

Non-Profit Noora Health (YC W14) Reduces Readmission Rates - kevin
http://techcrunch.com/2014/03/23/noora-healths-training-program-for-patients-and-caregivers-improves-recovery-and-reduces-readmission-rates/

======
kyro
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 Outdated TVs running local cable still seem to be the standard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.

~~~
edithaelliott
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

~~~
edithaelliott
or edith@noorahealth.org

------
dr_
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).

~~~
chimeracoder
> 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/](http://www.healthrecoverysolutions.com/)

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

~~~
dr_
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.

~~~
_delirium
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.

------
nicoles
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.

------
naveenspark
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!

------
harvestmoon
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.

~~~
bunkat
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.

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

