE how to MACRA?]

healthcarelaw

There’s always something new to worry about for the healthcare industry.

On Jan 1st, 2017, a new law to track physician performance went into first gear. It’s called MACRA – a law that could be as important as the Affordable Care Act, which led to the name Obamacare.

MACRA is short for Medicare Access and CHIP Reauthorization Act of 2015, which was signed into law in April 2015. It’s an attempt to give carrots and sticks to clinicians. Payments or penalties based on quality of care.

MACRA’s intent is to pay clinicians based on outcomes. Have them compete with each other by issuing penalties for one half and incentives for the other.

MACRA is applicable for 55 million people in the US, covered under Medicare (federal insurance for 65 or older and people with disabilities). These patients are served by more than 500,000 clinicians who will now come under its umbrella.

The law streamlines older mandates (of EHR incentives and Quality Reporting) into a single rule. It has two tracks under the Quality Payment Program: Merit-Based Incentive Payment System (MIPS) and Advanced Alternate Payment Model (APM).

Most physicians are likely qualify for MIPS rather than APM.

[Advisory Board’s Q&A about MACRA final rule is a sound read]

A 2,398 page long administrative burden

To start with, the final rule is 2,398 pages long. You can skim it here. You don’t have to read it all. We’ve done the legwork for you.
Get the FREE infographic that outlines:
– MACRA eligibility and performance categories
– Incentives and penalties
– Tips on getting prepared

As with many laws, the makers are concerned with covering all bases. In doing so, what we have is a mammoth dictum that can drown its intentions.

Even if doctors follow the law as intended with or without help of consultants, new requirements call for an increase in reporting. Doctors or their staff will have to figure out what categories they qualify for, measures they would like to adhere to, track them while seeing patients, code accurately later and ensure completion before annual deadlines.

It’s estimated that quality reporting costs $40,069/physician/year. That’s about $15.4 billion in tracking and reporting measures for Medicare, Medicaid and private insurers.

Expect administrative burden to go up significantly given the uncertainty surrounding MACRA and its expansiveness.

“Focus is the patient.” But is it?

The day Centers for Medicare and Medicaid (CMS) released the final rule, they wrote on their blog that the focus was the patient because physicians could now report on only pertinent measures. If everyone spends more time and effort in reporting then shouldn’t an equivalent saving ensue through better patient care?

This is more wishful thinking than what might happen in practice.

Under quality improvement programs, doctors are required to report that they are adhering to specific quality measures (e.g. doing a foot exam for a diabetic patient).

These measures are converted to a point-based system. Using points, doctors are compared to other doctors. A score is derived based on what they could’ve done vs what they did. That finally determines how much someone makes.

Not simple.

As one doctor said, “I’ll now have to prove that my patient is obese when it’s so obvious that he is!”

[Read: Some doctors are advocating just saying no to MACRA]

Scoring makes the effort into a game. The composite score becomes a goal in itself beyond patient care.

Private insurance companies often follow Medicare

The insurance business model unfortunately works on denying or delaying or making partial payments. Lesser the payouts, greater the profitability. Some smaller insurance companies can make payments only until their monthly budgets run out.

MACRA has the risk of establishing a new payment norm for a large percentage of doctors. A doctor could earn less. Work more completing administrative tasks.

Private insurance companies often follow what federal insurances do. For example, they establish fees based on Medicare’s fee schedule. When Medicare fees drop, their fees drop. A regulation linked to payments could wickedly hand them a new tool to curtail payouts.

Physicians and their medical societies, already divided, will not be able to stand against insurance behemoths.

Of course, I love the intention of MACRA. Improving quality of care is welcome.

What is worrisome is its implementation. We will begin to see its full impact only in 2019 when CMS determines payments for what goes live now.

Many pegs need to fall into their right places. Doctors need to embrace it by following measures as intended. Patients need to benefit from better quality because of those measures. Administrators need to ensure financial sustainability amidst increased workload.

For its own sake, healthcare needs to be far more streamlined than it is. Watch out before it becomes a millstone around our industry’s neck.

_

Not sure how to MACRA?

The final rule is 2,398 pages long. You don’t have to read it all. We’ve done the legwork to make it simple for you.

Here’s a FREE infographic that outlines:
– MACRA eligibility and performance categories
– Incentives and penalties
– Tips on getting prepared

_

 

Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 
Image: Alexas_Fotos/Pixabay

10 Jan 2017

[Infographic] MACRA – All You Need to Know

On October 14, 2016, the Centers for Medicare & Medicaid Services (CMS) released a final rule that implements the Medicare Quality Payment Program (QPP). The rule describes key aspects of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaces the current Sustainable Growth Rate (SGR) formula for physician payments with a new value based payment model.

Under the final rule, healthcare professionals will have to start reporting quality data for 2017, to avoid negative payment adjustments in 2019. While the complexity of shift towards value based payment models may seem overwhelming, it is important to prepare now and avoid the payment adjustments. Here are manageable bits of information that will help you understand MACRA and get started.

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Skip spending countless hours trying to understand MACRA.
Get MACRA compliant, even if you don’t have time or resources to hire additional staff.

We’ve done the legwork. Gmacramipshandbooket your FREE MACRA survival guide.

In this 15-page guide, you’ll learn:
– How CMS defines MACRA tracks and categories (Page 2)
– Choosing your track and compliance timelines (Page 3, 4)
– How will your MACRA score get calculated with examples (Page 5)

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