by Claude Risner, Healthcare Business International

Care Pathway Management (CPM) software administers health systems, connects data and orchestrates the patient’s journey using predetermined and rigorously analysed rules. It claims to improve clinical capacity and patient satisfaction, whilst slashing paperwork and billing overheads. Lumeon is a leader in this field. It’s working with many of the UK’s top commercial operators and close to signing with the NHS directly. Last week, it launched its own care pathway marketplace. Lumeon is alternatively, a revolutionary pioneer, or a jumped-up admin system. We investigate.

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Lumeon, which changed its name from Qinec last week, is ten years old and took VC funding in “the last five”. It’s now working in 11 countries, and is used by seven of the top ten private healthcare operators in the UK, including Bupa, Alliance Medical and Optegra.

Here’s how it works. Providers integrate the software into their existing IT infrastructure and share access. Patients entering the system are assigned to a specific pathway and have their interactions tracked and managed as they receive treatment. Administrators must still input much of the data and clinical decisions are still taken by clinicians. But the software guides, shares choices made by other clinicians, alerts decision makers to potential complications down the road and lets the patient know what’s coming up. As they move along the pathway, it evolves to fit the data. The software is cloud based and can, if needs be, integrate with existing electronic medical records (EMRs).

“Take the example of a patient coming in for magnetic resonance imaging (MRI),” Wyatt says. “When that appointment gets scheduled, the system can automatically send out a pre-appointment email asking the patient if he has any metal in his body. If the answer comes back ‘yes’ the system could route the patient from an MRI to say, a PET CT and inform the clinician. All this might seem fairly obvious, but it’s wasting thousands of man hours in administration and on the day imaging cancellations.”

Wyatt says the care pathway approach has three key advantages: first, measurable care that knows what treatments were offered and their outcomes; second, predictable demand that counters bottlenecks or waste and transmits data in real time; thirdly, standardised practice, clinical and otherwise, across entire organisations.

The larger your organisation, and the more complex your pathways, the higher the potential for bottlenecks, confused and overwhelmed patients and brand damaging variance. (Note that its pricing model is based on the number of consulting physicians that work in its clients’ organisations).

Lumeon says it can prove it works: billing overheads, paperwork, and clinical contact time were cut by 90%, 80% and 80%, respectively, for some clients. Clinical capacity also grew for one client by 20% and patient satisfaction improved by 60% for another. Undoubtedly, this type of performance data is vital for private providers competing against the NHS and justifying their access to public funds.

Winning over the doubters

Digital Health is a booming industry and one would think that others were already doing this. In the US, in particular, companies like HealthLoop and Ratchet Health market themselves as patient engagement platforms or patient navigators. HealthLoop claims to offer “longitudinal, condition-specific care plans that provide electronic virtual check-ins for patients around episodes of care” – whatever that is!

Wyatt admits that there are people doing similar stuff to Lumeon. But, he claims, none cover the entire patient journey. There are also systems that capture outcomes but don’t track the steps the patient has gone through to achieve them. That doesn’t measure real value, he says.

What about their customer base: Have they lost any clients? And, given what Lumeon claims to offer – efficiencies that grow in parallel with the complexity of the health system – why is it not working for the NHS?

Yes, they’ve lost clients, but they were smaller businesses who were less suited to the product. “It’s obviously of less value if you are only working out of one location,” Wyatt admits.

Kane says they are already selling to the NHS indirectly through people like Optegra and Alliance Medical. They want a closer relationship, but it’s difficult to engage as a smaller provider – although, with 85 employees and 65 UK customers, Lumeon is far larger than many of its peers. She lets slip that there will be “interesting news” on this front in September, and clinical commission groups (CCGs) are an “interesting prospect”.

Some may be concerned that clinical pathways put too much faith in routine and divert control away from the clinician. Is there a slippery slope between using computers as an aid and removing the clinician entirely? Lumeon brags of cutting clinical contact time, after all.

Wyatt acknowledges that this is a concern for some people. But the system is primarily designed to ease the administrative burden, freeing up time for clinicians to practice. “If at any point through the pathway, a clinical decision is made, there’s always human interaction.”

A new healthcare market?

Once providers have Lumeon up and running, they can begin to collect data on interactions, costs, patient characteristics and inputs. Placing these building blocks of value-based healthcare into context and designing a system that works to align them is Lumeon’s second function: care pathway optimisation. At this point, it becomes more like a consultancy. It helps providers to sift through the data and define the most efficient and effective pathways with the best outcomes.

Others that offer similar services are not as comprehensive, says Wyatt. The UK National Institute for Clinical Excellence (NICE), for example, is prescribing clinical pathways, but not how they should be operated: who you should contact, when and so on.

Last Monday, Lumeon launched an online market place for pathways. These have been constructed in advance using its experience developing pathways for its users. Kane not only expects people to buy them, but others to sell them.

“What we are hearing from the market is that care pathways are now seen as efficient and useful in helping providers to deliver measurable, predictable and controlled care. But creating them is hard. It’s difficult to know what good really looks like. So we saw an opportunity there and we are providing proven pathways that are transferable, scalable and shorten the time to market.”

By transferable, Kane means across borders and organisational boundaries. Although, to her knowledge, specific pathways have not yet been shared internationally, many of their clients are pan-European and best practice, she claims, should be the same everywhere. ‘They can always tweak around the edges,” adds Wyatt.

All the existing pathways on the market place are Lumeon’s, and they say they were created internally, without using their clients’ data – although, clients can choose to sell their pathway IP, should they wish. Of course, you need the software if you want to develop your own. Kane does say externally produced pathways are on the way, but won’t say who’s developing them. Paper-based pathways are already doing a solid trade elsewhere, she says, and there are other leading indicators from the US.

The doubters would still question why operators would want to sell their efficiencies at any price? Operational expertise is after all a valid commodity – think of the Indian groups entering Africa. And pathways can only be transferred between relatively similar systems or providers. So Alliance Medical cannot develop a dialysis pathway, and how much would it want for an MRI pathway?

On the other hand, CPM is intriguing because it moves the market from individual services to entire courses of treatment. That means payors can buy the entire pathway in one go, and leave the orchestration between different providers to Lumeon, which sits above the system pulling the strings. That allows competition on each discreet node of care, as well on the pathway. It’s also what you might call value-based healthcare compatible: it measures outcomes that could be paid for. “It’s early days, but the potential is there,” says Wyatt.

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