That's a great point. If you could write the script to optimize healthcare, what variables do you think we should be measuring?

At my core, I believe clinical rigor needs to be our foundation. The criteria for clinical excellence are well established with data from clinical trials, practice guidelines, and statements from specialty societies. It is well documented that our level of adherence to those standards is terrible.

Then, surrounding clinical rigor is the variable of patient experience. We have healthcare systems, technologies, and great practitioners committed to excellence. Unfortunately, the patient's ability to access can be blocked by several barriers. So far, the focus has generally been towards a more consumer or retail experience. But I see this as tangential to the core issue of clinical excellence and rigor because I think that's the best way to achieve the outcomes we’re all striving for.

Let's pivot and talk about patient needs. What barriers are preventing us from using patient data, collected through technology, to address patient adherence post-hospitalization or intervention?

One issue is we're not adequately collecting data. And there are issues around policy and privacy constraints as well as economical and commercial constraints. But there's a bigger issue related to analytics. 

If data are simply ingredients for a recipe, you need to translate the sugar, flour, eggs, etc. into a cake. From a provider perspective, there's the problem with how to translate this deluge of data, like weight, diet, hemodynamics, etc., into something meaningful. As the doctor, you have limited time with the patient, and if you were given all this data and expected to figure it out – analyze the data, distill it into the next best action, and then deploy that action given all sorts of constraints – in the moment, that would be an impossible task. Further, with constraints like affordability, it can seem like a pyrrhic victory to say someone needs a certain drug or device when they have a huge deductible that needs to be met and they can't possibly begin to pay for it.

Do you think these barriers are being driven by technology itself?

No. I think the biggest barrier is that people manage what's measured and we're not measuring what matters. For example, let's look at 30-day readmission rates. Why are we looking at a utilization metric instead of something like mortality? Well, we know why, it's because of the initiation of the Hospital Readmissions Reduction Programs (HRRP) in 2012. And from that, we did not see reductions in readmissions, but this shouldn't be our primary metric of success since it's been well documented that the reduction was associated with increasing mortality.

It brings me back to the question of what's our focus? Because ultimately, if we're not focused on clinical excellence, the outcomes we're all mutually trying to achieve aren't going to happen.

To that point, there seems to be some hesitation from providers in terms of adopting these tools. Do you think the data provided by consumer devices is as reliable as data from medical devices?

There has always been skepticism about the reliability of consumer-generated data and if tools like wearables are accurately tracking health points. Despite these challenges, we must overcome this skepticism by collaborating with the patient to ensure that the data generated are accurate and can be personalized in a broad clinical context that considers other data sources.

As for the reason doctors don't want to implement these tools, they have enough data and and admin stuff to do; electronic medical records, billing, signing, and now we're adding more data to review. Again, a large part of it comes down to this deluge of data and the need for analytics to distill it into the next best action

Do you think technology can help pivot HCPs and healthcare leaders from a model of episodic care to value based care? Is it that simple?

I don't think it's simple, but I do think technology is essential. I don't know my patient's total cost of care, adherence, hospitalizations, etc. If I'm going to switch from being paid for volume to being paid when a person isn't hospitalized, I need to know all this information. An adequate tech stack is critical, but so is having the right performance measurements and incentives. Technology will be foundational to nuanced excellent clinical care that will translate to better outcomes. If value-based contracting is going to work, those outcomes must be adequately measured, and the rewards must be commensurate with the benefit conferred by doing the right thing for the patient.