Dr. Joe Kvedar is the Residency Program Director of the Department of Dermatology at Harvard Medical School. He is also the Founder and Director of the Center for Connected Health, an organization whose provocative goal is to help patients “become their own primary care provider.” I caught up with Dr. Kvedar at a recent health conference, and asked him to explain what his company’s approach contributed to the healthcare landscape.
Dr. Val: What is the Center for Connected Health?
Dr. Kvedar: Connected Health’s mission is to empower patients to be maximally in control of their own health destiny. As much as possible, we’d like to see patients become their own primary care provider.
There are three principles that must work together to accomplish this: first you must have accurate information about the health behavior that you want to change. Measurements must rely on quantifiable data (like the step count of a pedometer) rather than more general self-reports of how physically active you are. Second, the report must be in a format that offers specific feedback to the individual. Trending of information is critical, but the trends must be understood in context. For example a patient with diabetes needs to see how their blood glucose levels are behaving over time, but more than that they need to see how their food intake was influencing these levels. And third, data-driven coaching inspires the application of data to real lifestyle improvements.
Giving accurate information about yourself (in a format that is contextually trended over time) to a person that you trust can inspire behavior change. People are more likely to change their unhealthy choices when they know they’re accountable to someone for them. An appropriate coach can be anyone from a friend in a social network to a digital avatar, to a doctor or nurse.
Dr. Val: So what’s the rate limiting step in getting this behavior change model adopted? Is it lack of financial incentives?
Dr. Kvedar: That’s certainly part of it, but it’s even more than that. Healthcare providers gravitate towards human resource-intensive solutions. Providers are simply not used to thinking of technology as a tool. Instead, they often perceive the solution to better patient compliance as an increase in staff to serve them. But this is not feasible given our provider shortage and increasing healthcare burden. It’s just really hard for doctors to imagine that patients could be coached effectively by an avatar, yet there are many examples of it working.
Dr. Val: So who are your clients?
Dr. Kvedar: We work primarily with large employer groups, enhancing their employee benefits packages. For example, we have a blood pressure management program that includes an electronic blood pressure measurement device that subscribers can use at home. It works the way a cell phone service does – you get the device, and then the monthly subscription cost is based on the coaching piece of the program. The coaching messages are automated, and dependent upon the input from the device. We are developing similar programs for glucose management and weight loss.
Our services are also used by Partners Healthcare (a group of about 7000 physicians). The behavior modification programs are offered to patients as part of a performance improvement strategy. Our physicians’ compensation for care is influenced by pay for performance measures. Other provider groups may want to adopt our program if P4P is expanded by Medicare. But right now the provider demand is miniscule because reimbursement is fee-for-service and there’s no provider business model for these programs. But employers are opting into them more regularly now. Health plans are also likely to be a good market for us in the future.
Dr. Val: So where is this all leading? Do you envision that one day patients will be shepherded into specific online groups and programs based on their primary care physician’s assessment of their needs? Will we try to offload some lifestyle modification and health education to an online environment?
Dr. Kvedar: The bottom line is that the growth in chronic illness is far outstripping the provider supply. If we continue with our current fee-per-service model of care to try to meet these needs, the system will break. People are becoming comfortable with the notion of interacting with the healthcare system online, and that trend is going to continue to grow.
Having an electronic medical record is an important first step to maximizing online engagement. If we can then get doctors to think about providing population-based care, rather than “units of care” then we’ll really be able to serve more people at a lower cost.