Episode #156: A novel virtual care platform supporting patient access and population health – with Lyle Berkowitz MD, CEO & founder, KeyCare

Friends, In my upcoming book, Beyond The Walls, I spend an entire chapter discussing how platforms have revolutionized other industries and how they’re about to do the same in healthcare.  Over the past couple of years, I’ve had the privilege of interviewing and learning from the experts who have been working with platforms for years. Geoffrey Parker, who wrote the now classic text The Platform Revolution, Vince Kuraitis, and Dr. Randy Williams have been working over the past decade to introduce the platform revolution into healthcare. If you’re interested in really understanding what platforms in healthcare look like and what differentiates them from our more typical business models, I recommend you listen to my podcast interview with Vince and Randy (episode # 149, April 19th 2023) and read chapter 7 in my about to be published book, Beyond The Walls.  During that interview, Vince & Randy mentioned an exciting example of a platform business model in healthcare. The company is called KeyCare. It was founded and is being led by physician entrepreneur Dr. Lyle Berkowitz. In this interview we’re going to discover how this novel platform is attempting to solve the issues of access to care, capacity, cost-effectiveness, and burnout amongst providers and their teams. Lyle Berkowitz, MD, is the Founder and CEO of KeyCare, the nation’s only virtual care company built on the Epic platform. He has more than twenty years of experience as a primary care physician, health system executive and informatics expert, and serial entrepreneur. Previous roles include Founder & Chairman of Healthfinch, Chief Medical Officer at MDLIVE and Director of Innovation for Northwestern Medicine in Chicago. Dr. Berkowitz is also Editor-in-Chief for Telehealth and Medicine Today.  He’s served on numerous industry boards in the past and is currently a board member for Oneview Healthcare. Lyle has been listed as one of HealthLeader’s Twenty People Who Make Healthcare Better, Healthspottr’s Future Health Top 100, and Modern Healthcare’s Top 25 Clinical Informaticists. He has been elected to Fellowships in both the American College of Physicians (ACP) and the Healthcare Information Management Systems Society (HIMSS). He graduated with a Biomedical Engineering degree from the University of Pennsylvania and is an Associate Professor of Clinical Medicine at the Feinberg School of Medicine at Northwestern University.   In this interview, we’ll discover: How KeyCare can address the shortage of primary care physicians in American healthcare. The major differentiating benefits of KeyCare and the variety of use cases for healthcare systems. The three “R’s” and the three “C’s” that are critical for the adoption of KeyCare as well as other virtual services. Throughout the interview Dr. Berkowitz illustrates the numerous ways that healthcare systems as well as other provider groups can utilize and leverage KeyCare. The initial use case, and probably the most challenging to manage, is ‘on-demand’ and ‘urgent care’ – or what might be considered part of the so-called ‘digital front door’. Instead of staffing and managing their own virtual on-demand urgent care services, healthcare systems can rely on KeyCare. Lyle points out that on-demand care is not a differentiating value proposition for healthcare systems. By outsourcing it, systems can focus their efforts and resources on the aspects of care that are differentiating and of higher margin. One sub-category of on-demand urgent care is patient populations in value-based contracts. Lyle suggests that KeyCare could assist healthcare systems in reducing avoidable ED visits and other costly alternatives, thereby lowering the costs of care in these risk-based populations.  Another significant use case is primary care. Lyle proposes that KeyCare could become an extension of a PCP’s team, performing a number of functions that enhance efficiency of care, allowing a provider and their on-site teams to perform to the top of their license, and increasing access and capacity, enabling a provider to manage much larger panel sizes. The way this might work would be for KeyCare to manage patients with chronic disease who are relatively stable, to perform routine visits including annual wellness visits, and to do follow up care. This would allow PCP’s to see more complex patients as well as new patients. In risk-based contracts, KeyCare could assist by closing care gaps and updating data points for risk score adjustments, thereby helping to appropriately increase the per member per month (PMPM) payments.  In addition to on-demand and primary care, KeyCare can also offer specialty services such as behavioral health.  There are a few key benefits to KeyCare (sorry, I couldn’t resist).  First, one differentiating benefit is that KeyCare is essentially a virtual provider group that is on an Epic instance. The advantages to healthcare systems who are on the Epic electronic health system are significant in terms of interoperability through: (1) the Epic ‘Care Everywhere’ function which would allow for robust data sharing; (2) cross-instance scheduling via new functionality called ‘Book Anywhere’; (3) cross-instance on-demand telehealth requests via new functionality called ‘Telehealth Everywhere’; and (4) cross-instance messaging, orders and referrals.  This cross-instance functionality and automatic interoperability allows KeyCare to send messages, schedule appointments and referrals, perform telehealth visits, and obtain and record patient information in patients’ charts – all without the need for new interfaces. It would appear seamless to patients as well as to providers.  Another benefit to healthcare systems is that KeyCare has urgent care providers who are licensed in all 50 states. This is a major market advantage to healthcare systems or other provider groups who are interested in winning contracts from a wider swath of potential customers such as employers who have employees and beneficiaries that live beyond a local or regional geography.   A third benefit, Lyle suggests, is that it will be far more cost-effective for a healthcare system to outsource virtual, team-based extension of PCP’s teams rather than build and maintain these services in house. KeyCare is essentially a virtual care focused factory.  As such it’s likely to be far more efficient than virtual care teams functioning within healthcare systems, and it will be constantly investing in people, process and technology to upgrade and optimize its effectiveness and efficiency.   KeyCare is a two-sided platform – a “population health enablement company”. On one side, there are the customers that would utilize KeyCare’s services – healthcare systems, provider groups, payers and employers. On the other side are the virtual providers and virtual provider groups who are offering their services. KeyCare is the technologic and business platform or marketplace that brings them together.   The promise is there. But, as Dr. Berkowitz points out, there are 3 challenges to overcome in provider acceptance and adoption. He refers to these as the “3 C’s”.  The first “C” is presenting providers with a clinically-connected care team that they feel comfortable with – sharing their patients and their data. The second “C” is compensation – assuring providers that this will enhance their compensation rather than diminish it. The third “C” is culture – the change management as well as workflow configuration required to integrate this type of care.  But, the promise is there, and it’s an important one. From a patient perspective, KeyCare can increase convenient access to care through its myriad use cases, including offering virtual specialty services such as behavioral health. From a provider perspective, it can reduce provider burnout by removing the more routine functions and services – enabling providers to grow their panels and focus on more complex care needs. From a healthcare system perspective, it can increase efficiencies of care, create patient growth, improve performance in value-based contracts, and allow systems to focus their resources and capabilities into higher margin more differentiating services.  It seems to be a win-win-win. I applaud Dr. Berkowitz for his patient-centered mission and his ingenuity in creating this novel population health enablement platform. I’ll leave you with my favorite quote of this entire interview: Our goal, our purpose in life, as an organization, is to make sure everybody gets the healthcare they deserve and they get that access. The more we can do online, the more that relieves the pressure for providers in the office as well, so both sides can win.” Until Next Time, Zeev Neuwirth, MD