David Brown believes that palliative care — management of symptoms — will be the new model of care for all chronic disease. “Today’s palliative care does not write the patient off who suffers from pain and symptoms but has 20 years left to live,” says Brown.
His firm, Vox Telehealth, based at the Straube Center, is developing a mobile health solution for palliative care. It will help patients in the end-of-life stage to connect with their own physician plus other means of support, including a chaplain. “Our program is an intentional walk alongside the patients and their caregivers, providing resource on resource, says Brown. “We try to engage the patient and the family to take a role in decision making, to determine his or her own level of action and involvement.”
Dr. David Barile developed the content for Vox Telehealth’s palliative program, and the chaplain service will be provided through the Healthcare Chaplaincy of New York and their seasoned palliative consultant, Linda Emmanuel, Buehler Professor of Geriatric Medicine at Northwestern University.
Brown, 43 and a graduate of Vanderbilt University, established Vox Telehealth based on his observation that patients need more support than doctors usually have time to give them. He’s betting that patients who are educated and prepared by his web-based solutions will get much better care and have better outcomes. “Our internal motto: the wiring of technology will always evolve, but the wiring of humanity generally will not,” says Brown. “We are building our programs on technology- based platforms that are a fantastic complement to the clinical process.”
The palliative care program will be the second one Brown has launched. Vox Telehealth’s first solution, OrthoCare, is for orthopedic surgery. It educates and prepares patients before orthopedic surgery and continues to monitor them remotely for up to 90 days after discharge (U.S. 1, June 25, 2014). OrthoCare finished its preclinical review and its pilot was rolled out in partnership with Bon Secours Healthcare System of Virginia last month. A number of hospital contracts for OrthoCare are forthcoming.
Brown claims that his platform is so flexible that it can accommodate both knee surgery and end-of-life decisions. Orthopods operate and heal. Palliative care physicians manage pain and symptoms and help people adjust to the reality of their diagnosis.
With $2.4 million raised so far, and having closed a second angel round of $1.1 million in June, Brown is not looking for funding now. He wants to sidestep the demands of institutional investors and venture capitalists who would likely push to cash out. “They would want you to go to market ASAP,” says Brown.
Instead he will focus on rolling out more programs in other treatment areas. He also wants to hold on to as much equity as possible and alludes to how the valuation might change dramatically soon. “We have a number of customer contracts and industry peer relationships that we are extremely confident about,” says Brown. “We are raising just what’s needed now.”
He has decided who pays for the orthopedic program (the hospital) and how much it costs but has yet to work out the payment model for the palliative program. It will be available to any hospital and will likely be popular among the 4,500 hospitals in the nation who already have palliative care physicians, counselors, or chaplains.
The program depends on a lot of engagement with the caregivers. The first tier of the two-tiered program is based on the four-step pathway that is being patented by Barile (see main story, page 8). The caregivers are referred to information modules about each step — diagnosis, prognosis, goals of care, and treatment plan. If they are struggling with accepting the diagnosis, it offers support content for patient and caregiver, such as suggesting ways to prepare for their next visit to the physician.
“It takes a long while for the patient and caregiver to realize that they can be in control, that they can ask for more time in the doctor’s office,” says Brown, “Much discussion is needed. This is a huge factor in getting the type and level of care they want.”
Once the patients and caregivers get the prognosis and move to goals of care, the program gives them the tools to decide on their Advanced Care Directives and to help their doctors fill out their POLST form.
The palliative care program will not zero in on hospice, though it will offer hospice as a choice. A hospice patient needs a higher level of care than can be accomplished with a web-based program. “By the time the patient goes into hospice mode, our level will taper off,” says Brown.
Patients or caregivers will be able turn to a chaplain for help in decision making. Chaplains are specifically trained to engage patients of any religion or those who have no religion. In fact, one study showed that it is not typically helpful for someone to consult with a pastor who has no expertise in the healthcare field because some of them say that giving up on treatment translates to “giving up on God.” This leads to the patient asking for a higher level of care.
Even the term “giving up” is fraught. It may evoke the so-called “death panels” that haunted the debates over managed care. Brown denies this is a big problem. “Discussion has moved away from the hyper political witch hunt of the death panels. People are realizing the cost of care is unbearably high and patient satisfaction is unbearably low,” says Brown, quoting research studies. “We are not advocating death. We are advocating decisions. Patients get dissatisfied with their care pathway but are not educated about the likelihood of success or the potential side effects.”
A better idea: to reintroduce the reality of death as a part of life and start to have the discussions that few physicians are prepared for or are willing to have. Doctors typically see medicine only through a curative lens, says Brown. “It is amazing that the default mode is the absolute most aggressive care.”
“We have a certain amount of confidence that palliative care will become the model for all chronic disease. We will focus on empowering the patient for action,” says Brown.
VOX Telehealth 100 Straube Center Boulevard, Suite 205, Pennington 08534; 888-360-4869. David Brown, founder and CEO. www.voxtelehealth.com.