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What is CareOps and why do we need it?

Healthcare providers have started to realize that integrated, end-to-end care journeys deliver better clinical outcomes at a lower cost than the current, fragmented standard of care.

Delivering these better results, however, is not about implementing point solutions or optimizing each part of the patient journey separately but about improving the care delivery process end-to-end.

CareOps is a set of practices and tools to build, operate and improve software-powered care flows. It uses principles from agile software development, quality improvement and design thinking and applies them to healthcare processes. CareOps brings clinical, operations, product and compliance teams together, overseen by strong clinical leadership. Ultimately, CareOps increases a care provider's ability to deliver higher quality care at lower cost and drive improvement cycles more frequently than its peers.

In this first article, we make a case for why CareOps is relevant right now. The second article introduces the different stages in the CareOps lifecycle and the third article proposes metrics to measure and drive the CareOps practice.

What is CareOps?

The word CareOps is a compound of “care operations” and the continuous development practice of DevOps in the software field, reflecting the combination agile software principles with clinical expertise and clinical operations.

For any care provider organization (virtual, hybrid or in-person), the goal is to deliver high-quality care to patients in an efficient way. CareOps is a set of cultural philosophies, practices and tools that creates the ability to evolve and improve service to patients at a faster pace than provider organizations using traditional ways to manage care delivery.

This speed enables care organizations to provide a better experience to their patients and care teams, improve outcomes and compete more effectively. CareOps brings key roles together - clinical, product and technology, complemented by regulatory compliance where relevant - around three key principles:

  • Focus on value
  • Cross-functional collaboration
  • Accelerated iteration
CareOps team and CareOps lifecycle
The CareOps team and CareOps lifecycle

Why is CareOps important?

Healthcare systems haven't seen meaningful improvements in waste and unwarranted variation despite major technological advances. This is costing the world hundreds of billions of dollars and countless lives each year.

CareOps takes a system view of the care delivery process to address these issues, as opposed to looking at point solutions.

Optimizing the results for one process is not the same as operating that process in the way that leads to the most benefit for the overall system. (W. Edwards Deming)

Imagine a surgeon performing state-of-the-art robotic surgery on a patient, who is discharged the same day. The surgeon and her organization, the hospital, have spent millions on the robot and many hours perfecting processes that lead to minimal length of stay. After a quick discharge, the patient can recover in the comfort of his own home, where a home nurse is assigned to wound care.

A short length of stay and the patient is back in the comfort of their own home fast. Everybody wins, no?

Now imagine the nurse not disinfecting her hands between patients. What would be the result of this care delivery process? Bad outcomes in the form of infection, and time and resources wasted in the form of infection treatment, readmission and potentially more.

This hypothetical example shows what has been widely understood for a long time and applied in business for decades. The results of a system must be managed by paying attention to the entire system, not just by optimizing parts of it. Looking at desired outcomes, the millions invested in the robot and all of the efforts spent on optimizing the in-patient processes are futile if the next actor in the process doesn't know what to do.

The fee for service model has fueled exactly this behaviour: siloed optimizations delivered by point solutions that have little to no positive impact on the results of the overall system.

Luckily, many care organizations (often virtual-first) are fed up with this status quo and have started to put in place integrated, end-to-end care processes to battle fragmentation and its consequences. They do this because there is a clear long term advantage. Better control and purposeful improvement of the care delivery process means building a competitive advantage as a provider organization. In turn, this ensures higher value to patients, their care team and payers as well as long term financial success for the organization.

Looking to a future where value-based care will be part of our arsenal, we have begun developing our competencies in this arena.Eren Bali, CEO and Co-founder at Carbon Health

However, managing end-to-end care journeys is rapidly becoming more complex, caused by 4 distinct factors.

The rise of the multidisciplinary team

The first factor is the rise of the multidisciplinary care team. By now it’s widely accepted that beyond the clinical intervention, addressing psychosocial, dietary, logistics and other needs can contribute to better clinical outcomes.

Maven Clinic for example supports women and their families in the entire journey from pre-conception to well into childhood and provides 30+ specialty care providers along the way.

Coordinating these so everyone takes the best next step at all times is a task currently handled by care coordinators, but there is a limit where throwing additional bodies at a problem isn’t the solution anymore.

More medical research than anyone can handle

The second factor is the explosion of published medical research and the gap it creates between scientific research and clinical practice. As Dr. Neel Shah (CMO Maven Clinic) said the current challenge is not a lack of knowledge, but rather a lack of execution. A recent study illustrates this perfectly: PCPs would need over 26 hours per day to follow national care guidelines for an average number of patients.

In an age where medical research is being published at an increasing pace, no single person in the care team is able to hold all of the relevant clinical knowledge for a given patient in a given medical condition in their brain. And as teams grow, it’s impossible to communicate this knowledge to each other effectively (combinatorial explosion of the lines of communication in growing teams).

Eventually, a system that holds this knowledge and assigns tasks to stakeholders will be vastly superior to relying on all stakeholders to align.

The alternative is unwanted variation in clinical care and again the issue of siloed optimization: each individual stakeholder optimizes from their point of view, not taking the larger system into account.

New channels and modalities for care delivery

The third factor of increased complexity in care delivery is the explosion of channels and modalities. The pandemic darling, care delivery has many variations ranging from in-person consultation to teleconsultations to asynchronous remote patient monitoring.

Care workforces can now be hired on-demand with companies like Wheel, SteadyMD, OpenLoop, Sprinter Health and CareSend. From mere clinical bodies to grow your team to fully managed care including the white-labeled software to support efficient clinical operations. Nurses are being dispatched to patients’ homes to perform activities that used to take place at the clinic. And companies like Certific are going even further, removing burden from clinicians where possible and betting on the vast potential of self-directed care.

Picking up medication at the pharmacy instead of having it delivered at home is rapidly becoming a relic of the past. And although more care is done virtually, many healthcare services still need physical presence. In these cases, a warm handoff between the virtual care provider and the in-person provider ensures a consistent journey across different parts of the system and better outcomes as a result.

On top of this comes aligning all of these efforts with evolving reimbursement modalities. As a provider organization, you can’t run experiments freely if that means significant chunks of revenue are at risk. There's no need to re-iterate how fee-for-service disincentivizes reduction of visits, treatments and procedures but even in value-based care models, an organization will tend to experiment within the boundaries of the reimbursement framework.

In the end, coordinating this as an easy and flawless experience is essential for better patient care, and that’s exactly the goal of partnerships like the one between Hims & Hers and Carbon health.

Keeping up with consumer expectations

Personalization is the fourth factor that is making life more complex for the care delivery organization. "Personalized medicine" has been an important buzzword but has failed to reach scale in recent years. Consumers' expectations have only risen without being answered properly. The advent of D2C care providers shows there is an appetite to deliver on these expectations.

[D2C] companies build models in which the patient is the customer that holds them accountable, rather than middlemen with their own incentives, such as insurance plans, employers, and PBMs. In practice, this means that [D2C] companies offer patients clear details on what kind of care is offered, how much it costs, what to expect from their treatment, product, or service, and how to get it. And most importantly, these companies empower patients to use that information to make decisions about how, when, and where they get what they need to achieve their goals. Link to article

A person with mental health issues used to have only one option; to have a physical consultation. Now, some patients will still insist on that physical encounter. Others stick to the 1:1 model but are fine having a consultation over video call. Others prefer a 1:many model with group therapy sessions and others yet are fine in a 1:none model consuming self-help programs through a smartphone app. Or why not a combination of all of those? In a D2C or B2B2C model where the consumer has the power, good luck as a care provider to cater to all those preferences.

To recap: the four drivers of complexity impacting care provider organizations:

4 factors of increased complexity in healthcare
4 drivers of complexity to manage end-to-end care journeys

CareOps enables provider organizations to deal with this complexity

CareOps revolves around dealing proactively with this complexity. First by bringing people together from siloed departments. Second, by providing a clear framework to design, operate and improve care delivery processes. Third, by aligning on relevant metrics to track performance. The result is efficient, evidence-based, personalized care across the full care continuum.

The important point to make is the need for leadership from the clinical side. Whereas clinical, product and engineering each have seats around the table in CareOps, the roles with clinical expertise and clinical operations responsibilities should be in the drivers seat in CareOps initiatives.

Provider organizations that fail to practice CareOps:

  • Deal with the increased complexity in a reactive and fragmented way
  • Show reduced operational and clinical excellence due to partially implemented processes
  • Deliver fragmented, variable care leading to subpar outcomes
  • See higher degrees of burnout and turnover in their care teams
  • Incur more cost due to lack of automation
  • Are exposed to existential risk as they don’t evolve their practice to continuously meet or exceed evidence-based standards and consumer expectations
The CareOps Lifecycle
The CareOps Lifecycle

Those who do practice CareOps on the other hand,

  • Are able to provide highly personalized, multidisciplinary and appropriate care based on the latest medical research.
  • They do this at a competitive cost by driving efficiencies across the full care delivery value chain through automation
  • Stay ahead of competition by closing the outcomes feedback loop and iterating continuously.

To do this, they master each stage of the CareOps lifecycle.

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