During both my medical school and residency experience I had the opportunity to rotate through many intensive care units. I was always impressed with the compassion, expertise, and care rendered by devoted physicians, nurses, and other team members who practiced at the edge of life and death. I was also equally impressed with the amazing array of technology, clever monitoring devices, and sensors that kept a literal real-time pulse on how the patients were doing. During my training (in the mid-90’s), they were just starting to hook these sensors together in arrays that could be monitored remotely. This was the very beginning of the eICU movement which continues to grow today.
What struck me then, and continues to do so today, is how powerful the ability to monitor patients can be. Obviously, in the ICU setting this monitoring must be in real time as both the small and the subtle can have significant and serious implications. But what would its power be in the care of our everyday lives, or in the care within communities? What if your Primary Health members were all “instrumented” (with their written consent and explicit permission) to give you real time updates on how they are doing? We already see the beginnings of this today with specific chronic conditions like diabetes. Livongo was able to IPO effectively with a single device (blood glucose) and some coaches on the backend by parlaying this into the concept of “Applied Signals.” Kudos to Glen and team for introducing the market to that term, as well as the concept of real-time monitoring for conditions.
However, the opportunity to actively “monitor” the population in other ways is often missed because the signal speed is very slow (in the case of health risk assessments and claims data) or even when signals are being picked up, they are not connected to a care team that is available, able to interpret them, or incented to intervene. Despite the introduction of multiple generations of gadgets, sensors, and monitoring devices, the grand irony isn’t all the clinical noise that these devices create—it is the deafening silence because there is no connectivity to traditional care delivery or the various telehealth models. When a digital tree falls in the digital health forest, does it make a sound? Apparently not.
At Crossover, we are fully embracing—and confidently stepping into—this silent void. And it’s interesting how today’s current conditions have made this instantly relevant. Let’s test how Primary Health performs during the COVID-19 pandemic where healthcare monitoring gets real—and fast.
What all employers have realized is that they are now in the population health business, and they are deputized epidemiologists making decisions about R0, air circulation patterns through buildings, and contamination rates based on density. Employers want their populations monitored through daily symptom screeners and temperature checks, and are beginning to explore how personalized devices could be used to detect subtle physiologic clues that might provide earlier detection (i.e., heart rate variability via Apple Watch, Oura ring, etc). Effectively, employers want their population’s health monitored, and more than that—they want to know that there is a medical group standing behind the input sensors, ready to take appropriate action when something problematic is detected. This is where Primary Health as a clinical, financial, and experience model, and Crossover Health as the model provider group, really shine—we not only detect the signals but we can also take action by connecting directly with the member, ordering a test, following up on the results, and enrolling members in a COVID Care program to follow them for the full cycle of their illness. It is coordinated, integrated, and comprehensive in both scope and scale. We can do this for onsite, nearsite, and virtual populations.
That’s because the clinical, financial, and experience attributes of Primary Health make it perfectly suited to function as a “monitoring service” for the entire population attributed to its care, even as we move past the pandemic. Crossover Health monitors the baseline and routine health of members by having them complete an annual “Up To Date” episode of care. This is the classic Health Risk Assessment, with a twist(ed fiber connection to an actual care team). Based on member’s answers, we make recommendations, enroll them in specific care programs, and offer to track along with them. We also plan to connect with them via their preferred devices for simple physiologic metrics like weight, activity, calories, sleep, heart rate, and others that may be relevant to their care. Crossover’s Primary Health model doesn’t just passively track their health journey, we co-create an “annual health strategy” to proactively guide them to their chosen destination as well.
The monitoring is further enhanced when we can link additional “data accounts” to your overall health portfolio (think mint.com-style data connectivity and aggregation). By linking in “claims data” we get another level of monitoring. These pooled data are also bounced against our clinical operating system and its associated care metrics. We can now evaluate “gaps in care,” which represent open care items that should be closed out as part of the Up To Date episode of care but are now rounded out here. As we begin to aggregate more data we start to get more diagnoses and conditions, and we can begin to monitor these as part of a “condition management” approach. We can now proactively begin to monitor these individuals with known conditions, individually reach out to them, and in partnership, ensure there is a clear plan, active management, and a close connection. And we provide this monitoring during the day, during the night, and during holidays. We can do this across all service lines, across multiple conditions, and across the severity spectrum. We do this today, we’ll be doing it tomorrow, and we will be making it even better in the future.
And, the response from your $1 PEPM telemedicine provider? Deafening…silence.
1. Up To Date – is a specific episode of care type that guides member through basic health questions based on age, gender, and conditions that captures all the essential population health metrics that help us measure our clinical performance. This effectively replaces the health risk assessment performed by many employers which are often disconnected from care delivery.
2. Annual Health Strategy – is an approach Crossover Care Teams take to help each member have an identified, written, and actionable annual health strategy that is specific, measurable, achievable, relevant, and time-bound.
3. Claims Data – the enrollment, medical, and pharmacy information captured by payers regarding the health care activity of members. This typically includes a variety of codes collected as part of the clinical documentation and associated billing process. This data can be “rich”, but is often “dirty”, and requires quite a bit of “massaging”.
4. Gaps in Care – are specific care metrics that are as yet not completed (either because they are not done or no data is present to satisfy the condition – ie, there is no record of a colonoscopy being performed therefore a “gap” in recommended care exists).
5. Condition Management – a set of services rendered to people with a specific medical condition that requires some form of ongoing, active, or advanced care to ensure proper management, control, and financial stability of a medical condition.