I was surprised to discover that the biggest scare for caregivers isn’t getting your loved one to the hospital–it’s getting them discharged. Through my uncle’s years-long journey with early-onset Alzheimer’s, I ironically felt most nervous when he was “stable.” Harried hospital nurses waited for us to choose where to fax my uncle’s 100-page medical record for review. From lists of addresses and phone numbers, we just chose the ones closest to home. The first to respond would win the case and the insurance dollars that followed.
Every year this discharge process inadvertently directs more than $250 billion of Medicare spending to the most convenient post-hospital care providers, not the highest quality. MedPAC reports that 46.8% of patients went to providers that were outscored by five or more providers within a 15-mile radius on quality ratings like patient satisfaction and re-admissions back to the hospital. Less than 15% end up at a top-quality provider within 15 miles. Like the 10 million American families who will choose post-hospital care this year, I never meant to reward my uncle’s case to the doctors with the best real estate and fax machines–yet the outdated discharge process I experienced quite nearly guaranteed it.
As my uncle racked up discharges from hospitals to nursing homes to home care, I saw that rearranging the logistics of discharge could realign the incentives. I founded Aidin six years ago to convert the faxes and phone calls of discharges into smart auctions where hospitals could make providers compete for patients. Rather than limiting choice, hospitals would encourage provider competition and show patients all their options. Instead of highlighting geography, hospitals would engage patients with personalized real-time outcomes and cost data right when choosing. Aidin invites interested providers looking for new referrals to offer care to patients and compete to be chosen as patients review patient satisfaction, cost and re-admission scores–82% of patients using Aidin choose the top-performing provider, and high-quality providers win three times as many referrals.
Health care’s sheer size means few players have enough access and influence to make a difference. While the biggest innovation plays in health care require significant investment, the smartest approaches address existing operational headaches to strategically instigate change. I never imagined that lists of nursing homes and 100-page faxes could cause so much patient harm and misdirect so much money. While politicians and executives hustle in D.C. and boardrooms to steer the health care juggernaut from above, I remain glued to ordinary health care transactions of discharge, authorization, clinical document transfer, patient choice–the faxes, the calls, the clicks–that repeated in tens, hundreds, thousands and millions at a time generate marketplaces that enable reform today.
Graney is the founder and CEO of Aidin
This appears in the November 27, 2017 issue of TIME.