Health care through the lens of a technology entrepreneur

If you want to see the future of health care, the can’t miss conference of the year is the Health Innovation Summit hosted by Rock Health in San Francisco. As a practicing primary care doctor, I had the opportunity to view health care through the lenses of technology entrepreneurs. I thought the conference was even better than the one I attended last year. Absent was the provocative rhetoric by 2012 keynote speaker Vinod Khosla who noted that “technology will replace 80 percent of doctors.”

What continued to remain was the curiosity, confidence, enthusiasm, and optimism that health care and medical care could be even better and the willingness of entrepreneurs to fix a problem and build a business around it.

Themes I found particularly interesting included the following:

  • Make health care smarter by creating platforms, whether software or hardware, like wearables, to collect patient data and to analyze data, whether at the individual or population level, to gain insights and change behavior or predict outcomes.
  • Make health care better by using expertise from other fields, like the wisdom of the crowds, to provide patients more accurate diagnoses particularly when it revolves around a constellation of systems more likely due to a rare diagnosis.
  • Make the health care a more personalized care experience comparable to other industries with the use of information technology and mobile computing.
  • The creation of the ACA will fundamentally shift how patients will access care. This provides a tremendous opportunity for entrepreneurs.
  • Entrepreneurs believe that they can both do good, improve the health and medical care of individuals and the community, and make money.

Keynote speaker, former president of PepsiCo and former CEO of Apple, John Scully predicted that in health care “you will see big branded consumer health care services – much like we are comfortable with the national brands Starbucks, Chipotle. It may start as large branded urgent care clinics.”

He expects the irrevocable changes in how people access health care as a consequence of the implementation ACA.  Higher health care costs due to its mandates and entitlements will force employers to cut costs by increasing deductibles to $5000 by 2018, move to self insurance, and create more penalties and incentives for employees to be healthier. Faced with higher future out of pocket costs, he expects the public to find cheaper means for care as well as to seek alternative methods to stay healthy.

Scully is focused on these two areas. Instead of accepting the fact that patients on average wait 20 days before getting an appointment, wait again in the lobby for another hour before getting face time with a doctor, which last only seven to eleven minutes, Scully and this group at MDLive are delivering a superior experience using technology and the business discipline of a consumer facing company.

Already MDLive provides telehealth services to Proctor and Gamble, McKinzie, and Yahoo. The 2300 doctors of MDLive are US based doctors, certified, trained, and monitored by MDLive to ensure each experience is high quality. Careful triage and protocols ensure that patients get the right care. Those with more serious issues are recommended to seek alternative care. Everything at MDLive complies with HIPAA.

He is focused on replicating that experience with consumers in the urgent care market. Scully found that 24 percent of the US population, roughly the same number that owned an iPad, visited an urgent care clinic twice over a year. Yet despite a fairly high national penetration of use, unlike Apple, there is no national brand or presence that people talk about. Scully noted that out of the three top urgent care issues (upper respiratory infections / flu like symptoms, flu shot, and prescription request), two can be done online more quickly and for less by connecting care.

MDLive will soon deploy a medical kiosk, which will be available at a large pharmacy chain. The kiosk is complete with full screen HD video monitor, high precision digital camera, digital stereo audio, medical grade devices. Members of MDLive will be able to access doctors on the video monitor in less than 2 minutes. Should a prescription be needed, it will be quickly available at that pharmacy. With a monthly membership fee of less than $15, a video visit with a doctor under $40, Scully believes people will prefer this method of care which is more convenient and less costly.

He might be right. If deployed across a national pharmacy chain, might this be the national health care brand he envisions?

Scully also has focused on his belief that people, faced with higher health care costs, will seek alternative methods to stay healthy. Specifically, the public will embrace wearable devices that track information, link it with big data, and adopt the actionable behaviors that was created from predictive analytics. This should improve health and outcomes.

This is the purpose of his other company, Misfit Wearables, and its first product, Shine. With a battery life of months rather than one week, Shine collects data on sleep and exercise and synchronizes with a smartphone. Imagine if an entire nation tracked their data, which then was then subsequently analyzed, what impact might that have on the health of the nation?

With patients forced to find less costly solutions to receive care as well as incentives to stay healthy, Scully expects many exciting companies to develop to fill these needs.  The time for innovation is now.

Both collecting data and making smarter decisions and better discoveries with the data was the theme of “Turning Lemons Into Lemonade.” Inspiring stories from entrepreneurs Sean Ahrens, Jared Heyman, and Leah Sparks demonstrate how health and medical care can be better when driven by personal passion and experience.

Ahrens, cofounder and CEO of Crohnology, suffers from an “incurable condition” of Crohn’s Disease.  He realized that every patient in this situation becomes an experimenter and a researcher. What treatments and remedies work? Which ones do not? He created a platform, which helps others track information, pools the data together, and connects with other patients as well as researchers so everyone benefits from shared learning and discovery. Ahrens already has about 4000 patients in 66 countries and is the subject of the documentary “In Our Own Hands.” Giving patients tools to not only track how they respond to various therapies but also the ability to share and learn from experiences from others will be powerful.

As a practicing doctor, I found Heyman’s story of clinching the right diagnosis, particularly when it is a rare diagnosis, very compelling. Is it possible to harness the wisdom of the crowd, often observed to be more precise and accurate than an expert, if a process was created to leverage group knowledge? His personal journey began with his 18 year old sister who changed from a joyful and energetic freshman into a women afflicted with profound fatigue, hot flashes, and suicidal thoughts. Until her diagnosis of fragile X-associated primary ovarian insufficiency (FXAPOI) at the NIH, his sister had seen numerous doctors over many years. She recovered within three weeks of the right diagnosis and proper treatment.

With CrowdMed, Heyman has created such a process. Using a “marketplace” where doctor and non-doctors place “bets” that a certain set of symptoms are due to a specific illness, in a trial of 20 test cases, the crowd also had one of the top five potential diagnosis as the correct one. Each of the test cases had a rare diagnosis. The first test case was his sister’s. The crowd got it right.

Health care through the lens of a technology entrepreneur

Sparks’ personal journey began after suffering not just one miscarriage, which affect one in five women, but four. Though she understood the complexity of both female and male factors in fertility and recurrent fetal loss, she wanted to know why. She sent off the tissue from her most recent miscarriage and had it analyzed. A chromosomal abnormality caused the miscarriage. Further analysis of her other 15 unfertilized eggs showed that only 3 were completely normal. With this reality, Sparks miscarriage rate was not the oft quoted rate of 1 in 5, but in fact 4 in 5.

This insight compelled her to improve maternity and prenatal care, which are the leading costs of hospitals and health care, the largest contributor being pregnancy related complications. There is not much data currently available that can predict future complications prior to the event. So with Wildflower Health, Sparks has created a platform to make health care smarter by acquiring real data, analyzing it, and then based on the results provide feedback to individuals and health payers to change or nudge behavior. Repeat cycle. Would it be possible to get better outcomes?

Sparks story has a happy ending with the delivery of a healthy baby.

All inspired stories. All very promising technology. All raising important unanswered questions.

Health care has trailed other industries with not only acquiring data but also analysis to nudge behavior. Big data ready drives consumer purchasing behavior with frightening accuracy and efficiency as noted in the New York Times profile of retailer Target and its use of analytics as well as its other article about how the food industry successfully attempts to cater to our most basic evolutionary urges of salt, sugar, and fat.Won’t others who will “lose” as consumers consume less to become healthier simply find other ways to circumvent these new initiatives and technologies?

Will knowledge of what to do really nudge people into healthy behavior? Evidence in behavioral economics demonstrates that knowing, at least in the area of retirement planning, does not equate to doing. It is more than just the individual, but the environment a person finds herself in. If there is some optimism, it is that the food industry beginning to cater to the public desire of healthier choices with fewer calories. This is no different than employers, who with 401k plans had a hands-off approach, have now increasingly have shaped the desired behavior with target date mutual fund plans, auto-enrollment, and auto-escalation in contribution percentage.

Will the sacred doctor-patient relationship simply become a transactional commodity? Will it be more about a brand that cares for us rather than an individual person? With an increasing number of doctors seeking employee status with large hospitals and health care systems and patients switching both insurers and doctors due to costs, job changes, or lack of choice, perhaps that day has already arrived. Yet health care and especially medical care, it isn’t just about the treatments but the relationships and human connections that matter.

Finally, who owns all of this data collected by wearables, technological platforms, and others? When doctors collected epidemiological data in research studies like the Women’s Health Initiative as well as the Framingham Heart Study, both which have provided significant information on the use of hormone replacement therapy as well as our understanding of coronary artery disease, the public benefited. Will private companies, which spent the time, money, and energy to collect and analyze this information simply make it available to the public or other providers? Might they act like Target use the information to gain a competitive advantage over others or sell the information for others to use (think the need to opt out of various marketing campaigns from other trusted partner companies)? Already the public is becoming skittish with privacy, tracking, security, and targeting whether via social media (Facebook), search engine (Google), or via other large financial services, retailers, or consumer technology companies.

Nothing is more personal or private than one’s health. Do people want their medical information in the cloud and mined the same way companies currently mine one’s purchasing habits, demographics, and extrapolate to provide what they think I want or what I really need? In medical care, are want and need the same as consumer purchases?

Despite these personal observations, it is clear that in health care the status quo is not acceptable. As doctors and future patients, we all should feel confident that health care can be better. It will, however, be accessed, engaged, and delivered in a very different way. The individuals I highlight here are just a small sampling of the many speakers and participants at the conference. While not all will succeed, each contribution will make health care more personal and convenient.

Though it isn’t clear whether the public will accept wearables, forgoing a long-term relationship with a primary care doctor for a virtual visit in a kiosk, track individual data to nudge healthier behaviors, or use the wisdom of the crowd to clinch the right rare diagnosis, one thing is clear.

Health care is already marching toward a path where it never be the same again.

Davis Liu is a family physician who blogs at Saving Money and Surviving the Healthcare Crisis and is the author of The Thrifty Patient – Vital Insider Tips for Saving Money and Staying Healthy and Stay Healthy, Live Longer, Spend Wisely.

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  • southerndoc1

    You seem very comfortable with having the “future of health care” determined by the for-profit entrepreneurs.

    • guest

      Couldn’t have said it any better! I guess he knows where the money is at.

    • http://www.davisliumd.blogspot.com Davis Liu, MD

      I’m reflecting on what I saw. If you feel uncomfortable in the “future of health care” as defined by these entrepreneurs, how might you fix it then?

      • southerndoc1

        Actually, this isn’t the future, it’s very much the present of American health care: the health care of DaVinci robots, proton-beams, Cancer Centers of America. Evidence free, profit driven, and aimed at “consumers” (and legislators) who respond to slick PR campaigns.
        What would I do to fix it? Doubt if I can do that, but I think we, as professionals, need to call them out for what they are. They’re not “entrepreneurs willing to fix a problem,” they’re hucksters out to make a buck, be it selling soda pop or selling health care.

        • http://onhealthtech.blogspot.com Margalit Gur-Arie

          There is a strategic and very clever difference here. Presently they are extracting profits from upscale “luxury” items, but as people get poorer, they plan on extracting profits from large volumes of cheap, largely discretionary, and equally useless items, like treating common colds via large computer screens.

        • Suzi Q 38

          I had my hysterectomy daVinci.
          I had an adverse outcome after.
          I think that the jury is still out on this expensive machine.

          I would not allow a surgeon to use it on me again.

          • Guest

            Most women only have one uterus.

          • Suzi Q 38

            Thank goodness you are a brain surgeon and know that!

          • Guest

            Well, they do prostatectomies as well. But the subset of hysterectomy patients who also require prostate surgery is fairly limited. :-P

          • Suzi Q 38

            I thought they were trying to use it for other surgeries as well….
            Thanks for the laugh.
            Would a urologist use daVinci for females at all?

          • Guest

            If we didn’t laugh, we’d cry. But in all seriousness, I’m sorry you had a bad experience. I did know what you were getting at, I was just being silly.

          • Suzi Q 38

            Thanks.
            What are they going to do with all of these machines?
            Keep using them, regardless of patient’s adverse outcomes?
            Each costs a million or more, right?
            Don’t they pressure surgeons to utilize these expensive machines?

          • guest

            Really good question. I hate to know the answer. All I can say is that with Johnson and Johnson they continued to use their faulty hip replacements YEARS after it was known they were faulty. It has resulted in a mess. Lawsuits and numerous surgeries to redo the original faulty hip replacements. (BTW I am a different guest than the previous. I’m a PCP not a surgeon).

          • Suzi Q 38

            Thank you.
            I really don’t trust some drug companies.
            I don’t say that in a rude way….I understand that their job is to sell drugs or whatever hip replacement….but this is ridiculous.
            Sad.

            Thanks for letting me know, you too are too intelligent to be a “troll.”

            It would be nice if you pick a fake name….even if it is your pet’s name.

            Thank you.

          • guest

            I actually have. I have been drg drll drgn on and on. For some reason ever few months my name gets dropped from disqus and I forget my password to sign on. so for now I have been guest until I sort this out.

          • PrimaryCareDoc

            Actually, Suzi, the jury’s back. With the exception of prostatectomy, the robot outcomes are worse, with more complications and greater time under anesthesia.

          • Suzi Q 38

            Thanks for letting me know.
            I will warn my family and friends.

      • Suzi Q 38

        Right or wrong changes are sometimes difficult for doctors, as well as many other professions.

        One thing that I have learned is that many are reticent to change. Myself included.

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    Very nice overview, Dr. Liu. So basically, health care is too expensive, so “we” pass legislation that makes it prohibitively more expensive, and then a host of saintly entrepreneurs (who previously sold sugary drinks), come in to “nudge” the public in a less filling, better tasting direction, while extracting any pennies left over after the big guys took all the dollar bills from everybody’s pocket.

  • Close Call

    Funny how Khosla thinks that technology will replace 80% of doctors, but then invests 24 million in Healthtap, a service that relies ONLY on doctors to give medical advice for free (not to mention exposing them to lawsuits).

    I wonder if Khosla would be cool with 80% of doctors on Healthtap leaving.

    • BobSmith77

      It was a bold statement to get attention and largely nothing more. Treat it was a throwaway comment and nothing more.

  • Suzi Q 38

    I think that the virtual doctor would be good for patients with the same chronic condition, say stroke or paralysis. They are homebound or live in a nursing home already, and have great difficulty getting to the doctor.
    This would be a “house call.”
    Who would take the BP, etc.?

    • http://kevinlmcmahon.com/ Kevin L McMahon

      Stephen Ponder, a pediatric endocrinologist in Texas, has been offering his patients with type 1 diabetes access to his ‘house call’ practice since 2007. Lots of happy patients, no waiting room, time and money saved and documented outcomes superior to his traditional practice.

      • Suzi Q 38

        I think that this will be the “house call” of the future.
        How do physicians get paid for the on line calls?

        • http://kevinlmcmahon.com/ Kevin L McMahon

          Historically it’s been a combination of covered visits (BCBSTX and Driscoll Children’s Health Plan (Medicaid for South Texas)) and fee for service based on scheduled quarterly visits. I think we’ll see this moving to more fee for service in advance of the visit and less provider involvement with insurance carriers other than helping patients submit for reimbursement on their own and at their own risk. I don’t think this model works for just any physician… you really have to be great and well known and respected by the patient community at large just to get a small percentage to participate in this forward thinking model. I have consulted with Dr. Ponder to establish his practice in Texas and of course the landscape is constantly changing so who knows what’s next.

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