Joseph Lewarski: Build strategy around change

‘The things that got us here may not be what drives us in the future’
Friday, October 10, 2014

VIENNA, Va. – After working within the HME sector from many angles—provider, manufacturer, member services organization—Joseph Lewarski has added consultant to his resume. In that role at GRQ, a boutique healthcare consulting firm based in Vienna, Virginia, he will help create sound strategic and business development plans for companies trying to navigate the evolving healthcare landscape. Here’s what Lewarski, most recently vice president of clinical affairs at Invacare, had to say about where he hopes to steer those companies.

HME News: Why have you stuck with this field?

Joseph Lewarski: I’ve always believed, even when I first got into home care in the 90s, that it would become the primary place to provide health care. That’s becoming more and more true with the focus on wellness, clinical outcomes and cost effectiveness. Hospitals and acute care will always exist, but there are many new models of care developing, some we don’t even know about yet. For me, it’s understanding this on a macro level, and applying it on a micro level with different organizations and trying to align them all.

HME: As you’re surveying the evolving landscape, what kinds of questions are you asking of yourself and your clients?

Lewarski: Everyone is looking at ways to be more holistic in the management of patients and health care overall. From a strategic perspective, where is health care going to be provided? What role will different organizations play in the delivery of care?

HME: We’ve written a lot about how HME providers are changing course in the face of this changing landscape, but what about HME manufacturers?

Lewarski: Technology needs are definitely going to change. Insurance companies are creating plans to accommodate cost and they’re shifting more of the out-of-pocket expenses to the user. As consumers have more skin in the game, they become more active in the process. So there’s a greater level of consumerism. If you look at non-medical devices, look at Fitbit (a device that allows users to track daily activity, calories burned, sleep and weight). It’s $100. The whole space is changing.

HME: What does this greater level of consumerism mean for HME manufacturers specifically?

Lewarski: In the next decade, I think they need to be thinking about how products get to patients differently. There are going to be different business models that come out of this. I’m not saying one will go away or will be replaced, but there will be different business models. The current method has too many levels and too much cost, and everyone sees it. Certain therapies are service intensive—they require a human touch—so I don’t think everything will become a remote business model, but there are things that can be done differently.

HME: Traditionally, the HME industry hasn’t been one to change course quickly.

Lewarski: The companies that are coming into health care from the technology space or the industrial space—they don’t have the prior biases about how care is supposed to be delivered and they’re coming up with better mousetraps. You need to be building an idea and a strategy around change. The things that got us here may not be what drives us in the future.



As a caregiver alum who (for years) assisted an aging parent to remain at home, I couldn't help but notice how the design of HME is so far behind the times.  For example, the bedside commode was particularly frustrating. Rather than making it easy for her to get on and off, the design made it hard to do for herself, which meant that someone always had to be there to help her.  And for such a basic human need, it was very disruptive to her life, as well as the lives of my siblings.  <p>

I've come to understand that bathroom commodes are commodities, mass produced in China, often bundled into large healthsystem group purchasing contracts at minimal cost, or priced to sell directly to consumers via direct mail catalogues at +/- $50-100/unit.  The real cost of this HME was borne by unpaid family caregivers and underpaid direct care workers. <p>

But now, the caregiver ratio will become such that no one should be counting on this for much longer.  In addition, there are now ways to perform urinalysis at home, remotely transmitting the data into someone's EHR.  This is particularly important for people with chronic illnesses who often have mobility challenges that make it hard to travel to an MD office or lab.<p>

Seems like HME companies should realize that their commodity equipment now holds promise to serve as a platform for emerging remote patient technology monitoring.  <p>

Scratching my head as to why they are not raising their own profile, approaching health information technology companies (with deep pockets) to develop creative ways of engaging chronically ill patients with optimizing their own health status.  One common sense approach may be to embed new technology within existing HME that is used for activities of daily living:  data can be captured and sent without placing a new burden on either care recipient or caregiver. May even make likelihood of compliance more likely.<p>

Would love people's thoughts on this question: " Why aren't HME companies taking the lead to make this happen?"