When we look back at contemporary health systems 50 years from now, we will consider them to be an technologically indulgent folly of grand proportions, driven by an imperative to deliver more and more complex care in order to justify higher and higher costs.
In a fee-for-service context, elaborate technologies justify higher costs. An elective angiogram costs $25,000. If this had to be paid by individuals, there would be no interest in conducting them with the frequency that they are performed today.
Perhaps this is why Singapore, with its health savings accounts with health costing around 4% of GDP (achieving the same high outcomes of Australia), lacks the excesses of more universal health systems?
The use of bariatric surgery for obesity is perhaps the most egregious example of this phenomenon. A AU$20,000 – 30,000 procedure is now introducing moral hazard that will undermine attempts to introduce behavioural and lifestyle change i.e. “Why bother changing my lifestyle when I can simply get a lap band to fix me later?”
Pharmaceutical companies are also using this play book with the introduction of their new, highly-specialised, so-called “biologics” to the market, particularly in the cancer area. They are often protein based and extremely difficult to manufacture, but are also very targeted. Funders are responding to this threat with value-based payment schemes where by the drug company only gets paid if the treatment succeeds.
Current health market settings establish this perverse incentive. Moves to value/outcomes-based care will remedy these perversities, providing incentives for activities that reduce care costs. In such an environment, the cheapest interventions also become the most profitable.
Home delivered broccoli instead of lap-bands.
CBT SMS’s instead of SSRIs and psychotherapy.
A rapid learning health system instead of a profit yearning sickness market.
TRACKED SINCE BIRTH: THE RISE OF EXTREME BABY MONITORING
DOES TRACKING A BABY’S EVERY MOVEMENT, CRY, AND WET DIAPER MEAN HAPPIER PARENTS AND HEALTHIER INFANTS, OR ARE WE TURNING OUR KIDS INTO TAMAGOTCHIS FOR NO REASON?
For the first 10 months of her life, her mother, Yasmin, kept detailed records of Elle’s sleep patterns, feedings, and diaper changes, noting the data points with a pencil and paper on a clipboard. A few months in, she digitized the logs, graphed the data, and became a more knowledgeable parent.
“It helped me feel confident,” she told Fast Company.
Elle wasn’t a very good sleeper, even for a baby. The pediatrician told Yasmin she needed to let her daughter “cry it out” until she fell asleep, but that never worked. For the sake of her sanity (and sleep), Yasmin took problem solving into her own hands. She wanted answers: Did she put Elle to bed too early? Too late? Give her too many naps? Parsing data, she thought, would help her figure it out. “That was the kind of stuff we were looking for,” she said.
Unfortunately for the Lucero family’s sleeping habits, Yasmin never found a definitive answer. Per the data, Elle was just fussy.
The results suggested Yasmin couldn’t engineer better naps, as she’d hoped. Just knowing that, however, made her feel better. “If you come to the conclusion that you have no control, then it’s okay to relax and just do whatever is convenient for you at the moment,” she explained. (Of course, many parents come to this conclusion at the moment of birth, without all that tedious data tracking.) But for Lucero, a conclusion–any conclusion at all–was all she wanted.
Many new and sleep-deprived parents crave that peace of mind and would kill for a data set that helped them determine if putting little Emma down an hour earlier would mean a restful night for the whole family. But unlike Yasmin, most people aren’t trained statisticians. Tired moms and dads with no mathematical background aren’t about to write down hundreds of data points, and might not know how to analyze that information anyway. Twenty-two months into Elle’s life, even Yasmin has semi-abandoned the project, and keeps much less rigorous records now.
In the imminent future, though, any curious parent with an iPhone will have access to helpful analytics, thanks to the rise of wearable gadgets for babies. Following the success of self-trackers for grown-ups, like Jawbone and Fitbit, companies likeSproutling, Owlet, and Mimo want to quantify your infants.
Mimo Onesie
These devices connect to a baby via boot, anklet, or onesie, and record his or her heart rate, breathing patterns, temperature, body position, as well as the ambient conditions of the room. They aim to replace baby monitors, which give an incomplete picture of a sleeping child. There’s also the nascent “smart diaper” market, led by Pixie Scientific, which scans dirty diapers for signs of infection.
In addition to alerting parents of any concerning findings, these companies encourage a big-data approach to parenting. By gathering information on your kid’s poop, sleep, and eating schedules, the idea goes, you can engineer a happier, healthier baby. The accompanying app for the Sproutling monitor, for example, looks at patterns specific to your child and its environment to offer insights–the kind that Yasmin craved–that might help the child sleep better. It might find that little Jake naps better in complete dark, for example.
The Sproutling monitor
In theory, all this data will lead to more rested, relaxed parents and healthier kids. As of now, parents do a lot of this in the dark. “There’s no owner’s manual,” Sproutling CEO Chris Bruce told Fast Company. His company hopes to change that. “It’s smart technology that helps raise the parenting IQ.”
When Bruce talks about “parenting IQ,” he doesn’t just mean his customers. Sproutling and its cohorts want to use their arsenals of data to better inform research. “The promise of big data is that we can monitor every single environmental parameter and we can find correlations and detect patterns,” added Bruce, calling big data the “holy grail” of his business. Both Owlet and Sproutling indicated that they will offer up their intel–anonymously!–to researchers so that all future parents can better understand babies.
Parents like Yasmin, who haven’t had a full night of sleep in months, are desperate to have that information. She didn’t want to know average sleep patterns–information available in baby books–she wanted bell curves. Yasmin knew her baby wasn’t normal, but she didn’t know how abnormal and her own analyses couldn’t clarify that, either. “I wasn’t finding the exact data I wanted to see,” Yasmin said, after scouring the Internet for answers.
An aggregation of Yasmins, however, can provide those insights. At least that’s the hope.
What sounds like a lot of progress for parenting also means handing a digital record of your baby over to an iPhone app. Are the benefits worth that?
While these apps could improve infant health by telling a parent the exact right nap or changing time, the app in large part benefits parents. Anxious first time moms and dads who worry about every little movement (or non-movement) can monitor their children more closely than ever. “You see your baby lying there and you don’t see them moving,” Bruce, who has two young daughters, said of his experience with old-school video monitors. “You can’t see them breathing; your first thought is: ‘Oh my God, something is wrong.'”
Unlike a basic $35 baby-monitor, the $250 Owlet bootie and accompanying app can alert parents if anything serious has gone wrong, like if a kid stops breathing, or if his heart stops beating. That means no more unnecessary freakouts for the over-protective and inexperienced dad like Bruce, which leaves more time for him to do other dad things.
But, to an extent, these apps take advantage of parent anxieties. “SIDS is the number one cause of infant death. That’s really scary to parents,” Jordan Monroe, a cofounder of Owlet, told Fast Company. Monroe has no kids, but while talking to friends and friends of friends with babies, he found that to be a common worry.
Those fears don’t come from a place of reality, though. According to the Center for Disease Control, 4,000 infants die each year from Sudden Unexpected Infant Death. Only a fraction of those deaths occur because of “accidental suffocation and strangulation in bed,” according to the CDC report. And even SIDS–which causes about 2,000 deaths a year–might stem from underlying brain issues, according to recent research. Monitoring a child’s breathing with a high-tech bootie won’t cure SIDS.
As anyone who has ever had any contact with a hypochondriac knows, those facts don’t really matter. Parents will continue to worry. And, as we saw with Yasmin, certainty has a lot of value. A certain type of parent, like TechCrunch’s Leean Rao, thinks that $250 for Owlet or $200 for Mimo’s version–Sproutling hasn’t yet announced pricing–is a reasonable price to pay to worry about one less thing. In her review of Sproutling, she writes:
As a relatively new parent myself, I would have loved to be able to use some of the data from a wearable to help determine optimal sleep patterns for my child. I’m not sure if it would have helped my daughter sleep through the night earlier in her development, but to me as a fledgling parent, knowledge is power.
Of course, the dollar amount is only a part of the price parents pay with these apps. They give up their children’s data and possibly privacy. “We’re creating the largest data set of infant health data,” Monroe said–a chilling statement in certain contexts. Trackers could turn around and sell their troves to insurers or be forced to hand them over to the government. The information is also vulnerable to hackers.
These companies say they take security issues seriously. “Security encryption has been designed in our system from the get-go,” said Bruce. Anonymous sharing with researchers is both opt-in and anonymous for Sproutling users. But, even Bruce admits that our cultural acceptance of privacy changes every day. What seems innocuous today might feel invasive tomorrow (or vice versa).
Is that risk worth the stated benefits? At this point, it’s not clear these monitors offer many health solutions. The breathing and sleeping alerts will calm (and draw) a lot of parents. But, none of these companies see that as the “holy grail.” The main sell is the tracking. And what does that do for parents and babies?
Arguably, it means finding those little tweaks that make life easier. But, as Yasmin discovered, sometimes babies fuss just because. Numbers don’t always offer solutions, as technical theorist and staunch critic of the self-quantified movement Evgeny Morozov wrote in his book To Save Everything, Click Here: The Folly of Technological Solutionism. “Self-trackers gain too much respect for the numbers and forget that other ways of telling the story–and generating action out of it–are possible.”
While pediatricians typically ask new parents to chart and report feedings and bowel movements for a few weeks after bringing babies home to make sure all systems are go, obsessive tracking beyond that could get in the way of parenting, some doctors say. “Often, when babies have regained their birthweight and are 10-14 days old, I instruct families to dial the tracking down,” Dr. Wendy Sue Swanson wrote on her blog. She adds:
I want new parents to gain confidence and appreciate the homeostasis with following a baby’s natural routine. Relying only on the numbers may cause parents to miss out on the nearly unspeakable experience of parenting a new baby and all that a baby intimately communicates from the beginning. It’s better to look up at the sky to know if it’s raining than to consult the weather report on your iPhone.
After all, do you really want to treat your child like a Tamagotchi?
MIT’s Hacking Medicine program believes that entrepreneurship is best suited to tackle health’s largest problems
he best healthcare solutions alleviate suffering at scale, often via technology to de-skill medicine, increase quality and lower costs, thus broadening access
Clinicians often get in habits and practices that are hard to change
Be a missionary, not a mercenary. Find a mission and customer with whom you truly empathize. The rest will come if you use that as your compass.
Entrepreneurship is not academic, though one should try to be strategic you don’t need an MBA.
The most important aspect of entrepreneurship is the entrepreneur’s mindset: to have a mission, clear use case and the persistence to solve it creatively.
Broad realization that technology can be used to scale medicine at a broader systems + population health
Changing healthcare reformsin the US is aligning incentives for better systemic healthcare
Large entrenched healthcare institutions are having a tough time adapting versus more agile startups
Start up costs have plummeted, so it’s more capital efficient than ever
The ubiquity of mobile computing and low cost diagnostics and sensors make health data liquidity and tracking easier than ever
Rising middle classes and health infrastructure in emerging economies are expanding access and demand globally
Why it’s the best time to be a healthcare entrepreneur
We caught up with Zen Chu, the founder of HackingMedicine and the current Entrepreneur in Residence at MIT to ask him some burning questions about digital health and entrepreneurship. Hear more from Chu at our sold out Healthcare Bootcamp in Boston tomorrow, along with thought leaders from athenahealth, MC10, IDEO and others.
What was the impetus for starting HackingMedicine?
We started MIT’s HackingMedicine program to push a philosophy that entrepreneurship is best suited to tackle healthcare’s largest problems. Housed within the Trust Center for MIT Entrepreneurship, it serves as a place to welcome non-healthcare engineers and entrepreneurs and connect them to Harvard Medical School and connect them to Harvard Medical School, the Health Sciences & Technology joint graduate program between MIT and Harvard, and Boston’s wonderful teaching hospitals. Our content and most programs are open to everyone and the mission is to infect more entrepreneurs to tackle healthcare problems.
How do we better engage clinicians in technology innovation in healthcare?
The best healthcare solutions alleviate suffering at scale, often via technology to de-skill medicine, increase quality and lower costs, thus broadening access for more people around the world. Clinicians often get in habits and practices that are hard to change. Our Healthcare Hackathons have brought hundreds of clinicians and health professionals together with entrepreneurs, engineers and hackers. We have now moved over 1500 participants through hackathons on 4 continents and we believe the process we have developed and freely teach is one of the best ways to identify unmet healthcare needs and bring diverse perspectives together to create high impact and creative solutions.
What is the number one piece advice you have for entrepreneurs?
Be a missionary, not a mercenary. Find a mission and customer with whom you truly empathize. The rest will come if you use that as your compass.
How do you ‘teach’ entrepreneurship?
Learn through doing. Entrepreneurship is not academic, though one should try to be strategic you don’t need an MBA. Classes and books can only go so far and every startup or technology is it’s own beast depending on the team and challenge. I think the most important aspect of entrepreneurship is the entrepreneur’s mindset: to have a mission, clear use case and the persistence to solve it creatively.
You’ve said it’s the most exciting time to be an entrepreneur? Why now?
This is truly the best time in the history of the world to be a healthcare entrepreneur:
Broad realization that technology can be used to scale medicine at a broader systems + population health
Changing healthcare reforms in the US is aligning incentives for better systemic healthcare
Large entrenched healthcare institutions are having a tough time adapting versus more agile startups
Start up costs have plummeted, so it’s more capital efficient than ever
The ubiquity of mobile computing and low cost diagnostics and sensors make health data liquidity and tracking easier than ever
Rising middle classes and health infrastructure in emerging economies are expanding access and demand globally
Like moths, we are attracted to light. In a company, that light is innovation. Everyone wants to be a part of the latest greatest thing. But that should not come at the expense of delivering on a product that has already been developed.
Stephen Miles argues that a balance must be maintained between optimization on one front and growing things on the other front. “I think a lot of times we optimize on one or the other which sub-optimizes the company,” Miles says.
He presents three key ways to maintain this balance.
To be successful, innovation requires both the planting of seeds and the pruning of buds.
Experimentation is a strategy that supports innovation without sacrificing optimization.
Leadership teams should contain a complementary mix of planters and pruners, or innovators and optimizers.
Along the lines of self-driving cars and smart glasses, Google‘s newest venture promises to wow the tech scene. Only, it’s not quite tech, at least in the traditional sense. The venture is called California Life Company, or Calico for short, and its goal is to extend human life by 20 to 100 years.It sounds surreal, until consider that we already extended human life by 20 years over the past century. The average girl born today will live to be 100, a once outlying achievement.
Other research outlets have made relevant discoveries over the years, including worms thatdivide stem cells without aging and that resveratrol, found in red wine, seems to defend against diseases related to aging and could be manufactured as a more potent synthetic drug.
Meanwhile, companies such as Elixir Pharmaceuticals, Sirtris Pharma and Halcyon Molecular set out to extend human life, only to shut down (or be acquired, then shuttered by the buyer), many times running out of money before bringing a product to market.
But one thing is true: The quest to live just a bit longer is in demand.
But living longer comes with its own challenges. One imagines doubling our elderly population and the strain that would put on their families and on resources in general. On the other hand, by allowing people to age slower, it’s possible a solution could extend our productive years, rather than the elderly years — so, an extra decade of being 30, rather than an extra decade of being 90 — a more attractive option for both individuals and culture as a whole.
Mashable spoke with experts in the space, who predict Calico will indeed approach the latter (Google declined to comment for this story). It won’t likely be one magic bullet solution, but rather, a group of solutions — a suite of products that will catch our imagination just as Google Glass and self-driving cars have.
The Problem With Aging
In a TIME profile, Larry Page said that solving individual diseases, even ones as pervasive as cancer, would not increase life expectancy by much. To reframe, cancer is the symptom; the true disease is aging itself. As we age and our cells wear down, it causes other old-age diseases.
“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,”
“Today we spend an incredible amount [of money] out of keeping people alive in a bad state of health,” says Aubrey de Grey, chief science officer of the SENS Research Foundation, who presented a TED Talk on anti-aging.
This might explain why many people have no interest in living longer.A Pew study shows 56% of Americans would not choose to slow the aging process, even if such medical treatments were available.You may have read about the suicide of 60-year-old sports blogger Martin Manley. His website reveals his distaste for the physical and mental limitations of old age.But de Grey doesn’t expect a solution from Google to follow this trend, adding length to the “unwell” years of life while the number of healthy years remains the same.
“We will not be able to extend life without extending health,” he says. “Longevity is a side effect.”
Why Google?
For most of us, Google’s investment into longevity was a surprise (but note, Google will not be operating Calico, only backing it). Others already in the space were able to see the connection.
What Google brings to the table is data. “Not just one set of data, multiple forms,” says Harry Glorikian, founder of life sciences consulting firm Scientia Advisors. “Search data, GPS data, all sorts of other pieces, electronic breadcrumbs that you produce all out there to get a picture of you.”
This data could be paired with each person’s genome — a partial genome can be mapped today for $99 via 23andMe (another Google investment), but many are hoping a full genome will cost as much in the next few years.
Daniel Kraft, medicine and neuroscience chair of Singularity University, affirms that this will require people to relinquish some privacy, in hopes of helping others and themselves, but predicts it to be something many will do.
“Lot of folks will be happy to share elements of health history,”
“Lot of folks will be happy to share elements of health history,” he says.
For an example of how data can impact health, just look to Google’s Flu Trends, which predicted flu outbreaks based on search data, although it turned out to be accurate only in certain cases.
Finally, note that Google isn’t entirely new to this space. Singularity University has had a lot of cross-pollination with Google, Kraft says, and Ray Kurzweil, director of engineering at Google, is an advisor to Maximum Life Foundation, says founder David Kekich.
Glorikian notes that, much like how Google’s development of Glass inspired developers to create uses for it, the Calico announcement will bring further attention and energy to life extension.
“When one of these behemoths points to a certain place, everyone has to believe that there’s something there,” Glorikian says.
The Solution Won’t Be a Magic Pill
We won’t see an anti-aging product from Calico come to market in a year — it’s a long-term venture. The company is likely assembling a team (the announcement only mentioned leadership of Art Levinson, who is former CEO of biotech company Genentech) and deciding what kind of research to do. Of course, there are several types.
First, there is the idea of the engaged patient. You have the “ability to manage your prevention if you know the risk of certain diseases,” says Kraft. Again, think genome mapping.
Second, de Grey maintains that a medical solution will be discovered before a solution involving nanotechnology — and the medical solution will allow some of us to live long enough to also benefit from future solutions. A medical solution might involve cell therapy, gene therapy or injections. Nanotechnology could include tiny robots that repair our cells or assist organs.
Who Will Pay for It?
An early criticism of Calico was that it sounded like something that would increase the split between the rich and the poor, leaving millionaires to live as long as they like (a few extra years to spend all that money doesn’t hurt), while less privileged people would settle for traditional lifespans or shorter (many children in developing countries continue to die without lack of access to clean water).
The rich already have the option of cryonics, preserving their bodies after death in hopes future technology will revive them. It costs $200,000.
It is possible individuals will not need to cover costs of anti-aging treatments themselves? Much like health care today, it makes for a convincing job perk.
De Grey expects these solutions to be paid for by neither the individual or the employer, but rather, the government. Between social security and Medicaid, the government spends billions on treatment for old-age illnesses and providing for the aging population. Perhaps a product that slows aging will be seen as preventative care — over time, it may prove cheaper and could save government money down the road.
“These therapies will pay for themselves so quickly,” de Grey says.
Further Questions
An extra 100 years to live that you didn’t expect is a daunting idea. But because many of these solutions will piggyback over time, it’s not likely to be a sudden burden. As any technology comes to market, we as a culture must learn to use it both safely and with respect for others.
But still, asking the ethical questions is an important step. With an extra set of productive years, should people have second careers (or second marriages)? If you’ll be in this world for longer, does it reduce the drive to have children? Will a larger population mean more competition for resources?
A popular Steve Jobs quote communicates life’s brevity as a benefit to the human race:
“Death is very likely the single best invention of life. It’s life’s change agent.”
But even with increased lifespan, death is never too far away. When asked about the difference between solving death and solving aging, de Grey was quick to point out the obvious: “I’m not working on a solution to stop people from getting hit by cars.”
For many years Jamie Oliver has been on a crusade to fight obesity and bad eating habits, with the aim to equip people the world over with cooking skills and a greater appreciation of fresh food.
Sydneysiders have witnessed his mission through numerous television shows, campaigns and cookbooks. Now it’s closer to home, with the announcement of the first Ministry of Food centre in NSW.
The British chef will open a cooking school in August to teach basic kitchen skills. It will be at the Stockland Shopping Centre at Wetherill Park in western Sydney, which is undergoing a $222 million redevelopment. It will be Oliver’s fifth Ministry of Food kitchen in Australia.
“Obesity is not just a diet-related disease. It’s the biggest killer in Australia and what the Ministry of Food is, it’s a fix and response that really does transform people’s confidence in the kitchens,” Oliver said.
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The cooking classes, funded by the not-for-profit arm of electrical goods retailer The Good Guys, will focus on basic cooking skills, nutrition, budgeting, meal planning and shopping tips.
Oliver said recipes would be healthy and tasty and would include desserts.
“We all love ice-cream. Life is about ice-cream and sometimes people get confused with some of my messaging,” he said.
“Of course we want to be as healthy as possible but we don’t want to edit out things in life. Life is about having beautiful treats and cakes and things like that.”
He said the problems began when parents gave in to their child’s requests for more soft drinks and desserts. “That’s the sort of repetition that gets us into trouble. Absolutely I give my kids ice-cream but my wife is fairly strict about when and how much.”
This year, the Australian Diabetes Council revealed that a diabetes epidemic had gripped the western suburbs of Sydney, with Liverpool in the south labelled as the suburb with the highest number of people with the disease.
Of the 10 suburbs with the highest incidence of diabetes, seven were in Sydney’s west, said head researcher, Alan Barclay. This includes Liverpool, Mount Druitt, Campbelltown, Westmead and Blacktown.
The high rates could be drastically reduced with a combination of improved primary healthcare and better knowledge of healthy cooking, he said in July.
“People need to know more about food and how to prepare it,” Barclay said. “We have to start doing more in schools and in the local community.”
The co-host of Channel Nine’s Today show, Lisa Wilkinson, will be the ambassador of the Ministry of Food centre.
peer support is a powerful model to support behaviour change
social media-backed sharing of progress reinforces achievements
Stevens is the CEO of KEAS > workplace health interventions
Calico, communities, legislation and tech drive a new era of health
October 14, 2013 12:45 pm by Josh Stevens | 0 Comments
America’s healthcare system has historically taken only baby steps to empower individual health and wellness ownership – until now. Recent events are about to alter existing healthcare paradigms and I believe this to be the most pivotal of moments. With Google’s Calico, the Affordable Care Act (ACA), Penn State’s wellness debacle and the rise of health-oriented social, healthcare entities are now taking a microscope to existing practices and infrastructures. What will they find? An industry destined for a radical makeover that will result in a prevention-based and consumer-driven healthcare network.
Let’s take a look at the players involved, from the good (social networking and technology), the bad (Penn State’s wellness initiative) and the TBD (Calico and the ACA).
The Emerging Models
Legislation, technology, communities, and social networking are forcing a healthcare overhaul. Consider Google’s Calico: It has the opportunity to create the largest online community to share health information, turning personal health on its head. With a greater global consumer reach than any other organization, Google has the access and resources to throw at this opportunity, making it the ideal company to coordinate this effort – and being led by Art Levinson, the Bill Gates of biotech, doesn’t hurt.
Addressing the issue of aging in a share- and prevention-oriented effort is a response to the growing presence of the “empowered patient.” Calico could finally deliver on the promise for people to have the ability to seize proactive command over their health with a full understanding of their health data and risk factors. Previously constrained by outdated regulations and a healthcare system that doesn’t prioritize prevention, the tables are finally turning. The potential can live up to the hype.
The October 1 launch of ACA-mandated healthcare exchanges is another step toward preventative care and information sharing. While the ACA is polarizing on both sides, (the outcome of its execution remains yet to be seen) the core of the ACA will impact the resulting healthcare industry in a way that empowers individuals to own their well-being and fosters collaboration with all patient caregivers.
The Anti-Model
Pennsylvania State University recently (and wisely) repealed a recent decision that established apunitive-based health and wellness program. Love or hate it, even the ACA agrees with the ‘carrot’ versus the ‘stick’ (companies can offer a reward of up to 30 percent of health costs for employees who participate in programs like risk assessment). Given the backlash and media attention Penn state received, it was an unfortunate way to learn what not to do.
Additionally, HIPAA is about to be a relic. Designed in a bygone era, HIPAA will be rendered obsolete thanks to the ACA. Because the ACA will provide benefits to those with pre-existing conditions, HIPAA’s privacy laws will only exist as roadblocks to individual health and wellness. The future of healthcare is driven by information sharing. It’s time for HIPAA to die
The Proven Models
Peer support in healthcare is proving to be wildly successful. As consumers, we increasingly seek the wisdom of crowds to create and sustain meaningful behavior change. El Camino Hospital in Mountain View, CA, recently launched a healthcare program for its employees in which social networking was a one of the tent poles in the program. During an 8-week time frame, over 1,000 participants lost over 1,000 pounds and began eating more fruits and vegetables. What was the number one motivating factor? Sharing progress updates with colleagues.
Today, 80 percent of healthcare costs are associated with preventable illnesses such as obesity, diabetes, hypertension and high cholesterol. It’s no wonder people are demanding to take back ownership of their health. Social networking, communities, technology and legislation are propelling old school healthcare into a consumer-driven and preventative-based model. I say bring it on — it’s about time.
Going back to first principles to examine what really matters in a therapeutic relationship and discovering its the relationship. That a health coach previously working at Dunkin’ Donuts might be more effective than a Harvard trained doctor might be difficult to compute, but makes complete sense.
Iora Health seem to be limit testing this idea.
Is a Health Coach Better Than an Overworked Doctor?
Iora Health CEO Rushika Fernandopulle at the WIRED Data | Life Conference in New York City. Photo: Christopher Farber.
Suzanne Koven was walking in the rain when she slipped, fell and fractured her right shoulder. It took surgery and months of physical therapy to heal.
“The recovery was miserable,” she said. But it came with a silver lining.
Koven is a primary care doctor at Massachusetts General Hospital, and the hospital insisted that for her first three weeks back she had to take twice as long to do her job. Suddenly, she had the luxury to actually spend time with her patients, to talk with them about what was wrong and how she could help.
“It was the happiest time in my career,” she said. “It completely transformed the nature of the interaction [with patients].”
That wouldn’t last. When her three weeks were up, Koven had to rejoin a system that rewards quantity over quality. She was back to seeing 20 patients a day.
But just a mile away from her office, at Iora Health’s main offices in Cambridge, Rushika Fernandopulle was busy brewing just the kind of medicine that inspired Koven to go into primary care more than 20 years earlier — a practice that, at its core, is about building relationships. At Iora Health’s clinics, teams of doctors, nurses and health coaches work together to take care of patients holistically, bundling together mental health services, peer support groups and nutrition counseling with more traditional primary care services like physical exams.
This model builds on a team-based approach to medicine known as patient-centered care, itself part of a larger movement to cut costs and improve health by upping the quality of primary care. The idea behind it is if people’s baseline health is better, the system will have to spend less money paying for expensive emergency procedures later.
What’s key to our model is to build a team around the patient — Rushika Fernandopulle
Large healthcare outfits, university systems and Silicon Valley upstarts have tried this approach with varying results before. But Iora wants to take this concept a step further by actively going after the most expensive, high-risk patients, spending more time and resources on each one, and investing in building in-house data analytics and IT tools. Along the way, the company is killing the standard model, in which doctors are paid for each service they provide, and redefining what a health provider is.
“What’s key to our model is to build a team around the patient” in a data-centric way, said Fernandopulle at the WIRED Data|Life conference in New York City yesterday. They take data from hospitals, pharmacy benefits companies and patients to monitor how patients are doing and to identify what patients to treat in the first place.
So far, he says, this approach has met impressive results. The company has been able to reduce emergency room visits by 48 percent and hospitalizations by 41 percent, resulting in an overall 15 percent reduction in healthcare costs in pilot studies at its four practices in New Hampshire, Nevada, New York and Massachusetts. Plus, the physicians in his clinics tend to be happier.
It’s the type of effect that Koven noticed during her three-week stint working at half her normal pace. She doesn’t have hard data to back this up, but she noticed that it took her patients roughly 15 minutes to start confiding in her. During a normal 15 minute visit, the patient would never get to that point. More open communication, she says, also made her less likely to order unnecessary expensive tests and medications.
At Iora, that’s standard partly because of the way the payment system works.
A provider pays a lump sum of money, usually between $150 and $200 a month, for each patient instead of forking over money per service. Then it’s up to the team to decide how to best treat the communities they serve. The system only works if the clinic keeps patients healthy. It behooves Iora to figure out exactly what’s wrong and tailor treatment to its patient population.
Sometimes that means cutting back on medications or the number of specialists patients see. It can also involve phone calls, text messages, video conferencing through Skype, or group sessions like Diabetes Clubs during which patients socialize and teach themselves how to best manage their disease.
To do this in a data-driven way, the team surveys patients for feedback and uses that information to tweak how care is delivered. It actively collects blood pressure, blood sugar and prescription refilling data to make sure patients are sticking to their health plan. If they don’t refill a prescription, for example, the system creates a task for a health coach to follow up with the patient.
Fernandopulle recounted the story of “Mr. Edwin,” a patient with end-stage renal disease and anxiety. His panic attacks sometimes prevented him from getting the dialysis that was keeping him alive, which resulted in 17 emergency room visits and $280,000 in healthcare costs.
His health coach asked him what calmed him down and he said listening to music. She used Iora’s discretionary budget to buy him a $45 iPod onto which the health coach loaded merengue music, Mr. Edwin’s favorite. Mr. Edwin took his merengue music with him to dialysis, and, Fernandopulle says, that quelled his anxiety and prevented expensive ER visits. This would have never happened in a traditional healthcare setting, he said.
Because that hinges on having a good rapport with patients, the company puts a premium on social skills. A background in health isn’t even necessary to get hired as a health coach. For example, before joining the company, some of Iora’s best health coaches worked as cashiers at Target and Dunkin’ Donuts, possibly the last place a traditional healthcare system would look for talent.
“It’s one of the most innovative models out there. What they’re doing is trying to start to think outside the traditional confines of who can provide care,” said Ashish Jha, a professor of health policy at the Harvard School of Public Health. “You don’t need to go to medical school to be a great health coach, to connect with people and motivate them. Those skills exist much more broadly.”
But, he says, that’s not an approach the healthcare establishment is necessarily ready to adopt in its entirety. The concept of building practices around team-oriented care might be scalable, but a strong leader is critical to make this model successful. “It would take a very special, very large healthcare provider to tolerate this approach. The idea that you’re going to get a health coach from Dunkin’ Donuts just seems hard to tolerate.”
Then, there’s the question of whether small companies like Iora can really make a dent in the country’s $2.7 trillion healthcare bill. There are hundreds of experiments and pilots around the country trying to redefine primary care, and it’s still unclear what will work, says Kevin Tabb, the CEO of Beth Israel Deaconess Medical Center in Boston. ”It’s not clear that a small company has the resources to really develop sophisticated systems on their own. Google couldn’t pull it off.”
I don’t think of talking with patients and getting to know more about them as some warm and fluffy add-on. It’s what medicine is — Suzanne Koven
Still, Tabb says, if one or several of these works out, it could still have a big impact.
And it wouldn’t have to be as scalable as you might think. “Five percent of the sickest patients are responsible for more than 50 percent of the healthcare spend,” Tabb said. “It may be that we only need to provide intensive care to a small percentage of the population.” What Tabb means by “intensive care” is not the intensive care unit of a hospital, but the type of personalized, regular care experimental primary care practices like Iora provide.
What all this says to Koven is that healthcare is very much a service industry. And what sets a good service apart is the ability to listen to customers well and to make them feel like what they say matters. That builds trust.
“Primary care — or my idealized version of primary care — actually allows for much more of that storytelling,” Koven said. “I don’t think of talking with patients and getting to know more about them as some warm and fluffy add-on. To me, it’s what medicine is.”
And that’s the type of medicine Iora Health is trying to kickstart.
Bill Gates: Here’s My Plan to Improve Our World —
And How You Can Help
BY BILL GATES
11.12.13
6:30 AM
I am a little obsessed with fertilizer. I mean I’m fascinated with its role, not with using it. I go to meetings where it’s a serious topic of conversation. I read books about its benefits and the problems with overusing it. It’s the kind of topic I have to remind myself not to talk about too much at cocktail parties, since most people don’t find it as interesting as I do.
But like anyone with a mild obsession, I think mine is entirely justified. Two out of every five people on Earth today owe their lives to the higher crop outputs that fertilizer has made possible. It helped fuel the Green Revolution, an explosion of agricultural productivity that lifted hundreds of millions of people around the world out of poverty.
These days I get to spend a lot of time trying to advance innovation that improves people’s lives in the same way that fertilizer did. Let me reiterate this: A full 40 percent of Earth’s population is alive today because, in 1909, a German chemist named Fritz Haber figured out how to make synthetic ammonia. Another example: Polio cases are down more than 99 percent in the past 25 years, not because the disease is going away on its own but because Albert Sabin and Jonas Salk invented polio vaccines and the world rolled out a massive effort to deliver them.
Thanks to inventions like these, life has steadily gotten better. It can be easy to conclude otherwise—as I write this essay, more than 100,000 people have died in a civil war in Syria, and big problems like climate change are bearing down on us with no simple solution in sight. But if you take the long view, by almost any measure of progress we are living in history’s greatest era. Wars are becoming less frequent. Life expectancy has more than doubled in the past century. More children than ever are going to primary school. The world is better than it has ever been.
But it is still not as good as we wish. If we want to accelerate progress, we need to actively pursue the same kind of breakthroughs achieved by Haber, Sabin, and Salk. It’s a simple fact: Innovation makes the world better—and more innovation equals faster progress. That belief drives the work my wife, Melinda, and I are doing through our foundation.
WE WENT ON A SAFARI TO SEE WILD ANIMALS BUT ENDED UP GETTING OUR FIRST SUSTAINED LOOK AT EXTREME POVERTY. WE WERE SHOCKED.
Of course, not all innovation is the same. We want to give our wealth back to society in a way that has the most impact, and so we look for opportunities to invest for the largest returns. That means tackling the world’s biggest problems and funding the most likely solutions. That’s an even greater challenge than it sounds. I don’t have a magic formula for prioritizing the world’s problems. You could make a good case for poverty, disease, hunger, war, poor education, bad governance, political instability, weak trade, or mistreatment of women. Melinda and I have focused on poverty and disease globally, and on education in the US. We picked those issues by starting with an idea we learned from our parents: Everyone’s life has equal value. If you begin with that premise, you quickly see where the world acts as though some lives aren’t worth as much as others. That’s where you can make the greatest difference, where every dollar you spend is liable to have the greatest impact.
I have known since my early thirties that I was going to give my wealth back to society. The success of Microsoft provided me with an enormous fortune, and I felt responsible for using it in a thoughtful way. I had read a lot about how governments underinvest in basic scientific research. I thought, that’s a big mistake. If we don’t give scientists the room to deepen our fundamental understanding of the world, we won’t provide a basis for the next generation of innovations. I figured, therefore, that I could help the most by creating an institute where the best minds would come to do research.
There’s no single lightbulb moment when I changed my mind about that, but I tend to trace it back to a trip Melinda and I took to Africa in 1993. We went on a safari to see wild animals but ended up getting our first sustained look at extreme poverty. I remember peering out a car window at a long line of women walking down the road with big jerricans of water on their heads. How far away do these women live? we wondered. Who’s watching their children while they’re away?
That was the beginning of our education in the problems of the world’s poorest people. In 1996 my father sent us a New York Times article about the million children who were dying every year from rotavirus, a disease that doesn’t kill kids in rich countries. A friend gave me a copy of a World Development Report from the World Bank that spelled out in detail the problems with childhood diseases.
Melinda and I were shocked that more wasn’t being done. Although rich-world governments were quietly giving aid, few foundations were doing much. Corporations weren’t working on vaccines or drugs for diseases that affected primarily the poor. Newspapers didn’t write a lot about these children’s deaths.
This realization led me to rethink some of my assumptions about how the world improves. I am a devout fan of capitalism. It is the best system ever devised for making self-interest serve the wider interest. This system is responsible for many of the great advances that have improved the lives of billions—from airplanes to air-conditioning to computers.
But capitalism alone can’t address the needs of the very poor. This means market-driven innovation can actually widen the gap between rich and poor. I saw firsthand just how wide that gap was when I visited a slum in Durban, South Africa, in 2009. Seeing the open-pit latrine there was a humbling reminder of just how much I take modern plumbing for granted. Meanwhile, 2.5 billion people worldwide don’t have access to proper sanitation, a problem that contributes to the deaths of 1.5 million children a year.
Governments don’t do enough to drive innovation either. Although aid from the rich world saves a lot of lives, governments habitually underinvest in research and development, especially for the poor. For one thing, they’re averse to risk, given the eagerness of political opponents to exploit failures, so they have a hard time giving money to a bunch of innovators with the knowledge that many of them will fail.
By the late 1990s, I had dropped the idea of starting an institute for basic research. Instead I began seeking out other areas where business and government underinvest. Together Melinda and I found a few areas that cried out for philanthropy—in particular for what I have called catalytic philanthropy.
I have been sharing my idea of catalytic philanthropy for a while now. It works a lot like the private markets: You invest for big returns. But there’s a big difference. In philanthropy, the investor doesn’t need to get any of the benefit. We take a double-pronged approach: (1) Narrow the gap so that advances for the rich world reach the poor world faster, and (2) turn more of the world’s IQ toward devising solutions to problems that only people in the poor world face. Of course, this comes with its own challenges. You’re working in a global economy worth tens of trillions of dollars, so any philanthropic effort is relatively small. If you want to have a big impact, you need a leverage point—a way to put in a dollar of funding or an hour of effort and benefit society by a hundred or a thousand times as much.
One way you can find that leverage point is to look for a problem that markets and governments aren’t paying much attention to. That’s what Melinda and I did when we saw how little notice global health got in the mid-1990s. Children were dying of measles for lack of a vaccine that cost less than 25 cents, which meant there was a big opportunity to save a lot of lives relatively cheaply. The same was true of malaria. When we made our first big grant for malaria research, it nearly doubled the amount of money spent on the disease worldwide—not because our grant was so big, but because malaria research was so underfunded.
But you don’t necessarily need to find a problem that’s been missed. You can also discover a strategy that has been overlooked. Take our foundation’s work in education. Government spends huge sums on schools. The state of California alone budgets roughly $68 billion annually for K-12, more than 100 times what our foundation spends in the entire United States. How could we have an impact on an area where the government spends so much?
We looked for a new approach. To me one of the great tragedies of our education system is that teachers get so little help identifying and learning from those who are most effective. As we talked with instructors about what they needed, it became clear that a smart application of technology could make a big difference. Teachers should be able to watch videos of the best educators in action. And if they want, they should be able to record themselves in the classroom and then review the video with a coach. This was an approach that others had missed. So now we’re working with teachers and several school districts around the country to set up systems that give teachers the feedback and support they deserve.
The goal in much of what we do is to provide seed funding for various ideas. Some will fail. We fill a function that government cannot—making a lot of risky bets with the expectation that at least a few of them will succeed. At that point, governments and other backers can help scale up the successful ones, a much more comfortable role for them.
We work to draw in not just governments but also businesses, because that’s where most innovation comes from. I’ve heard some people describe the economy of the future as “post-corporatist and post-capitalist”—one in which large corporations crumble and all innovation happens from the bottom up. What nonsense. People who say things like that never have a convincing explanation for who will make drugs or low-cost carbon-free energy. Catalytic philanthropy doesn’t replace businesses. It helps more of their innovations benefit the poor.
Look at what happened to agriculture in the 20th century. For decades, scientists worked to develop hardier crops. But those advances mostly benefited the rich world, leaving the poor behind. Then in the middle of the century, the Rockefeller and Ford foundations stepped in. They funded Norman Borlaug’s research on new strains of high-yielding wheat, which sparked the Green Revolution. (As Borlaug said, fertilizer was the fuel that powered the forward thrust of the Green Revolution, but these new crops were the catalysts that sparked it.) No private company had any interest in funding Borlaug. There was no profit in it. But today all the people who have escaped poverty represent a huge market opportunity—and now companies are flocking to serve them.
Or take a more recent example: the advent of Big Data. It’s indisputable that the availability of massive amounts of information will revolutionize US health care, manufacturing, retail, and more. But it can also benefit the poorest 2 billion. Right now researchers are using satellite images to study soil health and help poor farmers plan their harvests more efficiently. We need a lot more of this kind of innovation. Otherwise, Big Data will be a big wasted opportunity to reduce inequity.
People often ask me, “What can I do? How can I help?”
Rich-world governments need to maintain or even increase foreign aid, which has saved millions of lives and helped many more people lift themselves out of poverty. It helps when policymakers hear from voters, especially in tough economic times, when they’re looking for ways to cut budgets. I hope people let their representatives know that aid works and that they care about saving lives. Bono’s group ONE.org is a great channel for getting your voice heard.
Companies—especially those in the technology sector—can dedicate a percentage of their top innovators’ time to issues that could help people who’ve been left out of the global economy or deprived of opportunity here in the US. If you write great code or are an expert in genomics or know how to develop new seeds, I’d encourage you to learn more about the problems of the poorest and see how you can help.
At heart I’m an optimist. Technology is helping us overcome our biggest challenges. Just as important, it’s also bringing the world closer together. Today we can sit at our desks and see people thousands of miles away in real time. I think this helps explain the growing interest young people today have in global health and poverty. It’s getting harder and harder for those of us in the rich world to ignore poverty and suffering, even if it’s happening half a planet away.
Technology is unlocking the innate compassion we have for our fellow human beings. In the end, that combination—the advances of science together with our emerging global conscience—may be the most powerful tool we have for improving the world.
Jointly Health is the first Big Data Analytics and Closed-Loop Decision Support Platform for Remote Patient Monitoring
From their website:
Company Overview
Jointly Health is a venture-backed company headquartered in Orange County, CA. In collaboration with Qualcomm Life, Jointly Health provides a very disruptive, end-to-end Remote Patient Monitoring and Analytics Platform that can detect changes in health states much earlier and with greater specificity. Jointly Health also makes this information actionable by healthcare professionals inside their existing workflow.
First Application
The first application of Jointly Health is to reduce preventable hospital admissions in patients with complex chronic disease. In the U.S. there are 4 million preventable hospitalizations resulting in $88 billion in preventable costs and unquantifiable amounts of human suffering. Remote patient monitoring has the potential to reduce these hospitalizations but is plagued by missed intervention opportunities, false alarms and inefficiencies. Jointly Health solves these problems.
Uniqueness
Jointly’s proprietary platform utilizes a number of advanced technologies including Predictive Analytics, Complex-Event Processing, Real-Time Analytics, Signal Processing and Machine Learning and has four distinct advantages.
1. Can collect a wide variety of remote health data at high velocity and volume. This includes multiple types of physiological data, human observational, environmental, contextual, and other meta data.
2. Has an adaptable ecosystem that enables our customers to build complex disease models which we can then execute.
3. Can remotely detect changes in health states much earlier and with greater specificity.
4. Provides healthcare professionals with a closed-loop decision support system for intervention optimization.
Kreindler elaborated on the value of high speed data for applications including remote patient monitoring and analytics to proactively detect deteriorating health states before they being to detract from quality of life. The energetic talk concluded by touching on how Jointly Health, in collaboration with Qualcomm Life, harnesses big data and analytics to make “information actionable.”
