Category Archives: quantified self

data saving lives, entrepreneurship, health market quality, healthcare, healthy habits, nutrition, policy, quantified self, rapid learning health systems

Bloomberg: Big Data Knows You’ve Got Diabetes Before You Do

 

http://www.bloomberg.com/news/2014-09-11/how-big-data-peers-inside-your-medicine-chest.html

Did You Know You Had Diabetes? It’s All Over the Internet

By Shannon Pettypiece and Jordan Robertson Sep 12, 2014 6:07 AM ET

Photographer: Rick McFarland/Bloomberg

The headquarters of Acxiom Corp. in Little Rock, Arkansas. The Acxiom list was compiled by various sources, including… Read More

Photographer: Joshua Roberts/Bloomberg

An electronic medical records system.

Photographer: Joe Raedle/Getty Images

An elderly man reached for medication in Florida.

Photographer: Joe Raedle/Getty Images

An elderly woman with her medication in Maine.

The 42-year-old information technology worker’s name recently showed up in a database of millions of people with “diabetes interest” sold by Acxiom Corp. (ACXM), one of the world’s biggest data brokers. One buyer, data reseller Exact Data, posted Abate’s name and address online, along with 100 others, under the header Sample Diabetes Mailing List. It’s just one of hundreds of medical databases up for sale to marketers.

In a year when former National Security Agency contractor Edward Snowden’s revelations about the collection of U.S. phone data have sparked privacy fears, data miners have been quietly using their tools to peek into America’s medicine cabinets. Tapping social media, health-related phone apps and medical websites, data aggregators are scooping up bits and pieces of tens of millions of Americans’ medical histories. Even a purchase at the pharmacy can land a shopper on a health list.

“People would be shocked if they knew they were on some of these lists,” said Pam Dixon, president of the non-profit advocacy group World Privacy Forum, who has testified before Congress on the data broker industry. “Yet millions are.”

They’re showing up in directories with names like “Suffering Seniors” or “Aching and Ailing,” according to a Bloomberg review of this little-known corner of the data mining industry. Other lists are categorized by diagnosis, including groupings of 2.3 million cancer patients, 14 million depression sufferers and 600,000 homes where a child or other member of the household has autism or attention deficit disorder.

The lists typically sell for about 15 cents per name and can be broken down into sub-categories, like ethnicity, income level and geography for a few pennies more.

Diaper Coupons

Some consumers may benefit, like those who find out about a new drug or service that could improve their health. And Americans are already used to being sliced and diced along demographic lines. Lawn-care ads for new homeowners and diaper coupons for expecting moms are as predictable as the arrival of the AARP magazine on the doorsteps of the just-turned 50 set. Yet collecting massive quantities of intimate health data is new territory and many privacy experts say it has gone too far.

“It is outrageous and unfair to consumers that companies profiting off the collection and sale of individuals’ health information operate behind a veil of secrecy,” said U.S. Senator Jay Rockefeller, a West Virginia Democrat. “Consumers deserve to know who is profiting.”

Senators’ Attention

Rockefeller and U.S. Senator Edward Markey, a Democrat from Massachusetts, introducedlegislation in February that would allow consumers to see what information has been collected on them and make it easier to opt out of being included on such lists. In May, the Federal Trade Commission recommended Congress put more protections around the collection of health and other sensitive information to ensure consumers know how the details they are sharing are going to be used.

The companies selling the data say it’s secure and contains only information from consumers who want it shared with marketers so they can learn more about their condition. The data broker trade group, the Direct Marketing Association, said it has its own set of mandatory guidelines to ensure the data is ethically collected and used. It also has a website to allow consumers to opt out of receiving marketing material.

“We have very strong self regulation, we have for more than 40 years,” said Rachel Nyswander Thomas, vice president for government affairs for the DMA. “Regardless of how the practices are evolving, the self-regulation is as strong as ever.”

Yet the ease with which data is discoverable in a simple Google search along with Bloomberg interviews with people who showed up in one such database suggest the process isn’t always secure or transparent.

Open Access

Dan Abate said he never agreed to be included in any list related to diabetes. Two other people on the same mailing list said they didn’t have diabetes either and weren’t aware of consenting to offer their information.

In Abate’s case, neither he nor anyone in his family or household has diabetes and the only connection he can think of for landing on the list are a few cycling events he participated in for a group that raises money for the disease.

“I could understand if I was voluntarily putting this medical information out there,” Abate said. “But I don’t have diabetes, and I don’t want my information out there to be sold.”

Bloomberg found the diabetes mailing list on the website of Exact Data in a section for sample lists that included dozens of other categories, like gamblers and pregnant women. The diabetes list contained 100 names, addresses and e-mails. Bloomberg sent e-mails to all of them, and three consented to interviews. There were no restrictions on who could access the list, available on search engines like Google.

Online Surveys

Exact Data’s Chief Executive Officer Larry Organ said the list posted on its website shouldn’t have included last names and street addresses, and the company has since deleted any identifiable information. He said the data came from Acxiom and Exact Data was reselling it.

The Acxiom list was compiled by various sources, including surveys, registrations, or summaries of retail purchases that indicated someone in the household has an interest in diabetes, said Ines Gutzmer, a spokeswoman for the Little Rock, Arkansas-based company. While Gutzmer said consumers can visit the Acxiom website to see some of the information that has been collected on them, she declined to comment about how any one individual was placed on the list.

Acxiom shares rose less than 1 percent, to $18.66 at the close of New York trading. The company has lost 29 percent of its value in the past 12 months.

Sharing Information

One of the more common ways to end up on a health list is by sharing health information on a mail or online survey, according to interviews with data brokers and the review of dozens of health-related lists. In some cases the surveys are tied to discounts or sweepstakes. Others are sent by a company seeking customer feedback after a purchase. The information is then sold to data brokers who repackage and resell it.

Epsilon, which has data on 54 million households based on information gathered from its Shopper’s Voice survey, has lists containing information on 447,000 households in which someone has Alzheimer’s, 146,000 with Parkinson’s disease, and 41,000 with Lou Gehrig’s disease. The Irving, Texas-based company provides survey respondents with coupons and a chance to win $10,000 in exchange for information on their household’s spending habits and health.

The company will share with individual consumers specific information it has gathered, said Jeanette Fitzgerald, Epsilon’s chief privacy officer.

Suffering Seniors

KBM Group, one of the largest collectors of consumer health data based in Richardson, Texas, has health information on at least 82 million consumers categorized by more than 100 medical conditions obtained from surveys conducted by third-party contractors. The company declined to provide an example of the surveys. KBM uses the information for its own marketing clients, and sells it to other data brokers, said Gary Laben, chief executive officer of KBM.

“None of our clients wants to engage with consumers or businesses who don’t want to engage with them,” he said. “Our business is about creating mutual value and if there is none, the process doesn’t work.”

Data repackaging is extensive and pervasive. The Suffering Seniors Mailing List help marketers push everything from lawn care to financial products. It consists of the names, addresses, and health information of 4.7 million “suffering seniors,” according to promotional material for the list. Beach List Direct Inc. sells the information for 15 cents a name. Marketed as “the perfect list for mailers targeting the ailing elderly,” it contains a breakdown of those with diseases like depression, cancer and Alzheimer’s, according to its seller’s website.

Clay Beach, the contact on Beach List’s website, did not return calls and e-mails over the past month.

‘Confidential’ Clients

Little is known about who buys medical lists since data brokers say their clients are confidential, Rockefeller said at a hearing on the issue in December.

Promotional material for the Suffering Seniors data found by Bloomberg on Beach List’s website initially included a list of users. The names of those users have since been removed.

One customer was magazine publisher Meredith Corp. (MDP), which used the list in a test for a subscription offer for Diabetic Living magazine, said Jenny McCoy, a spokeswoman. Other users have included the American Diabetes Association, which said a small portion of names from the list was given to one of its local chapters, and Remedy Health Media, a publisher of medical websites.

Magazine Advertising

Remedy Health may have used the list to advertise one of its magazines, which has been defunct for several years, said David Lee, the company’s executive vice president of publishing.

A growing source of data fodder are website registration forms that ask for health information in order for a user to access the site or receive an e-mail newsletter.

One such site is Primehealthsolutions.com, which provides basic health information on a variety of conditions. It makes money by collecting data on diseases its users have been diagnosed with and medications they are taking, which people disclose when signing up for the site’s e-mail newsletter.

The site has more than three dozen lists for sale, including a tally of 2.2 million people with depression, 267,000 with Alzheimer’s, 553,000 with impotence, and 2.1 million women going through menopause.

Jason Rines, a co-owner of Prime Health Solutions, said he will share the lists only with those marketing health-related products, like pharmaceutical or medical device makers.

Purchasing Trail

Acxiom said it uses retail purchase history or magazine subscriptions to make assessments about whether someone has a particular disease interest.

Health data collection is troubling to people like Rebecca Price, who has early-stage Alzheimer’s disease. While she now makes no secret of her disease and serves as a member of the Alzheimer’s Association’s early stage advisory group, that wasn’t always the case. Price, a 62-year-old former doctor, said she initially didn’t even tell her husband of her condition for fear word would get out and harm her personally and financially.

“It is a very, very personal diagnosis,” Price said.

Social media is another potential way information can be collected on patients, said Dixon, of the World Privacy Forum, who warns patients to be more careful about what they share on sites like Facebook.

“Don’t ‘like’ the hospital website or comment ‘thank you for the great breast cancer screening you gave me,’” she said. “Under the Facebook policy that is public information and it is in the wild and if someone goes to that site and pulls it off, it is totally public.”

Facebook Policy

While it would be possible for data miners to scrape ‘likes’ and public comments from Facebook Inc. (FB)’s social network, the company said such practice is against company policy and, if discovered, would be blocked.

“We don’t allow third-party data providers to scrape or collect information without our permission,” said Facebook spokeswoman Elisabeth Diana. “Third-party data providers that work with Facebook don’t collect personally identifiable information and are subject to our policies.”

For consumers who want to know what list they may be on, there are limited options. KBM for example doesn’t have the technological capabilities to look up an individual by name and tell them what lists they are on, though they can purge a name from all their lists if requested to do so, said CEO Laben.

Acxiom started a website last year that allows people to view some of the information it has on them. Those who choose to can correct or remove their data.

Epsilon’s Fitzgerald says the best way for consumers to protect themselves is to be more aware of where they are sharing their information and pay more attention to website privacy policies.

“If people are concerned, don’t put the information out there,” Fitzgerald said. “Consumers would be better served if they were educated more on what is going on on the web.”

(A previous version of the story mistated the name of the Direct Marketing Association and corrected the spelling of Facebook spokeswoman Elisabeth Diana.)

To contact the reporters on this story: Shannon Pettypiece in New York atspettypiece@bloomberg.net; Jordan Robertson in San Francisco atjrobertson40@bloomberg.net

To contact the editors responsible for this story: Rick Schine at eschine@bloomberg.net Drew Armstrong

data saving lives, entrepreneurship, health market quality, healthcare, healthy habits, nutrition, policy, quantified self, rapid learning health systems

What Uber for healthcare might look like

Interesting take on imagining the future of healthcare.

http://www.kevinmd.com/blog/2014/08/uber-health-care-will-look-like.html

What the Uber of health care will look like

 | POLICY | AUGUST 5, 2014

For a very long time, one of the most valuable business assets in New York City was a yellow cab taxi medallion. With recent value in the $1 million dollar range, ownership of the medallion was a virtual cash annuity, combined with equity growth (in 2004 medallion prices were in the mid $200,000 range and have increased in value 15% year over year in the 9 years since). As one owner once put it, “it even makes money for me while I sleep,” since the cars can be rented when the owner is off shift.

 

Medallion owners tend to fall into two categories: private practitioners and fleet owners. Private practitioners own their own car, have responsibility for maintenance, gas and insurance, and tend to use the cash flow to live while allowing the medallion to appreciate over the course of their career. They then cash out as part of their retirement plan.

Fleet owners have dozens of medallions; they lease or buy fleets of automobiles and often have their own mechanics, car washes and gas pumps. They either hire drivers as employees or, more often, rent their cars to licensed taxi drivers who get to keep the balance of their earnings after their car and gas payments.

In London, taxi drivers have to invest 2 to 4 years of apprenticeship before they can take and pass a test called “The Knowledge.” However, like NYC, finally getting that a licence to operate a Black Cab in London is a hard-working but stable way to earn a living.

Now imagine that someone comes along that can offer all the services of the NYC yellow cab or the London Black Cab directly to the general public, but does not have to own the medallion, own the car or employ the driver. With as much as 70% lower overhead, they provide the same service to the consumer; in fact they are so consumer friendly that they become the virtual gatekeeper for all the taxi and car service business in the community.

How, you ask? Outsourcing the overhead and just-in-time inventory management; they convince thousands of people to drive around in their own cars with the promise of a potential payment for services driving someone from point A to point B. All these drivers have to do is meet certain standards of quality and safety. This new company does all the marketing and uses technology to make the connection between the currently active drivers and those in need of a ride; they provide simple and transparent access to a host of cars circulating in your neighborhood, let you know the price and send a picture and customer rating of the driver, all before he or she arrives, and they process the payment so no money ever changes hands.

This is the premise behind Uber, a very disruptive take on the taxi business. As a recent article in Bloomberg noted, the slower rate of growth in medallion value is already attribute to the very young company; a recent protest by Black Cab drivers in London resulting in an eight-fold increase in Uber registrations.

Now imagine that a new health care services company comes to your community offering population health management services on a bundled payment or risk basis. They guarantee otherwise inaccessible metrics of quality and safety to both large employers and individual consumers. They employ only a handful of doctors, but do not own any hospitals, imaging centers or ambulatory care facilities.

However, they are masters at consumer engagement, creating levels of affinity and loyalty usually found with consumer products and soft drinks. They use a don’t make me think approach to their technology, seamlessly integrating analytics and communications platforms into their customers lives, and offer consumers without a digital footprint a host of options for communications, including access to information and services via their land lines or their cable TV box. They leverage high-level marketing analytics to determine who will be responsive to non-personal tools for engagement, like digital coaching, and who requires a human touch.

Care planning is done based on clinical stratification and evidence; population specific data is used to determine the actual resources required to achieve clinical, quality and financial goals. (A Midwest ACO has more problems with underweight than obesity, do they need to maintain their bariatric surgery center?) Physicians serve as “clinical intelligence officers,” creating standing orders across the entire population, implemented by non-clinical personnel; they also create criteria for escalation and de-escalation of services and resource allocation based on individual patients progress towards goals. They employ former actors and actresses as health coaches and navigators, invest heavily in home care and nurse care managers and use dieticians in local supermarkets to support lifestyle changes (while accessing and analyzing the patients point-of-purchase data to see what they are really buying).

The primary relationship between patients and their health systems is with a low cost, personal health concierge: Primary care physicians are only accessed based on predetermined eligibility criteria and only with those physician who agree to standards of quality and accountability are in the network. Multi-tiered scenario planning for emergencies is built into the system. For professional resources only required on an as-needed basis, such as hospital beds, surgeons and medical specialists, access is negotiated in advance based on a formula of quality standards and best pricing but only used on a just-in-time basis.

They are not a payer, although a professional relationship with them is on a business-to-business basis. They are a completely new type of health system, guaranteeing health and well being, transparent in their operations and choosing their vendors based on their willingness and ability to achieve those goals. In doing so, they significantly reduce the resources necessary to achieve goals for quality of care and quality of health across the entire population; they treat quality achievement as an operational challenge and manage their supply chain accordingly.

Am I suggesting this a new model of care? No, I am personally an advocate for physician-driven systems of care. But this kind of system is very possible, and there are companies working on models of national ACOs using many of these principles.

The Uber of health care will have much less to do with the mobile app; and far more to do with creating value by minimizing overhead, designing flexible operations, supporting goal-directed innovation and bringing supply-chain discipline to the idea of resource-managed care delivery. It will involve embracing models of care delivery that leverage emerging evidence on non-clinical approaches to health status and quality improvement, and focusing on designing goal-directed interactions between people, platforms, programs and partners.

I can hear more than a few of you creating very good reasons why it wont work (“You can’t put an ICU bed out to bid!”), but these scenarios are very doable. If we want to revitalize the experience of care for patients and professionals, we must be willing to acknowledge and embrace dramatically different, often counter-intuitive, new operating models for care that will require new competencies, forms of collaboration and reengineering the roles and responsibilities of those who comprise a patients’ health resource community.

Steven Merahn is director, Center for Population Health Management, Clinovations. He blogs at MedCanto.

data saving lives, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Crossing the creepy line – big data in health

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data.

http://www.bloomberg.com/news/2014-06-26/hospitals-soon-see-donuts-to-cigarette-charges-for-health.html

Your Doctor Knows You’re Killing Yourself. The Data Brokers Told Her

By Shannon Pettypiece and Jordan Robertson  Jun 27, 2014 2:35 AM ET

Photographer: Evan Sung/Bloomberg

Photographer: Pat LaCroix

Photographer: David Paul Morris/Bloomberg

A cupcake eater in San Francisco.

Photographer: Matthew Staver/Bloomberg

A cigarette smoker in Denver.

Photographer: Tim Boyle/Getty Images

A customer at a convenience store in Des Plaines, Illinois.

You may soon get a call from your doctor if you’ve let your gym membership lapse, made a habit of picking up candy bars at the check-out counter or begin shopping at plus-sized stores.

That’s because some hospitals are starting to use detailed consumer data to create profiles on current and potential patients to identify those most likely to get sick, so the hospitals can intervene before they do.

Information compiled by data brokers from public records and credit card transactions can reveal where a person shops, the food they buy, and whether they smoke. The largest hospital chain in the Carolinas is plugging data for 2 million people into algorithms designed to identify high-risk patients, while Pennsylvania’s biggest system uses household and demographic data. Patients and their advocates, meanwhile, say they’re concerned that big data’s expansion into medical care will hurt the doctor-patient relationship and threaten privacy.

Related:

“It is one thing to have a number I can call if I have a problem or question, it is another thing to get unsolicited phone calls. I don’t like that,” said Jorjanne Murry, an accountant in Charlotte, North Carolina, who has Type 1 diabetes. “I think it is intrusive.”

Acxiom Corp. (ACXM) and LexisNexis are two of the largest data brokers who collect such information on individuals. Acxiom says their data is supposed to be used only for marketing, not for medical purposes or to be included in medical records. LexisNexis said it doesn’t sell consumer information to health insurers for the purposes of identifying patients at risk.

Bigger Picture

Much of the information on consumer spending may seem irrelevant for a hospital or doctor, but it can provide a bigger picture beyond the brief glimpse that doctors get during an office visit or through lab results, said Michael Dulin, chief clinical officer for analytics and outcomes at Carolinas HealthCare System.

Carolinas HealthCare System operates the largest group of medical centers in North Carolina andSouth Carolina, with more than 900 care centers, including hospitals, nursing homes, doctors’ offices and surgical centers. The health system is placing its data, which include purchases a patient has made using a credit card or store loyalty card, into predictive models that give a risk score to patients.

Special Report: Putting Patient Privacy at Risk

Within the next two years, Dulin plans for that score to be regularly passed to doctors and nurses who can reach out to high-risk patients to suggest interventions before patients fall ill.

Buying Cigarettes

For a patient with asthma, the hospital would be able to score how likely they are to arrive at the emergency room by looking at whether they’ve refilled their asthma medication at the pharmacy, been buying cigarettes at the grocery store and live in an area with a high pollen count, Dulin said.

The system may also score the probability of someone having a heart attack by considering factors such as the type of foods they buy and if they have a gym membership, he said.

“What we are looking to find are people before they end up in trouble,” said Dulin, who is also a practicing physician. “The idea is to use big data and predictive models to think about population health and drill down to the individual levels to find someone running into trouble that we can reach out to and try to help out.”

While the hospital can share a patient’s risk assessment with their doctor, they aren’t allowed to disclose details of the data, such as specific transactions by an individual, under the hospital’s contract with its data provider. Dulin declined to name the data provider.

Greater Detail

If the early steps are successful, though, Dulin said he would like to renegotiate to get the data provider to share more specific details on patient spending with doctors.

“The data is already used to market to people to get them to do things that might not always be in the best interest of the consumer, we are looking to apply this for something good,” Dulin said.

While all information would be bound by doctor-patient confidentiality, he said he’s aware some people may be uncomfortable with data going to doctors and hospitals. For these people, the system is considering an opt-out mechanism that will keep their data private, Dulin said.

‘Feels Creepy’

“You have to have a relationship, it just can’t be a phone call from someone saying ‘do this’ or it just feels creepy,” he said. “The data itself doesn’t tell you the story of the person, you have to use it to find a way to connect with that person.”

Murry, the diabetes patient from Charlotte, said she already gets calls from her health insurer to try to discuss her daily habits. She usually ignores them, she said. She doesn’t see what her doctors can learn from her spending practices that they can’t find out from her quarterly visits.

“Most of these things you can find out just by looking at the patient and seeing if they are overweight or asking them if they exercise and discussing that with them,” Murry said. “I think it is a waste of time.”

While the patients may gain from the strategy, hospitals also have a growing financial stake in knowing more about the people they care for.

Under the Patient Protection and Affordable Care Act, known as Obamacare, hospital pay is becoming increasingly linked to quality metrics rather than the traditional fee-for-service model where hospitals were paid based on their numbers of tests or procedures.

Hospital Fines

As a result, the U.S. has begun levying fines against hospitals that have too many patients readmitted within a month, and rewarding hospitals that do well on a benchmark of clinical outcomes and patient surveys.

University of Pittsburgh Medical Center, which operates more than 20 hospitals in Pennsylvania and a health insurance plan, is using demographic and household information to try to improve patients’ health. It says it doesn’t have spending details or information from credit card transactions on individuals.

The UPMC Insurance Services Division, the health system’s insurance provider, has acquired demographic and household data, such as whether someone owns a car and how many people live in their home, on more than 2 million of its members to make predictions about which individuals are most likely to use the emergency room or an urgent care center, said Pamela Peele, the system’s chief analytics officer.

Emergency Rooms

Studies show that people with no children in the home who make less than $50,000 a year are more likely to use the emergency room, rather than a private doctor, Peele said.

UPMC wants to make sure those patients have access to a primary care physician or nurse practitioner they can contact before heading to the ER, Peele said. UPMC may also be interested in patients who don’t own a car, which could indicate they’ll have trouble getting routine, preventable care, she said.

Being able to predict which patients are likely to get sick or end up at the emergency room has become particularly valuable for hospitals that also insure their patients, a new phenomenon that’s growing in popularity. UPMC, which offers this option, would be able to save money by keeping patients out of the emergency room.

Obamacare prevents insurers from denying coverage because of pre-existing conditions or charging patients more based on their health status, meaning the data can’t be used to raise rates or drop policies.

New Model

“The traditional rating and underwriting has gone away with health-care reform,” said Robert Booz, an analyst at the technology research and consulting firm Gartner Inc. (IT) “What they are trying to do is proactive care management where we know you are a patient at risk for diabetes so even before the symptoms show up we are going to try to intervene.”

Hospitals and insurers need to be mindful about crossing the “creepiness line” on how much to pry into their patients’ lives with big data, he said. It could also interfere with the doctor-patient relationship.

The strategy “is very paternalistic toward individuals, inclined to see human beings as simply the sum of data points about them,” Irina Raicu, director of the Internet ethics program at the Markkula Center for Applied Ethics at Santa Clara University, said in a telephone interview.

To contact the reporters on this story: Shannon Pettypiece in New York atspettypiece@bloomberg.net; Jordan Robertson in San Francisco atjrobertson40@bloomberg.net

To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Andrew Pollack

business, complex adaptive systems, cool, data saving lives, entrepreneurship, facts & data points, file note, health market quality, healthcare, healthy habits, management and leadership, meaning, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology, startup, storytelling

The Vitality Institute: Investing In Prevention – A National Imperetive

Vitality absolutely smash it across the board…

  • Investment
  • Leadership
  • Market Creation
  • Developing Health Metrics
  • Everything…!

Must get on to these guys…..

PDF: Vitality_Recommendations2014_Report

PDF: InvestingInPrevention_Slides

Presentation: https://goto.webcasts.com/viewer/event.jsp?ei=1034543 (email: blackfriar@gmail.com)

 

From Forbes: http://www.forbes.com/sites/brucejapsen/2014/06/18/how-corporate-america-could-save-300-billion-by-measuring-health-like-financial-performance/

Bruce Japsen, Contributor

I write about health care and policies from the president’s hometown

How Corporate America Could Save $300 Billion By Measuring Health Like Financial Performance

The U.S. could save more than $300 billion annually if employers adopted strategies that promoted health, prevention of chronic disease and measured progress of “working-age” individuals like they did their financial performance, according to a new report.

The analysis, developed by some well-known public health advocates brought together and funded by The Vitality Institute, said employers could save $217 billion to $303 billion annually, or 5 to 7 percent of total U.S. annual health spending by 2023, by adopting strategies to help Americans head off “non-communicable” diseases like cancer, diabetes, cardiovascular and respiratory issues as well as mental health.

To improve, the report’s authors say companies should be reporting health metrics like BMI and other employee health statuses just like they regularly report earnings and how an increasing number of companies report sustainability. Corporations should be required to integrate health metrics into their annual reporting by 2025, the Vitality Institute said. A link to the entire report and its recommendations is here. 

“Companies should consider the health of their employees as one of their greatest assets,” said Derek Yach, executive director of the Vitality Institute, a New York-based organization funded by South Africa’s largest health insurance company, Discovery Limited.

Those involved in the report say its recommendations come at a time the Affordable Care Act and employers emphasize wellness as a way to improve quality and reduce costs.

“Healthy workers are more productive, resulting in improved financial performance,” Yach said. “We’re calling on corporations to take accountability and start reporting health metrics in their financial and sustainability reports.  We believe this will positively impact the health of both employees and the corporate bottom line.”

The Institute brought together a commission linked here that includes some executives from the health care industry and others who work in academia and business. Commissioners came from Microsoft (MSFT);  the Robert Wood Johnson Foundation; drug and medical device giant Johnson & Johnson (JNJ); health insurer Humana (HUM); and the U.S. Department of Health and Humana Services.

The Vitality Institute said up to 80 percent of non-communicable diseases can be prevented through existing “evidence-based methods” and its report encourages the nation’s policymakers and legislative leaders to increase federal spending on prevention science at least 10 percent by 2017.

“Preventable chronic diseases such as lung cancer, diabetes and heart disease are forcing large numbers of people to exit the workforce prematurely due to their own poor health or to care for sick relatives,” said William Rosenzweig, chair of the Vitality Institute Commission and an executive at Physic Ventures, which invests in health and sustainability projects. “Yet private employers spend less than two percent of their total health budgets on prevention.  This trend will stifle America’s economic growth for decades to come unless health is embraced as a core value in society.”

healthy habits, quantified self

Non-invasive glucose monitoring

 

 

http://www.fiercemobilehealthcare.com/story/researchers-develop-biometric-watches-glucose-monitoring-pulse-tracking/2014-06-14

Researchers develop biometric watches for glucose monitoring, pulse tracking

June 14, 2014 | By 

Research papers published in The Optical Society’s journal Biomedical Optics Express, detail how the biometric watches rely on what’s called a “speckle” light effect, which is the result of laser light hitting uneven surfaces or the scatter of laser light from an opaque object.

The glucose biometric system, which monitors the bloodstream for glucose and hydration, represents a groundbreaking technology, according to its research team.

“Glucose is the holy grail of the world of biomedical diagnostics, and dehydration is a very useful parameter in the field of wellness, which is one of our main commercial aims,” bioengineer Zeev Zalevsky, of Israel’s Bar-Ilan University, said in an announcement. The researchers said a commercial device could reach market within two to three years.

The pulse tracker biometrics watch, under development by the Optics Research Group at the Delft University of Technology in the Netherlands, promises to deliver pulse data non-invasively and provide readings not impacted by a wearer’s movements, according to a second study.

“This paper shows for the first time that a speckle pattern generated from a flowing liquid can give us the pulsation properties of the flow in spite of motion-induced artifacts,” graduate student and biomedical engineer Mahsa Nemati said in the announcement. “Sophisticated optics is not necessary to implement this, so the costs for devices can be kept low. Another advantage is that the devices can be non-contact or far from the sample.”

The device news comes as wearable mHealth device interest is growing among consumers, grabbing interest from tech titans and drawing attention from federal agencies.

A survey from Mavosky Health/Kelton revealed that 81 percent of Americans would use a wearable health device. That presents a lucrative opportunity for tech companies looking to enter the industry, such as Microsoft, Google and Apple.

For more information:
– read the announcement
– check out the study on the glucose monitoring device
– here’s the study on the pulse tracking device

business, complex adaptive systems, data saving lives, health market quality, healthcare, healthy habits, musings, nutrition, policy, politics, quantified self, quotes & aphorisms, rapid learning health systems

The Hospital of the Future is not a Hospital

Great insights into where capital is being invested in US healthcare…

http://www.healthleadersmedia.com/print/LED-305089/The-Hospital-of-the-Future-is-Not-a-Hospital

The Hospital of the Future is Not a Hospital

Philip Betbeze, for HealthLeaders Media , May 30, 2014

Pursuing expensive inpatient volume in the traditional sense is a strategic dead end. Any new construction undertaken by hospitals and health systems should be based on adaptability, patient flow, and efficiency gains—not bed count.

I’ve spent a good deal of time the past several weeks interviewing senior healthcare leaders for my story in the May issue of HealthLeaders magazine about the hospital of the future. But in truth, that headline might be a bit of a tease.

As it turns out, the hospital of the future doesn’t look much like a hospital at all. Instead, it’s a cohesive amalgamation of plenty of outpatient modalities that represent growth in healthcare. Inpatient care, increasingly, represents stagnation and shrinkage, in the business sense.

In the past, a story about the hospital of the future has meant investigating healthcare organizations’ access to capital, and their ability to fund expensive new patient bed towers with all-private rooms and top technologies, in a race to grab volume from competitors.

Under that operating scenario, the sky was the limit, in terms of what organizations were willing to do to attract volume.

That calculus has changed drastically.

In a recent survey on healthcare design trends conducted by Minneapolis-based Mortenson Construction, 95% of the healthcare organizations surveyed said most of the projects they are undertaking are predominantly ambulatory in nature.

“If, in theory, the [Patient Protection and Affordable Care Act] has now got 7 million people engaged in healthcare insurance who didn’t have that previously, the inrush of patients will be outpatient-based,” says Larry Arndt, general manager of healthcare in the company’s Chicago offices. “What’s not needed is bed space or heavy procedural space.”

A Strategic Dead End
The PPACA, employers, and commercial health plans have made clear that pursuing expensive inpatient volume in the traditional sense is a strategic dead end. That doesn’t mean new patient towers won’t go up, but it does mean their construction will be based on adaptability, patient flow, and efficiency gains, not bed count.

As few as five to seven years ago, says Arndt, a healthcare leadership team would take a capital improvement project through a planning and programming phase in which they followed a traditional approach. The team would utilize widely standardized metrics and program their building based on what they’re doing now, with no consideration of the future, Arndt says.

By contrast, within the last five years, more leaders have been embracing the concept of lean operational improvement.

In order to be competitive in a limited amount of reimbursements, they have had to become more efficient. So instead of the traditional approach of programming new construction based on how the organization operates today, instead, it attempts to map out its current patient flows and discover how to become more efficient. Only then will the team look at how to build around that improved and more efficient model.

Indeed, a whopping 22% of respondents to Mortenson’s February survey said they were “doing nothing” construction-related right now, and only 5% were planning for a traditional replacement hospital.

Instead, a majority said they are focusing new construction on building clinics that can feature just about any outpatient modality except surgery, Arndt says.

Healthcare Shifts to Outside
They’re focusing on combining dialysis, radiology and other treatments that can be provided in one location. And they’re funneling more of their capital budget to items that are outside the realm of new construction, like home health and what Arndt calls e-home healthcare—in other words, technological solutions that help patients access their caregivers outside of any facility.

“Our customer understands that healthcare is moving more toward healthcare outside a facility,” says Arndt. “That means more money is being invested in health information technology. Also, you see more constellation or satellite projects, for example, a small 15,000-20,000 square-foot clinic in a neighborhood. That allows patients to travel a shorter distance to a less congested environment, but yet allows connection to the bigger facility if needed.”

Modular construction is a trend that Arndt sees developing quickly. It’s in the process of designing a clinic for a client that will feature modular walls, to make it more flexible for the changes in care protocols that are assured, but that healthcare’s leaders aren’t sure how will ultimately affect their competitive offerings.

In one clinic, doctors want to be able to meet with patients in groups, for example. Modular walls mean physicians can occasionally meet with groups of patients instead of individually, or vice-versa. Their space is less limiting.

“The clinic can adapt,” says Arndt.

Prefabricating buildings is also gaining steam in healthcare, he says.

“Money is being invested much more wisely than it has been in the past,” he says. “For the design/construction field, we have to be more lean too.”

Part of that lean attitude means offering customers 3-D modeling that starts with design partners, such as the people who will be staffing the building, to optimize work flow.

Adapting Takes Time
“We can prefab things we couldn’t years ago,” he says. An example might be a bathroom “pod” that can be built offsite and installed on site. Full exam rooms can be prepared the same way, and models can be constructed to test care protocols with the team that will be working there.

Arndt’s customers, he says, can be categorized two ways. Either they’re thinking broadly about adapting to the future without knowing exactly what it’s going to bring, or they’re standing idly on the sideline until they understand better how the PPACA and other drastic changes in how healthcare is provided and paid for will affect their bottom lines.

Neither approach is necessarily better than the other, but waiting just puts off the action that needs to be taken. It can be a prudent approach, but even in healthcare, what works can change quickly. Designing, building, and adapting still takes time.

Don’t wait too long.

Philip Betbeze is senior leadership editor with HealthLeaders Media. 

data saving lives, facts & data points, healthcare, healthy habits, musings, nutrition, policy, quantified self, rapid learning health systems

Apples cocks up HealthKit slide at WWDC…

It’s already starting to seem a lot like HSG, except less credible…!

 

http://rockhealth.com/2014/06/digital-health-entrepreneurs-thoughts-healthkit/

Embedded image permalink

A digital health entrepreneur’s thoughts on HealthKit

Guest Contributor
June 03, 2014

Tags: 

This morning, Apple made its much-anticipated move into healthcare with HealthKit (aka, the formerly rumored HealthBook.) With a typically dissonant and ever-growing ecosystem of health apps, devices and data, digital health needs a major player to enter to integrate these products and tools. We’re excited about what the largest company in the world is capable of doing for digital health. Here’s some perspective on what a seasoned digital health entrepreneur had to say about today.

Aaron Rowe
HealthKit is really exciting. Putting all of this information in one place, in a gorgeous app that will reach a ton of people, could do wonders for public health. But it won’t do much good if the on-screen content is designed without input from people who deeply understand health metrics. It looks like Apple or one of its partners made some technical mistakes on a slide that was shown during the big reveal of their new health app.

The slide, which appeared toward the end of the HealthKit segment of today’s WWDC keynote, neatly displays four key metrics for diabetes management: glucose, carbs, walking, and diabetes medication adherence. The numbers and units that Apple used as examples to illustrate their vision don’t make sense. When you measure your glucose with a personal blood sugar meter, it is measured in mg/dL— but the example shown by Apple displayed these numbers in mL/dL. Whoops!

What’s worse, the app screen features an SMS-style message from a particularly photogenic doctor who says, “You’re making great progress with your diet and exercise. Keep it up.” While the graph above this message shows a steady and very unhealthy looking uptrend in the users glucose readings. The current reading shown on the app is 122 “mL/dL”.

“People with a fasting glucose level of 100 to 125 mg/dL have impaired fasting glucose (IFG), or prediabetes,” according to a National Institute of Diabetes and Digestive and Kidney Diseases website. “A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.

It strikes me as particularly unusual that Apple would make these mistakes, since they are known for their intense attention to detail. Perhaps this kerfuffle happened because none of the folks who were involved with the WWDC keynote know what medical details should look like—is there some disconnect within the group that is building HealthKit?  Have the designers who worked on this screen had enough contact with Apple’s partners at the Mayo Clinic or recently hired health experts? Not long ago, the Cupertino-based company onboarded several noninvasive glucose-monitoring experts from the wearable Raman spectrometer company C8 MediSensors and an early employee of Rock Health’s own Sano Intelligence.

I hope HealthKit will help patients understand and react to the results of every common blood test that is done in the home and medical labs–from cholesterol to creatinine. This could be one of the greatest ways in which Apple can make the world a better place. But they may need to sync internally to refine their understanding of these numbers, before they release this potentially lifesaving product into the wild.

Aaron Rowe is a research director at Integrated Plasmonics, a San Francisco startup that has developed a new class of spectrometer and surface plasmon resonance sensor chips. He and his colleagues are exploring ways to expand the scope of chronic disease management programs, enhance the success of new medications, and increase the usefulness of telemedicine by bringing a wide variety of in vitro diagnostics devices into the home and workplace. You can follow him on Twitter at @soychemist

 

health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Esther Dyson on the population health rampage!

 

http://www.healthleadersmedia.com/print/TEC-303509/Esther-Dyson-Launches-Population-Health-Challenge

Esther Dyson Launches Population Health Challenge

Scott Mace, for HealthLeaders Media , April 15, 2014

A tech investor with a proven track record of attracting innovation and money to a variety of endeavors is looking for a few good communities to compete for the greatest improvement in five measures of health and economic vitality.

Wellville

Healthcare ladies and gentlemen, start your communities.

That was the call on April 10 from angel investor and tech advisor Esther Dyson, whose population health dream has taken a big step toward reality with the launch of the Way to Wellvillecompetition.

From now until May 23, Dyson’s nonprofit startup, HICCup, is inviting communities to apply to be one of five contestants in a five-year-long competition to get healthy using everything from the latest fitness gadgets to reality TV. Dyson is HICCup’s founder and chairman of EDventure Holdings.

The 20-page application form is not for the casual applicant. Individuals or consultants need not apply – we’re talking community health organizations, other nonprofits or perhaps the local Better Business Bureau.

Esther Dyson’s Population Health Dream

Why bother? Several reasons. Dyson is an early investor in all sorts of innovative startups, with a proven track record of attracting innovation and money to a variety of endeavors over the past 25 years. She also is a great listener, having convened various listening sessions around the country last fall to get this latest idea off the ground.

Dyson’s fledgling organization, HICCup, found its footing in those sessions, and also a CEO, Rick Brush, who spent nearly a decade at Cigna, where he was chief strategy and marketing officer for the national employer segment and launched the payer’s Communities of Health venture.

Esther Dyson

Esther Dyson
Photo: courtesy of Joi on Flickr.

At one of those early scoping sessions, Brush asked the kinds of tough questions about what Way to Wellville should be measuring that landed the answers in HICCup’s FAQ and himself in the CEO’s chair, Dyson tells me.

A ‘Learning Lab for Health’
“What we’re trying to do is almost create a learning lab for health with subsidiary projects and contests along with the five-year marathon,” Dyson says.

Back to that lengthy application, which goes beyond asking about a community’s healthcare, straight to the health of a community, seeking such metrics as percentage of temporary residents, household income, poverty levels, and a slew of outcomes data – percentages of a community with diabetes, heart disease, asthma, smoking status, obesity and more.

Applicants also have to describe their top previous successes and failures trying to improve community health, healthcare financing innovations such as ACOs, patient-centered medical homes, population health, bundled payments, and so on.

In other words, it’s a lot of the things that HealthLeaders readers are currently embarking on both individually and collectively. And if the prestige of being selected for the first-of-its-kind national competition of sorts doesn’t intrigue you, there are a couple of other things to consider.

First is the cash prize at the end of the five years. HICCup itself won’t be rewarding such a prize, but hopes to raise $5 million for it. “Honestly, contestants are going to have to spend $15 to $50 million as a community to do this, so you’re not doing this for the prize, though of course it matters to some extent,” Dyson says.

Second, and more importantly, Way to Wellville contestants will become part of a larger community amongst the five competing communities. They will meet face-to-face in September at an annual conference, Next Step to Wellville, about a month after the five competing communities are selected.

The actual judging of who wins in 2019 has yet to be decided, but it will be a third party for legal and fiduciary reasons. Dyson emphasizes that the organization doesn’t have all the answers yet.

Metrics Matter
If you believe, like I do, that healthcare is closer than ever to some tectonic shakeups courtesy of technology, then Way to Wellville is likely to be a great observation post. Innovative medical hardware and software companies are already flocking to a variety of competitions such as this. Way to Wellville is just taking a bigger view of what kind of population health solutions will ultimately be necessary.

Expect also a lot of intermediate measurements and competitions.

“We’re hoping that some of these quantified self vendors will come in and donate devices to the communities and so we’ll have Fitbit and Fuelband contests,” Dyson says. “[Add to that] the county health rankings and all of these sorts of official measures, most of which are a year or two old, and we’re all going to get a lot more real-time data.”

“You can’t report transitions to diabetes every month,” Dyson says, “so there will be some health measures that are kind of yearly, but then there are, the outcomes measures tend to be slow. The input measures, like the percentage of school lunches that contain no French fries or something, you can measure in more real time.”

The $15 to $50 million table stakes per community sounds daunting to me. “It’s not the community goes and gets a $50 million grant from somebody,” Dyson says. “It’s more than they get a $10 million grant for, let’s say, heart health. There’s a $2 million program for food subsidies for fruits and vegetables. There are accountable care organizations that find an investor to improve the health so that their costs go down. There are social impact bonds.”

Philanthropists Wanted
“So it’s a combination of a large number of different kinds of funding from donors, from social investors, from vendors giving in-kind services or goods, and maybe in outer years, the school board raises a bond to do something with the school lunch. Each community is going to need to get money and support from a variety of courses in a variety of funds.

“We’ll be looking for people who want to invest in various ways of producing health. We’re also looking for donors [and] philanthropists.”

And of course, Dyson is reaching out to her famous set of angel investor friends. The goal, of course, is to go beyond that. Another way to maintain excitement on Dyson’s agenda is “a cheesy reality TV show” and perhaps a documentary.

As we see more and more crowdfunded efforts springing up in healthcare technology, Dyson’s approach has some similarities – with perhaps a crowd with deeper pockets, or at least one that’s been around the startup block a time or two.

Dyson hopes for up to 50 applicants for the five spots, and already has solid interest from several communities. Her population health dream is alive, and by this fall we should start to see some manifestations of it.

Scott Mace is senior technology editor at HealthLeaders Media. 

healthy habits, quantified self

Bedroom darkness and obesity

Might be worth having a look at, especially with the Barangaroo building site aspiring to be a night sun at the moment…

http://www.bbc.com/news/health-27617615

29 May 2014 Last updated at 23:58

By James GallagherHealth and science reporter, BBC News

Woman asleep

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Sleeping in a room with too much light has been linked to an increased risk of piling on the pounds, a study shows.

A team at the Institute of Cancer Research in London found women had larger waistlines if their bedroom was “light enough to see across” at night.

However, they caution there is not enough evidence to advise people to buy thicker curtains or turn off lights.

The study of 113,000 women was published in the American Journal of Epidemiology.

The women were asked to rate the amount of light in their bedrooms at night as:

  • Light enough to read
  • Light enough to see across the room, but not read
  • Light enough to see your hand in front of you, but not across the room
  • Too dark to see your hand or you wear a mask

Their answers were compared to several measures of obesity. Body Mass Index, waist-to-hip ratio and waist circumference were all higher in women with lighter rooms.

Prof Anthony Swerdlow, from the Institute of Cancer Research, told the BBC: “In this very large group of people there is an association between reported light exposure at night and overweight and obesity.

“But there is not sufficient evidence to know if making your room darker would make any difference to your weight.

“There might be other explanations for the association, but the findings are intriguing enough to warrant further scientific investigation.”

Body Clock

One possible explanation is that the light is disrupting the body clock, which stems from our evolutionary past when we were active when it was light in the day and resting when it was dark at night.

Light alters mood, physical strength and even the way we process food in a 24-hour cycle.

Artificial light is known to disrupt the body clock by delaying the production of the sleep hormone melatonin.

Body Clock

Prof Derk-Jan Dijk, from the Surrey Sleep Centre, said there would be no harm in trying to make bedrooms darker.

He told the BBC: “People in general are not aware of the light present in their bedroom, I think people should assess their bedroom and see how easy it would be to make it darker.”

Street lights, some alarm clocks and standby lights on electrical equipment such as televisions could light a room, he said.

“Overall this study points to the importance of darkness,” he concluded.

Cancer

The study was funded by Breakthrough Breast Cancer and the findings emerged from a long-term study to understand the risk factors for breast cancer. Obesity is known to increase the odds of the disease.

Dr Matthew Lam, from the charity, commented: “It’s too early to suggest that sleeping in the dark will help prevent obesity, a known risk factor for breast cancer, but the association is certainly interesting.

“Whilst we are learning more and more each day about the environmental, genetic and lifestyle factors that affect breast cancer risk, it is not yet possible to predict who will get breast cancer, and for women who have been diagnosed with the disease, we can’t yet say what caused it.”