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EvergreenHealth: Evolving Care Outside The Clinic for Better Outcomes

In 2016 we formally announced our collaboration with EvergreenHealth to deliver interactive care plans for Total Joint Replacement.

“Across our organization, we strive to be a trusted source for innovative care solutions for our patients and families, and our partnership with Wellpepper helps us deliver on that commitment,” said EvergreenHealth CEO Bob Malte. “Since we began using Wellpepper in 2014, we’ve seen how the solution enhances the interaction between patients and providers and ultimately leads to optimal recovery and the best possible outcomes for our patients.”

EvergreenHealth is an integrated health care system that serves nearly 1 million residents in King and Snohomish counties in Washington State, and offers a breadth of services and programs that is among the most comprehensive in the region. More than 1,300 physicians provide clinical excellence in over 80 specialties, including heart and vascular care, oncology, surgical care, orthopedics, neurosciences, women’s and children’s services, pulmonary care and home care and hospice services. With expansion into more rural areas, and a catchment area that serves Seattle’s ‘eastside’ home to Microsoft and other major technology companies, delivering virtual care is both an imperative for an an expectation of EvergreenHealth patients.

Since our initial announcement, we’ve seen thousands of patients complete care plans and outcome surveys, and expanded within the musculoskeletal service line to include preventive care, spine surgery, and general rehabilitation.

User Experience

EvergreenHealth has a white labeled version of the Wellpepper patient application called MyEvergreen and available in Android and Apple App Stores. Clinicians use the Wellpepper clinic portal, and receive alerts to their email inbox if patients report any issues or unexpected outcomes.

EvergreenHealth has deployed care plans based on their own clinical best practices. 

Outcomes

  • Thousands of patients have used Wellpepper interactive care plans at EvergreenHealth
  • Interactive care plan users show higher scores on standardized outcome reports than those tracking outcomes without an interactive care plan
  • EvergreenHealth patients show a higher engagement level than Wellpepper’s overall 70% engagement

I would not want to have another knee surgery without the app. I was 81 and it wasn’t hard for me at all!

Total Knee Replacement Patient at EvergreenHealth

Technology

This deployment used a white labeled Android and iOS application for patients, and a clinic portal for clinicians. Patient invitation is synched with the Cerner medical records software using an ADT feed. Clinicians are notified of patients requiring additional help with an email alert. Wellpepper’s entire HIPAA secure platform was leveraged for this implementation, and EvergreenHealth deployed custom care plans based on their own best practices. They continue to add innovative features as they are added to the Wellpepper platform.

Posted in: Exercise Physiology, Healthcare costs, Healthcare Technology, HIPAA, Interoperability, M-health, Outcomes, patient engagement, Prehabilitation, Seattle

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Wellpepper Receives Seattle Business Magazine’s 2017 Leaders in Healthcare Gold Award for Achievement in Digital Health

We are honored to have been named the Gold Award winner for outstanding achievement in digital health from Seattle Business Magazine’s 2017 Leaders in Health Care!

Thank you to our amazing team and partners!

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Press Release, Seattle, Uncategorized

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The Disneyfication or Consumerization of Healthcare

I had the privilege of participating in my second panel hosted by Curtis Kopf, Senior VP of Customer Experience at Premera, at the recent Washington State of Reform Health Policy Conference. Curtis was formerly of Alaska Airlines and is new enough to healthcare to be able to point out idiosyncrasies of healthcare, and he led the audience, my fellow panelists, Elizabeth Fleming, VP of Group Health Cooperative, Tabitha Dunn, VP of Customer Experience at Concur, and me on a rollicking discussion of who excels in customer service, how to emulate consumer organizations, and how not to emulate consumer organizations.

I enjoy panels as they afford the opportunity to evaluate my own perspective based on the insights of others usually in extremely different roles. This panel was unique as we represented payer, provider, employer, and digital health/technology: practically a cross-section of the industry.

Both over coffee prior to the panel and on the panel, we talked a lot about the influence and guiding principles of Disney as the quintessential consumer experience focused organization. Tabitha had just returned from a holiday trip with her family, and Curtis had the opportunity to attend the Disney Institute for customer service training during his time at Alaska airlines.

Before getting into the takeaways from our experiences and thinking about what to take away from Disney, we started the panel by discussing why consumerization was a topic in healthcare at all.

A number of factors have converged to drive consumer or patient-centric approach we now see in healthcare:

  • 20M newly insured people offered an opportunity that brought new players, like Walgreens, Walmart, Medical One, and Zoom+ into primary and urgent care market
  • On demand services like Uber and constant communication through messaging apps, and the ubiquity of smart phones created an expectation of healthcare on demand.
  • High-deductibles made consumers evaluate more closely how they were spending their healthcare dollars
  • Getting over the hump of initial EMR integration made physicians ask why they couldn’t have consumer-quality tools to do their jobs

Regardless of what happens with the ACA with the incoming administration, we don’t expect many of these things to change, although there may be more competition in primary care as these new players put pressure on incumbents.

How do you react when there is more competition? A customer-centric approach is a good place to start, which brings us back to Disney. As a child, I did a school project on Walt and his empire, but have to admit I didn’t know as much about them as my fellow panelists.

Here are my key takeaways from the discussion:

  • Disney is extremely consistent, which provides autonomy for their staff to make good decisions within the 4 values that Disney holds. Although you may think that the brand is the highest value, it is actually safety. A Disney cast member is allowed to break character only when safety is at risk. Consider this as you think about the healthcare experience: safety and good experience are not mutually exclusive.
  • If you’re going to try to emulate an experience from another industry, make sure you fully understand that company’s or industries core values. The that resulted when executives managed to the HCHAPS survey: Nurses were given scripts to follow rather than making decisions, which is the exact opposite of how Disney actually operates. Nurses should have been given autonomy to work within the values of the health system and the needs of the patient.
  • Disney has an entire underground operations center that supports what guests experience above ground. This supports both the safety but also the experience of the park. Curtis toured this facility while at the Disney Institute. What struck me the most about this was the realization that the hospital has no back-office. We’ve met with administrators in their offices that are converted hospital rooms. First, think how uninspiring this is for employees as an office. Second, these are usually on active hospital floors, so patients experience random water cooler conversation as they are in care.

As an outsider to healthcare, it took me a while to get used to going to the hospital to have meetings, and it still makes me uncomfortable to pass patients waiting in hospital beds in the hallway while I’m going to negotiate a contract. This lack of a “back-office” impacts patients and staff alike, and really extends to every patient interaction. The EMR is essentially back-office software. Why hospitals run their patient-facing experience from this essentially line of business technology is beyond me.

Although at Wellpepper our client is the health system, our most important user is the patient. We want to ensure that the patient experience is as good or better than any popular-patient facing applications, and represents how the patient understands their care. As a result, we are able to enable patients to participate, and self-manage, and still deliver valuable information to help the internal health system operations center be more effective, which is why I’m always happy to talk about the consumer experience in healthcare.

 

Posted in: Behavior Change, Patient Advocacy, Patient Satisfaction, Seattle

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Seattle Business Magazine’s 2017 Leaders in Health Care Awards

Among many individuals and organizations leading the charge in Washington’s world-class health care industry, we are elated to be listed as a finalist in Seattle Business magazine’s 2017 Leaders in Health Care Awards. It is truly a privilege to be nominated as well as to serve as a member of Seattle’s innovative community.

We are very excited for Seattle Business’ gala awards ceremony on March 2nd.

Posted in: Seattle

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Better Living Through Big Data

This week I had the opportunity to participate on a lively panel at General Assembly Seattle organized by Seattle Health Innovators, and moderated by Corinne Stroum of Caradigm. Fellow panelists included Randy Wise formerly of Group Health and now at EveryMove, Ang Sun of Regence/Cambia, Lifesprite founder Swatee Surve, and Daniel Newton of Accolade.

Corrine sent us a series of great questions in advance, and we had a rich discussion and so many questions from the audience that we didn’t even get to half of them. It’s a big topic, and with payers, providers, and technologists on the panel there was a lot of opportunity for broad perspectives. There’s a discussion of having a follow-up to this panel to continue the conversation—stay tuned for more on that. The general themes of the discussion included the value of big data to influence individual health with examples like the quantified-self movement, but more generally how our ability to collect and analyze can lead to more personalized and better healthcare. img_3265

At Wellpepper, we have a lot of data to analyze. As Wellpepper CTO Mike Van Snellenberg pointed out in his Stanford MedX talk and I’ve also talked about in this paper in The Journal of MHealth, having data provides an opportunity to get answers faster than using the traditional scientific method. Rather than formulating a hypothesis, setting up an experiment, collecting data, analyzing the data, and then going back to the drawing board if your hypothesis is not born out, data enables you to ask a series of questions and get immediate and sometimes surprising answers.

The panel kicked off with the sharing of some surprising things that we’ve found from the data,  ranging from which mental health tools were favored by different populations to the ability to predict hospital readmissions. In addition to finding trends from explicit patient input, we also discussed the ability to draw insight from activities including social media and mobile usage patterns. Swatee mentioned the Instagram analysis that showed color scheme on photos was a predictor of depression.

The ability to combine both passive and active patient-generated data, and draw conclusions from broad date sets these data sources can help to deliver better care – resulting in what Daniel Newton referred to as “small data.” That is, I’m going to learn as much as I can about you, and then tailor care to you, which is the approach Accolade takes.

As with any talk on tracking and data, questions of privacy came up. While all the panelists thought that there have become standard terms for people to opt-in to sharing health data, describing the use of that data was deemed important. At this point, Ang Sun from Cambia (who admitted that, as a healthcare plan, they had a heck of a lot of data on people), mused that he wished his physician knew as much about him as Google did. Generally, there was consensus that, if the purpose of the data sharing was for connecting people with the appropriate healthcare services, people would opt in.

Our panel was pretty aligned on the idea that there is big value in big data for healthcare, but that the general applications and usage are still in early days. First, there are the privacy concerns and even laws. Second, current healthcare organizations using this first generation of EMRs have limited ability to look at aggregate data for trends. However, with new technology and personalized approaches to care, we see great promise in big data and predictive analytics for healthcare.

Posted in: Clinical Research, Healthcare Research, Research, Seattle

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Justin Sledge Transforms Senior Care at Aegis Living

When it comes to delivering quality care, Chef Justin Sledge rebels against the idea of senior homes being “retirement homes” by providing great nutrition and interactive design.

Justin aims to combine compassion and creativity to provide the best care for senior residents at Aegis Living. The chef has tremendous influence in the senior home’s decision-making process in nutrition and design due to his wide range of experience and passion to help senior residents. While it is often believed for senior care homes to be quiet and slow, Aegis Living – under Justin’s guidance – blossomed into lively space for the community.

“I believe the best treatment and care is through spending time with loved ones,” says Justin, chef of Aegis Living for five years. “We want to make this a place where everyone wants to visit.”

1028161200bAegis Living has several locations throughout the west coast – each with a different decorative theme, but same core values.  Justin is currently at the helm of the Victorian themed Aegis Living’s kitchen. Every detail that goes into the many floors such intricate dining room, archaic-style movie theater, and hand-painted pizza kitchen spoke volumes about the staff’s care and compassion towards the residents.

The chef of twenty-three years has made the decision to switch from restaurants to senior care and has been there ever since. Justin was also known for baking treats for Seattle’s charitable Queen Bee Café where profits are donated to the city’s selected charities.

I had the privilege to be Justin’s guest as he gave me a tour of what appeared to be a magnificent manor located in Seattle’s Queen Anne area. The windows are wide with a perfect view of the soccer field next door where children often come to play – and visit Aegis Living for tours and activities with the senior residents. A lavish private dining room seats sixteen guests and serves lobster for family holiday dinners. One floor hosts a game room with a handmade painted golf course for residents to play with visiting grandchildren. It seems the entire home was brimming with delightful activities for the senior residents and their guests to enjoy.1028161225b

At the large kitchen, the chef presented the menu of the day – Alaskan salmon, classic Caesar salad, and grilled beef tenderloin – all made with fresh local ingredients. Justin oversees the menus throughout all the Aegis Living homes.

Justin lead me through the Memory Care floor with a multitude of family paintings such as a grandfather laughing with his grandson on a fishing trip and an elderly couple smiling and walking together. He explained that photos like these help trigger good memories for seniors and improves their mood. All the décor and structure are carefully chosen to elicit positive emotions and memories in senior residents. There were also multiple studios for crafts and leatherwork, lavish salons and a beautiful pool. There were even rooms decked out to look like a jungle with screens that play hiking and wildlife documentaries for seniors to calm themselves from anxiety.

The tremendous amount of compassion in each care is what makes Aegis Living stand out most. There is a large social aspect that heavily influenced the design of Aegis Living homes and encourages frequent interactions with friends and family.

Lastly, I was able ask Justin a few questions about his work with Aegis.

 

Q: Why all the focus on design and aesthetics?

JS: Art helps to bring out positive emotions in our residents. It is not a place to put away some of the most important people in our lives who have helped shaped our future. We want to make it as nice an experience as we can for the residents.

 

Q: Why did you decide to choose Aegis Living over your previous career as a restaurant chef?

JS: This was the best decision of my life. I was a chef for twenty-three years and it was like Hell’s Kitchen. The job was demanding and the hours even more so – I hardly had time to see my kids. There would be countless weekends where I had to skip out on ballet recitals and family picnics because of work. This is much more fulfilling and I’ve never been happier. Here, I get the best of both worlds where I have more time to see my kids and I still get to do what I love – being a chef.

 

Q: How do you deal with competitors?

JS: We hope to inspire competitors to do what we do. We hope they try to recreate the same level of care towards their senior residents as well. This might mean switching to more local fresh ingredients or quality of life programs and activities.

 

Q: What are the next steps for you and for Aegis Living?

JS: We are expanding and building six more senior care homes throughout the west coast these next few years. I will be there to help train new staff and help plan everything from what the place should look like to what’s on today’s menu for our senior residents.

Posted in: Aging, patient engagement, Patient Satisfaction, Seattle

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MHealth and Big Data Are Catalysts for Personalized Patient Care

Although there are many complexities wrapped around our healthcare system, Stanford University’s 2016 Medicine X Conference starts finding solutions to improving patient care by focusing on increasing patient engagement and transforming how patients are treated in the system.

Wellpepper CTO Mike Van Snellenberg, who spoke at MedX in September with digital health entrepreneur and physician Dr. Ravi Komatireddy, addressed several important aspects of big data collection.

“Collecting big data is like planting trees. You need to plant the seed of the process or tooling,” says Van Snelleberg. “Over time, this matures and produces data.”

Mr. Van Snellenberg, who has collected and analyzed patient data at Wellpepper, discovered several key aspects of data collection that could improve care continuity for both patient and providers. He shared this to his MedX audience.

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“Wellpepper has already uncovered new understandings about which patients are most adherent as well as indicators of readmissions,” says Van Snellenberg. “That’s very valuable information.”

“We’ve discovered that, as you collect patient-generated data, these types of insights as well indications about the effectiveness of certain clinical protocols will be available to you. This will help allow for providers to encourage positive patient behavior,” he stated.

Mr. Van Snellenberg spoke further at an interview in October about collecting and using patient-generated data.

 

Question: What groups can benefit off the collecting of big data?

Snellenberg: Collecting patient-generated data can ultimately produce better outcomes and patient care for hospital and clinics as well as the patients themselves. The more in quantity and detail, the better it is to help produce good results. Data collection has tremendous value that can allow hospitals and clinics to learn more about their patients in between hospital visits, thereby filling in missing gaps in patient information. We also realized that collecting big data can potentially prevent complications or readmissions by identifying warning flags before the patient needs to return to the clinic.

And as mentioned, analyzing big data has provided us insights about which patients are most adherent. For example, we have found that patients with 5-7 tasks are adherent while patients with 8-10 tasks are not.

 

Q: What are some things you have discovered using patient-generated data?

MS: We were able to make observations on the patterns. We also discovered a strong linear correlation between the level of pain and difficulty of patients.

Traditionally, patient data remained in the hospital. This often left big gaps in knowledge about the patient in between hospital visits. By collecting and data in between visits to the hospital, you can discover important correlations that would not have been discoverable without data.

 

Q: What are some possible methods to collect patient data?

MS: Dr. Ravi Komatireddy, who worked in digital health, suggested several programs such as Storyvine and AugMedix.

Usually, data is collected by patients recording symptoms and experiences on a daily basis in a consistent manner and then managed afterwards. For example, patients themselves tend to keep track of their progress in diaries or using the FitBit to record the number of steps and heart rate.

 

Q: What are some of the most unique aspects about this year’s MedX?

MS: One unique aspect about the MedX Conference is that it provided more opportunities for diverse voices to be heard in addition to health professionals – including a mix of health patients, providers, and educators.

The mindset was also encouraged to change. Some of the convention’s most progressive talks on stage happened when phrases such as “How might we…” and “Everybody included” are brought up in the discussion.

The term “Everyone included” came up most often, pushing for more perspectives outside of JUST the physicians. MedX’s solution-oriented focus proves to be heading down a successful route to improving patient care in the healthcare system as well as acting as the initiative to open doors for new voices to be heard.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare Technology, Outcomes, patient engagement, Research, Seattle

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Health Care Innovators’ Uphill Climb

The Healthcare Innovators Collaborative and Cambia Grove have joined forces to present a series of talks on our evolving healthcare challenges.

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This series was run out of University of Washington last year, and this year’s sessions, subtitled “Under the Boughs” are held at Cambia Grove – where a new Sasquatch In Residence (SIR) ensures that the patient voice is present in the conversations.

September’s session took off with Dr. Carlos A. Pellegrini, Chief Medical Officer of UW Medicine, discussing the shift to value-based care. Pellegrini defined UW’s transformation as a process with 6 key goals:

  1.  Standardization

Standardization improves efficiency and is key to reducing cost and improving outcomes. Today, surgeons performing surgery at different hospitals may have varying tasks per hospital. Patients may receive different instructions depending on which physician or department they interact with. As a result, it is difficult to compare outcomes or optimize clinical workflow without a form of standardization.

      2. Population Health Management

Using system data to anticipate patient needs before they become major problems can both improve care and lower costs.

       3. Medical Home 

Implementing the medical home model can allow providers to be more aware of all of their patients and manage them proactively in measurable groups.

       4. Clinical Technology

Better use of clinical technical systems and of technology generally will enable more efficient and proactive patient care.

Dr. Pellegrini suggested they need to identify which patient was calling and suggesting the care they needed. For example “It’s Linda Smith, and she’s due for a mammogram.”

       5. Risk Management

“The Healthy You” – Sending better information to clinicians can help keep patients healthy, such as regarding activity level for obese patients.

        6. Smart Innovation

In contrast to standardization, consider opportunities to   customize experience/treatment for patients to deliver personalized and targeted care.

Understanding and measuring outcomes is also seen as key to approaching this evolution. Still, it was pointed out that providers, payers, and patients all understand a positive outcome differently. For example, for a provider the outcome is usually functional, for a payer or employer the outcome is financial, and for the patient it is often quality of life.

Only when these three outcomes are considered at once can we have true value-based experiences.

While Dr. Pellegrini and interview Lee Huntsman lamented the fact that US healthcare is ten times as expensive as other models, like the UK’s system, at present only 3% of UW Medicine’s revenue comes from value-based models, and it costs them $200M per year to maintain EPIC.

With numbers like this, the shift to value-based care has some big uphill battles. Keep fighting the good fight everyone, we know that the burgeoning health community in Seattle and the Cambia Sasquatch will!

Posted in: Healthcare Research, Healthcare transformation, Meaningful Use, Outcomes, Patient Advocacy, Seattle

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Patients As Designers Of Their Own Health

Seattle’s grassroots healthcare community continues to gain traction with a new meetup for patient-centered design. Last week’s meeting was generously sponsored by MCG a subsidiary of Hearst Publications who are quite active in the healthcare world with content and education. The panel discussion featured Dana Lewis, a patient-maker who is active in the open source movement for diabetes care and built her own artificial pancreas, Christina Berry-White from the digital health group at Seattle Children’s, and Amy London, Innovation Specialist at Virginia Mason. The group talked about how to effectively get feedback from patients, and how patient hackers like Dana can take poor design into their own hands build tools they need, and ultimately influence large healthcare companies, in this case device manufacturers.

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Dana, Christina, and Amy, photo credit Alina Serebryany

The panel had great advice for understanding and developing products and improving processes for patients, as well as for soliciting feedback from patients. Here are a few of my takeaways.

Tips for developing products and process

  • Understand patient’s goals and desires. Often the goals of the hospital or health system are not the same as the patient’s. After meeting with a group of patient advocates one Virginia Mason surgeon realized that the only outcome that really mattered was whether the patient had a positive experience.
  • Let patients customize their views and experiences. Amy talked about a particular chart where she wanted to see the graph rising to show increasing blood sugar and another user she talked to wanted to see the graph lowering to show insulin lowering and a need for intervention. Amy was confused by this view but created her open source artificial pancreas interface to enables people to choose their own view, and the result was that people who had diabetes looked at it the same way Amy did and parent-caregivers of diabetic children wanted the second view. Which brings us to the next point–
  • Differentiate between users. Patients often have different requirements than their caregivers, whether that’s parents caring for a child or teen, or adult children caring for a parent. As well, the clinical workflow shouldn’t dictate the patient experience.
  • Get feedback early. Amy mentioned meeting with a device manufacturer who showed her an almost ready for release glucometer that was intended to fit in the pocket. She quipped “you obviously didn’t test this with women’s pockets.”

Tips for collecting feedback

  • Build it into the product. Christina from Children’s mentioned that when they switched from reams of paper to an iPad-based tool for patient on-boarding forms the physicians wanted to stop using it because it did not immediately integrate with the EMR. Luckily the tool had a feature to survey users on whether they preferred using it to paper, and the answer from parents was overwhelmingly yes. The digital health team showed these results to the physicians, and the tool stayed in place.
  • Be creative when soliciting feedback. Children’s knew from experience that parents and patients were reluctant to give them negative feedback after a lifesaving experience like an organ transplant, so they used techniques that are often used in brand market research: analogies. For example, they asked teens to describe a digital tool as a car, and found out that their tool was like a pick-up truck to them: useful but utilitarian.
  • Use patients to collect feedback. Patients are also often intimidated to provide direct feedback to healthcare professionals as they see them as authority figures. At Virginia Mason patients who have already had a successful joint replacement visit post-surgical patients to find out how they are doing, and talk about their own experiences. Patients are a lot more candid with each other, and Virginia Mason was able to benefit from understanding the questions they asked the peer ambassadors and incorporate that information into formal programs.
  • Ask the questions at the right time. If you want to understand post-operative experiences ask within a few weeks of the actual experience, not 6 months later.
  • Be aware of selection bias. Patients who volunteer for focus groups are often those who have the time and money to be able to do so. Your feedback may be skewed towards retired patients, and those who are not hourly workers. Consider how you will cast a wide net.

Lots of great advice at this event, much of which we already incorporate into our processes and products at Wellpepper, although I definitely got some new ideas and it’s great to see the community coming together to share best practices. My only disappointment with the event was that with a title of Patients as Designers, I expected to see more patients on the panel. While there was a last minute cancellation of a patient-maker, it would have been amazing to have Children’s and Virginia Mason bring one of their patient-designers to be on the panel. Maybe next time?

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Lean Healthcare, Research, Seattle

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Taking the Fear Out of Total Joint Replacement

I’m not quite ready for a joint replacement but many of our Wellpepper users are, so I found myself spending a recent Saturday morning at a session called “Taking The Fear Out of Total Joint Replacement.” This patient-focused half-day workshop was free to potential patients and sponsored by an organization called SwiftPath that specializes in minimally invasive outpatient total joint procedures. Total joint procedures are feeling the crunch of reimbursement changes in the Affordable Care Act, and one way to lower costs is to perform them in an outpatient facility. However, due to the minimized time an outpatient candidate would spend under the supervision of a doctor, they must be highly engaged in their self-care efforts, including losing weight or quitting smoking if necessary. With people having replacements at younger ages, and often having both knees and hips replaced, the need for engaged patients continues to grow.

I attended the workshop to get an idea of the patient’s perspective on the information and on the procedure. Health systems frequently offer Total Joint Bootcamp but this was intended as an introductory session for people who may be undecided about getting a replacement. The sessions included information about good candidates for minimally invasive total joint replacement, expectations of patients and their caregivers for participation, learning, and recovery, and an overview of the physical therapy involved. The host for the day was Dr. Craig McAllister who is one of the principals of the SwiftPath method. With the exception of the initial opening sequence of surgeons talking about the effictiveness of the methodology, the day was primarily patient focused, starting with risk stratification as a means to determining the best candidates for surgery, through tracking patient reported outcomes, and ensuring patients and caregivers were equal participants in care. There was also a session on determining how a patient pays. Dr. McAllister noted at one point that this entire patient-centered approach was completely different than what he was taught in medical school.

Two of the most powerful sessions were also patient-focused. The first was a patient panel consisting of an OR nurse who had a recent knee replacement and biked to the session, a few people who had experienced both in-patient and outpatient replacements, and one who was not originally a candidate for surgery because he was a smoker. While quitting is a requirement for the surgery, he initially didn’t want to until he realized that he would lose his opportunity to have Dr. McAllister perform the surgery, concluding that he needed the surgeon more than the surgeon needed him: “If I didn’t do what he said, the next patient in line would.” I thought this was a really interesting approach to motivating change: be inspiring and selective, not punitive or even threatening. All of the participants talked about having low pain levels, and some not using the prescribed opiates. As part of the program, Dr. McAllister closely tracked their post-surgical pain, nausea, and opiate usage. One patient disclosed that he drove himself to his first post-surgery physical therapy appointment, and although this was not encouraged, his PT actually gave him the all-clear to drive home.

The final session of the day was possibly the most striking. It featured a police officer and the founder of a drug addiction non-profit, Amber’s Hope talking about opiate addiction. This session was sobering, both from the impact of the drugs but also because measures to control these dangerous substances have actually exacerbated the problem. Since opiates cannot be prescribed by phone, and post-surgery patients are not mobile enough to visit a physician, get a prescription, and take it to a pharmacy, physicians need to prescribe what they believe will be enough pills prior to surgery, which can lead to leftover pills. Most non-prescribed usage of opiates comes from these leftover pills, which means that educating patients on how to dispose of them is key. In Kirkland, Washington where this session took place, for example, the only way to dispose of them is to take them to the local police station. (FDA recommendations for disposal of prescription drugs can be found here.) At Wellpepper, we track the use of both over-the-counter and prescribed painkillers as part of treatment plans. We do this for two reasons: first, it’s a valuable piece of information about a patient’s pain levels and recovery time, and second, too often these pills are prescribed as needed and usage isn’t monitored, leading to a nationwide opiate problem.

I attended this event so I could better understand the people who will eventually use our software. I learned a lot more about changes in care delivery, and got some great ideas for continuing to engage patients that you’ll see in future updates to our products.

Posted in: Behavior Change, Opioids, Outcomes, Patient Advocacy, patient engagement, Patient Satisfaction, Physical Therapy, Seattle

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LAM Conference – A patient’s perspective

Dr. George Pappas, LAM Regional Clinic Director

Last weekend, my husband and I attended the Regional TSC and LAM Conference at Swedish Medical Center in Seattle, WA. This conference covered current research developments, treatment options, and patient education. I attended because I wanted my husband to learn more about Lymphangioleiomyomatosis (LAM), because I am a patient. The LAM Foundation defines LAM as “a rare lung disease that usually strikes women during the prime of their lives… this disease is characterized by an abnormal growth of smooth muscle cells, especially in the lungs, lymphatic system, and kidneys.” LAM occurs almost exclusively in women, and it is usually misdiagnosed for years, often as asthma, emphysema, and/or bronchitis. LAM is considered a progressive disease, which can lead to lung transplantation 10 years post diagnosis or for some, like me, it progresses slower. Treatment with a mTOR inhibitor, Rapamune, may improve lung function, which was all the buzz at this conference, but unfortunately there is no cure.

This conference was coordinated by the patient advocacy networks, The LAM Foundation and TS Alliance, and was designed to provide patients with the opportunity to interact with the LAM scientific community, physicians, and patients. I have to be honest, I was surprised to see a packed room because there are only 3-5 LAM patients per million women in the world. I later learned that newly diagnosed patients traveled from as far as Alaska with their loved ones for the same reasons as I: to learn more about clinical drug trials, to ask questions, and meet other ‘Lammies’. This mutual interest was palpable during the presentation by Dr. Ray Yeung, a surgeon and renowned LAM expert. Hands were flying up with questions. Dr. Yeung spoke about the pros and cons of clinical trials, and the pathogenesis of Angiomyolipomas (AML) and LAM. Dr. Yueng had a great amount of positive energy for what he has learned about LAM through his research and it was awesome to hear from a scientist about the importance of patients getting involved in clinical trials.

After the session with Dr. Yeung, we had lunch and I got to talk to a very lovely woman that worked as a Patient Relations Advocate for Lundbeck, a pharmaceutical company that sponsored the conference. Her role was to bring the face of the company to the patient advocacy foundations and their patients, and in return be the voice of patients in order to always keep us in the forefront of the company’s mission. I was particularly impressed with this, especially coming from the pharmaceutical industry, which tends to get a bad rap as being money centric. I continue to be awestruck with her grace, attitude, and lovely disposition, and how she didn’t once talk about her company, but wanted to know more about ME, not my disease. I really hope that our talk (and the fact that I thanked her repetitively) and the other conversations she had with patients that gathered around us, made her journey worth it.

On the drive home, she really got me thinking about how important her role is, and how the information she gathered will be priceless to both Lundbeck and to the LAM community; what she learned cannot be found in any search engine or book. I believe there is a huge disconnect between patients and some of the key players in making us… well, not patients anymore. The folks that advocate for us are so important because not only do they form an overarching understanding of disease, research treatments, help us keep symptoms under control, argue with the insurance companies, help us manage setbacks, etc., they also help us realize there is meaning to getting up in the morning and living life knowing we are not alone. It’s like having a big mama bear always looking out for you, so you can focus on you and not your disease.

Upcoming events…
The International Rare Diseases Research Conference & LAMposium, Cincinnati, OH, Sept 22-25, 2016
LAM Regional Conference, Cleveland Clinic, November 5, 2016.

Posted in: chronic disease, Clinical Research, Managing Chronic Disease, Patient Advocacy, patient engagement, Rare disease, Research, Seattle

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Different System, Same Challenges: Long-Term Care Perspective From Canada

Kristin Helps, our Director of Client Operations, and I had the opportunity to speak about delivering Empathetic Care for Seniors Through Technology at the annual BC Caregiver’s Association Conference in Whistler, BC. The BCCPA is the representative body for long-term care, skilled nursing, homecare and retirement facilities in the province of British Columbia in Canada. These types of facilities are mostly privately run, by both for-profit, and charity organizations, as opposed to acute care which is run by provincial and regional authorities. While this was a BC organization and conference, delegates came from across the country, and ranged from individual home care works, to facility owners, to university professors and researchers.

For the most part we heard similar challenges to those encountered in the health system in the US:

  • Communication between care settings
  • The struggle to deliver patient-centered care
  • Decreasing reimbursement for homecare
  • Enabling staff to operate at the top of their license

At the same time, people expressed a desire to age in place, and the health system wanted to be able to support this. While 80% of Canadians cited wanting to die at home, only 40% actually do.

One of the big differences we noted at this conference was that speakers and participants were calling on the Federal government to step in and fix many of the problems in a way that we don’t often see in the US. Another difference was that participants were looking globally for solutions to challenges, particularly in dementia care.

Looking Globally for Dementia Care

This was our first time at this conference and veterans told us that the previous year was quite focused on analytics, while this year the focus was on dementia care. While not primarily our area of expertise at Wellpepper, we heard about a number of innovative initiatives to improve care, including a novel approach by the government of Japan. Japan decided to characterize dementia as a social problem rather than a medical problem and trained bank tellers and grocery store clerks to recognize the signs of dementia. It was thought that these people were most likely to see problems, for example if someone was unable to understand how to pay bills or buy groceries. Considering that many with early onset dementia are quite successful at hiding changes from their loved ones, this idea is quite interesting. It also puts the responsibility for care back into society rather than relying on medical facilities that often distance the rest of us from the challenges of aging.

Basketball courts at Aegis Living Seattle

Basketball courts at Aegis Living Seattle

The Butterfly Household Model of Care, which was initiated in the UK, but has been implemented in Alberta with some success, is another novel idea. People with dementia often don’t know what day it is or what they had for lunch, but they do have vivid internal experiences, often remembering happier times of their lives. Butterfly Households are designed to stimulate people with dementia with bright colors, and also to stimulate memories with areas designed to invoke feelings of the past, for example an ice cream shop or an area with old photographs. The idea in a Butterfly home is to meet patients where they are, and caregivers report much joy in delivering care and significantly fewer of the violent behaviors often associated with dementia.

While not a designated Butterfly Home, you can see some of these techniques in action at Aegis Living in Capitol Hill, Seattle. Here are a couple of pictures from when I visited last fall. In an outdoor area they have a car and a garden shed designed to stimulate conversation and fond memories, and an old-gym styled basketball court, where you can shoot hoops sitting down.

Invoking memories at Aegis Living Seattle

Invoking memories at Aegis Living Seattle

To find out more about the topics in this post:

Bank Tellers Act Serve as Caregivers in Aging Japan

BC Caregivers Association

Butterfly Household Model of Care

Aegis Living Capitol Hill Seattle

If you’re interested in learning more about our talk on delivering empathy through technology, contact us.

Posted in: Aging, Behavior Change, chronic disease, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Managing Chronic Disease, Seattle, Uncategorized

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Patient Engagement in Surgical Outcomes Research Webinar

Hosted by Surgical Outcomes Club
Featuring speaker Danielle Lavalle, PharmD, PhD
03.17.16

I attended this webinar yesterday to learn about patient engagement in research development because of a simple reason: here at Wellpepper patient engagement is very important to us and I love research. I think of research as a tree, a question starts in the trunk and branches out to all these different observations while the leaves take in nutrients so the tree can thrive. Patients are a lot like leaves; they provide nutrients for the research to grow and in some cases without them there would simply be no tree. As with the example of the Comparative Effectiveness Research Translation Network, CERTAIN, they have found ways for patients to provide that vital ‘nutrient’ directly via a Patient Advisory Network. The Patient Advisory Network is made up of caregivers and patients that partner with researchers to provide their perspective in order to improve current research. This is a wonderful collaborative way for a patient to have a voice for many and as Dr. Lavalle said “…patients bring in an insider’s perspective that clinicians and researchers may not think about.”

The role that patients have through the Patient Advisory Network is indispensable; they provide an insiders perspective, articulate the most pressing questions and concerns, and help researchers think through what information should be relayed and how. For example, using language that is understandable by patients themselves, not just clinicians! Patients can partner with CERTAIN through advisory group membership, as a research partner, as a research and materials reviewer, or as a patient representative. One way CERTAIN reaches patients is via their blog; take a look and see if you can help!

-From Dr. Lavalle’s slides/webinar

In this webinar, Dr. Lavalle talks about the development over the last year of the CERTAIN project, Comparison of Outcomes of Drugs and Appendectomy (CODA) Trial for Appendicitis. The study poses the question: is there a new way we should be approaching the treatment of acute appendicitis – Appendectomy or ‘Antibiotics First’ strategy? “No studies to date have compared the impact of these two treatments for appendicitis on the overall patient experience or included standard PROs in addition to clinical outcomes.” With this factor ascertained, the importance of incorporating the patients voice in the very beginning was important to CODA. Therefore, CODA posed the following question to the CERTAIN Patient Advisory Network: If you landed in the ER with Appendicitis would you would you randomize between appendectomy or antibiotics? The attached graphic sums up the results of such findings. Dr. Lavalle was surprised that so many people would randomize, me too actually!

Patient engagement provides a dynamic aspect to research, that comes to all of us as no surprise, but CERTAIN has done a wonderful job of creating a great community that brings together both patients and research experts that in return makes research outcomes that much more beneficial. I am very curious what the patient centered outcomes will be for the treatment of appendicitis with either surgery or antibiotics. I guess we will all find out when the CODA project concludes in 2020.

Thank you for the wonderful talk Dr. Lavalle!

Next Surgical Outcomes Club Didactic Session: Thursday April 21, 2016 at 2 pm (ET)

Posted in: patient engagement, Patient Satisfaction, Research, Seattle

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2016: The Year of Telehealth

Judging by the freezing rain hitting my window pane and the darkness that comes at 430 pm, it is evident we are coming to the year’s end here in Seattle. As always the approach of a new year brings a great number of predictions and I don’t mean the kind that are derived just out of hope, but out of reality. A quick Internet search produces many real 2016 telehealth predictions; some are witty, honest and steadfast, others more conservative. However one common thread not to ignore is the ever increasing benefits of telehealth and the great strives by the US Congress to regulate and support such. For instance there are 17 telehealth bills pending in the Senate and 21 in the House; from excise tax on medical devices to the “VETS Act to improve the ability of health care professionals to treat veterans via telehealth…” The 114th Congress ends in January 2017 so the progressive reality of telehealth to have a presence in your healthcare entity is undeniable and if such already exists it will be more palatable.

Another common thread in my searches is the statement: 2016 will be the Year of Telehealth. It is easy to believe this statement without any gullibility especially after experiencing first hand the steadfast innovation of telehealth over the last few months of 2015. Coupled with the readmission penalties, competitive advantage, telehealth parity laws, quality reporting outcomes incentives, and transformation of rural care it is no surprise that this statement is used liberally. Furthermore every year it is becoming increasingly more difficult to find skeptics of telehealth, the list of benefits are always increasing and scrutiny of our healthcare system forces many to find solutions. Telehealth is on that strong progression towards not just being an added bonus to way we provide care to our patients, but in some cases the only way we provide care.

I would never claim to be an elite expert in the field of healthcare innovation and policy, so I do not want to go into what I think will happen in 2016, but one cannot help feel the buzz in our Wellpepper office in Fremont, Seattle, WA. Our group serves has an example of what is going on in the mhealth field; we have grown in leaps and bounds just over the last 6 months in order to keep up with the demands of the industry. I cannot believe how incredibly lucky I am to be part of such great innovative team of professionals that have one goal of many in mind that brings my sentiment home, to make healthcare better for all of us.

Happy New Year!

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, M-health, Seattle, Telemedicine

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Press Release: Sentara Healthcare Chooses Wellpepper

Sentara Healthcare Chooses Wellpepper for Mobile Patient Engagement in Headache Care

SEATTLE, Nov. 19, 2015 /PRNewswire/ — Wellpepper, Inc. today announced that Norfolk, Va.-based Sentara Healthcare is partnering with Wellpepper to provide a mobile patient engagement solution for headache care. Wellpepper is a clinically validated patient engagement platform. Sentara is an integrated not-for-profit system of 12 hospitals and more than 100 sites of care, including a robust neurosciences program. Sentara patients who suffer from migraines and other severe headaches are able to use the Wellpepper mobile application to report their headache experiences in real time, including pain, triggers and use of over-the-counter or prescription medication. Sentara Neurologists are able to use the information collected to diagnose, treat and monitor the ongoing progress of headache patients with the goal of better outcomes, fewer office visits and lower healthcare costs.

“We believe Wellpepper can help us provide timely care for headache patients,” said Alexander Grunsfeld, MD, medical director for Sentara Neurosciences. “Sentara encourages patients to be partners with us in their care and the Wellpepper solution offers a new opportunity to achieve that goal.”

Currently, when patients are referred to a neurologist, they are asked to complete surveys and try to remember what triggered their headaches. Follow-up surveys are typically given every 3-6 months. The result is often multiple office visits and patient care is delayed until the root causes for headaches are eventually discovered.

Data collected through the Wellpepper application is presented to healthcare providers via a clinical dashboard. Neurologists can easily communicate with headache patients to alter treatment plans without the patient having to unnecessarily visit the office. Wellpepper also provides a way for patients to log pain levels using the visual analog pain scale and to record medication use and how much.

“Too often, data collection from patients is disconnected from their care plan,” said Anne Weiler, co-founder and CEO of Wellpepper. “Being able to use patients’ own smartphones and tablets to provide care plans and show results using Wellpepper is not only a way to help drive patient engagement, it is a way for healthcare providers to gather strong, real-time data and patient-reported outcomes in a way that after-the-fact surveys cannot.”

Approximately 18 percent of women and 6 percent of men between the ages of 12 and 80 suffer from migraines in the U.S. According to a study published in the Journal of General Internal Medicine, migraine cases require, on average, 2.3 more physician office visits than non-migraine controls (9.1 vs 6.8, respectively) and were significantly more likely to have been seen in an emergency department (20.7% vs 17.6%) or admitted to a hospital (4.5% vs 2.8%).

For more information about Wellpepper or to find out how the Wellpepper patient engagement solution can support value-based payment models, please visit wellpepper.wpengine.com or email info@wellpepper.com.

For information on the Sentara Neurosciences program, visit www.sentara.com/neuro

About Sentara Healthcare
Sentara Healthcare, based in Norfolk, VA, celebrates a 127 year history of innovation, compassion and community benefit.  Sentara is a not-for-profit family of 12 hospitals in Virginia and North Carolina, the Optima Health Plan, a full array of integrated services and a team 30,000 strong on a mission to improve health every day.  This mandate is pursued through a disciplined strategy to achieve Top 10% performance in key clinical measures through shared best practices, transformation of primary care and strategic growth that adds tangible value to the communities we serve. www.sentara.com

About Wellpepper
Wellpepper is a healthcare technology company that provides a clinically validated platform for digital treatment plans delivered via mobile devices. The Wellpepper patient engagement solution improves patient adherence and outcomes with its patent-pending adaptive notification system and just-in-time, task-based instructions and by fostering communication between healthcare providers and patients. Wellpepper is used by major health systems that are moving to an accountable care organization model and need to track and improve patient outcomes while lowering costs. Wellpepper was founded in 2012 to help healthcare organizations lower costs, improve outcomes and improve patient satisfaction. The company is headquartered in Seattle, Washington.

Posted in: Healthcare Technology, M-health, Press Release, Seattle, Telemedicine

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Is Seattle Ready For A Seismic Shift In Healthcare?

The plans to open the Cambia Grove, a health care innovation center, were first announced about this same time last year at the 25th Annual Governor’s Life Sciences Summit. Nicole Bell, executive director of Cambia Grove was then quoted saying, “Why couldn’t we be for health care what we are for coffee, aerospace, for online retail and for independent rock-and-roll?”IMG_2081

A year later and timed perfectly to coincide with the 17th Annual National Institutes of Health (NIH)/SBIR/STTR Conference, Cambia Grove announced results from the 9 page “Report on Health Care Innovation in Washington State.” This report effectively established a baseline for the economic impact of health care innovation sub-sector in Seattle. Based on the numbers, it seems as though Seattle is poised to compete with rival health care hubs like Boston and the Bay Area.

IMG_0412Here are a few of the more impressive stats. Pay levels are for this sub-sector of this industry are 8% higher than average with $2B in compensation, not to shabby. Apparently these employees are amazing rock stars with 300% more productivity than an average worker and they create $6.8B in direct output?!?!? With this astounding productivity that 8% doesn’t seem like quite a commensurate salary increase.  While there are 22,500 jobs across the state, it is not surprising that over 80% of them are concentrated in Seattle. After Nicole Bell revealed these report highlights, she commented that it would make sense to create or convert even more jobs in to this thriving job sector. I guess we bike riding, coffee drinking, online shopping, wearing jeans and Tevas to work Seattlites must really be on to something here.

I am absolutely thrilled to have taken a path that is leading me into this new sub-sector of healthcare innovation and start-ups where evidently I’ll be working in the land of serious overachievers. As a RN, I’m no stranger to long hours and hard work. Coming from traditional healthcare institutions where the norms are grueling 12-hour shifts, you literally have to ask someone if you can go pee because you can’t leave your patients unattended and you learn to ingest your lunch in under 5 minutes.

IMG_0413As much as working in traditional healthcare has taught me clinically, I couldn’t imagine moving into a healthcare IT analyst role after completing my Masters degree in Clinical Informatics. I imagine if I stayed, I’d probably end-up stuck in a cube trying to unscramble the EHR mess or analyzing already broken workflows attempting to integrated a new piece of technology that never went through any real usability testing by actual healthcare workers who would be suing it. Having used both Epic and Cerner products, I was like “I told you so!” after reading articles about the recently published JAMA reporting the lack of adherence by EHR vendors to conduct usability testing. I digress. My point is I’m waiting with bated breath for the lagging traditional healthcare industry to get the swift kick it needs by the younger, more ambitious and more productive innovation sub-sector. The report is effectively calling out to health innovators in Seattle that the time for a seismic shift is now…in healthcare, hopefully not literally a seismic shift in Seattle. Either way, Seattle Health Innovators prepare yourselves, let’s get ready to compete with Boston and the Bay Area.

Posted in: Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Seattle

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P4 Medicine, How You Can Live To Be 100

I was fortunate enough to be on the guest list for the event, “An Evening Discovering Scientific Wellness” hosted by Arivale at Chihuly Garden and Glass this past week.  The space was packed with over 600 guests, which included: students, scientists, nurses, entrepreneurs, investors, doctors, schoolteachers, software engineers and really anyone with an interest in being part of a new transformation in healthcare.   My fascination with what Arivale plans to do originates from three different perspectives: as a scientist with an undergraduate degree in Neurobiology, a healthcare provider (Registered Nurse) and most currently as a graduate student in Clinical Informatics with a penchant for technology. Arivale plans to bring together all of my interests in science, clinical data and technology to create a personalized plan to optimize wellness.

Be forewarned, P4 Medicine (Predictive, Preventative, Personalized and Participatory), is not for the squeamish.  Maybe you have seen the funny coffee table book “What’s Your Poo Telling You?” Well, now it can tell you more than you ever imagined. Arivale, a new Seattle start-up co-founded by biomedical pioneer Leroy Hood, MD, PhD, actually aims to analyze your microbiome (the polite word for poop and/or the bugs inside you) as one part of their unique approach to transform how we think about our health.

Clayton Lewis, CEO and co-founder of Arivale, introduced co-founder Lee Hood (who probably needs no introduction in Seattle) as a visionary man who “speaks about the future in the present tense.”  Dr. Hood described how Arivale evaluates samples of blood, saliva, microbiome, genetic sequencing and Fitbit data to give participants an entirely personalized set of actionable health data. The fundamental piece is a personal coach who will create a tailored wellness plan.  Not only will the coach call each month to check-in and guide the participant but, they will also integrate any new data and make adjustments to the original plan.

After hearing Arivales pitch, I do question how they plan to deal with the FDA and providing P4 medicine complete with health recommendations to consumers. This is not entirely dissimilar what 23andMe tried to do 2 years ago marketing Personal Genomic Services directly to consumers and shortly thereafter, the FDA required them to stop. Since then, 23andMe has gone through several rounds of R&D and now has the official blessing from the FDA. Along with the FDA approval of 23andMe earlier this year, the FDA also announced two important pieces of regulatory information making the path for other companies like Arivale easier.

  1. FDA is [sic] classifying carrier screening tests as class II. In addition, the FDA intends to exempt these devices from FDA premarket review.
  2. The FDA believes that in many circumstances it is not necessary for consumers to go through a licensed practitioner to have direct access to their personal genetic information.

Why is P4 Medicine so important? The crowd of at least several hundred let out a collective murmur of surprise when Dr. Hood dropped the factoid, ‘living to be 100 is going to be new norm for children being born into the next generation’. He jokingly followed with, “We want to get you to 100 and then you are on your own.” He pointed out that while our genetics may give us the predisposition for certain diseases, they don’t necessarily define our health.  If genetic variants are known, you can do something about them. Arivale wants to provide people with meaningful, personalized diagnostic information so as to optimize as many aspects of their health as possible.  The goal is to make those 100 years of life full of vigor, fitness and optimal health.

Next, two of the original 100 Arivale pioneers took the stage and spoke about their experiences.  The first woman explained her diagnosis of a ‘suspect immune system’ and not having enough T-cells.  This came along with a daily dose of antibiotics and lot of ‘no’s’ to activities she enjoyed such as long distance running.  The microbiome testing revealed that the antibiotic was not wiping out her endogenous gut flora.  Based on genetics, hiking in the woods, not long distance running, was the best exercise for her.  With Arivale, she realized her body was resilient, adaptive and was able to literally ‘start trusting her gut.’  In describing her experience with Arivale, she ended by saying, “Instead of seeing myself as a sickly, non-running person, I now see a person with a diverse life, a diverse gut and an adaptive life.”

The second woman opened by recounted her entertaining experience of giving birth during the 2nd quarter of the Superbowl last year. Her motivation to join the current cohort of 300 Arivale participants, was due in part to optimize her health but she also wants to be around as long as possible for her child. She is part way through the program, has received stellar results on her blood work and just the day before received her genetics phone call. Her genetics revealed a moderate risk for obesity and that her body had difficulties disposing of toxins. Going forward, Arivale will make recommendations on for life style changes based on these revelations.

Patient engagement is one of the newer buzzwords in healthcare and Arivale really gives it a new spin. We are entering a new era where people have access to the data and tools available to truly be active participants and take more control over their health outcomes.  We can no longer lay the blame on genetics because as Arivale is proving, we can now make informed decisions that can alter the expression of our genes and help us to achieve our wellness potential.

After the presentations were over, I went to the Info table to see how I could be part of this second set of 300 beta participants in the Greater Seattle area this fall. Sadly, it is not free this time around, the cost is now $1,999.

Posted in: Health Regulations, Healthcare Disruption, Healthcare motivation, Healthcare transformation, Seattle

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