Keas: Disease and Wellness Management

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Millions of Americans suffer from chronic diseases such as diabetes, obesity, arthritis, and hypertension. The 90% of our senior citizens have at least one chronic condition (1). And, a large share of our health care money is spent during last eighteen months of life because of the complications and adverse effects of chronic diseases. As we talk about reducing healthcare costs, any program or policy must have a credible plan to manage chronic diseases.

The technological progress has made it possible for more and more patients to live longer with chronic diseases. For example, cancer and AIDS used to be resulted in immediate deaths even few years ago. Now they have been transformed into chronic diseases.

Now, our systems face a huge problem as a result of this technological progress. For chronic conditions, the diagnosis, treatment plan, and medications are just small pieces in overall picture. The success of managing the condition largely depends on adherence to the recommendations by patients, probably for the rest of their life. Oftentimes the treatment plan includes significant changes in food habits and behaviors. The patients with chronic back pain may never forget to take the pill, but patients with high cholesterol may not follow the treatment prescribed by the doctor. This is because the later patient does not face any immediate adverse consequence of not following any plan. On the same line, the patients with diabetes and obesity require extensive behavior change both from patient and family. The treatment plan of these diseases depends largely on patient’s family support, financial situation, and host of other interrelated social factors.

Unfortunately, most health plans does not pay for the cost that doctors or hospitals may have by monitoring and encouraging patients to follow the recommendations. In his book, Christensen pointed out that this is not the fault of physicians or insurers. This is the misapplication of business model that was designed to treat acute diseases. The doctors at hospitals and clinics are paid for diagnosis, evaluating the progression, and remediation, but not paid for patient adherence management. So, alternative model must emerge. The primary vehicle for behavior dependent chronic care could be “Facilitated Network” model not the hospital business model. This is the model where participants exchange information with each other and receive encouragement to follow treatment plans. Another related model is “disease management network” similar to Healthways Inc, which could be used for chronic diseases with deferred consequences.

KEAS has a mission to integrate both “behavior dependent” and “deferred consequence” chronic disease management under a single platform. This makes sense because some chronic disease such as Asthma may have both challenges. Keas has many partners such as Healthwise,, Dr. Green, which provides highly personalized and data driven disease management plans. It has forged partnership with Quest Diagnosis to receive laboratory data electronically. Also, patients can add any relevant data on a regular basis- a journal type facility. It also provides facilities like, where similar patients could share information with each other keep themselves motivated to follow treatment plans. Keas has a dashboard like user interface which shows important health indicators for the particular disease and how well patient is doing-Green means great, yellow means some risks, red means needing of serious attention. They do these based on intelligence gathered from Quest Diagnosis and care plan partners.

However, in my mind, KEAS’s model faces same challenges I described earlier- a large number of chronic disease may not have immediate consequence and needs significant behavior change. Moreover, challenges exist in automatic data collection from electronic medical records and other systems. In my opinion, we need following healthcare related policy changes for KEAS or similar other platforms to prosper.

Nudge people to adhere to therapy:In his book, Christensen mentioned a ground reality- “becoming healthy only becomes a priority after they become sick”. He urged that health needs to be linked to financial health of patients more directly. We will be successful if the pursuit to becoming healthy becomes pursuit to becoming wealthy. One implementation process could be:

  Create a health score like FICO score.
  Punish the score if patients do not adhere to treatment and do not improve health factors that could be improved easily. 
  Employers could contribute money to their 401K type funds (at least some part of the contributions) based on health score   
  of individuals. The system such as described above are essential for Keas and other disease management network to thrive 
  and create a sustainable business model that would be beneficial to society.

Outcome based payments: Current reimbursement system does not create incentives for physicians to follow up and encourage preventive care. They actually want us to become sick so that they can execute some procedures or prescribe another drug. Therefore outcome based reimbursement is therefore a MUST have requirement. Doctors must have incentives for making that compassionate phone call or even visiting patient’s house, or talking to patient over Skype like interface.

Widespread usage of Standards and Interoperability- diverse set of health applications must be able to send/receive data files seamlessly and semantically as per the architecture proposed below.

Usability of device and software- The usability of hardware and software must consider diverse populations with different degree of familiarity with computers- elderly and patients with disabilities.

Clinical Data Ownership: Systematic exploration and acceptable solution of the clinical data ownership issues is required. At this time you need doctor’s approval to release lab data, but most doctors may not have ability or desire to release lab data (exception is one great company: Kaiser).

The conceptual data flow needed to implement the recommendations:

EMR Systems--> MS Health Vault or any PHR platform --> Keas or similar platforms--> Health scoring organization--> Employers or Privately run (similar to Vanguard) health savings account or 401 K type funds.

References: (1) The Innovator's Prescription, Clayton M. Christensen


Submitted by Adrish Sannyasi