Today on THCB Spotlights, Matthew chats with a couple of the OGs from the original days of Health 2.0—Scott Shreeve, founder and CEO of Crossover Health, and Jay Parkinson, founder of Sherpaa, who were the first ones doing something different in terms of doctors figuring out this digital health stuff. The two of them ask the question, what would happen if you married the physical world with the online world and created a new care model that exceeds at both? While Scott was putting in onsite primary care clinics to employers like Apple and Facebook, he realized Crossover wasn’t reaching 70% of the people they were contracted with because many employees were geographically remote. Meanwhile, Jay was doing something similar with virtual primary care—which differs from traditional telehealth in that his model enables a true relationship between patient and provider—and the rest is history.
Open Letter to Athena
By SCOTT SHREEVE
Afterburner (af·tər′bər·nər) n.
- A device for augmenting the thrust of a jet engine by burning additional fuel in the uncombined oxygen in the gases from the turbine
- The augmentation of thrust obtained by afterburning may be well over 40% of the normal thrust and at can exceed 100% of normal thrust
Athenahealth is one of my favorite companies anywhere. I believe they have a great vision, a highly capable team, an incredible business model, and an unprecedented business opportunity before them. However, for all the amor, I have been disappointed that even with all their blistering success (Bam, Bam, and Kabam!) they have captured less than 2% of the target market since the IPO. I am not just disappointed for them but for the entire ambulatory care space which doesn’t seem to readily get the value of the collective intelligence inherent in the network.Continue reading…
Shocking Google Health Back to Life
I hope to use this post to motivate my good friends at Google Health into taking a much more public, visible, and proactive role in the health conversation. More importantly, it is a call to Google HQ to wake up to the opportunity within health care to leverage their current tools and technology to create a platform that others can use to enable the creation of a next generation health system.
The scene was familiar, but it didn’t take away the tragedy. A young motor vehicle accident victim was involved in a head on collision with a drunk driver. The blunt trauma to the chest had created a literal mish-mash of complex internal injuries. The ambulance crew had attempted multiple times enroute to obtain a pulse and the monitors were all flatlined from the field. They intubated the patient in the field, performed CPR enroute, and initiated a ATLS protocol which included shocking the patient en route. In the face of asystole (lack of heart movement) after blunt trauma to the chest, the indication is to literally crack the chest open (called a anterolateral thoracotomy), a serious medieval last ditch rescue effort to save a life.
Death to Innovators – The Tragedy of Healthcare Innovation
Tragedy
- A disastrous event, especially one involving distressing loss or injury to life
- A tragic aspect or element.
- A drama or literary work in which the main character is brought to ruin or suffers extreme sorrow, especially as a consequence of a tragic flaw, moral weakness, or inability to cope with unfavorable circumstances.
The Advisory Board to the Health 2.0 Conference have been rehashing the recent conference in preparation for the fall program. We are continuing to try to push the boundaries of how to highlight bleeding edge innovations (dessert) and the new tools and technologies (eye-candy), but trying to be disciplined in challenging the community to put up their hard core case studies (nutritious tofu in the words of Esther Dyson) that demonstrate why this movement actually matters. This latter one requires thoughtful discipline, and hard data, from people trying to do very hard things (like obtain accurate personal health data from disparate sources, help consumers understand and optimize health value, and show how these new models of care actually lower cost). We look forward to producing a great program and I will keep you posted on these conversations.
The reason it is so hard to “do the right thing” in health care is that the current environment is a conspiracy of connundrums – no accountabilty, no transparency, rules/regulations, culture, binding contracts, third party payments, behavioral choices, lack of evidence, etc ad nauseaum. A real world example of how this plays out can be seen in the Vicious Cycle of Healthcare Innovation. This article highlights what happens when health care providers “do the right thing” but are rewarded with less money, which then kills off not only their desire but also their capability to do the right thing. Its a beautiful mechanism to ensure that the status quo never changes. This “Death to Innovators” concept has been highlighted by Intermountain Healthcare (pneumonia), Virginia Mason (back pain), and health innovators like Rushika Fernandopulle , MD at Reinnassance Health.
These tragedies have to be overcome. Given the grip of the medico-industrial complex, and their lobbying minions in DC, the only hope I have is that an entirely new system of health can begin to develop and emerge “off the grid” for the current non-consumers of healthcare. From this toehold, and from early and small efforts of the myriad groups seeking to change the financing of healthcare, I am hopeful that innovation can emerge that will align incentives, coordinate care delivery, improve outcomes, and be rewarded appropriately for these results. That is why I am involved in the various efforts to not only bring innovation to light but also demonstrate that these models can flourish.
Disruption breaking out over at Scott Shreeve’s place
Clayton Christensen's publisher is pressing me to read The Innovators Prescription and then interview him. Sadly I haven’t had the time to pay the book the attention it deserves. Messrs Kuraitis & Kibbe already did a review on THCB and probably said what I’d say, which was that like several other Harvard Business School profs, they got the problem right but the solution wrong. I’m on record from a couple of years back saying that Christensen’s guns are aimed in the wrong direction.
But to be fair my criticisms are pre-publication. Scott Shreeve has a great interview with Christensen’s co-author Jason Hwang (the late Jerome Grossman is also a co-author). and in this interview several of the incentive issues which concern those of us who understand how innovation gets stopped in health care, are addressed. Well worth reading.
Open source is a transparent Trojan horse
By Scott Shreeve
I have been blogging and twittering
from the World Health Innovation and Technology conference this week
while waiting to present today. The keynote speaker before me was Scott
McNealy, the Chairman and founder of Sun Microsystems. He has a long
and storied history with Sun, and a well earned reputation as the “human quote machine.”
He delivered.
His talk started with several examples of his health care experience
(long time user as a hockey player and father of four boys) and
business experience had so many corollaries. The fight for standards.
The fight for common interfaces. The fight for privacy and security.
The find for high quality, low cost, and transparency.
Moving up the health care value chain
By Scott Shreeve
Last week, I participated in a very cool live podcast with the ReadWriteWeb editor Richard Macmanus. While I am finishing up my commentary based on that experience, I did want to comment on another post by Richard who is one year into his diagnosis of Type I Diabetes. He mentioned that his favorite Health 2.0 application was MyMedLab.
In full disclosure, I serve as an advisor to
the company as well as a participant on the call that was conducted. I
became involved with MyMedLab while conducting my own survey of
promising Health 2.0 companies, tools, and technology. I was intrigued
by their Health 2.0 delivery model of leveraging the internet to remove
inefficiencies of time, location, and physician approval for routine
wellness laboratory testing.
I became convinced after using the service for myself. Since I
hadn’t ordered lab test since my medical school entrance physical exam,
and I was preparing for an upcoming physical, I ordered the baseline
wellness tests I knew my primary care provider would want (conveniently
organized by “profiles” – individual tests that are grouped together to
provide disease or organ system specific information). I wanted to
maximize my time with my doctor and come prepared with as much
information to review during our appointment as I could.
Electronic health records provide the foundation for clinical excellence
By 
I have mentioned this many times but it bears repeating with three
recent news articles – the electronic health record itself is not a
game changer but it is a powerful information gathering tool.
However,
by gathering information in a single collaborative place, EHR
technology allows all clinical providers to measure, monitor, and begin
to improve the way they provide care. It is this later part, which is part of the overall organizational transformation enabled by the technology (not solely because of it), that allows an organization to achieve the promised high performance results of an often painful EHR implementation.
At Kaiser, “The EMR is the Foundation of Everything We Do”
By 
Continuing his series of interviews about the business care for Health 2.0, here Scott Shreeve interviews Anna-Lisa Silvestre, the VP of Online Services for Kaiser Permanente.
SS: Anna-Lisa, nice to meet you. Tell me a little about your background?
AL: I started out with Kaiser Permanente 23 years
ago as a health educator. I was fortunate to be able to transition into
the interactive technology unit that was created in the mid 1990’s. We
had a singular focus on developing online capabilities back in the good
old HTML days. However, things have dramatically changed since then and
we now have over 2.5M members who have activated an online account; 60%
of those users signed on two or more times last year.
Safeway uses incentives and transparency to improve employee health
By 
In this interview on “The Business Case for Health 2.0,” Ken Shachmut,
Senior VP Strategic Initiatives, Health Initiatives, and Health
Re-engineering at Safeway, shares is thoughts on some of the highly
impressive results that the company has obtained by introducing market-based
health plans.
SS: Ken, thanks for making time today. Tell me a little about your background?
KS: I have been active as an executive and
management consultant for over 30 years. I graduated from Princeton in
Engineering and later obtained my MBA from Stanford. In consulting, I
worked first with McKinsey & Company,
later at Booz Allen Hamilton, and for awhile independently. I had done
some consulting for Safeway. I later joined Safeway and have been there
the last 15 years in various capacities.
Due to my consulting background and analytical focus, I am
frequently asked to look at new challenges and opportunities for the
organization. As health care costs continued to rise, we started
looking at ways that we could engage our employees or work with the
unions to control costs. The process has been highly successful, and we
now have broad participation in “market-based health care” (MBHC) plans
– starting with our non-union population and evolving into our union
plans currently. In consequence, our employees are now much more
actively involved in their health care and are making better choices
that improve their health. As a result of our learning and success, we
have helped to create the Coalition to Advance Health Care Reform
(CAHR) which is led by our CEO Steve Burd. CAHR now has over 60
companies as members.
