Health Business Blog

In a darkly hilarious scene at the end of the movie Dr. Strangelove, the world is coming to an end as a Soviet Doomsday Device triggers the Apocalypse. Just then, Peter Sellers (who plays Strangelove) rises from his wheelchair and shouts to the US President, “Mein Fuhrer, I can walk!”

I was reminded of this scene when I read a more serious and encouraging article about ReWalk, an Israeli exo-skeletal device that allows paraplegics to walk. The inventor, Amit Goffer designed the device for himself after suffering an accident in 1997.

The idea is pretty simple: strap a set of padded, motorized struts on the legs and waist, and connect them to sensors and controllers that allow the wearer to get around. The device lets people walk, ascend and descend stairs, and generally get back toward more normal function. The fact that it has actually been done is amazing and life-changing.

In addition to increasing mobility, the device helps prevent health problems that typically plague the wheelchair bound, such as urinary and digestive problems and pressure sores.

No doubt it will be useful for paralyzed war veterans, too.

The device is being commercialized by Goffer’s company, Argo Medical Technologies.

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Dr. Strangelove is one of the best movies of all time and you haven’t seen it you must.

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Healthcare Economist hosts the latest edition of the Health Wonk Review blog carnival.

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An Archives of Internal Medicine article (Conflicts of Interest in Cardiovascular Clinical Practice Guidelines) is getting a lot of notice today. In essence, many of the physicians who develop guideline that influence practice patterns and payment decisions have conflicts. The authors recommend only allowing those without conflicts to write the guidelines.

This isn’t a new issue. In 2006 I wrote a piece (Another dirty little secret is out in the open) and am reposting it below because it’s timely:

A year ago in Time to deal with medicine’s dirty little secrets?, I wrote about a variety of practices that are relatively well-known in the health care field but would be shocking to outsiders. Industry often takes the blame for “aggressive marketing tactics,” and no doubt some of that is deserved. But physicians are also culpable.

The open secrets include the ghostwriting of journal articles by industry sponsors, physicians and academic medical centers holding ownership stakes in companies whose products they are researching, the clinical role sometimes played by orthopedic sales reps, and perhaps the most egregious example: physicians who set guidelines having financial relationships with the companies that benefit from how those guidelines are set.

Now we have a new example, which is even more serious than usual. A recent New England Journal of Medicine article blames Eli Lilly for overzealous promotion of Xigris. According to the Boston Globe:

Eli Lilly and Co. funded medical guidelines created for the treatment of [sepsis] in an effort to boost sales of a drug with questionable benefits. The allegation was made by senior scientists at the National Institutes of Health. [They] said Lilly tried to shape the guidelines for use of the drug Xigris by sponsoring a three-pronged marketing campaign

The first two phases are by now almost standard practice in the industry:

1. Lilly paid a task force to spread the word that hospitals were rationing Xigris because of its cost, which forced docs “to decide who would live and who would die”
2. Lilly “orchestrated” the development of practice guidelines to treat sepsis that called for early use of Xigris (an example of the phenomenon I have described before)

But then Lilly allegedly took a third step, which was a little shocking even to me:

Now, Lilly is sponsoring lobbying efforts to turn the guidelines into quality standards. Hospitals that follow such quality measures receive higher payment from insurers.

What’s happening here? Basically, an influential group of doctors is being lazy and greedy, and Lilly is enabling their behavior. The doctors put their fingers in the cookie jar and Lilly keeps restocking it. The public is paying for the cookies –in the form of higher product sales and sub-optimal health care– and should get fed up!

I have no problem with companies using legal means to promote their products, even if their tactics are “aggressive.” They owe it to their shareholders to maximize return on investment. But it isn’t in their long-term interest to push things as far as the medical profession often lets them.

Industry leans on the reputations of individual physicians (aka “key opinion leaders”), medical societies (aka guideline writers), and journals to legitimize their marketing messages. It’s up to the medical profession to scrutinize industry claims and issue independent guidelines and quality standards. Sometimes these claims hold up and deserve to be propagated. Sometimes they don’t. If the docs and journals don’t do their jobs they deserve to lose credibility.

It’s hard to know the extent to which medical guidelines are already corrupted. The situation is a bit like the incident when the Chinese President’s plane was refitted. In the process of fixing up the plane someone inserted a bunch of listening devices (presumably at no extra charge). When the Chinese checked out the plane and realized it was bugged they had to rip the whole thing up. That’s something like what is going on within the major payers. They’ve stopped treating journal articles and guidelines as objective and have started doing their own analyses. But do we really want to leave health care decisions just to them?

Here’s some free advice to the different players in health care:

• Industry: Feel free to market your products and services aggressively, but don’t take things too far. If you do you’ll end up killing the goose that lays the golden eggs. No one will trust doctors, guidelines or journals anymore
• Physicians: Remember that pharma and device companies are not stupid. If they spend money supporting your research or sending you to conferences or sponsoring continuing medical education it’s because they expect to get a return on their investment. It’s awfully hard to remain objective in such instances. Your job is to adopt the best medical practices and put the patient first –sometimes that requires expensive new treatments and sometimes old, cheap standbys are better
• Payers: Go ahead and challenge the objectivity of journal articles and guidelines. On the other hand, don’t pretend that low cost is always synonymous with best treatment. Expect physicians to keep you in line on that.
• Patients: You need to look out for yourself. Find a good, honest physician. Take a look at who’s sponsoring the educational materials you receive. Ask your physician about alternative treatments and do some research yourself

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This is the transcript of my recent podcast with OrganizedWisdom co-founder Unity Stoakes.

David Williams:            This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Unity Stoakes, is co-founder and President of OrganizedWisdom.  Thanks for being with me today.

Unity Stoakes:            Thank you so much David.

Williams:            First of all, what do you mean by “Organized Wisdom”?

Stoakes:            OrganizedWisdom is an expert-driven platform for health and wellness. One of the things we discovered five years ago when we launched it is was there was all sorts of great information on the web, but it was mixed in with random information, really a lot of junk.  So we saw this big problem that needed to be fixed, namely the need to organize the wisdom; to find the nuggets within the chaos.

Williams:            What kind of wisdom did you focus on initially and how has that evolved?

Stoakes:            Five years ago the user-generated content trend was just starting. And over the last five years more doctors have been moving online.

They started participating via blogs.  They started participating via Q&A sites.  They started contributing their wisdom.

A lot of health experts are coming online to share their health knowledge and wisdom. We have seen a transformation, especially over the last two years with the growth of sites like Twitter.

Williams:            Are these experts just coming online as a byproduct of joining Twitter, Facebook and Linkedin like everyone else? Or is there something a little different about health care?

Stoakes:            Actually there’s something really different about health care. A problem that still exists today is the online health gap. What I mean is that virtually all consumers and patients are now going to the Internet before, during and after a doctor visit to search for information, find doctors or get help related to health and wellness.

Yet there’s this big disparity.  Even though there are more experts and doctors online, it is still only a few thousand of the 720,000 doctors in the United States that are actively engaging online.  So what’s different is this big gap that still exists.  Our mission is to try to close that gap and inspire more health experts, more doctors to move online and to leverage digital media to raise the standard of care.

Williams:            And how do you do that?

Stoakes:            Step one is getting them to participate online.  They’re online, in many cases, for personal reasons. They have Facebook accounts, they may have a website, but it’s getting them to share that first link, to write that first blog post, to answer that first question, to interact with a patient for the first time via e-mail.

To really inspire doctors to move online, the way to do that is to celebrate the early successes, to honor and pay homage to those early adopters and innovators who are taking the first steps.

Williams:            Even within that relatively small subset of physicians that are online, it seems to me a lot of the interactions are really physician-to-physician. Then there are a lot of other interactions that are patient-to-patient.

There’s not that much crossover where you see doctor/patient interactions.  Where does OrganizedWisdom fit in there?

Stoakes:            You really hit the nail on the head.

OrganizedWisdom is building a “mobile tool box” for doctors and other health experts.  It’s something that is easily accessible both in office and online to help these experts and these doctors better educate and enhance the patient experience.

What I mean by that is we’re actually creating a platform where every health expert can have their own destination that they can use to collect their wisdom, their documents, their illustrations, their videos, the same 20 questions they probably answer every single day. They can use that destination to sit with patients, whether it’s in front of their computer or on their iPad –which has now gained huge traction within the physician community– and use this platform as a way to connect with patients when they’re in office, but then be able to say, here is my web address, go here and search for this topic.

They can then start writing what we call “information prescriptions” rather than just prescriptions for drugs. These prescriptions guide patients to a specific destination on the web. That way patients are really connecting with their doctors and have a place to go during the doctor visit, but also after they leave the doctor.  Because what we’ve noticed is the first thing people do when they leave their doctor’s office is go to the web and try to understand what the doctor just told them.

Williams:            Are the interactions one-to-one or one-to-many? Or is there a mix?

Stoakes:            That’s a great question.  There is actually a mix.

In OrganizedWisdom you publish and collect the wisdom that you have to share once, but it’s open.  It’s an open system that’s available to all, so you can actually reach and help thousands or millions of people by sharing your wisdom. But you can also use that wisdom and knowledge that you have on a one-on-one basis with your patients when there’s a real doctor/patient relationship in the office.

Williams:            You described your origins: organizing the wisdom and finding the nuggets out there on the web.  And now, of course, as OrganizedWisdom has gotten bigger, you’ve got tons of information even within your own platform.  How do you keep making sure that it’s wisdom and nuggets and that you don’t end up with the same sort of spam that’s out there on the web in general?

Stoakes:            Two things really.  Technology does play a huge role in this, but what we’re really trying to do is create this expert health grasp and use it as a trust filter.

What I mean by that is, when you go to a site like Google or Bing, it’s basically an algorithm.  It’s a technology and machine guiding you to information.  It’s making the determination of what information is good and what information is bad.  In the case of OrganizedWisdom and this expert health grasp that we’re building, only the information, the links, and the content that has been shared and recommended and saved by this expert network gets through the system.

So we’re really counting on the wisdom of this expert community to be that filter and make sure that quality content comes through.  Sometimes bad information can slip through a system, but that’s why we have a human review process, a review board.

We analyze the data constantly.  We’re constantly purging the system so that if we see trends or negative reactions emerging from certain posters, then we can filter those experts out of the system.

In fact, we do that on an ongoing basis.  You have to apply and be approved to be in our system. I would say we decline two-thirds of the applicants.  So there’s a very high bar just to be nominated into the system, but then we also review the data very closely after these experts are in the system to determine if anyone should be deleted and excluded.

Williams:            There’s growing awareness that some free health care websites put the privacy of users’ health care information at risk. In fact that’s what a lot of the business models are based on.  Can you tell me a little bit about the OrganizedWisdom business model and if there are concerns that users should have about their privacy?

Stoakes:            Yes, first of all we don’t collect any private information on individuals.  We actually serve as a buffer between the doctor and the patient.

There is no direct link between the doctor and the patient.  So a doctor can come in and distribute and promote and share their wisdom, but they don’t know specifically who those people are that they’re sharing it with.  So even though it’s an open system, there is no direct link.

One of the great trends we’ve seen in the online health space over the last few years is this business model emerging where the default is to be open and transparent and to use the power of the aggregate data in new ways. One great example of that is a company you’re probably familiar with, PatientsLikeMe, where the community agrees upfront to sign away their privacy, sign their data away. But they get a lot of great benefits in return for doing that and an opportunity to help the community at large as well.  There are a lot of great opportunities and innovation to use the data in aggregate and that’s where the real power is.

The federal government has just released and open sourced most of the nations’ health data. You can go to healthdata.gov and now get access to amazing amounts of data that they just opened up.  I think this is going to spur a new wave of innovation in the health and wellness space because entrepreneurs and innovators are going to be able to use that in new and exciting ways that we can’t even think of yet.

Williams:            You’ve been describing some of the advances in technology, in particular, some of the new devices like tablets and smartphones.  Is there a role for more traditional print media in all of this or is it a dinosaur?

Stoakes:            Absolutely, and in fact, we just announced recently a very large deal with Readers Digest, which is one of the nation’s most respected brands both with consumers and doctors. A big part of that deal is to distribute our online content in printed form in over 300,000 doctors offices.  So doctors will be able to pull out these wisdom cards in printed form for the top questions asked by their patients and hand their patient a destination to go online to get more information.

I definitely think there are huge opportunities, and in fact, it’s essential to be bridging the offline world with the online world.

Williams:            There has clearly been a lot of progress just in the few years since you started OrganizedWisdom.  If you would look out three to five years from now, are there any particular things that you would point to that are going to be very different from what we see today?

Stoakes:            I’m so excited right now because I really believe we’re at this unique moment in history. We’re at this moment because for the first time in years you’ve got true backing from the federal government and numerous local governments.  You have entrepreneurs who are starting to do exciting things in the health and wellness space and you also have investors from the private sector who are, for the first time, wanting to move into this space.

When I say “this space” I mean the new health innovation space.  There really hasn’t been much over the last 15 years, but over the last year, I’ve seen this moment develop where all these different constituencies including physicians, hospitals, and health experts are all understanding that the way to tackle today’s biggest challenges in health care is to come together and innovate and try new things. They are ready to do things differently.

Williams:            I’ve been speaking today with Unity Stoakes.  He is co-founder and President of OrganizedWisdom.  Thanks a lot for your time and your insights.

Stoakes:            Thank you so much.

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Medicare is the ever-growing elephant dragging the country under, so I’m pleased to see that its beneficiaries are starting to feel a bit of a squeeze. In Medicare rise could mean no Social Security COLA, the AP explains how Medicare premium increases are sucking up the full Social Security cost of living increase for many recipients:

When Medicare premiums rise more than Social Security payments, millions of people living on fixed incomes don’t get raises. On the other hand, most don’t get pay cuts, either, because a hold-harmless provision prevents higher Part B premiums from reducing Social Security payments for most people.

Predictably, most of the article focused on the hardships visited on seniors whose finances are being hurt by the lack of a Social Security boost. But luckily, the article devotes at least a little space to telling the cold, hard truth:

Older people might feel they are falling behind because they haven’t had a raise since 2009, but many are benefiting, said Andrew Biggs, a former deputy commissioner of the Social Security Administration who is now a resident scholar at the American Enterprise Institute.

Consumer prices dropped, but Social Security benefits didn’t drop, Biggs said. At the same time, health care costs went up, but Part B premiums stayed the same for most beneficiaries.

“They are better off because of that,” Biggs said. “Somebody else is paying for a greater share of their health care. This will get me hate mail, obviously. But it is what it is.”

While I feel badly for senior citizens living on a fixed income and paying more toward Medicare, I feel worse about younger, working people who pay into Medicare, Social Security and the general coffers (through income tax) in order to pay for seniors’ pensions and health care. Many of these folks don’t have health insurance themselves, and certainly won’t be in a position to enjoy the relatively generous benefits received by those on Social Security and Medicare today.

I’d like to see Social Security payments actually drop (not just hold steady) when Medicare cost increases are high. That might give seniors more of a stake in helping the country address the health care cost conundrum.

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OrganizedWisdom encourages physicians and other health experts to move online and share wisdom through blogs, open forums and link sharing. In this podcast interview, OrganizedWisdom co-founder and President Unity Stoakes and I discuss the rapidly evolving online health care world. Topics we cover include:

• The “online health gap” and how it’s being closed by health experts
• How the vast world of online health care information should be organized and shared
• The interaction of online health care and traditional print media, in particular OrganizedWisdom’s partnership with Reader’s Digest
• What the future will bring and how OrganizedWisdom will take part

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David Williams interviews OrganizedWisdom's Unity Stoakes [ 15:34 ] Play Now | Play in Popup | Download

If you’re my age you may recall the Prego spaghetti sauce ads from the 1980s. “It’s in there,” replied the convenience-seeking housewife whenever the husband questioned whether the sauce had a particular ingredient. The same thing is true of the Patient Protection and Affordable Care Act. It contains everything you might expect, like the individual mandate, subsidies to buy health insurance and medical loss ratio rules for insurers. But it also contains a good number of relatively obscure, yet potentially significant items.

California Healthline (Overlooked but Not Forgotten: Three Lesser-Known Reforms) highlights some of these items on PPACA’s first birthday.

• $15 billion over 10 years for a Prevention and Public Health Fund for wellness initiatives
• A 6500 person Public Health Service Ready Reserve Corps for emergency response to public health crises and national emergencies
• Accountable Care Organizations that could integrate physical and mental health care to address the large number of people with both kinds of health problems
• A pathway for the approval of generic (or “similar”) versions of biotech drugs. The wording in this section was pretty vague, so there is active fighting underway on key definitions that affect the timing of new drug introduction

It will be interesting to see whether the PPACA fight settles down at all over the next year. My best guess is more of the same: a dedicated group working on the details of implementation, and an even more fervent bunch trying to reverse the law or undermine it. Perhaps as the Republican primary campaign gets underway we’ll start to hear someone articulate alternatives to PPACA that are more thoughtful than the knee-jerk rejections of “ObamaCare” that pass for policy these days. If a Republican is willing to tackle Medicare costs in a serious way I’ll  be eager to hear about it.

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This is the transcript of my recent podcast interview with Continua Health Alliance Executive Director Chuck Parker.

David Williams:            This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Chuck Parker,  Executive Director of the Continua Health Alliance.  Chuck, thanks for being with me today.

Chuck Parker:            Thank you.  I appreciate the opportunity.

Williams:            Chuck, what is Continua and why is there a need for it?

Parker:            Continua Health Alliance is an association of organizations throughout the world that are focused on the interoperability of personal health care devices.

The real need was to create an ecosystem for these interoperable devices and ensure that they have the appropriate connection mechanisms, the standardization mechanisms to make sure that they all can communicate together. The goal is an end-to-end solution for individuals who need to monitor themselves with health conditions in the home or to provide that information to others who may be caring for them.

So in essence, the Alliance was formed to help standardize the industry of personal health care devices.

Williams:            When you talk about personal health care devices and connected health, what kind of devices and systems does that mean in practice?

Parker:            Continua looks at about twelve different device classes. These are things such as weight scales, blood pressure cuffs, pulse oximeters, glucometers, and thermometers.  We also consider activity monitors and we’re adding devices as we go along.

These devices, when paired, can help an individual with a chronic disease manage their disease state more effectively. They can enable an elderly person to live more safely at home for a longer period of time. And they are also for those individuals who may want to monitor their health conditions before they ever require medical attention.  It could be used by performance athletes who want to monitor their conditions and see how well they’re performing over a period of time.

This is where we focus our efforts. When we talk about connected health it means taking that device information, collecting it and presenting it in a standardized way for personal health records or electronic health records.

Williams:            A related concept to “connected health” is the “connected home.” You appear to be moving into that space through a relationship with Continental Automated Buildings Association.

Parker:            CABA is a recent liaison that we are working with to take a look at how to automate the entire home.

What this really means is that there is some underlying technology put in place.  Currently we use ZigBee wireless network meshing to collect data throughout the home. The reason for that is that we want these devices to be mobile.  We want to be able to pick these devices up anywhere in the house, put them on, measure, and then put them down again and not have to worry about plugging into a computer and having the right phone settings.  We want to make sure that this is easy to use.

What we’re working on directly with this association is the “connected home,” to ensure that homes of the future have the ability to monitor these devices, to pick that information up and transfer it seamlessly. It doesn’t take a lot of user interaction to set that connection up.

Williams:            Traditionally there has been a major separation between devices and services aimed at the homebound elderly –often 85 plus– and younger athletes looking to optimize their performance. But you’re talking about those two things together.  Do you think there is more of a convergence coming or do they remain very separate kinds of markets?

Parker:            I think there is a convergence there.  Where the difference comes in is who pays.  I think that’s really the only significant difference that we see in the future.

The device types themselves are similar. If I’m monitoring my cardio activity, that device, that relatively simple device, is somewhat the same that I would put on an older person who wanted to see what their heart rate is. The underlying technology is somewhat very similar.

You may mix it with different components, so I may have additional components with my elder care to make sure that I’m doing the right things. But still even a performance athlete wants to use a cardio monitor, weight scale, blood pressure cuff to understand that they’re not doing anything damaging to the heart or vascular system by getting one’s blood pressure to the wrong point.

So there is a convergence of these markets because the devices’ underlying structure is somewhat similar. But what we do is we mix and match them in different ways.  So I may add a glucometer in the future for somebody who has diabetes, but I would still be using, in essence, the same weight scales and the same blood pressure cuffs.

Williams:            What about the evolution of some of the devices themselves?  I’m thinking especially about the gigantic leaps that cell phones have made over the past few years, especially the iPhones and Android phones.  Do they threaten some of the more specific health-related devices that people have been working on for a long while?  Do those go together over time?

Parker:            I do believe so.  We forecast that we’ll see smart phones or feature phones that have the capability of capturing this information.  Slowly at first, but eventually the majority of the market will be based on the cell phone, because there again, we want something that’s mobile with us. If I’m a mobile individual and I want to go out and I need to measure myself at a restaurant for example because I’m not feeling well, I want the ability to do that with my cell phone.

There’s widespread adoption of cellular handsets, so this will make it a little bit easier for us if we can ubiquitously put that type of technology inside either feature phones or smart phones and then be able to use it relatively easily by individuals.

There’s always that background statement that elders are resistant to technology. It’s somewhat true when you look at computer technology, but if you go back and look at that same population, you’ll see that there is widespread use of cell phones.  So they already understand how to use this relatively small form factor device. It’s a technological device, so we have that capability built into those devices that becomes something that’s a little less intrusive and a little less scary for them to use. We see that it would help us in the adoption rate, at least potentially for that market segment.

When we look at the healthy individual, certainly they are using these phones quite extensively. It makes it easier for them if it’s not something else that they have to carry along with them.  You can use it with your existing device.

So the answer is yes.  We see that the cell phone and the mobile platforms are a significant growth pattern for us.

Williams:            You mentioned an important point before about who is paying being a big driver of the market. So I’m wondering, what kind of progress is the industry making in the different markets?  Traditionally it’s been hard to get health plans to pay for remote monitoring.  They’re usually looking for reduced medical costs.  Employers are looking at medical costs but also overall productivity.  On the individual side if someone is buying it either for themselves or a loved one, they may be looking for independence, peace of mind.  How is it going in terms of the companies in this space trying to make an economic argument that’s successful?

Parker:            We are definitely working with those commercial insurance companies.  One thing to note is that we are international so we don’t focus just on the U.S.  The U.S. is a unique market with its mix of private payers and government paid options, but we do look at this from a perspective of international alliances as well. We work closely with organizations like the NHS in understanding and helping them see the bigger picture of the cost reduction.

There have been studies done here in the U.S., specifically with the Veterans Administration. You have a very large deployment of this type of technology where they’ve seen significant savings in costs in being able to monitor and measure individuals directly at home.  We are seeing that there is true evidence that this does save money, and significant amounts of money. In some cases we’ve seen anywhere from 53 to 85 percent savings in individuals who have chronic disease states such as heart failure or diabetes.

What we’re also seeing is a willingness for individuals, particularly males 18 to 34, to invest directly in this technology by themselves.

We have seen self-funded employers pushing their carriers to help cover individuals and provide a way for them to do participate in “healthy living plans,”  to help their staff stay healthy.  It obviously helps reduce their costs.  We’ve actually seen returns on this anywhere from two-to-one to four-to-one on cost savings for companies who have gone this route as well.  A current study that’s going to be published by Partners HealthCare in conjunction with EMC is bearing this out specifically.

With that said, we’ve had some high interest from the private insurers.  UnitedHealthcare, for example, is very interested in this technology and exploring testing and pilots.  Rightfully said, it takes evidence-based guidelines and evidence-based medicine and demonstrations to show that this technology works.  We’ve been at this for four years and we’re starting to be able to demonstrate those results today.

From a physicians’ office perspective, they are seeing workflow gains. The reality is that we’re not able to produce enough doctors to manage the current crop of individuals that are aging into the healthcare system at the rate that they are.  So we need to make sure we can operate this more smartly and effectively.

What we’re seeing already from a quality measurement perspective is that the current quality standards require that a diabetic come into the physician’s office once every quarter to get the information.  Well, if we’re using remote monitoring technology –this is research that’s currently going on at Cleveland Clinic– we’re seeing that that drop to once every five months now.  So what that means is that we don’t have to bring the individuals into the physician’s offices.  We still get the same amount of information and the same quality of information, but we don’t have to bring that individual, which often involves arranging for transportation for that individual to go to the physicians’ office.  This is also taking up an office visit time that a physician can be using more appropriately for other individuals.  So the quality is still there and it’s just a matter now of beginning to work with physicians’ offices to help them understand what the workflow needs to be.

Williams:            There are some changes underway in the organization of physicians and hospitals. Particularly I’m thinking about Patient Centered Medical Homes and Accountable Care Organizations.  Does this concept of connected health play in directly there?  Do these new structures within healthcare actually make much of a difference?

Parker:            Oh certainly. If you take a look at the way that Patient Centered Medical Home is structured with level two and level three, some of those performance measures actually are about staying in contact with that patient directly at home as opposed to having to bring them into the physicians’ office.  So once you get to level three of the Patient Centered Medical Home, clearly there is a component of what we do.

The same thing with Accountable Care Organizations. With bundled payments or almost a return to capitation, you’re looking at how to keep individuals out of those expensive modes of health care and rewarding organizations for treating the patients where it’s most cost effective.  Here again, the evidence is overwhelming that if we can keep an individual at home longer, and when they do have crises we can bring them into a physician’s offices rather than the emergency rooms then it’s much more cost effective in the longer term.

By the use of these technologies, you certainly have much better visibility in what’s going on with an individual.  If they’re taking glucometer readings three times a day, I can begin to see the patterns and trends of that individual patient. If they have episodes over the weekend I know I can bring them in for treatment to the physicians’ office on Monday and provide them some video feedback that says, ‘How about trying some different techniques while you’re doing things over the weekend so that we can monitor and manage you better, rather than waiting for that diabetic to crash and bringing you into the emergency room?”

Williams:            On the Continua Health Alliance website, in the description of your activities, one of the things that I have to ask about is “plugfests.”  What’s that about?

Parker:            Plugfests are opportunities where companies get together to test their devices individually in a safe testing environment.  What it means is that we can bring these companies together in a safe, behind-the-scenes way for them to do pre-market testing of their devices.  These may be barebones, literally circuit boards that they are testing to make sure that their devices can connect in the appropriate ways and it’s doing the expected things to meet the Continua requirements for certification.

Williams:            I’ve been speaking today with Chuck Parker, Executive Director of the Continua Health Alliance.  We’ve been talking about connected health.  Chuck, thanks for your time today.

Parker:            Thank you.  I appreciate it.

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Check out the latest Cavalcade of Risk blog carnival at My Personal Finance Journey. It’s the Riskiest Jobs edition.

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Continua Health Alliance is focused on creating an ecosystem where personal connected health devices can communicate using common standards. In this podcast interview, Continua’s Executive Director, Chuck Parker and I discuss the meaning of “connected health” and the “connected home,” progress in demonstrating return on investment, and the link between Continua’s activities and emerging delivery models such as the Patient Centered Medical Home.

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David Williams interviews Continua Health Alliance's Chuck Parker [ 15:54 ] Play Now | Play in Popup | Download