I recently interviewed Todd Johnson, Chief Executive Officer at HealthLoop to learn more about how HealthLoop is keeping patients engaged with their providers in between visits to improve quality of care.
HealthIT & mHealth: Could you provide me with some background information about yourself and HealthLoop to start off with?
Todd Johnson: I have been in healthcare IT since 1999 prior to joining HealthLoop as the CEO two and a half years ago. I was the CEO of a healthcare company called Salar, which sold software solutions to large academic medical centers and health systems. HealthLoop is a Silicon vValley based digital health company with thirty-five employees. It was started by a primary-care physician, Dr Jordan Shlain. The general premise of the company is: as patients we spend 99.9% of our time not with our doctors, yet our doctors are the ones guiding our diagnoses and our treatment plans. Once doctors have given you your treatment plan and discharged you, there is no feedback whatsoever about what is going on with you. The healthcare system has been completely designed around optimizing transactions. Doctors and hospitals source of revenue is based on how many patients they see, how many procedures they do and how many patients are staying inpatient at the hospital. The healthcare system has gotten really good at optimizing around throughput, shortening our visits with our providers and shortening our stays in the hospital. Therefore as patients we are getting increasingly less time with our doctors.
Nationally we are spending forty-four billion dollars on medical care that is unnecessary. If the physician knew that the patient was doing well, or more importantly knew that the patient was not adjusting well to the treatment or having adverse events, they could intervene and modify the treatment plan to be more cost efficient and provide and a better outcome for the patient. Through an acute episode of care, HealthLoop checks in with patients on an often daily basis with to remind them on what they need to do, guide them and educate them on what is expected and how they should be feeling. This assesses how they are recovering so that if there is a complication the doctor can be notified before it is too late. The provider can then take the necessary steps to mitigate the issue and make sure that the patient gets the best treatment possible. We do this through technology, we have a team of clinicians out in Mountain View that we call empathologists that offer care plans to patients. The care-plans detail what to expect through a very specific episode of care. When the patient is diagnosed or scheduled for a surgery, they get enrolled in one of these care-plans and receive daily check-ins from the provider. The patient can then log into a secure site where they get an interactive dialog of what they need to know for that particular day, what they need to do that day and what symptoms they need to look out for.
HealthIT & mHealth: Do the providers have pre-set messages that they can easily send out during their normal workflow?
Johnson: I think you are hitting on one of the fundamental challenges of the business, which is doctors and their teams are short on time. The implementation of HealthLoop is designed to be absolutely frictionless. There a couple of different ways a patient can get enrolled in HealthLoop. A physician can order their enrollment through the patient’s medical record, just like they would order a drug. However, the most popular method of implementation is integrating with the scheduling system where HealthLoop enrollment will be automatically triggered by certain events. The care plan is all pre-filled so there is really nothing that a provider has to do on a daily basis.
HealthIT & mHealth: Does HealthLoop then pick up on the ADT and SIU HL7 messages?
Johnson: Yes, that is a popular methodology for collecting diagnosis and patient health information, but it is not the only methodology that we utilize. We also use order events, and hospital discharge messages.
HealthIT & mHealth: Are you looking to continue using HL7 or are you looking into FHIR or web services?
We love FHIR, I think it will take a few years to get to any reasonable set of critical mass in the real world. Traditionally, healthcare IT systems have been really difficult to implement and it adds to a good chunk of the expense, time and organizational resources to get systems up and running. Being a Silicon Valley company, with Silicon Valley designers, we are always trying to figure out how to make integration into existing health systems as friction-less as possible. We have our implementation time down to just a couple of weeks for large health systems, which health systems are not used to.
HealthIT & mHealth: What different conditions have you found can be aided the most by using HealthLoop?
Johnson: We search for the conditions with the biggest impact. You could create a protocol for patients with the common cold, which would include a lot of patients, but the failure rates for the common cold are extremely low. Therefore, we look for episodes of care where there is enough variability in cost and outcome and where having this type of patient management system can have a true impact on patient outcomes and total cost of care. If you look at the road map towards value-based care, CMS has identified those conditions, which include procedures such as spine surgeries, cardiac catheterizations, and coronary artery bypass. In order to have a positive impact on the workflow of entire practices, we have developed specialty modules like Orthopedics, OBGYN, Neurology, Cardiovascular, ENT and general surgery.
HealthIT & mHealth: What are the patient engagement numbers like for HealthLoop?
Johnson: We have an opt-out protocol so all patients get enrolled unless they alert their provider that they would like to opt-out of the program. Eighty-one percent of those patients activate their accounts and are actively engaged. Providers usually predict that their younger patients will be more engaged than their older patients. The truth is that the sixty to seventy year age group is the most likely age group to be one-hundred percent engaged. Even the elderly cohorts are engaged up to forty-seven percent of the time. The least engaged cohort is the eighteen to twenty-five year old male. Women are more engaged than men and mothers of children who are going through a health episode are likely to be one hundred percent engaged. So the numbers are outstanding and what is very cool about HealthLoop is that the patients are doing all the work, we are not burdening providers with extra work. The patients are happy to do the work because they are sick or injured and they want to be engaged to get the best outcome possible.