My favorite State Fair treat is Lemonade Shake Up. I have memories of drinking it at various county and state…
Christopher “Chris” McCann, MBChB is co-founder and CEO of Current Health of Boston, MA.
Tell me about yourself and the company.
I’m originally from the west coast of Scotland, now based in Boston. My background is in computer science and medicine. I started Current Health in 2015 based on the experiences of my grandmother. She was repeatedly hospitalized for things that could have and should have been managed at home. Current Health was built to be a one-stop partner for any healthcare organization to deliver care in the home, using our technology platform, our services, and our knowledge and operational models.
What financial models support hospital-at-home and remote monitoring services?
The biggest thing holding back care at home, care outside the hospital, is the financial model across the industry. It’s just too immature and nascent. The CMS acute care at home waiver has obviously been very relevant to our business. That is just a waiver. It is due to expire when the public health emergency expires. There is a bill in the Senate right now to extend that and we’ve been working hard to see that bill passed.
We are reimbursed under Medicare RPM codes. But to be honest, we don’t see many hospital systems that see that as a driver of delivering more care at home. They’re more focused on using us for total cost of care reduction within alternative payment model populations that maybe they set up locally with a payer or on the post-discharge side, helping to improve patient flow and manage capacity, particularly when they’ve been capacity-constrained over the last 18 months between staffing shortages and, in some cases, capacity with COVID patients inside the hospital.
Does the market offer enough FDA-cleared sensors to give clinicians an adequate view of a patient at home?
Yes, absolutely. Not only do I not believe that there is a monitoring gap any more, I think the data that we see from hospital-at-home programs that we manage shows that patients are achieving, in some cases, better safety outcomes in home than they do in hospital. There is not a monitoring gap at the moment. That isn’t the problem that exists in the market.
In terms of scalability, is proprietary expertise involved in identifying the relevant information from a constant stream of home monitoring device data so that a clinician can get involved when needed?
There is. That’s partly why I would say that we are not a remote patient monitoring company, because simply getting monitoring data and dumping that on the physician is not helpful to anyone, particularly when you are managing a multi-thousand patient population.
The key thing is actionability. How can you identify that one patient, or that group of patients, who require an intervention and get that actionable insight to the right person at the right time? That is, to be honest, even more important than capturing the monitoring data in the first place.
The staffing crisis is probably the biggest issue we have in healthcare right now. We don’t have enough registered nurses. We don’t have enough doctors. So we have to be able to help those staff that we do have — who are already overworked, who are already burned out – and help them focus on the patients who need them most and make their lives easier
How can the industry address the last-mile problem of patients who are being monitored at home who require blood draws or other in-person services?
As a company, we have made it clear that we don’t see ourselves as an RPM company. Remote monitoring is a feature of how care is delivered in the home, but it doesn’t actually, on its own, solve any particular problem. Because as you just said, you need that ability to go out into the home and do something about a patient who needs action or intervention. Even before that, for some patients, you need the ability to go out to set those patients up and help deal with technical support problems. Many of the patients we deal with are seniors. Half of them don’t have internet access and half of them don’t have smartphones.
We need to resolve that, firstly to partner with ancillary in-home services for things like labs and pharmacy and new delivery. We orchestrate that. We have our own clinical command center to provide virtual RN and MD services to support our clients in particular shifts, overnights, or on weekends. We can also do across the threshold logistics and technical support. Combining the technology with those services is, in our view, part of what is needed to solve the market problem.
An important part of in-hospital care is asking the patient how they are feeling or observing their level of discomfort, and that happens by people popping into their room at all hours. Can patient-reported outcomes and E-diaries adequately capture the patient’s perceptions?
EPRO symptom reporting, the capturing of contextual data like that, is critical. Many times patients readmit or come to the ER for things that are difficult to measure through biometric data. Pain is quite a good example of that. Pain is subjective, and in some cases, doesn’t measure on any biometric reading. But pain can absolutely bring someone back to the ER and absolutely massively affect quality of life. Being able to capture that is critical, and we incorporate that into our alarming system.
We also have to make sure that there is an accessible presence from an RN or a physician. It is certainly part of the acute care home waiver that patients need to be able to access a physician or RN if they need to.
I’ll say one other thing, which is that this is one of the reasons we were attracted to the Best Buy acquisition of Current Health. They have the caring centers. While Current Health focuses on the clinical side, the caring centers focus on the social side. They have social workers. They look more holistically at the individual and provide a wider range of social support. That is going to be important to how healthcare at home programs develop in the future.
How do you see Best Buy proceeding in healthcare and how will your company change under its ownership?
I’ve sat with the Best Buy Health senior leadership team and I report to the president of Best Buy Health. Our strategy is split into three parts, and this is all in the latest standings call. The first one is consumer health, which is, let’s get every health and wellness device into Best Buy’s flows and on Bestbuy.com. Interestingly, Best Buy is a larger channel for some devices than anywhere else. The second one is active aging, which was the acquisition of GreatCall. That’s more about how we help seniors age in their own home and a place of their own choosing. The last one is virtual care, and that’s where Current Health sits.
Best Buy is using its capabilities — such as Geek Squad, access to consumer and medical health devices installs and online, the caring centers that I mentioned before — to offer services to hospital systems and healthcare organizations to help them deliver care through the home. Best Buy is not trying to be, and never will be, a healthcare provider. That’s not what they want to do. They are there to help hospitals and healthcare provider organizations deliver healthcare to the home.
What technologies and services could change how life sciences research is performed via home-based clinical trials and monitoring?
Pharma has exactly the same issue as hospital systems. They want to move more clinical research into the home. They want to better the level of drugs and therapies in the home over the long term and do so with better outcomes for their patients. They want to be able to better measure how those therapies are actually doing for those patients, both clinically and from a quality of life perspective.
That last one has become important to regulators and payers. That’s where an organization like ours comes in. We enable better data capture in the home to understand how a patient is doing on a drug and what their quality of life is while taking it. But we also allow them to deliver drugs in new ways, taking drugs that would have been delivered in the hospital and delivering them in the home instead, at lower cost and with greater and greater access.
I would it sum up in saying that in the same way that we are seeing this decentralization of clinical care away from the tertiary bricks and mortar facilities, we’re also seeing a decentralization of clinical research. That is fundamentally a good thing, because we can deliver better care if we can look at that patient longitudinally across a normal segment of their life when they are at home.
How do you see the market and the company’s role in it changing over the next few years?
Care at home will be the biggest area of strategic growth within healthcare over the next three or four years. Everyone has identified it as a strategic priority. Few organizations really know how to get there yet. To your point at the start, the financial model is still a little bit opaque. Current Health is trying to help make that financial model more transparent, and operationally and technically, make it turnkey for a hospital to stand up a program like this for any population. I hope, and I expect, that we can continue to be a major part of doing that across the US.