One of the most exasperating aspects of healthcare in the United States is the gap between the level of spending and the resulting outcomes. The U.S. spends more than any other advanced economy in the world on healthcare, yet we have the worst outcomes among large-economy countries: shorter lifespans, higher rates of infant and maternal deaths, the most obesity, and highest rates of people with multiple chronic conditions.

Those aren’t the only problems with healthcare in the U.S., though. Medical errors lead to more than 250,000 deaths a year, and there are huge disparities in the quality of care by ethnicity and socio-economic status. Not to mention, the U.S. is the only high-income country that does not guarantee healthcare for all citizens—a significant factor in our country having one of the lowest rates of physician visits.

As medical science continues to advance, healthcare delivery has become increasingly complex. Add in the aging Baby Boomer generation and shortages of nurses and physicians, and you have significant strains on the system that hamper the delivery of quality care.

In physician offices, ERs, hospital rooms, and long-term care facilities, the system struggles to ensure that the right information reaches the right caregivers at the right time so they can make timely, well-informed decisions. In short: healthcare is plagued by suboptimal workflows.

“Healthcare is plagued by suboptimal workflows.”

Optimizing workflows, therefore, can make a major contribution to solving the two biggest problems in U.S. healthcare by improving patient outcomes and reducing costs.

Norwest Approaches the Challenges Holistically

The problem of poor workflows is a key consideration across all our investments in healthcare, and we approach it holistically:

• Diagnostics – identifying problem areas and how new diagnostic information impacts workflows and helps deliver better care.
• Medical products – moving care to lower-cost settings to prevent or delay more expensive or invasive procedures.
• Health technology – improving patient compliance, increasing access to care, easing administrative burdens on nurses and physicians, and ensuring access to necessary information at the right time.
• Value-based care – providing more holistic, cost-effective, timely care focused on complex, poorly served disease areas or specific patient populations with inequitable access to care.

There are Promising Signs of Improvement

Fortunately, hundreds of startups and early-stage companies are developing innovative solutions that produce multiple benefits. First and foremost are better patient outcomes. Additionally, this widespread innovation is leading the way to lower costs, shorter (or no) hospital stays, greater patient involvement, and more efficient use of caregivers’ time and skills.

“Fortunately, hundreds of startups and early-stage companies are developing innovative solutions.”

Let’s look at three companies tackling the problem of poor healthcare workflows from different perspectives.

Vertos – Minimally invasive treatment for lumbar spinal stenosis

The problem: As people age, many develop lumbar spinal stenosis, a narrowing of the spinal canal in the lower back from degenerative changes in the spine, leading to inflammation or compression of the nerves. This can cause pain or weakness in the legs, limiting mobility. For patients that fail conservative medical therapy, the traditional treatment has been open surgery on the lower back, which is expensive, highly invasive, and subject to complications – all while being relatively ineffective: only about a third of patients actually get better.

The solution: Vertos Medical’s “mild®” procedure is a minimally invasive treatment for lumbar spinal stenosis in which an incision about the size of a baby aspirin is made in the lower back and some of the tissue pressing on the spine is removed without leaving an implant in the spine. The procedure typically takes less than an hour and does not require general anesthesia, implants, stitches, steroids, or opioids.

The impact: A far higher percentage of patients receive lasting relief, while hospitalization costs are drastically reduced.

Monogram Health – More effective treatment of end-stage kidney disease

The problem: For the more than 37 million American adults living with chronic kidney disease, access to specialized care is vitally important. In many cases, however, patients face dismal health outcomes and poor quality of life. This is due to barriers in accessing care and a deeply entrenched, volume-focused system with poor adherence to evidence-based care. Compounding matters is an insensitivity to how socioeconomic conditions can affect health.

The solution: Monogram Health is an at-home care service focused on the diagnosis, treatment, and care of persons with polychronic conditions, including chronic kidney and end-stage renal disease. Monogram’s multifaceted approach includes nephrologists, geriatricians, endocrinologists, internal medicine specialists, nurse practitioners, registered nurses, social workers, and pharmacists. This ecosystem works with patients and their doctors to create an in-home care plan tailored to individual needs.

The impact: Tripled rates of home dialysis; reduced hospital readmission rates that are half the national average; and sharply lower costs through the emphasis on personalized, in-home care.

iRhythm – Capturing elusive data on atrial fibrillation

The problem: Atrial fibrillation (AFib) is an irregular heartbeat (arrhythmia) that can lead to blood clots, stroke, heart failure, and other heart-related complications. At least 2.7 million Americans live with AFib. One of the most vexing aspects of AFib is that the irregular heartbeats occur periodically and often at short, random intervals, making it very difficult to accurately diagnose. For many years, the preferred method of recording arrhythmia has been a Holter monitor, a bulky device that must be worn for up to 48 hours in hopes of catching episodes of AFib. But oftentimes the arrhythmia episodes don’t occur within the 48 hours when the patient is being monitored. In addition, due to the cumbersomeness of Holter monitors, patient compliance is even more irregular than their heartbeats, leaving huge gaps in the diagnostic information available to doctors.

The solution: iRhythm Technologies’ Zio service replaces Holter monitors with a small, band-aid-sized device that patients can wear on their chest all day with no disruption in their normal routine, for up to 14 days. At the end of the recording period, the patient mails the monitor back to iRhythm, which analyzes the data and provides a physician with a detailed, actionable report on the patient.

The impact: Physicians receive more detailed information, leading to a sharply increased rate of accurate diagnoses. Earlier diagnoses reduce the incidence of strokes and other life-threatening events, thereby saving lives and lowering treatment costs. Patients are spared inconvenience, raising compliance levels. Lastly, the Zio system is much more cost-effective compared to Holter monitors.

Innovations Produce Multiple Positive Outcomes

Solutions to the twin problems of high costs and suboptimal outcomes have a common element: improved workflows. Doing a better job of getting the right information to the right caregivers at the right time can go a long way to improving our healthcare system through one or more of the following results:

• Increasing the accuracy of diagnoses
• Shortening the time needed to begin appropriate treatment
• Reducing or eliminating unnecessary tests
• Treating patients for shorter periods and in less-expensive settings
• Reducing the incidence of complications and avoiding additional treatment
• Improving patients’ quality of life