Tech Startup Ties Fortunes to Obamacare

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    With all the heat that the Affordable Care Act (ACA)—otherwise known as “Obamacare”—has been taking lately, you might think that a technology company whose flagship product was spawned by Obamacare might be having second thoughts about hitching itself to that particular wagon. But a few minutes with Zach Silverzweig would likely rid you of any such notion.

    Silverzweig is a co-founder of CipherHealth, a New York-based provider of patient-engagement systems to hospitals. CipherHealth’s first product, launched in 2011 and known simply as “Voice,” is a platform used to call patients after they’ve been discharged from a hospital to determine if they’re having any problems, so those problems can be resolved before the patient has to be readmitted. Since the ACA penalizes hospitals whose readmission rates rise above a certain level, hospitals have been incentivized to reduce those rates. And CipherHealth figured that helping hospitals accomplish that would lay the foundation for a viable business model.

    Since the emergence of Voice, CipherHealth has launched four additional products: Orchid, a recording tool for nurses to use when they make their rounds; Echo, a tool that aids the process of providing patient discharge instructions; Link, a remote patient monitoring system; and View, a patient care plan management tool.

    I spoke with Silverzweig  earlier this week, and I centered the discussion around Voice, since that was the ACA-inspired vehicle that kick-started CipherHealth. He explained that with Voice, post-discharge calls are made to triage patients after they return home, so that high-risk patients can be identified and  routed to a caregiver in a hospital system who can intervene before a readmission is required. He said there are two key elements:

    The first is around using a very direct avenue of patient communication. We are able to reach 70 percent of patients after they go home from the hospital with our voice calling platform. That number is huge. Surveys show that in the best cases, that percentage has traditionally been in the teens, maybe 20 percent. With the outreach model we have, and perfecting it over the last three or four years, we’re really able to get in touch with a high volume of patients, and ask them very simple questions that have a high predictive value in terms of identifying those who are at risk for readmission. So when we do that, in concert with a hospital intervening with those patients who are having trouble, there’s a very direct result. We’re able to solve those patients’ problems before they come back to the hospital for readmission.

    The second element, Silverzweig explained, has to do with the integrated nature of CipherHealth’s product suite:

    This comes more into play with the larger hospital systems that we work with—the hospital clients we have that use multiple parts of our solution. Everything is really built on a single platform. For each of our five products, any concerns that are identified by any of those products all go to the same space for being resolved. That allows you to create an integrated model for managing care in a complex system.

    Silverzweig went on to elaborate on the Obamacare connection:

    It’s really a direct line. The very first project we were working on was analytics to identify patients who were at risk for readmission. We had read through the Act, and saw the penalties that were going to come through from CMS [Centers for Medicare and Medicaid Services] related to the readmission of CHF [Congestive Heart Failure]  patients. At the outset of the Affordable Care Act, it was something like one in four CHF patients who were readmitted. The Affordable Care Act had these very specific penalties related to these readmissions, and we directly targeted that in our value proposition. Clients are seeing 15 percent to 30 percent reduction in readmissions, bringing them below the national average so they don’t get penalized.

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    I asked Silverzweig how CipherHealth might be affected if there are changes to Obamacare brought about by a Supreme Court ruling or by revisions championed by a Republican-controlled Congress. He said the parts of the ACA that are core to CipherHealth’s business are safe:

    We were really nervous about that, when the Supreme Court was first ruling on major aspects of the bill. As far as we can tell, we’re not that concerned about it because the entirety of the Affordable Care Act is not as contentious as certain parts of it. The insurance exchanges are extremely contentious, and there’s more uncertainly in that area, as well as in the Medicaid Expansion, vs. the areas where we work, which are really the quality incentive and preventative care programs that were put into place as part of the Act. These things have been very effective in terms of producing a reduced readmission rate and saving money overall.

    It’s worth noting, by the way, that CipherHealth was recently named the No.1 Best Place to Work in Healthcare by Modern Healthcare, so I asked Silverzweig what advice he might have for other small tech companies to help them become a best place to work. He said the most important thing is transparency:

    Having a great culture when you’re just starting with five or seven people, that’s easy—it takes a very particular kind of person to join a company that’s that small. You’re working with folks who are incredibly committed, and who just have a different set of values and beliefs in what you’re doing—that’s the easy part. With the next 10, and the next 10, and the next 10, it gets harder and harder and harder. So what we’ve tried to do is create an extremely transparent culture. We do things like sending out a quick survey to rate us from one to 10 on a particular aspect of the company. We’ve come up with core value statements to identify what it is that drives success in our company, and really live up to those. So the first step is to create that transparent framework, and collecting that information from your team; and the second is making sure you act on it.

    Another key component, Silverzweig said, is diversity:

    Diversity in the workplace is huge, in terms of creating a very balanced, very smart company. We deal in a unique world, because we’re in the world of nursing—our primary audience is the nursing leadership, and as a result, we deal with female executives a lot more than most folks do. It’s been relatively easy to maintain a diverse work force, but thinking about that balance, and making a concerted effort, especially in IT, to find folks from various backgrounds who are open-minded to joining a company like this, and starting that process really early, is really important. If you start with a team of 10 male developers, it’s going to be really hard to start building a balanced group. If you start with a diverse group of 10, it’s already self-reinforcing, and helps you grow to that next level while maintaining a balanced structure.

    A contributing writer on IT management and career topics with IT Business Edge since 2009, Don Tennant began his technology journalism career in 1990 in Hong Kong, where he served as editor of the Hong Kong edition of Computerworld. After returning to the U.S. in 2000, he became Editor in Chief of the U.S. edition of Computerworld, and later assumed the editorial directorship of Computerworld and InfoWorld. Don was presented with the 2007 Timothy White Award for Editorial Integrity by American Business Media, and he is a recipient of the Jesse H. Neal National Business Journalism Award for editorial excellence in news coverage. Follow him on Twitter @dontennant.

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