CEO Describes Growth of Watershed Health’s Care Coordination Role
Watershed Health, a company formed in 2013 to foster data sharing across the care continuum, is highlighting the exchange it has helped develop in Austin, Texas, to allow partners to share clinical documents and data about social determinants of health such as food, housing, and transportation needs. In a recent interview, Watershed CEO Effie Carlson described the company’s growth and how it partners on data sharing.
Founded in Alabama by cardiologist Chip Grant, M.D., who now serves as executive chair and chief medical officer, Watershed has raised $13.6 million in funding led by an investment from First Trust Capital Partners with participation from Create Health Ventures, FCA Venture Partners, Impact Engine, 450 Ventures, LDH Ventures II/Launchpad Digital Health, MassMutual Ventures, Capstar Partners, and Wanxiang Healthcare Investments. The company says it delivers free curated, relevant data that providers need, along with secure collaboration tools.
Healthcare Innovation: Could you describe Watershed’s approach? Are there certain ways that it's like a traditional health information exchange and some ways it's different?
Carlson: The things we have in common with a health information exchange is that we are bringing together information from disparate systems for the purposes of aggregating it at a patient level. What makes us different is we include a larger number of participants. An HIE is traditionally more hospital- and large physician group-focused. We include post-acute providers — SNFs and home health — and things like DME or wound care clinics or non-emergency medical transportation, or whatever it may be. If you are in the business of or adjacent to health and well being of another human, you're a Watershed user.
HCI: What’s the Watershed business model? Who’s paying to participate?
Carlson: We orient the cost to at-risk organizations — health plans primarily, sometimes at-risk physician groups, ACOs, different people who have to take a longitudinal view. People who have a longitudinal view have an investment in a community becoming much more functional. We made the decision several years ago to do that, and now we partner with health plans and others across the country to bring these kinds of opportunities to communities.
HCI: Your recent announcement is about the Austin region, but is the plan to expand to lots of other communities?
Carlson: We already are in other communities in Texas, and we're also in other states. We’re also in Alabama, Indiana, Mississippi, and some other places. The reason we're highlighting what's happening in Austin is that it involves what we normally do plus including public health folks and the jail system. We are highlighting that everyone there is not letting the arbitrary nature of funding silos or words like public vs. private determine things. Being able to work together in a tech-enabled way with intention allows us to really maximize the opportunity. So Austin provides a roadmap for how all of these different types of organizations can come together in a really specific way.
Whereas traditionally if you show up in a clinic and I don't know anything about you, I have delays in the services I'm able to provide you, or in knowing that there are risks associated with your care. So any clinical person in the community, if you're treating that patient, can come into Watershed and get context and see the patient’s acute care history quickly. They could see that Effie has been in the ER 15 times in the last six months. That's a quick, relevant piece of information. Then they are able to treat far more effectively. Going the other way, once I'm done treating the patient, being able to transition that person to the next level of care is important. When a patient shows up at a physician's office or a clinic, they don't have to ask the patient to be the arbiter of the story, right? They can see what happened, and then they can close the loop automatically with the person who referred out. Partners leverage Watershed in those transitions that we are usually using fax machines and phone calls and text messages and disparate systems for. It allows for real-time contextualized portable information that's relevant to what's happening.
HCI: Is part of the challenge getting enough of the hospital systems and the provider organizations to be contributors, so that the data set is really rich?
Carlson: Well, it’s not all or nothing, but yes, density is always a component of things. We’ve hit a critical mass and density in Austin that allows that to be really robust. We're partnered with four of the five HIEs in Texas. So if a hospital system is already using an HIE, we're not trying to replace that infrastructure. We're trying to connect infrastructures. So if the hospital system wants to leverage that connection, I can work with that, as opposed to making them redo things. We like practicality, and if it's a usable thing, we will use that. If you have tools that you like, please use the tools that you have in the way that you like. If you don't have tools, we give you those tools, and then we bridge the space between the tools that don't talk to each other. That's the way that we drive density.
The other thing is that because Watershed is free for providers and communities, providers propagate it themselves in a lot of ways. Once the momentum starts, every entity becomes like a little nucleus, and they get the folks who they work with to participate with them. If I work with 15 people on a regular basis, this could address 80% of my coordinating efforts, right? That's really how communities come together.
HCI: When you're looking at new markets to consider going into, are there things you're looking for, either in a state or region, that make it a priority?
Carlson: Well, we've done it two different ways. We've had our health plan partners take us places and say, I want you here. And we've had communities like Austin say, Hey, come here. And both have worked.
When a provider leverages Watershed, it's payer-agnostic, it's patient-agnostic, it's just workflow. It doesn't matter if you're an unhoused person or a CEO, you're getting the same level of coordination, because it's just ubiquitously how work is performed. We need somebody or something in the community to be that first nucleus. And as we work with hospital systems and health plans across the country, some of them are bringing us to their other markets. And sometimes it's even just geography. We started in Alabama, and have moved into Mississippi and Louisiana. There is a lot happening in that Southeastern region, just by virtue of proximity.
HCI: So might a regional Blue Cross plan be who you work with?
Carlson: Yes. We’re statewide in Alabama because of our relationships there. We have about 63% of all hospitals in the platform today and almost 100% of post-acute providers, which is pretty crazy. Alabama is the most connected post-acute environment in the country, and we're hoping to have that same thing happen in Austin. We’re really grateful for how the community came together there and then brought us in and allowed us to help be the underpinning for that. But they're the ones that really, truly understood the opportunity and and we're just helping them realize it.
One of the most interesting things about this story in Austin is it was born from crisis. It was born from COVID. It was a community coming together in response to crisis, and doing the right thing and working hard, but then also keeping it going. They said, we've built relationships. We've all acknowledged our opportunities. Let's take it to the next step and keep going.
