The Tech Tribune staff has compiled the very best tech startups in Dallas, Texas. In doing our research, we considered several factors including but not limited to:
Additionally, all companies must be independent (un-acquired), privately owned, at most 10 years old, and have received at least one round of funding in order to qualify.
While the importance of addressing social determinants of health (SDOH) is now a common theme in reputable conferences, learnings are growing richer and more intense. In June, The West Coast Payer and Provider Summit to Address Social Determinants of Health for Complex Populations was an industry gem hosted in Scottsdale, AZ. Here is a recap of what I felt were some of the biggest takeaways from the summit.
Throughout the summit weekend, many workshops were presented by thought-leaders in the space. David Shore’s workshop was a veritable delight of new twists on old themes to jog the mind and start a new race for transformative change within one’s sphere of control. Some key points included:
First, we had the Triple Aim, then quadruple and now… the quintuple aim:
As this Triple Aim Statement continues to expand, what do you envision to be the sixth?
Early stage entrants working on cloud platforms to connect care, patient created and social data are seeing encouraging early gains. Below are some notable platforms to keep an eye out for:
The Real-World Education Detection and Intervention (REDI) Platform:
ORCHWA Platform:
This was a “blow you away presentation” with some truly powerfully meaningful novel approaches driven by Jason Cunningham, MD, CMO of West County Health Centers. Below are suggested steps one can take to innovate the virtual world of healthcare:
While the consensus opinion and extensive research clearly indicate the magnitude and causal nature of SDOH’s influence on health outcomes, quality, and cost, most interventions depend on unique funding streams. This is because ROI hasn’t been proven to hit mainstream reimbursement. Examples include:
Return on investment is largely focused on health outcomes, but how can we measure the social outcomes of Social ROI?
Getting patients where they need to go, when they need to go is a top priority that has an impact on not only outcomes but patient experience in terms of ease and convenience. Just think about your own stress when your car is in the shop, stress can agitate any clinical state. Interesting approaches to speeding up patient transport include:
Patient engagement often is a “catch-all” bundled term. But new ways of disentangling the terms unlocks possibilities, such as:
“Housing first” advocates began changing the landscape and the dialogue on the all-too-common reality of homelessness. One size doesn’t fit all in this multidimensional problem. A notable example is the homeless and housing resource team created by ANTHEM Indiana Medicaid. If patients aren’t ready to be confined by walls, the program provides a cell phone and a mobile app to engage them with online tools.
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Over the last few years, it has been very clear from research that Social Determinants of Health (SDOH) variables have a major impact on health outcomes. It is estimated that close to 80% of health outcomes are impacted by SDOH. With the rise of population-based risk contracts in both the commercial and government sector, it is essential for both providers and payers to collaborate in the identification of best practices to address these SDOH variables. This is especially relevant as providers such as hospitals assume greater risk in arrangements with plans throughout the country such as Accountable Care Organizations (ACO) and bundled payments.
Many national associations such as the American Hospital Association (AHA) and America’s Essential Hospitals have developed resources and launched learning collaboratives for hospitals and health systems to address these variables such as food insecurity, housing, and transportation. Health system innovation and care-redesign models driven by organizations such as Healthbox and AVIA have launched collaboratives and forums to educate and address SDOH initiatives. The May 3, 2018, Healthbox forum discussion on “Challenging the Status Quo of Social Determinants” visually captured the opportunities and challenges ahead into one image (Figure 1):
These variables have always been a focus of many health systems in terms of articulating their benefit to the community, but now they have particular importance given the rise of more population risk contracts.
Several major barriers have impeded the industry’s progress in addressing SDOH variables: funding and regulations. Fortunately, we have begun to see opportunities in both areas emerge in 2018!
Medicare Advantage (MA) has a regulation titled “Uniformity Standard” that requires all of the plan’s benefits, including cost-sharing, be the same for all plan enrollees. On April 2, 2018, the Centers for Medicare & Medicaid Services (CMS) outlined several widespread changes in this regulation that both providers and plans have advocated for over the last several years in their 2019 Medicare Advantage Call Letter. CMS expanded the flexibility of lifting the uniformity of supplemental benefit to allow different segments of an MA plan to offer specific benefits to a targeted population like diabetics. This can begin in CY 2019 (January 1, 2019) after the plan designs are approved by CMS. An example could be reduced cost sharing for foot or eye exams. In their official bids that were submitted by the June 4, 2018 deadline, the MA plans can include any of these supplemental benefit elements. Hopefully, providers will see many of the plans deciding to include these additional benefits in their MA bids to address the SDOH variables.
Additionally, in the Bipartisan Budget Act (BBA) that was passed in early 2018, Congress has taken it further by extending the lifting of the uniformity of the supplemental benefits to all chronically ill members of the MA plans effective January 1, 2020. This reinforces the need for us to gain valuable lessons during 2019 in order to determine what works and what doesn’t before it is transitioned to a broader population.
The Chronic Care Act of 2018 extended the Center for Medicare & Medicaid Innovation’s (CMMI) Valued-Based Insurance Design Model to all 50 states in 2020. This model was launched in 2017 to allow Medicare Advantage plans to offer supplemental benefits and reduced cost-sharing to seven conditions including Coronary Artery Disease or Congestive Heart Failure. The model focuses on four approaches:
The creation of more supplemental benefits will enhance the quality of services we provide for our patients especially in terms of addressing the SDOH. Encouraging the inclusion of these targeted supplemental benefits will allow us to partner with payers to improve the health of the country in a more innovative way.
At PCCI, we have been directly involved in national and state-driven education forums, presentations, and roundtables directed to design and deploy local models for the Connected Communities of Care program (previously known as the Information Exchange Portal) that bring together providers, payers, philanthropic organizations, community-based organizations (CBO), and local/state government entities. While most markets continue to be in a learning mode, significant and tangible activities are being initiated in a number of municipalities, including Dallas, Raleigh-Durham, Louisville, Detroit, Chicago, Phoenix, Salt Lake City, as well as across whole regions. For example, North Carolina recently requested proposals for the development of a North Carolina Resource Platform via the Foundation for Health Leadership & Innovation. The goal of this multi-year program is to connect over 3,000 statewide community-based organizations via technology, and facilitate SDOH. This will be completed through a programmatic coordination of referrals between healthcare providers and community resources to comprehensively identify and address the needs of individuals across the state. On a broader level, the Accountable Health Communities Model deployed in 2017 is engaging 31 organizations across the country to address a critical gap between clinical care and community services in the current healthcare delivery system. This is being done by testing the process of systematically identifying and addressing the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services to see if it will impact healthcare costs and reduce healthcare utilization.
Our experience over the last five years across Dallas tells us that models will need to address six tracks to be successful: Governance, Legal, Technology, Clinical Workflows, CBO Workflows, and Sustainability (Figure 2). The maturity and evolution of the models need to develop and be staged within a multi-year deployment framework (concentric circles in Figure 2 represent the progression and evolution of the model with outer circles representing mature and more sophisticated models).
There is also a critical upfront readiness and deployment/implementation assessment that is important in order to stage the deployment of a Connected Community of Care program. This broad representation of the community’s fabric is critical to ensure that:
Addressing SDOH is finally moving from a “buzz” word to implementation pilots. While we talked a lot about population health over the last 10 years, doing population health without a truly engaged and “Connected Community of Care” is like focusing on rescuing people from drowning in a river vs. building a bridge so they can cross it safely. As we continue this journey, let us make sure we build a bridge that adapts to the needs of each community and has emerging local and national models of care to ensure sustainability. We don’t want to end up with a bridge like the Choluteca Bridge in Honduras, connecting nothing to nowhere.
Acknowledgments: Valinda Rutledge, PCCI Executive Advisor and Lindsey Nace, PCCI Marketing and Communications have contributed to this article.
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The Parkland Center for Clinical Innovation has received a CMS Accountable Health Communities grant from the Centers for Medicare and Medicaid Services. The $4.5 million grant is designed to address large cost drivers in healthcare.
In May, PCCI will begin a five-year data collection period as part of the grant’s Assistance and Alignment Tracks of the Accountable Health Communities model. PCCI is one of 32 participating sites in 23 states and the only one in North Texas.
Ted Shaw, chair of the PCCI board of directors, said the center will use the grant to “utilize the innovative and transformational capabilities of PCCI in an effort to reduce health disparities in the North Texas region and across the nation.”
In addition to addressing large healthcare cost drivers, the grant is designed to address unmet health-related social needs—like food insecurity and inadequate or unstable housing—that affect chronic healthcare problems in Dallas-Fort Worth.
The AHC model will test innovative service delivery models and track screenings of Medicaid and Medicare beneficiaries at risk for emergency department visits to see if the new models can reduce expenditures and enhance care.
PCCI was awarded the AHC’s “alignment track,” which is the most intensive study-level and includes screening, education, referral, navigation, and alignment of community resources to ensure responsiveness to high-risk beneficiaries’ needs.
PCCI will be partnering with five healthcare providers in DFW—Parkland, Methodist, Children’s, Baylor, Dallas Metrocare—as well as 289 community-based organizations and Texas Medicaid to design, implement, and evaluate this track.
April 12, 2017
One of 32 participants nationwide to link clinical, community services
DALLAS – The Parkland Center for Clinical Innovation (PCCI) has been named a recipient of the CMS Accountable Health Communities (AHC) grant by the Centers for Medicare & Medicaid Services. The Assistance and Alignment Tracks of the Accountable Health Communities Model will begin on May 1, with a five-year performance period.
PCCI is one of 32 participating sites in 23 states. UT Health Science Center Houston and CHRISTUS Santa Rosa are the only other Texas sites that will conduct and test interventions.
“We are poised to utilize the innovative and transformational capabilities of PCCI in an effort to reduce health disparities in the North Texas region and across the nation,” said Ted Shaw, chair of the PCCI Board of Directors. “PCCI is dedicated to designing solutions that bring together clinical care, public health and community services in a coherent strategy to meet the community’s healthcare needs.”
The grant was designed to specifically address the largest cost drivers that extend beyond the scope of healthcare alone including unmet health-related social needs such as food insecurity and inadequate or unstable housing which may increase the risk of developing chronic conditions, reduce an individuals’ ability to manage these conditions and lead to avoidable healthcare utilization.
“We are very proud that CMS has entrusted PCCI with an Accountable Health Communities Model Grant. This award recognizes the great work PCCI and the Pieces Technologies, Inc. teams have done over the last few years and is a great opportunity for PCCI, Parkland and the Dallas community to expand our mission of creating a world of connected communities where every health outcome is positive,” said Steve Miff, PhD, president and CEO of PCCI.
“We are thankful to our Dallas AHC grant partners, Parkland Health & Hospital System leadership and board, the W.W. Caruth, Jr. and Lyda Hill Foundations for their ongoing partnership, and for the letters of support from Dallas Mayor Mike Rawlings, the Dallas County Health Department, and Dallas County Judge Clay Jenkins,” Dr. Miff added. “We look forward to getting started and partnering with CMS and other leading organizations across the country to improve the health of every community.”
The AHC model was established to test innovative service delivery models and seeks specifically to test whether uniform screening of Medicaid and Medicare beneficiaries at risk for emergency department visits will reduce expenditures and enhance quality of care.
CMS launched the project by announcing the participants for two of the three tracks, the Assistance and Alignment Tracks. PCCI had been awarded the Alignment Track, the most intensive level which includes screening, education, referral, navigation and alignment of community resources to ensure responsiveness to high risk beneficiaries needs.
PCCI will be partnering with five healthcare providers in the Metroplex (Parkland, Methodist, Children’s, Baylor, Dallas Metrocare), 289 community based organizations and Texas Medicaid to design, implement and evalute this model.
To view a list of the assistance and Alignment Tracks bridge organizations in the Accountable Health Communities Model, please visit: https://innovation.cms.gov/initiatives/ahcm.
PCCI is an independent, not-for-profit healthcare intelligence organization focused on creating connected communities through data science and machine learning. It combines deep clinical expertise with advanced analytics and artificial intelligence to enable the delivery of precision medicine at the point of care. PCCI is a recipient of more than $45 million in grants directed at developing and deploying patient centric cutting edge technologies connecting communities, Parkland Health & Hospital System and beyond.
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Lindsey Nace
214-590-3887
lindsey.nace@pccipieces.org