Below are links to the uploaded slides for both keynote speakers.

***Please do not copy or reproduce any of these slides without permission from the authors.

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Speaker Comments:

The speakers reviewed some of the major topics in prevention today including the research on obesity and how prevention can bring down the cost of our health care system. Silent Venom film Much of the discussion centered on obesity in children, and particularly how the system in which humans operate has to change in order to encourage healthy behaviors.

Audience Comments:

The audience asked questions including:

•How can employers get people to engage in health wellness programs?

•Do incentives work?

•How do you get people to pay for prevention when it isn’t an immediate concern?

•How can you use stimulus and other money to change the system?

Key Quotes:

•“Out of sight is out of mind.

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If junk food isn’t there then kids won’t eat it.”

•“If [junk food] is not at school they won’t eat it and they won’t eat twice as much at home.”

•“Humans are responsive to their environment and will make choices based upon what’s around us.”

•“Focus on changing behavior, not changing weight.”

•“7 conditions cost us $1.12 trillion a year in health care costs and lost employee productivity.”

•“People’s lives get in the way of thinking about their health.”

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•“I have little confidence in the ability of education alone to solve the obesity problem. We have to build an environment where it’s easy to do what we want people to do. For example we could subsidize healthy foods.”

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Speaker Comments:

The session focused on the positive and negative impacts of a public insurance plan on the country and insurance industry. Andrew Hyman from the RWJ Foundation noted that the public plan could provide a degree of efficiency and could improve competition. Or on the negative side, Kenneth Sperling of CIGNA noted that a public plan could undercut private plans and run them out of business. The insurance industry supports a reform proposal that includes an individual mandate and insurance portability. More on the plan supported by the insurance industry can be found on the industry trade association’s website (www.ahip.org). The question was also raised about whether the reform debate should be as black and white as public plan or no public plan. There are other health reform options that aren’t receiving as much attention.

Audience Comments:

Everyone in the audience agreed that there were problems in the health insurance industry that required solutions. There was a great deal of debate about what the best reform options were and how much different parts of the system would have to sacrifice for reform to pass.

Key Quotes:

•“Everyone has to lose for health reform to pass.”

•“If you have a 401k with an index fund then you want the insurance companies to maximize profit.”

•“Reform is not an all or nothing option. The choice is not a public plan option or nothing.”

•“People view reform as black or white. They think it will bring nirvana to the health care system or bring the end of health insurance or perhaps western civilization.”

Breakout Session II: Pricing in Pharma and Biotech

Speaker Notes:

·         Drivers of cost: drug costs, research and development, pharma cost, etc.

·         Patients only pay portion of biological therapies and drugs

·        

Pricing and reimbursements for each drug differs – different pricing strategies

·         Unrealistic to use a simple model – e.g. Cost-Plus pricing model – because each drug is unique (i.e. patent time period, marginal cost of productions, R&D, insurance, etc.).

·         The Fear Chamber dvdrip Pricing is affected by the market and stakeholders and patients receiving drugs

·         The current issues facing price structure: A big gray area. Policies and decisions are constantly changing.

·         Patient’s greatest asset is information. Patients should leverage resources – domestic and global.

·         Another factor that plays into pricing models – currency changes. A common strategy is to assign countries to certain pricing bands (i.e. Country A: US/Europe… Country D: Africa).

· The King and I dvdrip          Value of drug is NOT correlated with the price of drugs (this is a bad assumption)

·         Orphan Drug Act (1983): Develop drugs for disease that affect fewer than 200,000 people

·         In the big scheme – the total expenditure of biotech is small. The benefits are huge for patients with rare diseases (both cost and life).

·          The current pricing models cannot be sustained.

o        No one has built in control/evaluation

o        Everyone will face budget shortfall

o        Wider disparities

·

         A system change is needed. Torn Curtain psp

·         At the end – the bottom line is – this is all for patients. And the question that everyone should be asking is: Does the product work for that patient’s disease?

Audience Notes:

·         Question: How does international pricing models such as UK and Asia compare with US?

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·         Answer: US: Not just cost-effectiveness but also clinical effectiveness. UK’s program such as NICE is based on cost comparison. Canada’s care is universal for health but not for drugs.

·         Comment: Very important to know the history of pricing to understand the existence of price disparities.

·         Comment: Difficulty of pricing insurance and drugs – the same drug may treat multiple conditions.

Speaker Notes:

·         Leaders need to focus on how information technology can be integrated into their organizations and companies. They need to evaluate their workflows, examine needs, and identify ways that IT can improve their work; moreover, need to focus on what can be change within their control. Organizations will have to define additional responsibilities on roles and accountability.

·          Two concerns with healthcare IT: (1) security (2) privacy

·         Incremental changes are easier, as opposed to full automation.

·         Hospitals need to change business models.

·         Need a push for standardization.

·         Organization leaders need to address: (1) clinical benefits (2) efficiency (3) learning curve (4) success stories (5) needs of staff

·         Ensure that hospitals are doing what they need to do to get FULL VALUE of the system / software. Learn how to customize technology to fit organization’s needs.

·         Same system is not the same system for everyone.

Audience Notes:

·         The Big Lebowski video Electronic medical records can be analogous to ATM machines in banks. It’ll take a lot of investment, time, effort, and culture change to switch over – it’s a process. And it’ll all be worth it in the end.

·         Not to focus on loss of autonomy for physicians, but to shift paradigms on perspective and to see it as a shift of physician roles.

·         With an unclear return on investment (ROI), why is the public’s message saying that people are “idiots” it they decide not to adopt technology?

·         At what point will we be confident enough to say that technology in healthcare is worth spending billions of dollars? What is the right balance and what other evidences are needed?

Quotes:

·         Need innovative thinking: There is a reason why things are changing in that direction

Talking points from the discussion:

There are often conflicting problems that spur health disparities. “How do you include everyone?” “It sometimes feels as if though every group needs to have its own lobby. There is no multidisciplinary or multicultural organizations that address these issues.” This often makes the situation feel very overwhelming to providers and those who are unfamiliar with cultural differences in health. Jeanette DeJesus agreed, saying, “I almost feel as if though it is unethical for me to not include African Americans in my organization’s work…”

Kristi Rodriguez raised a conflicting point however, “One mistake that leads to disparities is that we assume that all African Americans or all Latinos have the same experiences…that is a mistake.’ She makes the point that United has very different outreach on the East and West coast to Latinos. This is because on the east coast the Latino population is consists more of Cuban and South American populations, whereas on the west coast the Latino population is mainly Mexican.

One attendee raised the point that providers are often lacking in basic tools for cross-cultural communication, which frequently makes them shy away from asking culturally sensitive questions about health. Jeanette raised the pint that this is an issue of scale. Health care providers often are not educated on issues of race or culture as it pertains to medicine. Organizations like Hispanic Health Council are limited in their ability to conduct outreach to providers on a larger scale. Greater participation is needed from large health care corporations. Kristi Rodriguez explained that United is beginning to expand their resources in this area, but it is still developing.

Another attendee raised the point that this is the responsibility of the state on some level. In California for example, it is now required by,statute (Title 6) that there are translators available for patients for whom English is not the primary language. there are still hurdles. For example, depending on the language, there often is not an employee on site, but someone who is reachable by phone. More and more medical schools are beginning to incorporate this into their curriculum, and it has been very popular with students.

Aditional challenges: There is not enough focus on wellness care and prevention. These activities are not reimbursed by insurers. However, prevention would reduce many existing health disparities. in general a greater focus is needed on nutrition and helath habits. United Healthcare has it’s Generations of Wellness program, which incorporates a strong educaitonal component, providing funding to schools for health foods.

Jeanette makes the point that in order to improve prevention education on the community level it is imperative to have people who speak the language and who look and act like the people who receive the education. “There must be sincerity and honesty,” Jeanette said.

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Impact of reform on healthcare investing

Speaker comments:

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            $20 billion of VC and growth capital went into healthcare in 2007.

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$20 million used to be enough to fund a product to commercial development, but now it takes up to $200 million.

Flight to healthcare industry is receding back to levels from around the dot-com era.

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Long-term investing must anticipate government reform and legislation, especially in unpopular areas of healthcare, such as insurance and pharma.

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To analyze the value of a company, quantify how the business is effected by or exposed to government rules.

Audience comments:

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Q: As comparative effectiveness reveals marginal benefits from certain products, how will investing be effected?

A: VC is currently broken – it funds many companies and 90% of them fail.  Comparative effectiveness will reveal the better companies.  This might pose an increased risk to some companies, so backend investing should discount for it.

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            Fraud – For public investing this can create great opportunities if the company truly has solid underlying value

For private investing, you should avoid companies with potential for fraud or product overuse because this can’t be anticipated in the due diligence process.

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Key quotes:

            “Healthcare investing will be in incremental changes and improvements.”

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Comparative effectiveness and the FDA

Speaker comments:

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            Is more knowledge better?  Should I have access to everything?  Should drugs not be provided until they are proven to be better?  And how strong does the data need to be to prove this? 

These presumptions are all in the aim of increasing effectiveness at a decreased cost. Will the need for evidence stifle innovation? Healthcare cannot be divorced from politics.

Audience comments:

            Pharma should have the responsibility to design their trials with the policy and access in mind, because formularies are not decided by trained academics.

It is important to tease out externalities, such as tort law and financial limitations, to allow for the standardization of care

Key quotes:

            “CMS has to lead the way.  The private sector won’t.”

We “must embrace an upper limit on healthcare to get traction to move.  This will reveal the opportunity costs”

Speakers:

- This revolution is not about the technology itself, it is about access and communication, and improving the relationship between patients, and between patient and physician
- So much “fluff” in the system, technology is a means to enhance the core relationships and minimize the influence and intrusiveness of the middleman
- Online technologies allow physicians to reach out to patients and patients to reach out to other patients (the patient is the focal point)
- Hello Health: Patients can friend members of their care team, experiment with telemedicine, for example the patient can send photos to their dermatologist who can interpret
- Diabetes Hands: Two social networks for people “touched” by diabetes, including families, caregivers, healthcare professionals, pharma (as long as no promo intentions
-Tudiabetes and Estudiabetes (Spanish) is analogous to Facebook for diabetes patients (11 000 members for tudiabetes, US, Canada, UK, Australia; Estudiabets, Mexico, Spain, Columbia, Argentina, US)
- Why are both these innovations relevant? how to provide better care to patients while keeping costs under control, sharing patient experiences, sharing of best practices, bring out “closet conditions” that are suffered silently like diabetes, an “outlet”, identifying situations of misdiagnosis, opportunities and challenges

Epic Movie on dvd Audience Questions:
- Do you serve as a community of best practices? To what extend is health coaching part of your platform?
Hello Health: Large part of reaching out to patient via email, text, ensuring continuity of care, creating a strong relationship with your physician, the physicians provide coaching and disease management tools; individualized, not cookbook medicine 
Diabetes Hands: Shared experiences provide expertise, portal of expertise, focused on individual needs, interest groups such as healthy eating best practices groups; Diabetes Hands will soon collaborate with prominent hospitals to tie community with the patient control records to better quantify what is happening 
- I see Hello Health and Diabetes Hands as serving two extreme ends of the continuum - 2 places where consumers can get information- from physicians and from other patients - is there any plans to integrate these together?
Hello Health: Interoperability is important, but more organically designed into the system, relaying information between the physician and patient. In the future, we can see an integration of systems, stroner use of hyperlinks etc but the down side is that some technologies such as EMRs are disruptive to work flow and to physicians; benefits of separating functions. Future - can also make platform open source.
Diabetes Hands: Moving towards consolidation, collaboration, as even in the Health 2.0 space there are many programs serving as a variation on the same theme. But there is also value in having several types of programs, as patients can choose the one that they like the “feel” of the best (eg choices between google, yahoo etc).
- How do you make money off what you do?
Diabetes Hands: we are a non profit so we don’t monetize from members (take away from patient experience) we offer the service for free and seek grants from private funds and foundations.
Hello Health: By providing better engagement with patients and thus providing a better bang for the buck.

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- How is information housed to protect patient confidentiality?
Hello Health: Information is housed securely, paperless, ensure portability, using latest security.
- Where do you see the line being drawn with “cookbook”/”customized” medicine?
Hello Health: I believe medicine is 1/2 art 1/2 science, technology can be a decision support at the point of care, but it should not be the decision itself
Diabetes Hands: Our online communities may be able to pick up things that do not lie on the traditional “roadmap” - where symptoms are actually the result of other things - perhaps a patient lost their job and their stress levels are resulting in symptoms, not a biological reason

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- Where do efficiencies drive from?
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Hello Health: Structured emails become part of the medical record, can do ICD coding, reserving time for patients who need face to face care; high tech and high touch
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- In the Tudiabetes model, are we ignoring the input of physicians?
Alerts in the system to refer back to physicians, although we recognize that physician is important - issues such as how to compensate if not volunteers, not forgetting individual experience.

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Pay for Performance

Speakers: Spending on the healthcare industry is currently growing
faster than our nation’s economy, while we are not receiving the
quality of care expected from this investment. Debates over pay for
performance continue primarily because our country does not want to Toxic Skies ipod Deep Red trailer
limit the amount we spend on healthcare and it is difficult to balance
several political agendas without knowing A Priori which one will

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work.

Audience: To make this payment scheme work, improvement and
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rewards. This means that a small rural hospital can be rewarded for
improving the relative quality of their care, while a large urban
hospital will need to meet an absolute standard level of care before
they are rewarded. Empowering all hospitals, big and small, to improve
through these means is necessary to ensure everyone is involved in
making the U.S. national healthcare system better.

Key Quote: “Realize that the hassles associated with managing a pay
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value to offset these costs.”  Robert Galvin

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