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Startup Health: Care Coordination - It Takes a Village, and a Tech Platform

How three health tech entrepreneurs joined forces to create the next big thing and put the patient back at the center of their care.

“It’s not just about coordinating between the formal healthcare physicians and the formal providers. It’s also the family and a sprawling network of direct and indirect caregivers that play a critical role in mitigating the illness experience for complex patients,” Rob Attwell, COO of Careteam, says.

When physician Alexandra T. Greenhill, CEO and Chief Medical Officer of Canada-based Careteam, approached Jeremy Smith, a health tech executive that she worked with years prior, to talk about building a new type of healthcare collaboration platform, Smith’s response was something to the tune of “Great minds think alike.” He had led multiple large-scale technology and clinical change initiatives across the spectrum of health, so this was right up his alley.

“What they were creating was similar to something I’d been wanting to start,” Smith says. “So I looked at Alexandra and said, ‘Well, we could either do this in competition or we can do this together.”

Greenhill was keen on the prospect that Smith would join her and Rob Attwell, a seasoned entrepreneur and industry expert in the tech field, on a moonshot mission to systematically change how health care teams collaborate. Greenhill and Attwell previously worked together on another tech project and were interested in addressing the challenge of connecting patients, families, and health care providers as a modernized definition of an effective health care team — one that is distributed across many organizations and also includes the patient and their family. Today, 99% of care already happens outside of the hospital, yet there is no platform to manage the complexity of that.

Greenhill opted for collaboration.

“And I said, ‘Sold,’” Smith recounts.

Two years in, Greenhill is at the helm of this venture, known as Careteam, with Attwell serving as the Chief of Operations, and Smith as the Chief Commercial Officer. Headquartered in Canada and expanding into the U.S and United Kingdom, the three industry gurus are the core of what is quickly becoming a coalition of change agents dedicated to solving the fragmentation in health care.

“My mother battled cancer, got through it, but then broke her leg putting her back in the hospital. Watching that care journey convinced me that the challenge is not ‘Can you look up past EMR results from five years ago,’ but particularly for patients and their caregivers, ‘What’s next? What do I need to do tomorrow? Who is doing what?”

The Redefinition of the Modern Healthcare Team

In February 2016, eight months before the launch of Careteam, the international medical journal Health Expectations released results of a 62-person study in which individuals living in Canada with heart failure were asked to identify their care team members and their respective roles. The patients identified anywhere from 2–19 team members. Caregivers, nurses, family physicians and cardiologists were frequently identified, but teams also included what the researchers called “hidden carers” like dentists, foot care specialists, drivers and housekeepers. Most individuals also described participating in self‐management.

Here’s the irony: while collaboration and patient-centeredness are both recognized as essentials to personalized care, especially for complex conditions like heart failure or dementia, patients and their go-to network of caregivers are not always considered as members of the healthcare team.

“It’s not just about coordinating between the formal healthcare physicians and the formal providers. It’s also the family and a sprawling network of direct and indirect caregivers that play a critical role in mitigating the illness experience for complex patients,” Attwell says.

Whether it’s a grandson across state lines, a trusty neighbor, or a preferred driving service, the better providers understand each patient’s system of hidden carers, the more effectively they can engage their abilities and relationships towards maximizing patient health.

That’s one of the core pillars of Careteam. The company has designed an AI-enabled, patient-first ecosystem using a healthcare team collaboration platform that includes family members and third party app integrations. With their care collaboration platform, patients have the opportunity to be active agents in their care, and that includes identifying who else needs to be involved within their personal circle of support.

“It’s about the experience of care, not just about the outcome,” Greenhill says.

In a value-based healthcare marketplace that requires people to be savvy consumers and an active participant of their healthcare journey, knowing a patient’s care team and how that team functions is essential to a patient’s ability to understand how to engage in their own care plan.

“By creating this sort of home base for patients, and their families, we think that we can have a powerful impact on a triple bottom line,” Attwell says. He pauses, then adds, “Actually, we’re delivering benefits on a Quadruple Aim.”

The Quadruple Aim was created by the Institute for Healthcare Improvement (IHI) with four core dimensions: improving the health of populations, enhancing the experience of care for individuals, reducing the per capita cost of health care and increasing the satisfaction of healthcare providers. Health organizations across the world use this Quadruple Aim framework to assess the ROI of new innovations. So for Careteam’s model, their four dimensions of ROI include: Dimension 1: the platform enables clinicians to create a virtual “binder” of personalized care plans for patients with complex and chronic health issues; Dimension 2: the patient and their main caregivers then have the ability to share that “binder” with the patient’s circle of care; Dimension 3: health organizations can also monitor whether the care plans are being followed, and intervene if things get off track; and Dimension 4: the resulting better care outcomes and experiences impact the bottom line, lowering costs and use of resources.

“It’s something audacious, and it’s a big task, but the thing is, we have a vision as to how the experience can be different, and we know that in a world where there’s a lot of noise, we just haven’t seen anything like what we’re trying to do,” Attwell says.

Making Careteam Ubiquitous

Careteam is currently managing three hefty projects, all part of a first cohort focused on seniors and dementia. With funding from the Baycrest’s Center for Aging and Brain Health Innovation (CABHI) , they’ve been able to deploy the technology in two sites in Ontario. These include Mackenzie Health’s senior wellness and geriatric outreach teams, in addition to their biggest project, a group of 23 organizations under the regional geriatric program Champlain Dementia Network in the nation’s capital of Ottawa that have come together to improve care for dementia patients.

Complex, chronically ill patients require multidisciplinary teams to address their many health needs; dementia is an iconic example of this growing requirement. This means, Careteam is rolling out its technology in one of the most challenging areas of health care. The Careteam execs are not gluttons for punishment. Rather, this baptism-by-fire approach, in which a company matures their technology in a notoriously difficult field of medicine is a strategy often employed by successful startups.

Careteam’s pilot of their platform with thousands of dementia patients is an equally strategic move.

“Ultimately, we’d like to be something that is ubiquitous and available everywhere for patients and their teams. That’s why we’re starting with conditions like dementia where there’s a high risk of readmission, and where lack of adherence to a care plan becomes expensive,” Attwell says.

The team says they started in Canada because it’s in their backyard where they can leverage their networks, but they are now expanding to the US and United Kingdom. In the U.K., Careteam has been working with the National Health Service (NHS) through the National Institute of Health Research (NIHR) to develop implementation sites across the UK.

“There’s a lot of commonality between Canada, the US and the UK in terms of the need for this kind of platform,” Smith says. “At the moment In the UK we’re seeing a lot of innovation programs and funding to support new approaches, particularly in this area.”

To date, adoption of their platform in Canada has been “overwhelming.”

“Overwhelming in the best way,” Attwell notes. “We were a little bit surprised by the reaction in Canada. With single payer healthcare, adoption could have been tough. But the response has been, ‘Yes, we need that. Let’s talk.’”