Duxlink Health, Florida based multi-specialty practice group with Duxlink Health Technology, the sister technology company, provides its unique integrated solution, Duxlink Tele-Hospital™. The solution focuses on one goal – “High risk Population Health Management to reduce unnecessary hospital readmissions.” The main product, Inter-reality Care™ (both On-site and On-line Care) provides hospital level of care for high risk patients in the post-acute care continuum.
The Upcoming Perfect Storm
Duxlink Health was formed at the inception of Medicare’s official reimbursement of Telemedicine in the US along with the shifting paradigm from fee-for-service to value-based care for cost reduction. Based on National Quality Forum 2017 Report, preventable 30-day readmission costs the US $25-45B annually, 5-30% higher than regular admissions. Recently in October 2018, Medicare just released a BPCI (Bundled Payment for Care Improvement)-Advanced program, extended the 30-day metrics to 90-day readmissions, which is much harder to achieve. For example, the 30-day readmission rate for heart failure is average approximately 20%, the 90-day is over 50% in the US, but can be over 90% in some hospitals.
The BPCI-Advanced program has not only elevated the clinical quality threshold, but also is posing a 20% of upside/incentives or a downside/penalties on the 1,300 hospitals nationwide in the US that already signed the contracts with CMS. This may accelerate estimated 450 hospital closures in the next a few years projected by Morgan Stanley in August 2018.
The Key Challenge
The fundamental problem of hospital readmission is the silo of patient data and care from all the entities, outside of hospital, due to lack of data integration and focused high risk care delivery. Although many programs have been trying to decrease readmissions using data analytics to identify high-risk patients, or administrative networking to establish preferred partners in post-acute care, yet the average national readmission rate has been flat with only ~1% lower based on American Health Rakings over the last six years.
Duxlink believes that in additional to analytics and networking, the healthcare industry has to deliver hospital level of care without sacrificing care quality in the post-acute care continuum, ie Hospital – In-patient Rehab Hospital – Nursing Home – Home Care – Patient Selfcare at Home. With this believe, Duxlink Health and Duxlink Health Technology have developed a unique Eco System of Tele-Hospital with multiple technical and clinical platforms of hospital level of care from integration of device, data, implementation and services in the post-acute care continuum, a huge under-served market to decrease preventable hospital readmissions for care quality and cost savings.
Assorted Services
The delivery of Duxlink Health Tele-Hospital is through Interreality Care based on homegrown technology integration of Duxlink certified EMR and Tele-care Platforms. The Interreality Care has two facets; On-Site and On-Line Care. The company offers a full scope devices based on clinical needs from simple vital signs to hospital grade 12-lead ECG, pulmonary function tests, ICU level telemetry for continuous 24/7 real-time monitoring, labs and imaging as well as intervention services outside of hospital.
Duxlink has elevated the current Tele-Health industry from primary care based low to intermediate risk care to specialty based high-risk complex care, such as active heart failure and acute chest pain. Usually, these patients are admitted to hospitals for observation. Now, the Duxlink service has On-site Integration with hospital grade diagnostics, such as ECG, labs and Imaging coupled with On-line Monitoring and a personal touch. The company’s High-risk Identification service contains clinical risk and utilization cost analysis on the entire care process and the Intervention Service delivers the implementation of the best practice for just-in-time intervention to effectively control the cost of the entire care continuum.
Paving its Way through Challenges
The only set of widely accepted and objective measures is both hard quality metrics (improved patient life quality or longevity) and cost at the same time.
Duxlink Health believes that to achieve the best costs, the ultimate goal should reduce all unnecessary hospital admissions beyond 30-day readmissions with more intensive clinical care outside of the hospital. Duxlink Health has made significant progress since 2016. Working with Memorial Healthcare System, the 5th largest public hospital system in the US, the Duxlink-Memorial trial demonstrated not only a 75% reduction of 30-day readmissions, but also 86% of all unnecessary admissions beyond 30 and even 90-days with $4.86M savings out of 112 super high risk patients with average 5 admissions/readmissions over 12-18 months.
Duxlink Health shares one of the most notable customer experiences which was related to a patient with multiple organ system failures. “Sanchez, the 68-year-old was suffering from hypertension, coronary disease, heart attack, multiple stents, bypass surgery, EF 25-30%, defibrillator, 2 mechanic valves, chronic renal failure, and COPD on oxygen 24/7. From early 5 months of 2016, Sanchez had 6 admissions/readmissions. In the last readmission, he had a cardiac arrest after getting into ER. The nurse doing CPR had a shock from his defibrillator. After surviving 15-day ICU/hospital stay, he was told to go hospice with only 6 months to live. But after getting Intereality care from Duxlink, Sanchez had no readmission or any admission for over 2 years, a saving ~ $520,000 as a single patient!”
“Recently, the patient developed atrial fibrillation which worsening both his stabilized heart and renal failure. We have to start a potent anti-arrhythmic medication which interacting with his blood thinner. With this, we have to perform labs, monitor him and adjust his medications for his heart failure, renal failure and blood thinner on daily basis remotely for the patient at home. Without the technology system and clinical care integration, this only can happen in the hospital setting today. With the continuous Interreality Care, the patient condition is improved without the need of hospitalization so far,” Dr Shen added.
Another example is a patient with acute heart attack. Stanley is an 87 years Veteran of Manhattan project in WWII. Later November, he had a chest pain at home and call 911. Ambulance crew evaluated him and kept him at home. One day before Christmas Eve, he had similar chest pain. The family thought it was a similar presentation as a month ago. However, since the Duxlink Health patient kit is available, 12 lead EKG was performed and the graph was transmitted wirelessly to Dr Shen remotely. Acute heart attack was diagnosed. The patient was treated immediately and transferred to the hospital.
With immediate communication, a cardiologist was waiting for him in the ER before his arrival to avoid long waiting time. While he was waiting for intervention, he unfortunately had a cardiac arrest. Luckily, he was successfully resuscitated, and 2 stents were deployed at 2 over 90% blocked arteries. He was able to walk out hospital 4 days later. The case illustrated the potential revolutionary role of tele-hospital on a patient with life-threatening heart attack diagnosed remotely in his bed room before his cardiac arrest.
Next Generation of Tele-Visit
In additional to the data management and care delivery of population health management on high risk patients, Duxlink has developed Interactive Apps, bringing next generation tele-communication, virtual or mixed reality of real-time face-to-face care with patients, family, related providers and specialty physicians remotely. With its patented platform integrating new virtual reality/mixed reality of 360º camera and its On-Site and On-Line care workflow, the Intereality Care can bring both virtual and physical experience and interaction to a new level for high-risk care in the post-acute care continuum.
The Leading Light of Duxlink Health
Michael Shen, the Founder and Chief Medical Officer of Duxlink Health, is a cardiologist holding 4 board certifications with expertise in Healthcare IT, Imaging, EMR/Analytics, and Device integration. He has enriching working experience in both technology industry and clinical care. After graduation from Yale University Cardiology fellowship, while working as the Director of Nuclear Cardiology at Robert Wood Johnson Medical School south campus, Dr. Shen established the 1st Cardiac Informatics Lab in the US focusing on analytics of procedure utilization in 2001. In 2003, he was recruited to be the Head of Cardiac Imaging & Procedure Utilization at Cleveland Clinic in Florida for over 11 years. When Medicare started reimbursement of telemedicine in 2015, he left the Clinic and founded Duxlink Health and Technology, focusing innovation and integration of technology and clinical care as the new Duxlink Tele-Hospital for high-risk post-acute care.
Foreseeing a Radical Future
Duxlink Health is building a Post-Acute Care Network (PACN) with partner alliances. The goal is to establish a service platform in the region and then extend it to the state and national level. Duxlink health’s Specialty Network for Acute Care (SNAC) utilize remote hospital level of technology to provide specialty care services and Population Health Management on high risk patients reducing post-acute care readmissions effectively and efficiently.
Leveraging its patented eco system of platforms and integrated clinical services, Duxlink Health is leading the post-acute care industry, managing top 5-25% of high-cost population (50-87% cost of the healthcare) with complex chronic diseases for population health management in south Florida. Duxlink Health is preparing for its mission of bringing the most reliable hospital care for the patients by integration and innovation of both technology and clinical services and scaling up on regional and national level.