In this episode of The Connected Care Team podcast, Rebecca MacKinnon, founder, and CEO of 5th Dimension Strategies discusses her background in post-acute care and how technology factors into the shifting healthcare environment.
Meeting Demand in Post-Acute Care
Ask any healthcare professional why they joined the industry, and they will likely recount a personal story that motivated their decision. Rebecca MacKinnon’s interest in post-acute care was sparked in the late eighties when patients were being encouraged to self-manage their recovery process much sooner than in previous decades. After welcoming her second child, Rebecca returned home after just a 24-hour hospital stay.
“It always seemed an oddity to me that we spend less than 1% of our lives in a hospital or in a physician's office, but we spend probably 90% of our healthcare dollars in those two places. And so for me, post-acute just makes a lot of sense.” – Rebecca MacKinnon
Consulting in Health Tech
After founding Beyond Now, a home health EMR software company, Rebecca sold the company to Cerner. The experience revealed her passion for working with early-stage companies, leading to the creation of 5th Dimension Strategies, an early-stage consulting firm that supports healthcare technology companies. Rebecca has helped lead several companies through various growth cycles within acute care and other healthcare environments through her work.
“I think that any innovator who's entering healthcare has to pay particular attention to workflow and figure out how to create strategic relationships that really allow you to get into the steps that healthcare clinicians take.” – Rebecca MacKinnon
Engaging Patients in a Post-Acute Care Environment
As healthcare continues to shift to a post-acute care environment, providers are looking for ways to engage with patients outside the hospital. One of the biggest hurdles they face is the resistance of older patient demographics. Particularly in home health care, older patients have been slow to adopt healthcare technology, including virtual care and remote patient monitoring tools. Rebecca notes that younger demographics, who she refers to as “the new parent,” are big adopters of health tech.
“But I can say it's only the very oldest in, the 75 plus that are true resistance to tech because so much of the world has gone there. The rest of us know we have to adapt, it's just the pace of it.” – Rebecca MacKinnon
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Dr. Will O'Connor: With us today, we have Rebecca MacKinnon. Rebecca is the founder and CEO of 5th Dimension Strategies, a consulting business serving the needs of companies in technology and healthcare services. She also founded BeyondNow, which was a home health EMR software company, which she sold to Cerner in 2003. And they developed systems that reduce administrative paperwork, provided clinicians with remote access to charts, speed third-party reimbursement, and share information between home care and hospital settings. So Rebecca, you've had quite a successful career. Thank you so much for joining us today on the podcast.
Rebecca MacKinnon: Thank you for having me.
Dr. Will O'Connor: We really appreciate your time. Why don't we start with the origin story, tell me a little about bit how you got involved in healthcare.
Rebecca MacKinnon: I'm from rural Kansas, and what makes up a great rural Kansas family is men historically would work in agriculture and women went into healthcare and my family was no different. I started my career on the administrative side of a provider organization, a post-acute organization. Believed very strongly in the mission of that organization, and I was early in my career and they offered me the opportunity to take on the tech strategy for that group.
Rebecca MacKinnon: It was the late eighties and patients were being pushed quickly out of the hospital. With my first child, I got to have a lovely five-day stay in the hospital, and then by the time I was having my second child, I got all of 24 hours and had to get home. So I kind of viewed that time of healthcare as the first innovation of healthcare where patients were being asked to move back into self-management very quickly.
Rebecca MacKinnon: Home care and post-acute care organizations were asked to bring technology strategies forward to meet that demand. And it was an incredible time to be a part of the industry.
Dr. Will O'Connor: Healthcare is such a big space, is that part of what drew you to the post-acute area? Some of your personal experiences?
Rebecca MacKinnon: I think personal experiences are a big part of whatever an entrepreneur launches. And for me, I came from communities that were very self-sufficient. And it always seemed an oddity to me that we spend less than 1% of our lives in a hospital or in a physician's office, but we spend probably 90% of our healthcare dollars in those two places. And so for me, post-acute just makes a lot of sense.
Rebecca MacKinnon: For the majority of the time that we're enjoying our lives, we have to figure out how to manage on our own. We're making self-determined decisions, and we want the guidance and support of the health system, and we want it in ways that allow us to continue to live our lives. So I think the technology aspect of post-acute has always been attractive to me.
Rebecca MacKinnon: It's never lost its intrigue as far as how technology is changing post-acute and the delivery of healthcare into what used to be the homes, but now it's how we walk, talk, and live.
Dr. Will O'Connor: I agree with you completely and that's a statistic I also am a fan of where most of the time spent is outside that acute care environment and focusing on care there is so important. You know, it's one thing to be interested in healthcare and interested in post-acute and understand some of the needs there, but it's a completely different thing to then start your own company and become CEO and then sell it to a billion-dollar EMR company. How did you get BeyondNow started?
Rebecca MacKinnon: Well, I mentioned that I got the opportunity to lead the tech strategy for the post-acute company that I was working for. And it was so successful that that organization started performing well above its peers which made it an acquisition target in the health system. Yet, in an M&A transaction, the acquirer didn't understand our technology expenses. My line item became a target and I offered to acquire the technologies out of the transaction and they accepted it.
Rebecca MacKinnon: So that's how BeyondNow was born. I came from an entrepreneurial family. If you don't like the way the world looks, take action and change it. So the opportunity was one that felt natural to me to go ahead and move into this exciting new space that was developing, but it was a hard road. What was very different from how I grew up as a child is that banking is not something you can rely on for technology.
Rebecca MacKinnon: This world of venture capital, early-stage investment, that was really new for me. The big net stretch that I had to make over a decade took that to heart, made it a passion too of mine. And ended up in the Midwest growing a very nice high-growth company that made it to one of top four in the nation serving hospital-based post-acute agencies, which is what drew Cerner to us.
Dr. Will O'Connor: Talk to us a little bit more about your current role as CEO of 5th Dimension Strategies and some of the things that you're currently focusing on.
Rebecca MacKinnon: So after BeyondNow was acquired by Cerner, I had this incredible couple of years where I learned what the hospital tech market looked like. The Cerner experience was awesome, but I'm an early stage person, that's what I learned about myself. That I truly enjoy the inception, the launches, the go-to-market, the competing as an innovator and achieving cash flow break even, that is an incredible moment in a company's life path.
Rebecca MacKinnon: So I went back to the early-stage to help other young tech companies find their successes. And over the last 15 years, that's what I've been doing as a consultant. I have had a number of equally or better interesting exits for the companies that I work with. But in that process and through COVID, life puts us on slippery slopes. And one of my favorite clients that has been a long-term client has had a tech project that she's been trying to launch.
Rebecca MacKinnon: Capital has been thin for it. And I said, you know, now is a great time. There's incredible talent available, let's put them to work and let's see if we can launch that vision that she always had in her mind. So together we have now started a product group inside of 5th Dimension called SoulFIRE Health. And we are on our own go-to-market path.
Rebecca MacKinnon: So SoulFIRE is just like my portfolio of other companies, but probably just a little more near and dear to my heart, and we're on our own go-to-market path as we speak. We are in the process of actually launching into the marketplace. So over the last 18 months, we were able to make the tech investments necessary and we have identified four markets to enter into with SoulFIRE health.
Rebecca MacKinnon: SoulFIRE is a content company for healthy nutrition and lifestyle behavior. One of the areas I've always been passionate about part of post-acute, is there are five chronic diseases that cost the healthcare system more than a trillion dollars. And there are two things in common about those five chronic diseases, and that is lifestyle choices, nutrition, activity.
Rebecca MacKinnon: How we conduct ourselves in our decision-making around those two spheres of our lives directly change the path, iIf not completely reversed, it can directly change the path of those five chronic diseases. The content in that area for the healthcare system or for any coaching model has been very thin. So we took that upon ourselves to launch both the tech platform with the delivery of that content and we're in the process of actually taking that to market.
Dr. Will O'Connor: So one of the things I've noticed working in the communication and coordination space is we can offer a lot of help in both a value-based environment and a fee-for-service environment, but we're still very much living in a fee-for-service world. And I know those five chronic conditions are driving a trillion dollar spend and those can be impacted with lifestyle, as you said, but how do we change the model?
Dr. Will O'Connor: Because your acute care environments, those five chronic conditions lead to conditions where you get an inpatient visit where they are making money off that stay, right? So how do we incent the environments that are still operating in a fee-for-service model or mostly a fee-for-service model? How do we incent them to do this?
Dr. Will O'Connor: Because you're right, the impact that lifestyle changes can make on those five chronic conditions is enormous. How do we do that?
Rebecca MacKinnon: I think it's an incredibly important question, one which I don't believe there's a really quick answer for, but I can say that I think there are several opportunities that innovators can deploy to try to approach that question. So by far what reigns in healthcare from my perspective has become workflow and workflow probably dictates more healthcare behavior than even financial incentives do.
Rebecca MacKinnon: So I think that any company, and I know that TigerConnect is huge at how do you improve the workflow for healthcare providers. I think that any innovator who's entering healthcare has to pay particular attention to workflow and figure out how to create strategic relationships that really allow you to get into the steps that healthcare clinicians take.
Rebecca MacKinnon: So that's one big effort that I think innovators can take on. A second, is I think we need to, as innovators, put our emphasis on companies that do understand this new incentive equation. And there are many really good healthcare providers that have moved beyond fee-for-service and are actually playing in this world of value-based care models, innovation models that CMS have launched.
Rebecca MacKinnon: There are all kinds of great tools being placed into the marketplace around that new incentive structure. But I think that as innovators we often become just as mentally lazy as our healthcare providers may get around the financial equation. If we can't see a direct action for a direct return, we have a hard time conceptualizing why somebody would want something.
Rebecca MacKinnon: So when you look at this healthcare environment, you have to look for what's not on the surface. You do have to look for those other payer sources for those ways in which the healthcare system is getting paid to take the action that isn't as readily apparent in the fee-for-service model. But from my experience coaching young companies, that's very hard to get innovators to think about because we're so conditioned to, we took an action and we got paid a dollar for that action.
Rebecca MacKinnon: So I think that's the big challenge, is to get people to understand how the incentive systems are changing and how you can become a part of that.
Dr. Will O'Connor: That really sounds like there are two keys. You know, embrace that new incentive equation that is becoming more favorable, but also really focus on the workflow and making the right thing to do also the easy thing to do. And embedding things that can impact these conditions into the clinician workflow. And yes, you're right, it is something we try to do as well. What do you see as the biggest obstacles today for getting into that caregiver, that clinician workflow?
Rebecca MacKinnon: The tech players. There are two classes of tech players today. There's your really big success stories that have been, in some cases, given hundreds of millions of dollars. And they get to play at senior levels that others don't even get to. It's hard to envision how they would get to play at those levels on thinner capital. So this big separation between the mega capital and then the average capital is truly creating a significant competitive advantage for the people who can put that capital together.
Rebecca MacKinnon: But the risk in that, with mega capital is they lean too heavily on the lead of we just have to get at the senior ranks of the health system and then everything else will trickle down and occur. But the actual implementation of systems in healthcare is very very hard. And I've always said that in decision-making in healthcare that there are more people who can say no to a decision than who can say yes.
Rebecca MacKinnon:And I think that's where the mega players end up missing how important the innovators are and collaborating with the innovators that have their small foothold in a particular health system. Because if you can build upon those kinds of footholds, that's what gets you changed between how your capital works at the senior levels and then how you get embedded in the workflow.
Rebecca MacKinnon: Many companies call it land and expand. They look for innovative relationships that can help them open doors, that they have a hard time getting that far deep into the health system. At the same time, the innovators can get that deep but they have a hard time scaling because they don't have the capital to get to the senior levels.
Rebecca MacKinnon: So I think the big answer really rests in the tech side for us to relaunch what it means to have that community where you foster strategic relationships, that you recognize that being a competitor is more than shutting out someone. It may be being an extremely good competitor is about opening up your doors and allowing even more innovation to impact your company.
Rebecca MacKinnon: So the companies that are, I think, holding back innovation are your big EHR companies, have gone into completely defensive mode and they've created barriers to entry that are pretty stiff and difficult. I think there are second-tier players coming up that are developing that mindset. I don't believe it's overall good for our tech environment and I don't think it fosters growth among the entire industry.
Dr. Will O'Connor: Do you think 21st Century Cares Act will have any impact on that?
Rebecca MacKinnon: I think it's gonna have a huge impact. I think it's gonna foster a whole new wave of innovation. And I think it is going to draw those EHR companies back from the workflow. I think they're gonna find that their real power in the industry has become their platform and their data model and the ability to allow the innovators to bring solutions to the front end.
Rebecca MacKinnon: How that evolves over time in terms of how they continue to then concentrate their power because that's what they will go after doing, I don't have that much of a crystal ball. But I do think we're gonna see a whole new flourishing of innovation as the industry on the provider side understands what the power of the Cares Act is.
Dr. Will O'Connor: Rebecca, one thing I wanted to ask you about was, you know, when we were talking earlier about the shift from the acute care environment to the outpatient environment and your personal experience staying in five days versus 24 hours, there's more and more of that across every service line. So the care is being shifted to that outpatient environment.
Dr. Will O'Connor: That's going to come, I believe, with an increased need for the ability to engage patients in that environment and as well as being able to monitor them with remote patient monitoring. Talk to me a little bit about your current thinking there.
Rebecca MacKinnon: Love this question because I have some very definite thoughts about it. Again, we have this polarization that has taken a hold that is very difficult for innovators to figure out where they fall in this. You have the older end of our demographic, and I'll put anybody who's 50 plus in that older end. Though I am now in my mid-fifties and I don't consider myself old.
Rebecca MacKinnon: But when you look at that demographic, we are the poster children of these nutrition and activity behavior challenges that have hit hard in the chronic diseases. And so that is tugging innovators in the healthcare system by its sheer numbers to slow innovation. Because our 50 plus, and especially if you get to 60 and 70 plus are not big adopters of new technology and are kind of resistive and there's a lot of barriers and we all can talk for hours about how that's impacting bringing technology into the home.
Rebecca MacKinnon: But I can say it's only the very oldest in, the 75 plus that are true resistance to tech because so much of the world has gone there. The rest of us know we have to adapt, it's just the pace of it. But your younger end, which I would call the new parent, anybody who is from 20 to 40 are huge adopters of the technology and they're almost doing it in ways that are creatively destroying the health system.
Rebecca MacKinnon: The wave of telehealth, the wave of digital health, the wave of these new technologies are fragmenting the health system and the health system is rushing to try to figure out how to deal with even the credentialing requirements. We know who's providing the services to this younger demographic are qualified and capable of providing the telehealth service that's being offered.
Rebecca MacKinnon: So that group is really challenging change in the health system, and I would give the greatest compliment – I've worked for over two decades with a group called Springboard Enterprises. It's a big sponsor and supporter and an alumni of tech women, women who have come through either life sciences, digital health, any number of tech kinds of orientation for healthcare.
Rebecca MacKinnon: That organization recently launched a women's health program, which really brings highlights to how women are changing the adoption pace for healthcare tech. And what's interesting about that is as you start to look into that, the young moms have their app suite. They have the apps on their phone that get them to the solutions that they need to have from an agile, quick, responsive ability to serve their family.
Rebecca MacKinnon: And I think that that's almost flying under the radar of the health system of how important that advent of the mobile phone and having your apps that get you to that access have become in those families. And it won't be many years where that will emerge very quickly as who controls the healthcare system, which technologies control the healthcare system or access to it.
Rebecca MacKinnon: Because the aging out, you know, the boomers, we have a more definitive timeline, but that new generation of parent and mom is really gonna change the way technology serves families from the healthcare provider.
Dr. Will O'Connor: You know, those new moms and dads are also becoming new doctors and new nurses and we're trying to meet them where they are and figure out how to fit into that workflow. And how to fit into that mobile paradigm of very fast communication and a very high degree of efficiency. And as I'm sure you know, in your experience, the last thing someone would describe an acute care environment as is efficient, right?
Dr. Will O'Connor: So you get these new clinicians coming in and we're seeing a lot of friction with asking them to use existing technologies like fax machines and pagers that we're seeing out there a lot. It's been incredible to watch, but as a technology company, we're really trying to keep up with that and shift to that paradigm.
Rebecca MacKinnon: And I also think it's going to challenge our regulatory framework. And what I mean by that is, you wanna hear a massive groan from the innovators in healthcare tech. It’s whisper the letters of HIPAA. There are many in the younger generation who say that is an outdated, no longer relevant framework and restriction for health tech companies.
Rebecca MacKinnon: I don't believe that's completely true, but I do think there's going to have to be some review again of healthcare privacy, the ability to get integration and interoperability among tech companies. And what that new framework looks like, I don't know what that new framework should look like and still maintain the privacy and the protections that we as American consumers need to be assured of.
Rebecca MacKinnon: But I think that there is this whole new view that is coming about as to what kinds of privacy and protection and what that looks like for these young families. And I think regulators are gonna have to get into this discussion and grapple with some really hard questions between how the boomer defined that and now how the millennial and the Gen-Zer is gonna define it.
Dr. Will O'Connor: Well Rebecca, thank you so much for your time today and sharing your knowledge, your perspective, and your experience. You have been very generous with your time. Thank you so much for joining us.