Tuesday, October 25, 2016

Does Healthcare Understand the ‘On Demand’ Consumer?

By Pieter Nota
Executive Vice President,
CEO Personal Health Businesses

Royal Philips

The age of the ‘on demand’ consumer has inspired a lot of discussion in recent years. Industries such as retail, hospitality, media, government and education have all undergone a sharp and drastic period of change led by digital innovations. 

Obviously, they are not the only ones. In healthcare, the world is changing too: the appetite for digital services is growing and so is the need for reliable information. 

“Is bronchitis contagious?” and “How many calories should I eat” were both top Google health searches between January and November last year. Last year around 1 in 20 Google searches were health-related. In 2015, more than 3 billion downloads of mHealth apps have been estimated for the main app stores, allowing people to self-monitor disease conditions and adjust their lifestyles. Gradually, we are becoming empowered to know more about our own health – and act on it.

Understanding the challenges
Does healthcare understand this shift? Communication with friends and family is fast and frictionless today; people can do business, shop and put themselves through a university degree course online. They can now manage their finances seamlessly via phone apps; using virtual reality they can visit and examine the world’s most famous artworks.

Soon, they will ask why healthcare isn’t being delivered the same way.

From one perspective, the challenges embedded in the industry are broad and deep, and the limitations revolve around access to and free movement of data. Medical information is sensitive and often struggles to flow around the complicated and tangled bureaucracies constructed around healthcare services in many countries.

This lack of access to data and poor care co-ordination has worked to the detriment of patients and has inhibited health outcomes. For example, despite steady progress towards universal medical records, a vast majority of patients still have to repeat the same basic information to multiple healthcare professionals, according to the Future Health Index1, a survey of 25,000 patients which was commissioned by Philips. Most say they have also experienced repeatedly taking the same tests, delaying treatments and burning up valuable time. 

These are big challenges for an industry negotiating digital change and it is not a unique problem.

Beyond traditional models 
Healthcare delivery has reached the same juncture as taxis, broadcasting and hospitality did with the arrivals of Uber, Netflix and Airbnb. Broadcasters used to decide what people watched and when; now streaming services like Netflix allow viewers to choose and enjoy their favorite movies and TV series in one sitting. As a result, streaming services are now a vital part of all traditional broadcasters’ online offerings. Whole industries have been transformed by the ‘on demand’ consumer and quickly overtaken by innovations.

People can now rent out their own homes to visitors as opposed to taking the traditional route and booking a hotel or a bed and breakfast. Airbnb tapped into consumer appetite for different experiences and more personalized accommodation anywhere in the world and as a result disrupted the hospitality industry.

I am not suggesting that healthcare is standing still. Research suggests consumers want more connected healthcare. Over half (57%) of patients surveyed for the Future Health Index (aged 18-34) said they owned or used at least one health monitoring device, with 71% saying they would be interested in scheduling appointments online and 66% interested in receiving medical test results online.

Where will healthcare go next?
The research also highlighted some fault lines: around 74% of patients actively managed their own health but 75% of doctors thought patients needed to take a more active role. There’s obviously a disconnect between what people think they are doing and what doctors are observing.

At Philips we want to narrow that gap by empowering people to take better care of themselves, using digital technologies and connectivity. At IFA 2016, we are introducing a wide range of connected personal health innovations that empower consumers to stay healthy, live well and enjoy life.

Empowering consumers to engage in their health and take control of their lifestyle choices is precisely what Philips’ connected personal health programs do. Data from our connected health devices – such as Philips’ health watch, digital blood pressure monitors and body analysis scale – supports the small lifestyle changes that make a big difference.

Data accrued from connected devices which monitor patients, sensors in hospital rooms, wearables and lab equipment will ultimately transform healthcare in a huge way and usher in a new era of care delivery, reducing costs and saving time. 

Soon consumers will want to access their lab results via their smart phones within minutes of leaving a medical center; they will want their data to be accessed on multiple devices and freely exchangeable, and they will want healthcare delivered from the comfort of their own homes.

And as care delivery moves that way, consumers will finally be able to add real-time, connected healthcare to the other digital services they now take for granted and use every day.

[1] More than 2,600 healthcare professionals and 25,000 patients were questioned in Australia, Brazil, China, France, Germany, Japan, The Netherlands, Singapore, South Africa, Sweden, UAE, UK and US. 

Pieter joined Philips in 2010 as CEO of Philips Consumer Lifestyle. Prior to that he was on the Board of Management as Chief Marketing & Innovation Officer at Beiersdorf AG (a.o. Nivea), based in Hamburg, Germany. He started his career at Unilever in the Netherlands as a Brand manager in 1990, rising to Marketing Director and Member of the Executive Board of Unilever Poland and Germany, where he worked until 2005.

Pieter was born in the Netherlands in 1964. He is married with two children and holds a degree in Business Administration from Erasmus University in Rotterdam, the Netherlands. Follow Pieter on: LinkedIn

The Face of Health Care

By Ingrid Blair 
Vice President, Business and Marketing 
3M Drug Delivery Systems Division

We’re constantly told that the face of health care is changing, but what exactly does that changing face look like and what does it mean for the future? As the population ages, that face probably has a few more lines and wrinkles, but it’s also a wiser and more inquisitive face when it comes to health matters. ‘Take two aspirin and call me in the morning’ isn’t going to cut it for this face. And when we are talking about serious diseases, such as Chronic Obstructive Pulmonary Disease (COPD), the faces of patients and their caregivers want to be as informed as possible. 

Of course, it’s one thing to have the information; it’s an entirely different matter to put that information into action to achieve optimal results. That’s where health care providers and industry can come together – uniting technological advancement with improved communications to overcome obstacles to effective treatment.  

At 3M, we apply science in collaborative ways to overcome such obstacles – developing new solutions that create healthier populations. One recent project we’ve been working on is treating the unmet needs in the respiratory drug delivery market to improve quality of life for those affected with COPD. 

For the 65 million people worldwide1 who are affected by this disease, it is absolutely imperative to consistently receive the right amount of medication into the correct location of a patient’s respiratory system, which could allow them to live full and productive lives. 

However, recent studies have shown that traditional devices have failed to improve patient competence and adherence, leading to an increase in complications. One study has shown that approximately 76% of pressurized Metered Dose Inhaler users make at least one mistake each time they use their device.2 These mistakes range from angling the mouthpieces the wrong way, to inhaling too much of the product, to not holding their breath long enough. Similarly, approximately 94% of Dry Powder Inhaler users make critical usage errors.3 Another study has shown that around 60% of COPD patients do not adhere to their prescribed therapy.4 Additionally, only 25% of patients use their medications every day as prescribed.5

This research has made it clear that patients are struggling with current options in COPD treatment. Thankfully, through the application of innovative technologies to inhalation devices, developers have been able to engineer “intelligent” inhalers to improve patient competence and adherence. For example, 3M’s new Intelligent Control Inhaler helps improve competence by controlling the inspiratory flow rate, so that variations in breath inhalation strength do not affect dosages; additionally, it incorporates step by step on-screen instructions, to help patients use the inhaler more effectively.

As for adherence, the device will ‘connect’ with a mobile app providing real-time data for patients and doctors about device usage as well as long-term trends in inhalation breath profiles. Patients will know when they took a dose and they’ll know if they took the correct amount. No more situations where a patient gets distracted and then forgets if they were just about to take a dose or if they just got done taking one! 

From the perspective of the health care provider, communications are greatly improved as they don’t need to rely on the patient’s memory or inexact descriptions to explain how their treatment has been going. Reception of real-time data will allow for treatment plan modifications that lead to healthier outcomes. 

While millions of patients continue to struggle with diseases such as COPD, there is hope that new “intelligent” devices will improve patient competence and adherence through technological advancements, while real-time data sharing builds more trusted relationships between patients and their healthcare providers. The face of health care might be continually changing, but with innovative solutions in drug delivery on the horizon, that face is beginning to show a bit of a smile. 

Ingrid Blair is the Vice President for Business & Marketing of 3M’s Drug Delivery Systems Division, a recognized world leader in business and innovation.  In this role, Ingrid has global responsibility for leading business strategy, marketing, and operations for the development and supply of complex drug delivery systems solutions for global pharmaceutical customers.  Related products are developed to meet a variety of patient needs within inhalation, transdermal, microneedle and digital health segments.   

Ingrid has spent 29 years at 3M in positions of increasing responsibility in technology development, laboratory management, and global business leadership.  She is a Certified Design for Six Sigma Master Black.  She is currently a member of the Inclusion Steering Committee at 3M.  An engineer by training, Ingrid has a bachelor’s degree in Chemical Engineering from the University of Minnesota.  

  1. http://www.who.int/respiratory/copd/burden/en/
  2. http://www.sciencedirect.com/science/article/pii/S0954611107004477
  3. http://www.sciencedirect.com/science/article/pii/S0954611107004477
  4. https://www.ncbi.nlm.nih.gov/pubmed/18990964
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629978

Monday, October 24, 2016

Surgical Robots – Current Status and Next Generation Solutions

By Alind Sahay

Vice President
Noxilizer, Incorporated

Today, robots are present in a variety of application areas in the healthcare space – in surgery, pharmacy, rehabilitation, hospital services and many new application areas.  With orders of magnitude improvements in processing power and maturing of sensor technologies, there is a global and societal trend toward increased use of robotics. Global spending in robotics, and correspondingly, in the surgical robotics areas is expected to more than double in the next 5 years. 

The surgical robotics field is over three decades old – the first robot-assisted surgical procedure occurred in 1985 when a neurological biopsy was carried out using a PUMA 560 robotic arm.  In this article we will take a look at areas where there has been significant adoption – laparoscopic and general surgery, orthopedic surgery, spine and neurology – and explore next generation solutions that are expected to drive further growth.

In the laparoscopic surgery area, in 2016, we expect more than 700,000 robotic procedures worldwide. Clinical adoption, to date has been driven by benefits from the reduction in hand tremors, the minimally-invasive nature of the system and improved visualization.  Along the way, there have been innovations such as improved image resolution, shortened set-up time and, recently, improved visualization to identify vasculature beneath the tissue surface.   A number of studies have shown that robotic assisted surgery leads to shorter hospital stays and faster recovery times.  However, there continues to be a debate regarding the clinical benefits of robot assisted surgery.

While more recent clinical data may demonstrate clinical benefits, next generation solutions have the potential to provide step-function improvements. These solutions include Laparo-Endoscopic Single Site Surgery (LESS), Natural Orifice Transluminal Endoscopic Surgery (NOTES) and further improvements in surgical field information that could be presented through a merged visualization display.   Surgical field information will include further improvements in 3D vision, in vasculature information, improved haptic feedback, as well as cellular level information. These next generation systems have the potential to further reduce overall cost as well as improve final outcomes.  One robotic system that provides NOTES capability recently became commercially available and we expect that more Single-Site Surgery systems will become commercially available over the next 2-3 years.

In the orthopedic space, adoption has been slower – in 2016 we expect approximately 100,000 worldwide robot-assisted procedures.   In this space, there are two types of available robots – active robotic systems where the bone machining is autonomous, and passive robotic system where the robot constraints the surgeon but the machine is under the surgeon’s guidance.  Recent clinical publications from all these systems have demonstrated that component positioning and alignment, using robot assisted surgery, is statistically superior to manual surgeries.  And in a recent 2-year follow-up study using an active robotic system, there is evidence that for robotic surgeries, there is less bone loss when compared to manual surgeries. 

A significant challenge faced by orthopedic robotic systems is that the robot is only responsible for bone machining, which is one half of the surgery – the other half is the design of the orthopedic prosthesis itself.  Therefore, by integrating the development of the robotic systems and prosthesis, there may be synergistic opportunities related to system design, clinical workflow and business processes.  For example, by using a robot, it is possible for orthopedic implant companies to eliminate a significant portion of the bone preparation hardware, thereby significantly reducing cost.  Synergistic possibilities in improving the design include further reduction in invasiveness and potentially reducing overall operating time through workflow improvements.   As more long-term data is available with more recent improved systems, orthopedic robots will also demonstrate an improved quality of surgery.  In the spine space, recent retrospective and prospective clinical studies have shown a significant reduction in complications and revisions for robot assisted surgeries.

Recent clinical data, from robot assisted surgical procedures, provides strong evidence of improved alignment and reduced bone loss (orthopedic robots), reduced recovery times (laparoscopic and general surgery robots) and reduced complications (spine robots).  Next generation solutions described earlier have the potential to significantly decrease invasiveness and improve clinical outcomes.  Because robot systems are computer controlled and have the capability to store surgical case data records, these systems will eventually incorporate Artificial Intelligence to augment the surgeon’s decision making process.   For these same reasons, these systems will be used more routinely for quality control purposes within a hospital system.  With further increases in procedure volumes and increased competition, we can reasonably expect that the cost of robotic surgeries will come down, while outcomes are being improved. 

Alind Sahay is a research and development business leader and innovator with over 20 years experience developing and launching innovative medical devices for global markets, which includes over 12 years leading product development for image based robotics at Integrated Surgical Systems and navigation systems at GE Healthcare. His business development experience encompasses defining and executing on technology-based opportunities, including licensing and collaborations. 

Currently, he is Vice President, Research and Development at Noxilizer. Previous positions include Program Director, Endo Health Solutions, where he was responsible for the complete research and development portfolio for the Healthronics product line and Director, Product Development at Terumo Cardiovascular Systems, where he managed new product development and line-extensions for cardiac pumping systems and associated disposables.

Healthcare 2025: Ten Top Technologies That Will Transform the Industry

By Reenita Das
Partner and Senior Vice President
Transformational Health

Frost & Sullivan


As healthcare moves to a model of “any time”, “any place,” “continuous” and “personalized” care, it is important to identify the key technologies that will enable this transition and work toward their implementation into different care settings.  Frost & Sullivan’s Visionary Healthcare research has identified several technologies that are most likely to impact healthcare paradigms by 2025.

Figure 1: Healthcare World in 2025

It is interesting to note that technological advances in the fields of computing, machine learning, nanotechnology and electronics are all playing a role in helping reshape the industry.  The figure below provides an overview of the top technologies that will change this industry dramatically, and an analysis of the timeframe for their commercialization and maturation.

Figure 2: Timeframe for Commercialization and Maturation of Top 2025 Technologies

Quantum Computing

We are now beginning to see larger datasets in healthcare research and delivery to analyze and make sense of entire genome sequences, impact of environmental, behavioral and hereditary factors on health, population health data, patient generated health data, etc. The amount of such data becoming available is only set to increase exponentially by 2025. The available computing prowess, even those of supercomputers, will not be adequate to generate quick and actionable insights from such large data sets. But quantum computing, that has a far greater calculation capacity than traditional computers, could help solve some of the highly complex healthcare problems. One noteworthy company in this field is Canadian D-Wave Systems, which boasts of clients like NASA and Google. However, the possibility of widespread quantum computing is prevented by the problem of quantum incoherence, which, it is hoped, will be solved sometime soon.

Artificial Intelligence

While the human capacity to analyze and make deductions is superior to any other species on the planet, it is still limited in terms of the volume of information that can be processed quickly. Artificial intelligence makes this process faster by several degrees and far more efficient than humanly possible. IBM’s Watson, for example, can read 40 million documents in 15 seconds. With machine learning capabilities, the technology’s healthcare applications are boundless. Some of the applications currently being developed are assisting physicians and radiologists to make accurate diagnoses (IBM Watson Health), predicting which potential therapeutic candidates are most likely to work as efficient drugs (Atomwise) and mining medical records data to improve healthcare service delivery (Google DeepMind Health).

Robotic Care

Robots have been in healthcare for a long time now – the Da Vinci surgical robot is a case in point. But several other robotic applications are emerging and we should expect a lot more robots operating in the healthcare space by 2025. Consider the simplistic telepresence robots like those offered by InTouch Health, allowing the doctor to ‘move around’ and examine patients, while being seated at his or her computer at a distant location. Or Aethon’s TUG robots that help hospitals internally transport their pharmacy supplies, lab samples, patient food, clean or soiled linen or even trash, all by itself. Then there are the patient and elderly care robots that help in lifting patients from beds to wheelchairs and back, like the Robear robot or the Riba robot in Japan. Finally, robots can also play a role in pediatric therapy for autism disorders, phobias and as distractions; several examples exist - Phobot, PARO, NAO and Milo.


At the nanoscale, robots can play entirely different roles, this time inside the human body, traveling through bloodstreams. Ongoing research is exploring the potential nanorobots can have in vitals monitoring, performing body functions (e.g. carrying oxygen, destroying infectious agents like bacteria), targeted drug delivery (e.g. cancer therapy, blood clotting) or even to perform nanoscale, in situ surgeries. The actual list of applications of nanomedicine, the umbrella term for nanotechnology applications in healthcare, is even larger and fascinating. It includes assisting biological research (cell simulations), being intracellular sensors for diagnostics and playing a role in molecular medicine (genetic therapy). At the very least, we should see the beginning of testing of such applications by 2025.


The year 2025 should bring not just the introduction of robots inside our bodies, but also the transformation of the human body itself into partial robotic beings. This can manifest in several forms, some of which are visible even today – limb replacements, organ replacements, internal electronics, and capabilities, limbs or senses that are enhanced in function than their normal counterparts. Apart from the ‘bionic’ prosthetics movement, an estimated 30,000 – 50,000 people already have an implanted RFID chip inside their bodies. In the future, we are likely to see enhanced capabilities in terms of vision, hearing or with limbs, especially in defense application areas. Artificial pancreas is a subject of intense research, and it is likely that more sophisticated versions of these devices may even be implanted in the human body in the future – to supplement or even completely replace normal pancreas.

Brain-Computer Interfaces

Another form of cyborgization is the use of brain-computer interfaces to connect a wired brain directly with an external device. Apart from the research and brain-mapping applications currently in use, the technology is being developed for ‘neural bypass’ applications - helping paralyzed patients regain control of their limbs via ‘external’ connections to the limbs. Similar applications are being developed wherein the body’s neural framework is tapped using electric stimulation to modify certain functions. Existing examples include cochlear implants and pacemakers, while applications being developed include retinal implants (to restore sight) and spinal cord stimulators (for pain relief).

Medical Tricorder (Diagnostic Device)

Taking cue from the device popularized by the Star Wars franchise, efforts are aimed at developing a hand-held portable diagnostic device that can scan the human body and diagnose their ailments within seconds. While the fantasy version of the device could do this, current efforts are more realistic in their approach. The $10 million Qualcomm Tricorder X Prize competition launched in 2012, for example, aims at diagnosing 13 medical conditions (10 required, 3 elective) including strep throat, sleep apnea and atrial fibrillation, with a consumer-friendly interface device weighing no more than 5 pounds. With the winners of this competition set to be announced in 2017, we could expect such devices to be commercially available by 2025.

Digital Avatars

After self-diagnosing using a tricorder, patients in 2025 will want to get in touch with a doctor. Of course, telehealth will be an option, but there might be another option available for satisfying queries or getting more information on the diagnosis – just like the generic voice assistants available today. While Siri or Cortana are voice-only assistants, the Dr. WebMD of 2025 can be a digital avatar that can appear in holographic projections to assist patients and caregivers with their healthcare queries. The holographic projection of a human doctor, backed by artificial intelligence technologies, will allow for it to handle several queries simultaneously. Beyond answering queries, it could schedule appointments for a physical checkup with a doctor in your network, and share notes of your conversation with a doctor, in a digital-physical care coordination model. 

Augmented / Virtual Reality

The applications of the two related technologies are manifold and relevant to both sides of the care delivery equation – providers as well as patients. Providers can benefit from using enabled glasses for medical education - to study the human anatomy, for example, and for observing and studying surgeries as they were performed. Augmented reality could also be used during live surgeries to ‘see through’ anatomical structures to know the location of organs and blood vessels. On the patient side, one of the most advanced applications that are already in use is the treatment of various phobias and other mental health disorders. As the technology advances, we can expect more advanced applications to emerge by 2025, especially for healthcare providers.

3D Printing

3D printing is a well-known technology with several existing applications in healthcare, including orthopedic devices and several implants. Another application that is being considered is of 3D printed medicines, which can allow alteration of daily dosage and enable personalized medicine by customizing formulations of the drugs. Another niche that is now opening up is that of 3D Bioprinting – the possibility of ‘printing’ tissues or even organs. Applications range from skin tissue for burn victims to organ replacements for patients. Tissues thus printed can also be used in drug development, a service currently being offered by Organovo.

Companies within the healthcare industry must examine and study the impact of these technologies on their business, as well as investing into utilizing these in the future if they are to continue to sustain themselves profitably in the new environment.

This article was written with contributions from Siddharth Shah, Research Analyst and Venkat Rajan, Global Director, both from the Visionary Health program of Frost & Sullivan’s Transformation Health practice.

Monday, July 11, 2016

Leveraging Medical Artificial Intelligence to Meet the “Silver Tsunami” of Healthcare

Robert Kaul 

President and Chief Executive Officer
Cloud DX Incorporated

Recently, a study by Johns Hopkins made headlines by claiming that medical errors are now the third leading cause of death in the US. While that startling statistic was later challenged as being overly broad, it’s clear that over 100,000 people die in the US every year from preventable medical errors.

The US Government reports that every single day, around 10,000 Americans turn 65 and qualify for Medicare. If current Medicare spending trends continue unchanged, according to the US Social Security Advisory Board, healthcare spending will consume the majority of the federal budget by 2030, leaving little room for any other functions of Government.

The so-called “Silver Tsunami” of retiring baby-boomers not only puts enormous economic stress on our current healthcare system, it also raises the demand for support services. A looming shortage of doctors as well as personal home healthcare workers has generated anxiety in the industry. The only obvious solution is to deploy technology to help care for older adults, whose chronic conditions consume over 33% of all healthcare dollars.

Now imagine a world where medical errors were a thing of the past, and every person has the option of growing old at home in safety and dignity... all due to the dawn of medical Artificial Intelligence (AI).

Simply put, medical AI enables computers to help interpret healthcare data by recognizing patterns, providing insights to physicians to make better treatment decisions for patients. In the past healthcare progress relied on the discovery of new medications, vaccines and surgical procedures. Since the turn of the 21st century, the pace of these advances has slowed, and the growth of digital healthcare has taken off. 

Advances in electronic medical records, remote patient monitoring platforms, and big data analytics have become a driving force in improving existing healthcare workflows and providing better patient outcomes. 

In the future, medical AI will automatically track and dramatically reduce preventable medical errors and increase productivity. AI platforms will deliver so-called “deep data”, in real-time, to fully integrated patient management systems. Automating the selection of treatment options and reviewing possible calculated outcomes will give professionals unprecedented new tools to deliver better health. Initially, AI will aid medical professionals to make more informed decisions but will not replace providers themselves; however within the next few years AI will be able to make simple diagnoses, prescribe medication and vector patients to the optimum treatment resources with no human supervision. This autonomy is going to be required if medical AI is going to actually “bend the cost curve” and free up human resources for more complicated cases.

Adopting predictive analytics via medical AI will allow physicians to sort through large amounts of data using statistical methods to deliver predicted outcomes for patients in a matter of minutes. Incorporating AI’s predictive analytics into the healthcare field has the power to revolutionize the way providers and patients manage diseases and outcomes. This accurate and precise process can narrow down the moment of when a patient becomes ill, a critical step in providing preventative measures and treatments.

Implementing AI into healthcare systems will grant patients access to remotely monitor non-life-threatening conditions outside of a clinician’s work space. A patient could potentially describe their symptoms via an app and be presented with information to autonomously care for themselves. This not only reduces costly and time-consuming trips to medical clinics but also allows for data sharing from patient to clinicians, should a threatening complication occur. 

Leading an organization into the ever-changing transformation of healthcare requires an appreciation of global innovation and implementation opportunities. Over the next decade, society will inevitably usher in a new era of healthcare; one where clinicians and their AI partners provide a lifetime of wellness management to prevent illness rather than simply treating symptoms. Early detection of negative health conditions in near real-time will be the leading factor that will reduce the cost of care over a lifetime, as well as improve patient outcomes in the case of illness or injury. 

Organizations who are early to adapt to this growing AI trend will enjoy a competitive edge over those who are less equipped to do so. Full adoption of medical AI will ultimately ensure that everyone receives the support and resources they require. As a society we must embrace our responsibility to protect the future of healthcare. The sooner this notion sinks in, the sooner we will all begin enjoying the journey to improved health and wellness. 

Robert Kaul is the President & CEO of Cloud DX Inc, a digital healthcare startup based in Brooklyn, New York. Their Cloud DX Connected Health Platform is revolutionizing personal health monitoring by providing outstanding accuracy  and user experience at an affordable cost. Cloud DX was won multiple awards including 2015 Startup of the Year for Innovation. Team Cloud DX is a Top-7 finalist in the Qualcomm Tricorder XPRIZE, a 4-year global innovation competition to create a futuristic “Tricorder” that autonomously diagnoses 14 separate health conditions. The winner of the $6 million top prize will be announced in January 2017.

Will The Move To Value-Based Payments Be A Long-Term Trend Or A Short-Term Fad?

Rahul Dubey

Senior Vice President 
Innovation and Solutions
America’s Health Insurance Plans (AHIP)
Innovation Lab 

Shahid N. Shah
Entrepreneur in Residence and Strategic Adviser 
America’s Health Insurance Plans (AHIP)
Innovation Lab 

The Affordable Care Act (ACA), Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), Merit-Based Incentive Payment System (MIPS), Alternative Payment Models (APMs), Precision Medicine Initiative (PMI), and Patient-Centered Outcomes Research through PCORI are all taking us towards a more value-driven payment system for the U.S. healthcare system. Physicians and hospitals have been, for decades, paid fees for services they perform on patients and the higher their volume the more money they made (regardless of outcomes). Given the unsustainable growth rates in national healthcare spending, all health insurers and the federal government are working to figure out how to pay providers and health systems for the value they deliver to patients and the public health system.

The question on the minds of many skeptical health systems and front line healthcare professionals, who have lived through multiple cycles of managed care that were going to “revolutionize the industry” in the past, is whether value-based payments are a long-term trend or short term fad?

To help answer that question, America’s Health Insurance Plans’ (AHIP) Innovation Lab (IL) has been facilitating and moderating many “Solution Working Groups” (SWGs) between payers (insurers), providers (health professionals and systems), retailers (pharmacies, clinics), and pharmaceutical manufacturers. An SWG is a collaborative session usually focused on an insurer’s “stated need” and centered on a specific, tough- to- solve problem which typically involves health systems and care providers. 

For every SWG, AHIP IL convenes major stakeholders across multiple institutions, value-added technology, and services partners. Stakeholders could be as wide and varied as physicians, nurses, call center personnel, pharmacists, dentists, or even actuaries. Anyone willing to help eliminate innovation logjams is welcome. Once we get all the stakeholders into a single room for one or two days we’re able to speak not from siloes but from a collaborative patient team’s point of view. Instead of looking at the problem from a particular institutional viewpoint, we try to imagine what’s best for the patient’s long-term care and sustainability from a financial perspective. Too often solutions are envisioned without sustainable business models but, when multiple stakeholders work together, our solution working group participants have been able to create sustainable innovations.

1. The path to payments in VBR and FFS both remain complicated

After running dozens of SWGs at AHIP IL, we’ve come to the practical conclusion that value based reimbursement (“VBR”) initiatives are real and that insurers are serious about implementation. There is little reason to believe that VBR is a fad, especially because it’s hard to unwind later. The other major learning from AHIP IL’s SWGs is that most of the pressing problems in healthcare cannot be solved without significant reworking of agile multi-stakeholder and multi-institution workflows and information architecture. 

The entire healthcare industry’s aspirations to shift from fees for services (FFS) to value-based care is now well understood. However, repeatable evidence-driven execution plans of how we’re going to go from FFS to VBR remains elusive. CMS’s new MACRA and MIPS programs along with substantial bi-partisan work being done on the yet to be passed 21st Century Cures Act indicate that the Federal Government is very serious about value-based care. However, the significant IT, data interoperability, and unparalleled cooperation among traditional competitors that will be required to make value-based care a reality are not really well understood. Will these value driven aspirations stand the test of time or will we end up falling back on old models because the industry’s structural problems of reliance on volume and state-specific licensure requirements not let the fees for services business models die? 

ACA, MACRA, MIPS, APMs, PMI, PCORI, and the many other initiatives the healthcare industry has embarked upon all have an insatiable appetite for data. Through our SWGs, we’ve come to a consensus that existing workflows and data architectures built on siloes across institutions prove that the efficiencies in cost and improvements in outcomes that we need across the healthcare industry cannot be created without changing the reimbursement model to a more value-driven system. Many institutions cannot handle complex next generation value-based business models which require more collaborative and flexible multi-organizational structures. This means that the best will survive and we’ll need to figure out how to fold in the rest into centers of excellence.

If insurers and more sophisticated organizations can help health systems and providers become more agile, then value based reimbursements will move from aspirational to operationally capable and sustainable initiatives. VBR is real, it’s here, but it’s unevenly applied because the path to defining, agreeing upon and measuring outcomes along with payments attribution issues remains complicated. We still have a lot to learn, especially through our collaborative experience at the AHIP Innovation Lab, but it’s clear there’s no turning back.

The AHIP IL is an open lab – if you have payment reform, patient facing tools, payer focused solutions, or ideas around provider led care management please reach out to Rahul Dubey and see how we can run a Solution Working Group (SWG) centered on one or more of your ideas. 

Rahul Dubey is currently responsible for collaborating with the C-level executives at AHIP's Health Plan Membership to develop and implement innovative, best in class, emerging solutions and approaches that accelerate utilization of these mission critical applications in order to deliver a higher quality of care, improve the wellbeing of consumers and drive down the cost of care received.  

Rahul is responsible for creating the Lab's one of a kind concept, continues to fulfill its mission of delivering an invaluable resource for AHIP Membership and leads all of the Lab's collaborative and confidential Solution Working Groups that involve individual payers, providers, manufacturers, MedTech, innovative solution providers  and the AHIP Innovation Lab's trusted and crucial Inaugural Partners. 

Shahid N. Shah is an award-winning and influential healthcare IT thought leader who is known as “The Healthcare IT Guy” across the Internet. He is AHIP Innovation Lab’s technology strategist, business modeling specialist, and entrepreneur in residence responsible for helping insurance plans define and create solutions to major innovation challenges. 

Thursday, July 7, 2016

Executive Perspective: Tomorrow’s Doctors Need Compassion, Leadership and Patient Focus

By Harold L. Paz, M.D., M.S.
Executive Vice President
Chief Medical Officer

Compassion is a unique characteristic.

This simple truth is integral to the evolution of health care and the role of physicians in the future. No matter how sophisticated technology gets, computers and data can’t offer compassion, but they can dramatically change where, how, when and what care is provided.

This evolution is already changing the way we think about the doctors of tomorrow.

In a peer-reviewed article recently published in the journal Academic Medicine, I argued that the emerging model of health care will not only be fundamentally different from the traditional fee-for-service model, but it will require a whole new way of thinking for physicians.

What will the physicians of the future look like and how will they operate? We can expect that physicians will play an important role when patient care is more “art” than science or can’t be automated. This will increase the pressure on academic medical institutions to look for and develop the personality and skill sets necessary to fill the void left by technology.

Consumer-directed health care, where patients are more actively engaged in their own health and wellness, is accelerating this move to what I call the “third curve” of health care. The first curve is characterized by the familiar fee-for-service approach to delivering medical care, where each activity is a billable event. Ian Morrison defined the second curve as population health, where the medical community started to focus on the bigger picture of disease and condition management, including the idea that prevention and wellness efforts can make a significant difference in the progress of chronic conditions.

As we enter the third curve of health care, we acknowledge that patients, not physicians, own their health.

New resources and tools will enable each individual to take more ownership, become more likely to adhere to care plans, and feel empowered to take charge of their well-being. Doctors must embrace these new tools and resources, such as mobile apps, telemedicine, home health, urgent care centers and other technologies to improve the health of patients. By the same token, Aetna has the opportunity to play a critical role in personalizing each member’s health and wellness “ecosystem” over time, beginning in the home and extending out into the community by partnering with health care providers through the use of innovative tools and data analytics.

Collaboration will be the key to leading us into the future. If the doctor-patient relationship is to be preserved, physicians must be trained to serve as leaders of multidisciplinary teams that work to address all five determinants of health.

As a former dean of two medical schools, I know that we have a responsibility to train students to succeed in this new world order of consumer-driven health care. By 2025, we will face a physician shortage of 90,000. While shortages generally predict increased demand, I believe that in Curve III things could take a different turn, accelerating more than just the need for more doctors, but demand for a new breed of physician.

With the capabilities, strengths and challenges of all of the players in the health care system, I see a remarkable path forward. Our successful move into the next curve of health care will be predicated on putting patients first, emphasizing compassion, embracing change, and building both hard knowledge and soft skill training into the programs that are building our future medical professionals.

This article was originally published on The Health Section, Aetna’s online news magazine. For more information like this, go to https://news.aetna.com.

Dr. Paz leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses. He is responsible for driving clinical innovation to improve member experience, quality and cost in all areas of the health care delivery system. Reporting to Aetna’s Chairman and CEO, he is a member of the company’s executive committee.

Before joining Aetna in 2014, Dr. Paz served as CEO of Penn State Hershey Medical Center and Health System, senior vice president for Health Affairs for Penn State University, Dean of its College of Medicine and Professor of Medicine and public health sciences for eight years. Prior to his appointment to Penn State, he spent 11 years as Dean of the Robert Wood Johnson Medical School and CEO of Robert Wood Johnson University Medical Group.

The Positives and Perils of Patient-centric Approaches to Healthcare Data

By Matt Patterson, M.D.


Imagine a future in which dozens of different patient-centered technology solutions compete with one another, contributing to a disastrous combination of higher costs, lower-quality care and scores of angry and confused patients. Without robust health information interoperability, this scenario is a very real possibility in the U.S.   

The need for interoperability comes at a time when healthcare is under extraordinary pressure to improve overall care quality and cost efficiency. The Affordable Care Act is tightening the screws even further on the revenue side. For these reasons, it is understandable that health systems are eager to deploy a patient-centric approach to data portability and interoperability. 

The good news is that in both private and public discussions with health and policy leaders, there is encouraging talk around interoperability through open and available application programming interfaces (APIs), which allow health data solutions to communicate with each other. Public comments by Health and Human Services Secretary Sylvia Mathews Burwell and Centers for Medicare and Medicaid Acting Administrator Andy Slavitt support this analysis. 

While imperfect, a patient-centric approach is currently the best framework available. Individuals should own their data and have easy, real-time, plain-English ways of opting in and out of recording and sharing data in both identified and de-identified ways with anyone they wish, to benefit themselves and/or society at large. 

However, the patient-centric approach is not a cure-all. In fact, Meaningful Use Stage 3 – and its requirements for making data available to patient-facing applications – could result in unintended consequences for clinician workflows.

The stated purpose of Meaningful Use is to leverage certified electronic health record (EHR) technology in stages to improve quality, efficiency and care coordination while maintaining the privacy and security of patient health information. The hoped-for results in Stage 3 include improved outcomes.

Yet Meaningful Use and open APIs for consumer-facing applications will not be enough to solve the interoperability challenges we face. For example, imagine an emergency department physician ordering tests for a patient who knows those tests were already recently done by another provider. Even if that patient has an application on his or her phone that can access data from various sources, it is still unlikely this could translate to a scalable, reliable, effective workflow for the physician. The more likely results are already familiar to those dealing with ineffective health information exchanges (HIEs): incorrect data, a difficult-to-navigate solution, a failure to tailor the focus to the specialty of the user, or suboptimal data provenance, to name a few.

By relying too heavily on a patient-centric approach, we risk diminishing momentum toward the real game-changer: enforcement of affordable, open, bi-directional APIs among all health information systems. This is a must-have on the road to innovative and intuitive workflow solutions for clinicians and consumers. Referring back to the scenario above, ED physicians need access to an integrated workflow that incorporates their own hospital’s data, along with relevant patient data from multiple other disparate sources. This will enable more cost-effective, efficient and clinically accurate decisions.

While this may sound idealistic, it is absolutely achievable. We can start by putting the consumer in the driver’s seat as the broker of his or her data in ways that reduce unnecessary complexity. For example, the creation of a simple consumer-facing application that simply has two buttons - ‘Record’ and ‘Share’ - would provide control over an individual’s data and interoperability in an easy, real-time way. From there, wide-open, bi-directional interoperability among the patient’s historical data sources can support nimble, innovative workflow solutions geared toward clinician use and faster, more informed decision-making. 

Another benefit to giving the patients real control over their data is the potential to finally expose the overt data blocking that exists today. Data belongs to individuals. Those acting as gatekeepers should no longer be able to profit from blocking access. The gate should be unlocked to create innovative workflows and value from this data. Ultimately, business models that simply monetize the hoarding and simple transmission of data from closed, Byzantine health information systems without creating meaningful insights and workflows will crumble – as they should.

With all this in mind, health systems seeking to innovate with patient-centric technology solutions should support open APIs and discourage data blocking practices from their incumbent vendors. And, by partnering with technology firms that offer demonstrated interoperability and workflow innovation capabilities, these health systems can create tools that improve the lives of patients and those who care for them.  The results can have a powerful impact on both individual patient care, and the broader healthcare system.

Dr. Matt Patterson has built his career around the goal of delivering better quality healthcare to more people at a lower cost. Responsible for operations, he leads AirStrip's people, processes, and technology required to deliver the full value of AirStrip mobile solutions to clients. Dr. Patterson joined AirStrip from McKinsey & Company, where he was a core leader in the North American Healthcare practice's strategy and operations engagements. He focused on clinical and business model transformations of major U.S. health systems transitioning from "pay for volume" to "pay for value" environments.

Dr. Patterson also brings a wealth of clinical and operational leadership from his experience as a former U.S. Navy physician, where he served as the Medical Director of the Naval Special Warfare Center in San Diego, CA—the elite training command of the U.S. Navy SEALs.

Five Technologies That Will Disrupt Healthcare
By 2020


By Reenita Das

Partner and Senior Vice President
Transformational Health

Frost & Sullivan

Frost & Sullivan’s Transformational Health program provides insight on the growth opportunities driven by innovative healthcare technology

The healthcare landscape is changing exponentially and the following technologies are expected to have far-reaching implications in terms of diagnostics, treatments and delivery of care in the future.

1. Artificial Intelligence: CAGR of 42% to reach $6.6 billion in 2021

Artificial Intelligence (AI) is defined as the intelligence demonstrated by machines or software with the ability to depict or mimic human brain functions. AI in healthcare aims to improve patient outcomes by assisting healthcare practitioners in using medical knowledge, which has been thoroughly analyzed and memorized by these systems, thereby providing excellent clinical and medical solutions. AI systems have the potential to provide physicians and researchers with clinically relevant, real-time, quality information sourced from data stored in electronic health records (EHRs) for immediate needs.

The AI market for healthcare applications is expected to achieve rapid adoption globally, with a CAGR of 42% until 2021. Excellent patient outcomes, reduced treatment costs, and elimination of unnecessary hospital procedures with easier hospital workflows and patient-centric treatment plans are the prime reasons for the wide adoption and successive growth of the AI market in the healthcare industry.

By 2020, chronic conditions, such as cancer and diabetes, are expected to be diagnosed in minutes using cognitive systems that provide real-time 3D images by identifying typical physiological characteristics in the scans. By 2025, AI systems are expected to be implemented in 90% of the U.S. and 60% of the global hospitals and insurance companies. In turn, AI systems will deliver easily accessible, cheaper and quality care to 70% of patients.

AI is consistently improving the approach and access to reliable and accurate medical image analysis with help from digital image processing, pattern recognition and machine-learning AI platforms. For example, a startup, Butterfly Network, has developed a handheld 3D-ultrasound tool that creates 3D images of the medical image in real time and sends the data to a cloud service that identifies the characteristics and automates diagnosis. Such clinical support from AI is expected to have a significant impact on the overall medical imaging diagnosis market and its growth.

Innovative, automated patient guidance and engagement solutions, such as AI-enabled medication adherence to observe patient devotion by using advanced facial recognition and motion-sensing software, have started to automate one of the major healthcare processes of directly observed therapy (DOT). New entrants with similar solutions are expected to rapidly capture this sub-segment of the market.

IBM Watson Health’s recent acquisition of Truven Health Analytics for $2.6 billion creates a new and important dimension in health data analytics, further strengthening IBM’s already strong healthcare market position.

2. Immunotherapies: Checkpoint inhibitors growing at 139% CAGR

Immunotherapy provides therapeutic benefit by focusing on the capabilities of the immune system in regards to the tumor and promises to transform cancer care. It charts new territory in both individual duration of survival and the potential for significant numbers of patients to benefit. For example, malignant melanoma is a significant unmet medical need with limited treatment options. More than 160,000 cases of melanoma are diagnosed worldwide with 40,000 deaths annually.

The promise of immunotherapy rests largely in its aptitude for broad application in various patient populations. Once the algorithm for its effective use in the oncology setting is properly realized, the growth potential is humongous. While checkpoint inhibitors dominate the current headlines in the clinical care communities, other promising approaches include novel molecular constructs such as chimeric antigen receptors (CARs), therapeutic combinations with old and new drugs, dosing regimen modifications and vaccines. The market for check point inhibitors was valued at $3 billion in 2015 and is expected to reach $21.1 billion by 2020, growing at CAGR of 139%.

3. Liquid Biopsy: Potential to monitor tumors non-invasively

Liquid biopsy extracts cancer cells from a simple blood sample and has the potential to revolutionize cancer treatment by non-invasively monitoring cancer cells. Today, repeated biopsies are needed to study the changing tumor and present a huge challenge to the patient. Liquid biopsy provides attractive investment opportunities for diagnostic companies. The focus on blood biomarkers, such as ctDNA and CTCs, has unleashed the potential to now track and monitor tumors in a non-invasive manner. It is expected in about two years, liquid biopsy will become an adjunct to tissue biopsy. This technology has proven to be much more effective and detects worsening of a disease condition even before a CT scan. There are key benefits to this technology where “go to the source” is not a concern, unlike tissue biopsy.

4. CRISPR/Cas9 (RT): Disrupting the way R&D is conducted and products are developed

CRISPR/Cas9, a gene editing technique, can make targeted modifications to DNA accurately, cost effectively and reliably. In short, it holds the promise of transforming the way R&D is conducted and products are developed across major sectors of the global life science economy. This technique catapulted onto the research scene in 2014, and companies are flocking to provide research tools and develop therapeutics using the technology. Sangamo Biosciences is the most prolific company to have applied one of these technologies—Zinc Finger Nucleases—to the development of clinical-stage human therapeutics. Other companies, such as the start-ups CRISPR Therapeutics and Editas Medicine, have focused on CRISPR, having received millions in VC funding.

However, while human therapeutic applications of gene editing steals the limelight, there are other sectors, including agriculture and specialty chemicals, in which the technology has advanced beyond research onto the market. Gene editing offers the ability to do the following:
  • Modify critical traits in crops and animals
  • Boost food crop yields and nutrient quotients
  • Create crops capable of withstanding blights, pests or climatic extremes
  • Breed hardier, disease-resistant farm animals with improved nutritional profiles

An analysis of NIH-funded projects mentioning CRISPR/Cas9 from 2013 to 2015 finds astronomical growth of this promising gene editing technology. From 2013 to 2014, funding grew seven times, and from 2014 to 2015, funding more than tripled. Academic researchers are not the only end users adopting CRISPR/Cas9 as the technique is having a major impact in therapeutics as well. The technology overcomes many of the challenges with RNAi, TALENs and ZFN genome editing tools, promising to be a market worth hundreds of millions over the next few years.

5. 3D Printing: Game changer for organ or tissue repair

3D printing technology has enormous potential in healthcare due to its ability to be customized. Customization can dramatically reduce surgery times and medical expenses. Currently, the largest applications are 3D-printed scaffolds or prosthetics (orthopedic implants) and medical devices, such as dental implants and hearing aids. The game changer for 3D printing will be in human tissue printing: printed livers, hearts, ears, hands and eyes, or building the smallest functional units of tissues, which can lead to the fabrication of large tissues and organs. This can be used as surgical grafts to repair or replace the damaged tissues and organs.

It is estimated more than a million people need kidney transplantation worldwide. However, only a little more than 5,000 people receive a transplant, as there is an insufficient number of donor organs. Scarcity of legally donated organs has led to a dramatic increase in a worldwide illegal organ trade. The 3D printing business for healthcare is expected to be worth approximately $6 billion by 2025. Some prominent companies in this field are Stratasys Ltd., Arcam AB, Organovo Holdings Inc., Johnson & Johnson Services Inc. and Stryker.

These five technologies have enormous potential to transform the healthcare industry.

This article was written with contributions from Nitin Naik, Global Vice President of Life Sciences; Christi Bird, Senior Industry Analyst; Divyaa Ravishankar, Senior Industry Analyst; and Venkat Rajan, Global Director of Visionary Healthcare with Frost & Sullivan’s Transformational Health Program.

Friday, April 15, 2016

Retail Health – A New Delivery Model for Preventative Care?


By Alex Hurd
Senior Director
Health& Wellness

Walmart, U.S.

Drug Store News
, one of the leading publications in the retail pharmacy industry, recently dedicated its cover story in the February 2016 edition to the retail health fair phenomenon currently underway in America[1]. Engaging individuals around their health in locations they visit with great frequency – such as grocery stores and retail pharmacies – may be one of the simplest forms to drive large-scale, individualized public awareness around such key health issues as flu prevention and early diabetes detection. These events could represent an access point for health education and preventative health services for millions of individuals who currently don’t engage with the healthcare system, whether it is for lack of insurance, lack of time or simply lack of knowledge on where to start.

So does this trend prove that broad access to immunizations and free basic health screenings can play a key role in our country’s public health infrastructure?   It may be too soon to tell, but with over 140 million weekly customer visits, no organization is better positioned to have a major impact in this space than Walmart. On October 10, 2015, during its inaugural national “America’s Biggest Health Fair” which was executed simultaneously across all of its more than 4,500 stores in the U.S, the company delivered over 280,000 free health screenings, 51,000 immunizations and distributed over 1.9 million healthy product samples[2].

In addition to performing the role of a “public health early warning system,” health fairs at retail could also function as a starting point in a Healthcare Consumer’s personal journey towards better health by arming him or her with solutions that deepen their knowledge around a specific health issue and facilitate simple actions and incremental steps towards improvement.

Payers have also shown great interest in collaborating with retailers to engage their members in a positive and simple way in an area of their lives with which most struggle. An example of a fruitful collaboration is the Humana Vitality initiative in which a large national health insurer offers discounts on healthy foods to eligible members. The program has been running in partnership with Walmart for over three years and Humana has seen significant improvement in the engagement and health of participating members. The number of employees who had markedly better health increased by more than 24% over the three years compared to 14% of employees who remained disconnected from the program, and unengaged employees had 56% more emergency room visits and 37% more hospital visits than their healthier peers.[3] 

Do these examples point to a new delivery model and/or distribution channel for preventative care? Perhaps, but in order to fulfill their potential, retailers will need to foster the type of partnerships and build the type of eco-systems that are able to harness frequent Healthcare Consumer touch points and leverage state of the art education and engagement techniques as well as advances in science and technology to create new innovative and integrated product and service offerings to help Healthcare Consumers make a lasting, meaningful difference in their lives.

Alex leads New Product Development and Payer Innovation for Walmart's U.S. Health & Wellness business. His team focuses on delivering payer solutions that drive down the cost of healthcare by leveraging Walmart's broad assortment of health & wellness products and services. Alex holds a BA in Global Business from the University of Florida and MBA from the Kellogg School of Management & Hong Kong University of Science and Technology. He is a Fulbright Scholar and fluent in five languages.

[1] Health Event Horizons, Drug Store News, Vol.38 no.2, February 2016
Walmart H&W Internal Reports, October 2015
Louisville Courier-Journal, http://www.courier-journal.com/story/money/companies/2016/03/29/humana-wellness-plan-boosts-health-bottom-line/82382488/March 2016