When my grandparents entered an assisted living center and were in the final years of their lives, it was up to my parents to sit in on conversations about end of life planning. They worked through difficult, but important, discussions about how my grandparents would want to be treated or medicated or resuscitated if and when they couldn't make those decisions for themselves.
And it was up to my parents to relay that information to the rest of us in the family -- and a couple of us lived halfway across the country. Naturally, there were unanswered questions and a sense of helplessness. Though I think my parents are pretty good communicators, it's not easy to remember all the details of these sometimes lengthy conversations and a bits of information usually stray as the message is relayed from one person to the next. And I didn't really know how I could help.
Now there's a startup in Austin that's trying to make that process more robust and personalized for people who need to plan for a future with a serious illness. Iris Plans, which launched at the SXSW Health and Medtech Expo this year, is offering advanced care planning to people with serious illnesses -- and their families -- that provides a more detailed discussion of end of life planning than most healthcare systems and is conducted via videoconferencing. And that planning typically starts as soon as a diagnosis has been made.
"Often times, if you suddenly have a serious diagnosis, you have all this medical jargon thrown at you, you have all these apparent choices," Steve Wardle, co-founder and CEO of Iris Plans, said. "But you're overwhelmed, and, often times, making a decision kind of in a crisis."
That means the decision is basically made by the physician, perhaps without really delving into a patient's goals and lifestyle.
This is where advanced care planning -- or palliative care -- comes in. Palliative care is a relatively new field that integrates several healthcare disciplines to best manage pain, mental stress and other factors impacting the quality of life for anyone with a serious disease. Hospitals began building palliative care teams over the past decade. And with a limited pipeline of medical professionals going into the field, many hospitals don't have the time and staff to provide a high-level of service for all of their patients.
Iris Plans is a startup with a telehealth service that connects patients and their families to a network of palliative care professionals, especially in cases where one may not be available in the facility where they are receiving care.
The palliative care consultation involves asking a lot of questions about what a patient's ideal day would be like. Do they want to pursue as much treatment as possible? Or are they more interested in managing pain and finding ways to enjoy the rest of life with as little time in the hospital as possible? Or maybe they want to find a way to see the world before the disease becomes too advanced to let them to do so.
A palliative care team can help provide information about what that means -- the risks associated with treatments, potential costs and how certain decisions could conflict with each other.
"When people get palliative care, they live better," Wardle said. "So they're happier and their symptoms are better managed and there's lower stress. Their families do better -- so their families have less stress -- and they're much more empowered."
That's why Wardle partnered with Dr. Stephen Bekanich to create Iris Plans. The company has networked with palliative care professionals across the country -- mostly nurses and social workers -- and has built a telehealth platform that allows advanced care planning experts to meet with the patient (and their family or friends) via video conference. The system allows people in multiple locations to be on the same screen to help learn how they can help each other and the patient.
Bekanich, who had been working in an ICU, decided to change careers after seeing his grandparents go through chronic illness. Even as a doctor, he felt helpless to improve their situation.
"Their interactions with the healthcare system did not go well," Wardel said. "He saw them suffer, an that just really kind of deeply affected him."
Bekanich switched fields and went on to become the medical director of palliative care services for the University of Utah Hospitals and Clinics in 2005, the taking on the same role at the University of Miami Miller School of Medicine before coming to Austin to lead the palliative care program for the Seton Healthcare Family in 2012.
Wardle, meanwhile, started his career in investment banking for high-net-worth individuals. He parlayed that knowledge into micro finance with the Grameen Foundation to help some of the lowest income people in the world, providing small loans to help people build small businesses.
Working with Insurance Companies to Cover Patient Expenses
In Africa, Wardle worked with Grameen to use mobile phones as a way to reach and educate people about micro finance. Then, they expanded their mobile phone strategy to healthcare. Wardle loved it, and when he met Bekanich and fellow co-founder Andrew Chen, whose background is largely in tech with companies including CognitiveScale and Spredfast, last year the three decided to launch Iris Plans.
Iris Plans videoconferencing is designed to set up pretty easily, but the company has a white glove service to assist people with limited computer experience
The company has closed about $400,000 in seed funding, and it plans to raise a bit more seed funding before seeking venture capital later this year. Their goal is to reach 100,000 people -- plus their families who sit in on planning sessions. They do have customers, Wardle said, but declined to discuss revenue.
The Centers for Medicare & Medicaid Services is now trying to incentivize more palliative care and offering doctors reimbursement for providing that with Medicare patients. Most insurance doesn't cover such advanced care. Iris Plans is talking with health insurance companies to have palliative care covered.
Iris Plans' standard pricing ranges from $500 to $1,500, although they're running promotions now that bring the price down to about $200. That investment, in many cases, could help avoid some medical expenses, depending on the patient's goals.
Wardle said that unnecessary healthcare costs more than $200 billion a year in the U.S., much of which could be prevented with more in-depth healthcare planning.
"When you get care that you wouldn't have wanted or wasn't beneficial, it costs you money, so it's bad for you in that way, and it's bad for your health," he said. "You only have so much energy to expend, and you need to expend it doing the things that will help you."
