Telemedicine and the Changing Healthcare Landscape in America

By Michael Fratkin, M.D.
Founder/Director
ResolutionCare






As a palliative care physician, I’m not really a technology guy. My choices in gizmos reflect this…the intuitive Apple computer, Zoom videoconferencing, athenahealth’s EMR, etc… My view of “meaningful use” is very different than that of the Department of Health and Human Services.

While they define “meaningful” with a carrot and a stick, I tend to define it in relational terms. As somebody who has worked with thousands of patients approaching the end of their lives, I have come to realize that in all of human history, people have never suffered in the approach to dying as they do today. Even without the incredible technology, advanced medicines, and the defined roles for healers that we have today, our predecessors had what people have always needed the most…the presence, intimate connection and care of those who loved them most.

I daresay that our ancestors also had a much better understanding that death is simply a natural part of our experience as human beings on this earth. We need to restore the traditions of compassionate home-based care and the capable use of a few simple principles of medicine. And we also need to integrate telemedicine technologies as a way to strengthen the relationships we have with our patients.

Because I believe that if technology is used to better serve the doctor/patient relationship, and if technology is used to improve the patient’s experience of their care, only then we can successfully achieve the “Quadruple aim” of healthcare: improved outcomes, better quality care, lower costs, and sustainable well-being for healthcare professionals.

To me, the amazing technology at our fingertips is only as valuable as its ability to serve and support our relationship to each other and to our collective well-being. And most importantly, to the patients we serve. Telemedicine doesn’t replace face-to-face, compassionate communication between doctor and patient. But it can increase its value. The “house call” is one of the oldest and most effective means of delivering care. If you boil it down to boring health economics terms, its value to cost ratio is really hard to beat.

Telemedicine cannot—and I would argue it should not—ever replace the house call. But it can significantly add to the doctor/patient relationship, improve communication, and provide the ability of a multidisciplinary team to follow up with comprehensive, coordinated care between home visits.

Telemedicine has become an important part of the necessary changes taking place across our healthcare landscape. What we know from our own lives is that our character and sensibilities are forged by adversity and difficulty. As an observer in the care of people facing the completion of their lives, I am convinced that the “pain points” are what awaken the inspiration needed to confront habitual problems, narrow self-interest, and self-destructive tendencies. Our healthcare system belongs to us, and it is our responsibility to recreate it so that it becomes entirely centered on value. And value, in our new healthcare system, must be defined by the experience of the very ill and those of us who wish remain as well as possible throughout life as we interact with our healthcare system.

This is an exciting time to be a care provider in the United States. Incredible change is afoot, and those of us who have long dreamed of better ways to care for patients are finding ways to challenge the status quo and change things for the better.

At the same time, technology has reached a tipping point. Cloud based technologies, mobile health platforms, patient engagement platforms and telemedicine technologies are all available to us. The challenge is to fuse the powerful technologies we have at our disposal with a real understanding and appreciation for the fact that technology cannot replace compassionate, soulful care.

Is there any better definition of “meaningful use” than that?

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Michael D. Fratkin, M.D., is an experienced educator and physician with a diverse background in Internal Medicine and Hospice and Palliative medicine. He is dedicated to the physical and spiritual well-being of patients and their families as they face complex medical conditions in the context of integrated health care delivery.

Dr. Fratkin is the Founder and Director of ResolutionCare, established in August 2014. He launched this social enterprise to bring greater capacity for Palliative Care services to the community and to enhance capable and soulful care to everyone, everywhere as they approach the completion of life. ResolutionCare innovates with emerging payment models and technology to restore the tradition of home-centered care.

Taking the Pulse of the Medical Device Market

Questions and Answers with:
John Daley
Multi-Site Vice President, Quality Assurance
Boston Scientific

By Patricia Stamas-Jacoby

 

Consolidation, globalization, evolving technologies, and the advent of patient-centered care are just a few of the key trends driving the healthcare market as we move into 2016. How will these sweeping changes affect both established corporations and emerging healthcare businesses?

Much remains to be seen, but John Daley, Multi-Site Vice President, Quality Assurance, Boston Scientific recently fielded a few key questions from Frost & Sullivan. He shared his insights about opportunities and challenges in the medical devices market space while providing specific examples from his vantage point at Boston Scientific.

Frost & Sullivan: What Boston Scientific product lines do you see--and forsee--being influenced most by technology?

There really isn’t a single area that is not going to be radically influenced.  Whether it is through direct technology improvements to the device itself, like in a pacemaker, or through breakthroughs in advanced manufacturing technologies that let us do things better and faster.  One area worth highlighting is in our direct visualization arena.  With the tremendous shrinking of CCD camera technologies, we have been able to launch a market leading, disposable, endoscope.  The resolution of this digital system is so superior to the old fiber-optic viewing scopes that it has literally resulted in changes of diagnosis.

Frost & Sullivan: What are some of the key challenges and opportunities you see medical device manufacturers facing today?

The key challenge is also the greatest opportunity and that is managing our radically changing global environment.  Whether it is in how we design for a global market or how we ensure regulatory compliance, the world is becoming far more complex.  With the growth in places like China comes great opportunity to serve those markets.  However, as they grow, they naturally start to demand more from both a performance and a regulatory standpoint.  Just slapping a Chinese-language label on a product developed for the European and American markets is no longer good enough.

Frost & Sullivan: "Products becoming services" is a key current trend in healthcare devices--can you provide any examples of this transition with Boston Scientific products? Any current market tests or success stories?

This is one of the most exciting frontiers in the industry and it is something we are putting a lot of effort into.  Among other efforts we have ongoing, we hope to be an integral part of the “internet of things,”  in a way that lets us really have a positive impact on patient health.

For example, we are experimenting with new and more powerful forms of radio-frequency identification (RFID) and intelligence that allows us to track and manage inventories of our products across our customer network, all at a much lower cost than with existing technologies.  These technologies help us to ensure our products are always available when needed, but do not require our customers to hold large quantities of stock that take up valuable clinical space and that will eventually expire. 

This technology can also potentially tell us when there are problems with the conditions in which the product has been stored, such as when a product is stored in humidity or extreme conditions that could compromise the performance of a unique device.  Further, we have been rapidly building our Advantics healthcare solutions organization, focused on helping hospitals and healthcare systems improve cost, quality and outcomes through best-in-class tools, technology and expertise.

Frost & Sullivan: The healthcare market has moved towards solutions that bundle device, data, and analytics and value-based reimbursement models. How is your organization meeting this challenge?

We have really bolstered our corporate accounts footprint in the past few years for just this purpose.  Just one example would be how we are now working far more closely with the purchasing entities to help them understand not only their usage but also their buying patterns so we can both find a way to get to a nice win-win with regard to servce.

Frost & Sullivan: How do you maintain quality assurance with the fast-moving changes technology is bringing to healthcare and healthcare products and services?

We do this by having a rock-solid Design Control system.  Because the system stays at the “what must be done” level wherever possible, the teams all have great leeway to adopt (or discard) technologies and techniques that help them improve our products and services.

Frost & Sullivan: What is your biggest current challenge as Vice President, Quality Assurance?

Managing the complexity of our global businesses and trying my best to ensure that best practices and people are recognized throughout the entire network.  Also, as part of that recognition, making sure we keep our workforce motivated and current.

Seven Principles for Launching an Internal Corporate Innovation Team

By Mohan Nair
Senior Vice President, Chief Innovation Officer
Cambia Health Solutions






Many organizations create innovative solutions that dominate markets for some time going forward, but there comes a time when those organizations spend most of their time maintaining their leadership--and the  status quo--because they have become the organization to beat. This behavior, over time, becomes the very behavior that destroys innovative actions within the employee base. The mindset becomes, why rock the boat when there seems to be such smooth, successful sailing?  Few companies in this category behave differently. Unfortunately, these companies are often replacing themselves long before others do it to them.  

Innovating culture can take a long time to create and a few minutes to destroy because it is a fragile element of the vast enterprise value creating system.  Like the nervous system is to the human structure, this system functions independently from the bone structure but keeps it in motion at all times in its own way.  Innovation officers know this well. They tap into this system to generate ideas that turn markets and create the future in the present.

Seven Principles To Assist You In Designing Ideas That Turn Into Markets:

1. Find a Core Purpose or Reason for Being

Ideas can come and go but ideas for a greater cause fuel themselves. The era of taking orders is still around but fast losing steam in our new economy.  Build to change the way things are and you will find people who see the reason to join you.  The younger generation tends to place purpose over money in many jobs selections.  There are reasons finding meaning beyond yourself generates fuel for innovation.

2. People > Ideas

Innovation is always fueled by ideas in an objective-driven economy.  But in the next century, people will be the ones who take ideas to the future.  Invest your energy in people and the ideas will come. Why?  Because people will feel the value of corporations moving from output to the  people generating the output.  We often speak of the death of loyalty in corporations.  Be the opposite and win because loyalty comes with how you engage others in co-creating the future. 

3. Start Small, Think Big

Many innovation programs are launched with a lot of noise but they usually fall short of value creation. Instead, launch small but think big.  Small  budgets, big ideas.  Small  teams, big outputs.  More can always be done with less, especially when organizations can be shown how to get one thing done quickly.

4. Practice What You Preach

Innovation teams organize ideas, coach ideas into programs and also ensure that those ideas get noticed.  Few and more effective teams actually are the change they wish to create.  They build things, they create their own ideas as well as coach ideas; they are the very examples of what a leader should do.

5. Build Both Human and Technology Systems

Innovation teams who want to collect ideas immediately search for technology that crowd sources ideas and can graduate ideas with votes etc. This is a very valuable way to gain scale and challenge the enterprise.  This is half of the challenge.  The other half is the processes people go through to come up with an idea. How does the manager think about ideas being worked on in the first place?  Will someone share their idea if they get no reward for stepping outside the box?  These are small examples of the list of human system challenges that must be addressed and designed into or out of the activity of enterprise-wide innovation.

Operational ideas find a pathway while transformational ideas are killed to remove waste or variation because that is the goal of operational systems. So, we must live with two systems – an operational system and an innovation system.

6. Enable, Accelerate, Then Create

When I first took over as Chief Innovation Officer over four years ago, I was eager to produce shocking new solutions in healthcare.  I felt it was my role to disrupt the market.  My CEO gave me sound advice in my new role, and suggested I create a new paradigm of culture in the organization.  He advised me not to shock the system with the obvious angle of incidence expected but instead to be of service to others in their need to innovate.  I then began to enable others in their ideas and focused my team on “servant leadership” and being humble with our capability but audacious with our goals.  We now focus on helping others, accelerating a few to success and then creating the future rapidly.

To launch an innovation initiative, you should consider first helping and enabling others to think and do new things; then be the example to accelerate a big problem using the talents of your innovation team. Finally, you may consider designing and launching companies and products that open new markets.

7. Lead Down, Ideas Up

Many organizations that have succeeded enough to dominate markets get there through great leadership. The organization generally would acknowledge that leadership and creativity were essential to getting the company where it is.  Subtle but problematic is when the enterprise takes its lead from leaders and not from everyone else closer to the customers.  For innovation programs to succeed, they must be led top-down but enable ideas bottom up.  When everything comes top-down--including ideas and direction followed--we cannot redefine the future, we just live in the present without the collective attentiveness of the enterprise.

A culture of innovation in the enterprise has always been a competitive advantage.  But now more than ever, hyper-competiveness in the world of more unknowns than knowns puts incredible pressure on our ability to gather and harness insights into products or services.  Moreover, when an economy is propelled by more than money but also by purpose-driven motivations, new markets can appear while some are asleep at the wheel.  To stay awake and live the future, innovation must be practical and within the reach of all in the enterprise.

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Mohan Nair is Senior Vice President and Chief Innovation Officer at Cambia Health Solutions, Inc. in Portland Oregon.  He is author of “Strategic Business Transformation: The 7 Deadly Sins to Avoid” (Wiley: 2011. New Jersey)
For more information follow him at @mohanemerge 

(C) 2016 by Mohan Nair

Leveraging Technology to Better Navigate the New Healthcare Landscape

By Dennis A. Robbins, Ph.D, MPH
Creativity & Transformation Officer
KPN Heath






Better engagement is the key to getting people actively involved in their own health. Better engagement also helps people learn to better navigate the healthcare system. This, in turn, can help them make more informed, meaningful and astute choices.  To maximize this process we need to shift our thinking about engagement from the passive, subservient patient to focusing on engaging and activating the “person” to pursue a healthier trajectory.

“Persons” make choices and changes consistent with what is perceived to be of value, important, or meaningful to them.  We need to create strategies that give people information, support, and encouragement. This will help them to embrace changes that will make a healthy difference in their lives.

Sustainable engagement does and will not happen magically or easily. Our decades-entrenched tourniquets and temporary fixes while initially designed to change the trajectory of lifestyle-related diseases and their associated mortality are now failing us. This is exacerbated by how complex it is to navigate the healthcare landscape with agility and ease. For this, technology can be an immense resource.

Engagement is not a one size fits all solution for patients. Persons, not patients, initiate change, so we need to shift our focus from changing the patient to supporting the person.  Each person is different, so different ways to help nudge and engage and support him or her need to be available and deployed. Strategy is not dictated by populations, sex, race, ethnicity, size, or shape alone. The real trick is to sustain and transform an extrinsic motivation into an intrinsic one that creates a lifestyle change. In essence this is about adding years to our lives and life to our years!

Adopting a person-centric approach profoundly transforms how all our decisions (including those that are health-related) are made and who has the authority and ability to make them in a way that is consistent with our values, priorities, preferences, beliefs, and aspirations in the context of our broader life experiences.

Today, most individual solutions are fragmentary and still rely on very expensive and time consuming human-to-human interaction.  This approach is simply not scalable to the need, especially considering, listing just one example, the estimated 120,000,000 people in the U.S. with pre-diabetes and diabetes.
 

Virtual assistant technology, available 24/7, can be programmed in motivational interviewing techniques, interface with glucometers and wearables, interact with and actually control other apps, and use virtually any of the native apps on smartphones (GPS, the camera, etc).  Think about recording adverse reactions such as injection-site reactions and rashes, telling a person what the healthiest food is at a restaurant, and giving a summary of the past week’s glucose readings, calories eaten and steps walked – all in the context of goals reached and how the person performed in relation to others on his virtual team.

The goal is for a health-oriented lifestyle to replace the current disease-focused approach and for the person to be the key participant in his or her own health outcomes. It is now possible for each person to have his or her own health coach that’s always there to offer customized advice on diet, exercise and other lifestyle changes in a dynamic fashion in order to reverse decades of poor choices by presenting evidence based facts.

Studies have found that a virtual discharge nurse reduced hospital readmissions at the 30-day mark by 30%. In fact, 74% of participants in a hospital pilot-study said they would rather interact with an intelligent virtual assistant than an actual human being. In relation to behavior, a study of antipsychotic medication adherence showed an increase to 89% adherence with a virtual health assistant, versus the historic rate of 50%.

The technology is available, the knowledge is there, but do we have the will to step out into a new approach that will move us from healthcare to health?  Time will tell.  But, if my hunch is right, those companies that pioneer extending this technology to the masses will benefit financially for years to come.  And remember. It’s all about the person.


 

Regenerative Medicine: Could This Be Healthcare's Saving Grace?

 

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




Regenerative medicine is one of the fastest growing biomedical industries in the world because patients are being cured of diseases that were once incurable. Regenerative medicine represents a new paradigm in human health because the vast majority of treatments for chronic and life-threatening diseases focus on treating the symptoms, not curing the disease. In fact, there are few therapies in use today capable of curing or significantly changing the course of a disease. New regenerative medicine is changing this by engineering, growing, and regenerating tissues and organs using biological processes similar to those normally used in humans. There are already over 500 regenerative medicine products available on the market.

Figure 1 shows the current status of this treatment:



Knee Replacements will be Unnecessary in the Next Five Years
Cell therapy makes up over 60% of the regenerative medicine market, most of which is in the area of stem cell therapy. Adult stem cells can be used in the areas of cardiology; musculo-skeletal, including neurology; optometry; dermatology; cosmology; wound healing; and cancer. Stem cell therapy, when combined with immune and gene therapy, shows even greater potential to cure diseases. This new combination of regenerative cell therapies will open a new age of medicine, forever changing how it is practiced. For example, in the future, knee replacements may no longer be needed with regenerative cell therapy.

Regenerative medicine is not only driven by new evidence indicating these therapies are capable of curing diseases, but also by the fact that the world’s population is aging. In Japan, 25% of the population is over the age of 65. In the U.S., by 2030, 19% of the population will be over 65. By 2030, there will be more people older than 60 than younger than 10, globally. Today, there are fewer children under the age of five than adults over the age of 60. In addition, healthcare systems in many countries are burdened by costly treatments for their aging and increasingly ailing populations. There are few solutions for containing the rising costs of healthcare; therefore, countries like Japan are helping regenerative medicine companies gain a foothold with new products. In doing so, they are hoping to keep their populations healthier longer, thus reducing the cost of healthcare. 
 
Figure 2 shows the geographical activity in this space, with US leading currently:

 

In the U.S., there are hundreds of clinics offering non-FDA-approved stem cell interventions for a wide range of conditions. Clinics charge $7,000 to $10,000 per treatment, multiple treatments are often required, and no insurance coverage is available. The 2014 FDA guidelines indicate it will be necessary for clinics to offer stem cell therapy in order to have an approved Biological License Application (BLA). If the stem cell isolation procedure is “more than minimally invasive,” it may need to be licensed as if it were a drug. The following are companies with technology with the potential to innovate regenerative medicine:

• Orthofix International; Texas, U.S.A. company providing reconstructive and regenerative orthopedic and spine solutions
• BioStim; an electrical stimulation to enhance healing of the spine and neck
• VersaShield; a thin hydrophilic amniotic membrane to cover wounds and is derived from human placental layers amnion and chorion 
• COLLAGE™; a synthetic bone graft substitute product that has demonstrated biocompatibility and safety of collagen in over 10 million implants.
• Capricor Therapeutics; California, U.S.A. company focusing on the prevention and treatment of heart failure and heart attacks 
• CAP -1002; a leading product using cardiosphere-derived cells to treat post-myocardial infarction (heart attack), advanced heart failure, and Duchenne Muscular Dystrophy. 

Big Pharma Investments Big in Regeneration Medicine Big Pharma cannot be left out of this race. Many companies have become interested in regenerative medicine. Pharmaceutical companies are building relationships with innovating regenerative medicine companies.
 
Pfizer has created its own unit, Neusentis, in Massachusetts, U.S. Neusentis’ main focus is to develop cell-based therapies for age-related macular degeneration. Celgene and Teva Pharma Celgene has a 4.5% stake in Mesoblast to develop an Acute Graft Versus Host Disease (GVHD) program. Teva Pharma holds a 20% stake in Mesoblast and is a major partner in the Chronic Congestive Heart Failure (CCHF) program, in phase III clinical trials. Johnson & Johnson Johnson & Johnson invested 12.5 million in Capricor Therapeutics (CAPR) for support in a stem cell therapy program. The investment could increase to $325 million, depending on milestone attainment. The program has also received $20 million from the California Institute for Regenerative Medicine. Phase II trials for treatment of cardiovascular disease have been scheduled.

The global healthcare consumer demand for stem cell therapies is very high, with stem cell therapy tourism gaining popularity – mostly from the U.S. Globally, many stem cell therapies are not clinically proven or tested, with only a few resulting in positive clinical results. These international clinics are charging anywhere from $20,000 to $100,000 per treatment, and they are not covered by insurance. In most cases, more than one treatment is required. Transnational supply-side economics is driving the market; there is low regulation and multiple offerings for numerous conditions, with some being offered to treat life-threatening diseases. Regenerative medicine has the potential to ultimately change the way medicine is practiced throughout the world. 

This article was written with contributions from Jane Andrews, Ph.D., Senior Consultant with Frost & Sullivan’s Transformation Health Program. For more information on regenerative medicine, please visit http://bit.ly/1MWo63Y.