In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Joseph Kvedar, MD.
This profile was published in the December, 2012 issue of HealthLeaders magazine.
"I can't call any doctor's office customer friendly, and these technologies give consumers and patients a way to directly connect and they tend to love it."
After nearly two decades of pioneering research into connected health as a reliable model for healthcare delivery, Joseph Kvedar, MD, has won fans and won over skeptics.
Kvedar is founder and director for the Center for Connected Health, part of Boston-based Partners HealthCare System. He started the Center in 1995 on the premise that healthcare doesn't always have to be delivered in a doctor's office or a hospital. His use of home monitoring, text messaging, and the now ubiquitous smartphone, shows improvements to patient health, provider efficiency, and a hospital's bottom line. His findings are just in time for the changing reimbursement reality, and for consumer demand of quicker access to personal medical data.
A self-described early adopter and gadget lover, Kvedar says he was always interested in how technology could make him more productive. In fact, he personally uses nearly a dozen tech tools everyday to monitor his own health, from wireless activity devices to medication reminders. "I'm a living laboratory for this stuff!"
Kvedar aimed his enthusiasm for technology at the healthcare industry nearly 20 years ago when he founded the Center for Connected Health. He says, his "aha" moment occurred when, as a dermatologist, he was involved in a research study that questioned whether a set of still, digital images could be a substitute for a dermatologic exam.
"The person who came in to be one of the blinded observers in the study sat down and did 30 cases in two hours. That was the turning point," he says.
Knowing there was no way to see that many patients in that short period of time led Kvedar to examine the traditional doctor-patient relationship.
"I hadn't really thought... you might be able to substitute images but you also might be able to be more efficient by asking the question whether the doctor and the patient always need to be in the same place at the same time. All these light bulbs went off, and I never looked back after that."
Kvedar's research predates the terms ACO and mHealth, but his findings solve contemporary problems, particularly in chronic disease management. For example, what began 10 years ago as a telemonitoring pilot program of congestive heart failure patients continues to show a 50% drop in the readmission rates.
Those results are particularly useful because Partners HealthCare is a Pioneer ACO. Kvedar says he is certain the health system will be able to show that not only can technology keep patients healthy and out of "brick-and-mortar" clinics, but also can help hospitals drive down costs to accommodate bundled payments, the PPACA, and payment caps. "You can't keep hiring people, that's 60% of our cost—labor. So, if you keep hiring people, you're not going to bend the cost curve. And, the technology is such that we can extend providers across larger numbers of patients."
Kvedar's use of technology and analysis of patient data has benefits beyond the balance sheet. His patient groups embrace things like uploading their blood glucose levels to an online program that is shared by doctors and nurses for diabetes management. Instead of feeling cheated that they didn't get any "facetime" with a doctor, the patients feel like they have a "hotline."
"Let's face it, we, in healthcare, have set up a system where we're hard to get to; we're hard to interact with; we're not really customer friendly. I can't call any doctor's office customer friendly, and these technologies give consumers and patients a way to directly connect and they tend to love it," he says.
One of the biggest cultural shifts has to come from doctors themselves. Kvedar says they have to let go of their traditional role of sole caretaker and hand over some control to patients.
"We believe, and we have evidence to support the notion, that as a profession we way under-appreciate what patients can do for themselves. We don't give them enough to do, we don't feel comfortable delegating to them; we're far more paternalistic than we need to be."
By and large, Kvedar says patients are ahead of providers in the tech curve and, once given a little bit of coaching, most are willing partners in managing their care. He points to success at one of the Center's programs where patients monitor their blood pressure from home.
"Their blood pressure data is fed into a website wirelessly so they can watch their trends, and their provider can watch their trends. We also give that particular group of patients algorithms so they can make changes to their own medications based on their blood pressure trends."
Kvedar's use of technology, all its data points, and nifty gadgets might seem to be the center of his research, but what really drives his work is patients: getting them healthier, faster. It just so happens that he also may have found a way to do it cheaper.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.