Caralyst Health Whitepaper

Matt Millett

Havisha Pedamallu

Moataz Ali

Owen Zhang

Alex Stepansky

Company Summary

Caralyst aims to provide high value care by optimally matching patients and physicians based on communication styles and personal characteristics, providing a basis for better understanding and trust between the two. Our platform will allow physicians to understand their patients as individuals, rather than a set of symptoms. Patients and physicians will create profiles telling us about their care preferences. We will ask patients which identity factors they would like their physician to be considerate of and questions to determine their preferred communication and decision-making styles. Meanwhile, we will ask physicians similar questions about which patient demographics they have experience treating and feel they could best support, along with their preferred communication and decision-making styles. Patients will be presented with a list of physicians and a description of what qualities they do and do not share with each physician. In addition, patients can review their care experience, which will improve the algorithm and provide feedback for physicians.

Problem

There is overwhelming evidence showing that patient-physician relationships have an impact on health outcomes, care provided, and patient satisfaction. This type of relationship is rather unique, being built off of four key factors: mutual knowledge, trust, loyalty, and regard. Patients and physicians must be knowledgeable about each other to establish a basic relationship. Both parties must have faith in each other, with patients trusting the doctor’s competence and intent, and doctors trusting that the patient is truthful. In addition, both must be loyal to each other to allow a long-term and trusting relationship. Lastly, all of these elements will contribute to the level of regard the patient feels, or belief that their physician is “on their side.” Patients are often open and vulnerable with their physicians, and may disclose information that they haven’t even shared with close family and friends, underscoring the important role a physician plays in a patient’s life. (1)

The patient-physician relationship can affect patient outcomes in terms of behavioral, subjective, and objective measures. Behavioral outcomes include adherence to treatment, coping, and emotional status, and subjective ones include knowledge, understanding, and pain. Both of these are heavily influenced by the relationship, since if a patient believes their doctor is trustworthy and is doing everything in their power to help them, they will feel more understood and be more willing to comply with medications and treatments. Patients that have a strong relationship with their doctor will also report higher levels of satisfaction in terms of the care they have received and have a more positive outlook on their prognosis and health. These effects, in turn, can improve objective measures, which include quantifiable metrics such as vital signs, blood test results, frequency of visits, and survival. (1)

The healthcare industry’s inability to properly match patients and physicians has created many inefficiencies and a lower quality of care overall. The lack of a strong relationship contributes to lower patient satisfaction which poses a large burden on the healthcare industry as patients are more likely to switch providers. Nine out of ten patients say they are willing to change providers and 74% report that they are inclined to delay appointments or seek care if they are not satisfied with their provider. (2) Patient acquisition is an extremely expensive process with it being five times more expensive than retaining an existing patient. In healthcare specifically, word of mouth is the most effective marketing tool since patients sharing their positive experience would be more compelling than a facebook ad, for example. Retaining existing patients and providing them a great quality of care is the best way to increase the amount of word of mouth advertising. (3) In addition, an alarmingly high percentage of Americans view the emergency room as their primary care physician, which is an incredibly expensive practice as ER visits can be 12 times more expensive than a visit at a doctor’s office. In fact, 73% of Americans believe going to the ER is easier than scheduling a doctor's appointment. (7) When a patient switches physicians or does not have an established PCP, they will be disrupting their continuity of care, which is crucial for better healthcare outcomes and allows physicians to work more efficiently.

The lack of proper patient-physician matching has also contributed to the presence of healthcare disparities for minority groups; African Americans, Asian Americans, Latinos, and Muslims all report a lower quality of care due to their ethnicity or race, and LGBTQ+ patients often fear descrimination from health professionals and fail to seek care. For example, between 1990 and 2005, mortality rates for heart disease, breast cancer, and stroke decreased overall; however, the gap between black and white mortality rates has increased.(4) Such results demonstrate that despite scientific advancements being made to improve health outcomes, not everyone has been able to effectively reap the benefits.

Despite social factors contributing to these disparities, a patient’s physician also plays a large role in ensuring patients receive proper standards of care. When matched with doctors of their own race, African American patients were 47% more likely to agree to a diabetes screening, 10% more likely to get a flu shot, and 72% more likely to accept a cholesterol screening, showing that a stronger patient-physician relationship can increase equity of care.(5) There is also a strong disparity in lung cancer survival rates which correlates with a lower rate of surgery for black than white patients, even after controlling for corrected for stage of disease, type of insurance, socioeconomic status, age, availability of care, and coexisting illnesses. Both black and white patients who have undergone surgery show similar survival rates, however 71.4% of black patients compared to 67.0% of white patients have received a negative recommendation for surgery.(4) One possible reason for this difference is implicit bias among physicians which can weaken the patient-physician relationship and worsen health outcomes for underserved populations.

LGBTQ+ patients often face more direct forms of descrimination such as being verbally harassed, refused treatment, and asked inappropriate questions. In fact, over 50% of LGB and 70% of transgender patients have had a negative experience when seeking care. (6) In fact, 23% of transgender patients do not seek care when needed in fear of having a negative experience. Such cases occur everywhere from small towns to large cities like New York City. The consequences of such prevalent discrimination can be life-treatening, as these patients may miss important screenings or check ins and allow preventable conditions to worsen.

There is currently no unified, centralized, and reliable method for patients to learn more about physicians in the context of issues that actually matter to them. Many review sites contain a generalized rating of a physician, but this treats a physician as one-size-fits all. However, each person has different factors that matter to them and affect how they seek care.

Solution

Caralyst offers a digital platform that matches patients and physicians based on shared characteristics. Both patients and physicians will create profiles telling us about their care preferences. When patients create their profile, we will ask them which identity factors they would like their physician to be considerate of (e.g., “I would like my physician to be LGBTQ+ friendly” or “I would like my physician to have experience working with African American patients''). We will also ask them questions to determine their preferred communication and decision-making styles (ie. “When conveying difficult information, I would like my physician to be blunt/make me feel comforted and ease into the news” or “I would like my physician to state which treatment option is best/discuss options with an unbiased view and leave the ultimate decision to my family and I”). Meanwhile, we will ask physicians similar questions about patient demographics they have experience treating and feel they could best support, along with their preferred communication and decision-making styles. Patients will receive a curated list of physicians they are matched with alongside reasons they were matched and areas where they differ. After a patient visits a provider they were matched with, they will have the opportunity to review their experience and provide feedback. This information will allow us to improve the matching algorithm.

The matching platform will be made available for longitudinal care specialties where the patient-physician relationship is particularly important, such as primary care, cardiology, pulmonology, and endocrinology. We hope to lay the groundwork for a strong and understanding relationship between patients and physicians. The average doctor’s appointment lasts for 13-16 minutes which is not enough time to foster the strong and intimate relationship that is necessary. However, by matching for and pointing out shared characteristics between the two, patients will enter the appointment knowing they have a physician they can trust and one who understands them.

Value Proposition

By optimally matching patients with a physician, we will increase patient satisfaction, in turn increasing patient retention for insurance companies, physician practices, and hospital systems. The healthcare industry is currently transitioning to a value-based care model where physician reimbursement is tied to the quality of care provided. Both satisfaction and retention are key metrics in value-based care. Tied to satisfaction is the fact that the more a patient likes and feels comfortable with their physician, the more likely they will be to listen to their suggestions and less likely to delay care when an issue arises. This will also address the issue of high rates of unnecessary and expensive ER visits, since patients will know they have a reliable PCP they can visit instead. An increase in patient adherence and more prompt and regular care will result in better healthcare outcomes, and therefore, decreased healthcare spending.

Potential Customers and Market Analysis

Companies like Cigna, Aetna, and Blue Cross Blue shield can benefit in majority to this as this will aid in offering patients the ability to be matched to a PCP that they will adhere to and are able to go see regularly. This will lead to a multitude of benefits including better care, better health outcomes, more adherence on the patient’s end, and a less likely result of patients going to see specialized doctors through increased adherence to preventive care as well.

Competitive Differentiation

Caralyst’s success is rooted in our mission to increase the parity and clarity of care. By offering a tool that allows physicians to build stronger relationships with patients and better treat their needs, we are accelerating the healthcare industry’s transition to value-based care. We provide physicians and patients alike the opportunity to work with individuals they understand and help everyone feel comfortable within the healthcare field. Caralyst works to promote the art of medicine by fostering patient-physician relationships built on empathy and humanity.

Referenced Literature

Chipidza, F. E., Wallwork, R. S., & Stern, T. A. (2015). Impact of the Doctor-Patient Relationship. The primary care companion for CNS disorders, 17(5), 10.4088/PCC.15f01840. https://doi.org/10.4088/PCC.15f01840
Shryock, T. (2020, November 12). The growing financial impact of patient satisfaction. Medical Economics. Retrieved February 15, 2022, from https://www.medicaleconomics.com/view/growing-financial-impact-patient-satisfaction
Practice Builders. (2018, July 27). Importance of Patient Retention: 8 Benefits That Every Practice Loves. https://www.practicebuilders.com/blog/importance-of-patient-retention-8-benefits-that-every-practice-loves/
Alsan, M., Garrick, O., & Graziani, G. C. (2019). Does Diversity Matter for Health? Experimental Evidence from Oakland. National Bureau of Economic Research. https://doi.org/10.3386/w24787
Hostetter, M. & Klein, S. (2018, September 27). In Focus: Reducing Racial Disparities in Health Care by Confronting Racism. The Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/2018/sep/focus-reducing-racial-disparities-health-care-confronting
Lathan, C. S., Neville, B. A., & Earle, C. C. (2006). The effect of race on invasive staging and surgery in non-small-cell lung cancer. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 24(3), 413–418. https://doi.org/10.1200/JCO.2005.02.1758
American Heart Association News. (2019, June 4). For LGBTQ patients, discrimination can become a barrier to medical care. American Heart Association. https://www.heart.org/en/news/2019/06/04/for-lgbtq-patients-discrimination-can-become-a-barrier-to-medical-care
MHE Staff. (2019, September 2019). Younger Americans Use ERs as Their Primary Care Provider. Managed Healthcare Executive. https://www.managedhealthcareexecutive.com/news-analysis/younger-americans-use-ers-their-primary-care-provider