Treadmill Laptop Computer Stand

Like millions of people around the world, this New Years I again resolved to exercise more. After a bunch of failed attempts in prior years, this year would be different. I decided to word my New Years Resolution a little differently as well:

Find a sustainable exercise pattern that works for me, together with the tools to support it.

Emphasis on sustainable, as in beyond the first quarter. I also said I would find a pattern that works for me by the end of the year. That way I don’t need to feel like a failure even if I have not found the right thing for me when summer rolls around. There still will be plenty of time to keep looking.

This year I also told a few friends about my goal, which implicitly makes me feel more accountable. Actually, I did that before, and no one really cares about someone else’s exercise goal. What’s new this year is that I wrote this blog post, shared it on Facebook and Twitter, and now the whole world can see my New Years Resolution, and my laptop treadmill contraption, if they happen to stumble across this site. More importantly, I changed the context for exercise.

The first principle of behavior change is that our behavior is highly context-dependent. Our behavior at the office is different than at home. Our behavior at home is different than at the ball game. Our behavior at the ball game is different depending on whether our team is winning or losing. When it comes to behavior, context is everything.

In my 2010 exercise experiment, I am changing the context of my morning email routine so that the default behavior, the path of least resistance, encourages something healthier.

By nature, we are lazy. And even if we don’t think we are, the laziness assumption is always a better strategy when designing new tools and processes. We seem to be obeying one of the most fundamental laws of physics, to find an equilibrium point that minimizes energy consumption.

For a lot of us, this laziness equilibrium point is on the couch with chips and drink in hand watching American Idol, which, this time of year is on TWO nights a week.

Since it looks and feels kind of stupid to stand on my treadmill and type on my laptop with the treadmill turned off, I turn on the treadmill and walk. Next thing you know, I have walked five miles, answered all of my emails, reviewed a new contract, checked in on Facebook, written a couple of tweets, and completed this blog post.

Maybe this year my resolution to exercise more is actually going to work! If I only can convince my wife that my new treadmill office contraption is as aesthetically pleasing as it feels…

April 20, 2009, Page 9

In “Wrong Prescription,” Dr. Scott Haig correctly suggests that digital medical records are no silver bullet for the costly, inefficient U.S. health system, but for the wrong reasons [TIME, April 6, 2009].

Information technology (IT) improves efficiency with the rules of the game currently in play. If the rules reward treating disease complications but discourage management and prevention, IT will help health-care businesses churn out more complications per hour.

The fundamental flaw in our current system is that despite decades of debate, no one has an adequate stake in preventing those costly complications in the first place.

Steve Brown — Published in TIME

Social media is often defined as “people having a conversation online.” In contrast to mass media produced by a few, social media is generated by grass roots efforts of millions of people. It has become the largest and most interesting use of the web.

Despite the fact that health care is one of the most information intensive fields, the health care industry notoriously lags behind every other industry in its adaptation of information technology. To get our initial bearings, we decided to kick off the discussion by asking the audience to describe their own personal use of social media.

I was happily surprised to hear many personal stories, including using the Barack Obama iPhone application to mobilize “get out the vote” efforts, and using Myspace to find band members for weekend gigs—personal examples given by senior leaders of some of the largest and most influential health care organizations in California!

The challenges we face in reforming, modernizing, and improving health care are not for a lack of talented and committed people eager to make things better. Health care is a field full of committed and smart people applying a continuous stream of innovation in addressing difficult challenges.

Efforts to create the more proactive and responsive models of care enabled by the Internet, however, have been stymied for a decade by outdated policies that too often reward inefficiency and penalize prevention.

The health care industry may not need to solve all of its problems, however.

Some of the challenges in chronic care, public health, and wellness that currently seem so intractable to our institutions may have surprising community-based and grass roots solutions, enabled and spread through social media.

Social Media Primer Transcript

1. Social Media Primer for Health Care Executives
   Steve Brown
   Adaptive Business Leaders
   December 11, 2008

   http://brown2020.com

2. Social Media Defined:
   People
   having a conversation
   online
3. What are we sharing?
   Ideas: WordPress and Blogger
   Friends: Facebook
   Photos: Flickr
   Status: Twitter
   Websites: Digg
   Videos: YouTube
   Slides: Slideshare
   Documents: Scribd
   Music: Myspace
   Events: evite
   Books: Amazon
   Restaurants: Yelp
   Travel tips: Tripadvisor
   Articles: ArticlesBase
   Notes: 3banana
4. Social media is growing rapidly
   WordPress unique users
   Facebook unique users
   Twitter unique users
5. Just for a sense of scale…
   Comparison of Google Trends data
   Global Warming, Football, Sex, Facebook
6. Why are we sharing?
   Because life is richer when we share
7. Why Should Health Care Executives Care About Social Media?
   Social Media is about Connectedness. In Business and in Life, Connectedness Wins
   Barack Obama Case Study
   Connectedness is part of the solution to:
   Wellness challenges including obesity and lifestyle diseases that relate to our own motivation and behavior
   Chronic care management challenges exacerbated by isolation, loneliness, depression
   Aging population challenges resulting from cognitive decline and neurological disease
   Public health and research challenges that depend on the velocity and relevance of real-world information
8. In Google, Winning is a Function of Connectedness
   PageRank: How many pages link to the pages that link to you?
   BarackObama.com Case Study: What was the number one issue of the campaign?
9. The Most Connected Sites Win
   Comparison of BarackObama.com and JohnMcCain.com
   Pages and backlinks as a result of social media
10. Digging Deeper Into Obama vs. McCain. Looking at the 501st page in Google
    JohnMcCain.com content: Campaign generated press releases
    BarackObama.com content: User generated blogs and local groups
11. Traditional Media:Passive, expensive, celebrity driven. People you only think you know.
    From Barbara Walters Presents: The Most Fascinating People of 2008.
12. Social Media:Active, engaged, free.Real people, real conversations.
13. Real Time Activity on Facebook from Palantir
    120 million active users, now 4th most trafficked website
    10 billion photos, adding 30 million per day
14. Social Media and Your Business
    How do people find and judge your organization?
    How do you listen to and motivate your employees?
    How do you listen to and motivate your members?
15. Top Three Barriers To Social Media
    “None of my friends are there”
    “I feel thrust into a public space”
    “It’s too much effort”
16. Overcoming Barriers: Social Media For Adults
    Applications that have value even before you have any “friends” on the network
    Applications that start with private thoughts and share gradually, with clear privacy control
    Applications that effortlessly integrate with what you already know and do
17. For Discussion: Potential Applications of Social Media in Health Care
    Wellness
    Chronic Care
    Brain Fitness
    Public Health
    Research
18. Chronic Care 1.0
    Scripted
    Top Down
    Inherently Limited
    Labor Intensive
    Home health monitoring technology examples
    Honeywell Hommed Genesis
    Intel Health Guide
19. Chronic Care 2.0
    Unscripted
    Grass Roots
    Open-Ended
    Social
    Display of social network of informal caregivers
20. Real Life is Unscripted
    wefeelfine.org
21. Real People are Diverse
    wefeelfine.org
22. Real Needs are Highly Personal
    wefeelfine.org
23. Connectedness and Your Brain: Keep Learning and Stay Engaged – Or Else!
    From “The Coming Neurological Epidemic” TED talk by Biochemist Gregory Petsko
24. Social Networks and Brain Health
    Women who had daily contact with friends and family cut their risk of dementia by almost half.
    If you stay connected, you have a better shot. Whenever we have even the most basic exchange, we have to think about how to respond, and that stimulates the brain—Valerie Crooks, clinical trials administrative director at Southern California Kaiser Permanente Medical Group, lead author.
    American Journal of Public Health 1221-1227, July 2008, Vol 98, No. 7
25. Social Graph on Facebook
    More connected outside = More connected inside
    Brain map from brainmaps.org
26. Social Media: A New Window Into Human Behavior
    Unprecedented ability to measure social and emotional behavior of a populations
    Opportunity to understand problems based on real world data, not from the laboratory!
    Who is currently at the forefront of human behavior research? Social media companies!
27. Every Day Presents a New Way to Connect, Engage, and Learn
    Ocarina iPhone Application from Smule: your phone becomes an electronic flute you can play with people around the world.

New Ideas About Human Behavior in Economics and Medicine, Peter Orszag, Director of the CBO, October 16, 2008

The current economic crisis emerged because as a nation we have been consuming more than we have been producing, and borrowing the difference. Poorly thought through banking regulations made credit too easy, and millions of Americans borrowed against their homes to finance consumption. Because economic growth depended on the “American Consumer”, policymakers rationalized, denied, and delayed addressing the problem. Home prices rose, borrowing rose, people used rising home prices to service debt and to consume. The resulting credit bubble burst, as every credit bubble does, deflating the assets of millions and costing millions more their jobs, their homes, and their security.

Beyond the housing credit bubble, a bigger fiscal challenge looms: Productivity in our economy is fundamentally shifting due to the demographics of an aging population. As baby boomers retire, our economy shifts further in the direction of producing less while consuming more, especially in health care. It is possible that technology will improve productivity, and people may postpone retirement. On the other hand, health care costs may rise faster than projected because of the epidemic of obesity and resulting chronic illness. In any case, there is little doubt that current spending trend is not sustainable.

When the next economic crisis hits, we will look back and see that despite clear warning and plenty of hard data, policymakers had delayed, denied, rationalized and obfuscated any meaningful reform to our currently ill-thought out health policies that already fuel over $2 trillion a year in health care spending.

At an institutional level, incentives must be changed to encourage more efficient models of chronic care. Half of health spending is the result of chronic illness. Complications can be prevented through better monitoring, management and prevention, yet we are painfully slow to implement policy changes that could accelerate innovation and adoption. At an individual level, baby boomers need accelerated innovation in technologies, products, and services that help them keep physically and mentally fit in order to stay productive longer in a highly competitive global information-based economy.

It is a law of nature that anything unsustainable must and will change. The only question is whether or not we will make the changes proactively and thoughtfully, or the changes will be imposed on us painfully and in a crisis. Recent CBO reports contain a glimmer of hope: Because a substantial part of health care spending is driven by human behavior, these are not fixed costs. How doctors practice medicine, or how patents communicate with doctors, and how we live our lives are all major factors in the future trend of health spending.

Many of the same factors that can reduce health care spending, like healthy lifestyle choices and continuous learning that promotes brain fitness, also enable us to be more productive in the global economy. The next financial tsunami is not inevitable but perhaps we can do something about it.

Intel Health Guide Blood Pressure Monitoring

After over three years of research, development, and market study, Intel announced the launch of the Intel Health Guide, an Intel-branded device for remotely monitoring and managing patients with chronic illness at home. From Intel’s demo one can see that the device is a laptop computer no keyboard and a reversed touch-screen. Patients can connect and upload blood pressure monitors and other medical devices to communicate results with remote health care providers. In addition to vital sign data collection, the health monitoring software also provides patient reminders, surveys, educational content, and other communication tools.

Although Intel appears to be targeting at the same chronic disease management market, the Health Guide from Intel adds features and functions far beyond its predecessor Health Buddy from Health Hero Network, now a division of Robert Bosch. It will be interesting to see whether or the enhanced functionality such as video conferencing and multimedia content will be the key to market adoption.

Intel Health Guide Home Health Monitor

The real barriers to adoption of remote monitoring and other chronic care strategies may be less about functionality than about institutional incentives and business models ingrained in our health care system. The health care market with Medicare in the lead still rewards health care providers far more for treating the complications of chronic illness than it does for proactive management and monitoring aimed at preventing them.

The incentive systems that determine the viability of new models of health care enabled by devices like the Intel Health Guide and the Health Hero Health Network Health Buddy could be about to change, however. With favorable results from the Medicare chronic care improvement demonstration project currently underway from Health Hero Network in Washington and Oregon, Medicare coverage for health care providers to offer home health monitoring services may be around the corner.

Press Release: Intel Announces its First Home Medical Device to Better Connect Clinicians with Patients

Intel® Health Guide is First Product in Series Designed to Enable More Personalized Care Management for Chronic and Age-related Conditions

Intel Health Guide Telehealth Appliance

SANTA CLARA, Calif., Nov. 10, 2008 – Intel Corporation today announced its Intel® Health Guide, a care management tool designed for health care professionals who manage patients with chronic conditions. The Health Guide represents Intel’s entry into a new category of personal health systems that go beyond the simple remote patient monitoring systems available today.

The Intel® Health Guide, which received 510(k) market clearance from the U.S. Food and Drug Administration (FDA) in July, is a comprehensive personal health system that combines an in-home patient device — the Intel® Health Guide PHS6000 — as well as an online interface — the Intel® Health Care Management Suite — allowing clinicians to monitor patients in their homes and manage care remotely.

“The Health Guide is a step forward in offering more personalized and effective management of chronic health conditions in the home,” said Louis Burns, vice president and general manager of the Intel Digital Health Group. “Intel has spent years researching the needs of both caregivers and patients, and we are now moving to launch a series of products that will help extend care from the hospital to the home. Our products will help address the challenges of an aging population and rising rates of chronic disease.”

Intel is collaborating with health care industry leaders around the world to validate the clinical benefits of the Health Guide for a wide range of chronic disease conditions and health and wellness applications. Pilot studies in the United States are currently planned with health care organizations such as Aetna, Erickson Retirement Communities, Providence Medical Group in Oregon and SCAN Health Plan. The goals and objectives are to assess how the Health Guide integrates with different care management models in the home. These first studies focus on the ability to demonstrate improved health outcomes for conditions such as heart failure, diabetes, hypertension and chronic obstructive pulmonary disease.

Customers such as Advanced Warning Systems, Inc., (AWS), a provider of health care discovery products and web-based services, monitor people for acute cardiovascular symptoms that can cause sudden death. AWS will use the Intel Heath Guide to connect with a targeted class of users, including retired athletes and post-war veterans suffering from post traumatic stress disorder (PTSD), with the highest incidence of cardiovascular related illnesses.

The Health Guide promotes greater patient engagement and more efficient care management by enabling communication between patients and health care professionals and providing clinicians with access to the most current, actionable data. This solution offers interactive tools for personalized care management and includes vital sign collection, patient reminders, surveys, multimedia educational content, and feedback and communications tools, such as video conferencing and alerts. Clinicians have ongoing access to data so that they can better manage each patient’s conditions while patients benefit from customized care in the comfort of their own living room.

Intel is working with leading health care organizations that have an understanding of health care delivery to develop unique patient care plans as well as multimedia educational content for chronic conditions. Specifically, Intel is working with the Mayo Clinic to have licensed educational content from MayoClinic.com made available to customers using the Health Guide. In addition, Intel is working with the American Heart Association to create care plans based on the organization’s treatment guidelines for a pilot project for the ongoing management of patients with heart failure. The intent is to help health care professionals monitor patients and remotely manage their care in accordance with science guidelines and also to provide patients with ready access to credible and targeted education material.

Intel has also hired a team of clinical experts to provide a range of professional services to enable health care organizations to successfully integrate the personal health system into their current disease management programs and models of care.

Additionally, Intel plans to use the core technology components of the solution to build products targeted for new areas such as independent living and programs for health and wellness management and to support new devices such as mobile phones and handhelds.

American Medical Alert Corporation, a national provider of remote patient monitoring devices and 24/7 health care communication services, will be the first U.S. market channel partner for the Intel Health Guide. By adding the Intel Health Guide to its portfolio of offerings, AMAC will be further equipped to provide its customers with the best in care management technologies. The Health Guide is designed to be used by health care professionals to manage their patients at home and is not currently available for general consumer purchase.

For information on how to purchase this product, visit www.intel.com/healthcare/ps/healthguide/wtb.htm. For more information on the Intel Health Guide, visit www.intel.com/healthcare/telehealth. To learn more about Intel in health care, go to www.intel.com/healthcare.

About Intel

Intel [NASDAQ: INTC], the world leader in silicon innovation, develops technologies, products and initiatives to continually advance how people work and live. Additional information about Intel is available at www.intel.com/pressroom and blogs.intel.com.

Yesterday, I had the good fortune to hear a thought provoking presentation on innovation and design thinking by the CEO of IDEO, Tim Brown. Tim described the lengths to which IDEO designers go to understand the point of view of their users and then to generate a stream of prototypes as they experiment and try out ideas. Prototyping is part of the learning process. Insights are more likely to come spending time with extreme users, the youngest and the oldest, and the most challenged.

Here is a presentation by IDEO from the First Conference and Intensive Training on User-Centered Design in May 2008 which conveys the IDEO design process and basic principles of design thinking:

Nowhere is the IDEO approach to human centered design more necessary than in health care, where we spend more resources than any other sector of our economy and yet we still have the greatest unmet needs. While I was CEO of Health Hero Network, we partnered with IDEO to design the first Health Buddy device for home health monitoring. Here is a sketch from the Health Buddy design patent that we received on the in-home appliance that served as the front end for a home health monitoring service:

Health Buddy Design Patent Sketch

Our goal with Health Buddy was to enable people with chronic conditions to effortlessly record health status information at home and share it with remote care providers over the Internet. We hoped to enable caregivers to identify problems early and do a better job of educating and supporting patients at home to prevent more serious problems that would lead to hospitalization.

The first design challenge that I gave IDEO was to enable my grandmother to communicate meaningful information with her nurse over the Internet using just one trembling knuckle. The second challenge was to use design to deliver a friendly, supportive and compassionate interface to remote caregivers so that patients would feel comfortable in sharing information daily about health issues that most people would rather not think about.

The collaboration with IDEO was tremendously successful in creating an better interface to chronic care from the home. The most common response from our users was that they “felt like someone was there for them.” Hospitalizations were reduced, patients adhered to treatment, and caregiver productivity improved. Now if only the design of the economic models of health care could catch up to advances in designing a better chronic care model!

Partners in Health has been improving chronic care in rural communities in Rwanda through an innovative model of care inspired by Paul Farmer. The regional hospital sees its mission as training community members to extend care into the community and monitor patients at home in order to prevent disease complications and the need for hospitalization. The hospital tracks symptoms and medications using electronic medical record (EMR) systems based on open source technologies. Meanwhile, the United States continues to neglect reforming our crisis-oriented health system because “we can’t afford it”, and the cost of chronic care continues to explode as the population ages. With far fewer resources, but with more creativity and courage, innovative leaders in Rwanda are creating new models of care based on prevention because they can’t afford not to. Maybe we can learn something from Rwanda.

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

A patent recently issued to Health Hero Network describes a simple but powerful idea that addresses the pandemic challenge by enabling near-real-time syndromic surveillance that can be adapted on the fly. Easy-to-navigate survey devices collect data from hospital waiting rooms, school nurses, and other points of care. The survey script can be changed and updated remotely by public health authorities based on the latest information. The devices report data to central computers that look for any unusual patterns and then alert public health authorities immediately so that they can investigate further.

Disease outbreaks that look like the flu at the beginning can be hard to detect early because flu-like symptoms are common and are not always reported. The first cases of an outbreak may be spread out over many different clinics, hospitals, and schools in a metropolitan area. Unusual patterns might emerge only when looking at a broader cross section of a region. The other challenge is that we may not know what data is relevant and important at the beginning stages of an outbreak. Where it might have been fever, rash, and working in a mail room for one threat, it might be diarrhea and travel to a specific region or eating a particular food in another threat.

While many efforts have been discussed and may even be underway to facilitate early detection of outbreaks by sifting through electronic medical records and pharmacy data, the most important information might be missed because no one knew to ask the right question. When we do figure out what question to ask, we won’t have time to add fields to medical records or change forms. Our public health authorities need the ability to change the script as soon as they learn new information.

Despite the simplicity of the approach, it is not easy to organize health systems around new ways of doing things. On the other hand, maybe we won’t need to. Public health surveys could be pushed to iPhone users, for example. There just might be enough iPhones out there by now to provide a statistically significant sample size enabling highly sensitive early detection of potential public health emergencies.

More information on Health Hero Network patents.

The images above came from a live Webcast of a gastric bypass surgery performed at Tufts-New England Medical Center in Boston by Dr. Scott Shikora, Chief of Bariatric Surgery at Tufts-NEMC, along with bariatric surgeons Dr. Michael Tarnoff and Dr. Julie Kim. Click on the images to watch the complete video on YouTube.

You also can watch Dr. Stan Hoehn perform a minimally invasive gastric bypass at Shawnee Mission Medical Center in Kansas by clicking on the image below.

A Consensus Panel convened by the National Institutes of Health (NIH) indicates bariatric surgery for people with a body mass index (BMI) of 40 or higher, or people with a BMI of 35 or higher with one or more related comorbid conditions such as diabetes, hypertension, and cardiovascular disease.

Bariatric surgery is regarded by leading physicians on the panel as a lifesaving tool that enables, or in fact forces, the patient to change lifestyle and eating habits.

With 100 million Americans struggling with at least one chronic condition, and over 60 million Americans considered to be clinically obese, we can expect a lot of bariatric surgery ahead. Can we really address the issue of obesity by forcing ourselves to change behavior under the knife, or are there other ways to address this epidemic?

Transcript:

Slides 1-23: Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ?30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ?30% Source: Behavioral Risk Factor Surveillance System, CDC.

Slide 24: Citations • BRFSS, Behavioral Risk Factor Surveillance System http: //www.cdc.gov/brfss/ • Mokdad AH, et al. The spread of the obesity epidemic in the United States, 1991—1998 JAMA 1999; 282:16:1519–1522. • Mokdad AH, et al. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001; 286:10:1519– 22. • Mokdad AH, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003: 289:1: 76–79 • CDC. State-Specific Prevalence of Obesity Among Adults — United States, 2005; MMWR 2006; 55(36);985–988

Slide 25: Obesity Trends Among U.S. Adults between 1985 and 2006 Definitions: • Obesity: Having a very high amount of body fat in relation to lean body mass, or Body Mass Index (BMI) of 30 or higher. • Body Mass Index (BMI): A measure of an adult’s weight in relation to his or her height, specifically the adult’s weight in kilograms divided by the square of his or her height in meters.

Slide 26: Obesity Trends Among U.S. Adults between 1985 and 2006 Source of the data: • The data shown in these maps were collected through CDC’s Behavioral Risk Factor Surveillance System (BRFSS). Each year, state health departments use standard procedures to collect data through a series of monthly telephone interviews with U.S. adults. • Prevalence estimates generated for the maps may vary slightly from those generated for the states by BRFSS (http://aps.nccd.cdc.gov/brfss) as slightly different analytic methods are used.

Slide 27: • In 1990, among states participating in the Behavioral Risk Factor Surveillance System, 10 states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater than 15%. • By 1998, no state had prevalence less than 10%, seven states had a prevalence of obesity between 20- 24%, and no state had prevalence equal to or greater than 25%. • In 2006, only four states had a prevalence of obesity less than 20%. Twenty-two states had a prevalence equal or greater than 25%; Two of these states (Mississippi and West Virginia) had a prevalence of obesity equal to or greater than 30%.

“Telebegeleiding thuis geeft mensen met chronische ziekte meer veiligheid en zelfvertrouwen.”

Indu and Matthew managed to assemble a stellar collection of entrepreneurs, movers, shakers, and creators of the next generation of the eHealth field. A full house discussed search engines that learn from personal health records, social networks that support patients, and how the wisdom of crowds is transforming medical knowledge.

We all know that the current way we organize and manage healthcare is dysfunctional and unsustainable. How else could we find a way to spend $2 trillion per year and leave 45 million people uninsured? How else could we spend so much and still have such mediocre outcomes compared to the rest of the world?

There have been many promising ideas proven futile and many vain attempts at healthcare transformation. What is different this time around? Finally the ecosystems are in place, the tools of production are widely accessible and development costs are so low that citizens do not need to wait for the institutions to be the deciders.

We have entered a new phase of rapid innovation and experimentation that is producing a wave of brave new ideas, some of which will be disruptive to current ways of doing things and some of which will be revolutionary. Pay attention to the list below, because you will be seeing these people in headlines for years to come.

Health 2.0 User Generated Healthcare
Conference Agenda

It is not just the fact that Bill Clinton and The Clinton Foundation negotiated a deal on antiretroviral (ARV) drugs. It’s not just the fact that the once complex cocktail regimen of pills can be combined into one generic pill. It is because an army of community health workers visit patients in their villages every day, checking in to make sure everything is OK, and to make sure that everyone is taking their medicine.

Daily support and monitoring at home, working with informal caregivers in the community to surface problems early so that bigger problems can be prevented: That is the key to improving quality of care with limited resources.

Dr. Paul Farmer, as chronicled in the book “Mountains Beyond Mountains” by Tracy Kidder, realized this in Haiti a decade ago, and now the Partners in Health “accompagnateur” system is being rolled out in developing countries around the world. Is there something we might learn from Rwanda?

Conference Programme

Tuesday 28 November 2006
20.00 – 22.00	Welcome Reception – Registration
Wednesday 29 November 2006
08.00 – 09.30	Registration with Coffee and Tea
	Plenary Session 1
09.30 – 09.40	Opening Jack van Gelder • Chairman of the day Well known Dutch TV Journalist, Announcer
09.40 – 09.55	Welcome address Martin Eurlings • Minister Economic Affairs Province of Limburg
09.55 – 10.15	Strengthening the regional silver economy Marion Gierden-Jülich • Secretary of State for Generations, Family, Women and Integration, North-Rhine Westphalia
	Trends 1
10.15 – 10.45	Turn Silver into Gold – creative entrepreneurship Mary Furlong • Professor Entrepreneurship, Santa Clara University California (USA) Mary Furlong was founder of Seniornet (1986), ThirdAge Media (1996) and Mary Furlong and Associates (2002). The 45- to 64-year-olds are among the fastest-growing population of Internet users, and they spend more time on the web than their college-aged kids. Marketers who want to reach this group have to learn the right code. Download presentation (Powerpoint)
10.45 – 11.15	Coffee break
	Plenary Session 2
11.15 – 12.45	Towards a longer working life – ageing and the quality of work life Juhani Ilmarinen • Professor For Age Management and Work Ability Finnish, Institute of Occupational Health Thanks to the pioneering work of Juhani Ilmarinen Finland has won the Bertelsmann Prize this year for outstanding performance in the field of Active Ageing in the Economy and Society. Investments in the Work Ability of workers lead to a return of 12 to 30 times the original investment. Download presentation (Powerpoint) Remote health monitoring and management Stephen Brown • President, Health Hero Network (USA) Stephen Brown is the founder of Health Hero Network, a company now recognized as an industry leading innovator and solution provider for remote health monitoring and management in the USA with cost effectiveness for major healthcare institutions Download presentation (Powerpoint)Chances and choices in an ageing society Dolf van den Brink • former Member of the Board, ABN/AMRO Bank Co-author of the book ‘Vergrijzing Leeft’ on Ageing in The Netherlands – The ABN AMRO Bank is on the forefront of banks who invest in strong relationships with older clients by adapting and developing services. Download presentation (Powerpoint)Bayard: a winning publisher’s strategy targeted to the mature people Maxime de Jenlis • General Manager, Bayard Group Benelux De Jenlis developed six magazines for seniors in European countries, one of which is Plus Magazine in the Netherlands with a total circulation of nearly 1 million and a turnover of approx. 50 million Euros, including brand extension activities. Download presentation (Powerpoint)
12.45 – 14.00	Lunch at Rodahal
	Break Out Sessions 1
14.00 – 15.15	Health and Lifestyle
	Trends in prevention Chairman • Onno van Schayck, Professor Preventive Medicine, co-Director Research Institute CAPHRI Personalized Nutrition – Relevant for the silver generation Rob Beudeker • Business Unit Director/VP Personalized Nutrition, DSM Rob joined Gist-brocades in 1984 and has held various management positions at Gist-brocades and DSM Food Specialties since. At present he is responsible for New Business Development at DSM Food Specialties and acts ad interim as VP Personalized Nutrition at the DSM Innovation Center. Download presentation (Powerpoint) Health creates wealth – meeting the legitimate demands of an ageing population for innovative and high quality health care Rory O’ Connor • Vice President Medical Affairs, Pfizer, Europe/Canada Pfizer is one of the world’s largest enterprises; with 100,000 employees and 12,000 medical researchers. Pfizer manufactures pharmaceuticals for 38 million patients worldwide. Motto: “Adding years to life, and life to years.” Download presentation (Powerpoint) Valueing the 50 plus consumer Klaus Ruhnau • Vice President Marketing Solution Management, Hartmann AG Hartmann AG (yearly turnover 1.2 billion) is known for its variety of products for wound treatment management and skin treatment continence management and for succesful communication with 50 plus consumers. Stay in touch with the older consumer or you will have to learn it the hard way. Download presentation (Powerpoint) Prevention as a challenge for the health care sector Guus Broos • Member of the Board of Orbis Medical and Healthcare Group of Companies Orbis is active in cure, care, independent and assisting living and homecare services. Orbis operates a hospital (Maaslandhospital), 10 independent and assisting living homes, homecareorganisation and a hospice in the region of Limburg. Real estate development for older people. Download presentation (Powerpoint)
14.00 – 15.15	Living and Home Environment
	Living and Home Environment Chairman • Alex Sievers, Senior Consultant, INBO Advisors Real Estate Senior communities: are they the future? Sun City – recreation in the adult community Don Schordje • President, Recreation Centres of Sun City (RCSC) The RCSC manages the seven recreation centres in the first active adult community in the world: Sun City. RCSC is a non-profit organization that operates the Sun City recreational facilities for the benefit of its members. To develop and build for seniors – challenge of the century Rob de Jong • Director, TCN Property Projects TCN Property Projects is one of the Netherlands’ top project developers, distinguishing itself through innovative concepts and creativity in design, management and financing. TCN is involved in the initiative ‘Senior City’. Builders and developers have to acknowledge the preferences and wishes of older people. Download presentation (Powerpoint) Living together – intergenerational living forms Thomas Möller • Manager, Freie Scholle The Freie Scholle is housing corporation, which distinguishes itself in the debate about new living arrangements for seniors with a preference for intergenerational living arrangements. Villages and, cities should offer people of all ages a variety of choice, so that people of all ages can meet, talk, support and serve each other in daily life.
14.00 – 15.15	Work and Income
	Chairman • Paul Staal, Arbo Unie, vice chairman BOA, chairman STECR, platform ReintegrationAge management and return on investment in older workers Juhani Ilmarinen • Professor For Age Management and Work Ability, Finnish Institute of Occupational Health Thanks to the pioneering work of Juhani Ilmarinen Finland has won the Bertelsmann Prize this year for outstanding performance in the field of Active Ageing in the Economy and Society (‘Towards a longer Worklife!’). Investments in the Work Ability of workers lead to a return of approx. 12 to 30 times the original investment. Download presentation 1(Powerpoint) Download presentation 2 (Powerpoint)
14.00 – 15.15	Tourism and Culture
	Travelling Chairman • Dick Knook, Professor of gerontology emeritus, University of Leiden and ‘Senior’ Consultant The future (of tourism) belongs to the seniors: Challenges of a fast growing market Dick Knook • Professor of gerontology emeritus, University of Leiden and ‘Senior’ Consultant Dick Knook published the book Seniors & Tourism. Tourism will become one of the world’s main economic sectors in this century, which will also see a strong ageing of the population in many countries. The confluence of these two trends is opening up numerous opportunities. Download presentation (Powerpoint) A world to win Richard Smits • Director Tour Operator Maaskant Reizen Maaskant Reizen is active in the market for Third Agers in the Netherlands, organising round trips ans excursions throughout Europe. Download presentation (Word) Travelling with a handicap Fini de Paauw • Publisher Blauwe Gids (Accommodation Guide for persons with a handicap) and Vice President of the National Council for the Handicapped and Chronically Ill Handicapped people face numerous barriers in accommodations and transport. They represent a fast growing market segment, also because of the ageing of the population. A chance for entrepreneurs.
14.00 – 15.15	Communication and Networking
	Media and Communication Chairman • Jack van Gelder, Journalist, Announcer Effective communication – how to do it? Maxime de Jenlis • General Manager, Bayard Group Benelux De Jenlis developed six magazines for seniors in European countries (one of which is Plus Magazine in the Netherlands) with a total circulation of nearly 1 million and a turnover of approx. 50 million Euros. Download presentation (Powerpoint) Innovation in the media: the advance of seniors Jan Slagter • Director and Chairman, Max Broadcasting In only a few month’s time, Max´s programmes became the best watched programmes in the Netherlands. The ‘50PlusBeurs’ (50PlusFair): the world’s largest communication platform and market place Alexander van de Kerkhof • Director, 50PlusBeurs With 560 exhibitors and 100,000 visitors the 50PlusFair is THE annual event for 50+ people in the Netherlands. Download presentation (Powerpoint)
15.15 – 15.45	Coffee Break
	Break Out Sessions 2
15.45 – 17.00	Health and Lifestyle
	Chairman • Onno van Schayck, Professor Preventive Medicine, co-Director Research Institute CAPHRICare technology for the silver century Maarten Janknegt • Member of the Board of Directors, Siemens Netherlands NV Arthur de Bos • Project Development, Siemens Siemens´ Medical Solutions division is one of the world’s largest suppliers of the health care industry. The company is reknown for linking innovative medical technology, health care information systems, management consulting, and support services to help customers achieve tangible, sustainable, clinical, and financial outcomes. Download presentation (Powerpoint)Technology as condition and driver for economic participation of senior citizens. Lessons from European comparative studies Lutz Kubitschke • Researcher, Empirica Ingo Meyer • Empirica Empirica is one of Europe’s leading research institutes in the field of technology and ageing. Lutz Kubitschke led programmes such as SeniorWatch which is at the base of many new developments. Scenarios for future independent living Josephine Dries • Researcher TNO Information and Communication, the Netherlands Organisation for Applied Technological Research Josephine Dries has over nine years experience in researching the relationship between ICT and older people and new design concepts of ICT applications (user centered design) involving older persons. Download presentation (Powerpoint)
15.45 – 17.00	Business development
	Master class Entrepreneurship Reaching out successfully to baby boomer and senior consumers Mary Furlong • Professor Entrepreneurship, Santa Clara University California Mary Furlong was founder of Seniornet (1986), ThirdAge Media (1996) and Mary Furlong and Associates (2002). The 45- to 64-year-olds are among the fastest-growing population of Internet users, and they spend more time on the Web than their college-aged kids. Those who want to reach this group have to learn the right code. Download presentation (Powerpoint)
15.45 – 17.00	Work and Income
	Workplace Innovation Chairman • Paul Staal, Arbo Unie, vice chairman BOA, chairman STECR, platform Reintegration Ireland’s National Workplace Strategy – supporting older workers Cathal O’ Regan • Head of Workplace Strategy at Ireland’s National Centre for Partnership and Performance Recent policy developments in Ireland reflect a commitment by Government and the Social Partners to supporting older workers and recognising their vital role in Ireland’s growing knowledge economy. These developments are outlined by Cathal O’ Regan of the NCPP, which acts to support such policy developments. Download presentation (Powerpoint) Age as a part of diversity management: A business case Mike Sharrock • Managing Director, BP Netherlands Demographic change as one real challenge for BP, one of the largest energy suppliers in the world… Download presentation (Powerpoint) Life course policies in organisations: a quick scan Dorinde Brands • Advisor, Expertise Centrum Leeftijd (Expertise Centre on Age and Life course) The Expertise Centre has more than ten years experience of successfully influencing national and European legislation and the legal infrastructure against age discrimination and for the equal treatment of people of all ages. It supports employers and employees in redesigning age strategies and investments following a life course perspective. Download presentation (Powerpoint)
15.45 – 17.00	Tourism and Culture
	Cultural Entrepreneurship Chairman • Conny Groot, Director of Catharsis Producties Amsterdam The silver economy from a film producers view San Fu Maltha • Film Producer San Fu Maltha, one of the Netherland’s key producers, produced a.o. the highly successful features ‘Phileine says sorry’ and ‘In Orange’. Recently he released the biggest Dutch language film ever. Paul Verhoeven’s epic war thriller BLACK BOOK. Download presentation (Powerpoint) Cultural entrepreneurs – exploring the silver market Hans Jörg Schütz • Film-Kommunikation – Agentur für Filmmarketing Weimar The world of the cinema sometimes seems an exclusive world of popcorn chewing youngsters who watch the latest movies. Film Kommunikation developed new marketing concepts to attract older audiences to see high quality film. Download presentation (Powerpoint) Bealtaine Festival Ireland: Celebrating creativity at an older age Sue Russel • Director, Bealtaine Festival This annual event in May involves all of the main Irish cultural and artistic institutions, attracts 35,000 older visitors in hundreds of events and has become one of the largest Irish festivals. Download presentation (Powerpoint)
15.45 – 17.00	Communication and Networking
	Older consumers in focus Chairman • Jack van Gelder, Journalist, Announcer Adapting marketing and product strategies to the untapped silver potential Pieter Paul Verheggen • Trend Watcher, Motivaction A Motivaction survey showed that the web and computer industry left a silver market of 500 million Euros untouched. Download presentation (Powerpoint) Supermarket for all generations Ulrike Stöcker • Manager press and communications, EDEKA Unternehmensgruppe Nordbayern-Sachsen-Thüringen Edeka developed a successful, award-winning supermarket concept aiming at all generations and taking into account the ageing consumer. Download presentation (Powerpoint) Matching staff and consumers: a winning team B&Q (to be confirmed) The most well-known and successful age diversity story is the story of B&Q, warehouse for home and garden. Optimising the match between customers and staff in terms of age leads to a considerable increase of consumer satisfaction and 20% increase of turnover.
19.00 – 22.00	Dine Around Tour, Maastricht
Thursday 30 November 2006
08.00 – 09.00	Registration with Coffee and Tea
	Plenary Session 3
09.00 – 09.05	Opening Jack van Gelder • Chairman of the day Well-known Dutch TV Journalist, Announcer
	Trends 2
09.05 – 09.45	Longevity and pension reform – the silver economic perspective Dick Sluimers • acting chairman of the Board of Directors of ABP ABP: the pension fund for employers and employees in service of the Dutch government and the educational sector. With an invested capital of EUR 160 billion and 2.4 million customers ABP is Europe’s largest and the world’s second largest pension fund. Download presentation (Powerpoint)
09.45 – 10.30	Do’s and dont’s in communicating to aging boomers and seniors – illustrated by TV campaigns from the world Jean-Paul Tréguer • CEO of Senioragency International, the 1st international advertising network dedicated to 50+ consumers, based in 12 countries. Jean-Paul Tréguer is one of the world’s top silver marketers and author of ‘50+ Marketing’ (Palgrave Publisher).
10.30 – 11.00	Coffee Break
	Plenary Session 4
11.00 – 12.45	The AARP global network on business development Ladan Manteghi • AARP (50 plus member organisation USA) AARP has 36 million 50 plus members, issues ‘AARP The Magazine’ with a circulation of 22 million households, offers its members numerous services. AARP launched the AARP Global Network this year as a business to business association aiming at ensuring the needs of the ever growing global ageing population. Download presentation (Powerpoint)Living in Sun City keeps you alive Don Schordje • President, Recreation Centres of Sun City (RCSC) The RCSC manages the seven recreation centres in the first active adult community in the world: Sun City. RCSC is a non-profit organization that operates the Sun City recreational facilities for the benefit of its members.Ageing Society: New Opportunities? Peter van Leeuwen • Managing director, ING Bank, the Netherlands Are we to face a collapse of publicly financed pensions, or will a whole range of new arrangements arise to mitigate these financial problems and give way to new ventures? As Managing Director Institutions at ING Peter is responsible for service and product development for the public health sector and the public sector. Peter van Leeuwen also is Managing Director of ING Medinet, the centre of expertise for public health care. ING Medinet regulary publishes (sector related) research and organises events on various health care topics. Download presentation (Powerpoint) Care technology for the silver century Maarten Janknegt • Member of the Board of Directors, Siemens Netherlands NV Arthur de Bos • Project Development, Siemens Siemens´ Medical Solutions division is one of the world’s largest suppliers of the health care industry. The company is reknown for linking innovative medical technology, health care information systems, management consulting, and support services to help customers achieve tangible, sustainable, clinical, and financial outcomes. Download presentation (Powerpoint)
12.45 – 14.00	Lunch Rodahal
	Break Out Sessions 3
14.00 – 15.15	Health and Lifestyle
	Health Chairman • Paul Staal, Arbo Unie, vice chairman BOA, chairman STECR, platform Reintegration Healthy ageing – a consumers perspective Frans van der Ouderaa • Researcher, Unilever Corporate Research UK As one of the largest food businesses in the world Unilever makes a big impact on people’s health. Its mission is to add vitality to life. Frans van der Ouderaa is a specialist on the impact of food on older persons. Download presentation (Powerpoint) The Funding factor: Vitality & Insurances Alexander Korbee • Business Development Manager Prevention, Achmea Social Security Achmea is one of the largest insurance companies of the Netherlands, investing heavily in health and prevention related services. The core of these services is “The “Vitaliteitshuis” concept. The person responsible for these services and this concept as part of the business development activities of Achmea, is Alexander Kobree. Download presentation (Powerpoint) Technology supporting Health & Lifestyle Jeannette de Noord • Senior Director New Business Creation in the Business Unit Consumer Health & Wellness of Philips Electronics Jeannette’s work has a strong focus on the senior consumer. Royal Philips Electronics (headquartered in the Netherlands; 126.000 employees worldwide) is a global leader in healthcare, lifestyle and technology, delivering products, services and solutions through the brand promise of “sense and simplicity”.
14.00 – 15.15	Living and Home Environment
	Chairman • Alex Sievers, Senior Consultant, INBO Advisors Real EstateKey values and senior living, silver power – stimulation program Kees Penninx • Senior Policy Officer, Netherlands Institute Care and Welfare Zilveren Kracht (Silver Power) is a national stimulation program on civil society and living environment. It supports organisations and persons in staying productive and use their skills, knowledge and experience of seniors for the benefit of the community.Regional planning and development Alex Sievers • Senior Consultant, INBO Advisors Real Estate Walter Brouwers • Province of Gelderland INBO is an independent agency for regional planning and development, future vision development for neighbourhood and local community strategies. Sievers took the initiative for the project Senior City.
14.00 – 15.15	Work and Income
	Financial Services Chairman • Wil Foppen, Director of the Universiteit Maastricht Business School and Associate Dean of the Faculty of Economics & Business Administration of Universiteit Maastricht. Serving the silver economy Norbert Wahl • Director, Sparkassen- und Giroverband Rheinland-Pfalz The savings bank is a major player in the regional economy and takes an active role in developing silver economy strategies. Some building blocs for a sustainable solution of ageing in Belgium Frank Lierman • Chief Economist Dexia Bank, Belgium New financial arrangements for seniors Peter van Leeuwen • Member of the Board of Directors, ING Group, the Netherlands Download presentation (Powerpoint)
14.00 – 15.15	Tourism and Culture
	Health Tourism Chairman • Josef Hilbert, Director health Industries – Institute Work and Technology, Gelsenkirchen Creating a European network on health tourism Josef Hilbert • Research Director Health Industries, Institut Work and Technology, Gelsenkirchen. Josef Hilbert is responsible for development and initiatives on health tourism und “Kurorte” in German regions North Rhine Westphalia and Mecklenburg Vorpommern. Download presentation (Powerpoint) Health and prevention – a new role for spa’s Eberhard Volger • Doctor for Sebastian Kneipp Institut – Europäisches Centrum für Naturheilverfahren Demographic change urges us all to concentrate at prevention. Create better conditions for productive ageing in the future. Health Institutions such as ‘Kurorte’(spa’s) may have a new and important role to play. Download presentation (Powerpoint) Dutch market for spa’s – a work in progress Sjef van der Linden • professor rheumatology Maastricht Long term effects of spa therapy Marlies Sobczak-Boumans • spa expert A future full of chances Download presentation (Powerpoint)
14.00 – 15.15	Communication and Networking
	Doing business through seniors organisations Chairman • Jack van Gelder, Journalist, Announcer The AARP global network on business development Ladan Manteghi • AARP – 50 plus member organisation USA AARP has 36 million 50 plus members, issues ‘AARP The Magazine’ with a circulation of 22 million households, offers its members numerous services. AARP launched the AARP Global Network this year as a business to business association aiming at ensuring the needs of the ever growing global ageing population. Download presentation (Powerpoint) The big deal Arno Heltzel • Seniors Association Unie KBO Paul Mulder • Achmea Insurances The seniors association with 300,000 members and Achmea Insurances provide health insurance for older persons. A success story. Download presentation (Powerpoint) Supporting the silver economy – not just for profit Daniël de Levita • adjunct Director, Seniorweb Raquel Wanrooij • Rabobank – Case Study Seniorweb is a website and computer learning community in The Netherlands with 60,000 members in the 50 plus age groups. Teaching older persons to use the computers and use internet banking is certainly serving the development of the silver economy. Download presentation (Powerpoint)
	Plenary Session 5
15.30 – 16.00	Closing Session Announcement of next conference Award: Winner of the Best Practice Competition Final Conclusions

Transcript

Slide 1: Caring for People with Chronic Illness: The Role of Telehealth Technology Steve Brown CEO, Health Hero Network 29 November 2006

Slide 2: Our Shared Vision A better model of care serving people who struggle with chronic conditions.

Slide 3: What the world is thinking about right now:

Slide 4: What the world is thinking about right now:

Slide 5: What the world is thinking about right now:

Slide 6: What the world is thinking about right now:

Slide 7: What the world is thinking about right now:

Slide 8: What do we want?

Slide 9: What’s Telehealth Got To Do With It? A Better Model of Care = Change Behavior and Moving Care to the Home

Slide 10: How to Change Behavior and Move Care to the Home • Personal Coaches for Everyone? • Nurses with Phones? • Nurses with Cars? • Doctors with Phones and Cars? Remote Health Management Technology! What Gets Measured Gets Done!

Slide 11: The Market Has Arrived “ r. B ohana, an 82-year-ol W orl W arII M d d vet , has been abl t m ove from l vi i eran eo i ng n hospi underround-t -cl m edi ce he ock cal supervi on t a B rookl st o apart entw i h si o yn udi m t t hel ofa rel i y si pl m oni ori he p at vel m e t ng syst from H eal h H ero N et ork. em t w The hand-hel H eal h B uddy consol , w hi d t e ch pl i o hi phone, del vers hi bl ugs nt s i s ood pressure erans A ffai nurse. and w ei ghtreadi t a V et ngs o rs Ital prom pt hi t answ era seri of so smo es qual t i quest ons abouthi l i at ve i s ung and ci at ai m ent , l ke w het rcul ory l si herhi breat ng s hi i bet erorw orse t t day before. st han he “ s i so si pl a 2-year-ol coul do i , Thi s me d d t” M r. B ohana sai .” d

Slide 12: Success Story: Veterans Administration February 2006 Today • 16,000+ patients enrolled in daily home telehealth with Health Buddy • Deployed in 120+ clinical sites • Over 100 programs for 30+ chronic conditions

Slide 13: Care Management Process with the Health Buddy System Scripted messaging, monitoring and reporting platform Education, monitoring Personalized, remote care and feedback at home management and support.

Slide 14: Technology Enabled Model of Care The Health Buddy System Technology Provider Patient Enabled Directed Centric

Slide 15: Expanding the Reach of the Health Buddy System The Next Step: Platform Independent Content Delivery Solutions

Slide 16: Health Buddy Teleguidance Health Buddy Teleguidance Project Contributors: Health Hero Network • Delivery of Health Buddy Meavita Program content through the Sananet B.V. television with IPTV Impact Media • Pilot Program – Available for Meavita customers in the Netherlands – Initial program for diabetes patients – Health Buddy Teleguidance will Launch in 2007

Slide 17: Care Management Process: Technology-enabled, Provider-directed Model Health Buddy Desktop • Keeps care provider “in touch” with patient – Monitor patient daily – Assess patient risk – Identify change in patient’s health – Intervene before crisis occurs • Improves productivity • EMR Integration • Secure web application

Slide 18: Health Buddy Desktop: Tools to Enable Management by Exception

Slide 19: Health Buddy Programs  Adult Asthma 2  Hyperlipidemia • Library of 100+ programs  Advanced Illness /  Hypertension 1 • Over 30 health conditions  Med. Compliance Palliative Care  Anticoagulation  Myocardial Infarc. • English & Spanish  Bipolar Disorder  Pain Mgt 2 •  Cancer 2  Pediatric Asthma 2 Ready to deploy  Caregiver  Polypharmacy • Customizable  COPD 1  PTSD  Coronary Artery 2  Pre-Diabetes  Cystic Fibrosis  Schizophrenia  Depression 2  Sr. Wellness – Evidence based practice  Diabetes 1  Substance Abuse guidelines  Functional ADLs  Smoking Cessation – Patient education  Heart Failure 1  Spinal Cord Injury – Care management  Hepatitis C  Weight Mgt  HIV

Slide 20: Care Management Process: Personalized Coaching and Monitoring • Dynamic branching logic collects information on: – Symptoms – Behavior – Knowledge • Delivers unique reply to each patient response in the form of – Call to action – Information / education – Further assessment – Reinforcement / reminder – Acknowledgement

Slide 21: Care Management Process: Creating Feedback Loops Knowledge • Identify high risks & potential problems Behavior • Address needs through dynamic content Symptoms H M L Knowledge • Move risks to lower levels Behavior • Stabilize health status Symptoms H M L • Identify changes in status Knowledge early on Behavior • Manage by exception Symptoms H M L Stabilize Patients Over Time

Slide 22: VA Outcomes 2002: Telehealth Reduces Inpatient Utilization* • 40% reduction in ER visits • 63% reduction in hospital admissions • 63% reduction in hospital bed days of care • 64% reduction in nursing home admissions • 88% reduction in nursing home bed days 1-Year Telemedicine Care Coordination • Significantly improved Quality of Life SF36V Demonstration * Published in Disease Management Volume 5, Number 2, 2002.

Slide 23: VA Outcomes 2005: Telehealth Improves Clinical Outcomes* • Hospitalizations declined from 630 inpatient days pre to 122 during intervention period • Bed Days Of Care fell from 8.63 to 1.65 (p < 0.001) • Blood Pressure: 129/73 to 119/69 (p < 0.05) • Weight: 196 to 192 (p < 0.01) • Shortness of Breath 0-10 Scale: 4.0 to 2.7 (p = 0.02) 1-Year Telemedicine • ACE Inhibitor Avg Daily Dose: 24mg/d to 35 (p < 0.01) Care Coordination  -Blocker Avg Daily Dose: 84 mg/d to 94 (p = 0.05) Demonstration * Published in Telemedicine and e-Health Volume 11, Number 1, 2005.

Slide 24: SPAN-CHF II Study 2005: Telehealth Reduces Hospital Readmissions* All Cardiac 2.5 Heart Failure Hospitalizations Re-Hospitalizations 2.0 2.20 63% 1.82 Reduction 72% 1.5 (p=0.029) Reduction 1.0 (p=0.03) 3-Month CHF Study 0.81 0.5 0.51 Hospitalizations PPPY 0.0 Control Health Control Health Buddy Buddy * Presented at American Heart Association Annual Meeting, Scientific Sessions, 2005.

Slide 25: Mercy Study: Compliance Drives Outcomes Medication Compliance as Hospitalization Costs for CHF Measured by Pharmacy Claims patients decreased 52% PPPY and Patient Self-reporting 100% $25 80% $20 $25,013 94% 1-Year Diabetes & 60% $15 HF Study 40% $10 $11,854 34% 20% $5 0% $0 Before Health Buddy Standard Health Buddy

Slide 26: Patient Acceptance Patients enjoy significant improvements in quality of life1 • 95% patient satisfaction2 • 86% better understand their treatment and are better able to manage their health condition • Patients feel more connected to their care provider2 1 Diabetes Technology & Therapeutics, Volume 4, Number 6, 2002. 2. Henry Ford Medical Center, CAD Study, 2004. (n=602)

Slide 27: The People We Serve “Health Buddy is the best thing to come down the pike. When I get up in the morning, I feel confident I am good for another day.” Wally Browning 1941-2006

Slide 28: Contact Information: Steve Brown, CEO Health Hero Network, Inc. 2000 Seaport Blvd. Fourth Floor Redwood City, CA 94063 stevebrown@healthhero.com 650-779-9101

“Health Hero Network’s Health Buddy system represents the very best of innovations in health care. It’s an elegant solution that truly makes the timely delivery of quality, cost-effective health care a reality,” said ABL President, Mimi Grant.

In bestowing the award, the ABL noted that the Health Buddy system, currently used by over 12,000 patients, has delivered significant clinical outcomes including reduced hospital admissions, reduced inpatient bed days, increased medication compliance, and reduced costs. The Health Buddy system is also recognized as the leading telehealth solution in use by the Veterans Affairs Administration (VA), deployed in over 100 of its clinical sites across the country. Coincidently, Kenneth Kizer, MD, former head of the Veterans Health System, was honored by the ABL for his leadership while he was at the helm of the VA, where he was the principal architect of the largest transformation in the organization’s history.

“Health Hero Network was founded on the vision that health care can be transformed to provide better service to people who struggle with complex chronic conditions while substantially reducing medical costs,” said Steve Brown, CEO of Health Hero Network. “To be recognized alongside other outstanding health care CEOs and business leaders in California is a great honor. Recognition of our Health Buddy system and its proven effectiveness in organizations such as the VA, our nation’s largest health care delivery system, is validation for us that the time has come for a better system of care,” added Brown.

About Health Hero Network
Health Hero Network develops and markets the Health Buddy system for health improvement. The system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves patients’ quality of care. Based in Redwood City, California, Health Hero Network’s systems are protected by over 57 patents. http://www.healthhero.com

This is the presentation I gave for the Emerging Opportunities in Home Management and Health Applications session of the Connections Digital Living Conference hosted by Parks Associates and CEA, May 4, 2006.

Connections Digital Living Conference Transcript

• Wiring the world for a new model of health care
  Steve Brown, CEO, Health Hero Network
  Emerging Opportunities in Home Management and Health Applications
  Connections Digital Living Conference, May 4, 2006
• Health Hero Network
  Our mission is to create a better system of care serving people who struggle with chronic conditions
• US Healthcare in 2006
  16% GDP
  $2,100,000,000,000
• US Healthcare in 2015
  20% GDP
  $4,000,000,000,000
• Portion of healthcare spending on people with chronic conditions
  78%
• What does it all add up to?
  $69,900,000,000,000
  -Present value of unfunded liabilities in Medicare,
  Federal Reserve Governor Edward Gramlich, April 21, 2005
• What’s Our Diagnosis?
  The current model of institution-centered care, based on crisis response, with inadequate attention to managing chronic conditions, is not sustainable and must change
• Chronic Conditions Defined
  Conditions that can’t be cured but must be managed
  Often caused or made worse through behavior
  Lifestyle factors: Smoking, obesity, stress
  Can be improved through behavior change
  Medication compliance, diet, exercise
  Early detection and intervention
  Patients cannot be passive
• Disease Management Defined
  Disease Management Association of America:
  “Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.”
• A Brief Look at the Past … and Future?
  Early-Mid 1990s: Managed Care
  Payers monitoring physicians
• A Brief Look at the Past … and Future?
  Late 1990′ – Present: Disease Management
  Payers monitoring patients
• A Brief Look at the Past … and Future?
  The Future: Physicians monitoring patients
  Accountability to payer
  Technology Supported Chronic Care
• What’s “Telehealth” Got to Do With It?
  Chronic care improvement
  = Moving health care to the home
• How to Move Healthcare to the Home
  Nurses with phones?
  Nurses with cars?
  Doctors with phones and cars?
  Technology!
• VA Chronic Care Model
  Daily education, monitoring and feedback at home
  Personalized care management and support
• Health Buddy – Patient Interface
  Symptom management, education, feedback
  FDA cleared communication hub for third party medical devices
• Health Buddy – Provider Interface
  Daily patient status and reports
  EMR integration
  Content development tools
  Clinical programs include
  CHF*
  COPD*
  Hypertension*
  Diabetes*
  Asthma
  Coronary ArteryDisease
  Post CABG
  Osteoarthritis
  Sleep Apnea
  Obesity
  Cancer
  HIV/AIDS
  Dementia
  Depression
  PTSD
  Schizophrenia
  Bi-polar
  Spinal cord injury
  Palliative care
  *NCQA Certified
• VA Chronic Care Results
  Veterans Administration Community Care Coordination Service, Florida
  63% reduction in hospital admissions
  60% reduction in hospital bed days of care
  Published in: Disease Management, Volume 5, Number 2, 2002
  Veterans Administration Heart Failure Study
  81% reduction in inpatient bed days
  Published in: Telemedicine and e-Health Volume 11, Number 1, 2005
• Model at Work Outside VA
  New England Medical Center SPAN-CHF II
  72% reduction in HF hospitalizations
  63% reduction in cardiac hospitalizations
  Presented at Heart Failure Society of America, 2005
  Henry Ford Health System Obesity Study
  >10 lbs weight loss in treatment group
  <.01 lbs weight loss in control group
  To be Published 2006
• Medicare Modernization Act:Section 721
  Section 721: Chronic Care Improvement Defined for Medicare FFS
  1. ELEMENTS OF CARE MANAGEMENT PLANS.—A care management plan for a targeted beneficiary shall be developed with the beneficiary and shall, to the extent appropriate, include the following:
  (A) A designated point of contact responsible for communications with the beneficiary and for facilitating communications with other health care providers under the plan.
  (B) Self-care education for the beneficiary (through approaches such as disease management or medical nutrition therapy) and education for primary caregivers and family members.
  (C) Education for physicians and other providers and collaboration to enhance communication of relevant clinical information.
  (D) The use of monitoring technologies that enable patient guidance through the exchange of pertinent clinical information, such as vital signs, symptomatic information, and health self-assessment.
  (E) The provision of information about hospice care, pain and palliative care, and end-of-life care.
  2. CONDUCT OF PROGRAMS.—In carrying out paragraph (1)(C) with respect to a participant, the chronic care improvement organization shall—
  guide the participant in managing the participant’s health (including all co-morbidities, relevant health care services, and pharmaceutical needs) and in performing activities as specified under the elements of the care management plan of the participant;
  use decision-support tools such as evidence based practice guidelines or other criteria as determined by the Secretary; and
  develop a clinical information database to track and monitor each participant across settings and to evaluate outcomes.
• Medicare Modernization Act:Section 722
  Section 722: Chronic Care Improvement Required in Medicare Advantage
  (2) CHRONIC CARE IMPROVEMENT PROGRAMS.—As part of the quality improvement program under paragraph (1), each MA organization shall have a chronic care improvement program. Each chronic care improvement program shall have a method for monitoring and identifying enrollees with multiple or sufficiently severe chronic conditions that meet criteria established by the organization for participation under the program.
• A New Hope
  Creative public policy can unlock resources for programs that improve chronic care and save money
  Creative business solutions can enable private sector to take risk and guarantee results
  Information technology can enable systems of care that ensure best practices and measure performance

In this presentation at the World Congress for Health & Human Capital Management in Wasnington DC, I described a new Chronic Care Model based on the Health Buddy system and designed to align incentives and enable health care providers to monitor and support patients at home, identifying problems early and educating patients in order to prevent expensive and painful complications of chronic disease.

Transcript

• Slide 1: Breaking the Deadlock: New Partnership Models to Improve Chronic Care Steve Brown, Founder and CEO, Health Hero Network Inc. Health & Human Capital Management Congress, January 25, 2006
• Slide 2: Health Hero Network We develop and market the Health Buddy® System: A patient-centered technology and service platform that empowers individuals to manage chronic conditions at home – with professional monitoring and support.
• Slide 3: Deadlock: Human, Social Costs “Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.” – New York Times, January 11, 2006
• Slide 4: The Price of Deadlock $69,900,000,000,000 -Federal Reserve Governor Edward Gramlich, April 21, 2005
• Slide 5: Something’s Got to Give •  Institution-centered care based on crisis response, inadequate attention to care management or prevention •  “Global Aging” combined with “Global Gaining” forcing payers to deal with largest cost driver, chronic illness •  To address these needs, healthcare is going electronic, focusing on the home, reorienting around the patient •  Deadlock persists because of misaligned incentives
• Slide 6: A New Hope •  Creative public policy can unlock resources for programs that improve chronic care and save money •  Creative business solutions can enable private sector to take risk and guarantee results •  Information technology can enable systems of care that ensure best practices and measure performance
• Slide 7: VA Chronic Care Model Daily education, monitoring and feedback at home Personalized care management and support
• Slide 8: VA Chronic Care Results Veterans Administration Community Care Coordination Service, Florida •  63% reduction in hospital admissions •  60% reduction in hospital bed days of care Published in: Disease Management, Volume 5, Number 2, 2002 Veterans Administration Heart Failure Study •  81% reduction in inpatient bed days Published in: Telemedicine and e-Health Volume 11, Number 1, 2005
• Slide 9: Model at Work Outside VA New England Medical Center SPAN-CHF II •  72% reduction in HF hospitalizations •  63% reduction in cardiac hospitalizations Presented at Heart Failure Society of America, 2005 Henry Ford Health System Obesity Study •  >10 lbs weight loss in treatment group •  <.01 lbs weight loss in control group To be Published 2006
• Slide 10: ACCENT / Health Buddy Program •  Consortium of Physician Groups •  Bend Memorial Clinic, Oregon •  Wenatchee Valley Medical Center, Washington •  AMGA oversees clinical protocols, quality management •  Care management process based on Health Buddy® system •  Begins Feb. 1, serving 1,600 high- cost patients with CHF, diabetes, COPD, and co-morbidities
• Slide 11: ACCENT Incentive Model • CMS pays consortium flat monthly fee based on program enrollment • Consortium assumes risk for fees against delivering 5 percent net savings • Consortium receives bonus if savings exceed target
• Slide 12: The Model Revisited •  Organize physicians to take risk, guarantee performance in chronic care •  Technology enables patient self-management / monitoring, ensures accountability •  Model could work for any payer segment •  Opportunity for disease management organizations to work through physicians

ALEXANDRIA, VA, – July 5, 2005 — The Centers for Medicare and Medicaid Services (CMS) has selected Health Hero Network, the American Medical Group Association (AMGA), and medical groups in Washington and Oregon to demonstrate how doctors can use home health monitoring technology to help Medicare patients with severe chronic illness live healthier, happier, longer lives – and reduce Medicare spending by preventing hospitalizations. The medical groups are Bend Memorial Clinic in Bend, Oregon, and Wenatchee Valley Medical Center in Wenatchee, Washington. The medical groups will implement a physician-led, technology-supported care management program for up to 2,000 Medicare beneficiaries with congestive heart failure, chronic obstructive pulmonary disease, and/or diabetes.

The group has named its effort the “ACCENT Project” — Advancing Chronic Care through E*Health Networks and Technologies. It is one of six projects selected by CMS under the Care Management for High-Cost Beneficiaries Demonstration. The CMS initiative will test approaches for transforming how doctors and hospitals provide care for high-cost Medicare patients with severe, complex chronic conditions. The goal is to improve the quality of life for these patients while significantly reducing costs. The ACCENT Project is notable among awardees because it will be conducted across multiple sites and because of its robust use of health information technology.

“The ACCENT Project will demonstrate that doctors and patients with severe chronic illness, supported by information technology, can establish a new partnership to provide exceptional preventive care for patients in their homes, and keep them healthier and living independently longer while reducing costs,” said AMGA President Donald W. Fisher, Ph.D. “CMS is rightfully coming to focus on creative new approaches to managing high-risk patients with chronic conditions. They are suffering under the current, crisis-driven approach to care, and they account for most health care spending. We look forward to partnering with CMS to show how medical groups supported by health information technology will produce great results for Medicare beneficiaries and taxpayers.”

CMS is requiring that Care Management for High-Cost Beneficiaries Demonstration awardees demonstrate improvements in the quality of care for high-cost Medicare patients who represent most of the program’s expenditures. Awardees are guaranteeing to CMS that they will save at least 5 percent of the total Medicare costs for the patients assigned to them.

The ACCENT Project’s key technology component is the Health Buddy system from Health Hero Network. Doctors and nurses at Bend Memorial Clinic and Wenatchee Valley Medical Center will use the Health Buddy appliance to coach patients at home about preventive behaviors that will keep them healthy. The doctors and nurses will use data generated by the Health Buddy appliance to spot problems and intervene early, before patients get so sick that they need to go to the emergency room or be hospitalized.

The ACCENT Project is slated to begin on January 1, 2006, and will last three years. CMS will assign to the ACCENT Project a patient population of approximately 2,000 patients who are already under the care of physicians at Bend Memorial Clinic and Wenatchee Valley Medical Center. Project coordinators will then actively recruit, enroll and manage CMS-assigned patients with the active cooperation of medical group physicians.

Beneficiary participation in the programs will be voluntary and will not change the amount, duration or scope of participants’ fee-for-service Medicare benefits. Fee-for-service Medicare benefits will continue to be covered, administered and paid under the traditional Fee-for-service Medicare program. Programs will be offered at no charge to the beneficiary. Organizations chosen for the demonstration will not be able to restrict beneficiary access to care or restrict beneficiaries to a limited number of physicians in a network.

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

About Medical Group Association
The American Medical Group Association (AMGA) represents medical groups, including some of the nation’s largest, most prestigious integrated healthcare delivery systems. AMGA advocates for the multispecialty medical group model of healthcare delivery and for the patients served by medical groups through innovation and information sharing, benchmarking, leadership development, and continuous striving to improve patient care. The members of AMGA deliver health care to more than 50 million patients in 42 states, including 15 million capitated lives. Headquartered in Alexandria, Virginia, AMGA is the strategic partner for medical groups providing a comprehensive package of benefits, including political advocacy, educational and networking programs and publications, benchmarking data services, and financial and operations assistance. For more information, visit www.amga.org.
Contact: Julie Sanderson-Austin, RN, VP, Quality Management and Research, 703/838-0033, ext 356, jsanderson-austin@amga.org

About Bend Memorial Clinic
Offering primary and specialty care since 1946, Bend Memorial Clinic includes 70 physicians representing 13 branches of medicine. It is the largest multi-specialty group east of the Cascades and functions as a comprehensive referral center for physicians and communities throughout the state. At Bend Memorial Clinic, your health is our passion.
Contact: Kim Barnes, Director Marketing & Business Development, 541-317-4370, kbarnes@bmcllp.com

About Wenatchee Valley Medical Center
Wenatchee Valley Medical Center, established in 1940, is a multi-specialty group with offices in seven communities in North Central Washington, serving an area of approximately 12,000 square miles. The medical center was founded on a commitment to serve patient needs by providing the highest quality healthcare and services in an atmosphere of concern and caring, with an organizational commitment of assisting in the development of one of the nation’s best rural healthcare delivery systems. Today, approximately 210 physicians and midlevel providers represent over 30 specialties and subspecialties and provide comprehensive medical and ancillary services to patients.
Contact: Richard Bennett, Assistant Administrator, 509-663-8711 ext. 5084, rbennett@wvmedical.com

=========================================================

HEARING

before the

SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE

ONE HUNDRED NINTH CONGRESS

FIRST SESSION

__________

WASHINGTON, DC

__________

JUNE 30, 2005
STATEMENT OF MR. STEPHEN J. BROWN, PRESIDENT AND CEO, HEALTH
HERO NETWORK, INC., MOUNTAIN VIEW, CA

Mr. Chairman and Committee members, I am Steve Brown, and I am the CEO of Health Hero Network, a technology company in Mountain View, CA.

We serve people struggling with chronic illness. Our technologies are designed to enable caregivers to coach and monitor patients at home. I am going to talk about some of the commonsense things that Senator Lincoln talked about, and I am also going to talk about some of the programs we are involved with, which hopefully will make the CBO happy about the results as well.

My view is that health care does not start when we are wheeled into the emergency room, and it does not start at the doctor’s office. Health care starts at home, with our own behavior and with prevention.

Most people in Medicare have a chronic illness. For them, prevention means reducing the complications of chronic illness and living independently longer. From our work with the Veterans’ Administration, we have seen that when caregivers and patients work together on daily management and prevention, they can improve the quality of life and reduce costs.

To illustrate this point, I am going to introduce Wally Browning from Huntington, WV, who recently was interviewed in his local paper. I included this in the written testimony.

Wally Browning is a Vietnam veteran. He served our country in Vietnam, and now he is being served by the VA and by Health Hero Network.

Wally has congestive heart failure, one of those high-cost, high-risk conditions that require very close attention and management. It is also one of the leading causes of hospital admissions for Medicare.

Every day a nurse at the VA checks in on how well Wally is doing, remotely, by sending message to a device installed in Wally’s home, called Health Buddy, and I brought that for you to see too.

With simple push buttons, Wally is able to answer questions that appear on the screen and tell his nurse how he is doing; tell his nurse about new symptoms transmit data about his blood pressure and his weight and also get feedback and coaching from his nurse about his condition and about his health program and about healthy choices that he needs to make.

A VA nurse uses a computer with a secure Internet application to analyze Wally’s data every day and flag potential problems before they become worse. The result has been fewer emergencies, fewer stays in the hospital, greater peace of mind, and cost savings for the VA. As Wally puts it, after he checks in with his Health Buddy, he feels like he is good for another day.

Wally is like 20 million Americans with complex chronic illnesses who are at risk of going to the hospital any day. Many of these hospital admissions can be prevented if we coach and monitor patients at home.

The reason our health care system is in trouble, even though we spend nearly $2 trillion a year on it, is that we are not paying for the right model of chronic care. For 40 years, Medicare payment has been based on episodic, face-to-face encounters with a doctor, usually in reaction to a crisis.

But chronic illness is not episodic. It is long-term, and it needs to be managed every day. If we want to prevent hospitalizations, we need to coach and monitor patients at home before a crisis occurs.

We know it is possible because we are doing this every day across America for thousands of veterans. According to the VA, hospital admissions for patients in the program were 63 percent lower than for a comparison group with similar high-riskconditions.

Last year, we worked with the Information Technology Association of America to look at the question. What if Medicare could achieve similar results to the VA with similar patients? The answer published by the ITAA–and that report is also in the written testimony–is that we would save over $30 billion a year.

As a result of your leadership and that of your colleagues, the Medicare Modernization Act starts to recognize that people with complex chronic illness need continuity of care and prevention rather than more episodic crisis management. That is a major step forward for Medicare, and now the challenge is execution.

We are participating in two large-scale chronic care improvement pilots authorized by the Medicare Modernization Act. We are also working with the American Medical Group Association and its physician groups, like the one in Bend, OR, to create a chronic care model based on coaching and monitoring patients at home, under the supervision of their primary physician.

Part of the wisdom of the recent Medicare initiatives is in recognizing how technology can play a vital role in transforming the model of care for chronic illness. Information technologies can extend care into the home and coach patients to improve their own lives and change their own behavior. Caregivers can detect early and deliver the right care at the right time before there is a crisis.

Health care and prevention starts at home, and the right technology can help people struggling with chronic illness and connect them to better care. I thank you for inviting me to testify today.

http://aging.senate.gov/hearing_detail.cfm?id=270687&

Mountain View, CA – May 23, 2005 – Health Hero Network’s Dutch partner Sananet B.V., an eHealth company offering information and communication technology products and services to improve the quality of health and social services in the Netherlands was selected by the Dutch Ministry of Health, Welfare and Sport (VWS) for a best practice project in telemedicine. Sananet was invited to demonstrate their project using Health Hero Network technology at the Ministerial Conference and Exhibition e-health 2005, May 23 and 24 in Tromso, Norway. The Ministerial Conference is a high-level conference and exhibition sponsored by the European Commission to promote advances in health care enabled by information and communications technology (ICT).

Representatives from Sananet will present their experiences and results with remote health monitoring for heart failure patients in Limburg to public health experts and decision makers from the entire European Union. Sananet will demonstrate the Health Buddy® system used in their telemedicine program sponsored by the Dutch Ministry of Economic Affairs and the Provincie Limburg which covers Heart Failure patients at the Academic Hospital Maastricht, the Atrium medical center in Heerlen and the Orbis medical and care group in Sittard/Geleen. The technology presented in Tromso will include the Health Buddy® appliance for monitoring and coaching patients with chronic illnesses and web-based decision support tools providing health data and services for care providers.

“In the Netherlands we showed that patients feel more safe and their self efficacy improves significantly after 6 weeks using the Health Buddy ® appliance at their home. The results are very promising for the near future and we expect that more patients with chronic illnesses will receive a Health Buddy ® appliance. In the Utrecht region we developed a telemedicine program which covers COPD sponsored by the Asthma foundation, and there we expect the same results. The selection as a Dutch Best Practice by the Ministry of Health for this Telehealth solution will accelerate the structural embedding of telemedicine programs in the Dutch Healthcare System, “ noted Jan Ramaekers, Sananet CEO. “Sananet is honored to have Health Hero Network as a strategic partner.”

“Around the world, people with chronic conditions have similar needs for coaching and monitoring at home in order to prevent hospitalization and improve the quality of care,” noted Steve Brown, Health Hero Network CEO. “Health Hero Network is honored to partner with leading innovators in Europe to advance chronic care, which is a critical necessity given the growing health needs of an aging population.”

About Sananet
Sananet B.V. offers products and services to enable professionals and patients to use sophisticated information and communication technology (ICT) for eHealth. Sananet enables healthcare professionals to link care providers with each other and patient data regardless of time or place, helping to provide efficient relations between different care partners and patients. The simplified communication facilitated by Sananet results in increased quality of care. Sananet’s services include consultancy, network capacity, training and solutions support. http://www.sananet.nl/

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com.

HEALTH HERO NETWORK CEO STEVE BROWN TO ADDRESS
ASIA-EUROPE MEETING IN LONDON
Home Health Monitoring Pioneer to Demonstrate how the Health Buddy® System
Is Being Globally Adopted to Improve Chronic Care

London – February 22, 2005 – Nations around the world can use similar approaches – including deploying home health monitoring technologies for people with chronic illness – in dealing with the challenge of aging populations, Health Hero Network CEO Steve Brown will tell an audience of European and Asian government and business leaders today.

Brown will deliver his address, “Advancing Chronic Care with eHealth Technologies in Japan: Proving Global Solutions for an Aging Population” at the annual Asia-Europe Meeting (ASEM) Conference on eCommerce in London. Health Hero Network markets the Health Buddy® system, a comprehensive technology solution for home health monitoring of people with chronic illness. In his speech, Brown will compare the implementation of home health monitoring in Japan in partnership with Yamatake and the deployment of the Health Buddy system in the Netherlands in partnership with Sananet.

“The need to improve chronic care for aging populations is driving very different health care systems to adopt very similar technology solutions,” Brown will say in his speech. “The Health Buddy system has led to dramatic improvements in the health of chronically ill patients in the U.S. and reductions in cost, and our partners are starting to experience similar successes in their initial efforts in their countries.”

ASEM is a multilateral forum for action-orientated debate between the EU Member States and Asian partner countries: Brunei, Burma, Cambodia, China, Indonesia, Japan, Korea, Laos, Malaysia, the Philippines, Singapore, Thailand, and Vietnam. The objective of this conference is to identify ways of increasing trade and investment through the use of online technologies.

About Health Hero Network
Health Hero Network develops and markets the Health Buddy® system for health improvement. The Health Buddy system serves as the interface between patients at home and care providers, facilitating patient education and monitoring of chronic conditions. The system includes monitoring technologies, clinical information databases, Internet-enabled decision support tools, health management programs and content development tools. Through increased communication, behavior modification, and prevention, the Health Buddy system improves the quality of care. Based in Mountain View, California, Health Hero Network’s systems are protected by over 55 issued US patents. http://www.healthhero.com

eHealth Programme

Monday 21 February 2005

08.30 Arrival and Registration

09.30 Plenary Session. Oficial Opening & Introduction
Conference Chairperson: Prof. John OÕReilly, CEO, Engineering and Physical Sciences Research Council

Keynote Speakers:
The Hon. Mike O’Brien, the UK Minister for eCommerce
Sir Richard Sykes, Rector Imperial College, London
Mr Takeshi Natsuno, Managing Director of Planning, i-mode Business Division, NTT DoCoMo Inc. Japan

Summary & Information on Streams

11.00 Coffee Break

11.30 eHealth Stream Session 1
Theme: Medical & Technology Future Convergence.
Chairperson: Professor Ricky Richardson: Vice President, ISFT, Chairman, UK eHealth Association

11.35 AneHealth, Anywhere. Professor Ricky Richardson, Chairman, UK eHealth Association

11.55 The Biological Continuum. Professor Richard Kitney, OBE, Professor of Biomedical Systems Engineering, Imperial College

12.15 The Impact of Molecular Biology on the Practice of Medicine.
Professor Stephen Smith, Dean of Medicine, Imperial College, London

12.35 Interactive Discussion. Chairperson: Professor Ricky Richardson, Vice President, ISFT, Chairman, UK eHealth Association

Professor Ricky Richardson
Professor Richard Kitney, OBE
Professor Stephen Smith

13.00 Lunch – Buffet in Conference Centre

14.00 eHealth Stream: Session 2
Theme: Telemedicine and International Outcomes.
Chairperson: Dr Niels Rossing, Danish Society of Clinical Telemedicine, Hon. Fellow of the European Federation for Medical Informatics

14.05 A European Perspective on eHealth as an agent for reform
Mats Larson; President European Health Telematics Association

14.20 Asian Perspectives on eHealth as an agent for reform
Ki-Chan Ahn, Korean eHealth Association
Tan Sri Dató Dr Abu Bakar bin Suleiman, President, International Medical University, Malaysia
Dr Sablee Aspar – Brunei
Prof. Wang Cai-you, Deputy Director of the Centre for Health Statistics and Information, Department of Health, The Peoples Republic of China

15.30 Interactive Discussion

15.45 Afternoon Tea

16.00 eHealth Stream: Session 3
Theme: Global Applications for eHealth.
Chairperson: Professor Ricky Richardson: Vice President, ISFT, Chairman, UK eHealth Association

Professor Jean-Claude Healy; World Health Organisation
WHO eHealth Strategy
The WHO Health Academy
eHealth for Crisis Management

16.30 Interactive Discussion

17.00 Streams Close. Exhibition and Networking.

17.30 Close of day 1

18.30 Meet and Travel to Dinner

19.30 Conference Reception & Dinner; The Royal Naval College, Greenwich

23.00 End

Tuesday 22 February 2005

08.30 Arrival, coffee, exhibitions

09.00 eHealth Stream Session 4
Theme: Putting eHealth Into Practice.
Chairperson: Professor Richard Kitney (OBE), Professor of Biomedical Systems Engineering, Imperial College

09.05 The National Programme for Information Technology (NPfIT):
Implementation and beyond. Richard Granger, Director General of IT for the NHS

09.20 NPfIT Local Service Providers: Perspectives on Achieving Successful Implementation.
Tim Smart – President, Consulting & Systems Integration, British Telecomm
Ken Lacey – Global Managing Partner Health & Life Sciences, Accenture
David Baker – NHS Account Director, CSC Alliance
Peter Hutchinson – Managing Director, UK Public Sector, Fujitsu Alliance

10.20 Interactive Discussion
Richard Granger
Tim Smart
Ken Lacey
David Baker
Peter Hutchinson

Conor Ward – Partner, Lovells Solicitors

10.40 Morning Coffee

11.00 eHealth Stream: Session 5
Theme: Realising Benefits from eHealth – Europe.
Chairperson: Mats Larson, President, European Health Telematics Association

Selected Case Studies:
The Danish eHealth Experience – Dr Arne Kverneland, Head of Department of Health Informatics, National Board of Health in Denmark.
Telemedicine Clinic, Barcelona – Dr Henrik Agrell, Vice President, European Telemedicine Clinic,
Current Finnish eHealth experiences and International Society for Telemedicine update – Dr Jarmo Reponen, President, Finnish Society of Telemedicine
Provision of regional cross-border eHealth programmes in Europe – Mark Simon, Chief Executive, ComMedica
NHS Direct New Media – Prof. Bob Gann, Director, NHS Direct New Media
HINE European eHospital Survey – Murray Bywater, Silicon Bridge Research

12.45 Lunch – Buffet in Conference Centre

14.00 eHealth Stream Session 6
Theme: Realising Benefits from eHealth – Asia
Chairperson: Tan Sri Dató Dr Abu Bakar bin Suleiman, President, International Medical University, Malaysia

Selected Case Studies:
The Ministry of Health hospital IT project, Malaysia – Dató Dr A Jai Mohan, Vice-President, Malaysian Health Informatics Association
Longitudinal population health records on a single platform in Hong Kong – Dr Chun Por Wong, Immediate past President of the Asia Pacific Association for Medical Informatics
An eHealth solution in Japan – Steve Brown, President and CEO, Health Hero Network Ltd

15.00 eHealth Stream Session 7
Theme: Looking To The Future; eHealth Innovation
Chairperson: Professor Ricky Richardson, Chairman, UK eHealth Association

Microwave Endometrial Ablation To Treat Heavy Menstrual Bleeding – Mr Ellis Downes MRCOG, Consultant Gynaecologist & Obstetrician, Chase Farm Hospital, North London UK
Technology & The Patient – Jo Wright, Managing Director of Global Health Business, British Telecom & Dr William Rutter, Chairman, iMetrikus
DVD-based training in the recognition of autism and Asperger syndrome
Prof. David Skuse; Institute of Child Health, Great Ormond Street Hospital for Children

16.00 Afternoon Tea

16.30 Plenary

Keynote Speakers:
European Commission: tbc
Mr Wang Zhong Min, Vice Administrator of the Standards Administration of China

Conference Chairman’s Summary:
Prof. John O’Reilly, CEO, Engineering and Physical Sciences Research Council

18.00 Official Close of Conference

18.30 Reception at ExCel, Exhibition and Conference Centre

20.30 End

Transcript

Slide 1: Mainstreaming eHealth

Slide 2: Advancing Chronic Care with eHealth Technologies in Japan: Proving Global Solutions for an Aging Population Steve Brown CEO Health Hero Network Ltd Mainstreaming eHealth

Slide 3: The Aging Population Challenge in Japan • Total population drops from 120M (2000) to 100M (2050) • Population over 65 rises from 18% (2000) to 37% (2050) • Traditional familial care of elderly declining rapidly • • New solutions needed for chronic care Mainstreaming eHealth

Slide 4: What can eHealth do? • Tools to support and educate patients to improve self- care, wellness, and health behavior • Tools to support caregivers in the monitoring and management of patients with chronic disease • Value to patients, caregivers, and society: Prevent the worsening of chronic disease Increase access to chronic care Lower the burden and cost of chronic care Mainstreaming eHealth

Slide 5: Tools to support and educate patients • Easy-to-use interactive countertop device • Daily personalized dialogue and guidance • Communication hub for home medical devices Behavior modification Mainstreaming eHealth

Slide 6: Personalized daily guidance and feedback • Congestive Heart Failure • Chronic Obstructive Pulmonary Disease • Coronary Artery Disease • Diabetes • Hypertension • Asthma • Depression • Senior Wellness (diet, activity, medications) Development tools and platform approach enables adaptation to local needs Mainstreaming eHealth

Slide 7: Fully customizable dialogue content • Example from Dutch COPD program operated by Sananet BV in Netherlands Mainstreaming eHealth

Slide 8: Communication hub for home medical devices * Subject to appropriate regulatory approvals Open system can serve devices from many different vendors Mainstreaming eHealth

Slide 9: Tools to support caregivers • Web-based application services for caregivers • Daily patient status and needs stratification • Symptoms, behavior, knowledge Monitor everyone but manage by exception Mainstreaming eHealth

Slide 10: Systems approach Enabling an improved model of chronic care Mainstreaming eHealth

Slide 11: Yamatake Corporation – Pioneer of chronic care improvement in Japan • Over 90 years experience in innovating in process automation and factory automation • Develops new business in the fields of health care, energy conservation and food safety and agriculture • 7,100 employees, over 1.4 billion (USD) in sales – 2003 • Created the Safety Service Centre which runs a personal emergency response service • Developed chronic care improvement system and service based on Health Buddy® system in partnership with Health Hero Network • Chronic care improvement services through Safety Service Centre Mainstreaming eHealth

Slide 12: Obstacles to improving chronic care in Japan • Insufficient economic incentives for healthcare providers to focus on prevention • Entrenched healthcare interests and institutions are slow to change • Population health factors are moving in the wrong direction (obesity, diabetes, lung disease all rising) Does this sound familiar? Mainstreaming eHealth

Slide 13: Situation in Japan is model for global needs to improve chronic care for aging population • Very different healthcare systems in Japan, Europe, USA • Very similar needs to improve chronic care for aging populations Leading toward similar eHealth solutions Mainstreaming eHealth

Slide 14: Video example is from Health Buddy® program in Netherlands operated by Sananet BV Mainstreaming eHealth

Slide 15: Similar chronic care improvement programsand pilots underway in 2005 • Japan (Yamatake) • Netherlands (Health Ministry, hospital pilots with Sananet) • USA (Veterans Affairs national program, Medicare pilots) Opportunity to learn from examples around the world New body of evidence being generated to support systems approach to improving chronic care for aging patients Based on eHealth enabling tools Mainstreaming eHealth

Slide 16: Future developments will further increase capabilities applications globally Health Buddy® 2 Processor: Samsung ARM 2410 Memory: 64MB Persistent Storage: 32 MB Operating System: Linux Screen: 640 x 240 Color LCD Ports: 4 USB, 1 RJ45 Serial Modem: 33.6 kbs Multiple languages Remote configuration 45 health applications Mainstreaming eHealth

Slide 17: Contact Information Steve Brown CEO Health Hero Network Ltd 40 Abbey Road Monkstown, Co. Dublin Ireland Tel: 00353 1 280 3997 Fax: 00353 1 280 9806 stevebrown@healthhero.com Mainstreaming eHealth

In the 2004 election, I had offered to help Steve Poizner campaign for a state legislature seat. Steve had an extraordinarily positive spirit that clearly served him well as an entrepreneur. He had achieved great success in business, but remained humble and dedicated, walking door to door to get to know his community and to listen to their concerns. I admired his attitude and approach, and decided to help out.

On election day, I went to my assigned polling places, checked lists to see who had voted, and called people to “get out the vote”, offering a ride if to the polling place if needed. I couldn’t see how my small effort could make a difference, but in the end, Steve lost by only a few votes. I regretted not making more calls.

We have intractable challenges in health care, which will consume $1.7 trillion in the United States this year. We seek leaders with the courage and the humility to take on the challenge of reform. Do you think that anything will change in the next four years?

Have you ever had an experience where you go to the doctor and find yourself filling out the same three-page form asking for the same information that you have filled out many times before?

Or an experience where the one medication that really seems to work for your child is not covered by your insurance without an appeal, and each time you need a refill, they seem to have lost the results of your appeal and need to start over?

I remember one visit to a local medical center that I won’t name other than to say that it is in the heart of Silicon Valley. Without an electronic medical record, I remember the doctor asking me in earnest, “Think, Steve, think! When did you have your last tetanus shot?”

We all have stories and personal experiences of the inefficiencies of our healthcare system.

Some of us may have started to see some new ideas based on the Internet making their way into the mainstream, ideas that open our eyes to new possibilities for a better and more efficient healthcare system. We can go to the Internet to research treatment options, schedule doctor visits, get personalized advice and feedback, and look up our own personal medical records. Maybe Silicon Valley ideas can help transform healthcare, as they have in other major fields.

Yet healthcare costs continue to explode, and it is bankrupting our government. Let me tell you why.

In San Jose, California, just south of Silicon Valley, a farm worker will show up at the Valley Medical Center emergency department with a foot ulcer that has become unbearable and has gangrene, a complication of diabetes. He has been to the hospital many times before, but no one will have any records, or know his history. He will spend 10 days in the hospital, where his foot will be amputated. He doesn’t have insurance, and now he won’t be able to work, either.

Then he will be sent home, where no one will be helping him manage his diabetes until the next crisis, when the cycle will repeat.

Any doctor will tell you that this is the most expensive and most painful way to treat diabetes. The tab will be picked up by Valley Medical Center and passed on to taxpayers, one way or another.

Just across Highway 101 from wealthy Palo Alto, a child lives with asthma in East Palo Alto. She will go to the Stanford Hospital emergency department for the 10th time this year, unable to breathe, parents in a panic. This time the child will be admitted to the hospital for three days.

Then she will be sent home with no support in monitoring and managing her asthma to prevent the next crisis. The cycle will repeat.

Med-Cal will be charged tens of thousands of dollars, not to mention the missed school days, the missed work for the parents, and the mental trauma of constantly living from crisis to crisis.

Within a few miles of the headquarters of Google, Yahoo, Cisco Systems, Intel, Sun, Hewlett Packard, and eBay, an 85-year-old woman lives alone in Mountain View with congestive heart failure. She will have a doctor’s appointment tomorrow. Everything will appear to be fine.

Tomorrow evening she will have difficulty breathing. By Friday she will be retaining fluids. No one will know. But she won’t call her doctor because she just had a visit and everything was fine.

Saturday she will feel worse and her legs will be swelling, but it is the weekend and she doesn’t want to bother her doctor. On Sunday, she will dial 911, and will be admitted to El Camino Hospital, where she will stay for 10 days to get stabilized.

Then she will be sent home again, alone, with no one monitoring or managing how she is doing, and the cycle will repeat.

Medicare will be billed tens of thousands of dollars.

Do any of these cases sound familiar? How many of you know someone with diabetes? Asthma? Congestive heart failure? How about emphysema or COPD? Hypertension? Coronary artery disease? Depression, or another mental health issue?

Do you know what these conditions have in common? They are all chronic conditions that need to be monitored and managed every day. If they aren’t, they get worse until you end up in the hospital.

Just how big is this issue? Chronic disease accounts for a vast majority of the $1.7 trillion that will be spent on healthcare in the United States this year. In the State of California, chronic disease accounts for most of the $200 billion we will spend on healthcare.

This year, there will be over 450,000 hospital admissions in California for the 7 chronic conditions I mentioned. That’s right, 450,000 acute care hospitalizations, costing $15 billion, for chronic conditions that can and should be monitored and managed before they become an acute crisis.

In public health these are called “ambulatory care sensitive hospital admissions”, which means, hospital admissions that you might have been able to prevent, if you had better care before you ended up in the hospital.

Here is the interesting part: If you look at who is paying the bills for hospitalizations that result from our failure to properly care for patients with chronic disease, over 70% is paid for by government: Medicare, Medi-Cal, cities and counties.

So how can we do it better? Let me share a few stories from my experience as CEO and founder of Health Hero Network, a Silicon Valley technology company focused on improving chronic care.

Our product is the Health Buddy® system, a home health monitoring system that links patients at home with care providers on a daily basis. A simple countertop messaging device connected to the phone line educates patients about their disease, guides them in daily self-care, and monitors symptoms. The data is transmitted to nurses and doctors, who use web-based tools to quickly see which patients are having problems before the condition becomes a crisis.

Working together, we have shown that public health nurses can monitor and educate uninsured farm workers with diabetes, heart failure, and hypertension. By improving self-care at home, and by identifying problems early when they still could be treated in a community health center, these program have cut hospitalizations in half, and saved millions of dollars per year.

We have shown that hospital case managers can monitor, educate, and support children with asthma covered by Medicaid. Kids learn about medications and symptoms, and begin to recognize and prevent impending asthma attacks. These kids gain confidence that they can live normal lives, while cutting their need to go to the emergency department to a fraction of what would have been expected.

We have helped nurses and doctors at the Department of Veterans Affairs to reduce hospital admissions for chronic diseases like heart failure, diabetes, COPD, hypertension, and depression by an unbelievable 63%, while improving quality of care and support for aging veterans. As a result, the VA is rolling out home health monitoring programs through its medical centers around the country as part of a national chronic care improvement program.

Home health monitoring programs at the VA are an important part of a technology-enabled transformation that has improved quality and access while reducing overall costs by 24%, according to the Undersecretary of Health at the VA who initiated the programs, and this transformation is just getting started.

If Med-Cal could achieve results like the VA, the savings would be $8 billion per year, one billion more than the structural budget deficit that is forcing Californians to compromise on education, roads, and lots of other important things we all care about.

Our experience at Health Hero Network is just one small example of a transformation in healthcare that is starting to take hold around the country. At our last count, 46 states have recognized the opportunity to improve the way they handle chronic care in their Medicaid programs, and have initiated Medicaid transformation projects and chronic care improvement programs.

Sadly, though, California’s response so far has been that “things are so bad right now that we can’t even think about fixing it.” The only ideas to be discussed come down to either cutting services or raising taxes.

That is why we urgently need fresh thinking in our government. We need leaders with the vision to see that it is possible to transform services in ways that improve quality and health care access, and lower costs at the same time. We need leaders with the guts to take on healthcare transformation precisely because our health system is in crisis.

Silicon Valley innovations in technology and the Internet have enabled transformation in just about every other industry to improve services and lower costs.

If the State of California can partner with Silicon Valley to transform healthcare across this state, not only will we improve quality of life for those who suffer from chronic disease, we will also remove a drag on our State budget, and on the economy.

One day we will have a smarter healthcare system in California that can serve those who need it most – without breaking the budget.

One day we will have a new model of care in California that empowers and supports citizens proactively rather than in reaction to a crisis after crisis.

The tools for transforming healthcare are made right here in Silicon Valley. This will be a new growth industry for California, creating jobs and serving a growing need around the world.

This can happen and will happen when we choose leaders who have the vision and courage to step forward and make a difference.