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Chiropractic 2.0: The Technology Adjustment and

Revolutionizing the Patient Experience

Dr. Jay Greenstein

con·clu·sion

/kənˈklo͞oZHən/

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To Solve the Global Healthcare Crisis…

We must…

…leverage emerging technologies and engage patients in innovative ways…

…create remarkable experiences…

…grow our practices and our impact…

…and drive global change.

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What Hasn’t Changed in the Last 25 Years?

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The total direct and indirect cost of Low Back Pain in the US is upwards of $200,000,000

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• “Six of the 13 included RCTs showed that NSAIDs are more effective than placebo regarding pain intensity. NSAIDs are slightly more effective than placebo regarding disability.

• However, the magnitude of the effects is small, and the level of evidence was low. When we only included RCTs at low risk of bias, differences in effect between NSAIDs and placebo were reduced.”

“The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.”

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CONCLUSIONS AND RELEVANCE: “Despite numerous published clinical guidelines, management of back pain has relied increasingly on guideline discordant care. Improvements in the management of spine‐related disease represent an area of potential cost savings for the health care system with the potential for improving the quality of care.”

http://www.palmer.edu/alumni/research‐publications/gallup‐report/

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“The joint effort will look to find a more efficient and transparent way to provide health care services to their employees and families, the companies said.”

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“Consumers might find they have fewer choices about where they can get services.”

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Cost of Supply Goes Down

More Buyers Enter the Market

Sales and Profits Grow Exponentially

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InformationEnabled

Chiropractic?

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The New Era of Healthcare

Revolution/rev-uh-loo-shuhn/

A radical and pervasive change in society and the social structure, especially one made suddenly

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Evidence‐based Healthcare

Intelligence‐based Healthcare

DACBOE

D

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Patient Reported Outcomes Into

Portal

Clinical Interventions

Applied

Improved Clinical Interventions

Applied

Patient Reported Outcomes Into

Portal

Data Aggregated and Analyzed by

Any Variable

AI applied to data to improve clinical decision making

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Resource Based Relative Value Scale Physician work Practice expense Professional liability insurance

(PLI)

MPPR First code paid at 100% of

allowed amount Subsequent code paid at a 25%-

50% reduced practice expense portion of the reimbursement

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6.60

1.34 1.38 1.01 1.712.92

13.18

26.97

22.65

30.54

27.08

31.04

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

January February March April May June July August September October November December

Pay Variability % Across 20,501 Services Provided

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“The Department of Labor estimates that about

one claim in seven

made under the employer health plans that it oversees is initially

denied -

about 200 million claims out of the 1.4 billion submitted yearly.”

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Speaking of Denials and Bundling…

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A

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“Deep CNN algorithms are expected to be among the most effective and efficient methods for diagnosing

dental caries.”

“The literature indicates that the preferred approach to healthcare cost prediction is cost on cost prediction using supervised learning methods...with ANN (Artificial

Neural Networks) providing superior performance for higher cost patients.”

“ANN technology showed the

most important genotypes predicting cervical

dysplasia.”

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It is estimated to affect more than 30 million people worldwide every year, potentially leading to 6 million deaths.

“The results demonstrated that InSight is capable of sepsis prediction up to 3 h prior to the zero hour, with sensitivity and specificity that rival or exceed the individual strengths of

existing clinical detection tools.”

A computational approach to early sepsis detection Jacob S. Calvert a , Daniel A. Price a , Uli K. Chettipally b,c , Christopher W. Barton c , Mitchell D. Feldman d , Jana L. Hoffman a,n , Melissa Jay a , Ritankar Das a

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Where is Chiropractic

in its use of AI?

C

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112

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B

“First and foremost, blockchain is a public electronic ledger built around a P2P system that can be openly shared among disparate users to create an unchangeable record of transactions, each time‐stamped and linked to the previous one. 

Every time a set of transactions is added, that data becomes another block in the chain (hence, the name).”

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• When all is said and done, for me, this whole thing is about “No Middlemen.”

• The whole idea is anyone, anywhere should be able to trade value with anyone, anywhere else—trust them immediately—and do it directly.

• That, for me, is blockchain basics.

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“The present banking system is littered with numerous cases of fraud and corruption which is aided by the possibility of making transactions untraceable… 

…By implementing DLTs, transactions can be traced no matter how long or complicated they appear.”

O

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Virtual Reality – Gaming Rehab

139

140

Virtual Reality – Gaming Rehab

BIG Data

141

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143

144

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145

146

147

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148

Multisegmental ROM

In‐Line Lunge

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Posture Angel

3D Balance

1‐Leg Vertical Jump

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Overhead Squat

EEngagement

Technology

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Is There a Business Use Case

for Improving Patient

Engagement?

What Does EXCEPTIONAL

Service Look Like?

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Top Drivers of Patient Satisfaction

1. How well staff worked together to care for you .792. Overall cheerfulness of the hospital .743. Response to concerns/complaints during your stay .684. Attention paid to personal and special needs .655. Staff sensitivity to inconvenience of care .656. How well nurses kept you informed .64

1. Staff worked together as a team .642. Nurses anticipated your needs .643. Staff responded with care and compassion .62

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How Do You Currently Measure Patient 

Satisfaction/Loyalty?

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What’s the “Competition” doing to drive adherence?

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“The data shows that our prescription benefit management members who are using ScriptSync mobile app have improved their adherence anywhere from 6% to 10%.

And statistics show that if the national adherence rate was increased by just 1 percentage point, it would generate $6 billion of health-care savings a year.”

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“Consumers have been conditioned

to expect exceptional

customer service experience-every time-and it’s the

difference between retaining a customer or losing them to

the competition.”

“Customer Service Becomes Customer Experience…At the

center of improved customer experience is the basic task of getting to know the customer in

order to identify their

expectations.”

“Technology is transforming

customer experience...Every single

customer interaction is a

means for disruption and a differentiator versus the

competition.”

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“With all of the innovative ways to adapt from traditional,

outdated service strategies to modern and

customer-centric processes,

there’s no excuse for anything less

than an exceptional customer

experience.”

“Today, a Leader without

technology is like a fisherman without a rod.”

“Customer Expectations Are Set by Mobility...The proliferation of mobile provides endless benefits.”

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The impact of mobile applicationson medication adherence:

a systematic review.

Transl Behav Med. 2019 Aug 6

“All 11 RCTs showed improvements in adherence”

The Use of Mobile Apps and SMS Messaging as Physical and Mental Health

Interventions: Systematic Review.(n=27studies)

“The review shows the promising and emerging efficacy of using mobile

apps and SMS text messaging as mHealth interventions.”

J Med Internet Res. 2017 Aug 24;19(8):e295. doi: 10.2196/jmir.7740.

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What  MOBILE Technology Have You Implemented to Deliver an Exceptional Experience and Improve Adherence?

90 Days

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510 App Users

vs.

453 Non App Users

36% Increase in Visit Adherence

139vX

50 weeks=

6,950 v/yr

$448,8486,950v/yr

=$65v

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6,950X

1.36=

9,452v/yrX

$65=

$614,380

$614,380‐

$448,848=

$165,532

What’s Your Annual Revenue?

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Do the Math…

Annual Revenuex

1.36=

???

22% of App Downloads Have Come From 

Outside Our Practice

5 New Patients/Month

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Raffle One Custom Mobile App

No Development Fee ($1,999)

50% off Monthly Rate$99

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SCCtech

678

506

7543

ENTER YOUR EMAIL

Evidence‐based Healthcare

Intelligence‐based Healthcare

DACBOE=

The FutureRemarkable

Patient Experiences

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DACBOE=

The Futureof

Healthcare

Join Our Growing CommunityHealthTech Tribe

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What are healthcare consumers looking for

today?

“Consumers seek convenience, health improvements, and cost savings, with variation based on consumer segments.”

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https://www.kaizenovationtech.com/chiro-2-event

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• We are in a global healthcare crisis and• The world is changing rapidly because of tech

• How do we use tech to solve some of our biggest issues and enhance the patient experience• Data – outcomes and reimbursement• Artificial intelligence – to make sense of all that data

• Cloud computing – staying connected and convenience

• Blockchain – remove the middleman/data security• Outcomes – 3d cameras to improve assessment and treatment

• Experiences – mobile apps to improve adherence

ChiroEco Data

New Patients/Year 433

Average Paid / Visit $38

Average Annual Collections $449,000

Visit Increase w/ Mobile App 4.23

Yearly Collections Increase $69,671