<ul><li>Altoida: <a href="https://www.businesswire.com/news/home/20211025005153/en/Altoida-and-Ionian-University-Investigate-Breakthrough-Software-Device-for-Parkinsons-Disease-Diagnosis" target="_blank">Altoida and Ionian University Investigate Breakthrough Precision Neurology Device for Parkinson&#39;s Disease Diagnosis</a></li><li>Altoida: <a href="https://www.businesswire.com/news/home/20211018005097/en/Altoida-Launches-5-Year-Multi-Center-Alzheimer%E2%80%99s-Study-with-Eisai-and-Ionian-University" target="_blank">Altoida Launches Massive Multi-Year Alzheimer&#39;s Study with Eisai and Ionian University</a></li><li>AmbiFi: <a href="https://www.prnewswire.com/news-releases/vuzix-and-ambifi-join-forces-to-provide-ambient-technology-solutions-for-healthcare-practitioners-301395558.html" target="_blank">Vuzix and AmbiFi Join Forces to Provide Ambient Technology Solutions for Healthcare Practitioners</a></li><li>b.well Connected Health: <a href="https://medcitynews.com/2021/10/unitypoint-health-b-well-connected-health-partner-to-implement-digital-first-patient-journey/" target="_blank">UnityPoint Health, b.well Connected Health partner to implement digital-first consumer strategy</a></li><li>Babylon: <a href="https://www.prnewswire.com/news-releases/babylon-announces-new-collaboration-with-microsoft-to-drive-healthcare-innovation-and-improve-health-access-and-affordability-around-the-world-301402269.html" target="_blank">Babylon announces new collaboration with Microsoft to drive healthcare innovation and improve health access and affordability around the world</a></li><li>BehaVR: <a href="https://www.prnewswire.com/news-releases/sumitomo-dainippon-pharma-and-behavr-announce-landmark-deal-for-multiple-virtual-reality-digital-therapeutics-301401488.html" target="_blank">Sumitomo Dainippon Pharma and BehaVR announce landmark deal for multiple virtual reality digital therapeutics</a></li><li>Blue Shield of California: <a href="https://news.blueshieldca.com/2021/10/18/blue-shield-of-california-google-cloud-collaborate-to-transform-medical-billing-by-bringing-real-time-reimbursement-information-to-providers" target="_blank">Blue Shield of California, Google Cloud Collaborate to Transform Medical Billing by Bringing Real Time Reimbursement Information to Providers</a></li><li>BreatheSuite: <a href="https://www.drugdeliverybusiness.com/fda-clears-breathesuites-device-to-turn-regular-metered-dose-inhalers-into-smart-inhalers/" target="_blank">FDA clears BreatheSuite’s device to turn regular metered-dose inhalers into smart inhalers</a></li><li>Bright.md: <a href="https://www.prnewswire.com/news-releases/navigate-by-brightmd-modernizes-digital-healthcare-experience-to-direct-patients-to-the-right-venue-of-care-the-first-time-301398574.html" target="_blank">Navigate by Bright.md modernizes digital healthcare experience to direct patients to the right venue of care, the first time</a></li><li>DarioHealth: <a href="https://www.wflx.com/prnewswire/2021/10/18/dariohealth-unveils-its-digital-musculoskeletal-solution-dario-move-hlth-2021/" target="_blank">DarioHealth Unveils its Digital Musculoskeletal Solution Dario Move at HLTH 2021</a></li><li>DrFirst: <a href="https://www.prnewswire.com/news-releases/independent-health-partners-with-drfirst-to-give-its-prescribers-access-to-real-time-prescription-benefit-check-for-covered-patients-301401128.html" target="_blank">Independent Health Partners with DrFirst to Give its Prescribers Access to Real-Time Prescription Benefit Check for Covered Patients</a></li><li>Elation Health: <a href="https://www.prnewswire.com/news-releases/elation-health-chosen-for-innovation-lab-to-reduce-burdens-for-family-physicians-301402931.html" target="_blank">Elation Health Chosen for Innovation Lab to Reduce Burdens for Family Physicians</a></li><li>Firefly Health: <a href="https://www.businesswire.com/news/home/20211004005063/en/Firefly-Health-Launches-Health-Plan-for-Employers" target="_blank">Firefly Health Launches Health Plan for Employers</a></li><li>GeniusRx: <a href="https://www.prnewswire.com/news-releases/geniusrx-expands-its-digital-pharmacy-reach-by-launching-geniusclinic-and-geniusiq-to-provide-telehealth-services-and-medication-price-transparency-to-meet-the-growing-consumer-demand-for-accessible-and-affordable-healthcare-301402833.html" target="_blank">GeniusRx™ Expands Its Digital Pharmacy Reach by Launching GeniusClinic™ and GeniusIQ™ to Provide Telehealth Services and Medication Price Transparency to Meet the Growing Consumer Demand for Accessible and Affordable Healthcare</a></li><li>Google: <a href="https://www.fiercehealthcare.com/tech/google-taps-headspace-executive-to-lead-consumer-mental-health-efforts" target="_blank">Google taps Headspace executive to lead tech-driven mental health efforts</a></li><li>Graphite Health: <a href="https://www.fiercehealthcare.com/tech/intermountain-presbyterian-and-ssm-health-announce-new-digital-transformation-company" target="_blank">Intermountain, Presbyterian and SSM Health announce new digital transformation company</a></li><li>Groups Recover Together: <a href="https://www.businesswire.com/news/home/20211018005217/en/Groups-Recover-Together-Launches-a-Proprietary-Digital-Platform-Designed-to-Support-Members-Struggling-With-Opioid-Addiction" target="_blank">Groups Recover Together Launches a Proprietary Digital Platform Designed to Support Members Struggling With Opioid Addiction</a></li><li>Happify Health: <a href="https://www.psfk.com/2021/10/happify-health-launches-ensemble-an-ai-based-mental-health-coach.html" target="_blank">Happify Health Launches Ensemble, An AI-Based Mental Health Coach</a></li><li>Hashed Health: <a href="https://www.newswire.com/news/leading-healthcare-and-blockchain-investors-join-hashed-health-effort-21528494" target="_blank">Leading Healthcare and Blockchain Investors Join Hashed Health Effort to Accelerate Digital Transformation</a></li><li>Health Gorilla: <a href="https://finance.yahoo.com/news/health-gorilla-announces-intention-become-153000805.html" target="_blank">Health Gorilla Announces Their Intention to Become a Qualified Health Information Network</a></li><li>Hello Heart: <a href="https://medcitynews.com/2021/10/hello-heart-study-shows-potential-for-digital-tools-to-help-manage-blood-pressure/" target="_blank">Hello Heart study shows potential for digital tools to help manage blood pressure</a></li><li>Histolix: <a href="https://www.prweb.com/releases/histolix_launches_direct_to_digital_pathology_read_diagnostic_equivalency_clinical_trial/prweb18268197.htm" target="_blank">Histolix Launches Direct-to-Digital Pathology Read Diagnostic Equivalency Clinical Trial</a></li><li>Jasper Health: <a href="https://www.prweb.com/releases/jasper_health_and_imerman_angels_partner_to_match_jasper_members_with_cancer_care_mentors/prweb18232187.htm" target="_blank">Jasper Health and Imerman Angels Partner to Match Jasper Members with Cancer Care Mentors</a></li><li>Limbix: <a href="https://www.healio.com/news/psychiatry/20211014/limbix-announces-smartphone-tool-for-treating-youth-depression" target="_blank">Limbix announces smartphone tool for treating youth depression</a></li><li>Mediktor: <a href="https://www.mediktor.com/en-us/blog/mediktor-raises-13m-round-for-its-ai-triage-and-pre-diagnosis-medical-assistant%25ef%25bf%25bc" target="_blank">Mediktor raises $13m round for its AI-Triage and pre-diagnosis medical assistant</a></li><li>Microsoft: <a href="https://mspoweruser.com/microsoft-for-startups-founders-hub/" target="_blank">Microsoft announces the launch of Microsoft for Startups Founders Hub</a></li><li>Microsoft: <a href="https://www.healthcaredive.com/news/microsoft-integrates-health-specific-cloud-offering-with-cerner-ehr/608491/" target="_blank">Microsoft integrates health-specific cloud offering with Cerner EHR</a></li><li>Neuroflow: <a href="https://www.theprogressnews.com/news/state/experts-in-the-medical-community-align-to-bridge-gaps-in-behavioral-healthcare-with-neuroflow-formalizing/article_efa13e0b-084c-50e7-a193-9c9a30376cb4.html" target="_blank">Experts in the Medical Community Align to Bridge Gaps in Behavioral Healthcare with NeuroFlow Formalizing Clinical Advisory Board</a></li><li>Papa: <a href="https://www.fiercehealthcare.com/tech/papa-uber-health-team-up-to-coordinate-rides-for-seniors-to-tackle-social-isolation" target="_blank">Papa, Uber Health team up to coordinate rides for seniors to tackle social isolation</a></li><li>PopHealthCare: <a href="https://www.prnewswire.com/news-releases/pophealthcare-launches-emcara-health-301396978.html" target="_blank">PopHealthCare Launches Emcara Health</a></li><li>Reemo Health: <a href="https://www.prnewswire.com/news-releases/reemo-health-enters-into-know-how-agreement-with-mayo-clinic-for-tech-enabled-cardiac-rehab-and-maintenance-301402539.html?tc=eml_cleartime" target="_blank">Reemo Health Enters Into Know-how Agreement With Mayo Clinic For Tech-enabled Cardiac Rehab And Maintenance</a></li><li>Salesforce: <a href="https://www.salesforce.com/news/press-releases/2021/09/21/salesforce-launches-health-cloud-2/" target="_blank">Salesforce Launches Health Cloud 2.0, a Connected Platform to Help Deliver Health and Safety from Anywhere</a></li><li>Sanaby Health Acquisition Corp.: <a href="https://www.businesswire.com/news/home/20211014006145/en/Sanaby-Health-Acquisition-Corp.-I-Announces-Pricing-of-150-Million-Initial-Public-Offering" target="_blank">Sanaby Health Acquisition Corp. I Announces Pricing of $150 Million Initial Public Offering</a></li><li>Scripta Insights: <a href="https://www.prnewswire.com/news-releases/healthcare-bluebook-and-scripta-insights-partner-to-deliver-the-ultimate-member-cost-containment-solution-to-reduce-medical--pharmacy-out-of-pocket-spend-301401713.html" target="_blank">Healthcare Bluebook and Scripta Insights Partner to Deliver the Ultimate Member Cost Containment Solution to Reduce Medical &amp; Pharmacy Out-of-Pocket Spend</a></li><li>Sensely: <a href="https://www.prnewswire.com/news-releases/sensely-launches-virtual-primary-care-301401429.html" target="_blank">Sensely Launches Virtual Primary Care</a></li><li>Seqster: <a href="https://www.prnewswire.com/news-releases/seqster-joins-olives-marketplace-to-aggregate-patient-centric-healthcare-data-at-scale-for-payers-and-providers-301401835.html" target="_blank">Seqster Joins Olive&#39;s Marketplace to Aggregate Patient-Centric Healthcare Data at Scale for Payers and Providers</a></li><li>Sorcero: <a href="https://www.prweb.com/releases/medistrava_and_sorcero_partner_to_provide_ai_driven_language_intelligence_solutions_to_the_life_science_industry/prweb18271803.htm" target="_blank">Medistrava and Sorcero Partner to Provide AI Driven Language Intelligence Solutions to the Life Science Industry</a></li><li>Total Brain: <a href="https://www.prnewswire.com/news-releases/total-brain-introduces-heart-rate-variability-measurement-and-stress-management-tools-301403634.html" target="_blank">Total Brain Introduces Heart Rate Variability Measurement and Stress Management Tools</a></li><li>Vim: <a href="https://www.prnewswire.com/news-releases/vim-partners-with-anthem-blue-cross-and-providence-st-joseph-health-for-tech-enabled-performance-acceleration-in-value-based-care-program-301397650.html" target="_blank">Vim Partners With Anthem Blue Cross And Providence St. Joseph Health For Tech-Enabled Performance Acceleration In Value-Based Care Program</a></li><li>Virgin Pulse: <a href="https://www.virginpulse.com/blog-post/virgin-pulse-announces-intent-to-acquire-welltok/" target="_blank">Virgin Pulse Announces Intent to Acquire Welltok</a></li><li>VisualDx: <a href="https://www.businesswire.com/news/home/20211018005163/en/VisualDx-Announces-Collaboration-with-Janssen-to-Pilot-New-API-and-Bring-Equitable-AI-to-the-Point-of-Care" target="_blank">VisualDx Announces Collaboration with Janssen to Pilot New API and Bring Equitable AI to the Point of Care</a></li><li>Vital Data Technology: <a href="https://www.prnewswire.com/news-releases/vital-data-technology-launches-affinit-insights-for-near-real-time-gap-closure-to-speed-up-targeted-intervention-and-support-value-based-care-models-301392080.html" target="_blank">Vital Data Technology Launches Affinitē Insights™ for Near Real-Time Gap Closure to Speed Up Targeted Intervention and Support Value-Based Care Models</a></li><li>Vitality: <a href="https://www.prnewswire.com/news-releases/findings-from-vitality-study-provides-blueprint-for-businesses-to-avoid-a-post-pandemic-workplace-failure-301402902.html" target="_blank">Findings from Vitality Study Provides Blueprint for Businesses to Avoid a Post-Pandemic Workplace Failure</a></li><li>Withings: <a href="https://www.medtechdive.com/news/withings-fda-nod-afib-detecting-wearable-apple-smartwatch/608119/" target="_blank">Withings gets FDA nod for AFib-detecting wearable, taking on Apple</a></li></ul>

Announcements Made at HLTH 2021

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Chief Medical Officer

Ever hit ‘Accept’ on the Terms &amp; Conditions of a newly downloaded app, skipped the fine print, and scrolled all the way down to move ahead? It’s a likely scenario, but now we’re facing the reality of what we may have agreed to. Up until recently, most of us fell for this standard practice, something the tech industry counted on and benefited from: gathering personal data from mobile devices and well beyond the app. What they did not account for was the consumer distrust of this sneaky behavior, developing very protective boundaries around the use of their private information, once becoming informed. For example, Apple recently updated its privacy label to clearly reveal how data is obtained, giving the consumer a choice. At that time, a reported 95% of all Meta (formerly known as Facebook) users with an iPhone iOS opted not to share their data*. Social media platforms could expect a hit to their revenues and could see people start to leave the platform as a compromise of their non-health data privacy breeds mistrust. Healthcare industry is no different, but there’s time to correct the pattern Healthcare systems and payers are using consent forms in the same way and with a similar purpose, having patients sign away their rights to their data, and not fully explaining the multitude of secondary data sales (from operational improvements to clinical research) that they may have unknowingly agreed to share. As this becomes more apparent, if healthcare systems do not get out in front of this they risk consumers questioning the intent of their care teams and the security of their personal information. They can easily say, “if I pay for my services at the hospital, I expect that only the provider and I will access my data for my personal care. When did I agree to having my data re-used and re-sold?” Legally in almost all states, healthcare systems actually do own the data that they collect – though this is not apparent to many patients. Neither are the long-term repercussions if that data is ransomed, stolen, or used to make more expensive healthcare products or services that might be out of their price range. Healthcare systems and organizations have a vital opportunity to rebuild trust with their consumers by embracing privacy by consent and being transparent with the use of their data. Consumer as a Partner: Two-way trust system The opportunity is ripe for building consumer engagement around creating transparent methods of information gathering. Safely, securely, and in most recent cases, virtually, consumer engagement can be the differential consent-based business model that can harness user trust through reciprocal data sharing and rewards for participation. So, who is doing this right? One of the best examples of a privacy-based consent approach is the All of Us Research Program, led by the National Institutes of Health, with support from Scripps Research Translational Institute, where Dedalus has been conducting ongoing customer service with participants. With a unique and intimate view into this two-way engagement approach, it’s clear that consumer trust can be gained when there’s unwavering privacy in this current environment and they’re positioned as a key stakeholder. While stating ambitious goals of recruiting one million or more participants, the most notable part of the program is that it was designed around privacy and security, to build trust with communities, especially those who have been underrepresented in biomedical research, including racial and ethnic minorities, LGBTQ+ people, residents of rural areas, and other groups. As a trusted partner, Dedalus developed and maintains an ongoing FISMA Moderate security posture. In other words, <a href="https://www.dedalus.com/na/perspectives/all-of-us-research-program/" target="_blank">Dedalus</a> operates under an extensive set of security controls while engaging with participants and when collecting their healthcare data. Positioning participants as active partners, helping to guide efforts and decide how their data will be used for research, is only going to lead to more trust, discovery and interest in their wellbeing in the long term. The <a href="https://clicktime.symantec.com/3Er1xHV7YUpvYiSwEiSp5F97Vc?u=http%3A%2F%2Fjoinallofus.org%2F" target="_blank">All of Us</a> Research Program to date, has engaged more than 400,000 participants in sharing their data, and is the first of any program that provides information back to the participant, if interested, as a benefit of their participation. The participant is also made aware of the outcomes their data has served, developing a true partnership when the reciprocation is valued on both sides and utilized for the greater good of our future generations. *<a href="https://www.bloomberg.com/news/articles/2021-07-14/facebook-fb-advertisers-impacted-by-apple-aapl-privacy-ios-14-changes" target="_blank">https://www.bloomberg.com/news/articles/2021-07-14/facebook-fb-advertisers-impacted-by-apple-aapl-privacy-ios-14-changes</a> About Dr. George Mathew, CMO George Mathew, M.D. M.B.A, F.A.C.P. is the Chief Medical Officer for Dedalus Group, North America, and serves as the clinical informaticist, expert and healthcare thought leader to our customers in the transforming healthcare marketplace of payer, provider, life sciences and federal, state and local government healthcare businesses. His experience includes consulting, technology development, and business development work at GE, Goldman, Sachs and Co., WebMD, Pfizer, Medidata Solutions, and Aetna/CVS. Dr. Mathew brings a strong technology innovation focus to this role having founded a healthcare technology start-up earlier in his career and continues to advise several healthcare IT startups through the Health 2.0-NYC community. George is based in the greater New York City area and continues to practice medicine as a hospitalist.

Healthcare Data Privacy: Who's Doing It Right?

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VP and GM Watson Health, Life Sciences

Most see the promise and potential for <a href="https://www.ibm.com/watson-health/learn/healthcare-data-analytics" target="_blank">healthcare data analytics</a> to help address issues around quality, cost and access. But given the exponential growth of healthcare data – which is expected to have a compound annual growth rate (CAGR) of 36% through 20251 – organizations can quickly become overwhelmed on how to deliver real-world success with real-world data. The first, most important step in driving value from data and analytics is to clearly define: What problem are we trying to solve? This fundamental definition of the use case will guide better strategies for using real-world data and help organizations determine what they need to be successful. Once that definition is in place, organizations can evaluate all of the other aspects of using real-world data successfully. For example, they can better decide about what types of data they need, the level of quality of the data, how quickly data is accessible, and how well data sources are linked to one another. Of course, there are operational considerations, too, such as constructing a scalable data infrastructure, as well as managing data governance, privacy and consent management. There is a lot to consider, but perhaps the best way to illustrate the steps is to share how a couple of our clients have successfully used real-world data in the real world. Satisfying regulatory requirements with external control arms One of our clients, a small biomedical device company, had a product with a broader indication in the rest of the world than it had in the United States. It wanted to expand the US-labeled indication and align regulatory status globally. Because use outside of the US had clearly established efficacy and safety for this indication, the company did not want to conduct a randomized controlled trial. Fortunately for these situations, with the passage of the 21st Century Cures Act, the U.S. Food and Drug Administration (FDA) expanded the use of real-world data in the regulatory approval process. IBM Watson Health researchers created an external control arm from a patient registry using <a href="https://www.ibm.com/products/marketscan-research-databases" target="_blank">MarketScan Commercial Claims</a> and Medicare Supplemental Database. The client submitted the medical device submission to the FDA using an external control arm in late 2020. While official approval is still pending in this case, the <a href="https://www.ibm.com/blogs/watson-health/advantages-of-external-control-arm-studies/" target="_blank">appropriate use of external control arm studies</a> has the potential to save time and money for life sciences companies. Meeting the interoperability mandate, managing consent <a href="https://www.ibm.com/topics/interoperability-in-healthcare" target="_blank">Interoperability in healthcare</a>, the seamless and secure sharing of health data, has long been a goal for the industry. Regulatory requirements aim to hasten the industry’s progress toward true interoperability. HealthPartners, a national healthcare provider and payer organization, is managing an increasingly large and diverse amount of data. They recently selected IBM Watson Health to help them meet the recent U.S. interoperability mandate and go beyond the mandate to help deliver better experiences for patients and members. Moving to a <a href="https://www.ibm.com/products/fhir-server" target="_blank">FHIR server</a>, modernizing data ingestion and leveraging advanced analytics will enable this organization a secure, efficient health data exchange. This capability will help provide an interlocking, comprehensive view of information from providers, which can help personalize care. Vision for what’s next For too long, disparate data has led to fragmented care and incomplete information. Many organizations are still seeking that holistic, representative and insightful view of all of this data, including claims, clinical, imaging, labs, genomics and wearables. We believe that this vision will be the future of healthcare and life sciences. Because it’s not data, but rather the patient who is at the center of every meaningful healthcare endeavor.  (1) IDC White Paper, sponsored by Seagate, Data Age 2025: The Digitization of the World from Edge to Core, November 2018

How companies are using real-world data in the real world

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Co-Founder and CEO

In the United States, we spend significantly more of our GDP on healthcare than our peer nations. Yet, we rank at the bottom when comparing the quality and efficiency of healthcare delivery in our country – we all can agree that this is a problem that must be addressed. And it could be partially to blame for why one in five healthcare workers are walking away from the profession. One silver lining of the COVID-19 pandemic has been the added visibility given to alternative methods of healthcare delivery and sites of care. By reconsidering how we deliver care, namely the superior efficacy of care in the home, we are finally on the cusp of transforming the stifling cost of medicine in our country, while addressing our nation&#39;s overall health and well-being.  In Washington state, the epicenter of the U.S. coronavirus outbreak, the state&#39;s largest community-based non-profit health system MultiCare, partnered with DispatchHealth to address COVID-19 related surges in hospital capacity and fear-based deferral of health care. We worked collaboratively to meet the changing needs of the community by launching two pivotal programs, Hospital at Home and Clinic Without Walls. Two different Hospital at Home models launched: one under the CMS Waiver Program where patients were admitted from the hospital ER and one through DispatchHealth’s &quot;Advanced Care&quot; offering where patients were admitted through Dispatch’s on-demand, in-home mobile ER services. Clinic Without Walls addressed patients deferring treatment out of fear or inability to leave home by bringing the care to them. These patients were typically inappropriate for a simple video visit due to memory impairment or the complexity of their medical conditions. Leveraging technology and an enhanced video visit facilitated by an in-person, highly trained medical technician, the strategy allowed providers to remotely complete a more complex exam on those patients with chronic disease and comorbidities without the patient ever leaving home. An early snapshot of data revealed unprecedented patient satisfaction in both programs with an NPS score of +98. The partnership enabled MultiCare, a health system with more than a centuries-long legacy of excellence, to quickly right-size its care model while still focusing on a superior patient experience and the high-quality care its community expects.    In the United States, our healthcare system spends an unsustainable four trillion dollars (17% GDP). Research and experience back an estimation that 60% of patients in the emergency room setting, 25% of inpatient admissions and 20% of skilled nursing facility stays, roughly $340 billion of our annual spend, qualify for substitutive care in the home, where costs are 20% to 40% lower on average. Imagine the ability to use those dollars for issues like homelessness, hunger, and education.    To say the COVID-19 pandemic sparked a boom in complex home-based healthcare is like calling the musician who has worked years at mastering their craft an overnight success –DispatchHealth has been perfecting the practice of high acuity healthcare in the home for almost a decade and that work was built on the shoulders of maverick clinician-pioneers who came before DispatchHealth. And globally, we&#39;re late to this party! For example, every metropolitan and regional hospital in Victoria, Australia, has a hospital at home program. What the pandemic has done is raise broader awareness of care outside the four walls, as well as the inequity of care for some of our homebound and access-challenged populations. We&#39;ve witnessed hundreds of thousands of patients use telemedicine for the first time or have their first house call in the case of DispatchHealth. ER utilization hasn&#39;t rebounded to pre-COVID levels. I suspect that those patients got a taste of a more convenient personalized care solution that costs a lot less.    For executive leaders managing health systems, meeting the changing demands of patients is time sensitive. The value of partnering to scale complimentary service lines that enable fewer avoidable emergency room visits, hospital admissions, or stays at skilled nursing facilities using an evolved hospital-like setting without walls. This enhanced approach to care empowers clinicians to go beyond traditional clinical treatment settings and meet patients where they are, with the type of convenient care they are growing to expect.

We're Late to the Party and Don't Even Know It: An Immediate Fix for America’s Ailing Healthcare Delivery System

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US Life Sciences & Health Care leader

Most business leaders I talk with—particularly in health care and life sciences—want to do more to improve health equity, but they often don’t know where to start. Government, community, and leaders of non-profit organizations sometimes struggle with the best ways to organize the ecosystem so that improvements in health equity are sustained and significant. The first step is to recognize that health equity is an outcome. It’s not a program, initiative, or effort. It is the core business of life sciences and health care. Health equity is the fair and just opportunity for every individual to achieve their full potential in all aspects of health and well-being. Health equity can be measured by health disparities, which are preventable differences in health outcomes across different population groups. Health inequity is especially apparent along lines of race, with Black, Indigenous, and People of Color (BIPOC) experiencing barriers that lead to poorer health overall when compared to white populations.  COVID-19 highlighted the stark health inequities in society. We see this both in the US and globally. In the US, Black, Latinx, and Native Americans have been dying at a significantly higher rate from the disease.1 Before we can improve health outcomes, we should first address health inequity. For example, if vaccination rates for BIPOC populations achieved parity with overall population rates, we are likely to see much lower rates of infection and fewer deaths across all communities. Announcing the Deloitte Health Equity InstituteWe believe we have a collective opportunity to address the challenges of the past, heal the present, and build a more resilient health care ecosystem for the future. Health equity is an issue we have been working to improve—internally and externally—for the past decade. Last summer, we published a blog acknowledging <a href="https://www2.deloitte.com/us/en/blog/health-care-blog/2020/racism-is-a-public-health-crisis.html" target="_blank">racism as a public health crisis</a>. We are now investing in a more focused approach to help health care and life sciences organizations, their leaders, and their communities achieve health equity as an outcome.The <a href="https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/health-equity-institute.html" target="_blank">Deloitte Health Equity Institute</a> will help identify and address challenges related to health equity. Why an institute? We have been doing pro bono work on racial equity and health equity and have been seeing patterns of impact. We recognize that health care and life sciences leaders are hungry for data, analytics, and insights. (There is no playbook for improving health equity). We see a need for a convener that can identify which approaches are most effective and openly share them within the health care ecosystem and the public. Through the Health Equity Institute, we will provide insightful data and relevant research that companies may find useful as they work to improve health equity. 8 questions for Kulleni Gebreyes, M.D., director of Deloitte’s Health Equity InstituteDeloitte is passionate about working to address the disease of racism in collaboration with our clients and broader communities. We want to open a dialog about effective and impactful strategies to prevent, treat or cure this disease. We established the Deloitte Health Equity Institute to share our most impactful learnings, to extend the efforts of others, and to make meaningful contributions to broader health-equity issues. I recently spoke with Dr. Kulleni Gebreyes, the Institute’s director, about the importance of health equity for our clients, their customers, and the communities they serve. Asif: How is Deloitte responding to health care and life sciences organizations that are working to improve health equity?Kulleni: Deloitte, in particular our health care and life sciences practice, has been working on equity-related issues for decades. This is not new. The confluence of the COVID-19 pandemic and the recent movement toward greater social consciousness made us realize that we need to be models for change. We also want to help business leaders who are ready to take the first, or next step. They shouldn’t have to wait for regulations and rules before they make changes…they have everything they need right now to lead change. We are demonstrating how we work collectively with not-for-profits, community-based organizations, governments, and communities to make an impact. The Health Equity Institute will provide financial support for many not-for-profits and community-based organizations to help them drive the same agenda. We are modeling the behaviors and the change we want to see in the world. Asif: What are the challenges for health care and life sciences leaders who want to have an impact on health equity?Kulleni: This is a vast and complex issue. One of the biggest challenges for business leaders is deciding where or how to start. Data can often help illustrate the barriers to health equity and the root causes of health care disparities (i.e., differences in outcomes). Business leaders should know what programs to implement and whether those programs are having the impact they anticipated. The investment of resources and time also should be aligned with their overall business strategy. For example, Deloitte has been leveraging our data to identify vaccine deserts, which can help our clients pinpoint where to establish vaccination sites and mobile clinics. We track hundreds of variables, including drivers of health (also known as social determinants of health), and other health access indicators. This helps us understand what matters and how it matters. We use this information—and other data from the ecosystem—to identify communities that can benefit from a wide array of health equity programs. Asif: Recognizing that where and how to start is a big challenge. What guidance would you give business leaders who are ready to act?  Kulleni: We offer a construct to help business leaders consider the roles they can play and the challenges they should try to address. More specifically, we have identified four domains that health care and life sciences business leaders should consider as they continue their efforts to improve health equity:<ol><li>Our organization: How can we reimagine our approach to diversity, inclusion, and belonging to advance equity among our workforce, and to address their unmet social needs? Data gathered from an organization’s employees, for example, might be useful in designing more equitable employee-benefit programs. Some organizations might consider mandating cultural competency and implicit bias training for all employees.</li><li>Our offerings: How can our products and/or services more effectively meet the needs of our patient population across demographic groups? A health plan, for example, might address health equity through its benefit designs, or use a value-based payment model to reward network providers that demonstrate equitable outcomes. Life sciences companies might use a health-equity lens when evaluating their R&amp;D processes. All leaders should ask if equity is being incorporated into new products and services. </li><li>Our community: How can we serve our local communities as health equity leaders? Every organization has a corporate and social responsibility. Health care, life sciences, and public health organizations should evaluate their community partnerships and look for ways to become better partners. Strategically investing in communities could build upon existing assets while also helping to fill gaps. Partnering with traditional competitors could help to magnify the impact on health equity.</li><li>Our ecosystem: How do we strategically amplify our positive impact through our vendors, partners, and public platform? Consider diversity when selecting vendors and suppliers. Urging vendors and business partners to emphasize diversity could further amplify the overall health equity initiative. </li></ol>Asif: As we think about “the organization” domain, what is the relationship between diversity and the workforce?Kulleni: Diversity, equity, and inclusion, and health equity, are interrelated and interdependent, meaning that one can’t advance one without advancing the other. Health equity means everyone has a fair and just opportunity to achieve health and well-being. Diversity means that people of various races, ethnicities, and sexual orientations are represented in leadership and throughout the organization. But diversity doesn’t occur naturally. It has to be done intentionally. Organizations typically hire for cultural fit. Business leaders should rethink their talent-recruitment strategy when it comes to diversity. Asif: The pandemic highlighted health inequities. How did equity factor into the development and distribution of the COVID-19 vaccines?Kulleni: Let’s start at the beginning. A lack of diversity in clinical trials—and follow-on real-world data—creates multifactorial issues. COVID-19 moved those issues to the forefront. A human-centered, equity-based design requires that clinical trials for all drugs—and specifically the vaccines—should have appropriate representation. When clinical trials and real-world data include women and racial minorities, the product is no longer defaulting to a white male. Drugs that are primarily tested on white men might not have the same impact on women, or people of different ethnicities. For vaccine distribution, many organizations have tried to make doses available to communities. As you mentioned <a href="https://www2.deloitte.com/us/en/blog/health-care-blog/2021/building-covid-19-vaccine-confidence.html" target="_blank">in your recent blog</a>, Deloitte helped one state identify and evaluate vaccine deserts. We also worked with a major teaching hospital to set up vaccination clinics aimed at lower-income and/or mobility-challenged residents. Data that includes the diversity of research used to develop the vaccine might be useful in swaying people who are on the fence. If the trials weren’t diverse, some people might wonder if the vaccine will work for them, or if they will suffer different side-effects.  Asif: What do you see as the connection between health equity and the <a href="https://www2.deloitte.com/content/dam/Deloitte/de/Documents/life-sciences-health-care/DI_Forces-of-change_Future-of-health-g.pdf" target="_blank">Future of Health</a>?Kulleni: Over the next 20 years, we expect that the definition of ‘health’ will be much broader than it is today. It will include mental, emotional, social, spiritual, and financial well-being, as well as physical health. Equity is at the center of this vision. We expect consumers will have access to their own health data, and interoperability. They will allow them to share this information with their clinicians, who will be focused on detecting and preventing disease…rather than merely treating it. The Future of Health is also an opportunity for health care and life sciences companies to improve health equity within their organizations. If you don’t have different groups represented in leadership and throughout the organization, it can be difficult to design equitable therapies, equitable products, or equitable services. In a future that is consumer-centric and focused on wellbeing and prevention, health equity can become a reality. A health equity lens is critical for better consumer engagement and a healthy community. Asif: As a clinician, did you see the impact of health inequities?Kulleni: Systemic bias and racism are being discussed openly today in a way that we haven’t seen before. But there are also subconscious biases and clinicians are no more immune to that than anyone else. When I was working as an emergency room physician, I saw the manifestation of health inequities through individual biases, structural biases, and barriers to care. Some patients received a different level of care based on their race, ethnicity, or gender. For example, some studies have shown that the type or amount of pain medication prescribed to a patient is influenced by race, gender, ethnicity, and language. There are also economic inequities that should be addressed. A low-income person might not have access to reliable transportation and might wind up missing important medical visits as a result. Environmental inequities also have an impact on health. Is the water safe to drink? Is the air safe to breathe? Where someone lives can influence their chances of getting cancer.  Asif: What are you hearing from clients? Are they moving with more of a sense of urgency?Kulleni: Ten out of 20 health care CEOs that we surveyed recently say health equity is one of their top three priorities. Based upon interviews with 28 additional health care executives, we found that most organizations are starting at different points and are moving at different paces. However, they are all headed in the same general direction. Some organizations have had a chief health equity officer for a decade or more. Others have been focused on identifying the problem and areas where they can have an impact. For some life science and health care organizations, the pandemic converted health equity from a program and a set of initiatives to a strategic imperative for the overall organization and the board. Even executives who have always prioritized health equity realize that they can be doing more. There is a recognition that health equity is structural, institutional, and systemic. There also appears to be an understanding that opting to do nothing will likely only perpetuate this issue. ConclusionGovernment agencies, community groups, public health organizations, and life sciences and health care companies are growing increasingly passionate about having a meaningful impact on health equity. It is clear that we all need blueprints for action. We all require data, insight, and models that show us how to engage the entire ecosystem so that we can leverage disruptive technologies to make a nonlinear impact in health equity. The opportunity for exponential change is real and now. Endnotes1.   COVID-19 hospitalization and death by race/ethnicity, CDC, August 18, 2020; Health equity considerations and racial and ethnic minority groups, CDC, July 24, 2020

Deloitte’s new Health Equity Institute urges a business solution to address a moral imperative

Blog - 0101

Chief Technology Officer

Hospital leaders have faced unexpected surges in patient demand, meaning the ability to anticipate and adapt to rapidly changing circumstances is more important than ever. What if we could predict potential bottlenecks in patient flow in real time – and prevent them before they occur? Hospitals around the world have long faced challenges with bed and staffing shortages to meet demand for acute care, a situation that has been exacerbated by the pandemic. Across the world, emergency departments (EDs) manage overcrowding even in ordinary times, with intensive care units (ICUs) often operating at or near capacity. The result, all too frequently, is waits and delays, leading to frustration, anxiety, and potentially harmful outcomes in patients, while increasing pressure on staff [1]. While our first reaction may be to assume that more beds and more staff are needed, the real issue is often not a lack of resources per se, but one of patient flow: anticipating and knowing when to transition a patient from one care setting to the next. It’s a dynamic and fast-moving challenge.  Managing patient flow calls for an enterprise-wide view across different parts of the hospital or hospital network, something that is often missing. With clinical and operational data dispersed across disparate systems, care teams lack wider situational awareness beyond their unit or department. This lack of readily available and actionable information can hamper patient prioritization, slow down patient transitions, and lead to unforeseen bottlenecks in patient flow. The COVID-19 crisis has highlighted many of these challenges, while also encouraging smart thinking around tackling them. Healthcare providers are sharing data in real time to visualize untapped capacity, facilitate patient transfers and to forecast and prepare for future demand. Using the power of AI and predictive modelling, we can extract relevant insights on patient flow and patient care needs from vast amounts of real-time and historical hospital data, to predict capacity needs in the next 24 to 48 hours. As we move to a post-pandemic era, we have the opportunity to embed these data-driven practices into everyday management of patient flow – from hospital admission all the way to hospital discharge and, ultimately, monitoring in the home.  Managing transitions across care settings with AI A typical scenario might involve a patient being taken to the hospital with heart palpitations and shortness of breath. While en route, a notification is sent to the patient flow coordinator in a central command center who oversees current and predicted patient capacity across a network of hospitals.  With an instant picture of which hospitals have beds available, the patient can be directed to a hospital where they can swiftly receive the care they need. While the patient is triaged in the ED, care teams can prioritize further clinical evaluation based on, among others, a machine learning algorithm that combines patient vital signs and physiological data to predict risk of health deterioration. And, with an up-to-date overview of bed availability across the hospital, the patient can be pre-allocated a bed in the right care unit, in close alignment with the team on the floor.  When the patient is stabilized in the appropriate critical care unit, patient flow teams can begin to plan the next steps in the care journey. Smart algorithms can help to estimate when the patient will be ready to be transferred to a lower-acuity care setting in the hospital for telemetry monitoring. Based on a transition review list that is updated dynamically, the patient flow coordinator can assist physicians in prioritizing clinical evaluation of patients who may be ready for transfer. Having sight of how many patients in the ED are waiting for an inpatient bed helps identify potential bottlenecks early and manage patient flow accordingly. Once the patient is deemed stable enough to be transferred to the medical-surgical unit, discharge readiness scores and readmission risk will provide a clear picture of when they are ready to be discharged.   Improving patient flow and reducing length of stay With thousands of patients flowing through a hospital network on any given day, it’s easy to see the benefits of having centralized clinical and operational insights to manage patient flow.  Rather than working in silos, healthcare providers can coordinate care across their entire enterprise. Coupled with the power of predictive analytics, it becomes possible to manage patient flow proactively from one care setting to the next, preventing congestion and overuse of critical resources.   For patients, it means they don’t need to stay in the hospital any longer than necessary. This, in turn, offers other patients a better chance of getting access to the critical care they need. As a result, healthcare enterprises can serve more patients, thereby reducing backlogs. Smoother patient flow can also benefit their bottom line. For example, one US hospital estimated that they could save $3.9 million annually by eliminating ED overcrowding through accelerated transfers to inpatient settings [2].  Extending care coordination from the hospital to the home In the future, centralized care coordination could be further extended into the home, using <a href="https://www.philips.com/a-w/about/news/archive/standard/news/press/2021/20210209-philips-completes-the-acquisition-of-biotelemetry-inc.html" target="_blank">remote diagnostics and monitoring</a> to keep a caring eye on patients as they resume their daily lives. As my colleague Roy Jakobs has outlined before, <a href="https://www.philips.com/a-w/about/news/archive/blogs/innovation-matters/2021/20210113-redefining-transitions-of-care-extending-where-and-when-care-happens.html" target="_blank">improving transitions between acute and post-acute care</a> is one of healthcare’s biggest opportunities as it becomes increasingly distributed. Again, this is where <a href="https://www.philips.com/a-w/about/news/archive/features/20200604-predictive-analytics-in-healthcare-three-real-world-examples.html" target="_blank">predictive analytics in healthcare</a> could make a difference.  Ongoing health monitoring at home has already demonstrated its value in managing chronic diseases such as COPD, with one pilot study in the US showing an 80% reduction in acute 30-day COPD readmissions and $1.3 million in savings [3].  Ultimately, that is how future healthcare systems will manage patient flow more effectively and efficiently across the patient journey – relying on data-driven decisions to ensure that the right patient gets the right care in the right place at the right moment. With greater understanding of patterns in patient demand and patient flow, healthcare leaders can also form long-term strategies for hospital capacity planning, making better informed decisions about the types of care settings and resources that are needed. Uncertainty will remain a part of healthcare, as it is in life. But by better forecasting what may happen next, healthcare systems will become more adaptive and resilient in the face of change and crisis. That’s a prediction I’m willing to make.   References[1] Rutherford PA, Anderson A, Kotagal UR, Luther K, Provost LP, Ryckman FC, Taylor J. Achieving Hospital-wide Patient Flow (Second Edition). IHI White Paper. Boston, Massachusetts: Institute for Healthcare Improvement; 2020. http://www.ihi.org/resources/Pages/IHIWhitePapers/Achieving-Hospital-wide-Patient-Flow.aspx[2] Foley M, Kifaieh N, Mallon W. Financial Impact of Emergency Department Crowding. Western Journal of Emergency Medicine, Volume XII, no. 2: May 2011, 192-197. https://pubmed.ncbi.nlm.nih.gov/30193738/[3] Reducing hospital readmissions with integrated COPD care. Philips case study. [Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.] https://www.philips.com/a-w/about/news/archive/case-studies/20191001-reducing-hospital-readmissions-with-integrated-copd-care.html

The role of AI in helping hospitals forecast and manage patient flow

Blog - 0100

Director, BARDA Alliance

Director of Division of Research, Innovation, Ventures at BARDA

No two people are the same. Not only do our genetic make-ups differ, but also the choices we make and the choices that are made for us – including education, employment, how we live, where we live – are among the many variables that influence our health outcomes. Furthermore, as we progress from infant, child, to adult, and older adult, our vulnerabilities to disease also drastically change.  These differences can cause vastly disproportionate experiences to shared public health crises. While public health crises impact everyone, rarely are there one-size-fits-all solutions across all populations. So how can we be better prepared to protect all people, particularly high-risk populations, from known and unknown pathogens and their consequences?  A more prepared future is one that’s equipped with inclusive medical countermeasures (MCMs) that can shield diverse populations from emerging pathogens.1 Forging this future could start today with the help of <a href="https://jlabs.jnjinnovation.com/blue-knight" target="_blank">BLUE KNIGHT™</a> – a joint initiative between Johnson &amp; Johnson Innovation – JLABS (‘JLABS’) and the Biomedical Advanced Research and Development Authority (BARDA).  Joining Forces to Support Startups Through the ‘Valley of Death’ BARDA’s remit is clear: it aims to develop and make available MCMs that address the consequences of chemical, biological, radiological and nuclear (CBRN) threats, pandemic influenza and emerging infectious diseases.2 One of its main objectives is to equip entrepreneurs at any stage with the tools necessary to enable the successful development of innovative approaches against health threats. This goal directly supports the mandate of its parent organization, the Office of the Assistant Secretary for Preparedness and Response (ASPR). ASPR is tasked with leading the U.S. in “preparing for, responding to, and recovering from the adverse health effects of emergencies and disasters by supporting our communities’ ability to withstand adversity, strengthening our health and response systems, and enhancing national health security.”2 When it comes to global infectious diseases, no one community can be completely safe until all communities are safe – so the development of future MCMs must both recognize health equity gaps and work to solve them. The Johnson &amp; Johnson Family of Companies is supporting this goal with its <a href="https://www.jnj.com/our-race-to-health-equity" target="_blank">Race to Health Equity</a>, recognizing urgency to expand and accelerate commitment and momentum to eradicating racial and social injustices. One aim is to forge collaborations that have the potential to foster better outcomes and profoundly change the trajectory of health for humanity.  Through Blue Knight, the strengths of our two impactful organizations fuse together to build an inclusive entrepreneurial ecosystem. We aim to help guide startups past the “valley of death,” by connecting them with our networks, incubating ideas and encouraging residents to address the needs of multiple populations, particularly those most vulnerable or at-risk. Breaking Down Silos to Build Up Solutions COVID-19 exposed many substantial, underlying health inequities, including disparities among racial and socioeconomic minorities, elderly populations, immunocompromised patients, and those in rural or underserved communities.3,4 We believe innovators must understand the unique needs of different populations and develop bespoke approaches to address these population-specific gaps. Blue Knight aims to support innovation across the full preparedness spectrum—from detection to prevention, treatment, and prediction. These approaches expand beyond traditional classes of MCM products (e.g., therapeutics, diagnostics, and vaccines), and leverage emerging science and technology that support the development of next generation MCMs.  One key area of opportunity is accelerating diversity and inclusion within clinical trials. <a href="https://jlabs.jnjinnovation.com/JLABSNavigator/company/Acclinate_Inc." target="_blank">Acclinate, Inc</a>., a Blue Knight company based at JLABS @ Washington, DC, aims to tackle this with their HIPAA compliant platform utilizing predictive analytics and machine learning to identify diverse individuals most likely to participate in research.5 The company pairs their technology with an intentional, phased approach to educating and empowering diverse individuals by improving access to relevant and reputable resources.  Another area of focus for Blue Knight is designing better solutions to protect vulnerable populations on either side of the age continuum.  Individuals with a lower immune response—including our older adult populations—may be at increased risk if vaccines are less effective at enhancing their immunity. <a href="https://jlabs.jnjinnovation.com/JLABSNavigator/company/7_Hills_Pharma" target="_blank">7 Hills Pharma</a>, a Blue Knight company residing at JLABS @ TMC in Houston, Texas, aims to address this challenge with a first-in-class oral adjuvant that enhances antigen-specific immune responses and may increase the effectiveness of infectious disease vaccines for geriatric populations.6 The lead compound, 7HP349 allosteric activator, is in Phase 1 clinical testing.  While COVID-19 initially put older adults at risk,3 what if the next pathogen is of greatest threat to our children? Children represent 22% of the country’s population,7 and more importantly, they’re the future. Despite this, we rarely design solutions specifically for the unique physiology and care requirements of children – leaving children with far fewer medical options. From solutions tailored to all vulnerable age groups to addressing heightened infection severity due to pre-existing conditions or poor access to quality care – we need solutions for all. Moving Towards More Equitable Preparedness Together  When the needs of certain populations remain unmet, such as when MCMs, by nature of their design, are easier to deploy in more densely populated urban areas (e.g., due to cold-chain storage requirements or reliance on specialized health care workers to administer), it can undermine overall effectiveness and make us all vulnerable. To be prepared for the next global threat, we feel we must prioritize this public health issue and be visionary in developing inclusive, population-centric solutions. If you’re working on potential preparedness solutions for vulnerable populations, <a href="https://jji.jnj/3BAQvxj" target="_blank">sign up</a> to share your startup’s approach with Blue Knight!  (1) <a href="https://www.whitehouse.gov/wp-content/uploads/2021/09/American-Pandemic-Preparedness-Transforming-Our-Capabilities-Final-For-Web.pdf?fbclid=IwAR2RfWqBfdI6ZcrXUPmA8JfveVxXB33zv6lav4vJ5xqSq30a3XXU2WPAJn0" target="_blank" style="font-size: 9px;">The White House</a>. American Pandemic Preparedness Report. Accessed: Sept 2021. (2) <a href="https://www.phe.gov/about/barda/stratplan/Pages/introduction.aspx" target="_blank" style="font-size: 9px;">U.S. HSS</a>. BARDA Strategic Plan. Accessed: September 2021.  (3) <a href="https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html" target="_blank" style="font-size: 9px;">CDC</a>. COVID-19 People With Certain Medical Conditions. Accessed: Sept 2021. (4) <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html" target="_blank" style="font-size: 9px;">CDC</a>. Introduction to COVID-19 Racial and Ethnic Health Disparities. Accessed: Sept 2021.  (5) <a href="https://jlabs.jnjinnovation.com/JLABSNavigator/company/Acclinate_Inc." target="_blank" style="font-size: 9px;">Johnson &amp; Johnson Innovation – JLABS Navigator</a>. Acclinate, Inc. Accessed: Sept 2021. (6) <a href="https://jlabs.jnjinnovation.com/JLABSNavigator/company/7_Hills_Pharma" target="_blank" style="font-size: 9px;">Johnson &amp; Johnson Innovation – JLABS Navigator</a>. 7 Hills Pharma. Accessed: Sept 2021. (7) <a href="https://www.childrensdefense.org/state-of-americas-children/soac-2021-child-population/#:~:text=In%202019%2C%20there%20were%20over,percent%20of%20our%20nation&#39;s%20population" target="_blank" style="font-size: 9px;">Children’s Defense Fund</a>. The State of America’s Children. Accessed: Sept 2021.

BLUE KNIGHT™: Building the Shield to Protect Vulnerable Populations

HLTH Foundation

Blog - 0099

At its best, the capability of the American healthcare system is inspiring: we can transplant human limbs and design mRNA vaccines. But at its worst, American healthcare is fallible to the same injustices that pervade our society. The odds of a person receiving the care they need varies dramatically by gender, race, and geography, resulting in a system that leaves many Americans harmfully in the lurch. I believe we can deploy digital health to build the equitable, trustworthy healthcare system that all Americans deserve. Research demonstrates that <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.114.001612" target="_blank">women</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5478215/" target="_blank">non-binary people</a> are consistently less likely to be believed when they express concerns about their symptoms. Even when supported with objective clinical data, <a href="https://www.aamc.org/news-insights/how-we-fail-black-patients-pain" target="_blank">Black and brown people</a> are less likely to be offered tests and treatments. People who live in rural America and people who live in redlined neighborhoods of urban America are less likely to have access to <a href="https://www.ers.usda.gov/webdocs/publications/93141/eib-209.pdf" target="_blank">healthy food</a>, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(19)30241-4/fulltext" target="_blank">safe environments</a> and <a href="https://www.npr.org/sections/health-shots/2020/11/19/911909187/in-u-s-cities-the-health-effects-of-past-housing-discrimination-are-plain-to-see" target="_blank">other basic means of wellbeing</a>.  As an OB/GYN, my perspective on our healthcare system is informed by people who are starting or growing their families. Each journey to parenthood is personal and punctuated by moments of vulnerability. For people who live at the intersection of gender, racial and geographic inequities these journeys can quickly turn from joyous to devastating. A Black pregnant person in America is <a href="https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer" target="_blank">three to four times more likely</a> to die during childbirth than a white woman, irrespective of her education or income level.  In the wake of a global pandemic that put these inequities into stark relief, the federal government has identified healthcare as a key element of the national infrastructure in urgent need of repair. The provisions of the <a href="https://underwood.house.gov/media/press-releases/black-maternal-health-caucus-co-chairs-underwood-and-adams-celebrate-historic" target="_blank">Build Back Better Act</a> feature some of the most ambitious healthcare investments in our nation’s history, including a sweeping “Momnibus” package to expand the workforce in maternal health and support the development of digital strategies. While much has been made about the dollars pouring into the space, the opportunity is to deploy this capital intentionally to create a system that works for everyone.  Women are half the population and <a href="https://www.hcup-us.ahrq.gov/faststats/NationalDiagnosesServlet" target="_blank">childbirth is the most commonly used healthcare service</a>. <a href="https://www.marchofdimes.org/partner-the-healthcare-costs-of-having-a-baby.pdf" target="_blank">One out of every four hospitalizations</a> in the United States is either a mother or a baby after a birth. The <a href="https://www.hcup-us.ahrq.gov/reports/statbriefs/sb107.pdf" target="_blank">total cost of those hospitalizations is 0.6% of the entire US GDP</a> — roughly comparable to the value added to the US economy by the <a href="https://fred.stlouisfed.org/series/VAPGDPAER" target="_blank">arts and entertainment industries</a>. In the broader effort to reform healthcare, the needs of people who are building their families is a sensible focus and investors have taken notice. In August, <a href="https://mavenclinic.com/" target="_blank">Maven Clinic</a>, where I serve as chief medical officer, helped lead the women’s and family health category to a record-breaking fundraising year. And an increasing number of startups have sprung up to address the spectrum of needs across reproductive health services. <a href="https://www.heyjane.co/" target="_blank">Hey Jane</a>, provides seamless access to medical abortions; <a href="https://www.onstella.com/" target="_blank">Stella</a> ensures women are well supported during menopause; <a href="https://irthapp.com/" target="_blank">Irth</a> (as in “Birth without the B for Bias”), has taken off as a Yelp-like platform for and by Black women to share trustworthy reviews of childbirth providers. These companies represent an unmistakable shift toward care models that center the patient and by design, affirms individuals and their lived experiences as the core value proposition.  In 1971 political philosopher John Rawls described a principle that became foundational to the liberal perspective on justice. To design fair systems, he said we should imagine ourselves behind a “veil of ignorance” that keeps us from knowing who we are. If we did not know our gender, race or geography, he argued, we would almost certainly ensure that our social systems serve the interests of the most vulnerable. In other words, we would design a health system that serves a pregnant Black woman in the Mississippi Delta just as well as it serves a white man in New York City. A half century later, the veil of ignorance is not just a thought experiment. Digital health has accelerated our ability to rebalance who is centered and ensure that gender, race and geography no longer determine whether people in America have the opportunity to thrive. How we use this ability is up to us.

Deploying Digital Health to Build an Equitable, Trustworthy Healthcare System

Blog - 0098

CEO & Founder

The mammoth efforts of governments, researchers, and health care institutions over the last year have shown us just how far we can collectively take our best ideas when we put our minds together. With lightning speed, revolutionary messenger RNA (mRNA) vaccines have been developed and used against the coronavirus that causes COVID-19, a defining global health challenge of our time.  But what happens when the crises caused by the pandemic are over? The world is jam-packed with great ideas that will either never get off the ground or take decades to move to market. For instance, it took nearly half a century for the innovations and research driving the development of the mRNA vaccines to impact the lives of patients.  It shouldn’t take a crisis to move the needle on innovation in healthcare. What are the roadblocks? Among various reasons, two seem to emerge: Some innovators don’t understand the complex healthcare ecosystem in which their ideas will evolve and many stakeholders haven’t adopted a process for identifying, developing, and scaling projects that could have the highest translational success rate.  Fortunately, there are solutions. For nearly two decades, my team and I have been fighting tirelessly to create what we think to be new therapeutic opportunities for patients while also paving a path for other innovators. To help entrepreneurs like myself, I realized it was critical to develop a model that serves as an on-ramp to innovation. This model has been fundamental to the growth of my own company, <a href="https://www.nanobiotix.com/" target="_blank">Nanobiotix</a>.  Communicating a Vision Nanobiotix has been one of the pioneers in the application of nanotechnology in medicine for more than 18 years. Our lead product candidate is a potential first-in-class radioenhancer called <a href="https://www.nanobiotix.com/effects-of-nbtxr3/" target="_blank">NBTXR3</a>. The concept behind this innovative product is simple: Leaning on the universal principles of physics, we designed nanoparticles that can be injected directly into virtually any solid tumor and activated by radiotherapy. The physical properties of these nanoparticles increase the dose of radiation delivered within the tumor without increasing the dose in surrounding healthy tissue, inducing significant tumor cell death. Data also show a potential priming of the immune system to attack the targeted tumor as well as metastatic tumors. But at the time Nanobiotix was founded, the medical application of nanomedicine was nascent, and explaining our unique physics-based approach to medicine had never been done before. We knew that translating our technology into a therapy that could help patients was the ultimate goal. We believed in the science — but how could we get the buy-in of investors, regulators, healthcare professionals, and the pharmaceutical industry? Only after we could describe what, why, and how we approached bringing new drugs to market were we able to inspire people to join and support us.  It was a little like being the first man on the moon: We only had one shot at telling people back on Earth what it was like to take that “first small step for man.” It was an exciting day when our efforts to translate our science and vision were successful. Our stakeholders — both internally and externally — not only understood our language, but they started speaking it as they shared our vision (now their vision!) to a wider healthcare ecosystem. Our first small step had become one giant leap forward, and the momentum helped carry us to our first <a href="https://www.globenewswire.com/news-release/2019/04/04/1797273/0/en/Nanobiotix-Announces-First-Ever-Radioenhancer-to-Receive-European-Market-Approval.html" target="_blank">European market authorization</a> for NBTXR3 to treat patients with locally advanced <a href="https://www.mayoclinic.org/diseases-conditions/soft-tissue-sarcoma/symptoms-causes/syc-20377725" target="_blank">soft tissue sarcoma</a> in 2019. Standardizing a Process to Support Innovation Helping other innovators take their own “first small step” became one of my passions. In 2012, I was elected vice president of the European Technology Platform on Nanomedicine (ETPN), an initiative led by industry in partnership with the European Commission to address the application of nanotechnology in healthcare and provide guidance on the startups developing the best ideas, and helped found the ETPN’s <a href="https://etp-nanomedicine.eu/about-etpn/nanomedicine-translation-hub/" target="_blank">HealthTech Translation Advisory Board</a> (TAB).  When I first began my work with the board, there was no process for choosing these startups. With so many thousands of ideas to choose from, we didn’t have the bandwidth to focus on them all. We realized quickly that we needed to standardize the way we identified and accelerated the startups with the most opportunity to breakthrough and have an impact for patients. To do this, we set specific criteria based on scientific merit and industrial viability. By prioritizing startups that met our criteria, we were able to identify 50 proposals to support rather than trying to focus our energy on thousands of concepts and hoping for the best. For example, TAB beneficiary <a href="https://www.rubynanomed.com/" target="_blank">RUBYnanomed developed the</a> RUBYchip — the first non-invasive cancer progression monitoring device that isolates circulating tumor cells (CTCs) through liquid biopsy. Now this product will have an opportunity to have a meaningful impact on patient health. Giving Innovators an On-Ramp Unfortunately, in the world today, we don’t always select, and then support, the best ideas from concept to market.  For 40 years, biochemist Katalin Karikó believed in the therapeutic potential of synthetic mRNA to teach the cells in our bodies to make their own medicine. She sought grants and corporate funding to support her work, but she was again and again <a href="https://www.nytimes.com/2021/04/08/health/coronavirus-mrna-kariko.html" target="_blank">denied</a>.  Undeterred, Karikó eventually proved that yes, we can design mRNA and potentially use it to create <a href="https://www.statnews.com/2020/11/10/the-story-of-mrna-how-a-once-dismissed-idea-became-a-leading-technology-in-the-covid-vaccine-race/" target="_blank">proteins that might vaccinate against disease</a>, mend damaged tissue, or even reverse certain diseases. Despite her innovative research, she wasn’t given much industry support, and she was left — with the assistance of only a few close colleagues — to translate her own vision.  Today, it’s hard to imagine a healthcare ecosystem that doesn’t include mRNA vaccines, but without Karikó’s dogged commitment, she might never have had the opportunity to lay the foundation over which a golden age of vaccinology was built. Of course, not all researchers share Karikó’s stamina, and it’s easy to see why, without the proper support, some of them might give up. To date, about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915619/#pmed.1002049.ref001" target="_blank">1 million</a> papers from clinical trials have been published. While billions of dollars are spent each year on this research, about 85 percent of it fails to make a practical impact.  In the world of healthcare, untold numbers of great ideas fizzle out before they ever have a chance. By carefully selecting and supporting novel projects, we can focus our efforts on those that are truly worthwhile. And when it comes time to finance and develop these projects, rather than wasting billions of dollars on ineffectual research and diverting resources from those opportunities to provide potentially life-saving opportunities for patients, we can spend a whole lot less to shape the ideas that truly improve, enhance — and even expand life for people around the world.

Building Better On-Ramps to Innovation to Improve, Enhance, and Expand Life

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Vice President and Chief Health & Science Officer

Women, including people who are assigned female at birth1 and those identifying as women, are underrepresented in scientific and clinical research, with profound consequences.  Biological females have anatomic, physiologic and genetic characteristics that affect their health. For example, they are more likely than biological males to develop osteoporosis due to hormonal changes, to injure their knees when playing sports due to the bone structure of their hips and knees, and after puberty, to experience depression for a variety of reasons.2 Emerging evidence also suggests that gender, which is associated with social constructs and differs from biological sex, also significantly influences health outcomes.3,4 One critical component of advancing health equity is to consider the role of women in the clinical research ecosystem. When women are underrepresented in clinical research – as study participants, clinicians, scientists and leaders – and when sex and gender are not explicitly considered in scientific studies, gaps in medical knowledge and ultimately poorer outcomes result. The industry must continue to use data and technologies and make systematic changes to help address this problem. Enabling more women to participate in clinical trials Women have faced several barriers when it comes to participating in clinical trials. A US Food and Drug Administration (FDA) 1977 guideline excluded biological females with childbearing potential from participation in phase I and II clinical trials of drugs until evidence of reproductive toxicity was available.5 The FDA did not reverse this restriction until 1993, which led to lasting effects and severe consequences.  One review of sex differences in pharmacokinetics in FDA-approved drugs found that, for most drugs, biological females had elevated blood concentrations and longer elimination times than biological males, which were not explained by differences in weight. These findings may account for more frequent adverse drug reactions among females, as medications typically have standard dosing for adults or may be prescribed by weight, but rarely account for sex-based differences in metabolism or elimination.6 Efforts to enroll more females in clinical trials have been slow to yield increases, with the consequence being “sex inequality that hides in plain sight.”7 There are signs of progress; representation of females in pivotal clinical trials for novel drug approvals, including sex-specific indications such as post-menopausal or post-partum conditions, has increased from 40% in 2015 to 72% in 2019.8 However, very few studies examine or fully characterize gender as a variable. Scientific publications often mistakenly use the terms sex and gender interchangeably, creating additional gaps and confusion, and leaving room for improvement in the science.  To make further progress, the industry must continue to improve access to clinical trials. Data and technology can help. Can <a href="https://www.ibm.com/products/clinical-development/features" target="_blank">decentralized trial technology</a> improve access for participation of females in decentralized trials? Can <a href="https://www.ibm.com/watson/health/resources/life-sciences-real-world-data/" target="_blank">real-world data</a> help organizations uncover insights about the full patient experience with medications, including sex and gender differences in treatment preferences and response? Moving forward will require using data and technology to surface insights for meaningful action. Empowering women to conduct and lead research Another way to increase focus on sex and gender issues in clinical research is to have greater representation within research and leadership teams. It is estimated that less than 30% of the world’s researchers are women.9  For decades, men have been known to publish more than women across scientific fields. One study found that, while women publish just as many papers as men year-to-year, women tend to have shorter careers.10 Another study demonstrated that parenthood largely accounts for this gap, by limiting the short-term scientific productivity of women.11 A survey of grant-funded academic physicians revealed that women spend 8.5 more hours per week on domestic activities than men, with women being more likely to take time off when childcare arrangements failed. Fortunately, this “parenthood penalty” appears to be decreasing over time, although new data suggest that the pandemic has exacerbated this gender difference, likely due to increased caregiving responsibilities taken on by women.12 Notably missing are robust data about these factors in non-binary individuals.  The lack of representation of women in the science and technology workforce is not new, and organizations have sought creative solutions. For example, IBM has programs dedicated to empowering women’s success in STEM with pioneering steps of hiring women for “high tech” jobs in 1934 and promising women equal pay for equal work in 1935.13   There have been many initiatives and resources devoted to supporting women’s professional advancement across industries. But <a href="https://www.ibm.com/thought-leadership/institute-business-value/report/women-leadership-2021" target="_blank">IBM’s global study, “Women, leadership, and missed opportunities,”</a> found that, despite increased awareness of imbalances, only one in four organizations make the advancement of women a top 10 priority. The 2021 study found that the pandemic may have driven more women out of the workforce, resulting in fewer women in the pipeline to fill executive roles than there were in 2019.14  Organizations should look at the structure of their policies and processes to ensure they are building a more equitable foundation. For example, higher education institutions should ensure tenure processes are family friendly. Businesses, like IBM, that offer paid parental leave so any parent can assume caregiving responsibilities for newborns, may help keep all birth parents on their career pathways. These somewhat simple steps can contribute to a more equitable organization. In institutions engaged in scientific or clinical research, such policies may also help to close the sex and gender knowledge gaps around treatment by ensuring diverse perspectives are brought to leadership decisions. While I’ve cited many statistics, studies and data to support statements in this blog, sex and gender equity in science and clinical research is also a deeply personal issue. As a female surgeon with a PhD in biomedical informatics, I’ve been the “first” many times in my career. While now well represented in many fields, I still routinely hear from brilliant young women who are discouraged at all levels of their education and training. And women have shared with me many experiences of times when their health, or the health of someone they love, has been at risk because of a legacy of health inequities.  Women deserve better. Now is the time to speak up and make key structural changes to help deliver better quality care for our friends, family members, colleagues, neighbors and ourselves. Learn more about <a href="https://www.ibm.com/watson-health" target="_blank">IBM Watson Health</a> or hear more from Dr. Jackson at her panel at HLTH 2021 (1) Assigned sex at birth is usually based on external anatomy, also referred to as biological sex or sex. https://www.uwmedicine.org/provider-resource/lgbtq/lgbtq-inclusion-glossary(2) National Institutes of Health Office of Research on Women’s Health Infographic: How Sex and Gender Influence Health and Disease.(3) https://www.who.int/news-room/q-a-detail/gender-and-health(4) https://www.jacc.org/doi/abs/10.1016/j.jacc.2015.10.067(5) https://www.fda.gov/consumers/free-publications-women/timeline-fda-accomplishments-womens-health-1993-present(6) Zucker, I., Prendergast, B.J. Sex differences in pharmacokinetics predict adverse drug reactions in women. Biol Sex Differ 11, 32 (2020). https://doi.org/10.1186/s13293-020-00308-5(7) Ibid.(8) https://www.fda.gov/media/143592/download(9) http://uis.unesco.org/en/topic/women-science(10) https://news.northeastern.edu/2020/03/05/do-women-publish-less-than-men-in-scientific-fields-turns-out-scientists-have-been-asking-the-wrong-question/  Note: This study does not specifically address non-binary people.(11) https://advances.sciencemag.org/content/7/9/eabd1996/tab-pdf Note: This study does not specifically address non-binary people(12) https://www.nature.com/articles/d41586-020-01294-9(13) https://www.ibm.com/employment/inclusion/downloads/empowering_women_in_tech_ibm_case_study.pdf (14) https://www.ibm.com/thought-leadership/institute-business-value/report/women-leadership-2021

Prioritizing women in scientific and clinical research

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President & CEO

The Carolyn Green Story Carolyn E. Green was a staunch advocate for women’s rights and a mentor for women leaders in STEM. At the height of her career, Carolyn was the Executive Director of Strategic Investments for Pfizer’s Worldwide Research and Development, where she was responsible for a strategic venture capital fund that invests in early-stage biotechnology companies aligned with Pfizer’s R&amp;D strategy. With more than 20 years of operating and investment experience, much of Carolyn’s career was devoted to translating emerging scientific ideas into novel therapies to address unmet medical need. I met Carolyn at a local women’s life sciences networking group, and we immediately connected. Over time we started to introduce family and friends and became good friends. She was a passionate life sciences leader and supporter of women in the life sciences, and our networks grew together over time. We were together with some close friends the night she fell ill, and the following week we all came together to support each other and her family through the unthinkable diagnosis and loss of hope that followed.  When we lost Carolyn, we all deeply felt the void, with her family affected most profoundly. The idea of creating something positive that could carry her name and her legacy was a small consolation that helped us to remember our love and care for her and do something positive that she would have been excited to be a part of. So, we founded the Carolyn E. Green scholarship to help young women that are pursuing post-graduate education and leadership in the life sciences, in memory of her leading voice. Carolyn Green was an inspiration and a force, an incredibly talented, loving, and intelligent woman who created a positive impact in the industry that will be felt for eternity and our grassroots efforts to give back to young women exemplifies her impact.  The Carolyn Green Scholarship  With this scholarship, funded by her peers, friends, and fans, Carolyn is being remembered for her tireless support of women seeking to build their leadership and executive opportunities in the life sciences industry. The scholarship supports other young women in post-graduate studies to help them develop business and leadership skills. Specifically, scholarship funds are awarded to advance women in business-related programs at a post-graduate level, in any accredited educational institution in the world. To be considered, applicants submit an essay detailing their educational choices, the rationale for their interest in life sciences leadership, their prior industry experience, and leadership goals. We invite women of all backgrounds to apply, and applications open in February each year and close in May. Scholarships are renewable with an application each year, for women continuing their studies. You can learn more <a href="https://carolynegreen.com/apply/" target="_blank">here</a>.  The Need A growing number of women pursue post-graduate study in science and medicine. Often, they begin their career working at a laboratory or in clinical development, but the pathway to business leadership is challenging. In 2020, only 6% of biotech’s CEOs were women. Industry representation of women was just 14%. The causes can vary. One established issue is that women are not promoted to roles with P&amp;L responsibility, a prerequisite for business leadership. The Carolyn Green Scholarship prepares awardees for P&amp;L roles by explicitly supporting business and leadership education. Our Why: Awardees “I feel so grateful to Carolyn in spirit for being such a dynamic and fearless leader. She was someone whom I aspire to be like and someone I would have asked to be my mentor. I appreciate those that put the scholarship together in her name so that students like me and all of us can do better in the world. The quicker we are to crossing that finish line with our education, the stronger we’ll be at our mission in advancing equitable healthcare for large patient populations. This scholarship has helped afford me to do just that and I thank you so much!” - Emily Williams, Key Account Manager, Pfizer Innovative Health “I was honored to receive a scholarship in memory of Carolyn E. Green – an intelligent, inspiring, and talented leader in the life sciences community. Financial support and mentorship from the Carolyn E. Green Foundation contributed to my Master’s in Public Health at Harvard University and has supported my career dedicated to patient engagement in clinical research. Over these past two years, I’ve met several passionate and energizing colleagues who have been positively impacted by Carolyn and her legacy; I celebrate Carolyn by continuing to uplift and support women around me as they pursue leadership opportunities, advance new therapies to address unmet medical needs, and improve public health.” - Ellyn Getz, Director, R&amp;D Patient Partnerships, CSL Behring Join Us! -- Presenting the 2021 Carolyn E Green Scholarship Awards at HLTH 2021 This year, in partnership with the HLTH Foundation, the Carolyn E. Green scholarship awards will be hosted at the <a href="https://www.hlth.com/event" target="_blank">HLTH</a> conference in Boston, MA on Tuesday, October 19th from 6-7:30 pm ET during the Women at HLTH/ShePowers Health Awards Reception at the Omni Boston Seaport Hotel. Join us to celebrate our three scholarship winners, honor Carolyn Green, and support gender equity for women leaders in the life sciences.

Carolyn E. Green Scholarship Award at HLTH 2021: Advancing Women and Honoring a Leader in the Life Sciences

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Founder & CEO

It is easy to forget that the supply chain is often as much a part of the patient care team as the provider or hospital. Secure, resilient, efficient supply chains are essential for every patient encounter as well as our national security. Supply chain leaders were thrown into dangerous and unfamiliar conditions during the pandemic. Their challenges required heroic and unusual efforts to ensure that the right products got to the right patients at the right time.It is important that we take stock in the lessons learned over the last year so that we can transform this important, undervalued, foundational component of our healthcare delivery system. Supply chains are complex, global and prone to disruption When infections surged in our communities last year, the rush on critical supplies broke the inventory systems, tracking systems and other processes that had been optimized for predictable demand and delivery.  Trinity Health’s Senior Vice President of Supply Chain, Ed Hisscock, is responsible for supply chain at 92 hospitals across 22 states. The pandemic forced Hisscock to think differently about his job. He quickly realized that little viable product was coming from state or national stockpiles. He had to figure it out locally.  Soon, a Ford subcontractor was supplying face shields and a local brewery was providing hand sanitizer. He collaborated with traditionally competitive local health systems on sourcing supplies. He helped start a consortium focused on sharing resiliency data. His ability to collaborate and innovate became a critical skill that saved the lives of patients and caregivers. Hisscock sees his team differently now. It includes a web of suppliers, manufacturers, raw materials sources, and stock locations. The value chain is focused on the patient and includes many internal, external, local, domestic and international stakeholders. So the members of his team rely on different software platforms and different sources of truth.  As a result, hospitals and suppliers struggle to understand how to tactically and strategically optimize what they do. “We are all duplicating each other’s work trying to curate what is true about a product or a vendor… it doesn’t make sense,” said Hisscock. “These duplicative, redundant, analogue processes are inefficient on a good day and crippling during a crisis.” Supply chain has always been a team-sport, but we play it without sharing the information the other members of the value chain need to be successful. We don’t typically share demand, utilization, and inventory data that would help plan production. We don’t share outcomes and patient experience that would help the community understand performance. We lack the incentives to share this and other valuable data with trading partners, often out of fear for leverage. Traditionally we have valued information asymmetric over transparency. That must change. The new supply chain model A growing number of providers and suppliers see a new, more collaborative approach on the horizon that re-balances the relationship between cost, security, and resiliency. And a growing chorus of public and private stakeholders, startups and investors are jumping to meet the challenge.  In June, the White House recently released its report EO 140171 which described the vulnerabilities of critical US supply chains and laid out a roadmap for building resiliency. Among the findings was the erosion of the “industrial commons,”2 too much focus on short term cost savings, and the absence of cooperative mechanisms that align supply chain stakeholders.3 Outside of Washington, health systems have been organizing into new networks designed to promote transparency and trust. The Healthcare Industry Resilience Collaborative (HIRC)4 is an award-winning resiliency initiative led by Spectrum Health, Mayo Clinic, and dozens of other health systems and suppliers who want to address the impact of supply chain disruptions on patient care. “We have to learn to collaborate around data and the supply chain jobs to be done,” says Bill Selles, Senior Director of Procurement at Spectrum Health and a founding member of HIRC. “These are not supply-side problems or demand side problems… they are industry problems that require an investment in industry solutions.” HIRC is actively developing the network and tools required to collectively address supply shocks, backorders, and supply chain transparency concerns using a variety of high tech and low-tech approaches. Venture capital funding seems to be increasingly focused on supply chains as well. Supply chains have never attracted the same level of investment as other sectors in healthcare and life sciences. However, in 2020, venture capital poured a record $12.6 billion into supply chain technology startups in North America.5  A transformation has begun.  Trends show that leading providers and suppliers are maturing from an internally focused, centralized approach that stresses unit cost and volume aggregation, to an external and patient-focused approach that stresses value creation with external stakeholders. Whereas most providers and suppliers have been focused on cost and efficiency, supply chain leaders are increasingly focusing on strategic collaboration and patient value. This transformation from internal trust towards external trust requires new thinking, new technologies, new processes and new incentives for sharing data across companies. Successful transformation will take time, investment and leadership. Until recently, there’s been too little funding for supply chain modernization, too little reward for supply chain innovation, and too few incentives to be a healthy supply chain partner.  That’s changing. Prepare for a flurry of new initiatives and collaborative networks designed to shore up our supply chains. The transformation has begun with initial efforts focusing on the sharing of data and improved communications. Over time the infrastructure and incentives for data sharing will mature towards a truly patient-centric, decentralized model. “Sudden supply chain disruptions are a growing threat to patient care,” says Selles. “It’s exciting to see our dozens of leading providers and suppliers coming together to reimagine how we operate as an integrated ecosystem to solve problems proactively and collaboratively. Now is the time to push the industry forward.” (1) https://www.whitehouse.gov/wp-content/uploads/2021/06/100-day-supply-chain-review-report.pdf?utm_source=newsletter&amp;utm_medium=email&amp;utm_campaign=the_white_house_plan_for_efficient_resilient_healthcare_supply_chains&amp;utm_term=2021-06-30(2) https://hbr.org/2021/05/the-challenge-of-rebuilding-u-s-domestic-supply-chains(3) https://hashedhealth.com/efficient-resilient-healthcare-supply-chains/(4) https://hircstrong.com/(5) Pitchbook Q4 2020 Emerging Tech Report: Supply Chain Tech(6) Adapted from 2015_Deloitte_HCLS_Predictions_2020_Supply_Chain_Supplement.pdf

The path towards efficient, resilient healthcare supply chains

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Senior Consulting Director, Health Navigation

COVID-19 and the start of an unprecedented pandemic forced an inescapable intersection of our personal and professional lives. Employee priorities changed and so has the conversation around benefits. With no industry untouched by the economic impact of the pandemic, employers have never been more burdened to both inventively protect their bottom line and gatekeep expendable benefits while also radically investing in their people. Fortunately, containing cost and delivering an employee-centric benefit offering do not have to be mutually exclusive.  There are three strategies employers can flex to reduce healthcare costs while driving true value for employees: 1. Invest in telemental health Over two-thirds of today’s workforce are wrestling with depression, anxiety or addiction. With constant headlines of violence and natural disasters flooding our inboxes and social media platforms, the heaviness of the world around us compounds that battle and adds stress to our day-to-day lives. For many, the rising delta variant cases have rekindled feelings of isolation, fear and hopelessness initially ignited by the pandemic. The already staggering accessibility and affordability gaps uniquely tied to the mental health sector have become deeper and wider over the last year – and employers simply cannot afford to be complacent in the problem for a moment longer.  Fortunately, telemental health is turning these long-time affordability and accessibility gaps upside down. At the touch of a button, sophisticated algorithms can match employees with leading licensed psychiatrists, psychologists or therapists uniquely fit to their preferences and clinical needs within minutes. The leading telemental health solutions boast of their vetting processes to secure the most qualified, results-proven provider pool, representing a broad range of specializations and backgrounds. Most solutions also have user-friendly scheduling apps to secure same-day appointments by way of video, audio or texting, making communication with a clinician not only convenient but driven completely by employee preference. The cost per session is dramatically lower than most cash prices with out-of-network clinicians and competitively aligned with standard in-network allowed amounts, making whatever cost-sharing arrangement a win-win for both employee and employer. Countless studies have revealed that employees with access to available, high-quality clinicians at an affordable price point are tapping into mental health support in ways they otherwise wouldn’t. What’s true for general medicine is true for mental health: improving accessibility to care promotes early intervention, which reduces high-cost interventions that stem from delayed care. Equipping employee populations with elevated mental health benefits reinforces the message that an employee’s wellbeing is a valued priority worthy of employer investment. 2. Deploy tiered networks Over the years, numerous employers have adopted “narrow network” strategies to cut both employer and employee costs. Narrow networks work by reducing the in-network provider pool to drive patients to a select group of providers, who (in exchange for the exclusivity and uptick in business) agree to a lower contracted pricing for services. While savings are realized via reduced premiums, the narrow network design only results in net cost savings if the narrow network is comprised of high-quality, cost-effective providers, and employees stay within the network.  Lower premiums mean very little if narrow network providers are ordering needless imaging or employees continue to see their beloved PCP of 20 years, who is now out of network. The narrow network design can often translate to employees as narrowed patient choice, which turns out to be one of the fastest, most effective ways of upsetting an employee. In our experience, narrowed network designs mean well, but the dollar savings never seem to outshine the navigation nightmares and benefit dissatisfaction that coincide with executing them. The better choice for saving employer and employee money without narrowing patient choice OR sacrificing quality is offering a tiered network. Without altering the broad in-network provider pool, tiered networking incentivizes consumers to use designated providers in exchange for lower out-of-pocket costs. This “<a href="https://tuftshealthplan.com/broker/why-choose-tufts-health-plan/tiered-network" target="_blank">smarter, not smaller</a>” strategy involves ranking in-network providers using case quality data around outcomes, episodic case-cost and (re)admissions. The providers with the best outcomes and cost-effective track records are given a designated distinction and employee cost-sharing is reduced when leveraged over non-designated or lower tier providers.  Cost savings from narrow network and tiered network designs both rely on successfully steering employees to new providers, but what makes tiered networking more successful is that it steers by incentivizing choice versus compelling it.  For tiered networks to succeed, it comes down to incentivizing the use of a preferred set of providers versus forcing a limited network upon employees.  3. Use data to connect the right people to the right benefits and programs  With healthcare costs on the rise, employers have been on the hunt for solutions that leverage data insights, machine learning and predictive modeling to accelerate benefits engagement and utilization. By partnering with healthcare analytic companies, employers can use the claims and demographic data at their fingertips to deliver personalized messaging that maximize an employee’s visibility and access to benefits and programing uniquely relevant to them.  Whether it is life-threatening preventive care gaps, chronic illness diagnoses or simply a recent birthday indicating eligibility for retirement planning, claims and benefits administration data tell a powerful story of opportunity and need. With so much energy spent artfully crafting cutting edge total rewards packages, employers should be flocking to the strategic solutions that help increase meaningful benefit engagement. A total rewards package with all the bells and whistles is only impressive to the employees who engage with it. While still maintaining the highest bar of privacy and HIPAA compliance, employers can meet employees in the routine and pivotal moments that matter with targeted guidance and support.  <ul><li>Health: Enrollment guidance, provider searches, cost comparisons, clinical programs, health savings accounts and benefit program engagement</li><li>Wealth: Financial wellbeing, retirement savings, budgeting and debt management</li><li>Career: Pay, performance, time off and total rewards</li></ul>The resounding theme echoed across all three strategies is that perhaps the most strategic moves employers can make to reduce healthcare costs are the same moves that will drive the most value to employees. It’s no longer about choosing the least disruptive costs to cut and instead about thinking outside the box to implement benefit offerings that meet real needs in new ways.  As we approach month 18 of the pandemic, the workplace cultures with the most loyalty to their organization and productive engagement are employers who are rejecting the status quo and transforming their benefits and communication strategies to meet the contextualized needs of their employees. Mary McHale is a senior consulting director at Alight, a leading cloud-based provider of integrated digital human capital and business solutions.

The “win-win” paradigm: Employee benefits that bend the cost curve and prioritize people

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Chief Health Equity Officer

Health inequities result from unequal allocation of resources – goods, services or opportunities – and manifest themselves in unequal social, economic and environmental conditions, or the determinants of health.1,2 This unequal access may occur along several dimensions such as race, ethnicity, gender, income, disability status or geography.   Why, despite best efforts, have communities been unable to make progress toward health equity? What can we do differently?  One explanation is that structural inequities exist beyond the influence of any single institution or sector. Employers often struggle to define their role and responsibility in ensuring optimal health for their employees beyond providing comprehensive health programs, benefits administration and access to care.  Addressing inequities requires employers to adopt a systematic view that includes changing narratives to embrace health equity as a moral imperative and a goal that must not be compromised. Equity in this context means being treated fairly, and it comes from the idea of moral equality, and offering everyone fair and just opportunity to achieve their optimal level of productivity. It includes offering equal chances to be productive in the workplace, and equal concern for employee health and social needs. Employers are beginning to recognize their unique potential to promote optimal health for their employees and advance health equity. However many are also struggling to take their efforts from conceptual strategies to meaningful actions. Here are five principles and practical ways employers can, and should, help advance health equity: 1. Know the employee population and build the business case with data. While the moral and ethical case for addressing health inequities is compelling, making the business case and understanding return on investment is just as important for addressing health inequities. The business case is for the employers to understand their baseline, as well as potential gains from promoting equity (including increase in employee retention, increased satisfaction, work engagement, improved business performance and productivity), and where the employer can be most effective. It should be incorporated as a priority into corporate health and well-being strategies, <a href="https://www.ibm.com/products/health-insights" target="_blank">healthcare data analytics</a> as well as <a href="https://www.ibm.com/watson-health/solutions/employer-benefits-management" target="_blank">benefits administration</a>. For example, Blue Cross of Minnesota partnered with University of Minnesota to analyze data to determine how much health inequities cost the state.3 They found that each year, more than 700 lives are lost along with $2.26 billion. By building the case with data, and acknowledging the problem head on, these organizations are striving to give all communities access to healthcare. 2. Understand the social and mental health needs of employees.  Race, ethnicity and other sociodemographic data including geography and income, have not traditionally been used in population health analyses. This is especially true for private, commercially insured populations, which represent the majority of insured individuals in the United States.4 But this data can help businesses develop strategies around access, utilization and outcomes among their employees – stratified by race-ethnicity, geography and wages – to help them identify gaps and create solutions. Adding social determinants of health to claims and clinical information can help organizations find the insights they need to <a href="https://www.ibm.com/blogs/watson-health/5-examples-of-using-social-determants-for-population-health/" target="_blank">improve population health</a>. As purchasers of health services for employees, businesses can also leverage value-based purchasing power to hold plans (and third-party administrators for large, self-insured companies) accountable for collecting this data and using it to reduce disparities. Employers can also assess the cultural competence of a health plan by reviewing their Health Plan Employers Data and Information Set (HEDIS) scores and the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which can provide a basis for comparison and guide selection of plans. 3. Provide employees with resources to maintain optimal health, including personalized programs When communicating with employees, businesses should consider diverse cultural health practices and preferred languages. Engaging with employee affinity groups can help employers gain cultural insights to better communicate with specific populations. Evidence-based strategies5 and culturally sensitive programs6 can help strengthen an internal culture of health in the workplace. They can also help address shortcomings within healthcare services that may result in compromised care for racial and ethnic minority groups. Using race and income data can help highlight disparities regarding healthcare utilization. For example, studies have shown that Black patients who are cancer survivors and on high-deductible health plans, incur more barriers to follow-up care than white cancer survivor patients on the same health plan.7 These social and cost-related barriers often include a need for Black patients to delay filling prescriptions, skip drug regimens to save money or see a specialist for follow-up care. Comparing health plan elections and utilization across racial groups can highlight such differences in health outcomes between white and Black employees. We also know that lower wage-earning employees have different perceptions about their employer’s support of their health and wellness concerns, when experiencing workplace stressors, compared to higher-earning employees.8 4. Invest in environmental, social and governance efforts. An employer’s investment in their environment, social and governance (ESG) portfolio can be a central factor in measuring not only sustainability, but also the ethical and moral value or impact of the company. Employers can set ESG goals and measure progress and impact of their policies on the communities in which they are located and serve. An organization’s ESG policies can impact individual and population health, as well as sustainability, in the communities where they are located.   As an example of commitment to transparency and accountability around ESG policies and metrics, IBM tracks and reports progress on how our technology, services and talents are being applied to make a positive environmental and social impact.   5. Collaborate with community stakeholders in an effort to achieve health equity. Companies are part of and should understand the broader needs of their surrounding communities. Corporate social responsibility can be a valuable partner in these endeavors to help achieve health and racial equity. For example, <a href="https://www.ibm.org/" target="_blank">IBM’s corporate social responsibility programs</a> help employees engage with their communities, resulting in more than 2 million volunteer hours in 2020. Collaborating with local organizations and healthcare providers to address social determinants9 and coordinate care options for employees may also help contribute to the delivery of more equitable care. Coalitions could include local public health departments, social services, commerce and community stakeholders. These five principles and action steps can help employers address health equity, from meeting the individual needs of employees to more broadly contributing to their local communities. By connecting with their stakeholders, businesses can potentially develop more effective responses to health disparities and provide equitable opportunities, especially for employees and families with higher social needs to better access and manage their healthcare. Hear more from Dr. Dankwa-Mullan at HLTH 2021 (1) https://www.ncbi.nlm.nih.gov/books/NBK425845/(2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816016/(3) https://www.bluecrossmn.com/about-us/corporate-social-responsibility/health-equity(4) https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf(5) https://www.cdc.gov/mmwr/volumes/65/su/pdfs/su6501.pdf(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5094358/(7) https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767589(8) https://journals.sagepub.com/doi/10.1177/08901171211024416 (9) https://journals.sagepub.com/doi/full/10.1177/0890117118812822a

Five ways employers can help improve health equity

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Sr. Vice President & Chief Health Equity Officer

Health equity is described as every person having an opportunity to achieve their optimal health — without unfair differences in their ability to access or receive care. In a healthy and just society, health disparities would not exist. Yet these considerable care disparities — connected to race, gender, socioeconomic status and sexual orientation — do exist from community to community. Coming together to address variation in health care outcomes for everyone and building a more modern, better-performing health care system overall will empower quality outcomes for everyone. And, doing so will confront health care inequities head on. So how can we as an industry resolve health inequities? Identifying and acknowledging that disparities exist is a crucial first step. Further, meaningful change will include recognizing the impact of implicit bias on our thoughts and decisions to address health disparities.  We must also acknowledge that this change will take time. Results may not occur until well past our tenure. But there are ways to achieve opportunities, build momentum and create a foundation for lasting impact. Four pathways to equityAcross the UnitedHealth Group companies, our key metric for health equity is improving clinical outcomes. To organize our activity against this goal, we prioritized four pillars of action. These categories offer opportunities for results that lead to bold, long-term systemic change. Each pillar lends itself to measurable goals, so that leaders can <a href="https://www.optum.com/business/resources/c-suite/insights/health-equity-cfo.html" target="_blank">build a business case</a> to support the investment of resources needed to address each one.  1. Leveraging data and emerging analytics to monitor and address disparities in careThrough community partnerships, it is possible to gather richer consumer data, ZIP code information and social isolation data. This will help to build a more comprehensive picture of all the factors that can impact people’s health. Healthcare organizations have already identified the populations with poor utilization or outcomes. Overlaying social determinants of health information can reveal the root causes. This will further concentrate efforts to overcome disparities and inequities, guide your partnerships and inform the financial rationale for your actions. 2. Delivering on personalized care based on individual needsRoot causes threaten an individual’s core safety and well-being and prevent them from achieving optimal health. These causes can include social determinants like economic factors as well as non-economic factors such as mistrust or disaffection for a healthcare system that does not match their individual needs. Personalizing for needs means offering care programs that people trust, can easily access and want to engage in. Any effort to learn more about the root causes that impact your populations will naturally lead out into the community; and community involvement will create a deeper understanding of what truly shapes the lives of people who live there.   3. Improving the health of underserved communitiesCOVID-19 made the health inequity in our communities clear. Widespread and costly disparities were on display as the entire nation watched the tragic results. This cannot continue. A powerful first step toward equitable care is to make health equity part of the organizational mission. This supports the mandate of looking at everything through an equity lens. Unconscious or implicit bias can be hard to spot, but poor clinical outcomes are obvious. The level of bias in health care is the same as in the general population and it will need to be addressed in everything from scheduling to surgery. It will be easier to integrate into your culture when it is an openly stated part of the mission. Next, narrow in on the population whose clinical outcomes are falling below benchmark. Ask your leaders to look for the underlying causes and identify where demographic data may be incomplete or systems unable to collect it. Gather feedback from this population and see if their feelings about their health experience match staff perceptions. Doing this will reveal gaps that can be addressed. Finally, choose one area where you believe you can make the most clinical impact and focus resources there. 4. Promoting equity and diversity in the health workforceA natural way to narrow in on health equity is to start with your own organizational culture and levels of diversity. Do you match the populations you serve? Can you ensure that employees are culturally competent to serve the community? Do they understand and respect the cultural norms, language and beliefs shared by your consumers? Building gender and racial diversity into the recruitment process and leadership succession plans are concrete ways to advance here. Another consideration is inclusion. Even if you have diversity in your ranks, those in the minority may not feel like they have a voice at the table. Only leaders can create a respectful, welcoming environment that brings forward all voices. Research tells us that diverse companies are 35% more likely to outperform their peers. So, along with advancing health equity, those who enable a diverse, inclusive workforce are also building a more resilient, competitive organization. The pandemic taught us many lessons in health care, and we can take heart in the courageous strides we made there. But our job is not yet finished. Health leaders have a critical role to play in advancing health equity. It is up to us to take the lead in addressing systemic issues and improving health outcomes for everyone. Health equity can’t be addressed as a short-term fix. It will require the same passion and drive with which we pursue other growth strategies. It will require the same sense of urgency, sacrifice and cooperation required of us during the pandemic. And it will take formal, out-loud, organizational commitment. To read more on health equity, <a href="https://www.optum.com/about-us/health-equity.html?V=optum.com/healthequity" target="_blank">click here</a>.

Health Equity: Four Pillars of Action

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World events of recent years, including the global pandemic, its related economic fallout, and incidents of racial violence have called stark attention to the many racial disparities in mental health care.  As just one example, <a href="https://www.ncbi.nlm.nih.gov/search/research-news/10210/" target="_blank">rates of depression and anxiety spiked</a> among Black Americans following George Floyd’s murder in May 2020, with no mental health care safety net in sight: Amid the pandemic, the field was experiencing an era of <a href="https://www.forbes.com/sites/williamhaseltine/2021/03/09/the-covid-syndemic-the-mental-health-crisis-of-mental-health-workers/?sh=4b2cffaf51c2" target="_blank">unprecedented demand for mental health services</a> that <a href="https://www.healthaffairs.org/do/10.1377/hblog20201113.817116/full/" target="_blank">Black Americans were less able to access</a>. Similarly, the U.S. uptick in anti-Asian racism resulted in <a href="https://www.apa.org/monitor/2021/07/impact-anti-asian-racism" target="_blank">increased anxiety, depression, and sleep concerns</a> for Asian Americans and Pacific Islanders, and AAPI individuals are worryingly <a href="https://www.apa.org/monitor/2021/04/datapoint-mental" target="_blank">less likely to receive mental health care</a> than any other racial group. In these and other ways, events of the last few years held a mirror up to the field of mental health care and pointed out our collective failings in caring for huge numbers of our populations. So how do we do better, and care for the mental health and well-being of all of our patients and members more fully? To start, it’s become apparent that leaders in mental health care need to broaden their thinking about their diversity, equity, and inclusion (DEI) strategies to incorporate the psychological concept of belonging. In this sense, to belong means to feel <a href="http://www.otheringandbelonging.org/the-problem-of-othering/" target="_blank">safe, accepted, and welcomed</a> for all aspects of your identity in a group setting. In the context of the workplace—where Modern Health meets most of its members—<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ltl.20552" target="_blank">belonging relates to</a> “feeling seen for your unique contributions, connected to your coworkers, supported in your daily work and career development, and proud of your organization’s values and purpose.” Belonging is a fundamental need, as made evident by the <a href="https://www.nami.org/Support-Education/NAMI-HelpLine/COVID-19-Information-and-Resources/COVID_Isolation_Guide.pdf" target="_blank">sharp drop in psychological well-being</a> in the era of social isolation during COVID. If, as mental health leaders, the ultimate goal of your DEI initiatives is to support and uplift your members, prioritize their well-being, and extend them more equitable opportunities, then belonging cannot be left out of your planning. When you add belonging to your strategy (and it becomes DEIB), you’ll think more holistically about equitable spaces for providing care, the types of care that should be offered, and even who should provide it.  On that note, probably the most obvious “solution” for addressing DEIB in mental health is increasing the diversity of provider networks. This is a crucial effort for many reasons; <a href="https://doi.org/10.1002/jcop.21580" target="_blank">research has shown that a provider-client racial match</a> may be linked to greater satisfaction, increased service utilization, decreased dropout from treatment, and other positive treatment outcomes, for example. But there is a dramatic shortage of mental health professionals worldwide, and the shortage of providers who identify as Black, Indigineous, and People of Color (BIPOC) is even more pronounced: A <a href="https://www.apa.org/workforce/data-tools/demographics.aspx" target="_blank">2019 assessment of practicing psychologists</a> in the U.S. revealed that 83% identified as white, 7% as Hispanic, 4% as Asian, and 3% as Black/African American, nowhere near mirroring the racial makeup of the nation. Yet, despite industry awareness of the problem, between 2009 and 2019, the percentage of psychologists who identified as white remained relatively steady, showing little to no change in the diversity of the field. The challenge becomes even more pronounced when intersectionality is considered (e.g., a patient seeking a provider who is Black, queer, and female). We and our peers must commit to narrowing this gap while recognizing that it will take decades to close it. By leveraging technology to connect providers with individuals not in the same region, we are able to start optimizing for this imbalance as we try to increase the supply of BIPOC providers. But in the meantime, we must find ways to improve mental health outcomes for diverse populations now.  While it’s not scalable to rapidly increase the diversity of the worldwide mental health provider network, it is scalable to improve the skills of the providers the world does have available. So we propose making culturally centered care a standard practice for all mental health providers. By culturally centered care, <a href="http://dx.doi.org/10.1037/a0038122" target="_blank">we mean care that is</a> “patient-centered, values cultural humility among providers, and is implemented in environments that respect and appreciate patient diversity and represented cultures.” Culturally centered care has cultural humility at its core—in other words, the provider being open to worldviews other than their own, which they may never fully understand but are still committed to respecting and learning more about. Evidence shows that culturally centered care works, and we believe all providers—both U.S. and international—should be trained in culturally centered care and participate regularly in continuing education to overcome pre existing and lingering biases and stereotypes.  The last element of integrating DEIB into mental health care that I want to address is something I mentioned earlier—how considering belonging mandates questions about how and where mental health care is delivered. We believe it’s crucial to offer people a choice in how they want to receive mental health care. While clinical therapy is widely considered the default modality of care, our research shows that not only do most people not need this intensive type of care, more than 50% of our members don’t prefer this type of care. Desire for therapy versus other treatment types like one-on-one coaching, self-serve digital care like courses and meditations, and group care vary by demographics like age, gender, and ethnicity, and to fail to offer a choice in care type is to fail to offer culturally centered care. Similarly, integrating belonging into mental health care necessitates making space for individuals to improve their well-being in the context of their social identities—places where they can collectively share, connect, heal, and grow. Examples include identity-specific, provider-led group sessions in mental health care settings and employee resource groups in the workplace.  While there are many ways to address the rising need for mental health services among diverse populations amid the continued shortage of mental health providers who identify as racial and ethnic minorities, we believe these three factors are crucial to developing a system of mental health care that fosters a sense of belonging, acknowledges cultural diversity, and improves access to care for our entire populations.

Belonging and Culturally Centered Care Are Key to Effectively Supporting the Mental Health of Diverse Populations

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Clinical trials have been transforming at a rapid pace to adapt to a drastically changed world as a result of the pandemic. Just like during any major event in history, there are those who readily seek new technologies and methodologies and emerge as winners. Those reluctant to adapt to their environment are left in the dust. To illustrate this reality, only 10.4% of Fortune 500 companies have survived since 1955. Blockbuster Video was late to realize the importance of online video-streaming technology, passed up on the opportunity to acquire Netflix, and became part of history after only a few years. Meanwhile, many clinical trial sponsors and CROs are beginning to realize that the traditional way of conducting clinical trials is becoming quickly antiquated. In addition to the need for new technology that enables remote and hybrid trials, there is a need for better quality data coming directly from the patient. What is Real World Data for the patient, study sponsor, or for the researcher? We can first start with what Real World Data is not. Real World Data is not the bulk purchase of de-identified data sets. It is not static data, a snapshot of someone’s health at one point in time. For it to be Real World Data, then, it must be real-time and longitudinal. It also must account for all people including people in under-served communities who are especially vulnerable and have suffered disproportionately during the pandemic. In other words, Real World Data needs to capture how and where people live, ease of access to healthcare, as well as other important social determinants of health.  Patients, as well as their family and caregivers, need seamless access to their longitudinal health timeline. Improved access to key health history of study participants can greatly improve the effectiveness and efficiency of clinical trials, while lowering their cost. For study sponsors, access to high quality, multidimensional Real World Data is extremely valuable for running analytics, machine learning, and AI to gain important insights for drug development. Researchers would like to measure the safety, efficacy, and quality of drugs. Most importantly, patients need to be engaged with their health data to ensure retention in the trial. Patients who had a great experience are more likely to return for future trials for which they qualify. To keep up with the rapidly changing environment and to emerge as a winner, CROs, Pharmaceutical companies, and life science enterprises need to embrace Real World Data that is patient-centric, longitudinal, multidimensional, and real-time. This will lead to more meaningful insights and Real World Evidence as well as better, faster, and cheaper clinical trials. Study participants will enjoy a better experience, and researchers will have access to better quality outcomes data, all feeding into the positive feedback loop leading to improved future trials.  Real World Data has tremendous value not just for Pharma but across the entire healthcare spectrum. Healthcare providers, especially those specializing in oncology or rare diseases, need the patient’s health history, often across multiple providers scattered across the country, to quickly onboard the patient, accurately diagnose the disease, and provide effective intervention as well as long-term follow-up care. Having a longitudinal health record not only saves time, it can save lives. Patient records are often offered in paper or CDs and typically take a minimum of 4-6 weeks to obtain with patient consent. The result is often a thick binder of health data that is not standardized, not intuitive, and cannot be readily utilized.  Providers and payers are now subject to the Interoperability and Patient Access final rule. On April 30, 2021, the requirements for hospitals with certain EHR capabilities to send admission, discharge and transfer notifications to other providers went into effect. On July 1, 2021, CMS began to enforce requirements for certain payers to support Patient Access and Provider Directory APIs.  Healthcare insurers are also adopting a patient-centric mindset as a result of the legislation. To truly adopt a patient-centric mindset is to anticipate the needs of the patient and provide them a comprehensive view of their health on-demand. With this, patients will be better able to identify actions that lower certain health risks. In addition, payers will be able better engage their patients and their caregivers, leading to an improved care journey. Payers will be able to capitalize on improved risk adjustments from access to real-time data. Patients could then benefit from a healthy lifestyle through lower insurance premiums. Real World Data is only real when the patient is in complete control of aggregating and sharing their EHR, genomics (DNA), wearables and medical devices. Pharma, payers and providers all obtain tremendous value from Real World Data. It is time they realize what is real and what is not.

The Future of Health Data: Real World Data is only Real when it includes the patient

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Head of Clinical Innovation

In May of 2020, just as the world was beginning to grasp the full, horrifying effects of the COVID-19 crisis, <a href="https://www.hlth.com/digital-content/hlth-matters/blog/the-looming-mental-health-crisis-in-nursing" target="_blank">I penned a piece for this blog</a> on what I believed to be a looming mental health crisis in nursing. I shared data from a survey that my company, <a href="https://www.trustedhealth.com/" target="_blank">Trusted Health</a>, had conducted of nurses working on the frontlines of the pandemic, which found that nurses were experiencing steep declines in their mental health and they felt unsupported by their facilities and the industry at large.  Just over a year later, and in spite of significant media reporting about the issue of clinician mental health, I wish I could say that the situation has improved and that nurses are getting the support they need. Sadly, <a href="https://uploads-ssl.webflow.com/5c5b66e10b42f155662a8e9e/608304f3b9897b1589b14bee_mental-health-survey-2021.pdf" target="_blank">the follow-up to our original study</a> found not only are nurses continuing to experience severe, adverse mental health effects as a result of the pandemic, but many of them are now considering leaving the profession entirely. In fact, nearly half of the respondents in our survey reported that they feel less committed to nursing. This finding was particularly pronounced amongst nurses under 40, who were 22 percent more likely than average to report that their commitment to nursing had decreased.  At a time when the US Bureau of Labor Statistics projects that we need 1.1 million additional nurses in order to avoid a further shortage and tens of thousands of Baby Boomer nurses planning to retire in the coming years, we simply cannot afford to lose the nurses we already have -- and particularly those in the early stages of their careers. The situation is dire enough that <a href="https://www.help.senate.gov/hearings/a-dire-shortage-and-getting-worse-solving-the-crisis-in-the-health-care-workforce" target="_blank">the US Senate met recently</a> to discuss possible legislative solutions.  The unfortunate reality is that the healthcare industry has never been particularly good at retaining nurses: even before COVID-19, nurses were reporting record levels of burnout and nearly 20 percent left their first post within two years. But as with so many aspects of the healthcare system, the pandemic has exacerbated long standing issues and made the status quo untenable. In order to prevent a tsunami of departures, hospitals must put strategies in place to support and retain their nursing workforce. Here are three ways they can do so.  Create new opportunities away from the bedside. Many nurses who are considering leaving the profession are conflicted, and can still be won over. In the short-term, nurse leaders need to meet with members of their staff individually and move nurses who are in periods of mental distress from the most demanding units like the ER or ICU into less acute roles or away from the bedside entirely. Over the long-term, technological advances like telehealth, remote patient monitoring and eICUs can help hospitals better leverage the skills of each individual nurse while still delivering a high standard of care. Career planning -- typically non--existent or an afterthought at most hospitals -- also needs to be a priority and focus less on simply moving nurses up the career ladder, and more towards tailored programs that map to each nurse’s career goals and preferences and do a better job at retention.  Focus on culture over messaging. While the campaigns referring to nurses and other healthcare workers are well-intentioned, <a href="https://jme.bmj.com/content/46/8/510" target="_blank">nurses have made it clear</a> that this label is harmful. Moreover, when held up next to the finding from Trusted’s survey that the overwhelming majority of nurses feel that their mental health isn’t supported by their facility or the industry at large, it can feel hollow. Hospitals who focus on gestures like yoga classes or pizza parties over substantive workplace changes risk making nurses feel that they are simply being placated, rather than truly supported. Culture changes should be informed by listening that starts at the top of the organization and might include strategies meant to address bullying and incivility, education and coping mechanisms for compassion fatigue and moral injury, and comprehensive support for nurses who are experiencing acute mental health issues.  Rethink the nursing workforce. The industry’s thinking about nurse staffing ossified years ago, and hasn’t evolved in response to more widespread generational changes in attitudes about work. Many nurses tried travel nursing for the first time during the pandemic, and aren’t keen to move back into full-time roles even as COVID-19 wanes in the US. The technology that the vast majority of hospitals use to do workforce planning is woefully outdated and needs updating to newly developed systems that can easily push out extra shifts to full-time nurses, local per diem nurses and travel nurses. This approach allows hospitals to avoid paying exorbitantly high fees for contingent labor, while giving Millennial and Gen Z nurses the flexibility they are looking for in their careers.  While I found the results of our study deeply concerning, as a former ED nurse and a longtime nurse executive, I believe that there is still time to address these issues and to prevent a full-blown crisis. In reading through the write-in responses to our survey questions and speaking with nurses in the Trusted Health community, I firmly believe that most nurses -- even those who are considering other options -- love this profession and want to stay in it. But we must start giving them the support they need to do so.

The Urgent Need for Nurse Retention Strategies

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Global Head of Biopharmaceuticals

The efforts of health and care workers, governments, scientists, private and public institutions in tackling the pandemic and developing a vaccine in less than a year pay testament to our collaborative human grit, determination, and ingenuity.  At the same time, however, the pandemic has also pushed our healthcare systems to the brink and exacerbated pre-existing inefficiencies. The challenge was daunting even before a global pandemic emerged where critical decisions impacting healthcare access and sustainability needed to be made. But with an estimated 2 million people in backlog for cancer care in UK alone1 and similar situations in other countries worldwide, as well as a global accumulated debt of 17.5 trillion dollars2 and counting, healthcare systems face insurmountable pressures in the days ahead. Conversations about how to invest and where we invest to build a better and more equitable healthcare system have never been more urgent.  Some of these changes that need to be made at a macro level are already underway – such as changes in planning and delivery of care, greater use of data and digital tools like artificial intelligence and telemedicine. However, there is an opportunity to examine other areas already available, that could help deliver efficiencies while protecting - and in some cases even improving - patient outcomes. How biosimilars could help to deliver more sustainable healthcare  Biologic medicines—produced by a complex process involving living organisms—have transformed the treatment of severe conditions like cancer, colitis and rheumatoid arthritis positively impacting millions of patient lives. In the future too, we see an increasing role of biologics3. If we look at Europe, today, over 30% of all drug spend is on biological medicines4, and in the US, according to 2017 data from the IQVIA Institute, biologics represented 37% of net drug spending but 2% of all US prescriptions.5 Biosimilars, follow-on medicines after the patent expires, match the reference medicine in terms of quality, efficacy and safety. They can expand access by providing a number of affordable therapeutic options. The savings thus generated from their use can be redeployed to other areas like providing access to new therapies, helping support vital changes within the system and contributing towards long-term sustainability across the healthcare system.   The world’s first biosimilar was approved in Europe in April 2006. Over the last fifteen years, over 60 biosimilars have been approved by the European Commission for use, which today account for 10% of the total biologics market. Since their introduction, biosimilars have not only brought clinical benefits to patients but have also generated substantial savings for healthcare systems.  For example, Bavaria, Germany, biosimilars have helped to reduce the treatment waiting time for rheumatoid arthritis patients from 7.4 years in 2015 to a few months.6 A very recent example from the UK, where patients with rheumatoid arthritis are now able to access biologics treatments earlier due to biosimilars. Despite the proven benefits and years of clinical use, there is inconsistent adoption of biosimilars both between, and even within, countries.   Turning the tide to create a sustainable environment for biosimilars Between now and 2025, biosimilars are expected to generate savings of USD 285 billion, this is a substantial sum when we take into account that this is nearly twice the amount that will be spent on COVID-19 vaccines (estimated at USD 157 billion) over the same time period.7 With an increasing number of biologics coming off patent, there is a huge potential and opportunity for biosimilars to bring value for patients and healthcare systems, especially in newer therapy areas for biosimilars like multiple sclerosis, ophthalmology, and immuno-oncology. As some countries emerge from the other side of the pandemic, we find ourselves at a critical juncture where the future of our healthcare systems rests on the decisions that we make now. In order to successfully deliver a sustainable model that meets the needs of patients, national regulators, policymakers and healthcare stakeholders, we must work together in four core areas to address barriers to biosimilar adoption and improve access for patients worldwide.  Acceptability Confidence amongst patients and physicians plays a key role in the acceptance of biosimilar medicines. Supporting better education for physicians and patients with unbiased information on biosimilars, stimulates choice, allowing the treating physician to choose the most appropriate treatment for their patient, and at the same time, instills confidence in the patient about the use of biosimilars. Accessibility  Increasing access to affordable medicines and reducing inequalities in healthcare provision have become a central objective of policymaking in recent years – as evidenced by Europe’s Pharmaceutical Strategy and Beating Cancer Plan, both of which identify increased use of biosimilars and generics as important tools in achieving their goals. These policies are very encouraging but need a concerted effort to ensure that they are reflected in national guidelines, encouraging clinical use. Meanwhile in the US, policymakers should authorize a temporary add-on payment to health care providers in Medicare Part B to increase prescribing and use of biosimilars (as opposed to the current system, which encourages prescribing the most expensive option). Availability To ensure that biosimilars remain available and viable for the long-term, there needs to be a sustainable market that supports and incentivizes manufactures to deliver biosimilars. Suggested measures could include: gain-sharing and smart procurement practices like employing a multi-tender approach which encourages healthy competition. There is also a need to continue to streamline regulatory measures to enable biosimilar use from day one of expiry of the exclusivity period.  Affordability  By adopting common sense policies that encourage competition between biosimilars and reference biologics, governments and healthcare systems can reduce their medicines expenditure and increase uptake significantly.   Taking action to create more sustainable healthcare  When thinking of the challenges ahead, we must remind ourselves that nothing will change if nothing changes. In order to create more sustainable healthcare, where patients have access to the right treatment, we need to not only reflect on how we plan and deliver healthcare services, but also support the interventions that can help deliver the biggest impact. Biosimilars have shown they have the potential to deliver better outcomes for patients and the future of our healthcare systems. However, it’s now time to turn that potential into reality. (1) Over 2 million people in backlog for cancer care. Available from: https://news.cancerresearchuk.org/2020/06/01/over-2-million-people-in-backlog-for-cancer-care/. Accessed June 2021(2) The International Monetary Fund Annual Report 2020. Available from: https://www.imf.org/external/pubs/ft/ar/2020/eng/. Accessed June 2021(3) Untangling Biosimilars. Available from: <a href="https://cen.acs.org/articles/88/i48/Untangling-Biosimilars.html" target="_blank" style="font-size: 8px;">Untangling Biosimilars (acs.org)</a>. Accessed June 2021  (4) The impact of biosimilar competition in Europe. Available from : https://ec.europa.eu/docsroom/documents/31642/attachments/1/translations/en/renditions/native. Last Accessed: June 2021 (5) Medicine Use and Spending in the U.S. A Review of 2017 and Outlook to 2022 – IQVIA. Available at https://www.iqvia.com/insights/the-iqvia-institute/reports/medicine-use-and-spending-in-the-us-review-of-2017-outlook-to-2022. Accessed June 2021.(6) ProBiosimilars. New study shows: Rheumatoid patients have faster access to biological therapy since biosimilars exist. Available from: https://probiosimilars.de/presse/versorgung/studie-biologika-und-rheuma-patienten/. Accessed June 2021.  (7) Global Medicine Spending to Reach $1.6 trillion in 2025 Excluding Spending on COVID-19 Vaccines, According to IQVIA Institute for Human Data Science Study. Available from: Global Medicine Spending to Reach $1.6 Trillion in 2025 Excluding Spending on COVID-19 Vaccines, According to IQVIA Institute for Human Data Science Study (yahoo.com). Accessed June 2021

How biosimilars could help healthcare get back on track

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Chief Medical Officer, VP of Healthcare Worldwide Commercial

Senior Director, Global Healthcare Business Strategy

The entire healthcare industry has been impacted by COVID-19 in an unprecedented way. The pandemic has had a substantial global impact, and in many ways, it has raised the bar on what we need to collectively deliver as an industry. These events have further highlighted disparities and health inequities that should be kept at the forefront of care delivery moving forward.   As defined by the U.S. Department of Health and Human Services, health equity is the attainment of the highest level of health for all people. Population-level factors, such as the physical, built, social, and policy environments, can have a greater impact on health outcomes than individual-level factors. The root causes of health inequity can be directly linked to a failure to address these population-level factors, one community at a time. In addition, linkages between science, policy, and practice are critical to achieving health equity.1 There is an urgent need to extend essential services and offerings to those who are disadvantaged due to socio-economic factors, racial injustice, advanced age, and other differentiators that are biologic or societal in nature. Microsoft is working closely with our customers, public health teams, and partners across the globe to achieve more for the communities they serve.   Currently we are focused on improvements in 3 key areas: vaccine equity, AI for health equity, and decreasing the digital divide.   Vaccine Equity To ensure the fair, equitable, and efficient distribution of the COVID-19 vaccine, health organizations and communities need a secure and interoperable platform that balances the complexities of the registration, scheduling, and supply chain distribution, with the broader public health mission to deliver a safe and effective vaccine in a prioritized manner.   Microsoft has been committed to helping public health agencies and healthcare providers to deliver the COVID-19 vaccine to individuals, around the world, in an efficient, equitable, and safe manner. Our vaccine management capabilities help healthcare providers roll out vaccination programs reliably while scaling and adapting to meet community’s needs as vaccination capacity and demand changes over time.  As vaccination rates have risen and in many communities plateaued, we have seen a shift away from mass vaccination sites to a focus on community-led outreach initiatives designed to address:  <ul><li>Accessibility, by using mobile units and/or pop-up clinics in schools, parks, parking lots, and churches. </li><li>Convenience, by allowing for walk-in appointments and offering vaccinations and other health services at family community events, and </li><li>Hesitancy, through unpressured conversations led by trusted members of the community who are empowered with the right information and resources. </li></ul> By listening to community leaders on how best to engage the populations they serve, Microsoft and its partners have supported local efforts to bring vaccinations and other essential health services to the high risk, vulnerable, and underserved.  Access to data has also enabled communities to make better informed decisions. Microsoft has developed interactive visualizations to help everyone understand the scope of the challenge and the progress being made towards ending the pandemic. <a href="https://www.microsoft.com/en-us/ai/ai-for-health-covid-data" target="_blank">Explore maps for COVID-19 Vaccinations, Risk Levels, Progress to Zero (P0), Rt, Testing, and Spread Analysis. </a> AI for Health Equity The health of people and communities around the world has been improving over time. However, progress has not been equal across the globe, and there is a great need to focus on societal issues such as reducing health inequity and improving access to care for underserved populations. While researchers work to unlock life-saving discoveries and develop new approaches to pressing health issues, advancements in technology can help accelerate and scale new solutions.   AI can be used to identify and address human error, speed up time-to-treatment, and deliver insights for a host of social issues present in treatment and care. Doctors at <a href="https://www.cuh.nhs.uk/news/ai-speeds-cancer-treatment/" target="_blank">Cambridge University Hospitals NHS Foundation Trust</a> are using AI Technology, known as <a href="https://www.microsoft.com/en-us/research/project/medical-image-analysis/" target="_blank">Project InnerEye</a>, is a result of an eight-year collaboration between Cambridge-based Microsoft Research and Addenbrooke’s. Its aim is to save clinicians many hours of time laboriously marking up patient scans prior to radiotherapy.   Microsoft is committed to using AI to address social and treatment bias. As AI algorithms are developed it is key that healthcare providers do not miss, or misrepresent, marginalized communities. We know that it is important to work with providers to develop accurate models that help to eliminate bias. This translates to better data, better collaboration, and better care for all.   <a href="https://customers.microsoft.com/en-us/story/860471-ribera-salud-health-provider-azure-en-spain" target="_blank">Ribera Salud</a>, a healthcare business group and its technological division FutuRS, have implemented a predictive model, based on AI, which analyzes and processes the variables of each patient to predict their evolution, based on objective data analyzed by Microsoft Azure and its Machine Learning tools. Ribera Salud health group sought to improve the quality of care for patients, acting preventively based on predictions about the possible clinical worsening of patients’ conditions. This tool, supported by AI and, more specifically, by machine learning, has allowed Ribera Salud to have greater control over patient risks without incurring a greater workload for health professionals. That is why this model facilitates what is known as &quot;Right Care, Right Now,&quot; that is, providing the right care at the right time to achieve optimal results for the patient.   The Americans with Disabilities Act of 1990 (or ADA) highlighted the need to provide accommodations to those with disabilities. Communication is fundamental to providing equal access. To be more inclusive and avoid biases that skew decision-making in AI and machine learning systems, Microsoft is investing in AI-powered innovations that can create new possibilities regardless of how a person listens, speaks, or writes. We are committed to increase the representation of people with disabilities in datasets and influencing future technology to ensure the global independence and inclusion of people with disabilities in society. Our <a href="https://www.microsoft.com/en-us/ai/ai-for-accessibility" target="_blank">AI for Accessibility Program</a> invests in projects around the world seeking to address how to build experiences and data sets that are accessible for people of all abilities.  Decreasing the digital divide Perhaps the most obvious implications of implementing or relying upon new technologies in public health are the risk of unequal access to such technologies, inequalities in the opportunity to benefit from such technologies and inequalities in the burdens generated by such technologies.2   Digital technology can play a critical role in bridging barriers to health equity, including care access and delivery; from creating personalized experiences for patients to staying connected with patients over the care continuum, wherever they are located.   However, we need to ensure that all individuals have access to affordable broadband and understand how to effectively utilize this essential technology. In 2017, we launched the <a href="https://www.microsoft.com/en-us/corporate-responsibility/airband" target="_blank">Microsoft Airband Initiative</a> to expand broadband access in rural America. Today, we are expanding Airband to U.S. cities that face some of the largest broadband gaps among racial and ethnic minorities, specifically Black and African American communities. As part of Microsoft’s <a href="https://blogs.microsoft.com/on-the-issues/2021/06/02/racial-digital-inequity-airband-broadband-access/" target="_blank">Racial Equity Initiative</a>, team members at Microsoft are working to modernize access and support underserved communities of color though <a href="https://hbcuconnect.com/content/362258/microsoft-and-hbcu-connect-partner-to-get-black-tech-professionals-hired-in-1st-quarter-of-2021" target="_blank">Historically Black College or University (HBCU) engagements</a>.  Global healthcare has been impacted by the pandemic, and the bar has been raised on what technology is needed to deliver essential services in an equitable way. While innovative technologies have always promised significant transformation for healthcare, it is now an imperative for organizational resiliency and to advance the health of people and communities around the world. Our partners and customers continue to inspire and motivate us to co-create solutions with communities for those who are often the most marginalized and impacted by health inequities.  Join us at the upcoming virtual discussion “<a href="https://www.hlth.com/digital-content/webinars/can-healthcare-bounce-building-equity-through-health-system-resilience" target="_blank">Can Healthcare Bounce? Building Equity through Resilience &amp; Responsiveness</a>” on June 29, 2021 to learn more.  REFERENCES <ol><li><a href="https://www.cdc.gov/minorityhealth/publications/health_equity/index.html" target="_blank">Paving the Road to Health Equity - OMHHE - CDC</a> </li><li>Smith, M. J., Axler, R., Bean, S., Rudzicz, F., &amp; Shaw, J. (2020). Four equity considerations for the use of artificial intelligence in public health. Bulletin of the World Health Organization, 98(4), 290–292. https://doi-org.lopes.idm.oclc.org/10.2471/BLT.19.237503</li></ol>

A Global Focus on Health Equity

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Vice President

Digital technologies can improve many parts of the patient experience, and complex therapy journeys are no exception. Reaching and supporting people through their desired channels, at the right time, makes meaningful improvements to their therapy adherence—which results in better health outcomes.  As the demand for patient support services continues to evolve and grow, the technology for person-centered care is finally available. Life sciences companies and manufacturers have the ability to adapt and deliver next-generation patient services to improve patient health in connected ecosystems.  Here are five ways life sciences companies can take action and begin to adapt:  #1: Recognize increasing service and experience expectations from patients. Health consumers have an expectation of services and experiences based on the digital products they use as consumers. Immediacy is now the norm and there really is an app for almost everything. Need a ride or takeout? Open an app and you’re done in two minutes. Need to buy just about anything? It just takes a couple of taps—and you’ll have exactly what you need in two days, if not sooner.   Having experienced these user-friendly and intuitive interactions, patients can’t help but demand them across other facets of their day-to-day life, including healthcare. They want their healthcare experiences to be easy, efficient, and intuitive. When it comes to life sciences organizations, the stakes are high because the patient’s wellness may very well depend on the support they receive in these digital touchpoints.  While the health care industry has been slower to adapt than other sectors, digital transformation is picking up speed. There is an opportunity to shift life sciences patient services from an agent-centered support function to patient-centered. This means more self-service, more workflow automation, and agents equipped with better insights to help patients.  #2: Reframe the patient engagement problem.Delivering a good patient engagement experience is both a data and design challenge. How do you leverage patient data, with appropriate consent, for delivering right-sized service programs? How do you build differentiated web and mobile experiences at scale? Answering these questions reframes engagement in terms that lead to more effective, faster solutions. #3: Advocate for internal management of the patient experience. Outsourcing may have worked in the past, and it may still be an option for specialized service transactions (e.g. prior authorizations), but overall coordination of service delivery for a differentiated patient experience should be handled internally. Manufacturers need to own their patient service platforms to gain a more longitudinal view of patient interactions and data. This approach requires a long-term view of technology investments. It empowers organizations to build deeper relationships with patients, facilitate access, increase trust, and drive adherence. It’s also the leading way to address the growth of specialty products and personalized therapies, which require more integrated patient services.  When patient services programs are outsourced, it’s harder for life sciences organizations to demonstrate, with certainty, how their products are delivering value and making meaningful improvements to their patients’ outcomes.  So, it’s not surprising more and more organizations are choosing to insource the patient engagement platforms in-house.  #4: Ensure the systems being used to build patient services programs are flexible and scalable. Life sciences organizations should aim to deploy and enable a cost-effective platform that is sized for their current situation, while making sure it has a foundation that can scale as they grow and add new services and therapies. To do this, they can start small and take an iterative approach to deployment. It’s wise to demonstrate the value of a new in-house patient services platform by starting with one or two therapies and building from there.  Our Deloitte team recently deployed our industry-leading <a href="https://www2.deloitte.com/us/en/pages/consulting/solutions/patient-engagement.html" target="_blank">ConvergeHEALTH Connect for Life Sciences</a> platform at a global life sciences company to help them meet patients’ needs both today and in the future. Our solution works on top of Salesforce Health Cloud in a way that is flexible and scalable, building unique and transformative capabilities specifically focused on supporting client needs in patient services. This work is just one part of a much larger journey we have taken with this client to transform their patient experience. With the deployment of this award-winning solution, touchpoints across an organization’s support programs are cohesive, facilitating engagement with patients across multiple seamlessly integrated digital channels. Access issues are eliminated, making it possible to meet each patient where they are—engaging in ways that align with individual preferences.  The platform has also been tailored to each of the geographic areas the organization serves. This not only allows companies to configure their engagement for different populations, but it means their new patient services programs can adapt as the industry and patient needs continue to evolve.   #5: Understand that the benefits of a comprehensive patient services experience are already proving to be game-changing.If we have learned nothing else from our four years of successful deployments of ConvergeHEALTH Connect for Life Sciences, we have learned that having a single source of truth for customer interactions generates data and insights that can transform the way life sciences organizations engage with patients across age groups and diverse backgrounds.  Since launching their new platform, the leading global life sciences company we worked with has been able to: <ul><li>Accelerate patient onboarding and access with enrollment streamlined across multiple channels, reducing the time to therapy </li><li>Improve therapy adherence with configurable program management, including helpful education and support touchpoints</li><li>Reduce the administrative burden with the introduction of more efficient document management</li></ul> Conclusion: As life sciences organizations adopt this way of thinking, they’re ready to begin deploying differentiated experiences to provide more meaningful patient engagement, improve health outcomes, build deeper relationships, and support personalized therapies for patients.  Research shows that consistent engagement across multiple channels enables better, faster access to therapies and medications, empowers patients to improve therapy adherence with well-timed support and education, and creates much-needed feedback loops. The faster we can make it the norm, the better everyone’s health can be.  To learn more about how Deloitte collaborates with life sciences organizations to deploy a platform that is ready to provide memorable, scalable patient services, <a href="https://www2.deloitte.com/us/en/pages/consulting/solutions/patient-engagement.html" target="_blank">visit our website</a>.

Reframing the Transformation of Patient Services

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Founder and Chief Executive Officer

<a href="https://www.linkedin.com/pulse/taking-stand-vaccines-hlth-2021-jonathan-weiner/?published=t" target="_blank">Read Post on LinkedIn</a> Following the science is our best path forward With COVID-19 showing dramatic improvements in the United States, we are gradually experiencing a return to more normal daily routines and business activities. The HLTH team is looking forward to welcoming our community back to an in-person event in Boston on October 17-20. We will also offer a full digital component for those unable to travel and join us this year. We are, however, cognizant of the risk of COVID-19 transmission from unvaccinated individuals. Concerns remain and are justified. The context of mass suffering in India, WHO’s declaration of ‘an unacceptably high plateau’ in the global case rate, as well as continued concerns about the spread of B.1.617 and development of other highly transmissible variants are reminders that we cannot relax our efforts to halt the pandemic.  We are acutely aware of our privilege and responsibility to frontline healthcare providers, who have put their lives on the line to save ours, and to the healthcare industry that has worked tirelessly alongside them to develop and provide access to vaccines, increase production of protective equipment, and much more. We recognize their sacrifice and celebrate their achievements during this global crisis. While there is still much to be learned about COVID, one thing remains clear, and that is, a fully vaccinated population is our best hope for preventing the spread, saving lives and putting an end to this pandemic. The HLTH team remains unequivocally devoted to safeguarding our staff, attendees and the local community hosting HLTH. We cannot and will not ignore the science: vaccinated individuals are the most unlikely demographic to catch or transmit COVID. Those who remain unvaccinated, are the most at risk and also pose a significant risk to others. For these reasons and, having carefully considered all viable options, we have made the decision to require everyone who plans to join us in person at HLTH 2021 to provide proof that they are fully vaccinated. We all play an important role, and have a responsibility, in pushing for herd immunity--for our mutual health, for the overall economy and as the only means of protecting those who may not have an option to get vaccinated. Further, clear assurance that we’re adhering to the highest standards of health protection will facilitate confidence and reduce concerns for those attending our event in person and looking to us to do the right thing. As we see restrictions ease on the wearing of masks and social distancing requirements, it is our goal to offer an environment where our attendees feel safe and are safe. We will make every effort to ensure an excellent on-site experience and will continuously evaluate our approach. It is our hope that we will be able to make the wearing of masks a personal decision and minimize social distancing restrictions throughout HLTH 2021--including the evening networking events. All decisions will be based upon guidance from state and local leadership as well as best practices determined by the CDC. The HLTH community has anticipated this moment - the chance to gather in person once again - and we are committed to making it a productive, high-value reunion and creating an occasion to acknowledge all that has transpired during the pandemic. Modeling digital health transformation, HLTH registrants will be able to use CLEAR’s Health Pass, a free mobile experience on the CLEAR app, where they will be able to submit proof of vaccination, ensuring a safe and frictionless event. HLTH will release full details on how the process will work and publish a comprehensive COVID mitigation plan for its 2021 event in the coming weeks. We also recognize and appreciate that there are some members of our community that may choose not to get vaccinated, for reasons such as health issues or religious beliefs. We must balance that with our responsibility to create an environment for the fully vaccinated attendees that we will welcome to HLTH 2021. Any attendee who remains unvaccinated or simply is not ready to travel, will have the option to participate in HLTH 2021 through our digital platform. Boston, as our host city, is a national leader in healthcare and life sciences. During this time of transitioning back to some sense of normalcy, we are grateful for the knowledgeable leadership and ongoing efforts of city and state leaders and BCEC staff who have partnered with us and continuously informed us, ensuring a safe event for all. For most, HLTH’s vaccine requirement will come as a relief. We recognize that some will strongly disagree with our decision, but we ask for your understanding. For any individual already registered to attend HLTH 2021 in person who does not plan to get vaccinated by the start of the event, we will work with you to convert your registration to a digital pass, refund your registration without penalty or transfer to HLTH 2022. Please contact us at info@hlth.com to make the switch. On behalf of the entire HLTH team, we are grateful for your support and for the frontline healthcare workers, essential workers, industry professionals and everyone else following the science to save lives. We will continue communicating directly and openly with you as plans evolve, and invite you to reach out with comments, questions or concerns. We hope to see you at HLTH 2021!

Taking a stand on vaccines at HLTH 2021

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National Health Tech Leader, Audit & Assurance Partner

Principal

Health tech innovators are playing a key role in reshaping the health care industry in response to COVID-19. With COVID-19 having accelerated the future of health; moving forward, those driving innovation and transformation will likely be well positioned for success.  As it did for all industries, the pandemic created an unprecedented crisis for the health care industry. But unlike in many industries, it also created opportunities. It triggered rapid and large-scale responses such as adoption of virtual care delivery, an increased focus on mental health and well-being, a push for quicker drug and vaccine candidate discoveries, and a greater understanding of the impact of social determinants on health and health inequality. And health tech innovators were critical to this response. In fact, in 2020, venture funding for health tech innovators crossed a record $14 billion and nearly doubled in comparison to 2019, according to a recent Deloitte <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/health-tech-private-equity-venture-capital.html" target="_blank">analysis</a> of Rock Health’s Digital Health Funding database. The Deloitte Center for Health Solutions analyzed the latest venture capital funding data and interviewed 15 venture capitalists, private equity investors, and corporate venture capitalists (CVCs). These interviews revealed that: <ul><li>Health tech innovators focused on developing products, services, and solutions that the Center for Health Solutions’ analysis finds align with Deloitte’s thesis for the <a href="https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/future-of-health.html" target="_blank">Future of Health</a>—more specifically, products and solutions that address well-being and care delivery, along with open, secure data and interoperable platforms. These sectors are likely to continue receiving a significant share of funding in 2021 and beyond</li></ul> By leveraging experience across different industries and sectors in health as well as their own network, investors can bring more than financial support to innovators and the industry in general. In particular, CVCs can bring specific health care knowledge, act as an incubator to co-develop products with the innovators, and become customers. Innovators can focus on transformative business models, developing a consumer-centric approach to health care, and creating ecosystem partnerships. However, it can be imperative for investors, including industry incumbents, to coach innovators and support them with industry and regulatory expertise, in addition to capital, to accelerate toward the future of health together. What’s next?Health tech innovators have an opportunity to achieve a key place in the future of health but may need to overcome a few hurdles to sustain and thrive in this future.<ul><li>As technologies evolve and simultaneously become table-stakes, innovators can succeed if they focus on the empowered consumer, have agile business models, convene or participate in ecosystems, and have the ability to scale rapidly. A winning value proposition today may be a ‘me-too’ tomorrow. Innovators should be ready to use data analytics, drive technology changes and adoption, and clearly demonstrate value to customers.</li><li>Innovators selling to incumbents often encounter long sales cycles and subsequent cash flow challenges. Sales leadership, channel partnerships, and creation of a marketplace ecosystem can help shorten sales cycles and alleviate investor and market concerns over business adoption. Innovators should also be mindful of how they price their solutions, even with an initial anchor client. Pricing to create a network effect early on might mean a longer timeframe to profitability, a greater need to scale, and require more capital to sustain losses.</li><li>While the current regulatory environment is encouraging, with the relaxation of regulations to encourage virtual health and guidance on interoperability rules and price transparency, short- and long-term uncertainties may remain as situations around the pandemic continue to evolve. Innovators should remain aware of and able to adapt to changes. </li></ul>As the health tech market continues to grow, successful innovators should quickly move beyond minimally viable products to demonstrate market opportunity to their customers through improved quality, decreased costs and/or a better experience. According to investors, scalability and key return on investment metrics will likely separate the winners and losers.   <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/health-tech-private-equity-venture-capital.html" target="_blank">Read the full article here</a>.  Peter Micca is the Audit &amp; Assurance Health Tech leader and is a partner with Deloitte &amp; Touche LLP. Simon Gisby is the Future of Health leader, Risk and Financial Advisory, Deloitte Transactions and Business Analytics LLP. This publication contains general information only and Deloitte is not, by means of this publication, rendering accounting, business, financial, investment, legal, tax, or other professional advice or services. This publication is not a substitute for such professional advice or services, nor should it be used as a basis for any decision or action that may affect your business. Before making any decision or taking any action that may affect your business, you should consult a qualified professional advisor. Deloitte shall not be responsible for any loss sustained by any person who relies on this publication.﻿About DeloitteDeloitte refers to one or more of Deloitte Touche Tohmatsu Limited, a UK private company limited by guarantee (“DTTL”), its network of member firms, and their related entities. DTTL and each of its member firms are legally separate and independent entities. DTTL (also referred to as “Deloitte Global”) does not provide services to clients. In the United States, Deloitte refers to one or more of the US member firms of DTTL, their related entities that operate using the “Deloitte” name in the United States and their respective affiliates. Certain services may not be available to attest clients under the rules and regulations of public accounting. Please see www.deloitte.com/about to learn more about our global network of member firms. Copyright &copy; 2021 Deloitte Development LLC. All rights reserved.

Trends in health tech investments: Funding the future of health

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There’s no denying that the pandemic profoundly altered the trajectory of virtual care. COVID-19 brought us well beyond the conversation around telehealth’s value. Yet perhaps the biggest impact of the pandemic on telehealth has been the realization of all that it can do. What was once viewed as a platform for providing ‘one-time-only’ urgent care, is now being used for scheduled primary and specialty care visits with a patient’s own provider and much more.  Now, there exists a strong desire to make telehealth a foundation for a modern, connected care experience. The new imperative for digital connectivity translates to embedding telehealth into traditional healthcare activity so a broader range of services can be extended in ways that elevate the consumer and provider experience. This transition requires leaders to reimagine their approach to virtual care and focus on future-proofing their telehealth strategy in an evolving environment. The following areas of focus are key to prepare for. Prepare for care without borders. During COVID-19, federal and state governments expanded telehealth by waiving or suspending regulatory barriers to telehealth, including state licensure and credentialing. As a result, medical knowledge and skills can be projected from one side of the country to the other, proving that technology knows no geographical boundaries.  As discussions around whether to maintain relaxed licensure requirements take center stage—with a bill that would allow providers to <a href="http://mgaleg.maryland.gov/2021RS/bills/hb/hb0732f.pdf" target="_blank">seek two-year approval</a> to provide telehealth in other states and draft legislation for a “<a href="https://connectwithcare.org/medical-excellence-zone/" target="_blank">Medical Excellence Zone”</a> allowing providers to practice across state lines— it’s imperative healthcare operators ensure their telehealth infrastructure allows services to reach patients, regardless of location, seamlessly and securely. This flow of care services will happen in both directions, in and out of any region and will therefore include competitive inbound services from similar organizations not operating physically in your domain. Did anyone mention Amazon (Primary) Care play? Moves toward specialty care without borders have already proven impactful for caring for children in rural and underserved communities. During the first months of the pandemic, when in-person visits were limited to the sickest pediatric patients, demand for telehealth <a href="http://nemours.mediaroom.com/media-releases?item=122827" target="_blank">rose by 2,400%</a> at Nemours Children’s Hospital in Florida. At this hospital, telehealth gave families of all socioeconomical backgrounds regardless of location, a pathway for scheduled visits with primary care and specialty care providers.  Prepare for telehealth to enable new care delivery models. This year hybrid approaches have emerged in various facets of our lives, from schooling to work. Perhaps nowhere can hybrid models be more impactful than in healthcare. While multiple flavors exist, hybrid care models blend physical and digital care encounters. Leading organizations like Penn State Health have already proven hybrid care approaches to be successful in achieving better clinical outcomes and higher patient satisfaction.  Virtual primary care (VPC) is an example of an innovative hybrid care model already experiencing great traction in the market – one we fully expect to redefine healthcare in the coming years. VPC takes the best of traditional primary care, adds disease management techniques and data integration, and presents the patient with a digital-first, user-friendly experience and journey. Patients can connect with their selected PCP virtually and be referred for in-network labs, imaging and specialists as needed (some via telehealth, and some in physical locations). VPC bridges gaps in care and serves as a gateway to longstanding patient-provider relationships.  While relationships between patients and providers are likely to strengthen because of these new care models, we should expect that the power-balance between payers and providers will be reset with the arrival of these technologies and programs.  Prepare for telehealth to move from consumer-driven (transactional) to care-oriented (relationship-based). While it may be easier to grasp the subtleties of relationships during face-to-face interactions, telehealth has the power to enhance these connections. For this to happen, telehealth must be woven into all the different places that can sustain relationships between a patient, their doctor and their care team. From the hospital to the home and everywhere in between, telehealth must be embedded and the experience across each setting must be unified.   Leaders can set themselves up for success by taking a holistic approach to this challenge, extending telehealth capabilities to complement and reinforce wherever care happens. If we go back to the example of VPC -- at its core, is its ability to foster ongoing, longitudinal relationships between patients and providers. It gives patients access to tools like secure messaging, enabling regular correspondences with their doctor and perhaps most importantly, allows them to see the same doctor visit after visit—whether that be for primary care, behavioral health or otherwise.  Since most healthcare happens around long-term conditions, the arrival of longitudinal telehealth is highly impactful.  Prepare for an ‘always on’ world of healthcare. Access to healthcare has advanced beyond the mobile phone, app or browser. As virtual care continues to evolve, we need to expand our thinking around the types of technologies that can be used to facilitate healthcare interactions. Everything from TVs to watches are now fair play, as is the addition of automated, asynchronous interactions.  The proliferation of devices that can be used to connect patients and providers positions us well to make healthcare present not just at the time of a visit but “between visits” as well. Through a mix of technologies, we can introduce care companionship. This is especially critical for our most vulnerable patients – from individuals living with diabetes or battling cancer to those recovering at home after surgery. In these scenarios, remote devices (sensors) monitor patients’ physical and physiological activity, alerting clinicians to patterns that suggest the need for a telehealth checkup, or an ambulance. As telehealth shifts care into the home, the more we open up that technology infrastructure and allow it to “play well with such others,” the better the experience will be. Future proofing your telehealth strategy. In many ways, the battle for the legitimacy of telehealth has been won—but that’s not to say the war is over. As an industry, we are at an inflection point. If virtual care is seen only for what it has enabled during the pandemic—an alternative to the corresponding physical visit—we will miss out on the opportunity to reimagine the distribution of, and experience people can have with healthcare when it travels over technology. By reimagining how virtual care can fundamentally enhance the patient journey, and the way medical practice needs to adapt (gulp!), healthcare organizations will be better positioned to achieve their virtual aspirations for 2021 and beyond. The time is now. bio:Roy Schoenberg, MD, is president and CEO, <a href="https://business.amwell.com/resources/from-virtual-care-to-hybrid-care-covid-19-and-the-future-of-healthcare/" target="_blank">Amwell</a>.

Getting one’s ducks in a row, with Post-COVID telehealth

HLTH Blog

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Special Assistant to the Director, Biomedical Advanced Research and Development Authority (BARDA)

Biologist, Biomedical Advanced Research and Development Authority (BARDA)

In what the <a href="https://www.fda.gov/emergency-preparedness-and-response/about-mcmi/what-are-medical-countermeasures#:~:text=About%20MCMs-,Medical%20countermeasures%2C%20or%20MCMs%2C%20are%20FDA%2Dregulated%20products%20(,a%20naturally%20occurring%20emerging%20disease" target="_blank">Biotechnology Innovation Organization</a> (BIO) is calling a “monumental campaign to combat, and hopefully eradicate, COVID-19,” it’s become evident that small, creative-thinking biotech companies are needed to help lead on the frontline.1 Through our joint initiative, <a href="https://jlabs.jnjinnovation.com/blue-knight" target="_blank">BLUE KNIGHT™</a>, the Biomedical Advanced Research and Development Authority (BARDA) and Johnson &amp; Johnson Innovation – JLABS (JLABS) are collaborating with early-stage companies with the goal of bringing leading ideas to patients. By building the Blue Knight community, we aim to be better prepared with even more deployable potential solutions when the next health threat strikes. To do so, we are challenging you, commercial innovators, to explore multi-use opportunities for your technologies that may help shift the paradigm of preparedness and rapid health threat response.  What are Multi-Use Technologies? Multi-use technologyI models provoke innovators to think outside the box when conceptualizing market impact. Rather than developing a narrow concept that addresses one commercial need, multi-use technologies have the potential to address multiple gaps. One of these potential utilizations may be a medical countermeasure (MCM)—a product that may be used during or in response to a potential public health threat.2 Multi-use technologies can help us move out of the “one bug-one drug” mindset3 towards nimble and more sustainable models of innovation that are capable of addressing routine health needs and have the potential to quickly adapt during a public health threat.  The <a href="https://jlabs.jnjinnovation.com/JLABSNavigator/filter/isBlueKnight" target="_blank">Blue Knight portfolio</a> exemplifies the types of potential multi-use solutions we aim to support, including wearable detection devices and platform technologies that may help address emerging infectious disease needs, as well as support broader disease areas.  Three Reasons to Consider Identifying a Multi-Use Approach  <ol><li>Expanded markets. Technologies that can support multiple markets are often seen as advantageous because of the potential for increased revenue and manufacturing opportunities. By broadening potential impact, your idea may appeal to a more diverse set of stakeholders, potential partners, and investors, leading to potentially greater impact for more patients. This can also allow you to diversify funding across both dilutive and non-dilutive sources. </li><li>Building trust across the healthcare spectrum. Getting your technology to market can be challenging. However, once you’ve navigated the regulatory, manufacturing, and distribution hurdles with one product and application, each subsequent utilization may face fewer barriers. You may be able to leverage and maximize your initial investment in your product by supporting additional indications for that product. Multi-use technologies can help stakeholders across the healthcare spectrum – from regulators and providers to patients – gain familiarity through commercial use of these technologies prior to use as an MCM in emergency settings. When physicians can gain experience with a technology as a standard care therapeutic first, they may have increased confidence using the therapeutic in a crisis compared to something that may be developed in a specific response to the crisis. Further, every time a technology is submitted and approved for a new use, its archive of safety and efficacy data has the opportunity to be strengthened. When it comes time to evaluate for an emergency response, this data archive can become the backing for a stronger regulatory submission. Together, the combination of engaged stakeholders, strong data, and established trust may be key for streamlined adoption.</li><li>Accessing greater support. For even the most promising solutions, having a strong support network may be the most critical component in establishing market share. Developing a multi-use technology can help expand your network into the preparedness space to enhance public health security through the development of MCMs. By connecting with both private and public sector mentors, you can access new perspectives for anticipating the unexpected and navigating the expected barriers to market readiness. With preparedness solutions, developing these partnerships before the next health threat emerges may be critical. By connecting early, you may gain a better understanding of the development process and support for setting expectations while working to position your technology to help address emerging health threats.</li></ol>Getting Started: Reimagining Possibilities for Your Technology In response to the COVID-19 pandemic, we’ve seen many innovators pivoting or repurposing existing science and technologies to address MCM needs.1 In 2020, for example, Johnson &amp; Johnson Innovation worked with over 100 global innovators to explore COVID-19 applications for their approaches.5 While pivoting can help further our repertoire of pandemic solutions, it must happen more proactively because, in emergencies, it’s often the solutions with proven efficacy and safety that can be rapidly scaled to meet new manufacturing demands and deployed in unprecedented timeframes.  For companies already innovating with the aim to address infectious pathogens, pivoting for pandemic preparedness may not be a far stretch. For others, identifying a preparedness utility may require creativity and unorthodox thinking.  While we need solutions for combatting specific threats, it’s also critical to develop end-to-end technologies that may be foundational for improving patient care and responsiveness across routine health challenges. One great example is the safety syringe: a high-performance, retractable needle that evolved in response to an increasing incidence of needle-stick injures among medical professionals.6 They aren’t often at the forefront when discussing the extraordinary ideas supporting our COVID-19 response, but if the manufacturing supply chain did not already exist and providers were not already trained to use them, the vaccine rollout could have looked very different. End-to-end solutions developed years ago, like the safety syringe, are now the tools helping us cross the finish line in addressing COVID-19. Ready to Accept the Challenge?  Looking ahead, it may be the innovations of today that become the solutions for future threats. Blue Knight aims to shift the paradigm of health threat preparedness by developing a rich pipeline of science and technology solutions that can address the innovation gaps. Together, we hope to establish promising technologies now, so that they become the critical tools waiting in our toolbox to deploy during the health threat. Let’s start reimagining possibilities together: <a href="http://jji.jnj/blueknight" target="_blank">sign up to meet with us</a>!  I BARDA <a href="http://phe.gov/about/barda/stratplan/Pages/barda-guiding-principles.aspx" target="_blank" style="font-size: 9px;">defines</a> multi-use products as products that demonstrate efficacy against a wide range of specified threats…, that can find durable and well-defined commercial markets and leverage market force. References:  <ol><li>Biotechnology Innovation Organization. BIO COVID-19 Therapeutic Development Tracker. Available at: https://www.bio.org/policy/human-health/vaccines-biodefense/coronavirus/pipeline-tracker. Last accessed: April 2021. </li><li>U.S. FDA. What are Medical Countermeasures. Available at: https://www.fda.gov/emergency-preparedness-and-response/about-mcmi/what-are-medical-countermeasures. Last accessed: April 2021.  </li><li>U.S. HSS. 2014 Public Health Emergency Medical Countermeasures Enterprise Strategy and Implementation Plan. Pg. 31. Available at: https://www.phe.gov/Preparedness/mcm/phemce/Documents/2014-phemce-sip.pdf. Last accessed: April 2021. </li><li>U.S. FDA. Clinical Trial Diversity. Available at: https://www.fda.gov/consumers/minority-health-and-health-equity/racial-and-ethnic-minorities-clinical-trials. Last accessed: April 2021. </li><li>Johnson &amp; Johnson Innovation. Deals Around the World. Available at: https://jnjinnovation.com/node/video/deals-around-the-world. Last accessed: April 2021. </li><li>Biospace. Retractable Safety Syringe Market. Available at: https://www.biospace.com/article/retractable-safety-syringe-market-popularity-of-disposable-automatic-retractable-safety-syringe-is-growing/. Last accessed: April 2021. </li></ol>

Embrace the Challenge: How Startups Can Help Shift the Preparedness Paradigm

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Executive Healthcare Advisor - Global Industries Group

Since the rise of the smartphone, chatbots and text have taken the place of traditional modes of business communications. In healthcare, consumers are demanding scheduling apps or telehealth appointments, and opting for remote monitoring to track their conditions more efficiently while at home-- especially patients with busy schedules and those who live far from their providers. In the past, providers spoke of the patient experience. Now they speak of patient expectations. These expectations mean telehealth and digital health are here to stay, and the pressure is on to offer services that are consistent, repeatable, and scalable.  Added to these pressures: The requirements of social distancing make telehealth fundamental to healthcare. Many hospital employees such as radiologists are also working from home, further straining provider tech stacks. Hospital systems can either get ahead of this trend and create opportunities to capture new populations and drive efficiencies, or risk falling behind. New operational models are needed to meet patient expectations, enable newly distributed workforces and unlock opportunities for organizations to remain relevant. Four Ways to Meet Patient Expectations &amp; Opportunities with Cloud Infrastructure Health systems may wish to go “all-in” on the cloud and start with a clean slate, but the reality is usually more complex, with apps and data stored on-prem and elsewhere and emerging technology existing alongside legacy systems. Here are four major routes to upgrading healthcare provider stacks:  <ol><li>Public Cloud provides resources to any organization or individual via the internet. Hardware making up the compute, storage and network elements of the service are owned and maintained by the cloud provider and it is shared between multiple tenants. For users the advantages are many—a primary one being the ability to create scalable, near-instant infrastructure at the click of a button. Public cloud options offer speed and simplicity, often at reasonable cost. However, options and pricing are limited to a single vendor, offerings may fall into the “one-size-fits-all” category and many providers fear vendor lock-in. </li><li>Private Cloud infrastructure provides single tenancy and allows the cloud vendor to maintain a private cloud or run apps and data in the health system’s private data centers. A private model gives the healthcare provider more control –the one-size-fits-all problem no longer exists – but comes at a much higher cost.</li><li>Hybrid Cloud infrastructure combines public and private clouds with connectivity and orchestration among environments that allows sharing and mobility of data and resources. Call this the “reality-based model”, because hybrid IT can be complex--a problem for IT pros as they manage many different sources. </li><li>Multi-Cloud includes more than one public cloud service provider for virtual data storage or computing power resources, with or without existing private cloud and on-premises infrastructure. The healthcare provider can choose the best configuration, and multi-cloud also reduces dependence on just one cloud vendor. For example, providers may choose to have one cloud vendor for apps and workloads, and another for their database. As a result, costs may be diminished, and healthcare organizations can tap into the proprietary cloud apps of multiple cloud providers. On the face of it, this seems to invite further complexity, but with the right platform in place this strategy provides more flexibility. We’ll explore that, next.</li></ol> Think Cloud-Fit, Not Cloud-FirstWhile many operations are opting for a cloud-first stance, I propose finding a proper cloud-fit. With a good cloud-fit, healthcare providers can opt for AWS, Azure, and Google Cloud, Oracle public clouds and VMware hybrid clouds--all at once. They can take advantage of the tremendous variety of microservices on the back end, whether it&#39;s long-term storage, artificial intelligence, or machine learning. AWS has countless microservices on its back end that save providers time on new builds. This multi-cloud option places the burden on the vendors to provide the expertise and because mission-critical apps are often stored on private cloud and on-premises infrastructure, multi-cloud is also applicable here. In short, multi-cloud can handle it all.  With multiple vendors, healthcare organizations can preserve resources for options that provide the best value. A properly fit multi-cloud option saves on constructing infrastructure, too: For example, a hospital in Abu Dhabi extended its care services into a hotel at the beginning of the COVID-19 onslaught--an overnight pop-up hospital. They were able to meet incoming demand almost immediately with multi-cloud. Other systems use multi-cloud approach for care continuity. Even in a time of stress, these healthcare organizations can ensure there is no disruption of services. They can take a portion of their workload and move it into a public cloud provider in a hybrid model—thus ensuring they have the availability of services where it is needed most. Managing the daily operations of a multi-cloud architecture can be complex and requires significant IT resources. But these issues are fixable. How to Avoid the Complexity TrapAs ZDNet <a href="https://www.zdnet.com/article/remote-work-and-tech-jobs-how-cios-are-changing-their-priorities/" target="_blank">points out</a>, the IT skills gap just keeps getting bigger. Almost all IT decision-makers had at least one job they couldn&#39;t fill over the past year, while 69 percent still have multiple unfilled positions. Everyone should therefore strive for simplicity of management.  VMware’s <a href="https://www.vmware.com/solutions/virtualization/cloud-management-platform.html?SRC=WWW_US_GP_multi-cloud_SiteLink" target="_blank">Cloud Management Platform</a> normalizes operations and makes them consistent, repeatable, and scalable for efficiency and simplicity. It also offers comprehensive reporting and analytics that improve capacity forecasting and planning while optimizing workload placement, resource acquisition, and utilization. Healthcare providers can have a cloud-fit that&#39;s just right for them.  Providers are balancing rapid growth in IT infrastructure demands due to telehealth and digital health as well as patient expectations for a more modern healthcare experience against current system limitations, time and budget to scale and deliver on strategic business goals. The right cloud-fit can help health systems manage to patient expectations, meet distributed workforce demands and remain prepared for a digital health future. Join VMware on April 27th for a virtual event to continue this conversation – VMware Executive Summit Online- Lead the change for your modern apps and cloud strategy featuring a healthcare breakout. <a href="https://vmwarereg.fig-street.com/042721-summit/?cid=7012H000001KWPj" target="_blank">Register now</a>.

The IT Dilemma for Health Providers:  Patient Experience is the New Differentiator

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Senior Vice President

Innovation is often associated with young people, but the next wave of tech is being sparked by those focusing on ageless design—an approach that looks at design for multi-generational users as well as for the changing needs of a user over time. In less than 10 years, the US will reach a demographic turning point where all baby boomers will be older than age 65 and one in every five residents will be retirement age. This presents a tremendous opportunity in tech to build solutions that foster social connection, promote fitness and good nutrition, address chronic illness, monitor markers of health, and simplify living to create a higher quality of life for all. What we are seeing is that aging is unleashing exponential growth in every industry. Businesses that target the economic power of the 50+ population will see enormous gains and this is going to continue for the foreseeable future. The Longevity Economy represents the economic contribution of Americans over the age of 50. In 2018, believe it or not, it was more than $9 trillion--yes trillion--and is projected to grow to $13 trillion by 2030. Therefore, when we look at this economic activity, we know startups and large companies are eager to deliver new products and services to this market, and we believe that we can help. AARP Innovation Labs is committed to finding the most disruptive startups that are tackling society’s most pressing problems as we age. We are approaching the “Age of age.” Inclusive and Consumer-Centered DesignAs a serial entrepreneur, investor and corporate innovator, I have witnessed the ebbs and flows of startups across different innovation ecosystems. The startups shaping the “AgeTech” wave approach their solutions with a heart first perspective. More often than not, the entrepreneurs that we meet in this space are solving for their father, mother, or close family member. Designing with a specific person in mind, takes into account the use cases and scenarios that apply to his or her circumstances. It is critical to validate design by testing it with target consumers to identify and address situational challenges and personal bias. Designing for all as we create health related products and services, requires intentional and inclusive approaches, and at the end of the day, always puts the consumer at the center of the process.   Physical Activity &amp; FitnessI come across companies that are seeking to help older adults maintain a higher quality of life, better health, and enhanced physical function. As an older adult, regular physical activity is one of the most important things you can do for your health. It can prevent many of the health problems that seem to come with age. It also helps your muscles grow stronger so you can keep doing your day-to-day activities without becoming dependent on others.  <a href="https://www.mightyhealth.com/" target="_blank">Mighty Health</a> was created because of the founder’s personal experience with helping his father change his lifestyle after heart surgery. Most wellness apps are designed for motivated millennials, making them feel less relatable to older adults. These apps don’t take into account evolving health needs, joint issues, or technical limitations. Mighty Health is focused specifically on the 50+ with exercise and nutritional support as well as a personal coach to help motivate users on their journey to becoming more physically fit.  Fall Prevention Falling is one of the biggest threats to the health of older adults and can reduce their ability to remain independent. However, falls don’t have to be inevitable as you age. You can reduce your chance of falling or help a loved one prevent falls. There are proven ways to reduce and prevent falls, even for older adults. Zibrio, the creator of the SmartScale, can measure physical balance to correctly identify people who are at risk of falling. One of the founders of this solution, a world class athlete, creates balance training programs for older adults. Most people don’t realize their balance is deteriorating and most only get help after a fall occurs, which may be too late. The Zibrio Balance Coach app provides the why behind the balance score, and tracks progress over time. To reduce falls, balance training is also recommended to be included in physical exercise programs for older adults as exercise has been shown to reduce falls. Unpaid Caregiving Caregiving can be a full-time job. In fact, it’s a reality for one in five Americans. Caregivers manage doctor appointments, provide transportation, make sure medications are taken on time, and keep the home going – to name just a few of the vital tasks performed on a daily basis. Therefore, caregivers welcome anything that could help them manage all their day-to-day activities. Keeping life in motion and bringing loved ones together to support a family member was the inspiration for <a href="https://www.caregather.com/" target="_blank">Caregather</a>. The company was founded based on one of the co-founder’s personal experience with a family member’s diagnosis with cancer. These caregiving solutions designed to make the life of unpaid caregiver easier and to keep your loved one safe and healthy. I have to admit that turning 50 came with a sense of appreciation for all of my life experiences, and a bit of hesitation as I contemplated what the next half of life would look like. Living through a pandemic has brought to light the disparities that exist across society, especially for the 50+. It has also provide us with the opportunity to reimagine the lives we want for ourselves as we age. As a member of the innovation community, AARP Innovation Labs will continue to champion entrepreneurs leveraging their experiences to bring forth new solutions that empower people to choose how they live as they age.

Empowering A Changing Demographic

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Head of US Digital Health Strategy

The COVID-19 global pandemic caused massive disruption and exposed existing gaps in the US healthcare system. Such inefficiencies posed urgent risks to people living with chronic diseases, forcing healthcare providers to quickly adopt new models of care, access and delivery. The evolution to prioritize digitalization has accelerated! The need for rapidly evolving digital technology and remote care supports a larger, more patient-centric approach— “portable health”. Portable health is an ecosystem of connected, location-independent healthcare services and solutions, accessible wherever and however patients decide. Today, we overwhelmingly opt for more personalized lifestyle approaches that fit into our busy lives, and healthcare is no exception. Through intelligent digital solutions, we can better individualize care while improving utilization and outcomes for a broad range of patients. At its core, portable health is about integrating care seamlessly into people’s lives, regardless of where they live, what they do or who they are.  Here’s why portable health is here to stay: <ul><li>Safety: Remote care is a requisite in today’s climate. With 35% of Americans still delaying medical care due to COVID-19,1 we need to develop solutions to better serve these shifting healthcare needs. The move to more patient-centric healthcare provides a virtual opportunity for patients and caregivers to minimize physical contact while remaining safe and hands-on in the ongoing management of patient health. </li><li>Convenience: The number of Americans aged 65+ is projected to nearly double from 52 million in 2018 to 95 million by 2060.2 As this population ages, the flexibility of healthcare at home will become imperative to those whose physical abilities may be declining, or who have multiple chronic conditions requiring care from various specialists. Convenience is a critical factor for people younger than 65, too. With the recent COVID-19 lockdown restrictions along with current surge, we’re spending an increasing number of hours per day working while also managing family needs (e.g., home schooling). This has required telecommuting for many.3 With intensified schedules and work-life environment imbalance, decreasing the amount of time spent traveling to visit a doctor while continuing efficient care needed will progressively be essential to so many.  </li><li>Enhanced care: In addition to the safety and convenience of portable health, the customized patient-driven nature provides a benefit to healthcare that many people crave. Certain treatments can now be implemented at the time and place a patient chooses. Through innovative technologies that are now available, treatment plans can be better tailored to a specific person, rather than a population or a disease state. Additionally, innovations in digital health – mobile and voice tech, chat bots, wearable devices and more – can further accelerate improvements in patient experiences through data and analytics. </li></ul>The beauty and value of portable health is using digitally-focused solutions to provide practical, meaningful support and therapeutic guidance for patients outside the doctor’s office and within the context of their daily lives as a mom, dad, police officer, teacher, etc.—not as a “patient”. Through an interconnected web of customized care and innovative technologies, an individual can receive support and healthcare providers can receive better data informed by real-world observations. With analytics, patients and doctors have data at their fingertips to better encourage adherence and management of chronic diseases, like diabetes. In addition to healthcare providers, pharmaceutical companies play an important role in seamlessly integrating the portable health ecosystem into the lives of patients. As a partner in the healthcare community, Novo Nordisk aims to diversify holistic digital health interventions and support offerings to improve engagement and medication adherence among patients. We’re committed to making strides in digital health to better support people with chronic metabolic disease through safe, convenient and customized care. By actively leveraging the latest technology and partnerships, we can facilitate care delivery with greater efficiency. The existing gaps in our healthcare system will continue to be exacerbated as the COVID-19 pandemic progresses, threatening the health of those patients who struggle with and manage chronic diseases every day. However, as these problems are uncovered, I’m confident that solutions will be found. The healthcare industry is revolutionizing new and innovative ways to accelerate care and appropriate interventions for the millions of people living with chronic diseases. Enhancing and individualizing patient experiences is essential to providing sustainable care for those who need it most. Today’s problems call for advanced solutions beyond traditional protocols and pharmacotherapy, leveraging digital, technology and data. There is no time like the present to make this happen. References <ol><li>Centers for Disease Control and Prevention. Reduced Access to Care: Household Pulse Survey. Available at: https://www.cdc.gov/nchs/covid19/pulse/reduced-access-to-care.htm. Last accessed: September 2020. </li><li>Population Reference Bureau. Fact Sheet: Aging in the United States. Available at: https://www.prb.org/aging-unitedstates-fact-sheet/. Last accessed: September 2020. </li><li>National Bureau of Economic Research. Collaborating During Coronavirus: The Impact of COVID-19 on the Nature of Work. https://www.nber.org/system/files/working_papers/w27612/w27612.pdf. Last accessed: October 2020.</li></ol>

Reimagining healthcare: The shift toward patient-centric health

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EVP and Chief Innovation Officer

I’m looking forward to the annual HLTH conference next week to share more on the growing trend of voice technology in the health care space and what’s next for Houston Methodist. Voice technology is one area of innovation that has had rapid adoption in our households and more and more in the clinical setting. It has given us accessibility and convenience to information, integrating into our daily lives as an assistant, planner and a resource to discover the unknown.  Voice is only one of many areas that has gone through rapid adoption during 2020. It has become evident to me during this pandemic that innovation in healthcare is not only the key to survival, but also our hope of improving care; reducing costs; improving the work/life balance of physicians and simplifying the way that consumers access and interact with the health care system. Significant moves have been made in health care innovation in recent years. COVID-19 has only sped along and aided in the adoption and acceptance of these innovations. Consumers have matured in the years since the Internet became a center for commerce in the 10+ years since the iPhone was released. Consumers shop online for their shirts and shoes, order groceries online and sign up for activities. And, in the year of COVID-19, we have witnessed the explosion of all things virtual: school, meetings, happy hours and virtual family gatherings. Online shopping and Facetime have rapidly changed the way that we conduct commerce and connect with family, yet health care interactions have been woefully slow to change from the basic clipboard on your way in the door to the paper bill you get in the mail. Health care providers must do better or they, like the dinosaurs, will not survive. At Houston Methodist, we have been active adopters of innovations in health care. We focus on products in the beta stage or beyond and have learned to rapidly scale those innovations. Our philosophy is to work in a “quad” model for innovation where the upper-left quadrant is “graduates” of the innovation center and includes those areas that are deemed successful in their return-on-investment for achieving quality or financial returns and the lower-right-quadrant are those products that “rest-in-pace” and did not have their intended results. The other two quadrants are rounded out with the pilot and the pipeline. The Center for Innovation leadership group, or what we call “DIOP,” which stands for Digital Innovation Obsessed People, is responsible for working with operating units to identify the pipeline, asking tough questions about our investments and tracking the results to discontinue or graduate a project. The results of focusing on innovation BEFORE it was essential for a pandemic such as COVID-19 enabled our system to be ready with telemedicine options for the consumer, allowed us to have virtual ICU cameras installed before they were absolutely necessary and have a touchless check-in for users as well as two-way-texting solution between patients and offices. Houston Methodist had over 50 care pathways that provided key information to patients that had successfully reduced length-of-stay and readmissions by over 25%. And, we had empowerment tools such as iPads and Alexa devices designed for patient rooms. We had AI tools such as MIC/Sick Bay in our patient rooms, symptom-checkers and chatbots. When COVID-19 came, the hospital pivoted within days to create a virtual, touchless environment for our patients and the results demonstrated that the innovations we invested in were well worth it. There is so much more work to be done as we aim to graduate (or retire) more innovation opportunities that improve the lives of our patients and providers as well as reduce the cost of care and increase the quality of care for patients. Health care providers must embrace transformation, otherwise risk disruptors circling with new technology and innovative ways of thinking. On Tuesday, October 13, I’ll share how we’ve embraced innovation like never before through our collaboration with Amazon Web Services to bring clinical voice technologies that drive clinical efficiencies and improve patient safety. Fostering a culture of innovation has led us to this opportunity and will continue to get us past this year -- the year that everything changed.

Navigating 2020 by Embracing Innovation

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In the last several months, we have seen a drastic boom in telehealth usage due to the circumstances created by the COVID-19 pandemic. If the current state of telehealth is any indicator for the future, we may see utilization of all digital care technology expand beyond the traditional four walls. Has health consumer behavior truly changed enough to continue this trend even past the pandemic or will they revert to old ways? Also, what do we do when telemedicine simply is not enough? This past July, Wellframe hosted a HLTH GoLIVE webinar, Filling the Gaps of Telemedicine, with BlueCross Blue Shield of Tennessee, Blue Cross Blue Shield of Massachusetts and Oliver Wyman.  During the webinar, the panelists discussed how a unique combination of digital capabilities can help close previous gaps in care. We followed up with the panelists to share their biggest takeaways. Jacob Sattelmair, Co-founder and CEO, Wellframe “Telemedicine solves a lot in terms of convenience and accessibility, but [doctor’s visits] are still a 13-minute encounter where 99.9% of someone’s life is in between. We do think that as more people are trained to use digital and virtual channels to access care, and more solutions are coming out to fill in some of those gaps, people will be acclimated to look to digital as a way of getting support, not just when they’re talking to a physician, but in between. And I think those are some exciting opportunities that we see for our partners.” Andrea Willis, SVP and Chief Medical Officer, BlueCross BlueShield of Tennessee “We are mostly a rural state. And for the most part, we did see that access was improved because of this rapid expansion [of virtual health]. But it also shone a spotlight on where there were disparate areas as well. We decided that we did not want to miss this moment to actually be a part of true public health. So we gave a grant to the Tennessee Department of Health, for example, to improve access in some rural areas, and we joined with other companies to increase broadband access... what this has done is brought all the right stakeholders to the table for us to go in collectively to support increased access for everybody.” Sukanya Soderland, Chief Strategy Officer and SVP, Blue Cross Blue Shield of Massachusetts “What we&#39;re starting to see is some of the expectations that consumers have had outside of healthcare, where our lives are run off of our phones, are starting to infiltrate into healthcare. That means a lot of health plans will need to raise the bar, and it&#39;s upped the ante for all of us. As far as telehealth is concerned, a lot of the initial responses that I&#39;ve seen in some of the survey work have demonstrated that consumers have been pretty satisfied with the virtual options that they have in light of COVID. But, I don&#39;t think that&#39;s something we can rest our laurels on at this stage because again, the expectations will continue to rise. We’re going to have to bring a deeper discipline to our offerings moving forward.” Marcia Macphearson, Partner, Health and Life Sciences, Oliver Wyman “COVID-19 created a powerful force accelerator for telehealth adoption by providers, patients and payers that has exposed a much wider set of stakeholders to a substantially different experience of healthcare; if this adoption rate persists it holds the promise to materially shift consumer healthcare behavior which has been long promised but not previously delivered upon. Maintaining telehealth adoption momentum is now a key objective for stakeholders across the industry but will require continued efforts across capability enablement, addressing digital inequity across populations, and reimbursement and policy reforms.”

Filling the Gaps of Telemedicine

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HLTH Team: Tell us about your work – and how Microsoft has responded to the COVID-19 pandemic. Dr. Rhew: When COVID-19 was first reported in China and the infection began to spread quickly throughout other parts of Asia, Europe, and the United States, Microsoft engaged at an early stage to help healthcare organizations and governments worldwide respond to the crisis.   One example, heightened public concern along with a readily transmissible respiratory pathogen necessitated that health systems adjust their underlying processes for screening and triage. Providence, a large multi-state multi-hospital health system with significant presence in the greater Seattle region, applied an artificial intelligence (AI)-based “chat bot” technology developed by Microsoft to address the rising patient concerns about the virus. By asking a series of questions based on the latest Centers for Disease Control &amp; Prevention (CDC) guidelines, the chat bot screened patients for COVID-19 symptoms and/or exposures. Patients with symptoms and/or exposures were subsequently directed to Providence’s telehealth portal for clinical evaluation and possible testing. The bot was facilitating successful and efficient population-level care coordination. This enabled high-risk and/or symptomatic patients to receive a timely remote clinical evaluation, without increasing the risk of virus transmission to other patients or extending the wait-times for those with symptoms. Since then, Microsoft has delivered the same chat bot technology for hospitals and governments across the globe. Today, more than 45 million people globally have been using this bot technology. Early in the pandemic, we also saw hospitals and ICUs overflowing with COVID-19 patients, accompanied by critical shortages in personal protective equipment (PPE), lab testing kits, ICU beds, ventilators, trained critical care specialists, and medical treatments. In response, Microsoft launched and participated in collaborative efforts with partners across the healthcare ecosystem. <ul><li>One example was the collaboration between the American Hospital Association, Kaiser Permanente, Kearny, Merit Solutions, Microsoft, and UPS to launch Protecting People Everywhere, an initiative powered by the HealthEquip™ app through which PPE donors and their donations could be matched with potential recipients. The app ensured the equitable distribution of critical PPE and other medical supplies to the places they were needed most. </li><li>In another example, GE Healthcare and Microsoft joined forces to help critical care specialists do more with their resource constraints by developing and launching a virtual ICU solution called Mural™. The Mural™ Virtual Care Solution is hosted on Microsoft Azure and integrates several disparate critical-care data sources (electronic medical record (EMR), telemetry, ventilator, infusion management, etc.) into a single pane of glass, allowing for remote consultation of ICU patients at scale. </li><li>Microsoft applied its chat bot to facilitate the donation of convalescent plasma from those who had recovered from the illness as part of the “The Fight Is In Us” Campaign. The plasma will be used to help find a potential treatment for COVID-19. </li></ul>Our teams also collaborated with Adaptive Biotechnologies to launch ImmuneCODE which is sharing one of the largest, most detailed views of the immune response to COVID-19 based on de-identified data generated from thousands of COVID-19 blood samples from patients around the globe. Information from ImmuneCODE will accelerate ongoing global efforts to develop better diagnostics, vaccines and therapeutics for COVID-19. Technology has played an important role in helping to battle the pandemic, and Microsoft will continue to lean in to support efforts where technology can make a difference. HLTH Team: What’s surprised you most about the response to COVID-19? What has Microsoft done to help customers push forward in new and different ways?  Dr. Rhew: One of the most notable changes that emerged as a result of the pandemic was the rapid and large-scale adoption of virtual health. The passage of the Coronavirus Aid Relief and Economic Security Act (CARES Act), which provided funds through the Federal Communications Commission’s (FCC’s) telehealth grants program, along with subsequent federal actions to lift technology and reimbursement restrictions previously placed on virtual interventions, were key drivers in fostering the rapid adoption of telehealth services. St. Luke’s University Health Network (SLUHN) provided a prime example of how hospitals were dramatically shifting their ambulatory practices towards a virtual care model. SLUHN, a large regional health system encompassing multiple counties across two-states, introduced and adopted telehealth using Microsoft Teams™ as its virtual care platform. In a matter of days, the health system trained thousands of staff and providers to conduct, document, and schedule virtual visits – fundamentally altering its healthcare-delivery apparatus. Using the platform, they now schedule and evaluate thousands of patients daily.  Recognizing that technology has a role to play in accelerating progress for solutions to the pandemic and other pressing healthcare concerns and challenges, Microsoft accelerated its efforts to develop and launch the Microsoft Cloud for Healthcare. The Microsoft Cloud for Healthcare brings together trusted and integrated capabilities for customers and partners that enrich patient engagement and connects health teams to help improve collaboration, decision-making, and operational efficiencies. HLTH Team: I understand you worked in infectious disease research early in your career—how has that work informed or prepared you to understand and meet the needs of healthcare providers?  Dr. Rhew: Infectious diseases is one of the few specialties in medicine that balances the needs of the patient along with the needs of the community and society. Just as important as prescribing the right antibiotic is knowing when not to prescribe it or when to stop it. As I reflect upon my days as an AIDS physician and researcher, my responsibility was to treat the patient, study the disease, promote education and prevention, and constantly assess the community-resistance patterns of HIV and other infectious agents to the latest antibiotics.  Today, with COVID-19, we are faced with a similar but broader-scale balancing act. Implementing public health measures to decrease the spread of infection and keep hospitals afloat, balanced against the impact that these measures may have on the economy, education, and people’s civil liberties.  Microsoft has taken a very thoughtful and principled approach as to how we as a company would respond to the pandemic. The heart of our response have been guiding principles to put people’s safety above all else as we worked to help our customers and protect our employees.  There’s been a lot of learnings through our efforts about best practices. Some of my personal learnings and best practices I’ll take forward include:  <ol><li>Lead with empathy </li><li>Lean on existing crisis management principles </li><li>Move quickly and move together </li><li>Listen to the experts </li><li>Communicate frequently and transparently </li></ol>HLTH Team: Can you tell us more about the work you’re doing that can transform our response to COVID-19; supporting re-opening and a phased approach to recovery?  Dr. Rhew: Microsoft, along with its partners, have been working on a variety of ways to help support businesses. Those areas span facilities and workforce preparation, management and operations. Microsoft provides Power Platform™ technologies that organizations can use and customize to address all of these areas to meet their needs.  However, for others looking for a fully managed service, our partners have developed programs using Microsoft technology. For example, one of those partners is United Health Group (UHG) and the program is called ProtectWell™. The core components of ProtectWell include: an employee mobile app for self-attestation; employer app to enable facility check-in; and closed-loop COVID-19 lab testing in coordination with major lab testing sites such as LabCorp and Quest. The program started with UHG and Optum employees. Since then, UHG has offered the program at no charge through the end of the year to U.S. healthcare organizations, businesses, or universities. HLTH Team: What’s next for you? For Microsoft? Where do you see us in 6 mos or a year in relation to COVID-19?  Dr. Rhew: A primary area of focus for us at Microsoft will involve exploring how healthcare can be made easier, smarter, and more efficient for patients and providers. Microsoft Cloud for Healthcare, an end-to-end healthcare specific platform, will serve as our vehicle to help achieve this goal. In May 2020, we announced the availability of the public preview of Microsoft Cloud for Healthcare. Through the public preview, we’re working closely with partners across the healthcare ecosystem on key use cases, to facilitate integrations into existing platforms and systems of record, to streamline the workflows, and to ultimately deliver better experiences, better insights, and better outcomes. With respect to COVID-19, we will continue to lean in to help, focusing on helping everyone get back to their places of work or school, which includes our recently launched initiative to help 25 million people worldwide acquire the digital skills needed in a COVID-19 economy. About Dr. David Rhew: Dr. David C. Rhew is the Global Chief Medical Officer (CMO) and Vice-President (VP) of Healthcare for Microsoft. He is the Chairman of the Health and Fitness Technology Division for the Consumer Technology Association and serves on CTA’s Board of Industry Leaders. He co-holds six U.S. technology patents that enable authoring, mapping, and integration of clinical decision support into the electronic health record. David is currently an Adjunct Professor at the Stanford University School of Medicine.

COVID-19 Discussion with Dr. David Rhew

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An event like HLTH VRTL shows off the depth and breadth of the healthcare market – an incredible amalgamation of players from all corners of the industry. Among those players are employers – market influencers who don’t always get the attention they deserve. If you were to play a word-association game and mention “healthcare,” it’s unlikely that anyone would respond with “employer;” yet employers are major players in healthcare, providing coverage to more than half the insured population in the United States.  At Mercer, we recognize the crucial role employers play in transforming the healthcare marketplace to be a more rational system that benefits both employers and their employees. Transformation is desperately needed: Employers are paying reimbursement rates that are more than twice those of Medicare, on average. Such a system is simply not sustainable for plan sponsors. Value must become central to the conversation. The simple equation, “Value equals quality divided by cost,” is key to transformation. When quality and cost are out of balance, it benefits no one. Employers can get greater value out of the healthcare system by demanding higher quality and putting downward pressure on costs.  By reinventing with an eye on value, employers can create a future in which: <ul><li>Quality, affordable healthcare is accessible to all members. </li><li>Benefits serve the diverse range of employees and their families, reflecting individual values. </li><li>Vendors are efficient and continuously seek improvement. </li><li>Dollars spent on healthcare deliver tangible value to the business. </li></ul>With this vision in mind, Mercer has constructed an impressive track for HLTH VRTL, featuring four C-level speakers.  On the topic of quality, employers rarely know the whole story when it comes to healthcare quality metrics. Clarify Health CEO Jean Drouin will talk about how that’s changing and opportunities for employers who are armed with better quality data.  Cost is a key component of value, and the CEO of Mr. Car Wash, John Lai, will share how his organization rolled out employee programs designed to maximize cost efficiency while maintaining incredible employee engagement.  Hear from Laurie Ledford, CHRO of Marsh and McLennan Companies, about how a diversity, equity and inclusion strategy can bring value to an organization, and how that strategy intersects with healthcare.  Our track will wrap up with a discussion about how digital health is creating new opportunities for value in the healthcare market, and what that may mean for employers looking to reinvent their strategies. CEO of Galileo, Tom Lee, will join to share his perspective on how the events of this year have accelerated the value of digital health. 2020 is the year everything changed, and it marks the beginning of a big shift for employer-sponsors. Employers are uniquely positioned to reinvent the healthcare marketplace to realize greater value from the system.  To learn more, please join our half-day Employer track on Thursday, October 15th from 11:00 a.m. to 4:00 p.m.

Transformation is Key to Greater Healthcare Value for Employers

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The COVID-19 global pandemic brought a sudden and overwhelming disruption to the practice of medicine. While the healthcare ecosystem rightly focused on the immediate needs of patients infected with the virus and on finding a medical solution, the management of other diseases unfortunately frequently moved to the back burner. Seeking to keep their patients safe, systems and practices stopped a huge proportion of in-person doctor-patient interaction, and this was only partially offset by the significant increase in telehealth. The change has been significant for patients with chronic inflammatory and autoimmune conditions, who typically see their providers regularly to manage their diseases. Crohn’s patient Tina Aswani Omprakash shared how she has been feeling in a recent blog post for Everyday Health titled, “Immunocompromised in the Age of Coronavirus.” She describes her reaction to getting an unexpected email from her gastroenterologist that said, “Hunker down, Tina. Don’t come in, but take your meds on time. We will chat over telehealth and discuss your labs.” Her reaction reflected the fear and uncertainty many of these patients currently feel: “To me, it felt like game over.” Postponing care has already had an impact on patients. A May KFF Health Tracking Poll revealed that nearly half of adults surveyed (48%) had delayed receiving healthcare services due to the pandemic, with 11% reporting a condition worsening as a result. Physicians concur. A July survey from The Larry A. Green Center in partnership with the Primary Care Collaborative reported that, while 46% of clinicians are offering preventive and chronic care management visits, patients are not scheduling them. They note 36% of patients are requiring more care due to exacerbation of existing health issues from lack of access during the pandemic. These statistics are troubling. Patients with chronic inflammatory and autoimmune diseases, in particular, have progressive diseases for which disruptions in care may mean irreversible damage to their health and wellbeing. Conditions like rheumatoid arthritis, lupus, ulcerative colitis, psoriasis, and many others require constant vigilance from patients and caregivers, and are painful and debilitating, even when well controlled. The ongoing work patients must put into treatment – monitoring medications, diet, sleep, and exercise; limiting symptom-exacerbating stress; making and managing frequent appointments – increases their mental load. On top of that, their “invisible” diseases mean they regularly invest time advocating for themselves to insurance providers, employers, schools, government agencies, and more, often just to prove that they are sick and need care. Finding lasting solutions for patients There are, though, some reasons to be hopeful. While the pandemic is changing our world, our response to it has also demonstrated that, when the situation demands, we can swiftly respond and we have seen the acceleration of certain trends that promise to improve patient care. All around the world, we have seen thoughtful and resourceful problem-solving. Take for example Japan’s decision to enable direct delivery of medicines by mail or the first time, allowing patients to get the prescriptions they needed, or state regulators in the US issuing emergency rules that removed barriers and enabled patients to continue on their treatment. Some of those solutions, initially devised as quick fixes to help patients who would otherwise have suffered, have worked so well that they deserve consideration for the long term, and certainly if we face a second wave. Below are four areas that I believe warrant prioritization: <ul><li>Double down on digital – While treatment has been impacted all along the patient journey, with new diagnosis and initiation particularly hard hit, some help came from the rapid adoption of telemedicine. A recent report from Decision Resource Group shows that the number of rheumatologists using telemedicine went up from only 6% in 2019 to as much as 46% in 2020. This is undoubtedly a good thing, but we must make sure that everyone can benefit. As more and more people use digital technology to overcome barriers to care, we have also seen others left behind due to socioeconomic challenges such as lack of access to high-speed internet connections, smartphones, laptops, as well as understanding of how to use them. For telecare to reach its full therapeutic potential, we must address these issues. We must also make it easier for physicians to offer this as an option, which means smart policies that tackle reimbursement of telehealth visits on par with office visits. It is worth considering whether the temporary provisions that CMS made to enable patients on Medicare to receive care virtually are worth making permanent. </li><li>Rethink site of care – While telemedicine can help with continuity of treatment, early data suggest that it’s harder to get patients diagnosed and initiated on treatment virtually because of inability to conduct diagnostics and necessary tests. That’s why it’s important to rethink site of care. Must we see a patient at a hospital or HCP’s office to get a diagnosis? Can we create tools and diagnostic kits and work with nurses to enable patients to get care at home? What about at the pharmacy or mobile clinics? How can we support pharmacists more in their increasing role in disease management? I am confident we can find answers to these questions by applying the same thoughtful and resourceful problem solving that happened during the early days of COVID-19. </li><li>Understand the impact of COVID-19 on chronic conditions – One of the most important things we can do is to help ensure the medical community can collect and analyze real-world data to understand how COVID-19 affects patients with chronic diseases. That’s why I’m proud Pfizer took swift steps to support large-scale patient databases and registries that will help this community understand how the virus impacted patients with autoimmune diseases. For example, we supported the SECURE-IBD Database, an international pediatric and adult database monitoring outcomes of COVID-19 occurring in patients with inflammatory bowel disease. This database, and the cooperation it represents, will help generate the data and understanding physicians and patients need to make informed decisions about their medicines and care. That brings me to my last point. </li><li>Break down the silos - The healthcare ecosystem is complex. We have witnessed unprecedented levels of collaboration among industry, governments, and academia to find vaccines and therapies for COVID-19, with Pfizer leading the way with our five point plan to collaborate. I believe we’ll need that kind of systemic collaboration and partnership to make sure patients with chronic diseases continue to receive care if a second wave or resurgence in cases results in further disruptions to care. </li></ul>Above all, we must put the interests of the patients first. Once we are past this current crisis, we must consider how we can sustain access to care for people with chronic diseases everywhere – not just during a pandemic. If any positives are to be drawn from the experiences of the recent months, one may be that we learned ways to make our systems better. About Richard Blackburn, Global President, Inflammation &amp; Immunology at Pfizer: A thirty-two-year veteran of the pharmaceutical industry, Richard Blackburn is currently the Global President of Inflammation &amp; Immunology at Pfizer. In this role, he oversees a portfolio of important medicines that address the needs of patients with autoimmune and chronic inflammatory diseases. He also directs the commercial development strategy for an industry-leading pipeline of oral, biologic, biosimilar, and topical treatments for autoimmune and chronic inflammatory diseases with a focus on Rheumatology, Gastroenterology, and Medical Dermatology.

Lessons from the Pandemic to Address Disruptions in Care

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GM Healthcare

As COVID-19 continues to transform the health care needs of millions of people – from routine to critical care, from in-person to virtual settings – digital health is stepping up to meet the needs of a world in crisis. Digital is helping us improve care access, meet changing patient needs, and better contend with every stage of the pandemic.  My wife is a physician, and over the past few months I’ve been in awe of the tireless dedication she and her colleagues show day in, day out on the frontlines. This crisis has brought out the best in them – and I see that in our teams at CVS Health too. Our presence in communities across the country has been extremely powerful as we work to help people get the care and support they need. Incredible collaboration, focused teamwork and no-nonsense attitudes have enabled us to make rapid progress in a short period of time.  As I shared on a recent HLTH webinar, it’s never been more critical to meet patients where they are on their health care journey. Several areas of service stand out as examples of just how dynamically we’ve evolved, and what to look for as digital programs continue to innovate throughout the pandemic and beyond.  Expanding critical, digital access to care and medication COVID-19 didn’t make other health care needs go away, but it did create a general reluctance to seek care. According to our recent Time for Care study, nearly 60% of Americans have cancelled or delayed a health care appointment due to concerns about exposure to COVID-19 since the pandemic began.  To help individuals safely receive treatment for minor, non-COVID-19 illnesses and injuries without having to visit doctors’ offices and hospitals, we offer virtual health care services through our MinuteClinic® locations 24 hours a day, seven days a week, right from a mobile device or computer. And people are taking advantage – in Q2 2020, our total MinuteClinic virtual care visits were up over 750% compared to Q2 2019. Virtual care and digital access are especially important for more vulnerable populations who rely on regular medication. Six out of every 10 adults in the U.S. suffer from a chronic condition, with many having two or more. CVS Health retail prescription home delivery volume was up more than 500% in Q2 2020 vs. Q1 2020, allowing people to receive critical medicine while minimizing interactions outside their home. Digital refills of specialty medications increased, and we also saw a 40% increase in provider adoption of our Specialty Expedite offering, which helps patients start on life sustaining medications within the most critical first 30 days. New experiences like “Spoken Rx” read prescription details out loud by scanning an RFID tag affixed to prescription bottles, a major accessibility improvement for our visually impaired patients.   COVID-19 testing on the frontlines Testing has been one of CVS Health’s major frontline responses to the crisis. The staggering consumer demand for COVID-19 testing created immediate logistical challenges for those wanting to minimize possible virus exposure and help control community virus spread.  In April we launched a digital screener, scheduler and registration system that allows patients to arrange their COVID-19 test at a designated date, time and location. The testing began with a few large scale sites, then progressed to drive-thru testing outside select CVS Pharmacy locations. Through the end of July, CVS Health administered more than 2 million COVID-19 tests, the majority of which were scheduled digitally. More than half of our 1,800+ testing sites are located in counties that serve moderate to high needs communities, as measured by the CDC Social Vulnerability Index. We’ve also launched Return ReadySM, which uses our digital platform, to help businesses bring employees back to work safely with flexible testing options. Bottom line: Innovation can’t wait COVID-19 has made innovation and the ability to scale -- quickly -- more important than ever before. Continuing to grow our digital foundation and expand our services to meet the changing needs and preferences remains our priority. I’m proud to work with the incredible team of innovators and changemakers across our company and beyond who are focused on doing whatever they can to improve the health and safety of our country. About Firdaus Bhathena: Firdaus Bhathena is the Chief Digital Officer of CVS Health. In the role, he leads the creation and implementation of CVS Health’s digital strategy, which is focused on overcoming obstacles to health care engagement through personalization, simplicity, and tech-driven partnerships. Firdaus has extensive experience in technology entrepreneurship and delivering world-class enterprise and consumer software products at scale. Prior to CVS Health, he spent twenty years in the world of venture-backed startups. He co-founded WebLine Communications after winning the MIT $50K Business Plan Competition. WebLine was acquired by Cisco Systems, and he later founded Relicore, which was acquired by Symantec. He holds several patents in software and distributed systems, and is a frequent speaker at industry events. He holds BS and MS degrees in computer science and electrical engineering from MIT, where he was a Tau Beta Pi National Engineering Honor Society Graduate Fellow.

Bringing Out the Best: Digital Health and COVID-19

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Principal Group Manager - Microsoft Healthcare Israel

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.  HLTH Team: Tell us a bit about Microsoft Research and Health Next?  Hadas Bitran: Healthcare NExT began as an incubation initiative within Microsoft Research, experimenting with different technologies and approaches to help meet our healthcare customers’ needs. As we’ve progressed, we’ve drawn on the wealth of expertise found across Microsoft, not just within our research organization. By combining our reputation in research with our expertise in health and life sciences, we’re delivering innovation that empowers digital transformation at scale and we’re convinced that healthcare may be artificial intelligence’s most urgent application.   HLTH Team: Where does your team fit in? What problems/issues is your team trying to solve and why?  Hadas Bitran: I lead the Microsoft Healthcare group in the Microsoft Israel R&amp;D Center. We are focused on health artificial intelligence (AI), and our team leads the development of healthcare language services: conversational AI and natural language processing (NLP) technologies used in the healthcare and biomedical areas. Worldwide, our healthcare customers continue to be overburdened with information and challenged by inefficiencies. The healthcare industry is also overloaded with unstructured text. Understanding this text and putting it into structure is key to unlocking insights, and our team is working to help ease these burdens.  HLTH Team: We have heard about the Microsoft Healthcare Bot utilization during COVID-19. How did this bot come to be?  Hadas Bitran: During a Microsoft company hackathon, we were looking to create a multi-turn conversational technology that would empower patients with self-service assessment and symptom checking. The Microsoft Healthcare Bot service was born.  HLTH Team: How was the Microsoft Healthcare Bot service being used before COVID-19?  Hadas Bitran: Before COVID-19, we had about 4,000 customers using the Microsoft Healthcare Bot service to power their virtual health assistants. They were using it for symptom checking, finding locations and business hours, completing questionnaires, telehealth, and delivering patients with answers at scale to various health-related questions.  HLTH Team: What about after the virus hit?  Hadas Bitran: When the virus hit, we saw the overwhelming impact to frontline workers around the world. We worked with the CDC to create a CDC COVID-19 symptom checking protocol for screening people and checking symptoms, to help reduce the burden on healthcare workers. We worked 20-hour days, through nights and weekends, to ensure the service fulfilled these needs. We created templates in the product to enable quicker development of COVID-19 response bots. The first COVID-19 bot was created in just four days. Then this timeline became two days, and finally there was a customer that created a bot in just one day using our technology. We now have Microsoft Healthcare Bot instances worldwide within the government, healthcare, and retail industries in 25 countries.   HLTH Team: Besides symptom checking, how else is the Microsoft Healthcare Bot service being used?  Hadas Bitran: The U.S. Veterans Affairs Department recently deployed their bot built in under a month via the Microsoft Healthcare Bot service. This new, conversational tool marks a first for the agency and can be accessed around the clock to triage symptoms related to COVID-19, and offer targeted responses regarding testing options, stimulus payments, telehealth, scheduling, prescription refills and more. Together with alliance partners, we have also launched the CoVIg-19 Plasma Bot, a self-screening tool that anyone can use to see if they qualify to donate their plasma. Beyond this, the Microsoft Healthcare Bot Scenario Template Catalog includes templates for many other bot scenarios, for example - returning to the workplace screener, mental health questionnaires, appointment booking, filing claims, provider lookups, and more.    HLTH Team: What other exciting technologies can we look forward to from your group?  Hadas Bitran: We just launched as part of Azure Cognitive Services Text Analytics for health, now available in public preview. With the influx of healthcare data generating over a zettabyte of healthcare data every year, it is increasingly critical for providers to unlock access to the information in free text to drive greater efficiency and overall better healthcare outcomes. Using NLP techniques, the health feature of Text Analytics enables developers to process and extract insights and valuable information from unstructured clinical documents. Trained on a diverse range of medical data —covering various formats of clinical notes, clinical trials protocols, and more—the health feature is capable of processing a broad range of data types and tasks, without the need for time-intensive, manual development of custom models to extract insights from medical data.   HLTH Team: Do you have examples of Text Analytics for health in action?  Hadas Bitran: In response to the COVID-19 pandemic, Microsoft partnered with the Allen Institute of AI and leading research groups to prepare the COVID-19 Open Research Dataset, a free resource of more than 47,000 scholarly articles for use by the global research community. Using Text Analytics for health and Cognitive Search, we developed a COVID-19 search engine to enable researchers to generate new insights in support of the fight against the disease. Text Analytics for health is also at work powering our clinical trials matching technology. You can access an example implementation of it, that matches patients to COVID-19 trials, on Bing.com. People can use this to match with a COVID-19 clinical trial so they can help in the search for possible solutions to the virus. Visit Bing.com, scroll to the right, and you’ll find an icon for COVID-19 resources with options for “clinical trials” or “take the CDC self-checker.”   HLTH Team: Expand a bit more on your work on using this technology with clinical trials.  Hadas Bitran: At any moment in time, there are more than 50,000 clinical trials around the world looking to recruit patients for their studies. For patients, it is challenging to find clinical trials that are a match. At the same time, researchers are struggling to recruit suitable participants for their clinical trials. Patient recruitment is the main cause of delays in trials, and 50% of the trials fail to reach their recruitment target. The Clinical Trials Matching technology uses state-of-the-art NLP technology that can understand both clinical trial protocols and patient health information– and match accordingly. In the case of COVID-19, for example, it helps narrow down and prioritize the set of potential clinical trials to a more relevant set of trials for which the patient appears to be qualified. Take a look at Bing.com for an example of this in action.   About Hadas Bitran: Hadas Bitran is Head of the Healthcare Group in the Microsoft Israel R&amp;D Center, as part of Microsoft Healthcare NExT in Microsoft Artificial Intelligence and Research. Hadas and her group are focused on building AI technologies and solutions for the healthcare space, including language services, natural language processing, conversational intelligence and personal health assistants technologies and services. During her career in Microsoft, Hadas has been developing products in the domains of Healthcare, Personal Assistants, Recommendation Systems, Online Advertising and Consumer Privacy. Her work has been shipped as part of Cortana, Bing and the Windows Operating System. Before Microsoft, Hadas held senior leadership positions at SAP. Prior to that, she managed R&amp;D and product teams in start-up companies. Hadas received her B.Sc. degree in Computer Science from Tel Aviv University, and her MBA from Kellogg School of Management, Northwestern University in Chicago.

How Health AI Became Key in COVID-19 Response

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Chief Executive Officer & Founder

Healthcare is notoriously conservative in its adoption of technology, yet, we have seen the use of telehealth skyrocket because of the pandemic. We interviewed Thomas Graf, MD, FAAFP, Chief Population Health Officer, Ascension Medical Group and Jean Drouin, MD, Chief Executive Officer, Clarify Health, to get their perspectives on whether health systems should make a similar push to invest more in big data infrastructure and healthcare analytics. Dr. Graf’s institution, Ascension Medical Group, is a 22 state, 100 plus hospital health system, with about 10,000 employed clinicians and a full range of facilities, from critical access hospitals to academic medical centers. Dr. Drouin’s organization, Clarify Health, is a healthcare analytics platform company that serves payers, providers, and life sciences companies. Its business applications deliver insights into opportunities to improve care, optimize networks and referral patterns, and identify unmet needs and risks of patients and populations. Its software products leverage its platform, comprised of longitudinal patient journeys for over 300 million Americans and one of the most powerful analytics tech stacks in the healthcare industry. HLTH: Why have health systems lagged other industries in their ability to leverage big data analytics? Dr. Graf: Health systems invest a fraction of what other industries do in technology. We have invested in the basics, like electronic health records, operating systems for pharmacies, labs, and radiology. While I have seen an explosion of information that could be used to better diagnose and treat patients, I also see that we are limited in our ability to transform massive amounts of data streams into usable and actionable information. It took providers ten years to be able to reliably prescribe beta-blockers for patients who had a heart attack in the hospital. Not because doctors did not know how, not because nurses did not understand the drug, not because the pharmacy did not want to dispense it, but because we could not find a way to keep the drug top of mind and do it in a reliable fashion. I think our recent experience with COVID-19 highlights the fact that health systems are absent really good information about our populations when they are outside of our four walls. We need to understand what is happening to patients in real-time.  HLTH: Do health systems have the data they need to leverage machine learning and AI? Dr. Drouin: Unfortunately, electronic health record data is not the be all and end all. It is only a small picture of a patient based on limited interactions with the health system. There are many other forms of information. There is critical information to be gleaned from medical claims, labs, genomics, prescriptions, and social determinants of health. Bringing all these data together would manifest the fullest picture of a patient and then could be used to improve the care that we deliver. Healthcare has fallen behind other industries in its ability to bring together an integrated, real-time, and actionable perspective on its consumers (i.e., patients) because our data is siloed, delayed, and disaggregated. This is what makes it so difficult to use the full power of machine learning, without which we cannot be precise about predicting a person&#39;s health. Consumer companies, like Amazon, and banks, like JP Morgan, have addressed this challenge head on because understanding their consumer is vital to their business. They obtain all the relevant bits of data and information needed and build the richest consumer profile possible. HLTH: How well do health systems understand their consumers today? Dr. Graf: I think that depends on how you define the consumer. We understand most of our “loyal” customers (people who use our facilities a lot), moderately well. If the consumer is a patient who is in the hospital today or was in the hospital a month ago, we have their EMR data. If you define the consumer as a patient who touched the health system two years ago, then I would say we have a slightly imperfect understanding of their healthcare needs. However, if you define a health system consumer as anyone who is within its community, broadly and geographically defined, then I would say we have a huge gap in our understanding. We have a very fragmented picture, at best, of what their needs are and how they would best respond to care. Companies like Verizon and Amazon know more about me than my local health system does. Those companies know I do not exercise as much as I should and I drink too many sugary drinks, and they know the impact of that on my health. For health systems, there is an under-appreciation of the power that information can bring. HLTH: Can data and analytics help health system improve care? Dr. Graf: Most hospitals struggle to use medical data in a way that is actionable. Take blood pressure data, for example. We accurately measure and monitor blood pressure, but that does not mean that every patient has their blood pressure under control. Medical data is not the answer. We know that patients who have transportation issues and food insecurities struggle with disease management; depression impacts blood pressure and cholesterol management, we get that. But, what about the opportunities for impacting care that we do not see or do not know about? We need to have that data and have it in a coherent fashion. Dr. Drouin: You can reveal a lot about a patient’s health needs when you link data from different sources, for example social determinants of health data and clinical data. With large enough data sets it is possible to train models to answer even some of the toughest questions. Our healthcare system is currently faced with many questions like, “what will care patterns look like in the new normal?” “Should we expect an unforeseen tsunami of other diseases coming on account of care being delayed?” Machine learning makes it possible to answer these questions. You can put a shock into a model, such as COVID-19, and predict the burden of disease moving forward. With social determinants of health data, the model can include factors such as job loss rates, transportation access declines, and food insecurities and therefore predict more precisely. This is the kind of a thing a bank would do to assess their forward risk and learn about their liabilities on mortgages, for example.  HLTH: How should health systems use data and analytics in the future? Dr. Graf: I think the future lies in being able to understand the clinical status of our communities in real-time; to understand when they are getting better or worse and to determine which interventions are most needed. This is where we are headed at Ascension. At Ascension, we serve the poor, the vulnerable, and the underserved. We care not only for the folks who come to us but all the folks in our community. We want to create a healthier community by connecting individuals with the part of the network that fits their needs. We want to be proactive about care. If a patient has a procedure in the hospital and their wound gets infected at home, I want to know. I can prescribe antibiotics early to avoid admitting them into the hospital for IV antibiotics. We need to be alerted when there is a significant change in pattern, see what is causing it, and then push that information to the most appropriate individual. If a patient is depressed, their primary care physician should know and intervene. If someone has lost their job, we should connect them to social services or job training. If a patient loses their housing and no longer has a refrigerator to store their insulin, we need to know. Being proactive is much better care for the patient, less expensive, and lowers hospital readmissions. HLTH: What types of analytics are available to help health systems today? Dr. Drouin: Our healthcare system has fostered incredibly transactional relationships. However, we are moving to value-based and longitudinal care models, which require payers and providers to have a better understanding of the whole person and the whole community. Ultimately, health systems, physician groups, and even health plans are dealing with day to day patient care and thus need actionable solutions. They need to understand things like patient volume and service line utilization, referral flows and patterns, a patient’s individual health risks and care needs, and a provider’s cost-efficiency and clinical performance (particularly if participating in value-based care models). At Clarify, our mission is to leverage healthcare data and advanced analytics to provide these actionable insights via on-demand software solutions.

The future of big data analytics for health systems

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The COVID-19 crisis has created tremendous healthcare delivery challenges due to the difficulty of both doctors and patients to meet in person. These challenges have been increasingly addressed via digital and telehealth technologies to enable doctors and patients to connect safely and maintain continuity of care. Although digital and telehealth technologies have been available for years, historically these technologies experienced barriers of poor reimbursement and regulatory restrictions that led to low adoption rates. These barriers are increasingly being addressed due to the COVID crisis with additional support from payers and regulatory bodies.   Although consumer-facing telehealth has received the most attention, there are other areas of medicine undergoing similar transformations. In particular, pathology has faced a unique challenge during the COVID crisis. Because pathologists practice in-person using optical microscopes to view tissue slides that are often handled by multiple individuals and are routinely shipped to other institutions for second opinions, pathologists have faced a personal risk during the COVID crisis. In fact, early in the pandemic, a prominent pathologist at the University of Washington tragically passed away from COVID-19. Fortunately, the technology exists to support pathologists to work remotely and safely. High-volume digital slide scanners and digital pathology slide viewers enable both the digital transmission of slides and remote work. Despite the availability of technology, other challenges remained including the low adoption of digital pathology infrastructure prior to the crisis and regulatory barriers that restricted pathologists to performing primary diagnoses only in a lab certified by the Clinical Laboratory Improvement Amendments (CLIA). The College of American Pathologists advocated CMS for the flexibility to work remotely and in March, CMS waived those requirements as a public health emergency response. Even before COVID-19, there was a strong case for adopting digital pathology in hospitals and labs. Digital pathology increases the availability and efficiency of pathologists and improves response times to patients, streamlines second opinion processes, and makes querying archives far easier. The need for a digital pathology solution will only become more acute as the increase in demand for tests is amplified by a decreased pathologist workforce. According to the Journal of the American Medical Association, the number of active pathologists decreased by about 18% in the last decade. At the same time, the WHO estimates that the number of new cancer cases will rise by ~60% over the next two decades. This increase in cases with a decrease in the workforce is leading to pathologists who are struggling to keep up with their workloads, impacting patient outcomes, value-based payments, and creating overall conditions of workplace burnout.  Paige technology offers solutions to both problems. Our digital pathology enterprise imaging solution includes a digital slide viewer, FullFocusTM, that was recently FDA-cleared for primary diagnosis. It is designed for high performance and offers increased interoperability across scanners and monitors (for now, the initial clearance is in conjunction with Philips Ultra-Fast scanners). Our digital pathology technology offers pathologists the ability to safely work and collaborate while enabling hospitals and labs to maintain business continuity during this crisis. Furthermore, our upcoming digital diagnostics portfolio will provide actionable information to pathologists during diagnosis leading to enhanced diagnostic confidence, productivity and faster results for patients across multiple cancers and biomarkers.  COVID-19 has challenged pathologists, hospitals, and labs to provide continuity of quality care while maintaining safety for pathologists. Fortunately, the technology to meet this challenge exists today and is rapidly being adopted by hospitals, labs and pathologists around the globe. Paige is excited to support this critical practice in medicine today and bring many more breakthroughs to the field in the future. About Leo Grady: Leo Grady joined Paige as CEO in early 2019, bringing with him leadership experience and expertise in cutting-edge clinical software. He has more than 15 years of experience in prototyping, developing, and bringing to market some of the industry’s most advanced machine learning, computer vision, and medical imaging technologies and products. Since joining Paige as CEO, Leo led the company to receive FDA Clearance and Breakthrough Device designation by the U.S. Food and Drug Administration (FDA). Prior to joining Paige, he was the Senior Vice President of Engineering and Product at HeartFlow, a leading computational diagnostics company. Previously, Leo served in a variety of scientific and leadership roles at Siemens. The author of two books, over 100 peer-reviewed journal and conference papers, and the owner of 300 issued or pending patents worldwide, he was inducted as a Fellow in the American Institute for Medical and Biological Engineering in 2014. In 2012, he was the recipient of the Edison Patent Award in medical imaging. Leo received a B.Sc. degree in Electrical Engineering at the University of Vermont and a Ph.D. in Cognitive and Neural Systems from Boston University.

Digital Pathology is No Longer the Future of Medicine—It’s a Necessity of Today

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Robert M. Califf: Robert M. Califf, MD, MACC, is the Head of Clinical Policy and Strategy for Verily and Google Health for Verily and Google Health. Prior to this Dr. Califf was the vice chancellor for health data science for the Duke University School of Medicine; director of Duke Forge, Duke’s center for health data science; and the Donald F. Fortin, MD, Professor of Cardiology. He served as Deputy Commissioner for Medical Products and Tobacco in the U.S. Food and Drug Administration (FDA) from 2015-2016, and as Commissioner of Food and Drugs from 2016-2017. A nationally and internationally recognized leader in cardiovascular medicine, health outcomes research, healthcare quality, and clinical research, Dr. Califf is a graduate of Duke University School of Medicine. Dr. Califf was the founding director of the Duke Clinical Research Institute and is one of the most frequently cited authors in biomedical science.

COVID-19 Discussion with Robert Califf

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As the COVID-19 pandemic continues to impact society worldwide, the scientific community is racing to understand SARS-CoV-2, the novel coronavirus that causes the disease, and respond by developing diagnostic and therapeutic approaches to combat it. Among the most powerful tools being used is CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats), a gene-targeting and gene-editing technology based on the mechanism that bacteria naturally use to fight viruses.  CRISPR has enabled an efficient, precise and affordable way to manipulate and edit genomic DNA and RNA, completely unlocking a new frontier for biological engineering. Well before the COVID-19 pandemic, researchers had begun to use CRISPR to find new ways to cure diseases, including cancer, blindness and Alzheimer’s disease; develop more sustainable methods for producing fuel; and improve food crops to better feed the growing global population.  In nature, CRISPR plays an important role in microbial immunity. By understanding the mechanism that bacteria naturally use to fight viruses, the research community and biopharma industry are now applying CRISPR-based genome engineering to the following potential solutions for COVID-19: Rapid Diagnostic Tests Scientists and companies are using CRISPR to detect the RNA of SARS-CoV-2 in patient samples, developing diagnostic tests that are more efficient than the standard polymerase chain reaction (PCR) diagnostic tests now in use for COVID-19 testing, which must be conducted in sophisticated centralized labs by trained technicians. Supplementing PCR tests with CRISPR-based approaches could broaden access to COVID-19 diagnostic testing, a key strategy for stopping the transmission of the virus. The availability of such testing will be critical as we transition out of a complete shelter-in-place mode. Treatments Understanding how a pathogen operates at the host-pathogen interface is critical to developing new treatments. To that end, researchers are using the genome-editing power of CRISPR to shed light on how SARS-CoV-2 interacts with the proteins in human cells and then generate appropriate cell models. As described in a recent Nature publication, these cell models could lead to faster discovery of a potential new treatment or an existing drug combination that could lead to a potential treatment. Furthering this approach, therapeutics developers are leveraging the convergence of technologies including CRISPR and artificial intelligence to rapidly advance discovery and development programs in innovative ways. Vaccines Researchers are utilizing CRISPR technology to develop a genetic vaccine. This approach involves using CRISPR to precisely target, cut and eliminate SARS-CoV-2 and its genome to stop the virus from infecting cells in the lung.  Collaboration as an engine to advance COVID-19 research  With SARS-CoV-2 transmission continuing on a global scale, it is more critical than ever that scientists have access to innovative tools that can enable rapid and accurate research. As an example, the team at Synthego, a genome engineering company that leverages machine learning, automation and gene editing to build platforms for science at scale, has been working hand-in-hand with the CDC, MIT’s Broad Institute, UCSF and others in government, academia and industry to help accelerate research being conducted by scientists in the trenches.  Inspired by the work that our collaborators are pursuing, Synthego developed COVID-19 specific tools designed to help enhance the speed and effectiveness of the development of rapid diagnostics and treatments. These tools include bioinformatically designed custom Cas13 guide RNA collections that can be used for individual or multiple gene knockouts to develop diagnostics for SARS-CoV-2 and algorithmically-designed multi-arrayed CRISPR single-guide RNA (sgRNA) gene knockout libraries targeting 330 human genes that interact with SARS-CoV-2 proteins. These libraries can be used to investigate the molecular mechanisms of SARS-CoV-2 to identify drug combinations of enhanced efficacy, as described in this recent publication. Additional contributions have been focused on supporting the development of critical reagents for novel CRISPR-based COVID-19 point-of-care diagnostics including the STOPCovid protocol and the Sherlock™ CRISPR SARS-CoV-2 Rapid Diagnostic, which received Emergency Use Authorization (EUA) from the FDA in May.  The unprecedented innovation taking place in the biopharma industry, academia and government in response to the COVID-19 pandemic today will provide a foundation for improving human health tomorrow. The current scientific efforts are representative of a paradigm-shifting movement in the life sciences – one in which the convergence of multiple technologies, the speed of information flow, and the rapid programmability and agility of technologies such as CRISPR will fundamentally change how research and development is approached and conducted. As society emerges from shelter-in-place orders, the scientific discoveries enabled by CRISPR-based genome engineering are poised to continue to drive innovation. Using the latest transformative tools, technologies and approaches, the scientific community is able to address both the challenges of today and those of the future.  About Jason Steiner: Jason Steiner, Ph.D., Chief Strategy Officer at Synthego, leads the company&#39;s business strategy and partnerships efforts to enable academic institutions and biotech and pharmaceutical companies to leverage Synthego’s gene engineering platform to accelerate the research, discovery, and development of next-generation therapeutics, including genetic and cellular therapies. Before Synthego, Steiner spent several years in the clinical genomics space commercializing liquid biopsy technologies in reproductive genetics and oncology at Natera. He holds a doctoral degree in materials science engineering from the University of California, San Diego, where his research focused on the development of nanoparticle delivery systems for therapeutics and diagnostics in oncology.

The Role of CRISPR Technology in the Development of COVID-19 - Rapid Diagnostic Tests and Treatments

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Chief Operating Officer

BU Lead of Global Health and Value, Rare Diseases Business

HLTH Content Director, Jody Tropeano interviews Manisha Gulati, Chief Operating Officer, Clarify Health and Bhash Parasuraman, Vice President and BU Lead, Rare Disease Patient &amp; Health Impact, Pfizer . They both recently presented on a HLTH GoLIVE series webinar called “Rearchitecting the drug launch model.” The discussion zeroed in on the incentives of regulators, payers, providers, and patients, which are often at odds with each other when it comes to drug launches.

Rearchitecting the Drug Launch Model

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The HLTH team is saddened and outraged by the racially motivated violence that pervades our society and the most recent string of horrific incidents that have forced an ugly truth into the light. There is no more fundamental health goal than the assurance of personal safety and the ability to engage in daily life without fear of violence or discrimination. If we desire a world where any of us can live safely and peacefully, we must defend the rights of all of us to do so. This is very personal to us as an organization, members of the healthcare community and as fellow citizens. HLTH condemns racism in all forms, individual and systemic. We champion inclusion, diversity and kindness. We stand for justice for Black Americans and all other marginalized people, and recognize that by definition equality is only possible when it applies to everyone. To our healthcare colleagues, we urge resolve on the part of our industry to combat racism and other inequities as part of our mandate to heal. At HLTH, we are determined to do our part. In 2019, we established the HLTH Foundation to develop and support initiatives that promote equality, diversity and access in healthcare. Through its partnerships with United States of Care, Parity.org and The Advancement League, HLTH has already taken steps to advance equitable access to care and promote diversity in the healthcare workforce. CSweetener, HLTH Foundation’s virtual mentorship program for women in healthcare, relaunched earlier this year with an expanded focus on diversity and inclusion, including: new support for intersectional women to help them combat the injustices that obstruct their paths to leadership; recruitment of mentors who can help mentees develop leadership in diversity, equity and inclusion; adoption of inclusive language; and collecting participant demographics that will help ensure the program serves all women fairly. Bringing to bear the platforms of both the Foundation, the HLTH event and content platforms, we are taking the following additional actions to address racism and enable equal opportunities for health, safety and inclusion in healthcare, for all people. Immediate Measures <ul><li>Having already taken Parity.org’s Parity Pledge, HLTH has also taken the Diversity Pledge, a commitment to interview at least one person of color for every open position at the level of vice president or higher, including the c-suite and board of directors. Please join us and take the pledge! </li><li>HLTH staff will refuse speaking engagements that fail to meet standards for race and gender diversity </li></ul>HLTH VRTL (October 12-16) <ul><li>Full-day event dedicated to Health Equity that will boldly explore race as a social determinant of health, racism in healthcare, new approaches to public safety and the path to health equity. Shaping keynotes and debates around themes that address race, justice and at-risk populations, including Inequities and Disparities in Health, Access to Affordable and Quality Care, Mental and Behavioral Health, and and COVID-19’s Impact </li><li>2nd Annual Women at HLTH event, with a focus on organizational strategies for achieving gender parity in healthcare leadership and health outcomes </li><li>Race and gender integrated as considerations in speaker invitations and in evaluating agenda diversity for HLTH and partnered programs </li></ul>Ongoing Initiatives <ul><li>Partnership with Break Into the Boardroom to help drive gender parity on healthcare boards </li><li>Annual research with Oliver Wyman to expand knowledge around gender parity in healthcare </li><li>Direct outreach or partnership with organizations devoted to underrepresented executives, providers, patients, government officials and startup founders, as a means of driving opportunities to underrepresented groups via the HLTH platform (i.e., invited speaking roles, startup pitch competition, guest blogs, etc.) </li></ul>2021 and Beyond <ul><li>Hosting a HLTH GoLIVE webinar series focused on health equity </li><li>Hosting a HLTH GoLIVE webinar series focused on gender parity </li><li>Expanding HLTH Matters blog posts and executive interview series to include issues related to the mission of the HLTH Foundation, including racism in healthcare </li><li>Ensuring the use of inclusive language in all materials </li></ul>We recognize that this is only a beginning. We will continue driving toward our vision of an equitable health future and welcome your partnership on the journey. Let’s work together to make change on the side of right and goodness. Be well, Janna Guinen Executive Director HLTH Foundation

Anti-Racism, Diversity & Inclusion at HLTH

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Trevor Martin:

Dr. Trevor Martin, Co-founder and CEO of Mammoth Biosciences, is leading the company with the mission to democratize access to CRISPR and affordable and effective diagnostics that enable individuals to better understand their health. To make his vision a reality, Trevor partnered with CRISPR discoverer and pioneer, Jennifer Doudna, and her two recent Ph.D. researchers, Janice Chen and Lucas Harrington along with fellow Stanford Ph.D., Ashley Tehranchi. Since its founding, the team has built the world’s next generation CRISPR platform and the world’s first CRISPR-based diagnostics platform capable of detecting any biomarker or disease with DNA/RNA. To do so, Mammoth has raised $23M from lead investor Mayfield and other influential institutional and angel investors including Tim Cook, Brook Byers, Bob Nelsen, and Jeff Huber.

Trevor kicked off his career in science at Princeton, where as an undergraduate student in Molecular Biology, he began his research career in the university’s Storey Lab. In his time there, he conducted independent research in quantitative biology and was ultimately awarded the top honor for his senior thesis in molecular biology. After Princeton, Trevor went on to complete his Ph.D. in Biology at Stanford University, combining techniques from statistics and genetics and developing methods around mapping the determinants of quantitative traits in both humans and microbes. In addition to having taught multiple courses in statistics at Stanford, Trevor has penned educational guides for university courses across the globe. His work has been featured in outlets like FiveThirtyEight and The Atlantic, and he has been featured on Forbes’ 30 Under 30 list in 2018.

COVID-19 Discussion with Trevor Martin

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates.

About Richard Saynor: 

Richard Saynor is Chief Executive Officer (CEO) for Sandoz, a global leader in generic and biosimilar medicines. Mr. Saynor has more than 20 years of pharmaceutical leadership experience in branded and generic medicines across established and emerging markets. He leads with the purpose to pioneer access for patients, and is committed to developing and commercializing high quality, affordable medicines that address unmet medical need.   

Richard Saynor joined Novartis from GlaxoSmithKline (GSK) Pte. Ltd., where he spent nine years in a variety of leadership roles across therapeutic areas and geographies. He most recently served as senior vice president of classic and established products as well as commercial and digital platforms. He was responsible for £10bn of post-patent products covering a number therapy areas (respiratory, allergy, urology, anti-infectives, CNS). Previously he held the roles of senior vice president and global head of established products and senior vice president of classic brands and generics for Europe, Japan, and the emerging markets and Asia-Pacific (EMAP) region. Prior to that, Richard Saynor held commercial operations leadership roles at Sandoz, serving as Region Head of Asian Markets, and as Region Head of Asia-Pacific, Latin America, Canada and Turkey. 

Richard Saynor earned his Bachelor of Pharmacy from the University of Bradford in the United Kingdom. He is a member of the Royal Pharmaceutical Society in the UK, and served on the board of GSK India from 2018 to 2019. However, he will tell you that his most important role is that of husband and dad. 

COVID-19 Discussion with Richard Saynor

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Co-Founder, Chief Health Officer

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. Over the last few weeks, countries including Japan, New Zealand and some in the EU <a href="https://www.nytimes.com/2020/06/12/travel/reopening-europe-caribbean-virus.html" target="_blank">have begun to reopen</a> after months-long battles with COVID-19. Guided by data, bars, restaurants, and even sports stadiums are <a href="https://hosted.ap.org/kernradio/article/d47ede495574d8096e73074bcc16cc40/fans-savor-return-stadium-sport-virus-free-new-zealand" target="_blank">refilling with patrons</a>. The United States too, is beginning to reopen, but unfortunately, the approach here in America is being largely guided by optimism more than evidence.  Far from a successful elimination of the virus, like <a href="https://www.nytimes.com/2020/06/08/world/australia/new-zealand-coronavirus-ardern.html" target="_blank">New Zealand</a>, more than 20 states have seen <a href="https://www.washingtonpost.com/nation/2020/06/13/coronavirus-live-updates-us/" target="_blank">increases in their average daily new coronavirus cases</a> compared to previous weeks. Some states, including Arizona, Arkansas, North Carolina, Texas and Utah, continue to reopen despite seeing <a href="https://www.reuters.com/article/us-health-coronavirus-usa/record-spikes-in-new-coronavirus-cases-hospitalizations-sweep-parts-of-u-s-idUSKBN23L0JB" target="_blank">record numbers of hospitalizations</a>.  Private organizations cannot wait or rely on a coordinated, national response to COVID-19. More than 120,000 Americans have lost their lives, yet there is still no coordinated national testing program. Regardless, cities and states across the country are feeling the pressure to reopen, despite health risks, as double-digit unemployment rates continue to threaten a new recession. Economic concerns have taken priority over health concerns, but it’s not a tradeoff we need to make. To start, we need widespread testing, and that’s a huge opportunity for employers.  In carefully balancing the needs and appropriate level of risk for their business and their people, employers can help facilitate widespread testing in order to move America closer to where we need to be. Testing is a critical piece that can’t be overlooked. Our own data and <a href="https://osf.io/s23tx/" target="_blank">protocols for testing</a>, created in collaboration with researchers from major universities, shows that the chances of missing a COVID+ employee with basic measures such as temperature checking is <a href="https://www.statnews.com/2020/06/02/optimism-not-evidence-driving-americas-return-to-work-strategy/" target="_blank">greater than 86%</a>. With PCR testing, that number drops to as low as 2%. By confirming that workers are not infected with COVID-19, employers can effectively reduce health risks in their workplace and communities.  When workers are healthy, <a href="https://www.wsj.com/articles/healthy-workers-are-more-productive-study-finds-1502219651" target="_blank">they are more productive</a>. It’s an obvious, but crucial link as employers have a direct economic incentive to ensure the health of their employees even in the best of times. During a global pandemic, in which a coordinated government response has fallen flat, employers can take a leading role in testing their workforce. The impact of workplace illness is amplified since it may prompt an employer to shut down their workplace to curb spread. Along with the economic benefits, companies also have moral and social obligations to the communities in which they serve.  Fortunately, employers have led throughout this crisis. In the crucial days before state governments issued stay-at-home orders, countless businesses across the country began implementing their own responses; adopting remote work policies and deploying safety and sanitation processes for essential workers who couldn’t work remotely. This leadership likely saved countless lives by helping slow the transmission of COVID-19. Companies can continue to lead by adopting proper methods. With broad testing for COVID-19 among workforces, businesses can make it clear who is safe to return to work, especially when <a href="https://www.acpjournals.org/doi/10.7326/M20-3012" target="_blank">40 percent or more of transmissions are spread asymptomatically</a>.  Of course, employer-led testing programs are not one-size-fits-all. A tech company with the infrastructure to support remote work will have different needs than a manufacturing plant or a university. Hesitation to implement testing and compliance programs is understandable, but the sooner employers begin preparing for, and implementing, appropriate return-to-work testing plans, the faster they can safely get people back to work and help slow the nationwide economic skid.  At Collective Health, we’re building on seven years of experience administering health plans and population health programs to help support this effort with Collective Go: a comprehensive and adaptive solution to help reduce risk and facilitate safer workplace reentry. Collective Go uses a dynamic protocol to provide organizations with a product and a series of measures supporting testing, workplace safety guidance, screening, and risk assessment. We’ve been encouraged by the initiative we’ve seen employers take across the country to do their part in helping combat COVID-19. However, it’s imperative that employers continue to follow the latest epidemiological data in crafting their plans. Absent a widely distributed vaccine, employees will need ongoing testing as they are continuously exposed to new potential carriers. Evidence-based approaches, like the one we’ve created with Collective Go, are key to meaningfully reducing the risk of COVID-19 in workplaces and in our communities. While we’ve seen progress in our collective fight against COVID-19, the virus remains active and in some areas of the country, more so than ever. Until we’ve truly eradicated the virus, the country and its businesses will need to adapt to this new reality. Employer-led testing programs will be key to doing so in a safe, responsible, and productive manner.  About Dr. Rajaie Batniji: Dr. Batniji uses his background as both a physician and political economist to create a better, data-driven, and more efficient health insurance experience. He provides direction on Collective Health’s partnerships with healthcare providers and networks and oversees Collective Health’s analytics teams, and employee health management programs.He received his doctorate in International Relations (Political Economy) from Oxford University, an MD from UCSF, and BA and MA degrees from Stanford University.

Employers Can Lead For a Safe Reopening

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Chief Strategy Officer

The management of chronic conditions, such as diabetes, asthma and congestive heart failure, have long required judicious oversight and management from a savvy healthcare provider, along with - in many cases - daily actions on the part of the patient, to execute the evidence and guideline-driven instructions of their healthcare providers to remain in the “safe zone.” Provided the trust behind this arrangement is maintained, there’s the usual cadence of physician office visits - say 3-4 times per year - when the physician-patient team can check in on progress and make any required course corrections. And in more dire situations, or in ones where new variables may be introduced (e.g., the initiation of insulin for a patient who is naive to the drug and to injections as a whole), that frequency of interaction between the patient and provider may increase in order to maintain a safe health trajectory. COVID-19 has turned this paradigm on its head. For months now, patients cannot see their healthcare providers in the usual manner, as offices may have been either closed or imposed restrictions for emergency visits only. In some counties in the US and in some countries globally, this persists today. And that’s not all. COVID-19, apart from its immediate impact on the continuity of care in chronic condition management, has further uncovered underlying and systemic problems in healthcare. As mentioned, the patient-provider cadence of meetings has been interrupted. While telemedicine services can help to address this issue, COVID-19 has further uncovered societal disparities in the basics required for telehealth to even work. Access to reliable high-speed internet, smartphone use and provider practices equipped with telehealth technology are barriers for telehealth in underserved communities. Security and privacy are risks with the rapid introduction to telehealth. When the first wave of tele-consults due to COVID-19 constraints manifested, many shifted to and adopted tools. Adding to the complexity, , some of these tools faced significant challenges as it related to ensuring privacy and security. So while the healthcare community was scrambling to deal with the new impositions of COVID-19, many “holes in the bucket” were discovered. The truth is no one has ever experienced anything like this, and certainly not since the pandemic in the early 20th century. It could take well over a year to develop a vaccine, and even though Dr. Anthony Fauci - the respected and renowned Director of the NIH National Institute of Allergy and Infectious Diseases and arguably, one of the world&#39;s top 5 virus pandemic experts - recently expressed cautious optimism about a vaccine by the end of the year, is that the only solution? Do we sit still in the interim? Enter stage left - Innovation. There is an incredible opportunity for innovation to unlock alternate strategies to help cope with these impositions of COVID-19 on chronic conditions and that too, well beyond our pandemic has subsided. We are beginning to witness this through telehealth and the increase in virtual care. On March 27, 2020, the Coronavirus Aid, Relief and Economic Security (CARES) Act was enacted into law. Amongst other things, the bill provided a further expansion of telehealth services. <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality" target="_blank">McKinsey recently surveyed consumers</a> and unearthed that 11% of US consumers used telehealth in 2019 versus a whopping 46% who are using telehealth today due to COVID-19 altering healthcare visits and breaking that continuity of care. This can only help so much until it faces the foundational constraints we’ve already mentioned. How do we take this a step further? What else can be done with digital technology and more importantly, the data it generates therein. First, some somber statistics about how dire the risk is for those who suffer from chronic conditions in the midst of COVID-19. According to <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w" target="_blank">CDC case surveillance in the US</a>, people with chronic conditions are 6 times more likely to be hospitalized and 12 times more likely to die from COVID-19. Diabetes is one of the most common underlying health conditions accounting for 30% of cases. That’s nearly three times the normal incidence of Type 2 diabetes in the US! <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7144611/" target="_blank">What experts now believe</a> is chronic inflammation, immune response impairment, and potential direct pancreatic damage is the association between COVID-19 and diabetes. The <a href="https://www.medscape.com/viewarticle/931470" target="_blank">most recent study published</a> examines specific characteristics before and at the time of hospital admission, which predict worse outcomes among people with diabetes. One of the key conclusions: BMI is a major risk factor. This research determined one in ten people with diabetes hospitalized for COVID-19 die within a week. Thus, chronic conditions must be a part of this conversation and we must move beyond just telemedicine in order to address the problem. The advent of digital health and digital therapeutics - those digital health solutions that generally meet a higher level of rigor associated with evidence, claims, randomized control studies, FDA clearance, cybersecurity certification and clinical workflow integration - has been accelerated by evidence-driven health apps, wearable technology, and advanced sensors. These digital health solutions are already impacting chronic disease management in ways that both traditional care and telemedicine cannot solve alone. Add to that advanced, artificial intelligence and machine learning techniques that can be used to turn patient-generated health data from those who suffer from chronic conditions into behavior patterns which inturn, can aid in the response to their condition amidst this unprecedented pandemic. Digital health solutions can analyze patterns in heart rate, blood pressure, blood glucose, physical activity, weight, sleep, medication adherence, diet, age, gender, you name it. This data can be both self-entered, and also brought-in via a series of technology-enabled (e.g., BLE, NFC, etc.) protocols, to take out the “adoption and engagement friction” associated with manual data entry. In one quick move, digital health improves what we refer to as the four “V’s” of data: Variety, Velocity, Volume, and Veracity. The variety is the data patterns mentioned above. The velocity is near-real time, and the volume therefore is high. With trusted sensor integration, or even integrations with labs and EMRs, the veracity of the data is increased. All of these contribute to perhaps the most important “V” - the fifth one: Value. So what can we do with this data? We can run primary analysis, to address basics like “what’s the pattern for a male vs. a female, younger vs. older, tech-savvy vs. non-tech savvy person, etc. That primary analysis is facilitated by tools such as Tableau, Microsoft Power BI, R and others, where data vectors can be input, cleansed (according to data governance best-practices) and then plotted to inform on “patterns of interest.” These patterns can be a good event (such as a patient remembering to take their medication) or a bad event (such as a low blood sugar value for a diabetic or rapid weight gain for a patient with the onset of CHF). Then, add to this the more advanced statistical pattern recognition techniques of clustering (as an example, K-nearest neighbor (K-NN)), or discriminant functions (as an example, linear discriminant functions) whereby the data isn’t just answering “what” event happened, but more importantly, “why” it happened. Once a pattern is discovered, probabilistic and predictive models can then be used to understand “when” such an event may occur again. There are predictive models - the likes of Gaussian, Bayesian, Markov and others - that can be used to predict the trajectory of a patient. And finally, these data then fuel adaptive models, which apply machine learning algorithms to “fine-tune” and adapt the model to track, trace and predict a patient’s pathway based on the data they are entering. The output of such analysis can inform providers to then apply their clinical training to guide the patient to the best therapy pathway. Without the data and advanced algorithms, the provider will have little to go on, but their ability to optimize the treatment pathway for the patient is illuminated by data and analytics. Welldoc has used such techniques to predict the onset of hypoglycemia, develop models that isolate feature usage within the digital health solution that are predictive of a successful pathway, and continued persistence of engagement to ensure the patient remains in the “safe zone.” All of this while not being able to physically or virtually “see” their healthcare provider. What we learned through our research is early identification of individuals at risk of either succeeding or failing with a specific therapeutic pathway. Leveraging data and advanced analytics associated with digital health can therefore increase the efficacy of telehealth services to be more patient and condition-specific. We can apply these methods to COVID-19 too and learn clues from patients who are suffering to better inform our response. What are good and bad symptoms that impact the onset or recovery? It’s important to note that this can be very individualistic. Hypothetically, we may discover that an unrelated medication mitigates progression for many patients, but the taking of certain actions can have a completely different effect for two different individuals.  The bottom line is digital health solutions offer hope and can help us address this conundrum when a doctor’s office is empty and patients can’t leave their homes. Remote capture of real-time data coupled with predictive analytics are key during this pandemic and beyond. The capability exists to remotely monitor critical health conditions, predict future outcomes and utilize data analytics to help drive the course of patient actions to a more healthy future.

Role of AI and Machine Learning in Chronic Disease Management During COVID-19

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Stacy Lindau, MD: Dr. Stacy Lindau, MD, MAPP, is NowPow’s founder and Chief Innovation Officer, a practicing physician and tenured professor at the University of Chicago. She is an experienced principal investigator with 15 years of continuous funding from federal sources, including the National Institutes of Health (NIH), the Center for Medicare and Medicaid Innovation and the Agency for Healthcare Research and Quality. Her scientific work is published in the highest impact medical literature and she is internationally known as an expert in women’s and population health across the life course. Stacy earned her medical degree from Brown University and a master’s degree in public policy from the University of Chicago where she was a Harris Child and Family Fellow. She was a Robert Wood Johnson Foundation Clinical Scholar (and served on the National Advisory Committee) and is an Aspen Institute Health Innovation Fellow and serves the Health Innovators Fellowship Board of Overseers. She has a BA from the University of Michigan Honors College in secondary education and political science and worked in broadcast journalism at Dow Jones and Company’s Wall Street Journal TV. Dr. Lindau is also president of MAPSCorps, a nonprofit community asset mapping organization that has employed more than 2,000 youth in 6 urban and rural geographies.

COVID-19 Discussion with NowPow

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. Healthcare Must Adapt and Embrace Digital Health to Survive The COVID-19 pandemic has had a tremendous impact in the United States and around the globe. It has taken too many lives and disrupted too many more, including by postponing or preventing medical treatment. The fragility it has exposed in our healthcare system must be addressed in order to restore public confidence. In some ways we have started already. In a matter of weeks, we’ve seen a decade’s worth of growth in the adoption of telehealth and other digital health tools, as hospitals and clinics scramble to keep serving patients. Blue Cross Blue Shield of Massachusetts reported recently that the number of telehealth claims it received per day went from about 200 in February to more than 38,000 in May. In some cases the rapid adoption of virtual care was made possible by leveraging previous investments in then underutilized telehealth platforms. However, much of the recent mobilization occurred through general consumer/business video platforms such as FaceTime and Zoom, the use of which was liberated by the temporary relaxation of outdated regulations. For this recent shift to make a permanent impact, however, and truly improve the lives of patients, we need to think and communicate clearly about how these technologies can be used effectively in a post-COVID world. I see three essential ways that digital health technologies will have to adapt in order to continue providing real benefits to providers and patients. Serve the Neediest Telehealth has been widely adopted during the pandemic for the simple reason that it allows doctors and patients to consult without the risk of infection. It has also allowed physicians to reach underserved communities, many of whom are at greater risk for COVID-19 complications, and manage milder cases of the virus remotely, freeing up hospital beds for the sickest patients.  But when the pandemic has ended, those applications will abate as well. When they do, digital health technology risks becoming little more than a convenience for those who could visit a provider’s office but prefer not to. Telehealth offers much more value to people who have great difficulty reaching a doctor’s office because of disability, advanced age, remoteness or some other significant obstacle. At the same time, it is these very populations that are often limited in their ability to access and navigate modern smartphones, computers, and connected devices. Extending these technologies to the populations that need them most should become our paramount goal, achieved not just through the design of appropriate software and hardware, but through empathetic support services which can bridge this divide and address health disparities.  Emphasize the Benefits to Quality of Care Similarly, we need to more fully communicate the vast functional value of telehealth. During the pandemic, its simplest expression – enabling people in remote locations to see each other and converse in real time – has been tremendously valuable. But if we are to make continued progress, we need to convince providers and patients that telehealth is much more than conducting medical appointments by videoconference. Technologies like remote patient monitoring, tracking apps and algorithms that make sense of longitudinal patient data can do much to increase the quality and effectiveness of healthcare. Many of these applications have been employed ingeniously during recent weeks out of necessity. For example, during Italy’s initial COVID outbreak, Roche created an app in collaboration with a startup, clinicians and patient advocacy groups to monitor patients remotely and set up virtual doctor’s visits at a time when hospitals and clinics were overwhelmed. Others have developed chat bot assessments, self-monitoring tools and analytics tools to support COVID patients and manage demand for services. A paper published online May 5 in Diabetes Technology &amp; Therapeutics described how two patients with type 1 diabetes, one newly diagnosed, were successfully treated at home for diabetic ketoacidosis during the pandemic thanks to the availability of continuous glucose monitoring systems. These tools have value far beyond COVID, but for it to be widely realized the healthcare system will have to recognize the full potential of digital health. Protect Patients and Their Data We must also remember that the digital health experiments of recent weeks required loosening regulations and reimbursement policies. Medicare coverage has been expanded for telehealth services, HIPAA rules have been suspended for communication by phone and videoconference and restrictions on practicing medicine across state lines have been loosened to make remote care more feasible. Some of these regulations may have been unnecessary in the first place, but not all of these rollbacks should remain in place after the crisis has passed. We need good regulations for digital health that make sense during normal times as well as crisis, allow the introduction of new digital biomarkers and therapeutics into a trusted system for validation, and enable the transmission and use of patient data while maintaining privacy and security. Data is the lifeblood of modern medicine, and managing it responsibly is of utmost importance.  The overnight explosion in the adoption of digital health tools due to COVID is a welcome silver lining to what has been a difficult and tragic few months for healthcare. The pandemic has exposed many weaknesses, among them our inability to collect, analyze, and act on data as quickly and effectively as we should. We can and must do better, and one way to make progress is to move digital healthcare forward with the needs of patients in mind. It seems likely that the vast majority of people who have ever visited a doctor remotely did so for the first time in the last few weeks. This is a rare chance to transform that brief introduction into a long-term relationship. If we do not think carefully today about how to use digital tools effectively and communicate their value in a post-COVID world, we risk losing the momentum this unique historical moment has provided us. For more information on digital health, click <a href="https://www.roche.com/about/business/diagnostics/value-of-digital-health.htm" target="_blank">here</a>. ********************************************************************* Pravene Nath - Global Head of Digital Health Strategy, Personalized Healthcare  Pravene is responsible to launch digital health products and ensure strong acceptance and adoption by healthcare systems (including physicians, hospitals, payers, and patients) - and ultimately deliver the full potential of these digital tools to patients. Prior to Roche, Pravene worked at Mindstrong Health, where as the Chief Product Officer and SVP of solutions and healthcare operations, he was in charge of building teams to launch Mindstrong&#39;s digital biomarker, patient engagement, telehealth, and care management products. He also oversaw the build-up of Mindstrong&#39;s inside sales team, customer support operations, and payor/provider implementation teams. Before that, Pravene was the CIO and CDO for Stanford Health Care and Stanford University School of Medicine, where he oversaw 600 employees and a $200 million operating budget deployed across digital health strategy, healthcare analytics, enterprise information technology, product development, and physician and nursing informatics. While there, he led the efforts to develop and launch the Stanford MyHealth mobile apps that reached 320,000 subscribers within 3 years. He received Becker&#39;s Healthcare&#39;s CIO Leadership Award and Stanford was designated by US News as the Most Connected Hospital. Prior to his time at Stanford, Pravene was the Chief Medical Information Officer for NYU Medical Center in New York, where he oversaw all enterprise EHR and physician/nurse informatics programs.

COVID-19 Updates with Pravene Nath

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To the HLTH Community,  In our last communication to the HLTH community, we stated that during this period of dynamic change, you can depend on us, to be honest, responsive and transparent. Our top priority is to ensure the safety of our attendees and uphold the values of the health community that we serve.  After critical and thoughtful consideration, and with the support and guidance from our <a href="https://www.hlth.com/hlth-matters/blog/An-Update-from-the-CEO-of-HLTH" target="_blank">Advisory Committee</a>, we have made the decision to transition HLTH 2020 to an entirely virtual event. <a href="https://www.hlth.com/virtual" target="_blank">HLTH VRTL 2020</a> will take place, October 12-15, 2020. The year everything changed - we are facing a global health pandemic, a cultural crisis and will have one of the most important Presidential elections of our time. Now more than ever, it’s essential for us to gather together to spark true change and discuss the impact that this past year will have on the industry going forward. We’re developing a brand-new virtual agenda that will focus on the history-altering events of 2020 that have affected our hearts, minds, and forced us to question our current policies and business models. <a href="https://www.hlth.com/virtual/agenda-overview" target="_blank">See the agenda overview here.</a> While we may not be able to meet in person this fall, you can still expect an exceptional virtual experience, bringing together leaders from across the health ecosystem to help solve some of the industry’s largest problems and to bring to life some of the most promising opportunities to improve health.  You’ll be able to attend sessions from top health &amp; political leaders, listen to startup pitches, meet with key solutions providers and sponsors, and build new partnerships and connections through 1:1 networking opportunities; including our virtual <a href="https://hlth.com/virtual/hosted-buyer" target="_blank">Hosted Buyer program</a>, <a href="https://hlth.com/virtual/funding-founders" target="_blank">Funding Founders program</a>, and <a href="https://hlth.com/virtual/table-talks" target="_blank">Table Talks</a>. Also, get ready to be surprised with some amazing entertainment! We’re so excited for you to see what we have in store. Right now, our mission has never been more important and we&#39;re so excited for the potential that a virtual experience has to bring us all together in new ways. We can’t wait to be able to connect virtually with you all. - The HLTH Team

HLTH 2020 Has Gone Virtual

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General Manager

Q&amp;A with Paul Roma In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. HLTH Team: As a business leader, how are you setting priorities and managing your organization through these unprecedented times? COVID-19 has disrupted everyone. As a business leader, I need to make sure that we’re taking care of our employees and clients. Many people are working from home, maybe they’re juggling taking care of kids or parents, they could be struggling with stress or anxiety. Our clients are wrestling with the same issues we are. It’s more important than ever for employees to be flexible and stay connected – with each other and with clients.  I’m proud of the way our teams have stepped up to support our clients, partners and communities. IBM is aligning with needs across industries to help address business continuity, security risks, supply chains, remote workforces, and of course, supporting health and human services. IBM has several initiatives to help companies prepare their workforce for the new normal. For example, <a href="https://www.ibm.com/products/return-to-workplace-advisor" target="_blank">IBM Return-to-Workplace Advisor</a> helps employers monitor data and make evidence-based decisions about when to return to the workplace. HLTH Team: What’s the role of advanced technology in a pandemic? How is it helping patients right now? Patients have a lot of important questions right now. For example, people might ask their providers how they can tell if they have COVID-19, or where they can go for testing. They might need to check coverage with their health plans or employers. Or they might need unemployment or food assistance from government agencies. People are flooding healthcare and human services organizations with these questions at the same time some call centers are managing their own remote work situations. Organizations can use AI to help connect people to the answers and resources they need. This is especially important during times of crisis. Conversational AI can help these organizations answer common questions about COVID-19. We’ve shared some examples in a <a href="https://newsroom.ibm.com/2020-04-02-IBM-Offers-Watson-Assistant-for-Citizens-to-Provide-Responses-to-COVID-19-Questions" target="_blank">news release</a> about how government and healthcare organizations around the world are using Watson Assistant for Citizens to help answer people’s questions quickly and accurately. HLTH Team: What are some other ways advanced technology and AI are helping organizations with COVID-19 response efforts? One important way AI is being used by health systems is to help providers on the front lines. AI can help surface the information providers need – such as evidence-based drug and disease information – at the point of care. They can make more informed decisions if they have access to the latest evidence. We’ve given free access to <a href="https://www.ibm.com/products/dynamed-and-micromedex-with-watson" target="_blank">DynaMed and Micromedex with Watson</a> to help providers with access to high-quality content about drugs and diseases, including COVID-19. Life sciences companies are working hard to find a way to prevent, contain and treat COVID-19. It’s a challenge to work under this timeline, because clinical development is a long process. One of IBM’s key initiatives is to help accelerate discovery around COVID-19, and there are a number of efforts underway – including our high-performance computing consortium. We are also offering IBM Clinical Development free of charge to eligible research teams focused on COVID-19. We’ve been able to help sponsors get several COVID-19 trials running across 35 different sites. One example, Bionical Emas, published a <a href="https://bionicalemas.com/case-study/covid-19-pneumonia-case-study/" target="_blank">case study</a> about how it was able to set up a clinical trial on COVID-19 in five business days.  Employers are using advanced tech to make better decisions, too. Right now, employers are deciding about when employees can return to the workplace. They have to do it in a way that protects employee health while balancing the needs of their customers and clients. Lots of factors come into play for each worksite. Local COVID-19 infection rates, employee symptoms and health risk factors, local regulations, company policies…and these factors keep changing all the time. As I mentioned earlier, IBM is working to help employers support their employees in the new normal. <a href="https://www.ibm.com/products/return-to-workplace-advisor" target="_blank">IBM Return-to-Workplace Advisor</a> fits into that effort, as it’s designed to help employers and employees look at all of these data sources together and determine how best to proceed for their organizations. As one final example, public health officials are looking to technology to help mitigate the spread of COVID-19 as states ease social distancing rules. Contact tracing can help case workers identify clients who have been infected and follow-up with anyone who might have been exposed. These are powerful capabilities to help slow the spread of the disease.  HLTH Team: How has COVID-19 affected advanced technology adoption? In the race to respond to COVID-19, I think we have seen some acceleration around digital transformation and the adoption of things like telehealth, as well as advanced technologies, AI and blockchain. Here’s just one example: a blockchain-powered network is helping address medical supply shortages. Many of us have heard of how COVID-19 has exhausted supply chains for things like masks, gowns or other equipment needed. Other companies have stepped up to mass produce some of these items – but before hospitals and state agencies can purchase from them, they have to, first, identify these new suppliers, validate they are a trusted supplier, and be able to see what they’ve got in their inventories, real-time. To help with that, IBM launched <a href="https://www.ibm.com/blockchain/solutions/rapid-supplier-connect" target="_blank">IBM Rapid Supplier Connect</a>, which is designed to help government agencies and healthcare organizations find and onboard new vendors. Advanced technologies, cloud, AI, blockchain are all proving to be useful tools in the COVID-19 crisis. I expect healthcare will continue to use them to solve our toughest challenges. About Paul Roma: Paul Roma is the Global General Manager for IBM Watson Health, an organization helping to lead the transformation of health around the world by applying next-generation technologies, such as data, analytics, AI and hybrid cloud, to address the most pressing health challenges globally. Watson Health partners with the greatest minds in the healthcare world – including Memorial Sloan Kettering, Mayo Clinic, the Broad Institute of MIT and Harvard among others in life sciences, health plans and tech – to research, develop, train and test our technologies.

COVID-19 Updates with Paul Roma

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CEO and Co-Founder

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. I’ve heard it said that some of the best marriages show their true strength when faced with adversity. In the face of COVID-19, this clearly rings true as we witness unprecedented and extended partnerships and collaborations to fight what has been defined as “our generation’s greatest war.” I have been both inspired and humbled by all the leaders willing to pivot, dig deep, think outside the box, and put aside our individual company goals in the spirit of one shared goal – to conquer COVID-19.  This “new normal” has created new rules and new ways to partner. As we develop innovative solutions to solve for COVID-19 and to help prevent a future pandemic, I believe we’ll look back on the partnerships forged during this trying time as a key part of the equation. In particular, these significant components of working together will steer our success: Fast Moving Relationships Are Good: Yes, we’ve all experienced partnering in health care. Yet, think about how long it took for some of these partnerships or extended agreements and projects to emerge. Today, just as COVID-19 took off at an alarming rate, so has the speed of alliances forming to stop its progression. In our collaboration with Amgen to discover and develop neutralizing antibodies targeting SARS-CoV-2 to potentially prevent or treat COVID-19, we started work immediately with a verbal handshake. It’s not about economics. It’s about saving lives. We are not the only companies forging ahead in this fashion. A new standard has been established, recognizing there is no time to waste.  Remain True to Who You Are Individually and Together: Every one of us is stretching the potential of innovation to fight this new enemy. However, we will only win if we stay true to our existing and collective strengths. At Adaptive, we believe the key to diagnosing and treating disease lies within our immune system - nature’s most finely tuned diagnostic and therapeutic. We spent the last 10 years building a unique platform that can read and translate the immune system. Over two years ago, we formed a partnership with Microsoft to map population-wide immune responses to diseases at scale. When COVID-19 hit, we didn’t have to pivot. We were immediately able to apply our platform to advance solutions for the pandemic. As infectious and debilitating as COVID-19 is to society, the immune system sees it as it would any other disease and our platform works in the same way. Whereas others are focused on the virus itself, we have extended our partnership with Microsoft to focus on the immune response to the virus from people who have contracted COVID-19 or have been exposed.  Commit to the Long Haul: As health leaders, we’ve all worked together to solve issues of the day while planning for tomorrow. However, among the extraordinary challenges of COVID-19, the importance of playing the long game becomes even more critical. We need to constantly understand how what we are solving for today will also benefit us in the future -- to manage and prevent COVID-19 and potentially future pandemics.  For example, there are many unanswered questions and challenges on the testing front today. Through our partnership with Microsoft, we recently announced <a href="https://immunerace.adaptivebiotech.com/" target="_blank">ImmuneRACE</a> – a virtual clinical study to develop a new diagnostic based on patients’ immune responses. With two types of tests currently available, we see the need for a third kind of diagnostic test – one that we believe can give a more accurate picture of a patient’s COVID-19 “status” that could help contribute to reopening society and potentially better manage and contain the virus long-term.  Everyone Can Be a Partner: Unfortunately, COVID-19 is anticipated to become “part of life” for the foreseeable future. What we are doing today can - and should - impact how it is managed for years to come. That’s why half the battle in the war with COVID-19 will be our willingness and ability to share information with each other. This war will not be won alone. Individual companies, public health organizations, academic researchers and government entities must work collectively towards diagnostics, treatments and vaccine solutions. I am encouraged by the traction here. From worldwide efforts in the U.S. and beyond, we are seeing less competitiveness and more collaboration to share research and information. If anything is going to silence the open source vs. proprietary research debate, it will be COVID-19. At Adaptive, we are proud to commit that the de-identified data we uncover with Microsoft about the immune response to the virus will be freely available to any researcher, public health official or organization around the world via an open data access portal.  Our collective “end game” is to advance solutions for COVID-19. As we do, I know we are also advancing how we partner and collaborate for an even greater impact on the overall health of patients and society for years to come.

Partnering Our Way Out Of COVID-19

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Chief Medical Officer and Senior Vice President for Healthcare and Life Sciences

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. Before coronavirus, our country was experiencing its own silent mental health epidemic. <a href="https://www.cdc.gov/mentalhealth/learn/index.htm" target="_blank">One in five</a> adults experience some form of mental illness each year and, as <a href="https://pediatrics.aappublications.org/content/early/2020/05/08/peds.2019-1536?utm_source=STAT+Newsletters&amp;utm_campaign=a4d4393b19-MR_COPY_01&amp;utm_medium=email&amp;utm_term=0_8cab1d7961-a4d4393b19-151683053" target="_blank">new data</a> highlights, pediatric mental health visits to the ED increased 60% between 2007-2016. With this year’s Mental Health Awareness Month coinciding with a global pandemic and the highest <a href="https://www.nbcnews.com/business/economy/u-s-economy-shed-record-20-5-million-jobs-last-n1202696" target="_blank">unemployment rate</a> since The Great Depression, I can’t help but share the concern of experts and agencies anticipating an <a href="https://www.washingtonpost.com/health/2020/05/04/mental-health-coronavirus/" target="_blank">unprecedented</a> mental health crisis.  So many of us are experiencing isolation and loneliness, job loss, and anxiety from social and economic upheaval. For those already living with mental health issues, however, the <a href="https://www.kff.org/health-reform/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/" target="_blank">compounding effects </a>of this crisis can be devastating. My heart goes out to those who have experienced loss during this pandemic but have been unable to say their goodbyes or find comfort in traditional rites of mourning. I worry about frontline <a href="https://www.buzzfeednews.com/article/scaachikoul/coronavirus-frontline-workers-depression-mental-health" target="_blank">healthcare workers</a>, many of whom are experiencing anxiety, depression, and PTSD — even <a href="https://www.nytimes.com/2020/05/19/health/pandemic-coronavirus-suicide-health.html?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=88150954&amp;_hsenc=p2ANqtz-8Q0d6w2a9PKz8u56phXbB2EazQYpfp3m1boTKYdcEBStLs-bBTfrz4NPkesO-O3q517aOWig3MBlrar8gmr8VIQ-0TeQ&amp;_hsmi=88150954" target="_blank">suicidal thoughts</a> — from exhausting shifts tending to the sick and dying. There is also growing concern that individuals and populations with more acute mental health disorders (e.g., the homeless) are <a href="https://khn.org/morning-breakout/going-without-life-saving-therapy-social-distancing-orders-complicate-mental-health-care-crisis/?utm_campaign=KHN%3A%20Daily%20Health%20Policy%20Report&amp;utm_source=hs_email&amp;utm_medium=email&amp;utm_content=88150954&amp;_hsenc=p2ANqtz-8Q0d6w2a9PKz8u56phXbB2EazQYpfp3m1boTKYdcEBStLs-bBTfrz4NPkesO-O3q517aOWig3MBlrar8gmr8VIQ-0TeQ&amp;_hsmi=88150954" target="_blank">forgoing care</a> due to social distancing orders. The pandemic is making it clear that we can&#39;t neglect or isolate behavioral health but must instead see it as integral to caring for the whole person. <a href="https://www.medicalnewstoday.com/articles/324030#Anxiety-and-depression-similar-to-smoking" target="_blank">Studies</a> have shown time and again how deeply intertwined mental and physical health are. In some cases mental health directly impacts physical health, whether due to chronic stress on the body or engaging in risky behaviors. Behavioral health challenges also make it more difficult for people to adhere to care and treatment plans. Not only is addressing behavioral health crucial to people’s total wellbeing; it’s also essential for containing runaway costs to the system. A <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/returning-to-resilience-the-impact-of-covid-19-on-behavioral-health?cid=other-eml-alt-mbl-mck&amp;hlkid=a67e715c4e74404b9ce3ee39619c9f48&amp;hctky=11790988&amp;hdpid=77fd8c2c-9522-4c29-8841-c63419bf1ecf" target="_blank">McKinsey analysis</a> of national insurance claims data found that 60% of overall medical expenditures are driven by the 23% of members who have mental or substance use disorders. As a physician and technology leader, I see behavioral health — and its integration into a whole-person approach to care — as an area ripe for innovation. These four strategies to address the U.S.’s rising demand for behavioral health are top of mind for me: <ul><li>Increase access. The digital front door has expanded the access point for patients to get the care they need—and the same holds true for behavioral health. Traditional healthcare providers can leverage technology capabilities such as AI-driven chat bots, virtual assessments and triage, and virtual care appointments to help reduce barriers to entry for patients seeking care and services for mental and behavioral health — a challenge that has long plagued the healthcare system. We can also expect startup digital health companies such as TalkSpace to continue to grow by democratizing access to behavioral health services (they’ve reported a 65% uptick in clients since mid-February). </li><li>Support and engage patients. Healthcare providers offering behavioral health services can stand up online communities for patients seeking resources, advice, and support from others who may be experiencing similar issues. Organizations can also proactively engage behavioral health patients on digital journeys to ensure they are routing patients to the support they need, when they need it. </li><li>Facilitate better care coordination between care teams. Care coordination is vital, especially in transitioning patients from physical to behavioral health services. Organizations can use a connected platform to drive visibility and collaboration across care teams to ensure that no patient slips through the cracks. </li><li>Strengthen preventative measures for vulnerable populations. Social Determinants of Health (SDoH) factors, such as limited access to food, safe housing, and job security, can lead to prolonged stress and trauma in vulnerable populations. Organizations can bolster their community prevention efforts by risk-stratifying populations based on SDoH data. This information can be used to prioritize community partnerships that help alleviate these stressors and to conduct outreach that will help connect vulnerable groups to the care and services that they need. </li></ul>Even as we begin to recover, re-open and emerge from the worst of the pandemic, the realities of this crisis will only begin to settle in — likely exacerbating an already wide gap between the supply and demand for behavioral health services in the U.S. (especially in <a href="https://www.cnn.com/2018/06/20/health/mental-health-rural-areas-issues-trnd/index.html" target="_blank">rural</a> areas). Now, more than ever, we need to enlist the power of technology to help the industry better scale and integrate behavioral health services to reach more people in need. About Ashwini Zenooz, MD: Ashwini M. Zenooz, MD is currently the Chief Medical Officer and SVP for Healthcare and Life Sciences at Salesforce. Dr. Zenooz was most recently the Chief Medical Officer at the Department of Veterans Affairs (VA) overseeing the national EHR modernization program. She has also held senior policy development and operational roles including serving as Deputy for VA Health Policy and Services, Legislative Health Policy Fellow with U.S. Senator Richard Blumenthal, Committee Staff on U.S. Senate Committee on Veterans Affairs, and Chief of Imaging Services. Dr. Zenooz received her MD in the Medical Honors Program at the University of Florida. She completed radiology residency at Henry Ford Health System and an Abdominal Imaging fellowship at Massachusetts General Hospital. Dr. Zenooz is board certified in radiology and continues to practice medicine today.

Enlisting Technology to Address the Looming Behavioral Health Crisis

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Chief Scientist

In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. About Acacia Parks: As Chief Scientist at Happify Health, Acacia’s research focuses on digital methods for managing and treating depression and anxiety, as well as chronic health conditions. Her passion lies at the intersection of research and regulatory strategy for digital therapeutics. She received her B.A. in Psychology from Reed College, and her Ph.D. in Psychology from the University of Pennsylvania, where her graduate research helped build the foundation for research on bringing mental health interventions to the general public. Prior to joining Happify Health, Acacia was an Associate Professor of Psychology at Hiram College.

COVID-19 Discussion with Acacia Parks

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In response to the COVID-19 pandemic, our team will be interviewing experts from across the ecosystem to bring the HLTH community timely facts and updates. As we know, the highest-risk groups for COVID-19 are made up of people who are 65 and older and people living with chronic conditions. Hypertension, diabetes, obesity, and other preventable chronic conditions make people susceptible to the most severe forms of COVID-19. Of course, the virus doesn’t affect everyone in the same way, but the general trend is that older people are at higher risk of the worst consequences of the disease. If they have underlying conditions, including preventable ones, that risk is compounded. The trend has seemed to hold consistent even among younger people. The young people who have contracted COVID-19 and experienced the most severe consequences seem to be those who were less healthy before the virus struck. However, younger adults who contract COVID-19, particularly those who lack underlying conditions, typically have demonstrated greater resilience. They often report “feeling a little off” and then return to normal. People in our communities of color are also bearing a disproportionate brunt of COVID-19 infection. This is no doubt correlated, at least in part, to the fact that they suffer disproportionate rates of lifestyle-related diseases. Yet, independent of COVID-19, the evidence is clear that, if you help individuals at risk of physical inactivity, obesity, diabetes, cardiovascular disease and other non-communicable diseases to adopt and maintain healthier lifestyles – engage in regular physical activity, follow healthy nutrition practices, manage stress, and sleep better – you can functionally slow the aging process. So, it’s at least imaginable that a population of individuals 65 years old and above whose health markers show them to be biologically younger would be at somewhat reduced risk for the most severe forms of COVID-19 or any future pandemic.  So, what if we viewed healthy lifestyle coaching and support as an adjunct piece of the epidemiological preventive puzzle for future respiratory-viral pandemics? I’m not talking about specific, individual immunity against COVID-19 or any other virus – although there is evidence to suggest that participation in regular, moderate amounts of physical activity can help enhance general immune function. But, consider how a population made up of healthier and more active individuals, might present the virus with a more resilient opponent, at the population level, among those infected. For instance, evidence overwhelmingly shows that exercise boosts mood and reduces levels of anxiety and depression. When people are dealing with any type of condition, if we can enhance their mental outlook, then their health outcomes tend to be better. Exercise has a role in boosting resilience both physiologically and psychologically.  To take the idea a step further, what if we didn’t just promote active, healthy choices but actually invested in making them possible and accessible to all people regardless of race and socioeconomic status? Tomorrow’s public-health strategy will, of course, endeavor to reduce the likelihood of individuals being exposed to a virus or contagion. But, future strategies should also include ongoing lifestyle behavior change, delivered at scale, to reduce the severity of the consequences of viral outbreaks like COVID-19 for those individuals who contract it. I would like to see public health and epidemiology invite physical-activity and healthy-lifestyle promotion to their table. I believe we all could work together to equitably empower people to adopt healthier lifestyle behaviors on a population scale, and do it in the name of pandemic readiness, not as a way to address COVID-19-like maladies from an immunity standpoint, but as an adjunct tool to help with more effective management of the risks associated with battling such an illness.  It is my hope that evidence-based programs that are demonstrated to help people adopt and maintain healthier lifestyles, and those individuals who are qualified to deliver such interventions, can be part of the conversation around promoting optimal population health. When the worst of COVID-19 is past, public health should become better funded, better understood, and even more looked to as an essential part of the overall strategy that steel us against threats similar to what is so disrupting our lives today. Empowering people to be more physically active, eat more healthfully, better manage their stress and sleep routines, and live overall healthier lifestyles is a logical piece of that puzzle. About Cedric X. Bryant: As President and Chief Science Officer, Cedric X. Bryant, Ph.D., FACSM, stewards <a href="http://acefitness.org/" target="_blank">ACE</a>&#39;s development of strategies to deliver exercise-science and behavior-change education in ways that are engaging and compelling, recruiting more people to become exercise professionals and health coaches and equipping them for growth in their respective fields. He&#39;s responsible for driving innovation in the area of behavior-change programming, overseeing the development of programs that <a href="http://acefitness.org/" target="_blank">ACE-Certified Professionals</a>® can utilize to help people adopt and sustain healthier lifestyles. Furthermore, he leads ACE&#39;s exploration of how science-based programs and interventions appropriately integrate into healthcare and public health. Dr. Bryant is also responsible for ensuring the scientific accuracy of ACE-commissioned studies, publications and all other materials that ACE creates. He represents ACE as a national and international presenter, writer and subject-matter expert, and highly sought-after media spokesperson. Finally, Dr. Bryant shares his expertise as a member of the Institute of Medicine&#39;s Obesity Solutions Roundtable, the National Association of Physical Literacy&#39;s Advisory Board, the Prescription for Activity Task Force&#39;s Leadership Council and Executive Committee, Exercise Is Medicine&#39;s Credentialing Committee and the International Consortium for Health &amp; Wellness Coaching&#39;s Council of Advisors. He earned both his doctorate in physiology and master&#39;s degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school&#39;s highest alumni honor that is given to select alumni who are considered leaders in their professional fields. Dr. Bryant and his wife, Ginger, are avid golfers and the proud parents of four physically active young men.

A More Resilient Opponent for the Next Pandemic

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In recent months, the nation has watched in awe as tens of thousands of nurses have raised their hands to go to the frontlines of the COVID-19 pandemic, putting themselves at great risk in order to help overwhelmed hospitals. Even now as the rate of cases starts to slow and the country looks to get back to some semblance of normality, the effects of the pandemic continue to linger for clinicians who have had to ration care, watch their colleagues fall sick and care for severely ill patients.  As a former ER nurse who spent nearly a decade working in Level-1 trauma centers, I have witnessed this first hand. The memories of traumatic patients from my time at the bedside still linger even years later. And as a nurse executive, sending nurses to the front line brought stress, anxiety, and sometimes even tears. The gravity of this situation really hit home, as it did with many of my colleagues who share my growing sense of alarm at what will likely be the long-term negative impact on the mental health of our nursing workforce.  New data shows the toll COVID-19 has taken on nurses’ mental health  In an effort to better understand how the pandemic has impacted nurses, my company, <a href="https://www.trustedhealth.com/" target="_blank">Trusted Health</a>, recently conducted a survey of 1,425 nurses across all 50 states, two-thirds of whom were providing direct care to COVID-19 patients. What we found was startling.  The nurses in <a href="https://assets-global.website-files.com/5c5b66e10b42f155662a8e9e/5eac7f8885c94fd16ca2f898_mental-health-survey-2020.pdf" target="_blank">our study</a> reported a 30% decrease in their mental health since the pandemic hit, rating their current facility an average of 4.8 (on a scale of 1 to 10) in terms of the support it provided related to their mental health and well-being. When asked how they think that the healthcare industry prioritizes and supports nurses’ mental health and well-being as a whole, nearly 95 percent said they felt that it was either not a priority, or if it was a priority, that there were inadequate measures in place to support it. How the industry needs to change  What makes these results particularly noteworthy is that awareness of the issue of burnout and its adverse effects on patient outcomes has been <a href="https://www.ajmc.com/journals/ajac/2019/2019-vol7-n2/making-an-evidencebased-case-for-urgent-action-to-address-clinician-burnout" target="_blank">widespread</a> within the healthcare industry, and there have been a series of efforts -- some very high profile -- to address it. And yet, our data shows that nurses largely see this as lip service.  So where is the disconnect? I believe it stems from the fact that the solutions have largely been at the surface level and have put the onus on nurses themselves to manage their own mental health and well-being. In order to address this issue and prevent an onslaught of COVID-19-related mental health issues, we need to focus on meaningful changes, in particular: <ol><li>Close the academic-practice gap. We need to rethink the way that we educate nurses. Newly licensed RNs often find that their schooling hasn’t prepared them for the structural realities of being a nurse, such that <a href="http://rnworkproject.org/" target="_blank">one-third ultimately leave their first post within two years.</a> We need to integrate skill-building around wellness and stress management into the curriculum for undergraduate and graduate programs. From there, Continuing Education Units (CEUs) can build on that foundation, offering additional relevant content around mental health and well-being. </li><li>Accompany wellness programs with large-scale structural changes. <a href="https://www.the-hospitalist.org/hospitalist/article/121385/leadership-training/promoting-health-healthcare-employees" target="_blank">Nearly 90 percent of hospitals</a> have some kind of employee wellness program, but overall participation remains low. I believe this is in large part because they fail to address the root of the problem via meaningful system-wide changes. One such change – and perhaps the most important – is an effective staffing system. No amount of gym discounts or healthy snacks can compensate if nurses are working excessively long hours, have unsustainable patient assignments, or aren’t able to take a break during the day. Additionally, evidence suggests the industry-standard 12 hour shift also leads to burnout and patient safety issues. </li><li>Institute support programs tailored to nurses’ specific needs. While the type of basic counseling that is generally provided through an Employee Assistance Programs is sufficient for some needs, nurses who are working in high-stress units like the ICU or ED often require more comprehensive support. Nurses need an ecosystem of options that includes access to crisis support, cognitive-behavioral skills building, and mindfulness techniques. As one example, Trusted Health and The Ohio State University’s College of Nursing <a href="https://news.osu.edu/new-partnership-supports-nurses-on-the-front-lines-of-the-covid-19-crisis/" target="_blank">recently launched a program in this vein</a> – staffed by nurses, for nurses. <a href="https://www.physiciansupportline.com/" target="_blank">Similar programs for physicians</a> have also recently sprung up in response to the pandemic. This peer-to-peer relationship has been shown to be effective in getting people to open up and catalyze healing in other high stress jobs like the military, law enforcement and fire fighting. </li></ol> Parting thoughts A growing chorus of voices from the frontline have begun to speak out about the effect of COVID-19 on clinician mental health. Last week, Dr. Tsion Firew, an emergency medicine doctor based in New York, wrote a <a href="https://www.cnn.com/2020/05/06/opinions/help-before-its-too-late-firew/index.html" target="_blank">harrowing op-ed</a> in which she underlined the struggle she and her colleagues now face: “Medical professionals are indeed heroes, but we are also human. Many of us are suffering beyond anything we are able to articulate and the weight of this moment is heavy upon our shoulders. Heed our call. The front line of this pandemic needs mental health resources and emotional support to process the destruction we cannot prevent, we cannot fix.” COVID-19’s legacy for healthcare is still being written. I for one hope that those of us who work in the industry will use this moment, when the eyes of the world are upon us, to come together to find meaningful solutions to help the millions of selfless healthcare professionals who have risked their lives to save ours.  About Dan Weberg:  Dr. Dan Weberg is an expert in nursing, healthcare innovation and human-centered patient design with extensive clinical experience in emergency departments, acute in-patient hospital settings and academia. He currently serves as the Head of Clinical Innovation for Trusted Health, the staffing platform for the healthcare industry, where he helps drive product strategy and works to change the conversation around innovation in the healthcare workforce. Prior to joining Trusted, Dan spent seven years at Kaiser Permanente, where he held executive roles in nursing innovation, research, and technology strategy across eight regions, 38 hospitals, and 60,000 nurses. He was also part of the founding faculty for the new Kaiser Permanente School of Medicine. Dan is on the faculty at The Ohio State University College of Nursing and multiple innovation fellowship programs. He previously taught on nursing innovation and leadership at Arizona State University. He is on the editorial board for Nursing Administration Quarterly and has authored two dozen peer-reviewed articles and two textbooks, including Evidence Based Innovation Leadership for Health Professions and Leadership in Nursing Practice. Dan earned his Bachelors in Nursing, and was in the first cohort to graduate from the Masters in Healthcare Innovation program at ASU, as well as the first-ever graduate of the PhD in Healthcare Innovation Leadership program at ASU. His clinical background is in Emergency and Trauma nursing at Level 1 trauma centers in California and Arizona.