Tackling the realities of population health: Acupera

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Better outcomes, preventing diseases, closing care gaps and creating cost savings for providers are all promises made by those who espouse the virtues of population health. Historically, however, these promises have not been met in many instances, causing some to believe that true population health management may still be just out of our current reach. Others, like Ron Razmi, Chief Executive Officer, Acupera, feel that it is not the practice itself, but the unrealistic, misguided approaches that many practitioners of population health employ that cause so many disappointing results. 

(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)

Free: Your approach to population health management is rooted in your professional background. Could you please describe your career path?

Razmi: I started my career in medicine as a cardiologist, but my background is that of a physicist that went to medical school. 

 One of the first things I did in my career was developing cardiovascular applications for MRI (magnetic resonance imaging) imaging. Historically, MRI or CAT (computed tomography) scans were not used in managing cardiac patients. A group of us worked on developing the initial applications of that and wrote a textbook in doing so. Through that [process], I got exposure also to the business side of things.

Using my background as a cardiologist, and as someone with an interest and expertise in technology, I switched to business development and worked in a corporate finance group at McKinsey for a good number of years focusing on life sciences and private equity buyouts. 

Back in 2009, I saw the writing on the wall around digital health and decided to start Acupera. What I was seeing at that time was a lot of overly simplistic and unrealistic solutions that worked well in a technology lab, but when you brought them to the real world, there were a lot of barriers to adoption in the clinical environment. In particular, I noticed that a lot of the solutions didn’t necessarily understand the workflow aspects of how healthcare is delivered.

Our goal early on was to to go beyond electronic health records (EHRs) and analytics, and to answer the question: How do you make the right things, specifically the right tasks, happen at the point of care? The point of care not necessarily being the doctor-patient interaction, but with the care team. We wanted to make sure that we went beyond considering just the doctor because today you must know how the entire care team collaborates in managing a patient or a population of patients.

With these things in mind, we built an engine that is intelligent, that automates a lot of work that most other solutions skip over in terms of the proper workflows needed for each member of a care team. Our system tells each member of the care team, including the patient, what they need to do. We don’t know of any other solutions in population health that accomplishes this objective as well as we do.

Free: The term “population health” is used by so many in healthcare, but few posses the same definition of its processes, functions and impacts. From your perspective, what do you see as the biggest misconception within the area of population health management today?

 Razmi: I think the biggest misconception, right now, is the fact that this is easier to do than it actually is. A lot of the solutions you see out there are quite simplistic. They would never be able to support the workings of a large and virtual care team that manages a large population of patients. If you, for example, go to HIMSS (Healthcare Information and Management Systems Society) and walk the exhibit hall, I bet you you’ll see a lot of products that have population health on them, but once you lift the hood, you see that there’s not a whole lot there. What they are about is a secure messaging platform between providers, or between providers and patients, or, you know, really first-level analytics. Unfortunately, none of this stuff incurs the kind of change you need to drive real outcomes – outcomes being improving quality of care, but at the same time doing it in a way that lowers cost of healthcare and increases efficiencies.

Simplistic thinking, thinking that population health management is actually easier than it really is, I would say, is the biggest misconception. That disconnect exists because most of vendors in the space have not seen what population health efforts look like in the real world.

Free: What population health management pain points does your engine remedy that you feel other solutions sometimes miss?

Razmi: Simply put, we provide a tool around which you can support your business objectives even as the new business models are emerging healthcare.

 Population health management is where the world is going. The health systems are going to be in the business of managing their patient population in the future. Saying that, we’ve created a tool that industrializes what you need to do, allows you to scale, [and] takes you where you want to go without having to hire a lot of people and necessarily change all of your processes. It’s flexible that it could be tweaked to your environment, but comes in with a lot of the intelligence and automation already built-in.

We have found that too many population health solutions tend to focus on the area of communication which is important, but they add a great deal of manual labor in the process. Our engine is designed to avoid this common misstep. 

Free: Many providers believe that some problems that exist within population management today are caused by the lack of time that vendors spend in the field, outside their controlled environments. Do you agree with this sentiment?

 Razmi: You know, I don’t think it’s just a matter of taking time. I think a lot of the people who built these health IT companies are not from a clinical background. So, I am not sure it is so much that they are not taking the time rather than the fact that a lot of the realities of healthcare are hard to internalize for people who are not from healthcare.

The reality is customers are not going to tell you what products need to be built. Customers can tell you what their pain points are, but they cannot tell you what products need to be created to address those pain points. So, if you’re hearing the customers areas of need, then you come back into your shop to sit down and conceive of a product, unless you have deep expertise in the environment, chances are good that a lot of the things you are designing may have subtle barriers to them that you are not aware of.

Also, in terms of the healthcare environment, you have to understand that getting ongoing access to the customer is quite difficult. You can’t necessarily engage, or be present, in the interactions with the patient and his or her care team members. There are a lot of barriers and solutions  to overcoming these barrier are not necessarily within reach for those with a true lack of understanding of real-world healthcare. So even if they do spend time in the field, some vendors may not understand completely the environment or behaviors that they observe, making it impossible to create a comprehensive product.