We’re gathering for an after-work brainstorming session/meet-up at the Meadhall in Kendell Sq. on Friday, May 11th and we’ll kick off our main day of coding on Saturday, May 12th.

We invite the MIT community to join other entrepreneurs, developers, researchers, informaticians, citizen-scientists and like-minded innovators for this fun day of health-hacking. It’s a great way to network, make an impact in health care, and potentially win some cash prizes.

Event information and registration available

at

Health 2.0′s Boston Big-Data Code-a-thon

(http://www.health2con.com/devchallenge/health-2-0s-boston-code-a-thon)

The time is right to hack healthcare, but as entrepreneurs we often are setback because we can’t get to the people that are making the decisions in healthcare settings, government, and industry. To help fix this, Bob Higgins, Richard Foster, Jim Dougherty and Hacking Medicine have teamed up to bring you Dr. Joseph Kvedar, the Founder and Director of the Center for Connected Health within Partners HealthCare. If you ever want to sell or partner with a hospital, Dr. Kvedar is the ideal person to speak to because he is the one who makes the decisions about which technologies to bring into their Center and how to commercialize them. He also is a Co-Founder of Healthrageous, a personalized health technology company, which is based on the technology platform developed at the Center. The goal of this event is to help connect entrepreneurs to the marketplace and give you open access to Dr. Kvedar and ask him those questions you can’t find the answer to on any website. Also we are going to select 3-5 student entrepreneurs to give their 60 second pitch at the end of the event and get direct feedback from Dr. Kvedar himself. If you would like to pitch, please answer a couple of quick questions here.

EVENT DETAILS:

Date: Monday, May 14th
Time: 7 – 9PM
Location: Trust Center for MIT Entrepreneurship, One Amherst Street, E40-160, Cambridge, MA

EVENT SCHEDULE:

7:00 – 7:15 PM: Registration Opens (free pizza and drinks will be served)

7:15 – 7:30 PM: Student Idea Pitches

7:15 – 8:30 PM: Open mic session with Dr. Joseph Kvedar

EVENT SCHEDULE:

To register for the event, please sign up here.

As an M.D./Ph.D. who has tended toward the basic sciences I was initially nervous about the foreign worlds of engineering and business that seemed to be the core of Hacking Medicine (held at the MIT Media Lab on 2/25 and 2/26/2012).

When I arrived I had several ideas for problems in medicine, but I couldn’t have predicted how the forces which had initially made me nervous could provide such interesting and viable solutions.

The problem I posed was one of scheduling.

My wife works in a pediatrics clinic.  Due to a 40% “no show” rate and no penalty for not showing, my wife and her colleagues are forced to overbook their schedule so that they have enough patients who do show up to bill for.

This results in an unbalanced system which results in many days with far too many patients, rare days with the right number of patients, and still days when too few people show up.

My initial idea was to shift some of the financial burden of a “no show” to the insurance companies and the patients so that these parties are incentivised to get the patient to the clinic.

Enter Hacking Medicine.

After positing my problem I was approached with an entirely MIT solution:  Use machine learning trained on patient characteristics and prior no show rates to assign each patient a likelihood to show value between 0.1 and 1 (A full 1 is for steady person who always shows up).  Then each provider can be assigned a schedule that is more likely to add up to 20 patients actually showing.  So for a 1 you wouldn’t overbook their spot – they are going to be there.  For a 0.5 you would overbook a second 0.5 so that each slot adds up to 1.

On average this system promises to normalize Dr’s schedules and save money for the practice by filling wholes in the schedule and eliminating the tendency of patients to leave when they are frustrated by waiting too long for their doctor.

Creating such a system over such a short time frame has been really interesting.  It has been eye opening to have a team of MIT computer savvy undergraduates who are able to code these ideas into a prototype so quickly.  Along the same lines having MBA types envision a way to make this actually work as a company makes the whole exercise feel “not like an exercise”, but like starting a company.

More to come.  Another component we are adding is adding a “Doodle” form for rescheduling so that patients who previously said they could like an earlier appointment so that when such a slot opens up we only contact them if they could make it on that day.

Today is 2/26/2012.  I am very excited to get into the media lab and keep Hacking.  Thanks to all the participants and organizers.

Gabriel M. Belfort, M.D./Ph.D.

“Large amounts of money are being spent on things outside of actual healthcare; CEO bonuses, pharmaceuticals, malpractice insurance premiums, lawyers, etc. This accompanied with the new ‘Customer Service’ initiatives that reward physicians who practice bad medicine is clouding the future of medicine.”

To me, this report illustrates these important points:

1. The delivery of health care in the United States has become extremely fragmented over time, leading to a total systemic breakdown. That physician’s quote above illustrates it all–there is too much money and power floating throughout the health care delivery system that do not revolve around the patient-physician relationship. System dynamics dictates that the more entities in a system, the more complexity. No wonder the health care system in the United States has proven so difficult to fix. The sheer level of complexity with the number of stakeholder groups (patients, physicians, payers, pharmaceuticals, the government, lawyers, need I go on?) and their interactions makes it extremely easy for communication failures to propagate and diverting attention away from what should be the core of health care delivery: the patient.

2. Hacking medicine successfully requires an understanding of these systemic interactions. Regardless of what aspect of health care you are trying to hack, whether its contributing to health and wellness or making costs more transparent; you must remember what stakeholder interactions you are trying to hack and how that contributes to the overall system of health care delivery. Health care delivery in this country will not change overnight by implementing new technologies and innovations, but incremental changes will eventually add up to a critical mass in which the health care industry must sit up and pay attention, less they be rendered irrelevant. Furthermore, once we hack certain interactions in the system, we must remember to expand our scope and determine what other factors have bearing on a person’s health: socioeconomic status? Distance to fresh produce? Methods of transportation? Public policies dictating what types of foods are available at your local supermarket or what types of medical services are available to you? What about farm subsidies; how do they influence health and wellness?

3. Hacking medicine may not necessarily involve technologies, but a total paradigm shift with regards to providers. What concerns me about the Physicians Foundation report is the attitude taken by young and upcoming physicians with regards to their profession. From reading the report, it appears to me that perhaps matriculating medical students may go into medical school with some expectations of what they expect to gain from medical school and come out with a cynical view of what it means to be a physician due to the systemic failure of health care delivery today. How can we as medicine hackers change the perspective of providers such that they feel inspired to practice medicine again, or is that not our concern? Whose responsibility should it be to get more providers optimistic about health care in this country? Without inspired providers, where does that leave us, the patients?

We have a long way to go and it may not be perfect, but I think we’re at the start of something truly amazing. Hopefully many of these questions that I’ve posed in this post will be answered as we continue to hack medicine.

Apply to Rock Health Boston.  Do it now!

Rock Health has just expanded to Boston.  You may have heard of Rock Health because of all of their media attention ( http://rockhealth.com/about/press/ )  and the acquisition of one of their first startups.  The accelerator was co-founded by Nate Gross and Halle Tecco.

They’ve been blowing up in the bay area, and just recently expanded to Boston, partnering with Harvard med school.

Applications are open, and all info: http://rockhealth.com/boston/

The time is right to hack healthcare, but as entrepreneurs we often are setback because we can’t get to the people that are making the decisions in healthcare settings, government, and industry. To help fix this, Bob Higgins, Richard Foster, Jim Dougherty and Hacking Medicine have teamed up to bring you Eric Buehrens, the former Chief Administrative Officer from Beth Israel Deaconess Medical Center (BIDMC), one of the largest and most prestigious academic medical centers in the world. If you ever want to sell or partner with a hospital, Eric is the ideal person to speak to because he is the one who makes the decisions at the top. Prior to his current role, he served as Interim President and Chief Executive Officer of BIDMC. The goal of this event is to help connect entrepreneurs to the marketplace and give you open access to Eric Buehrens and ask him those questions you can’t find the answer to on any website.  Also we are going to select 3-5 student entrepreneurs to give their 60 second pitch at the end of the event and get direct feedback from Eric Buehrens himself. If you would like to pitch, please answer a couple of quick questions here.

Tuesday, April 10th, 2012 

7:00 – 9:00 PM

Trust Center for MIT Entrepreneurship, One Amherst Street, E40-160, Cambridge, MA

Event Schedule:
·      7:00 – 7:15 PM: Registration Opens  (free pizza and drinks will be served)
·      7:15 – 7:30 PM: Student Idea Pitches
·      7:15 – 8:30 PM: Open mic session with Eric Buehrens

Event Schedule:
To register for the event, please sign up here

Advisory Board Members/Co-Sponsors
Bob Higgins, Harvard Business School
Richard Foster, Yale School of Management
Jim Dougherty, Sloan School of Management

On Monday, March 26, the Supreme Court began hearing arguments for all cases involved with the Patient Protection and Affordable Care Act (PPACA). Unless you have been living under a rock, you probably know that the PPACA is the landmark health care legislation passed by the 111th Congress and signed into law by President Obama on March 23, 2010. You may be more familiar with one portion of the law that became an immediate point of contention after the PPACA was signed into law. Many states filed suit against the government immediately after signing, arguing that the PPACA is unconstitutional because it calls for an individual mandate. This means that every citizen is required to have health insurance, not unlike what we are used to as residents of Massachusetts. In this blog post, I aim to outline and explain what is being contested in the Supreme Court, and its potential implications on health care reform in the United States. I will also shed light on other, less publicized, portions of the law that have profound implications for healthcare costs for the poor and elderly and for healthcare entrepreneurs trying to breathe new life into a troubled system.

“That our generation is able to succeed in passing this reform is a testament to the persistence –- and the character -– of the American people, who championed this cause; who mobilized; who organized; who believed that people who love this country can change it.”
— President Barack Obama

Passed in 2010, the Patient Protection and Affordable Care Act (PPACA) held a number of provisions aimed at extending health insurance coverage to more than 30 million previously uninsured Americans, while reducing costs associated with health care services and outlawing provisions that prevented many citizens from receiving private health care coverage (The White House, 2010). For example, health insurance companies are no longer allowed to deny coverage due to preexisting conditions. The provisions of the PPACA of concern in the Supreme Court arguments come into effect in 2014 and are listed below:

• The individual mandate: This provision will require that everyone not currently insured under an employer-sponsored plan or a government-subsidized plan (Medicare, Medicaid, etc.) must carry health insurance or pay a penalty.

• Expansion of Medicaid eligibility: Medicaid eligibility will expand to include all individuals and families with incomes up to 133% of the poverty level. Otherwise, there is no federal requirement that states provide health insurance for adults with no dependent children. States that do not adhere to this provision may see their federal Medicaid subsidy withheld. (Galewitz, 2010).

28 states in total, including Florida, Colorado and Texas, have filed joint or individual lawsuits against the federal government stipulating that the PPACA’s provision to mandate that each individual must carry health insurance is unconstitutional because it violates state sovereignty under the Commerce Clause:

“Regulation of non-economic activity under the Commerce Clause is possible only through the Necessary and Proper Clause. The Necessary and Proper Clause confers supplemental authority only when the means adopted to accomplish an enumerated power are ‘appropriate’, are ‘plainly adapted to that end’, and are ‘consistent with the letter and spirit of the constitution.’ Requiring citizen-to-citizen subsidy or redistribution is contrary to the foundational assumptions of the constitutional compact.” (Supreme Court, 2012).

In other words, states filing suit against the federal government are arguing that for the federal government to mandate that individuals be insured and to order that Medicaid eligibility be expanded would be an unconstitutional expansion of federal powers, as it would be beyond Congress’s constitutional purview for regulating interstate commerce.

Oral arguments to the Supreme Court began on Monday, March 26, and will continue through Wednesday, March 28. Over the course of three days, the following questions will be discussed:

1. Whether the case is premature because the portion of the law regarding the individual mandate and the expansion of Medicaid hasn’t yet taken effect;

2. Whether Congress abused its power in mandating that Americans be insured or face a penalty;

3. The constitutionality of the individual mandate; and

4. Whether Congress violated federalism by stipulating the expansion of Medicaid, a program delivered by the states and partially subsidized by the federal government. (The New York Times, 2012).

If the Court rules that the provisions are unconstitutional, many Americans who would have gained eligibility for public health insurance programs will now be left uninsured, which was one of the main achievements of the PPACA. More alarming would be what this potential ruling might mean for other federally subsidized state programs, such as transportation and education subsidies, that hinge on states meeting certain requirements to receive federal grants. Regardless of the Court’s decision, many of the provisions will remain intact, including those expected to reduce the costs of health care services in the United States.

Implications for Health Care Reform in the United States

Other provisions of the PPACA that have already gone into effect include the creation of the Center for Medicare and Medicaid Innovation (CMI), responsible for developing and testing innovative payment and delivery models for the Medicare and Medicaid populations. Earlier this year, CMI announced the availability of $1 billion to support the testing of proposed models for three years ready for rapid deployment (Center for Medicare and Medicaid Innovation, 2012).

One effect of the PPACA was catalyzing the health care entrepreneurship movement, where startups and public-private partnerships emerged to promote innovative solutions for health care delivery in the United States. With the emergence of health tech accelerators Rock Health, Blueprint Health and Healthbox, and the press surrounding the digital health movement (i.e. TechCrunch’s 6 Big HealthTech Ideas That Will Change Medicine in 2012), the industry seems to be ripe for a revolution.

Medicare and Medicaid insure a specific subset of the American population (the elderly, low-income and disabled individuals) who often receive the most services and as a result comprise a large portion of health care costs (Medicare Payment Advisory Commission, 2007; McHugh, et al. 2010). By targeting innovations for this specific patient population, health care costs should decrease in the long-term, and extending Medicaid via the PPACA as it stands would enable these technologies and new delivery models to be accessible to a population that otherwise would not receive these benefits.

In addition, a provision that took effect at the PPACA’s enactment involved giving the Food and Drug Administration the ability to approve generic versions of biologic drugs and grant biologics manufacturers 12 years of exclusive use (Kaiser Family Foundation, 2010). This provision gives biotechnology and pharmaceutical companies the incentive to develop cheaper versions of new biologic drugs and put more resources into research and development efforts for future drugs.

Based on the first day of arguments, it appears as though the Court is ready to move on from the question of consideration and move on to questions of legality and constitutionality. The Court is expected to rule on the case in June, immediately before this year’s general election, making this a highly charged issue with likely enormous repercussions for both President Obama and the eventual Republican presidential nominee.

Citations:

Center for Medicare and Medicaid Innovation, Health Care Innovation Challenge. http://innovations.cms.gov/initiatives/Innovation-Challenge/index.html. Assessed March 26, 2012.

Galewitz, Phil. Consumer’s Guide to Health Reform, Kaiser Health News (2010).

Kaiser Family Foundation, Health Reform Implementation Timeline. http://healthreform.kff.org/timeline.aspx. Assessed March 27, 2012.

McHugh, Matthew D., Carthon, J. Margo Brooks, Kang, Xiao L. Medicare Readmissions Policies and Racial and Ethnic Health Disparities: A Cautionary Tale. Policy, Politics & Nursing Practice; 11(4): 309–316, November 2010.

Medicare Payment Advisory Commission. 2007. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission, p. 103.

The New York Times, A Guide to the Supreme Court Challenges to Obama’s Health Care Law. http://www.nytimes.com/interactive/2012/03/19/us/guide-to-supreme-court-challenges-to-obama-health-care-law.html?ref=us. Assessed March 26, 2012.

Supreme Court of the United States, Patient Protection and Affordable Care Act Cases. http://www.supremecourt.gov/docket/PPAACA.aspx. Assessed March 24, 2012.

The White House, Health Care that Works for Americans. http://www.whitehouse.gov/healthreform/healthcare-overview#healthcare-menu. Assessed March 24, 2012.

Last year’s Challenge winner Ginger.io (MIT Media Lab spin-off and the most recent Health Technologies track winner of the 2012 SXSW Accelerator) and MIT-based semi-finalist Wellfra.me will be on hand to provide their own insights about the Challenge. To find out more about the Challenge, visit www.datadesigndiabetes.com.

Hope to see you there!

Data Design Diabetes Information Session – Boston/Cambridge

Cambridge Innovation Center (CIC), One Broadway (4th Fl), Cambridge MA 02142

6-7:30pm

Tuesday, March 20, 2012

Boy, were they right.

Once I got to Austin, all the haphazard pre-planning I had done was immediately thrown out the window. Although my background is in health care and I’m incredibly passionate about new technologies in health care, just by perusing the schedule and seeing who was on tap to speak at SXSW I quickly realized this was a rare opportunity for me to explore some of my other interests, such as media, politics and open government. As a result, I ended up wandering from panel to keynote to featured session ranging from Government as a Catalyst: Prizes 4 Tech Innovation (moderated by fellow TPP alumna Jenn Gustetic); Arrested Development actor Jeffrey Tambor’s acting workshop; and Code for America‘s panel on the amazing efforts that cities are doing to incorporate technology to better serve their citizenry. You can take a look at my notes from SXSW on my Twitter feed.

Upon reflection, I realized that the uniqueness of SXSW as a conference is that regardless of your professional background and interests, there is something in every single talk and encounter that is applicable to your line of work. If there are any themes that I took away from my first time to SXSW, it would have to be the following:

• Communication, engagement and accountability are key. Every single session I attended stressed the importance of these three elements. BravoTV’s Andy Cohen and New York Times executive editor Jill Abramson all noted the importance of ensuring their customers were engaged with their offerings, whether it was via fan interaction with a television show (Top Chef) or via the public editor column at the New York Times. Social media has definitely made it easier to communicate and facilitate interaction with your customer. Enabling your customer to engage with their favorite TV show or their health care provider or their local government starts a feedback loop whereby the citizen gets to participate and feels like someone is listening to their concerns. And by enabling interaction, the consumer ensures that the government, or the newspaper or their health care provider is held accountable for their services.

• How stakeholder groups define innovation influences how we approach implementation and dissemination. One of the questions I’ve been mulling over even post-SXSW is what the government’s role should be in cultivating and disseminating innovations. During SXSW, I realized that how one feels about that question is largely dependent on how you define innovation and the pipeline for which you think innovation should be implemented into society. For example, during Jenn’s panel on government prizes, it was noted that many of the government-sponsored prizes still had not resulted in sustainable businesses. Furthermore, many cities are adopting digital methods for engaging with their citizens in order to reduce inefficiency in government processes, particularly during times of crisis, and citizens have produced various apps to help them live better lives (i.e. transportation apps). However, many of these apps and services are free. Must innovation be spun off into sustained businesses? Some economists would argue that providing these apps and open sourced websites already results in the positive externality of bettering a citizen’s life by reducing inefficiency and enabling behavior change. I’m not sure any of us have the answer or solution to what the government’s role should be in assisting entrepreneurs and innovators, but I have a feeling this will become increasingly important in the 21st century and particularly in this upcoming election.

Finally, and perhaps most importantly, I left SXSW and Austin incredibly inspired by the conference attendees I met, the conversations we had, and the discussions elicited by conference sessions. I’ve always been a believer in bringing together people of all different disciplines to work on complex systems problems, as everyone brings a different perspective to the table and SXSW was exactly that in action. Where else would you be able to say that you ran into Dropbox’s Drew Houston, Zappos’s Tony Hsieh and actress Gabrielle Union within a few blocks of Sixth Street? (Yes, that actually did happen and I am still in a slight state of awe.) It was also so great to hang out and meet groups of people that ordinarily would be quite difficult to organize together (special thanks to Cal@SXSW and Jeff Yang).

Code for America co-founder Jennifer Pahlka said in the closing keynote that we as developers, designers and technologists are in a unique position to change the system. We have the skills and the know how to just make stuff happen.

So what are we waiting for?

All health & wellness sessions will be held at the state of the art AT&T Conference Center, right by the University of Texas at Austin campus. Here are a few of the sessions I’m personally looking forward to:

1. Crowdsourcing a Revolution: Can We Fix Healthcare?

As a nice follow-on to my discussion on prizes and challenges to incentivize individuals and groups to innovate solutions to some of America’s toughest challenges, this panel combining individuals in government and the XPrize Foundation will discuss how we can use challenges to catalyze significant changes in healthcare delivery.

2. Are Wired Hospitals Losing the Patient Connection?

I was lucky enough to see Michael Graves at Social Media Week NYC speak about how his personal experience of being disabled gave him a much needed perspective on how to redesign the modern hospital room and medical tools. The qualitative data I used as part of my thesis work at MIT also indicated that a fresh perspective was necessary to design an effective system for using telemedicine to deliver psychological health care services to active duty service members and their families. This panel seeks to open up a discussion on how best to implement these technologies to improve health care delivery, but ensure that we don’t lose sight of what really matters: the patient.

3. The Future of Digital Health

Consisting of a bunch of rockstars in digital health today, this panel will discuss where they think the future of digital health is headed, from apps to information management and behavior change.

4. Startup Health: Transforming Healthcare in America

This dynamic discussion will focus around what can be done to nurture health and wellness entrepreneurship in America, and why it is so needed now. I would love to hear what Esther Dyson has to say about the potential for public-private partnerships to transform health entrepreneurship and am hoping that it will come up in the discussion.

5. Launching Companies in Regulated Industries

We all know that one of the hurdles faced by fledging startups and entrepreneurs in health and wellness entrepreneurship is the fact that the health care industry is so heavily regulated in this country. Aza Raskin from our friends at Massive Health joins this panel in discussing the many issues that new companies face when it comes to regulations and competition from established entities in these multi-billion dollar industries. Note that this panel will be at the Hilton Austin Downtown.

Of course, there are other health and wellness events going on at SXSW, including:

Social Health Startup Bootcamp, featuring a ton of inspiring leaders in digital health and entrepreneurship, brought together by social health leader Shwen Gwee and the awesome Sara Holoubek (who I had the pleasure of finally meeting at SMWNYC);

iH3 Interactive Happy Hour, co-sponsored by our friends Massive Health;

Code Blue – The Health 2.0 | Startup Health SXSW Party, bringing together all individuals and groups passionate about digital health and health tech startups;

Rock Health’s ZenDen, which will definitely be a welcome respite from all the craziness;

and finally, the 2012 SXSW Accelerator, featuring our friends and MIT Media Lab spin-off Ginger.io.

In addition to myself, founding hackers Elliot, Zen (@accelmed) and Andrew will be on-site in Austin, so please say hi! You can also follow all the action at www.sxswh.com and with Twitter hashtags #sxswh, #sxsh and #ih3.

Looking forward to meeting all of you hacking medicine worldwide. See y’all in Austin!