While working at Oscar Health, Vijay Kedar became familiar with the uphill battles clinicians and insurers face trying to transition patients from the hospital to home.
Trying to get patients the right equipment and services means navigating a fragmented industry of home-based care resources with little visibility, and it can often take weeks to get medical supplies delivered to patients, Kedar told FierceHealthcare.
He also experienced it firsthand when his mother, a stage 3 cancer patient, spent four months in the intensive care unit fighting acute respiratory distress syndrome. After his mother was discharged, Kedar said his family was unprepared for the challenges of helping her transition to home-based care.
She needed a year of intensive home-based therapy and required a range of medical equipment and services such as liters of portable oxygen, mobility support, wound care supplies and physical and respiratory therapy.
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“We had to coordinate a dozen equipment and supply vendors, all these siloed retailers that had one or two things she needed. There was very little guidance or support on what she needed or how to manage it or navigating her insurance benefits,” Kedar said.
The family spent thousands in out-of-pocket costs for the equipment. After weeks of delays, faulty equipment and unreliable patient support, Kedar’s mother ended up being readmitted to the hospital, he said.
It’s a “broken” system in need of an overhaul, Kedar said
He teamed up with Gabe Flateman, co-founder and former chief technology officer at direct-to-consumer mattress company Casper, to build an infrastructure that aims to simplify the process of getting home health care supplies.
The company they co-founded, Tomorrow Health, works like the Amazon of home health care equipment.
Patients recovering from surgery or illness at home or managing a chronic condition can use the company’s website to find the products they need; the platform navigates prior authorizations and insurance billing and then ships the equipment directly to patients’ homes in two business days, according to Kedar.
The platform is now available in 25 states with Medicare Part B, including most of the Northeast, Texas, Washington and Michigan. The company contracts with both Medicare and private insurers as an in-network provider.
The company plans to cover all 50 states by the end of this fall, Kedar said.
Tomorrow Health has attracted a who’s who list of investors and advisers.
The company is backed by Andreessen Horowitz, Box Group and Rainfall Ventures. Individual investors include the CEOs of Tenet Healthcare, Flatiron Health, Quartet and PillPack and the chief financial officers of Stripe, Massachusetts Medicaid and the World Bank, according to the company.
Industry advisers include Trevor Fetter, former CEO of Tenet Healthcare; Trent Haywood, a former Blue Cross Blue Shield Association executive; Beth Bierbower, who had served at Humana; and Phyllis Yale, an advisory partner at Bain and board member at BCBS Massachusetts, Bristol Myers Squibb and DaVita Health.
With the shift to value-based care models and the baby boomer generation aging, the healthcare industry is increasingly focused on home-based care.
“What we have heard from health plan executives is that transitioning care outside the hospital to the home is a critical strategic priority,” Kedar said.
The COVID-19 pandemic has only intensified the demand for home-based care. Thousands of COVID-19 patients are being discharged from hospitals, including many who had been on ventilators. Patients are being discharged faster than normal, just one to two days after coming off a ventilator as opposed to weeks of step-down care.
To build the platform, the co-founders spent time digging into and understanding the industry, they said.
“We talked to patients, physicians and insurers to understand their challenges. We realized there were three areas where we needed to innovate—partnerships and collaboration, a tech-enabled operation and exceptional patient experience,” Kedar said.
Flateman brought his e-commerce expertise to the company to focus on infrastructure and logistics.
“We wanted to use technology and systems to automate the cumbersome elements of a process and a process that needs a better interface,” he said.
He added, “But you can’t put technology on top of broken healthcare infrastructure. You have to get in there and rebuild the infrastructure and offer a better experience.”
Tomorrow Health had to coordinate with supply manufacturers, integrate its system with insurers and build a user experience on par with what’s in the consumer market.
The aim is to provide a holistic home care platform that works as a trusted partner to patients, families, physicians and insurers to manage home-based care, Kedar said.
“We want to create a product, services, guidance, and support that we would feel comfortable having for our own parents and families,” he said.
Source: Fierce Healthcare