February 02, 2016

Our 2016 Innovator Cohort: The Right Price, Place & Partners

At Innovations in Healthcare, we believe that the right answers to a lot of the most vexing problems in healthcare delivery are already out there. Our job is to identify and amplify healthcare innovation around the world.

This year the search for our newest cohort of innovators led to a review of over 180 organizations. In this search, we uncovered interesting trends in technology, investment, and strategies to address chronic disease. In selecting our 2016 Innovator Cohort, we found that these top organizations illustrate three broad ideas in healthcare:

The Right Price

First, we identified innovative organizations that are working hard to provide healthcare at the right price. Veteran innovator Narayana has been a pioneer in finding ways to make surgery more affordable in India. Now, a new venture in the Cayman Islands is successfully scaling these ideas in another part of the world. Health City Cayman Islands is working to provide more affordable surgical care to patients in the Caribbean, the US, Canada and Latin America through its medically advanced tertiary hospital.

Reversing the rising rates of chronic disease in countries around the world requires stronger partnerships between providers and patients and between public and private sector healthcare systems. AccuHealth is a tele-monitoring company in Chile that uses data to predict and prevent complications from chronic diseases, ultimately saving both patients and health systems money. AccuHealth provides patients with portable technology that enables patients to collect their own biometric data such as blood pressure, blood glucose, temperature, etc. The information is then sent to a telemonitoring center, analyzed by AccuHealth professionals, and relayed to patients' main health providers. Information is protected by a secure network database. So far the organization has monitored over 8,000 patients and reduced typical costs for complex patients by 60%.

In many parts of Latin America, health systems are struggling to find the right harmony between public and private services. Long waits in overburdened public systems can result in poor health outcomes. While people with higher incomes are able to turn to the private sector for needed services, few private services are affordable for lower-income populations.  
Clínica SiM
 is a retail clinic network that provides affordable and accessible healthcare to people in Northeast Brazil where some 58% of people live in poverty. The organization currently includes 6 clinics that offer about 17,000 medical services a month.

In India, where the public sector plays a much smaller role in healthcare than Latin America, disjointed care within the private sector leads many people away from coordinated primary care that could lower costs for both patients and systems. Furthermore, few physicians choose to become primary care providers causing shortages, particularly in underserved areas. These shortages often leave rural and low-income populations without reliable or affordable access to quality care and patients often seek out routine care at costlier hospitals. NationWide has built a structured primary care delivery network, using a combination of physical clinics and telehealth to improve the sustainability of primary care delivery. NationWide currently operates 30 clinics, and estimates that they benefit approximately 300,000 people. Through standardized training and testing requirements, clinical protocols for common conditions, and regular provider assessment, the organization is also helping to train and retain quality family care doctors. 

The Right Place

Too often health systems are built around hospitals instead of around people.  Many of the innovators in our network have found ways to bring services to populations where they live and work, making healthcare more accessible. Our 2016 cohort continues this theme.

In India, 78% of the population lives in rural areas, but only 2% of medical professionals are working in these areas. Rural Health Care Foundation operates a chain of 11 low-cost primary healthcare centers spanning four districts in underserved West Bengal. These clinics, which offer primary care, ophthalmology, dental and homeopathy services, are providing improved access to healthcare for people living in low-income, rural areas, where public healthcare delivery is sparse and private healthcare is often not located.

In Brazil, Projeto CIES uses a fleet of mobile medical centers -- built into vehicles such as wagons, vans, and containers – to provide moderately complex exams and procedures to communities in need. The organization started by building the “Health Wagon” in 2008 -- a mobile health center which was equipped to provide ten types of specialty care to 3,000 patients per month. Since then, Projeto CIES has expanded its fleet of mobile medical centers to 60 units in 10 regions of Brazil, which together serve over 2,000 people each day. They have provided care for over 500,000 people since their founding and have helped to dramatically reduce waiting times (in some cases, from 4 years to less than 30 days).

In Nigeria, where the healthcare delivery system is very fragmented, PurpleSource is working to elevate the quality of existing clinics in Lagos and link care across the healthcare system. PurpleSource takes over the management of conveniently located clinic networks in Lagos that are over 40 years old and in a state of decline and builds them back to functioning, profitable enterprises. By focusing on improving care in these clinics and finding ways to use technology to lower costs, standardize quality, and empower patients, PurpleSource has revitalized clinics providing care to more than 30,000 patients in Lagos. Ultimately the company hopes to offer its management and financial expertise to disparate clinic networks throughout Nigeria.

Finally, one organization working across four continents is showing how one of the most influential places to affect healthcare is your own home and community. Microclinic International uses the power of social relationships and networks to change individual and group behaviors for the better. Microclinic International uses a “train-the-trainer” model to lead community groups that meet to learn about healthy behaviors, manage and monitor their health, and engage in social activities. In most locations, such as the Middle East and the United States, Microclinic International’s programs focus on managing cardiovascular disease, obesity, and diabetes; in Kenya, they have expanded their focus to HIV/AIDS and are using social groups to improve medication adherence and patient retention in care.  The organization has established and evaluated over 1,500 groups worldwide.

The Right Partners

Partnerships are central to healthcare innovation and creative organizations are thinking through the best ways to form sustainable relationships that advance healthcare.

In Mexico, as in many countries in Latin America, public systems struggle to meet demand and public-private partnerships can help alleviate gaps. This is especially true for populations in Mexico where health facilities are disproportionately concentrated in large urban areas, resulting in a lack of access to comprehensive, affordable healthcare for people in rural and semi-urban areas. COFAS constructs hospitals in rural and semi-urban areas of Mexico and is able to make care affordable through the efficient use of technology, improved processes, and intelligent resource allocation. In 2014, COFAS hospitals provided care to over 77,000 patients. One COFAS hospital was accredited through Seguro Popular, a Mexican public insurance program serving low-income populations. By partnering with the governmental program, COFAS will be able to expand the reach of the hospital even further.

In Kenya, LiveWell Clinics is a primary healthcare company that uses a “hub-and-spoke” model to serve densely populated, low-income areas in Nairobi, Kenya. In this model a main clinic (hub) is supported by several satellite clinics (spokes) run by nurses.  By partnering with hub and spoke clinic owners this organization is able to provide back-office support services (claims processing, referral to hub clinics from the spokes, training, quality improvement, and supply chain) to clinics.

Partnerships between technology companies and clinics are showing a lot of promise in increasing quality and lowering costs in healthcare. access.mobile is a digital health company operating in Uganda, Kenya, Tanzania, Nigeria, and Ghana that digitizes patient records into a light patient management system and automates communication with patients via SMS, email, and smartphone notifications. Its primary product, marketed to hospital and clinic administrators, is called amHealth. Clinics pay an annual licensing fee for use of the software, which allows the organizations to streamline and automate patient care and communication between medical providers and patients. By pairing smart technology with existing clinics, access.mobile is able to increase efficiency and patient engagement, which leads to greater patient retention and ultimately increased revenue for clinics and hospitals. access.mobile recently adopted security standards that are aligned with global norms and HIPAA.

Finally, one of the most important partnerships is that between a provider and a patient. In the U.S., WiserCare has created a platform to help physicians and patients make customized treatment decisions through an online survey platform that uses an individual’s clinical information and survey responses to determine best-fit treatment options. The physician’s office sends a WiserCare survey invitation to a patient and the patient fills out the survey prior to his or her appointment, answering questions about their personal values and preferences. WiserCare uses the results of this survey, in conjunction with an individual’s key clinical measures to determine what treatment paths best fit the patient; it produces a personalized report for the patient, as well as a summary for the doctor.  Founded in 2011, Wisercare has decision-making modules for ten urological conditions, spinal disk herniation, birth control, lung cancer and birthing, and is in the process of adding modules in additional medical fields.

Meet the Innovators!

We are so thrilled to welcome all of these innovators into our network. Learn more about these organizations and all of their right ideas at Innovations in Healthcare at our upcoming Annual Forum in Washington, DC, April 4th and 5th.  For more information on this invitation-only event, contact me at Jennifer.cook@duke.edu