Non-Profit Noora Health (YC W14) Reduces Readmission Rates | Hacker News Reader

Non-Profit Noora Health (YC W14) Reduces Readmission Rates

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54 pointskevin22 comments

This is absolutely fantastic. Patient education is one major and crucially important part of healthcare beyond hospital/clinic walls that is often overlooked because staff don't have time and don't 'dumb' things down enough for the average patient to understand. One thing that may be useful would be an online portal with videos/quizzes for patients to reference after discharge. Often times patients will express understanding of the education they receive only to, presumably, forget it all when they get home.

On a semi-related note, the use of iPads is an interesting channel, and one that's been long overdue. I'm surprised that no one (that I've seen yet) has started a company providing bedside iPad media services -- movies, games, messaging, etc. Outdated TVs running local cable still seem to be the standard form of inpatient entertainment.

Also great to see designers getting into healthcare! I'd love to help out any way I could.

There's a UK company that has flatscreen tv's with limited internet connectivity and telephones. These are mounted on huge wall-mounted arms that swing over the bed.

The service is expensive and lousy. Most people would be much better off taking a laptop and 3g dongle or a tablet.

(But with good locks to prevent theft).

The problem is not due to staff not having time, or not dumbing things down. The problem regarding patient education will always be engagement and motivation.

Agreed in that engagement and motivation are big issues. But time and time again I've witnessed physicians rushing through explanations of a patient's condition and management in a language far too sophisticated for a layman's understanding. I know that nurses typically walk through discharge instructions with a patient, so maybe my perspective is one-sided. Although I do think physicians should have a bigger role in educating and motivating patients by providing them with a thorough understanding of their conditions and medications.

I meant more about patient education in general rather than specifically discharge instructions.

also, from my experience, the stories of patients not understanding something about their discharge and then being readmitted because of that lack of understanding is far less than the cases of patients being readmitted simply because they chose not to follow specific instructions regarding their health.

You can't fix fat with education (no matter how shiny of a device it's on) and fat, generally speaking, is what causes a lot of of the chronic diseases that perpetuate the need for hospitals in the first place.

> I'm surprised that no one (that I've seen yet) has started a company providing bedside iPad media services -- movies, games, messaging, etc. Outdated TVs running local cable still seem to be the standard form of inpatient entertainment.

They market themselves slightly differently from how you describe it, but Pad In Motion does essentially this: http://padinmotion.com/

> Also great to see designers getting into healthcare! I'd love to help out any way I could.

Where are you based? My startup[0] also works in this space, though we focus on a different approach (patient education isn't our main angle, and readmission rates aren't our primary metric).

[0] https://www.boardrounds.com/

Haha, I'm based in NYC and actually spoke to your co-founder this past week at Blueprint!

Thank you! We certainly envision engaging patients and their families after they are discharged from the hospital. This will come in the form of accessing their personalized learning plans from the computer and other devices, as well as providing written materials to those who prefer that method. Our content is designed to meet patients where they are in terms of their preferences and health education needs. We have encountered numerous patients who continually want more information, as well as those who just want the basics. We have the ability to serve both of these preferences with our interactive tool.

Apart from the interactive patient education, we are also testing providing patients with relaxing and meaningful media. Currently, we offer patients a guided meditation exercise which has been a huge hit!

We would love to talk to you more about our work - always happy for input and help - feel free to get in touch with us at info@noorahealth.org

or edith@noorahealth.org

Patient education tools such as this are certainly a good idea. The only question I have is why do this as a non-profit? If you are reducing readmission rates for hospital, especially with respect to certain core measures (and CHF is one of them), you are actually saving the hospital money. And we are not talking nickels and dimes - up to 2% of payment. It is also the hospitals responsibility to provide good patient education, as that will have an impact on patient satisfaction scores, and presumably bring more patients in the door. There are companies which do some of this, such as provide the patients with tablets to take home for 30 days. Hospitals can and should be charged for this, and since there is a clear business model here, I'm just curious as to why run this as a non-profit. (At least with respect to hospitals in the USA).

> If you are reducing readmission rates for hospital, especially with respect to certain core measures (and CHF is one of them), you are actually saving the hospital money. And we are not talking nickels and dimes - up to 2% of payment.

Yes and no. You are saving the hospital on their readmission penalties, but those currently only apply for three conditions (CHF is one of them). Furthermore, the penalties are not always enough to cover the increased revenue that the hospital gets from the readmission - in other words, some hospitals may actually make a profit from the readmission even when the penalty is factored in.

Also, the "up to 2%" is itself complicated. Because of the way the penalty is deducted, other seemingly-unrelated factors (like the patient and insurance demographics of the hospital) have a huge impact on how large the penalty is, even holding everything else constant.

> Hospitals can and should be charged for this

Currently, even the hospitals that receive the highest readmission penalties are not willing or able to pay (much) money for reducing readmissions. The way their budgets are structured doesn't really allow for this[0].

I say this from experience - my startup also creates a product that happens to reduce readmissions (though this is not our primary goal), and one of the reasons that we emphasize our other (larger) benefits for the hospitals is that most hospitals just won't pay much for a product that reduces readmissions.

On top of that, it's also a very crowded space. Health Recovery Solutions is a for-profit company that does more or less the same thing: http://www.healthrecoverysolutions.com/

[0] Yes, it's inefficient, but that's a separate discussion.

The larger point I was trying to make is really why run this as a non-profit. If I choose to Donate, what am I really donating towards? Am I making a donation towards helping medicare reduce it's costs, because the hospitals aren't incentivized enough to take their job seriously? Or donating for a service that hospitals really should be providing to their clients, whom they are charging?

It's not as clear to me, as a non-profit solution, as something like Watsi would be. I'm familiar with HRS, I saw their Blueprint presentation and get their email updates, but should a reason to run a company as a non-profit be because there are already too many for profits in the same business? There may be a number of companies in this space, but this is all still pretty early stage, with no clear winner yet.

Bit of a side point, but the "should this be funded through donations?" and "should it be a non-profit?" questions are slightly different. It's entirely possible to run a nonprofit that funds itself via fees for its services, though it might not qualify as a public charity in that case. For example, many hospitals are nonprofits, and are funded primarily through charging patients & patients' insurance. The hospitals could also buy services from other nonprofits. The nonprofit structure just means they aren't intending to make a profit to return to shareholders, not that they never charge anyone for services.

Thats actually not true. The readmission penalties make it so hospitals are not paid at all for the readmission.

> The readmission penalties make it so hospitals are not paid at all for the readmission.

That's the goal, but that's not how it actually works out in practice - look at the details of how the penalties are levied, and you'll see why.

If they were implemented perfectly, that would be true. Or if all payers used a bundled payment system, that would be true. But neither of those are the case (at least not now).

(An easy way to see this is to see that there is a cap for the maximum penalty - so if the total amount made on readmissions is larger than this cap, the hospital would still make money overall[0].)

[0] Of course, nothing can be simple (that would be too easy!), so the actual way that these are calculated is even more convoluted - take a look if you're interested, but don't say I didn't warn you. :)

Hi dr_ - I am Edith, one of the co-founders of Noora Health. We completely agree that this is a service that hospitals should be willing to pay for, and one that will improve metrics they care about. Our vision of constructing our non-profit is to be able to have a sustainable revenue model so that we do not have to depend on donor dollars alone for the development of our content and technology. We will charge US hospitals, and use the revenue to subsidize our work with underserved populations, including India. We want to continue to be engaged with these populations during the development and testing of our platform so that it is designed for a diverse population. Donations made online go ENTIRELY to support our work in India, and not towards developing our tech product. Please feel free to reach out if you have further questions - edith@noorahealth.org or info@noorahealth.org.

Thanks for explaining how it actually works Edith. The idea certainly sounds intriguing, and I wish your team good luck.

This has such a huge potential impact! Having talked with them, I love the model of subsidizing developing countries by charging the ones in the USA.

Disclosure: I am biased (Noora is in our YC batch). That being said, what Noora is doing is very important. If patients and caregivers have better education on what to do post treatment, outcomes improve. The cost savings gained from the reduction in readmissions is an added bonus. Go Edith and Katy!

The picture showed: "It's normal to have pain and some swelling after a surgery."

==> Person reads that, feels better. Person has complication like internal bleeding and gets sick. Lawsuit?

The idea sounds noble and useful; I just wonder how to avoid the legal complications.

Self diagnosis of symptoms has me concerned as well, but in both directions. Some people may always assume that their symptoms are 'normal' and not seek care while others will always assume their symptoms are 'problematic' nullifying the benefit.

Unless the information is tailored to each patient (prior history, current medication, family history) I think it would be very difficult to provide useful advice in either case. Also, the first person that dies because they listened to a flash card and didn't call their physician would be catastrophic.

More practical advice like 'if something doesn't feel right, give us a call' backed by a phone number with nurses on call that had your full medical history to review would seem to be more useful. I've always been grateful that my medical coverage includes a toll free number where I can get sound advice about changes in my health.

This is amazing! What are your plans to roll out in other cities?

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