Episode 27: Improving Access to Connected Health with Jeff Burbank, Chief Strategy and Transformation Officer for FMCNA
Delivering new technologies that help patients connect with their care teams while at home has never been more essential than during the COVID-19 global pandemic. Jeff Burbank, Chief Strategy and Transformation Officer, joins Field Notes to discuss the importance of making connected health technology better and easier to use for home therapy patients.

Brad Puffer: Welcome, everyone to this episode of Field Notes. I'm Brad Puffer, on the Medical Office Communications Team at Fresenius Medical Care North America, and your host for this discussion today. Here we interview the experts, researchers, physicians, and caregivers who bring experience, compassion, and insight into the work we do every day. For the hundreds of thousands of people living with kidney failure, who rely on dialysis as a life sustaining treatment, providing easier access to home therapy is essential. Delivering new technologies that help patients connect with their care teams while at home has never been more critical than during the COVID-19 global pandemic. As we work to make these options better and easier to use, there are still challenges on the road to rapid adoption of home therapies. So, what are those barriers we need to overcome to truly transform kidney care into a home first treatment model? To answer those questions, we have invited our Chief Strategy and Transformation Officer, Jeff Burbank, to the program. Jeff previously worked at NxStage, the leading home hemodialysis option for patients, and brought his passion for innovation to Fresenius Medical Care North America three years ago when the companies merged. Jeff, welcome to Field Notes

Jeff Burbank: Thanks, Brad. Happy to be here, and obviously love the topic of today, because I've been dedicating a lot of my life to it.

Brad Puffer: Yeah, I wonder if you can start by just giving us a little more about your passion for home dialysis and how that led to your role here in Fresenius Medical Care.

Jeff Burbank: Sure. So I was in the dialysis industry for many years and decades, and saw the way we were doing dialysis in the center and thought more frequent, more flexibility would be both clinically and lifestyle superior to what the options we had. So we formed a team and dedicated ourselves to creating a new option, the NxStage System One, and led that to the point where we really thought we could do more by joining forces with – at the time one of our biggest customers – Fresenius, and had a shared vision of what we could do for patients and how much farther we could take it together versus independently. So I got really excited about that and helped the team at Fresenius put the team at NxStage together and we've done great things ever since.

Brad Puffer: Yeah, certainly you've been a great partnership and we've really seen home hemodialysis take off in the last few years as the two companies have come together. Well, as we continue the evolution of home therapies, what do you now feel that patients need the most to be successful? How important is both the transition to home and then the frequency of touchpoints to make this really work well?

Jeff Burbank: I think there's a really simple paradigm to hang all of our strategies and thoughts off it with related to home. Everything from a patient and patient family perspective ought to be looked at on benefit versus burden. And our objective has to be to optimize or increase the benefit that patients receive from doing therapies at home, and significantly reduce the burden of accomplishing that.

There's just so many things that go into that, most people focus on just the treatment, the system, the machine, but it's really much broader than that because you have deliberated supplies, you've got to learn how to use the device, you've got ongoing support, there's all kinds of things that go around that. And what are the limitations to lifestyle by doing it? Can you travel with it or not? All those types of things we put into that bucket of burden that we need to reduce. And then the capabilities of the system, then the process will define the benefit as well.

Brad Puffer: Well, Jeff I think your title really says everything you need to know about where Fresenius Medical Care wants to go in the future. So as our transformation officer, what are the barriers that you see are still in the way of us truly meeting our goals of making home the top choice for all patients on dialysis?

Jeff Burbank: I still think we're in early days of that transition to more patients choosing home therapies. I think that the biggest is probably that we have done such a good job of refining in center therapy, that that's the normal course for patients. And I think we need to change that paradigm to say the normal course is to a home therapy. And if it's not right for you, if you can't accomplish that successfully then we have this backup that's called in-center, and we'll always have that, and it's always available, but that everybody's desire and expectation should be to ensure that every patient has the opportunity to explore that option first, the home option first. And essentially has to fail it before they can get to in-center. I think that would be a huge paradigm shift and very beneficial to patients if we could all get on that same page.

So breaking that paradigm, and I think there are organizations that are really leaning into that, I think Fresenius is one of them and there are other providers that are getting on board with that slowly but surely, so it's an exciting transition to see there. Beyond that we really, really need to make it simpler. We have to have better user interfaces, we have to essentially create a virtual environment that is as good, and I believe could be even better, than what a patient and their family would experience through an in-center treatment paradigm. So in the center you have all the staff and the people, well, we need to provide that same type of experience in the home through connected health and other tools that are now available and relatively economically efficient. So we just need to replicate that hug that we give patients in-center and the confidence that gives them in the home environment, as well as continuing to reduce all the challenges of the logistics of their supplies, all the things that get in the way of adding to the burden of doing home therapy.

Brad Puffer: I think I heard you lay out potentially three major challenges making the therapy system easier to use, making sure everything is really integrated so that connected health connecting to your care team, and then as you mentioned the supply chain and the supplies and making that easier for patients, I want to break down each of those if we can just a little bit more. So when we talk about our machines, what really needs to be done there to take it to the next level? Can you give us a little preview for example, of what's to come?

Jeff Burbank: Yeah. I think what you'll see is based on the learning and the experience that we've had, we've seen opportunities in the user interface, we've seen opportunities in the-- I include within the user interface the entire user experience. So that's how easy is it to connect to customer service or tech support, is that one button and you're in and talking to the person that you've talked to in the past, those types of experience, how easy can we make it. So it's that part of the system, but it's also the system's capability, flow rates and things like that, that over time will improve as the economics and the technology of those economics are becoming-- new options are becoming available. So we'll see a continuous improvement in the capability the therapeutic capability of systems, as well as the user experience around those systems.

Brad Puffer: Yeah hopefully, we'll have a chance to talk in the future when some of these new technologies are rolled out, when we go into deeper and talk about connected health, I know that's a huge passion for you making sure that our patients are connected to their care teams. What are some of the real barriers there? I understand not everybody has easy access to the internet even in this day and age correct.

Jeff Burbank: Yeah, and you know I've made a point of bringing this to the forefront, I think historically it was very easy to define what a medical device was or a pharmaceutical, and it was very easy to have payment structures in place for those. I think the world is changing where part of your clinical success part of your quality of life under a therapy like this is your ability to connect to your care team and have a support team to help you through learning the device, helping you in uncomfortable times, asking questions and we know the data shows that with that connected experience your health outcomes are better, your total cost of care would probably track your health outcomes, so it should be less expensive. So we need to consider things like connected health, a medical device for your therapy and ensure that every patient has access and reimbursement can support that access. The challenge with shifting to home is we don't want to put added burdens in the cost of, oh I use a lot more water than I used to, so now I have an increased water bill, I have an increased electrical bill, I now have to have a high-speed internet connection that I didn't need without the therapy. Those should all be considered part of your health costs, and we should try to advocate for a reimbursement system that supports that. We don't want to shift the economic burden to the patient when they choose a home therapy that's better for them.

Brad Puffer: And technology is allowing everybody to be connected. I mean, there are cost barriers, but from a technological perspective, even areas of the country that were disconnected are now suddenly becoming connected.

Jeff Burbank: Yeah. I'm pretty passionate about this and get very excited. There are new technologies, actually we're recording over one right now called Starlink, which allows high speed internet connectivity literally anywhere in North America. So the technology is now coming on the scene to be able to really meet the patient where they are and give him the same-- him or her the same experience that we'd have if you were in a dialysis center with a commercial internet connection. 

Brad Puffer: And I think I've heard you say before that, as you mentioned this internet connection, this connectivity is really just important as a lot of the prescriptions that are patients are taking in your opinion.

Jeff Burbank: No question. I think we're starting to see the results of clinical trials to show that patients will stay on the therapy longer when they have that connected experience and their clinical outcomes can improve, so it's integral to the quality of their care.

Brad Puffer: Yeah. I'm really excited to see where this continues to evolve, because I know our connected health experience has just been getting better and better, and there's a lot of effort to improve that experience for patients, really exciting stuff.

Jeff Burbank: It's a very exciting area because we can deliver those feature improvements over the air. So it's not as hard as upgrading some of the other technology, and we've seen that the connected health solution that Fresenius offers on the next stage platform and their peritoneal dialysis platform have continuous improvements, and we've delivered a lot across the last couple of years there to enhance that experience for patients and staff.

Brad Puffer: Yeah. That's great, Jeff. I want to hit on the last thing you mentioned, which is supply chain. We know storage of home dialysis supplies can be a burden for patients in smaller homes or small apartments, for example, in an urban environment. Some people might just think it's easier to go a short distance to a dialysis center instead, how do we help change that?

Jeff Burbank: First, we need to recognize that no solution fits every patient and that's part of the reason why we architected the system the way we did. Having the opportunity to have concentrate for dialysis or having pre-mixed bags, depending on water and travel. So first off, you have to have a very flexible supply chain that offers different options, because in our experience one solution doesn't work for everybody.

The second thing that's going to be really exciting is, as we continue to grow the home adoption, the solutions that we can bring to make the supply chain more user friendly will increase. Density and volume do a lot, as we've seen with Amazon. Look what Amazon can do now with the customer base that they have and the volume they have versus five, 10 years ago. I mean, literally it's a completely different experience. And the same will occur with more home adoption, it'll give us the ability to have better solutions. That's the infrastructure part of it. I think there's a technology part of it too where future product designs can help to reduce the total volume of the supplies and we'll endeavor to do that as well.

Brad Puffer: Well, so clearly there are some things still to work on here to get to where we want to be around home therapies. But it seems like a lot of these topics will require partnerships and support, we really can't do it alone. Whether it be reimbursement for internet access or other issues, we'll need help to transform kidney care, correct?

Jeff Burbank: I think that's right from a lot of different perspectives. We need to try to evolve reimbursement to support this new therapy approach. We need to work really hard on the back end to try to integrate things so customers or patients don't have to talk to multiple people – that they have one point of contact. That was what was intriguing to me by combining Fresenius and NxStage, is that we could integrate the experience for our patients better, and I just think that plus the technology, there's just a lot of fronts that we have opportunities to improve the experience and the outcomes for patients.

Brad Puffer: Well, Jeff at the end of the day, despite some of these barriers we've discussed that remain, it seems like you're pretty excited about the future. What do you think the treatment of kidney failure in dialysis will look like another 10 or even 20 years down the road? How far away do you think we are from making home dialysis the most popular and easiest treatment process for patients?

Jeff Burbank: Well, I think what drives me is the belief that with continued investment and refinement, that we can significantly reduce the burden and improve the clinical outcomes. So I really think we're at the beginning edge of what's possible and maturing these technologies, and these processes, and the taking advantage of new capabilities like connected health will really transform that experience so that it is less invasive to patients and they can live a more normal life with kidney disease.

Brad Puffer: What a great way to end, Jeff. It's been wonderful discussing this transformation of kidney care with you, and thanks for joining us to give us some great insights into our efforts to improve the technologies we're using to help our patients transition home dialysis and make that a reality for many more people with kidney failure.

Jeff Burbank: Thanks for having me, Brad.

Brad Puffer: And our audience, thank you for joining us. Please, know that your feedback is always welcome. If you have any comments on today's episode, topics of interest to you or speakers you want to hear from, let us know by clicking the feedback link featured on the Field Notes website on fmcna.com. And don't forget, you can find Field Notes on the Apple Store, or Google Play, or on fmcna.com. We hope you'll come back and join us, as we have more topics to discuss in the weeks ahead. Until next time, I'm Brad Puffer and you've been listening to Field Notes by Fresenius Medical Care. Take care everyone.