Health Leads expands movement to place social needs at the center of preventive care

At TEDMED 2012, Rebecca Onie asked a simple question with an extremely complex answer:

Why don’t we have a health care system that keeps us healthy?

As a college sophomore, Onie realized through her work as a legal aid intern that lack of basic needs like food, heat, transportation, and health insurance were preventing people from achieving – and, more importantly, maintaining – good health. And she found that most often, doctors practiced a “don’t ask, don’t tell” policy around these issues, assuming, though not without anguish, that these solutions were simply out of reach.

In 1996, Onie co-founded Health Leads, an organization that enables clinicians to “prescribe” food, heat, and other basic resources their patients need to be healthy, alongside medical care.  And what began as a student-run organization in a pediatric waiting room is now national in scale.  In 2014, nearly 1,000 student Advocates will connect over 14,000 patients and their families to the resources they need to be healthy.

In the last two years, Health Leads has received over 1,000 requests for expansion from hospitals, providers, health systems, and others looking for a way to address their patients’ non-medical needs.  On our blog in September, Onie called this demand “symbolic of a much larger shift taking place in the healthcare system.”

And this demand comes from a healthcare system ready for a change.  As Onie reported on Forbes.com after her trip to the 2014 World’s Economic Forum’s Annual Meeting in Davos, the sector is finally asking not whether it is necessary to address patients’ social needs, but how to do so effectively:

This momentum extends beyond the handful of health systems whose vision and values tie explicitly to a comprehensive definition of health….Each of these signals the unprecedented moment unfolding in the U.S. healthcare system, triggered by shifting market trends and financial incentives.

Recently, Health Leads received a $16 million grant from the Robert Wood Johnson Foundation (RWJF) to scale its impact.  The grant represents the largest in Health Leads history and one of the largest ever awarded by RWJF.

The grant will enable Health Leads to serve more patients around the country, as well as help facilitate its next phase of growth – building a national movement to catalyze the healthcare system to address patients’ basic needs as a standard part of care.  In a new article on Stanford Social Innovation Review (SSIR), Health Leads outlines its innovative approach to scale, intending to partner with a small number of leading health systems to drive the change it seeks in the healthcare system:

“Growing in this way enables us to focus on deep integration with our partners, and frees up valuable resources and management time to focus on catalyzing the ecosystem surrounding those partners.”

One of the first new partners in this phase of Health Leads growth: Massachusetts General Hospital (MGH).  Last October, Health Leads opened a desk at MGH that has already served hundreds of patients. And most recently, the organization has expanded west.  At the end of May, Health Leads launched two new sites in California’s Bay Area – one at Contra Costa Regional Medical Center and the other at Kaiser Permanente Medical Center – Richmond.  It is partnerships like these that Health Leads believe will drive the sector to the “new normal” it envisions.  As Health Leads said in SSIR:

Going small may not be glamorous. But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.

Continuous Human Body Measurements Will Make Us Better

Shankar Chandran

Shankar Chandran

As Vice President of the Samsung Catalyst Fund at the Samsung Strategy and Innovation Center in Menlo Park, Calif., Shankar Chandran spearheads strategic investments in disruptive technologies with a special focus on mobile health. Earlier positions in engineering, business development, and management, as well as experience inventing and taking eight technologies through the patent process, and degrees in engineering, materials science, and business equip Chandran for eyeing early stage and disruptive venture capital investments in technologies targeted at high growth sectors including cloud infrastructure, mobile technology, mobile health, next-generation user interfaces, and the internet of things.

TEDMED: What’s the most remarkable innovation you are seeing in health tech or medicine, and what is driving it?

Chandran: It’s the coming together of sensors and algorithms. The human body is the most complex system out there and the only time we are used to measuring anything in the human body is when we go for our annual physical. Now, technology and market forces are converging to the point where sensors are becoming accurate enough and algorithms are becoming sophisticated enough to take continuous measurements of the human body. That is the most remarkable innovation in front of us. It never existed before.

The Samsung Gear Fit, for example, can be worn on your wrist and measures your heart rate continuously. And that is just the beginning. Imagine measuring not only heart rate, but also other important vital signs continuously and noninvasively. That changes the paradigm of collecting data about the body. And what is in the market today is just baby steps toward what is likely to happen over the next three to five years.

Here’s an example: Years ago, when jet engines were adopted, they were an incredibly complex system. They would take a jet engine down for preventive maintenance every 30,000 miles or so. Today we have hundreds of sensors in every engine that constantly measure so-called “vital signs.” The moment something varies from what is normal they take it down. They don’t want to wait until the thing fails, obviously. Consider that the human body is way more complex than a jet engine; we just haven’t been able to measure a lot of things very well until now.

TEDMED: What’s the most important factor for entrepreneurial success in health tech—and is that different from your own key to success?

Chandran: One of the key things for an entrepreneur in any of the new emerging health tech categories, such as digital health and mobile health, to think about as they develop their technology, product, and vision, is that it’s going to have to work for a lot of different people. We’re all different with respect to genetics, ethnicity, age, sex, habits, lifestyles, and so many other parameters that affect us. All of these things matter when it comes to doing something about heath tech. To be successful, entrepreneurs have to have a very broad vision that works for a very large segment of the population.

Does that apply at Samsung? Samsung’s success is probably the opposite: We’re a consumer electronics company. We have the ability to micro-market what we can do. We’re able to slice and dice the market and build so many variations of the same product that may work, for instance in Korea but not Japan, in the U.S. but not China. For instance, we make 100 different Galaxy phones to make it work anywhere in the world.

But it’s hard to micro-market a health tech algorithm or sensor that’s going to make people’s lives better. It’s going to have to work for everyone. So for entrepreneurial success in health tech, the vision needs to be broad. That’s a challenge that very few companies have been able to manage very well.

TEDMED: For entrepreneurs with needle-moving ideas in global health, what are the keys to finding collaborators and supporters across specialties, industries, and geographies?  

Chandran: First and foremost, the entrepreneur’s idea needs to be highly disruptive, and not just an incremental turn on something that exists already. It must fundamentally solve, through ingenuity, a problem that is very hard to solve. Collaborators, regardless of geographies, will naturally gravitate toward the most disruptive ideas.

Also, the solution to the problem needs to have a large enough impact. It needs to work for a large market. Big companies, global corporations, and established companies naturally gravitate toward large opportunities. If they see the potential for a little company that is solving a problem with a large addressable market, then that matters.

Third—and perhaps the most important key—is that the entrepreneur needs to have the ability to tell the story extremely well. New companies need to rise above the noise. Their ability to tell the story must answer the biggest questions about how disruptive they are and how they are solving a big problem effectively. If they can do that, that’s what will let them rise above the noise and attract people. In fact, the phones won’t stop ringing.

The greatest technology communicator I have ever had the opportunity to listen to in my career has been Steve Jobs. People might not know the number of times he would practice before he got on stage to present anything new. I have personally heard that he would practice at least 50–60 times before he gave a keynote at Apple’s worldwide developer conference or at the launch of the new iPod or iPhone. That tells you a lot. It says that communicating the quality of the idea and the size of the opportunity and the impact it’s going to have on people’s lives is as an important an entrepreneurial trait as it is to actually invent the thing.

TEDMED: In 2020, you’re asked to give a TEDMED talk about the biggest transformation you helped bring about in your field. What is it?

Chandran: Technologies will help us fundamentally change our habits to live a better life. These will be individualized technologies that measure the human body and generate data that can be compared to the population in general. It will be continuous—every second or several times a second, depending on the vital signs being measured. We will measure multiple vital signs to get insights about a person. We will use those to change habits around eating, sleeping, managing stress, and more.

As we all know, there’s $8 trillion spent around the world on health care; $3 trillion of that is spent in the U.S., primarily on diagnosing and fixing chronic diseases. If what I am predicting happens, then we prevent that spending on the chronic diseases by delaying or eliminating some of them. That becomes a big deal. That is the biggest transformation I think is possible over the next 5 or 10 years.

Chandran is a Curator for The Hive at TEDMED 2014.

Case study: From research to web platform, a behavior change program that’s working

As healthcare pays ever-closer attention to programs and research that measure the relationship of patient engagement to outcomes and medical costs, one company has developed a program that delivers the golden egg of behavior change results.

Prevent is a web-based platform by Omada Health that aims to help patients with prediabetes avoid the full-blown disease. It’s a translation of results from the NIH-funded Diabetes Prevention Program (DPP) study, and encourages lifestyle tweaks like exercise and healthier eating. Participants are given a digital scale and join a small online community of some 12 people with of those of similar BMI’s, age and locales for what Cameron Sepah, PhD, Omada’s Medical Director, calls “the dynamic of group therapy in an online experience.” They also undergo an intensive 16-week online training program that includes live health coaching, and move to a maintenance program for the remainder of one year.

The company has published the results of its research study, showing an average weight loss of 5% over the course of a year, and a 0.4% reduction in A1c (a hemoglobin linked to blood sugar levels). Sepah credits the company’s success in great measure to Prevent’s design and user interface. Omada’s team includes former employers from Google, IDEO and Amazon, a fine pedigree.

Secondly, Sepah says, the DPP program – now disseminated nationally by the Centers for Disease Control and Prevention – was well validated from the beginning with its broad and intensive research. Prevent is constructed to closely follow its best practices.

“The [DPP] program itself was very resource intensive and expensive. That’s the challenge in terms of translating to the real world,” he says, adding that to date there have been some 30 translations of it with varying success rates.

In contrast, Prevent has thus far been proven to be cost-effective and accessible to socioeconomically diverse patients. Omada sells it to insurers, employers, and health systems, to whom it guarantees a positive ROI. The company recently closed its Series B funding, raising $23 million to accompany the $4.5 million it raised last year.

Going forward, Omada may venture into management for other conditions in which behavior change modifications are key, Sepah says, such as smoking, insomnia, hypertension or back pain, with the next product rollout slated for 2015.

Which Comes First, A Knockout Biz Plan or the Next Big Thing?

The aptly named Health Tech Hatch (HTH) helps entrepreneurs, many of whom are quite young, fund and test their dream projects. The company offers crowdfunding support and concept testing and feedback. HTH has advised a number of campaigns on Indiegogo.com, one a group of Johns Hopkins undergraduates competing for the Qualcomm Tricorder XPRIZE with a smartphone enabled diagnostic device. Another project is developing a curriculum for a venture classes in health innovation, in pilot with a university in the Midwest, says Patricia Salber, HTH’s founder and CEO.

Web“To date, there haven’t been academic projects that have raised big funding or gone viral, like Scanadu or Lumo Back, so we’re working to help them design a curriculum that they can use to show students how to build a business plan,” she says, adding that all too often entrepreneurs will come late to the realization that even before funding they need to consider building communities, looking for donors and rolling out public relations. Colleges are also adding venture courses to keep those who would drop out and form a company a la Gates & Co. in schools, Salber says.

What are trends in healthcare innovation?

“We’re in the era of validation,” Salber says.

“People have designed all this stuff but we still have relatively little information as to whether it works. Other folks would say it’s all about integration. We’ve built all these silos, but now what we’re seeing is people trying to figure out how to build these into a platform. I just want to look at my steps on a Fitbit platform; I’d really like everything to be in one place,” she says.

“Plus, by and large most health apps aren’t being used. We need to figure out how to really engage people. I think that’s going to happen when physicians start to prescribe apps,” Salber says.

Catalyst is an ongoing series about health innovation, focusing on companies from the TEDMED Hive. For more information about The Hive 2014, click here.

TMIcon

Feed the Data, Record a Fever

Move over, plastic stethoscopes: A number of innovations from TEDMED Hive 2013 companies aim to help even the littlest patients become engaged in their own real-life care.

Kinsa makes an oral thermometer that leverages the crowdsourcing power of a smart phone. The thermometer plugs into and transmits data to a free smartphone app – iOS now, but Android as well in the future – which also records and tracks symptoms and temps for easy retrieval at a pediatrician’s office. What’s more, the next phase of the product will provide crowd sourced data from social networks to allow parents to see what’s going on in a child’s neighborhood or school. Strep going around? Lice? Better act now.

The company is focusing first on tracking childhood ills, because mothers are the primary users of thermometers, says Kinsa deputy CEO Qian Qian Tang, and because children are prime carriers of highly contagious diseases like flu, whooping cough and measles.

The FDA approved the thermometer in January and a first prototype is in production. It’s priced at $19.99, a point below many digital thermometers on the market, but to reach the mass market it will need to provide local data.

Kinsa also offers a solution for getting the temp in the first place: The iOS app runs a game to keep Junior amused while you’re trying to take his temp, and send a warning signal when he wriggles and loses contact with the thermometer – a problem he can correct himself.

Asthma is another prevalent childhood disease – some 6.8 million kids in the U.S. suffer from it, according to the CDC – and management can be tricky. GeckoCap is a small low-energy smart button that, when placed over an asthma inhaler, wirelessly sends dosage records when near a smartphone. It also glows to let kids know when it’s time for their next dose, potentially avoiding a serious attack.

The idea is to help young patients learn to manage their condition and to get the knack of using wireless reporting.

“As a physician, I couldn’t educate my adult patients because they don’t want to learn anymore, but with children there’s really a place to make some change,” says Yechiel Engelhard, CEO and founder.

Engelhard says the company aimed to assist asthma patients because of the disease prevalence, and also what he says is a lack of innovation in drug administration for it. GeckoCap is in initial production for product testing, and has also partnered with a number of medical institutions that are eager to conduct studies on dosage administration and response with the first large group of patients to adopt the technology this summer.

Nanoly Bioscience aims to help save lives of children in the developing world. Many lack access to vaccines, in part because vaccines need to be kept within a precise temperature range until administered. Breaking the “cold chain” contributes to some 25% of wasted vaccines each year, according to the World Health organization, and hampers delivery to remote parts of the world that have no electricity.

Despite the best efforts of many aid organizations, there are still critical gaps in cold chain equipment. “Looking at what exists now, you’ll find refrigeration for the cold chain; you’ll find camels that carry solar refrigerators,” said Nanxi Liu, Nanoly’s founder. The Gates Foundation has awarded millions in research for solutions, but Liu points out the need is dire enough to accommodate many ideas.

For its part, Nanoly is skirting the equipment issue entirely. The group is developing a non-toxic nanoparticle polymer that will eliminate the need for refrigeration for protein-based vaccines. It can be mixed with the vaccine at any point in its supply or transport chain.

Liu says she and her co-founder saw the unmet need for Nanoly first-hand: “He’s from India. I grew up in rural China, and I didn’t get any of my immunizations until I came to the U.S. Both of us saw an impact in our lives from a lack of vaccines, and we saw the problems of vaccine transportation first-hand,” she says.

Intel’s Top Social Innovation for 2012, Nanoly’s R&D has received funding from Intel, Dell, UC at Berkeley, Cornell and Duke.

Catalyst is a regular series about innovation in health and medicine, with a focus on companies from TEDMED 2013 Hive. Click here to read previous posts.

How to find your nearest lifesaver

It’s hard to imagine a more concrete use of mobile health technology than Raina Merchant’s MyHeartMap Challenge.

Screen Shot 2014-03-06 at 2.37.21 PMWorking with a group of students at Penn Medicine, Merchant, an emergency medicine doctor with a keen interest on how crowdsourcing can further solutions in medicine, developed an app for citizen sleuths to mark the locations of AEDs (Automated External Defibrillators) in Philadelphia County.  A mobile-compatible website allows users to find the AED nearest them.

To date, there is no universal database showing where to find the devices, which can help jump start a heart that’s been hobbled by cardiac arrest. Showing a keen knowledge of human motivation, Merchant made the search into a contest with cash prizes of up to $10,000. Participants could also win $50 for spotting a “golden” AED, a la eggs or Willie Wonka’s Tickets.

The Challengers mapped some 9,000 AEDs in Pennsylvania alone, a total Merchant hopes to expand nationally. To her surprise, the contest winners weren’t 20-somethings, but a pair of determined searchers over the age of 40.

“We were thrilled that we could provide a map to life-saving devices that people otherwise may have walked right by,” Merchant says.

Merchant got the idea from DARPA’s Red Balloon Challenge, which challenged participants to find 10 red weather balloons released in the U.S.  An M.I.T. Media Lab team won – natch — finding all ten balloons in just under nine hours using social network technology.

The Penn Social Media Lab team at 30th Street Station in Philadephia. Dr. Merchant is at left, in gray.

The Penn Social Media Lab team at 30th Street Station in Philadephia. Dr. Merchant is at left, in gray.

As the MyHeartMap project progressed, a Philadelphia councilwoman had an idea: Couldn’t the AEDs be designed to be more memorable and easier to spot? Hence the Penn Defibrillator Design Challenge. A web platform asks users to contribute designs, and the first winner has been installed in the city’s 30th Street Station.

MyHeartMap is one of many projects for Merchant, who is the Director of the Social Media Lab at the Penn Center for Health Care Innovation, established in July of 2013.  The lab conducts and publishes research about the intersection of health and local and social media, “culling through billions of Tweets,” as Merchant explains it, to understand how Twitter can better cardiovascular health with prompts on resuscitation, critical care, and public health policy.  Its secondary goal is to develop new digital tools for public health.

“We’re exploring, in a rigorous academic way, what we can learn about devices like Fitbits and other wearable devices and how we can measure them. We think about how physicians can be aware of the latest tools on the market, and how they should talk to their patients about them,” Merchant says.

“We’re encouraging citizen scientists to think about different ways to take on big problems. Traditionally, as physicians, we take a passive approach to how we study things, but we’ve had a lot of success in getting the public to help with the process.  We think we can come up with better results working with patients and publics than with a more insulated methodology,” she says.  (Merchant, along with other special guests, spoke more about crowdsourcing research at last week’s Great Challenges Hangout on Medical Innovation. Click here to watch the video.)

While an academic setting for any kind of mHealth venture is atypical, Merchant says it allows for great multidisciplinary interaction between physicians, schools of business, computer engineering, design and medicine, as well as inter-generational wisdom sharing.

“Everybody has a say at the table. It’s great when the junior people tell the seniors how things really work on Twitter,” she says.

— Stacy Lu

New Roads on the EHR Interstate

First, the good news:  We now know that some 83 percent of primary care physicians are using electronic health records (EHRs) in some fashion.

In the best of all worlds, all that collected information would be securely available to a patient at the touch of a button. How close are we?

For starters, New York is about to become the largest state with a unified patient portal and provider access to electronic health records.

That’s thanks to the New York eHealth Collaborative, a non-profit initiative and participant in TEDMED 2013’s Hive innovation showcase, which will be piloting the portal, SHIN-NY, in a few hospitals over the next few weeks.  It will reach patients across the state in 2015.

The state’s portal is Blue Button compliant, meaning it meets technical standards set out by that initiative, a public-private partnership with the goal of providing all Americans secure access to their health information.

In designing the portal, NYeHealth asked residents to choose from among various submissions; the winner after 100,000 votes was Mana Health.

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When might we see national conformity and communication?

“That is the vision, and the challenge,” says Anuj Desai, NYeHealth’s Vice President of Market Development. Though a number of small states have their own portals, each model is slightly different.  A few states have started programs, however; Florida and Michigan now allow for direct, secure email between physicians and specialists to account for “snow-bird” patients that fly south to avoid winter cold.

NYeHealth is also driving a multi-state initiative, which has gathered 19 states 47 vendors to drive interoperability, by developing specifications for eventual industry-wide use.

A number of organizations have joined the effort as well and are leveraging NYeHealth’s specifications, including the U.S. Department of Veterans Affairs (VA), Department of Defense and Kaiser Permanente. The biggest stumbling blocks at this level are policy versus technical differences, Desai says. Some states automatically opt patients in for electronic health data sharing; others assume patients records are off-limits unless patients specifically opt-in.

“We’re excited about the pace of things; it’s gaining urgency. Consumers are expecting it to happen. If you go to an ATM, you get instant access to your money. If you’re using social media, you can access your account anywhere. Why shouldn’t health care be like that?” he says.

Meanwhile, at Blue Button Headquarters

One feels that sense of urgency when speaking to Adam Dole, a Presidential Innovation Fellow working on the Blue Button Initiative, which also appeared in the Hive. Blue Button had its beginnings some seven years ago when the VA began making records accessible to its patients, culminating in the launch of an online portal in 2010. Today, more than 50 percent of providers use some form of electronic health records (EHRs) and 150 million or so Americans are able to access a least a part of their health records.

“The culture of medicine has gotten in the way of enabling consumers to be an equal member of their care team.  For many people, it’s still an intimidating experience to go to the doctor, let alone let ask for additional services. But I’m happy to say there is a quick tide change here, and we’re seeing huge advancement in their way [consumers] see their right to access information,” he says.

Blue Button rolled out a beta of its Connector portal just this month, which offers consumers a first look at an eventual one-stop access to their health data. (Dole’s predecessor, Ryan Panchadsaram, spoke at TEDMED 2013 about why info delivery design is critical to Blue Button’s success.  Watch his talk here.)

Source: Office of the National Coordinator for Health Information Technology

Source: Office of the National Coordinator for Health Information Technology

Over the past few months, Dole and the Blue Button team have concentrating on bringing national pharmacy chains to its data pool, including Walgreens, CVS, Rite-Aid, Kroger and Safeway.

“The reason we chose retail pharmacy chains is not only do they have a huge reach, but they also represent major issues in our healthcare system that access to human machinery and data could actually solve, like medication adherence, dosage management and drug interactions. We think that people behind the counter have all those records, but they don’t,” Dole says.

Future goals include bringing more insurers into the loop.  The added benefit to them may be presenting a more open, friendlier presence than they currently have, Dole says, likening their current public persona to the DMV (ouch) and the ultimate goal to be as well-known for customer service as Zappos.

Yet the remaining technical task, Dole admits, is gargantuan.

“We’re probably still in the development phase comparable to when mainframes were the size of an entire building and there was no value proposition for PC’s. That took 30 years to bring to fruition. We’re at that same early stage with data liquidity and interoperability, we have a long way to go,” Dole says.

— Stacy Lu