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Keona is positioned to benefit from the switch to remote health care

 In June 2020

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Oakkar Oakkar founded Chapel Hill-based Keona Health in 2014. Its triage software is used by about 12,000 medical providers.

By Mike MacMillan

A minor medical emergency, an unanswered call to the doctor’s office, and an unnecessary trip to the hospital in Chapel Hill in 2011 got Oakkar Oakkar to start thinking more broadly about how health care is delivered in the U.S.

“If someone had answered the phone that day, I would never have gone to the hospital,” Oakkar says. “It was an inefficient and expensive way to address what should have been a simple problem.” It was, he says, a matter of communication and of triage.

From that experience came Oakkar’s Keona Health, a Chapel Hill company formed in 2014 that develops software to help hospitals and clinics determine the level of urgency presented by patients seeking help through phone calls, emails, texts or other channels. The COVID-19 crisis has sent demand for Keona’s service skyrocketing as health care providers manage a flood of traffic.

“Some of our customers saw call volume jump by as much as 50 times” as the virus spread, Oakkar says. “At the same time, you have regular patients who don’t want to come into the office, and doctors who may be working from home, so you can use telemedicine to bring these two together.”

Keona’s revenue has doubled each year since 2015, according to Oakkar, who declined to provide details. Its software is used by about 12,000 providers serving more than 20 million patients in the U.S. and Canada. It employs about 20 people, mostly in Chapel Hill. Major customers include call centers and telepath programs run by Tampa, Fla.-based Sykes Enterprises and San Antonio-based Carenet Healthcare.

Keona’s technology is designed to help providers identify the most endangered — triage, in medical jargon — and improve patient experiences by avoiding unnecessary hospital visits. It also can help manage costs by providing remote access to nurses, doctors, schedulers and other health care professionals.

Many industries such as banking, retail and travel long ago moved customers toward more self-service, but health care has proven a tougher nut to crack. Privacy regulations are an important consideration, while customers have often been unwilling to provide as much compensation for telemedicine as in-office visits. Dealing with a caller’s health questions isn’t like using artificial intelligence or machine learning to put together a Spotify playlist. Medical advice must be right. The intellectual property behind that process is where Keona’s value resides.

But the coronavirus pandemic has prompted Blue Cross and Blue Shield of North Carolina and other insurers to change payment policies to encourage remote health care. Keona is positioned to benefit from that switch.

From Hawaii to Chapel Hill

Born in Myanmar, Oakkar was a software developer in Hawaii when his then-girlfriend, now wife, was accepted to the Ph.D. program in epidemiology at UNC Chapel Hill in 2010. He knew little about North Carolina, but arrived with a bachelor’s degree in business from the University of Hawaii. He enrolled in UNC’s health informatics program, which combines data science and health care curricula.

Keona was launched during Oakkar’s first semester by a team that included Javed Mostafa, a professor at the UNC School of Information and Library Science; Jimmy Kaanapu, now the company’s chief technical officer; and Stephen Dean, chief operating officer. They envisioned an app that would improve communications between patient and health care providers. The first client was UNC Campus Health, where the app provided a link between students and the health system. With early funding from the National Institutes of Health, Keona targeted other university health care providers, signing New Orleans-based Tulane University Campus Health as its second client. But Oakkar saw that the approach had its limitations.

“The utilization was low,” he says. “Most patient contact was still coming over the phone.” He realized Keona needed to offer a broad-based platform that served call centers if they hoped to build a viable business. It was a pivotal moment for the company.

In Chapel Hill, Oakkar had met Ted Zoller, who directs the Entrepreneurship Center at UNC’s Kenan-Flagler Business School. Oakkar gained access to Launch Chapel Hill, the university’s startup accelerator program that guides promising new companies. Keona was among its first cohort of companies in 2013.

“Launch Chapel Hill was incredibly helpful to us in making the pivot to an enterprise-level platform,” Oakkar says. Zoller and Jim Kitchen, an entrepreneur-in-residence at Kenan-Flagler and an active angel investor in the Triangle, connected Oakkar with new sources of capital, including a 2014 investment of $2.6 million. The following year, Keona went to market with its new platform, landing the Virginia Women’s Center, a physician group in Richmond, Va., as its first client.

“A core characteristic of entrepreneurs is their ability to recognize the need to adapt to changing circumstances and willingness to take immediate action during turbulent times,” Zoller says. “Crisis is their call to action and drives innovation. Oakkar and Keona are a good example of that.”

The company recently landed an undisclosed investment from New York-based Riverside Acceleration Capital, a 32-year-old private equity group with a specialty in funding business-software companies. Keona is “fundamentally changing the industry by leveraging the benefits of a cloud-based solution,” says Jonathan Drillings, a partner in the New York office.

He cites advantages that include simplified onboarding and updating, scalability, and the ability to integrate easily with electronic medical-records platforms and other online patient services. “The market size [for these services] is many times larger than it is today,” Drillings says.

Intelligent triage

While Keona’s platform can be used for many functions, it’s triage — especially triage as related to the novel coronavirus — and the ability to expand the software’s use rapidly that are in the spotlight. Call volume had declined in early May from a peak in April, but remains four or five times normal levels, Oakkar says.

As worried inbound callers describe their symptoms, Keona’s algorithms take call-center operators through a series of queries to assess if the individual has the disease and then what to do. Data might include a patient’s medical and travel history, pre-existing conditions, recent contacts, and current medications. Analytics, including a database that incorporates as many as 20 million factors, are used to determine the level of urgency.

“Do they have asthma, a fever, high blood pressure? All that is critical to know,” Oakkar says. When a patient calls in complaining of a sore throat and a cough, he adds, there are a lot of possible outcomes in addition to COVID-19.

Because of the pandemic, patients and providers are quickly becoming more accustomed to remote interactions. As Oakkar notes, call centers aren’t just about answering the phone; they’re part of an increasingly important value chain for delivering care. The use of predictive models, machine learning, artificial intelligence and video to deliver services more efficiently appears likely to accelerate with huge impacts anticipated for both providers and patients.

“Non-COVID-19 patients are being sent home from the hospital,” he says. “They don’t want to go to the doctor’s office. Instead, they’re being cared for remotely. Telehealth is becoming a clinical workhorse.” This change, he adds, plants the seeds for Keona’s growth.

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