Tag Archives: Cisco

SPI Digital Health: As Patient Activation Remains a VBC Provider Pain Point, is Cisco’s CPaaS the Remedy?

The value-based care (VBC) IT ecosystem continues to evolve and mature. But patient activation and engagement remain the ‘missing links’ on the ‘last mile’ of the VBC chain. Hundreds of vendors are seeking to close this gap, but most solutions fail to find the sweet spot of giving care managers the tactical intelligence to guide their care strategies, while enabling populations to take greater responsibility for their health. 

At last week’s HIMSS2023 show in Chicago, Cisco demonstrated its enterprise communications platform (CPaaS). Having enjoyed some success in the NHS in the UK with it, Cisco now has high hopes for CPaaS in the US, by far the world’s most developed VBC market. 

The Signify View 

A complete PHM/VBC IT solution enables healthcare providers to aggregate all the data from different sources (e g EHRs, claims, social determinants of health) and develop risk stratification, clinical decision support and analytics tools so providers know exactly who their most expensive, highest priority cohorts are (as illustrated below).  

In recent years, IT vendors have developed and delivered an almost complete ecosystem of data aggregation, health insights and care co-ordination tools that are highly valued and used by ACOs, IDNs and other organisations where success under VBC reimbursement is paramount. However, among care management IT buyers patient activation and engagement remains a key challenge in executing on the workflows that these insight tools inform. The tools provided to support this are mostly falling short.  

Complete Integrated Care/PHM Solution

This area remains something of a ‘blind spot’ for providers and vendors. Leaning on the old adage ‘if you build it, they will come’, some providers have discovered (the hard way) that it is not enough to just build a portal or booking management tool and assume patients have the time, inclination or even the basic IT skills to register and log in to access their personal health information, book appointments and view content or care plans. Some providers acknowledge the struggle with their portals’ ‘digital front door’, where it might take several clicks for a visitor to find the information they need. 

Some healthcare providers also still rely on their EHRs to activate and engage patients. But data pulled into EHRs is not broad, particularly around social determinants of health and payer data that would offer an additional layer of information on how to handle different patients. The fact that some providers use multiple EHRs exacerbates the challenge. 

Indeed, all EHR and PHM vendors have a tool that claims to support patient activation and engagement, and EHR vendor marketplaces are awash with software bolt-ons. But most of these solutions fail to address some of the process and IT hurdles providers face in delivering VBC, and the hurdles patients face when interacting with these solutions. Multi-channel bulk communication (e g via SMS or WhatsApp) that triggers calls to action to a patient (for example sending a link to make an appointment) is available on many EHR platforms, and is one step up from asking a patient to log in to a portal or relying entirely on old fashioned calling for patient outreach, but it is still very manual. Providers recognise that good communication and education to change patient behaviour are key enablers in VBC.   

Solutions, therefore, that offer a more strategic and tactical approach to patient activation and engagement are valuable. More than ever, patients need more accurate patient activation and engagement tools with built-in intelligence that can identify care gaps. They also need solutions that improve the patient experience, are secure, are interoperable with different platforms used for patient identification, use software that can find unstructured data more easily and have AI/ML capabilities to identify rising risk patients through predictive analytics. 

Competitive, but no Game Changer 

By all accounts, CPaaS is a highly competitive solution that performs at the same levels of other leading products in this space. Cisco is very well-resourced with a pedigree in US healthcare via Webex and IMImobile (the UK company bought by Cisco in 2021), and the fact that CPaaS is geared towards VBC is another positive. But what would enable CPaaS to really stand out would be more focus on game changing ‘tactical’ intelligence around patient activation and engagement for care management teams. 

Cisco also faces stiff competition from other, more established vendors in the US VBC market. PHM vendors like Innovaccer, Inovalon and 1upHealth (who we wrote about last week in this Insight) – previously focused on data aggregation and workflow tools helping prioritise patients, develop analytics and offer best practice recommendations on how to manage patients with different conditions – are now focusing on patient activation and engagement, with some success. 

Some have achieved success by acquiring specialist technology, especially in the last couple of years. Recognising the opportunities in patient activation, Healthcare Catalyst, a major non-EHR vendor, bought Twistle in mid-2021.  

Leveraging more patient behavioural data to bring more intelligence into CPaaS, thereby allowing providers to gain a greater understanding on the best channels and best times for patient outreach and activation, would certainly help the product stand out in this competitive market. Further data on patient support networks and how these can be leveraged to support adherence to care plans, appointment booking and medication adherence, are also tools that buyers would value to enable a more tactical approach to patient activation. 

Big tech companies also enjoy obvious advantages in this market. The likes of Google and Amazon have a wealth of patient behavioural data without needing to rely on an EHR or clinical data. If anyone can manipulate human behaviour to follow care plans etc, it is big tech. Provided patient privacy concerns can be overcome, they could be a very disruptive element in this market. 

Different Routes to Market 

Given the above, and the fact that Cisco is launching CPaaS into a cauldron of a US market, it must choose its route to market carefully. Aside from selling direct to hospitals, what other options exist for Cisco? 

It is noteworthy that the company has a decent position in the US virtual care software market. It competes with telehealth specialists Amwell and Teladoc, video conferencing generalists like (Microsoft) Teams and Zoom and some EHR vendors that have their own virtual care platforms. Selling CPaaS as a provider-patient bridge to an established virtual care customer base could be a viable option. 

Another option would be to partner with a leading VBC IT vendor. As mentioned earlier, many of these vendors have focused on developing data aggregation and care management workflow/analytics tools, to the detriment of good patient activation tools. This is now a focus for many, and Cisco could have a part to play here by partnering with these vendors. Many will have the behavioural data needed to inform more tactical outreach, and the combination of this with CPaaS would offer the potential to really address the needs of provider care management teams.   

Lack of Definition 

Patient activation and engagement is the final piece of the VBC ecosystem jigsaw and is a current focus of technology investment. As IDNs and ACOs seek to arm themselves with the full suite of VBC solutions and close any final remaining care gaps, the patient activation and engagement tools market is ever more fiercely competitive.  

Launching CPaaS into the US now is good timing on Cisco’s part, but it is just one of any number of solutions and product differentiation will be its biggest challenge. How Cisco develops the product to address the points raised above will ultimately determine just how disruptive it can be.