How “unmentionable” stressors can hurt our health: A live online event this Thursday

By Stacy Lu

Debbi Heffern was too busy caregiving to go for that colonoscopy.

A dietitian and lactation consultant in St. Louis, Missouri, Heffern had been a caregiver for decades; first, for her mother, who died of cancer; and then for her mother-in-law.

“My mother-in-law was determined to live on her own. I made sure we jumped through all the long-term care insurance hoops in the right order, and had to line up paid caregivers. When she took a turn for the worse or needed new equipment I had to be on top of all that. Then her identity got stolen. Untangling that was a nightmare,” Heffern says.

Sure, Heffern had recently turned 50, but she had a healthy life style, except for the stress, and who had time for a colon cancer screening? Unfortunately, she had an ugly surprise when she was tested three years later.

“I ended up with stage four colon cancer, which required multiple surgeries and 32 rounds of chemo. While my employer was very accommodating, recovering from surgeries and all that chemo meant a lot of time away from my own job. If I had gotten my screenings when they had been recommended, I’m told I might have had only stage two or three, and perhaps wouldn’t have needed two of the surgeries or so much additional follow-up chemo,” she says.

Four in 10 adults in the U.S. are caring for an adult or child with significant health issues, up from 30 percent in 2010, according to a recent national survey by Pew Research Center. Given our aging population, that number is almost certain to increase, with employers taking a chunk of the burden, at least financially: A 2011 Gallup study says full-time employee absenteeism due to caregiving duties costs employers some $25 billion annually.

What is less obvious is the hidden impact caregiving has on employee health. Byproductsshutterstock_83284207 of unrelenting stress, such as depression and poor sleep, and a lack of attention to personal health, including nutrition and exercise or — as in Heffern’s case — neglecting preventive care, take a toll. Eliza Corporation of Danvers, Mass., a leader in health engagement management, in partnership with Altarum Institute, developed the Vulnerability Index (VI) to help insurers and employers measure how life issues like caregiving, financial troubles or marital problems impact employee health. The Company says the index has three times the predictive power of self-reported health problems than traditional measures.

According to their research, these vulnerability factors make people much more susceptible to chronic conditions such as mental illness, lower back pain and diabetes. Caregiving shows a particularly strong link; caregiving employees are nearly three times more likely to be highly vulnerable to health issues than non-caregivers. The Pew study also showed that caregivers were more likely to have faced a recent health crisis than non-caregivers.

Tracking a clear relationship can be tough, however, as employees are not likely to bring topics like caregiving — Eliza Corporation calls them “The Unmentionables” — to the fore.

The VI research says people are eager for help; about 80 percent of respondents are willing to accept help from their doctor or health plan on an “Unmentionable” issue like financial stress; that rate jumps to 96 percent of people wanting help from either their doctor, their health plan – or just as importantly, their employer – with their caregiving stress. Just being surveyed brings overwhelmingly positive feedback, says Alexandra Drane, Eliza Corporation’s Founder and Chief Visionary Officer.

“The reason people like it is because they know these life stresses are why they’re not feeling well, but nobody asked them these questions before,” she says.

“There is a lot of counseling for cancer patients available both through our insurance company and where I was treated. But I don’t think anybody ever asked me about the caregiving stress,” Heffern says.

Even those organizations that already have invested in tools like this to address caregiving and other life-context issues often have trouble gaining traction – simply because people don’t know about them.

“For the past few years, Cigna has been refocusing its business on the individual,” said Joan Kennedy, vice president for consumer health engagement for the health services company. “We have invested in resources and experts to help people with coaching services, care management programs, and employee assistance programs. The challenge is that many people just don’t realize these resources are available to them.”

Cigna has a pilot program in collaboration with Eliza, using the Vulnerability Index to reach out to individuals that might help, and then connecting them to the resources best matched to their needs, Kennedy says.

How might the “Unmentionables” affect health? How has using the Index to screen employees worked so far?  Hear more about what Eliza learned from their research in a TEDMED Great Challenges online live event this Thursday at 2 PM ET.  Click here to get started.

Will technology lead us to healthcare cost transparency? A live online event this Thursday

shutterstock_155823119Imagine this scenario: You’ve done research on the web and your smartphone — which took minutes; not weeks — and you know how much several providers near you will charge for your tonsillectomy, barring complications; you know the fair price for the procedure.

Fact or futuristic science fiction?  Can recent tech innovations lead the way to healthcare cost transparency? Startups like Castlight Health, PokitDoc, and Clear Health Costs are using the power of data, mHealth and the internet to help employers and patients compare prices and find doctors; what are the results so far?  How are patients responding? And will transparent pricing really help change the way the system works?

Join TEDMED and special guests this Thursday at 2pm Eastern on Google+ for an online discussion focusing on Technology and Health Cost Transparency.

MODERATOR: Dan Munro is a journalist and writer covering healthcare and digital health for Forbes and the founder and CEO of iPatient– an online service designed to help transform the patient-provider dialog.

Read Dan’s guest post on the TEDMED blog about the future of health cost transparency, and follow him on Twitter @DanMunro.

Jeanne Pinder is the founder and CEO of ClearHealthCosts. A Great Challenges Team Member, Jeanne has been a leader in the health cost transparency movement, partnering this Summer with WNYC to crowdsource the cost of mammograms.
Follow Jeanne on Twitter @CHCosts.

Maribeth Shannon is director of the California Health Care Foundation’s Market and Policy Monitor program, which promotes greater transparency and accountability in California’s health care system. Maribeth was featured in Health Affairs this week for her coauthored piece, No Method To The Madness: The Divergence Between Hospital Billed Charges And Payments, And What To Do About It.”
Follow CHCF on Twitter @CHCFNews.

Amy Edgar is an Assistant Professor of Nursing at Cedar Crest College, one of the sites selected to participate in Great Challenges Day Live as part of TEDMED 2013. Amy is also the Founder of the Children’s Integrated Center for Success.
Follow Amy on Twitter @ProfAmyE.

Lisa Maki is the CEO and founder of PokitDoc, an online marketplace aimed at sharing health care information and cost details to help patients find clinicians and care services. At TEDMED 2013, PokitDoc was one of 50 startups featured in the Hive.
Follow Lisa on Twitter @LisaMMaki.



What To Do With Transparent Pricing In Healthcare

By Dan Munro

The snowball started with Steve Brill’s epic Time cover story, “Bitter Pill” (subscription required). In some ways, it’s been an avalanche ever since, and the whole topic of pricing transparency in healthcare has become front-and-center to the much larger healthcare debate. In many ways, I think we’ve made more progress on healthcare pricing transparency this year than the preceding 10 or maybe even 20 years.

Until recently, we’ve all been held captive to a system that had no real obligations and refused to openly share the cost of any service or procedure with us as patients. Walk into any of America’s 5,000+ hospitals and ask the cost for a full knee replacement. At best, you’ll get a quizzical stare. At worst, you’ll be asked, “How much you got?”

According to this 2013 study from Brigham and Women’s Hospital, there are about four million Americans living with a total knee replacement, and we average more than 600,000 full knee replacements per year. How can anyone, anywhere –with any remote credulity– say that we either don’t know or can’t tell you the cost of this high-volume procedure? The corollary would be like saying that McDonalds hasn’t the foggiest idea of their cost for a potato, bun or meat patty, and that we’re not allowed to know the price of a hamburger until after it’s served. It is laughably absurd, except that it’s all so tragic and represents (in aggregate) about 18% of our GDP.

Until fairly recently, the U.S. healthcare system has been perfectly content to revolve around the employer as benefits provider and the innocuous and relatively small patient co-pay. Even after full implementation of the Affordable Care Act, the bulk of Americans (about 48%) will continue to get their health coverage through their employer. Another 27% will continue to get their health coverage through Medicaid or Medicare. Those two groups alone represent about 75% of the U.S. population (~ 321 million in 2016).

Dan Munro will moderate a live, online Great Challenge discussion about transparency in health care pricing on Thursday, October 10 at 2PM ET.  Find out more here.
Dan Munro will moderate a live, online Great Challenge discussion about transparency in health care pricing on Thursday, October 10 at 2PM ET. Find out more here.

Brill’s article definitely sent shock waves through the $3.5 trillion healthcare industry, but it was anecdotal evidence. It wasn’t really indicative of a systemic problem. Like Mayor Vaughn in the movie Jaws, we found it too easy to say “a few bathers were injured” and that the small beach community of Amity was not infested with a man-eating shark. “Amity, as you know, means friendship.”

All of this lurched another big step forward earlier this summer when the Government released payment history for 100 procedures at more than 3,000 hospitals around the country [Government Drops Big Data Bombshell On Hospital Industry].  The Washington Post included a revealing chart of charges at two hospitals in Florida that are literally fewer than 2,000 feet apart.

The evidence was clear, and now voluminous, accumulated over several years from about 60% of the hospitals in the U.S. There was simply no discernible logic to acute care pricing. It wasn’t state, regional or even local; it wasn’t an inpatient versus outpatient facility and it wasn’t a different procedure. In other words, there was no reason for such a wide variation in cost.As a contributing factor, something else also kept happening year after year. The cost of insurance for access into the healthcare system kept escalating. Then the actual benefits started to be less generous. Deductibles kept increasing. Services like dental, vision and mental health were completely stripped out and companies were still choking on their annual commitment to employee health benefits. This scene – as described by one CEO – played out faithfully for many employers – each and every year.

“When an employer sits down with his health care providers – the broker, the health plan, the physician, the hospital, the drug and device firms – everyone in the room wants it to cost more – and they’re all positioned to make that happen.” Lynn Jennings – CEO of WeCare TLC – Top Ten Healthcare Quotes for 2012

Even big, bellwether companies like Microsoft began to buckle under the toll. For the first time in its storied history, the global software giant could no longer simply extend rich healthcare benefits without an employee contribution. At a surprise “town-hall” style meeting in 2010, Microsoft informed its sizable employee base and then released this statement.

We can confirm that Microsoft has begun to evolve its employee health care benefit. There will be no changes for the next two years, but in 2013, employees will contribute to their health care.”

That’s the backdrop. But the scenario is changing rapidly. Today, there are a host of new companies like Castlight Health, PokitDoc, and Clear Health Costs that have jumped in to fill the void of healthcare pricing. Castlight Health, founded in 2008, is arguably the oldest and could easily be one of healthcare’s next IPOs. In the course of about five years it has raised over $180 million in venture funding. Castlight isn’t really a B2C solution as much as a B2B (employer/employee) one, but there are others targeted directly at all of us as patients.

The questions and challenges, however, cascade quickly from there.

  • What is the larger objective? For healthcare to mirror a consumer-centric, retail model?
  • What value does pricing alone have when it’s untethered from either quality or affordability?
  • As a consumer I’m definitely motivated to find the best healthcare I can, but what if it’s way beyond my reach financially?
  • Will this spawn a kind of healthcare lending industry like education and mortgages?
  • What real difference, if any, can pricing make in an emergency situation? NB: Hospital admissions through the ER represent about 50% of all hospital admissions (here)
  • In healthcare, demand will always exceed supply. Are we, in fact, building unrealistic expectations around the capacity of transparency alone to lower pricing?

A few things are becoming crystal clear. As evidenced by this banner headline in the Wall Street Journal last month, “Walgreen to Shift Health Plan for 160,000 Workers,” our healthcare system is moving away from a defined benefit model of healthcare coverage to a defined contribution model. In that model, more choices will become available, and served with consumer convenience, including price. That price may be untethered from quality (or personal affordability), but it will be transparent. The last remaining question could well be: What do we do with it?

Dan Munro is a freelance writer and Contributor at Forbes. He writes regularly about the intersection of healthcare IT, policy and innovation at Read more from him here, and follow him @danmunro.

 Opinions expressed by our guest bloggers do not necessarily reflect TEDMED’s.  


Reducing medical errors will require better reporting tools, engaged patients and – you guessed it – culture change


Reprinted with permission from MedCityNews

“Culture change.” Those words just keep coming up again and again in talk about what’s needed to reduce healthcare costs, to make better use of health information technology, and in this case to stop preventable medical errors that harm patients.

Patient Safety America founder John James recently published a study in the Journal of Patient Safety that estimated the annual number of medical errors in U.S. at up to four times the number the Institute of Medicine estimated in 1999. He joined other experts representing vendors, providers and pharmacists on Thursday for a TEDMED Great Challenges Google+ hangout focused on eliminating medial errors.

Conversation about how and why he compiled the report was a jump-off point for some specific ideas around how physicians, vendors and patients can incite culture change.

Better reporting tools

Hospitals currently use something called the IHI Global Trigger Tool to flag and measure adverse events. Dr. Michael Victoroff, a family physician and risk management consultant, said hospitals shouldn’t just be collecting data on errors but looking deeper into the kinds and causes of errors that are happening. That could be especially useful for identifying places that have figured out how to prevent a particular type of error.

Ana Hincapie, an assistant professor of clinical sciences at California Northstate University College of Pharmacy, noted that there are many medical errors that happen outside of the hospital setting, such as at the pharmacy, that aren’t being accounted for. Victoroff added that a lot of great data on medical errors is being captured in the form of lawsuits and complaints, but attorneys and hospitals keep that data private.

Include patients in reporting

One idea thrown out was the inclusion of patient input in determining medical errors. Perhaps, for example, in the same way that hospitals administer patient satisfaction surveys, what if someone develops a standard survey instrument that patients were expected to complete after visiting a provider? Or, better yet, what if patients were prompted to review their medical records after every visit, to ensure that what’s been recorded accurately reflects the care they received?

“When patients have access to their own records, they start looking at what’s in there,” said Victoroff. “They become one of the main safety tools for the entire system. They’re the only ones in many instances that can reconcile the accuracy of their record with the truth.”

James chimed in that sometimes, though, it takes years for diagnostic errors to be uncovered. “There are things that you don’t realize about your care until it’s put in perspective,” he said. That implies the need for a long-term strategy for incorporating patient feedback into medical record keeping.

Foster a culture that values patient education

Physicians have limited time to spend with patients, but that doesn’t mean they have to skimp on education. James suggested that providers stay efficient by keeping on hand a set of prepared videos that objectively explain complex topics that doctors often have to explain to patients, and usually do so with a certain bias. That might include things like next steps for a patient with an elevated PSA level, or guidance for a patient who’s debating breast cancer screening.

“Some of these standard things that patients don’t understand the nuances of very well I think need to be put into a video format and actually the doctor doesn’t need to be there,” he said. “He tells his patient, go watch this and come back to me with your questions. There are no bright, clear answers here.”

Victoroff agreed and took that idea a step further. “The internet is the most powerful tool ever invented to help patients collaborate with doctors and care systems,” he said. “It only takes me 10 minutes on the internet to find downloads, guidelines, checklists, questions to ask your doctor, video, and also very valuable blogs and patient comments from people who have had the same thing or similar […] All (administrators) have to do is point patients in the direction of it and give patients a little guidance on how to filter out the nonsense.”

Foster a culture that values active prevention of errors

In his own practice, Victoroff offered a $50 reward to anyone who caught him about to “do something terrible,” he said. Hospitals should convey encouragement to employees to speak up if they see something suspicious.

Push industry players to do their part

John Cox co-founded a health IT company focused on patient-physician communication called Visible Health. He said that in talking to pharmaceutical and medical device companies, he’s been encouraged by their increasing desire to bake patient safety initiatives into the products and services that they offer. For example, a pharma company wants to develop a mobile tool to make patients more aware of the clinical protocols around a condition. “I think there’s a great opportunity for them to be leaders because they do have the economic capabilities to do so,” he said.

A live online event: How can patients help track medical errors?

Why is it so difficult to assess the number of patients that are harmed by medical care errors in hospitals?  And what can patients do to help make sure potentially harmful incidents are accurately reported?

shutterstock_2833913A report published this month in the Journal of Patient Safety says that mistakes contribute to the deaths of some 440,000 hospital patients each year – roughly two to four times as many as previous estimates. Why the wide variance?  As Marshall Allen of ProPublica reported via the NPR Shots blog, a number of studies have given vastly different numbers of fatality rates, including the Institute of Medicine’s (IOM) oft-quoted 1999 report, “To Err is Human.”

John T. James, PhD, a toxicologist at NASA,  compiled numbers for the new study using a weighted average of four reports, including the IOM’s, and according to the Global Trigger Tool, a method of reviewing medical records. That total pointed to a lower limit of 210,000, but James theorizes that life-shortening errors of omission due to failure to follow medical guidelines, as well as diagnostic failures, are under reported. The real number of fatalities, he says, is more than twice that, comprising about one-sixth of all deaths each year in the U.S.

James wrote a book, “A Sea of Broken Hearts,” after the death of his son, which he claims is the result of preventable errors by a cardiologist unit. He also founded an advocacy group called Patient Safety America.  The biggest reason for under reporting at an organization level, he maintains, is “the pride of not being willing to admit an error. Others are failure to recognize any error occurred and fear that your colleagues will know about your error,” he says.

While all parties would like to eliminate errors, James writes in the report, reducing medical errors in our complex and fragmented medical system can only be done with the help of patients, who are constants in this equation. As he says in the study:

All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.Even for those harms identified in the medical records of Medicare patients, only 14% become part of the hospital’s incident reporting system.

He acknowledges that without a system overhaul, though, that will be difficult. “[Patients] may assume that harm is part of trying to get medical care. They may not know how to report errors or they may fear the confrontation that could be involved. I can tell you personally that loss of a child from medical errors leaves you devastated physically and emotionally. A survivor may simply not have the emotional reserve to deal with the system that, in my opinion, does a great job of protecting the one who made the error,” he says.

John James will be our featured guest in a live online conversation tomorrow as we explore the issues surrounding medical errors reporting. Marshall Allen (@Marshall_Allen), who reports often on patient safety issues, will moderate the group. Ask questions via Twitter using #GreatChallenges, and we’ll answer as many as we can on air. Click here to sign up.


Marshall Allen, Reporter, ProPublica and the ProPublica Patient Harm Community

John T. James, PhD, Chief Scientist of Space Toxicology, NASA Johnson Space Center

John Cox, Co-Founder, President and Chief Executive Officer, Visible Health, Inc.

Ana Hincapie, PhD, Assistant Professor of Clinical Sciences, California Northstate University College of Pharmacy

Michael Victoroff, MD, Executive Vice President and Chief Medical Officer, Lynxcare

Where Health Begins: Lessons from TEDMED’s Great Challenges

Reprinted with permission from

On September 12th, Health Leads Chief of Staff Sonia Sarkar took part in the TEDMED Great Challenges Google Hangout, “Where Health Begins,” to discuss the role social determinants play in patients’ health.  Special guest Mindy McGrath, Director of Government Relations at the Association of Academic Health Centers (AAHC), kicked off the discussion by sharing the AAHC’s new online social determinants of health toolkit for clinicians, patients, and community members to access best practices for addressing the social determinants of health.  Here are some of our key takeaways from the discussion:

  • The primary access point of care should be within the doctor’s office. While key contributors to health exist outside the doctor’s office, the clinic can still be the place where patients connect to the resources they need to be healthy.  As Sonia pointed out during the discussion, the doctor’s office can effectively be the hub for both medical care and social service connections:

What we’ve been focused on at Health Leads is ensuring that patients have access to the information they need to be healthy within the context of the healthcare setting.  What is important about this particular access point of care is that…it enables us to think about the interplay between where patients get access to resources and where they get access to healthcare.  You can bring those two things together, rather than having the two systems remain separate.

  • We must train health professionals for the new 21st century model of healthcare. As more and more institutions seek out ways to address social determinants, future healthcare professionals must be aware of and understand the full set of factors that affect their patients’ health.  Doctors need to have the knowledge and resources they need to have these tough conversations with patients.
  • We can repurpose the traditional clinic to meet patients’ non-medical needs.  From standard screening paperwork and the prescription pad to electronic medical records, there are a number of tools already in place within healthcare that can be reinvented to address patients’ non-medical needs in conjunction with medical care.

At Health Leads, we are excited to be a part of these important conversations on the social determinants of health.  While we recognize that a number of factors that affect patients’ ability to get and stay healthy exist outside the clinic walls, our vision for healthcare includes the idea that the doctor’s office can be re-imagined to be the place where patients go to address these most basic resource needs.

Watch the TEDMED Great Challenges discussion.  Read more about the Association of Academic Health Centers’ Toolkit.

Panelists included Dr. Bob Atkins, Associate Professor of Nursing at Rutgers University, Dr. Sandeep Kishore, Co-chair of the Young Professionals Chronic Disease Network, Dr. Anne Beal, COO of Patient-Centered Outcomes Research Institute, and Mindy McGrath, Director of Government Relations at the AAHC. The panel was moderated by Amy Lynn Smith, healthcare communications writer and strategist.    

A Great Challenges Online Event: Shopping for Health

Note:  This online event, originally scheduled for September 19th at 11 am ET, has been postponed.  We will announce the new day and time here and via #GreatChallenges.

“Let food by thy medicine,” Hippocrates once said, and thousands of years later, grocery stores are apparently embracing his philosophy.

In a new trend for the industry, a majority of food stores who responded are offering wellness (56%), cooking (46%) or weight management classes (28%) according to the Shopping for Health 2013 survey, conducted by the Food Marketing Institute (FMI) and published by Prevention magazine.

The survey covered thirty-nine FMI member companies, representing thousands of grocery stores nationwide, and is the 21st in a series of annual reports on America’s food shoppers.

Screen Shot 2013-09-16 at 11.34.44 AM

Retailers are offering other benefits like dietitian tips, store tours that focus on health eating (81%) and events that promote immunizations and health screenings.

The rub: Though stores are beginning to offer health services, shoppers haven’t really caught on. The survey shows two-thirds of shoppers said they have not seen any health related information or classes offered in the supermarket.

“It suggests that while retailers are doing all these great things for their customers, consumers aren’t looking in the aisles.  Aside from grabbing them and taking them into a class, how do we interact with them?  How do we make it exciting?” says Susan Borra, RD, FMI’s senior vice president of communications and strategic planning.

Other surprises were shopper perceptions of their family’s health and food preparation. Ten percent of shoppers with children 6 to 18 think of their children as overweight, but some 33 percent of those aged 6 to 19 are overweight or obese, according to the CDC.


“There’s a lot of issues with obesity that we’ve been seeing year over year, and we have 21 years of data in this report,” Borra says.

On the plus side, almost 90 percent of stores surveyed provided healthy recipes, and more than half of the respondents had tried one.  And confusion about what’s actually healthy – and what’s not – has lessened.

“For the first time in a long time consumers are really feeling like they are making improvements in their lives. They feel like they’re going somewhere on this path to health,” Borra says.

What’s behind the decisions and perceptions each shopper makes when he or she enters a food store?  How do they try to achieve healthy eating, and how have their attitudes towards it changed?  How can businesses acquire a competitive edge in health and wellness in a responsible way?

To discuss these and other issues around shopping for health, join TEDMED’s Great Challenges Google Hangout; we’ll announce the time and date soon. Susan Borra, as our guest, will examine more key findings from the survey*. Follow FMI on Twitter @FMI_ORG.

Sally Squires, Senior Vice President and Director of Health and Wellness at Powell Tate/Weber Shandwick, will moderate the conversation. Squires is a nationally syndicated columnist, web chat host, Lean Plate Club creator, and health/nutrition writer.  Follow Sally on Twitter @sallysquires.

*A free download of the 2013 Shopping for Health report will be made available to participants following the event.

TEDMED speaker Lisa Nilsson to show new bodies of art

TEDMED 2012 speaker Lisa Nilsson, who wowed the audience with her fantastic paper sculptures of human anatomy, will show her latest work,  a series called “Connective Tissue” in New York City from October 10 through November 9th at the Pavel Zoubok Gallery.

Nilsson constructs the pieces with tightly curled, 1/4-inch-thick strips of Japanese mulberry paper and the gilded edges of old books, using a centuries-old process called quilling, or paper filigree. This painstaking technique — larger pieces take Nilsson about two months to complete — was popular with nuns and the aristocracy from the 13th through 18th centuries.

Angelico (detail) 2012,  mulberry paper and the gilded edges of old books. Photo: John Polak
Angelico (detail) 2012, mulberry paper and the gilded edges of old books. Photo: John Polak

As she explained in her TEDMED talk,  the “fleshy” quality of the coiled paper drew her mind towards picturing anatomy, and hand-colored illustrations in an ancient French medical book inspired her first piece, a transverse view of female torso.

Nilsson uses a variety of sources for her work, including aged hand-painted French and German anatomy texts, as well as images from the U.S. National Library of Medicine’s Visible Human Project. The male cadaver for that project is that of a 38-year-old Texas murderer who was executed by lethal injection.

“I do notice, especially with that male figure, that his body is very thick and imposing. He’s not a delicate individual, and I wonder if that has something to do with the life he led,” she says.

The resulting pieces are lush yet, upon closer inspection, intricate, delicate and fragile, like the human body.  Nilsson says her work is popular with surgeons – for obvious reasons – but that non-medical folk also appreciate it’s unique and visceral vantage point.

Screen Shot 2013-09-06 at 12.04.39 PM

In an interview with Installation magazine, Nilsson said:

Attention to detail and careful observation are, for me, a means of practicing devotion, a practice common to the scientists and makers of religious art that I admire.  I am inspired, aesthetically, by scientific imagery and objects.  My approach to my work is “play-scientific.”  I use tweezers and scalpels and pretend I’m a surgeon from time to time, but without any of the intense responsibility of the real thing, for which I would be decidedly ill-suited.

For more, visit and watch TEDMED Curator Jay Walker’s Q&A with Nilsson.

Join a Great Challenges Online Discussion: Where Health Begins


How much of a role do social determinants — genetics, life circumstances,environmental conditions, and behavior — play in overall health?

While these factors aren’t part of disease outcome data, healthcare providers and organizations have realized they may be, in fact, the ultimate contributors to health status. The World Health Organization has made attention to social determinants part of the fundamentals of its work and a priority area in its general program from 2014-2019.  And according to the Association of Academic Health Centers (AAHC), medical care alone accounts for less than 25% of a population’s health status, with the balance being determinants like environment or behavior.

The great healthcare population, however, may still be grappling with how to view and measure social determinants of health. To that end, the AAHC has put together an online toolkit, partially funded by the Robert Wood Johnson Foundation (RWJF) (which also funds TEDMED’s Great Challenges Program), to help organizations address the social determinants of health. Created with contributions from the AAHC, RWJF, the WHO and the Centers for Disease Control and Prevention, it includes best practices and case studies from academic health centers across the U.S., and a self-assessment questionnaire.

“There’s a growing understanding in the clinical community of the importance of the social determinants of health,” says Mindy McGrath, Director of Government Relations at the AAHC.

One reason may be implementation of the Affordable Care Act (ACA), she says. While the ACA is focused on insurance coverage, “There are many pilot programs, demonstration projects and side goals of the legislation that look at how to organize and pay for care in ways that are more focused on health outcomes. The next step will be:  How do we reform our delivery systems to be more geared toward keeping people healthy?”

Toward that end, a number of organizations report using theToolkit to good effect, including Health Leads, which helps connect patients to basic resources. (Read more about healthcare’s growing awareness of social determinants from Rebecca Onie, Health Lead’s Co-Founder and CEO.)

McGrath will join TEDMED in an online discussion, “Where Health Begins,” this Thursday at 2 pm ET to discuss social determinants, the AAHC’s efforts, and related Great Challenges such as the role of poverty in health. Our moderator is Amy Lynn Smith, a healthcare communications writer and strategist.

Join us for the discussion and post questions on Twitter #GreatChallenges; we’ll answer as many as possible on air and Twitter.

Follow AAHC on Twitter @aahcdc; follow Amy on Twitter @alswrite.

Rebecca Onie: At last, healthcare considering patients’ social needs

By Rebecca Onie

In April of 2012, I had the opportunity to pose a simple question to the TEDMED community:  What if our healthcare system actually kept us healthy?

This is a simple and universally shared aspiration –the idea that our healthcare system could prevent patients from getting sick in the first place, rather than only treating patients after they have fallen ill. But as is so often the case in healthcare, this can feel intractable. Addressing the root causes of poor health –for example, prescribing antibiotics to a pediatric patient only to find out she has no food at home or is living in a car—can feel overly expansive, complicated, and expensive.

At TEDMED 2012, we sought to present a solution that is instead simple, effective, and cost-effective: in the clinics where Health Leads operates, physicians can prescribe healthy food, heat in the winter, and other basic resources patients need to be healthy, alongside prescriptions for medication. Patients then take those prescriptions to our desk in the clinic waiting room, where our corps of well-trained college student Advocates “fill” those prescriptions by working side-by-side with patients to connect them to the existing landscape of community resources.

The response at TEDMED, as well as the continued demand that Health Leads has experienced since then, has been swift and unequivocal: over the past nine months, we have received expansion requests from more than 700 healthcare institutions that are urgently seeking solutions that will address their patients’ true health needs.

This demand is symbolic of a much larger shift taking place within the healthcare market. The next 12 months, as we all know, will be an unprecedented moment of fluidity and possibility in healthcare. More than twenty million previously uninsured people will introduce complex social needs into the Medicaid system – in the face of a 21,000 physician shortage. Healthcare providers, accountable for delivering health outcomes in this challenging landscape, are compelled to pursue new care delivery models that account for the realities of patients’ lives.

A Health Leads advocate at Hasbro Children's Hospital in Providence, Rhode Island meeting with a patient. Credit: Courtesy of Health Leads
A Health Leads advocate at Johns Hopkins Hospital Children’s Center in Baltimore, Maryland meeting with a patient. Credit: Courtesy of Health Leads


These providers – like Health Leads partner Nassau University Medical Center (NUMC)– are leading the way in demonstrating that it is indeed possible to address patients’ basic resource needs in a clinical setting. NUMC has fully integrated Health Leads into its pediatric outpatient operations – empowering doctors, nurses, and social workers there to ask their patients: Are you running out of food at the end of month? Are you worried about paying the electrical bill?

If the answer is yes, those same providers can refer any patients in those clinics to Health Leads, just like any subspecialty referral – and our Advocates can provide real-time updates to the rest of the clinic team about whether or not a patient got the needed resource, yielding better informed clinical decisions.

Furthermore, NUMC is just one of many institutions that are acknowledging the economic value of addressing patients’ social needs – two-thirds of Health Leads’ clinical partners cover all or some of the cost of our services.

Shifting market trends in healthcare are providing increasing financial incentives for healthcare institutions to pay for models like Health Leads: for example, to achieve Patient-Centered Medical Home certification, institutions must show that they 1) maintain a current resource list on five topics of key community service areas of importance to the patient population and 2) track referrals to patients/families.

Health Leads fulfills both of these basic requirements and also gives clinicians a fully built-out patient flow that is aligned with the design principles of a medical home: we are physically based in the clinic, available to patients with a referral from their primary care provider, and are incorporated as part of the greater care coordination team.

The healthcare system is moving.  Clinicians are demanding the ability to address all of the factors that prevent their patients from staying healthy. Patients expect to be able to speak with their doctor about the things that are making them sick in the first place –running out of food at the end of the month, or lack of electricity needed to keep their medicine refrigerated. And hospitals are allocating scarce budget dollars to address these needs.

At long last, the healthcare system is grappling with the realities of patients’ lives. If we together act now to adopt  practical, simple solutions that work, we can move at last from imagination to implementation. And we can create a new kind of healthcare – for patients, for doctors, and for all of us.

Rebecca Onie is Co-Founder and CEO of Health Leads. Join a representative from Health Leads and other organizations for TEDMED’s online discussion about the social determinants of health this Thursday at 2 pm ET. Ask questions via Twitter #greatchallenges – we’ll answer as many as we can on air.