Joe Rubinsztain, M.D is the CEO and Co-Founder at ChronWell. The company provides technology-enabled solutions such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM). Previously, he was the President at gMed, which was acquired by Modernizing Medicine in 2015.
In this future-oriented interview, Dr. Rubinsztain walks us through how ChronWell works and their progress during COVID-19. He provides interesting insights into how technology will play a bigger but quieter role in the future.
Watch this insightful interview (18+min) to glimpse into the future of gastroenterology.
◘ We can manage three birds with one stone – 1) stay connected with technology 2) manage chronic conditions and 3) recover lost revenue
◘ “You have to think beyond the one-to-one intervention that is limited in the scope of time or place”
The Transcribed Interview:
Praveen Suthrum: Joe Rubinsztain, CEO of ChronWell, thank you so much for joining me today on this conversation. I’m really looking forward to learning more about your company and how you got started. But first, I wanted to welcome you.
Dr. Joe Rubinsztain: Thank you Praveen, it’s a privilege to be here and I just love your work.
Praveen Suthrum: Thank you. Let’s start Joe, by finding out why you started ChronWell? What was the underlying idea? And what prompted you to start in this line of work?
Dr. Joe Rubinsztain: I was always passionate about computers and while I was going to medical school, we had created an early-stage Electronic Health Record. We brought that to the United States, created gMed and that became very successful. And we detected toward the end of it that the market was becoming saturated and heavily regulated. And innovation did not play such a central role anymore on the EMR. But there was a lot more to innovate beyond the EMR. Taking technology from being archival into actionable technology was critical for us. And so we figured that why not take the next step and create a new iteration of the technology that has measurable results and influences people to be at their best health.
Praveen Suthrum: What is this next iteration? What does ChronWell do?
Dr. Joe Rubinsztain: ChronWell keeps patients and doctors connected well beyond the office visit. It helps patients with chronic conditions stay at their best possible health in connection with their doctors. And it allows doctors to better play in the value-based ecosystem.
Praveen Suthrum: How does the patient engage and how does the practice engage?
Dr. Joe Rubinsztain: Imagine you have a patient that attends your medical practice and has IBD. And you’ve diagnosed that IBD and you now know that patient needs to take a special diet, needs a test regime, needs to have questions answered, you need to track their weight, and you need to make sure that you’re providing guidance for how to take the medications and things like that. So, as a doctor, you’ve issued a set of orders. We can understand those orders, we can prepare an intervention plan, we can marry great people with great technology to help the patient navigate the care for IBD. And we can connect with other players in the industry to make sure that they’re receiving the right diet such as Modify Health or to measure their vital signs with connected scales and other devices. And then keep the doctor informed with very little friction. So, imagine a patient has a care navigator or a concierge per se that is helping them navigate the condition, answer the questions, measuring the results, and that is constantly keeping the doctor apprised of everything that is going on but powered by technology to make sure that no stone is unturned and that every single detail is accounted for.
Praveen Suthrum: COVID would actually have accelerated a business model such as this did that happen in what way did it influence your business?
Dr. Joe Rubinsztain: COVID was a fast accelerator for us. Doctors were really concerned. They were no longer able to see patients. Some of the elective procedures couldn’t be performed anymore and telemedicine wasn’t enough. The practice wasn’t geared to allow that patient to establish that connection. Plus the doctors needed to reactivate the revenue stream and while they lost some of it, they discovered that Medicare had already approved a set of codes that allowed for them to take care of chronic patients. You could essentially manage three birds with one stone – you could stay connected using technology, you could manage chronic conditions, and at the same time, you could recover some of the lost revenue.
Praveen Suthrum: A lot of practices feel that COVID is going to now come and go and then in the post-COVID period we’re all going to revert back to an older form of care so, there’s going to be a decline in telemedicine. I’d wonder you know what you would say to something like that?
Dr. Joe Rubinsztain: The world has changed and in some areas, this has changed and become a little bit more divisive but in other areas, it has changed for good. Patients no longer fear interacting with doctors over remote platforms. Technology has already become our main lifeline of communication more than person to person. Social distancing is going to prevail until not only do we have a vaccine, but we have distributed that vaccine and we’ve developed herd immunity and who knows if we’re going to get another mutation. This is a different world and it has definitely changed.
Praveen Suthrum: Very interesting. Let’s fast forward the conversation to a point of time in the future. So, what role do you see technology playing in GI in healthcare and for a business like yours?
Dr. Joe Rubinsztain: We see technology playing a much bigger role but a much quieter role. Right now we as consumers are full of noise every day. We have social media platforms that push a lot of information to us a fraction of it could be useful a lot of it is ads. But what if you could have some technology that is really analyzing on the back end those things that matter to you and are able to generate an adequate intervention without getting too deep or disruptive into your life. For example, you already have smartphones and you do texting and doctors already have EMRs. Imagine if you had a very smart brain on the back end that is constantly churning information from previous claims or information from other EMRs, laboratory values, social media trends with permissions and within the boundaries of the law. Imagine that we now understand also the patient’s environments and social-economic factors and behavioral parameters. And you turn all that into an AI model or into a machine learning model that can come up with the right interventions for that patient in a personalized way.
So, personalized medicine is not just a genetic analysis it’s also a behavioral analysis. If you put all that together and if you have a very smart brain on the back end that is connected with people who are well trained and capable of empathizing with a patient, you can really deliver a great experience. It’s going to utilize some of the things that you already use such as texting and maybe social media and other communication channels to drive positive influence to help you become better. To help doctors consume a lot of information in very little time so that they can make the best decisions possible. Because those decisions were well-curated and summarized from multiple angles that only a machine can do. And so think of technology as an augmenter that is not constantly in your face but on the back end constantly analyzing and feeding you the relevant information that allows you as a doctor to be more effective, to be very efficient, and to not have to work too much and make those little changes in the patient that truly have a difference with respect to their outcomes and the cost of care.
Praveen Suthrum: I love your response on this. Help us understand from a gastroenterology standpoint if you can connect these dots for GI in particular. What does the future look like from you know this lens that you’re seeing?
Dr. Joe Rubinsztain: Imagine that you now have the ability to not only take information from a company like Echosens who is great at diagnosing the liver non-intrusively or non-invasively. And imagine that you can now compile also laboratory data, socio-economic data, and you then partner with a company like Modify Health to deliver a diet. And then you deliver an internet-connected scale that all feeds into a central database that analyzes trends, and analyzes the patients and suggests, for example, the message that is the most effective for this person to deliver. And instead of having that message at first being delivered by a human, you send a text.
Now you’re measuring how that patient actually took that info. And if that info didn’t nudge the scale, then you now have a person that picks up the phone, that has been very well trained, and has consumed very quickly the information necessary to help that patient nudge along. If that still doesn’t move the needle imagine now that we’ve generated a report for that patient automatically, that goes in, to the provider, who is very friendly with respect to the risk of that patient not following diets or potentially not moving in the right direction. So, that the doctor can make the right medical decisions and then we can go again through that cycle of the computer in the back end generating the interventional strategies, interpreting the data, and coming up with actionable items that are well distributed between the automatic side of the story, and the assistant side of the story, and the provider side of the story. And if you really know how to distribute those, you can make changes at a low cost that are going to have a big impact on the cost of care. So, that’s one example.
The example gets much more interesting when you’re going to IBD. IBD has a very complex outcomes framework. We’re working uh very hard into building a very intelligent outcomes framework in our platform that takes information from multiple sources. Not just from laboratories or EHRs but other data as well. That allows us to truly use for example machine learning to understand the difference in interventional patterns or the difference in behaviors that happen when you do an A/B test of two different types of approaches. And see if that patient actually had in the right direction or if you can use AI or you know neural network analysis to understand early trends for complications can you intervene sooner? That technology is only working transparently on the back end in only sending the signals that make sense and through channels you already know. So, you don’t have to download apps, you don’t have to install new systems, you can just come into the physician practice and with very little friction, you can tell them – “look, we’re going to work together. Give us a plan we’ll take it from there. We’ll consume it. We will send you regular reports into your EMR; you don’t even have to learn new technology. And MR. Patient, you don’t have to download our app. You’re welcome to. It’s great, it’s very useful but if you don’t want it, we’re capable of communicating with you through several channels.”
In the end, as you start looking deeper and deeper and deeper into all these chronic conditions and you start coming out with outcomes frameworks, interventional patterns, best practices, data-driven behavioral analysis, A/B tests, and machine learning that comes together into – “hey what do I need to tell this nurse to tell the patient in order to have the maximum possibility of them getting better?” That’s when it gets really interesting.
Praveen Suthrum: Excellent. So, in this world, Joe would the role of a gastroenterologist in these conditions, let’s take those two specific examples that you narrated, and it was fantastic to listen to you frame it the way you did. So, in that world would the role of a gastroenterologist increase or decrease?
Dr. Joe Rubinsztain: It increases. Look, we as physicians have been trained to care for patients. Along the way, we discovered that we needed to do a lot of regulatory work, and a lot of documentation work, and administrative work. And we needed to cater for the fee-for-service crowd, and we needed to spend less time with patients. And you know the practice of medicine quickly became the business of medicine. And a lot of people had that conflict of you know ‘What did I train for? To help or to or to be just a worker?’ Imagine if you very intelligently took a lot of that administrative work and regulatory compliance and put it into an automated process. And you could treat patients more with less time. You could make those interventional changes that make the biggest difference.
There are two things that could happen there – one is you can see more patients in less time because you had to use a lot less time interpreting information. You can look at it distilled. And the second thing that would happen is that you would have technology that augments you. That allows you to click a button and connect with a patient without really having to be synchronous. It can be asynchronous communications. Or you can have a well-trained nurse that really knows how to work together with you, who is certainly following your treatment patterns because technology understands your treatment patterns and she’s constantly monitored to make sure they comply with the treatment patterns that you’ve set. And you can take a look at everything that they’ve done.
Praveen Suthrum: You know when I interact with physicians and gastroenterologists in particular, and I take a step back and observe these interactions, a lot of the doctors are thinking – ‘If I become a technologist also or move a little bit into that world then I don’t touch lives one-on-one, I touch lives one-to-many.’ So, I’m just wondering is the healthcare world in transition? So, in the future would there be a hybrid model between private practice hospitals and a completely new world where doctors are seeing patients but just differently, not how they see today?
Dr. Joe Rubinsztain: That’s a great question. Yes, there are some of us who like to touch more people with less effort and we’re focused on efficiency. But there are also people that thrive on connecting with others and helping others one-on-one. I don’t think there is one answer to that question. I think that people that want to be very efficient and build a great business, and a great practice can and they need technology to do that. But also there are people that want to connect with their patients and want to help them the most and want to prove that they’ve made a difference in their life and they also need to use technology there. So, either way, technology is going to help them achieve that goal. The interesting thing is that we’re going to be shifting from a fee-for-service to a value-based model who knows when but it’s certainly slowly moving in that direction. And in that case, you just don’t have a choice. You have to think beyond the one-on-one intervention that’s limited in the scope of time or place. You have to live with the patient in their lives, not in your office. Influence has to happen outside the boundaries of the office itself and outside the boundaries of time. And the only way to erase time is to automate the burden.
Praveen Suthrum: Brilliant. So, how exactly can GI practices use ChronWell today?
Dr. Joe Rubinsztain: You would contact us. You would contact our sales team. We would make a presentation for you. It’s funny because when we talk to a practice we basically tell them – “Look you need to do very little we’re going to be working with your EHR. So, it’s embedded in your workflow and then we tell them, and oh, by the way, we will collaborate with you on chronic care management and you don’t have to invest anything. We will come in and we will build this new revenue line with you and we will partner on it. And this initiative requires very little work and it requires no capital investment on your side.” And so it’s easy for them to come back, talk to our sales team, we go through the process. It’s much easier than selling an EHR for sure. And as they get deeper and deeper into the program they discover that it has many dimensions that they didn’t think of, and they start collaborating more and more in understanding a broader outcomes framework than just the interactivity perspective of it.
Praveen Suthrum: So, how do they get paid?
Dr. Joe Rubinsztain: So, Medicare has already approved a set of CPT codes that are related to chronic care management, principal care management, and remote physiological monitoring. And some private payors are already joining in the fray. Essentially what happens is that we partner with the practices, once the patient is a good candidate for it, they notify us. We work with the patients to make sure that the program is a good match for them. And we report to the practice the activities that we’ve performed. The practice invoices the activities and pays a subcontractor fee for those services.
Praveen Suthrum: Was there anything else that you wish to share before we close?
Dr. Joe Rubinsztain: We need to start thinking differently about how we interact with patients. We know we’re busy as providers seeing, many patients over and over every day or doing many procedures over and over. It is true that some of these procedures are going to be disrupted with DNA technologies and the like. And the sources of revenue for the provider are going to change over time. In any iteration of that change, a deeper relationship with the patient is going to be critical. And a better relationship with the payor is going to be critical. And payors only want two things – They want to know you’ve delivered great care and that they didn’t pay too much for it, right? And patients only want to know of one thing that they trust you to make them better. The only way to do that is to truly be in touch with them. So, think of the experience beyond the fee-for-service and beyond your practice as a full experience, not a limited experience. This goes way beyond those CPT codes. And it goes into the new model of healthcare which is much more pervasive than an interaction that you get paid for.
Praveen Suthrum: Joe, thank you so much for sharing all your views. It was a very educational experience for me and I’m sure everybody who’s watching this will feel the same.
Dr. Joe Rubinsztain: Thank you, Praveen. It was my privilege. Your questions were great and I’m glad to be working again with the GI community. It’s a privilege.
Praveen Suthrum: Thank you.
By Praveen Suthrum, President & Co-Founder, NextServices.