There is no single organization worthy of mention in the same breath with San Diego-based West Wireless Health Institute when discussing the contribution of non-profit groups to the mHealth movement.
Founded by billionaire entrepreneurs Gary and Mary West, and guided by a blue chip laden executive team with all of the elements required to both think big and execute, the Institute has burst onto the scene in 2011.
It seems as if each week the Institute launches a new initiative, and there is little reason to think this team of heavy hitters is anything but just getting started.
I interviewed Don Casey, CEO of the Institute and former worldwide Chairman of Johnson & Johnson’s comprehensive care group and member of the J&J’s executive committee, where he oversaw the company’s cardiovascular, diagnostic, diabetes and vision care franchises around the world (now you see what I mean by “blue chip” executive team), just before the mHealth Summit last December.
Unfortunately, at the time of the interview West had yet to announce nearly any of the many bold and exciting initiatives announced in the months since, so when the opportunity presented itself to interview the Institute’s Chief Medical Officer Joe Smith, MD, PhD, I jumped at the chance. (UPDATE: Don Casey resigned as CEO of West Wireless on 3/17)
In addition to the announcement of the West Health Policy Center, the Institute sponsored the Care Innovation Summit in Washington D.C. in conjunction with the Centers for Medicare and Medicaid Services, and which was attended by more than 1,200 people. The Institute’s Wireless Health Council announced the release of a novel reference architecture to create a Medical Grade Wireless Utility available at no cost to hospitals and health care systems throughout the United States. Additionally, the Institute announced, with the Carlos Slim Health Institute, the Sense4Baby(TM) wireless fetal monitor pilot research study in Mexico. Finally, the Institute has launched its own venture fund, the West Wireless Health Fund, to aggressively invest in entrepreneurs that have a vision for tackling the rising costs of provided health care. Over the course of the past two years, the Institute has grown from less than six full time employees to a team of more than seventy that includes physicians, engineers, software experts, financial analysts, and other critical support personnel.
During our conversation I was able to ask Dr. Smith about each of these projects and how they have progressed to date, so please read the transcript of our conversation below and share your thoughts on the Institute’s ambitious activities in the comments.
BTE: While wireless health monitoring is best suited for chronic diseases, do you see any acute conditions well suited for wireless sensors?
Joe Smith: It’s interesting, if you play forward to what drives people to the emergency room there are definitely a few areas where I think it could prove useful for many types of patients. Much of that concern can be alleviated by judgement and looking at something, or judgement and making a measurement, and they needn’t go to the emergency room where the cost of providing care is truly the greatest.
I recently watched with some interest as a gentleman out in Minnesota imagined a home medicine kit which includes a wireless enabled blood pressure cuff and thermometer and something that looks like Skype so you can talk to the health care professional, give them some objective health information about how the patient or the baby is doing and make some initial triage decisions about whether that needs to be seen emergently today or perhaps tomorrow. You can imagine bringing diagnostics to patients rather than bringing patients to diagnostics, so if you have a particular quandary about whether this or that is or isn’t, the notion of having the diagnostic there and then simply moving the data is intriguing.
I agree with your contention that there is an enormous opportunity for chronic disease, but in the middle space between chronic and acute there is acute exacerbation of chronic diseases which I think could have a huge impact on wireless technology in that space as well. Finally, for some acute presentations, as we have just outlined, I believe there is some opportunity for wireless there as well. So I do think there is certainly some opportunity in acute care, but the biggest bang for your buck is going to be in chronic disease management where we already spend 80-percent of our health care dollars.
BTE: Will the Institute be partnering with any payer groups to increase the implementation/adoption of remote monitoring?
Joe Smith: We are a non-profit medical research association so the notion of partnership is an interesting notion, but we do meet with them to discuss the gospel of more affordable health care. We will take cues from them on what types of things they feel are most needed, and we will run that up against docs in hospitals to find out where the needs really are to drive the kinds of innovations we pursue, but in terms of “partnership” not so much.
BTE: What emerging technologies, once they are adopted more widely or ubiquitously, do you believe will have the greatest impact on the cost of delivering care?
Joe Smith: I think from a general perspective any technology that allows you to have actual diagnostics for chronic diseases where you can make course corrections to keep people out of hospitals and away from those expensive sites of care, I think that makes a world of sense. I think they are starting to make some sense in terms of the alignment of financial incentives, such as when you think about Medicare ruling not to pay for hospital readmissions for some conditions within 30 days of discharge for things like heart failure, myocardial infarction and pneumonia.
I think there is a huge opportunity to use technologies like wireless blood pressure cuffs and weight scales with heart failure patients for instance, even finger pulse oximetry devices, all of these can be deployed to make minor course corrections in peoples conditions so that they don’t end up with a catastrophic collision. There are a number of chronic conditions one could start talking about, such as COPD and heart failure which come to mind immediately, but I think you can use these simple connected devices to make interventions in a bunch of different chronic conditions from which people suffer.
BTE: I noticed following the recent Care Innovation Summit you co-hosted with CMS in Washington, DC, around the time you announced the launch of the West Health Policy Center, that there were a number of developer challenges featured. Is the developer challenge model and use of reward-based incentives to drive purposeful and targeted innovations something we can expect West to support in a big way moving forward?
Joe Smith: We are all about trying to build effective ecosystems in the medical marketplace and we will work as hard as we can with whomever we need to in order to advance innovation in cost effective health care delivery. Certainly wireless technologies, particularly the ubiquity of wireless communication, that is pretty much the low hanging fruit, and a couple of kids together in a garage developing an app that will help an individual better understand the attributes of their disease really makes a ton of sense, that is the notion of letting a thousand flowers bloom and anything we can do to accelerate that feels great.
One of the other areas where we are putting a fair bit of energy is around rational health care policies and regulatory and reimbursement framework and we just launched the West Wireless Health Policy Center in DC where we are going to do our best to encourage making very subtle changes in interpretation or regulation of reimbursement policy so we can incentivize the low-cost solutions and the adoption of cost saving technologies, all of that makes sense to us.
BTE: You have recently launched a Sense 4 Baby pilot program in Mexico, and I am curious what what your experience has been like working south of the border and if you have encountered any unique/unexpected challenges?
Joe Smith: That is another example of moving data instead of moving patients. What we are trying to do here is realize that pregnant women with high risk pregnancies are probably the patient cohort you would like to move the least if you think about it. The notion of an expectant mother getting on a bus to go see her doctor makes very little sense, so if we can take all of the technology that resides in a docs office to deal with high risk pregnancy and put that in a backpack and give it to a Pomodoro or health care worker out in Mexico that rationale makes sense.
We were lucky enough to partner with the Carlos Slim Health Institute – whom I believe was recently named the richest guy on the planet – and we have enjoyed their support in trying to get this done. This is a project that has more than a years worth of history, as we have been doing protocol development and initial protocol study here at the Institute in the US with Scripps and we are looking forward to a longer, more robust trial in the rugged environment of Mexico. We have been down there now a couple times, the reception we have gotten is incredibly warm, the people there are incredibly excited about doing it, so we have kicked it off down there but in terms of early results its too early to see that.
BTE: As co-manager of the West Health Investment Fund do you encourage companies to look at international business opportunities and emerging markets for their products, or do you encourage them to focus strictly on the US market, or both?
Joe Smith: That is a great question and I think the answer is not ‘either/or’. If you remember Willy Sutton the bank robber, when they asked him why he robs banks he responds, ‘because that is where the money is’. I think if we are going to lower the costs of health care the most prominent market we need to focus on is the US where we outspend every other country on the planet in terms of dollars per unit of health care delivery, so I think we have an obligation to look first at the US. However, if one is going to achieve all of the cost savings one would like one is going to have to think about using the commercial scale of other technologies and that requires some consideration of attaining worldwide adoption.
So I don’t see it as an either/or, but rather to achieve maximum efficiency and achieve the lowest cost solutions we can, we have to think very much globally and listen very much globally. I was at a meeting of the US-India Chamber of Commerce and there was some discussion about what we could take from the US health care system and deploy in India, and my thought was there is no where in India that has harmed me so much that I would hoist our problems onto them. The opportunity for trickle up, or the notion that solutions can work and reverse course on us which we could then import into the US, that has to be something that we also look very seriously at.
BTE: Another recent initiative you have launched is the West Health Policy Council, which has been leading the drive to deploy Medical Grade Wireless at hospitals and health systems across the country. How has that been received and how long do you think it will take for Medical Grade Wireless to become ubiquitously adopted?
Joe Smith: The reception thus far has really been phenomenal and I think its due in part to the fact that the individual hospitals have wanted something that would solve this issue, but were looking for some broader and independent voice to give them confidence that this could be done. When you think about wireless health care applications, the FDA has a responsibility for approving that the devices themselves are safe and effective and merit use, and yet the FDA doesn’t control the wireless infrastructure in hospitals, and so the devices rely on something in order to function that the FDA doesn’t get a chance to regulate, so that gives them some pause when ensuring that the devices they regulate are actually going to function as they should. So the FDA likes this notion of having some level of assurance and utility-based standards. The hospitals very much like this notion of having some more or less standard they can refer to, and device manufacturers like knowing that there is some backdrop for the functionality of their devices, that there is some environment they can build to, so everyone has been looking to it but there hasn’t been a business model created for the development of such a thing so this was a perfect place for a non-profit like ours to step up.
I think Ed Cantwell has done a great job of understanding the environment given his past history, I think he can understand it and he can work with the different stakeholders and get this concept to reality. So we had early enthusiasm and acceptance and there are now a number of hospitals that have signed up to be exemplars of this and I think in relatively short order it moves from being an interesting thing to being an expected thing.
BTE: I recently did an interview with Tom Watlington, CEO of Sotera Wireless, which is a company the West Health Fund has an investment in, about his company’s ViSi Mobile product and I received a comment from a reader that spoke to the potential accountability risks associated with products like Sotera’s ViSi Mobile. In the age of the Accountable Care Organization and reimbursement based on outcomes rather than fee for service, capturing so much more data that physicians will now be held accountable for could increase accountability risk and undermine provider ability to receive reimbursement for care. Can you speak to the accountability risk associated with the adoption of technologies like Sotera Wireless ViSi Mobile?
Joe Smith: I understand what you are saying, but I don’t think it necessarily passes muster, I think its more of an interesting piece of tissue paper because for everything we do as docs there is accountability – for every test we order and every decision we make. If the argument is we will have too much information to manage, that is an argument I can understand, but we have been growing information availability in health care by leaps and bounds, for instance we now have genomic sequencing available and we can understand the relative utility of a medicine against a particular set of symptoms a patient may have and we have some accountability for knowing that now. I think if you start to say, “we can’t do this because we will be accountable for the information”, I think that is moving backward and not forward. We do owe it to patients, as we gather more and more information about their conditions, to become more efficient at information management, but that is a generic concept not related to a specific technology.