Data has shown that roughly one-quarter of traditional Medicare spending for healthcare is for services provided to Medicare beneficiaries in their last year of life—a proportion that has remained steady for decades.
A large portion of these resources go towards care that is misaligned with patients' wishes or unwanted due to a lack of communication and planning about patients' end-of-life care preferences.
Advance care planning for serious illnesses or end-of-life can help transition difficult conversations into actionable plans so that patients' individual preferences are respected while improving the quality of care. But, making advance care planning scalable and actionable across health systems has been a challenge.
Koda Health launched five years ago to modernize advance care planning, streamlining the process of proactive health care planning and document completion.
Health tech company Guidehealth is teaming up with Koda Health to embed smart, compassionate planning tools directly into the clinical workflows of its growing provider network.
Koda Health is a patient decision support platform that navigates goals of care conversations at scale, driving total cost of care reduction and reduced utilization for patients by making sure that the care that they want is the care that they get," Tatiana Fofanova, Ph.D., CEO and co-founder of Koda Health, told Fierce Healthcare in an interview.
Fofanova started the company with Desh Mohan, M.D., who serves as chief medical officer, and Katelin Cherry, the company's chief technology officer. The founding team connected through the Texas Medical Center's (TMCi) Biodesign program, which tasked the team with finding solutions to issues affecting the world's largest medical center.
"One of the things that we were really interested in understanding is why, when seniors are aging, they often receive care that is misaligned with what they really value and what they really want. There's a lot of misaligned care that occurs, particularly during serious illness and towards the end of life," Mohan said during an interview. "Our question was, 'How do we make sure that we're driving care that individuals actually value, that they actually want? How do we get to that holy grail of driving goal concordant care?'"
Koda Health brings a scalable, digital-first approach to a historically complex and emotional process, noted Sanjay Doddamani, M.D., founder and CEO of Guidehealth. “By embedding Koda into our value-based care ecosystem, we’re equipping providers to have meaningful conversations with patients, reduce unnecessary interventions and ultimately improve the experience for families and clinicians alike," he said.
Koda serves more than 700,000 patients through its digital platform. Its advance care planning solution pairs a cloud-based ACP platform with an in-house 1:1 longitudinal ACP support and navigation. This allows healthcare organizations to provide scalable, personalized ACP without an increased organizational lift, according to the company.
Guidehealth, which launched in 2023, uses advanced technology to support health systems and clinical networks in scaling value-based care beyond the inpatient setting. Guidehealth facilitates care coordination like prior authorization and referrals and uses artificial intelligence to better predict the needs of patients. Guidehealth also assigns virtual clinical team members to work with its partner systems, called Healthguides.
"What's most exciting to me here is that one of the most challenging parts, and one of the most expensive parts of healthcare is end-of-life care. And, we do such a terrible job in that area," Doddamani said. "How can we modernize our approach to making advanced care planning more accessible and integrated into broader patient choice support that's at a platform level, at an enterprise level? So that's where we come in. We have all the data. We have Gen AI levers, including voice calls using AI. We have certified medical assistants who are well trained to manage basic blocking and tackling of everyday issues across care plans, but don't have the level of sophistication that Koda Health brings with advanced care planning."
Guidehealth supports more than 600,000 lives and partners with leading health systems and clinically integrated networks across the country to advance value-based care performance. The company provides a technology-enabled services platform that integrates directly into primary care workflows, enabling providers to identify high-risk patients, coordinate care and reduce administrative burden.
The partnership with Koda Health allows Guidehealth’s virtual Healthguides to integrate Koda’s full ACP platform, supporting everything from guided decision-making to real-time sharing of patient preferences across care teams. The partnership brings together predictive insight, empathetic outreach, and tech-enabled scale, executives said.
Improved processes for advanced care planning is imperative for providers managing large populations, Doddamani noted.
Health systems and clinically integrated networks face a large burden of high-cost advanced illness care needs. Koda Care’s digital advanced care planning solutions along with Guidehealth can seamlessly improve advance care planning patient interactions that enables better document completion for advanced care preferences, goals and advance directives. This ensures all care is value-based, personalized and clinically appropriate throughout their healthcare journey, executives said.
Koda Health provides scalable advanced care planning across populations, Fofanova said. "There is a wide variety of needs, readiness levels, comfort levels, both amongst patients and providers, for having these sorts of conversations with everyone involved in that patient's care. We make it easier to engage by making it a consumer-native experience, so patients are able to access it through any way they engage with technology, whether it's call, text, email, MyChart, access. Consumers also are able to access it at any level of illness severity, whether they're very healthy all the way up through the last year of life, and we provide really accessible entry points for each level of severity," she said.
Many advance care planning initiatives focus either on the documentation process or on providing end-of-life medical care, Fofanova noted. Koda Health's key differentiator is that its multi-modal approach makes the service accessible to both high-risk and low-risk patient populations.
"Not only do we have high rates of engagement, we have really high rates of engagement across race, gender and socioeconomic status, which is pretty huge, and when patients are able to define what matters to them, whether it's through the patient-facing web application, the portal, or through calls, however they choose to interact with healthcare, they're able to get the kind of care that they want, driving cost savings and appropriate utilization," Fofanova said.
AARP research shows that there is a willingness among older adults in the U.S. to prepare for the end of their lives. A survey of roughly 1,900 adults found that seven in 10 (69%) say the topic of end-of-life is generally avoided, most (85%) say they are comfortable with discussing death and dying.
Koda Health’s platform supports the entire ACP journey – from patient education and guided decision-making to electronic documentation and real-time data-sharing with care teams, the company said. In recent deployments, the company said it demonstrated significant reductions in unnecessary acute care utilization, high rates of patient satisfaction and significant cost-savings.
The company's digital ACP platform also benefits providers, Mohan noted. Paper-based ACP overwhelms patients and lack the specificity needed for effective use by providers.
"Some of the inherent barriers that we have seen, which is why Koda exists in the first place, and that's a very human problem. These are difficult conversations to have sometimes. And as a physician myself, I can speak for other providers, we often don't receive a lot of the training that is necessary to guide these conversations. There's often a lack of training, there's often a lack of time to have these important conversations, and also the toolset to be able to ensure this is a successful process," he noted.
"That's why Koda was developed in the first place is to provide the time, the training and the tools to really make this a scalable process. The exciting thing is that we've seen in our data is that not only have we been able to implement this in a scalable way, but we've been able to show tremendous impact."
Koda Health has a patient NPS score of 87, which speaks to patient satisfaction, according to the company. Eighty-five percent of users complete their ACP, 4X times the national average, and 68% of patients are more likely to enroll in appropriate hospice care.
Data shows that, based one existing deployments, unnecessary admissions to the hospital and unnecessary ICU utilization decreases while hospice use and length of stay increase. "These are often services that are not utilized as much as they should, and we see that goes up, and all that leads to tremendous savings for health systems. It's exciting to see that it's driving better patient experience, but also better utilization of appropriate services as well," Mohan said.
The healthcare system and federal regulators are focused on driving toward better value-based care, but it’s been a challenge to scale VBC at a health system level, Mohan noted.
“One of the things I think is really exciting about Guidehealth is they have an incredible model where they're really able to support these large organizations that are providing care to hundreds of thousands of lives that have traditionally struggled to figure out a way to really achieve value in these models, and they've now been able to support them,” he said. ‘I think in this first partnership there’s going to be a phase one in collaborating with Guidehealth, but I'm excited for the growth in our relationship, because I think that the value that we can create together, both in terms of better care, but also value for systems, is going to be tremendous.”
In 2022, Koda Health received $3.5 million in growth capital backed by Ecliptic Capital, Sigmas Capital, CRCM Ventures, Headwater Ventures and individual investors. It secured an undisclosed sum in a second seed funding round last year, also backed by Ecliptic Capital with Memorial Hermann Health System, AARP and the Texas Medical Center (TMC) Venture Fund also participating.
Memorial Hermann Health System also backed Guidehealth's $14 million seed round last year.