Difficult conversations, made simple Advance Care Planning for All
Koda Health is a patient-driven platform for shared decision making and decision capture that integrates seamlessly with the health system. Effectively, it’s “TurboTax for difficult healthcare conversations.” We guide patients through a decision making process, capturing their responses to generate legal documents (such as advance directives and medical powers of attorney) that integrate directly with a health system’s EMR. Patients can update and notarize their care preferences at any time, and our customers always have up to date information on their patients’ care requirements. This single source of truth for patients and health systems stands contrary to the current disjointed standard of care where most of the emotional, clinical, and documentative burden falls on physicians. Our unique superpower is intentional design that motivates patients to make decisions they’re willing to stick to! Our proprietary, patent-pending technology delivers personalized, engaging content that drives decision making in this population. This approach has resulted in engagement rates that are 5 times higher than the existing standard of care. We fundamentally do not buy into the concept that older adults are bad at technology, but that they are bad at using technology that was developed for a 25 year old. We’ve designed our platform around the needs of our unique user base and their approach to decision making in mind. Our users are 65-95 years old, with an average age of 78. Furthermore, our digital/asynchronous approach drives equity of access, resulting in higher ACP completion rates in black patients than white patients.
Physician discomfort with end-of-life care conversations has resulted in an epidemic of unwanted care that costs payors and health systems over $100 billion annually in avoidable health costs. Currently, most providers avoid these conversations until a patient falls critically ill, resulting in poor patient and family satisfaction, unwanted healthcare utilization, and uncontrolled costs at the end-of-life. Some systems have simply tried to focus on legal forms like advance directives, however these documents are often confusing and rarely provide the necessary medical care clarity that providers need. Others only introduce advance care planning to their sickest patients, who have often already lost decision making capacity, through in-person navigators. Studies further indicate a worrisome trend, where underrepresented minorities show an even lower rate of Medicare-supported ACP than average, by a factor of two in the case of African Americans. Thus, not only has our current healthcare system made it difficult for individuals to plan for serious illness care, it’s created inequitable access to important services and deprived those who need it the most. Finally, Medicare has launched several programs incentivizing healthcare organizations to bring ACP into the clinical setting through reimbursements, performance metrics, and shared savings bonuses. However, with the national ACP engagement rate hovering around 7%, most health systems struggle to comply with program requirements and feel unprepared for the regulatory changes coming down the pipeline.
The clinical and financial impact of Advance Care Planning (ACP) is well documented; it's due to this impact that CMS has recently introduced a CPT code for ACP and has spurred recent acquisitions in this space - Iris Plans acquired by Aledade in 2022 and Vital Decisions acquired by Evolent in 2021. However, the core issue most organizations have is effectively delivering ACP at scale and without overwhelming operational lift. To that end, Koda Health currently has 3 research studies underway to demonstrate our ROI. Our first study, backed by the National Science Foundation, compared Koda to ACP via telemedicine in 200 patients and found that digital ACP through Koda has substantially higher engagement/adoption rates than a telemedicine intervention. Based on the results of this first study, we are actively preparing an NSF Phase 2 application with a much larger cohort of patients. Our second study, directed principally by Houston Methodist, is evaluating the claims data associated with the admission and hospice utilization rates of the first hundred (high risk) patients to use the Koda platform. Finally, our third study is backed by the NIH and will be carried out by the University of Pennsylvania. This study will explore the relationship between patients that create their plans via Koda and their Medical Power of Attorney, as these healthcare proxies are critical to ensuring patients’ wishes are honored at the end of life.
