By Sarianne Gruber
“Where ever there are bundled payments today, physicians are typically required to report out on patient-reported outcomes,” says Dr. Todd Johnson, CEO of Noble.MD. The Pennsylvania-based digital health company provides a technology platform called Theo – defining a new standard as the interface for capturing patient-reported data. At the MedCity Converge Conference, Dr. Johnson shared his predictions on how the MACRA payment reforms, Meaningful Use and Bundled Payment programs would act as catalysts for incentivizing patient-generated data. At our interview, he foresees today’s new healthcare programs, such as bundled payments, and digital wellness tracking, making it a requisite for doctors to gather information directly from patients. However, the real turnkey is to give actionable information back to the patients so they can be proactive about preventive care and staying out of the hospital. “But what we found was that doctors and nurses just don’t always have much time. We’re helping healthcare providers to save time by more efficiently capturing the information they [the physicians] need to pass on [to their patients] for these programs,” claims Dr. Johnson. Interview highlights with Dr. Todd Johnson (gently edited) starts here:
How are reimbursement programs trending towards requiring patient information?
I think that what MACRA will do is provide a launching pad for increased importance for capturing this data across all specialties. With MACRA in place, a physician will have to either participant as part of a bundled payment or will have to participate in the MIPS program. This new metrics incentive program is going to consolidate PQRS and all of the other quality surveys, and is going to necessitate that doctors have a standardized, useful and actionable as well as efficient means of capturing all this data. In 2019 the [MACRA] law becomes effective, so for the next several years, capturing and benchmarking that data will become very important. Plus, ensuring that every health system that their patients are receiving care and are self-reporting the care back to the physician, also is done in manner that puts them [providers] in a good position to remain stable financially.
How have physicians been able to transition to this new mindset?
I think few physicians have time to really consider it. When they do consider it, they are very concerned about the requirements that are being put on them, and especially how they are going to meet the requirements.
Is the Theo platform a tool to help reach the MACRA and MIPS levels?
Yes. Yet, no one knows what the actual MIPS question set will be, but we are currently working with our clients to design a patient reporting quality management system. We are capturing the patient-generated information and developing a baseline to understanding where they are now. Once the CMS publishes the surveys that they’ll use, we can rapidly move to help to doctors.
What have you seen so far as the benefits of collecting patient-generated data? Have you been able to perform any studies?
We have been able to prove how the use of our system improves patient and health outcomes. Yes, we have run studies across the patient population spectrum from pediatrics all the way through elder care. Our tool has helped a number of hospital systems demonstrate a real positive impact on their patients. Children’s Hospital of Philadelphia (CHOP) is a client of ours, and were an early user of the Theo platform. The head of vaccinations at CHOP really wanted to understand why patients or the parents of the patients were opting out of HPV vaccinations and other really important vaccinations. What the CHOP team was able to find out from conducting study [via the digital Theo platform] was that a significant portion of patients were opting out because they didn’t understand what the potential ramifications were of not having their child vaccinated. Also, they didn’t understand the wealth of data behind the safety of vaccinations. By presenting that data to them in a very easy to understand manner, the CHOP teams have been able to increased HPV vaccination rates by a significant level. This study will be presented at the CDC conference this fall and is to be published in a peer review journal.
At Nobel.MD, have done the same for other healthcare organizations and in many of different populations. With a large Miami primary care practice, we were able to increase flu vaccinations rates by 37% and increase rates of cancer screenings by 10% to 20%. We are able to increase the number of patients who were interested in and willing to undergo advanced care planning. With a signed and stored document, an advanced directive in put their EMR over the period of that project. All of these are opportunities is what everyone is trying to do now to improve patient care and decrease overall system costs.
Can the platform help providers meet Meaningful Use?
The Theo platform can help physicians meet Meaningful Use. What we have seen is that with most EMRs, everyone has a patient portal, but very few of them are effective. The best example of that is MU 2015 stage 2, when CMS had to lower the bar to a single patient having access to a portal system. But the reason why is that EMRs weren’t built for patients to use them. EMRs were built for physicians to use. Physician and nurses are well trained and can easily pick up these types of complex systems. They understand the terminology used in the EMR, which are often at times very detailed oriented. They are also OK with a screen with 1,000 different numbers on it. Patient interfaces, on the other hand, need to be kept extremely simple. For elderly patients especially for whom sight may be becoming an issue, large buttons are created. They need to capture as many patients can and make it as useful as possible. Vocabulary on patient interfaces are written on a 4th grade or lower grade reading level. We need to do this to make it usable by everyone. That’s where many of the EMRs attempts at patient interfaces have stumbled.
How does Theo’s customizable platform facilitate the exchange of data from the patient to physician and back to the patient?
While in the waiting room or in the exam room, the patient is handed an iPad, usually in a private environment before the doctor arrives. Preset questions, mainly multiple choice, guide the patient through the survey. Disease status and changes in health, ability to taking care of oneself and signs of depression, the success or challenges of following the care protocol can be directed by the provider on Theo’s customizable platform. Noble.MD makes sure the platform captures correct questions for the selected patient types or protocols, along with specific document preparation directed in Theo. For example, if the patient is an elderly primary care patient, the doctor or nurse can choose to have the patient run through a data input needed for a basic annual wellness visit. If an orthopedic surgeon’s patient is about to have a hip or knee replacement. Theo can reach out to that patient through email or text message on how the patient is following the doctor’s orders. Simple checks on whether patients are taking their medications as the doctor requested leading up to their surgery, on the day before surgery, did they remember to not eat or drink anything before the procedure. Theo can keep the patient engaged leading up to a procedure, plus give information back to the patient. To goal is make sure the patient understands and remembers the importance of following directives for optimal results. Theo digitally facilitates the medical team and patient to work together.
Any comments you would like to add about the digital health innovation?
What we see as hindering the progress is a reticence to innovate because it is seen as uncertainty. There is a fear of the unknown when you are adopting a new solution. What we’re seeing since the ATA was passed in 2010, and now that we are 6 years into this, is the solutions that are surviving, growing and thriving are ones that are proven because we have the data behind it. Ask for measurements of results, the ROI, but don’t fear innovation. And don’t fear digital health. It is a very important part of the future. It is helping to save time and make life easier for many healthcare professions to better take care of their patients.