A shared view of medical recovery

Bhavini Patel Scott Gerlach Jacob Rader

Interactive Project Management

Digital Production Consulting

Creative Resource Management

Web Programming

Software Development

Math and Physics Education

Product Engineering

Large Scale Mechanical System Design

Founders

Research in Context

HealthcareActors

Insights from Research

Obsession with the technical nature of care drives providers to neglect many of the factors that affect patient perception

Healthcare doesn’t help patients understand recovery

The one-sided nature of knowledge in healthcare leaves patients feeling disconnected from their own care

Readmission Cycle

Obsession with the technical nature of care drives providers to neglect many of the factors that affect patient perception

Healthcare doesn’t help patients understand recovery

The one-sided nature of knowledge in healthcare leaves patients feeling disconnected from their own care

Implications for Design

The delivery of health services should be timely and practical for patients

Patients need structured frameworks to help them define their recovery

The generation of health knowledge needs to be collaborative.

Implications for Design

Timely & practical

Structured frameworks

Collaborative

Reduce readmissions while improving outcomes and perceptions

Timely & practical

Defining Value

Improve the clarity and accessibility of information related to medical recoveries

Structured frameworks

Reduce readmissions while improving outcomes and perceptions

Defining Value

Collaborative

Improve the clarity and accessibility of information related to medical recoveries

Reduce readmissions while improving outcomes and perceptions

Create resilient, dynamic models of medical recovery by balancing professional knowledge and patient experience

Defining Value

Reduce readmissions while improving outcomes and perceptions

Improve the clarity and accessibility of information related to medical recoveries

Create resilient, dynamic models of medical recovery by balancing professional knowledge and patient experience

Value Proposition

Interactive Web Application

Product Features

Product Features

structured frameworks

collaborative

Product Features

timely and practical

Transitioning from Fee-based to Quality-based

“In a fee-for-service environment, the system is not financially affected by how many times you get admitted. It may call into question the quality of the care you receive, but from a purely financial perspective, it is advantageous to have you readmitted. In a value-based system, it’s just the opposite.”

Landscape

Affordable Care Act Hospital Readmission Reduction Program

“In the second year of the HRRP, beginning October 1, 2013, CMS estimates 2,225 hospitals will be penalized $227 million because of excess readmissions.”

Motivation

Build for Opportunity and Product Maturity

Customer Profile• Hospitals and Medical Centers• Small centers (500-1500 seats)• Large centers (3000+ seats)• Significant income from Medicare Patients• General surgery• Looking for new, external revenue models

Market Strategy

• Contact and Content generation• Mutually beneficial, heavily discounted pilot• Allow the product and case studies to mature with small, local medical centers• Engage large providers early and develop relationships• Land one large provider and re-invest for scale

• White label• Direct Sell• Layered Value: Readmissions, Quality Care, Externalize Expertise• Leverage relationships from Advisory Board and MD Specialists

Sales Strategy

9.6 million1.2 million

55,000

General Surgery

Market Size

Approx. number of general surgeries in the U.S. each yearApprox. number of surgeries performed by general surgeons in TexasApprox. number of surgeries performed by general surgeons in Austin

Market Reasoning• General surgery is understaffed• Rising demand of an aging baby boomer population• General surgery is not a profit center for large providers• Ideal for low cost solutions that don’t demand additional time from experts• General surgeries have a more homogenous recovery: increasing the likelihood of reducing

preventable readmissions.

Surgical specialty that focuses on abdominal contents including: esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland.

Market Size

%10%16

$11,200$178,080

Pricing Based on Patient Volume

$38,000$4,000$8,000

Losing Money to Readmission

Buying to Save

Percent of Readmission for General SurgeryPercent of Uninsured in the U.S.Average cost of ReadmissionAverage cost of uninsured general surgery readmissions per 1000 patients

License per 1000 seatsBrandingSupport per 1000 seats

$17,808$35,616$53,434

Savings for a 1% reductionSavings for a 2% reductionSavings for a 3% reduction in readmissions

Pricing

Revenue & Expense: Core Product

Revenue & Expense by Quarter

EBITDA: Core Product

EBITDA by Quarter

Phase I: Development

• Convert at least 2 targets into pilot programs• Working Prototype

Strategic IntentTo transition the design prototypes into a working web application that is ready for pilot

Actions• Hire a developer• Founder selling and reach out to targeted small-medium medical centers and surgical practices

in Austin • Develop working prototype and build web presence• Setup Infrastructure

Outcomes

2014

• Case study, testimonials, and ROI from pilot(s)• Matured product• Design Insights and implications for additional modules and 2nd stage development• Active sales team

Strategic IntentDevelop a one-year case study of core service while identifying opportunities for future growth

Actions• 12 month pilot with 1-2 medical centers• Continued research and development of Stitch • Near end of pilot hire first salesperson• Initiate conversations with large providers

Outcomes

Phase II: Pilot

2015

• 4000+ seats from several small-medium sized medical facilities• Leads/relationships with 4-6 large medical providers

Strategic IntentLeverage the case study and ROI from the pilot to convert an initial customer base

• Renew at least one pilot to paying customer• Leverage personal contacts from advisory board and salesperson to generate leads• Convert 3000+ new seats by focussing on medical centers analogous to pilot(s)• Hire content support and content specialist• Use design implications to prototype additional modules to capitalize on new patient interactions

Outcomes

Phase III: Smalls

2016

Actions

• Convert at least one large medical provider (3000+ seats)• Sell an additional module to at least one existing customer

Strategic IntentTransition into large volume health environments and extend product line with additional modules

• Pilot additional modules to existing customers at an initial discount• Deliver highly tailored pitches for 4-6 large health providers• Generate 20+ new leads for small-medium medical centers in Texas• Generate new leads in 4-5 new cities in the Southwest

Outcomes

Phase IV: One Big

2017

Actions

• Reach 12000+ seats

Strategic IntentScale and investigate additional revenue streams

• Hire second salesperson and a marketing resource• Ramp up marketing and sales volume• Target providers with similar profiles to existing customers in other major cities• Package additional modules with core service• Build an API for Stitch’s information models

Phase V: Scale

2018

Actions

Outcomes

EBITDA: Headcount

EBITDA and Headcount

EBITDA: Additional Module

EBITDA with Additional Module

Opportunity

Mitigation• Leveraging Design Research as a selling point• Layered Value lends to adaptable value creation

Risk, Mitigation and Opportunity

• Unique value in data model• Positioned at the heart new dialog between patients and providers• Solving tangible problems that align with longterm strategy

• Finding a Pilot• Showing ROI• Landing a Big• Fundraising

Risks

We strive to identify and develop ideas that help patients and providers transition toward quality based healthcare.

Stitch will drive direction, purpose, and products from user centered design techniques to ensure that the company remains mutually beneficial to both patients and providers.

We believe by designing better interactions between patients and providers that extend beyond traditional definitions of healthcare, Stitch will help define a richer understanding of health while creating new opportunities for value.

Approach to Problem Solving

Bhavini Patel Scott Gerlach Jacob RaderQ&A

Steve Conti

Appendix: Advisory Board

Seton’s Senior Director of Clinical Innovation and Population Management

James I. Rodriguez

President and CEO of TexHealth Central Texas

Ronald Luke, JD, PHD

Principal Consultant and President of Research & Planning Consultants, LP

General Surgery MD

As we make connections with MDs for content general we will look for alignment with the company and beneficial contact networks

Appendix: Headcount

Appendix: Improving Outcomes

Percent of Readmissions for General Surgery 10%http://www.fiercehealthcare.com/story/surgical-patients-bounce-back-post-op-complications/2012-08-29

Average Percent of Uninsured 15.9%http://www.cnsnews.com/news/article/susan-jones/gallup-percentage-uninsured-americans-higher-now-2008

Average Cost per Readmission $11,200http://www.beckershospitalreview.com/quality/6-stats-on-the-cost-of-readmission-for-cms-tracked-conditions.html

Text Messaging Significantly Improved Patient Adherence, Self-Care and Quality of LifeA recent study conducted by the Center for Connected Health, a division of Partners HealthCare, was the first to combine medication reminders with educational information, which may lead to the use of text messaging as an important way to educate patients and support positive behavior change.

“At the end of the six week study, 72% reported improved adherence. Over two-thirds of participants (68%) reported an improvement in the number of self-care behaviors they routinely perform, and 98% reported an improvement in at least one self-care behavior.”

"Text messaging is a cost-effective way to deliver short, concise information to patients over a longer period of time, and because it is automated, requires no extra effort from the provider," added Kvedar. "Our study also indicates that patients are willing and ready to integrate technology, such as text messaging, into their care. It can also help to improve communication between patients and providers."http://www.prnewswire.com/news-releases/text-messaging-significantly-improved-patient-adherence-self-care-and-quality-of-life-according-to-new-data-from-the-center-for-connected-health-103919508.html

A text messaging intervention to improve heart failure self-management after hospital discharge in a largely African-American population: before-after study.Over half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management.http://www.ncbi.nlm.nih.gov/pubmed/23478028

Appendix: Targets for Pilot

Arisehttp://www.arisemedicalcenter.com/about-us/Smaller for a reasonTo us, better care starts with a better experience—one that’s thoughtful. Special. Cozy, even. Smaller means more nurses per patient and fewer layers of formality. Wherever you visit us, we want you to feel warm, welcomed, and recognized. We want to get to know you. Then we want to get you home.

Physician-run for a reasonAt Arise, we like to let our doctors call the shots. Because we're physician-owned and operated, we're paying really, really close attention to every single detail that makes this hospital a better place for everybody: namely, you. We’re run by people who really understand health—not just how to build a hospital—so we can practice what we preach: less expensive, more attentive care.

Who We AreWe lead with care—which means patients come first. Always. We’re obsessed with delivering the best patient experience in Austin, and while state-of-the-art technology doesn’t hurt, we know the best care starts with the best people. So we hire the same people we’d want taking care of us. Here are a few people who make things happen at Arise.

Northwest Hillshttp://www.northwesthillssurgical.com/

• Doctors are in partnership with the hospital and the community.

• The physicians and staff at Northwest Hills Surgical Hospital perform an array of inpatient and outpatient surgeries, available to the entire community, in a convenient, private setting.

• We have recently expanded by adding a Hospital Outpatient Procedure Department to better serve our patients undergoing gastroenterology and pain management procedures. This expansion will allow us to serve more patients.

• We Take Pride in Offering the Best Individualized Care Possible

• Patients are increasingly entrusting their care to the committed professionals at Northwest Hills Surgical Hospital. Year after year, our patients give us excellent ratings for overall hospital experience and short wait times, and recommend us to their friends and family.

Austin Gastroenterologyhttp://www.austingastro.com/

South Austin Surgeryhttp://www.southaustinsurgerycenter.com/index.html

NorthStar Surgery (single surgeon practice)http://www.northstarsurgery.com/index.asp

Lakeway Regional Medical Centerhttp://www.lakewayregional.com/services/surgery-center/

Appendix: Targets for Content

John Abikhaled, MD• Dr. Abikhaled has served as Chief of General Surgery at Seton Medical Center and on hospital and surgery center boards and committees in the Austin area.

• Dr. Abikhaled has extensive experience in abdominal hernia repair, such as inguinal, umbilical, incisional, ventral, epigastric, and hiatal hernias. He performs laparoscopic and open hernia repairs.

• In addition, he is an experienced laparoscopic surgeon, treating gallbladder disease, colon disease (including cancer and diverticulitis), hernias, acid reflux (GERD), and adrenal gland disease. He also performs robotic-assisted surgery, which can allow for more complex operations to be performed with minimally invasive laparoscopic techniques.

• Dr. Abikhaled treats a variety of cancer conditions, including breast cancer, melanoma of the skin, thyroid cancer, and colon cancer.

• He has been recognized by Austin Monthly Magazine, U.S. News and World Report, and Castle Connolly as a “Top Doctor”.

• Austin Community College named Dr. Abikhaled “Preceptor of the Year” in 2008 for his efforts in teaching new Surgical Technology students and he has been nominated as Distinguished Surgeon by the Association of Perioperative Nurses.

• http://www.austinsurgeons.net/our-surgeons/john-abikhaled-md-facs/

Steven M. Fass, MD• 20 Years of Practice

• 5 Hospital Affiliations

• Performs 33 Procedures

• Treats 34 Conditions

• http://www.healthgrades.com/physician/dr-steven-fass-xjq5h

Jeffrey T. Meynig, MD• Dr. Meynig is certified in General Surgery by the American Board of Surgery and is a Fellow of the American College of Surgeons.

• He is a member of the Texas Medical Association and the Travis County Medical Society.

• His particular interests include laparoscopic surgery, breast surgery and surgical oncology.

• http://www.austinsurgeons.net/our-surgeons/jeffrey-t-meynig-md-facs/

Moya M. Griffin, MD• Performs 27 Procedures

• Treats 21 Conditions

• http://www.healthgrades.com/physician/dr-moya-griffin-xj2wt

Robert Askew, Jr. MD• Dr. Askew is an experienced laparoscopic surgeon performing laparoscopic surgery for diseases of the gallbladder, colon, small intestine, spleen, adrenal gland, liver and stomach.

• He also performs laparoscopic surgery for gastroesophageal reflux and diaphragmatic hernias.

• http://www.austinsurgeons.net/our-surgeons/robert-askew-jr-md-facs/

Bridget Brady, MD• http://www.ucomparehealthcare.com/drs/bridget_brady/