Joseph Kvedar, MD, VP of Connected Health, Partners HealthCare
It started 20 years ago with a vision to leverage technology to improve access to care and efficiency. But instead of the iPhones and FitBits that are driving care today, it was a camera the size of a shoebox that offered game-changing potential. Today, Partners HealthCare Connected Health continues to push the envelope by transforming healthcare through tools like remote monitoring and virtual care. In this interview, Joe Kvedar, MD, talks about how the organization has evolved to meet the changing needs of patients and providers, why telemedicine is finally rising to the top, and the problem with statistics around patient engagement. He also discusses what encourages him most as a physician, and how CIOs can navigate this brave new world.
Chapter 1
- Shared vision for Connected Health
- Value propositions: access & efficiency
- “That’s what got me excited.”
- Working with pharma & tech — “We haven’t had as much success collaborating with payers or other health systems.”
- Connected Health Fellows Program & Innovators Challenge
- Being “the glue” for innovators
- Focus on remote monitoring
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Bold Statements
My mentor at that time, John Glaser, saw the future in the same way that I did. He said, ‘I can’t imagine that this isn’t going to be important in care delivery.’ We were both off by at least a decade, as it turned out, but we had that same passion that connected health was going to be important for future care delivery.
We tend to be very patient-focused in our thoughts and in our approach. Connected health is a broad term. There’s a lot of connected health that is focused on improving doctors’ workflow, improving doctors’ efficiency, and improving doctors’ ability to get things done, but we’re much more focused on the patient side.
When I started we were the only act in town, so we didn’t really need to worry about who was in charge and how to coordinate; but nowadays, both AMCs have robust programs. There are lots of innovators doing good work. My job has changed in the sense that I’ve got to try to be glue in an environment where people naturally want to take their own destiny.
Connected Health has two value propositions. One is access and the other is efficiency, and how you view using this set of technologies in the world of shared risk versus a world of fee-for-service is an important differentiator.
Gamble: I think the best place to get started is by getting some background about Partners Connected Health — how and why it was formed and really what the primary goal is.
Kvedar: It’s been an interesting journey. It’s been a 20-plus-year journey now. If you can take yourself back to the earlier nineties, I am a dermatologist by training and I was at a time in my career then when I was looking for something new. My chair was giving me all kinds of projects, because he was a good mentor and wanted to help me find something that I was passionate about.
One of them was teledermatology, which at the time meant, could we use this new contraption called a digital camera to take images that were suitable and of diagnostic quality that you might be able to make a decision about a patient without the patient traveling. That was the concept.
We were looking at that, and to give some historical perspective, it was a less than one megapixel camera. It cost $12,000, and was about the size of a shoebox. The world has changed a lot in 20 years, but the insight which really led me on this career path was that you could open the opportunity for two kinds of value — access and efficiency — if you remove the constraints that you have to travel somewhere and meet in person to get healthcare done. That’s really what got me excited.
And so in 1995, with me dedicating about half of my time, and two half-time employees, we launched what originally was a subset of Mass General. Right at that time, Partners Healthcare was forming from the merger of Mass General and Brigham and Women’s, and we moved fairly quickly to Partners. My mentor at that time, John Glaser, who was our CIO, saw the future in the same way that I did. He said, ‘I can’t imagine that this isn’t going to be important in care delivery.’ We were both off by at least a decade, as it turned out, but we had that same passion that connected health — what we called telemedicine at the time — was going to be important for future care delivery.
That’s how we got started. We’ve maintained a strong focus on being an innovation group. We try to take projects anywhere from idea stage all the way to what I call, ‘ready for scale.’ We probably won’t be ever in the business of running something at scale, which would be tens or hundreds of thousands of participants in a given intervention. We’re taking things to the point where we might have hundreds and thousands in an intervention and be able to demonstrate how it could add value either, hopefully, by improving quality and, hopefully, by improving efficiency at the same time.
What makes this interesting to people in the marketplace, both internally to Partners and externally, is that breadth of expertise, from the early stages of iterative prototyping, focus groups, interviews, and ethnography, all the way up to the point where we have something in practices around the system. We’re learning what it means for doctors and patients to work with different types of intervention.
It’s all digital-backed, so the technology is in service of the mission, which is to change care delivery. Technology isn’t at the front. It’s always in service, though. Every project involves some use of technology, either some sort of sensor, package, wearables, mobile app, or a combination of those.
We tend to be very patient-focused in our thoughts and in our approach. Connected health is a broad term. There’s a lot of connected health that is focused on improving doctors’ workflow, improving doctors’ efficiency, and improving doctors’ ability to get things done, but we’re much more focused on the patient side.
The last comment I’ll make is that, as of two years ago, I have a different role here as well, which is overseeing all telehealth strategy system-wide. Our delivery system is a little bit like the federal and state governments in that we have we have two very powerful academic medical centers that do things independently of one another. They both have telehealth organizations; they don’t report into me, but my job is to move things forward where it makes sense for us as a system. In that capacity, I report directly to our Chief Clinical Officer. We have both that overarching strategy role.
Partners Connected Health really is an innovation team. We have around 56 people, which includes everything from psychologists, designers, software developers, clinical researchers, clinicians, nurses, and people who implement programs in the real world. It’s a quite broad-ranging skill set.
Gamble: Okay, so a lot to discuss there. As far as the work Connected Health does with hospitals, is that primarily done within Partners?
Kvedar: We have a wide reach into the industry, but most of the collaborations we have are with pharma and tech right now, companies like Daiichi Sankyo or Hitachi as examples. We’re collaborating with them and others in that same, those two verticals. We haven’t had as much success collaborating with payers or other health systems.
The other challenge with health systems is that if you look around the country at organizations who’ve either successfully done this or tried to do it, they’ve all formed separate entities. UPMC and the Advisory Board got together a few years ago and formed a joint venture, and Stanford spun out Evidation Health. We haven’t done that.
There is a natural tendency for hospital systems to not necessarily want to work directly with other hospital systems in this capacity, whether it’s competitive or because it wasn’t invented here. We haven’t really had those kinds of relationships with other hospitals. So yes, mainly it’s our internal system we work with. Just to remind you, we don’t just have the academic medical centers; we also a handful of community hospitals. We have a rehabilitation hospital network. We have home care. We have a large primary care contingent in the community. There are a lot of different potential internal customers there to work with.
Gamble: In working with those organizations, what are some of the things that Connected Health will do to help increase adoption?
Kvedar: There are multiple facets to that. There’s a strategic set of initiatives that we’ve recently undertaken to uncover and convene innovators around our system. One of them is called the Connected Health Fellows Program. It’s really just a way for people interested in digital health around our system to gather and talk. We have a few meetings a year where we teach a little bit about product development and design, and that seems to be going very well.
Then we have the Connected Health Innovator’s Challenge. It’s like similar programs you’ve heard about where we offer something in return for submission of ideas and proposals. In our case, we’re offering access to our design and software development capabilities. It’s a way, again, of bringing people together.
And that has changed over the years. When I started we were the only act in town, so we didn’t really need to worry about who was in charge and how to coordinate; but nowadays, both AMCs have robust programs. There are lots of innovators doing good work. My job has changed in the sense that I’ve got to try to be glue in an environment where people naturally want to take their own destiny, because in their minds they’re innovators. That’s an example of those two programs.
The other thing we do is we work fairly closely with our Population Health Management Team. We consider them an internal customer, and we help them with next generation pop health management solutions that involve connected health. For example, right now we’re spending a lot of energy ramping up home blood pressure monitoring for that subset of patients that are either newly diagnosed or hard to control. That’s where we’re spending a lot of our time. We have options to do more with them and we’re discussing the road map; it would be things like medication adherence or possibly diabetes home monitoring. There are some other things in the pipeline that we’re talking about as well for that next phase, but right now it’s about blood pressure monitoring.
And that links back to the fact that we are an organization that has risk contracts with all of our local payers. We’re an ACO. Massachusetts has just implemented a Medicaid Risk Program, and we’re becoming part of that. So we’ll have risk contracts all the way around. Right now, we have about 600,000 lives, and we’ll have more than that. And because of that, it’s important I mention that Connected Health has two value propositions. One is access and the other is efficiency, and how you view using this set of technologies in the world of shared risk versus a world of fee-for-service is an important differentiator.
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