Open Innovation in Health and Food Policy

Subsidize the Salad Bar

I’m sorry I didn’t see this one earlier but thanks to Khanna on Health for spreading the gospel on a recent March report from CDC: The Effect of Price Reduction on Salad Bar Purchases at a Corporate Cafeteria. The study tried to determine the effect of reducing the cost of the salad bar in a cafeteria, reducing the price by 50% during March 2012 and analyzing sales data by month for February through June 2012. The study found that reducing the price of salad drove up consumption by 300%. Amazing.

This is exactly the type of choice architecture that is needed to help create a healthier population. In the context of a corporate office, this sort of nudge could have serious positive consequences in terms of reducing health care costs, especially when combined with effective wellness programs. Yet, at the same time, as Khanna astutely points out in his own work:

Health system leaders I met with last year all raised their hands when I asked if they had wellness programs and kept them up when I asked if they also sold sugar-sweetened beverages in their cafeterias at highly profitable prices.  The irony was completely lost on them.  They had to be walked through the inconsistency of telling their employees to take (worthless) HRAs and biometrics, but then facilitating access to $0.69 22 oz fountain sodas.

This is the type of nudge that Bloomberg attempted here in New York City with the ‘soda ban’, but of course that was government dictating the choice architecture and not the employer. Regardless of who is doing it, subsidizing healthy foods makes all sorts of sense, especially in light of the fact that so much of the unhealthy choices are already severely subsidized. Soda is cheap because corn syrup is cheap because the US government subsidizes it. Leveling the playing field for healthy food should be an easy solution, but of course it is not. Corporate cafeterias are run in a way that incentivizes putting the soda machines in front while hiding the water or lowfat milk in back. However, if all the dots could be connected, corporate leaders would realize that the long-term benefits of helping keep employees healthy far outweigh the short term gains in the current paradigm. Who is paying attention?

Digital Advance Directives: Bringing End-of-Life Issues into the 21st Century

In a country that glorifies youth and tends to usher its elderly into nursing homes, death, dying, and the suffering they can entail are often ignored until it is too late for families to have important conversations about end-of-life care. Conversations about end-of-life care are important to initiate sooner rather than later so that families are equipped with valuable tools and information about their loved ones’ wishes should the unthinkable happen. The cases of Terry Schiavo and Nancy Cruzan illustrate how devoid of options the healthcare system and legal system can be when a person is no longer able to make decisions about their health and a family finds itself at odds (internally or with the state) over what choice is best. For this reason, Advance Directives─written instructions regarding medical care preferences─help to clarify a dying person’s wishes even if they are unable to speak or otherwise express their wishes.

While only one part of the picture, the amount of money spent on end-of-life care is staggering. As Atul Gawande points out in his article, Letting Go,  “Twenty-five per cent of all Medicare spending is for the five per cent of patients who are in their final year of life, and most of that money goes for care in their last couple of months which is of little apparent benefit.” To put it another way, in 2009, Medicare paid $50 billion just for doctor and hospital bills during the last two months of patients’ lives, more than the budget of the Department of Homeland Security or the Department of Education.

Part of the equation for reducing the cost of healthcare in this country is to eliminate unnecessary care. Right now, half of Americans still die in hospitals, despite numerous studies revealing a preference for dying at home. According to a recent Time/CNN poll, seven out of ten Americans say they would prefer to die at home. According to the Centers for Disease Control, only one out of four does so. A step in the right direction does not mean denying care to those who want it. But it is crucial to have an educated population that isn’t afraid to face tough questions like, “do I want to die in a hospital bed or at home?”

Currently, resources exist that outline the necessary steps one needs to take to ensure delivery of dignified end-of-life care. However, there is a great need for making it easier to access Advance Directives. Each state has its own laws regarding advance directives, making it difficult to establish a stream-lined process for completing this document. While the National Hospice and Palliative Care Organization has compiled pdf’s of all 50 states’ forms, there is no reason why machine-readable copies should not be made available by the states. While there is nothing wrong with filling out an Advance Directive by hand, in this day and age, having the ability to fill out such a form on the computer seems obvious. Digitization would help facilitate the next step in the process to ensure all families are not only talking about end-of-life care, but also putting to paper the necessary provisions that reflect their wishes.

 

 

 

 

Health 2.0 and the City as Unit of Health Measurement

Health 2.0, started in 2007, promotes, showcases and catalyzes new technologies in health care. They do this by convening health/tech conferences and sponsoring code-a-thons and prize challenges and have proven to be a leader in the field of health tech innovation.

Just this past week, they launched a new conference, Health:Refactored. Billed as the first "code and design focused conference", Health 2.0 brought together some of the best talent in the field to examine different health APIs and discuss the big question in health: how can technology bring healthcare costs down and help healthcare quality go up.  Bryan Sivak, CTO of the US Health and Human Services gave the first day’s Keynote and Sean Nolan, the chief architect for Microsoft’s Health Vault gave the second day’s keynote. However, there was one panel in particular that I would have loved to see, Esther Dyson’s "Data Liquidity: Theory and Practice". Esther is a former Wall Street technology analyst  and now a leading angel investor, entrepreneur, philanthropist, and commentator focused on breakthrough innovation in healthcare, government transparency, digital technology, biotechnology, and space. She is currently focusing on preventive healthcare.

While I missed the conference, fortunately, Scott Mace at Healthcare Leaders Media has an excellent post on what Dyson talked about. It was fascinating and exhilarating to learn that Dyson and others are looking to create city-wide ecosystems of health incentives. In many ways this fits into projects like NYU’s CUSP in New York which is looking to measure cities and use ‘urban informatics’ to help cities become more productive, livable, equitable, and resilient. Dyson’s HICCUP,  (Health Intervention Coordinating Council) is proposing to do that for health. As Mace writes:

Imagine a city where people bent on unhealthy living encounter a series of interventions at their work, home, local eateries, and schools. Where healthful food is subsidized and a few extra-fatty meals are zapped from the local restaurant menu. Prize-laden contests would motivate citizens to be physically active. And technology would measure it all, from the activities and rewards to population's health indicators. 

Dyson’s initiative, already unfortunately rejected by the X-Prize Foundation will look to capitalize on the Measured Self explosion by seeking supporting from body-sensor companies like FitBit. Says Dyson, "If you give us your thing for free, we'll give you a population of 80,000 and we will promote it very heavily, and try and get everybody in town to use it.” Considering the body sensor movement is still in its adolescence, it’s hard to say whether this would be a winning proposition for them. However, given that there are so many devices on the market, it could be a way to create long-term brand loyalty.

Measuring and incentivizing healthy choices at the city level is complicated and expensive proposition. And yet, it might just be the right unit of measurement to create a generation of urbanites who are healthier and more productive in the long run because of it. I will be following HICCUP closely in the months to come.

 

 

REVISED:: Thinking About Collaboration, By H. Skolnick

Thinking About Collaboration, By H. Skolnick

The benefit of connecting people to their communities lies in the creation of an engagement positive feedback loop. When individuals feel like they are part of something greater than themselves and they see the positive results that come from the collaborative partnership they are more inclined to immerse themselves in an array of civic activities. With more brains at the table the result of collaborations are proven to be better than that generated by an unaffiliated professional or bureaucrats that are too far from the issue to adequately assess the situation, the needs of those it impacts or the best strategies and solutions to purge the problem in sustainable ways.   

Through working for the federal government at the congressional district level I have noticed that most of America’s government institutions are ill equipped to respond to larger constituent issues or citizen generated ideas for development. The federal casework system for example is adequately designed to assist constituents with their specific IRS, INS and Medicare issues, but falls short in terms of ability to adequately respond to innovative ideas for improving life in their communities or solving greater issues of community importance. In Steven Johnson’s book, Future Perfect, collaborative peer networks are identified as a practical structural reality and solution for solving problems. Peer networks are identified as a new institution that can exist alongside the government and the state, corporations and the larger marketplace. They can be established via the Internet on the high tech spectrum or through face-to-face interactions in the real world.

Johnson is right to frame his argument on collaborative peer networks as a political discussion because without appropriate infiltration and acceptance by existing predominant institutional structures, peer networks will fail to gain footing in societal problem solving. Peer networks ideally emerge from and thrive on public or privately sponsored platforms; where collaboration is not just on the peer level, but also occurring between the institutional structures. What Johnson calls the power of “creative networks of cooperation” tears down the walls between consumer/constituents, non-profits, for-profits, the government… allowing these sectors to do what they do best while responding to the concerns and interests of the individuals that are directly impacted by the decisions, policies and products they produce.

Essentially, peer networks put people back at the center of governance. Platforms are established, maintained and conducted by government and nonprofit institutions, but the inputs, the issues, solutions and strategies are garnered at the bottom. Government no longer imposes their ideas on citizens; instead the people determine and guide the priorities and actions of their leaders. Peer networks really serves as a means for representatives to hear and address the interests of those they represent whether it is through funding the priorities established by local communities as a result of participatory budgeting or identifying the locations of pot-holes around New York City via 311.

Johnson’s example of the positive deviance Save the Children case study demonstrated the benefits of using peer networks to solve community issues in a bottom up way. The issue at hand was childhood malnutrition in rural Vietnamese communities and the aim was identifying a sustainable solution and strategy from within the locale, as oppose to from above (i.e. a development best practice). Jerry and Monique Sternin entered the community and found children who were well nourished. They identified a strategy to address the issue of malnutrition by recognizing the practices of these positive outliers in the community and had those community outliers present the methods for nutritious diets to their peers. Johnson also highlights the importance of diversifying and decentralizing collaborative structures to identify the best problem solving solutions and approaches.

The positive deviance example supports the idea of using peer-networks in a low-tech, community based environment. When a community is experiencing a problem, who is better at identifying the crux of the issue and viably sustainable solutions than the people who will be utilizing and benefiting from them?

 

REVISED:: Nesta's People Powered Health Program: Peer Networks and Long-Term Health Conditions, By H. Skolnick

Nesta's People Powered Health Program: Peer Networks and Long-Term Health Conditions, By H. Skolnick

While many problems can be solved with big data and technology, many community issues can be resolved with simple collaborative solutions. Nesta, an independent non-profit in the United Kingdom that provides investments, grants and assistance in mobilizing research, networks and skills to individuals and organizations with early stage innovative social venture projects, identified a plethora of issues surrounding individuals with long-term health conditions. As the population gets older and struggles with conditions manageable and preventable by lifestyle, establishing community and or neighborhood-centered support systems may be the future of health education and planning.

Nesta’s People Powered Health Program is supporting peer network solutions to supplement traditional health services for individuals with long-term health conditions. My favorite example of a People Powered Health Approach is the innovation that connects newly diagnosed individuals with a neighbor in their community that has the condition under control and can support the newly diagnosed person in doing the same. This is an example of empowering people through enabling them to use their skills to serve and assist members of their local community in ways that are essential to maintaining good health and sustaining a positive quality of life. While technology can certainly enhance connecting neighbors through the use of GPS, the program can just as easily connect (especially older) individuals through more traditional means such as advertisements in local community centers and via referral/recommendation from doctors and other health professionals.

People Powered Health initiatives chosen for the program sought to give individuals with long term issues more control over their lives, while recognizing their experiences and seeking their contribution through peer support. These teams received monetary aid and support to develop their ideas to a deliverable and replicable level. They received project specific support in collecting evidence on their effectiveness through developing local business cases, to bring their ideas to scale. The teams partnered with communities to develop locale-specific strategies to bring their innovative ideas to fruition. Most program solutions transcended traditional services delivery models, establishing support communities made up of patients, neighbors and health professionals committed to realizing the potential of peer driven support networks.  

Peer networking solutions will enable community members to create relationships that successfully address the issues that plague their locale. In the case of the health system, specifically addressing long-term conditions, there is a gap after being diagnosed and advised on how to tackle and control the condition. Adding another layer to the health or social service system will simply make it more expensive. Peer networks are an alternative platform for meeting individual needs in an informal way, which simultaneously builds neighborhood trust, interaction, and inadvertently, civic engagement.  

 

 

Addressing the Diabetes Epidemic with Data Design Challenges, By H. Skolnick

Sanofi is a drug company that takes corporate responsibility seriously. Its vision seeks to move beyond selling healthcare products they promote a healthy way of life and aim to prevent existing and future healthcare issues. Sanofi has proven dedicated to their vision through their innovation challenges. Partnered with Health Data Consortium, a collaboration among government, non-profit and private sector organizations that fosters availability and innovative use of data to improve health and health care, and Luminary Labs, Sanofi sponsors the Data Design Diabetes Innovation Challenge, which calls for start-ups to deign data-driven solutions to the diabetes epidemic, which impacts 8.3% of the American populations and with a price tag of $245 billion in 2012 alone. Start-ups are incentivized by a $100,000 prize with finalists given the chance to present at Demo Day at the Health Datapalooza in Washington D.C. The theme of this year’s challenge is using open data to fuel the tools needed to make the right decisions, with the right information, at the right time to improve diabetes in the United States.

The five finalists chosen to continue in the competition were announced at the 2013 TEDMED after being judged based on the ‘solution’s ability to demonstrate evidence based outcomes, provide a data-driven tool to members of the healthcare ecosystem, enable data-driven decision-making and utilize the latest methodologies in the field of data science to achieve these ends.’ Finalists were paired with expert mentors (from Luminary Labs) to help refine their concept and produce their prototype for their demo presentation and final judging. These finalists include:

AllazoEngine: Designed by Allazo Health, a healthcare analytics company that solves the problem of medication non-adherence for people with diabetes. The innovation leverages existing member data to anticipate which patients will not take their medications and predict the most effective interventions to influence each of those patients to take their medication.

Connect & Coach: A product of the software development firm PHRQL, which calls itself the first clinical and consumer application that enables dietitians and diabetes educators to perform Diabetes Self-Management Education and Medical Nutrition Therapy in local communities- namely via supermarket and pharmacy usage.

GoCap: Is a high-tech replacement cap for pre-filled insulin pens that can read dose amounts and time, which can be communicated to cell phones and glucometers. This data can be used for personal learning and disease control, high-level trend analysis and population-level analyses to help healthcare at the organizational level.

MediSapien Diabetic Clinical Data Repository: Created by ZyDoc, this program is an enterprise analytics platform that enables users to deposit unstructured data for transformation into fully-coded structured data.

Nuduro: Using learned preference technology used by Pandora, this innovation provides home and on-the-go meal recommendations that match individual taste and lifestyle with their unique nutritional needs.

            The 2012 Data Design Diabetes Innovation Challenge winner Ginger.io provides evidence that challenge winning innovations are not soon forgotten apps having raised more than $8.2 million before the end of the competition year. As health care becomes increasingly expensive and inefficient, the need for innovative ways to address the world’s health issues gains in importance. Pharmaceutical companies, hospitals, and other healthcare providers can learn from Sanofi’s example: though the business of health is a profitable one, it has a mandate to evolve to fit the needs and priorities of the population, feasible through the use of big data and tech in an “accountable care” framework. 

Anticipating the Possibilities for Feeding the World with 21st Century Technology, by H. Skolnick

Exciting steps are being taken to use technology and open data to address issues in the realm of agriculture to benefit global food security and nutrition. Reconvening after the G-8 and African leaders were brought together by the 2012 Camp David Summit, which resulted in the collectives’ commitment to the New Alliance for Food Security and Nutrition, the 2013 G-8 International Conference on Open Data for Agriculture is set to embark for Washington at the end of April. Leaders are focused on strengthening the virtual agri-community by sharing data relevant to agriculture as a means for leveraging public research investment, driving innovation and fueling economic growth in global agriculture.

Essential to sustainable development, which prioritizes both global and local stability, are innovations, which help not only the big agri-corporations that invest in the development of global agriculture, but also the farmers and local populations. If data and technology are simply established to progress corporate food companies and establish new markets for their patented seeds, the sustainability of global food security established through “big food” will be subject to the viability of corporate agri-practices (read strong reliance on oil, ever rising food prices, environmental problems tied to mono-cropping and super-resistant pests and weeds due to the excessive use of antibiotics and herbicides), which may not equate to enhanced nutrition and a long-term food security.

An article published by The Guardian earlier this year shows successful uses of mobile apps (ICT tools) in data collection and monitoring and evaluation (M&E), which have improved efficiency in agricultural and rural development. One example is M-Farm, an innovation that enables Kenyan farmers to access real-time market information (namely agri-retail prices) through mobile-texting. Farmers can connect to buyers via M-Farm’s marketplace, empowering them with bargaining power and eliminating middlemen from under valued price setting. M-Farm should be used as a model at the Conference; pointing to the importance of open data and technological advancements that help farmers directly. These innovations can help develop agricultural practices from within by using local know-how and enhancing regional expertise to address the issues hindering the sector.   

Technology, open data and collaborative innovations have been central to advances in agriculture and what happens at the upcoming G-8 Conference for Open Data in Agriculture will guide the scope of future advancement. While this use of data may prove corporate agri-practices are beneficial in realizing food security goals, the G-8 and involved partners should assess value of local knowledge and peer progression and ensure that the data being opened is actually helpful, accessible and usable for farmers in practice.      

As a platform for communication, Twitter can serve many functions. In the healthcare world, it’s unsurprising that people interested in health technology flock to this tech-based platform to share ideas and communicate with others in the health IT crowd. However, it’s not just health data analysts who are using twitter for health-related conversations; it’s patients and doctors, journalists and health entrepreneurs. Twitter has created the possibility of two-way communication between experts and novices and has helped to build global health communities. In fact, over the past 6 years, there have been over 170 million healthcare related tweets.

But how do you separate the signal from all the noise? This is a curatorial dilemma that all Twitter users face; there’s tons of data and tons of silly tweets. One option is to follow a few influential voices in the field, letting them guide you to relevant news stories, videos or trends. Another option is to search out hashtags of interest like #cutekittens or #diabetes. To this end, the consulting firm Symplur (motto: connecting the dots in healthcare social media) has come up with a useful and user-friendly way to capture the signal you want with their Healthcare Hashtag Project.

The project serves as a twitter aggregator for healthcare related topics, simplifying the search for relevant conversations on twitter, and showing trends on everything from specific diseases to healthcare conferences. Symplur clearly defines the goal of the Hashtag Project “to assist patients and providers with finding and connecting with peers and thought-leaders and start their journey into the world of healthcare social media.” If you are curious who is talking about a specific topic on twitter, #mhealth (mobile health) for example, the project will give you a list of the top influencers, a live feed of recent tweets and visualizations showing how the topic is trending overtime.  One function of the project that is particularly intriguing is the ability to segment out a specific point in time and read what people were tweeting about a topic. This allows, for example, a company to see how a news item spread across Twitter and what the subsequent reaction was from the healthcare community in the week after a product launch.

Symplur is not the only company looking to create value through social media analytics.  Datamnr, a New York-based startup is currently servicing financial firms and municipal and federal government entities to “transform social media streams into actionable signals.” This means extracting real time twitter information to get a jump on events that could influence the financial market or save lives in an emergency. Both Datamnr and Symplur are built around capitalizing on the Twitter phenomenon specifically and social media in general.  Symplur offers a suite of tools for building a social media presence for healthcare companies or even individual physicians. And while a cynic might say the Hashtag Project exists to generate clients for Symplur, it actually does much more than that. It’s a transparent and free service that allows anyone to dive into the healthcare space on Twitter. It's a highly useful entry point to understanding conversations in social media around diseases, technologies, and innovation in health. 

Posted by Noah Isaacs

Nesta's People Powered Health Program: Peer Networks and Long-Term Health Conditions, By H. Skolnick

While many problems can be solved with big data and technology, many community issues can be resolved with simple collaborative solutions. Nesta, an independent charity in the United Kingdom that provides investments, grants and assistance in mobilizing research, networks and skills to individuals and organizations with early stage innovative social venture projects, identified a plethora of issues surrounding individuals with long-term health conditions. As the population gets older and struggles with conditions manageable and preventable by lifestyle, establishing community and or neighborhood-centered support systems may be the future of health education and planning.

Nesta’s  People Powered Health Program is supporting peer network solutions to supplement traditional health services for individuals with long-term health conditions. My favorite example of a People Powered Health Approach is the innovation that connects newly diagnosed individuals with a neighbor in their community that has the condition under control and can support the newly diagnosed person in doing the same. This is an example of empowering people through enabling them to use their skills to serve and assist members of their local community in ways that are essential to maintaining good health and sustaining a positive quality of life. While technology can certainly enhance connecting neighbors through the use of GPS, the program can just as easily connect (especially older) individuals through more traditional means such as advertisements in local community centers and via referral/recommendation from doctors and other health professionals.

Peer networking solutions will enable community members to create relationships that successfully address the issues that plague their locale. In the case of the health system, specifically addressing long-term conditions, there is a gap after being diagnosed and advised on how to tackle and control the condition. Adding another layer to the health or social service system will simply make it more expensive. Peer networks are an alternative platform for meeting individual needs in an informal way, which simultaneously builds neighborhood trust, interaction, and inadvertently, civic engagement.  

 

Thinking About Collaboration- Specifically Peer Networks in Health, By H. Skolnick

Through working for the federal government on the district level, as they currently exist, many of America’s public institutions are ill equipped to respond to larger constituent issues or ideas for development. The federal casework system is adequately designed to assist constituents with their specific IRS, INS and Medicare issues, but falls short in terms of ability to adequately respond to innovative ideas for improving life in their communities or solving greater issues of community importance. In Steven Johnson’s book, Future Perfect, collaborative peer networks are identified as a practical structural reality and solution for solving problems. Peer networks are identified as a new institution that can exist alongside the government and the state, corporations and the larger marketplace. They can be established via the Internet on the high tech spectrum or through face-to-face interactions in the real world.

Johnson is right to frame his argument on collaborative peer networks as a political discussion because without appropriate infiltration and acceptance by existing predominant institutional structures, peer networks will fail to gain footing in societal problem solving. Peer networks ideally emerge from and thrive on public or privately sponsored platforms; where collaboration is not just on the peer level, but also occurring between the institutional structures. What Johnson calls the power of “creative networks of cooperation” tears down the walls between consumer/constituents, non-profits, for-profits, the government… allowing these sectors to do what they do best while responding to the concerns and interests of the individuals that are directly impacted by the decisions, policies and products they produce. Essentially, peer networks put people back at the center of governance. Platforms are established, maintained and conducted by government and nonprofit institutions, but the inputs, the issues, solutions and strategies are garnered at the bottom. Government no longer imposes their ideas on citizens; instead the people determine and guide the priorities and actions of their leaders. Peer networks really serves as a collective action means for representatives to hear and address the interests of those they represent whether it is through funding the priorities established by local communities as a result of participatory budgeting or identifying the locations of pot-holes around New York City via 311.

Of Johnson’s examples, the positive deviance Save the Children case study demonstrated the benefits of using peer networks to solve community issues in a bottom up way. The issue at hand was childhood malnutrition in rural Vietnamese communities and the aim was identifying a sustainable solution and strategy from within the locale, as oppose to from above (i.e. a development best practice). Jerry and Monique Sternin entered the community and found children who were well nourished. They identified a strategy to address the issue of malnutrition by recognizing the practices of these positive outliers in the community and had those community outliers present the methods for nutritious diets to their peers. Johnson also highlights the importance of diversifying and decentralizing collaborative structures to identify the best problem solving solutions and approaches. When a community is experiencing a problem, who is better at identifying the crux of the issue and viably sustainable solutions than the people who will be utilizing and benefiting from them?

The United States Department of Agriculture People’s Garden initiative is an example of a platform established by the government, but scaled-up by collaborative partnerships with organizations to establish community and school gardens. Government support enables local communities to use their gardens to address the issues that are most important to them. Issues range from providing fresh vegetables to local food banks and shelters to creating recreational spaces to promote health and wellness through fitness.

The benefit of connecting people to their communities lies in the creation of an engagement positive feedback loop. When individuals feel like they are part of something greater than themselves and they see the positive results that come from the collaborative partnership they are more inclined to immerse themselves in an array of civic activities. With more brains at the table the result of collaborations are proven to be better than that generated by an unaffiliated professional or bureaucrats that are too far from the issue to adequately assess the situation, the needs of those it impacts or the best strategies and solutions to purge the problem in sustainable ways.          

 

Authors@Steven Johnson: http://www.youtube.com/watch?v=EQX3M-9Cu_M