What do you get when you cross a health-based community engagement experience, a team with experience implementing health IT solutions and problems from a real world provider? Triage.me
Recently, I shared a (growing) list of health IT companies in Wisconsin, channeling my side interests of technology and health. In the weeks since, there seems to have been an overlapping series of health tech conferences (e.g. StrataRx, MedicineX and Wired Health Conference) that pop up in my news streams. While the ideas and comments were interesting, I couldn’t help but wonder whether the glory of technology was swamping out the utility of the solutions. Considering my (self-perceived) reliance on tech, I was feeling a bit blasphemous until I came across a blog post called: When the elephant in the room has no smartphone. The author, Carolyn Thomas, survived a heart attack (the infamous widow maker) and is a heart health advocate. Her post captures many of the issues that can arise when technology solutions are developed without taking medicine and every day life into full consideration.
Which was why I was really excited this week to learn more about a Madison-based health IT company called Moxe Health that is working to change that. Started by two former Epic Systems employees, Dan Wilson and Mark Olschesky, Moxe Health got inspiration for their first product during a Milwaukee BuildHealth Hack-a-thon in Spring 2012 when Aurora Health Care, a healthcare provider in the Milwaukee region, put forward a problem. Aurora was looking to reduce the number of non-emergency visits to the emergency room. The team set out to build a product, called triage.me, which could help address the problem.
*Update: Moxe Health was selected to participate in Rock Health, a seed accelerator for digital health companies. In addition to the four month incubator experience, companies get $100,000 investment from established healthcare players (Aberdare Ventures, Kleiner Perkins, the Mayo Clinic, and Mohr Davidow).*
Scope of the Problem & Current Efforts
Overutilization of the emergency department has been an issue that providers in Milwaukee have been working to address. The Milwaukee Health Care Partnership highlights two pieces of information that suggest the depth of this problem (see link for source):
- “Emergency department utilization was increasing at all hospitals in the county and almost half of ED visits made by Medicaid or uninsured patients were for primary care treatable conditions.”
- “Roughly one-third of Milwaukee county’s adult population was uninsured or covered by government insurance programs for low income individuals, including Medicaid and the county’s General Assistance Medical Program (GAMP).”
The Partnership has already taken a number of steps* to address these issues, including developing connections to manage care from emergency departments to medical homes. What problems could health IT help address?
Finding Solutions in Technology
Some of the reasons that patients give for going to the emergency department for non-emergency services include hours and transportation. Dan and Mark believe that technology is a good fit to address those issues but the type of technology is important. To evaluate the technology being used by their initial target population, they looked at the diverse demographics of uninsured and government insured patients and the data from a variety of studies on mobile phone use in the US, including the Pew Internet and American Life Project. (Side note: this project is data rich and really interesting to think about in terms of delivering “health” via technology.) Here are a couple of highlights that impacted the plan for triage.me:
- 85% of American adults have a cell phone and 45% have a smartphone. (September 2012)
- 73% of adult cell phone owners send and receive text messages (May 2011; survey of adult internet users 18 and older)
- 70% of cell phone owners and 86% of smartphone owners used their phones over the past thirty days for “just-in-time” information (April 2012)
- Young adults are the most avid texters by a wide margin.
- Those with lower levels of income and education text more often than those at the higher end of the income and education scale.
So what exactly is triage.me? According to Moxe Health:
triage.me uses either text messaging to help patients complete a short assessment based on the AHRQ’s Emergency Severity Index. We evaluate a patient’s acuity, insurance coverage and location, to find the nearest open community clinic or Federally Qualified Health Center (FQHC). We provide public transportation directions and notify the clinic that the patient is en route.
Triage.me addresses the awareness, accessibility and financial factors that cause patients to rely on the ED for non-emergent and routine care. Tailored to patients with Medicaid and those without insurance, triage.me seeks to lower bad debt and charity care costs by reinforcing the use of appropriate, primary care.
Another feature Dan and Mark have designed into triage.me addresses the heavy need for translation they saw in their work implanting health IT in various medical systems. In Milwaukee, their estimate is that approximately thirty percent of the patients are better served in a language other than English. Incorporating this need into the product up front will allow them to add that utility as the product matures.
Triage.me is easily adaptable to a web portal, which could appeal to a broader patient base. While the reasons aren’t clear, there is concern about the rate of growth of emergency resources by patients with private insurance.)
Is a Product a Product if Nobody Pays?
One of the other key features of health IT companies is who is the actual customer – in other words who will pay for the product/service? According to Dan and Mark, there are three parts of the equation that need to be addressed to be successful:
- Patient – Good user experience
- Provider – Efficient utilization of resources
- Payer – Low cost, high quality care
But who will see enough benefit to pay? The Moxe team has looked at this question and anticipates they can demonstrate benefit to both providers and payers. Providers could potentially improve their resource utilization, including scheduling healthcare professionals to match utilization patterns. Another benefit could be lowering the no show rate by better matching patients and providers. From a payer perspective, there is interest in products that encourage providers to utilize fee for service models. Echoing a growing discussion in paying for medical care, Moxe is also evaluating risk-sharing models that are developing in Accountable Care Organizations.
While it is clear they recognize the reality of paying customers, Dan and Mark continually come back to the benefit to patients. Could using triage.me decrease wait times for patients? Could the cost savings be used to cover the cost of the texts?
*Looking at the most recent report from the Milwaukee Health Care Partnership, you can see that one of their initiatives has been to use a healthcare scheduling exchange, called My HealthDIRECT, to better manage provider resources. My HealthDIRECT is a health IT company based in Milwaukee that (in addition to having a product that customers pay for) has raised venture capital from Arboretum Ventures and Chrysalis Ventures.