Reducing Physician Burnout

To decrease physician burn out, we are relying on a root cause analysis of precipitating systemic factors rather than the stress reduction techniques proposed through the various medical societies. These systemic factors include the business practice of medicine, administrative burden, loss of autonomy, the electronic health record, and a sense of powerlessness.

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To help physicians with the business practice of medicine, our team provides the tools to transition an existing practice or create a de novo practice specifically with independence, profitability, sustainability, and patient and physician experience in mind. The goal is to provide physicians with the benefits of employment without the bricks and mortar. Our platform is designed to give patients control of their health record and clinicians control of their own treatment algorithms while crowdsourcing and vetting best practice for specific conditions. This inherently solves problems of interoperability and provides patients the ability to share information, preventing duplication of care and ensuring an accurate, audited record to transmit to the clinician. The platform was designed to diminish administrative burden and provide ancillary revenue streams to physicians. A portion of revenue generated goes into a kitty to provide care to those who cannot afford to pay for it. This “kitty” fund is physician-directed allowing physicians a meaningful way to combat the sense of powerlessness they feel when they prescribe a treatment plan to someone who cannot afford to pay. In addition, tools within the platform help to drive patient engagement and compliance. The platform seamlessly syncs to the many processes associated with specific diagnoses allowing complete preparation for a clinical or surgical procedure and decreases physician stress by assuring and confirming facility and staff preparation.

Decreasing The Cost of Care

Decreasing the cost of care first requires a better understanding of what things cost. It is well known that what is not measured cannot be managed or improved. Once understood, strategies can be employed to decrease the cost required to deliver care. This confidence and understanding will allow transparency which will further lower price through competition. To track cost we need to follow the cost per doctor per patient diagnosis. In other words we need to measure the total cost of all resources – clinical and administrative personnel, drugs and other supplies, devices, space, and equipment – used during the entire care continuum for a specific patient’s medical condition.

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An integrated platform built by frontline stakeholders is employed to allow this task to be accomplished across the entire patient experience. In order to improve the value of health care we concurrently need to improve the outcome. This quality improvement is accomplished through crowdsourcing best practice for a given condition with segregation by physician and by procedure to allow tracking of cost per procedure. For example, in the hospital, approximately 30-40% of direct cost originates in the operating room; Transparency provides knowledge to surgeons surrounding the actual costs of providing surgical care allowing these key stakeholders and the operating room managers to develop targets for reduction and improving usage of health care resources. Our proprietary patient treatment plans can be tracked in a forward -looking manner on a per physician per diagnosis basis. The treatment plans from 360Patient natively track asset and expense categories to patient diagnoses and processes to account for all expenses for the patient as they navigate a specific diagnosis. The platform allows the crowdsourcing of best practice from other clinicians until an optimum process is developed. Finally, once cost is understood and mapped to outcomes, it becomes possible to confidently set competitive prices for healthcare rather than simply cutting reimbursement. In this manner we can shift the burden of massive cross subsidies that reimburse some services generously and pay far below costs for others, leading to excess supply for well-reimbursed services and inadequate delivery and innovation for poorly reimbursed ones.

Improving Patient Satisfaction

To improve patient satisfaction meaningfully a combination of strategies to decrease cost while maintaining or improving outcomes and improving access are required. One in four Americans (25%) say the cost of healthcare is the biggest concern facing their family (Monmouth University Polling Institute, 2/2017) and one in three Americans (33%) reported they could not access care in the last year because of cost (Kaiser Family Foundation).

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The key to unlocking this potential is to combine an accurate cost measurement system with the systematic measurement of outcomes while providing a mechanism to substitute and economize both supply and operational cost. Measuring and improving the actual cost to deliver care is important but equally important is the cost that the patient pays for care. Though it would seem these two are drectly related this is not the case. Typically, price is set at a level that ensures the service will reimburse better than the best payor; unfortunately, it is not set at a level that is based on the cost to deliver said care or guarantee that cost will be at least covered. Once cost is understood, prices can be set confidently regardless of the payer. Further, in order to eliminate the incentive problem in health care, we must be able to properly compare cost with outcomes. Access is another main driver of patient satisfaction. In 2017, the average new patient wait time for primary care was 24 days for a new patient (Merritt Hawkins 2017). To improve this time to access care, it is necessary to engineer more physician time to make more patient appointments available. This goal is made more dificult by the projected shortage up to 120,000 physicians by 2030. One effective strategy is to remove the duplication of services that occurs for patients with a given problem. Other strategies include decreasing the time spent on documentation and eliminating unnecessary administrative tasks, allowing physicians to work at the top of their degree. Phyicians currently spend about 16 min per hour in actual face-to-face time with a patient. If we could improve efficiency just 20% through technology and improved process we could increase this time to 30 min per hour - effectively doubling the workforce. Through the provision of an on-demand telehealth solution downtime can be effectively utilized while maximizig face-to-face time with the added benefit of freeing up the approxiamtely 121 minutes patients spend door to door for an appointment - often for care that could easily be achieved remotely. Decreasing the amount of patients who require care can be achieved through a wellness model without an additional burden on the provider since these can be taught asynchronously digitally or proactively through community seminars. Compliance can be tracked and the entire process gamified through an interactice dashboard of the various wearable solutions currently available. Finally, access can be improved through real estate - bringing the clinic and telemedicine solution to the community rather than forcing patients to a centralized facility. Smaller, lean hospitals can service a community's health needs - particularly when an effective remote monitoring strategy is deployed to keep patients from being admitted to the hospital. Language barriers can be a large barrier to access and while providing interpreters is a viable solution, they are not always readily available. Technology that collects data in a structured format can make this information readly available for a clinican in their native language.

Improving Quality Outcomes

Reducing the cost to deliver care and ultimately the cost paid by the patients cannot come at the expense of quality outcomes. As with cost, what is not measured cannot be managed or improved. To measure outcomes, we need to understand and document physical and historical baselines.

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Physical, objective structured data such as strength, range of motion, body composition, genetic makeup, quantifiable laboratory markers, vital signs, sleep patterns, visual acuity, lung function, and neurocognitive capacity can be checked and stored in the blockchain. Historical factors can be documented in structured format and coupled with standardized patient reported outcomes surveys. When the historical data is coupled with objective information, a wholistic view of the patient is achieved ready for intervention and forward tracking. At this point it becomes possible to follow an intervention and track its effect at pre-determined intervals allowing the rapid generation of randomized controlled studies and ultimately the development of crowdsourced clinical practice guidelines to achieve the best outcomes for a given patient diagnosis. With a standardized mechanism to develop and share these best practices, clinicians will have a mechanism to truly ensure they are providing the best care to their patients. Once this best practice protocol is identified for a given diagnosis it is paramount to ensure that compliance is achieved. This following of best practice needs to be measured not only on the clinician side but also on the patient side. Standardized and audited checklists are extremely effective to ensure that a prescribed treatment plan is implemented by the clinical staff thus reducing medical error. For patient compliance, a typical rule of thumb is that 1/3 of patients are partially adherent to treatment plans; 1/3 of patients are totally compliant and 1/3 of patients are non-compliant with a given treatment plan. To improve this compliance, physicians need to truly teach patients using common language and not medical jargon. Through this education comes increased understanding and improved compliance. This can be performed in a way that is unobtrusive to the patient and the provider. Further, gamification of the treatment plan can help drive compliance with real measurable, objective results through the same mechanism utilized to capture the patient baseline. As with cost, transparency to a patient’s outcome, compliance and how the two relate will be vital. When it is discovered that patients are not following a plan or the treatment protocol is not working or not being followed a root cause analysis needs to ensue so immediate corrective action can begin. This means that deficiencies need to be rapidly identified and reported by the front-line stakeholders whether those are the patients, nurses, therapists, caregivers or physicians. Reducing the cost to deliver care and ultimately the cost paid by the patients cannot come at the expense of quality outcomes. As with cost, what is not measured cannot be managed or improved. To measure outcomes, we need to understand and document physical and historical baselines. Physical, objective structured data such as strength, range of motion, body composition, genetic makeup, quantifiable laboratory markers, vital signs, sleep patterns, visual acuity, lung function, and neurocognitive capacity can be checked and stored in the blockchain. Historical factors can be documented in structured format and coupled with standardized patient reported outcomes surveys. When the historical data is coupled with objective information, a wholistic view of the patient is achieved ready for intervention and forward tracking. At this point it becomes possible to follow an intervention and track its effect at pre-determined intervals allowing the rapid generation of randomized controlled studies and ultimately the development of crowdsourced clinical practice guidelines to achieve the best outcomes for a given patient diagnosis. With a standardized mechanism to develop and share these best practices, clinicians will have a mechanism to truly ensure they are providing the best care to their patients. Once this best practice protocol is identified for a given diagnosis it is paramount to ensure that compliance is achieved. This following of best practice needs to be measured not only on the clinician side but also on the patient side. Standardized and audited checklists are extremely effective to ensure that a prescribed treatment plan is implemented by the clinical staff thus reducing medical error. For patient compliance, a typical rule of thumb is that 1/3 of patients are partially adherent to treatment plans; 1/3 of patients are totally compliant and 1/3 of patients are non-compliant with a given treatment plan. To improve this compliance, physicians need to truly teach patients using common language and not medical jargon. Through this education comes increased understanding and improved compliance. This can be performed in a way that is unobtrusive to the patient and the provider. Further, gamification of the treatment plan can help drive compliance with real measurable, objective results through the same mechanism utilized to capture the patient baseline. As with cost, transparency to a patient’s outcome, compliance and how the two relate will be vital. When it is discovered that patients are not following a plan or the treatment protocol is not working or not being followed a root cause analysis needs to ensue so immediate corrective action can begin. This means that deficiencies need to be rapidly identified and reported by the front-line stakeholders whether those are the patients, nurses, therapists, caregivers or physicians.

Increasing Life Expectancy

No other nation spends more on healthcare than the United States – 16% of the GDP. Despite the massive spend, the United States does not enjoy a commensurate improved life expectancy. In fact, in 1980 the average life expectancy in the US was 74.5 years which was comparable to other similar countries; however, since that time, the US has only gained 5 years while the similar countries have gained approximately 8 years. Much of this disparity can be attributed to lifestyle disease. In fact, it has been estimated that 90 percent of diabetes mellitus, 80% of coronary artery disease, and 70% of stroke and colon cancer are potentially avoidable through lifestyle modification. This represents a massive modifiable opportunity. In order to combat these lifestyle diseases, it is important to look once again at the root cause. Culprits include environmental causes, food availability, exercise, TV, Stress, and sleep.

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Despite the ability to add quality to a patient’s years in addition to years to their life, wellness programs have overall been poorly adopted. Unfortunately, the benefits of a healthy lifestyle are extremely difficult to easily quantify and communicate. Changes like weight loss, smoking cessation and exercise can take a while to show the true benefit which makes positive reinforcement difficult. In addition, personal lifestyle choices are extremely well protected and just that - personal. A multifaceted approach to wellness can be employed. Like everything in the 360Healthcure, it has to begin with transparency. Education and technology are the great equalizers allowing the dissemination of information and the streamlined communication of results and changes. Quantification of results occurs through the periodic update to the baseline health status. Healthy habits can not only be praised and encouraged in our younger patients but also financially incentivized in our adults. Unhealthy habits can be identified early and strategies for change rapidly deployed. Overall, the key to this change lies in our ability to affect the doctor patient relationship in a meaningful fashion – not incrementally but exponentially. This can occur through a thoughtful platform designed by the frontline stakeholders, encrypted in the blockchain and giving doctors control of their treatment algorithms and, most importantly, patients control of their record. By purposeful design and intent this solution is inevitable.