How can we harness the power of imagination to innovate in the pediatric health space?

shutterstock_193115849Innovation in health today occurs incessantly. We see new ideas daily, and the progress we’re making is exciting. But, most of that progress is being made in adult health. While there are 75 million children in the United States today, too often we take the approach of treating children like “little adults,” despite the fact that they have an entirely different set of needs, and those needs change year by year. This lag in pediatric health innovation has inspired TEDMED’s Shirley Bergin to serve as a judge at this year’s inaugural Impact Pediatric Health Pitch Competition at South by Southwest Interactive. (By the way, if you’re innovating in pediatric health, you have a few more days to apply!)

So how can we harness the power of imagination to innovate in the pediatric health space? To gain a better understanding of the barriers facing innovation in pediatric health and how we can move forward, we interviewed a handful of pediatric innovators – including several TEDMED Hive alumni. Read on to hear what they had to say.

What do you think is the biggest problem facing pediatric health today? What can be done to address it?

  • Jessica Eisenberg, VoiceItt: Childhood disabilities are on the rise…Since we are a long ways off for a cure for many of these conditions, we can develop technology to greatly enhance their quality of life. We are living in an exciting period where the development in technology has the potential to break down the gaps between people with disabilities and society, and help them to be fully included in society.

  • Lynn E. Fiellin, play2PREVENT Lab: I think one of the biggest challenges facing pediatric health today, particularly around preventive health, is finding children and teens where they “are.” Healthy kids don’t engage in the health care system beyond “well-child” visits and kids with chronic medical conditions have a number of other issues to address. Beyond vaccination during early childhood, the provision of preventive care…is fairly limited. Innovations in technology focused on preventive care in teens allow us to engage teens and provide them with messages and skill-building to develop behaviors that can lead to lifelong health.

  • Kyle J. Rose, mySugr: One major challenge for parents and healthcare professionals alike is knowing how much independence to give to children regarding the management of their health. How much and at what point?…Educational initiatives…often result in outstanding clinical outcomes, not to mention increased quality of life for both the child and their family.

  • M. Jackson Wilkinson, Kinsights: Misinformation. Parents are in a state of constant information starvation, and as healthcare tightens its belt, they get less face time with healthcare professionals than ever before, and the advice they get from friends, family, and the Internet is usually not vetted. As with so many other fields, pediatrics (and parenting) is in need of a strong dose of information literacy, and it’s innovators who can help develop tools to help patients and parents find the right information for them, rather than playing a dangerous game of telephone.

Why do you think innovation in the pediatric health space often lags behind other areas? 

  • Amy Baxter, Buzzy: In pediatrics, patients aren’t as articulate about what bothers them in healthcare. You don’t have the option of “voting with your feet” when you’re carried to a doctor’s appointment in a car seat. And since children don’t make the financial decisions, they don’t drive the marketplace. Many pediatric products have to come from pediatricians or parents who see a need and have the empathy and time to make them reality.

  • Kyle Rose, mySugr: The pediatric health environment has stricter regulations, for good reason. However, unfortunately in the world of medicine this can add a significant barrier to enter this market. This is true whether it’s a start-up with a new medical device or even a major Pharma company.

  • Roberto Flores, SmileTrain: Children do not have a voice in science, in the government or in a medical office. They need others to speak for them…This is a unique aspect of pediatric care that affects everything from innovation to financial support for children’s health…Innovation in the pediatric space can lay the groundwork for innovation in the adult medical arena and vice versa.

  • M. Jackson Wilkinson, Kinsights: Everything is a little more complicated for a pediatric patient. Parents are often more protective with their child’s health than an adult might be with their own, so it can be difficult to get cooperation for even simple experimental care. Couple that with increasingly complicated privacy regulations, and it’s often just enough to dissuade interested entrepreneurs and researchers.

What can be done to spread the notion that children are not just “little adults” in terms of medical needs?

  • Jessica Eisenberg, VoiceItt: Because it’s more difficult to understand the symptoms and needs of a child, we cannot make a diagnosis and rehabilitation plan in a short office visit. More time and effort must be invested with children to build up their confidence in expressing their needs. The more understanding we have, the more we can spread this notion.

  • Lynn Fiellin, play2PREVENT Lab: The use of innovative methods of reaching kids is much more likely to have greater impact, given that kids now are growing up with innovative technologies and they are “hard-wired” to interact with and respond to them. Demonstrating the successful use of new innovations in pediatric health will help to show stakeholders that innovative health care for kids needs to be designed specifically for them, not only to reach them, but to have a sustainable effect.

  • Kyle J. Rose, mySugr: The healthcare system will need a fundamental shift from short-term to long-term visions, in particular from the payer perspective. Young people do have specific needs. We need to address those needs and also be there to support them as they transition from pediatrics to adults, a time period when they need us most and where patients often fall through the cracks of the healthcare system.

  • Roberto Flores, SmileTrain: A child is different at all phases of development. A person who holds a newborn infant, plays with a child in preschool, plays soccer with a middle schooler and debates with a teenager, will realize that at different ages children’s bodies work differently, heal differently, have different needs, and are often affected by distinct medical problems. As pediatric care involves so many different types of “people” the need for innovation in the pediatric space is that much greater.

How can we better assess pediatric healthcare needs and encourage companies to innovate in them?

  • Jessica Eisenberg, VoiceItt: Bringing together technological companies and associations that have a deep understanding the pediatric population is the key element needed to instigate innovation.

  • Amy Baxter, MMJ Labs: Parents are the best motivators.  Educate them about what is really important for health, and do it transparently…Ignoring parents’ intelligent regard toward their healthcare decisions makes the healthcare providers look suspect, and parents seek other sources of information.

  • Lynn E. Fiellin, play2PREVENT Lab: I believe the best way to assess healthcare needs, in kids, and all individuals, is to review the literature, [and] interview the stakeholders…Once you identify the areas in need, companies need to recognize that looking at new ways of reaching individuals, thinking outside the box, is much more likely to have the desired effect of engaging this population and connecting with them about their most relevant healthcare issues.

  • Kyle J. Rose, mySugr: We believe that the evidence is already there. It is critical to show payers and government systems that if young people are healthy when young that this leads to higher productivity overall. The health economics speak incredibly loudly. Governments could encourage companies via special programs and funding for such outcome-based initiatives.

What inspires you to work in this area?

  • Jessica Eisenberg, VoiceItt: Giving a child back his voice, witnessing an expression of love, a joke or saying he is hungry or cold is one of the most incredible and emotional sights you can witness. Few things are more rewarding than hearing individual stories of connection, love and gratitude on a daily basis.

  • Donna Brezinski, Little Sparrows Technologies: As both a pediatrician and a mother, I am inspired to innovate in the area of pediatric health because in many ways I see children as our role models for innovation. Children have very few predefined expectations of what the world should be, and as such, are boundless in their view of what is possible…As innovators we should emulate their openness to imagine so that we can envision what our world could be rather than be restricted by what it is.  Innovating for children grants us freedom to be hopeful for the future.

  • Lynn E. Fiellin, play2PREVENT Lab: Before I moved into this field, I was doing intervention research with many young adults struggling with the consequences of risk behaviors they had engaged in during adolescence—specifically risky sex and drug and alcohol use. I thought if we could “turn back the clock” and teach them the necessary preventive health skills when they were young teens, we could help them to avoid these serious health consequences.

  • M. Jackson Wilkinson, Kinsights: The families. Parents and families devote so much time, energy, and resources to doing their best to raise a happy, healthy child. When you see how devoted they are, it’s hard not to want to clear aside everything standing in their way. Sometimes it’s something as simple as making sure you don’t ask the same questions over and over, and other times it’s incredibly sophisticated, but there’s a ton of work to do, so I’m happy to pick up my shovel and get to it.

Brain in Progress: Why Teens Can’t Always Resist Temptation

by Nora Volkow, Director of the National Institute on Drug Abuse at the NIH

It’s National Drug Facts Week, when middle and high schools all over the country host events to raise awareness about drugs and addiction, with the help of scientists from the National Institute on Drug Abuse (NIDA). The issues I discussed in my TEDMED talk—the changes in the brain common to obesity and drug addiction—are especially pertinent to the struggles teens face to resist drugs, because adolescence is a crucial period both of susceptibility to the rewards of drugs and of vulnerability to the long-term effects of drug exposure.

“My obsession is to engage the health care system in addiction.” Nora Volkow on Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]

“My obsession is to engage the health care system in addiction.” Nora Volkow at TEDMED 2014. [Photo: Sandy Huffaker for TEDMED.]

Adolescence is a time of major brain development—particularly the maturation of prefrontal cortical regions involved in self-control and the neural circuits linking these areas to the reward regions. The prefrontal cortex, where we make decisions and comparative judgments about the value of different courses of action, is crucial for regulating our behavior in the face of potential rewards like drugs and food. Adolescents are prone to risky behaviors and impulsive actions that provide instant gratification instead of eventual rewards.  In part, this is because their prefrontal cortex is still a work in progress.

The incomplete maturation of the prefrontal cortex is a major factor in why young people are so susceptible to abusing drugs, including alcohol, tobacco, marijuana, and prescription drugs. There are numerous pressures in their lives to try these substances (stress and peers, for example), but inadequate cognitive resources to help them resist. Because their brain architecture is still not fully developed, adolescents’ brains are more susceptible to being radically changed by drug use—often specifically by impeding the development of the very circuits that enable adults to say “later” … or “not at all” … to dangerous or unhealthy options. Thus, when drug abuse begins at a young age, it can become a particularly vicious cycle. Research shows that the earlier a teen first uses drugs, the likelier he or she is to become addicted to them or to become addicted to another substance later in life. It is likely that the same dynamics are at play when it comes to fattening food and the brain’s reaction to it.

Though parents may get frustrated by their teens’ poor decisions at times, they usually forgive them—because on some level adults understand that kids’ internal guidance systems aren’t yet fully functional. People often have a harder time extending that same forgiveness to adults who suffer from addictions or obesity, because we think they should be better able to control their impulses.  But, the fact is that their internal guidance systems, too, are compromised. For such individuals, it is not a question of free choice or just saying no to temptation; in many cases, only externally offered support and treatment can create the conditions in which their guidance systems can be gradually restored to proper working order.

Averting obesity and drug use also requires that, as a society, we take responsibility for the environments we create for young people. Instead of school cafeterias with an array of cheap, tempting foods high in calories and low in nutrients, we must expose young decision makers to food options that strengthen their health and resolve. Instead of stress-filled or empty time that promotes drug use, kids need access to appealing, healthy, and meaningful activities that encourage them to take pride in themselves and their behavior. Arming young people with scientific information about their bodies, brains, and the substances that can affect them is also crucial—which is the goal of National Drug Facts Week.

Obesity and drug abuse are medical issues, not moral failings. It is gratifying to present the converging science clearly showing this in a forum like TEDMED, composed of people who are informed and curious about the latest medical science. My hope is that the general public becomes more compassionate about these issues, supports wider access to treatment, and understands the importance of greater investment in research on the dynamic ways our brain can be changed by our behavior and vice versa.

Neuroscientist Nora Volkow, director of the National Institute on Drug Abuse at the NIH, applied a lens of addiction to the obesity epidemic in her TEDMED 2014 talk. We are excited to share Nora’s original piece on the TEDMED blog.

Join us Thursday, February 12 at 1pm ET for a live Facebook Chat with Nora to find out what we can learn about food addiction from studying the brain chemistry of people with drug addictions. Tweet your questions in advance using the hashtag #TEDMED.

Making Social Determinants a True Vital Sign: Last Week’s Hangout Participants Address Unanswered Questions

Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss how we can work towards making social determinants of health a true vital sign. Moderated by Philadelphia NPR Senior Health Reporter Taunya English, these experts discussed ways to incorporate social determinants of health, such as housing and education, into everyday clinical encounters.

If you were unable to join us, please check out the recast below.

We had so many questions from our audience that our hour-long broadcast was not time enough to address them all (once again, thank you for sending your questions our way!). We asked Pedro “Joe” Greer, Professor and Chair of the Department of Humanities, Health, and Society Associate Dean for Community Engagement at the Florida International University, and Marc Nivet, Chief Diversity Officer of the Association of American Medical Colleges, to weigh in on a few additional questions. Read on to see their responses.

What does the typical medical school include in its social determinants training?

Marc: More than 90 percent of our medical schools include topics related to social determinants. Through the accreditation process, we know that most medical school curricula include didactic and experiential learning programs in community health, health disparities, population health management, and prevention and health maintenance. Medical schools are often starting earlier by integrating this content in premedical programs, like the Summer Medical and Dental Education Program, which includes lectures and community activities to expose aspiring medical students to these issues while in college.

Has it been tough to make room on the syllabus – and convince school administrators that social determinants training is important for future health care providers?

Marc: Through the NIH-National Institute on Minority Health and Health Disparities-funded national learning collaborative Urban Universities for HEALTH, we have learned that leadership involvement is key to transformational change within institutions that leads to measurable improvement in communities. Our project leadership includes presidents of universities as well as deans of several health professional schools including medicine. Because leaders are engaged, strategic plans include a strong focus on training providers that understand the social determinants of health. This has led to significant changes, which include the development of pipeline programs, incorporation of holistic admission practices, and curricula innovations that include training about social determinants.

Does a patient’s socioeconomic status ultimately influence physicians’ decision-making regarding management of patients?

Joe: Unfortunately it does, but by dealing with the social factors perhaps we can make determinations based on medical need, and not a patient’s income.

How do we measure social determinants outside of asking questions?

Joe: We are currently developing a new methodology with the RAND Corporation that is embedded in our electronic health records and Social Portal.

How can we improve health of patients when mental health services are often cut in public system?

Joe: Behavioral health should be intimately tied to physical health. At Florida International University, we are currently trying that model and have hired a psychiatrist to be on our family medicine faculty. We are also working with our social work school and their mental health therapist – as well as the nursing school.

What role does cultural competence play in the provision of care? Is maintaining cultural competence a responsibility of the provider?

Marc: Cultural competence training equips health care providers with a set of knowledge and skills to become responsive to the needs of all patients, not solely racial and ethnic minorities. Cultural competence training helps the provider critically consider how a multitude of factors may influence health and health behaviors including but not limited to their own biases, the patient’s culture, the health care system, and larger societal issues. Once licensed, physicians must participate in continuing medical education to stay current in their field, and this also includes cultural competence training. Hospitals and clinics also provide health care providers with on-site training.

Joe: Cultural sensitivity is vital to improving the health of our patients, from the culture of economics, regions of the USA, country of origin, generations in this country, education, sexual preference, religious beliefs, and on and on.

How might health literacy factor into the issue of social determinants as a vital sign? To what extent is it the physician’s role to educate patients?

Marc: An individual’s educational experiences, socioeconomic background, experience with the health care system and history of access to quality care influence health literacy. Physicians play a critical role in health literacy by working with the patient to assess their ability to understand and follow through on health-related information. Ultimately, it is the responsibility of the health care team and the hospital and clinic leadership to ensure that health information is easy to understand and useful to support the patient’s health.

Discovering Beauty in Science: Q&A with Zachary Copfer

At TEDMED 2014, microbiologist and artist Zachary Copfer tells delightful stories about how bacteria became his artistic medium of choice.  We recently caught up with Zachary to hear more about him, his TEDMED experience, and what lies ahead.

Ultimately, I hope people see my work or watch my talk and say "Wow science is awesome, give me a lab coat because I want in on this!" - Zachary Copfer. (Photo by Jerrod Harris, for TEDMED).

Ultimately, I hope people see my work or watch my talk and say “Wow science is awesome, give me a lab coat because I want in on this!” – Zachary Copfer. (Photo by Jerrod Harris, for TEDMED).

Why does this talk matter now? What impact do you hope the talk will have?

I hope the talk will have the same impact that I strive for my artwork to have on viewers: to get people excited about science. Science is amazing, fun and beautiful! In my artwork, I have found a way to play with science to inspire in others the overwhelming sense of awe I feel when I step back and think of how complex and amazing the universe is.

Please list the top 3 TEDMED2014 talks or performances that left an impression with you, and why.

Naming the top three is almost impossible; I couldn’t even keep track of the number of talks that made me think “oh wow” or gave me goosebumps. Two speakers who instantly come to mind are Diana Nyad and Kitra Cahana. As amazing and awe-inspiring as I feel science to be, nothing can match the power of hearing stories about the human spirit. These talks both gave me goosebumps and had me tearing up a bit. Peggy Battin’s talk was another that left me thinking as I walked out of the auditorium. The issues she explored were issues that a lot of people don’t like to think about, let alone discuss. That makes it all the more important to have people like Peggy discussing them publicly so that others may start to feel more comfortable with them.

What is the legacy you want to leave?

The simplest way to put it would be to say that I want my legacy to be a smile. A shared smile evokes in other people an almost indescribable sensation. A genuine smile is a selfless act that makes other people feel welcome, connected and cared for in a way that few other expressions can communicate. A smile also says that life is fun and is meant to be enjoyed at every moment. To live a life that makes people feel the same way they feel when they receive a genuine smile would be the greatest legacy I believe one could leave behind.

What’s next for you?

To keep playing with science. To explore the aesthetic possibilities of scientific theories and to find ways to share them with others.

At TEDMED, Play Matters

square sleddersIn today’s fast-paced world, we often find ourselves caught up in the go-go-go, operating at breakneck speed and seldom taking a moment to simply stop and appreciate what’s around us. While we know life is busy, this holiday season we encourage you and yours to make time to truly take a break and get out and play.  It is in that spirit that we share this  – our final blog post for 2014. May you enjoy all of the benefits that play offers – from unleashing your inner creativity, to enhancing personal relationships, to nurturing physical health.

Why play? Our 2014 speaker Jill Vialet says it best: “Greatness demands imagination and imagination demands play. Your nine-year-old self knew it, and it’s time to remember: play matters.”

Which is exactly what the TEDMED team will be doing for the next couple of weeks. All work and no play makes TEDMED a dull organization, so we’re at it again. What’s “it,” you ask? It’s our annual break from our daily work life and an opportunity to enjoy the holidays with family and friends, and recharge our batteries – all while taking advantage of the many mental, social, and physical health benefits of hitting “pause” and allowing time for play.

We know well the benefits of taking time off, but beyond these, the need to focus that time on play is key.  For adults, the mental benefits of play are countless – play researcher Stuart Brown even claims it is as fundamental to human life as sleeping. In his TED talk, Brown explains that play fires up the part of the brain responsible for motor control, attention, and language, sends signals to the brain’s reward center, and helps with the development of contextual memory. There is also evidence that, in resetting the brain, playing makes us better at our jobs and fuels creativity. While kids need play for cognitive and social development, adults need play to stay sharp.

shutterstock_23141968That feeling you get when you’re laughing while playing with your loved ones? That’s the science of happiness in action. Research shows that a main reason adults play is to enhance social well-being – in fact, one study found that we are at our happiest when we are at play. The reasons here are twofold: 1) playing is how we make connections with other people, and as humans, connecting with others improves our happiness and 2) play allows us to be our most authentic selves, which translates to “optimal psychological functioning” (read: happiness).

Last but certainly not least, there is no question that play is good for our physical health. Play often involves exercise and fresh air – and if it’s fun, we’re more likely to maintain that healthy behavior. Beyond that, play is also the ultimate stress reliever, reducing the hormones in the bloodstream that cause us to feel tense.  So why not join us this holiday season and get out and play? Your body will thank you.

With that said, we wish you a wonderful, playful holiday. Be on the lookout for our official TEDMED 2015 dates and venue in the New Year – and register before January 1st to take advantage of our special ticket price. In the meantime, we’ll be sharing our staff picks of inspirational talks over the next two weeks. Enjoy!

How Can We Rightsize Treatment Costs? Last Week’s Hangout Participants Address Unanswered Questions

Last week, a diverse panel of experts joined us for a Great Challenges live online event to discuss how we can work towards rightsizing the business of healthcare to achieve the delicate balance between treatment innovation, accessibility, and affordability. Moderated by New York Times Senior Writer Elisabeth Rosenthal, the group explored what it takes to innovate in drug development, how we evaluate long-term treatments versus cures, and what new approaches can make novel treatments more accessible to patients while reducing healthcare system costs. If you were unable to join us, check out the recast below.

We had a so many questions come in via social media (thank you!), that we were not able to get through all of them during our one-hour event. So, we gathered the unanswered questions and  invited James Chambers, Vineet Arora, and Josh Fangmeier to weigh in and continue the conversation. Here’s what they had to say:

How does the insurance industry weigh long-term treatment versus a one-time cure? What other elements besides cost need to be taken into account?

Josh: Due to the fragmentation of the American healthcare financing system, insurers do not always have aligned incentives when it comes to paying for certain services. For example, private insurers could pay for a cost-effective therapy that reduces long-term costs for a medical condition, but Medicare, not private insurers, may capture the savings from this therapy as the patient ages. This has also been an issue for patients enrolled in both Medicare and Medicaid (dual eligible), where interventions by one program lead to savings captured by the other.

James: This is certainly a timely question given the introduction of Sovaldi. It asks questions not just of cost-effectiveness (i.e., value for the money) but also of affordability. As a cure is taken only once (or over a relatively short period of time) there is an incentive for the manufacture to charge a high premium. Even if over the life of the patient the drug represents good value for money, the high upfront cost may prove prohibitive to many patients and providers. We may have to move to alternative payment models in which the cost of a cure is spread over the period that the patient experiences the clinical benefit, i.e., to amortize payment of the drug. However, this is complex and raises many questions, e.g., who pays for the drug, and what happens if the patient shifts between plans?

Is flooding the market with more practitioners an economic strategy to lower healthcare costs?

Vineet: If practitioners means doctors, it takes over ten years to train a doctor, so its hard to “flood the market” with them, especially given the projected doctor shortage. If it means others such as nurse practitioners, there’s also a shortage there so feasibility would be hard. I don’t know how that would impact drug costs per se. Flooding the market also assumes that there is price transparency at the level of patients, and they can choose to go to the best value care – which we know does not exist. So as of yet, in my opinion this strategy would not work without these other things.

Do pharmaceutical companies have any ethical obligation to provide treatment to those who cannot afford it? Why or why not?

James: This is a very difficult question! I believe that if a patient who would benefit from a treatment does not receive it because of its cost, then as a society we have not maximized the benefit of available technology. I believe the healthcare system has the responsibility to offer a “base” level of care to everyone.

Vineet: I believe they do. We have created a healthcare system where anyone can get emergency care regardless of their ability to pay. So, as long as that exists, it means that we will be in a cycle of emergency care for chronic diseases that could be treated with medications unless we can figure out a way to cover the cost of the drugs to keep people healthy. The issue often is who is going to benefit.

How can we accurately and consistently evaluate the right approach to treatment based on the cost of a saved life or improved quality of life?

James: Other countries have national agencies/institutes that evaluate the costs and benefits of new technologies. This provides information to the healthcare system of the value of medical technology and helps prioritize the use of scarce healthcare resources. While PCORI is tasked with evaluating the comparative effectiveness of treatments (although to date it has performed very few head-to-head studies), it does not consider cost in its research. Only if we have information of the costs and benefits of alternative treatments can we use our technology most efficiently. Ironically, many of the leading methodologists on the economic evaluation of medical technology reside in the U.S., but the U.S. is somewhat unique to the limited extent that it uses these techniques.

How much stock can we put in cost-effectiveness studies? Is there a better way we could measure this?

James: There are many different types of analysis to evaluate medical technology, e.g., budget impact analysis to examine the financial impact on introducing a technology to a plan, or comparative effectiveness research to evaluate which of two treatments is most effective. Cost-effectiveness analysis is, however, the only approach that quantifies the VALUE of a technology, i.e., is the additional costs of a treatment worth its additional benefits. While some may argue that cost-effectiveness should not be the sole determinant in drug coverage policy, I believe that decision-makers should have access to this information if they are expected to make value and cost conscious decisions. Without this information, they have a hugely difficult (and maybe an impossible) task.

Might a system in which unused medicines can be returned to pharmacy (and reimbursed) help contain costs?

James: Absolutely.  A huge source of waste!  A very difficult policy to implement, though.

How much is affordable and are caps on out-of-pocket spend in ACA too high?

Josh: Increasing cost-sharing through co-pays, deductibles, and other forms of out-of-pocket spending has been a concern, especially for low-income populations. However, this has been a trend that pre-dated the passage of the Affordable Care Act (ACA). According to the Commonwealth Fund, from 2003-2011, single worker deductibles rose by 117 percent.

The ACA includes minimum value and out-of-pocket spending caps that limit the sale of insurance plans that provide little financial protection. For 2015, the out-of-pocket caps are $6,600 for an individual and $13,200. Although this is a considerable amount for many families, the ACA provides financial assistance, in the form of cost-sharing reductions, to those who enroll in marketplace plans. Cost-sharing reductions increase the value of a silver plan. For example, a Detroit resident making $20,000 would see the out-of-pocket maximum for the cheapest silver plan fall from $6,350 to $1,450, due to cost-sharing reductions.

What can we learn about drug pricing or drug coverage from looking at systems outside of the American one?

James: We can learn from other countries’ systematic approaches to evaluating medical technology. While each country takes a unique approach (some focus on comparative effectiveness, others cost-effectiveness), each formally evaluates new technology before it is introduced to the health care system. This provides information that can be used to implement value-based coverage of medical technology, and in some cases negotiate a price that is commensurate with the health benefits offered by the drug.

We can also learn that cost and cost-effectiveness can be accounted for, but not be the sole determinant in decision-making. France and Germany were previously hugely resistant to accounting for drug cost in national policy but now consider economics (while decisions are primarily driven by comparative effectiveness) in their assessment.

What new approaches can make novel treatments more accessible to patients while reducing healthcare system costs? Do we need to change our drug development models or is there change to be made elsewhere?

James: In theory, using cost-effectiveness evidence to guide coverage of medical technology will result in more efficient use of scarce resources and allow more patients access to effective technology.  However, such an approach is unlikely to be soon embraced in U.S. healthcare.

Maybe the most promising approach is value-based insurance design (VBID).  This approach aligns co-pays in a manner consistent with a drug’s value, i.e., a lower (or no) copay for cost-effective drug, and a higher copay for a cost-ineffective drug.  This approach provides an incentive for the patient to use more cost-effective care . This approach is arguably the most palatable for U.S. healthcare, as cost-effectiveness is not being used to deny or ration care, rather to encourage the use of high-value care.

Placing Science in Context for our Future Health Leaders: Action Inspired by the Great Challenges Program

We’re on a mission to better understand the impact that the Great Challenges Program and the TEDMED community are making in creating a healthier world. For the past 18 months, we’ve convened experts via Google Hangout for unbiased and broadly inclusive discussions on 20 of the thorniest issues in health and medicine today. Diverse subject matter experts share their perspectives and help the TEDMED community dive deeper into key barriers to success for each Challenge. TEDMED believes that when the world achieves a broad-based understanding of any given Challenge, it will then be in a better position to take truly effective action.

After a year and a half, we wanted to know: what impact has our Great Challenges Program had on you? How have these discussions prompted truly effective action from you or within your community? What is your Great Challenges story? We asked – and you answered.

As we read inspiring stories shared by the community, we also want to share them with you. This blog post is the first of a series of Great Challenge successes, so if you have not shared your story – now is the time.

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One of the most inspiring stories we heard was from Jodie Deinhammer, an Anatomy and Physiology high-school teacher at Coppell Independent School District, right outside of Dallas, Texas. Jodie teaches 150 juniors and seniors, and just last year, was Region 10 Secondary Teacher of the Year. From what we heard of Jodie’s story, the TEDMED team certainly wishes we had a teacher like her when we were in high school.

That’s because the Great Challenges Program has helped Jodie innovate in the classroom in ways that inspire her students to place health issues in context – the students don’t just learn about body parts; they focus on the global health system and ways in which we can all work together to shape a healthier world. And, the Program and the positive response from her students have even prompted Jodie to expand the reach of her classroom: two of her courses are available on the iTunes U app, where they have soared into the Top 10 rankings.

Last year, Jodie saw a tweet about one of our Great Challenges online events that focused on reducing childhood obesity. As a class her students watched that session and actively participated online. The students were so energized by the direct access to the expert participants who answered their questions, that they’ve become some of our most active community members. Of particular interest are the obesity and prevention challenges, which relate most closely to their classroom studies. Jodie reports that, “The big picture that we’re creating through the course is directly related to what they’ve watched and learned through the Great Challenges Program.”

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This year, in the first semester, the students have been looking at prevention and obesity, and based on what they’ve learned from the Great Challenges program and in class, have come up with one potential solution to address these large-scale issues: they built a six-week online class to help adults improve their overall health. As part of this online class, the students have come up one challenge per week: during the first week, the online class focuses on giving up a bad habit; during the second, it encourages users to get moving…you get the idea. The students will soon begin using it as part of a health challenge for the school’s teachers.

Next, the students move on to focus on another Great Challenge for the upcoming semester. They’ll tackle “the impact of poverty on health,” working on a program to provide technologies to developing countries in partnership with several global organizations.

This story is an incredible example of the ways in which the Great Challenges Program can empower participants to actively engage in improving their health and that of the world at large. We’re thrilled to see the Program putting science in a real-life context and helping to train the health movers and shakers of the future. And kudos to Jodie for her innovation in the classroom!

Now, it’s your turn – what’s your Great Challenges story? How has our program impacted your work or the way you live your life? Shoot us a note at challenges@tedmed.com. We can’t wait to hear from you.

Virtual Reality: Immerse yourself in health – Q&A with Howard Rose

In his TEDMED 2014 talk, game designer Howard Rose describes the extraordinary power of play in virtual worlds, and shares how virtual reality can harness the innate human power to recover from and prevent illness. We caught up with Howard to learn more about his TEDMED experience and what inspires his work.

Gaming, health, virtual reality, Howard Rose.

“The doctor-centered paradigm of healthcare underutilizes our innate human power to recover on our own, or to prevent illness in the first place.” Howard Rose, TEDMED2014. Photo: Sandy Huffaker for TEDMED.

What drives you to innovate?

For me, virtual reality (VR) is the ultimate creative medium. As a designer, I enjoy the challenge of transforming complex ideas into meaningful experiences that bring people insight and joy. Virtual worlds can range from being very realistic to a realm of total imagination. Because VR is so unconstrained, the design process invariably evokes challenging questions about the mind, body and senses that spark the creative conflict which drives innovation.

I’ve devoted my career to exploring the boundless possibilities of technology to solve real world problems, particularly problems in health. We are just beginning to discover how to apply VR to some of our toughest challenges to control pain, treat mental illness and improve rehabilitation.

Why does this talk matter now?

Virtual Reality is poised to revolutionize the way we maintain our health and deliver treatment. It will be targeted like a drug and deliver sustained benefits. But better than drugs, VR can be personalized to individuals’ needs on a moment-by-moment basis. VR will make us more resilient, able to perform at our highest capacity. This revolution will be driven by consumer demand.

Today we are at the edge of a wave of new virtual reality technology that costs a fraction of the systems I used 20 years ago. The VR revolution is amplified by advances in neuroscience and the expanding array of biosensors we wear and carry in our mobile devices. All the elements are finally here to deliver intelligent, compelling virtual experiences that know our strengths and weaknesses and respond to our needs. These technologies are going to help people stay healthier on a daily basis, and lead to new treatments for many conditions that today we suppress or control with pills – like pain, anxiety, depression, or post-traumatic stress.

What legacy do you want to leave?

I want to give people the tools to unlock their own potential to be happier, healthier and more productive. My goal is to make the virtual reality health games industry bigger than the entertainment game industry. I’ve been working toward that goal for 18 years at Firsthand Technology, laying the groundwork  with basic research and development.

I’m now part of a new venture, DeepStream VR, to focus on virtual reality games for pain relief, rehabilitation and resilience. DeepStream VR’s mission is to reduce the need for opioids in clinical practice, and provide new alternatives for people at home to relieve pain.

Collaborating for Innovation

Conflict of interest. Does it have to dominate the agenda when public-private partnerships address healthcare? And, how can such partnerships lead to more and better innovation?

These were two key questions explored during TEDMED’s latest in-depth discussion of the Great Challenges of health and medicine. Our diverse group of experts provided some insightful and thought-provoking answers. The participants, who ranged from game theorist to pediatric ethicist, discussed obstacles they’ve found as collaborators in public-private partnerships and potential solutions to make these relationships more effective. Dan Munro, a Forbes contributor, moderated the event.

One of the biggest issues identified throughout the discussion was the lack of clarity and “game rules” when it comes to public-private partnerships. Myra Christopher, the Kathleen M. Foley Chair in Pain and Palliative Care at the Center for Practical Bioethics, explained that there are at least 53 different definitions of public-private partnerships. Myra noted, “there is a real cry-out for better and common understanding about the current game rules.”

Another issue that came to the forefront during the discussion was conflict of interest. With so many players in public-private partnerships, it’s hard to avoid conflicts of interest. However, John Tyler, the General Counsel and Corporate Secretary for the Ewing Marion Kauffman Foundation, noted that, “conflicts of interest should not be an impediment. They should not be a barrier, but they should be understood and efforts should be made to try to manage them.” From John’s perspective, one way to make public-private partnerships more effective is to see the opportunity instead of the conflict, which can most likely be mitigated.

David McAdams, a game theorist and Professor of Economics in the Fuqua School of Business and Department of Economics at Duke University, also encouraged looking for the potential opportunities in challenging situations. When asked what the great challenges facing public-private partnerships in the next 20 years are in the context of shrinking resources, David responded that this might not necessarily be a bad thing. With fewer resources “you’re forced to try more creative innovation,” David noted.

With regards to the medical community, Skip Nelson, the Deputy Director and Senior Pediatric Ethicist in the Office of Pediatric Therapeutics, Office of the Commissioner at the U.S. Food and Drug Administration, brought up the issue of incentives. As grant funding is shrinking, “we need to find new ways of valuing what people are doing and promote them appropriately within those institutions.”

Polina Hanin, Academy Director at StartUp Health, brought up the idea of adopting an entrepreneur as a potential method of using public-private partnerships to foster innovation. Doing so would “allow [the entrepreneur] to see the intricacies and work flows that are really going to allow them to create a solution that’s going to work for the community… the organizations, and the patients that these startups are actually trying to help in the long-run.”

The participants agreed that at the core of any public-private partnership there must be trust and transparency. Once we “quit being such skeptics,” as Myra put it, there’s the potential for public and private entities to begin effectively collaborating for innovation.

If you missed the live event, catch the recast here: http://tedmed.com/greatchallenges/liveevent/497919, and stay tuned for our next Great Challenges hangout on Addressing Healthcare Costs next Thursday, December 11 at 12PM EST.

Why be normal? Q&A with Rosie King

Rosie King diagnosed herself with a high functioning form of autism (Asperger’s Syndrome) at age nine and has become a spokesperson for autism in the United Kingdom, including hosting an Emmy award winning BBC documentary on the subject. Shortly after her 16th birthday, she spoke on the TEDMED 2014 stage about her journey.

We asked Rosie a few questions to learn more about her remarkable story.

Why does this talk matter now?

I think the ideas I share in my talk have always mattered.  Society is at a stage where it is beginning to understand equality– I want this to move on from addressing racism and sexism, to addressing discrimination in all areas.  This is the only way to have a civilized society.

Gratefully not normal: "I wouldn't trade in my autism and my imagination for the world." Rosie King, TEDMED 2014.

“I wouldn’t trade in my autism and my imagination for the world.” Rosie King, TEDMED 2014. Photo, Sandy Huffaker for TEDMED.

What legacy would you like to leave?

I want everyone in the world to know that it is important to be themselves.  I come from a family where everyone is different.  We could be a sad family but we have always been encouraged to be proud of ourselves and celebrate our talents.  If the whole world was like my family then it would be a joyful world.  I want to take a little bit of my family’s attitude out there.  It could be like flicking a switch, and I hope that my talk will be that switch.  To ask someone to be anything other than who they really are is cruel, like killing their real self.  Also, that genuine self that could bring so much color to the world!

What did you learn at TEDMED?

Denise [TEDMED speaker coach] taught me about body language and how to speak to a big audience–  that was useful.  I also listened to a very interesting talk [Rebecca Adamson] about how Native American people were treated.  This made me very upset but also glad that it was being brought to light.

For all inquiries regarding speaking engagements or to learn more about her current work, please contact Joanna Jones.

Keep up with Rosie and her family on their blog, My Perfectly Imperfect Family, and check out the books Rosie has illustrated authored by her mother, Sharon.