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INTERVIEW: Clinically Meaningful Improvement for At-risk Patients

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Ryan Carlson
October 4, 2021

In our video health data series, "Leaders in Leveraging Health Data", we chat with Hiren Doshi, CEO of Brilliant Care.

Improve the clinical status of at-risk hypertensive or diabetic patients through data.

Are you addressing patient situations before they escalate? Having the right data can enable you to intervene at the right time with your at-risk patients.


Brilliant Care with Hiren Doshi: Clinically Meaningful Improvement for At-risk Patients

Ryan Carlson: I'm Ryan Carlson with Healthjump and I'm here with Hiren Doshi from Brilliant Care. He's the Chief Executive Officer. Thank you for joining us today to talk about Brilliant Care. 

Hiren Doshi: Thank you for having me Ryan. 

Ryan Carlson: So my first question is, give me just a brief synopsis of Brilliant Care. Who are you and what customer do you serve?

Hiren Doshi: Brilliant Care focuses on helping healthcare organizations proactively identify at-risk hypertensive and diabetics, and essentially focus on population health management. And then we do this by using personalized nurse care coordinators with high-touch care coordination and advanced remote technologies.

So we use this combination of these three. To help take at-risk hypertensive or diabetics who are uncontrolled and bring them under control and essentially improve health outcomes. 

Ryan Carlson: That's fantastic. So are you working with accountable care for value-based side of things as well for looking at the preventatives or to prove out those prevention plans? Tell me a little bit more like some of the areas in the actual business that you serve. 

Hiren Doshi: So, essentially we serve practices, and this can be anyone from a small practice to a large practice, a multi-specialty however greater application for this is by primary care providers, family medicine, providers, geriatricians, cardiologists, endocrinologists, nephrologists. Those top specialties.

Then we move on to ACOs where ACOs are heavily focused on total cost of care and they are always trying to see how, what can we do to minimize unnecessary ER visits, or what can we do to minimize unnecessary hospitalization and many of the things we do, in fact, everything we do is heavily focused on improving that access to care and, pro and preempting situations before they get escalated and, nipping it in the bud, if you will.

So that's how we help ACO. And then with systems the objective becomes a little different depending on what kind of system it is, it could be for the, our primary care facilities or clinics. It's the same agenda. However, they also have a need of how do you minimize the readmissions? How do you take patients at discharge and, provide them that enhanced care so that they don't show up back in hospitals.

Ryan Carlson: So is this one of those programs where you're sending the patients home with either some sort of remote connectivity or some closing the loop service. 

Hiren Doshi: Exactly. Basically what we do is, send patients home with remote devices. Based on the condition. So it could be a blood pressure cuff or a blood glucose meter or a weighing scale.

And based on the condition of the patient or the physician, the provider decides what's the most applicable one. And then a dedicated nurse care coordinator is assigned this patient. Who's essentially ensuring compliance for physicians protocols. Ensuring that their vitals or readings are staying within bounds.

And if they get escalated then they triaged them that what's going on? Are they not complying with the medication or are they not complying with a care plan. Or is it the treatment not working? And do they need to be seeing the doctor again so that something can be adjusted so essentially one way or the other, either by improving compliance and medication adherence, we get patient into better outcomes or by changing the treatment plan, we get them to better outcomes.

So essentially we achieve success one way or the other. 

Ryan Carlson: That's fantastic. So that's is supporting all systems. Now, are you a referral from the primary care physician? 

Hiren Doshi: Correct. 

Ryan Carlson: It is. And so you're providing the, nursing and and that's from your staff, right? Brilliant care provides that oversight.

Hiren Doshi: Correct. So we essentially act as a service provider. And we like to act as an extension of the practice to provide patient continuity of care. So we provide technology, devices. So, both hardware and software technologies and nurse care management, and that's the total package we provide and then act as their service provider to deliver the service turn-key.

Ryan Carlson: Yeah. So I've had interactions with a lot of tele-health. My wife's actually a provider who does telehealth for, mental health. And one of the challenges is when it's a referral and doing work on behalf of another practice is access to the records for the person that they're dealing with.

I'd imagine that since you're logging all of these different vitals logging into the practice EHR and then recording everything in the, you said that like in house, how is that all being facilitated. 

Hiren Doshi: So we worked directly with each practices' EHR, and in fact that's where Healthjump comes in. Healthjump has been a great partner of ours in helping us integrate with EHRs. So that we are accessing data directly from the EHR and posting it back into the EHR. 

Ryan Carlson: So you're, taking advantage of the, write-back to put the remote, the vitals and all of the information into the appropriate table. Okay. That's cool. Yeah. And then the as far as the technology side, you have a bunch of different partners that you're using.

Cause that home connectivity piece I've seen it explode, especially with the pandemic, with all of the push to remote care. Are you seeing an uptick in adoption of the at home monitoring. 

Hiren Doshi: All, these devices which are available in, with different levels of connectivity, in fact, we use cellular based devices. So, Our goal was we, deal with a population which is more older. Yeah, it's as this is a Medicare CMS reimbursed service. 

Ryan Carlson: Grandma does not pay for high-speed internet. 

Hiren Doshi: Correct. So, our goal was, and even then, even if they are willing to pay an even if they have it, they don't know how to connect with Bluetooth, how to pair.

So we took all these devices. We especially pick devices which are cellular enabled. So when they get these devices at home, all they do is turn them on, take a reading and the reading, it comes via cellular networks to us within 30 seconds. So it's seamless and it's very easy. 

Ryan Carlson: And so I imagine you're getting to intervene because it's not even waiting for the next visit. It can literally be, we can intervene within 30 seconds or do you prioritize the level of notifications? 

Hiren Doshi: Bingo. So, what we do is not not every reading ,is a is, is a crisis. You know, they are different. And we essentially treat them with a different level of priority. emergent reading, then it means we'll attend to them right away cause we could end up, uh, 

uh, saving a life or preventing uh, an unnecessary or an avoidable health emergency. And we've done many blood, pressure reading. And if it's 200 over 120 that is a problem.

If you pick up the phone and you triage it with the patient and you look. They have not been taking a medication and maybe you can do something or go let's, get you in to see your doctor before you get a stroke. 

Ryan Carlson: Great. So I want to pivot to the accountable care organizations and some of the individual practices.

You, mentioned that you're actually going to help them look at their data. Are you able to then mine things and find oh, here's everyone that hasn't had their A1C checked in the last six months? Here's a program. that, Are you making proactive recommendations on their behalf?

Hiren Doshi: Indeed. So what we do is we mine, mine, this data, and we look at every everyone who's uncontrolled hypertensive, which is considered a blood pressure, 140/80. Or A1C levels about eight some organization look at about seven. And then depending on that if patients had this reading last time, they came, which was a year ago, and then you don't have a better reading, which means chances are, they are still sitting at that level. So essentially we draw attention to a practice and we tell them, these are the patients you need to be looking at. And usually what happens is 20% of these patients who are uncontrolled are already scheduled to come in and for them, what we do is we help draw attention by doing charts so that when a physician sees a record, they just see, okay, this is the patient who needs a little extra attention. And then the, remaining of the patients who are not scheduled to come in, fact, they are the bigger candidates for this enhanced service. So we tell them, use your list. Uh, Let's let's attack this list.

Let's call these patients in and essentially by going in a very hyper-focused fashion, they're able to bring in the patients who would benefit the most. 

Ryan Carlson: So, given that it's really hard, I hear this a lot from accountable care organizations, the ability to find groups or patient populations that are at high risk are really hard, where typically, if I wanted to get, look up information about an individual, I need to know their name, what practice they're at, and then request their A1C levels. So how are you getting around that, that, that challenge that the standards are just getting in the way of. 

Hiren Doshi: Yeah. So it depends on the accountable care organization.

So some organizations are well integrated where they do good consolidation of data, of all their member practices and they're the, MSO plays or the ACO plays an active role in working with the patients. uh, And others are loosely associated, loose associations of individual practices.

It's easier to do this where it's the former than the latter. However, in both cases, ultimately keep in mind accountable care organizations ultimately depend on individual practice care centers. So really they then recommend us to the care centers and the care centers have to take a proactive role. 

Ryan Carlson: So because you are actually pulling Uh, the the data and you're getting all of the data. And you said that you're, doing data mining, I suppose that means that's how you get to then run based on your, your partnerships with the individual practices. 

Hiren Doshi: Correct. 

Ryan Carlson: So you, get to actually see that full data spectrum and run the analysis, and that's how you're actually able to go back from their own data. 

That's actually really cool. That's, something that not a lot of places are able to. Based on my conversations with others. 

Hiren Doshi: So indeed, and that's where we saw big white space where everyone cares about. If you look at it from a patient perspective, provider perspective, ACO perspective, or payer perspective, they all cared about who are these patients who are at risk, who going to either have episodes, which are not going to be desirable from an experience of health perspective or other biggest worries of physicians. That's what keeps the physicians up at night that what's happening to those patients of mine. Cause if you go and ask a physician, your at-risk hypertensives, what are you doing about it?

And the answer is I address and attend to them as they show up. Can we change it? Cause we have all this data and we proactively bring them in. And if we proactively bring them. And then we improve their compliance and, show them their reading. Cause if they see their readings every day and if they get a reminder of, they're not taking their medication every day, so we are putting them on a better course than they've ever been.

Ryan Carlson: So, do you have a, like the big light bulb? I imagine that you've got a lot of results. Is it a really positive picture? What, type of results do you see with this early intervention? 

Hiren Doshi: So that's a great question. The results we are seeing is, outstanding. It is so unbelievable where in 90 days we see 85% of all patients who are on the program and show clinically meaningful improvement in blood pressure readings, one in go from uncontrolled to control in less than 90 days. 

An average drop for patients with blood pressure over one 60 systolic is 30 points, which is a ridiculous number. So, essentially what we are seeing, and this is just in 90 days. And by the way, the effects start as early as within two weeks, because what happens is in most cases, patients fall off and, our companies only goal is high patient compliance. So we have such high patient compliance greater than 90%. 


 Because all our systems are designed around high patient compliance. That is our only single metric that our company cares about every day. That what was our patient compliance yesterday? And if it is below 90%, then we are like, why was it below 90% and we are so hyper-focused on that. As a result, what we are seeing is these kinds of clinical outcomes. So, Physicians who work with us are very happy and, healthcare organizations who we share this data. our, are floored.. They are like, oh my God, is this really possible? 

Ryan Carlson: So what I love of about everything I've heard is that you're taking healthcare data. You're getting the hard stuff that normally you can't get You're leveraging it. But most importantly, it's not just leaning on technology, but it's empowering the human in the loop. Yes. That compliance is just like a personal trainer. You hire a personal trainer to give you accountability and you want to do good.

Hiren Doshi: Right. 

Ryan Carlson: It's the human touch, that human interaction that, that makes people want to do better. And so I love the work you're doing. Thank you for sharing your story. And we look forward to hearing from you in the future. 

Hiren Doshi: Thank you for having me. 

Ryan Carlson: Absolutely. Thanks. Take care.

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