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Preparing For The Future

by Stuart Michaelson

Successful innovation demands talent, knowledge, funding and, perhaps most essentially for its creators and beneficiaries, a willingness to take the long view.

Dr. Richard Chang, thoracicsurgery director at Aria Health and one of a group of medical professionals taking the pulse of the area’s health care innovation for this article, compares widespread acceptance of new procedures and technologies in his field to that of the iPhone in everyday life.

Chang, who works mostly out of Aria’s Torresdale office, expects surgical use of robotics—one of his specialties—to one day be as prevalent as that gadget now so familiar to all of us for checking emails, texts, phone calls, weather and pretty much everything else without even thinking about it.

“In a short time, all operations will be robotic,” says Chang, who uses the da Vinci surgical system to operate through a few small incisions in robotic procedures for lung-cancer treatment.

And as the Philadelphia-area medical landscape continues its inexorable path from Flintstone to Jetson in such areas as dentistry, chronic disease management, radiology, prostate cancer and telehealth, tracking it all can seem as difficult as snapping a still photo from a moving train.

Da Vinci features a magnified 3D high-definition vision system and tiny wristed instruments that rotate and bend much more than the human hand. It enables surgeons to operate with enhanced precision, vision and control to translate surgical hand movements into precise movements of tiny instruments inside patients’ bodies.

Also used at Aria (which also has Frankford, Northeast Philadelphia and Bucks County locations) for procedures including cardiac, colorectal, general and urologic surgery and Dr. Chang’s lung cancer work, da Vinci allows large incisions without cutting through muscles. This minimizes post-operation pain and quickens recovery.

From a cancer standpoint, Chang says, the device allows for such minimally invasive procedures that don’t disturb the chest wall. “Minimally invasive,” he adds, “is the standard for care.”

Feedback from patients and their kin, Chang says, has been very positive, and from his standpoint, “You would be surprised how quickly (robotic surgery) patients function.” One such lung cancer surgery patient asked a week after a procedure about playing golf; with traditional surgery, for instance, there would be no heavy lifting for about three months.

As for older doctors learning robotic techniques, Chang, who trains some physicians on robotics, says, “The more advanced the surgery, the easier it is for older, more traditional doctors to adapt.”

EXPANDING CARE
Another area where an ability to adapt is vital is dentistry. Lately, the wheelhouse of a Travelocity-like innovation on the part of Wayne’s new WhyPayMore Dental, which provides free connections for patients (largely those without dental insurance) in finding the right care medically and financially.

WhyPayMore’s website, open to the public this fall, serves an area including Philadelphia, Delaware (north of Dover), and New Jersey (south of Princeton). Consumers choose treatments and preferred locations and use site filters for prices, dentist-quality reviews and insurance acceptances.

Once that’s done, they simply use appointment-scheduling buttons to make and confirm appointments with their chosen dentists, who, for each appointment, pay $100 to WhyPayMore (paying only for the first visit per client).

Company president Andy McKinley calls the service “risk-free advertising” for dentists, since they only pay once appointments are made. The business has six employees and, McKinley says, “tells patients what they need to know … location, where the dentists went to school, how much they charge.” Thus far about 150 dentists have signed on, and roughly 200 potential clients log on to the site daily.

McKinley says mostly dentists—and a few oral surgeons—are involved; his company verifies that they have a dental license and no citations, and are drawn to his service through a combination of salespeople, direct mail (including email) and “mostly old-fashioned meet-and-greet.”

There is no bad-debt risk for the dentists as they are paid up-front by patients, who benefit from discounted rates that have already been negotiated.

McKinley says that, between three and six months down the road, the process will be assessed and he and his management team will consider feedback received from patients and dentists before deciding about possible fine-tuning. In the meantime, though, he concludes, “We think this is a good thing, and so do dentists.”

NEW TECHNOLOGY
Plenty of good (and innovative) things are happening, meanwhile, at Thomas Jefferson University and Jefferson Health.

Beneficiaries in recent years of a $2.5 million gift from real estate developer Ron Caplan to help Jefferson’s innovative health program (assisting in treatment of head injuries, Parkinson’s and Alzheimer’s diseases, and other neurological diseases) and one for $110 million from the Sidney Kimmel Foundation for medical school scholarships, faculty hiring and state-of-the-art medical school facilities. Medical college dean, Dr. Mark Tykocinski says Jefferson is “truly in a forward-thinking mode about education and health science.”

For instance, it kicked off a program inviting Princeton University sophomores who pursue non-traditional pre-med majors or concentrations like architecture, engineering and computer science, to apply for early admission to Sidney Kimmel Medical College.

Also noteworthy is this year’s “hub-and-hub” merger with Abington Health, creating a new organization, known as Jefferson and encompassing Thomas Jefferson University plus Jefferson Health. Under the agreement finalized last January, the Abington name remains in the Abington region, with a Jefferson Health endorsement.

The new combined organization will include 19,000 employees, 3,370 physicians, 2,482 nurses and 1,751 in-patient beds and, says Tykocinski, “more training slots” in a merger he calls “significant.”

Another merger plan announced this year, with Jefferson adding Aria Health to its system, is in its “duediligence phase,” Tykocinski adds, following word in October of a nonbinding Letter of Intent allowing discussions toward integrating Aria into Jefferson Health.

Also noteworthy: a focus on telehealth, featuring a telehealth leadership fellowship directed by Judd E. Hollander. Tykocinski says Jefferson asks, “What are the areas to train health caregivers in telehealth, and in tailoring education for telehealth?” as the system expands telehealth regarding out-patient care and transitions in care (including in-patient), while developing the National Academic Center for Telehealth.

Telehealth, he adds, spurs improvements to such “important issues” as better connections in, for instance, patient discharge, allowing for enhanced communication between medical personnel and family members. “We expect huge developments for continued care and hand-off of care,” he says, calling telehealth improvements “one way to ensure that mistakes don’t happen.”

COLLABORATING FOR BETTER CARE
Tom Olenzak, director of innovation and corporate development for Independence Blue Cross and managing director of the Independence Strategic Innovation Portfolio, touts the Philadelphia area’s “fantastic health care resources.” He says, “One of the most exciting things is that we as a region are coming together and having a conversation about health care.”

One example is November’s Health Hack, sponsored by Independence and Jefferson, through its Innovation Pillar. Hackathons are events at which computer programmers and others involved with software and hardware development seek health care issue solutions. The event to attract health care professionals, engineers and students included presentations on drones involving health care delivery, wearables (like Google Glass) for better health care understanding, and efforts to cut hospital re-admissions.

Another Independence-Jefferson effort is the Independence Blue Cross-Jefferson Health Collaboration, which kicked off in July. Run jointly by the two organizations, the program is run by the Independence Blue Cross Center for Health Care Innovation and Jefferson’s Innovation Pillar. It includes an entrepreneur-in-residence program for researchers and clinicians with discoveries needing proof-of-concept support, as well as an innovation-engagement speaker series.

Also high on Olenzak’s list of praiseworthy health initiatives is TowerView Health, which, along with Independence’s Center for Health Care, is collaborating with the Perelman School of Medicine at the University of Pennsylvania (Penn Medicine) on a pilot program to help chronically ill people with multiple prescriptions make sure they take the correct medications at the right time each day.

Under that program, those in the study were provided with five pre-filled medication trays, each with a week’s supply of medication. The trays fit inside Internet-connected pillboxes that sense when members miss a dose, sending them reminders by phone, text, email or via lights and alarms. An integrated software platform also notifies the Penn Medicine research coordinator when members miss meds.

Olenzak also touts the CEO Council for Growth. The council, first announced in May, includes as founding members Ben Franklin Technology Partners of Southeastern Pennsylvania, the Children’s Hospital of Philadelphia (CHOP), Comcast, Drexel University, Independence Blue Cross, Safeguard Scientifics Inc., Thomas Jefferson University and Jefferson Health and the University of Pennsylvania Health System. As a group, Olenzak says, the council is “committed to finding new ideas, new business models and new technology to improve health care.”

ENCOURAGING INNOVATION

Olenzak further praised the Dreamit Ventures 2015 accelerator program for startup companies dealing with health challenges using tech solutions. Independence and Penn Medicine sponsor eight such start-ups, while CHOP sponsors two: the Simulated Driving Assessment, along with the Intelligent Molecular Cancer Analysis (which integrates DNA and RNA tumor profiling).

Independence and Penn Medicine also sponsor BoomerHub (concierge services for professionals with aging parents); Neutun Labs (health-care tracking software for those with epilepsy); and Pallas Medical (a mobile device to cool the scalp during chemotherapy and prevent hair loss).

The other five Independence-Penn Medicine start-ups are dBaza Health (clinically validated patient on-boarding platform to manage such chronic diseases as diabetes); GraphWear Technologies (low-cost graphene-enhanced flexible sensors to measure blood sugar, fat burning and dehydration); Gray Matter Technologies (impact-sensing sports mouth guard to identify athletes at concussion risk); Oncora Medical (software for radiation oncologists to compare current and past patients); and VisExcell (computer aided-detection in mammograms and other diagnostic imaging).

All were singled out for praise by Steve Barsh, chief innovation officer and managing director of DreamIt Health at DreamIt Ventures. Barsh says, “Gray Matter built a smart mouthguard to help detect concussions,” and GraphWear “delivered a sensor that sticks on like a patch to monitor your hydration level.

“The Dreamit health program,” he says, “was hugely successful. Over the course of four months, we saw entrepreneurs make incredible strides both in their products and in their personal development.”

The companies this year took part in an entrepreneur “boot camp” and pitched their concepts at the related “demo day,” both deemed “successful” by the Dreamit CIO. “Dreamit’s boot camp,” Barsh says, “spanned three days and helped focus the companies on rapidly derisking their most critical assumptions, explained how to break through to key customers, and the most important questions to ask in meetings that uncover hidden and critically important information.” Dreamit’s sold-out demo day saw nearly 300 people attend, including investors, press and partners.

Looking ahead to 2016—including the next group of health care technology applicants—Barsh, who moved to DreamIt this year after working as an advisor at CHOP in entrepreneurship and innovation, adds, “We’re still recruiting for our 2016 cohort, but I expect to see more medical devices, clinical-decision support platforms and applications that leverage big data and machine learning.”

ENHANCING THE EXPERIENCE
Also looking ahead, big-time, is the Temple University Health System (TUHS), which this year announced a collaboration with GE Healthcare, is aligning incentives promoting value by providing higher-quality radiologic imaging services more efficiently, and at a lower cost. The arrangement targets improvements in specific operational, financial and clinical outcomes, helping TUHS deliver high-value imaging services across its health system.

Under a seven-year agreement, TUHS and GE Healthcare plan to achieve performance goals enabled by new technology and industry best practices, as TUHS modernizes radiological imaging equipment with state-of-the-art GE technology, and benefits from such enhancements as data storage and retrieval, service-contract consolidation and consultation to optimize scheduling and workflow efficiency.

The arrangement includes financial incentives aligning the parties toward realizing shared objectives, including a targeted $39 million in operational savings over the life of the contract.

Dr. Clifford Belden, radiology department chair at Temple University Hospital and TUHS radiologist-in-chief, says that with the arrangement with GE, “We are looking at every aspect of our imaging services from a patient focus.”

All imaging equipment will be upgraded during the arrangement, says Dr. Belden, and “many of those will deliver new capabilities. The focus isn’t just on buying equipment, but on what it allows us to do.” That includes efforts to make operations more efficient at Temple as well as, for instance, Fox Chase Cancer Center and Jeanes Hospital, which are part of Temple’s health system.

Under the arrangement, Temple made no cash payment to GE, which becomes a preferred vendor to Temple and allows GE to provide services to equipment (GE or otherwise) and consulting services. Most vital, Belden adds, is what all this can do for the patient. This is really indicative of all the above Philadelphia-area initiatives: Making health care better for all involved.

“We look for improvements,” he says, “that lead to less waiting, for tests to be done more quickly. Our goal is that when you have a 4:00 appointment, by 4:10 p.m., you are on your way home: A system that works for patients. We already have outstanding physicians, outstanding radiologists. We are focusing on the patient experience.”

Published (and copyrighted) in Philly Biz, Volume 1, Issue 1 (December, 2015).
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