Transforming episode of care delivery

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POSTED August 9, 2019

A tailored care management solution for your organization

Implementing technology for a health system can be difficult. Given the number of stakeholders, workflows, and overall goals of an organization, the complexity adds up very quickly, and you should never be alone trying to figure things out. This is why the supporting teams here at Force have determined that a digital solution is only as effective as the teams supporting it. This blog is the first in a series of common implementation challenges and the “people” solutions we’ve built to address each one.

Problem #1: No care team is 100% standardized -- a major reason our clients select Force versus a ‘one-size-fits-all’ solution.

Our partnerships begin with thoughtful, meticulous pathway creation. We know with confidence -- after guiding 125,000+ patients through their episodes of care in Force -- that for a patient to be active and empowered in their digital care plan, it must be prescribed by their physician. Patients need to hear from and be nudged by a trusted source. Providers are the biggest drivers of patient adherence, so at Force you can expect that we’ll want to spend time with your physicians to help scale their unique voice and reach patients with thoughtful and personalized interactions.

To do this, we utilize our in-house team of clinicians from which the company was founded. Force’s Clinical Integration team works alongside each Force-enabled physician to curate a video-based care plan that reinforces critical instructions to optimize the patients’ recovery journey. With no additional work for your team, we collect all instructions and education you currently deliver to patients, from the first appointments to post-operative care, and digitize it for in an easy-to-digest format.  

It’s important to note, physicians never need to ‘start from scratch’ during the process of building their unique plan of care. Instead, we’ll begin with a template, created from best practices with other leading physicians across the country, which we help adjust to fit their individual instructions.

As much as we wish for smooth sailing after the initial care plan configuration, there are almost always tweaks that need to be made. The Clinical Integration team stays involved throughout the relationship to allow for agile pathway adjustment and future research enablement -- all of which is much easier to do with an up-and-running technology solution. The team has worked across hundreds of surgeon Care Teams and they have the process down pat.


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POSTED August 9, 2019

How Force minimizes the burden of implementing technology

At Force, we get out of bed everyday to fulfill our mission to deliver and support a digital health platform that connects patients and providers throughout episodic care plans. 

As we’ve built out our execution-based teams at Force over the past 5+ years, we’ve been hyper focused and iterative on the most seamless and efficient ways to implement healthcare technology. 

We learned early on that when it comes to orthopedic patient care, the services and support that sit alongside a digital health tool are critical to initial adoption and future success. 

We’ve worked with too many customers who have had a technology dropped on them with little to no support. We often find ourselves coming in to replace such tools once providers discover that technology alone cannot solve the challenges they’d like to tackle. Instead, a technology partner (with services) is required. Without giving away too much of our ‘secret sauce’ here’s how we do it:

While physician care plans are in the works, our Client Success and User Research Teams are busy engaging the physician’s support staff to understand their existing workflow in supporting the patient journey. 

With individual customer goals in mind (e.g. reducing episode costs and variation, improving patient experience and adherence), our team listens and maps out provider actions and touch points with patients from the time of initial consultation through post-op recovery or discharge to a home exercise program if non-surgical. 

The exercise is always beneficial for providers to understand how much they do in their efforts to support patients, and oftentimes generates productive dialogue for areas to improve once they take a step back and reflect upon their practice’s workflow. From the Force side, this also helps us understand the best way to configure the Force experience to make it unique to each physician’s practice. Along the way, we’re able to keep an ear to the ground on pain points within the practice and brainstorm where Force can help. 

While technology in healthcare is still not always embraced with open arms, by taking the time to understand the workflows of each individual practice, we can configure and mold the technology to act as a win/win. Our ultimate goal is to implement the technology to complement their practice workflow and save providers time. In some cases, this might mean replacing the 50+ voicemails that accumulate during a busy day in the clinic with Force HIPAA-compliant messaging. In other cases, it might be configuring the proactive outreach in Force Navigation to replace what nurses track today in spreadsheets, Outlook calendars, and post-it notes. At the end of the day, every physician, their practice, and their programs are unique; cookie-cutter technology solutions simply do not work.


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POSTED August 9, 2019

Ensuring patient success with Force patient support

Once the physician and their Care Team have worked alongside us to configure the platform to their specifications, we’re ready to have the first patients enrolled! We often hear from providers and executives alike that ‘our patients are not tech savvy and they won’t use a program like this.’ Our response is simple: ‘Patients will use technology if they have support.' The average age of patients on Force is 66 years. The majority of them have a smartphone, tablet, or laptop allowing them to access the platform. But we learned early on that just because patients have a device, it doesn’t necessarily mean they are proficient users of technology.

Enter Force’s Patient Success Team. While we have designed and built a patient-facing product in the most user-friendly, physician-prescribed fashion possible, there is a population of patients who still need a hand. Our product helps us identify those patients so we can provide additional support for the patient themselves, or, in many cases, to the patient’s care partner/coach who may be using the technology on behalf of the patient. 

For surgical patients, we over-invest in identifying the patients that need extra help before surgery so we can get them logged in to access their care plan, review important pre-operative instructions, and complete necessary preoperative baseline outcome forms. Most importantly, when it’s time to come back to Force post-operatively, they remember what to do. 

Typical patient portals have a ~30% usage rate. At Force, we didn’t build a technology that would only touch 30% of the addressable population. We strive for an 85%+ patient log in rate across our entire client base and are consistently taking patient feedback into action to create the best possible user experience.

Our best days are when we hear from patients and providers about what they love and similarly, what could be better about Force. Knowing that the work we do every day is helping to improve the quality of life of patients to get them back to the things they love to do is our fuel. With providers, we’re energized by helping to make them more efficient in their day to day to free them up to care for the patients that need them the most.


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POSTED August 1, 2019

How to Use Data for Evidence-Based Improvement

In today’s era of value-based care, patient outcomes can serve as strong metrics of provider success. As a result, organizations are managing new mandates to collect patient-reported outcomes (PROs) at increased rates. Improved data collection can give providers greater insight into clinical practice and how patients are progressing throughout their episodes of care. 

The medical field has long been a champion of advancing evidence-based practice. However, with an influx in data collection, healthcare organizations must ask themselves, “how is our organization using data to drive change?”

This question is difficult to answer and often involves a dedicated research or quality improvement team to tackle. In the first part of this series, we’ll focus on strategies for data collection. Force supports organizations in various research capacities to ensure patient data is collected appropriately to make informed decisions related to patient care and risk mitigation. To assess if your organization’s data is actionable, we recommend considering the following:

Is your data easily accessible?

Electronic data can often be difficult to isolate and download, making it challenging for providers to locate the variables they need. Conversely, outcomes collected via pen and paper cannot be easily aggregated and evaluated across the patient population overall. Today, data comes from disparate locations, including digital and paper-based, making it almost impossible to aggregate into meaningful trends. The ability to compile datasets electronically into a singular source is essential to acting on research or quality improvement goals.

Is your dataset(s) flexible enough to view trends over time?

Digitization allows for data to be collected more frequently. For example, as patients log onto Force every day, they are asked to rate their current pain from 1-10. This data can be sequenced over time and presented back to care teams, providing valuable insights into how different patient cohorts are recovering over time. But it’s not as simple as choosing a platform with the singular purpose of collecting PROs. Patient engagement platforms create new opportunities to extend provider reach and allow patients to access questionnaires in the same place they access their personalized recover tools. Force helps organizations achieve >75% collection rates, while maintaining or improving the all-important patient experience.

Can you view data in real time? 

Platforms like Force enable users to view critical data in real time, allowing providers to attend to patient concerns before they escalate into complications. A patient-facing platform is meaningless unless it enables informed decision-making for providers without disrupting workflow. For example, a provider may want to know how a patient is responding to a certain pain medication in order to evaluate whether a new treatment plan should be considered. With access to the full suite of a patient’s health history, PRO responses, and other data (e.g. steps, pain, photos, videos, messaging etc.), benchmarked across similar patients in Force, action can be taken within minutes to determine whether follow-up steps are necessary. 

How can I use my data to drive change?

As the healthcare market moves toward reimbursement for the complete episode of care, it is important that providers use data to better understand the patient journey. When organizations select partners that allow them to critically examine trends in their data, they may start to work toward standardization of best practices leading to cost savings, strong PROs, and high levels of patient satisfaction. In the next part of this series, we’ll discuss our work with academic medical centers that are expert at developing processes to drive change.


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POSTED July 17, 2019

Smart Tasks: seamless, proactive patient outreach

Smart Tasks enables proactive care management at every critical point in an episode of care. Click here to read more about how our latest feature works.

At Force, we take pride in the technology we build for our clients. Our Product Team is expert at collaborative discovery of the most complicated challenges in healthcare. After all, solutions are only as great as your understanding of the challenge you’re facing.

Why Navigation

As organizations start taking on more risk as part of a shift to value-based care, we have seen several strategic themes emerge, centered around controlling cost, patient experience in the home, and outcomes. Success with these themes require justifying services and increasing efficiencies. Patients are spending more time than ever outside the well-controlled walls of the hospital, but there is not efficient infrastructure for controlling the home, where patients spend 90% of their episode of care. Maximizing the reimbursement also requires collecting and demonstrating quality patient-reported outcomes.

The most effective way to operationalize these goals is to:

  • reduce variation across the system
  • create value by strategically allocating services / resources
  • prevent leakage outside of the system

The Challenge

Understanding the importance of navigators in our evolving landscape was the first step. After years of working with some of the most distinguished medical centers, we understood that it’s crucial for providers to implement a comprehensive care continuum. However, we knew very little about the role navigators play in creating that care continuum on a day-to-day basis. So, we conducted discovery interviews and onsite shadowing, with the people who understand this problem best -- nurses and navigators -- to help us answer two questions:

  1. 1. What are indicators of true “patient navigation” (either as a dedicated navigator or shared responsibilities amongst care team members)?
  2. 2. What are the most common challenges regarding navigation?

It quickly became clear that navigation still largely relied on stacks of paper, folders, post-it notes and spreadsheets. After synthesizing our findings, we found that navigation can be defined as:

  • identifying and optimizing high-risk patients
  • conducting proactive outreach and relationship building
  • managing peri-op expectations and discharge planning

The Solution

Almost everyone we spoke with was tasked with overseeing thousands of patients, with extremely limited resources. Their challenges and frustrations became apparent, most consistently regarding the care team’s ability to: 

  • standardize touchpoints
  • set reminders to follow-up
  • plan for discharge
  • build lasting relationships with patients

Having identified these key pain points in the existing navigator experience, our next step was to brainstorm potential solutions that would comprise the bulk of the Smart Task feature. Some issues arose more often than others, helping guide our team according to the navigators’ core needs. 

For example, navigators consistently identified standardizing patient touch points as a central part of their workflow, but it was not always clear who they needed to contact, or when and how to contact them. To complicate matters even further, high-risk patients typically require additional check-ins or follow-ups that differ from the standard pathway. 

Spreadsheets, post-its, highlighters, and paper checklists aren’t the answer, which is why we set out to design a streamlined, intuitive tool to help navigators manage patients across the episode.

The Design

Our next step was to begin translating these feature proposals into digital designs that strategically balanced ease of use and visual appeal. Before launching Smart Tasks, we conducted several rounds of user testing to ensure our solution and design actually met the core needs of the end-users. 

For these tests, we recruited a handful of navigators who graciously volunteered their time to try out our prototypes. As each navigator interacted with the prototype, we took note of where the designs succeeded, where the tester struggled, and what noteworthy patterns emerged. By the end of each round of testing, we were able to identify and prioritize the design tweaks that needed to be made before putting in the hands of our users, to ensure that our final product would set navigators up for success. 

The Future

The introduction of Smart Tasks is only the beginning. As we learn from the experience with each patient and provider we serve, our team becomes increasingly aware of workflow challenges and causes of outcome variation. Although we can’t give too much away, our next series of iterations will be incorporating data from over 100,000 patients to further augment navigator tasks with predictive analytics, so you as a provider will know exactly where your efforts will yield the greatest impact on patient care.

Click here to learn more about how Smart Tasks works.


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POSTED May 7, 2019

PRESS RELEASE: University Hospitals embraces new technology to extend physical therapy reach

“This video platform and series allow our orthopedic department to extend far beyond traditional geographical borders. We are enhancing patient engagement and communication with care providers with this telehealth tool throughout the episode of care for total joint replacement.” 

-- Matthew Kraay, MD, Director, Joint Reconstruction and Arthritis Surgery, UH Cleveland Medical Center


University Hospitals announced that they are expanding Force across their 18 hospital system. This decision is the result of a successful pilot with seven surgeons and 200 patients in which 90% of the patients who were offered the platform logged in and readmissions were reduced by 28%. Read the full press release below. 

PRESS RELEASE: University Hospitals embraces new technology to extend physical therapy reach

Surgery patients can rehab from home with instructional videos

CLEVELAND – University Hospitals Cleveland Medical Center recently announced a new collaboration with Force Therapeutics to aid in the rehabilitation for orthopedic surgery patients. 

Though there can be challenges in managing care for patients who come from greater distances, particularly those who require post-operative physical therapy, UH is empowering patients with information and communication wherever they are. 

The New York-based company is a surgeon-prescribed video platform that guides patients throughout their rehabilitation through video, episode-based education and rehab, automated navigation, and digital communication.

As patients engage in their prescribed care plan, physicians are able to collect patient-reported outcomes and discrete data and analytics throughout the entire process. This platform not only scales navigation teams, but allows clinicians to more closely monitor patient progress throughout their recovery.

University Hospitals conducted a successful three month pilot of the program and is now expanding the use of this program across the 18 hospital system. The initial pilot program included seven surgeons with 200 patients who had an average age of 64.

Almost 90 percent of the patients who were offered the program logged in and completed the entire video set of physical therapy tutorials with positive outcome. Most importantly, a 28 percent reduction in readmission rates was experienced as a result of the virtual therapy sessions.

“This video platform and series allows our orthopedic department to extend far beyond traditional geographical borders,” said Matthew Kraay, MD, Director, Joint Reconstruction and Arthritis Surgery - UH Cleveland Medical Center. “We are enhancing patient engagement and communication with care providers with this telehealth tool throughout the episode of care for total joint replacement. 

The technological solution solves a multitude of problems for orthopedic surgery patients including reductions of complications and readmission rates, and serves as improved options and value for patients. 

The agreements UH recently formalized with Walmart and General Electric to provide their employees with orthopedic care is especially important for patients who would seek treatment with the hospital as the telehealth option would bridge distance and ease the rehabilitation process.

Force Therapeutics presently provides video rehab instruction for over 50,000 patients in 50 hospitals across the country with 155 surgeons participating in the programs.


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POSTED December 19, 2018

Integrating the clinical voice in health technology

Caroline is a member of the Force Clinical Integration Team

Healthcare is a complex service industry made up of a variety of stakeholders, each with varying goals and incentives. Service industries produce value through things that are primarily intangible such as customer service,, advice, knowledge, design, data and experiences. Clinicians play a unique role.  Ultimately clinicians are responsible for delivering care and therefore serve as intermediaries between the business and the patient experience of healthcare.

 

Given this unique position, clinicians have skills that are vital to excellent care delivery which can be challenging to quantify and automate through technology. As utilization of healthcare technology continues to grow, product development must recognize and be guided by expert, innovative clinical voices.

 Successful clinicials are skilled in both emotional intelligence and clinical reasoning. Clinical reasoning is a standardized process comprised of:

  • describing the situation
  • collecting information
  • interpreting information
  • diagnosing the problem(s)
  • establishing goal(s)
  • taking action(s)
  • evaluating outcomes
  • reflecting on learning(s)

A clinician may spend 5 minutes or 3 hours moving through the clinical reasoning cycle, however, each part of the process is essential to delivering high quality, effective healthcare. The graphic below provides a closer look at what happens in each phase of the clinical reasoning cycle.

Timeline of touch points across a traditional episode of care.

With increasing demands being placed on healthcare providers to provide more efficient and effective care, technology has emerged as an essential component in any value-based strategy. Despite its obvious benefits, technology in healthcare cannot fully replace the human side of care delivery. Accurately recognizing, understanding and managing patients’ emotions is extremely difficult to build into technology (artificial intelligence and machine learning are working on this challenge). Additionally, two phases of clinical reasoning stand out as particularly challenging to automate - 1) the interpretation phase, in which providers use their medical expertise and past patient care experience to process information and arrive at a diagnosis, and 2) the contemplation phase, in which providers reflect on outcomes and internalize new learnings. Because of the complex, human-centered nature of clinical care, it’s therefore essential that healthcare technology companies invest in and utilize clinical expertise to guide their partnerships and growth.

 

At Force, we believe that evidence-based, excellent clinical care has always been and will continue to be at the heart of valuable healthcare. It’s our job (and the job of technology in healthcare as a whole) to elevate and empower clinical reasoning, decision-making, and evidence-based care delivery. Force incorporates multiple strategies to ensure that clinical expertise drives our product development and client relationships. The Clinical Integration & Research team is comprised of clinical and non-clinical members uniquely positioned to guide internal and external conversations around clinical best practice, research design and implementation, and product development for success across a variety of stakeholders. Force consistently over-invests in client relationships, particularly with clinical end-users, because we know that clinicians are the true drivers of healthcare quality and value.

 

The unique nature of the healthcare industry and the service it provides necessitates that technology recognize and elevate clinical care providers. To date, technology cannot replace the emotional intelligence, empathy, or expert reasoning capabilities of skilled clinicians. The real value of technology in healthcare is therefore found in learning from and with clinicians, and empowering them to provide more efficient and effective care. As an industry leader, Force is proud to be clinical at its core and dedicated to upholding the highest standards of care delivery in every partnership.


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POSTED October 24, 2018

A culture of constant iteration and improvement creates better care

The delivery of healthcare is ever-changing -- but this moment, defined by increased patient volumes and unmanageable cost, is demanding a particularly acute shift from providers. Influenced by many different parties, including patients and payers, providers are constantly under pressure to do more, with less, while delivering stellar outcomes.

Industry leaders are staying ahead of the curve by integrating the latest technology into their everyday workflow. The impact of these tools are crucial to success in a healthcare landscape defined by value -- they also take a range of adaptation and learning from key stakeholders. 

We at Force are excited to be a part of this shift, in which these stakeholders are rediscovering what it takes to deliver incredible care. It’s core-value at our company to be constantly learning, and each and every member of our team contributes to supporting our clients in tackling new challenges and opportunities in orthopedics. 

I’m a part of the Clinical Integration (CI) team, which is made up of clinicians and researchers who are dedicated to creating a data-driven vision and strategic implementation plan. At the moment, we are heavily prioritizing and invested in digitizing patient-reported outcomes (PROs) collection. Our goal is to find new and creative ways to make PROs collection process more engaging and efficient, not only driving higher collection rates, but also providing more accurate and actionable data.

One of our latest project is improving the personalization of online outcomes forms. We collaborated with the engineering team to apply conditions and branching (also known as skip-logic), allowing patients to see relevant sets of questions based on their previous responses. Also, we are in the process of implementing PROMIS CAT (Computer Adaptive Test) which uses item response theory to optimize and sharpen the outcome measure. These efforts help further improve data integrity while optimizing patients’ experience by reducing their reporting burden and fatigue. With this feature we’ll be support our clients in collecting more data for evidence-base improvement and research. 

This is just one of many initiatives that are currently underway to continue the growth of our platform and client care-delivery. Force’s value of “life-long” learning springs from a commitment to constant iteration, improvement, and knowledge collection. We will continue to learn and discover digital solutions that can help providers standardize evidence-based best practices.


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POSTED August 7, 2018

Buyer's Guide: How to Evaluate Episode of Care Technology

With value on the rise, healthcare is reaching a tipping point. Patients and paying stakeholders are demanding more for less, putting pressure on providers to cut costs. Outpatient procedures and shortened time in the hospital require greater control of the home. And initiatives for strategic improvement are not possible without useful cost and quality metrics.

 

Technology is the answer. Leading organizations understand the opportunity digital solutions have to offer and are acting quickly to future-proof their service lines and stay ahead of curve.

 

But with tremendous opportunity comes a scrambled vortex of products and platforms, all with seemingly the same message. Until the market thins out, and the best solutions become clear, below are evaluation tactics and questions to guide you in finding the right technology to support your organization.

 

Is it comprehensive? 

Is your organization using five different platforms or portals to solve one challenge? You’re not alone. Instead, find one that creates a complete care continuum by asking-

  • Which organizations have used the platform to augment or replace traditional post-acute rehab services?
  • Are average PROs collection rates greater than 80%? If so, does this include one-, three-, and five-year outcomes?
  • Which product features will help virtually navigate patients? Is there evidence showing positive impacts on care team efficiency?
  • Are there additional fees associated with any features or services?

The whole is greater than the sum of the parts -- by finding one solution that meets these requirements, you’ve probably found a solution better than any combination of point solutions.

 

Is it validated?

Too often, we’re drawn to the ‘latest and greatest’ technology (bells and whistles included). With patients at risk, it’s important to look past the virtual reality goggles and motion tracking hardware and simply ask-

  • Who uses this? [i.e. tell me about five of your clients]
  • Which clients have had 1000+ patients use the technology?
  • Have any clients expanded use of the technology based on results? If so, which ones, and what was the scope of expansion?
  • Do research studies exist that show efficacy of this product?

Essentially, you do not want to be the lone runner ahead of the pack. Be risk-averse by letting your peers do the talking. You get what you pay for, so be wary of free trials or strategic partnerships.

 

Will this technology fit the specific needs of my organization?

Don’t spend tons of time and money changing your existing infrastructure to fit your purchase. Your organization is unique, which your bolt-on solutions should reflect. Adding or subtracting responsibility or workflow disrupts what you’ve already worked hard to build. Optimize and streamline what you have by asking-

  • How are Care Team workflows and pathways configured, and what is the post-go-live support model?
  • How is patient onboarding and ongoing support handled?
  • Will I be forced to integrate it with my EMR? Do I have the option to integrate?
  • Are reports catered for my use cases (registries, business analytics, etc.)?
  • What is required on my end from a technical standpoint?

 

Evidence-based change is only possible when you’ve reached a certain level of efficiency. Without customizable tech and ongoing customer support, it’s nearly impossible to move past the inevitable growing pains.

 

Is it substantive?
“Digital health” is a buzzword, and until we’re comfortable enough asking the hard questions, it will remain so. At the end of the day, your purchasing decisions reflect your business, so be curious to no end, and passionate about what matters most to your organization. Check every box, then check them again. The clinical and financial outcomes are worth the investment.


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