The Hive 2014: The next 10 startups announced

How will having access to data, counsel, diagnostic tools and even providers in our own homes and via smartphones change how we experience healthcare? The ten Hive 2014 entrepreneurs we’re announcing this week showcase some thoughtful and smart uses of cloud and web-based tech to improve the health of humanity.  Read all about them below and on TEDMED.com.

Edison Nation Medical

Edison Nation Medical innovation headquarters helps to commercialize qualified healthcare portal and medical device product ideas for faster progress in health.

Graphium Health

Graphium Health uses cloud computing and mobile tech to help physicians, administrators and patients make better pre- and post-surgery decisions.

Integrated Plasmonics

Integrated Plasmonics creates home-based diagnostic tools and apps to help patients better manage and improve chronic diseases from home.

Medlio

Medlio provides a virtual insurance card, giving patients a place to track data and to get transparent cost information to help connect with the right providers.

Moov

Moov helps people maximize exercise with a first-of-its-kind wearable device that can track movements in 3D space and make real-time recommendations.

Opternative

Opternative is the world’s first online eye exam that can deliver a prescription, signed by an ophthalmologist, for glasses and contact lenses.

Optimized Care Network

The Optimized Care Network, or OCN, leverages a virtual healthcare delivery model to improve healthcare accessibility and experience for both providers and their patients.

Phobious

Phobious is a mobile technology with a hyper-realistic virtual environment that aims to treat anxiety related disorders more quickly with systematic desensitization.

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SunSprite, the first wearable light tracker, tracks personal bright light and UV exposure so users can get enough light to be healthy while avoiding harmful rays.

Validic 

Validic is a platform connecting patients and providers with convenient, easy access to digital health data from a litany of devices, including healthcare apps,  wearables, biometric devices, and fitness equipment. 

Plus, don’t miss this week’s Hive curator interview on the TEDMED blog: Michael Blum, Associate Vice Chancellor for Informatics, a Professor of Medicine in Cardiology, and Chief Medical Information Officer at the University of California, San Francisco, talks about how we must and can provide clinical validation for wellness assessment devices. Read more here.

Convenient Sensing and Assessment Technologies Will Improve Life

 

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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.

 

TEDMED 2014 Program Announced: Speakers & Session Themes

unnamed-1It’s official – today TEDMED is sharing the first release of speakers who will take the stage during our first-ever, bi-coastal gathering. This unified program will take place simultaneously in San Francisco, CA and Washington, DC from Sept. 10-12.

Our speakers will appear in 9 sessions over the three days, each with its own individual theme. Our team has carefully selected each speaker and session theme to reflect the overarching message of TEDMED 2014: “Unlocking Imagination in Service of Health and Medicine.”

As you may have noticed, we’re pretty big on imagination around here. Our Chairman Jay Walker explained why.

“We at TEDMED believe the world urgently needs to transform its current trajectory, where our rapidly aging global population is colliding with skyrocketing rates of disease,” said Jay. “To create a better tomorrow in health and medicine for our planet’s seven billion people will require a multi-disciplinary approach, intellectual openness and above all, imagination.”

“Scientific rigor and evidence-based standards produce the raw material for discovery, breakthroughs and progress,” Jay said. “After that, it is imagination – the courage to ask big questions, and the willingness to dream of possibilities that never existed before – that will enable us to conceive the new solutions, embrace new thinking and implement the new approaches we need.”

“Accordingly, TEDMED is focused on ‘unlocking imagination’ because, quite simply, imagination is the turbocharger for everything else,” he said.

We’re very excited about the speakers who will help us “unlock imagination” at TEDMED 2014. They include some of the most respected names in science, journalism, education, business and technology. On the TEDMED stage they will tackle some of the most controversial issues in American life and health – explore amazing new scientific insights and medical approaches – demonstrate impressive new technology – wrestle with some of the toughest conundrums in health and medicine – and explore some of the most awe-inspiring phenomenon in both human nature and the natural environment, as well as the cross-influences of the two.

TEDMED has some additional exciting news today.

In collaboration with Imagine Science Films, we are releasing nine short avant-garde films inspired by the themes of the nine stage sessions at TEDMED’s September gathering.

“The creation of this ambitious film program reflects TEDMED’s tradition of emphasizing the complementary nature of science and art,” said TEDMED Partner and COO/CMO Shirley Bergin. “The scientific worldview and the aesthetic perspective can each open an invaluable window on the other.”

Our Director of Stage Content Nassim Assefi added: “These thought-provoking films, like the presence of artists and performers in every session of our stage program, are designed both to communicate science to the public, and to inspire the scientific imagination of the TEDMED community.”

TEDMED 2014’s integrated stage program will be organized around the identical nine session themes in both venues: the Palace of Fine Arts in San Francisco, CA and the Kennedy Center in Washington, DC. These themes and speakers within each include:

“Turn It Upside Down.” We’ll explore surprising insights that flip beliefs, question standard operating procedures, discard some closely held assumptions and lead to fresh insights about health and medicine.

“We Just Don’t Know.” Presenters will highlight the liberation that can take place when we recognize the limits of our knowledge – those transformational moments when we realize that the more we know, the more we realize how little we know.

“Flat Out Amazing.” This session focuses on imagination at the far edge of possibility, featuring stories of the seemingly impossible acts, facts or events that should inspire and dazzle even the most cynical or sophisticated listener.

“Stealing Smart.” Some of the best solutions to problems in health and medicine come from other worlds than the domain where the problem originated or is usually addressed.

“Don’t You Dare Talk About This.” Our speakers will ask difficult questions and boldly tackle controversial issues in health and medicine that many people are reluctant to discuss publicly, or even acknowledge as problems.

“Play Is Not a Waste of Time.” We’ll reveal the many ways that imagination rewards us, specifically how health and medicine are enhanced through the extraordinary power of play.

“Human Nature Inside and Out.” Speakers will share new views and unusual perspectives that reveal who we are as human beings and the impact of our environment on our health.

“Weird and Wonderful.” A joyful survey of surprising combinations and remarkable results. Speakers will discuss science and health trends that came out of left field, defied expectations or simply seemed completely off the wall — in a good way.

“I Was Just Thinking Too Small.” Sometimes we need encouragement to step back and see the full picture, realizing that a narrow focus can be as limiting as it is productive.

This promises to be the most exciting TEDMED gathering yet. Get ready to unlock your imagination! And stay tuned as we make additional speaker announcements and share further event details in the coming weeks.

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Community hospital starts its own patient-centered innovation center

Nick Dawson, who moderated last week’s Great Challenges Googe+ Hangout on medical innovation, is also the new Executive Director of Innovation at Johns-Hopkins Sibley Memorial hospital. He’s helped to run a new onsite Innovation Hub, a cross-disciplinary design studio set to launch this fall at Sibley. We talked to him about the Hub and its goals.

TEDMED: What are the Hub’s goals?

Dawson: The Hub will primarily foster a culture of patience and human centered innovation for everybody in the organization to take part in problem solving, improving processes and thinking about how we do our day-to-day work. The Hub will also engage in cutting and leading edge innovation and design work in health care to improve everything from patient experience to clinical process flow. We maybe even invent new products and services.  We’ll be changing culture plus doing classic innovation and design work.

Sibley's Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrid
Sibley’s Innovation Hub features new perspectives: Pictured: Nick Dawson and Joe Sigrin

TEDMED: Why now?

Dawson: There are some pragmatic realities. Healthcare costs have risen. Clinical quality, despite really well intentioned and impactful work, can be improved.  We may not have enough providers the future,  Above all, it’s become part of our collective discussion to question if we are delivering truly human centered healthcare and meeting the needs of our population, making them healthier and keeping them from being admitted to the hospital and from having serious chronic conditions. We’re having that conversation as country, and we ought to have that conversation within health systems.

TEDMED: Do recent statistics about poor outcomes in the U.S. fuel the fire, despite all the money we spend on healthcare?

Dawson: They are disappointing, and I’m certainly one to help beat that drum and say we need to be doing a better job. At the same time, [numbers] can be misleading because we really do some things incredibly well.  We pioneer techniques and procedures and we’re innovative as a medical community. For example, laproscopic procedures were developed in part right here at Sibley Hospital. A lot of new drug therapies come out of American pharmaceuticals.  So, while we do need to be having a serious discussion about outcomes, we should be proud taht we do have a high performing healthcare system.

TEDMED: You’ll have an embedded innovation team. Who’s on it?

The idea of “team” is loosely defined for us. Dr. Chip Davis, the CEO here at SIbley, and his team deserve the credit for championing the Hub’s vision, and having it be the first community hospital in the nation to have an embedded, well-thought through and resourced innovation center.  There are two of us running the Sibley Innovation Hub, myself and a colleague, Joe Sigrin, who is our Innovation Experience Advisor, and an advisory board.  We’re also developing a physician advisory board to provide clinical direction, and then we have the goal of trying to create widespread culture change. If we’re successful in our job, the whole organization will be part of the team and will be doing mini-projects and even full blown design on their own. We have a wonderful space I which to going to grow that army of design thinkers. It’s a space for everybody that comes into Sibley, whether they’re staff, medical staff or patients.

TEDMED: Will patients be involved?

Dawson: One of our driving goals is including patients in the process, and not just as end users, but as part of the design team.  Frankly, that’s the only way innovation is going to work. Once you co-design, it just feel so right.  It’s the only way that makes sense.

TEDMED: Who or what do you credit with launching a design revolution in healthcare?

That’s a fun one to ponder. There are the IDEOs and the Stanfords; we’ve seen design and innovation centers in many large academic institutions. They gave prominence to the idea.

Another partner, though, and one who ought to get more credit, is patients, those who have said, ‘My health and my condition, and my experience and my interaction with my doctor — that’s my responsibility, and here’s what I’m going to do to own it.  I may have to hack the system.’  They’re designing for themselves ultimately.

And then there are nurses.  All you have to do is shadow any nurse and they have hacks and workarounds for everything.  They don’t call it design thinking, but they have empathy for their patients and their peers and they’re always thinking about how to make things just a little bit better. We see that in doctors, too. Some doctor said, ‘I’m going to try this laproscopic thing, and I’m going to invent a prototype for it.’

There’s a culture in health that who has always existed.  It’s just now becoming a formal process.

– Interview by Stacy Lu

From the Internet of Things to the Internet of the Body

As Managing Director of Healthcare at GE Ventures, Leslie Bottorff invests in healthcare industry startup companies—with a preference for medical technologies and emerging business models. Her 15 years of venture capital investing experience includes her roles as managing director at ONSET Ventures, and investments and board seats at Sadra Medical, which was sold to Boston Scientific; Spinal Concepts, which was sold to Abbott Labs; Neuronetics; Relievant; and VisionCare Ophthalmic.

Earlier in her career, Bottorff spent 19 years in operating roles at large andventure- backed companies including Medtronic’s CardioRhythm division, Embolic Protection (acquired by Boston Scientific), Nellcor (now Covidien), Ventritex (now St. Jude), Menlo Care (acquired by J & J), and GE Healthcare. She has also served on advisory boards or as guest faculty at several universities including Purdue, Stanford, and UC Berkeley.

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

Bottorff: We’re seeing tremendous innovation in personal monitoring and in therapies for a wide variety of diseases. Combining therapies, diagnostics and digital communications is creating a more effective systems approach to patient care management. This means helping patients who are in the hospital or coming out of the hospital, living at home with chronic diseases as well as helping people who are not ill, but taking steps towards preventative care.

This is analogous to the emergence of the Industrial Internet, which GE is a major proponent of. This convergence of personal monitoring technology and advanced wireless communication is a pretty big opportunity for what I’ll call, the “Internet of the Body”. This convergence is going to be the driving force behind the advances we are seeing today.

In addition to personal monitoring, another area of remarkable innovation is noninvasive technologies to treat and diagnose conditions related to the nervous system. We’ll be able to take advantage of some of the electronics and connectivity that is now available. As one example, GE has a brain initiative being led by our Healthymagination unit.

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

Bottorff: It’s important for entrepreneurs to embrace innovation throughcollaboration and not think they have to be experts in everything to bring the many pieces of the puzzle together themselves. This is a multi-functional area. You have to recruit a strong multidisciplinary team and maintain focus. This industry is being re-invented as we speak; nobody’s got the formula. So it’s important to maintain focus and persevere to understand the needs of your target customer. Those factors are very synergistic to GE’s. We also need to stay focused, and we also need to innovate, which is why we stay close to the new thinkers and innovators. In a young and small company, you can be agile and you succeed or fail in much faster cycles than a large company. At GE, we think the best way to focus on what’s next and what’s coming is to partner with entrepreneurs and startups. We aim to help accelerate their growth and help them commercialize their ideas to really move the needle. At the same time, they may have the problem that they’re not able to scale, get big, or get reach. That’s the kind of thing we can help them with and one of the many reasons why we feel like it’s so important for us to collaborate.

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

Bottorff: We’re an infrastructure company that has global reach and global distribution. We see ourselves partnering with all sorts of external partners, including startup companies with great ideas for products and business entities in many of the countries we’re based in. Having operations in 170 countries, we can take the innovations that are going to be most appropriate to the right markets and geographies and help an entrepreneur do that parsing—to ask if their product is a fit for the infrastructure of a given market. So we can say to entrepreneurs, “Let’s talk about how we can help you most, because you don’t have the scale to get all markets .”

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?

Bottorff: GE would love to play an important leadership role in coordinating what will be an end-to-end system that delivers on the promise, and not just the hype of  “Digital Health”.

A lot of people have grand visions of how Digital Health is going to transform and improve healthcare, and that is exciting. But, getting from point A (where we are  now) to point B (the ideal future vision) is trickier than coming up with a grand vision. It’s going to require a lot of cooperation with a lot of parties and GE intends  to be right in the middle of it to help make it happen. The transformation between now and 2020 or 2030 will be remarkable.

The Hive 2014: The Next 10 Startups

As promised, today we’re announcing 10 more breakthrough startups that will join the TEDMED Hive 2014. This September 10-12 in Washington, DC and San Francisco, each will share their products and ideas for progress in health and medicine with our Delegates. Visit TEDMED.com for fascinating background info on these newly announced entrepreneurs, and to revisit the 10 startups announced last week.

Screen Shot 2014-06-12 at 3.55.54 PMScreen Shot 2014-06-12 at 3.56.09 PMScreen Shot 2014-06-12 at 3.56.22 PMToday, we’re also getting to know Hive Curator Sumbal Desai, Associate Chief Medical Officer for Strategy and Innovation at Stanford Hospital and Clinics, via our weekly Q&A blog series. She shares insights on how healthcare is reshaping itself to fit consumers’ digital expectations.

We’ll release more Hive startups next week.  Until then, follow the latest news @TEDMED.

Q2 Checkup: What Is Shaping Digital Health Innovation in 2014?

By Aman Bhandari

With 2014 halfway behind us, it’s time for a bi-annual look back at digital health innovation so far.  What have been our major influencers?

Six months is a very short time span in which to say anything is shaping a sector, but it’s also a good time frame for a snapshot. It wasn’t until I started thinking about what’s happened recently that I realized how dizzying the activity has been across the spectrum and potentially at scale. This is critical. In this year alone we are seeing some of the biggest players make bets and shifts, from the Office of the National Coordinator for Health Information Technology (ONC) to Apple, which means the digital health ecosystem will be impacted, and it could happen at scale.

-1First, look at the activity and record levels of venture funding in the digital health space; $700M in Q1 2014 alone, an 87% year over year increase according to Rock Health. This recent Harvard Business Review piece nicely summarizes why the time to be in digital health is now. There has (finally) been some chatter that we are approaching bubble territory in digital health, and while that may be true, there are at least three areas of optimism thanks to the infrastructure and ecosystem evolving at all levels: Continued Federal activity, Fortune 500/Wall Street involvement, and diversified venture funding.

1. Federal Government: Continued Data Liquidity Push
The federal activity from this year is across the board. Some highlights that will challenge entrepreneurs to develop a continued drive for enhanced data and information liquidity with an improved consumer experience over the long run include the following:

  • ONC releases 10 year interoperability vision
  • ONC re-organizes and creates an API committee. This wouldn’t have happened as recently as two years ago.
  • Medicare announces an historic data release of physician payment data revises other data related guidelines, potentially opening more access to commercial entities
  • FDA Open Data releases millions of files to entrepreneuers in a more accessible format
  • Healthcare.gov helps enroll millions of people

2. Digital Health at Scale: Fortune 500 Involvement

Following on CMS data transparency efforts, some of the largest health insurers, including Aetna, United Health and Humana, announced they will release payment data to consumers. And speaking of consumers, technology companies including Intel, Samsung, and Apple have entered in a big way, and it’s clear that wearables have gone mainstream. The Fortune 500 are paying attention and are also forming collaborations across silos, such as the Apple Epic and Mayo partnership, including:

  • Intel’s $100M+ acquisition of Basis
  • Samsung’s $50M digital health fund + S Health launch
  • The Apple Health Kit
  • Health insurance giants making payment data public

3. Startup Diversification & Investment: New Entrants

The third signal flare from 2014 to watch is the increased diversity of players including some who haven’t been as involved previously. This includes investments this year from venture funds Social+Capital and Andreessen Horowitz (a16z). Some of the new entrants are driving record amounts of funding and are bringing greater assets to bear.  Here are some highlights of startup activity:

  • Flatiron Health had one of the largest series B rounds in the digital health space ($130M)
  • Omada Health gets $28M series B lead by a16z
  • Better raises $5M from Social+Capital
  • Nant Health receives $100M from the Kuwait Investment Authority
  • 16 digital health acquisitions to date

Digital health innovation is still the wild West, admittedly, and there are many hurdles. What’s clear is that these three areas have backing from actors who can scale and bring on the best talent in the world. They’re creating a robust ecosystem that is shaping innovation in digital health. Across the board, there is a larger theme taking shape of capturing, aggregating and democratizing access to data, which is spurring entrepreneurial activity and the consumerization of health. In addition, novel cross-silo partnerships are forming. Collaboration across the health and tech sectors is no longer an option; it is a necessity if we are going to drive meaningful change in healthcare.

Which three things would you point to as harbingers for 2014?   TMIcon

 

Aman Bhandari has worked in corporate, non-profit and government organizations. He formerly worked for Todd Park, the US CTO, at the White House, where he helped to launch a variety of global and national health policy initiatives at the intersection of health IT, data, and innovation. He also co-launched the Health2.0 code-a-thon and developer challenge series. Follow him @GHideas.

 

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

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

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

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

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

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

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

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

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

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

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

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

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

Reshaping the healthcare workforce: Two case studies

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].