Pratik Patel, M.D., chief operating officer of San Diego-based care management platform vendor MDRevolution, offers a stark reminder of the true state of much of the data currently flooding healthcare providers' offices.

"Data aggregation has become a hot button issue, a wastebasket term, if you will," Patel said, "but the real-world situation in a lot of cases is that I give you all the data about you and next thing you know you could be 'at risk' for 50 different diseases. The healthcare system today doesn't look at an ecosystem of data, it looks at siloed aggregated data – and there is no way you can interpret it then. How can you? You have to look at an ecosystem, but at the same time, that ecosystem can't include 75 data points. It just can't do it."

Part of the trap Patel thinks the industry may be falling into is becoming enamored of "tech-only" approaches to decision support in an attempt to make sense of those many data points.

"Human nature wants to complicate things," he said. "There has to be a complicated algorithm and protocol and sophistication to solve the world's problems, and that's not always true."

MDRevolution is about to test the latest market to take advantage of its corporate philosophy—that regular evaluation of certain points of data and providing patients individualized ongoing encouragement, coaching, and motivation, will pay big system-wide dividends. The new point of opportunity for the company is the Medicare chronic care management payment system set to go into effect in January.

The Centers for Medicare and Medicaid Services will pay physicians approximately $42 per patient per month for their Medicare patients with two chronic conditions. One key stipulation of the regulation allowing the new payments is that each patient receiving such care gets at least 20 minutes of non-face-to-face care each month. Another is that the billing provider's practice need not provide all of that care directly. Toward that end, MDRevolution and Phoenix-based senior services reseller Elevate Seniors are offering the RevUp care coordination platform on a turnkey basis to physicians interested in the new care model.

"Chronic care management is not easy," Elevate CEO Walter Simmons M.D., said. "It's hand-to-hand combat. The approach to each patient has to be customized, it has to be focused. People have to understand you have their best interests at heart, because you're trying to mitigate and change behaviors, or give alternatives to what can be very expensive decisions. If a patient decides to go to the ER and use that expensive resource and potentially be admitted, there are a lot of dollars being spent."

Simmons and Patel are betting that provider organizations thinking of taking the step into CCM services will consider the MDRevolution platform, called RevUp, a sound investment if the approach saves them from having to spend money to hire staff and implement the technical infrastructure involved themselves. Patel said MDRevolution charges $7 to $10 per patient per month, depending on volume; Simmons said Elevate bills CMS under the contracting provider's NPI, leaving the provider "a good portion" of the payment.

The platform, compatible with any smartphone, syncs data from fitness devices, patients' medication regimens and nutritional diaries (photo nutrition diaries are encouraged), and employs metrics beyond barebones BMI measurements, such as visceral fat percentages and VO2 max. MDRevolution employs in-house nutritionists, fitness coaches, and nurses, and as its client base grows, leverages incoming patient data to refine its machine learning algorithms to help "customize" health advice sent out.

Patel says the 14-member MDRevolution clinical team can currently scale to 25,000 users, and as data continues to come in and the platform's machine learning capability gets more granular, that number is expected to grow. The machine learning, he says, will allow the team to quickly and efficiently identify those users that fall outside normal ranges, and then automate communication with a bank of messages designed to educate and provide a simple call to action to get them back on track.

"We have to develop the approach where it feels like we are talking to them one by one, but it's really one to many," he said.

More strategically, however, Patel says provider organizations that may wish to administer the platform themselves can do so after becoming certified in the RevUp approach, making it useful for ACOs, corporate wellness programs, or any model in which such preventive care is paramount. Corporate wellness program administrators, he said, are discovering that the usual incentives offered to patients for things such as getting wellness exams or biometric tests are coming up short in demonstrating returns.

"Every corporate wellness company we deal with, especially the self-insured, are moving toward paying you $100 for every lab you do, or $500 for this, or an iPad for that," he said. "The problem with that is none of that is tied to outcome. It's going to be critical to integrate with the payers and show that instead of expensive diagnostic tests, there are some tangible real positive clinical outcomes that can be gleaned from data aggregation and coaching and feedback. It always comes down to the dollar and whose pocket it's sitting in."

Both MDRevolution and Elevate are betting that as the responsibility for healthcare dollars shift ever more toward patients and their role in prevention, they'll demand something more than Patel's example of siloed aggregated data that paints anything but a clear picture. While patients who can benefit from chronic care management of one or more conditions may be the early economic sweet spot in driving costs down, eventually more accurate interpretations are going to become the norm for any patient, Simmons said.

"We need to be more customized, we need to know what your real risks are and what risks you really don’t have," he said. "Otherwise, you're going to get very tired of healthcare. We need to focus our time and attention on the screenings that make sense for you, and the diet and exercises that make sense for you, and we can't overburden you with disease states that you don't have. We have to give you good rationales, and most people are getting very smart. Most patients have a pretty reasonable level of intelligence, and they know what's important to them and what doesn't make sense."

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