by Brett Long
The problem we solve: Due to lack of full interoperability among health IT systems, health providers and payers often have limited knowledge of what patients and members are doing in the home. Failure to comply with medical and nutritional discharge requirements can lead to extraordinary costs for the health system and lower quality of life for patients.
About our solution: RDnote Home utilizes its clinical nutrition expertise to flag high-risk patients (in providers' EMR data or payers' claims data) who could benefit from specialized nutrition case management. After flagging patients, who enter the RDnote's queue, RDnote's protocols generate best evidence-based interventions corresponding to individuals' particular needs. Whether it is a daily text message, a visit from a community health worker, or an in-home consultation with an RD, RDnote Home addresses the needs of patients in the home before their problems become more acute, at great cost to patients and to health organizations.Progress to date:
We have an existing hospital customer who has purchased our inpatient software and is eager to deploy RDnote Home with its home health partners. We anticipate piloting it in Q1 2018.
We are in discussion with two health insurance organizations about piloting RDnote Home to validate its cost savings.
Creator: Brett Long
Education: Harvard University
Bio: Brett Long, Director of Finance and Operations for RDnote, has experience in both the private, public, and non-profit sectors. As a former director of a startup incubator program, he contributed to the creation and scaling of dozens of new for-profit and non-profit ventures. Moreover, as a former auditor, he conducted audits of several healthcare agencies throughout Louisiana. He also worked for a seed capital venture fund based in New Orleans. As a graduate of Tulane and Harvard, he will be completing the CPA exam in 2018.
Hospital Affiliation: Lafayette General Hospital
Title: Director of Finance and Operations
CEO, B.S. in Engineering; Registered Dietitian
Biography: Molly Hegarty, Founder and CEO of RDnote, has a BS Engineering from the University of Michigan and is a Registered Dietitian. She has worked as a process engineer at Intel, a dietitian for the petroleum industry, and a software development product manager. In the nutrition field, she was a 2016 Nominee for Outstanding Dietitian in Louisiana due to her successful implementation of nutrition-based wellness programs in Chevron’s Gulf of Mexico Business Unit. Her work has been recognized nationally by the Academy of Nutrition and Dietetics and she has been a featured speaker at national and Louisiana based nutrition conferences. She completed her Dietetic Internship at the Tulane School of Public Health.
Advanced Degree(s): B.S. in Engineering; Registered Dietitian
Based on their particular needs (daily text messages or calls, community worker visits, RD telehealth consults, etc.), patients receive targeted nutrition case management to help them manage their chronic condition(s). Nutrition has an outsized impact on outcomes, backed up by research because all patients, regardless of disease need to eat every day. In our discussions with patients, we have heard that patients find interacting ith the external health system byzantine and needlessly bureaucratic. Often they have only a simple question they need. Even a short interaction with a health professional can provide the insight and support they need to better manage their conditions. Readmissions are not only a huge driver of costs: they are also indicative of a problem becoming acute. Often this does not have to be the case. With our light-touch, targeted interventions, we can improve patients' quality of life and help them live healthier lives.
Physicians in hospital environments benefit from how our software reduces queries and charting time while improving care. Clinicians are grateful for tools that improve quality of care, especially in areas that are not their area of expertise. Nutrition is a perfect example because most clinicians receive minimal training in nutrition but welcome the opportunity to include best practices as part of their patient care. RDnote uniquely integrates with the medical record to reduce clinician burden of documentation and improving patient care at the same time.
“RDnote is simple to use, effective and positively impacts patient care.”
- GI Surgeon
Outpatient physicians benefit from referrals and increased revenue from diabetes counseling services as well as access to tools that improve nutrition care planning and compliance data for patients.
RDnote uses a nutrition focused case management approach to improve quality and cost of care for payers and providers. Nutrition is an underutilized high impact driver of care. Our inpatient and discharge planning tools drive revenue and improve quality of patient care while reducing clinican documentation times for hospitals. After discharge, our tools empower providers and patients to improve the quality of nutrition care provided and fed back to clinicians in the EMR, improving coordination of care, reducing readmissions, and improving patient engagement and satisfaction.
Suboptimal management of chronic diseases results in readmissions, for which insurers are increasingly feeling financial strain due to an aging population with chronic diseases. Insurers have trouble even communicating with their members, much less improving their health. RDnote Home helps health plans to acheive quality, clinical, and business goals by creating more effective and reliable communication and engagement with patients through its secure platform with nutrition focused case management and risk stratification. RDnote has the benefit of realtime patient discharge data from local area hospitals which allows faster and more effective ways to improve quality of care after a patient leaves an inpatient setting. This targeted solution will address poor disease management in the home, which over time will save payers millions while also improving quality of life for their members.
While RDnote has several products and services that address the entire continuum of care, this answer will focus just on RDnote Home, our home health product.
For the purposes of RDnote Home and its focus on diabetes, the cost of diabetes in the United States exceeds $245 billion per year (http://care.diabetesjournals.org/content/early/2013/03/05/dc12-2625). On a global level (Since RDnote Home is a digital product, we anticipate having businsess globally), 425 million individuals have diabetes (http://www.diabetesatlas.org/).
Research states that the 2018 cost per case of Medicare patients just with Type 2 Diabetes will be $13,102 (http://www.unitedhealthgroup.com/~/media/uhg/pdf/2010/unh-working-paper-5.ashx, p. 44). The report contains figures as well for Medicaid, commercial, and other types of patients. Further research states that 18.9% of Americans who are Medicare beneficiaries have Type 2 Diabetes (https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS/Downloads/Diabetes_DataBrief_2017.pdf) and that there are ~44 million beneficiaries (https://assets.aarp.org/rgcenter/health/fs149_medicare.pdf) enrolled in Medicare.
44 million beneficiaries * 18.9% = 8,316,000 beneficiaries with Type 2 Diabetes
8,316,000 patients * $13,102/patient = $108,956,232,000
The market is $108 billion just for Medicare. This does not include the amounts Medicaid or commercial payers are spending on diabetes (the $108 billion figure also ignores Type 1 Diabetes). Given the growth of the Medicare population, we anticipate this market will only continue to grow.
Projected 3 Year Growth
We intend to expand our inpatient and home health software to 6 hospitals in 2018. During that time we also hope to be piloting with at least 3 insurers to validate the cost savings of RDnote Home.
We also hope to partner with one large nutrition company, who will use our real-world nutrition data to improve their research and sales capacity. Finally, we would like to obtain one partnership with a digital health company who will desire to use our nutrition data API to enhance their own product offerings.
We hope to double all of the above numbers by the end of 2020 and, in so doing, be in a position for a successful acquisition.
How We Will Make Money
(This answer applies just to RDnote Home--each of our products has its own revenue model)
Health providers (hospitals, home health agencies, etc.) will pay for RDnote Home to avoid readmissions penalties and improve quality rankings. We anticipate 1-3 year contracts as we have done for our inpatient software.
Payers will pay for RDnote Home through a 1-3 year software subscription model as well. Their value proposition is greater cost savings.
About our Competition
(This answer applies just to RDnote Home--each of our products has its own submarket and corresponding competitors)
1) Omada Health
3) Other competitors such as AgaMatrix do not do exactly what we do, but, as manufacturers of devices and sensors to manage diabetes, they are a competitor inasmuch as they are part of the overall spend on diabetes. We differentiate from them by focusing more on providers and payers and less on pharmaceutical companies.
4) Beyond these three companies (and their analogues), AngelList alone lists 194 companies working in diabetes in some form (https://angel.co/diabetes).
Our plan is to win our share of the market through a superb patient experience and seamless ability to work with large institutional health organizations (providers, payers, etc.) to create a more interoperable and efficient system for all.
Progress with Customers to date
We have one current hospital customer and are negotiating pilot terms with our second hospital customer.
We are also discussing the possibility of a pilot with two insurers.
New Orleans and Our Company
Molly Hegarty moved to New Orleans in 2010 to complete her Dietetic Internship at Tulane University School of Public Health. Since that time she has successfully worked across New Orleans and southern Louisiana to improve health outcomes in resistant populations that struggle with obesity and chronic diseases impacted by nutrition.
Brett Long is a New Orleans native who returned to the city after graduate school to work in the city's startup community. The chance to be a part of a company with profound social impact that can also be a boon to the greater New Orleans startup culture is a dream come true.
RDnote is indebted to New Orleans and its startup community, which was a source of much mentoring for the founding team, for its success. The members of the founding team live in New Orleans and plan to do so indefinitely while growing RDnote with respect to both monetary and social impact.
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