Brown2020

Last week I spoke at the On Lok Lifeways Conference on October 22, 2008 in San Francisco, entitled “Sustainable Long Term Care: Ethics, Technology and International Perspectives.” The organizers asked me to draw insights from my experience in developing new models for chronic care as the founder and former CEO of Health Hero Network, and to compare that to what I had learned while traveling in Rwanda with Partners in Health last year. Here is my presentation.

In the most innovative models of care on both continents, health care providers have discovered that delivering better care with fewer resources can be possible with a proactive approach to supporting and monitoring patients at home rather than waiting for the inevitable complications of neglect. On both continents, healthcare providers have discovered that technology can be a useful tool to improve the effectiveness of care providers and to increase rather than replace personal touch.

In the United States, our healthcare system too often still penalizes rather than rewards prevention, especially in the largest fee-for-service system, Medicare. When it comes to innovation in disease management and prevention, we claim that we “can’t afford it,” while in a much poorer country in the heart of Africa, the government and the health system are working together to embrace innovation in home and community-based care because they can’t afford not to do it.

We have something to learn from innovations arising in places like Rwanda, where necessity truly is the mother of invention. Learning from such innovations can help us expose some of our own false dichotomies that too often have become an excuse to stifle innovation.

On Lok High Tech Chronic Care Transcript

• Slide 1: High Tech and Personal Touch: Case Studies in Chronic Care from United States and Africa Steve Brown, Founder and Former CEO, Health Hero Network On Lok Lifeways Conference, October 22, 2008 Sustainable Long Term Care: Ethics, Technology and International Perspectives
• Slide 2: Agenda   Background – Health Hero Network   Chronic Care Models   Example from US   Example from Africa   False Dichotomies in Chronic Care   A Better Mental Model
• Slide 3: Background: Health Hero Network We recognized a problem Too much effort spent treating the complications of chronic disease, and not enough on preventing them We had an idea A technology platform to enable a better model of care based on identifying problems early and changing behavior
• Slide 4: Health Buddy in 2008: Patients receive better support and monitoring at home   Daily check-in starts with “how are you feeling today”   Reporting symptoms and device readings like glucose and weight   Receiving supportive feedback and education
• Slide 5: Health Buddy 2008: Nurses can identify problems early and prevent complications   Dashboard to see how all patients are doing today.   Patients needs are triaged using red, yellow, green coding   Full picture includes symptoms, behavior and knowledge
• Slide 6: Why is innovation addressing the chronic care problem so painfully slow?   It is well known that monitoring high risk patients at home can improve care and reduce hospitalizations.   ABC World News Tonight featured Health Buddy way back in 1999 and predicted a new model of care for the 21st century.   The business of healthcare – especially in Medicare – still rewards treating complications far more than preventing them
• Slide 7: Meanwhile in Rwanda Africa, necessity is the mother of invention   Community health workers support and monitor at-risk patients at home   Focus on the simple things that have the biggest impact   Everything starts with “how are you feeling today”
• Slide 8: Partners in Health is a community-based model focused on prevention and education   The regional hospital sees its mission as preventing hospital admissions   Training community health workers to extend care into the community   Keeping organized and tracking patients with an open source electronic medical record system
• Slide 9: False Dichotomies in Chronic Care   High Tech versus Personal Touch   Improving Care versus Saving Money   Information Technology versus Simplicity
• Slide 10: False Dichotomy: Tech versus Touch. Explain the growth in social media! Life can be richer when we share more of it. 10 Lifeways Conference - Steve Brown 10/22/08
  Slide 11: False Dichotomy: Improving Care versus Saving Money
• Slide 12: False Dichotomy: Hi Tech versus Simplicity How About a Better Mental Model! Value Potential Value Cost Opportunity Realized Value Complexity
• Slide 13: Content can change the shape of the Potential Value Curve   Example: congestive heart failure, the leading hospital admission in Medicare   Focus on areas where you can make a difference.   Start with the simple things first
• Slide 14: Design can change the shape of the Realized Value Curve   Simplicity must be a strength
• Slide 15: Disruptive technology has radically changed the shape of the Price Curve   Cloud computing and resources   Open source tools for everything   Consumer electronics with open APIs   Result: 100x or greater capital efficiency
• Slide 16: Conclusions   High Tech can increase Personal Touch   Technology is just a tool, not a transformation   Apply the mental model to choose wisely   We can gain insights and inspiration in how to improve care and leverage technology from innovative models of care in highly resource constrained environments