Andrey Ostrovsky: Silicon Valley culture of unrealistic expectations has created a unicorn mentality in mHealth

Three years ago Boston-based Care at Hand, a mobile early warning system for elderly home care, was chosen out of 400 start-ups for a three-year entrepreneurship program supported by StartUp Health and GE's healthymagination initiative.

Co-founded by Andrey Ostrovsky, M.D., Care at Hand is focused on decreasing hospital readmissions and empowering home care workers with less formal training to document health observations more easily. The tablet-based platform melds the observations into predictive alerts for early disease detection and improved outcomes.

In 2015, as reported by FierceMobileHealthcare, the system was cited for providing big savings related to cutting readmission rates of at-risk Medicare patients, according to the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. It saved more than $100 a month per patient, about $600,000 total during a six-month trial.

Such success played an instrumental role in getting needed funding for expansion. FierceMobileHealthcare reached out to Ostrovsky to get an update on the program, as well as his insight on mHealth industry technology trends.

FierceMobileHealthcare: What is the status of Care at Hand?

Andrey Ostrovsky: It is thriving as payers and providers realize the importance of driving down acute care utilization by investing in the lowest cost-interventions. We are increasingly being incorporated into care coordination and care transition programs as a part of alternative payment models. Our technology is also being incorporated into several states' managed long-term supports and services. 

FMH: What's your perspective on how digital health devices and apps currently are being deployed within healthcare?

Ostrovsky: Unfortunately, the predominant culture in digital health is still that of optimizing margins. Profit growth is not a bad thing; in fact, it is the lifeblood of the innovation ecosystem. But Silicon Valley has lost sight of using profit as a means to an end rather than an end itself. The Silicon Valley culture of unrealistic growth expectations has created the unicorn mentality, a false belief that technology companies will become billion-dollar businesses.

The immense pressure on entrepreneurs to fulfill their investors' unrealistic expectations has led to unsafe, unethical and financially counterproductive practices. The evidence base that does exist shows limited results, and the process for creating research is too slow to keep up with the rapid pace of innovation needed for business growth. Improvement science is an excellent approach to bridge the gap between no evidence and rigorous randomized controlled trials for mHealth, but there is little competence or even awareness of the need for or capacity to do quality improvement with mHealth.

FMH: What do you consider the top obstacles to mHealth being embraced by consumers and providers?

Ostrovsky: Mobile health marketing and business models must move beyond business-to-consumer toward business-to-business or other creative models in order to bypass the constraints of purchasing power in the populations that are at highest risk of health and socioeconomic disparities. Often, the populations that need digital health tools the most are the ones that can't afford them. Reimbursement for mHealth needs to move away from fee-for-service.

This may be controversial because the majority of the mHealth advocacy efforts around reimbursement have been pushing hard for more CPT codes or other forms of telehealth reimbursement, particularly to achieve parity with in-person billable services. However, a more sustainable way to pay for mHealth, like any healthcare intervention, is through value-based reimbursement by using quality measures to determine bonuses or penalties based on performance of the mHealth solution or risk-bearing reimbursement.

Design of mHealth continues to ignore the person-level variability, notably in patient activation. Some patients may be able to use mHealth appropriately, sometimes. Many other patients/persons may not be supported enough, educated enough, motivated enough, or trusting enough of mHealth to use it. Designers of mHealth need to be very sensitive to these variations to have the technology create value at scale.

FMH: The Joint Commission announced that physicians/providers can use text for orders with some big caveats. What's your take on the action?

Ostrovsky: Like any innovation in healthcare, there has to be a balance of protection of patient safety with creation of new value through innovation. Regulations and guidelines need to strike a balance between the two. While it's probably taken longer than it should have, this is a well-thought out decision that is generally good for patients and providers.

To expedite these types of guidelines, we need to systematize the use, digestion and dissemination of quality improvement data so it doesn't take five years to do what could have taken two years or less. There is also an opportunity to use quality measurement tied to financial incentives to reinforce adherence to these types of guidelines. In fact, there is a broader opportunity of quality measurement to substantially improve the safe implementation of digital health in such a way that expedites achievement of the Triple Aim.

Editor's Note: This interview has been edited for clarity and length.