Thursday, November 15, 2018
Blog Page 2

The Case for Open Innovation in Health | Sara Holoubek of Luminary Labs

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“Most large healthcare companies will have numerous teams – innovation teams, maybe a venture fund, business units – all doing different things,” says Sara Holoubek, CEO of Luminary Labs, a consultancy known in healthcare for its expertise staging open innovation challenges. “How much more powerful would it be if everyone agreed on a common investment thesis? ‘We know our business model is changing and, therefore, where is our big bet?’”

The ‘big bet’ is not always easy for stakeholders in healthcare companies to agree on. Hence, Sara’s advocacy for open innovation, a methodology built for collaboration both internal and external to the organization. She’s been masterminding challenges, hackathons, participatory design sessions, and the like in healthcare for years, helping pharma companies, health plans, health systems and government organizations gain access to new ideas from external problem solvers and startups.

Open innovation not only brings much-needed agility to the way these big companies develop products, build partnerships, or pivot into new markets, but it also helps clarify which business problems the organization is actually trying to solve.

Large organization or small, how do you know when it’s time to take your innovation efforts outside? How do you make sure that your open innovation attempt is truly a ‘challenge’ and not just a splashy brainstorming session or hackathon to nothing?

A few weeks back, Luminary Labs published ‘The State of Open Innovation Report’ in effort to help benchmark the practice and build its business case as a worthwhile methodology for business innovation. Seeds of the report can be found in this interview. Listen in as Sara defines the practice and shares her tips and best practices.

Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health

Exponential Medicine

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By MATTHEW HOLT

After only maybe 5 years when I’ve been away running a conflicting conference in some other part of the world I finally get to go to Exponential Medicine the next 4 days. I met Daniel Kraft way back before he was famous, and his conference grew from being a week long academic session in an airline hangar in Mountain View to being a mega 4 day bash at the Hotel Del Coronado in San Diego (partly aided by TEDMED abandoning the venue and heading off in its own strange direction post billionaire buyout–well done Mark Hodash despite the lawsuit and yes I am jealous!).

Anyway, it’s going to be lots of fun. There’s plenty of people from my Health 2.0 world presenting. Lonnie Rae Kurlander, ePatient Dave, heck even John Halamka has been tempted off the farm — although I suspect Dave will have him in a headlock about access to his BIDMC data pretty quick).

Then there’s the surgeons and the weirdos. I leave Shafi Ahmed & Stefano Bini to decide which category they’re in, although whatever John Brownstein says I do owe him a nice bottle of scotch. Anyway, check out the program and if you haven’t bought yourself a ticket or bribed your way in, don’t worry it’s all being live streamed and Jessica DaMassa from WTF Health will as ever be interviewing anyone who doesn’t get out of the way quick enough.

So if you’re there I’ll be milling around not doing much, so say hi. And otherwise follow along here and @boltyboy

Health in 2 Point 00 Episode 56

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On Episode 56 of Health in 2 Point 00, Jess and I report from Livongo’s new office in San Francisco. In this episode, Jess asks me about Carrot Health’s $25 million raise for their digital smoking cessation program and 98point6’s $50 million raise for their on-demand primary care app. We also have our special guest star Dr. Jennifer Schneider here to tell us about how Livongo is working to Silence Noisy Healthcare with Applied Health Signals- Matthew Holt

 

We Know We Have to Address the Social Determinants of Health. Now What?

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By REBECCA FOGG

In the run-up up to this month’s mid-term elections, health care appears to be just one of many burning political issues that will be influencing Americans’ votes. But delve into nearly any issue—the economy, the environment, immigration, civil rights, gun control—and you’ll find circumstances and events influencing human health, often resulting in profound physical, emotional and financial distress.

Evidence suggests that separating immigrant children from their families could cause lasting emotional trauma. Gun violence and adverse weather events destroy lives and property, and create hazardous living conditions. Structural racism has been linked to health inequities, for instance where housing discrimination leads to segregation of black buyers and renters in neighborhoods with poor living conditions. The list goes on, and through every such experience, affected individuals, their loved ones, and their communities learn implicitly what health care providers have long known: that health status depends on much more than access to, or quality of, health care.

Some of the most influential factors are called social determinants of health, and they include education, immigration status, access to safe drinking water, and others. Society and industry must collaborate to address them if we are to reduce the extraordinary human and economic costs of poor health in our nation. Fortunately, many providers have embraced the challenge, and are tackling it in myriad, innovative ways.

Life-Saving Data That Is Nowhere To Be Found: Hospitals’ C-section Rates

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By DANI BRADLEY MS, MPH 

The United States is the only developed nation in the world with a steadily increasing maternal mortality rate — and C-sections are to blame. Nearly 32% of babies are born via C-section in the United States, a rate of double or almost triple what the World Health Organization recommends. While C-sections are an incredibly important life-saving intervention when vaginal delivery is too dangerous, they are not devoid of risks for mom or for baby. Hospitals and doctors alike are aware, as it’s been widely reported that unnecessary C-sections are dangerous — and hospitals and doctors agree that the number one way to reduce this risk is to choose a delivery hospital with low a C-section rate. However, information on hospitals’ C-section rates is incredibly hard to find, which leaves women in the dark as they try to make this important choice.

In an effort to help women make informed decisions about where to deliver their babies, we set out to collect a comprehensive, nationwide database of hospitals’ C-section rates. Knowing that the federal government mandates surveillance and reporting of vital statistics through the National Vital Statistics System, we contacted all 50 states’ (+Washington D.C.) Departments of Public Health (DPH) asking for access to de-identified birth data from all of their hospitals. What we learned might not surprise you — the lack of transparency in the United States healthcare system extends to quality information, and specifically C-section data.

Facts, Conclusions, and More Questions on the Road to Solving Disparities

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By SCOTT COOK PhD

We tested whether new payment mechanisms could be harnessed in health care delivery reform to reduce health and health care disparities. Here’s what we found.

First, there were facts that couldn’t be ignored:

#1: Children in rural Oregon on Medicaid suffered more health-related dental challenges compared to children with private insurance, including the pain, systemic health problems and disruptions to education that come with them. Advantage Dental, the state’s largest provider of Medicaid services, was determined to do something about it.

#2: New mothers on Medicaid in a New York City hospital were less likely to have a postpartum care visit compared to privately insured women. As a result, they missed assessments and screenings for a number of health conditions, some of which can lead to chronic health problems throughout their lives. For many women, the postpartum visit is one of the few chances to engage them in ongoing health care. The providers and care teams at the Icahn School of Medicine and the Mount Sinai Health System wanted to find out what it takes to increase postpartum visit rates.

#3: In Fairfax County, Virginia, multi-racial and multi-ethnic populations being served in three County-funded safety-net clinics were less likely to receive the typical high-quality care provided for hypertension, diabetes, and cervical cancer screening when compared to their Hispanic counterparts. The providers and teams at the Community Health Care Network stepped forward to address the issue.

Silencing Noisy Health Care?

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By MATTHEW HOLT

As you’ve probably heard (enough!) from me and Indu Subaiya over recent months on video, at Health 2.0 or here on THCB, we are finally arriving at the point where health care tech is “flipping the stack” — where we realize that we can’t practice the old way, and instead need to move the care of the chronically ill to an always on, always monitoring, always measuring, always messaging tech platform.

But we need to figure out a way to both create that platform and the services for the people who need help–without overwhelming them. Too often we are putting too much technology into patients’ and clinicians’ lives and creating too much noise. While I’ve been aping Bob Wachter calling for an air traffic control function in health care, one of the most interesting new companies in health tech/services, Livongo, has been working on a  related idea. They’ve been promoting it by looking to #SilenceNoisyHealthCare on Twitter and Linkedin recently

Tuesday 30th at 1 ET – 10 PT I’m hosting a webinar with Livongo’s CEO Glen Tullman & Chief Medical Officer Jennifer Schneider, M.D. Jessica DaMassa tweeted that Glen and I are in a cage match, and it is an Oxford v Cambridge affair (although Jennifer brings some Stanford & Hopkins class to the proceedings).

But what’s really going on is that Livongo is adopting a new philosophy that they think will silence the noise and fix the patient experience. What do they mean by that? Join me on the webinar to learn more

 

All Health Policy Is Local: The Case of the Individual Mandate Penalty in New York

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By CHRISTINE EIBNER, SARAH NOWAK, PREETHI RAO

Sarah Nowak
Preethi Rao
Christine Eibner

Although signed into law in 2010, the Affordable Care Act has been in constant flux, with key aspects changing due to time-dependent provisions, Supreme Court decisions and shifts in U.S. policy. The effects of changes to the ACA on health insurance enrollment and premiums often depend on state regulatory decisions and other state-specific factors. The elimination of the individual mandate penalty is a prime example of this when applied to New York state, which has unusual rules in its individual insurance market.

In 2019, consumers will no longer face financial penalties stemming from the ACA’s individual mandate, which requires most people to secure health insurance. Without pressure from the individual mandate to enroll, younger and healthier people might drop coverage, leading to premium increases. New York’s health insurance regulations and expansive safety-net programs could make the state’s insurance market particularly susceptible to premium increases after the penalty’s elimination.

New York uses what is known as “full community rating” in its individual health insurance market, which means that all adult enrollees, regardless of age or whether they use tobacco, are charged the same premium. In most states, the youngest adults in the market pay one-third of what older adults do, and tobacco users are charged 1.5 times as much as non-users. New York’s flat premium structure raises costs for younger enrollees and nonsmokers, making them more likely drop coverage when the penalty goes away.

Hospitals Can and Should Support Employees Who Are Victims of Domestic Violence: Here’s How

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By PATRICK HORINE

Every October we recognize Domestic Violence Awareness Month, an important opportunity to discuss this widespread social and public health problem and to take stock of what we can do better to protect victims of domestic abuse.

Unfortunately, the data shows us that health care is often a dangerous profession that is also rife with domestic abuse. Earlier this month a new poll of ER physicians revealed nearly half report having been physically assaulted at work (largely by patients and/or visitors in the ER). However, other data shows us that individuals in the health care professions – especially women—may be at greater risk of domestic abuse from a spouse or partner, while on the job as well. Data on domestic violence nationwide shows us one in four women are in a dangerous domestic situation, and one in four victims are harassed at work by perpetrators.  Women make up 80 percent of the healthcare workforce and an even greater percentage in most hospitals. When we do the math, this means one in 20 female healthcare workers are likely to be harassed or even assaulted on the job.

Furthermore, given that hospitals and most healthcare organizations are “open” facilities where anyone can walk onto the premises this further heightens the risk of a violent incident happening in the workplace. Over half of the homicides committed by intimate partners occur in parking lots and public buildingsNews stories like the ones about a California healthcare worked stabbed in the hospital parking lot by her estranged husband while her co-workers looked on are all too tragic and common.

The Futility of Patient Matching

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By ADRIAN GROPPER, MD

The original sin of health records interoperability was the loss of consent in HIPAA. In 2000, when HIPAA (Health Insurance Portability and Accountability Act) first became law, the Internet was hardly a thing in healthcare. The Nationwide Health Information Network (NHIN) was not a thing until 2004. 2009 brought us the HITECH Act and Meaningful Use and 2016 brought the 21st Century Cures Act with “information blocking” as clear evidence of bipartisan frustration. Cures,  in 2018, begat TEFCA, the draft Trusted Exchange Framework and Common Agreement. The next update to the draft TEFCA is expected before 2019 which is also the year that Meaningful Use Stage 3 goes into effect.

Over nearly two decades of intense computing growth, the one thing that has remained constant in healthcare interoperability is a strategy built on keeping patient consent out of the solution space. The 2018 TEFCA draft is still designed around HIPAA and ongoing legislative activity in Washington seeks further erosion of patient consent through the elimination of the 42CFR Part 2 protections that currently apply to sensitive health data like behavioral health.

The futility of patient matching without consent parallels the futility of large-scale interoperability without consent. The lack of progress in patient matching was most recently chronicled by Pew through a survey and a Pew-funded RAND report. The Pew survey was extensive and the references cite the significant prior efforts including a 100-expert review by ONC in 2014 and the $1 million CHIME challenge in 2017 that was suspended – clear evidence of futility.