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Podcast: The Role of Technology in Chronic Disease Management

Katherine Steinberg | May 10, 2017

Tune in to our digital health podcast series as we explore the role innovation and technology play in the healthcare landscape. We kick off this series with Adam Kaufman, CEO of Canary Health. Canary Health is a leading digital health self-management platform which has demonstrated success in helping people achieve improved health while lowering healthcare costs.

​Tune in to our next podcast available on May 18.

[TRANSCRIPT]

Katherine: Thank you for joining us for the first podcast in our digital health podcast series. My name is Katherine Steinberg, and I am a Vice President in Avalere’s Center for Payment and Delivery Innovation. In this podcast, we discuss the role of technology in chronic disease management with Adam Kaufman, CEO of Canary Health. Canary Health is a leading digital health self-management platform which has demonstrated success in helping people achieve improved health while lowering healthcare costs. We explore how the right technological solutions can empower patients to take control of their health, improve outcomes, and reduce costs to the system. Welcome Adam.

Adam: Thank you Katherine. 

Katherine: Adam, Canary takes a program that is traditionally delivered in person – the Diabetes Prevention Program – and makes it digital. When you were first coming up with this idea, did you get any push back from potential clients?  

Adam: We certainly have been on a long journey to  bring these programs to scale. I don’t know if pushback is exactly the word I’d use. I’m very sensitive to the competing priorities that health systems and health plans have. I think universally our experience has been that people see the value in engaging their population, and helping them get healthier andpreventing the progression of chronic conditions, but they’ve got a lot of other things on their plate. I’d say the main pushback we get is of two forms. One is we like this, but we have some other population we’re trying to deal with.

Often they’re focused on the sicker populations first. A lot of work around those who are very sick and coming in and out of the hospital, and so it has been a bit of a challenge to convince people that folks earlier in that acuity  level warn attention. We can make and impact that can actually save money. It’s been a long time that I’ve been at this in the number setting, so I do remember when there was pushback about doing it digitally, but we don’t get that part any more. 

Katherine: At the time, what made you stick with it?

Adam: First, I think like all of us in healthcare, you have to  believe in what you’re doing and be committed to helping people. It’s not easy to do that at scale and make impact, so it was largely that. I think like a lot of us who are trying to innovate in this space, you have to have faith that the world will catch up to your ideas. We’re not fully there yet. There’s a lot of work still to be done, but we take some pride in seeing that over time, more and more people are accepting these ideas, and we’re able to impact more and more people.

Katherine: Absolutely, why did you start with diabetes?

Adam: Two reasons: one, sheer luck. We were very fortunate a few years ago to form a relationship with the diabetes center at the University of Pittsburg, where for those of you not familiar, most of the original research around diabetes prevention was actually conducted at the University of Pittsburg and the University of Pittsburg Medical Center. Part of that was just the good fortune to fall in with that group and a lot of the exciting things they were doing. But beyond that diabetes really is a catch-all for a lot of things. Very few people have only diabetes, and a good portion of what it takes to be healthy is not just the clinical management. Maybe this is a good segue that our vision is that people need support around the clinical therapies they have in clinical management. There’s a lot of incredible work done whether it’s in the doctor’s office, or in the hospital, or around therapies, to help people manage the clinical elements. Often what’s missing is the humanistic part of that: how does that fit in with their life, why does this matter to them, why it is important now – and so we really focus on that. Diabetes is a case where most of the management is done outside of the clinical setting, and a lot of it has nothing to do with what your blood sugar is, or the particular physiological measure, but it’s about how do you talk to your family about it, what happens to your lifestyle, and how do you interact with the healthcare system.

 Katherine: Absolutely, that would be a good transition into why you decided to go beyond that, and beyond diabetes and move into a broader suite of chronic conditions. How did you apply the learnings from the diabetes prevention program in work to your chronic disease self-management?
 Adam: Most people first don’t think of themselves by what conditions they have or don’t have. It’s an unnatural conversation to say to someone “hey, we know you have diabetes, and that’s all we can talk to you about.” For us it was about first, building a more natural conversation with the consumer where we can talk about, whether it’s lifestyle, whether it’s the particular conditions you have, stress, coping, and say “what matters to you and what’s important in your life, and we can help you beyond, just that one condition.” We felt that was really important.
 Adam: Most people first don’t think of themselves by what conditions they have or don’t have. It’s an unnatural conversation to say to someone “hey, we know you have diabetes, and that’s all we can talk to you about.” For us it was about first, building a more natural conversation with the consumer where we can talk about, whether it’s lifestyle, whether it’s the particular conditions you have, stress, coping, and say “what matters to you and what’s important in your life, and we can help you beyond, just that one condition.” We felt that was really important. The learnings are pretty analogous. It’s interesting as we’ve started to expand over the last two years beyond diabetes and pre-diabetes into other conditions, is it turns out someone struggling with arthritis has a lot in common with someone struggling with diabetes. There’s an impact on your life, you got to take meds, you’re going to see doctors, and your family is afraid. Now, the physiological impact is a little different, but how if manifests in your daily life is pretty similar. Actually what we find is people tend to be even more similar in how they relate to their condition and what it means, across conditions more or less by stage of condition, than they would with someone with early diabetes compared to very late. Katherine: Interesting, Have you run into any obstacles with either public policies or payer policies in getting this type of program paid for?
 Adam: [Laughs] The answer is yes, we’re both smiling because it’s very had. It’s hard whenever you’re doing something new. I think that has nothing specific about this, or nothing specific about healthcare, and then within healthcare, there’s its added challenges. I think most of your audience will be familiar with cycles that payers think about in terms of how long members stay there. The real pressures have to deal with readmissions and other more acute, or what I would consider the more sever, conditions. So it’s interesting, there’s a lot more people who are impacted by diabetes, pre-diabetes, and early stages of arthritis, and heart disease, than are by later stages, but the impact on a sort of per-person is much less. They health system tends to be structured around the more severe cases and the more costly cases, and so making the business case and the clinical case that people should go a little bit more upstream, if you will, and impact earlier is hard. I think we’re making progress. I think it’s taken a combined effort of employers demanding it, and health plans, and parts of the government. We’re not fully there yet. We still spend far more when someone has gotten very sick than we do as a society before that.
 Katherine: Right, so given that, how do you go about figuring out the payment structure for this type of program?
 Adam: I think there’s two models. We started the business thinking that value-based care and the move on paying based on outcomes was really going to drive our business, and that’s a big part of it. I think as payers, providers, and even we’re seeing pharma and device companies are really paid on the outcomes, they naturally want to couple other services with things like what we do, so that’s been part of the growth. But what’s also been very interesting, is I think in particular the federal government, no one has told me this, but my hypothesis is they’re growing inpatient in waiting for that methodology to get to things like diabetes prevention. So interestingly in coupling with value-based care and these bundled payments, you’re seeing moves by the federal government, and the diabetes prevention programs is the best example, to just pay for these things directly in almost a classic fee-for-service model. And so we’re seeing this sort of dual model in payment for us where we’re bundled into things that matter, we’re part of the cost structure for care in a way that you would expect as you think about value-based care, but also people just saying, “we know it needs to happen, we as the purchasers, whether it’s government or employers need it to, and we’re saying to our plans and providers that you just have to do this, and here’s the fee-for-service rate almost.” 
 Katherine: So kind of building on that, since we know we’re living in a rapidly changing health care environment, and as you noted, the movement towards value-based payment doesn’t seem to be going away – at least that’s what we see from a trends perspective analyzed by our experts in Avalere’s Center for Payment and Delivery Innovation seem to tell us. Do you see an increasing role for chronic disease digital health programs in value-based payment models?
 Adam: Absolutely. The model of you’re sick, you go in to to your doctor, you go to your hospital, they do something to you, you go away, they don’t interact with you, they get paid, is clearly going away. How we get to that future of it being all worked through is going to take some time, and there’s a bunch of different models. You all at Avalere know better, but whether they bundle it with here’s a year of care for someone with diabetes, or it’s a full capitation model, all of those beg two things that are going to be critical for digital health. One is longitudinal interaction with that patient, so you’re not just seeing them when they’re there, but you’ve got to interact with that person beyond that one visit. They also beg that you as a health system or health plan, or any of the players are supporting the things around the medical care itself that drive outcomes. That’s I think, core to driving digital health. It’s also core to driving what I think are critical and important investments in social determinants of health and other things that meet people outside of the healthcare setting beyond just that one or two, or maybe six visits they have per year.
  Katherine: That’s great. It certainly seems like digital health has the opportunity to bring those pieces together, both from the medical side as well as from the social determinants perspective. Thank you Adam for your time today. I look forward to talking to you again soon. 
 Adam: My pleasure, thank you for having me.

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