Hello,
We’d like to introduce you to Orchestra Health. A new healthcare venture. Before we begin. We wanted to briefly talk about our perspective on the healthcare industry, Orchestra, and our writing.
Healthcare is fragmented. That's not a novel insight, but we wanted to set the context beyond healthcare is broken, which we think is a decidedly less helpful statement. Our opinion is that this fragmentation is going to get worse, not better. Without proper tooling the ability for healthcare professionals to deliver care will be impeded.
Many (too many) healthcare firms talk about how healthcare is becoming unbundled. If you’re unfamiliar, at its core this simply means that many healthcare services that used to be delivered broadly now operate in a more specialized manner. Some examples of this are the plethora of virtual & home care companies that have spun up over the last five years along with the skyrocketing demand for ASCs, direct-to-consumer practices and virtual care platforms focusing on a narrow scope of conditions.
At the same time private equity has been increasingly buying smaller private practices as investment vehicles. So while more and more of the hospital’s services are unbundling to smaller private practices, more and more of those private practices are being wrapped up in private equity networks.
Private equity (PE) is not a monolith buyer, but many smaller buyers acting similarly. Which means that even with these PE networks purchasing and consolidating private practices healthcare remains plenty fragmented.
In addition, PE firms tend to operate in one of two ways: buyout care providers vertically (ideally in a geography) and control the rails or buy similar groups of private practices (e.g. anesthesia groups, ASC facilities, PCP practices) and group them together in order to develop some scale economics. Both scenarios leave a lot to be desired from a coordination and interoperability point of view.
The problem with healthcare today is a failure to communicate.
There are no systems that properly connect one provider to another. EHRs have made this famously difficult and allowed a cottage industry to spring up in its wake. However, healthcare used to be centralized around their PCP and a single hospital, giving the patient some ability to keep all of their interactions, and health data, in one space over time. That is no longer the case. As it’s been noted, healthcare has left the building, which means that we need a better way of communicating not just within organizations, but across them.
Which brings us to our approach. Orchestra Health offers care coordination as a clinical service to surgical providers to improve their utilization & health outcomes. We standardize patient intake & triage, manage documentation prior to surgery, and facilitate the transition post-surgery. Instead of every stakeholder talking to every other stakeholder, in our model everyone talks to us and we act as the source of truth for the state of each patient's care journey.
We’re starting with surgery for two reasons: (1) the complexity and (2) for the patient.
Outpatient surgeries have doubled over the last ten years, and they will double again over the next ten years. The vast majority are moving to ASCs, which are independent and often physician owned compared to an outpatient surgical center (OSC) or a hospital-based outpatient department (HOPD), which are typically owned by hospitals. Surgery can be the most complicated healthcare you receive in your life, and it’s increasingly often being conducted by a facility that has no knowledge of your existence or health history until after you’ve been referred.
Surgery can be complicated and scary. Every American knows that healthcare is a mess but most of us hope that when the stakes are this high and the care this complicated that things would come together and start to work. Unfortunately, that is not always the case. When lines of communication break down between surgery centers, PCPs, and the patient’s specialists the burden of relaying information is often placed upon the patient.
You can imagine how efficiently healthcare proceeds when the patient is responsible for moving things forward (it doesn’t), as well as how much gets missed when the patient is responsible for relaying all said communications (a lot).
The bottom line is that this affects everyone’s bottom line. The surgeon’s, facility’s, and patient’s. Poor communication leads to surgery delays and cancellations. This is significant, because in a fee-for-service world you need to perform the service in order to collect the fee. From the patient’s perspective, an ounce of prevention is worth a pound of cure is not just an adage. Delayed care is more expensive care, and the price for the patient can be more than monetary.
If you’re thinking that this all seems pretty dire, we agree. However, there are a couple tailwinds at our back that make now a good time to solve this problem: (1) trends and (2) regulations.
As we mentioned, the number of outpatient surgeries will continue to increase as surgical care is unbundled from hospitals, which means the patients and types of surgeries performed at ASC’s will become more complex as care boundaries are pushed. We’re coming at this problem as providers are right in the thick of it. Ten years ago care coordination for these types of surgeries was much less common and annoying to deal with. Today, we’re starting to see serious cracks and delays with delivering care. If we do nothing, delays and cancellations are not just going to be common, they’ll be expected.
We think the pandemic is going to be seen as a major catalyst for innovation in healthcare. Changing regulations around who can deliver care and where it can be delivered means that the variety of care models will explode over the next 5 years. Coordinating care in a remote, asynchronous fashion and getting reimbursed for it would not have been possible 10 years ago, but it is now.
Briefly, we’ve decided to look towards much more accomplished writers and adopt rather than invent. In this case we’re borrowing from The Economist and opting not to include bylines. This also means that we’ll be speaking in the first-person, plural. We understand that this can be a little jarring but the goal of this decision is two-fold. Content over character and quality over quantity. We want the content of the information we share here to take front and center rather than the person. Additionally, we would prefer quality and cohesive thoughts over the quantity of content that we publish. By eliminating bylines, a single voice with a consistent opinion is left to tell our story.
