Hi2 Forum
Wednesday, October 7, 2015
Sunday, April 5, 2015
A 3-D Selfie to
Get You Healthy
Get You Healthy
How an interactive self-portrait can
transform health behavior through
time travel, points of self care,
and the power of pairs
transform health behavior through
time travel, points of self care,
and the power of pairs
Written by VIRGIL WONG
with contributions by VIVIAN YEH, PhD
with contributions by VIVIAN YEH, PhD
Six months ago, my cardiologist friend Dr. S was huddled in front of our neighborhood café with the last stub of a cigarette still smoking between his fingers. He started to cough and deftly retrieved his albuterol dispenser. As he exchanged successive puffs between a burning cigarette and the pressurized canister of an asthma inhaler, I braced for potential combustion.
Like nearly half of all American adults, Dr. S suffers from chronic disease, conditions that people have a strong degree of ability to ameliorate through their own actions. According to the CDC, chronic conditions account for 70% of deaths and more than 75% of the now $3.8 trillion cost of healthcare every year in the United States.
Chatterjee, A., Kubendran, S., King, J., & DeVol, R. (2014). Checkup Time: Chronic Disease and Wellness in America. Milken Institute.
Dr. S was in a pre-contemplation stage of prospective health behavior change with no intention to take any action in the foreseeable horizon. "I'll quit smoking and join a gym sometime next year whenever my practice is less busy," he would say.
If a physician with decades of experience cannot heal himself of his own toxic lifestyle, what hope is there for the rest of us? How can our healthcare system possibly compensate for the deleterious effects of billions of unhealthy actions (or inactions) we inflict upon ourselves every single day?
Healthier communities start with healthier individuals. As health entrepreneurs, we have to help people build healthier day-to-day habits that shape overall wellness and well-being. We must address health as an evolving and relative state of being – not a static and binary one. Health is a lifelong journey, not a destination.
Effective health behavior change interventions must be tailored for each person by finding creative ways to:
1 |
Assess past, current, and potential future states of health |
2 |
Promote self-efficacy, the belief in one's ability to accomplish goals, and |
3 |
Develop, follow, and iterate personalized mental models, the frameworks for making daily decisions that are self-determined and self-initiated. |
One size does not fit all. Our differences define us as individuals, and they heavily influence our successes and failures in preventing and managing chronic diseases.
Just as 2-D selfies depict our unique faces in some activity or environment, 3-D Healthy Selfies™ visualize our entire bodies as an interface to engage with our own clinical data, wellness planning, and self-tracking. They can be used within any point of self care, dyad peer support models, time travel simulations, and seeing ourselves with greater objectivity to drive motivation and improve outcomes.
Seeing Ourselves
In partnership with Boston-based Perfetch LLC, my company Medical Avatar launched the 3-D Healthy Selfie™ Cube, which will be on display here at this year's AHA Hi2 Forum. The Cube uses infrared sensors to generate a realistic 3-D avatar of users along with exact body measurements and other metrics. Access to a suite of customized nutrition, fitness, and diabetes management mobile apps is provided via the 3-D Healthy Selfie.™
The 3-D Healthy Selfie™ Cube by Perfetch and Medical Avatar
as seen at Oakwood Healthcare's Wellness Center near Detroit, MI.
as seen at Oakwood Healthcare's Wellness Center near Detroit, MI.
The 3-D Healthy Selfie™ is an immediate shift towards patient-centered communication. In cognitive psychology, the self-reference effect is our tendency to remember information more effectively if it is directly related to our sense of self. In studies starting in 19771, participants were more likely to recall adjectives that described themselves (self-referent encoding) compared to words with a specific letter (structural encoding). Self-referential content is more memorable because the self is a well-developed concept that is constantly used throughout one's life. Connections to this concept can help trigger elaboration and a more effective organization of available information.2 A realistic 3-D image of ourselves further reinforces this association to self.
When we tailor and personalize health information, we can increase awareness of the discrepancy between current and ideal behaviors to motivate change. For example, when informing Dr. S that he was not getting the amount of physical activity recommended by the Surgeon General, our health app could present his 3-D Healthy Selfie within this personalization framework:3
Meaningful Contextualization "You indicated that you would like to be a better role model for your children as well as your patients, but you are having trouble finding the time for regular exercise." |
Descriptive Feedback "You also mentioned that you are concerned about getting injured while exercising." |
Suggested Actions Based on Content Matching "Based on the information you gave to us, we have provided a list of possible strategies..." |
When we visualize self-referential health information, we can improve awareness of an intervention's efficacy to better motivate change. In a pilot study, I was working with post-bariatric surgery patients who were beginning fitness programs using weights. Participants who weighed themselves at weekly intervals frequently become discouraged when they gained weight, even if the weight could be attributed to additional muscle mass gained through training. Participants who had 3-D selfies generated each week, however, reported higher satisfaction ratings with their progress independent of weight loss or gain. One user wrote, "I weigh a little more since last week, but I can see the shape of my body changing. I'm on the right track!"
Points of Self Care
3-D Healthy Selfies™ and self-referential content should be active in all the places where we live our daily lives. “Points of care” refer to when clinical services are provided to a patient during a doctor's office or hospital visit. “Points of self care”, a term I coined with my business partner Lawrence H. Krampf, is where people control and initiate their own micro-actions every day to improve their health. Points of self care may include your home, office, gym, grocery store, or drug store (we are developing Points of Self Care™ as a digital map on your phone to track health-related activities in any of these locations).
Activating points of self care is crucial for reducing the costs of healthcare. As Lisa Suennen stated in the previous blog post, getting healthy doesn’t just occur when you get hospitalized. Effective treatment of chronic conditions in the doctor's office or hospital is expensive and unpractical, because daily actions like glucose monitoring for diabetes are required. For chronic diseases, utilizing your points of self care every day would likely have a great impact on outcomes than the points of care with providers at far less frequent time intervals.
Power of Pairing
Peer-led health behavior change is another utility of the 3-D Healthy Selfie. Peer support, within the health care context, is the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor. Peers have similar characteristics as the target population to better address health-related issues of a potentially or actually stressed focal person.4
Typically, peer support in the dyad model has less training than a peer “expert” who presents to a group, or a patient navigator, or paraprofessional. Dyad-based interventions have typically used in-person meetings at public places (churches, outpatient clinics, etc). One-on-one exchanges between peers and the focal persons is facilitated by sharing data between the participants' 3-D Healthy Selfies.
Health Time Travel
Most of us have a “planning fallacy” when thinking about our future. Or we have an overly optimistic view of what we are going to do and how easy it will be to do it. Episodic future thinking, or the pre-experiencing of the future from a personal perspective, may help counter this bias by increasing the elaboration of future plans and accuracy of future predictions. The more vivid the imagining, the better the thinking is at changing future views, like delayed discounting, or when individuals prefer a smaller reward in the present compared to a larger one in the future.
Delayed discounting is a robust phenomena documented in individuals who smoke and are obese. In studies of obese and normal weight individuals, a randomized episodic future thinking intervention lead to individuals expressing less delayed discounting and eating less food in a buffet tasting challenge. The 3-D Healthy Selfie can be useful in prompting vivid episodic future thinking by showing an individual their possible future self and sparking an individual’s planning about how to get there.
Dr. S participated in a health time travel study I recently conducted at Columbia University to compare different modalities for communicating personalized health content. For an embodied cognition condition, research participants placed their left hand into a metal box with a computer screen on top. As the smoker heard about premature aging of the skin, bone density loss, and vasoconstriction caused by smoking, they would see the effects on their own hand as a real-time video image.
A study participant sees real-time video of his own hand suffering from the effects of vasoconstriction caused by smoking.
I met Dr. S this past weekend, and he told me, "Every time I held a cigarette between my fingers and was just about to light it, I kept looking at my hand. I could see the premature aging, bone density loss, and vasoconstriction visualizations inside my hand. And I kept thinking about all the deleterious effects of smoking your damned study talked about." Dr. S of course already knew all of this information intellectually and would impart these kinds of details to his patients – but seeing the 3-D Healthy Selfie of his own hand had hit a nerve. After twenty years of regular tobacco use, he registered earlier this month for a smoking cessation program. "We'll see how it goes," he said. "No promises."
When we stepped outside the café, Dr. S reached into his pocket, paused, and smiled. "Don't worry. I'm getting my phone, not a cigarette."
If we can get even the most obstinate of physicians changing their unhealthy behaviors, perhaps there's hope for the rest of us as well.
VIRGIL WONGVirgil Wong is the Cofounder and CEO of Medical Avatar, a New York City-based company that offers the world's leading apps for patient engagement, reduced costs, and improved outcomes. He is presenting the Big Idea Session during The American Heart Association Innovation Investment Forum at 1:35pm on April 22, 2015. |
Keywords
3-D healthy selfie, patient engagement, health behavior change, chronic diseases, psychology, mHealth, mobile technology, apps, self-reference, patient-centered communication, visualization, personalization, points of self care, self-monitoring, tracking, peer support, dyad models, episodic future thinking, smoking cessation, nutrition, fitness
References
1 Rogers, T. B., Kuiper, N. A., & Kirker, W. S. (1977). Self-reference and the encoding of personal information. Journal of Personality and Social Psychology, 35, 677-688.
2 Symons, C. S., & Johnson, B. T. (1997). The self-reference effect in memory: a meta-analysis. Psychological Bulletin, 121(3), 371.
3 Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijkstra, A. (2008). Understanding tailoring in communicating about health. Health Education Research, 23(3), 454-466.
4 Dennis, C. L. (2003). Peer support within a health care context: a concept analysis. International Journal of Nursing Studies, 40(3), 321-332.
Thursday, March 26, 2015
How Can Entrepreneurs Reconstruct the U.S. Healthcare System?
This week’s blog post is a one-on-one interview
with Lisa Suennen, venture capitalist and healthcare business consultant. She
sits down with American Heart Association Director of Development, Jarod Hector
to discuss the United States healthcare system its inefficiencies, potential
solutions and what entrepreneurs should consider when starting a healthcare
business.
Jarod Hector: I am pleased to be joined by none other than the Venture
Valkyrie, Lisa Suennen. Thank you for sitting down with me today.
Lisa Suennen: Thank you, Jarod. As you know I am
a believer in the American Heart Association and its mission.
JH: This is a loaded question and there is no simple answer, but, as
you see it; what is currently wrong with healthcare as we know it?
LS: Wow, so many issues make our healthcare
system suboptimal. First and foremost,
and I presume we are talking about the U.S., the incentives are totally
misaligned. Providers are not paid to give patients what they want or need;
patients are not connected to what things cost or how to measure value; payers
are generally focused on how to drive down costs but not how to drive up
quality or personal service. And on
top of it all, people are generally uninformed and not interested in taking
good care of themselves in the near term when the consequences of poor health
behaviors are many years away. It is a
prescription for high cost, poor outcomes and constant disappointment for all
involved.
There are changes underway in the system and
trends that can help with these problems: price transparency, consumers being
forced to engage more due to their own financial share in the system,
regulation that fosters attention to patient satisfaction and outcomes. Also, the
availability of technology to help providers deliver better more personalized
care, etc. But it’s a long road to a
high value system and we are still very much at the beginning of the journey.
JH: Given, the healthcare system’s inherent inefficiencies, it seems
logical that technology and data analytics are the obvious solutions to help
improve the system. Are they enough on their own? And, if not, what else
needs to be done to improve care?
LS: Technology and data are essential to system
improvement, but they are not sufficient to make the changes needed. We also
need far better means of using the mountains of data in a meaningful,
personalized way. Clinicians and patients need tools to make the data useful in their
actual day to day experiences. We also
need to ensure that the system properly incents the use of the data for
positive outcome, both clinical and financial. Data can tell you what the likely problem is
and what might be done about it, but if the motivation isn’t there to make
change it doesn’t matter. That
motivation might be financial or personal.
The technology needs to be married to methods that engage participants
in the system to change their behavior for the good and for the long term. And
by participants I mean payers, providers and especially patients, whose
behaviors are notoriously difficult to change, even in the face of data showing
the importance of that change.
JH: We’ve discussed the problem and potential solutions. It seems as
though every 5 minutes, there is a new healthcare startup. What should an
entrepreneur who is thinking about creating a healthcare startup consider,
before making the leap? Is digital health, the “holy grail”? Should
entrepreneurs, still consider therapeutics and device? If digital health is the
chosen focus for an entrepreneur, should enterprise or the consumer be the
target?
LS: Wow! That’s a lot of different points tied
together, so let me break it apart a bit.
The most important thing to do when starting a
company of any kind is to ensure that you are solving a real problem and that
customers will pay you for the solution you are building, regardless of what it
is: digital health, therapeutic, device, whatever. This means that entrepreneurs must not be enamored with their own idea,
but spend the time to understand what potential customers’ challenges really are
and what they value within a solution. This is the same whether you are targeting
consumers or enterprises. Both will pay
for things that they value and that make their lives better in tangible,
measureable ways.
All too often entrepreneurs deliver products that
solve perceived problems, not real ones.
The biggest mistake I see made
time and time again is not getting out and talking to at least 50 entities or
people who might be your customers. Lean
startup methodology suggests you should seek at least 100 customer inputs. There is way too much Kool Aid drinking by
entrepreneurs who think their idea is so great that if they just build it,
customers will come. That Field of
Dreams strategy rarely works. And
consumers are particularly loathe to part with their money for healthcare
products since they are so used to having them paid for by others. It doesn’t mean they are a bad target, just a
complex one.
Digital health is not the holy grail. It is the marriage of technology to enhance
the value, precision and accessibility of other things, whether it is data,
treatment, drugs, devices, services, whatever.
I don’t even think we will be using this term in 10 years…it will just
be “health” and we will assume that it has a digital component, like virtually
every other business. There is an aching
need for great products of all types, health IT, health services, therapeutics,
devices. But in every single instance, the product needs to make a profound
difference in quality of outcome, respond to the individualized needs of
consumers and deliver value in a way that reduces overall cost to the
healthcare system. If you can
demonstrably meet those three criteria, it is probably worth building.
JH: How does the investment community (specifically VC) view the
healthcare sector? Do VC’s need to change their approach when looking to
invest in the sector? Beyond the money, what should entrepreneurs
consider before accepting VC money?
LS: The investment community is very
schizophrenic about healthcare investing.
There are some venture funds that are dedicated only to this; those are
clearly committed groups. The rest of
the venture world, and that is the vast majority, thinks healthcare is too
complex, too much in flux, too regulated and the buyers too conflicted to be
worth pursuing. We are starting to see
an influx of tech investors to some parts of healthcare, notably digital
health; but without a clear understanding of healthcare dynamics and workflow,
they may not realize the returns for which they hope. Traditional
healthcare investors, at the same time, need to be savvier about how technology
can change healthcare delivery; and, how essential health economics has become
to new product adoption.
“Digital health” has spurred a revived interest
in healthcare investing (and the numbers have risen from $300mm in venture
investment to over $5 billion in five years), but it is still dwarfed by
venture investment in other sectors. To be successful in this field, you need to
focus keenly on whether the concept you are backing can deliver on the “Triple
Aim” of better health outcome, lower cost, and improved
quality/experience. If the investment
can’t deliver on those things, it is likely not a winner. In this day and
age, it is especially important to be delivering improved health economics.
Entrepreneurs should enter into their investor
relationships like they are getting married. They should be sure that the
investor is a good partner, complementary in skills, able to bring value beyond
the dowry. I wrote an entire article about this topic.*
Entrepreneurs should also be careful not to seek
venture capital too early. All too often the goal becomes about raising
money and not about proving out the value proposition with customers. This is a mistake young companies make all
the time. Entrepreneurs should not make
venture capital a goal, but rather a means to an end, and that end is
growth. Venture money can help a young
enterprise grow, but it can’t fix a bad idea.
Make sure your concept is sound, customers want it, and that there
is a true market. And your solution has to be able to deliver before you get
too far down the financing road. It’s a
lot harder with high cost therapeutics, but there are evolving capital
efficient ways of starting businesses, even here.
JH: As you know, the American Heart Association
has funded many of the major innovations in cardiovascular disease and stroke
treatment and prevention. What more can the organization do to help advance
cutting edge innovations to the commercial marketplace?
LS: The AHA
has a uniquely good opportunity to help in transferring the massive amount of
research it helps fund and turn that science into faster cures and treatments
for patients. The AHA has already started, through its Science and Technology
Accelerator, to bring solutions from the lab to the patient. AHA can
further this opportunity with even more focus on that endeavor and by targeting
its funding efforts to all stages of the process between scientific discovery
and commercial delivery of products that improve the health of Americans and
others. Great science that never makes it into the bodies of patients does not
advance health. But investing beyond
the bench to get high value science to the market and into patients is a real
opportunity for AHA.
The AHA also
has an unprecedented brand and reach to educate the greater consumer and
provider community about best practices.
Considering the importance of behavior change in maintaining good
cardiovascular health, the AHA can be a partner to enterprises in education and
fostering an understanding about the importance of nutrition, exercise,
preventive health, etc. We need to
change how we educate our population about these things, starting with children
in school and also how we train doctors to practice. We need
to change our American concept of being healthy to something that is a lifelong
journey, not what happens when you get hospitalized. AHA has a role to play here in creating
programs that serve the entire continuum from preschools to medical schools.
JH: Well said Lisa. I want to thank you for your
time and being a champion of this organization. I look forward to seeing you at
our upcoming Health Sciences Innovation · Investment Forum on April 22nd
here in NYC.
LS: Thank you.
I am excited to attend the forum, it will be a tremendous day of networking and
sharing knowledge capital.
*Editor’s Note* the above referenced article can
be found here: http://venturevalkyrie.com/vc-or-valentine-how-venture-investing-is-like-romance/
Friday, March 20, 2015
What You May Not
Know About the American Heart Association
Welcome to the
American Heart Association (AHA) Health Sciences Innovation · Investment Forum
Blog! We will post weekly on a variety
of topics at the intersection of innovation, investment and entrepreneurship
within the health sciences ecosystem.
As an organization,
the AHA is committed to building healthier lives free of cardiovascular
diseases and stroke. Since 1949 the AHA has awarded more than $3.8B in
research grants, the 2nd largest source of funding behind the U.S.
government. While that will continue, the organization also recognizes the need
to accelerate science and technology to the commercial market.
Science and
Technology Accelerator Program
We have two
initiatives that highlight the AHA’s
entrance into the space. For the first time through our Science &
Technology Accelerator program the AHA will use donor designated dollars to
make strategic equity investments that we believe help advance the mission and
reach our 2020 Impact Goals: to improve the cardiovascular health of all
Americans by 20 percent and to reduce the number of deaths and disabilities
attributed to cardiovascular disease and stroke by 20 percent. To date, we have
made three investments and look forward to making a fourth later this year.
Hi2
Agenda
The other major
initiative the AHA has begun is the annual NYC Health Sciences Innovation · Investment Forum
(Hi2).
We are just one month away from the 2nd annual Hi2 Forum, set to take place on Wednesday,
April 22nd at the Apella Event Space at Alexandria Center. The goal of this groundbreaking
event is to bring together the brightest minds in academia, industry and
investment for world class collaborative discussion and to foster key
relationships that will benefit the ecosystem. This year’s event is poised to build off the
success of last year’s
bold beginning. For the first time in the organization’s history, last year’s Hi2 Forum brought the private
equity/venture capital industry, academia and the health sciences together for
an industry conference. The vision is for the Hi2 Forum to become the preeminent
industry conference hosted by a health NGO of its kind.
Fireside Chat with
Maria Bartiromo and Nicole Fisher
We are very excited
for this year’s
Hi2
Forum and pleased
to announce the return of our Fireside Chat Series. Last year, we were
fortunate to have noted venture capitalist Ken Langone, as well as serial
entrepreneur and TEDMED chairman Jay Walker as our guest speakers. In the
tradition of securing the most highly regarded experts we are pleased that this
year’s fireside chat speakers include James
Momtazee, Head of Healthcare Investing at KKR and J. Craig Venter, world
renowned genome scientist and entrepreneur. And, we are thrilled to have Fox
Business Network, Anchor and Global Markets Editor, Maria Bartiromo @MariaBartiromo
and President & CEO, HHR Strategies, and Forbes Contributor, Nicole Fisher
@nic_fisher, as our hosts of the Fireside Chat Series.
The theme of this
year’s Hi2 Forum is Transforming the Continuum of Care. As the population continues to grow
and life expectancy rises higher and higher the way in which healthcare is
delivered should evolve with the times. The AHA has been at the forefront of
major innovation over the years and continues to do its part as we strive for
innovation in healthcare in the 21st century.
This year’s event will feature experts in:
•
adhesive
technology
•
computer
technology
•
therapeutics
•
analytics
•
tissue
engineering
•
finance
•
professional
services
These talented
innovators will share the AHA stage and provide our audience with an experience
unlike any other.
To truly transform
the continuum of care the role of the entrepreneur is critical. We will harness
that entrepreneurial spirit at the Hi2 Forum with our 2nd annual Open Innovation
Challenge. A nationwide call to action for early stage entrepreneurs to uncover
new innovative tools to lower the risk of heart disease and stroke. We received
over sixty submissions and have twelve semifinalists live on a crowdfunding
platform, hoping to be one of the top three in terms of fundraising and social
shares. The top three will be finalists and receive AHA grants totaling
$25,000, and a chance to meet, mingle and present at the Hi2
Forum. To view the
semifinalists in our innovation challenge please visit http://www.medstartr.com/hi2forum15
April 22nd
promises to be a day you don’t
want to miss! The full agenda can be found here and to register please click here.
We’ll
continue to share all things health sciences, innovation and investment
related. Next week’s
blog post will be an interview with venture capitalist and AHA venture
consultant, Lisa Suennen @VentureValkyrie . Lisa will discuss how entrepreneurs
are going to tear down and rebuild the healthcare system. You don’t want to miss it!
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