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Rotman Insights Hub | University of Toronto - Rotman School of Management

A healthcare industry disruptor describes how her company is creating value in a complex industry

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Christy Prada

What are the biggest wicked problems in healthcare right now?

There are several, and from my perspective they are driven by two factors. The first is that there are so many stakeholders involved, which often means that there is no one right solution. The second factor is that in today’s resource-constrained world, there is an imperative to do more with less. Both factors manifest themselves in the problems we see in healthcare — from attempts to efficiently deliver care to an aging population, to safely incorporating technology like AI and wearables without compromising quality, to creating coordinated access to medical information along care pathways.

The backdrop to all of this is the overarching challenge of optimizing incentives across the entire system — for patients, providers and vendors. These are big, messy problems that many have tried to tackle. Yet few are successfully driving change.

Which of these problems did your company, Maple, set out to address, and why?

We set out to address a very specific challenge in healthcare: timely access to care. Every day, patients with non-urgent issues are forced to visit the emergency room because it can take days to see a family doctor. Our CEO and co-founder Dr. Brett Belchetz is an emergency room physician, and he saw this problem first-hand every day. When you have an emergent primary care issue that cannot wait the week it takes to get an appointment with your family doctor, that is a problem. We are addressing this by using the latest technology and a distributed network of physicians that enable patients to speak with a doctor in literally two minutes or less — anytime, anywhere.

Maple is also breaking down barriers around access to health records, because we believe it is important for patients to ‘own’ their health data. Canadians already bank, shop, and work online. Why shouldn’t they be able to access healthcare online?

According to the Commonwealth Fund’s global healthcare rankings, Canada is falling behind in key areas, including access, equity, administrative efficiency, and health outcomes. What is driving that decline?

Every country in the world is struggling with one element or another. No one system has gotten everything right to date. But in Canada, the decline is due in large part to how heavily politicized and misunderstood our system is. Despite high levels of spending, Canada has failed to effectively incentivize and foster innovation or efficiency. This is driven by our rigid payment and reimbursement models, antiquated governance models, cumbersome technology assessments and procurement policies, and lack of incentive for patients to use the system responsibly. What’s more, our decades-old privacy laws have not been refreshed in the context of today’s technology. That makes it challenging to use new technology to improve efficiency and quality of care.

Canadians already bank, shop, and work online. Why shouldn’t they be able to access healthcare online?

Canada also has a key challenge around market opportunity. We have a system that is nationally funded yet provincially delivered, and that creates extremely nuanced systems with business environments that vary from province to province. This can limit scalability and throw up barriers to new entrants looking to get into the healthcare market.

What could be done to turn this around?

For starters, policy makers can create and adapt policies and procurement structures to foster innovation and collaboration across provinces and enhance the scalability of Canadian solutions. We are starting to see this. The Canadian Medical Association (CMA) recently expressed interest in exploring a national approach to physician licensure, which will help to remove barriers around distributing physician capacity across provinces through virtual care. Specifically, this will help provinces experiencing acute doctor shortages, impacting quality-of-care locally.

Then there’s the creation of Ontario Health Teams (OHTs) in our province. These teams offer the potential for more streamlined procurement and service delivery, making it easier to source and procure solutions that can be scaled across the province, and enabling hospitals to collaborate more seamlessly with community providers on care pathways. While this is still a work in progress, I think it creates a great opportunity for a company like ours to use video technology and virtual care records to help coordinate and integrate care across the continuum.

Where do the biggest opportunities exist for innovation in healthcare?

Often, it’s the parts of the system that are the most strapped for resources, funding, physician access and technologies that are most open to innovation and collaboration. Take P.E.I., for example. The province has experienced recent ER closures, so access to care is a growing issue. We have been collaborating closely with Health PEI and in doing so, have created a unique opportunity to bring virtual care to the inpatient setting, helping to address major challenges, while evolving models of care delivery and improving outcomes.

Private healthcare providers such as insurers and benefit providers also create opportunities for innovation in health delivery. This is because of the aligned incentives in these spaces — managing cost, keeping people healthy and at work, and improving upon quality and differentiation to compete.

As a disruptor to the system, we know there will be critics who think our approach is too radical.

Virtual care creates opportunities to address many key barriers around access to care and sustainability, while also supporting improved access to information and patient empowerment — all things that support a more efficient single payer system.

In your experience, what is the best approach to healthcare innovation?

As a private player in the system, a key strategy of ours is to demonstrate an ability to partner with government and public sector players to co-design solutions. This demonstrates a commitment to improving care for Canadians in a way that is aligned with government incentives and funding structures and creates the opportunity for assessment and measurement of outcomes.

Again, our partnership with Health PEI is a good example of this. When one hospital was on the verge of closure because of a lack of physicians, we worked alongside hospital stakeholders to design, develop and pilot a sustainable solution that leveraged Maple’s team of virtual physicians to provide in-hospital care. The solution was the product of months of iteration on clinical workflows to integrate new technology, expand the scope of practice for clinicians on the ground, develop metrics to measure outcomes and evolve payment mechanisms to facilitate physician billings.

This would not have been possible without the support and leadership demonstrated by the hospital throughout the design and implementation stages. We have since turned the pilot into a long-term contract through this collaborative co-design approach and produced learnings that can be shared with other hospitals facing the same challenges.

Recent polls show that Canadians are excited about the positive changes that technology is bringing to healthcare, but they have concerns around privacy. What is Maple doing to make sure patient information stays safe?

Privacy is incredibly important when you are dealing with healthcare data. As a healthcare technology company, we have to be extremely well versed in all types of regulatory requirements and laws — particularly around the storage, use and maintenance of Personal Health Information (PHI) and rules around the physician/patient encounter — including how and where it takes place, platform security specifications and how the data appears on the device. Our application was built using a privacy-by-design approach and we engaged leading experts on Canadian healthcare and privacy laws, including Bonnie Freedman, former counsel for the College of Physicians and Surgeons of Ontario. We store all of our data in Canada using AWS Canada, which meets all required PHI privacy and security standards. We are currently undergoing our SOC 2 compliance to demonstrate our commitment to secure practices.

The virtual care model is not without its critics. What do you say to those who feel fee-based platforms only improve access for those who can afford to pay, and that they pull physicians out of the public system?

With something as politicized and personal as healthcare, not everyone is going to agree on what should be funded and how. As a disruptor to the system, we know there will be critics who think our approach is too radical. But that is inherent with innovation, particularly in healthcare.

To answer our critics, I point to the Canada Health Act. Many people interpret it to mean that all physician care should be free, and that it is wrong to charge for any services. This is not entirely correct. In fact, the Act says that physicians and other providers can bill privately for any service that is not insured by the province. Virtual care is clearly not an insurable service, but similar to dentistry, laser eye surgery and physical therapy, it is perfectly legal to bill for these services.

With respect to pulling physicians out of the system, our model is unique from other virtual care providers in that we do not limit their ability to work in the public system. Readers may not know that more than 50 per cent of physicians do not work full time. We are tapping into that unused capacity by allowing them to practice when they have free time. 

We are still big believers in patients having relationships with a primary care provider. But the reality is that even if someone has a family physician, it is rare that they can get in to see them right away when an issues arises. Our model is not meant to pull low-acuity cases out of the system; it is meant to pull them out of places like the walk-in clinic and the ER — where they do not belong.

Would you describe Maple as a disruptor?

Absolutely, and that is one of the things that drew me here in the first place. I was employee number three, and I was extremely motivated by the ambitious vision the founding team had for the future of healthcare in Canada. I have been lucky in my role here in that I get to drive truly transformative projects — from bringing virtual healthcare to a remote hospital to streamlining access to care for employees and insured individuals to partnering with companies like Life-Labs to make alternative testing approaches more accessible for Canadians. Our approach — which involves pushing the limits of traditional care models while making change tangible by supporting our partners through the journey — creates staying power and scalability.

Maple has already demonstrated the potential of disruption in the healthcare system through our quick rise to growth. In fewer than three years of providing care, we have a user base of more than 400,000 across 70-plus corporate partners and multiple care environments (including community, work, clinics, hospitals and governments). This type of growth demonstrates huge potential for continued momentum in disrupting the Canadian healthcare landscape.

What lies ahead for Maple?

We have big ambitions. We recently closed our a $14.5 million Series A investment round and we will be using this funding to make targeted investments in growing our team, adding functionality to our platform and building partnerships that will help us gain traction in the market. We also plan to augment and enhance how patients and providers communicate with each other, integrating AI into the physician end of the platform to aid in decision support and quality of care. Our goal is to become the technology platform on which all virtual care is delivered in this country.

Christy Prada (Rotman MBA ‘13) is VP of business development at Maple (