Last week at the MobiHealthNews 2016 event in San Francisco, CareMore CEO Dr. Sachin Jain gave one of our morning keynotes. We previously highlighted some of his remarks related to his take on AMA CEO Dr. James Madara's headline-grabbing panning of consumer digital health services, and just this week Forbes published Jain's prepared remarks from our event as his weekly column for the publication.
Dr. Jain opted to use most of his time on-stage taking questions from the audience, which led to a number of interesting exchanges about CareMore's remote monitoring program, Jain's top of mind challenges, and his advice for those looking to partner with CareMore on digital health programs.
"Our challenge is that we are very heavy on bricks-and-mortar," Jain said. "I’m very bullish on bricks-and-mortar for the most part because I think most people still like getting care in their neighborhoods delivered by someone that they actually know. There is a human touch to care delivery that is very old-fashioned but that most consumers actually really appreciate. The challenge with a care center-based model is that it is expensive... So I think we need to figure out ways to deliver that same sense of touch less expensively. That’s where a big focus of ours is going to be. Particularly because Medicare Advantage rates have declined as much as they have in the last couple of years and risk adjustment formulas have changed as much as they have in the last couple of years. There is going to be a drive towards innovation that delivers the same quality of high touch and level of service to members at a lower cost."
Jain's talk focused on CareMore's longstanding remote patient monitoring program, which he emphasized was much more than a technology initiative.
"We saw that patients, before they were attached to a remote monitoring program, were getting admitted and readmitted to the hospital for predictable reasons," Jain explained. "We were able to observe a pretty dramatic reduction in hospitalizations for those patients. Again, it’s not just about the remote monitoring, it’s about the warm and empathetic care [provider] who is actually connecting with the patient. Most studies, if you look in the literature, most studies of remote monitoring actually shows that it doesn’t work. Well, it doesn’t work because it is not really thoroughly integrated within a system of care. It’s actually, usually adopted as a standalone offering that is offered as an adjunct to the patient’s traditional healthcare system with a group of providers who are sitting in a call center in Mumbai or something like that. That stuff doesn’t work, for the most part. You need that human connection to actually engage patients with chronic diseases in their care. That’s a big part of our philosophy of care and something we try to integrate into how we use technology."
When asked about the biggest opportunities he saw for those working in digital health, Jain said there were an unlimited number of problems to solve in healthcare -- enough for all of us, our kids, and our grandchildren to work on. He went on to list three specific issues that are top of mind for him right now.
"Patients who are newly diagnosed with cancer: What do we do with them? Our system, regardless of whether you are at a NCI-designated cancer center or at a community hospital, that interaction almost always goes badly and never meets up with the patient’s or family’s expectations or experience," Jain said. "[Another:] The business around actually staying close to [and remotely monitoring] the right patients. [We have 2,500 patients in our remote monitoring program], but the reality is there is this whole other issue around identifying the movers. The folks who are not identified as being sick right now, but who have something about their clinical presentation that suggests that they will be sick some time in the near future. Being able to get some specificity on who those patients are is hugely important. How do you actually realistically engage caregivers in a secure and private way that is actually consistent with the permissions that patients have actually given you? Anyone who can help me with that, that’s a really important one. There’s really just an embarrassment of riches in terms of problems that we all have to solve together."
While he expressed the sentiment in a variety of ways, Jain stressed again and again during his keynote address and Q&A session that "healthcare outcomes are produced by ecosystems and not necessarily single interventions." This was a particularly important thread in his response to a question about how a company might go about partnering with him and his team at CareMore.
"We have had a number of conversations with pharma and biotech companies that typically take a kind of hammer-and-nail approach to solving these problems," Jain said. "They end up missing the point that healthcare outcomes are produced by teams, not by physicians. Digital health tools really only work if the provider understands and supports it, the patient understands and supports it, the caregiver understands and supports it. My observation of working in this industry — I was at Merck for three years, before that I was in the federal government — we tend to see our jobs really as applying our single intervention and forcing it down a channel. If you are in the business of selling readmissions solutions, you are just jamming your readmission solution or whatever system, not necessarily paying attention to the complexity of healthcare delivery — both from a care delivery perspective as well as from a patient and family perspective."
Jain said his "strong advice" to anyone working in digital health and looking to partner with health systems like CareMore was to take the time to appreciate and acknowledge the complexities of health care delivery. He said a conversation focused on that can help build a lot of credibility for digital health companies working with providers.
"I think very few people in this space really spend the time necessary to really understand the complexities of the systems they are trying to influence. The funds flows and the ways that primary care doctors interact with their hospital partners, interface with their specialist partners," Jain said. "If you can actually start to map all of that complexity and look at all the places where you can intervene and create information flows, then you can be a credible partner to a complex healthcare delivery organization. But, unfortunately, mostly what ends up happening is people end up thinking about their device, app, solution, and they think about it in this very linear, single-variable kind of way. 'If I just throw this into this system, it’s just going to work' — not recognizing that you are creating all sorts of workflow chaos or that there may already be systems that do part of what you are recommending and so now there is an implementation challenge of untraining 700 clinical staff on one way of doing something and then retraining them on a new way of doing something. I just think the level of sophistication of most business development conversations, with all due respect to everyone who works in this space, they are just really, really, really low."
Jain pinned some of the misaligned focus on venture-backed digital health startups focusing on their investors' interests rather than the patients, but he also offered up two preliminary criteria that he starts with when evaluating potential partners.
"Too often folks are looking for it to achieve some target that some VC kind of set for them, like: 'You’ve got a customer. Check.' As opposed to: 'You have created real patient impact. Check.' It’s a totally different conversation," Jain said. "When we look for partners and we have learned this, well, I’ve learned this, from lots of mistakes over years and years, you really want to work with partners who: Number one, have a realistic sense of the timeline of actually getting things done. Number two, can think about how complex the ecosystem really is that you are trying to influence and shape."