Interview with Dr. Ben Zaniello, Collective Medical Technologies

Dr. Ben Zaniello is the Chief Medical Officer and Vice President of Product for Collective Medical Technologies, a nationwide network covering every national health plan in the country, 30 million patients, hundreds of hospitals and health systems and tens of thousands of providers to improve patient outcomes. Dr. Zaniello has worked in care transformation for over a decade, most recently at Providence St. Joseph Health, the Seattle-based health system. We interviewed Dr. Zaniello about Collective Medical Technologies’ care coordination software, their recent expansion into the majority of Alaska hospitals, and their software’s ability to improve patient outcomes.

This interview has been edited for clarity and length.

Kylie Walsh: Tell me about Collective Medical Technologies’ applications, there are two: EDIE and PreManage?

Dr. Ben Zaniello: Yes, they are essentially in some ways the same thing. They certainly sit on the same data and the focus is making data actionable and useful at the point of care. What I mean by that is in the emergency department,  you’ll hear my bias, I view it less as product and more as just use cases, because I think where technology has really failed health care is that we’ve been very focused around solutions and not necessarily understanding the problem. And the problem in the ED, which was really how the company started, was about medical uncertainty and the fact that patients would walk into the ED and you didn’t know anything about them and what’s worse, is that you didn’t have time to figure it out. In our health care system today, you’re just seeing this high volume of patients in this very short period of time so even if there was data “out there” and the patient could even potentially provide some to you, you had no easy way to access it in a short period of time.

So, the first step was just connecting all these hospitals and pushing it into the EMRs such that you got this actionable report on every complex or high-risk patient, and again we could share data on every patient but then you get into that alert fatigue so we really want to focus on optimizing the provider workflow. So that was really the first step, but of course if you’re looking at the care collaboration in the ED, just having the EDs on is not ultimately successful, or I could say it’s successful but it’s not successful enough because once that person is in front of you, they’re already in the emergency department, the water’s a little under the bridge, everything you’re doing in therefore reactive. So what we started doing is bringing in the other members in the care continuum: skilled nursing facilities, ambulatory providers, behavioral health, health plans, all people that we having interactions with patients but in a highly fragmented way.

Our idea was to make it as easy as possible for these entities to get on our system and begin sharing data because at the end of the day, that’s going to drive better care for the patient if all of these providers are looking at the same playbook and not trying to do different things, undermining each other’s care plans.  So, that was the ED perspective and bringing these entities together, but when you step out of the ED, then it becomes a slightly different case of “How do I keep my patients out of the emergency room?” And one of those ways is creating a shared care plan and accessing a lot of the same data sources, like the prescription drug monitoring database to ensure that patients are not at risk due to their volume of prescriptions or type of prescriptions. It’s basically tying together these different data sources and putting the data into everybody’s workflow. For health plans there are the care and case managers who are getting active alerts on their high risk patients on the patients they’re concerned with. They’re informed if their patient has been in and out of the ED for the past week, so why is this patient going to the ED so much? Well maybe they don’t have a primary care doctor and that’s the health plan’s job, that’s not the ER’s job to find somebody a primary care doctor. So we essentially are allowing everybody to participate in the patient care in the best way possible in their explicit roles.

KW: And what states is CMT currently working in?

BZ: Well, working in hospitals is different than being live in hospitals. So we’re live in thirteen states so that’s all of the West Coast including Alaska, not including Hawaii, we just started working in Hawaii but we’re not live there yet. We’re live in 100 percent of hospitals in Washington and Oregon, every hospital uses us. I would say the majority of California, certainly not 100 percent at this point. We’re live in most of New Mexico and most of Alaska; we’re probably tracking to 100 percent in Alaska and New Mexico ideally by the end of the year. We have hospitals in Utah, where the company is based. We’re live in the majority of Massachusetts, in New Hampshire, in West Virginia, and I’m probably missing a state here. We have some Idaho hospitals that are live, again not 100 percent there. I think it ends up being around 13 states that we’re live in and I think we’ll be live in ten more in 2018. Today we have over 500 hospitals and over 1,000 other critical entities that are giving us real time data.

KW: You mentioned the roll out in Alaska; can you talk more about what that’s looked like?

BZ: So one of the tailwinds of what we do and I always emphasize really the pejorative use case when we advertise, but the opioid epidemic has been a huge issue in many states and we’ve had a lot of success with it in Washington and Oregon, and now California. Alaska essentially looked as us as an opportunity to address the epidemic. We were actually brought in by the Hospital Association along with the College of ED Physicians, the Alaska chapter to essentially create a paradigm in Alaska where all the hospitals are sharing data so they could identify and better care for high-risk patients, a high percentage of which, given Alaska and Alaska geography, had risk for the opioid epidemic.

And I want to empathize, again we’re a technology company and we’re very good at technology, but the success of our project is also because of strong governance and operations. So if you look at Washington and Oregon, in Washington it’s the ED leadership, the hospital association, in Oregon it is the Oregon Health Leadership Council. In Alaska we are run there, we are managed there by the head of their College of ED Physicians and their hospital association. We’re a technology company based in Salt Lake City, and I don’t want to undersell our technology, but at the same time, I always say we don’t save lives at Collective Medical. We enable providers to do a better job at their work, which is saving lives, and I think that’s an important distinction.

KW: Can you share any specific data on how Collective Medical has improved patient outcomes?

BZ: Our data out of Washington, and this how been borne out of three separate studies, including out of Oregon, show that in certain populations and generally most people focus on either Medicaid or the uninsured population and that’s happens to be the most expensive and the most at-risk population. And because of the financial nature of that care, they also tend to have the worst outcomes and the most medical co-morbidities. There’s a strong correlation there, let’s put it that way. But in the Medicaid population, for example in Washington State in our first project, we saw a ten percent reduction in ED utilization in the first year of the program. And when they looked at claims data that meant a $35 million savings. The project was actually built around a 5 year ROI of $35 million, so to see that in the first year, I would say really launched our company from an outcome perspective now a couple of years ago.

There have been smaller case studies as well. In the Tri-Cities they looked at care collaboration with and without our technology and saw a similar reduction in ED utilization with the people that were getting our reports, getting our reports about them.  Legacy Health in Vancouver actually had some internal data that they saw in their hospital a similar reduction in ED utilization with active use of our software and care plan. The Washington stuff was published a couple of years ago, the Legacy stuff is actually just last year.

But Oregon, even more excitingly, looked at the 2015 to 2016, and like everyone else with the ACA there’s been a huge demand for the ED, so it’s really hard to show in any kind of new study a reduction in ED utilization overall because essentially there’s just wide-spread increased usage of ED utilization across the county by everyone. All that said, when Oregon looked at their high-utilizer population, again their most expensive, most at-risk patients, they saw that they actually were reducing their utilization but in very specific ways, and I think this was the most exciting data point. They showed that within 90 days of putting in a care guideline into our system for a particular patient that reduced their utilization by a third, by 37 percent. So that’s exciting, because obviously that causes a reduction in ED visits, which is generally going to correlate to better care for a patient because you’re only going to be able to reduce that utilization if they’re going somewhere else and we’re going to assume that’s either primary care or ambulatory. And then the second exciting data point was that they showed this result in 90 days. So this is not an academic – you put in a care guideline for a patient and hopefully they’ll be better or hopefully this will create better costs someday – but that actually this can happen very, very quickly.

KW: I saw that Collective Medical recently secured $47.5 million in new funding, what does that mean for the company’s future?

BZ: We were a small, bootstrapped company that essentially spent pretty much 8 years focusing on Oregon and Washington and building up our care network there. Our plan is to use that money to do that everywhere else. I talked about the other states where we’re live and while some of those are approaching the 100 percent of penetration that we have in Oregon and Washington, our hope is to get that across the county because ultimately that’s going to be the most effective care collaboration network so that wherever you go, your patient centered care plan follows you. That was really how we entered Oregon because patients in Vancouver Washington were crossing into Portland Oregon and not having their information available. That’s also how we got our start in California as well, by following patients south into Northern California. But there’s a huge swatch of the county that we haven’t even begun to work in.

And I’ve worked in health care and health care tech for a long time. I worked in software for years before going back to medical school to become a physician. I think we all recognize that health care in general is in need of a drastic course correction and frankly, Collective Medical has the best opportunity of anyone to do this. Physicians hate technology, we’ve been so badly burned. EMRs just ruined all technology for physicians and this is the first time where I’ve been in a software company where people come up to us saying “I really love your software” or “We love what you do in Oregon, when are you coming to Iowa?” And that that opportunity to get to do provide that course correction in healthcare outside of patient care is just so exciting.