Co-Founder and CEO
We live in a modern information age where people want to be involved, they want to understand and they want support in that process but they want independence and they want skills and the current health care system doesn't deliver that.
Interview by Heidi Legg
What are you are trying to do?
Frank Moss, the director of the MIT Media Lab, was my advisor, and we created a group called New Media Medicine with another student, Ian Eslick. Our focus was on empowering patients to become active participants in the health care ecosystem.
My work was particularly about patients and clinicians collaborating effectively, and patients owning more leadership in their care. Ian's work was predominantly about communities of patients working together as teams to try to change the way medicine worked, to discover new cures, or try out new therapies, especially for diseases where disease communities were either orphaned or underserved.
For six years we worked together at the Media Lab and when I graduated in July, we decided to spin out our start up called Atelion.
We’re building technology where patients can lead their care. We’re allowing people to set goals with clinicians quantitatively and objectively that they use on their tablets and cell phones. It allows them to self-track actions and progress that they make towards their goals, and allow them to learn in real time. Much of it is based on the concept of 'situated learning;' that people learn best, not in a doctor's office or a classroom where it's artificial, but in the real world where they're encountering real problems.
Who is your audience?
We're building products for primary care and general outpatient medical care. Our main focus is building a chronic disease software platform that allows patients to lead their care. It’s a total inversion of the typical model of healthcare delivery.
Is your audience primary care patients or doctors?
Both. The typical care delivery is about clinicians telling patients what to do, and that's absolutely not what people want. We live in a modern information age where people want to be involved, they want to understand, and they want support in that process, but they want independence and they want skills. The current health care system doesn't deliver that.
Our model is one of apprenticeship where we help people develop self-efficacy so that they can lead their own care. We have coaches on the clinical side who are sometimes nurses, sometimes people with on-the-job clinical training as part of the team. They help people set goals and they communicate with patients effectively through our technology to help them achieve their goals.
It sounds like you are doing the same thing in primary care as IORA Health? (See our interview with Dr. Rushika Fernandupulle)
Rushika's concept of building practices that are team-oriented and in which coaching is a big component is definitely an inspiration to the work that I've done. I've known Rushika for about five years now, and we've riffed off each other’s ideas.
They build healthcare practices and we are a software company that makes tools for healthcare practices. We build this situation that allows them to connect in real time with clinicians back in the office without ever going in.
Who is backing you and what’s next?
Our company has evolved. I've done research in hypertension, diabetes, and other diseases. We did randomized controlled trials at MGH and at the Joslin Diabetes Center and had some pretty spectacular results in terms of outcomes. We’re very interested in supporting the next generation of primary care and other outpatient care motivated to achieve better outcomes for patients.
For the past couple of decades in this country, we've focused on volume-based healthcare. We get paid to provide services. As a result, we've been totally disconnected from actually making people healthier, because there's nothing about that model that rewards anyone or even quantifies their success.
With healthcare reform coming and with grassroots efforts like Rushika's practices at IORA, One Medical out in California, or The Ambulatory Practice of the Future at MGH, we’re not going to wait for healthcare reform. We know this is right, and those grassroots practices are our potential customers. These are doctors, nurses, and health coaches who are really motivated to help people get better.
Am I going to be able to buy a health plan that insures me for everything but my primary care, and then pay for a primary care doctor that is using your tool?
A growing part of healthcare reform is about accountable care, and they're establishing what are called 'accountable care organizations' that are on the hook for getting outcomes more and more over time.
The mainstream is gradually going to start shifting to that. This big mass of fee-for-services, like Medicaid and Medicare services, is starting to push towards adding more accountability in that care. The other grassroots approach is a whole emerging class of non-traditional healthcare providers that are based on the concept of value-based medicine. It’s the IORAs, the One Medicals, the direct primary care practices, the Walgreens, and the CVS storefront type models. You can either go to any one of those, or you can go to the more progressive of the traditional providers that are starting to integrate payment and delivery with health insurance where they benefit from outcomes. This is an evolving landscape that will be changing dramatically over the next decade.
How do you fit in?
We’re a startup company that's about five months old and a great deal of what we're doing now is engaging in this with clinical partners. We’re starting to understand who will be our earliest customers and also creating a market.
There's a market that exists for products like we're making, and part of it is that the market is not nearly as big as what it could be because there are no products that really do what we do. The IORAs of the world and others are at a loss. They can’t yet buy a product to do what they want it to do. So to answer your question of where someone could go to use our product in the next half a year, is that it’s only going to be these few select clinical partners.
We are doing commercial pilots. In the next year and a half, what we hope is that everyone who's exploring this value-based healthcare delivery paradigm is interested in using our product, and our goal is to hone that market, but that's an evolving landscape.
What’s your view on Obamacare?
In my eyes, the components of it that are helping to move us towards accountable-care are extremely positive. The fact that there's a recognition at a high level that we need to be working as a country to move away from just providing services to make money towards really being accountable for taking better care of people is extremely important. Do I think that that top-down approach is going to solve the problem? Absolutely not. I think that it's going to be a grassroots approach that has much more impact in the short term, but the fact that our government appreciates that grassroots reform is a meaningful trend, and is simultaneously working in a top-down approach to supplement that is really important. This is accountable care.
In the past month, I have learned about some components of the Affordable Healthcare Act that are very exciting for us. It has opened up a number of new channels for Value-Based healthcare providers (as opposed to traditional Volume-Based, fee-for-service). Even though there were some initial hiccups with Healthcare.gov, it is opening new doors for innovative healthcare plans and practices.
There are some aspects of ACA that are more about insurance rearrangement, and I don’t have great confidence that that's going to make a big impact. I think the bigger part is an alignment with the idea that we really need to focus on measuring, understanding, and being accountable for making people healthy.
It’s kind of crazy that that was not part of healthcare before. There are other countries that have fee-for-service medicine as well, but it's not as prevalent as the more logical model, which is the country has a pool of money to spend on healthcare and rather than focusing on monetizing every little action, they focus on the entire population, allocating money for each person and making sure that they get the outcomes that they want. I think our fee-for-service approach is part of what has been causing us to fall behind and our health care costs escalating. There's just a decoupling of real values.
Is shopping a good thing?
Oh, certainly, but you can't have shopping until you have transparency. I had to get my own healthcare, and I couldn't understand it, and I'm a doctor. I just finished a PhD in healthcare delivery, and I found the process utterly defeating.
You really need to have a transparent system that makes sense. Our system is so convoluted now, and therefore it creates a shopping experience that has no value.
What public opinion would you most like to change?
I would like to change the idea that people are not capable of really leading their own health care. That mindset in the past was okay, but this century and centuries forward, it's absolutely not okay. We can continue this opinion that we need to more efficiently tell people what to do, but it's not going to get us anywhere. At the same time, there's another public opinion that says, 'well, technology will solve the problem. We'll have robots and programs that will replace doctors.' I believe that will absolutely not be true because, yes, technology will help in making a rare diagnosis by pulling all the data together, but our real problem is things that we do to ourselves. It's diabetes, it's hypertension, it's cholesterol, and having a robot tell you what to do is going to be much worse than having a human tell you what to do. What you want in the end is people making good decisions for themselves because they're informed and involved, and we think it will be engaging and compelling to people.
Does value-based healthcare exist now?
It's evolving. You can get high deductible insurance that mainly benefits you when you have big emergencies. The higher deductible your insurance, the less coverage it has for primary services. A lot of insurers now are trying to muck around more in primary care and wellness. They all want people well because they don't want that downstream cost, but who are they? They're not doctors. They're not patients. They're a third party.
Think about your car insurance. Do you get car insurance that handles inflating your tires and your gas and changing your brakes? No. You get car insurance to deal with big issues, and you take care of the small things because it's more efficient not to have some third party involved and in the end it's probably more cost effective for you and a better experience.
New value-based care providers who are team-based and have coaching and tools like ours are about eliminating that power play. They are about creating total transparency and elevating the contribution of the patient, and understanding that if there is not buy-in from the people who need help, then we've lost everything.
Acute illness is where we've made extraordinary strides in medicine. We've done amazing things with antibiotics and vaccines and public health initiatives, and we've crushed it pretty well and we keep people alive.
We can save their lives, but because we've done that, chronic disease has taken over. It's 70% of our health care dollar today. In the next decade, it'll approach 90% due to social change and people living longer. People are becoming more unwell because they're more sedentary, and because we're just not as active as we used to be. So now diabetes, hypertension, and cholesterol - all these problems - are growing as well. It’s not just that we're living longer. It's also that we live different lives.
When will your product be ready?
We'll have a product that'll be with some of our early clinical partners in the next four months. We already had some spectacular results from our academic pilots. Our first product will be hypertension management, and in a year's time we'll have a product that encompasses a much larger spectrum of chronic disease. Between a year and two years, people will start to see it out there in the world and experience it.
How many of you are in the company?
Right now there are three of us who are co-founders and we just hired two more to join us.
You need an office. (currently they work in the Koa Labs in Harvard Square)
We’re shooting to be in this seed phase for another two to three quarters, in which time we're working on raising our Series A funding, and then growing substantially at that time.
Favorite place to get a drink?
I like the Red House to eat. That's one of my favorite places to eat. I'm not a big drinker.
How do you stay healthy?
I'm an avid surfer and kite boarder. I kiteboard on Cape Cod, and it's a quick hop up to the wall at Hampton Beach where I surf a lot. I also do some sailing on the Charles.
What event are you most looking forward to in 2014?
I am looking forward to a kiteboarding trip to Aruba this winter, and following the results of the Boston Blue Button Innovation Challenge. It is going to be interesting to see what kind of traction Blue Button has on patient health data portability, a major health IT problem in this country that is preventing innovation.