Nancy Fabozzi, Principal Analyst at Connected Health shares her thoughts.
We recently attend the Health 2.0 7th Annual Fall Conference held at the Santa Clara Convention Center in early October. This meeting is held every fall in the San Francisco area and is considered to be one of the premier events to gage the latest trends in disruptive health IT, particularly related to consumer health and patient engagement.
The conference was put on by Health 2.0, a San Francisco-based organization that provides events and media services designed to showcase innovative companies, technologies, and thought leaders focused on shaking up the status quo in healthcare. They also run the Health 2.0 Developer Challenge, a platform for connecting healthcare organizations to health technology developers, operate a media channel, and provide market intelligence services among other things. Health 2.0’s various conferences, developer challenges, and live code-a-thons have a global reach, extending across major U.S. cities as well as Europe, Latin America, the Middle East, and India. Matthew Holt and Indu Subaiya, M.D. founded the organization in 2007. Holt serves as Co-Chairman of Health 2.0.
His background includes over 20 years in healthcare and healthcare IT market research and strategy consulting, and he is also the founder and publisher of The Health Care Blog, a highly influential and popular blog that features contributions from leading figures across the healthcare industry. The blog launched in 2003 and currently attracts around 150,000 visitors a month. Indu Subaiya, Health 2.0’s Co-Chairman and CEO, is a physician who also has a background in strategy consulting and business. The Health 2.0 enterprise has become a powerhouse in the world of health IT start ups. According to their website, the organization has introduced over 500 technology companies to the world stage, hosted more than 11,000 attendees at their conferences and code-a-thons, and awarded over $5,277,000 in prizes through their developer challenge program. In addition, they have inspired the formation of 70 new chapters in cities around the world.
Event Demographics – Global Constituents, Focused on Disruption
The Health 2.0 Fall Conference featured 2000 attendees, 250 speakers, and approximately 3,000 associated companies. Kaiser Permanente and the XPRIZE Nokia Sensing XCHALLENGE was the key sponsor for the event and was joined by a generous roster of global corporate sponsors including large commercial healthcare payers (Cigna, Aetna, and UnitedHealthcare), non-profit organizations (California Healthcare Foundation, Robert Wood Johnson Foundation, Knight Foundation), numerous established and emerging health IT vendors, and provider organizations. The majority of IT vendors were smaller start-ups mostly focused on wellness and consumer health apps. We also saw a lot of vendors offering various tools for care coordination and population health management. The presence of Allscripts and athenahealth was notable as most of the large established, “mainstream” health IT vendors were not in attendance at Health 2.0 as sponsors or exhibitors. Retail giants Walgreens and Target had a noticeable presence—the Target logo was actually displayed on the event bag. Health 2.0 has a broad global reach so there was good representation from global companies. Of note, was a 70-person delegation from Finland (Team Finland) promoting the message that “Finland is the hottest spot in Europe for health and wellness innovations.” Another interesting global participant was Tim Kelsey, National Director for Patients and Information for the U.K.’s National Health Service (NHS). Kelsey, who emphasized the fact that the NHS spends $100 billion on healthcare per year, was promoting the new NHS initiative that seeks to “unleash the power of people” with new IT tools including patient feedback. Kelsey said he was attending the event to actively solicit relationships and gather information from vendors who want to serve the NHS as they open up data for this new push to engage patients. Vendors take note!
Keynote Highlights – New Political Thinking and Healthcare’s Seven Deadly Sins
Gavin Newsom, the current Lieutenant Governor of California and former Mayor of San Francisco, was the opening keynote speaker for the event. Newsom talked about technology-enabled trend lines that are changing the world, a theme he expounds upon in his new book, Citzenville. The book is about how ordinary citizens can use information technology to bypass political gridlock and invigorate the democratic process. Newson believes that a new governing philosophy started in the U.S. with the election of Barack Obama, and that this movement this will profoundly influence our future. The new thinking, driven by the digital natives, or the generation that is “bathed in bits,” is not top down. Rather, today, online, grassroots communities are being leveraged to build coalitions. The new normal will soon be characterized by bottom up, real time feedback loops, crowd sourcing, cloud computing, social mobile, and social everything. In addition, our hyper-connected world and exponential data is leading to the advent of personalized, customized data across all endeavors. All this is going to change not only the political system but also the way people interact with their healthcare system. In this new environment, citizens are not going to wait for Washington to act but rather will focus on local venues and resources where, Newsom claims, remarkable things are already happening. Of note, Newsom’s comments were given one day prior to the recent U.S. government shutdown and were thus particularly timely.
Indu Subaiya offered a sober look at the reality of the U.S. healthcare system in her talk about the “Seven Deadly Sins” or, as she says, “why I want to run for the hills.” The theme of this talk was Subaiya’s frustrations about the level of dysfunction that exists across several healthcare dimensions. She defines the Seven Deadly as – 1) Too much testing due to dysfunctional referral patterns and perverse incentives; 2) Hospital bills and prices that are too confusing and too much variable; 3) Bossy intermediaries between payers and employers that inhibit effective bargaining and price transparency, 4) Pharmacy Benefit Managers (PBMs) are very confusing and hoard information on comparative prices for drugs so employers cannot negotiate for the best deal; 5) EMRs don’t share data despite standards like HL7; market incentives still promote closed off EHRs; 6) Access to data, or who owns my data? Patient still struggle to get direct access to information like lab results; 7) End of life care, or why do we spend so much money on end stage patients when most doctors say up to 20 percent of care at this stage is futile? To address the dysfunction caused by these “deadly sins,” Subaiya believes that a shift in perspective is needed, from focusing on how much is spent to how much is made. We also need to question who profits from the status quo. Subaiya advises stakeholders to pay attention to under currents and counter currents in the market. Stakeholders need to understand whether their business model supports the current system or addresses market undercurrents. She advises companies to focus on what their business is trying to disrupt.
On a positive note, Subaiya did provide some examples of companies she characterizes as “beacons” in that they are trying to provide alternatives that address healthcare dysfunction. These companies include MyMedLabs which provides a way for consumers to request and pay for their own medical laboratory tests; patient portal vendor ManaHealth; Truveris which provides a platform for managing pharmacy benefits, and GoodRx which provides a consumer-facing website and mobile app for comparing prescription prices at local pharmacies.
Key Themes and Trends – Radical Consumers Making Sense of Health
The conference kicked off with Matthew and Indu providing a rundown of the key themes and trends for 2013. Probably the most important trend—and the one that dominated many of the presentations and developer challenges—is the growth of self-tracking of health status. While most self-tracking is still done by paper, the numerous new technology solutions available for sensing are inspiring a whole new range of users. This has caused the tracking movement to shift from fringe to mainstream, moving sensing from the clinical to the personal. The growth of these sensing devices is also helping drive a shift in the locus of healthcare from the individual patient encounter to continuous involvement via remote monitoring. Sensors and sensing data will impact all industries, thus the sensing movement represents huge market opportunities as a new ecosystem needs to be built up around these technologies. Another trend is that clinical data is going beyond simple biometric measurement into more advanced and customized functions. One aspect of this trend is the growing recognition that “health” is often determined by non-health factors. This means that health plans are bringing in more tools to address things like spirituality, sexuality, and other non-traditional areas that the Health 2.0 team jokingly terms as “unmentionables.” The empowered consumer is one of the biggest stories of 2013 and every healthcare conference and media outlet is covering this issue. We heard the term “radical consumers” mentioned and like that characterization. This refers to consumers who are reshaping how they engage with the healthcare system. Clearly, technology is changing the way providers are dealing with their patients. One of the key messages at Health 2.0 is that large providers are finally catching on to the importance of patient engagement. One example of this is the Blue Button movement which is growing in popularity because it provides an easy way for personal health data to become more accessible for patients. Consumer-enabled health technology solutions and enterprise-led consumer engagement initiatives are major trends that will only grow importance. The consumer mindset is also driving demand for greater price transparency so that people can shop for healthcare based on cost and quality. One of the most notable examples of this movement is the recent release of hospital pricing data by CMS.
While the brave new world of wearable sensors, radical consumers, and personalized data will no doubt open up new vistas of opportunities to improve healthcare, considerable challenges remain. Among these are -
Data mobility – sick people still cannot get access to data when they need it. Data at the point of care remains sparse. The Blue Button movement is being promoted to fix this issue, a sort of a personal health information exchange.
Trackers – it’s great that more people are using them, but new problems can arise when data is created outside of the traditional provider environment. Healthcare trackers need a feedback loop to make data actionable. Sharing is vitally important to ensure success.
EHR usability – most EHRs are still appalling and many providers hate them. User interfaces are terrible. This technology needs to become much easier for clinicians; improving usability needs to be a key focus area for technology vendors.
Unfortunately, the status quo for health IT in late 2013 is that provider IT systems are still predominately closed, installed solutions that inhibit interoperability. But the key message of Health 2.0 is that the movement to more mobile, open, and customized apps for both patients and providers is the undeniable wave of the future. We definitely agree.
Developer Challenges and Startup Showcase – Enthusiasm Abounds
As Health 2.0’s mission is to promote emerging and disruptive technologies, the conference showcased announcements for winners of various developer challenges. The Nokia Sensing X Challenge is a $2.25 million global crowdsourcing competition designed to accelerate the development of small, light sensing technologies that are better able to capture personalized clinical data. This challenge is part of the global XPRIZE enterprise, headed up by Dr. Peter Diamandis, Co-Founder and Chairman of the Singularity University, that creates incentivized prize competitions across various industries. The winners for the first phase, or Challenge #1, were announced and included five $120,000 Distinguished Award winners (Elfi-Tech; InSilixa; MoboSens; Owlstone; and Silicon BioDevices) and one $525,000 Grand Prize winner, Nanobiosym Health RADAR, which developed an advanced mobile nanochip sensing technology. Another featured challenge was the Robert Wood Johnson Foundation (RWJF) Hospital Price Data Challenge which is designed to increase the understanding and use of recently released hospital price data from CMS. This challenge is divided into two categories – A) visualization (interactive and static) and B) apps and tools. Category A sought entries from developers providing visualization tools that enable better understanding and comparison of pricing data. The first place ($9,000) winner of RWJF challenge for interactive visualization was Optimal Hospital which helps users explore their hospital options using eight different CMS data sets. The first place ($6,000) winner for static visualization was So, You Need Knee Replacement Surgery which provides an illustration that guides the user through the experience of researching information to help choose a hospital for knee replacement surgery and the ability to compare costs. More about first prize and other winners can be found out at http://www.visualizing.org. Category B of the RWJF challenge focuses on apps and tools that allow users to analyze and leverage pricing data for purchasing decisions or negotiating hospital bills. Winners for that phase of the challenge will be announced at the mHealth Summit coming up in December 2013.
Since 2008, the Health 2.0 conference has featured a fun showcase for startups, entitled “Launch!” This event is a coming out party for brand new ventures. Entrepreneurs do a brief (3.5 minute) demo of their products and audience members vote, by text message, for their favorites. The ten new companies demo’d this year included –
SmartPatient, a mobile app that leverages natural language processing to gage the patient satisfaction
MedVoy, a physician referral tools for patients and providers
Genetrainer, an app for personalized training and exercise plans based on users’ genetic profiles
Medlio, an app for patients that provides price transparency and information about deductibles and co-pays
InvolveCare, a social media platform that connects patients and family members
Recovery Record, an app designed to help patients with eating disorders
Vimty, a platform that helps people plan advanced directives and end-of-life care
Liviam, a care coordination tool for patient and providers based on a social media platform
Mevoked, an analytics platform designed to promote mental health and positive social behavior
OM Signal, wearable biometric sensors woven into clothing (electronic textiles, or bio-sensing clothing)
OM Signal was the winner of this year’s Launch! contest. The company, based in Montreal, is focused on bridging software and apparel and say they are on “a mission to bring personal wellness into our daily lives.”
Select Companies of Interest
Many interesting companies and technologies were featured during Health 2.0. presentations and on the exhibit floor. The following were among some of our favorites:
Box – The cloud file sharing and content management company is now making a big push into healthcare. Box was at Health 2.0 to promote its ability to integrate with EHRs. They announced a new partnership with EHR/PM vendor CareCloud, an alliance which is designed to integrate Box’s secure content-sharing and collaboration capabilities into the CareCloud cloud-based platform. Box also announced a partnership with Dignity Health to sponsor a $100,000 app challenge designed to drive innovation in patient education.
Evolent Health – Founded in 2011 by UPMC Health Plan and The Advisory Board Company, the company offers strategic management and technology advisory services to providers wanting to build value-based care programs.
Healthentic – This company offers a claims-driven analytics engine for large employers (500+ employees) that enables the development of customized health and wellness programs and strategies designed to control insurance costs and mitigate risk.
Keas – This vendor of corporate wellness programs provides a range of solutions with a strong emphasis on social interactions and peer motivation. Keas utilizes gamification strategies to promote wellness and focuses on the fun factor. The company’s motto is the belief in “the power of the group” as the key to creating individual change.
Patients Like Me – A chronic disease social network and communication platform designed to drive sharing, support, and research among patients. The PatientsLikeMe website currently has 230,000 patient members. The company is focused on connecting and making sense of patient-derived information (stratification and signal optimization) including publishing studies and presenting posters on key findings.
PatientPoint – This vendor of patient engagement solutions provides a suite of integrated solutions for patients, providers, payers, and sponsors that extend to every point along the continuum of care, thus enabling continuous engagement. Their care coordination platform is particularly robust.
SoloHealth – The company provides health kiosks for consumers to who can use the SoloHealth Station to directly screen their vision, blood pressure, weight, and body mass index, or do an overall health assessment—all for free. SoloHealth Stations are in 3,200 locations in retail environments, touching 32 million consumers. The technology is based on adaptive logic as it takes users through a series of questions. The platform is designed to empower consumers, improve outcomes and lower costs. What’s really interesting about SoloHealth is the consumer surveys that are done after patient’s use the station. These surveys provide a rich resource of data on various consumer health opinions and attitudes. SoloHealth Stations can also be used to disseminate information and are currently being looked at to promote information about the Affordable Care Act.
Final Thoughts
It was certainly inspiring to witness the energy, enthusiasm, and innovation bubbling out of the diverse group of stakeholders that make up the Health 2.0 community. As Peter Diamandis, the Chairman and CEO of XPRIZE, stated, “the healthcare system is on the way to its own demise and destruction.” A look at some of the great tech solutions that are rolling out today fills one with hope—maybe we’re going to solve this healthcare thing after all! It is not hyperbole to talk about “the dawn of a new era” in this instance. Change is real and that means opportunities for many emerging companies. However, we do caution against sugarcoating the long, hard road to success in field of health IT. Yes, it holds great promise to make things better, but it can also make things a lot more complicated. This is definitely true of clinical solutions designed to be used by healthcare professionals and certainly true of consumer-facing technology. Consumers have traditionally been slow to embrace health IT like personal health records and patient portals, but today, many factors are coming together to change that. However, we still don’t know exactly how these new “radical consumers” will evolve and behave, and this leads to great uncertainty for entrepreneurs. What percent of the population will really need and want smart t-shirts, Google Glasses, smart watch bands and so on? Will consumers replace their watch band fitness trackers with bio-sensing t-shirts made of smart fabric? Will we be willing participants in employer-sponsored social games designed to keep us fit? Exactly how much “quantification” and sharing of data will consumers accept? Reforming and disrupting a dysfunctional healthcare system is a highly noble cause, and the importance of IT is crucial and inevitable. The process will likely be slower and more painful than most are willing to admit. Perhaps the best caveat was offered by Tim Kelsey of the NHS when he said healthcare stakeholders need to not lose the human dimension as we look to new solutions. Yes, indeed.