We’re thrilled to present ten of the startups who will be joining the TEDMED Hive 2014 in San Francisco and Washington, DC this September 10-12. We’ll be announcing 10 more Hive startups this Thursday. Follow news here or @TEDMED.
At TEDMED 2012, Rebecca Onie asked a simple question with an extremely complex answer:
Why don’t we have a health care system that keeps us healthy?
As a college sophomore, Onie realized through her work as a legal aid intern that lack of basic needs like food, heat, transportation, and health insurance were preventing people from achieving – and, more importantly, maintaining – good health. And she found that most often, doctors practiced a “don’t ask, don’t tell” policy around these issues, assuming, though not without anguish, that these solutions were simply out of reach.
In 1996, Onie co-founded Health Leads, an organization that enables clinicians to “prescribe” food, heat, and other basic resources their patients need to be healthy, alongside medical care. And what began as a student-run organization in a pediatric waiting room is now national in scale. In 2014, nearly 1,000 student Advocates will connect over 14,000 patients and their families to the resources they need to be healthy.
In the last two years, Health Leads has received over 1,000 requests for expansion from hospitals, providers, health systems, and others looking for a way to address their patients’ non-medical needs. On our blog in September, Onie called this demand “symbolic of a much larger shift taking place in the healthcare system.”
And this demand comes from a healthcare system ready for a change. As Onie reported on Forbes.com after her trip to the 2014 World’s Economic Forum’s Annual Meeting in Davos, the sector is finally asking not whether it is necessary to address patients’ social needs, but how to do so effectively:
This momentum extends beyond the handful of health systems whose vision and values tie explicitly to a comprehensive definition of health….Each of these signals the unprecedented moment unfolding in the U.S. healthcare system, triggered by shifting market trends and financial incentives.
Recently, Health Leads received a $16 million grant from the Robert Wood Johnson Foundation (RWJF) to scale its impact. The grant represents the largest in Health Leads history and one of the largest ever awarded by RWJF.
The grant will enable Health Leads to serve more patients around the country, as well as help facilitate its next phase of growth – building a national movement to catalyze the healthcare system to address patients’ basic needs as a standard part of care. In a new article on Stanford Social Innovation Review (SSIR), Health Leads outlines its innovative approach to scale, intending to partner with a small number of leading health systems to drive the change it seeks in the healthcare system:
“Growing in this way enables us to focus on deep integration with our partners, and frees up valuable resources and management time to focus on catalyzing the ecosystem surrounding those partners.”
One of the first new partners in this phase of Health Leads growth: Massachusetts General Hospital (MGH). Last October, Health Leads opened a desk at MGH that has already served hundreds of patients. And most recently, the organization has expanded west. At the end of May, Health Leads launched two new sites in California’s Bay Area – one at Contra Costa Regional Medical Center and the other at Kaiser Permanente Medical Center – Richmond. It is partnerships like these that Health Leads believe will drive the sector to the “new normal” it envisions. As Health Leads said in SSIR:
Going small may not be glamorous. But if we can couple a powerful on-the-ground demonstration with pathways to change the sector, we will have the opportunity at last to transform health care for patients, physicians, and us all.
Healthcare is calling for all hands on deck. Most pundits are anticipating a primary care shortage thanks to greater usage of primary care under the Affordable Care Act. And with the rise in demand comes increased costs from an already bloated system.
What’s the remedy? Among suggested strategies on how to add workers, like making it easier and less expensive to train doctors, are innovative initiatives that address the problem from inside out: Making better use of the staff already in place – like allowing nurse practitioners to practice independently – or adding help at the clinician or community level.
Following are two case studies of care systems that have overhauled delivery with significant results.
Union Health Center: Modeling the A-ICU
Audrey Lum, Chief Clinical Officer of Union Health Center (UHC) in New York City, began reforming Union’s health care team along with Union administrators following a 2005 white paper from the California Health Care Foundation talking about how to serve the highest-cost patients – those with chronic health conditions – who were also under- or uninsured, low-income and not eligible for Medicare or Medicaid. Could these patients be better served, while reducing overall health costs at the same time?
The paper offered a solution: the Ambulatory Intensive Care Unit (A-ICU), which uses nurses, medical assistants, health coaches, community health workers, pharmacists, dietitians and others working at the very top of their capabilities and licensure as the front line of patient assistance and coaching, to allow physician and nurse practitioners to do more of what they’re best at: diagnosing, prescribing and managing care of complex cases.
Audrey Lum and Troy Trygstad discussed their patient home models on a recent Great Challenges Hangout about rethinking the healthcare work force. Watch a recap:
UHC was the perfect petri dish for its experiment, a health center with diverse patient base and unique history. Established in 1914 by the International Ladies’ Garment Workers’ Union, its patients are mainly still union members – laundry workers; porters; doormen – and unions subsidize their care, including operations costs. Around 30 percent of their patients are privately insured.
The center created health care teams staffed by physicians, patient care assistants, two health coaches, assistants and support staff. Teams work off of patient education templates created by clinicians, with input from all.
“It’s about educating patients and helping them learn how to take care of themselves. If you have a chronic disease, you live with it 365 days a year; you only go to the doctor when you’re very sick. How could we incorporate the preventative part of that in our care model?” Lum says.
Hiring culturally proficient health coaches and assistants helped make patients feel comfortable; the staff seem to be de facto community health workers. Staffers speak Spanish, Chinese and Creole, among other languages.
“They’re in the same neighborhoods and they shop in the stores, so there’s that separate connection. It speak to the relationship model of, ‘We’re in this together. Let’s get better as a team,’ “ she says.
Results are good. A 2014 case study review found that the total per member, per month costs for UHC as of 2013 were 17 percent lower than non-UHC patients, and that emergency room costs were 50 percent less. Patient time in the office decreased from 2 hours to an average of 48 minutes.
Training workers was an investment, Lum allows. It takes up to nine months for assistants to complete, with time dedicated specifically for staff to train with nurses and nutritionists. Union had the help of a grant from The Hitachi Foundation to set its change in motion. Still, the results beg the question: Why aren’t more practices doing this?
“It takes a lot of effort, and it takes a lot of time. People don’t realize that when you give a lot upfront, you get it back at the end. But when you’re trying to see as many patients as possible and get your fees-for-service, you want instant gratification,” Lum says.
Community Care Workers Calling
In the Community Care of North Carolina (CCNC) model, the patient home extends to the front door. In 2008, the state initiated a population-based transitional care initiative to prevent recurrent hospitalizations among high-risk Medicaid recipients with complex chronic medical conditions. Today, the community-based program establishes a medical home for more than 1.4 million patients.
Under the program, care managers follow patients, including home visits, with a special eye to medication adherence, reporting back to a primary care medical home; 90 percent of primary care providers in the state – and every hospital – participate, as do local health and social services departments. Physicians oversee care and share data on a dedicated network.
“We need health workforce reorganization to move from ‘when a patient who has a problem, they come to me’ to ‘a patient has a problem and we’re going to manage it no matter what.’ It becomes more about what happens outside of an encounter with a physician,” Trygstad says.
CCNC patient admission rates are consistently 40-50% lower than non-CCNC Medicaid patients. In a study of patients hospitalized during 2010–11, CCNC found that those who received transitional care were 20 percent less likely to have a readmission the following year compared to clinically similar patients who received usual care. As measured in 2011, resulting four-year savings to the state for hospital costs and other services were estimated at nearly $1 billion. In fact, North Carolina is the only state with consistent declining growth rates in medical spending over a decade.
Oregon, Colorado and Oklahoma have similar programs, but Troy Trygstad, Vice President of Pharmacy Programs for CCNC, says:
There were three key ingredients in the primordial goo in North Carolina that resulted in this DNA. There’s a strong historical culture of primary care and public health and population management by virtue of a strong emphases on rural health, supported by medical centers and big universities.
The second thing is that it happened early enough that a lot of the traditional barriers of entry weren’t established. There are certain stakeholders in health system that want to do care coordination and control infomatics, and they’re not going to be interested in an organic provider model that can take on risk.
The third thing is true championship. If you didn’t have strong personalities going to battle over time you wouldn’t be able to maintain [a program like this].
Finalists at the AARP Health Innovation @50+ LivePitch in Boston last week included a lab-quality DIY diagnostic kit and a smart phone that can tell when it’s user is getting a bad case of the wobbles.
Clearly, this is not your mother’s health technology, said TEDMED COO Shirley Bergin, who was one of the judges for the event.
““There really is something to the idea that today’s 50-year-old is yesterday’s 40. The way this group thinks about technology is sophisticated, from invisible sensors to wearable technology. They’re definitely ready to participate in a productive way,” she said.
The judges chose Lift Labs as their winner, which makes a spoon that automatically and unobtrusively prevents those with tremors from spilling food, an advance very much geared toward life quality.
The audience choice was Careticker, a web based program that helps caregivers track activities to earn incentives and to connect with other caregivers.
“Careticker is very focused on what I thought was a big theme; we’re living longer and taking care of those we love for longer periods of time,” Bergin said, adding that health tech innovation for this crowd seemed to center on needs-based items for an audience that was very much on the move.
“The psychographics of a 50-plus today is one of a very active individual, not somebody who’s thinking they’re on the last journey of life. They want to take advantage of all the world has to offer, and look for technology that facilitates an active lifestyle and promotes a good quality of life,” she says.
In a couple of weeks, TEDMED will begin releasing the names of startups joining its own innovation showcase, the TEDMED Hive. After reviewing the hundreds of Hiva applicants, the AARP contestants and those at SXSW, at which she was also a tech innovation judge, Bergin says the market seems to be shifting to a more mature phase of implementation and commercial viability.
For example, while you’re still seeing startups focused on big data, it’s more focused about how that data is going to enable you to take care of yourself, manage a chronic disease or facilitate some improved state of being. How is all of that data going to improve our health?
Entrepreneurs are also coming to terms with a venture capital pool that is finite, she says, and are delivering more sophisticated business model presentations; still mission-based, but with an eye as to how the work will scale commercially. One thing that might help: joining forces.
“Startups are trying to approach solutions from different angles, so I hope there will be more awareness that other people are addressing the same problems. My hope is that those are going to be more collaborations as well as innovations,” Bergin said.