Axial Exchange Aims to Keep Patients Healthy Outside the Hospital

8/4/14Follow @wroush

The United States has some of the best hospitals in the world. That’s why 800,000 international patients come here every year seeking specialty care, according to data from Chapel Hill, NC-based Patients Beyond Borders.

If only the great care most patients receive while they’re inside the hospital could continue after they’ve left.

Too often, patients are discharged from hospitals without the information or support they need to make a full recovery. They may lack key details about their condition or post-discharge care procedures. They may not realize how important it is to take their medications or come in for follow-up appointments and tests. Their primary-care doctors may not even have a record of what happened to them while they were in the hospital.

All of those problems contribute to a disturbingly high rate of rehospitalization, which, not surprisingly, has been one of the major drivers of rising healthcare costs in the United States. Nearly 20 percent of Medicare patients are readmitted to the hospital within 30 days of being discharged, according to a study in the New England Journal of Medicine. More than 50 percent of Medicare patients who have surgery while in the hospital are readmitted, or die, within the first year after discharge. All these unplanned admissions cost the nation an estimated $25 billion a year.

In short, a lot of the good stuff that happens inside hospitals gets undone through inefficiency, ignorance, and neglect. That’s the big problem Axial Exchange wants to solve—and it aims to save hospitals and healthcare organizations a lot of money in the process.

The Raleigh-based startup makes mobile apps designed to keep patients involved in their own healthcare after they leave the hospital. The apps, which are available for iOS and Android devices, include tools for medication management and appointment scheduling. They also connect to monitoring devices such as glucometers, blood-pressure cuffs, scales, and fitness trackers, and send the data back to doctors. There’s even reference information and educational materials from the Mayo Clinic.

“There’s a pretty astounding statistic: that while you are in the hospital you retain only 4 to 11 percent of what you are told,” says Joanne Rohde, chief executive at Axial Exchange. “When you get home and you’re on your own, all of a sudden you don’t know anything. So we have that baseline education component. And we’re networked, so that if you are taking care of an elderly relative you can still read everything. That’s really important, because no one ever gets well on their own.”

Three views of Axial Exchange's flagship mobile app: the home screen (left), a list of devices and services that connect with the app (center), and a personal health-tracking screen designed to help patients monitor headache occurrences.

Three views of Axial Exchange’s flagship mobile app: the home screen (left), a list of devices and services that connect with the app (center), and a personal health-tracking screen designed to help patients monitor headache occurrences.

Axial Exchange is still young—it was founded in 2010—and small (its headcount is just 14). It faces an uphill battle in trying to sell consumer-facing technology to hospitals whose IT experience is often limited to claims management systems and electronic health records. But it’s got some veteran technologists from Raleigh-based Red Hat and the Swiss financial services giant UBS at its helm, it’s backed by more than $10 million in venture funding from Connecticut-based Canaan Partners and the Mayo Clinic, and it’s an oft-mentioned part of Raleigh’s growing downtown startup scene. And there’s one huge trend working in the startup’s favor: the transition in the U.S. from a fee-for-service medical economy to bundled, performance-based reimbursement.

This change began before the passage of the Affordable Care Act, aka Obamacare, and could ultimately be just as important, especially when it comes to costly problems like hospital readmission. To reduce rehospitalization rates, CMS, the Centers for Medicare and Medicaid Services at the Department of Health and Human Services, has imposed a system of escalating penalties for poor performers. Hospitals whose readmission rates were in the bottom quartile nationally in 2013 saw their Medicare reimbursements drop by 1 percent. This year, CMS raised the penalty to 2 percent, and in 2015, it will go up to 3 percent.

“Given the margins some hospitals work on, that could literally put hospitals out of business,” Rohde says. So there’s a growing incentive for hospitals to make sure patients stay healthy after they walk out the door.

On top of that, Rohde says mobile apps like Axial Exchange can increase engagement and loyalty among privately insured patients, who are the customers hospitals really want to capture. Big national healthcare providers are buying up smaller regional hospital systems at a rapid clip, and the more of these high-paying customers a given hospital’s overall population includes, the more leverage it may have in … Next Page »

Wade Roush is a contributing editor at Xconomy. Follow @wroush

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  • jonkernpa

    I imagine this approach will work wonders with an engaged patient population. I like my gadgets, I like tracking & graphing (longitudinal) my blood tests results, I think I would be an interested user of such a mobile app. It is a great idea to bring this all to the fingertips of smartphone users. It will definitely cut down costs and improve folks’ lives to be more in touch and engaged. After all, as my wife (a physical therapist in long-term care facilities) always says about healthcare, you have to advocate for yourself.

    But, I wonder what *percentage* of the post-hospitalization re-admits are tied to apathetic folks who: (a) don’t pay for their care in the first place, so are not motivated to stay out of the ED, (b) are not motivated to do better with their health, (c) exhibit traits belying their lack of attention to being healthy, (d) do not have or care to use technology. All the whiz-bang technology in the world will not overcome apathy and complacency. And if the apathetic patient population disproportionately drives up the health care costs for all, we still have a major unsolved problem as a society.