Bridging the Gap: Neighbors Supporting Neighbors in Harlem

This guest post is by Manmeet Kaur, Founder and Executive Director of City Health Works — a nonprofit, social enterprise that aims to close the gap between hospitals and communities in Harlem.

Manmeet KaurIn order for health to flourish, we need people in our lives that make us feel supported and accepted. Social support is essential to well-being and plays a fundamental role in one’s ability to make healthier choices—it is a critical aspect of making health a shared value. Unfortunately, only half of adults in the U.S. report getting the social support they need. Those numbers are even lower among minority groups and those with lower levels of education and income.

In many countries around the world, however, communities already employ effective approaches that have demonstrated impact. In Cape Town, South Africa, for example, I worked with a nonprofit that hired people from the community and trained them as peer health educators to tackle chronic health issues. This is where I first witnessed the power of peer education and the ripple effect such educators have not only on an individual’s health, but also on other aspects of their lives.

When I returned to my hometown of New York City, I immediately saw the potential to adapt this model of health care delivery from abroad and apply it to my neighborhood here in East Harlem. This is a neighborhood in which life expectancy is 9 years lower than the life expectancy of residents of midtown Manhattan. 50% of healthcare spending in this community is on only 5% of the population. The level of chronic illness in this community is so great that clinicians struggle to deliver the high-quality care patients need. They often aren’t able to support patients through the necessary long-term nutritional and behavioral changes to keep chronic illness under check. They are completely overburdened.

That’s where City Health Works comes in.

Inspired by community health worker innovations from South Africa, City Health Works engages community members to serve as the bridge between the doctor’s office and the real challenges people with chronic illnesses face on an ongoing basis. We don’t replace traditional medical care. We simply fill a gap between the health care system and the everyday lives of the people that system is meant to serve.

We start by finding and employing individuals living within the neighborhood who have a strong sense of empathy and good listening skills, are non-judgmental in nature, and can speak to shared life experiences. We train them to become health coaches: we teach them how to build relationships with their patients and truly get to know their needs, which often go beyond health and health care. In addition to receiving training on basic health care in a clinical environment, health coaches learn how to make referrals to services like banking and housing, and recommendations for recreational activities, such as local walking groups, knitting clubs, and bingo nights.

Hospitals and clinics can refer patients directly to us. They refer individuals who struggle with multiple chronic diseases and the stressors of poverty, old age, physical and mental limitations, and language or literacy barriers. Most of them experience depression and struggle with social isolation.

We pair each patient with one of our health coaches so they can receive personalized support and the resources they need to make healthy choices. Initially, there is some hesitation on the part of patients. Health choices are, after all, deeply personal. But once they learn that their coach is from the same neighborhood, they grew up down the street from them, or they even live in their same housing complex, they become more comfortable. Trust is assumed and they open up.

Today, our health coaches meet one-on-one with more than 300 patients in East Harlem on a regular basis. Over the first two years of the program, we measured depression levels amongst our patients and found that simply having a health coach who visits them regularly had a huge effect on their social and emotional well-being. Coaches have a powerful ability to motivate their patients, help them build self-confidence, and strengthen their ability to manage their lifestyle and medical care. We are proving that adding extra support for those who need it most not only saves money, but saves lives.

By adopting practices from outside of the U.S.––an approach for which the Robert Wood Johnson Foundation is now actively seeking proposals––City Health Works has been able to provide critical social support for the people in New York City who need it most. We are changing attitudes about the role of community, fostering health as a shared value, and changing our patient’s expectations about the level of care they should be getting. By fostering an engaged community, we are breaking through the walls of isolation and building a Culture of Health.

Keeping up with 50+: How can we encourage innovation at the speed at which the 50+ population is growing?

shutterstock_164560796Forty-five percent of the United States population is more than 50 years old, and as science and medicine advance and lives extend, this number will only increase. As this key age group grows, keeping them healthy will be increasingly challenging, but no less crucial. As part of TEDMED’s commitment to fostering innovation in health and medicine – including for the 50+ population, TEDMED’s Shirley Bergin will once again be lending a hand to our partner AARP as an advisor for their Health Innovation@50+ LivePitch. (Applications are being accepted until February 20, so if you’re innovating in 50+ health and medicine – go ahead and throw your hat into the ring!)

To gain a better understanding of the problems facing 50+ health today and what we can do to address the specific needs of this age group, we interviewed three members of our TEDMED 2014 Hive, all of whom are doing great work to enhance health for the 50+ crowd. Read on to hear what they had to say.

What do you think is the biggest problem facing 50+ health today? What can be done to address it? 

Jon Michaeli, MediSafe: One of the biggest problems facing the 50+ demographic is access to affordable, quality care. Aging patients have diminishing access to time- and resource-strained providers who historically have helped to steer their care. As a result, many do not have adequate support to ensure they fill their medications and take them as prescribed. As baby boomers get older, they are diagnosed with more chronic conditions, resulting in an increase in prescriptions. Almost 20% of adults over 65 take ten or more medications and adherence rates drop by 30% in those taking four or more medications daily. Moreover, medication non-adherence accounts for more than 10% of older adult hospital admissions and approximately one-fourth of nursing home admissions. What this patient population needs are interconnected, interactive interventions that uniquely address their challenges, their acceptance of technology, their home environment, and need for caregiver and provider support.

Leon Eisen, Oxitone:Fears dominate the life of many over-50s, preventing them from engaging in adequately healthy behavior. An intensive educational activity accompanied with the 24/7 automated tracking of vitals — and continuous connection to the family members and healthcare professionals — could alleviate the problem.

Courtney Larned, CareSync: For the majority of Americans age 50 and over, the biggest health challenge is getting organized: building a medical team, with a primary physician who really cares and truly believes that older people can still live healthy, full lives, and specialists for any conditions or risk factors. It’s important to know what that patients know what they personally need. When patients…have a current file of [full] medical and family history…then they’re in the best possible position to make the healthiest choices on an ongoing basis and when emergencies happen. Other aspects of getting organized [include] knowing what health insurance covers, what it doesn’t, and what needs to be done in various medical situations to make the most of the insurance that you have; [being aware of drug, vitamin, and food conflicts]; and…putting your medical wishes into writing in a legally-binding advance medical directive…Information is power…the trick is to be as ready as possible.

Where do you see the biggest opportunity for innovation with the 50+ age set?

Jon Michaeli: With 86 million increasingly tech-savvy millennials, there are substantial opportunities for software platforms to help patients keep their care under control from their comfort of their own homes instead of being readmitted to the hospital for care. Non-proprietary cloud-based services are an ideal fit, because they allow multiple parties to participate in the patient’s care, irrespective of their technical capabilities (from landline phone and SMS, to web and mobile apps). Doctors and caregivers can be kept up to date remotely, correlate patients’ adherence to reported symptoms, side effects, biometrics and labs, and generally track progress without actively intervening unless necessary. This improves patient confidence and morale, gives loved ones peace of mind, and offers providers more visibility into patient outcomes.

Leon Eisen:The biggest opportunities will be found in educational, monitoring, self-management and behavior-changing solutions.

Courtney Larned:The generation that’s now stepping into senior citizen status is not used to the idea of being sidelined from anything and is going to want to stay as active as possible, in society, in the workplace, and personally. There’s a lot of room for innovation in government, to fully include all ages in task forces and work groups on policy issues. Practically speaking, there are a lot of ergonomic issues to consider in the workplace and public places – go to any health club and you’ll see the awesome adjustability of most of the machines. Why don’t we see this same adjustability in our office furniture and the medical equipment we are exposed to when we need CT-scans, MRIs, stress tests, radiation therapy and a host of other tests and procedures? So there’s another area crying out for innovation.

How do you think the quick growth of the 50+ population recently has impacted health innovation in this space? Do you see innovation growing in this area as the population increases? Why or why not?

Jon Michaeli: The propensity for chronic illness (and illness in general) increases with age, with chronic patients accounting for 75 – 80% of healthcare costs today. This is a major financial burden and is not sustainable. This in turn is driving innovation, as new technologies can monitor and provide care outside of the hospital. This need/demand is driving a supply of innovative solutions, and the investment appetite to fund it.

Leon Eisen:Innovations are growing exponentially as a result of quick market growth. The increase of population is resulting in more business opportunities.

Courtney Larned:We see and hear about a lot of innovation involving telemedicine, which has a lot to offer as an added tool for wellness, chronic disease, and certain types of easily diagnosed illnesses, but it’s important to remember that the human touch can never be fully removed from the equation. Telemedicine, trackers, smartphone apps, video house calls, and other services yet to be proposed can be a very helpful supplement for ongoing care. They should not be a substitute for an ongoing relationship with doctors or other medical professionals who know you, your situation, your preferences, challenges, and goals.

New Metrics for Measuring Health Are Coming

ThomasGoetzA noted authority in the design and communication of healthcare data and information, Thomas Goetz is cofounder of Iodine, a health technology company with a mission to turn medical research data into clear and actionable tools for ordinary people to make better decisions about their health. Goetz, who holds a master’s degree in public health from University of California, Berkeley, is also the former executive editor of WIRED and author of two books: 2010’s The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine, and 2014’s acclaimed The Remedy, recently chosen as a Best Book of the Month by iTunes and Amazon. His 2010 TED talk on visualizing medical data has been viewed more than 400,000 times.

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

Goetz: It’s the growing awareness that healthcare and medicine are consumer services, not just industries. We’re becoming aware that there is a consumer, often called the patient, who should be served. The tools of healthcare technology should be designed and optimized for that consumer experience, rather than for the goals of an insurer or provider or hospital. The shift that is happening is a step beyond patient-oriented; it’s consumer-oriented healthcare.

For instance, in every process or service that exists in healthcare we’re starting to ask, “Is that service actually incorporating the feedback of the consumer? Is it serving the consumer well? Is it designed to be the most smooth and least disrupting experience possible for individuals?” These questions have not traditionally been taken into account in healthcare. That’s a promising development, and one we’re trying to drive at Iodine.

What’s driving this innovation is a couple of things. One is that, through the Affordable Care Act and other changes in insurance, the consumer is now exposed to more of the cost of their healthcare. They’re asking, “What am I getting for my money?” Some organizations see that as an opportunity. The patient hasn’t been putting money into the system and now they are in ever greater amounts. That’s kind of the stick.

The other influence is more of the carrot: People are realizing that using the tools of good design and good customer service is a good business strategy in healthcare. There has always been a mantra that healthcare is different, medicine is different. But that’s not true. Healthcare has largely been a negative experience for people. People want to have a positive experience. They want satisfying and rewarding experiences in healthcare, instead of fear, uncertainty, and death.

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

Goetz: Traditionally, entrepreneurs have succeeded in healthcare by finding a niche or a need and creating incremental improvements. That’s changing. There is growing awareness that healthcare technology is potentially as vulnerable to the same kind of seismic shifts and exponential growth that has occurred in other industries. Now that wave is coming to healthcare.

That’s very aligned with my own interests and background, which has been charting the impact of technologies in industry. And that is what I’m trying to do now: leverage the exponential forces of data and analytics to turn those into something that benefits healthcare as it has in so many other industries.

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

Goetz: A strategy I’d recommend is to attempt to see what has worked in other areas or to find analogies that lay out a platform for success so that you don’t have to make up everything all at once. Adapt and implement a platform that has worked rather than build a whole new process in addition to creating a new market.

That said, it’s also true that a lot of these global health opportunities leverage different technologies, such as leapfrog technologies like the mobile infrastructure. Those can be significant advantages to a global health strategy.

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?

Goetz: I hope that in 2020 I’ve been part of a driving shift to where people’s real life experiences are captured and considered as valuable as the traditional bodies of evidence and research. I hope that we can define a new way of creating science and a new way of helping people make better decisions based on not just the sterile environment of laboratories, but on what works for real people in the real world.

It is part of what Iodine is working on. We have always thought of the physician, rather than the patient, as the authority who can measure experience. We’re going to start acknowledging that patient-reported data is potentially more accurate and has its own inherent value. The EHR’s reign as a primary document of patient experience will end. It’s going to be recognized as a great representation of the provider experience, but not the definitive document of patient experience.

What’s great about traditional metrics and what is being measured by the EHR is that there is a list of things we measure such as blood pressure and all sorts of levels in the blood. We need to collectively determine what are the new metrics that can be captured and that are valid when coming directly from the patient. Some of those will be the same metrics and some will be brand new metrics.

There could be much better and more pervasive measurements that take into account real people’s real world experiences. That shift is already starting, and in six years my predictive powers say that could be much more widespread. I hope to be a part of it.

Infecting Healthcare with an Entrepreneurial Ethos

ZenChuAs Healthcare Entrepreneur-In-Residence at MIT, Zen Chu co-directs the MIT/HST Healthcare Ventures graduate course and oversees MIT’s Hacking Medicine initiatives. He also runs Accelerated Medical Ventures, where he serves as cofounder and first investor for several medical and software companies. Earlier in his career, Chu co-founded and served as CEO for 3D-Matrix Medical Inc., a venture-backed MIT regenerative medicine company that had a successful IPO in 2011. He has also managed and led new ventures for Harvard Medical School, Wyss Institute, NetVentures, and Hewlett-Packard.

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

Chu: It’s the digital transformation of healthcare that’s enabling scalable medicine.

Our Healthcare Ventures course and the Hacking Medicine ethos at MIT define scalable medicine as “impacting and improving access and quality while reducing costs.” Most of that happens not through increasing the number of doctors and health professionals, but by moving it down the skill curve, all the way to getting patients engaged in their own care. That’s how you scale medicine, not just in the U.S. but globally.

What’s driving this is that we’re taking what’s been pioneered in Silicon Valley—sensors and technologies and software and the services enabled by them—and rolling that out with a different business model. We teach that even a nonprofit with a medical mission needs to be intentional about its business model and how it is sustainable.

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

Chu: Health tech is more complex than IT or other traditional entrepreneurial verticals. You’ve got so many stakeholders, third-party payment, and all of the incentives and disincentives therein. So, the key profile for successful entrepreneurs is resilience side by side with a mission. Healthcare is complex enough to frustrate even the most skilled and experienced teams. If you don’t believe in your particular mission, at some point it’s easier to walk away from the startup than continue on. The only thing that keeps teams together during those lows is resilience and the mission.

That’s no different from my own key to success. I have co-founded three companies, collaborated on many more, served on boards, and been an investor in others. Those are the skills that you look for.

I believe that entrepreneurship is what is going to save healthcare. To overcome the challenges we’re facing, we need that combination of creativity not just from clinicians and researchers, but from entrepreneurs and healthcare designers.

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

Chu: Many entrepreneurs and clinicians who want to do good in global health don’t realize that it’s not enough to be cheap. Oftentimes you have to offer a very different solution for the developing world. You can’t just transplant a therapy or a protocol from the developed world. The realities on the ground in these hospitals or local clinics are meaningful. The key to really impacting a country outside of the developed world is in targeting your solution to the local resources and culture and capabilities.

More generally, the key to navigating the healthcare challenge of complexity is to have a clear user and a clear job to be done. A lot of entrepreneurial teams will have a mission, but it’s too broad. Often they’re trying to make win-win-wins for the patient, insurer, provider, and supplier. They end up compromising and not focusing on a single user, whether it’s the patient or the provider or the supply chain manager. Narrowing it to a single user and job to be done makes everything else go much faster with less money.

For instance, Covidien is a company that rolled out surgical tools in China. Their cholecystectomy kit cost $300 in the U.S., and China has a huge market for gallbladder removal surgery. But the average reimbursement for that procedure is around $10 in China, so the math doesn’t work there. It’s not enough to offer a solution that’s well accepted here. You actually need a completely different solution there.

Or, with regard to culture, consider that cardiologists in the top hospitals in China and India see 100 – 150 patients per day. In the U.S., they complain if they have more than 20 patients in a day. The way doctors in the U.S. listen to and assess a patient to arrive at a definitive diagnosis is completely unrealistic in China and India. Your clinical algorithm completely changes because of patient volumes and the organization of hospitals there. Patients who go back for treatment of the same problem don’t even see the same doctor. So doctors think of everyone they send away as cured; they don’t even have that learning feedback loop.

Those are the fundamental differences in global health that you don’t really appreciate until you’re on the ground. There is no substitute for being on the ground and localizing your solution to that geography and system and culture.

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?

Chu: I’ve done multiple companies, but there’s a limit to the impact that any one company can have. What’s exciting to me is that I get to teach at MIT and in the Boston medical community. We’ve also been asked by BIO to host a Healthcare Hackathon for biotech and pharma company executives to try to inject a new level of innovation by teaching them how to apply new technologies and digital transformation around their pills and therapies. We’ll try to teach them design processes from Silicon Valley, agile product design, and user-centric design combined with healthcare business model frameworks. That’s what hasn’t really been taught well, not just to clinicians, but to entrepreneurs.

One of the best ways we pull ideas out of groups at hospitals and at conferences is to have them start talking about the terrible experiences in healthcare. There are so many of them. Whether you’re a physician, patient, supply chain manager, or back office nurse, there are terrible experiences in healthcare because we fundamentally underinvested in technology for decades compared to other industries. That’s the opportunity for entrepreneurs. The bar is so low.

Teaching those methods for business models in healthcare and medicine so that we can go beyond the reach of physicians, to what is much more scalable … that’s what’s rewarding. I think of what I’m doing as giving out openly and hoping to infect as many people with that ethos for entrepreneurship impacting healthcare around the world.

Match Great Science Minds with Passionate Managers

RegisRegis Kelly is the Director of QB3, the only one of the four California Institutes for Science and Innovation devoted exclusively to biology and the life sciences. He oversees an innovation center comprised of more than 200 quantitative biologists at three northern California campuses (UCB, UCSC & UCSF) who are converting discoveries into practical benefits for society.

Previously, Kelly was Executive Vice Chancellor at the University of California in San Francisco, responsible for the new Mission Bay campus, which is the center of academic planning for a 300-acre public/private biomedical research park in San Francisco. He also served as Chair of the Department of Biochemistry and Biophysics at UCSF; was the Director of UCSF’s Cell Biology Graduate Program; and was the Director of the Hormone Research Institute at UCSF. Today he remains Chairman Emeritus of the Bay Area Scientific Innovation Consortium (BASIC), is on the Malaysian Prime Minister’s Biotechnology Advisory Panel, and is a General Partner of Mission Bay Capital venture fund.

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

Kelly: Longevity research. You’ve probably heard about Calico, founded by Google, to stop or reverse the aging process. It’s a very exciting area with a surprising amount of progress being made.

We’re looking at cases where we medically accelerate the aging process, as measured by cognitive loss. For instance, elderly patients who undergo hip surgery or knee surgery are liable to suffer a severe cognitive loss. Radiation therapy on the brain, a traumatic brain injury, or a severe infection can also lead to cognitive loss. In the cases we’ve measured, the cognitive loss is caused by the way the immune system affects your hippocampus. And the mechanisms involved in medically accelerated cognitive loss are, as well as we can tell, identical to the normal process of aging in the brain. If we could slow down accelerated cognitive loss, I’m very confident those therapies would be beneficial for long-term cognitive loss, such as in Alzheimer’s.

This is not pie-in-the-sky stuff. At QB3 we have potential therapies in the pipeline and a pathway we can see getting into humans to test longevity. We’re talking about how we can get very close to an IND for phase 1 trials.

What is driving this is bringing together fields that hadn’t previously interacted. Normally, if you’re a neurobiologist then you spend your life in the neurobiology community; if you’re an immunologist, you do the same; and if you’re an imaging person or a physicist, you hardly talk to anyone else. Now, a marvelous synthesis among immunology, neurobiology, and imaging is producing spectacular results.

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

Kelly: We have 100 companies in the QB3 incubator right now, and we look at lots of companies that apply to our venture fund. We are always more responsive and excited about a company when there is clear passion from the founder or entrepreneur. If you come up with a great idea and you don’t have passion, then when something goes wrong you won’t fight through it to the end. People have to be prepared to pivot and change and adapt. It’s really about people with a commitment to making it happen.

The other thing necessary to successful entrepreneurship is people skills. Someone can’t start a company if they can’t build and work with other people. If they have ego problems and it’s all about them, it’s doesn’t work. People who can really build teams and teams that clearly love the leader work well. That’s a prognosticator that the company is going to succeed.

Of course, you’ve got to have an idea; almost everyone has a new idea in a new market. But the things that impress us are passion and people skills as well as the idea.

Is that different from my own key to success? Yes, on my good days, those are probably the keys to my success.

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

Kelly: This is entrepreneurship 101, but you must identify your customers and know that your product is what they want and will pay for. Selling life sciences products is not like selling iPhones. You must be careful about working on your reimbursement mechanisms and find out: is this really needed, by how many people, and who is going to pay for it?

In digital health people will often say, “Well, I hired a doctor,” or “I have a doctor friend,” or “I have a doctor on my panel and he’s going to tell me how to do it.” That doesn’t work. You need to talk to many doctors. The Lean Launch Pad insists, for instance, that you talk to 100 customers before they go ahead with your company.

Finding collaborators in other specialties is really important, and is a huge challenge. Trying to match someone with brilliant scientific insights or access to a new disruptive technology with someone who understands how to run a business is what we call “the Boyer-Swanson problem.” The fortuitous thing that made it possible for Herb Boyer, a scientist who was in my department at UCSF, to start Genentech was that he ran into the young entrepreneur Robert Swanson, who knew nothing about molecular biology, but knew about starting companies. The two of them together got Genentech off the ground. Very few scientists have business acumen; 90 percent of the time, you need a Boyer-Swanson match, and finding that is hard.

The Swansons—the people with managerial and organizational skills—are people who just like starting small companies. They love the excitement of starting something from nothing and seeing something with 30 percent probability of success coming to an exit in 5 years. They like the whole process and being surrounded by other people with that passion. They’re serial entrepreneurs; you’ve got to get them between companies. It’s like getting to people between marriages.

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?

Kelly: I’d love to be talking about how we put together this consortium that’s producing drugs that are reducing cognitive loss and affecting longevity. In six years we’re not going to have those in the clinic, but we certainly could have them clinical in trials.

Also, I’m excited about helping to transform American research universities to work better with the private sector. I’d like the boundary between universities and early startups in the incubator space to be so porous as to be nonexistent. Not only would we be feeding people into these entrepreneurial incubators, but also we would be hearing back from them what academics should be studying.

This is what QB3 is trying to do. If we could say that this QB3-type idea has spread so that 50 percent of universities in America are doing something like this, then that would be a major contribution to society.

Use Multiple Levers to Push the Needle

Mohit KaushalThrough a career that has spanned clinical medicine, venture capital, and health policy as a White House Health IT task force member and the FCC’s Connected Health Director, Mohit Kaushal has gained a unique and broad perspective on the challenges of healthcare technology. Last year he joined Aberdare Ventures, and he remains an Adjunct Assistant Professor of Emergency Medicine at George Washington University and an appointee to a committee that advises the Department of Health and Human Services on data access and use.

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

Kaushal: There’s no single answer, but there are a couple of themes I really like. Pure technology innovation is one big bucket that includes personalized medicine. Medicine is very reactive right now: we wait for people to become unwell before we treat them, especially with chronic disease. Personalized medicine is weaving genomics and real life data together to figure out when we can start managing people earlier in the progression of disease.

Deeper into that is using proteomics and epigenomics to understand the whole body’s network and signaling, and using that to better understand disease and to better target drugs. Many drugs, especially in cancer, are expensive, have terrible side effects, and only work for a certain proportion of cancers. And that’s because cancer is probably many different diseases. The notion of understanding disease at its core to better target drugs is remarkable, along with all the tools and technologies that enable that, such as genomic sequencing.

The other piece I’m very interested in is more on the delivery side: How do we reconfigure the delivery of care? How do we move from a system that’s been built for acute care, with big expensive hospitals and expensive doctors, to a system that takes care of patients in more cost-effective settings, such as outside the hospital? And how do we use technology to enable that?

The framework for that is data capture—remote devices and sensors, as well as data storage and analytics—to turn multisource data into insights and then allow us to intervene. That’s a convergence of connectivity, storage, analytics, and behavioral change. All of these are technologies that, wrapped around the right service models, will effect positive outcomes.

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

Kaushal: The most important factor for entrepreneurial success in any industry is the quality of the management team and a little bit of luck. If you have the best science and the best management team, you increase your chances of success.

To go deeper, the specific qualities depend on the thesis of the company. If you’re trying to start a biotech company, you’ll need a mix of people with clinical, scientific, and business skills; those are very specific to the company. But generically, success depends on a team that is cohesive and can execute together. At many stages of the company, you need someone who is the Jack-of-all-trades. That’s the person who is really putting it all together.

If you’ve met some of the best ones, they’ve got real drive, real motivation that is less about cash and more about changing the way we do stuff. All of them work extremely hard and face challenges. In a word, they have hustle.

Is that different from my own keys to success? I don’t know if you could call me successful! If the question is, “What is the key to success in venture capital?” there are some common elements, but it’s hard to say.

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

Kaushal: From the global health perspective, each market is very different. We could divide this into two themes: one is a scientific theme. I mean, a pill is a pill; it will work anywhere. But on the delivery side, it is different from country to country. There are different rules, regulations, delivery mechanisms, and infrastructures everywhere.

The first thing to think through is whether the end product as a manifestation is scalable as it is, or does it need to be tweaked for local markets? It’s not like WhatsApp, where you can build a very small labor company in the Bay Area to deliver the fundamentally same service around the world.

In terms of partners, it really depends on the specific population, but what many early stage companies need are partners who have local insights and knowledge and can help navigate the local distribution.

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?

Kaushal: I’ve been lucky to work on different pieces of healthcare. I was in the Obama Administration working on policy, and I think if you can move policy in the right direction by even a degree, the positive impacts are huge. But I was also in clinical practice as a practicing doctor, I do academic work, and the innovation of excellence is what I do now. Any transformation I could help bring about would tie all of those pieces together. What makes me passionate about where I am right now is using multiple levers to push the needle.

To Address the Continuum of Care? Collaborate

SeanHughesAs Chief Design Officer at Philips Healthcare, Sean Hughes leads the global design team, developing a broad range of world class products, interfaces, and consulting solutions to shape the future of healthcare and save lives. Over a 20+ year career across 3 continents and multiple business categories, he has built and led multidisciplinary award-winning design teams that deliver business results while maximizing the role of design as a key element of sustainable competitive advantage.

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

Hughes: There are a number of remarkable things happening in the health industry. One of the most fundamental ones is the rise and the breadth of digital technologies—from telecommunications, to Wi-Fi, to Bluetooth, to near field communication, to data aggregation—that are having a significant impact in healthcare and medicine. The fact that we can gather, communicate, analyze, and measure data is allowing us to think about how we might deliver care in very different way.

Another remarkable innovation for medicine is social media. The power of social media brings communities of patients and professionals together and provides them with the openness and ability to communicate. Patients are empowered now, coming to the table with their own diagnoses.

The new ways we can interact with technology is also having an impact on what we think we can do. These new interaction paradigms include very easily touch-controlled devices, voices becoming a way to navigate and better communicate, gesture control—which is the next thing in gaming, but is a way to track medical devices—and wearable technology, including smart, discrete sensors that you put in and around your body to monitor your health, lifestyle, and sleep. All of those can impact how we treat, diagnose, and care for people.

Driving all of this innovation in part are the challenges the industry is facing to deliver more care to more people at lower cost.

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

Hughes: What I saw in many of the Hive applicants, and what I believe is crucial to being successful, is a lot of passion and an enormous degree of self belief. Passion entails believing in your ideas and having the energy to continually push. Generally, if you’re innovating, you’re pushing against the current. In some cases it’s going to be disruptive and you have to challenge the status quo. You need a good degree of belief to convince others that this new or different way of doing things or looking at things is worthwhile so people will change their mind and follow you.

Timing is also really important. You can have a great idea, but you might be just a little bit early or ahead of the adoption curve and it will flounder. One or two years later, some other factors come to bear and you can have a massive hit.

Entrepreneurship is also about experimentation. Most successful entrepreneurs don’t often have the success with their first product or business. They’ve continued to evolve and push and it’s maybe the second or third time when they really hit the home run. Entrepreneurship is about active experimentation, risk, trial, and perseverance.

Finally, underneath it all, successful entrepreneurs possess an understanding of the market or the people they’re trying to reach.

Personally, I have a passion and desire to make a difference and that’s what I’m trying to do—to use design capabilities to help us deliver better healthcare. We passionately believe in that at Philips, which is why we’re working hard every day to create the future of healthcare.

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

Hughes: Networking, networking, networking. Increasingly, the world of healthcare is an incredibly complex networked ecosystem, and you have to be actively engaged within and open to working across that network. Of course, companies who are part of or applying to be in the Hive are taking one step in that direction, and many of them had already presented their ideas in other forums before TEDMED.

In the past, maybe life was simpler. At Philips, we made equipment, sold equipment, put it into service, and gave a service contract. That paradigm has changed. Our customers are asking us to do more, we want to do more, and we believe we can add more value by moving up the value chain, including by delivering services, offering solutions, taking some of our customers’ problems away, providing care outside of the hospital, moving care into the home, and transforming how care is delivered.

But we can’t do that on our own. We need to be active in that network with new partners, governments, local authorities, startup tech companies, or whoever it might be. And we can leverage our local network to help nurture smaller companies that collaborate with us. The era of open innovation is really upon us. Because of our global reach, scale, and R&D expertise, companies like Philips have a very active role to play in collaborating with smaller and more nimble companies to provide better healthcare solutions. We don’t have all the good ideas at Philips; we’re open to working with others who have good ideas. 

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?

Hughes: At Philips, we set ourselves a target to touch 3 billion lives per annum by 2025. That’s an audited number, not just made up, and it’s about us having a positive impact on the world. At Philips we talk about bringing innovation to you, and that’s how we’re going to measure that. We should be well on our way to achieving that by 2020.

Dreaming about what I’d say to that TEDMED audience in Washington in 2020 about what I have achieved as the chief design officer for Philips Healthcare, I’d like to be able to say we’ve been a leader in the digital transformation of care; we’ve brought care to more places and to more people; and we have a portfolio of solutions and offers across the continuum of care that help you through your healthcare journey of life, in wellness as well as clinical intervention. And we’d be able to pat ourselves on the back and say that we’ve delivered what our brand is all about, which is bringing innovation to you, the end user.

Convenient Sensing and Assessment Technologies Will Improve Life



Michael Blum is Associate Vice Chancellor for Informatics, a Professor of Medicine in Cardiology, and Chief Medical Information Officer at the University of California, San Francisco.

He is responsible for the strategic design and implementation of enterprise clinical and research information systems and technologies across the university, provides clinical leadership for the enterprise-wide implementation and optimization of the campus’s electronic health record system and enterprise data warehousing, and leads UCSF’s new Center for Digital Health Innovation.

As an active clinician, Blum specializes in general and preventative cardiology and is passionate about wellness and the prevention of heart disease through a heart-healthy lifestyle. He has been an advisor to numerous healthcare technology start-ups, early stage companies, and industry stalwarts and was the clinical lead on the joint Intel-Motion Computing development of the first successful healthcare-specific tablet computer, the Motion C5.

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

Blum: Outside the technology space, the huge change in medicine is how much more data patients and well people are seeking in trying to maintain their wellness. Their expectations have changed dramatically as they try to assess themselves and see how they compare to what they’re finding.

There are, obviously, all sorts of views about the quality of the information they’re finding on the Internet. Some is misleading in that it appears to quote scientific literature, but does not. There is a bit of confusion. But the change is that society has transitioned from relying on one trusted source to seeking information; Google has transformed the world that way.

In health tech, the remarkable innovation we’re seeing is in sensing and assessment. We’re on the precipice of seeing that things we couldn’t assess outside an intensive clinical environment are now going to be measurable and monitorable at home. We’ve already seen that with the ability to monitor heart rhythm. What is coming is the ability to assess things that previously needed blood draws and lab tests or monitoring in an office, clinic, or hospital.

Monitoring things such as blood glucose, constant heart rhythm, blood pressure, oxygen saturation, and carbon dioxide content in the blood will become straightforward. Communicating that data to ubiquitous smartphone technology and moving from there into much more sophisticated apps with algorithms embedded will be game changing.

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

Blum: We’ve seen a lot of entrepreneurial activity in health tech that’s been divorced from the clinical environment and from scientific validation. These devices have been built by technologists outside of the clinical environment without scientific validation that makes sure they’re accurate or that they have the rigor to assess people accurately and reliably.

Patients and individuals who want to assess and maintain their wellness and manage chronic diseases are expecting a device that has been validated and that they can have confidence in. They want to be able to have a discussion with their healthcare provider about the data that comes from it.

One of the critical factors will be validation done in a clinical environment by experts. That’s going to create new health tech partnerships with academics. We need devices that generate data that stands up to the light of scientific scrutiny and is believable.

That’s the environment we provide at UCSF. That’s what led to our collaboration with Samsung, and that’s what we view when we look at a startup or health tech opportunity. We look at their concept, their technology, and their interest in validating it in the clinical environment. A lot of things work, but do they allow us to do things better, faster, and less expensively? Answering that question will be the key to success.

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

Blum: If you can’t cure something, knowing about how much of it exists is not particularly helpful. But if you have a relatively straightforward and inexpensive technology solution that can lead to affordable treatments that have major impacts on the health of a population, then that’s fantastic.

For example, there are efforts to look at simple photographs of patients’ eyes—of their retinas and corneas—to determine if there is parasitic infection that could be treated with antibiotics to prevent blindness. But doing sophisticated heart monitoring and ultrasounds for people in a socioeconomic environment where treatment is unavailable? That is a different story.

The needle-moving things in global health are when you find technology applications or innovations that lead to assessments of individuals and populations in a state that is curable, treatable, preventable, or even manageable within the context of their healthcare and socioeconomic environment. If just the identification and monitoring makes it treatable, then that makes it needle moving.

Developing technology that finds something that is too intensive, too difficult, or too expensive to treat might be interesting, add to scientific understanding, and point out future areas for work, but it won’t make huge changes right then.

Finding and competing for collaborators, funding sources, and supporters who are philosophically aligned and have the resources is going to be effective. Collaborators and supporters are evolving an NGO approach to global health. For instance, the Bill & Melinda Gates Foundation is making huge efforts and impacts on global health in multiple areas. There’s a new collaboration at UCSF between Lynne and Marc Benioff in partnership with the Gates Foundation to give $100 million to look at efforts around preterm labor and other common healthcare problems in underserved populations. There will be some technology development there that will have a significant impact in global health.

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?

Blum: Six years from now we will use technology in a way that allows us to provide more preventative chronic disease management and wellness support to patients at home than we could have previously in many of their ambulatory encounters where they had to come to the healthcare environment.

Through the use of technology, in six years we will provide predictive information to individuals without them needing to come to us. The information tells them what they need to do to avoid getting sicker in the future. And it gives them the ability to manage their health much more effectively in real time, without needing to come into the healthcare space or wait for their six-month blood draw visit.

In six years we also will support aging-in-place of the elderly. Through the use of technology, we will know about and treat well in advance simple conditions like urinary tract infections that used to result in very bad outcomes such as urosepsis, falls, and broken hips. Early screenings for dementia will enable us to deliver support at home so elderly patients don’t need to go into assisted living.

We will have major impacts on disease management so that when we look back six years from now, we’ll see that the elderly are now able to enjoy their time at home much longer and individuals with chronic disease are able to manage their disease in a much more effective and less expensive way with connections to providers who advise them at home rather than in the office twice a year.

All of that will result in more satisfied and healthier patients with less cost to the healthcare system overall.


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 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.

Understanding Your Customer Is Crucial


A trained organ transplant surgeon and past Stanford surgery professor who led several biopharmaceutical companies and founded a venture capital business, Ken Drazan is now head of the Johnson & Johnson Innovation Center in Menlo Park, Calif. His goal there is to catalyze early stage innovation and bring transformative medicines, devices, and consumer products to Johnson & Johnson by identifying, shaping, and on-boarding the most promising science and technology opportunities from universities, academic centers, and technology and biotech companies.

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

Drazan: In health tech, it’s the marriage of high-performance cloud computing with wearable devices. In essence, a wearable device can sense data from one individual, aggregate similar data from among a group of individuals, and draw conclusions relevant to one person. Wearables could be devices that a physician would use in the diagnosis of a patient, or that a physician prescribes for use at home by the patient.

This technology is already being used, for instance, in electrocardiograms, the diagnosis of ear infections, and the detection of skin cancers. An image from a single patient can be compared over the cloud with a database of others’ images. I propose that this approach will go mainstream and become a way for all ambulatory-based physicians to gain the kind of peer input that only happens regularly in academic medical centers today.

An important trend driving this is that connecting to the Internet and doing cloud computing has become a commodity. It’s no longer expensive and anyone can access that technology at any time.

Another innovative use of technology in a disruptive business model is Theranos’s reinvention of phlebotomy. They have developed the ability to draw one-tenth the volume of blood that a lab would typically draw and integrated it with a microfluidics technology that enables the study of hundreds of disease biomarkers. A patient’s blood sample can be compared to thousands of others’ with similar medical backgrounds to determine variance versus normality. The patient experience is simpler, diagnosis is much faster, and the cost to look at hundreds of biomarkers is comparable to the traditional cost to assess just one.

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

Drazan: The most important factor for determining success is accurately defining the unmet need. Many startup business plan summaries I see target undifferentiated and generally not explicit needs. Because of that, their business models are really inefficient. It’s crucial to define the customer need and stakeholders accurately enough to create a business model.

That is the same as my own key to success. I become the most successful when I understand who my customers and stakeholders are and when I’m unambiguous about determining what their real needs are.

To be clear, a customer is someone who pays for something, while a stakeholder is someone who can potentially influence the business model, but not necessarily pay for it. The stakeholder might be a supplier, or they might manage the channel, compete with the channel, or provide enthusiasm and support.

Say you’re providing a population health tool for people with diabetes. Your customer could be the patient, the doctor, or the health insurer. If the patient doesn’t need a prescription but you need the tool distributed, then doctors are the stakeholders because they might have an opinion that is supportive or adverse to it. One really has to drill down to understand who’s a customer versus a stakeholder.

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

Drazan: The same question applies: Who is the customer? In the developing world it’s more difficult to answer. The parties that might normally pay for something in other markets have no capital in the developing world. You might have to go across geographic borders to find the true customer.

If you’re targeting the unmet need of hernia repair in Tanzania, for instance, the economy there either can’t pay doctors enough or the hospitals or governments don’t have enough money to buy the hernia mesh. So you have to go to a different customer, such as the Gates Foundation.

Conducting a very careful and deep local market map helps you understand how you might find new stakeholders and customers who could pay you to get there. That mapping process defines all the stakeholders; all those who provide economic support or derive economic benefit. That includes people as well as commercial and government entities.

Here’s an example: Potable water in the developing world has always been viewed as a fundamental problem to be managed by NGOs and governments. Several years ago, the CEO of Coca Cola was pitched on delivering potable water because Coca Cola has the most effective distribution capability in the developing world and in most countries. It has become a successful model of solving a global health problem with a commercial partner who has unmatched global and local expertise.

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?

Drazan: It’s behavior change. Behavior change in many disease categories would result in a significant transformation of outcomes and costs in many fields, whether it’s surgical, diabetic, mood disorders, and probably many more. Compliance with care and a broader collaboration between the patient, the provider, and the community would be a significant driver of value for companies, for our government, for tax payers, and for local economies. It is perhaps the most complex problem to resolve of all.

Bringing about behavior change comes down to better understanding your customer, in this case the patient. What are all the emotional, psychological, and business model tweaks that could increase compliance with medications, or that could increase rehabilitation after a major surgery? There could be innovation in specific programs, technology, monitoring technology, or business model incentives that would enhance the chance for success.

Could such changes come about in just 6 years? Absolutely.