An Interview with John Daley, Vice President, Quality AssuranceDistribution and Supply ChainBoston Scientific

By Patricia Jacoby
Publication Editor and Writer
Frost & Sullivan






Frost & Sullivan recently caught up with John Daley, Vice President, Quality Assurance and Distribution and Supply Chain at Boston Scientific, one of the largest medical device companies in the world. Mr. Daley is a Medical Technologies 2015 Advisory Board Member and a past recipient of Frost & Sullivan’s Thought Leader of the Year Award.

We posed the following questions about supply chain challenges, innovation and quality assurance and received some insightful responses.

Frost & Sullivan: How well prepared do you believe your supply chain is to face the challenges of the future? What has Boston Scientific done with its supply chain to be more prepared?

John Daley: “We are very well prepared. In fact, we devote a lot of management time in planning for global scope and reach. Our global partners are an integral part of our planning. We make every effort to involve them, empower them and bring them into the conversation.  In essence, we seek to make them true partners. “ 

Frost & Sullivan:  As healthcare providers continue to face reimbursement declines, how important have cost reduction strategies in your supply chain been to your company’s ability to respond to your customers’ pricing pressure?

John Daley: “Very important.  A key hedge against pricing pressures is to keep innovating, and to develop incremental value that people/customers can take part in.”

One specific example Mr. Daley noted referenced less developed markets. Sometimes, in these markets certain product features are of great importance while other product components are not attractive or sought after at all. Boston Science might, accordingly, offer a product with only the features a particular market desires. But never at the expense of quality.

Frost & Sullivan: What impact has the consolidation of U.S. hospitals and healthcare providers in recent years had on your supply chain for products you sell to those facilities?

John Daley:  “The impact of all the consolidation has been pretty substantial. It has had numerous effects on us as on other organizations from small to large…but it has also forced us to up our game and get better at presenting one voice to customers.”

For instance, like most of the industry, we work hard to have one voice to work with the large buying groups. Now coordination is key, as many hospitals have consolidated. But it is more important than ever to understand what your customer wants and needs.”

One example Mr. Daley shared involved the complications that can arise when a huge hospital has someone negotiating on their behalf and that person is not aware of all of the hospital’s needs.

For example, if a hospital is used to AM deliveries and doctors expect that but negotiations are done for less expensive afternoon deliveries without the involvement of medical staff or other key stakeholders, than that can be problematic. As so often happens in large organizations (as so many hospitals have now become) key decisions are sometimes made without input from those they most affect.
 
Frost & Sullivan: What types of healthcare customers have the greatest needs for innovation in the supply chain for your products?

John Daley: “There is room for innovation everywhere! Innovations can be made in packaging, shipping, product features, and also in how customers use your product. One innovative feature that comes to mind combines innovation and technology. It’s called Radio Frequency Identification, or RFID. It involves placing a tiny little chip in all products. Then, when the product is taken off the shelf, or used, the system relays the date, cost, expiration date and other data to the supplier. The supplier might also learn that 1 operating room uses 10 of these devices in a short period of time…so the supplier can pack 10 per box, not one per box, saving greatly on shipping economies.”

Frost & Sullivan: When it comes to Quality Assurance, can you address how Boston Scientific changed their quality systems in response to past FDA warnings?

John Daley: “We moved to a steward model for quality. We took the opportunity, in 2007, to completely overhaul and revamp our quality system, and to benchmark data for Field Action Performance. We greatly improved our results both internally and with 3rd party audits and we reduced issues significantly. In fact, Boston Science is living proof that when you take quality seriously and apply it in your innovations, it really can be a “win-win” for your company…and your customers.”

The Decentralization of Healthcare to “Everything to Everyone” or E2E

By Nancy T. Rector
Chief Operations Officer

and Hugh Rector
Chief Executive Officer
Kickstand Business Concepts, Inc.






The process of addressing acute care has been in a continual state of evolution and outward motion since the 1980’s. Today we are experiencing a hyper-decentralization phase that promises to improve not only healthcare, but to also improve our lives in many ways. One improvement in particular is the move from an acute patient care patient focus to complete preventive personal health and wellness. How did this outward process begin and where will it take us? Though this is a global movement, the following is a high-level look at the US in particular.
 
History

Necessity is the Mother of Invention

And so is revenue generation. Diagnosis Related Groups (DRG’s)  the Clinical Laboratory Improvement Amendment (CLIA) and the Stark Amendment fueled our team’s involvement in the laboratory decentralization processes as Clinical Concepts in the 1980’s and 1990’s. We assisted in the migrating of laboratory testing out of the main lab and into physician offices and clinics in order to provide a more timely result, closer to both the doctor and the patient, and to also increase revenues. The inception of the first phase began with smaller replicas of the larger lab instruments. As technology became smaller and more portable, the trend evolved into point-of-care testing with hand-held equipment and simplified lateral-flow membrane kit testing at the bedside in Emergency Rooms, clinics, and Physician Office Laboratories.

Outpatient Centers

The laboratory was not alone. In the late 1980’s IV therapy moved out of the hospital and into the home, initiating the startup of the home infusion therapy business. By bringing treatments into the home, this move made care more accessible and convenient for the compromised patient. At the same time, to simplify and streamline care access, Ambulatory Infusion Centers and Outpatient Surgery Centers, along with Renal Dialysis Centers, began popping up in locations further away from the main hospital institution.

Telehealth

The telephone telehealth system began its entrance into homes in the early 2000’s, allowing for the utilization of a telephone key pad to answer questions about an individual patient’s health and progress. Subsequently, circa 2010, was the advent of the “hard line” video and tethered sensors and system based software for remote patient monitoring. The latter was a beginning, but proved to be too expensive and cumbersome to capture wide-spread utilization.
 
Rocket Launch into the Home

In the last 5 years, wireless technology, cloud based software, and computing mobility designs  have provided the technological foundation for today’s plethora of smart phones, handy gadgets, and wireless sensors with data accessibility to clinicians, fitness enthusiasts, and the enthusiast hopeful, alike. The wide range of FDA registered or cleared wireless sensors includes 1 to 12 lead ECG’s, pulse oximeters, blood pressure cuffs, HD cameras for wound assessment, stethoscopes, glucometers, modules that provide a one lead ECG, respiration, heart rate, body position, caloric burn, and body temperature.  Additionally, there are also the physician-controlled robots, the Apple Watch, Google Glasses, and home monitoring systems that observe movement from one room to the next for Independent Living communities, and even smart TV’s that allow easy and convenient patient/consumer access. As a result, state by state regulatory changes that would provide reimbursement for revenue generation models are currently in progress, thus completing the move forward.

In fact, home renal dialysis units are even available today. I’m not holding out for “Home Surgery”, but never say never! With technology at the helm, there are waters that remain uncharted, and thus the possibilities are endless.
 
The Forces Behind the Process

Increases in regulatory control, coming from the FDA, HIPAA and the FCC, which required higher spending in medical device product development quickly inflated the product costs, while a steep reduction in cost reimbursement squeezed the financials of both the healthcare professionals and the institutions, thereby widening the chasm between sustainability and development. As a result, revenue generating centers became cost centers and large institutions were forced to take a new look at evaluating services. In order to justify higher priced laboratory products, some medical centers created “risk shares” with the laboratory through the tracking and measurement of specific outcomes to justify higher priced laboratory products. The better the outcome, the more dollars funneled back to the lab. As regulations tightened insurance provider processes, personal/employer increases in healthcare costs have escalated exponentially over the years, fueling the rise in the “wellness focus” with preventative care and personal fitness at the epicenter.  Add federal readmission fines to the already unbalanced mix, and the necessity of invention to find a stable equilibrium is substantially accelerated.

Almost simultaneously, society as a whole has largely taken interest in the individual health and wellbeing of its citizens, and is thus pressing the agenda for an overall improvement to general health. Consequently, the most motivated and relevant population and business segments have become vital driving forces behind the overall shift in focus.
 
Segments of Care

The generalized care population is divided into two primary segments: Rural and Urban. Within these two segments are three distinct subsets: controlled or “home based”, uncontrolled or “homeless”, and institutional organizations (state and local penitentiaries). Regional Medical Centers, Skilled Nursing Facilities (SNF), Home Health Agencies, and Federally Qualified Healthcare Center’s (FQHC) are currently juggling acute care populations from all three subsets, continually circulating the patients between various healthcare institutions and systems. At the same time, employers handle primarily the “home based” subset, driving employees into and between specific healthcare institutions, as required by the designated insurance provider. Consequently, the need to enhance savings in cost, time, and energy became critical, outweighing the initial emphasis on the patient, and thereby substantially shifting the paradigm to the necessity to move the health “care” instead of the patient. Such a dramatic paradigm shift was the inception of an unsteady healthcare prototype in dire need of equilibrium.
 
Telehealth vs. Telemedicine

Enter telehealth. Or is it telemedicine? When KBC works with clients we differentiate between the two, and define them upfront:

• Telemedicine is the communication of Clinician to Clinician via a device that allows for the transfer of patient data/information and enables interactive conversation for consultations and patient therapy access enhancement. Telemedicine systems are typically costly and purchased by large institutions, housed almost exclusively within the walls of the institution.
• Telehealth is the communication of Clinician to Patient via a device or devices that provides the real time transfer of patient data/information, data cloud viewing for trends, and interactive conversation for more accurate diagnosis and monitoring. Telehealth systems typically reside outside of the medical center or hospital institution, within the continuum of care: SNF, Home Health Agency, and within an individual patient’s home. These systems are less expensive and provide greater flexibility to fit the needs of both the patient and the clinician in the changing healthcare environment.

Telemedicine increases patient access to specialized clinicians in urban facilities, by “store and forward” processes and live video. Telehealth increases clinician-to-patient access and enhances the ability of clinicians to reach patients in their home and in facilities outside of the acute care arena. The long-ago-established, traditional doctor’s “house call” is back, new and improved, with many physician companies now implementing “concierge” programs that provide for primary care via telephone and video (HIPAA secure?). Sensors, video systems, and tablets/smart phones are abundantly available, providing the constant reminder that telehealth is a process not a product.
 
Tools

Today, a plethora of tools abound, with new ones being developed and launched on a continuous basis. Each tool is a part of a process, targeted to a specific result.  However, one size does not fit all; not all process are the same, and one tool does not fit all processes. Not yet… Nevertheless, KBC does utilize “point of care” laboratory testing, as a specific telehealth tool, in order to further enhance and amplify the process, providing additional patient data and outreach. The primary tool segments utilized are delineated below.

• Point of Care Testing – handheld systems providing bedside blood analysis
• Remote Patient Monitoring utilizing real time sensors:
• Regulated: FDA listed as Class 1 or FDA cleared with a 510K submission as Class II (real-time decision making data fully tested);
• Non-regulated: Fitness sensors
• Two-way video – HIPAA secure video with banking industry comparable processes and a history of dependability, reliability, and consistency in transmission
• Cloud-based patient data for clinician viewing or personal use
• Mobile applications for tablets/smart phones to facilitate “anytime, anywhere” access by both clinician and patient

The Future: Decentralization of Everything…
The March 2015 Frost & Sullivan Executive Mind Exchange, "Embracing a New Healthcare Future," engaged many innovative discussions among thought leaders in the field. One discussion entertained what healthcare would be like in five years and beyond. The participants came up with some highly-developed conclusions including: mobile phones would be a thing of the past; two- way communication/monitoring would be intricately woven into all integral aspects of the nuclear environment – the home and office (if there are any left) and apparel (i.e., glasses, contact lenses, watches, etc.); acute healthcare access would be consumer-driven, beginning at the local Walgreen's, CVS, Rite-Aid, etc. The theories are certainly thought provoking, though somewhat mind-boggling. More importantly, these theories demonstrate well thought out responses to the way in which technology is shaping society and ultimately, the way the healthcare landscape is evolving. These possibilities are within reasonable comprehension, not far from reality, and fully within our capabilities.
 
“Big data” will be an impetus for the design of the “interoperability” necessary for the “big picture” frame. A good friend and colleague, Dan Martens, CEO of Misix, Inc., stated it succinctly: “Last week I attended a session about Driverless Vehicles. The session made me think about how we will be connected to everything around us. I did some checking on the most recent stats about connected devices. Cisco predicts that by 2020 there will be 50 billion connected devices. A book that I am reading also states the same stat. A decade later, early predictions are one trillion. Whether it is 50 billion or 1 trillion; we are moving to an Everything to Everyone, or E2E  world. As technology changes accelerate, so will our lives. It is hard for me to imagine how my life will be in 2030, let alone when the new Apple Watch is released.”

Nancy Rector Chief Operations Officer of Kickstand Business Concepts, Inc., is a Clinical Microbiologist with over 15 years experience in global marketing, portfolio management, product development and customer service.

It’s Time to Embrace These Transformative Telemedicine Solutions

By Robin Farmanfarmaian
Senior Vice President
Arc Programs



It’s midnight, a child is running a high fever, and the hospital is a long way away. Instead of panicking and rushing him to the emergency room, his mother puts a device on his forehead that reads vital signs like Dr. Spock’s tricorder on “Star Trek.” The device sends the data to a physician via the Internet, and the mother receives her son’s diagnosis. It’s just a common cold, treatable with Tylenol, orange juice, and plenty of rest.

That is what we’ll experience in the near future. Right now, any patient with a smartphone can simply take a photo of a bad burn, send it to his or her physician, and find out whether the injury requires a trip to the hospital or just some aloe.

Telemedicine, which connects physicians and patients via electronic communications, is traveling at warp speed toward a bright, collaborative future between technology and medicine that will benefit the entire healthcare system.

New gadgets are helping educate patients on their own bodies and allowing them to monitor their health from home. Innovative tools now enable doctors to advise and treat patients from around the world, and improved data storage and processing devices are allowing patients and physicians to input, read, and share medical records at the touch of a few buttons.

But to take advantage of telemedicine’s potential, we need to figure out payment procedures and persuade more doctors and hospitals to offer telemedicine options.

The Benefits of Telemedicine Technology

Here are a few of the changes telemedicine will bring as implementation expands:

Cost reductions: By using new technology, patients and hospitals will see a significant decrease in costs associated with medical care. When more patients use telemedicine and stay home for their exams, consultations, and follow-ups, healthcare facilities and hospitals will need fewer support staff and have lower overhead costs. Doctors and hospitals will be able to process more patients and pass the savings on to all of them.

Greater patient engagement: Telemedicine makes the whole process of “visiting” the doctor easier for the patient, who won’t need to take time off work or travel a long distance for an appointment. Consultations and other interactions — such as requesting prescription refills, asking follow-up questions, or sharing test results — will be easier. This added convenience will also increase patient compliance, resulting in improved health outcomes.

Reduction in disease transmission: Waiting rooms, exam rooms, and hospitals are hotbeds for germs and viruses. Telemedicine reduces the risk of transmission for anyone with a weakened or compromised immune system. Sick patients can communicate with their doctors from home through video and data connections rather than bringing their germs with them to clinics and hospitals.

Increased patient pools: New portable medical diagnostic devices means there’s no need to travel to a clinic or hospital. Doctors will be able to consult with and treat patients around the world, from rural towns across America to remote villages in East Africa. Patients who face a three-day walk to the nearest village or hours of driving to the nearest emergency room will soon have immediate access to the best doctors from around the world.

Examples of Telemedicine Technology Advancing Medicine

Recent advancements in technology such as wearable gadgets, pocket-sized diagnostic devices, and centralized patient record storage in the cloud have made healthcare convenient, portable, personalized, and more affordable.

A few recent standouts are poised to take telemedicine to the next level.

Cloud Solutions: Electronic medical records are now being stored on external servers, like CareCloud and Practice Fusion, where they can be accessed by any physician around the world with permission. If a patient switches doctors, requires medical treatment while traveling, or needs emergency surgery, each physician will have quick access to the same medical files and a complete medical history with just a few keystrokes.

Tricorders: Tricorders aren’t just for Star Trek conventions anymore. Real handheld diagnostic devices are beginning to make many aspects of medicine fast, cheap, and portable.

• Gene-Radar: Nanobiosym’s iPad-sized device, which won the Nokia Sensing XCHALLENGE, analyzes a sample of blood, saliva, or other bodily fluids. When a sample is placed on a disposable nanochip and inserted into the device, the Gene-Radar can detect the presence of disease pathogens in less than an hour. It’s already been successful at testing for HIV, AIDS, malaria, tuberculosis, and E. coli.
• Scanadu Scout: When placed on the temple, this palm-sized device measures heart rate, temperature, oxygen levels, blood pressure, and even gives an electrocardiogram reading. The information is then sent via Bluetooth to a smartphone app, where it’s tracked over time. The app helps users understand how different activities, relationships, foods, and environments affect their body and will even send alerts if any of the vital signs seem troubling.

Expanded Internet/Cell Phone Coverage: Most of these new devices require an Internet and/or cell phone connection to store, analyze, or share information. Whether it’s across the world or simply across town, wider coverage is vital to the expansion of telemedicine. Companies such as AT&T are continuing to expand 4G LTE coverage to rural areas around the U.S., while others are developing innovative ways to expand Internet coverage to remote developing countries. For example, Google’s Project Loon is testing balloon-powered Internet near New Zealand’s South Island.

Smartphone Apps/Attachments: Many companies are developing apps and attachments that allow consumers to use their smartphones as monitoring and diagnostic devices. Other health apps get patients more engaged in their own health by making the entire process more convenient.

• CellScope: This mobile microscope attachment allows parents to check for ear infections from home.
• EyeNetra: This attachment and app can be used to measure the eye’s refractive error to determine a prescription for glasses or contacts.

Making Telemedicine a Reality

Despite the benefits that telemedicine is poised to bring worldwide, there are still two main aspects that are limiting expansion:

1. Who Pays? There are still a lot of questions concerning payments and discounts. Will insurance companies cover any of the costs? Will Medicare support the programs? How much of the cost will the patients bear, and how much will the hospital be responsible for? These issues need to be resolved through collaborative talks among insurance companies, hospitals, and tech companies so that consumers can access more telemedicine opportunities.
2. Hospital Compliance: To make healthcare available to areas that need it the most, more doctors and hospitals must begin offering telemedicine options. Tech companies must educate physicians and healthcare facilities on all of the telemedicine opportunities, as well as how implementation of these programs will expand their patient pools and benefit their facilities. Consumers can also drive telemedicine adoption by directly asking their doctors and hospitals to make telemedicine options available.

Telemedicine can provide affordable, convenient care to a vast pool of patients. It has the potential to improve the quality of care, lower costs, improve patients’ health, and ultimately save lives. The devices and technologies are here; it’s up to us to take advantage of them.

Robin Farmanfarmaian, a major driving force behind founding the successful Exponential Medicine Conference at Singularity University, has spent most of her career focused on making a positive impact on medicine and healthcare. Robin in currently SVP for Arc Programs, VP at INVICTA Medical, and the Executive Director for the Organ Preservation Alliance. Connect with Robin on Twitter and LinkedIn.

Leveraging Technology-Spawned Synergies to Add Years to Our Lives and Life to Our Years

By Dennis Robbins
Chief Clinical and Business Intelligence Officer
KPN, Dallas





Today’s literature is filled with articles reminding us how unhealthy lifestyles are making us sicker. Technology is held out as a potential panacea to help us out of this quagmire. While I trust that technology can make a huge difference, if we truly wish to improve the life of the person, a multifaceted approach employing diverse yet complementary devices and solutions is optimal. 

For example, a device monitoring A1C's for diabetes, while important, becomes even more powerful when that information can be seamlessly leveraged for improvement by engaging and activating the person towards a healthier life and lifestyle. We will never achieve that by becoming a patient. Patients are passive, wounded, sick, vulnerable, subservient and on unequal footing. Yet we label patients as non-adherent, non-compliant, and non-accountable. If the patient is passive why would we expect them to be anything else? As a patient, things are “done to me.” Accountability compliance and adherence are all passive demands made by others yet only I as an active agent can make a difference.

It is the “person” not the patient who can change but only when they find something to be sufficiently meaningful to stimulate, promote or sustain change. The central pivot or regulating fulcrum is the degree of meaning and value to the person. That is the foundation for true and effective engagement, activation and positive change. Each person is different; it is not a one size fits all enterprise. In fact, despite the most sophisticated trends, robust metrics, and past experience we are frequently surprised if not astonished by disparities regarding what we thought someone wanted and what they really wanted. Furthermore, no one knows the person better than the person him/or herself. Each of us knows our hot buttons as what is truly most important and meaningful to us. 

Perhaps the very agnosticism of devices and technologies that impose no attitudes or admonishments makes them so attractive. They can inform us, warn us, and help us achieve meaningful goals. Augmenting artificial intelligence technology in the form of avatars such as that employed by the Spokane based company NEXT IT or virtual coaching and supportive technologies of NOOM out of NYC and various forms of behavioral economics based nudging can be a great source of knowledge, guidance, support and inspiration. These can help shape the value equation for the person, essentially, what value or meaning a person assigns to a bit of information that motivates him/or to take that extra step towards positive outcomes. It is of utmost importance to be sure that we design for the goal at hand and make it achievable and not daunting or overwhelming. Moreover, we must take care and be vigilant to clearly articulate the value equation and the reminder that small changes can make huge differences. 

The fact the technology and devices are agnostic with no attitude is quite attractive. They just tell me what I need to know to help shape my decision-making and help me define an action plan.
They don't force me to become passive, subservient, or helpless rather, they serve as the substrate or foundation for decision-making and behavioral change. It is ultimately me who must choose and change for the better. It’s not about my relinquishing my control or responsibility to someone external or alien to me. And I do whatever I do as a freethinking person consistent with my personal choices, values and preferences. I can choose to be a vanguard or victim since I am the only one ultimately who can make a difference in my life and future.

Thus, if we can only make and activate changes in our lives as persons, then empowering the person through information, technologies, devices. support systems, and mobile solutions is a great way to initiate the process of behavioral change that is self-directed, self-driven and personally meaningful. Patients don’t change, take ownership or self-determine their futures and destinies; people do! The prescription for health centers on meaningful changes in behavior in concert with person-centric solutions. Person-centricity™ moves beyond models of consumer/patient empowerment, centeredness, engagement, and activation, and is reflective of how individuals make decisions within the broader context of their lives. This fresh paradigm accounts for the complexity and comprehensiveness of who we are and what we can become. 

The relationship between the notion of person-centricity and the transition from healthcare to health is symbiotic and functions both as the missing link and the common thread that weaves together the needs, choices and aspirations of people throughout their health and lives. This shift is critical and a necessary part of every aspect of our transition from healthcare to health and to bending the sickness curve to better curb and control avoidable costs, promote and sustain health while reducing unwanted lifestyle-related diseases and illnesses.

Dennis Robbins is prominent 
health care steward, innovator, thought leader, entrepreneur and health activist. and is Chief Clinical and Business Intelligence Officer at KPN in Dallas and an advisor to Sanovas in the San Francisco Bay area.

“Where is the Maestro?” Emerges as Recurring Theme at the 20th Anniversary Medical Technologies Frost & Sullivan Executive MindXchange

By Venkat Rajan
Principal Analyst
Frost & Sullivan






During his keynote, Dr. Joseph Smith, Chief Medical Officer and Chief Science Officer of West Health, drew a parallel between the healthcare industry as an orchestra with a number of brilliant practitioners, but lacking in the guidance of an authoritative conductor to synchronize individual efforts towards producing coordinated music.

That sentiment seemed to encapsulate one of the biggest overriding themes of the 20th Anniversary Medical Technologies Frost & Sullivan Executive Mindxchange. Over 2 days of interactive sessions on March 9-10 in San Diego, CA, speakers and thought leaders highlighted the various degrees to which the market many within the healthcare industry thought they once knew, is now being overhauled. 

“Inter-operability and Coordination”

Beyond his orchestra metaphor, Dr. Smith used the practical example of how newer automobiles are able to seamlessly use sensors and information towards collision avoidance, lane assistance, automatic breaking, automatic parallel parking, and other automated features. Those technologies help drivers mitigate user errors and provide warning about potential mechanical malfunctions.
In contrast, when it comes to the healthcare field, the introduction of a host of new devices and technologies has from his perspective, forced nurses and clinicians to be managers of technologies and synthesizers of information. Now these trained health professionals must ask themselves:

• What are the different monitors telling me about the health of my patient? Which ones are more important? How do I distinguish trends from anomalies
• How do I correlate readings from the various biometric monitors with to adjustments in treatment levels in another device (respirator, infusion pump, etc)?
• What is the appropriate level of response to various alarms?

This overburden not only draws time and attention away from patient -centric care, it also can be traced to the high rates of errors and avoidable mistakes that occur in care provision. In an outcomes-based compensation model for care, those errors are not only clinical issues they are also financial liabilities to the facility.

Ideally, if there was greater inter-operability between the various medical technology systems, the information captured and responses would be more automated and would enable care givers to more easily perform their responsibilities, as opposed to encumbering them.

As with many of the challenges plaguing the healthcare system, moving from theoretical solutions to practical applications can be a complex and protracted process. This process requires buy-in from a wide range of stakeholders, who typically are not accustomed to working with external entities. Medical device developers rightfully can point the finger at a lack of clarity from regulators, a lack of openness in the IT systems of EHR vendors, and a lack of willingness to pay for those added functionality and services from providers.

From talking to many of the attendees at the event, it is clear that the vast majority of their organizations are willing to explore and collaborate on developing innovative solutions.

Garry Fingerhut, Executive Director of Cleveland Clinic Innovations, seemed to affirm how the imperative for some of these transformations has influenced how organization evaluate and foster innovative ideas from their specialists. A retrospective of start-ups their organization has developed and spun out seemed to capture that shift over the years from more treatment centric tools and implant technologies to more information and analytics based solutions in recent years.

It’s not that these issues have not been tackled previously; attendees noted initiatives from the past that were launched to a great deal of hype but lacked the requisite momentum to gain traction.
Accordingly, an interesting question arises as to, what makes more recent developments any different than those previous missteps?

The answer, based on insights provided by other speakers, is quite possibly, timing. Timing in the sense that providers themselves are undergoing a significant reformation of how they are compensated for their services.  That in fact brings us to the second major overarching theme of the event, which is as providers continue the evolution towards value-based care models….. how do vendors work with them?

Outcomes Based Care and Vendor Positioning of Value 

With Dr. Steven Merahn , Chief Medical Officer for US Medical Management, providing the provider perspective and  Dr. Michael Dahlweid ,Vice President and General Manager, Solutions at GE Healthcare, providing the vendor perspective, attendees at the event got a comprehensive overview of the customer-centric  ideas and strategies technology developers are using to create solutions that address the needs of their customers.

Dr. Merahn highlighted many of the innovative approaches their organization has implemented to move our current care paradigm closer to one of disease management and value-based care. Rather than making incremental changes, their organization developed from the ground up the infrastructure and skill sets it needed to be successful in this novel model. Where others saw risks, their team saw opportunities for innovation.

In the previous fee-per- service model, there was a fairly straight- forward means for vendors to equate the price of their technology to the diagnostic test or procedure being performed. However, in this new model, the specific tool or combination of technologies used towards better care are secondary to the resultant outcomes. Dr. Dahlweid outlined a very deliberate and structured process by which medical technology developers could assess the rational for transitioning into outcomes (i.e. risk) based contracts with their customers. From the perspective of GE Healthcare, he was able to share some valuable insights into their thought process, case studies, and even in some cases the internal challenges a company might face in getting approval for launching such initiatives.  One interesting nugget that was gleaned, is that risk based contracts might not necessarily be for everyone. In cases where there isn’t a tangible metric that vendors could track, trend, and most importantly monetize, some concluded that an organization might be better served exploring other approaches for business model evolution.

Conclusion 


A key topic discussed during one of the interactive sessions, addressed the issue of industry convergence and risks of market obsolesce.  Participants highlighted the case study of Uber, and how this innovative IT based solution was able to take on the highly regulated and capital-intensive taxi cab industry. Similarly, in the healthcare space,  a key question was asked: How can participants avoid being a victim of disruptive innovation themselves?

Ultimately, I believe the key take away from this year’s event might be that while the forthcoming change is inevitable to healthcare, the strategies and approaches by which companies will react to those disruptions will be critical to the long term resiliency and success of their organizations.

Healthcare Beware! New Intruders are Coming – Introducing the New Gold Rush

By Reenita Das
Partner and Senior Vice President
Healthcare and Life Sciences
Frost & Sullivan
   


As the healthcare industry is transforming and becoming more consumer driven, the “5 Ps” are becoming the hub of the industry: Prevention, Personalization, Prediction, Preemption and Personal responsibility. As a result, there is a rush of new stakeholders who are entering the game and changing many of the rules. Who are these new breed of companies and what are they bringing to this industry? How are they transforming the way healthcare is practiced?


Social Media, IT Companies and Telecom: Shifting the Balance of Power

The foundation driving change in regard to how providers and patients interact and how medicine is practiced is "information technology."  We have witnessed a whole generation of content providers and social media companies – from Google, Facebook and Twitter, to Web MD and many more – that are playing the role of democratizing this data and taking it a step further by building consumer participation and responsibility into the mix.

Healthcare is a largely untapped market for specialized telecommunications systems with a strong immediate potential; therefore, it presents a handsome alternative revenue stream for this group. Telecommunication companies – or “telecoms” – are striving to customize their traditional offerings to meet the unique requirements and regulatory standards of the healthcare industry. These range from providing connectivity for enterprise mobility, asset management and exchange of health data in various formats; platforms for healthcare IT tools; mobile apps for physicians and healthcare professionals; all the way to patient engagement solutions.

At the consumer level, the telecommunications industry is targeting the increasingly health-conscious consumer with mobile apps that support education, health and wellness, patient monitoring as well as mobile communication.  On a larger scale, telecoms will eventually look toward creating a connected community or a “smart city” of which healthcare will be one component.

We are also waiting to see if media companies will seriously enter this space for the long haul. Time Warner Cable recently announced the “Virtual Visit” program, implemented via Cleveland Clinic's Center for Connected Care, whereby patients will be able to interact with their doctors via an encrypted two-way video without leaving their home. This product will be offered as a bundled service consisting of connectivity installation, customer premises equipment (modems and video conferencing equipment), and technical support in patients’ homes.

There are other cable companies in addition to Time Warner Cable that are entering this space such as Cox Communications and Comcast who are doing similar pilots and seeking additional revenue streams from healthcare. The competition is heating up with AT&T’s recent announcement to acquire DirecTV leading to more consolidation among internet and TV providers.  Should we now expect Google who, recently has been making moves to acquire gaming companies, to gear toward healthcare tech companies? Google has been trying to reinvent themselves and move outwards laterally for a while now.

Digitization of Health Draws Sensor/RFID Co.’s & Consumer Electronics into the Foreground

As healthcare moves toward a model of constant monitoring and feedback based on “on-demand, anytime, anywhere” concepts, sensor technology will drive the revolution of mobile health to the next frontier as it becomes more  available, visible and usable to people everywhere. Readings from sensors can be used in many facets of healthcare and disease prevention. Apart from regular monitoring, we can use sensors to track the emergence of disease, detect exposure to harmful environmental elements, or even predict the likelihood of developing health problems based on patient medical records, family health history and public health data.

Nokia held a competition in 2013 and again in 2014 called the Nokia Sensing XCHALLENGE. It is a $2.25 million global competition to accelerate the availability of hardware sensors and software sensing technology that individuals use to access, understand and improve their health and wellbeing.  The 2013 winner was Nanobiosym Health RADAR with a device that enables diagnostic testing in the palm of your hand. A drop of blood or saliva is placed on a nanochip and inserted into a mobile device. The user selects a particular disease strain from the software interface and then pushes the start button to begin. The device detects the presence (or absence) of that disease's pathogen in real-time with gold standard accuracy. These mobile diagnostic technologies are taking the laboratory to the patient – quite the reverse of where diagnostic testing has been so far. The tremendous advances in health sensing are truly game changing and will transform how doctors interact with their patients to address and solve health challenges. More importantly, it puts patients at the center of the care process and provides personalization.

As the line between health and fitness devices is blurring, every consumer electronics company – from LG to Samsung to Sony – is getting into the game. Thus begins a whole generation of wellness app companies that are now moving from the regular "step counting" outfits to more sophisticated platforms that includes building connectivity across all the stakeholders and connected to the cloud. Apple’s newest foray into setting up a medical technology division and focusing on building a healthcare playbook, as well as its recent discussions with FDA, shows how serious they are about the healthcare space.  However, on the acquisition front, Apple is definitely a slow mover, more resistant and less aggressive than Google, so it will be interesting to watch their technology acquisition strategy in regards to healthcare.

Direct to Consumer Testing Brings a Potpourri of Others

I believe the age of "direct to consumer testing" has already begun with devices such as the electrocardiogram monitor that can be carried in your pocket or the ability to take a hearing aid or eye test at home. This has heralded the advent of retail grocery and drug stores offering a “one stop shop” for diagnostic testing, monitoring and coaching. Global giants like the “Walmarts” and “Walgreens” of the world are clamoring to take control of the consumer as quickly as possible and provide a full service solution that can be personalized on demand. These consumer-facing testing devices are becoming the gateway to personalized medicine as they can aggregate data in a continuous contextual fashion. It then can be connected through the cloud to a supercomputer like IBM’s Watson to provide insights into not just your health but also your personal potential. In the future, we will have personal avatars that will help us reach our potential by way of coaching and motivation.

The Supply Chain is Growing More Complex

Outside of the coterie of healthcare products and service-type companies, we are also witnessing a complex supply chain emerging regarding logistics companies building their muscle and strategy for healthcare. Many of these companies like FedEx and DHL Express are already partnering with healthcare providers along the continuum of care and looking at extending their service offering beyond just distribution and logistics to build more value, consolidate cost and increase outcomes to this large diverse audience group. This implies these new entrants could start controlling more of the chain and eventually start competing with traditional pharmaceutical and medical device companies.

What do Healthcare and Hospitality Have in Common?

On a last note - healthcare and hospitality have much in common. For one, both have the same etymology. The word “hospital” comes from the Latin word “hospes,” or host, which is the root for English words such as “hotel,” “hostel” and “hospitality.” Imagine if we are treated as a guest in hospitals compared to being treated as patients. What implications does this have for healthcare providers? What does "guest-focused care" really mean?

In fact, as healthcare is becoming a consumer service industry, there are many lessons that healthcare can learn from the hospitality industry. In the future, it is expected that the hospitality industry will extend beyond recreation, leisure and wellness to healthcare services providing an end-to-end customer experience. The irony is we are already witnessing some of this by way of medical tourism. I do expect this will be a natural transition for the hotel chains of the world to enter into healthcare soon enough. Alternatively, it may be time for healthcare suppliers to push themselves out of their comfort zone and look at partners outside their traditional ecosystem rather than waiting for more intruders to attack.