Physician and entrepreneur Ryan Van Wert, M.D., co-founded Palo Alto, Calif.-based advance care planning solution developer Vynca in 2013 to create tech products to guide and document advance care planning discussions that would be easily accessible to necessary stakeholders, including patients, families and clinicians. Van Wert is also an assistant professor at Stanford University where he also maintains a clinical practice.
Since the company’s founding, its reach has extended to document the goals and wishes of more than 1 million aging or seriously ill patients.
Van Wert recently sat down with Hospice News to discuss the importance of advance care planning, its impact on the hospice space, and Vynca’s growth trajectory.
WIth Vynca being a start up, can you tell me about what inspired the formation of the company and how it came together?
My background is in critical care. This was ultimately spun out of a postdoc program at Stanford called biodesign, which is a health technology program focused on value-driven health care innovation. There was one other critical care doctor and two engineers on the [Vynca] team.
We have just seen one too many patients die on ventilator when they ought to have been receiving palliative care or hospice care. In many cases, there was a document that somebody later discovered sitting in a safe deposit box saying they never wanted that type of care. In a lot of cases, no one ever asked them what they wanted.
We know that most people when given the choice will choose to have quality time over quantity. It was just really seeing that happen time and again, and the impact that that was having on the patient, on the family members and on the clinicians. We saw there was a real problem. There’s often a care coordination aspect with multiple stakeholders involved and a very disparate health care ecosystem where these individuals are receiving care.
We recognized that there was a real opportunity to leverage technology to support organizations in solving all the operational problems that go along with this kind of decision making, with the ultimate goal of ensuring that there is appropriate access to palliative and hospice services.
Can you tell me about the solutions that Vynca has brought to market around advance care planning?
We think about our solution as different having four different pieces to it. The first is around what I’ll call workflow solutions that support caregivers and clinicians in having thorough discussions and making sure that they are codified in accurate documentation, whether that’s a summary document or whether that is a medical order or an advanced directive.
Our focus prior to 2019 was really just having the clinician drive this conversation. What we rolled out through the course of last year was a brand new suite of tools where now individuals who are part of a given organization can access their own advance care planning information. They can create their own advance care plan and share it with caregivers, and that for us has represented a natural extension into a patient-centered and patient-first mentality around how we approach not only this topic but how we approach health care technology in general.
That’s something that I’m really proud that our company built out over the course of the last year
There is a registry piece, which is an aggregation of any care plan that we manage and that we receive into our central secure cloud. This allows us to make sure that there is a single source, whether it’s for the patient or the caregiver or for a clinician, where they can access the most up-to-date and accurate documentation for that patient when it’s needed to direct care. We’ve seen some really powerful outcomes, such as 37% reduction in hospitalizations and 59% reduction in intensive care utilization and more than 50% reduction in 30-day readmissions.
Then the last piece is the business intelligence and reporting solutions that we offer, which help the organization to understand where they’re seeing in utilization, where they’re seeing success and seeing the most value from implementing an advanced care planning program. We pair this with a very high-touch model, both during the implementation phase and then through the life of our relationship with our client to support all of the change management, training, education, and everything that goes into actually making a transformative change at an organization.
What impact do you see advance care planning having on palliative care and hospice utilization?
The bottom line — and this comes from both my clinical experience as an intensive care physician and also our work at Vynca — is that discussions around future care preferences start with a conversation about values, choices and goals and fitting those into a care plan.
As it relates to palliative and hospice services, that discussion and facilitation of that process of having a high-quality discussion is really the gateway to being able to access those services.
Our health care system is still, unfortunately, very much geared toward the conveyor-belt mentality of doing everything [to the patient]. There’s very clear referral pathways and processes in place to pursue largely curative, intense care. Unless there’s a process in which a person can reflect on and express their care preferences, then more symptom-focused care and comfort-focused care are not by any means the default in the health care system.
Where we see ourselves fitting in is to enable health organizations to help patients feel empowered with their voices being heard and help clinicians feel like they’re armed with the tools to go through the process of decision making. And ultimately to have the output of that be a true and accurate reflection of what that patient wants.
Most Americans prefer less aggressive, comfort-focused care when they develop illnesses that are life limiting. Certainly there’s a spectrum and a process of how that happens, but at the end of the day, there’s very few Americans that want to die on a ventilator in the intensive care unit. The vast majority of Americans want to be comfortable at home and reflect on the things that make all the difference in terms of quality of life. Just having a conversation does lead to increased access utilization to these important services.
Do you see more payers in the space requiring or advocating for advance care planning, and if so what is driving their interest?
[The U.S. Centers for Medicare & Medicaid Services (CMS)] is kind of the ultimate payer, and they made their first move into advocating for advanced care planning three or four years now ago in recognizing advanced care planning conversations as a reimbursable activity, understanding that these conversations take time just like any other professional service that a clinician delivers.
The other thing that we’re seeing is that there’s an increased focus on making sure that there is access to palliative and hospice services. We’re seeing health plans start to embrace that. I think this is a very important issue for their members.
We can all put ourselves in the shoes of somebody with a serious illness who’s facing massive complexities of choices, decision making, and care coordination. It’s really a terrible time to feel like you don’t have the access and resources to not only the care you need, but support through those very difficult decisions. That’s where I think there’s ongoing opportunity for health plans to continue to make sure that their members with serious illness are being supported.
CMS is requiring advance care planning for participation in some value-based payment models that will likely impact hospice, such as primary care first. How do hospices and their referral partners need to adapt?
I think the goal of many of these initiatives, whether its Primary Care First or whether it is the [Medicare Advantage hospice carve-in], is to make sure there’s more continuity of supportive and palliative services in advance of a transition to hospice. I think we all recognize one of the big barriers in the current paradigm is the need for more transitional care that blends symptom and comfort focus needs with treatments that may extend quality or quantity of life.
For hospices this means getting more of a sense of their role in moving upstream of the end-of-life and supporting that transition and that continuity of care for individuals as they move through through that journey.
I think one of the biggest ways to provide that support is through high-quality goals-of-care care discussions that are best positioned to really explain the value of the services [hospices] offer, and how it might fit into a patient goals.
I think there’s a big role for hospices to step in and provide either formal palliative care services, or specifically to support some of those goals-of-care discussions that would ultimately allow that person to express their preferences in an accurate way to get the care that they want.
Last year Vynca received 10.3 million in Series B funding to fund expansion into new markets and new product development. What are Vynca’s plans for growth during 2020 and what are some of the strategies you are using to achieve this?
We have a continued focus on expanding our current presence, which is now across 11 states managing more than 700,000 care planning documents for more than a half a million unique patients.We will continue that focus on growth around the value-based programs and funding. That’s really driven a lot of interest in supporting high-quality advanced care planning.
In the conversations we’re having with executives at health systems, we see more and more that advance care planning and serious illness management is coming to the top five strategic priorities for these organizations for the coming year. We see it as, frankly, overdue, but we’re happy to see it.
The other area that we’re really interested in is supporting others in post-acute spectrum in having high-quality goals-of-care and serious illness discussions. We want to make sure that we’re continuing to address those needs.