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.

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

The Patient-Centered Health Record

By Peter Elias,  M.D.
Founding Physician
Family Health Care Associates




The other night I participated in a very useful Google+ hangout. The discussion focused on a subject I think is incredibly important: the patient-centered health record. Unfortunately, this topic is hard to discuss without drowning in technical terms and acronyms. I consider myself fairly tech-savvy and still struggle.

A (55 minute) YouTube video is here: Click here I think it is worth watching. But before watching it, consider reviewing the following basic information to help set the stage, first without tech terms or acronyms, and then repeated with some of the key jargon.

The current EHR model is that each office or institution owns and manages an electronic record that contains information about the patients in that system. Despite the obvious need and lots of talk, there has been little actual progress towards making these separate and mostly proprietary systems ‘interoperable’ and therefore able to share information. The result is that clinicians routinely work with incomplete or outdated information, patients are locked into their home system, and it is extremely hard for patients to access their own information in any meaningful or useful way. Care is less safe and less reliable, patients are prevented from actively managing their care, and clinicians are frustrated.

The model discussed in this video takes a different approach, one that appeals to me for both philosophical and technical reasons.

In this model:

The basic unit is a one-patient record unique to the individual patient.

• It is ‘open source’ meaning that the code is public, maximizing the ability to improve or modify it and create added pieces for new functions.
• This basic unit and its information are owned and controlled by the patient.
• This is where all the health and medical information about an individual patient is stored.
• It contains the most current, complete and up-to-date information.
• The patient has full access to their individual record.

• This patient-centered health record has a component that allows the patient to control access by others, essentially inviting their clinicians (or others) to see and use the information.
• Clinicians can access the system through their own software using one of two mechanisms:

• Using a straightforward process which gives them access to multiple separate patient records, and they work in the actual patient record.
• Using their proprietary clinician or institution owned system, which is linked to and synchronized with the patient’s individual record.
• In both cases, the ‘official’ version of the information is the patient-centered record, fully accessible to the patient.

• There are standardized connections between the clinician-based systems and the multiple patient-based records.

That was English. Now a version of the same information with some jargon:

• The patient has a record (EHR) to store his or her health information
• The patient has a record (EHR) to store his or her health information

• Ideally it is ‘open source’ such as NOSH (New Open Source Health Charting System) by Michael Chen.  Read more about this at https://noshemr.wordpress.com/.
• It is owned and controlled by the patient.
• It is where all the health information about an individual patient is stored.
• It functions as the ‘Source of Truth.’
• The patient has full access.

• The patient-centered record (such as NOSH) has a component that allows the patient to control who can see, change or use the information.

• This is sometimes called UMA (for user management and authentication).
• It has other names such as HIE of One (health information exchange of one).
• This is what allows the patient to manage who has access.

• Clinicians access the system through their own software using one of two mechanisms:

• They use a parallel open-source software system that has a list of the patients using individual patient records they have been authenticated to use.
• They use (work in) their institution’s proprietary system which is linked to and synchronized with the official patient-owned record.
• In both cases, the patient’s record is the Source of Truth and fully accessible to the patient.

• There are interfaces that make connections work.

• FHIR (pronounced fire) is the one talked about here.
• Other ‘application program interfaces’ (APIs) can be developed or used, especially if the system is open source.

There are several important considerations in a system like this:

• Open source improves security, adaptability, flexibility
• It is based on the assumption that patients should have full control over their health information according to their own needs, not just be given limited access by clinicians or their systems.
• If patients have full control over access to their health information, it goes without saying that they can access their own health information without either delay or barriers.
• It can be adopted incrementally rather than requiring the entire US healthcare system to turn a switch.
• Patients and clinicians can help us move from where we are now to a patient-centered health record system by:

• Understanding the concept.
• Being at least somewhat familiar with the terminology.
• And MAKING NOISE about wanting a system like this in their local setting.

Peter Elias is a family physician in Maine. He blogs at http://petereliasmd.com.

Pivoting Towards the Future -- Perspectives from the 21st Annual Medical Technologies: A Frost & Sullivan Executive MindXchange

By Venkat Rajan
Global Research Director
Visionary Healthcare
Frost & Sullivan



As I was flying into San Diego for the 21st Annual Medical Technologies: A Frost & Sullivan Executive MindXchange, it dawned on me that this would be my 10th year of participation in the event.  I thought back to 2006, when, as a recently hired analyst within our medical devices practice, I was able to head up the peninsula for the event which was then in San Francisco.  Despite being in the midst of having to revise months of research on the cardiac rhythm management device market due to the surprise announcement of the Guidant-Boston Scientific merger, I couldn’t pass up this unique opportunity to interact with a truly diverse group of strategy leaders across the industry.

Despite the changing topics and speakers, I think one constant over the past 10 years is that there is no better place to share ideas and learn from peers in the medical technologies industry than this event!

Because I never delete anything, I was able to pull up the agenda from the 2006 event. I thought it would be interesting to see how the issues and topics our industry is currently discussing have changed over the last 10 years. 

Among the key agenda items in 2006 were:

• Innovation and the Evolving Relationship Between Small and Large Companies
• Best Practices in Outsourced Relationships
• Best Practices in Account Based Selling
• Smart Strategies for the Changing Reimbursement Environment
• How to Win in Europe
• Driving Value and Loyalty via Physician Education and Training
• Competitive Product Differentiation and Technology Strategy

It’s amazing how some issues such as regulation and reimbursement are ever-present, while others which might have seemed like a crisis at the time quickly abate.

In fact, what was a very product-centric view of competitive strategies focused on technology iterations and advancing late stage treatment options in 2006 has now shifted to more preventative support tied to information and service based solutions.  That shift was reflected in the 2016 agenda, where we heard from thought leaders on subjects such as artificial intelligence, consumer engagement, new business models, data privacy, cyber security, wearables and the emerging retail healthcare environment.

That’s not to say that the need for product innovation is diminished. Keynote speaker Randy Hamlin, Vice President & Segment Leader, Philips Healthcare,
Was able to capture how ideation and innovation is occurring in different ways. The revolutionary Lumify technology that was covered in Randy’s talk required not just product innovation, but process innovation and business model innovation too. Failure to execute on any one of the three areas of innovation could have dramatically impaired this product from reaching the market or achieving sustainable success.

Another striking shift over the last decade has been the changing definition of ‘customer.’ Sales and marketing efforts that were primarily geared towards the physician and specialist have now shifted to the patient.  Dr. Peter Antall, Chief Medical Officer, American Well, brilliantly captured how a digital transformation that has disrupted other industries (transportation, social interaction, entertainment, hospitality) is now changing healthcare.  A care model that was historically built on the convenience of providers is now converted into one that places greater importance on the patient.  The premise he shared emphasized that telehealth was not necessarily a replacement to traditional care delivery, however a solution that could be integrated and enhance the ability of how and where care expertise can be provided.

One of the more provocative discussions was led by Alex Hurd, Senior Director, Product Development, Growth and Payer Innovation -- Health & Wellness, Walmart, who was able to lay out the retailer’s vision for becoming the front line of chronic disease and primary care in the US.  Intriguingly, the company’s concept of healthcare extends far beyond pure clinical services, and includes diet and well-being. In an industry that is moving towards more focus on population health, it is hard to argue that there is any other company in the world that employs or interacts with more people than Walmart. Expansion of the concept of retail healthcare creates market demand for new types of medical technology tools and support services.

An aspect of the event that I found fascinating was the sheer comprehensiveness of stakeholders across the entire healthcare continuum.  Panelists such as Bakul Patel, Associate Center Director for Digital Health, FDA, Dr. Jay Rajda M.D., MBA, FACP Medical Director, Aetna Innovation Labs and Dr. Maulik Majmudar from Massachusetts General Hospital were able to respectively provide context for how regulators, payers and providers view the potential impact of emerging technologies.  From the financing side, the Sand Hill panel had some intriguing perspectives on where Venture Capitalists view the greatest opportunities for market growth in Healthcare.

Change can be a bad thing when an industry is resistant to it or rigid in its approach, yet in the case of the medical technology industry, if the lively discussions and novel ideas I heard being discussed are reflective of the broader industry I foresee some truly exciting things in store for us.

Lastly, I would close with mentioning one of the more inspirational talks at the event, from Amy Dixon, Vice President, Glaucoma Eyes Organization.  She helped contextualize how the innovative solutions being explored impact patient’s lives on a personal level. One quote that stuck with me was her comment that, “There is no better time in human history to be a visually impaired.”  That is an interesting way to look at the diseases and conditions that afflict every one of us and our families.  It is astounding to think about what we can now do with medical technologies in patient care and disease management, as compared to the past. Outmoded care models that were inefficient and unreliable are giving way to novel approaches enabled by analytics and connectivity.

When I see you in 2017 for next year’s event, I would love to hear how some of the themes and topics covered this year impacted and were acted on by your respective organizations. Or, feel free to contact me at Venkat.Rajan@frost.com

Venkat Rajan, Global Research Director- Visionary Healthcare, Frost & Sullivan,
heads a global program focused on disruptions and transformations occurring within the healthcare sector. He delivers content via interactive analysis of ecosystem maps and diagrams, scenario planning, best practice case studies, market monetization  and models, and also addresses related topics in a converging marketplace.

Understanding Technology-Enabled Healthcare Solutions

Questions and Answers With:

Maulik D. Majmudar, M.D.
Associate Director
Healthcare Transformation Lab
Massachusetts General Hospital

By Patricia Stamas-Jacoby



 
You were recently a panelist on the Wearables: We Can Measure, But Can We Monetize? session at our Medical Technologies: A Frost & Sullivan Executive MindXchange event. Are there any insights you’d like to share? For instance, what business development opportunities do you forsee?

Thank you for the invitation…we had a really diverse group of panelists representing a lot of healthcare stakeholders, including insurance companies, healthcare systems, startup companies, consumer technology organizations, and the federal government. It was really interesting to see the opportunities and challenges from their unique perspectives.

For example, entrepreneurs are eager to find forward-thinking partners among payer and provider organizations to validate and implement their solutions. However, those organizations are getting overwhelmed with the inflow of "novel solutions” from the industry. It becomes obvious that they need a filtering mechanism for selecting promising products to actually test and implement. And the filtering mechanisms they typically use are traction and evidence.

However, without a strong collaboration between industry and healthcare delivery organizations, you get into a Catch-22 situation, where a company can’t build traction without pilots or contracts with their customer, and those customers are unwilling to sign contracts until they see solid proof of ROI via clinical trials. The federal regulatory bodies are also looking at healthcare organizations to test and validate these innovative solutions in an appropriate clinical environment to determine safety and efficacy. I hope the audience members walked away with a good understanding of the various challenges in scaling adoption of novel technology-enabled healthcare solutions, including wearables.

At the same time, the panelists strongly believe that there is a huge opportunity for technology-enabled solutions to disrupt the current model of healthcare delivery for consumers and patients. They key is a systematic and dedicated long-term approach to generating the necessary and relevant evidence base that will drive clinical adoption, regulatory approvals, and coverage decisions by payer organizations. Of course, that will take some time and significant resources. But, for it to happen in a timely and efficient manner, there needs to be a lot more conversation and collaboration around key clinical and administrative challenges faced by the various organizations.

For instance, what are the key pain points or “hair on fire” problems that these organizations are facing? Can they share some real-life examples or real-world data to demonstrate those issues? Could they sponsor open innovation competitions to solve those problems? I think by doing so, all parties will be very well aligned towards the end goal of solving real problems with real clinical or economic consequences and it will be much easier to prove the ROI for new products.

In addition to being a practicing cardiologist, you are also the Associate Director of the Healthcare Transformation Lab, (HTL) dedicated to improving healthcare through collaborative innovation. What projects are you currently working on that you find particularly promising or exciting? Any success stories you care to share?

We launched the Healthcare Transformation Lab in April 2014 with the mission of improving the experience and value of healthcare, for both patients as well as providers, through collaborative innovation. It’s still early, but we are thrilled with the progress and feedback we have received internally, from colleagues in various departments, as well as hospital administration.

The Lab has three major focus areas: open innovation, technology-enabled care delivery innovations, and clinical trials for technology validation. In regard to open innovation, we are really trying to understand and improve the culture of innovation within the organization. Over the past two years, we have organized “open innovation” competitions to engage the workforce (physicians, nurses, administrators, technicians, and researchers) within the MGH Heart Center.

In regard to technology-enabled solutions, we are experimenting with various use cases for telemedicine in subspecialty practices, such as cardiovascular medicine. We are also building a mobile application for patient navigation with the goal of improving the experience of multidisciplinary care visits. And finally, we are actively engaged in industry-sponsored clinical trials, including testing new diagnostic devices for heart failure and testing novel digital platforms for intensive lifestyle intervention for cardiovascular risk reduction.

The homepage of Healthcare Transformation Lab includes the statement “mobile devices need to be designed to integrate with the healthcare system more broadly.” Can you provide more detail on what you'd like to see happen and when you see that happening?

One of the many challenges facing companies developing technology-enabled healthcare solutions targeted at provider organizations is lack of an in-depth understanding of the inner workings of a large hospital system. First, there are a number of existing legacy health IT systems that physicians are using on a daily basis. Second, there are a number of new health IT initiatives that require physicians to spend more time on things that are not very intellectually stimulating or rewarding (such as clinical documentation and billing), as opposed to patient care. Finally, you have to convince the hospital administrators as well as the front-end clinicians of the value proposition (clinical and business) and incentivize each party to change behavior that will drive adoption of “yet another new technology ‘widget’.” I do believe that entrepreneurs and medical device companies are getting savvy about integration, interoperability, and business models.

One of the other founding guidelines of the Healthcare Transformation Lab is providing clinical input early. Why is this so important?

For the same reasons I mentioned above, we can’t have people building healthcare solutions in silos. It is not uncommon to see young, passionate, healthcare entrepreneurs go to conferences or ‘hackathons;’ hear pain points from a select few clinicians, and then go build a prototype product and bring it to a hospital for a pilot. They spend very little time validating the “pain point;” observing and confirming their assumptions and interviewing a diverse set of end-users in a diverse set of environments before landing on the actual need that is worth addressing.

As a practicing M.D., your thoughts on the advantages and possible pitfalls of emerging telehealth models? From a business perspective, your thoughts on the advantages and possible pitfalls of the telehealth model?

I am a strong proponent of new care delivery models; specifically those enabled by technologies that allow for synchronous and asynchronous communication without the need for an in-person visit in a traditional brick and mortar environment. I believe that a significant proportion of routine healthcare can be delivered efficiently and at high-quality using these new mediums (video visits or asynchronous communication via text or email), especially if you can leverage emerging diagnostics. There are a number of companies that are trying to prove out the business case.

What do you see happening in the near future for technology-enabled healthcare innovation?

The industry as a whole, the digital health industry, is maturing and undergoing some growing pains. I think entrepreneurs and investors realize that it’s relatively easy to build a mobile application or a wearable with some sensors, or even a data analytics platform, but trying figure out the exact clinical use case and demonstrate the value proposition that drives adoption by the customer (patient, provider, payer, pharma, etc.) is a lot harder.

Over the next 2-5 years, we will see a significant change in the rigor and maturity of healthcare technology companies. I hope there is a lot more collaboration between industry, academia, and payer-provider organizations to develop sustainable and scalable technology-enabled products and services.

Dr. Maulik Majmudar is a practicing cardiologist and Associate Director of the Healthcare Transformation Lab at Massachusetts General Hospital. He was also a Founding Member and Chief Clinical Officer at Quanttus, Inc., a venture backed startup that is transforming personal health via novel wearable technology that enables continuous physiologic monitoring. 

Dr. Majmudar also advises a number of other start-ups, leveraging his strong clinical training in internal medicine and cardiology. He enjoys teaching and lectures at Massachusetts Institute of Technology in areas of healthcare innovation & entrepreneurship, as well as medical device design and development.