Can We Trust Patient Reported Outcomes in Orthopedics?
Episode 381

Breanna Cunningham, Founder at CODE

Can We Trust Patient Reported Outcomes in Orthopedics?

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Can We Trust Patient Reported Outcomes in Orthopedics?

Episode 381

Recommended Books:

Redefining Health Care

The 7 Habits of Highly Effective People

Best Way to Contact Breanna:

Breanna@codetechnology.com

Linkedin

Company Website:

CODE

Can We Trust Patient Reported Outcomes in Orthopedics? with Breanna Cunningham, Founder at CODE | Convert audio-to-text with Sonix

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Saul Marquez:
Welcome back to the podcast. Today I have the honor of speaking with Breanna Cunningham. She’s the founder at CODE. As the founder of Code technology, Bree Cunningham oversees a company that develops products designed to collect patient outcomes data as a health transitions from a fee for service to paper or performance reimbursement model, it’s imperative that physicians are able to demonstrate the value of the services particularly when it comes to surgical interventions. The key to demonstrating value is having a validated patient outcomes. All health providers recognize the need to collect both pre and post intervention outcome data for surgical patients. The challenge is actually operationalizing it. In her role, Bree runs the day to day operations and technology and draws on her extensive health care experience and entrepreneurial skill to develop the firm’s strategic business plan. She also manages the organization’s leadership, oversees sales and marketing and develops and maintains relationships with advisors and investors. She seeks to provide health care institutions with simple solutions for collecting patient outcome data. So this is Bree, really excited to have you on the podcast and would love if you could just fill in any of the gaps with the intro that I may have missed. Welcome.

Breanna Cunningham:
Thank you and thank you for having me Saul. No, I think that did a great job summarizing the day in the life of if you will. And as far as my healthcare background, I’m a nurse by trade so that’s really what inspired me was my bedside nursing clinical days.

Saul Marquez:
Love it.

Saul Marquez:
What particular area of the hospital?

Breanna Cunningham:
Trauma trauma ICU.

Saul Marquez:
All right. Like the hardcore stuff.

Breanna Cunningham:
I really do. I really do. And nursing is so fun so I got into nursing very young and I did E.R. as well and would flow would do various aspects of the hospital just to get my learn on and then did the travel nurse thing for a while which was just fantastic and learned a lot about the different ways that medicine is practiced in different areas of the country. And it was a blast.

Saul Marquez:
That’s really neat. That’s really neat. So definitely it’s in your DNA. This ability to to have to shift in the moment. Entrepreneurship was something that really worked for you. So why did you decide to get into the medical sector to begin with?

Breanna Cunningham:
It’s funny I saw that question and the answer is I just always knew I ever since I was little my dad was a firefighter in Phoenix and my mom was in the Air Force and I used to spend a lot of time as a young kid in the firehouse and my dad said as long as my grades were good I was allowed to go on every call with him and I just loved it. Man on the call I would go off and all the medical calls I loved. So it wasn’t even really like a choice or a war. I never really debated it was just started and I’m going to do medicine.

Saul Marquez:
That’s neat, that’s really neat. I love it. So really it really cool that professions that your folks were involved in and then you just went for it and so you’ve been in it for a long time now in the healthcare space. What do you think a hot topic that needs to be on leaders agendas today is and how are you and your team at CODE addressing them?

Breanna Cunningham:
Yes so I think value. I mean I know it’s a very trendy buzzword right now. You can’t go to any conference without hearing about the shift from fee for service or volume to value. And the reason people are talking about it is because it really is important and it goes beyond just you know saying value. It’s really how do you measure it. What is your organization going to do about it and with it and then how are you going to incentivize and reward that? And so it’s a complicated subject and but it’s also really fun. You know I feel like if you if you look at the past several years in healthcare you know there was this really aggressive shift where fee for service was identified as I don’t wanna say being evil but having a lot of room for improvement and so much work was done through meaningful use and just really cost containment so cost containment has happened and now we’re kind of in this where I view it as the middle of all right what do we do that. And now it’s time to really shift cost containment has happened. Then what. Let’s increase value as a clinician as a provider It’s not super exciting to me is it just just here. OK. We cut a bunch of costs. Right. I know I want and the physician leaders out there want is to be able to provide better care, increase better care at a lower cost. So that’s where I think is very important right now. That’s a topic that every medical leader should be focused on. And there’s a lot of work to do on that subject. And so to answer the second part of your question is what is our organization doing about it. Well we do a damn good job collecting data. So patient reported outcome data is is so necessary it really is the backbone of a value-based health care is in the value equation and it’s the numerator. And the thing is is it’s not easy to collect. It’s a real pain in the butt, it’s a logistical nightmare. So where our organisation helps is really our clients can outsource the entire data collection process to code and sleep comfortably at night knowing that if they have a sustainable and reliable mechanism in place for getting them that critical piece of data that they need to make a difference.

Saul Marquez:
I love it. Yeah it’s definitely difficult. Right and so you guys have decided to hone in on orthopedics then?

Breanna Cunningham:
We have. So as of now ortho is definitely a real focus. That being said we have been in beta with cardiac for quite some time now as well we are we are mingling in a few other different modalities and definitely when you look at our one three five year plan C expansion outside of ortho so there there’s a couple of reasons that’s ortho really became our main focus. One is just in my clinical background as a trauma nurse I dealt with a lot of ortho and was doing a lot of ortho research. I also happened to be married to an orthopedic surgeon. So we’ve got an ortho household. And then And then thirdly and truly probably the most important reason from a business standpoint is is the economics surrounding ortho total joint replacement surgery is the most expensive elective procedure that’s that payers that payers are facing. And we’ve got this with the baby boomers we’ve got this titanium tsunami of patients that are in the market for a total joint. So really that has been a big driver as well.

Saul Marquez:
Love it. Not really great distinctions there and I totally get it. And so you know for the folks listening re I think there’s a lot of misconceptions right about about how do I do this. How much time does it take pre-op, Inter-op post on and not really Interop but post-op, really pre and post stop. So what are some common myths that you would dispel and how do you guys help enable?

Breanna Cunningham:
That’s a great question. So a couple of things related to that. So it’s interesting. This isn’t our company is early to market right. We we were really into PROs before they were cool. We waited for this way before CMS and CJR program before BPCI started incorporating PROs. So when you when you get down to it and you look at just the really nerdy science behind it, patient reported outcomes are awesome. There is so much value in this. This isn’t just like a survey like a Disney princess survey that you take on Facebook right. These are validated rigorously tested tools that give you a quantifiable result. So there’s a lot of amazing science behind it. So I think that that’s one of the myths that we have to that we have to dispel is that this isn’t just an age cap survey or a patient satisfaction score surveys is truly a tool. And you know I’ll use who’s in Coos example here is I can look at somebody walking down the street and guess who’s score. It’s like a Myers Briggs. So I think that that’s one of the big myths to dispel is this isn’t just some random survey. This is a really important clinical tool. The other myth I wouldn’t even necessarily say it was is a myth. So I might be going off topic if you need to rein me in Saul.

Saul Marquez:
No, this is good.

Breanna Cunningham:
Don’t hesitate.

Saul Marquez:
It’s all good.

Breanna Cunningham:
But I was actually just given a talk down in Florida on this subject and knows no patient reported outcomes as a lot of really cool thing that’s really fun from a science standpoint that’s great. But as it’s become part of this financial equation and as organizations are being for lack of better words forced into doing this right. So it’s not the free will of I really want to collect this because I care I have a reason to it’s that it’s mandated and there’s a financial incentive it really kind of has tainted it’s lost some of its luster especially on that day to day clinical level because it could be a pain in the butt. So I think one of the things that we try to as an organization is to get people back to really making outcomes cool again. Right. And understanding the importance of it. I also think there is a lot of work to be done Saul in defining what a good outcome is do we use the Delta do we do is the overall score. What are the appropriate intervals. And I think it’s so critical right now when you would ask what the most important thing medical leaders can be doing. I would even say particularly surgeon leaders should be doing is getting involved and helping define what these metrics should be. They are the experts in this right give them the data let them put it to use let them define what the actual metrics should be for defining a good outcome in orthopedic surgery. Cardiothoracic surgeons have done a great job pioneering this. They have a sophisticated registry. They even worked with consumer health to help define those metrics right. So the consumer health building something they got together and said OK. As an organization as surgeons what do we believe the metrics are what is good look like. And then they got consumer health to get on board with that and report those outcomes. So that’s where I really would encourage people to get involved.

Saul Marquez:
Love it. Great message there Bri appreciate you dispelling some of those. It’s definitely an interesting topic of conversation and one that’s warranted that deep dive. Tell me a time when you had a setback as you guys have put this technology, this platform together. What did you experience as a setback that has made you guys better?

Breanna Cunningham:
Yeah I’ve been so gosh you experienced a lot of setbacks also spent specifically this product line or this ortho line. Yes. I would say that one of the big setbacks or challenges that we had is that again we started collecting well before government mandates happened. Then the government mandate happened and where I was surprised was just This opportunistic approach that so many other organizations would have. I mean at that time there was CODE and a few other companies that collect it rose but overnight it felt like everyone in their mom had a piano company right or implant companies like Every striker and everyone just came up with a module for collecting outcomes. So that was really challenging is it is really this influx of market penetration from potential competitors. That was really big. The next for us and this for me I would say just you know I got into this very in a very pure way that I really care about what we’re doing we’re a very vision mission driven organization. And naturally when the government mandates what you do there’s opportunity in that right. Right. Went from being just this kind of cool thing that people would sign up with code because they had research dreams to I have to do this. So we wrote that way and it was fun and it’s good for the business. But what we really learned over that Saul is that you have making sure that people that our customers align with our values. Right. And it’s a totally different model a service model for signing up with someone who’s kind of checking a box to meet a government mandate versus someone that really truly cares about value how to measure it and how their organization is going to utilize that data and incentivize and reward it. So it’s just a different mentality. So one of the big challenges that I had to that we had to make as an organization is looking at that and really kind of defining our target customers and what that looks like and and making sure that we stayed really focused on not just this really shiny market that was mandated to use the product but making sure that we were focusing our energies on the long term customer that we really knew were going to care. Right.

Saul Marquez:
Yeah.

Breanna Cunningham:
So yeah.

Saul Marquez:
Definitely key. Yeah. So it’s an interesting thing that happens there right. The noise of the mandate and just kind of filtering through that to find the signal of your actual customer sounds like you guys did a really great job of that. It’s proved to have given you guys more strength and focus and I think it’s it’s a awesome thing. So that leads to the next one what’s been one of your proudest experiences to date with the firm?

Breanna Cunningham:
You know I still think the proudest is going to be yet to come. I wrote my notes here as maybe if some of those heart as I put some hard decisions and you know we just went through was an example of a hard decision where it’s to I I’m looking at this I’m looking at this revenue opportunity which is very compelling but saying is that the right target. And that was a hard decision and I would say that’s probably one that I’m really proud of making and I’m definitely had made CODE really fun again. We love. We love working with our clients on how to take their data and just maximize the value of it. And it’s really at the heart of what we do. So I’d say that the promise thus far.

Saul Marquez:
Love it. So why CODE? You know I think I like the name you know first it gives you the the feel like OK. They’re coders but then maybe medical billing. So what are your thoughts on that and love to hear.

Breanna Cunningham:
Saul, let me tell you I am good at other things I have strengths and weaknesses in naming conventions as one of our my weaknesses.

Saul Marquez:
You’re funny.

Breanna Cunningham:
Basic, like our our internal processes like I should have actually since been banned from not being able to name anything so get this. So CODE actually stands for. It’s an acronym for clinical outcomes and data engineering technology.

Saul Marquez:
Nice.

Breanna Cunningham:
So when the first product that we launched with CODE was actually a cardiac arrest app.

Saul Marquez:
Is that right?

Breanna Cunningham:
the same concept. It was a it was a tool that was used by clinicians to help document cardiac events and then that data would be rolled up into a registry. So because a cardiac arrest in a hospital is known as a code I really wanted that name in there. Chalk that up to one of the many poor decisions I ever made. And then once you get so far deep right it’s just like I can’t really change that. And maybe you know health care needed another acronym. No I’m just kidding. But that’s the story behind CODE.

Saul Marquez:
That’s cool. I get it I get it and you know I was curious about it and it’s fun to know the history of kind of how that happened and where you started to play and the pivots and that’s why I love having these conversations to hear the story behind what’s actually happening. Tell us about an exciting project you guys are working on today?

Breanna Cunningham:
Yeah. So I would say that once a cash registry has gotten so robust. Right. So it’s huge. And now that we’ve been around for five years, we have five years worth of data. So we’re talking about just just I mean it’s like a treasure chest. Right. So we have a lot of really fun research projects that we’re working on right now where I wouldn’t say formal research more just you know retrospective analysis and one of the topics that our team is having a lot of fun with and a lot of our our clients are having a blast with is robotics. So we’re doing a lot of robotics surveillance a lot of these products you know you’re and you’re Mayko you’re Fabio they’re quite new so isn’t there isn’t a beefy amount of long term outcome data on them. So now that we’re approaching this you know three- four year mark with that data it’s been really fun to kind of do some proactive implant surveillance so implant surveillance is one of the I would say ongoing things that we do that’s a lot of fun and particularly right now in the robotic area is something that gets our team fired up every day.

Saul Marquez:
Yeah. That’s really interesting Bree. So in the four years what have you found in a nutshell is robotics working, is it better? What have you found?

Breanna Cunningham:
So I would say we can have a great offline discussion about that. And I would I would also say that I do believe that we have a couple of our clients that are going to have some really game changing papers that will be accepted to next year’s Academy. So June is the deadline for those abstracts and we’re seeing some very very interesting things.

Saul Marquez:
So we will set the hook with that, folks. And if you’re curious about the work that Bree and her team at CODE are up to and figure some more out reach out to them we’ll be providing links to the company as well as best ways to get in touch with them and Bree. So getting close to the end of the interview here this is the lightning round and I’ve got a couple of questions for you. Followed by a book that you recommend to the listeners. You ready?

Breanna Cunningham:
I’m ready.

Saul Marquez:
All right what’s the best way to improve health care outcomes?

Breanna Cunningham:
Track outcomes and analyze the data.

Saul Marquez:
What’s the biggest mistake or pitfall to avoid?

Breanna Cunningham:
Not staying in the know right. Just kind of going about your day to day without staying up to date with relevant topics that are around you and then just not collecting data.

Saul Marquez:
How do you stay relevant as an organization despite constant change?

Breanna Cunningham:
Persistence.

Saul Marquez:
What’s one area of focus that drives everything in your organization?

Breanna Cunningham:
Our vision.

Saul Marquez:
Love it. And I’ve got two other ones that are more on a personal note. What is your number one health habit?

Breanna Cunningham:
Oh lately I’ve been super into the Peloton, Saul.

Saul Marquez:
Oh yeah?

Breanna Cunningham:
On the train the commercials real to me in.

Saul Marquez:
Yeah.

Saul Marquez:
I mean. I’m mom, I’m 24 weeks pregnant but you better believe I’m getting after after that bike these days.

Saul Marquez:
Wow. Good for you.

Breanna Cunningham:
Well thank you. Cardio is not my jam at baseline. I like more kind of high intensity training. But you know as I get older, the heart health is a real thing right

Saul Marquez:
It’s huge.

Breanna Cunningham:
Peloton.

Saul Marquez:
And it’s interesting because I mean you don’t even have to leave the house to do it which is amazing right.

Breanna Cunningham:
It’s so amazing. Yes I love it.

Saul Marquez:
Good for you. And one thing that I started doing is yoga from home. I have a yoga instructor that.

Breanna Cunningham:
You do? Like a human or a video?

Saul Marquez:
Yeah human. No like we do zoom yoga.

Breanna Cunningham:
Oh my gosh that’s so exciting I have to look into that. I was a huge Yogi back in the day. I love yoga because I got out of practice if you will as if you were kind of bouncing around the country for my husband end of his training his fellowship. Yep. I have I have a dream cell to get back into yoga. I might have to check out the Zuma yoga.

Saul Marquez:
Something to think about and how about your number one success habit?

Breanna Cunningham:
I mean consistency. I’d say consistency and showing up is easy especially as you kind of transition from the Karrada brand. Young bands start up right where it’s really fun and there’s a lot of energy to this day to day grind. I’d say consistency is key.

Saul Marquez:
Love it. And what book would you recommend to the listeners.

Breanna Cunningham:
So in the health care realm I’d love to read I read a lot. So I would say Redefining health care is a staple. You know read it, love it, carry it around and from a leadership health care leadership standpoint it’s old but I think it’s tried and true and that Seven habits of a highly effective leader great book.

Saul Marquez:
Now some great recommendations, oldies but goodies. And folks if you want to get access to all of this interview, the full transcript, the short notes as well as a list of links to all the resources that we have covered, go to outcomesrocket.health and in the search bar type in Bre Cunningham That’s Bre Cunningham or type in CODE in the search bar. Bre, this has been a blast. I really enjoyed the conversation with you and I’d love if you could just leave us with some closing remarks and the best place where the listeners could get in touch with you and continue following your work.

Breanna Cunningham:
Awesome. Well Saul, thank you so much for having me. This was a lot of fun I agree. And I’d say for a closing remark standpoint is there is a lot of work to be done in health care it’s a fun and exciting time. And let’s make it happen. It’s a hopeful time, challenging but hopeful and then to get in touch with me my email is Breanna@codetechnology.com or you can message me on LinkedIn, I’m pretty responsive on there as well and I would love to hear from you.

Saul Marquez:
Outstanding Bre, thank you so much again and looking forward to staying in touch.

Breanna Cunningham:
Thank you.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.

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