As part of Kaspersky’s Bring on the Future series, we meet businesses around the world who are changing their industry, and society, for the better.
Healthcare tech start-up Takoda is marrying web analytics with addiction counseling and psychotherapy to improve therapeutic outcomes. I spoke with Josh Fischer, their co-founder and CTO.
David: What’s the idea behind Takoda?
Josh: The idea is to measure therapists based on patient performance during treatment, just like in the movie, Moneyball, where runs delivered by each baseball player became their performance measurement. But unlike baseball, in the therapeutic care industry, there’s no single metric that everyone has created, certainly not as obvious as the number of runs batted in or home runs.
It’s hard to put all the various pieces together in a single company to do this, which is probably why no one else has tried to do this before.
No matter where in the world you might live, we’re at a unique time in the healthcare industry. Everyone has multiple electronic health records that are stored in vast ‘digital coffins’. These are so-called because this is where your data usually goes to die. Even if we usually see the same group of doctors in a single practice group, or live in a country with nationalized healthcare, chances are our electronic medical records are stored in various data silos all over the place, without the ability to link them together in any meaningful fashion.
On top of this, many therapists have their own paper-based ‘data coffins’: filing cabinets full of rarely consulted treatment notes. Takoda is trying to open these repositories, without breaching any patient data privacy or other regulations.
What industry challenges are you trying to solve?
When someone seeks treatment, they don’t necessarily learn how to get better or move beyond their addiction issues while they’re in their therapist’s office. They have to do this on their own time, interacting with their families and friends, in their own communities and environment.
Another part of the problem is in how we select a therapist to see for the first time. Often, we get a personal referral, or else we hear about a particular office practice. When we walk in the door, we’re usually assigned a therapist based on who is ‘up’ – meaning the next person who has the lightest caseload or who is free at that particular moment when a patient walks through the door. This is the same as how many retail sales operations work. The sole design criterion is to evenly distribute leads and potential customers.
Finally, the therapy industry uses two modalities that tend to make success difficult. One is that ‘good enough’ is acceptable, rather than pursuing true excellence or curing a patient’s problem. When we seek medical care (through private healthcare) for something that’s physically wrong with us, we can find the best surgeon, cardiologist or other specialists. We look at their education, their experience and so forth. Patients don’t have any way to do this when they seek counseling. The other issue is that therapists aren’t necessarily rewarded for excellence, and often practices let a lot of mediocre treatment slide. Both aren’t optimal, for sure.
We’re trying to change how care is delivered, how success is measured, and whether we can match the right therapist with the patient’s needs to get the best treatment outcomes. That’s a tall order!
It certainly is! How have you started to deliver on this big challenge?
Takoda put together its analytics software and began building its product about a year ago. At first, we thought we could create something that’s an add-on to the electronic health systems already in use, but we quickly realized that wasn’t going to be possible.
We decided to work with a clinic local to us in St. Louis (Missouri, USA) as a testing ground for the technology to see if our methods work. We picked a particular clinic because they already see numerous patients who are motivated to try to resolve their addiction issues. Also, the clinic accepts insurance payments whereas many therapists don’t deal with insurers at all. We wanted to have insurers involved because many of them are moving in the direction of paying for therapy only if the provider can measure and show patient progress. While many insurers will pay for treatment, regardless of the result, the industry is evolving. Finally, the company recognized that opioid abuse has slammed the therapy world, making treatment more difficult and a challenge to existing practices, so the industry is ripe for change. It’s a niche market, but we have to start somewhere. We’re going to reinvent this industry from the ground up.
What does the technology do?
First off, it uses research to better match patients with therapists, rather than leave this to chance or the ‘ups’ system that has been used for decades. For example, research has shown that matching gender and race between the two can either help or hurt treatment outcomes, using very rough success measures.
Second, it builds in some clever tech, such as using your smartphone to create geofences around potentially risky locations for each individual patient and providing a warning signal to encourage the patient to avoid these locations.
Finally, their system will allow practice offices to see how their therapists are performing and look carefully at the demographics. To make sure patients are better informed, we have to change the dynamic of how we deliver therapeutic care and how we rate therapists.
What are your ambitions for the company?
If we succeed, the potential benefits are clear. Just like in Moneyball, where a poorly-performing team changes to win more games, we hope to see a transformation in the therapy world with a lot more patient ‘wins’ too.