Serving the home health, home care and hospice industry since 1999.

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Michael Burcham

Dr. Michael Burcham is the CEO of Narus Health and a professor of entrepreneurship at the Vanderbilt Owen Graduate School of Management in Nashville. At this year's leadership conference of the National Hospice and Palliative Care Association, his keynote presentation was met with a standing ovation and cheers, plus more than a few tears.

Burcham detailed the disruptive forces threatening to change the social and economic structure in which hospice and palliative care operate today. He believes palliative care, heretofore the red-headed step-child in the healthcare basement, is ripe to be recognized as an equal care category on the continuum from curable disease to terminal illness. Payers are finally beginning to see that it serves twin goals, lowering costs and centering care around patient need.

7 Variables That Define Our Future

1. Patient Experience: this is our product.
The Future demands continuous, meaningful interactions with patient and family.
Technology: secure messaging.

2. Help with the Hard Stuff: proactively predict and mitigate risks.
The Future fuses management of the 'soft issue' data with the clinical data.
Technology: non-medical tools to record symptoms, behavior, family support, access to care, medical literacy.

3. Structured Care Plans: It's all about the data.
Future care plans must capture patient reported data; enable search, analysis, best-practices; and become a source of outcome data.
Technology: expand clinical systems to incorporate key personal attributes: issues, goals, actions, outcomes.

4. Scalable Service Design: people, process, technology.
The Future care team must evolve to include personal visits, phone, secure messaging, and video encounters. 
Technology: low-tech remote patient monitoring to include daily automated phone contacts.

5. Right Resource. Right Time: focus on risk and complexity ID.
Future designs will include digital triage via daily data ingest to identify those most in need of support, early in their journey, to manage the referral downstream. Care continuum partners will become risk partners.
Technology: data analytics

6. Patient & Family Connection
The Future involves thoughtful and personalized connections; communications to engage patients and families.
Technology: decision support tools; documents on phone; video messaging; online marketplace of community support resources.

7. A High-Quality Network: We must escape from our silos.
The Future demands a best-in-class network of providers, linked on behalf of patients.
Technology: communications systems: simple, compliant, comprehensive.

"We have deep expertise in understanding how the healthcare system works (and doesn't)," he said, introducing the source of his expertise and passion. Burcham experienced the death of his mother, his father-in-law, and his son within a few months of each other in 2015. He spoke of the book he wrote about his son, The Mask: A Father's Reflections of Loss:

"I have written this book to honor my son Ryan, and to share my journey of grief after losing him. The weight of sadness is often too heavy for conversation; so I’ve tried to share my feelings in poetry and thoughts. Love never dies - neither will my grief. But with grace, it is teaching me to be a better man. I’ve made a conscious choice to embrace grief; To reflect on its lessons as I write about the journey. These are my thoughts from my first year of loss. I never knew I had so many tears."

Disruption Destroys the Unprepared

Describing hospice as a calling, not a job, he observed that hospice and palliative care workers still too often focus on "what our organization does" and too little on "the benefits we provide the customer." "This makes us blind to an aging business model," he asserted. "The consequences are well-documented."

  • For over 100 years, people harvested, delivered, and sold ice. In the 40’s, the refrigerator was invented and that profession disappeared.
  • Blockbuster failed to take the advent of on-demand, streaming video seriously.
  • Kodak, which invented digital photography, was eliminated by it.

Burcham believes some healthcare organizations are heading for the same fate. "Just look at the era that was born in 2007, 'The Age of Acceleration.' Providers of services that empower consumers became possible that year thanks to faster microprocessors, massive storage capacity, open source software, the iPhone and Android, social media, big data tools and online video. New entrants are built to support active patient engagement by helping patients manage their health and care."

In the past 10 years, acceleration has changed every industry, including healthcare. "My entire banking and net worth are on my phone," he said, "and yet we don’t feel people can manage their own healthcare. Remember the industry that thought people could not make their own ice."

The task at hand now is to separate information from noise. He sees three powers that have evolved from these technologies:

  1. The Power of One: A focused individual can make a lot of noise. (e.g. Trump on twitter)
  2. The Power of Flow: A few like-minded people can start a trend (e.g. Parkland survivor students)
  3. The Power of Many: If we all agreed on the message, we would change the national conversation.

"90 percent of all the world's information was created in the last 24 months," he asserted. "Many of you got your clinical degree over 30 years ago. Thank about that. We may produce perfectly compliant patient records but there are entries missing: How does the patient feel? What are today's symptoms? How do you feel about your estranged son coming home? Why are afraid to talk to a pastor for the first time in years?"

The 5 Trends Shaping Our Future

  1. Fusion of Data. Demand for Value. The Growing Healthcare Economy: Technology is permeating every part of our lives.
  2. Innovation Opportunities emerging from this fusion:
    • Everywhere care: from hospitals to lower-cost locales.
    • CVS/Aetna and Walmart/Humana mergers reveal futurists' belief that people will turn to retail outlets for their care.
    • Preventative care: shifting disease management from reactive to proactive.
    • Personalized care: shifting from mass generalization to customization and precision. "We will not and cannot continue to treat every cancer patient the same."
    • Aging, Chronic and End-of-Life care: shifting from institution-based to community-supported, with data and technology support.
  3. Mobile and Technology Engagement Growing in Care Management
    • Nearly 40% of health care consumers looked online for information related to health and treatment. 
    • 18% of those surveyed consulted a provider using secure messaging, video chat, texting or email.
    • This shift occurred in less than a generation.
    • "There is nothing more terrifying to a caregiver than 'Dr. Google.'"
  4. A Move from Traditional B2 to a B2B2C Strategy:
    • online access to a physician
    • ubiquitous telemedicine services
    • expanding consumer choices
    • bundles of hospitals, MDs, other providers into integrated systems
    • self-insured employers financing their own plans
  5. The Shifting Workforce
    1. Decreasing number of Baby Boomers
    2. Increasing number of Millennials and GenXers (oriented more toward Urgent Care than to a regular physician)
    3. Sample consequence: over 71% of Millennials self-search and text as their preferred form of healthcare interaction

The Law of Disruption

Declaring that today your Zip Code+4 is a better determinant of health outcomes than your genetic code, Burcham defined the law of disruption. "While people change a little at a time, technology is changing exponentially; even the rate of innovation is increasing. People in an industry fail to appreciate the nature, extent, and velocity of the changes taking place. It starts at an industry’s edge, among small companies that have nothing to lose and are able to focus on solving problems. They bring in new business models, leverage new technologies, and change the customer’s expectations of what 'good' might be."

If there is a single sentence that can capture his message, Dr. Burcham suggested it would be, "Ask not what disease the person has -- but rather what person the disease has." No two patients with the same diagnosis need the same thing, he admonished. "Care triage must be optimized by a daily data update."

Burcham surveyed over 100 families regarding that they thought would enhance their own care management experience. They want: Give me my own data; listen when I report my symptoms; message my family; and give me 24/7/365 access to caregivers. "Remember that the concept called "The Care Continuum" only exists in our minds. Your patient has no idea when they've left one type of care and entered another. They do not think in terms of which silo they are supposed to be in." 

Michael Burcham founded a non-profit foundation, the Nashville Entrepreneur Center, to support healthcare entrepreneurs. He is also working with UBS to teach people how to plan for unplanned events, responding to the statistics that 60% of all bankruptcies are caused by an unplanned medical event and that 50% of people are bankrupt when they die.


©2018 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. One copy may be printed for personal use; further reproduction by permission only.