Boston Park Plaza Hotel
The cost of providing you with these reports has been supported by the conference organizers and the following sponsors:
Your reporter from this conference is Donna Cusano
Wed 21 October: morning
The theme of this conference is Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times. So far, this observer senses little of the desperation that crisis conveys, but its corollary – great opportunity in connection and integration of the products and services out there with patients/clients and clinicians.
The conference opened, of course, with what is happening on healthcare reform on the Federal level.
The morning keynote speaker, Stuart Altman, PhD, an expert in Federal and state policy, set the tone. As head of the healthcare policy office in the Nixon administration back in 1971, when the “crisis” was that healthcare spending was 7.5% of US GDP @ $75 billion and was a factor in the infamous wage and price controls – to today when it is 17% of GDP @ $2.5 trillion, healthcare expenditures have been in one crisis after another that neither Carter, Clinton or Bush could control. He stated that costs will probably not go down – but there will be shifting from Federal spending (down) to private spending (up). Though Americans use less healthcare on average than UK/EU citizens, our prices continue to go up and Medicare costs continue to be the 800lb gorilla in the corner, with bankruptcy projected now for 2017. We need to change the payment and delivery systems, and the bills in Congress will not do much because Altman’s Law prevails – “Most every powerful constituent group favors health reform – but if it is not their plan, they prefer the status quo.” Right now, the winners appear to be hospitals, doctors, pharmaceutical/device companies and equipment manufacturers; the losers are insurance companies who will not experience the huge influx of new insureds that they were counting on.
This wasn’t a gloomy talk by any means – Dr. Altman is a great speaker and having reform put into historical context was reassuring to the audience – and he had some good news for our sector in that there will be increased incentives for home based services (Rep. Ed Markey’s “Independence at Home Program”), working with comparative effectiveness systems. But dreaded cost controls may rear their head….
The aforementioned Rep. Markey (D-MA) teleconferenced in from Washington with more on the bills and “Independence at Home” which he had included into the House healthcare reform bill. As the chair of the Telecommunications Subcommittee he also has a great deal to do with communications and interoperability of systems. One excellent point he brought up about ‘the gorilla’ as that 10% of the Medicare population has 5+ diseases, and account for 50% of the costs. We’ll have a part of managing that, as well as preserving patient privacy which is a major concern of his.
The morning networking break was jam-packed in the narrow exhibit area, so I joined Verizon’s Addressing Interoperability session with Rajeev Kapoor, Global Managing Director of Verizon’s Healthcare business. From the start in the 1970s of “laying the pipeline” to today’s broadband and FiOS systems, where Verizon is leading is in interoperability and creating a hub for secure information exchanged and levels of connectedness. His model of ‘crawl-walk-run’ illustrated that not every area of healthcare would have or need the same approach, and most of all, systems needed to be kept simple a la Apple and Google models. Applying interoperability in healthcare systems must address critical issues: identity, integrity, access to data, telemedicine analysis and human interfacing, regulatory and privacy. Most of what he had to say seemed most applicable to hospitals, clinics and medical practice, so my question was on how this model related to at-home services and applications. Home would be a ‘hub’ for information, and outside the home the cellphone would be the personal health device (including wireless handheld data devices using mobile technology, GPS, body sensors) using 4G technology.
My final morning breakout was Wireless Tech and Patient Self-Management, a panel with Ted Blizzard of the MA Medical Society, Anand Iyer, CEO of WellDoc, Rajeev Kapoor, Jorge Perdomo of Generation One and Dr. Robert Schwartzberg of Sensei. Most of the discussion extended Mr. Kapoor’s remarks, concentrating on how wireless capabilities can ‘raise the bar’ on outcomes, ease of use and interactivity. I’ll report more on this later [see just below] …must run to join Remote Monitoring in 2014.
Wed 21 October: morning (continued)
Continuing with this breakout, Wireless Tech and Patient Self-Management, the panelists looked at the business model for wireless in patient self-management from several perspectives:
- have payors (insurance companies, self-insured employers) reimburse, justified by economic savings (in fewer/shorter hospitalizations, lowering care levels (Iyer)
- in changing behaviors and delivering information, wireless tech has to be affordable; there is a blurred line between medical conditions and wellness (is obesity a disease or does this simply drive other medical conditions) which make cost savings hard to gauge (Schwartzman)
- in self-management of chronic illness, there is a delicate balance between wireless solutions and adoption by clinicians and end users; it has to prove usefulness and be end to end (Perdomo)
- again, tech has to be kept simple to be acceptable; delivery of the right information at the right time is critical for motivating the patient to adopt it. He also questioned whether the payor should be the only revenue in this model – why not the patient?
The segment that needs self-management the most – older people – have the largest issues with devices; these need to be made acceptable with simple phones and M2M wireless in handheld devices. For this group, the technology has to work right the first time out of the box. The final issue discussed was data security – a regulatory issue that the FDA is going to be involved with within the next few months.
Wed 21 October: Afternoon
As much as I’m covering, I’m also missing some. A general session that I missed (to file the morning report) was Nicholas Christakis MD of Harvard Medical School on how social networks affect health for good or ill – for example how obesity can spread in a cohort group, and also using social networking to reverse certain trends (thanks Charlie Hillman, CEO of GrandCare, for this report).
On to Remote Monitoring in 2014. In projecting out their respective areas, the panelists Terry Duesterhoeft, President of Honeywell HomMed, Sandra Elliot, Director of Meridian Health (NJ), Don Jones, Qualcomm VP and Randy Williams, MD, President of Pharos Innovations, led by Steve Brown, CEO of 3banana, had views at variance on how adoption, payment sourcing and technology would look in five years. Duesterhoeft noted how Honeywell technology had already moved from the elderly to serving the chronic disease population, and how SaaS was key to integrating HomMed and other devices. Jones looked forward to new classes of devices, biosensors of the ‘band aid’ type and using wireless technology to ‘collapse space and time’. Williams defined the future question as how to most effectively change behavior around chronic disease and using connectivity in social networking and via healthcare providers to facilitate. Sandra Elliott’s model was consumer based – using data to change behavior around ‘pain points’, integrating social interaction and starting this process in the physician’s office – a phrase of hers was “where there’s pain, there’s gain” – and it has to be what the patient will pay for. On maintaining that changed behavior, Williams emphasized the role of trusted relations, routinizing and incentivizing the behavior and the need to ‘keep it simple.’
‘Wow’ session of the day
At the afternoon networking break, dropped in on the intriguingly named Remote Patient Monitoring: from Warfare to Homecare, presented by the even more intriguingly named Blue Highway. Blue Highway is the R&D arm of Welch Allyn. David Eilers and James DelloStritto presented their concept and technology in test: personal status monitoring (PSM) via thin, wafer-like bio-sensing materials or small SD card-like body monitors/recorders. For military use (developing in conjunction with Lockheed Martin), these multiple sensors in helmets, body armor, clothing and boots capture pressure, motion, respiration, heartbeat, gait, and probable action or position (e.g. running, lying down etc.), relaying the PSM information to a medic who can identify wounded or ‘down’ soldiers, predict problems (limping) and when coming to aid, gauge distance. If technically possible we will get their video embedded on this website next week. David Schieffelin, CEO of 24Eight, has partnered with Blue Highway to develop this PSM technology and concept for civilian healthcare, particularly fall detection AND prevention via gait tracking (aka The Holy Grail), through wearables such as bracelets, belt clips, shirts and insoles. For this observer, this was the ‘wow’ session of the day.
Wrapping up the day were three general session presentations by Mark Bard of Manhattan Research (Analyzing Digital Health by the Numbers), Joe Kvedar, MD of the Center for (Connected Health at Scale) and to close, a panel analyzing these presentations.
Attendance for this two day session was confirmed today at over 1000.
Additional product coverage from today’s meetings to come next week: Alcatel-Lucent/SaskTel, Meridian Health, iGetBetter, more.
CCH’s Achievement Awards for distinguished service to healthcare and commitment to HIT innovation were presented to John Glaser, PhD, VP and CIO of Partners HealthCare System, and Jay Sanders, MD, CEO of the Global Telemedicine Group. Both were panelists during the Symposium.