In the United States, doctors are dealing with a changing landscape. Thanks to the Affordable Care Act, insurance companies are paying them for the quality of care rather than for the number of patients served. But to properly measure this requires hundreds of hours manually extracting, organizing, and reporting the data.
Able Health developed a service to automate tracking and reporting so that health care professionals can focus on delivering care to patients instead of collating paperwork.
Founded by Rachel Katz and Steve Daniels in 2015, this Y Combinator company pulls data from electronic health records (EHR) and claims, then maps the information to the quality measures each health plan reimburses. The metrics are based on contracts between physicians and insurance companies and Medicare.
“We challenged ourselves to solve something that everyone hates and used a lot of human-centered design patterns to develop it,” Katz told VentureBeat in an interview. She said that under the current system, doctors are paid based on a percentage of patients diagnosed with a specific disease or illness as determined by a lab test. Health care organizations want to know the number of people afflicted, what the acceptable level is, can patients come back for a retest, and more. The process is really complex.
Katz and Daniels previously worked in related fields, with Daniels being the design lead at IBM Watson and Katz formerly producing strategy for health care and technology companies at McKinsey. They met when they attended Brown University. Throughout their careers, they looked to find the next “hotbed of innovation” where they could “get on the ground, roll up their sleeves, study the problem, and make a difference,” Katz said. This led to them thinking about what they could do to rethink how health care can be delivered.
“What we’re doing is bringing what you commonly see in Silicon Valley startups — agile product development, user-centric design, and building cloud-based applications — to this industry that doesn’t get this influence,” Katz explained. “We strongly believe that these practices will seep into health care. We’re excited to bring this approach to the world.”
Able Health believes its service will accomplish five things: Consolidate all the pattern data, pulling it from health records and claims in order to calculate how much money is captured; track performance by contract with different insurance companies and how it stands up against “measures that matter”; simplify reporting out to insurance companies, thereby preventing the annual headache administrators deal with; provide information to clinicians who just want an overview about how they can help patients; and deliver feedback to everyone, which will hopefully motivate physicians and clinic manager to improve performance.
The company deployed a pilot program over the summer in Louisiana with a small practice. It also has signed an independent practice association that has over 200 providers across San Francisco, spanning 45,000 patients in the network.
The hope is that in a year, Able Health will have a solid data outcome that it can show as proof that its model works. The team wants to touch as many administrators in health care as possible in order to ease the transition from the previous payment model to one around quality care. “If we do our job, people will actually say they don’t mind quality reporting, as opposed to what’s happening now,” Katz remarked.
Able Health has raised an undisclosed amount of funding.
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