Episode 3: "One solution does not fit all" with Kent Dicks of Alere Connect

3:11- Kent talks about how he got from top secret military work to healthcare, specifically remote monitoring of biometrics.

5:11 - Lessons from 9/11, monitoring vital signs and stress levels via biometric headsets. And how to transmit this information back to the cloud from a technology perspective. Hones in on cell phones.

6:00 - Working with McKesson to do a small pilot for diabetes patients and the Navaho indian reservation. Began to focus on the 15% of people consume 80% of healthcare cost. Found that the trick to ROI is to align the technology solution to these high-risk patients. But that’s hard because the people who most need the technology are probably the least likely to use the technology: elderly, indigent and either are intimidated or can’t afford the technology or will attempt to use the technology in a way that doesn’t contribute to their health, like downloading games or selling the device in a pawn shop.

8:40 - First hope was to monitor people in their disease to identify people who are likely to wind up in the hospital or in danger of their disease exasperating to the next level.

9:00 - Use of monitoring devices in heart failure, for example to avoid hospitalizations.

10:50 - Chasing efficacy, alignment of reimbursement of physician incentives and the latest technologies. Constant pursuit of the right solution to try to engage patients at the right cost and the right incentives to doctors.

12:30 Stakeholders most interested in technologies like this are those financially responsible for the patient, especially those interested in capititated cost. One of the most effective, and the most costly ways to improve outcomes is to have a skilled nurse work with patients. The least costly is if the patient can use their own device to monitor themselves, but this is also the least compliant. So need to find a solution in between. “one solution doesn’t fit all.” Need to figure out what fuels people to engage them and keep them as high compliant as possible and keep them out of the hospital or ER.

14:45 - How the MedApp solution walks the middle line between cost and effectiveness. This solution is designed for the 15% of the market that consumes 80% of the heath resources. It needs to be simple, transparent in the background, ubiquitous. It can’t require extra steps. Humans don’t work any other way. An example of how Kent’s scale is automatic and transparent this way.

19:05- with this 15% patient population … the plan is not going to know which phones or technology their patients are using. And also have to be careful that the devices are not “hockable.” The unit needs to be “dumb” but highly automated and easy for the business model to work, all within a regulated environment.

20:50 - McKesson pilot. “Let the nurses be clinicians, not technicians.” By using the MedApp solution was cheap to make and deploy to patients. 19:00 An example of a fail. Microsoft Healthvault and Cleveland Clinic try to use the patients own technology and connectivity to configure each patient for a congestive heart failure pilot.

23:30 - In this transformational period and experimental phase, the technologies are altering quickly. What we need to do is be less hardware dependent. People were concentrating on the health of the patient, but not the health of the device from a technology and connectivity standpoint. Need to be able to update firmware over the air, need to configure automatically if things change. Devices can’t be high maintenance otherwise the data-stream interrupts and the whole program goes down. What helped us most to become a key player here was our acquisition by Alere. Alere brought to us a full continuum of care to follow the patient longitudinally from a rapid diagnostic, care, education and data/analytic and informatic standpoint.

26:30 - The downside to a silo’ed industry which Alere overcomes with their “modular” approach. How Alere can identify dangerous trends in a patient’s health before they culminate in acute events. 28:00- transitioning from an analog company into a digital service organization

32:30- “CIA Effect.” You can’t replace all the operatives with technology and massive amounts of data. So much data that no one could act on it. It’s not cheaper to have nurses and just rely on data collection and technology. It’s not cheaper, because nothing was getting done. The best way to go is a hybrid approach. have powerful technology that collects data and synthesizes it down to key points. Then have the doctors and nurses be able to look at these points and determine who to act upon. One of the biggest problems have today, align incentives for doctors and nurses to make sure that they are paid to act on the information they get.

24:30 - Fitting seamlessly into the lives the healthcare providers. The technology or data we provide can’t require massive extra steps. Doctors want systems around looking at trending, do long haul work in the background. But the technology needs to be relevant and accurate, otherwise results in Alert fatigue.Fine tune system so the Alerts fire off appropriately.

37:10 - The priority of Alert Fatigue because it impacts workflow and efficiency. But this will take time to stratify patients so can classify patients for the alerts that matter. Otherwise, fire off alerts that are meaningless and that’s when systems fail.

38:05 - Alere’s customers are organizations concerned with controlling costs in health management. So sometimes subcontracted skilled nurses, direct payers, providers concerned about 30-day readmits, accountable care organizations (of course), large employer groups with chronic care programs trying to reduce costs like Toyota, GM, Ford or Steel mills. Those who are financially responsible for patients gravitate to us.

40:40 - Strategic approach — lots of conversations and experimentation. Trying to align technology with those where we can make the most difference, and therefore, we are most interesting to the payers and others who support those specific patients.

42:00 - The first thing that any investor is going to want to know. Advice to app makers. Listen, learn and figure out what things work. When create a solution, are you creating a solution looking for a problem or visa versa? Need to find a problem, then identify how big of slice of the market has this problem. Then make sure you know who will pay for it.

44:30 - “It could be cool, but is it needed?”

45:30 - The biggest timesuck for an entrepreneur? Chasing funding.

47:10: The best way to generate acceptance for an innovation is to generate energy: win awards, do press, get interviewed. Create buzz and educate the marketplace while you’re seeking approval for your development. Be sure to “show the shiny bits.” The human mind gravitates back to the sexy. Maybe it makes sense to keep the cool parts even though it might not be the best to support the business model. “If you build it, they might not come.”

50:10 - Kent’s prediction for the future … connectivity between the patient and healthcare stakeholders. Consolidation of the industry, engagement requires integration into a solution that all works together. Hardware commoditized. transformation of the newly available data into evolve into predictive solutions. Let's build “The Nest of Healthcare.”