The Urban Poor: Improving Care Block by Block
Toyin Ajayi, MD, MPhil | Chief Health Officer and Founder, Cityblock Health
You could say Dr. Toyin Ajayi is a radical. Her new company, Cityblock Health, aims to radically improve health care—and health—for low-income people living in big cities. Poor health outcomes plague the poor. Medical interventions reach low-income city residents late and cost more than you might think. Plus, innovation and improvement often target people who can afford care. Then add the trend toward transactional health care—the hollowing out of provider-patients relationships. These issues compound to create a problematic prognosis.
Ayayi prescribes a radical re-do of the care model. She builds neighborhood health hubs that integrate primary care with behavioral health and social services. New, tailored technology plays a role. So do incentives for providers. But strong patient-provider relationships could prove the most important linchpin for improving urban health—block by block.
Empathy in Action: Essential for Better Care
Ruth Berggren, MD, FACP | Director, Center for Medical Humanities & Ethics, The University of Texas Health Science Center at San Antonio
No one goes to medical school to learn the finer points of billing codes, says Dr. Ruth Berggren. Most would-be doctors go because they want to help people. But that can get lost in the intense pursuit of a medical degree, and would-be doctors can lose sight of patients.
Dr. Berggren aims to change that. Her own experiences gave her a first-hand look at people—at entire cities—at their worst moment. Berggren was at the flooded Charity Hospital in New Orleans during Hurricane Katrina in 2005. She responded to the devastating earthquake in Haiti in 2010. Most recently, she worked with victims of Hurricane Harvey in Houston.
Now, she takes students along on these missions for what she calls service learning. It’s effective. Not just for victims, but for future physicians too. Berggren says she teaches ethics in action. A close look at devastation, and at its victims, preserves students’ empathy. And empathy? That’s the fuel for better doctors, and for better health care.
Confronting Health Care’s Hardest Questions
Ezekiel Emanuel, MD, PhD | Chair, Medical Ethics and Health Policy, University of Pennsylvania
Dr. Ezekiel Emanuel is a bioethics professor, physician and author who wants to die at 75. “By the time I reach 75, I will have lived a complete life. I will have loved and been loved,” he writes. But not everyone loves that declaration. It caused quite a stir on social media.
You could say that’s just what Dr. Emanuel wants. To cause a stir. One recent suggestion: Medicare should emulate Netflix to tackle the issue of risk-adjustment in calculating payment.
Netflix held a contest. They wanted an entrepreneur to design the algorithms that would yield recommended movies for customers. The winning team earned a million-dollar reward. Worth it for Medicare, says Emanuel, if it wipes away the costs of folks who game the current risk-adjustment model.
Emanuel often takes an unconventional approach. It gets the rest of us to talk about the tough topics. But if you want to have that discussion with Emanuel himself, you’ll have to see him in person. Stir or not, he doesn’t do social media.
Will Health IT Finally Be Driven by Demand?
John Halamka, MD, MS | Chief Information Officer, Beth Israel Deaconess Medical Center, Chairman, New England Healthcare Exchange Network, Professor, Harvard Medical School
When doctors are confused about electronic health records and securely sharing data to coordinate and improve care, they turn to author and fellow physician, Dr. John Halamka. He manages a health information system that supports 3,000 doctors, 18,000 other health care employees and 3 million patients. He also practices emergency medicine, teaches at Harvard Medical School and runs a farm with his family.
Dr. Halamka has a unique view of the intersection of medicine and technology. He even refers to himself as the “Geek Doctor” in his own blog. Now, Halamka predicts that health IT is on the cusp of an exciting new future, no longer driven by government or advisory boards, but by consumers—by the demands of patients. A bold prediction for a doctor (or a geek).
“Think like a designer.” That’s Dr. Bon Ku’s advice for his medical students at Jefferson University—and it’s not a bad idea for all doctors.
Design thinking, in the tradition of Apple or Amazon, is not a trend. Increasingly, it’s the standard approach to improving products or delivering better service across a variety of industries. Dr. Ku says health care must keep up.
Ku believes health care professionals serve patients best when they craft the delivery of care from the patient’s viewpoint. Empathy is the foundation of good design. Design is not about the carpet color or the furniture fabric; it’s about ease of use, efficiency and a better experience for patients and providers. Ku is convinced that design thinking does more than improve care—it also prevents burnout and cynicism among health care professionals.
Is there a lopsided balance of power between patient and provider? Liz Salmi says “Absolutely.” In her professional role, she touts transparency—in the form of OpenNotes—as the solution. Salmi is a leading voice in a movement to give patients broad access to their health care records. That movement is also pushing providers to proactively share patients’ notes with their other providers.
Salmi’s personal story makes her viewpoint compelling: She was diagnosed with brain cancer at just 29 years old. Since then, she’s written more than 500 blog posts about her experience. The blog—in a sense, a journal of her life with the disease—not only helps her cope, but also contains information she says can help her care team. That’s why she and OpenNotes want to add a component to their concept. It’s called Our Notes. The new project tests the impact of patients adding to and updating their electronic medical records between clinical visits.
Lisa Suennen reads tea leaves professionally. She’s a venture capitalist. Her predictions can mean earning or losing a fortune. That’s why so many people look for her insight on the intersection of health care and technology. Here are some: Health care companies will prosper if they embrace technology and consumer experience as guiding priorities. Companies that traditionally excel in those areas—think Amazon or Google—could choose health care as a new fertile frontier. Blockchain (technology that allows digital information to be distributed, but not copied) will be the health care investor’s new buzzword. Although it’s used for digital currency like Bitcoin, it could have a role in electronic health records.
How confident is Suennen in her predictions? Look no farther than the name of her company and her blog, Venture Valkyrie. In Marvel Comics, Valkyrie is a demi-goddess known for super-human strength and stamina. In Norse mythology, a valkyrie decides which soldiers die in battle and which go on to glory.
Check back as we announce more speakers.