IVI-NSCLC Value Tool

Please see below some exciting news from the Innovation and Value Initiative (IVI) on the release of the IVI-NSCLC Value Tool. The press release is below.

IVI is excited to publish our Open-Source Value Platform (OSVP) model focusing on epidermal growth factor receptor (EGFR) positive, non-squamous non-small cell lung cancer (NSCLC), and we invite public comment on the model through April 1, 2019.

Oncology, and specifically lung cancer, is a disease area ripe for value assessment advancement. Therapies are rapidly advancing, often changing the care paradigm and offering patients and their physicians different options. Even with this rapid scientific advancement, for the 45,750 people diagnosed with EGFR+ NSCLC every year, the probability of survival at 5 years is still only 4.7%.

This patient population has a different outlook on value than patients with rheumatoid arthritis. It’s important to understand the patient perspective at the front-end so model development can be specified for individual patients. To that end, we worked with LUNGevity to ensure that patients’ viewpoints were “baked in” from the start. As part of this partnership, we conducted qualitative research with patients to begin including quantitative measurements of factors important to patients.

The research on patient perspectives and the entire OSVP model package – including complete documentation, R package, source code and user interfaces – are available on IVI’s website.
The next step in the model development process requires input from you: stakeholders passionate about value assessment and its impact on decisions for clinicians, patients and payers. We invite public comment through April 1, 2019. Contributions from a wide range of perspectives are a vital component of validating and improving the model. The technical expert panel will review and synthesize comments to develop prioritized recommendations for improvements to the next version of the model, which we will release in 2020.

Having a fully transparent model that allows users to update key assumptions, model structures, and parameter values is a major advance. Further the use of novel value components (e.g., value of hope), incorporating patient preferences through multi-criterion decision analysis (MCDA) framework, and other advances truly demonstrate the latest from the science of value assessment. Go check it out.

IVI-NSCLC Value Tool posted first on http://dentistfortworth.blogspot.com

Consumers’ and Physicians’ Growing Embrace of Digital Health via PwC

Most consumers would be willing to try an FDA-approved app or online to treat a medical condition, as well as receiving hospital care at home if would be less costly.

We’ve reached an inflection point on the demand side among consumers for digital health options, PwC suggests in their report on the New Health Economy coming of age. The report outlines health/care industry issues for 2019, with a strong focus on digital health.

Whether a menu of care options including virtual health to access specialists across the U.S., post-hospital virtual visits, or hospital care at-home, a majority of Americans supports a new era of care delivery, as PwC coins the broad landscape of telehealth.

Nearly one-half of consumers also said they’d be comfortable receiving health services from a technology company like Google or Microsoft.

This is consistent with a previous survey by PwC’s firm Strategy& conducted several years ago which asked consumers what industries they would trust to help them manage their health. Equal proportions (39-40%) of people said, “large retailers,” “digitally-enabled companies,” and “healthcare providers.”

Comfort with tech companies getting involved in health care services is now a viable scenario in health consumers’ minds, for nearly 50% of people.

PwC also notes that most physicians (3 in 4) have recommended an app or digital tool to patients. Two-thirds of these digital tool “prescriptions” (small “p”) have been met with success, the prescribers say.

This statistic also demonstrates a new tipping point and convergence between health consumers and their doctors, which has been a chasm for a while. I discussed this digital health supply/demand gap here in Health Populi.

Note that 31% of physicians were unsure about the results of their digital tool prescribing. We need better metrics to quantify this kind of encounter that will provide evidence for tools that work in consumers’ self-help hands, and those that don’t.

As patients-as-consumers grow more comfortable with telehealth, remote health monitoring and using consumer-facing digital health tools, they’re also envisioning the possibility and viability of more medical area at home.

Most people would be willing to use a medical care tool at home, such as those that check vital signs with a device attached to a phone; having a live visit with a physician via an app; checking their implanted medical device, like a pacemaker or cardiac defibrillator “long-distance” wirelessly by a physician; or, having an ECG at home using a device attached to their phone, communicating results to their physician.

These statistics from PwC’s health consumer surveys are underpinned by a key finding: most consumers are interested in an FDA-approved digital app or tool to treat a medical condition.

One-half of consumers would be likely to try such an FDA-cleared device. And again, most doctors told PwC they’ve brought up the subject of such digital therapies to patients, and 26% of patients have raised up the topic with their doctors.

Health Populi’s Hot Points:  A column in JAMA published  January 11, 2019 discusses Personal Health Records: More Promising in the Smartphone Era?

Dr. Christian Dameff and colleagues from UC-San Diego answer the question by saying, yes, PHRs are indeed more promising in this smartphone era with the advancement and adoption of FHIR standards that help make electronic health records more inter-operable. These standards are complemented by advances in internet-connected consumer devices that allow patients to collect personal biometric and other clinical data from well-designed wearable tech and remote health monitors. Technology companies beyond traditional health IT, such as Apple, Google, and Samsung among others, are advancing some of these applications.

Fostering the adoption of FHIR standards in healthcare beyond academic medical centers will be really important to bring virtual and technology-enabled self-care to mainstream patients dealing with the chronic conditions that are amenable to lifestyle and behavior changes —  say diabetes, heart disease, and respiratory diseases like asthma and COPD, all of which have a growing assortment of better-and-better designed digital health tools that can be used by consumers.

The authors conclude, “whether these technological advances ultimately improve patient outcomes, lower costs, and improve quality remain the most important unanswered questions.”

As clinicians and consumers join forces to take healthcare home, it’s incumbent on everyone to assess to measure these experiences in this early adoption phase. We’ll need to crowdsource and share findings from these studies to gauge what works. This will help pay-it-forward for future patients and doctors in helping forge more efficient and cost-effective health care, as well as high consumer-grade experiences.

We’ll be discussing the consumerization of digital health technologies on Valentine’s Day at HIMSS, 14th February 2019, during an all-day session hosted by Dr. Joe Kvedar and the Personal Connected Health Alliance. At 10:15 am that day, I’ll be on a panel with Greg Orr, VP of Digital Health with Walgreens; Nick Desai, President of Heal; and, Peter Rasmussen, Medical Director of Digital health at the Cleveland Clinic, focusing on digital traction in the consumerization of healthcare. 

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Consumers’ and Physicians’ Growing Embrace of Digital Health via PwC posted first on http://dentistfortworth.blogspot.com

Is there a physician available?

According to research by Leech et al. (2018), the answer may depend on whether or not you are black or white.

Compared to the control group, “Black” auditors were less likely to be told an office was accepting new patients and were more likely to experience both withholding behaviors and misattributions about public insurance. The strength of associations varied according to whether the cue was based on name or accent. 

In short, if you sound black or if your name seems black, then your chances of getting an appointment at a doctor go down.

Once a patient was able to access a doctor, however, a study by Fenton et al. (2019) found evidence that the quality of care received was the same across races.

better patient experience for white than black beneficiaries in most counties for Getting Needed Care and especially for Getting Care Quickly. In contrast, black and white beneficiaries reported similar patient experience regarding Doctor Communication in most counties. 

Is there a physician available? posted first on http://dentistfortworth.blogspot.com

Kohl’s and the Rebranded Weight Watchers in Retail Health

For the past two holiday shopping seasons in 2017 and 2018, I’d noticed pre-print ads in my local Sunday newspaper from Kohl’s, the value-priced retailer, featuring wearable technology for health. There were devices branded Fitbit on the front page of Black Friday’s 2018 ad, shown here, with other tech brands promoted inside the pages.

These ads were bundled in my newspaper along with ones from Best Buy, Target, Walmart, and other retailers featuring the same or similar wearable health-tech.

This week, Kohl’s announced a collaboration with WW, the newly-rebranded Weight Watchers, for the retailer to bring a WW “salon” space to the store.

With this move, we welcome Kohl’s into my ever-expanding retail health landscape. This announcement is part health, part real estate, and all about consumers’ growing role in self-care and healthcare payor.

WW needs new-and-improved positioning, both physically (via novel accessible real estate options) and marketing-wise to refresh the brand. Weight Watchers has been challenged by mobile apps, like MyFitnessPal and LoseIt! among others, which help people self-track calories for free. Weight Watchers has also weathered competition from the likes of Jenny Craig and Nutrisystem, the latter of which was acquired by Tivity Health in late 2018, home of the popular Silver Sneakers program, and other wellness assets largely focused on aging well.

The WW re-branding for the iconic weight loss brand was prompted by consumers’ waning interest in “dieting” in favor of more holistic ways to approach weight, resilience, and eating styles like paleo, gluten-free, DASH/Mediterranean, and keto.

WW’s latest tagline is, “Wellness that works.”

What does Kohl’s get from this collaboration? First, they can repurpose existing real estate which is an operational cost that now can be shared with the WW Studio, if the concept scales beyond a few piloted locations. The Active/Wellness category at Kohl’s captured 15% of its sales in 2017. That year, Kohl’s expanded its relationship with Under Armour across men’s, women’s, children’s and home departments. The retailer figured out there had been half a million searches for ‘Under Armour’ on Kohls.com the previous year, identifying an opportunity with pent-up demand from wellness consumers who shopped the store.

So Kohl’s is betting they can sell more activewear and wellness equipment to WW clients who will enter the bricks-and-mortar store and shop online, spending more share-of-wallet on exercise and fitness clothes, along with scales, yoga mats, and — to be sure — wearable tech devices.

Watch this space for more announcements like the Kohl’s/WW alliance to help people meet personal health goals closer to home, where we live, work, play….and shop.

The post Kohl’s and the Rebranded Weight Watchers in Retail Health appeared first on HealthPopuli.com.

Kohl’s and the Rebranded Weight Watchers in Retail Health posted first on http://dentistfortworth.blogspot.com

Uninsurance on the rise

In 2023, the U.S. Will Still Be the #1 Prescription Drug Spender in the World, IQVIA Forecasts

Today, as Congress kicks off hearings about the cost of prescription drugs in the United States, IQVIA published its 2019 report on The Global Use of Medicine in 2019 and Outlook to 2023. The top-line of the research is the robust pharma market growth will be driven by two factors, and limited by two others: spending in the U.S. and emerging markets (coined “pharmerging” by IQVIA) will push up spending, while limiting factors on growth will be increasing generics and expiration of brand patents.

The U.S. will continue to be the number 1 prescription drug spender in the world to 2023, IQVIA forecasts, shown in the first chart where I clipped the top 20 to 10 top spenders. The U.S. will be followed by China, Japan, Germany, and Brazil in 2023.

For context and comparison, note that the U.S. has some 326 million citizens, and China nearly 1.4 billion. China will have spent just over one-fourth of what the U.S. paid for prescription drugs in 2018, with roughly four times the number of health citizens.

The rate of growth of Rx spending looks fairly flat from 2019 to 2023, the second bar chart illustrates, with net growth of spending just over 4% by 2021-2023.

This moderate growth rate is a moment in time, because IQVIA expects a pipeline of new and more expensive products to be launched as older brands continue to come off-patent — the moderating force on the price-driven growth of the new specialty drugs.

The second chart illustrates costs of drugs by type and launch year, showing that the median list price for oncology and orphan drugs (defined as medicines that treat fewer than 200,000 patients globally) could exceed $200,000 per year by 2023. Thus, while the costs of traditional drugs aren’t increasing far above the rate of inflation, the new-new therapies are much higher-priced.

See the dark blue dot in 2023 north of the other dots, representing the median costs for a non-oncology drug with orphan status priced around $300,000.

Other key trends to expect leading to 2023 will be:

• The rise of patient advocacy roles in pharma companies
• The growing adoption of artificial intelligence and machine learning by pharma companies to drive more efficient drug discovery
• More philanthropic organizations targeting neglected tropical and public health diseases
• The increased use of real-world evidence (RWE) and patient involvement in clinical trials
  using consumer-generated technology.

IQVIA rightly calls out digital therapeutics (DTx) in this year’s report, noting the growth of mobile apps and digital tools submitted to the FDA for clearance or approvals. The first FDA cleared DTx was reSET from Pear Therapeutics, cleared in November 2018. This is used for the treatment of substance use disorder and is the first of many conditions Pear is developing in the mode of software-as-medicine to complement the usual standard of care.

DTx companies have been striking partnerships with pharma companies to help them “surround the pill” with service. We can anticipate more of these collaborations going forward as pharmas look to add value beyond the pill, and innovators leverage peoples’ everyday relationships with and trust in consumer technologies.

The limiting factor here will be proving the evidence for DTx on a case-by-case basis. Thus far, the FDA has been welcoming to these concepts.

Health Populi’s Hot Points:  I introduced this post noting today is the first of what will be a long and deep look into prescription drug pricing in America. IQVIA recognizes that, “the (U.S.) Federal government has proposed a sweeping set of pricing reforms for government programs with varying levels of impact and probability of being enacted.” Furthermore, “the next five years likely pose a number of challenges to biopharmaceutical companies, with payer actions on prices looming.”

The last chart was published today in Bloomberg, observing that drug stocks were under-performing ahead of today’s first Congressional hearing on the topic of drug prices.

The Democratic-led House of Representatives may be blamed for this hazing, but in fact voters across political party have been interested in the Federal government taking more assertive and proactive action for prescription drug prices. Polls among voters for several years have found that this issue is a concern for majorities of Democrats, Independents, and Republicans.

In an America lacking consensus across the wide range of issues on voters’ minds, health care costs – and particularly Rx costs and prices – rank top of mind for voters and House Democrats.

Americans have come to learn the role they play in subsidizing the cost of drugs and their development for the world’s health citizens. Note my math on the China ratio of 1:4 dollars spent on prescription drugs versus the U.S., with over four times the number of people.

This topic will inevitably be part of ongoing political debates as we lead up to the 2020 Presidential election. The patient is the consumer is the payor of health care, including prescription drugs at the point of purchase.

The post In 2023, the U.S. Will Still Be the #1 Prescription Drug Spender in the World, IQVIA Forecasts appeared first on HealthPopuli.com.

In 2023, the U.S. Will Still Be the #1 Prescription Drug Spender in the World, IQVIA Forecasts posted first on http://dentistfortworth.blogspot.com

Measuring caregiver quality of life

Poor health does not just affect the patient, but also the caregiver who provide physicial, emotional and financial support for these patients. To measure the impact of a disease on patient quality of life, there are a number of metrics one can choose from such as EQ-5D-5L, EQ-5D-VAS, SF-36 among others. Some of these surveys can be directly converted into cardinal patient quality of life (i.e., utility) values. One question that remiains is how one would measure how a disease affects the quality of life of a caregiver.

Two common approaches to measuring the effect of a disease on caregiver quality of life are the CarerQoL and the Care Experience Scale (CES). The CarerQoL has two versions, the first–Carer-QoL-7D–ask caregivers 7 questions where they rank how caregiving has affected their quality of life. The questions ask about caregivier fulfillment, relational problems with the patient, caregiver mental and physical health, caregiver ability to conduct their own household/work activities, financial issues, and support from other family members or friends. The CarerQoL–the visual analog scale CarerQoL-VAS–also askes caregivers how happy they feel at the moment and ask them to rate their feeling on a scale from one to ten.

The CES, on the other hand, asks caregivers about their experience along six attributes:

• Activities outside of caring (e.g., socializing, physical activity)
• Support from family and friends)
• Assistance from government and non-profit organisations
• Fulfillment from caring
• Control
• Getting-on with the care recipient

Like the CarerQoL-7D, each question caregivers can answer 1, 2, or 3, which correspond to to more, average and least positive experiences of caregiving.

In short, one can readily quantify the impact of caregiving on caregiver quality of life using either of these tools.

Measuring caregiver quality of life posted first on http://dentistfortworth.blogspot.com

What Should You Look For In A Dentist?

Looking for a new dentist can be intimidating, exhausting, or otherwise difficult if you’re not sure what you’re looking for. 

 

And sometimes, you may just not know what you should even be looking for. 

 

Maybe you’re searching for a new dentist because you’re new to the area, or you’ve been avoiding the dentist due to fear or lack of insurance and now you’re ready to take the next step. The internet is full of reviews, but how can you be sure that they are true and reflect real patient feelings? 

 

If you are looking for a new dentist for you and your family, we are here to help—whether or not you feel our practice is the right place for you. As dentists, our goal is to ensure everyone is able to find an office where they feel comfortable and are given the best services. 

 

To help you make those, decisions we’ve outlined what you should be on the lookout for when choosing a new dental practice. Here at Dr. Ku’s, we would be happy to talk to you about the services we provide and provide references if you would like to talk to any of our other happy patients. 

 

Talk to friends and family 

 

Before jumping to anonymous online reviews, ask your friends and family who their dentist is and if they would recommend them. If you are new to the area, your neighborhood lists on social media pages may contain recommendations as well. There are also dozens of high-profile and quality online directories with more recommendations and reviews, like Yelp and Google. 

 

If you’re moving and looking for a new dentist in the area, ask your current dentist for a recommendation. They may have classmates or former colleagues where you’re headed. 

 

When polling friends and family, make sure to ask about their dentists’ office hours and difficulty in scheduling an appointment. This will provide important information on how they deal with emergencies and how easy it is to schedule those coveted before-work appointments as well as what kinds of client care they have. 

 

Do they take your insurance? 

 

Once you find a dentist that comes highly recommended, call the office to make sure they take your insurance. This is critical to ensure you are not surprised with bills later. In addition to insurance, this would be a good time to ask about payment plans and financing options, too, should you ever need substantial work. Even if you don’t need them now, you might in the future; and, ideally, this new dentist could be your dentist for you and your family for life. 

 

Visit the office 

 

Next, visit the office to get a feel for the office staff and the dentist. You don’t need an appointment to come check out the space! While we hope that you won’t have to make frequent trips, it is important to feel at ease in the office. So, while you’re there, take a look at the technology options in place in addition to talking to the dentist and staff. This would also be a good time to ask about continuing education. If the staff prioritize continuing education and pursuing growing their knowledge new techniques, this is a good indicator they are staying on the cutting edge of technology. 

 

Ask about services 

 

When you visit the office or peruse the website, ask about what full list of dental services the practice offers. Do they see children in addition to adults? What about more complex procedures like root canals or dental implants? Some of these procedures are referred out by certain dentists, but others like to perform them in-house. If it’s important for you to see your dentist for all procedures, then make sure you discuss what is offered in-office.  

 

Choosing a dentist can be hard. Many people suffer from dental anxiety which can compound when visiting a new practice. Even if you don’t choose us as your dental home, we would be happy to provide insight and help as you choose your dentist. Dr. Ku’s office has been voted the number one dentist in Fort Worth by the Fort Worth Star Telegram for the second year in a row, partly because of this your-health-first style of consultation. Give us a call to talk about your options today!  

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What Should You Look For In A Dentist? posted first on http://dentistfortworth.blogspot.com

Trust in 2019 Via Edelman: The Plotline for Women and Healthcare

Fewer than one-half of consumers trust in government and media. Three-quarters trust employers, who in 2019 are the top-trusted institution according to the 2019 Edelman Trust Barometer released last week in Davos at the World Economic Forum.

Consumers in the U.S. over-index for trust in employers, with 80% of people saying they have a strong relationship with “my employer,” compared with 73% of Britons, 66% of the French, and 59% of people in Japan.

What’s underneath this is employers being trusted to provide certainty: most workers look to their employer to be a trustworthy source of information about social issues and topics about which there isn’t universal agreement. But there is a nuance here: while 72% of people globally trust employers on information about the economy, only 58% of workers believe their employers on the issue of technology.

My hypothesis on this is workers’ concerns about the impact of artificial intelligence (AI) and robotics on jobs. Note that AI was a major topic of discussions through the World Economic Forum Agenda. For example, here’s a summary of changing the AI narrative to reskill the workforce, bolster “bilinguality” among workers in terms of building up AI human capital, and ensuring against bias in AI applications.

Then there was this less favorable take on the AI-Davos conversations published in the New York Times on the “hidden automation agenda of the Davos elite.”

And here’s an essay right from the Davos folks’ WEF blog on why AI may fail women in the workplace and in the world.

So it’s interesting to note that Edelman found workers concerned about job security around the world. “Fears of job loss remain high,” the second chart asserts. Most employees are concerned about not have the training and skills to access a good job, and are concerned about innovations “taking my job away.”

It follows, then, that 8 in 10 consumers said how a company treats its employees is one of the best indicators of its level of trustworthiness. Furthermore, two-thirds of global consumers believe that a company’s good reputation may induce them to try a product, but unless they come to trust that company behind the product, they’ll soon stop buying it.

Edelman found that the most trusted employers lead on change across several dimensions in this order: societal impact, how an organization contributes to a better society; the organization’s values; the organization’s vision of the future; the organization’s mission and purpose; and, operational considerations like decisions that could affect “my job.” I note the order of importance, because larger societal impact comes here before how the organization’s decision impact my specific job.

One of the most striking findings in this year’s Trust Barometer is the gender gap between men and women when it comes to trust. Fewer women trust the different institution types across the board, with the largest gap toward business.

Furthermore, women tend to use social media more and “amplify” their opinions, news and information more frequently than men do by a relatively large margin. Social amplification is even more pronounced among women who are part of Edelman’s segment of the informed public. In Edelman methodology, the informed public are those consumers who are between 25 and 64 years of age, college-educated, in the top 25% of household income in their market, and report heavy media consumption and engagement in business news.

The percent of women from the informed public that amplify news and information brew 23 percentage points over one year 2018-2019, versus 18 percentage points among men.

The Mars vs. Venus consideration plays out in another question Edelman asked regarding what leadership issues people believe CEOs should lead on. The top three responses were equal pay, prejudice and discrimination, and training the jobs of tomorrow — issues that concern women, in particular those top two items.

Health Populi’s Hot Points:  Since you are reading Health Populi, I must pull out the one data point in the Trust Barometer most central to our coverage: health care.

The industry sectors chart compares trust levels across industry sectors. Trust gains among consumers were made across every industry sector….except for healthcare. Energy and financial services gained the most trust margin, followed by telecomms.

Healthcare stayed flat over the year, with about two-thirds of consumers trust the sector versus a high of 78% of consumers trusting technology. This, even in a year of the Facebook/Cambridge Analytica story, innumerable personal data breaches, and growing concerns about privacy.

Let’s overlay the lens of women-as-healthcare-consumers on the Trust Barometer findings. Women tend to be the Chief Health Officers of their families and homes, driving the large percentage of decisions and dollars related to healthcare and retail health purchases.

See this new podcast from The Commonwealth Fund on how U.S. healthcare fails women for some context.

If trust is a precursor of health engagement, then employers, governments, and media have to do a better job to engage women, who have the power to move dollars and traffic to one health/care destination versus another.

In particular, if technology entrants into health care can tailor and design services and streamlined life-flows based on women’s values and personal trust barometers, these new-fangled services may capture market share among these Chief Health Officers.

The post Trust in 2019 Via Edelman: The Plotline for Women and Healthcare appeared first on HealthPopuli.com.

Trust in 2019 Via Edelman: The Plotline for Women and Healthcare posted first on http://dentistfortworth.blogspot.com

Trends in Obamacare plans: 2019 edition

The Robert Wood Johnson Foundation conducted case study interviews of health insurance exchange marketplace (i.e., Obamacare marketplaces) in 10 states (i.e., California, Florida, Georgia, Indiana,
Maryland, Minnesota, Ohio, Virginia, Washington, and West Virginia) to determine trends in the available plans. One general trend was that large commercial insurers were leaving the marketplace.

Marketplace participation is now dominated by two insurer types: Medicaid-managed care organizations that entered the private insurance market for the first time under the ACA and affiliates of Blue Cross Blue Shield. In many cases, national insurers (e.g., Humana, Aetna, and UnitedHealthcare) and provider-sponsored insurers (an important exception being
Kaiser Permanente) have left the marketplaces. Regional insurers are still in some rating regions but have left others.

Of particular note, while health insurance premiums rose dramatically in 2018 (on the order of 20-30% increases), in 2019 the increases generally were more modest (single digits) and in some cases declined. This trend is despite the repeal of the individual mandate. What explains this trend?

First, narrow networks became more common.

The HMO products offered by Blue Cross Blue Shield affiliates and Medicaid insurers came to dominate many markets. PPO products had a difficult time competing due to higher prices for broader networks.

Second, some states instituted more generous reinsurance programs.

Two of our study states instituted reinsurance programs. They saw significant reductions in premiums from these programs, but the need for state financing of part of the cost was thought to inhibit use in other states.

Some insurers were worried that low-cost, short-term plans would take healthier individuals away from ACA-compliant plans. However, most insurers believed that the impact would be modest. Further, some states–like California–outlawed these plans in their exchange.

So why did premiums rise so much in 2018? This appears to be a one-off adjustment form the administration’s decision to end directly reimbursing health plans for cost-sharing reductions.

>

Trends in Obamacare plans: 2019 edition posted first on http://dentistfortworth.blogspot.com

Friday Links

Government shutdown slows drug approvals.
Does emailing your doctor save or cost money?
Digital health and direct-to-consumer marketing.
A smart watch for epilepsy.
Genetic instrumental variables (GIV).
The groin crusher.

Friday Links posted first on http://dentistfortworth.blogspot.com

The Consumer and the Payor, Bingo and Trust: My Day At Medecision Liberator Bootcamp

To succeed in the business of health information technology (HIT), a company has to be very clear on the problems it’s trying to address. Now that EHRs are well-adopted in physicians’ practices and hospitals, patient data have gone digital, and can be aggregated and mined for better diagnosis, treatment, and intelligent decision making. There’s surely lots of data to mine. And there are also lots of opportunities to design tools that aren’t very useful for the core problems we need to solve, for the clinicians on the front-lines trying to solve them, and for the patients and people  whom we ultimately serve.

At the end of each day, the HIT company has to remember that at the end of a digital transaction, there’s a person. That individual could be a member of a health plan, a nurse, a physician, a grandparent-caregiver tapping into her grandchild’s medical portal…all people, with different abilities to read and comprehend data, values, and incentives.

Earlier this week, I spent a day with Medecision’s digital health team, aka ‘the Liberators.’ My role in the event was to provide a through-line from introductions to trend-weaving what I heard and learned at the end of the day. In the middle of the day, I spoke about trends in health care focusing on the patient: as a payor, as im-patient, as digital, as a consumer, and as political.

As a payor, the insured patient in 2019 is likely to be managing a high-deductible health plan, responsible for first-dollar costs until s/he reaches that threshold. As such, health care spending feels like a retail event, prompting the patient-as-payor to ask, “what’s the price?” “What’s the value?” “What’s the product?” “What are the alternatives?” Even though price transparency has gone live online among more hospitals, this start-up phase is still heavy-lifting and confounding for people to understand. Health care costs continue to be the top pocketbook issue for most families in the U.S. across income cohorts.

As that payor, expecting retail service, patients are im-patient. Why can’t appointments be made online like I do with restaurants on OpenTable? What’s so hard about getting me my lab test on the day or next-day after I provide my sample? Health care surely doesn’t feel like the best retail experience, and that’s especially true for health plans. I shared the Temkin Group’s data on customer experience (shown here), where our favorites are found in grocery stores, fast food joints, and retailers. Health insurance plans? Not so much.

Patients are also digital: smartphones are fairly ubiquitous (although we must remember that not all people can afford data plans – my mantra, that connectivity and broadband are a social determinant of health). This means people (with connectivity) want work-flows for health care the way they conduct their financial affairs, social networking, travel planning, and way-finding. People are omni-channel, too, so health care must think like a retailer in reaching people wherever and however they want to be reached: online, via email, via text, phone call, and even via snail mail for some (albeit increasingly fewer) patients.

Patients are consumers, at the end of the day. As payors, digital beings, im-patient people demanding service levels they experience elsewhere — outside of healthcare.

Finally, patients are political. Health care was the top issue driving voters to the 2018 mid-term elections. Health care will also be top-of-mind among voters in 2020, who are becoming more aware of the risks of losing coverage. This week, the level of uninsured people in America rose to a four-year high, with the erosion of support for the Affordable Care Act by President Trump and Congress over the past two years. Growing concern for losing coverage for pre-existing conditions has become mainstream across political parties.

Politics underpin what’s happening in health plans in the public sector, and I spoke a bit about Medicare and Medicaid. The latter is the place to look, across the fifty State Governors, for Medicaid expansion (or not); growing integration of behavioral health to deal with depression, anxiety, and the opioid crisis; and greater attention to the social determinants of health and long term social supports (LTSS). You can see the latest Medicaid demonstration waiver data from a Kaiser Family Foundation analysis done January 9, 2019 shown in the bar chart.

To that point, during the day, two Medecision Liberators played out a scenario for complex cardio management. In the role play, a patient-persona was speaking with a call center associate. In the conversation, the plan member asked how the associate knew so much about them. Further into the conversation, the member said she needed to hurry off the call to get to her bingo game in time.

That conversation raised two important points and opportunities to drive health outcomes: first, on the issue of privacy and trust, as the member questioned just how the associate knew so much about her. That’s an opportunity to forge a bond of trust between the member and the health plan or provider, to discuss how bringing various data together can help paint a picture of her whole life and help her achieve better health.

The second item — the bingo game — presented an opportunity to discuss social supports, transportation to the event, and what the member might be snacking on during bingo. If it turns out she loves the salty snacks or M&Ms, the health coach has an opportunity to counsel the member on the impact of salt on her heart health, and suggestions for some healthier snacking.

This kind of conversation is inherent in the values that Health New England’s Lisa Holland discussed in the context of HNE’s customer promises for the organization: quality, thoughtfulness, and humanity.

The Medecision Liberators collaborated in a brainstorming exercise about social determinants of health, generating important insightful questions they would ask people about their lives to un-earth opportunities to address social supports. A few of these questions were:

• What’s your most challenging daily activity?
• Walk me through your typical day.
• Do you have someone you can rely on if you need help?
• What does living independently look like to you?
• Do you have access to healthy food?
• What did you do for entertainment today that gave you pleasure?
• Can you read?

That led me to end the day’s trend-weaving quoting one of my favorite JAMA columns from the recent past: that Value-based payments require valuing what matters to patients, co-written by Dr. Joann Lynn, Dr. Aaron McKethan, and Dr. Ashish Jha. This has become a pillar in my thinking about the role of respect and trust in health care between patients (as payors, consumers, self-carers and caregivers) and health care organizations. They ask and answer: “How can a care system be structured to deeply respect the myriad differences among patients when disabilities or advanced age makes those differences especially important? The answer is that the delivery system must proactively help affected people articulate their priorities and goals.”

Health Populi’s Hot Points:  The theme of trust was mentioned throughout the day, across a wide range of discussion topics. I noted in closing that this week also convened the World Economic Forum in Davos, during which Edelman annually updates their Trust Barometer. This year’s survey found that globally in 2019, the most trusted institution for consumers is the employer: both for ensuring a job for “me,” as well as for being a good corporate citizen in the community locally and in the larger world, in sustainability and responsibility.

This behavior drives trust, which we learned is the most important driver behind peoples’ engagement in health — a key finding in the first Edelman Health Engagement Barometer conducted in 2008. Eleven years later, trust as a health engagement requirement is even more important in light of our AI-enabled health care world.

We remember that at the end of every health IT transaction, there’s a person: a plan member, a consumer, a doctor, a caregiver.

“We are all the same,” a doctor’s essay in JAMA noted this week. Dr. Mandy Maneval, a family practitioner in Mifflintown, PA, wrote:

It strikes me that so many of life’s moments are dichotomies of health and disease, life and death, joy and sorrow. As a family medicine physician, this mirrors my everyday life. I often leave one patient’s room after giving bad news and immediately enter the next room to see the happy parents of a newborn. Navigating the full spectrum of human emotion is simultaneously exhilarating and exhausting. There are days when I feel like a hero and others when I cannot do a thing right…Connecting deeply through our shared humanity, no matter our differences, is one of the most precious gifts we offer and receive as physicians. We are all the same.

That works for physicians, and it works for all of us in the health care ecosystem. I thank Medecision for the opportunity to participate in this day of insights, team-building, and real human connection.

That last sentence was going to be the conclusion of this post. But just in time, on cue as this post was being scheduled on WordPress, an article titled A Framework for Increasing Trust Between Patients and the Organizations That Care for Them arrived in my inbox from JAMA published on 24th January 2019. Dr. Thomas Lee and colleagues explained:

Trust matters in health care. It makes patients feel less vulnerable, clinicians feel more effective, and reduces the imbalances of information by improving the flow of information. Trust is so fundamental to the patient-physician relationship that it is easy to assume it exists. But because of changes in health care and society at large, trust is increasingly understood to be at risk and in need of attention.

The authors outline potential approaches to increase trust between patients and health care organizations, which include:

• As a first step, leadership should acknowledge that trust is foundational and a trusting environment essential for good health care
• Measuring trust should be a standard part of evaluating patient care experiences, including those with health plans
• Transparency of patient care experiences should be part of measuring, monitoring and continually improving quality and safety
• Boards and leadership should routinely examine data that reflect on patient and staff trust, and include these in reward plans
• Standards, training and accountability systems should be developed for clinicians and for teams
• Relationships between patients and clinicians should be structured such that patients can make choices reflecting their personal preferences: this recognizes that patients know more about what matters to them and how they are doing
• Health systems should insure needs of patients for a navigator or translator are met
• Finally, patients should be actively engaged in designing solutions to the erosion of trust.

This article is free from JAMA’s usual paywall, so please click on the link above to access the entire discussion. These doctors who crowdsourced the recommendations really understand that it’s good to know about patient’s love of bingo, taste for salty snacks, and social support systems…and patients really do want to be part of their own planning and care.

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Americans Are Warming to Universal Health Care, Kaiser Poll Finds

Most Americans like the idea of universal health care as a guaranteed right, Kaiser Family Foundation learned in this month’s Health Tracking Poll.

This finding reinforces the voter turnout for the 2018 mid-term elections which was largely driven by peoples’ concerns for losing health access for pre-existing conditions.

The first chart notes important nuances under the majority support for a national health plan which, in this case, asked whether people favored a plan “sometimes called ‘Medicare for all.'”

I note that note all national health plan designs would need to be tied to Medicare. There are many ways to deliver universal health care to citizens beyond this concept.

Key features most Americans favor are indeed health insurance as a right, and the elimination of premiums and reduced out-of-pocket costs for most Americans.

Paying more in taxes and eliminating private insurance companies would be opposed by most people.

In addition, the vast majority of people would be concerned about a national health plan leading to delays in getting treatment, and to the potential erosion of the current Medicare program.

Most Americans believe in building onto existing programs — that is, making incremental changes to what they know-they-know — like expanding Medicaid or Medicare buy-in for people who don’t have health coverage.

The top two priorities, given the choice of only one, are tied: ensuring that the Affordable Care act’s protections for people with pre-existing conditions continue, and lowering the cost of prescription drugs.

These two health consumer objectives remain consistent with polling conducted approaching the 2018 mid-term elections.

Other issues, like a new Medicare-for-All plan, repealing/replacing the ACA, and protecting people from surprise medical bills were less important to people.

Majorities of people across party affiliation also favor a Medicare and/or Medicaid buy-in, reinforcing that Americans are more comfortable adapting and using the insurance channels they know and trust versus creating an entirely new system. Specifically:

• 69% of Republicans, 75% of Independents, and 85% of Democrats favor allowing people between 50 and 64 to buy insurance through Medicare (overall 77%)
• 64% of Republicans, 75% of Independents, and 85% of Democrats favor allowing people who don’t get insurance at work to buy into their state Medicaid program (overall 75%)
• Most Independents and Democrats would favor creating a national government administered health plan like Medicare for everyone, allowing people to keep their current coverage — nearly one-half (47%) of Republicans agree with this option (overall 74%)
• Medicare-for-All gets less traction with Republicans (only 23%) compared with 53% of Independents and 81% of Democrats (overall 56% of all Americans).

Health Populi’s Hot Points: The green chart is Gallup-Sharecare’s latest Health and Well-Being Index poll on the percent of Americans without health insurance. This reached a four-year high, the green line illustrates, up to 13.7% from a low of 10.9 percent in 2016 at the moment when President Trump promised to “repeal and replace” the ACA.

Of course, this has not happened. While ACA enrollment has eroded, and the law challenged in the Texas courts, it still survives.

Uninsured rates grew most acutely for women, young adults, and low-income people.

The KFF poll reinforces that Americans well appreciate the value of being health-insured, especially among people who are already sick and being treated in the health care system. Prescription drug costs, too, remain high-ranking in voters’ priorities with health care being such an acute pocketbook issue.

Health care costs are an integral part of family budgets in 2019. I notice that U.S. consumer confidence has hit a Trump-era low, according to the University of Michigan’s index of consumer sentiment. This is graphed here by my friends at Statistic, illustrating a dramatic drop in peoples’ sentiment since the November 2016 Presidential election.

Consumer sentiment is a view on consumers’ own tea leaves looking into their future financial situation. Given uncertainties about health insurance security, health care costs, in light of the current U.S. government shutdown, it’s clear health care will be on voters’ minds until people perceive they are health access-and-cost-secure. It is no wonder more Americans are warming to the concept of universal health care as a right for all.

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Adverse selection and single payer systems

In single payer systems, the problem of adverse selection in health insurance is solved because the single payer must cover all people. Because the single payer cannot avoid covering any individual, there is no strategic gaming on coverage decisions. There may, however, be strategic decisions made on the treatment of patients. Consider the case of a recent report on the mental health care provided by the UK’s National Health Service (NHS):

block contracts…provide a set payment for delivery of services over a certain period of time.
…Disturbingly the system can “cherry pick” patients, avoiding those with more complex needs that might consume more budget and resources,

Single payer systems could avoid this outcome if the payer reimburses providers on a fee-for-service basis. However, if they reimburse providers with a capitation or block contract, than physicians, hospitals and other providers will have an incentive to avoid treating the sickest patients. In short, while single payer systems will guarantee health insurance for the sickest patients, it is possible that patients may face challenges accessing care if providers are paid via capitation.

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Progress in the war on cancer

Siegel et al. (2019) present a review of cancer incidence and mortality statistics in American over recent decades. Their key findings were:

Over the past decade of data, the cancer incidence rate (2006‐2015) was stable in women and declined by approximately 2% per year in men, whereas the cancer death rate (2007‐2016) declined annually by 1.4% and 1.8%, respectively. The overall cancer death rate dropped continuously from 1991 to 2016 by a total of 27%, translating into approximately 2,629,200 fewer cancer deaths than would have been expected if death rates had remained at their peak. 

The authors used data from Surveillance, Epidemiology, and End Results (SEER) and the CDC’s National Program of Cancer Registries (NPCR) to measure incidence and data from National Center for Health Statistics (NCHS) and North American Association of Central Cancer Registries’ (NAACCR).

The most common cancers for men were prostate (20% of all incident male cancers), lung (13%), color & rectum (9%). For women the most common cancers were breast (30%), lung (13%), colon & rectum (8%). For male, deaths from lung (24%), prostate (10%), and colon and rectum (9%); for female the top cancers in terms of number of death are lung (23%), breast (15%), colon & rectum (8%).

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What If Marie Kondo Reorganized Health Care in the U.S.?

Have you read the life changing magic of tidying up, or Spark Joy, books by Marie Kondo? Her new Netflix series, Tidying Up with Marie Kondo debuted on January 1, and has enjoyed passionate early viewership by consumers in America who are among the world’s major hoarders.

If you opened any pop culture magazine or newspaper in the past week, you probably saw the results of a PR blitz promoting KonMari, the trademarked name for Marie’s clean-out method. As an example, the Wall Street Journal discussed the phenomenon in Ben Zimmer’s profile, “A Guru of Organizing Becomes A Verb” published this weekend in the Journal.

Marie is all about de-cluttering, organizing, and finding joy in our physical environments.

As a fan of Kondo-ing and Marie’s message of “sparking joy” with the items you live with, it leads me to ask: what lessons can KonMari have for U.S. healthcare?

Here are some of my favorite quotes of Marie’s that translate to health care…

”Tidying ought to be the act of restoring balance on people, possessions, and the home they live in.”

Consider how labyrinthine health care processes are, whether we look at patient “journeys” (a nice word for the Rube Goldbergian experience of being a sick patient in the U.S.) or physician workflows. What forms might “tidying up” these processes take?

“When we really delve into the reasons for why we can’t let something go, there are only two: an attachment to the past or a fear for the future.”

Through my years advising health care providers, both hospital settings and physicians’, I’ve observed that new devices brought into an institution are additive and too often do not replace old technologies. I think a lot about fax machines in this way: yet providers are still highly dependent on faxing, as I’ve learned from people in my Twitter feed who are quick to remind me this.

Many technologies may be comforting in the immediate term, but could also be preventing innovation at the edge. When is the right time to “jump the curve?” to the new world or workflow as my great mentor Ian Morrison asked in his book, The Second Curve.

Here, I would also add the challenge of data hoarding. There are people who believe that owning “all” the data is the end-game; these folks haven’t cottoned onto Open Source or cloud-sharing or network effects. Underneath this could be fear about securing data; but that, too, can be addressed. Globally, nearly one-half of people working in offices would rather get rid of their clothes than their digital files (39% in the U.S.). Read this insightful article on data hoarding to spot the opportunity for cleaning up and, I daresay, sharing and securing data.

If you don’t believe me, here’s a just-published article in Forbes about the importance of data-sharing to improve health care, presenting the persuasive case for The Chain of Survival in Healthcare. The piece is written by a consulting anesthesiologist with the National Health Service in the UK, @docsouthey.

”People cannot change their habits without first changing their way of thinking.”

Marie raises a good point: I would translate this as, “health care stakeholders in the U.S. need cognitive therapy.” There is so much that can be done with the amazing human capital on the front lines of health care in America – the nurses, the physicians and the pharmacists who happen to be the most trusted professions in the country, Gallup tells us. Liberating people to work at their highest and best use can help us address clinician burnout and the Quadruple Aim, while supporting shared decision-making between patients and their clinicians.

This mind-shift can also help legacy health care look at workflows and journeys through patients’ eyes – patients as consumers and payors. These are the pivotal roles of user-centered designers and service designers.

Health Populi’s Hot Points:  “There are three approaches we can take toward our possessions: face them now, face them sometime, or avoid them until the day we die.”

This last quote is the change-or-else manifesto that the likes of Clay Christensen and Jeff Bezos challenge. Instead of “possessions,” I think about “business model” and “workflow.” They are inter-related.

Imagine a hospital closing beds and shifting workflow to virtual care via telehealth channels. For health care providers, telehealth and virtual care are converging with healthcare delivery the we used to compartmentalize “e-business.” Today, e-business is just stuff done via ecommerce or online or via cloud computing….just everyday business flows. At places like Mercy (Virtual) Healthcare, Kaiser-Permanente (which conducts over 50% of their visits virtually) and Intermountain Healthcare, telehealth is just a new normal in health care delivery.

Ultimately, a Holy Grail would be to “spark joy” in health care, per Marie Kondo’s vision. While health care in America isn’t universally joy-ful or joy-inducing, there are examples of health systems prioritizing the starring roles of patients and clinicians, and streamlining design to de-clutter experience for all.

 

For further reading on how to “Kondo” your life, here are a few articles I’ve found useful and/or interesting:

How to de-clutter your computer, inside and out, from NBC News Better

How to KonMari your way to a happier digital life, PC Mag

The life-changing magic of tidying up your electronic life, Mother Nature News (MNN)

How to tidy your PC, Marie Kondo style, Techradar

Could Marie Kondo slow down fast fashion, Fortune

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What is a “digital practitioner”?

The FDA estimates that 50% of all 3.4 billion worldwide smartphone users have downloaded a health app. Do these apps work? Even if they work for the average patient, will they work for you? And with whom could you discuss your app-based treatment options?

To answer these questions, in the future you may need a referral to a digital practitioner, a health provider trained at evaluating diferent mHealth apps. A paper by Philips et al. (2019) predicts just such an approach.

As gamification and software platforms become more accepted, it is possible that the need arises for the new world of the “digital practitioner”: one who specializes in healthcare apps, accepts referrals from other practitioners, identifies the best programs to meet individual patient needs, and consults to assess whether game applications might improve clinical outcomes. Getting to this point will require new assessment tools validated via real-world evidence and comparative effectiveness research. Just as patients vary in their responses to medications, it is reasonable to assume that some patients will benefit more from one game over another. A 2-way gaming interface could permit the digital practitioner to monitor the progress of the patient, address any deficiencies that might be noted, and adjust the game accordingly.

While a digital practitioner would be useful, a key question is from where do they get their information and how do they measure treatment heterogeneity to map specific apps to individual patients. Further, a question remains whether a digital practitioner would be a person at all, or rather an app itself.

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Sugar Addiction? Is It Real?

When you hear about addiction, most of us think about substance abuse or alcoholism. However, addiction can come in many different forms and affect people of all ages and backgrounds.  

 

For example, many teenagers are addicted to technology, and researchers have concluded they feel very real withdrawal symptoms when kept from their phone or game systems.  

 

However, the one addiction that Americans suffer from more than any other else might surprise you. In fact, it’s nothing that will get you in trouble with the law and it’s not going to jack your phone bill up.  

 

Shockingly, it’s something all of us have in our kitchen cabinet.  

 

Interest piqued?  

 

If you haven’t guessed, sugar is America’s most ubiquitous addiction. While at first it may seem less dangerous than a drug or alcohol addiction, the truth is that it causes bodily harm and drives up costs in our health care system every day due to the expensive health conditions that directly result from obesity.  

 

If you think you may be one of the millions of Americans with a sugar addiction, keep reading to see what you can learn. 

 

Are sugar addictions even real? 

 

Just because it doesn’t involve an illegal drug and there hasn’t been a public awareness campaign around it doesn’t mean sugar addiction it isn’t a real and dangerous thing.  

 

In fact, since it is such a common ingredient in everything from pasta sauce to fruit juice, most people assume it’s perfectly safe. It is important to remind you that your brain depends on glucose (another term for sugar) for immediate energy to keep it working properly. However, a sugar addiction causes you to eat or crave certain foods or overeat certain foods even when your brain has ample glucose, and with the sensation that you can’t stop or can’t resist.  

 

But a sugar craving doesn’t mean that you want to snack on candy or sweets all day long. In fact, it’s actually a chemical reaction in your brain after the wiring’s been crossed (and the addition has formed). Several areas in your brain play a significant role in the crave sensation, to begin with. The hippocampus, located in your temporal lobe, is responsible for making short-term and long-term memories and plays a significant role in reward-seeking behavior.  

 

Breaking the addiction means rewiring your brain, and you will have to anticipate withdrawal symptoms, because your brain will think it doesn’t have enough glucose to keep you going. 

 

Could I have a sugar addiction? 

 

If reading thus far has you questioning your own sugar intake, then answer the following questions to see if it might be worth a conversation with your doctor or nutritionist. Answer each question with: yes, sometimes, or no. 

1. Do you have refined sugar (cookies, candies, etc.) at least every other day? 

2. Do you feel better while indulging and then worse later on? 

3. Do you have a hard time resisting desserts when they’re presented to you? 

4. When you eat sugar does it make you want more? 

5. Do you feel an impulse to eat sugar or do you hide how much you eat from family and friends? 

6. Are you frequently tired? 

 

If you answered yes to more than three of the above questions, you are considered at risk of a sugar addiction. 

 

Can the addiction be broken? 

 

The good news is that, yes, you can break the sugar addiction. However, just like all other addictions it is a challenge and will require hard work. Here’s where to start:  

1. First, it’s important to recognize that a craving is not the same thing as feeling hunger. If you are hungry, reach for a protein-rich snack instead of a carb or sugar-laden treat.  

2. Next, make sure you are avoiding stress and getting enough rest. (Both of these triggers can lead you make poor eating decisions.)  

3. Finally, change your environment. If you have a sudden craving, get up and go do something different. Whether that’s going for a quick walk or simply changing your scenery, it will break up the monotony of the day and help prevent you from falling back into habits of just reaching for a sugary snack to pass the time. 

 

Sugar addiction can be harmful not only to internal bodily systems but to your teeth as well. If you have been suffering from sugar addiction and haven’t seen a dentist in a while, give Dr. Ku a call today for a preventive exam. Dr. Ku has been rated the number one dentist in Fort Worth by the Fort Worth Star Telegram for a second year in a row, and he’s here to help you rejuvenate as you break your sugar addiction! 

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From Yorkshire Lad to Global Design for Health: A Profile of Sean Carney of Philips

Have you heard the story about a boy born in Yorkshire, England, who studies art in Birmingham, finds his way to Finland to work with design maestro Alvar Aalto, and then crafts a printer that Steve Jobs loved?

I have, at CES 2019, when I sat down with Sean Carney, Chief Designer at Philips.

It’s well-known that Philips has been firmly focused on health and health care, covering both clinical/professional healthcare as well as personal health for self-care. What you may not know is that underpinning the company’s innovations is a major commitment to all aspects of design. Design is embedded in Philips, which is one of first companies to bring design into a company in this way.

The person who leads that macro design ethos and workflows at Philips is Sean Carney. He’s part of Philips’ leadership team, and as such design informs corporate strategy at the company.

I was grateful to Sean for spending time with me at CES 2019 in Las Vegas to brainstorm the role of design in health/care.

Sean wears two hats at Philips: as Chief Design Officer, he manages the entire design team and workflow globally. But he dons a second hat, too, as General Manager of Healthcare Transformation Services, Philips’ consulting services for healthcare providers. Launched in 2013, the team now has about 150 health care consultants, spanning Chief Nursing Officers, Chief Marketing Officers, ex-department heads of hospitals — the range of professionals who can, as Sean said, “dig in and redesign care pathways that optimize performance through design.”

Consider Philips’ core business in the clinical tech supply side: the team works on the “micro level from the device” to the clinical workflow, Sean explained to me. Imagine cath labs that navigate inside a heart with software and guidance systems, x-rays and ultrasound tools at the ready. The consulting team assesses both patient experience and care pathways, beyond just the historical role of selling medical devices to health care providers.

To give you an example of this process, here’s one of my favorite examples of Philips’ design-ful approach in a health care setting. This video of “Dutch Masters” illustrates a collaboration to re-imagine a patient’s MRI experience in concert (literally) with the Rotterdam Philharmonic Orchestra, the Rijksmuseum (Amsterdam’s brilliant art collection), the Erasmus Medical Center, and AMC Amsterdam (not the cinema company but the Dutch academic medical center). I ask you to invest just two minutes to see this to get a sense of how design thinking can re-make patient and clinician experience.

Sean pulls this design thinking approach through the continuum of care that the Philip’s serves: from self-care at home through the company’s consumer health products into the hospital, to rehabilitation, and recovery back at home. Beyond one patient’s home, think about the larger community of many homes: Philips is involved with a Florida hospital group and a property developer conceiving a master plan of a city. So that brings Philips into the larger ecosystem of the healthy city which can be informed through data generated in smart, connected homes (see my post covering one wellness home concept here in Health Populi). One of the underlying concepts for this city will be the Blue Zones, to ensure active transportation, healthy food access, and wellness baked into the various touch points of city planning.

“We have designers embedded in each business unit from consumer health through clinical medical technology products,” Sean explained. “At Philips, designers work horizontally across business units, not in isolation; they’re connecting dots, patient journeys, and multiple points,” Sean said.

He continued: “As designers, we cannot just design the beautiful object anymore. Now we need to think about the wider ecosystem.”

Understanding that ecosystem, Philips is partnering with many organizations to innovate better solutions for health care providers and consumers. For example, Philips Mother and Child Care group recently allied with BabyScripts to bolster the company’s portfolio of services to help women manage prenatal care to improve outcomes and boost empowerment throughout pregnancy. At CES 2019, Philips announced a new teledentistry service, connected to the Sonicare oral health business, where toothbrush users could connect virtually with dentists via the Sonicare app. For this service, Philips is collaborating with the Toothpic dental network.

As I learned more about Sean’s career path and design journey, this assertion made sense and brought me full circle from his early career to his global design role at Philips today, in Amsterdam and around the world.

Sean grew up in Teesside in Yorkshire, in northeastern England. He attended art school in Birmingham, and then worked in Europe as a product designer. I asked him who were his early design influencers, and was surprised and delighted to hear the name of Alvar Aalto. You may know of Aalto through the  image here, the iconic Savoy vase that’s exhibited in the Museum of Modern Art. Sean also learned from Kaj Franck, another Scandinavian designer with a mission to imbue luxury into everyday objects, counter to the growing throwaway mentality we are now working to reverse in the developed world.

Thus was the lesson of quality and sustainability part of Sean’s design journey.

He was eventually lured to southern California, to join HP (Hewlett-Packard). There, Sean brought the ethos of quality to his design work in drawing up beautiful ideas for printers. But at that time and marketplace, HP management wasn’t looking for enchanting design: they were looking to sell more ink.

An influential customer then challenged Sean’s team to make the objective beautiful and functional. That demanding client’s name was Steve Jobs, head of Apple.

This was a wake-up call for Sean’s team. The short story is that Jobs was looking for a beautifully-designed printer (consistent with Apple’s Chief Designer Officer Jonny Ive’s sensibility) that could play in the Apple ecosystem. So Sean and team went back to the drawing board and created the AirPrint printer. It was made of glass and aluminum, and incorporated a little “theatre” into the process — as the printed document exited the printer, a front flap “lifted” to eject the page.

Jobs loved it – the functionality, the sleek design, and the theatrical output.

That’s when Sean thought more about service design beyond a product’s look and feel. It was also about the larger ecosystem in which the product functioned (e.g., HP’s printer working with Apple’s OS), devices and people playing well together in their collective sandbox (HP vs. Apple culture), and streamlining life- and work-flows for the people using the products.

Sean was later recruited by Philips to infuse his growing service design sensibility into the company as it doubled down on health and the larger health/care ecosystem. Carney’s design thinking translated into the Philips culture relatively quickly, as their 39 design awards garnered in 2013 from the prestigious iF competition attests; that story, here.

You can hear directly from Sean via this interview recorded at CES 2019 following his talk at the Digital Health Summit:

Health Populi’s Hot Points:  As health care systems must seek more sustainable ways to deliver services, the concept of “value” is pervading government and private sector payors around the globe.

The Quadruple Aim has become an operational beacon for health systems: that is,

• To enhance health care outcomes
• To enchant the process of care
• To ensure clinicians stay healthy and don’t burn out, and
• To lower per capita costs.

To accomplish such an audacious goal, one element must be added: that is the self-care and engagement of patients and consumers in their own health. This, then, requires respect for that individual. A seminal article in JAMA from October 2015 was a lightbulb moment for my thinking on this — titled, Value-Based Payment Requires Valuing What Matters to Patients. 

We turn to design professionals who have the skills to unearth the knowledge of what patients, caregivers and providers feel and think about health, care, and life-flows. Philips has embraced this mission through the vision and diligence of Sean Carney and the large team of designers working with Philips around the world.

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