Welcome to our B2B Thought Leadership series! We are delighted to start with a 2-part post from our interview with Bill Conlan, founder and CEO of CrossBridge. CrossBridge is a Software as a Service (SaaS) platform using data analytics to bridge care coordination gaps between healthcare payers and specialty provider practices. CrossBridge initial focus is on chronic inflammatory diseases, particularly in rheumatology.
Bill Conlan meets Bonnie Feldman
In 2017, before founding CrossBridge, Bill Conlan, health data analytics innovator, serial entrepreneur and ankylosing spondylitis (AS) patient, contacted Dr. Bonnie Feldman. He wanted to tap her expertise on “The Invisible Epidemic.” As a rheumatology patient, Bill is an unstoppable experimenter. Most notably, he uses Crossfit exercise to help manage his AS. He was concerned about the growing epidemic of autoimmune, autoinflammatory and chronic immuno-inflammatory diseases (CIIDs). He was particularly interested in the challenges CIIDs present to payers, practices and patients. Ask Bonnie about chronic immune disorders and digital health and of course she had a lot to share! This led to in-depth conversations around how to bring the best of conventional, functional and digital medicine to autoimmune patients.
The importance of collaborative care
In 2018, Bill and Bonnie drove from Philadelphia to Pittsburgh together to meet with staff at the newly opened Autoimmunity Institute at the Allegheny Health Network2, one of the first centers of excellence focused on autoimmune and autoinflammatory disease management. They both were impressed by the collaboration among different specialists working in the same practice, including huddle rooms, where practice teams consult on cases. Unfortunately, that kind of collegial teamwork depends on physical proximity, which has been shattered by the response to the COVID-19 pandemic. This highlights the essential role of digital collaboration platforms to coordinate teams in real and virtual environments.
Data management & value-based care
From the beginning of their friendship, Bonnie hoped Bill’s next company would directly or indirectly improve care for autoimmune patients. She was impressed by his incisive technical questions, reflecting his deep background in health data management software and analytics. This applies especially to payers in the context of the ongoing migration from fee-for-service (FFS) to value-based payments (VBP). So, she was delighted when Bill Conlan founded CrossBridge, a SaaS platform using data and analytics to help payers and specialist practices align incentives, streamline care pathways, and improve patient satisfaction and outcomes, all while reducing costs.
Bill Conlan’s entrepreneurial history
Before CrossBridge, Bill Conlan founded two companies that were sold to established health care behemoths. One was Health Qx, purchased by McKesson in 2016, and the other Truven, absorbed by IBM Watson. This pattern reminds us of the entrenched medical device development model (also seen in biopharma), where innovative engineers found companies and create new platforms and products, while the big established players buy small companies for their platforms, products and data to fold into their own products. Bill is now applying this track record of payer analytics innovation to CrossBridge.
Managing complex high-cost care pathways
The cost of treating and managing chronic inflammatory diseases (CIDs) is now greater than what payers spend on oncology! For one thing, the number of CID patients (~17.8 million in the USA, likely an underestimate), is already higher than the number of patients living with cancer. What’s more, unlike cancer, CIDs are treated by many separate specialties, producing more complex and expensive care pathways, complicating care coordination and adding to patient confusion and stress. Process inefficiencies between providers and payers waste tens of billions of dollars. Addressing those process inefficiencies is essential to reducing costs while improving patient outcomes.
As conceived by Bill Conlan, CrossBridge is built to reduce practice inefficiencies in applying evidence-based care (EBC) guidance and monitoring as well as managing patient care plans to minimize disease progression. Their SaaS platform initially focuses on rheumatology, for reasons explained below, but will expand to gastroenterology and dermatology, where similar issues pertain.
Specialty practice challenges in managing chronic diseases
For historical, path-dependent reasons, medical specialities have clustered around body parts: joints, skin, the gut, nerves. But immune disorders don’t work that way, because the immune system serves the entire body. In chronic inflammatory diseases, immune system signaling chemicals and cells inflame and damage their own hosts’ tissues. However, despite advances in immunology, the medical community still defines, diagnoses and treats CIIDs based on the particular tissues being damaged.
Neurologists treat multiple sclerosis (MS), gastroenterologists treat inflammatory bowel disease (IBD) and rheumatologists treat a variety of inflammatory joint and connective tissue disorders. Contrast this to oncology, one specialty that unites hundreds of types of cancer affecting tissues and organs all over the body.
Rheumatology and chronic immuno-inflammatory diseases (CIID)
Rheumatologists diagnose and treat a complex and often confusing mix of inflammatory and non-inflammatory conditions, all involving joints and connective tissue. Rheumatology has become a de facto autoimmune specialty because rheumatoid arthritis (RA) was the first disease recognized as autoimmune. Moreover, rheumatologists treat several other CIIDs that cause similar joint symptoms (see illustration).
To complicate things further, ongoing research in immunology is changing the definitions of rheumatologic diseases. All this makes data collection and analysis particularly challenging, as changing definitions make earlier data sets incompatible with new ones. This also affects the flow of data and information into the evidence base for clinical guidance.
Another big issue is a shortage of rheumatologists. This means longer wait times for patients, both for initial referral visits for evaluation and diagnosis as well as for ongoing disease monitoring and management. A further challenge in coordinating primary care and specialties is that practices and payers do not automatically share their data, so patient records may be incomplete in both practices.
The mixed blessing of specialty medicines
The advent of biologics 30 years ago has been both a blessing and a challenge to specialists, payers and patients. When first introduced in the 1950s3,4, clinicians greeted the glucocorticoids as silver bullets. Similarly, in the 1990s, they saw biologics, especially monoclonal antibodies (MAbs), as miracle drugs. But they do not cure, only modify the immune dysfunction, and (as with the glucocorticoids) often have serious side effects. Most importantly from a payer perspective, specialty meds are expensive.
Moreover, there are dozens of biologics now available. This makes it more difficult for rheumatologists to match drugs to patients to achieve optimal remission while limiting side effects. Just keeping track of which drugs to try when and in what doses and combinations is daunting. Furthermore, once a provider writes a prescription, treatment has just started. MAbs may require infusions, thus additional outpatient procedures (and costs). Even with oral drugs, patient adherence is an issue. Waiting for drugs to work, copays, side effects, all can be barriers to ongoing compliance.
A related challenge is monitoring patients in treatment: is the disease in remission or is the patient just between flares? Early detection of drug failure or disease progression requires ongoing monitoring and data collection, shared between primary care and specialists. Such early detection can help keep patients out of emergency care, hospitalization and surgery. All these interventions are more expensive than drugs. Moreover, they do significantly more harm to patients.
Crossbridge: How can IT help?
Among the many ways information technology can help clinicians is to assist them to navigate complex decision processes by automating care pathways. CrossBridge gathers evidence-based guidelines through its rules engine to save practices time and effort, reduce errors and lower payers’ costs. If followed with careful clinical judgment (not robotic expertise), such guidelines can also improve patient-measured outcomes and satisfaction.
A related issue is the variety of tools and questionnaires used for patient monitoring, typically filled out by patients on paper during care visits. Right now the use of these tools is rather haphazard, not consistent across practices. This presents challenges in measuring disease activity, treating to target and collecting useful data.
Based on Bill Conlan’s analytic background, CrossBridge is creating a value-based incentive model to apply standardized measures of disease activities to monitor patients. Clearly, automating such processes through a clinician dashboard can eliminate unnecessary office visits, move more encounters to telemedicine and gather higher-quality longitudinal data more easily and accurately.
Part 2 will discuss how Bill Conlan analyzed these problems and what CrossBridge is doing to address them.
How to contact CrossBridge
CrossBridge offers the most comprehensive Software as a Service (SaaS) solution available to help payers improve outcomes and lower costs of treating chronic inflammatory diseases (CIDs). These include such chronic autoinflammatory and autoimmune diseases as rheumatoid and psoriatic arthritis, the spondyloarthroses, inflammatory bowel diseases and multiple sclerosis. Supported by clinical advisory boards of leading specialist physicians and researchers, CrossBridge is an unparalleled resource for conquering complex disease. Go to CrossBridges main site at https://crossbridge.com or to their contact page. For more information on Bill Conlan, see his LinkedIn page.
DrBonnie360 is more than Your Autoimmunity Connection
We provide professional consulting services to companies that work to bring the best of digital, conventional and functional medicine to chronic inflammatory disease patients.
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