More than Healthcare: Innovation and the Social Determinants of Health
P2Health hosted More than Healthcare: Innovation and the Social Determinants of Health at the Prevention Institute in mid-August. This panel discussion that explored how applying a public health lens to digital health can spark new approaches and connections between non-traditional stakeholders and leverage product design to advance public health innovation outside of care delivery.
Our featured speakers included:
- Moses Ike, Investment Manager, Dignity Health
- Dayna Long, Staff Pediatrician; Medical Director, Center for Community Health and Engagement, UCSF Benioff Children’s Hospital Oakland
- Shingai Samudzi, CEO and Founder, ProjectVision
“[Innovation for the social determinants of health involves] impacting people’s healthcare without additional medication, without additional drugs, lowering the cost and improving the quality.”
Overview
This event recap below captures some of the key themes of our conversation as well as future opportunities that advance innovation that addresses the social determinants of health for better population health.
The following questions were essential for framing our conversation:
- How do the social determinants of health contribute to physical and mental illness?
- Why is it important that we take the social determinants of health into account when building new tools and methods?
- How can technology be leveraged to improve social determinants of health? In what ways are you seeing technology being used to support these determinants?
- How can innovating for social determinants of health reduce health disparities?
- How would you advise an entrepreneur interested in innovating for the social determinants of health? What questions should they ask?
- How can stakeholders in social systems shape innovation for the social determinants of health?
Challenges
- If we build it, they will come (The Killer App Theory). Layers of legacy software and decades of entrenched practices will not be undone with a single app. Tech has largely missed the mark by assuming that software will eat healthcare. The complexity of integration and implementation leaves the Killer App Theory dead in the water. You can build it, but there are so many obstacles (ie. social determinants of health) that enough people will not be able to come.
- Fitbit culture and Hollywood solutions. Tech supporting health must demonstrate clinically beneficial and meaningful outcomes. Period. The term “Fitbit culture” arose as a symbol of the digital divide in digital health. Product development in digital health has largely focused on relatively wealthy populations, which often have a lower burden of disease when compared to low-income populations and other vulnerable populations. The focus on “Hollywood solutions” or solutions for the wealthy minority) leaves our high-need vulnerable populations without useful products, reinforcing health disparities and exacerbating the growth in health care costs. In the words of one panelist, “Our healthcare system financially is broken because we’re such crap at providing service to low-income patients.”
- Where there’s a will, there’s low capability. Contrary to popular belief, this Robert Wood Johnson Foundation report suggests that the majority of health care professionals know that social determinants of health profoundly impact health outcomes. The desire is there but the capacity is not. Fragmented systems leave health care professionals without the time, resources, and support needed to help vulnerable populations become and remain healthy.
- The high cost of innovation for cost savings. At the end of the day, money drives a great deal of the dysfunction. With the shift towards value-based care, providers take on ever-increasing amounts of financial risk. This transition requires providers to identify their largest cost centers and test new solutions to reduce those costs. However, this transition is marked by an unsustainable balancing act between a partial fee-for-service system, quality care delivery and below net reimbursement for more innovative offerings.
“It’s flipping the paradigm of medicine to really promote health equity and to address population health.”
Opportunities
Solution-focused convening. Forums like P2Health.EDU events bring together stakeholders from tech and communities to pilot and innovate ways of collaborating that are beneficial for safety net hospitals and other stakeholders responsible for the health outcomes of vulnerable populations. Identifying and understanding the proverbial low hanging fruit — preventable, costly incidents — provide quick opportunities to better serve our communities.
Collaborative systems in community. There is a serious need, and therefore opportunity, for technology to create systems for collaboration across silos that address unmet basic needs like food insecurity or housing. Dr. Dayna Long has developed the HIPAA compliant platform Find Connect which provides algorithmic geo-located matching for culturally responsive resources and supports the development of partnerships and action plans based upon needs that families prioritize. The product also includes a dashboard for data analytics and quality improvements to provide feedback about how successful they are at addressing unmet needs and understanding the impact on health outcomes. Right now, it’s only used at UCSF but she is looking to partner with other institutions.
New and improved self-management. The key to self-management amid the complexity of the social determinants of health is to leverage predictive analytics to know people better than they know themselves. ProjectVision is identifying and analyzing the psychographics of patients — the attitudes, values, beliefs, aspirations and other motivational factors— and how these shape behavior as people interact with their environment. These insights will enable providers to better predict which patients will succeed or fail in any given self-management program providing clinical decision support to adjust treatment and other resources as necessary to achieve beneficial health outcomes.
Who’s ROI is it anyway?. As value-based arrangements roll out and scale up, it becomes increasingly important to think about who actually owns those savings. One of the hallmarks of our current systems is the spending vs. outcomes paradox. Most health care spending goes toward medical services even though most health care costs are driven by everything else EXCEPT medical services. One scenario that illustrates this issue is a digital health solution that reduces preventable asthma attacks, consequently reducing absenteeism in schools. Schools would receive more funding for having fuller classrooms without incurring the cost of implementing the digital health solution. Measuring the financial impact of innovation that addresses the social determinants of health needs to quantify the impact on other sectors outside of health. This would be a boon for the cash-strapped city, county and state health departments in better allocating their limited resources to maximize impact.
“[We need to be]…able to communicate to entrepreneurs and investors that there are a lot of really cool wearable devices that…we’ve seen a lot of really cool presentations about but we can’t really prove that this will address a need in our communities.”
Advice for entrepreneurs and investors
Get proximate. If you really want to disrupt healthcare, then spend more time getting to know the people who comprise that system: doctors, nurses, pharmacists and other professionals who work in ambulatory clinics and the patients they care for. Find opportunities for shadowing and walk in with one objective: learning through observation. One panelist added that while entrepreneurs view problems as opportunities, focus your product development on building on strengths that acknowledge the resilience of vulnerable populations and creating solutions to problems that patients and consumers are already working to solve. Incorporating the principles of cultural humility into product development is essential for creating effective solutions that consumers will use to change their behavior.
It’s the outcomes, stupid. The digital divide was not the only divide discussed. The communication divide between the digital health ecosystem and health care system on the importance of demonstrating a clinical outcome on a population that health systems and other customers needs is alive and well. Providers need to have demonstrably improved outcomes to facilitate implementation and scale.
Invest in the double bottom line. Digital health investing that addresses the social determinants of health should be done with a clear vision of what the exit means for the market as well as the lives of the patients the portfolio company serves. Digital health exits should target a 10x financial and impact return if they are truly innovative.
“…One thing that all three of us agree on is the fact that in the next 5 to 10 years precision medicine is going to be something that’s at the forefront of how primary care or preventive care is delivered.”
What’s Next
Growing role of policy and politics. Lobbying and political advocacy focused on the intersection of technology and the social determinants of health will grow in the future. This political movement will fuel multi-sectoral collaboration and innovation that reinforces the importance of addressing basic needs such as health for all populations. The factors that will contribute to the increase in political will include:
- The carrot and stick of government incentives and penalties
- The growing call for equity and civil rights
- A continued rise in non-workforce participation due to automation, artificial intelligence and other emerging technologies
- Financial pressures from the Medicaid reimbursement gap
Promotion of health equity as standard of care. Precision medicine promises to make health equity a reality. With the ability to assess and define risk stratification based upon population data, our health care system can shift from reactive to proactive and preventatively intervene to address that unmet social needs to prevent issues like diabetes, hypertension, asthma. The future is already here at UCSF Benioff Children’s Oakland Hospital as they pilot resiliency clinics for early intervention services to address mental health issues as well as collecting epigenetic and inflammatory markers to assess how these resiliency clinics help to mitigate the harmful effects of Adverse Childhood Experiences (ACEs).
Telemedicine as a platform. The progression of telemedicine from outlier to the new normal offers a roadmap for redefining the care delivery pathway. In particular for low income populations, the convenience of telemedicine saves time and therefore increases compliance and timely provision of care by reducing the barriers of transportation and wait times. Telemedicine also increases access to preventive care while reducing the costs of other services, making telemedicine more profitable for a range of billing codes. Another promising technology that would further reduce the cost of telemedicine is artificial intelligence to address basic patient questions as well as offering clinical decision support and navigation support.
Resources
Robert Wood Johnson report Health Care’s Blind Side
From Virtual Nurses To Drug Discovery: 90+ Artificial Intelligence Startups In Healthcare
Calling all public health tech entrepreneurs! Join the P2Health community for resources to help you scale: bit.ly/p2healthcommunity
