In this episode of the SeamlessMD Podcast, Dr. Joshua Liu, Co-founder & CEO at SeamlessMD, and marketing colleague, Alan Sardana, discuss how Digital Patient Engagement helps clinicians launch and scale prehab for surgery. See the full show notes below for details.
Guest(s): Dr. Joshua Liu (@joshuapliu), Co-founder & CEO at SeamlessMD
Episode 7 – Show notes:
[00:42] How Dr. Liu first learned about 'Prehab' from Dr. Mike Engelsbe, transplant surgeon at the University of Michigan Health System, co-founder of the University of Michigan Health System’s Prehab initiative (called the Michigan Surgical and Health Optimization Program or MSHOP) and Director of the Michigan State Quality Collaborative;
[02:20] Dr. Liu explaining the concept of 'Prehab' and how it improves outcomes by increasing the patient's baseline function before surgery, thereby accelerating the patient’s recovery after surgery;
[04:30] Dr. Liu sharing the time he also learned about Prehab from Dr. Francesco Carli, surgeon at McGill University Health Centre and one of the pioneers of Prehab;
[06:15] Alan explaining how MSHOP (Michigan Surgical & Health Optimization Program) makes evidence-based Prehab information easy-to-read and explains rehab as "training" patients for surgery in 4 key areas: Movement, Breathing, Eating, Relaxing;
[08:22] Dr. Liu sharing a personal experience of when a family member who underwent surgery, and Dr. Mike Engelsbe and the MSHOP team graciously sharing their Prehab program with Josh’s family;
[09:15] How the University of Michigan's original prehab program reduced average patient LOS by 2.3 days (n=100);
[10:15] How Prehab is a prescriptive regiment with accountability built-in for exercise, spirometry breathing, specific diets, and particular relaxation techniques;
[12:25] How the University of Michigan MSHOP team leveraged technology to scale prehab, including text messages and a web-based dashboard;
[12:55] How in 2017, Dr. Engelsbe's MSHOP team was awarded a CMS Innovation Grant to roll out their Prehab initiative across 21 different hospitals in Michigan, reached over 3000 patients, and found LOS reductions by 1.0 day and statistical significant cost reductions of $3,200 per patient for 90 days post-op (Link to research);
[15:45] How Dr. Stuart Wang, also a co-founder of the MSHOP initiative, used Morphomics Analysis to identify specific bio-markers about a patients' body to improve the accuracy of prehab;
[19:25] Mentioning a 2013 McGill University prehab study led by Dr. Liane Feldman and Dr. Francesco Carli which showed improved functional walking capacity and improved postoperative functional recovery (Link to research);
[20:00] How the current reimbursement model has limitations by only focusing on outcomes, and misses out on the opportunity to directly reimburse or incentivize best practices such as Enhanced Recovery After Surgery (ERAS) and Prehab;
[21:20] How the Cardiac Enhanced Recovery After Surgery Society has recommended Prehab as part of a Cardiac Enhanced Recovery After Surgery pathway;
[22:22] How Dr. Dionisis Vrochides (@vrochides) at Atrium Health implemented a Prehab component with their HPB ERAS program;
[23:50] How the American College of Surgeons backed a public health campaign in 2012 led by Dr. Thomas Varghese, thoracic surgeon at University of Utah, called 'Strong For Surgery' - which has free resources and checklists for clinicians implementing prehab and related initiatives;
[25:25] How Dr. Liu met Dr. Cindy Kin, Colorectal surgeon at Stanford, and collaborated to deliver a Digital prehab module on SeamlessMD (Link to Stanford Prehab story);
[28:25] How SeamlessMD makes Prehab scalable by having patients set daily goals, reminding patients to walk, tracking steps, compliance with incentive spirometry, and nutrition, and guides patients through prehab;
[31:00] How Digital Patient Engagement can reduce the friction for getting patients to follow a prehab protocol;
[32:00] Highlighting various prehab programs including Stanford, University of Michigan, McGill, UCSF, neurosurgery at Mount Sinai, urology at Brigham & Women's;
[33:33] Summarizing prehab outcome improvements including LOS, recovery time, pain management, quality of life, patients' feeling stronger; and
[34:00] Discussing whether delaying surgery by up to 1 month before surgery makes sense to allow for patients to receive prehab prior to surgery;
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