Improving Gender Diversity in Health Tech

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Image courtesy Healthegy

This article was originally published on Healthegy.com.

Last month, the seventh annual Rock Health Women’s Summit was held in San Francisco to promote gender diversity and support more women leaders in Digital Health. According to research from Rock Health, women are the predominant players in the health care marketplace. Women represent 78% of the health care workforce, make 80% of health care decisions in families, and represent 75% of all caregivers in the home. Their influence on health care is profound.

It’s strange, then, that women don’t have equal representation in industry, especially in terms of leadership positions. Women run only 6% of the companies in Digital Health. As it so happens, women also represent only 6% of the venture capital industry. (According to angel investor John Landry, who spoke last month at Capital W’s Boston Women’s Venture Summit, this number is even worse in Boston, with only 3% of VCs being women.)

The gender disparity in venture capital creates a barrier to achieving gender balance in the companies they fund, as VC teams with mostly men are more likely to invest in companies with mostly men. It’s been found that VC teams with women are two times more likely to invest in management teams with women and three times more likely to invest in companies with women CEOs.

Besides being equitable, from a business perspective, it’s also profitable to invest in companies with women on the executive team. According to Rock Health, start-up teams with women on the executive team raise more money than all-male teams during first rounds. Also, companies that have women in board-level leadership positions have been found to produce a greater return on investment.

Gender diverse companies also tend to have greater diversity in general, in terms of race, sexual identity, and sexual orientation. This is important to consider because employees these days – Millennials especially (now the largest generation in the workforce) – prioritize diversity at work. Millennials have a “remarkable lack of allegiance,” according to Lynne Sterrett of Deloitte Consulting, adding, “It’s a serious challenge to us as business leaders.” What has been shown to attract and retain Millennials is having shared personal values and a deep sense of purpose. According to Ali Diab, CEO of Collective Health, a company with a health care benefits platform, “There is a certain meaning, a certain sociological tapestry that Millennials want to feel when they come into the workplace. They want to feel like what they do has that social impact broadly speaking.” Diversity has been cited in numerous studies to be integral to creating a more inclusive work culture and has also been found to result in teams that make better decisions, perform better, and are more successful.

Events like the ones sponsored by Rock Health and Capital W last month help to spotlight success stories that can hopefully inspire others. One Massachusetts firm, Zaffre Investments, the investment arm of Blue Cross and Blue Shield of Massachusetts, and its managing director, Leah O’Donnell, were recognized at the Capital W Summit for being the investment firm with the highest ratio of women-led companies in 2014 and 2015. Six of the firm’s 10 companies are women-led, including Boston-based Ovuline, which has a fertility-tracking app.

Although progress is being made, change has been very slow. Terra Terwilliger from the Clayman Institute, who spoke at the Rock Health meeting, discussed the problem (in both men and women) of unintended bias, sharing an eye-opening study that demonstrated how removing gender from resumes can improve the chances of hiring more women. She challenged the audience to consider before hiring or not hiring an applicant to ask themselves if they, too, may have an unintended bias.

Ali Diab has solved this problem at Collective Health by instituting a 1:1 men to women hiring ratio. He shared that his inspiration for this was his personal experience, having been raised by a mother who worked. “I grew up in a household where my mom was a surgeon but my dad went to grad school, a PhD program, so I got to observe the power of having that sort of a professional female force in the house.” He went on to say, “I also got to observe all of the gender issues she had from her home country, which is in the Middle East … but also here in the US where she dealt with a lot of sexism. So for me it was a very personal thing, I just wanted to make sure we had women well represented because I just feel very passionate about it because of my mom’s experience.” Collective Health has been very successful with this strategy and has even managed to create an engineering team that includes 25% women, which is unheard of – “astronomical” according to Diab – in typical tech companies. Diab also shared that he feels Collective Health has seen the fruits of this hiring policy in the market as well.

Former VC partner Karen Boezi, now an investor with Broadway Angels, urged women to be more confident, speak up, and take more risks. She also encouraged greater investments in women, sharing her thoughts about how successful they can be. “Women, I think, can be very focused on ‘getting it done.’ They have their eye on the ball and they are very good executors, very good managers.” The panel was especially bullish about women with children, calling them “ruthlessly efficient.” In speaking about the positive experience of a small investment firm called Mission Bay Capital, which invested in her biotech company (among others), she said, “They’ve had nine exits so far, all led by women.”

Hopefully, as more people in Digital Health recognize the business advantages of having gender diverse teams in their firms, opportunities for women will continue to increase.

 

The Billionaire Doctor Who Plans to Cure Cancer

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Dr. Patrick Soon-Shiong (courtesy Wikimedia Commons)

Recently, I had the opportunity to speak to billionaire surgeon-inventor Dr. Patrick Soon-Shiong about his plans, both private and through the Cancer Moonshot 2020, to cure cancer.

Soon-Shiong, who made his fortune by founding and selling two pharmaceutical companies, has gathered a group of pharmaceutical companies, academic institutions, and insurers to spur cancer research and to attempt to make breakthrough gains by the year 2020. This effort dovetails with the Obama administration’s $1B plan to fund cancer research led by Vice President Joe Biden, whose son, Beau, recently died after a long struggle with brain cancer.

Soon-Shiong’s path to cancer research began while doing research for NASA that involved harnessing stem cells to make insulin. He stumbled upon a paper that reported that the binding of zinc to the blood protein albumin is what transposes it into pancreatic islet cells, enabling the production of insulin.  This discovery led to an “aha” moment.   “A light bulb went on. In fact you should feed the tumor, not stop the tumor.  And if you could take a nanoparticle of albumin and attach Taxol [a common cancer drug] at the core, then it [the tumor] would take up the albumin and kill itself, like rat poison.”  This revelation led to his creation of the cancer drug Abraxane, or albumin-bound paclitaxel (Taxol).  Abraxane is used currently in a wide variety of cancers, including breast, lung and pancreatic cancer. “To this day, oncologists don’t understand the mechanism of action of Abraxane,” he said,  “They think of it as another form of Taxol.”  According to Soon-Shiong, Abraxane works so well is because the binding to the blood protein albumin allows it to penetrate cancer tissues better.

Abraxane has had huge clinical and commercial success, but he says the path to getting there wasn’t easy.  Initially, after developing Abraxane, he approached large pharmaceutical companies but was unable to gain support despite showing that it had remarkable results in animal models.  He was forced to make the painful decision to leave a secure academic career to risk launching his own company.  His risk paid off.  He ultimately founded both APP Pharma and Abraxis BioScience to support his work.  In the end, APP Pharma was sold to Fresenius SE for $4.6B and Abraxis BioScience was sold to Celgene for $4.5B.  Then, in 2011, he founded NantWorks, a holding company with a portfolio of firms to pursue his diverse entrepreneurial interests.  One of these is NantHealth, a company that has developed a fully integrated digital health platform to collect and analyze genomics and proteomics data on cancer research patients.

Soon-Shiong, a bit of an heretic in the world of oncology, has ideas that veer from the traditional approach to cancer treatment.  One example is how he wants to harness patients’ natural immune abilities to treat their cancers.  “As we sit here speaking, we are creating 10,000 cancer cells a day.  And the natural killer cells in your body are monitoring it and killing it,” he said, “Cancer is a normal evolutionary process.  And guess how we’re trained as oncologists?  To give you the maximal tolerated dose of drugs to kill those natural killer cells that are protecting you, which makes no sense.  This is the dogma in oncology and even in drug development.”

He’d like to see drugs given at lower doses to cause what he calls “cytostress” instead of “cytotoxicity”.  The natural killer cells of our bodies look for cells that are under stress (by detecting distinct proteins and enzymes that are released) and then destroy those cells.  He suggests that chemotherapy should be administered at what he calls the “lowest effective dose” instead of the much higher “maximal therapeutic dose” typically given in clinical trials for cancer.  The lowest effective dose, he argues, won’t completely wipe out patients’ immune systems, and thereby allow patients’ natural killer cells to target “cytostressed” cancer cells.  He argues that this approach will revolutionize cancer treatment and lead to more cures and cites numerous personal anecdotes when this approach has worked for his patients.

Unfortunately, for the time being, he’s had a difficult time convincing oncologists and drug companies to move away from what he calls the “schizophrenic dichotomy” of treating with the maximal therapeutic dose that destroys natural immune function.

Another challenge to finding a cure for cancer, according to Soon-Shiong, is developing health IT systems to support cancer research.  “Cancer is really a rare disease,” he said, “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer.  So you actually need to create a collaborative overarching global connected system.”  He continued, “The problem is now you have the other obstacle to the advance of medicine and the cure of cancer…it is going to be bombastic, dogmatic IT.”  In order to solve this problem, Soon-Shiong is collaborating with other health IT experts in the Commonwell Alliance to facilitate the development of the digital architecture needed to support the interoperability of electronic medical records.

His critics question the sheer breadth of the projects he’s begun under his NantWorks empire, but Soon-Shiong seems too consumed with making his ideas a reality to worry about critics.  At a time when one might expect him to retire, he seems to be only just beginning. “At this point in my career, it’s just:  let’s show that there are patients that are alive.  Let’s show we’ve created less suffering in cancer patients and then expand it globally.”

How Jonathan Bush Plans to Build the Health Care Internet

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Jonathan Bush, the high profile CEO of athenahealth, has a grand vision of the future of health care and it involves building a “health care Internet.” In this world, primary care physicians are power brokers, connecting and referring patients to a cloud-based network of super-specialists that can care for patients regardless of their geographic proximity.

Primary care physicians will be able to find specialists anywhere in the country, even the world, with highly specific skills and knowledge for their most complex patients.

Patients will have the advantage of being cared for by doctors who have treated hundreds of patients just like them, instead of by doctors who may only see patients with their specific disorder a few times in their careers.

It sounds compelling, but in our currently disjointed system, it seems like a distant dream. Bush, in a keynote interview at the Digital Healthcare Summit in Boston, admits, “We’re sort of Star Wars 1 here in health care … So, ok, the market doesn’t work so well in health care, but what we want is a network.”

Moderator Brandon Hull challenged Bush a bit. At the conference, Bush shared a music video parody that ridiculed EMRs. Hull noted the video’s message that, “Doctors hate EMRs … The last I looked, you’re in the business of selling EMRs.” Bush agreed that what we currently have is far from what we want and pointed to the lack of a coordinated vision on the part of the government as a key factor.

He cited the rush to tie physicians and hospitals to electronic health record systems without supporting infrastructure as one of the reasons for the lack of interoperability. To get to his vision of a fully functioning software enterprise system, Bush recommends taking a hard look at our current situation. “With everything in life, the first thing that you want to do if you really want to live fully is to stare vividly and unflinchingly for a very long time at the awkward reality of your current situation and then you can look off to your right and see a beautiful world that you wish you were in.”

Considering the current tech challenges in health care, Bush takes a sympathetic stance on the plight of doctors. During the talk he shared the image of a painting that he takes inspiration from, called “The Doctor” by Sir Luke Fildes. In it, a pensive doctor sits at the bedside of an ill child. “This guy, to me, is on the edge of his humanity…” he shared. “And what I believe is that digital health represents the wicking away of the things … that don’t require this level of presence is the job of the cloud and is the job of technology.”

It’s a beautiful vision, but is it realistic or even attainable?

The brutal truth about health care today is that the pensive doctor now has a large computer screen between her and her ill patient. Bush admits that we’re far from the vision currently and admits that doctors’ documentation work has become “life-sapping.” His long-term vision, however, is to make this work automated and routinized, so that doctors can be more fully present for patients.

Bush notes with irony that currently 12 million faxes are sent between the IT systems of health care providers despite the overwhelming adoption of electronic health records throughout the health care system. Bush attributes the stimulus of the ACA with the wide but ineffective adoption of EMRs. Speaking of the stimulus, in his usual colorful manner, he said, “What did Keynes say? If you pay a 100 guys to dig a hole and another 100 to fill the hole, at least you get the ball rolling.” According to Bush, despite requiring the collection of meaningful use data, the government has built no infrastructure to actually receive and measure it. He went on to discuss how regulations just add additional complexity to the system, which when worked around, create “ridiculous absurdities” and additional bureaucratic drag.

Still, he feels there is plenty of room for innovation, which is reflected in the creation of athenahealth’s innovation arm, called MDP, or More Disruption Please. Through MDP, athenahealth provides investment and support to start-ups and entrepreneurs who share their connected health vision. “We think of health care as a few trillion dollar industry. It’s thousands of a couple of billion dollar markets, all masquerading as one thing … My thought with MDP is that what we need is thousands of companies with no cost of sale, no cost of implementation, that are very results oriented, maybe they almost morph between a vendor and a provider, and they kind of come together and focus on these thousands of industries and get a 10x return because you don’t have to put very much in and the cost of sale, of implementation, is so low because you have this backbone to plug into an app store, if you will, that you can start verticals.”

Besides improving care of individual patients with a powerful network of providers, Bush feels the health care Internet can also create a new opportunity to study diseases. Under our current system, it is difficult to get enough patients with certain diseases in one place in order to conduct a study with high enough power, but that could change with enhanced technology. He also sees an opportunity to better address population health, not just in those with chronic disease – which is a focus currently due to the high costs of care of these patients – but ultimately other groups of patients as well, and the ability to do this at scale.

One regulatory shift that Bush seems to favor is the emphasis on fee-for-value versus fee-for-service. He argues that risk-bearing creates a rich market with a large number of buyers and sellers, competitively innovating cheaper and better solutions. His hope, through MDP, is to help create this rich health care ecosystem. He asserts that it’s not athenahealth’s objective to build or be the storefront for all of these businesses, but rather to simply encourage their development.

This long-view of health care and investment in MDP places athenahealth ahead of the hundreds, if not thousands, of other EMR providers. It shouldn’t surprise anyone if someday the much-sought-after and elusive health care Internet is ultimately hosted on servers built by Jonathan Bush and athenahealth.

 

This article was originally published by Healthegy.

GV’s Approach to Healthcare Investing: An Interview with Dr. Krishna Yeshwant

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Please note:  This article was originally published on TechCrunch.com.

Healthcare investments — in particular, investments in digital health — are booming, and don’t seem to be slowing down. According to CB Insights, digital health funding hit nearly $5.8 billion in venture funding last year, surpassing the previous record of $4.3 billion in 2014.

One of the top venture firms, GV (previously known as Google Ventures), recently came out with their year in review, revealing that more than one-third of their investments are in the life sciences and healthcare. (They currently have $2.4 billion under management.) “I can think of no more important mission than to improve human health and global quality of life,” CEO Bill Maris said in a recent announcement.

One of the strengths of the GV life science and health investment team is having a diverse mix of PhDs and MDs as investors, including general partner Dr. Krishna Yeshwant. Yeshwant continues to practice internal medicine part-time at Brigham and Women’s Hospital in Boston, and credits that with helping to keep him in touch with the challenges facing healthcare.

I recently sat down with Yeshwant to talk about GV’s investment strategy.

Yeshwant started his career, interestingly, studying computer science at Stanford. From there, he helped found two tech companies, which were eventually acquired by Hewlett-Packard and Symantec. He could have successfully continued on his path in tech, but decided instead to go to medical school after his father became ill and needed a cardiac bypass. “I remember just being in the hospital thinking this is just messed up. There are so many areas for improvement,” he said.

He went on to pursue an MD-MBA at Harvard. During this time, he became involved in a lot of medical-device work, and even started a diagnostics company. This work eventually led him to work with Bill Maris at Google Ventures.

Thus far, one of GV’s largest investments has been with Flatiron Health, an oncology-focused technology company based in New York City. According to Yeshwant, the concept was developed by two former Google employees who received support from GV. “Flatiron is basically integrating EMR’s (electronic medical records) in the outpatient and hospital setting,“ said Yeshwant, “and it provides data back to physicians as well as aggregating data to aid with discovery and help with regulatory processes.”

Others have also recognized Flatiron’s enormous potential. Flatiron recently announced they received $175 million in Series C funding from Roche Pharmaceuticals. In addition to the funding, Roche plans to be a subscriber to Flatiron’s software platform. Their hope is to use the platform to identify and bring innovative treatments to market faster.

Yeshwant strongly believes in the need for more tech solutions in healthcare like Flatiron Health. “There’s a fundamental need for infrastructure. A single disease type of lung cancer is actually lots of diseases. Other more complex diseases are going to need more data sets, multisite trials, and we need to create infrastructure for that,” he said.

It’s hard to argue with him on that point. Massive amounts of biometric data are being collected in healthcare right now, but there aren’t nearly enough tools for storage, communication and analysis of that data. There’s a great deal of opportunity for healthcare startups that can specialize in data management and analysis.

Three such companies in which GV has invested in this space are Metabiota, which provides risk analytics to prevent and reduce epidemics; Zephyr Health, which uses global health data and machine learning to provide treatment insights to pharma and medical device companies; and DNAnexus, a company that helps companies store their genetic information.

“Once you’re in a world where you can scale up and down your computational analysis, you can ask lots of simultaneous questions of your aggregated data sets and that’s well suited to the cloud environment,” said Yeshwant. “We invest heavily in those spaces.”

Besides software-based companies, GV is investing in a diverse range of other types of companies in healthcare and the life sciences. One such area is the genomics space. Thus far, GV has made major investments in Editas, a CRISPR gene-editing company; 23andMe, which offers chromosomal analysis to consumers; and Foundation Medicine, a company that offers genomic analysis of various cancers.

Yeshwant also feels one of the biggest challenges (and opportunities) in healthcare is helping healthcare organizations shift from fee-for-service to fee-for-value. “That’s the direction we’re going,” he said. “How do we migrate big systems in that direction? That’s the fundamental question.”

GV therefore has made some significant investments in companies that are shaking up the traditional provider model, including the telemedicine company Doctor on Demand and the innovative primary care provider, One Medical Group. “Anything you can do to move healthcare from a high cost setting to a low cost setting is generally going to be successful in that model,” said Yeshwant. “Telemedicine is a good example of that. We have a company called Spruce Health which is essentially asynchronous care. Value based care is a big area for us.” (Spruce Health is a platform for dermatologic care.)

Yeshwant hinted that future projects may be in the areas of population health and chronic disease management, investment in companies that engage consumers directly and possibly even some work in women’s health. One thing’s for sure: We can expect more exciting things to come in 2016 and beyond for GV.

 

 

Walgreens: Investing in the Power of the Patient

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Thanks in part to Affordable Care Act reforms and the rise of digital health, patients now have more skin in the game, more health care tools at their disposal, and more information than ever before to take charge of their own health.

Dr. Harry Leider, CMO and Group VP of Walgreens, speaking on a panel at last week’s Digital Healthcare Innovation Summit in Boston, said health care providers must find a way to adapt to the schedules and demands of patients, who have more say over how their health care dollars – and their time – are spent.

“Traditional providers are learning that they [patients] are not willing to take a half-day off from work, figure out what to do with their kids, to get routine care,” he told the panelists. “People are busier, the information technology has made it easier to get solutions without having to spend a half-day somewhere.”

It’s no surprise, then, that pharmacy retailers are placing big bets on consumer-facing health care opportunities.

In the past few years, the pharmacy-services giant CVS Health has made big investments in this area, dropping tobacco sales, expanding its MinuteClinics, and also establishing a drug ad-herence program. Now with Walgreens’ recent announcement of its $9.4 billion acquisition of Rite Aid Pharmacies, it has effectively overtaken CVS to become the leader with 46.5% of the market to CVS’ 30.9% share.

But Walgreens is looking to get bigger on the back end as well. Also, just this week it announced an upgrade to their mobile app which improves its functionality and also expands their telehealth services to 25 states (previously available in only 5 states). Walgreens’ other health care investments hint at its level of commitment, including its partnership with controversial laboratory services company Theranos and a recent announcement that it has partnered with health information tech giant Epic to install that firm’s electronic health record software across all of its health care clinics.

Walgreens is banking on its huge presence to provide easy and convenient access to the next generation of health care consumers. “Everybody knows Walgreens,” Leider said. “We have 8,300 stores, 25,000 pharmacies, and over 1,000 nurse practitioners in our clinics.” He also emphasized that half of Walgreens are located in ethnically diverse areas, with a large number of especially high-risk populations, which gives them a unique opportunity to influence health care outcomes. “Take the average diabetic patient. Diabetes is an epidemic in our country, but especially among diverse populations. First of all, a diabetic, if they’re lucky, sees a primary care doctor two to three times a year. The average diabetic comes to our pharmacy counter 20 times a year. So the opportunity to provide systems that can solve problems is greater because of this.”

Walgreens has started a digitally supported Healthy Choices Program, which rewards consum-ers for walking, weighing themselves, logging blood pressure and blood glucose levels, commit-ting to smoking cessation, and setting other health goals. In addition, it offers digital health coaching, pharmacy checks, and even virtual doctor visits.

Roughly 800,000 people have signed up, Leider said. About 500,000, of those patients are sharing their personal health data with Walgreens. What the company has found thus far from its collection of these data is that engaged users (who are actively tracking their weight) lost an average of 3.3 pounds more than non-engaged users and 1 out of 6 lost more than 10 lbs. In addition, Walgreens found that its engaged users have overall healthier behaviors and better drug adherence.

Still, he’s not a blind advocate of digital health: “I don’t think digital health alone can solve the problems you’re talking about.” Leider insists that Walgreens is not trying to usurp the tradition-al establishment but rather be a resource to providers. “We really see ourselves as supporting traditional providers and adding value to the ecosystem. We’re not gearing ourselves up to do primary care,” he said. “So our strategy really is to provide a low-cost option for care and to partner with health systems and providers.”

Going forward, Dr. Leider would like to see a greater transition to value-based care. “Despite what everybody’s saying, most providers are still trying to keep the beds full and have the most number of visits. So, for all this tech to be funded and sustainable, it’s got to be the right envi-ronment to really reward people for staying well.”

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This article was originally published at www.digitalhealthcaresummit.com.  

Richard Parker on Global Payment Models & His Big Career Transition

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(Please note:  This article has been re-published from MedTechBoston.com.)

Richard Parker, former Chief Medical Officer at Beth Israel Deaconess Care Organization (BIDCO), is a man of many talents. In addition to working as a physician, medical director and board member at BIDCO, he has also worked as a political consultant.

Now, after working for the Beth Israel Deaconess Care Organization for more than 15 years, Parker is off on a new adventure – one he calls his most exciting yet: starting his own healthcare consulting company, Parker Healthcare Innovations. we recently sat down with him to hear about this career shift.

Q: Tell us about your work at Beth Israel Deaconess.

In 2000, I was asked to be the medical director for the physician organization and I agreed to do it if I could still see patients, so I was medical director 50 percent of the time and seeing patients 50 percent of the time. That was the beginning of a lot of learning about the business of medicine, pay for performance, contracts, how doctors are motivated, information technology, and EMR.

In 2012, we had the opportunity to apply for the Pioneer ACO. In the greater Boston area, there are 5 organizations that are Pioneer ACOs: BIDMC, Mount Auburn, Partners Healthcare, Steward, and Atrius Health. That was a very fast learning curve because previously we were just dealing with the commercial population, which was up to the age of 65; now, we had to add all patients over the age of 65 who were in this Pioneer ACO. It was a different game.

Older patients are not the same as younger patients. There is more illness, more chronic disease, more hospital admission, and so now, instead of thinking about patients one at a time (which is how we learned to care for patients in medical school), we had to think of populations of patients – about systems and public health. I had to think: What can we do to make our systems better so we are improving the quality of care for patients in tangible ways and decrease costs? And this is the irony and the conundrum: it is actually possible to increase quality and decrease cost at the same time.

That allows for the transition from fee for service (FFS) to global payments. In the FFS model, patients come in, we treat them, and we bill them; that compels more treatment, more admissions, more referrals. In the global payment world, we turn that 180 degrees, we say, ‘Okay, doctors – maybe hospitals – you have a budget. If you come in under budget, we’ll share the surplus with you. If you come in over budget, you’re going to write us a check.’ That is an extremely different financial model. So at Beth Israel, I was trying to figure out how to build the systems and then how to translate this message to providers.

Q: What kind of results have you had with the Pioneer ACO?

We’ve seen excellent results. In fact, the BIDCO Pioneer ACO was the leader in the Boston Market and we’re the third most financially successful Pioneer ACO in the country. We’ve seen a lot of success. By the second year, we saw results in terms of quality, cost and patient satisfaction.

Q: So, the big question: What motivated you to make the switch from that work to starting your own company?

Part of my motivation was waking up one day and saying, “I’ve been in the same place for 30 years.” I started as an intern at Beth Israel Deaconess and I’m now going to be 59 years old. I’m fortunate to be healthy and have a great family and if I wanted to do something different, this seemed like the right time to do it. With the success we have had at BIDCO, this would be a great time to use it as a launching pad to do something different.

Q: What is your vision for Parker Healthcare Innovations? What would you like to achieve?

The first part is assisting doctors, hospitals, and to a lesser extent, health plans, that are trying to make the transition from fee for service medicine to a global payment system. Some of the things I talked about earlier, the challenges, these are things I now know a lot about, through working with Beth Israel Deaconess for 30 years. The challenges exist in the areas of governance, information technology and care management. Though people often think about this as a financial enterprise, really this is an opportunity to improve systems of care and the quality of care.

For example, I started a nurse practitioner home visit program. The sickest now get a nurse practitioner visiting their homes monthly. Now, with the nurse practitioner making a home visit, we’re not seeing them in the hospital as much. Patients are healthier, happier, families are happier. This is a big win. This is a real obvious example of a systems approach to disease management.

There are certain diseases that we need to focus on in order to be successful. In the Medicare population, there are six: heart failure, diabetes, emphysema, chronic kidney disease, behavioral medicine, and palliative or end of life care. I anticipate helping groups of doctors, hospitals, and insurance companies in how to move in this direction because I know how to do it. Every system is different. There’s a lot to figure out and it’s not for the faint of heart to make that transition.

The other thing I’m doing in my company is giving a presentation on the topic of stress. My goal is to give this presentation to companies and to colleges because I feel that chronic stress has become a really enormous problem and I saw this when I was practicing medicine.

Q: What other trends do you see in the future? What else should the healthcare world be preparing for?

One colossal trend will be the demand for more value for money. There will be continued pressure on all of us to stop wasting so much. Healthcare costs are a big drain on the economy and businesses, whether you’re self-employed or you work for a big corporation, everyone is paying this colossal cost. The issue of cost in healthcare hasn’t been adequately addressed; it hasn’t been touched.

On a brighter note, I’m hoping that we’ll see more intelligent self-care, maybe leveraging technology. Technology is fabulous but only if used in a useful way. Hopefully with all this technology we can help people with self-care, around chronic illnesses, like weight management, stress, blood pressure control, diabetes. Hopefully we’ll see some really good things in that space.

I’d also like to see more care at home, less in the hospital setting. I consult to a home IV infusion company, called Soleo Health, and I think doing treatments for patients in the home is better, more comfortable and cost-saving.