Help in the trenches: Tackling complex chronic disease with AI powered clinical protocols
Every successful football team has a good quarterback — someone with the ability to step into the pocket, see the entire field and call the plays to advance the ball forward.
That’s how Dr. Karthik Ravindran sees his role as a primary care physician, engaging with patients to manage their whole health over the course of many years, ordering tests and calling in specialists as needed.
“I like to be in the trenches for the totality of it,” said Ravindran, who practiced through Tufts Medical Center for 10 years before a recent transition to Carbon Health, where he continues to see patients in person and virtually. “It’s not about managing in the short term.”
But in a health care environment that places ever-increasing demands on physicians to deliver both quantity and quality, providing the type of care that makes a real difference in patients’ lives can be difficult, Ravindran said.
That’s where Senscio Systems’ Ibis Health program, which combines AI-powered round-the-clock virtual care with clinical team support for comprehensive chronic care management, can help. Partnering with physicians to help support their most complex patients, Ibis Health allows medical providers to direct the focus of a patient’s care while leaving the day-to-day execution up to Ibis. Engaging patients in dynamic daily planning to take control of their own well-being, Ibis Health users report a 37 percent reduction in hospitalizations.
Ravindran serves as medical director for Senscio Systems, where he oversees the development of clinical protocols for the Ibis Health program.
The following conversation has been lightly edited for clarity and length.
First, tell me a little bit about yourself and why you chose primary care.
“I chose primary care specifically because I do enjoy the whole-patient management. It’s the difference between riding in a speedboat and trying to steer a cruise ship — it’s longer, more complicated, greater momentum, subsequently, too, it has its own payoffs. It does get messier, harder to pivot, and harder to do a lot of things that you can with a speedboat. But my interests lie in that, in the long-term relationships [with patients].”
You are perhaps becoming a rare breed, as it seems a lot of doctors are not entering primary care right now, or leaving the practice in droves. Why do you think that is?
“Our healthcare system is structured in such a way that it’s very top-down and not bottom-up, unfortunately. But there’s a lot of reasons. There’s quite a bit of administrative burden with primary care. [And…] there are not enough mental health and behavioral health supports [for patients] either, so as a PCP you are sort of pulled into things [that you are not specifically trained for]…because if you don’t do it, nobody else is going to be able to do it. It can get emotionally taxing, and emotionally draining, which also contributes to that attrition.”
What first attracted you to Senscio and its Ibis Health program?
“Managing complex patients — the ones who have numerous medical conditions, comorbidities, medications, hospitalizations — in a 5- to 10-minute [patient] visit, you can do it, but you do a really crappy job. There’s not a human way to possibly do it well. That breeds a certain level of helplessness in the provider. We’re sort of trained to be — and it’s not a correct ethos — but you are the one who is going to save the world and fix it, but you just can’t with the bureaucracy of the way health care is structured. It’s just not possible, and it’s not realistic either. People live 99 percent of their life at home and they spend 5 minutes in my office. That’s not their life. So what is nice about Senscio is the fact that it reaches into that 99.9 percent. If you come to my office and your blood pressure is great, but it’s crappy at home, that doesn’t mean a lot because you’re with me for 5 minutes. Just by virtue of having a brick-and-mortar clinic, you are limited in the insights you can have into patients on the ground. Senscio seeps into that interstitium and allows you [as a provider] to really get to know the patient, to see the patterns and the med adherence, where the blood pressure is going, when and how and what triggers it. There’s no way I can interrogate someone [in an office visit] and figure that stuff out reasonably.
“The other thing that attracted me was how do you prevent people from ending up in the hospital? The hospital sucks. So how do you mitigate things ahead of time? Barring catastrophes, a lot of hospitalizations, a vast majority of them, are preventable if you can sniff out the stuff that’s starting, if you can start to see the wheels falling off before you are completely in the ditch. With the Ibis Health platform … by monitoring and having people check in, you can start to see some of the bearings come loose, and you can bring the car in before you end up in the ditch. That’s rewarding [for a physician], to be able to prevent something, especially something that really sucks. And from a global health perspective, you prevent one hospitalization for heart failure, you are saving a ton of money for the system and for the patient as well, tens of thousands of dollars and ICU beds, when all it may have taken was an extra dose of their water pill. Being able to intervene and actually do something, that empowerment for me as a provider, it makes me feel good on the inside and it helps mitigate some of that institutional helplessness that exists in our healthcare system.”
What are some of the biggest challenges facing primary care physicians right now?
“The totality of medical knowledge and things you have to know doubles every couple of years now. With the knowledge comes immense amounts of data — we have new studies, new tests that come in, and in a lot of ways it’s like drinking out of a fire hose when you’re trying to manage patients in a very complex environment, balancing [specialist] providers and hospitalizations. And a lot of our system is very fragmented: data lives in six different electronic medical records from six different hospitals and nothing communicates with each other. All of that creates this very foggy and treacherous experience for both the provider and the patient. To be able to adequately manage that is quite difficult. Patients are overwhelmed by all the medical gobbledygook that gets dumped on them from hospitals and the doctor’s office, with canned instructions that don’t mean anything and meds with names that are hard to keep track of. From the provider side, information is everywhere and it’s very hard to keep track of and be actionable on it. … It’s not a seamless system, unfortunately.”
How does the Ibis Health program help cut through the fogginess that patients and providers experience?
“Just the fact that it touches patients in the interstitium: It’s not these episodic 5-minute [visits] where you have to cram in three months of life into 5-10 minutes all while trying to write a note and do all this other administrative stuff. … The member advocates have way more touchpoints than I could potentially even imagine [as a physician], they are virtually touching the patient constantly. They are touching base with them, there are clinicians keeping an eye on the vital signs in real time, making sure nothing hits the fan. As data comes in they are able to reconcile that in real time. If a patient gets discharged [from the hospital] and the meds are changed, but the patient doesn’t make the change [or they don’t take it because insurance doesn’t cover it], I may not find out about it in the office until months later, but Ibis is going to find out about it in real time. With a system like Ibis, you can identify some of these hurdles and hopefully intervene in a helpful way before three months down the road, at which point, you’re scrambling and you’re already behind.”
What are the biggest barriers to physicians adopting the Ibis Health program?
“Well, I think anything new is scary. … You get used to doing things a certain way, you feel comfortable with it, it may not be the most effective, but you know how to get through your day and provide enough care that you are not endangering anybody. So you feel OK. And anything that is new requires a little bit of bandwidth to learn, and people don’t have that bandwidth by virtue of the way the system is structured. And then, there are a lot of things out there. If you look at the landscape of healthcare, every single entity in the world wants to get in on it because there is tons of money to be made. … There is a fear of a loss of some autonomy, that this is just another one of those tech companies that wants to come in, pick up urgent care or pick up simple things that you would be compensated for if you manage it yourself. … A good PCP is also equally defensive of their patients. I get various garbage from wherever, and there are a lot of scam artists out there too. You become like a mother hen, you become protective, and immediately it’s just such a reflex for physicians to put the wall up.”
How is Ibis Health different from other programs that are out there?
“The thing about Ibis Health that’s actually really nice to me is that if you look at the landscape, every one of these other entities, they pick the easiest of the easy for the most part. … But the types of things that Ibis is diving into [with chronic care management], it’s the hardest of the hard, the thankless of the thankless, the burden of the burdens for our health care system. …There’s a sincerity to the mission that I don’t always feel like I see across the landscape, and that is a very attractive thing to me as a provider.”
To learn more about Senscio Systems and its innovative Ibis Health Program visit www.sensciosystems.com and www.ibishealth.org.
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