Bushwick Bill Dies After Battle With Pancreatic Cancer

Digital Healthcare

Article | November 29, 2023

“Health care is different, the data here is emotional! If you tell me you were buying a fishing rod online and were emotional about it, I’d say you are lying. But I do frequently see people helpless and confused when it comes to receiving health care, managing its costs, making sense of its data.”  - Senior Product Leader inOptum Global Solutions Pvt. Ltd. Yes, health care is different, and so is product management in it. This piece highlights the top 4 product management trends that are specific to health care and serve beyond being just a list of technologies making their way into health care. Health care consumerism Lance broke his ankle in a bicycle accident and is now in hospital waiting for surgery. Which of these words would describe him more aptly— a ‘patient’ or a ‘health care consumer’? The fact that Lance holds a high-deductible health plan, manages an interactive relationship with his primary doctor, keenly monitors his fitness through his smartwatch, and learns about healthier diet plans and recipes online — I can say he isn’t just receiving health care, but making active choices on how to pay for and manage his health. This choice and responsibility that people demand, is ‘health care consumerism’. This trend has been growing since 2015 when value-based care started picking up in the US. What does this imply for products/PMs? These are challenging and exciting times to be a product manager (PM) in health tech. This is because people are now demanding an experience equivalent to what they’re used to from other products in their lives, such as e-commerce, streaming platforms, and digital payments, to name a few. Any consumer-facing product (a mobile app, a web-based patient portal, a tech-enabled service) needs to meet high expectations. Flexible employer-sponsored health plans options, health reimbursement arrangements, price transparency products for drugs and medical expenses, remote health care services, and government's push to strengthen data and privacy rights — all point to opportunities for building innovative products with ‘health care consumerism’ as a key product philosophy. Wellness COVID-19 has tested health care systems to their limits. In most countries, these systems failed disastrously in providing adequate, timely medical assistance to many infected people. Prevention is of course better than cure, but people were now forced to learn it the hard way when cure became both inaccessible and uncertain. With lockdowns and social isolation, prevention, fitness, diet, and mental wellbeing all took center stage. Wellness means taking a ‘whole-person approach’ to health care — one where people recognize the need to improve and sustain health, not only when they are unwell, but also when they’re making health care decisions that concern their long-term physical and mental health. A McKinsey study notes that consumers look at wellness from 6 dimensions beyond sick-care— health, fitness, nutrition, appearance, sleep, and mindfulness. Most countries in the study show that wellness has gained priority by at least 35% in the last 2–3 years. And wellness services like nutritionists, care managers, fitness training, psychotherapy consultants contribute 30% of the overall wellness spend. So, what do health-tech PMs need to remember about wellness? The first principle is, “Move to care out of the hospital, and into people’s homes”. A patient discharged after knee surgery has high chance of getting readmitted if he/she has high risk of falling in his/her house, or is unable to afford post-discharge at-home care with a physiotherapist. This leads us PMs to build products that recognize every person’s social determinants of health and create support systems that consider care at the hospital and care at home as a continuum. The second principle is, “Don’t be limited by a narrow view of ‘what business we are in’, as wellness is broad, and as a health tech company, we are in health-care, not sick-care”. Wellness products and services include — fitness and nutrition apps, medical devices, telemedicine, sleep trackers, wellness-oriented apparel, beauty products, and meditation-oriented offerings, to name just a few. Recent regulations in many countries require health care providers to treat behavioural health services at par with treating for physical conditions, and this is just a start. Equitable AI Last month, WHO released a report titled “Ethics and Governance of Artificial Intelligence for Health”. The report cautions researchers and health tech companies to never design AI algorithms with a single population in mind. One example I read was, “AI systems that are primarily trained on data collected from patients in high-income settings will not perform as effectively for individuals in low or middle-income communities.” During COVID-19, we came across countless studies that talked about the disproportionate impact on minorities in terms of infections, hospitalizations, and mortality. A student at MIT discovered that a popular out-of-the-box AI algorithm that projects patient mortality for those admitted in hospitals, makes significantly different predictions based on race — and this may have adversely moved hospital resources away from some patients who had higher risks of mortality. How should I think about health equity as an AI health-tech PM? Health equity means that everyone should have a fair chance at being healthy. As a PM, it’s my job to make sure that every AI-assisted feature in my product is crafted to be re-iterative and inclusive, to serve any community or subpopulation, and is validated across many geographies. To prevent any inequitable AI from getting shipped, it is important to ensure that the underlying AI model is transparent and intelligible. This means knowing what data goes into it, how it learns, which features does it weigh over others, and how does the model handles unique features that characterize minorities. Integrated and interoperable In every article that I read on topics such as digital platforms, SaaS, or connectivity with EMRs, I always find the words: ‘integrated’ and ‘interoperable’ therein. Most large and conventional health tech companies started by offering point-solutions that were often inextensible, monolithic, and worked with isolated on-prem servers and databases. To give a consistent user experience, leverage economies of scope, and scale products to meet other needs of their customers, started an exodus from fragmented point-solutions to interoperable, integrated solutions. The popularization of service-oriented architectures (SOAs) and cloud vendors like AWS, Azure, and GCP has also helped. The what and how of integrated-interoperable solutions for PMs: Integrated solutions (IS), as I see them, are of two kinds — one, in which as a health tech company, we help our customers (health systems, insurance companies, direct to consumers) accomplish not just one, but most/all tasks in a business process. For example, a B2B IS in value-based care contract management would mean that we help our customers and health systems by giving an end-to-end solution that helps them enter into, negotiate, plan for, manage, get payments for their value-based contracts with health plans. In the second type of IS, we offer products that can be easily customized to different types of customers. For example, a health management app that people can subscribe to for different programs such as obesity, diabetes, hypertension, cholesterol management, as needed. The app works with different datasets for these programs and uses different analyses and clinical repositories in its backend, but still delivers a consistent user experience across programs to a user who enrolled in multiple programs, say diabetes and weight management. ‘Interoperable’ simply means that one product should be able to talk to other products both in and out of the company. For example, if product-A can alert a doctor about any drug-drug interactions or allergies a patient might have, while she is writing prescriptions for the patient in product-B (an EMR), then product-A does talk to product-B, and hence, is interoperable. This trend is picking up further with the growth of IoT devices, and industry-wide participation in adopting common standards for data exchange. Conclusion Though the article derives much of its context from US health care, I have tried to keep a global lens while choosing these topics. For developing economies like India, digitization is the number one trend as much of the health system is still moving from manual records to digitally store patient and medical data in EMRs. The good news is that India is booming with health-tech innovation and that is where consumerism, wellness, and equitable AI make sense. Once companies develop enough point-solutions for different health system needs and use-cases, Indian health tech will see a move towards creating integrated, interoperable (IGIO) systems as well. There are some other trends such as — use of non-AI emerging tech such as Blockchain in health information management, cloud infrastructure for health tech innovation, big data and analytics to improve operational efficiency in areas such as claims management and compliance reporting, Agile product management for co-developing with and continuously delivering to clients etc. — but I see them either as too nascent, or too old to feature in this list. Finally, as a health tech product manager, you can use the following questions to assess your products against the above trends — (Consumerism) do the products that I manage, empower consumers with choice, information, and actionability? (Wellness) Does my product emphasize keeping them out-of-hospitals and healthy in the first place? (Equitable AI) Am I sure that my product doesn’t discriminate against individuals belonging to underserved populations? (IGIO) And finally, is my product scalable, integrated and interoperable to expand to a platform, in the true sense?

Health Technology, Digital Healthcare

Article | August 21, 2023

A wealth of evidence supports the health benefits of keeping pets: increased life span, exercise, improved mental health, and a sense of purpose. But for older adults and those with disabilities, the responsibilities and expense of owning an animal can be overwhelming, and caregivers are often forced to take on those burdens themselves. To make matters worse, dementia patients can pose a physical threat to live animals. What alternate solutions exist for those who cannot safely or practically keep a live pet? Fortunately, information technology and robotics have advanced to the point that realistic, robotic emotional support pets are becoming a legitimate option. As research in this area advances, experts have found that robotic emotional support animals can offer a myriad of benefits similar to those associated with live pets. Robotic companions can also help caregivers. Robotic Emotional Support Animals in Practice Imagine the following scenario: An elderly woman with dementia suffering from Sundowner’s Syndrome relies on a strict daily regimen established by her caregiver. This routine is a delicate dance, balancing the patient’s meals, medication, and personal care, all designed to keep her as relaxed as possible. One afternoon, as the caregiver prepares dinner, the caregiver realizes that the patient’s beloved dog is nowhere to be found. She runs outside to look for the dog, leaving the patient to fend for herself. The patient is agitated over her missing dog and suddenly alone in a kitchen with pots and pans boiling. Fortunately, the caregiver finds the dog outside, but the patient is now too overwhelmed to eat or take her medication. Despite the caregiver’s best efforts at redirection, it’s a rough evening for everyone. How a Robotic Emotional Support Animal Can Ease the Role as Caregiver As any experienced caregiver knows, consistent emotional support for patients is critical. A robotic emotional support animal can significantly ease a caregiver’s role in this respect. Robotic companions replicate many benefits traditional pets provide – affection, responsiveness, and companionship – without the associated caregiving demands, such as feeding walking, or veterinarian visits. The Benefits of Robotic Emotional Support Animals The owners of pets are known to enjoy Reduced impact of depression Lower blood pressure Reduced triglycerides and cholesterol Longer survival rates after a heart attack 30% fewer doctor visits after age 65 Longer life spans Robotic companion animals provide genuine comfort, mirroring the emotional connection that living pets provide while lightening the caregiver load. Uplifting conversations about the robot companion elevate the moods of both patient and caregiver, potentially reducing feelings of burnout. In embracing such technology, senior care and assisted living facilities can foster an environment that makes staff and residents all smile a little more.

Health Technology, AI

Article | July 18, 2023

Rural, community, and independent hospitals are constantly facing mounting challenges in the form of staff shortages, accessibility to patient care and a multitude of cost concerns. Getting even one of these areas under control can help hospitals drastically boost their outcomes. Here are three areas of IT investment that hospitals must control to go beyond staying functional and create an excellent patient experience. Telehealth for Staff Shortage Healthcare currently face massive staff shortage with a projected gap of up to 48,000 primary care physicians and up to 77,100 specialty physicians till 2034. The effects of this shortage could be lessened by using virtual care, which would allow hospitals to care for patients through remote staffing. Digitalizing Patient Care with Asynchronous Telehealth Async telehealth of patients sending photos and videos to fast-track diagnosis. Async telehealth makes it easier for doctors to connect with more patients. This shortens the time it takes to see specialists and get important care services. Remote Patient Monitoring According to a CDC report, 90% of all healthcare spending goes into treating chronic conditions. Considering that U.S. nonmetropolitan areas have a high number of patients diagnosed with chronic conditions, accessibility is one of the contributing factors. Remote patient monitoring enhances patient care for people with chronic conditions. Wearable medical devices are already driving the move towards remote patient monitoring. Whether it’s through wearable weight scales, heart monitors, blood pressure bands, or pulse oximeters, clinicians can generate regular updates about a patient’s health readings and ensure a timely response in order to avert complications. Conclusion There is much to be achieved on the healthcare front when it comes to digitalizing care. The above technologies are enabling healthcare providers take delivery of medical care further than ever and ensure they generate more traction from their IT investments in these areas of medtech.

Article | July 17, 2020

The COVID-19 virus (C19) pandemic is turning out to be the event of the century. Even World War seems timid in comparison. We are in the 4th month of the virus (in non-China countries) and have gone past the lockdown in many places. Isn’t it time we re-think the approach? What if there is another wave of C19 coming soon? What if C19 is the first of many such events in the future? Before we get into analysis and solution design, summarizing the C19 quirks: While a large section of the affected population is asymptomatic, for some it can be lethal There isn’t clarity on all the ways C19 spreads It’s known to affect the lungs, heart, and kidneys in patients with weak immunity It has been hard to identify a definitive pattern of the virus. Some observations in managing the C19 situation are: With no vaccine in sight, the end of this epidemic looks months or years away Health care personnel in hospitals need additional protection to treat patients Lockdowns lead to severe economic hardship and its repeated application can be damaging Quarantining people has an economic cost, especially in the weaker sections of society If one takes a step back to re-think about this, we are primarily solving 2 problems: Minimise deaths: Minimise the death of C19 and non-C19 patients in this period Maximise economic growth: The GDP output/growth should equal or higher than pre-C19 levels One needs to achieve the 2 goals in an environment of rising number of C19 cases. Minimise deaths An approach that can be applied to achieve this is: Data driven health care capacity planning Build a health repository of all the citizens with details like pre-existing diseases, comorbidity, health status, etc. The repository needs to be updated quarterly to account for patient data changes This health repository data is combined with the C19 profile (disease susceptibility) and/or other seasonal diseases to determine the healthcare capacity (medicines, doctors, etc.) needed The healthcare capacity deficit/excess needs to be analysed in categories (beds, equipment, medicine, personnel, etc.) and regions (city, state, etc.) and actions taken accordingly Regular capacity management will ensure patients aren’t deprived of timely treatment. In addition, such planning helps in the equitable distribution of healthcare across regions and optimising health care costs. Healthcare sector is better prepared to scale-up/down their operations Based on the analysis citizens can be informed about their probability of needing hospitalisation on contracting C19. Citizens with a higher health risk on C19 infection should be personally trained on prevention and tips to manage the disease on occurrence The diagram below explains the process Mechanism to increase hospital capacity without cost escalation Due to the nature of C19, health personnel are prone to infection and their safety is a big issue. There is also a shortage of hospitable beds available. Even non-C19 patients aren’t getting the required treatment because health personnel seek it as a risk. This resulted in, healthcare costs going up and availability reducing. To mitigate such issues, hospital layouts may need to be altered (as shown in the diagram below). The altered layout improves hospital capacity and availability of health care personnel. It also reduces the need for the arduous C19 protection procedures. Such procedures reduce the patient treatment capacity and puts a toll on hospital management. Over a period, the number of recovered C19 persons are going to increase significantly. We need to start tapping into their services to reduce the burden on the system. The hospitals need to be divided into 3 zones. The hospital zoning illustration shown below explains how this could be done. In the diagram, patients are shown in green and health care personnel are in light red. **Assumption: Infected and recovered C19 patients are immune to the disease. This is not clearly established Better enforcement of social factors The other reason for high number of infections in countries like India is a glaring disregard in following C19 rules in public places and the laxity in enforcement. Enforcement covers 2 parts, tracking incidents of violation and penalising the behaviour. Government should use modern mechanisms like crowd sourcing to track incidents and ride on the growing public fear to ensure penalty enforcement succeeds. The C19 pandemic has exposed governance limitations in not just following C19 rules, but also in other areas of public safety like road travel, sanitation, dietary habits, etc. Maximise economic growth The earlier lockdown has strained the economy. Adequate measures need to be taken to get the economy back on track. Some of the areas that need to be addressed are: One needs to evaluate the development needs of the country in different categories like growth impetus factors (e.g. building roads, electricity capacity increase), social factors (e.g. waste water treatment plants, health care capacity), and environmental factors (e.g. solar energy generation, EV charging stations). Governments need to accelerate funding in such projects so that that large numbers of unemployed people are hired and trained. Besides giving an immediate boost to the ailing economy such projects have a future payback. The governments should not get bogged down by the huge fiscal deficit such measures can create. Such a mechanism to get money out in the economy is far than better measures like QE (Quantitative Easing) or free money transfer into people’s bank accounts Certain items like smartphone, internet, masks, etc. have become critical (for work, education, critical government announcements). It’s essential to subsidise or reduce taxes so that these items are affordable and accessible to everyone without a financial impact The government shouldn’t put too many C19 related controls on service offerings (e.g. shops, schools, restaurants, cabs). Putting many controls increases the cost of the service which neither the seller not buyer is willing or able to pay. Where controls are put, the Govt should bear the costs or reduce taxes or figure out a mechanism so that the cost can be absorbed. An event like the C19 pandemic is a great opportunity to rationalise development imbalances in the country. Government funding should be channelized more to under-developed regions. This drives growth in regions that need it most. It also prevents excess migration that has resulted in uncontrolled and bad urbanisation that has made C19 management hard (guidelines like social distance are impossible to follow) Post-C19 lockdown, the business environment (need for sanitizers, masks, home furniture) has changed. To make people employable in new flourishing businesses there could be a need to re-skill people. Such an initiative can be taken up by the public/private sector The number of C19 infected asymptomatic patients is going to keep increasing. Building an economy around them (existing, recovered C19 patients) may not be a far-fetched idea. E.g. jobs for C19 infected daily wage earners, C19 infected taxi drivers to transport C19 patients, etc. In the last 100 years, mankind has conquered the destructive aspects of many a disease and natural mishap (hurricanes, floods, etc.). Human lives lost in such events has dramatically dropped over the years and our preparedness has never been this good. Nature seems to have caught up with mankind’s big strides in science and technology. C19 has been hard to reign in with no breakthrough yet. The C19 pandemic is here to stay for the near future. The more we accept this reality and change ourselves to live with it amidst us, the faster we can return to a new normal. A quote from Edward Jenner (inventor of Small Pox) seems apt in the situation – “The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases”.