A Peek Inside the Harvard Forum on Health Care Innovation

Prof. John Quelch discussing the Bloodbuy case study.

The Harvard Forum on Health Care Innovation, a joint collaboration between Harvard Business School and Harvard Medical School, was recently held in Cambridge, Mass, on April 15-16, 2015. This private, invitation-only event assembled an elite group that included HBS and HMS alumni and faculty, as well as other key opinion leaders in healthcare. Cara Sterling, Director of HBS’s Health Care Initiative, who organized the event, shared that the goal for the event was to provide an opportunity for “people from different sectors to come together and talk freely” in order to “spur innovation in healthcare.”

One key aspect of the event was the introduction of the finalists of the HBS-HMS Health Acceleration Challenge, a contest that was launched to seek innovative, early-stage healthcare ventures that have great potential for transforming healthcare.

Out of a total of 478 applicants, 18 were selected as semi-finalists; from those, four of the brightest were chosen as finalists to share a $150,000 Cox Prize. They’ve also had an HBS case study written about them, and each team presented and received feedback at this year’s Forum. The final winner will be decided in a year’s time, by identifying the startup venture that is most successful in disseminating and scaling their healthcare solution.

Look out for the great work of these four finalists in the coming year:

  • Bloodbuy is a startup that aims to improve the efficiency and price transparency of the blood supply market by matching blood centers and hospitals through an online, cloud-based platform. In a pilot program, this system was found to decrease hospital costs by 23% while also decreasing the risk of blood shortages and the waste of blood products.
  • The I-Pass Patient Handoff Program is a training curriculum developed by six clinicians to improve the exchange of patient information between providers that occurs at the change of a shift. A research study of this intervention, published in the New England Journal of Medicine, found that use of I-Pass led to an impressive 30% reduction in medical errors.
  • Medalogix is a predictive analytics company that has created a product to that can assist those in the post-acute care sector to better identify hospice-eligible patients. Through working with Medalogix, clients have been able to successfully increase transfers to hospice from home health care and decrease the number of live discharges from hospice.
  • Twine Health is a startup that has created a cloud-based, collaborative care platform of the same name that enables providers to partner with their patients through coaches to provide seamless care and support for the management of chronic disease. In a recent clinical trial, Twine more efficiently helped patients achieve blood pressure control, which resulted in cost-savings (versus the traditional model of care).

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In addition to the Health Acceleration Challenge finalists, there was also an impressive line-up of healthcare experts that shared their thoughts throughout the two days in keynotes and panel discussions. Below are some of the highlights:

Value in Healthcare

Speaker Peter Orszag, Vice Chairman of Corporate and Investment Banking and Chairman of the Financial Strategy and Solutions Group at Citigroup, discussed three major structural forces that he feels will have a major affect on healthcare quality and spending, including the shift to value based payments, digitization of healthcare, and the increased role of the consumer in healthcare spending. He also discussed three big unknowns and their future impact on the heathcare cost curve, namely: future policy changes, increasing consolidation of the healthcare market, and emerging healthcare innovation.

A Blueprint for the Future

Mark Bertolini, Chairman and CEO of Aetna, gave a keynote speech entitled “A Blueprint for a 21st Century Health Care System” in which he highlighted five key measures that hold promise to improve healthcare:

  • System re-design that enables lower cost, higher quality care with increased access
  • Sophisticated health IT systems
  • Care optimization, especially to coordinate care for the 5 percent for whom most healthcare dollars are spent
  • Aligning economic incentives with healthcare goals
  • Increasing patient engagement.

Employers as Innovators

In an engaging panel discussion, moderator Bryan Roberts, Partner at Venrock, discussed the growing role of “employers as innovators” with expert panel members Ellen Exum, Director of Benefits/Global Design and Strategy at IBM; Adam Jackson, CEO and Cofounder of Doctor on Demand; Brian Marcotte, CEO and President of the National Business Group on Health; and Derek Newell, CEO of Jiff.

There was a robust discussion regarding the use of wearables and other tools as part of wellness programs to increase engagement and compliance, and to hopefully improve outcomes. One example was Adam Jackson’s Doctor on Demand which, for $40 per telehealth visit, has been found to decrease costs, decrease absenteeism, and increase productivity and morale.

Focus on Neurologic Disease

In a discussion with William Sahlman, Professor of Business Administration at HBS, Deborah Dunsire, MD, President and CEO of FORUM Pharmaceuticals shared her company’s mission of tackling neurological disease. Costs to society due to neurologic disease are great, she argued, not just in terms of direct costs, but also indirect costs – and there should be increased focus in developing treatments for these disorders. One significant challenge is the lack of mental health advocacy, which is an obstacle to obtaining funding for research.

The “Retail-ization” of Healthcare

Speaker Helena Foulkes, President of CVS/Pharmacy and Executive VP of CVS Health, shared the key factors that she feels are driving the “retail-ization” of healthcare:

  • Excessive spending on chronic disease
  • Increasing number of baby boomers on Medicare
  • Rising use of the internet to research health information online
  • Growing numbers of employers with high deductible plans.

She also shared the initiatives that CVS has begun to help tackle these problems, which include drug adherence programs, a focus on patients with the greatest needs, and integrating digital tools.

Dr. Watson Will See You Now

Speaker Mark Megerian, Senior Tech Staff Member at IBM Watson Solutions, shared the exciting (and for some, frightening) prospect of using machine learning and predictive analytics to make clinical recommendations via IBM’s Watson program.

Trained at Memorial Sloan Kettering (MSK), Watson has been shown to be capable of making recommendations similar to MSK oncologists, with 97 percent accuracy, for breast, colon, rectal, and lung cancers. They are now scaling to include other types of cancers and also to involve other organizations.

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Closing remarks were given by Dr. Jeffrey Flier, Dean of HMS, who shared that he feels healthcare delivery innovation has been sorely lacking, and that HMS and HBS are now deeply committed to medicine and entrepreneurship. Harvard hopes to lead healthcare innovation in the future. From the look of this year’s very promising Health Acceleration Challenge finalists, it seems his wish is likely to come true.

This article was originally published on MedTechBoston.com.

Precision Medicine: Pros & Cons

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23 chromosomes (image from Scientific American)

This past week, President Obama announced a $215 million proposed genetic research plan, called the Precision Medicine Initiative.  According to the plan,  the NIH would receive $130 million towards a project to map the DNA of 1 million people, the National Cancer Institute would receive $70 million to research the genetic causes of cancer, the FDA would receive $10 million to evaluate new diagnostic drugs and devices, and finally, $5 million would be spent on tech infrastructure to analyze and safely store this data.

Not surprisingly, this announcement sparked some online controversy.  If internet pundits are to be believed, this plan is going to prevent you from ever finding a mate, an employer, get health insurance, cause us all to become part of a giant genetic experiment to tailor human beings, and will also put us into crippling debt and line the pockets of Big Pharma.  I’m not even sure I covered it all…The complaints ranged from reasonable to ridiculous.  The most amusing are the conspiracy theorists who are certain that Obama must be plotting a genetic apocalypse.

But, in all seriousness, I have to admit I have concerns as well, despite being mostly optimistic about this news.

Here are some of the exciting positives offered by the precision medicine plan:

  • New diagnoses:  We may finally be able to identify genetic causes of diseases that were previously unknown.
  • Prevention vs. disease management:  Knowing genetic risks ahead of time can help us to focus more on preventing disease rather than reacting after-the-fact, once the disease occurs.
  • Early diagnosis:  We may be able to detect diseases earlier and at a more treatable stage.
  • Protective genes:  Some people have certain genes that protect them against diseases or prevent them from “expressing” their bad genes.  Studying these differences may help us to learn how to protect ourselves against those diseases.
  • Drug development:  Therapies can be developed in a faster and more efficient way by targeting certain genetic problems, rather than using the traditional trial-and-error method.
  • Personalized treatments:  Treatments can be tailored to a patient’s unique genetic aberration and we can avoid giving treatments to patients that we know may cause adverse reactions or that will fail to work.
  • Population health:  We can study genetic patterns in populations of patients to find out causes of diseases, develop treatments, and find ways to prevent disease.
  • Healthcare costs:  There’s a potential to reduce healthcare costs if focus changes to prevention rather than treatment of disease and also if we can streamline drug development.

But, let’s also look at the potential downsides:

  • Data storage:  We already know that gene sequencing of an individual produces MASSIVE amounts of data.  The sequencing of a million people is going to produce unimaginable amounts of data.  How will we store all this big data and analyze it to make any sense of it?
  • Privacy/Security:  Is there anything more personal and vulnerable to cyber-attack than your genetic information?  I wonder if the $5 million allotted to this effort will really be enough.
  • Data relevance:  According to Obama, the data will be collected from 1 million volunteers.  That’s not a random cross-section of people in the US and may not represent the population adequately in order to make population health recommendations.  I’d argue that only certain types of people would sign up and other types won’t.  Would we miss certain disorders? Would we see too much of another disorder in a population of volunteers for this project?
  • Culture:  How do we prevent people from abusing this information and not using it to screen potential partners, deny insurance coverage, denying jobs?  How will this affect culture?  Will we be cultivating a different kind of racism, on a genetic basis?  Are we on the path to a real-life version of the movie Gattaca?
  • Ownership:  Who will claim ownership of this data?  Will it be the government?  I’d argue that this data should be owned by the individuals from whom it comes, but the experience of the genetic sequencing (now genetic ancestry) company 23 & Me is worrisome.  For the time being, the FDA has blocked the company from allowing individuals from having access to their own genetic information.  Will this change as part of the new initiative or not?
  • Drug/device industry:  Genetic research and development of treatments has been very promising and productive in the private sector.  How will government involvement affect research?  Will our governmental agencies work cooperatively with them or competitively?  Again, if the experience of 23 & Me is any indication, this is a real concern.
  • Healthcare Costs:  Yes, there’s potential to decrease costs, but there’s also potential in greatly increasing costs.  It’s no small feat to genetically map a population, analyze the information, store it safely and securely, and develop recommendations and treatments.

Part of me is excited about the potential and I think that it probably does take a huge governmental initiative to tackle and impact population health, but another part of me is concerned about government invading a space that is so personal and private and I wonder if it could slow down progress in developing life-saving therapies in the private sector.

What do you think?  Are you excited or nervous about President Obama’s Precision Medicine Initiative?

Innovation for All

Innovation-in-Healthcare

I was in an interesting discussion yesterday with some colleagues on Medstro (a social media site for doctors).  We were talking about the pace of innovation at academic medical centers, but the topic got me thinking more broadly about who is driving innovation in healthcare right now.  The short answer seems to be:  “everybody”.

Innovation happens wherever people are desperately trying to solve problems.  On a global level, we have organizations like the Gates Foundation pouring funding into research and innovation to help eradicate deadly diseases in underdeveloped countries.  On a national level, our legislators and President have brought about the Affordable Care Act in recent years in an effort to improve healthcare disparity, cost, and quality.  (I’m going to have to defer the final verdict on this for another blog post in the future…).  On the healthcare delivery side, in the life sciences, among employers and insurers, we see efforts to innovate and improve healthcare quality, access, and/or cost.  In private industry, we see the proliferation of healthcare tools–apps, wearables, and other devices.  And, lately I’ve heard about some of the most inspiring innovators:  patients.  Recently, I read a couple of stories about patients hacking their diabetes devices to better suit their needs and another story about patients’ families starting biotech companies to work on developing drugs for rare diseases that have been typically neglected by industry.

Healthcare is big business.  A recent study by Deloitte estimates aggregate US healthcare spending at $3.8 trillion dollars for 2013..!

So, the question is:  who should be working on innovations that improve healthcare?

Is it appropriate for our government to fund efforts (as they’ve done with the CMS Centers for Innovation) to develop new models of care?  Should it be left to insurers?  Employers?  Should improving healthcare be left to the experts, scientists and doctors at elite academic institutions?  What about private citizens with the deep pockets, like Bill and Melinda?  What about all the companies making those wearables?  Have any of these devices even been shown to be helpful?  Are people just wasting their time on all these devices and collecting all this useless data that will only drive their doctors nuts and cause them to just order more tests and drive up healthcare costs some more?  Is it appropriate for patients with their non-medical backgrounds to drive healthcare innovations?

Among doctors (and others), these are controversial topics.

I have my own opinion and it is this:  Everyone that identifies problems within healthcare (and feels inspired) should work on finding solutions.  I admit that this may not be a popular answer if your only goal is to reduce that $3.8 trillion bill.  But, I like to think that we can actually reduce healthcare spending…but the key is not to start with that as the primary goal in mind.  The primary goal should be to cure disease and to improve quality of life and longevity.  One never knows  where the next great revolutionary idea will come from (maybe from a kid in a garage jailbreaking his medical device)?  Maybe this idea will transform not just the health and wellbeing of individuals, but solve the healthcare financial crunch we’re in.  After all, if someone finds a way to solve the obesity epidemic, they will effectively decrease a host of other very expensive diseases, like diabetes, heart disease, and cancer.

What are your thoughts?  Should innovation in healthcare be democratized and open to all, public and private, expert or not?  Or should it be left to the realm of scientists and doctors, the experts in the field?