Virta Health has been using our APIs in their revolutionary diabetes platform for the past few years. Fresh off a $93M Series C, their growth story is one worth sharing, so we caught up with Sam Reider, a Senior Software Engineer at Virta, to get his perspective on interoperability, discuss creative ways in which they’re applying clinical data to improve care, and share how Health Gorilla’s APIs accelerate product innovation.
Virta has made a lot of progress in the past year. For folks that may not be aware, what does Virta do?
Virta Health delivers a clinically-proven treatment to safely and sustainably reverse type 2 diabetes and other chronic metabolic diseases without the use of medications or surgery. For patients, we act as a telemedicine endocrinology provider, delivering care continuously and remotely. Our continuous remote care platform is essential for safe, sustainable, and scalable disease reversal, and gives patients access to their care team on a near real-time, 24/7 basis. Instead of going to an endocrinologist 4 times per year, our providers are constantly monitoring patients, intervening at the right time and ensuring patients are on a path to better outcomes.
Many digital health companies are beginning to use data to take on risk. How does Virta use data to drive its business model?
Virta practices a unique value-based care model and we put 100% of our fees at risk while tying payment to both engagement and health outcomes. Customers (self-insured employers and health plans) know how success is measured and only pay for improvements seen in their population. Our only incentive is to get patients healthy, and for patients with Type 2 diabetes that means controlling blood sugar which is measured by a patient’s HbA1c.
Before you started searching for solutions to track outcomes, what were the pain points you were trying to solve?
Tracking lab result values like HbA1c is critical not only for revenue recognition but also patient monitoring. Before integrating with Health Gorilla, we would have people manually create lab orders, then receive results by fax and transcribe them into our system. These tasks are tedious and error prone when executed manually. As the scale of our clinic grew so did the amount of time required to complete these manual tasks and the opportunity for data quality issues. It was clear we needed to remove human error from the equation by automating this entire process. That’s where Health Gorilla came in.
What other solutions did you consider?
We needed to place orders and get results from labs all over the country with the highest quality data as soon as possible given limited engineering resources. Before settling on Health Gorilla, we considered adopting a commercial EHR, direct point-to-point connections, and Change Healthcare’s lab interface. We decided against a commercial EHR because, as a full-stack tech company in healthcare with a unique care delivery model, we need to drive care team workflow and can’t do that within an off the shelf EHR. Building a national lab network with point to point connections via HL7 v2 didn’t fit within our timeline as integrations with LabCorp and Quest take about 6 months each. Also, HL7 v2 interfaces are difficult to build and maintain as they rely on dated web standards. We evaluated companies that offer to build point to point integrations but found their pricing wasn’t competitive. Change Healthcare offers a single interface that supports both LabCorp and Quest but it is over HL7 v2, doesn’t naturally fit automatic ordering, and lacks regional lab vendors.
What were the reasons Virta chose Health Gorilla?
Health Gorilla offered one API that made it easy to integrate lab ordering and receiving from a nationwide network of labs, used modern web standards, and was based on FHIR which lowered our implementation costs since we use FHIR internally. There was no other vendor in the market with this complete package.
How does Virta use Health Gorilla today?
Our core use-case for Health Gorilla is lab ordering and result processing via API. Orders are triggered automatically based on various criteria and results are processed automatically, allowing our providers to continuously monitor patient progress and measure outcomes.
Health Gorilla also helps us keep the rest of a patient’s care team in the loop with ongoing treatment, which is important as we are often de-prescribing complex medications like insulin. Before our Health Gorilla integration, we invested a ton of time getting correct contact information for the patient’s primary care doctor. Today, patients can search for their primary care provider when creating their account so we get the information we need instantly and it’s a better experience for the patient. This search is powered by Health Gorilla’s provider directory which is available through the base FHIR API. We plan to use the eFax API to send faxes when providers can’t communicate electronically, and are evaluating the Patient360 API for clinical record retrieval.
Outside of Health Gorilla’s APIs, we have found Health Gorilla’s web app useful for debugging, ad-hoc ordering, and de-duplicating patient records when demographic data on incoming results isn’t an exact match.
How long did it take to implement our APIs?
It took about a month. Our team was smaller back then, it was just me and half of one other engineer’s time.
How does this data serve as a competitive advantage for Virta? What are the strategic benefits?
It’s all about scale. Automating our process to monitor progress and measure outcomes means we can manage many more patients without hiring many more people. This automation is a necessary component of the system that gives us the confidence to adopt risk in our business model such that our incentives are aligned with our customers and patients. Using Health Gorilla to power this automation was a big benefit because it dramatically cut our implementation time and was the only natural fit.
What advice would you give to other digital health startups that are thinking about data access and considering value-based business models?
Don’t reinvent the wheel. Digital health startups should spend their engineering time on features that are unique to their business. Lab ordering, result processing, and patient record aggregation should not be built by a company delivering care.
Lean into the information model provided by FHIR and buy the features that are not unique to your business. You’ll be able to invest your engineering resources in the hard problems that differentiate your product.
To adopt risk, you need a clear way to measure success and your product needs to work. At Virta, we evaluate diagnostic lab results, retention, and medication use to measure our success. Our ongoing clinical trial and many peer-reviewed papers demonstrate that our treatment works and continues to work over time. Health Gorilla has enabled us to safely scale our business model and maintain our 100% at-risk fees, with the majority of payment tied to health outcomes.
Health Gorilla will be at the HIMSS 2020 conference from March 9–13. To RSVP for our HIMSS happy hour, click here. For more information, visit healthgorilla.com or review our API documentation at developer.healthgorilla.com.
For more information about Virta Health, visit virtahealth.com.