4 of 5 digital health solutions won’t make it to the doctor’s office, and Bram Van Leeuwen, Sanofi’s Lead for Digital Innovation BeNeLux, thinks he knows why. Health tech startups (and their health system advocates) should tune in to find out how they can up their odds of getting their tech integrated into existing points of care. Are there any health systems in the world that have excelled at implementing health tech solutions? Bram’s picked some winners and is sharing best practices.
Filmed at HIMSS/Health 2.0 Europe in Helsinki, Finland in June 2019.
If medical journals are the religious texts that guide me as a physician, the New York Times has become the secular source of illumination for my relationship to my country and the world I live in.
That doesn’t exactly mean that I feel like a citizen of the world. Quite the opposite, particularly now, with just me and my horses sharing our existence on a peaceful plot of land within walking distance of the Canadian border; my physical world seems quite small even though I am aware, sometimes painfully but with an obvious distance, of the calamity of our planet.
Early Sunday morning, drinking coffee in bed as the gray morning light revealed the outline of the trees and pasture outside my window, I read the Times on my iPad as usual and came across an article titled “What makes people charismatic and how you can be too”.
The article claims that charisma can be learned and cultivated, and that thought resonated with me as I think often about how we as physicians have roles to fill in the stories of diseases and transitions in our patients lives. I try to be the kind of doctor each patient needs as I walk into each exam room.
The article mentions three pillars of charisma: Presence, Power and Warmth.
As I think of my current third guiding light in addition to my medical journals and the New York Times, my DVD collection of the Marcus Welby, M.D. shows, which is shorthand for his character and all the other role models I carry mental images and video clips of, Charisma is definitely something we need to consider and cultivate in our careers.
My job, my reason for being, is to guide and motivate people, and how I come across, how people perceive me, helps determine my chances of filling that role.
So, these pillars of Charisma in the archetypal physician, in my case Marcus Welby, look somewhat like this – first quoting the Times:
“The first pillar, presence, involves residing in the moment. When you find your attention slipping while speaking to someone, refocus by centering yourself. Pay attention to the sounds in the environment, your breath and the subtle sensations in your body — the tingles that start in your toes and radiate throughout your frame.”
Marcus Welby was certainly a keen observer and a good listener. He was also aware of and in tune with his own feelings. Thinking back over my own writing, I recall posts like “The Power of Focus” and “Today’s Masterpiece”. This is about being present so you can connect with each patient, and also so you can do your best under whatever circumstances exist in that moment.
“Power, the second pillar, involves breaking down self-imposed barriers rather than achieving higher status. It’s about lifting the stigma that comes with the success you’ve already earned. Impostor syndrome, as it’s known, is the prevalent fear that you’re not worthy of the position you’re in. The higher up the ladder you climb, the more prevalent the feeling becomes.
The key to this pillar is to remove self-doubt, assuring yourself that you belong and that your skills and passions are valuable and interesting to others. It’s easier said than done.”
I think many of us are afraid to use the power we have and just as the Times article points out, power is not about status; in medicine it is about power to help, fix or influence. Consider their words “assuring yourself that you belong and that your skills and passions are valuable” – Marcus Welby certainly didn’t seem to doubt that when he spoke up to his hospital medical staff or to patients and families. He projected a quiet power and confidence that we, today, as cogs in the big healthcare machine may not always feel that we have. My own writing includes “Where is Relationship, Authority and Trust in Healthcare Today?” and “Getting it Right”.
“The third pillar, warmth, is a little harder to fake. This one requires you to radiate a certain kind of vibe that signals kindness and acceptance. It’s the sort of feeling you might get from a close relative or a dear friend. It’s tricky, considering those who excel here are people who invoke this feeling in others, even when they’ve just met.
To master this pillar, Ms. Cabane suggests imagining a person you feel great warmth and affection for, and then focusing on what you enjoy most about your shared interactions. You can do this before interactions, or in shorter spurts while listening to someone else speak. This, she says, can change body chemistry in seconds, making even the most introverted among us exude the type of warmth linked to high-charisma people.”
Marcus Welby, strict as he could be, exuded a well measured warmth, kindness and relatedness. I have speculated, for example in “Role Play”, that this warmth isn’t necessarily of our own making but emanating from the source of everything, whatever people may choose to call that.
When you get right down to it, I think healthcare providers today are too often viewed by others and increasingly also by themselves as interchangeable. That is the opposite of Charisma. Like so many times before in recent years, I’m puzzled by how everywhere else in our society people and businesses strive to stand out and to establish their constant presence, perceptions of power and warm relationships with their customers, while healthcare professionals are hiding too much behind a vail of sameness and anonymity, seemingly even creating distance and projecting a lack of warmth – almost on purpose in a misguided effort to seem professional?
Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.
By MATTHEW S. ELLMAN, MD and JULIE R. ROSENBAUM, MD
What if firearm deaths could be reduced by
visits to the doctor? More than 35,000 Americans are killed annually by
gunfire, about 60% of which are from suicide. The remaining deaths are mostly
from accidental injury or homicide. Mass shootings represent only a tiny
fraction of that number.
There’s a lot physicians can do to reduce
these numbers. Typically, medical organizations such as the AMA recommend
counseling patients on firearm safety. But there is another way to use
medical expertise to help reduce harm from firearms: physicians should evaluate
patients interested in purchasing firearms. The idea would be to reduce the
number of guns that get into the hands of people who might be a danger to
themselves or others due to medical or psychiatric conditions. This
proposal has precedents: physicians currently perform comparable standardized
evaluations for licensing when personal or public safety may be at risk, for
example, for commercial truck drivers, airplane pilots, and adults planning to
adopt a child. Similar to these models, a subset of physicians would be
certified to conduct standardized evaluations as a prerequisite for gun
ownership.
As a primary care physicians with decades
of practice experience, we have seen the ravages of gun violence in our
patients too many times. A 50-year-old man shot in the spinal cord 30 years ago
who is paraplegic and wheelchair-dependent. A 42-year-old woman who sends her
teenage son to school every day by Uber because another son was shot to death
walking in their neighborhood. A teacher from Sandy Hook who struggles to cope
with post-traumatic stress disorder.
Physicians can contribute their expertise toward determining objective medical impairments impacting safe gun ownership. These include undiagnosed or unstable psychiatric conditions such as suicidal or homicidal states, memory or cognitive impairments, or problems such as very poor vision, all of which may render an individual incapable of safely storing and firing a gun. In this model, the clinical role would be limited in scope. The physician would complete a standardized evaluation and offer recommendations to an appropriate regulatory body; the physician would not be the final decisionmaker regarding licensing. An appeal process would be assured for those individuals who disagree with the assessment.
While the relationship between gun violence and mental illness is complex, evidence shows that certain untreated psychiatric conditions are associated with violent acts, including active suicidal or homicidal ideation. Objective tools already exist to predict predisposition towards violent behavior such as the “SaFETY Score”that could be readily adapted to firearm safety assessment. Many countries, including Japan, Germany, India, and Israel, currently require an evaluation by a clinician as part of process of licensing to purchase a firearm.
To be sure, some say that doctors should “stay in their lane” when it comes to 2nd Amendment rights. However, advocates on both sides of the debate agree that firearms should be kept out of hands of those who might be a danger to themselves or others. With an objective and standardized examination, physicians could help accomplish this. While the 2nd amendment protects the right to bear arms, numerous laws already exist regulating features of firearms (such as silencers, shotgun barrel-length), and current laws permit seizure of firearms from certain dangerous persons, including those with substance use disorder or persons “adjudicated as mental defective or have been committed to any mental institution”.
New approaches are needed to bridge the
chasm in this debate. The creation of a system of physician evaluation as a
requirement for a license to own a firearm could take several forms but must
include a process that includes all stakeholders. Physicians perform
safety assessments already as part of our job. By developing a way to assess
patients for safe firearm ownership, we can help address this alarming public
health challenge.
Matthew Ellman is Professor of Medicine and Director of the Yale Internal Medicine Associates where he practices internal medicine at Yale School of Medicine.
Julie R. Rosenbaum is Chief of Medicine and Acute Care at Yale Health where she practices internal medicine.
It is now well established that Americans, in large majorities, favor universal health coverage. As witnessed in the first two Democratic debates, how we get there (Single Payer vs. extension of Obamacare) is another matter altogether.
295 million Americans have some form of health coverage (though increasing numbers are under-insured and vulnerable to the crushing effects of medical debt). That leaves 28 million uninsured, an issue easily resolved, according to former Obama staffer, Ezekiel Emanuel MD, through auto-enrollment, that is changing some existing policies to “enable the government agencies, hospitals, insurers and other organizations to enroll people in health insurance automatically when they show up for care or other benefits like food stamps.”
If one accepts it’s as easy as that, does that really bring to heel a Medical-Industrial Complex that has systematically focused on profitability over planning, and cures over care, while expending twice as much as all other developed nations? In other words, can America successfully expand health care as a right to all of its citizens without focusing on cost efficiency?
The simple answer is “no”, for two reasons. First, excess profitability = greed = waste = inequity = unacceptable variability and poor outcomes. Second, equitable expansion of universal, high quality access to care requires capturing and carefully reapplying existing resources.
It is estimated that concrete policy changes could capture between $100 billion and $200 billion in waste in the short term primarily through three sources.
1. Lowering drug prices: Our 4% of the world’s population is currently responsible for nearly half of the world’s drug spending. Total health spending per capita in the US in 2018 was $1,443 annually, 54% more than the 2nd biggest spender, Switzerland. Nearly 13% of that spend was on drugs.
2. Capping hospital private insurance fees: According to a recent RAND study, hospitals now charge the private insurance companies which insure 160 million Americans 141% more than they do for Medicare patients. It was 6% more in 1996, and 75% more in 2012. If we mandated that charges could not exceed 120% of Medicare charges, it would capture $90 billion in savings a year according to a 2015 NBER policy analysis. Just freezing fees where they are would capture $30 billion.
3. Reforming billing practices: After WWII, American taxpayers funded the creation of national health plans (through the Marshall Plan) for Germany and Japan. Both countries have hundreds of insurance companies but centralized clearing houses for billing and insurance processing result in low billing cost. Were we to implement this in the US (where we have 16 health care employees for every one doctor), we would save $90 billion a year.
The Medical-Industrial Complex has burdened the United States with an untenable and flailing health care system. Extending coverage and access to this highly variable and markedly inequitable system may improve the lives of some, at the margins. But to truly make a difference in our nation’s health and productivity, and the creation of healthy Americans, true reform with a focus on cost efficiency and true health planning will be required.
Mike Magee is a Medical Historian and author of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June, 2019).
Not all genetic testing is equal — and neither are the populations that have ready access to them. Anu Acharya founded Mapmygenome in order to fix the inequality in the amount of genetic data available on Indians. Despite being one of the largest populations in the world (20% of the world’s population is Indian), their genomic data only amounts to about 2% of what’s currently being collected and studied. Tune in to find out how this startup plans to scale to become the leading personal genomics company in India.
Filmed at Webit Health in Sofia, Bulgaria, May 2019.
Catalyst is excited to announce the finalists for Robert Wood Johnson Foundation’s Home and Community Based Care and Social Determinants of Health Innovation Challenges! The three finalists from each Challenge will compete in an exciting Live Pitch on September 16th, from 2:30-4:30pm, at this year’s Health 2.0 Conference in Santa Clara. They will demo their technology in front of a captivated audience of health care professionals, investors, provider organizations, and members of the media. The first place winners will be featured on the Conference Main Stage, September 17th at 3:15pm. Winners will be awarded $40,000 for first place, $25,000 for second place, and $10,000 for third place.
If you are attending the Health 2.0 Conference, join us to
see the finalists showcase their innovative solutions.
Home
& Community Based Care Innovation Challenge Finalists
Heal – Heal doctor house calls paired with Heal Hub remote patient monitoring and telemedicine offer a complete connected care solution for patients with chronic conditions.
Ooney – PrehabPal, a home-based web-app for older adults, delivers individualized prehabilitation to accelerate postoperative functional recovery and return to independence after surgery.
Wizeview – A company that uses artificial intelligence to automate and organize information collected during home visits, supporting the management of medically complex populations at the lowest cost per encounter.
Social
Determinants of Health Innovation Challenge Finalists
Community Resource Network – The Social Determinants of Health Client Profile, a part of the Community Resource Network, creates a whole-person picture across physical, behavioral, and social domains to expedite help for those most at risk, fill in the gaps in care, and optimize well-being.
Open City Labs – A company that matches patients with community services and government benefits that address SDoH seamlessly. The platform will integrate with HIEs to automate referrals, eligibility screening & benefits enrollment.
Social Impact AI Lab – New York – A consortium of nonprofit social services agencies and technology providers with artificial intelligence solutions to address social disconnection in child welfare.
For
the SDoH Challenge, innovators were asked to develop novel digital solutions
that can help providers and/or patients connect to health services related to
SDoH. Over 110 applications were submitted to the SDoH Challenge. For the Home
and Community Based Care Challenge, applicants were asked to create
technologies that support the advancement of at-home or community-based health
care. Nearly 100 applications for Home and Community Based Care Challenge were
received. After the submission period ended, an expert panel comprised of
subject matter experts, venture capitalists, as well as designers evaluated the
entries. Five semi-finalists from each challenge were selected to advance to
the next round and further develop their solutions. The semi-finalists were
evaluated again and the three finalists chosen.
For further updates on the finalists of the RWJF SDoH and Home and Community Based Care Innovation Challenge and other programs, please subscribe to the Catalyst @ Health 2.0 Newsletter, and follow us on Twitter @catalyst_h20.
Catalyst @ Health 2.0 (“Catalyst”) is the industry leader in digital health strategic partnering, hosting competitive innovation “challenge” events, as well as developing and implementing programs for piloting and commercializing novel healthcare technologies.
How is Walmart leading the convergence of clinical care and retail? With global scale that allows for everyday low prices in every community, Walmart is innovating both the clinical and lifestyle sides of healthcare. From pharmacy, food, sporting goods, and more, Walmart is creating an ecosystem that is homebase for a healthy lifestyle.
As the world’s biggest private health plan—with 1.4 million associates worldwide —Walmart is also expanding its associate wellbeing program by partnering with Fresh Tri, an innovative app that uses neuroscience to change behavior by offering practical suggestions, combating iterative thinking to meet specific goals.
Filmed at AHIP’s Consumer Experience & Digital Health Forum in Nashville, TN, December 2018.
For over a month, Kānaka ‘Ōiwi (Native Hawaiian)
elders and community members have stood in solidarity at Maunakea in Hawai’i.
They seek to protect their land, sovereignty, and culture from those who want
to build the Thirty Meter Telescope (TMT) on Maunakea. Maunakea holds both cultural
and spiritual meaning to the Kānaka ‘Ōiwi. Unfortunately, many astrophysicists
and TMT investors see Maunakea primarily as a means to make scientific
discoveries. The frequent narrative where Indigenous people need to defend the
value of their traditional knowledge[1], beliefs and culture to
Western scientists is a very familiar story that is often replicated in
healthcare, both at home in the U.S., and abroad.
Kānaka ‘Ōiwi elders blocking road to prevent TMT construction (Photo: Caleb Jones/AP)
Traditional medicine, as defined by the World Health Organization, is the “knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness”. Looking at this definition, it is clear that traditional medicine practiced by Indigenous people has equivalent goals to modern Western medicine. Therefore, are we harming our patients when we do not incorporate traditional approaches harmoniously to the practice of healing, and instead value Western medicine over traditional medicine?
The arguments for putting TMT on Maunakea follow a similar reflex to reject knowledge that is different from our own. Thankfully, letters and activism rallying against the construction of TMT on Maunakea, from both Indigenous communities and scientists, are highlighting how Indigenous people are not anti-Western science. In fact, they are beginning to envision how collaboration between Traditional Knowledge and Western science is possible, and potentially even synergistic. Similarly, Western healthcare, too, must foster an approach that centers Traditional Knowledge for Indigenous communities.
How can current and future healthcare providers
promote the value of both Traditional Knowledge and Western science, and thus
promote trust and collaboration between providers and patients?
In 2006, researchers conducted a study in the Northern Midwest to determine whether Native Americans[2] in this region preferred traditional or Western mental health services for substance abuse treatments. The study reported that 31% to 71.7% of participants found using community and traditional treatments to be effective resources for their health concerns. In contrast, the perceived effectiveness of Western-trained doctors is considerably lower (26%). Looking at this study, there is a clear disconnect and lack of trust between Western-trained healthcare providers and Native American communities, which the study authors believe stem from enculturation and experienced discrimination. This study clearly highlights the need for Western-trained doctors to begin acknowledging and respecting each Indigenous community’s traditional knowledge and beliefs. Not working harmoniously with cultural traditions and what patients are comfortable with will erode trust and limit the health outcomes of patients.
Dr. Kim Tallbear (Sisseton-Wahpeton Oyate), a genomics researcher and Associate Professor of Native Studies at the University of Alberta, has helped build a framework to model how Indigenous thought and concepts from Western science can come together. First, we must find ways in healthcare to “resist colonial science” (science that emerged from the exploitation of colonized people). Second, we need to understand how to “collaborate in good science”.
One example of resisting colonial medicine can be
done in reevaluating how one’s wellness is addressed. Instead of emphasizing
physical health, we can use a more holistic approach to assess health status.
Above is an example of a Native Model of Wellness from a study done in 2009 to determine the Native American perspective on wellness. Physical, cognitive, emotional, and environmental factors of wellness are all considered when examining one’s wellness. Although this model may vary from tribe to tribe, it is one example of a non-Western perspective that doctors can adapt into their approach to be more fitting for specific patient populations.
Next, Tallbear’s model highlights
the importance of collaborating in good science. Similar to collaborating
across medical disciplines to coordinate care and share expertise, this may
involve seeking expertise from Native community members about how tribal
protocol and social factors can be best reflected into their healthcare. Each
tribe has been impacted by colonialism differently and has faced both genocide
and ethnocide since European arrival. Great
medicine for Native people cannot occur unless clinicians unlearn what they
were taught about European arrival into the Americas. (In later blog posts,
we will discuss specific experiences, outcomes, and worldviews that will impact
how doctors should interact with Native patients.)
The Kānaka ‘Ōiwi protests against TMT on Maunakea shed
light on the systemic pattern of Western science’s typical disregard of Traditional
Knowledge. To provide the best care for Indigenous people, distinct worldviews
must be recognized and respected by clinicians. What has been taught in Western
education systems must be broken down so the notion that Western methods are
above all others can be halted. Coming together will benefit both the provider
and the patient. The provider will better understand their patient’s worldview
and the patient will feel heard and valued.
[1] We are using the Inter-Governmental Committee definition of Traditional Knowledge (TK), which is established as the “knowledge, know-how, skills and practices that are developed, sustained and passed on from generation to generation within a community, often forming part of its cultural or spiritual identity”. We are using TK rather than Indigenous Knowledge (IK) because Gregory Younging (Opsakwayak Cree Nation) surmises that TK is 95% IK and IK is often interpreted to be more static.
[2] All participants were tribally enrolled.
Specific tribal affiliations were not disclosed.
Internist,
Pediatrician, and Associate Professor at UCSF, Dr. Le is also the co-founder of
two health equity organizations, the HEAL Initiative and Arc Health.
Brooke
Warren is a Native American Studies major and recent graduate of UC Davis. She
is currently an intern at Arc Health.
Softbank Vision Fund is a $100 billion technology-focused fund with an eagle eye on the tech that is poised to disrupt large markets, including healthcare. From hyperscaling to detailed advice on pitching, VP Sakshi Chhabra Mittal goes deep on what they’re looking for from startups, especially those that have closed their Series A and are looking for a B.
Filmed at the Frontiers Health Conference in Berlin, Germany, November 2018.
Today on THCB Spotlights, Matthew talks to Jacob Reider. Jacob is the CEO of Alliance for Better Health, one of New York State’s 25 Performing Provider Systems which work to reduce unnecessary or preventable acute care utilization for Medicaid members by improving the health of communities. Alliance for Better Health has a new approach to this—they’ve created an Independent Practice Association (IPA) called Healthy Alliance IPA to pull together community based organizations focused on improving health and addressing the social and behavioral aspects of health. Their approach helps the 29 organizations within the IPA negotiate funding and creates an infrastructure for integrating social determinants of health into health care. Watch the interview to find out how this is going to work in practice.
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