March 18, 2015 - HBS Club of MN CEO Series event on "Lean" with HealthEast CEO Kathryn Correia and Cathy Barr, SVP, Community Services and President Bethesda Hospital

We are fortunate in MN not only to have a world-class health care industry & system, with leading-edge care systems as well as medical device manufacturers and entrepreneurs, but also a dynamic alumni club called "Twin Cities Alumni Network" or TCAN that was the brainchild of Columbia / Penn alum Dan Rutman.  Through this wonderful liason of clubs many of us benefit from events sponsored by other clubs in the Twin Cities, and meet and network with people across Clubs and affiliations with an interest in healthcare and medtech work.

This event put on by Harvard Business School's Club of MN , at Health East St. Joseph's Hospital, St. Paul MN offered a wonderful introduction into some truly groundbreaking work HealthEast and St. Jospeph's Hospital is doing, in my mind, to "industrialize" their services for greater patient satisfaction as well as efficient operations that may lead to higher quality as well as cost reduction.

A side benefit to attending was seeing a former student of mine from the Medtech MBA course I taught at University of St. Thomas, Adam Crepeau, who was hired to spearhead "Lean" initiatives at HealthEast after graduating from UST.  Adam's experience with SixSigma techniques as an engineer in industry (Wilson Greatbatch's company) and his passion for healthcare problem solving made him an ideal person to work with teams to identify and re-engineer core processes.

Health Care Event with HealthEast CEO on Wednesday, March 18

The HBS Chapter of the Harvard Club of Minnesota is delighted to present Kathryn Correia, President and CEO of HealthEast Care System and Cathy Barr, SVP, Community Services and President Bethesda Hospital as speakers of the 2015 CEO Series.

Correia and Barr will discuss the three Cs of success in today's ever-evolving healthcare environment: courage, creativity and openness to change. HealthEast embraced Lean and discovered surprising new ways to improve processes and performance while increasing the value they bring to patients, employees and communities. They will share their expert insights into Lean thinking and its role in the success and sustainability of health care.

Time: 5:30-7:30 PM
Location: St. Joseph's Hospital 3M AB Conference, 45 West 10th, St. Paul
Sponsored by: Harvard Club of MN
Cost: $25- Seating is limited to 55
RSVP: www.harvardmn.org
Questions: admin@harvardmn.org

Sincerely,
Ann Marie Hortillosa
Co-Chair HBS Club of MN

Agenda & Karin's notes:

• Welcome by Ann Hortillosa & John Malloy, HBS Club
• Live, learn, lead and HealthEast's Lean Journey - CEO Kathryn Correia, world leader on lean in Healthcare (had sepnt time at Geisinger and Thedacare, which applied Toyota's system to Healthcare).  Success = Creativity, Courage, Change, and Commitment.  With "Lean," employees who do the work change the work.  (Look for book "On the Mend," by John xxxx, Center for Healthcare Value.)
• Our patients, our communities, ourselves - Cathy Barr, VP Our Communities and President Bethesda.  Told story of Marjorie, a new patient in a LTC facility, who experienced shortness of breath and visited the hospital 6 times in a short time.  Upon talking with Marjorie, caregivers learned she was bored and anxious; she missed socializing and her cable TV shows.  Staff helped her with her core issue and she didn't experience the anxiety that drove her hospital admissions. 
• Improvement area visits: Model Unit, Cardiology, Readmission, Surgery Admission Status - facilitated by Lean Iniative Internal Consultant Adam Crepeau and key team leadership.

My favorite visit was to Heart Care, where RN Sue Fangel described the process they went through to determine why only 30% of patients were receiving the results from their non-invasive cardiac tests within 3-5 days (Echos, etc.)  They found that Health Information Management staff could not identify Echo reports in the EPIC data, and that MD's, Echo staff, and RN's all batched work, so that results waited indefinitely in piles waiting to be processed.  To fix it they eliminated batching, implemented a HIM SLA, "work smoothing" with Cardiologists for normal or no-change results, and empowered RN's to call patients with normal results.  (laughter re: "why are you calling me so fast?  you almost gave me a heart attack!")

March 13, 2015 - MIT Sloan Inaugural Conference on Accelerating Innovation in the Health Industry, Columbus Circle, NYC

As a 1995 MIT Sloan grad, and co-founder of the Healthcare Club with Trevor Moody when we were graduate students there, it was wonderful to participate in the first official MIT Healthcare conference since forming the Healthcare Program at Sloan, which was held in New York City (probably because the 100" of snow that fell in Boston this year hasn't melted yet and people can't get around very easily!) the school brought together to showcase some of the academic work MIT Sloan is doing in the field and a number of distinguished speakers.  The Healthcare Program at Sloan includes the addition of 5 or more courses to the Sloan MBA for a certificate.  The agenda for the conference is below, with some of my key takeaways in blue.

Seated at our table was a representative from Minute Clinic in New Jersey, who was interested in the transformation of Healthcare as it pertains to retail clinics, and a transformation I have been particularly interested in following as it started in MN as QuickMed ~2000 before being acquired by CVS, and academics Richard Bohmer & Clayton Christenson have written HBS case studies about Minute Clinic and it's clear disruptive impact on Healthcare which I have used while teaching the Medtech course at UST.  An added bonus for me was seeing some very successful graduate school friends who were in the audience as well, Debbie Bein Baron, who is now in BD at Pfizer, and Bryan Gilpin who has been working for Boston Scientific internationally and in Massachussets over the past 8 years.

The main feeling I had coming away from the meeting is that the work presented at the conference focused on organizational change from within hospitals and providers, vs. the innovation & themes I have been exposed to in our marketplace and other settings strike me as much more in tune with the dramatic change required to make our healthcare systems and market function like the industry it needs to from more top-down marketplace reform in INCENTIVES and INDUSTRIAL PROCESS.  The drivers I find most interesting in the dynamics of change are CONSUMER CHOICE and PROVIDER PAYMENT.  Could we find a way to focus in more clearly on those areas as key drivers of innovation?

Minnesota Innovations in Medtech & Managed Care:

• QuickMed/MinuteClinic - retail care
• Zipnosis / Virtuwell - online care
• Definity Health - re-introduction of high-deductible health insurance, with corresponding legislative work to introduce Health Savings Accounts
• Optum, the services arm of United Health Group, comprised of Rx (pharmacy benefit management) Insight (data for fraud detection turned Big Data for effective healthcare intervention research), and Health (proactive health management based on industrial platforms that can evolve.), 
• Fairview system experience as evidenced by Diabetes management with computerized care pathway recommendations, implementation of Zipnosis in the network, and proactive use of Patient-based electronic medical records.

Others I recognize as contributing core thought leadership in Healthcare Innovation, which I would have liked to have seen more development of in MIT's work, include:

• Regina Herzlinger (HBS!  ~first healthcare and first woman academic) and her fabulous thinking on Consumer Driven Healthcare and the implications of evolving the industry around healthcare that consumers both want and can afford
• iTriage - I asked the closing keynote speaker, former CEO of Aetna, Ron Williams, to comment on this remarkable company that Aetna bought out of Denver, CO, started by two physicians, that can enable consumers to self-diagnose & triage their care and if connected to an insurance plan, know the cost involved to them for different option.  He indicated it was "an app" that is useful to patients, but didn't elaborate further on the impact it could have on insurer's relationships with their members and patients' ability to interface effectively with providers.
• Atul Gawande's "Cheesecake Factory" concept - Why Can't Healthcare be Like the Cheesecake Factory?  (August 2012 New Yorker article on Hospital Chains.)  To me, this is the central question for true healthcare innovation aimed at both patient satisfaction and meeting the industrial goals of access, quality, and cost reduction.
• West Health and CMS Pilot projects - How can Technology Reduce the Cost of Healthcare?  That question should be right up MIT Sloan's alley... the student presentations on product/technology ideas for investment were rather traditional, not what I would have expected from Sloan now.
• CarePathways by Richard Bohmer, HBS - where are we at with de-mystifying medicine and making it more process-directed and less of an art?  How much more room is there?  How far would we get in reducing the ~30% waste in Healthcare Expenditures through process improvements?  

These are the types of questions I would have liked the MIT academics to have posed as central objectives of the healthcare center in addition to the interesting work that was presented.

• New York: Healthcare Conference

  MIT SLOAN IMPACT: ACCELERATING INNOVATION IN THE HEALTH INDUSTRY
  Friday, March 13, 2015 ($50 registration)
  Location: 10 on the Park | 60 Columbus Circle, 10th Floor, New York, NY 10019 
• http://mitsloan.mit.edu/alumni/events/2015-nyc-healthcare/#tabs-2
• Accelerating Innovation in the Health Industry:MIT Sloan brings together MIT faculty and alumni industry leaders to present research and discuss the state of the art processes, organizational transitions, and technological innovation within the health industry and academia as it relates to transformational care delivery and health management.

12:00 p.m.

Registration

12:30 p.m.

Welcome Remarks & Luncheon
David Schmittlein, John C Head III Dean, MIT Sloan School of Management

12:45 p.m.

The MIT Initiative for Health Systems Innovation
Joseph Doyle, Erwin H. Schell Professor of Management and Professor of Applied Economics
Retsef Levi, J. Spencer Standish (1945) Professor of Management and Professor of Operations Management
Janet Wilkinson, Senior Lecturer; Director of the Initiative for Health Systems Innovation  70 students currently in the Healthcare Club at Sloan.  Speakers, Career connections.

1:00 p.m.

Managing Organizational Changes in Health Care Systems
Kate Kellogg, PhD '05, Associate Professor of Organization Studies

Learn lessons regarding the implementation of medical reform on-the-ground, inside healthcare organizations. This research investigates the very critical stage that both policymakers and academics all too often neglect, namely the period after a policy has been adopted. Explore the case of implementation in Primary Care settings of a reform called Patient Centered Medical Home to highlight the cross-professional challenges that can occur within organizations after policy has been made. Discuss the role of subordinate professionals in facilitating reform implementation.  Dr. Kellogg described how she empowered Medical Assistants, the lowest level employee in the HC system, to influence Physician change to follow / comply with Health Reform regulations / objectives such as opioid contracts with patients so they don't share the drugs with those who don't have the prescription or processes for screening for Diabetes.  Like an Ops Re-Engineering initiative in Mfg - allows Dr.'s to work at the top level, and puts structural power in place at MA level.  A great example of effective organizational change.

1:30 p.m.

Healthcare Analytics in Action
Joseph Doyle, Erwin H. Schell Professor of Management and Professor of Applied Economics

Learn how BIG data can be used to measure value in healthcare. In particular, the use of randomized trials, along with natural experiments that focus on the effective random assignment of treatment to patients, can provide credible estimates of the effects of healthcare delivery reforms on costs and patient health. These methods also provide a framework to measure hospital and physician quality—an increasingly important task as payment reforms aim to “pay for quality.”

Mentioned CMS Innovation Institute.  

Big data: Cell phone apps for detection & prediction.

Camden - "hot spot" maps by Dr. Jeff Brenner - thought leader on bending the cost curve.

Interesting story of correlation between the AMBULANCE COMPANY that is called and which hospital the patients are brought to; some bring patients to expensive hospitals that impacts care & $ no matter where the patient lives.  

2:00 p.m.                   MIT Innovator in Healthcare Pitch
Ben Merewitz, MBA '15, Co-founder and CEO of Agile Devices - technology for faster access to blood vessels to save lives (45 sec BSC vs. 23 sec Agile)  Brian Hess CTO (or of Curative Ortho?)

2:05 p.m.

Break

2:35 p.m.

MIT Innovator in Healthcare Pitch
Samantha Simmons, MBA '15, Founder of Curative Orthopaedics, Inc.

2:40 p.m.

Cost and Quality in Healthcare - Network objectives max productivity, throughput, utilization, welfare.
Retsef Levi, J. Spencer Standish (1945) Professor of Management and Professor of Operations Management

The current policy discussions around healthcare focus on: health charges rather than the true cost of delivering healthcare; efforts to reduce avoidable medical errors; and measures of quality. The discussion will cover several collaborative research projects that engage Sloan faculty and students with clinicians and staff at Beth Israel Deaconess Medical Center, Boston. These projects are developing systematic approaches to analyze and measure cost and safety that provide decision support tools to inform and guide systematic improvement in network and process design and resource deployment.

Cost / Access / Quality Triangle: 

• Reduce Cost = Reduce CHARGES (30% waste due to overuse, underuse, underperformance, misuse)
• Access: HEALTHCARE REFORM
• Quality: Checklist

Checklist introduced by Peter Pronovost - reminded me of Jack Homer's "Aggregate Harm" - checklist prevented errors from absentmindedness, "noise," incompetence.

3:10 p.m.

Keynote Address
Peter Slavin, M.D., President of Massachusetts General Hospital

"Don't get mad, get data!"  Has enjoyed collaboration with MIT academics in social science and operations research to improve MGH's services with OR scheduling, primary care redesign, and hospital bed capacity utilization. 

4:00 p.m.

Break

4:15 p.m.

MIT Innovator in Healthcare Pitch
John Lewandowski, PhD Candidate, Founder and CEO, Disease Diagnostic Group.  Malaria.

4:20 p.m.

Labor-Management Partnerships under the ACA: Lessons from Kaiser Permanente
Tom Kochan, George Maverick Bunker Professor of Management; Professor of Work and Employment Research and Engineering Systems; Co-Director of the MIT Sloan Institute for Work and Employment Research

Kaiser Permanente and the Coalition of Kaiser Permanente Unions have built the largest, most successful, and sustained labor management partnership in American history. We have studied the partnership for the past fifteen years. We will use this research to illustrate how the healthcare workforce can contribute to innovation, quality of service, and employee satisfaction and development in healthcare.

Unit-based teams.  Didn't follow McKinsey's advice to split up Kaiser's unique model.  Has been successful through years of work on the organizational system.

4:50 p.m.

An Analytics Approach for Designing Clinical Trials for Cancer
Dimitris Bertsimas, SM '87, PhD '88, Boeing Leaders for Global Operations Professor of Management; Professor of Operations Research; Co-Director of the Operations Research Center

We propose an analytics approach for the analysis and design of clinical trials for cancer. We build a comprehensive database from clinical trials and use it to develop statistical models from earlier trials that predict the survival and toxicity of the combination of the drugs used, when the drugs used have been seen in earlier trials, but in different combinations. Using these statistical models, we develop optimization models that select novel treatment regimens. We apply our approach to gastric cancer with very encouraging results. Ultimately, our approach offers promise for improving life expectancy and quality of life for cancer patients at low cost.

BIG DATA.  Father died of cancer.  Excellent example of how we can improve care decisions with smarter use of the data that exists.  Recall Atul Gawande's point that physicians could never keep up with each individual journal article in order to make better clinical decisions....

5:20 p.m.

Keynote Address
Ron Williams, SF '84, Former Chairman and CEO of Aetna, Inc. (until 2011)

www.ronwilliams.net; RonWilliams@RW-2.com RW2 Enterprise, Equity and Consultation.  On MIT Corp.  Serves on BoD of JNJ.

Gave overview of U.S. HC cost vs. outcomes (the familiar story!)  Ron's analysis is that:

• Price of care in U.S. drives most of the cost.
• U.S. physicians earn more: student debt, PCP $186k, Ortho $442k
• Without financial constraints, "preferences rule"
• iTriage aimed at providing an "Amazon-like" experience
• What about Payer / Pharma relationship?  "We have needed to find a way to pay for innovation in pharma.  Great deal of risk.  Going forward into future will need to figure out how to pay for performance.  Look for things that have important benefits."  Karin thinks - how can we use the MARKET to determine the rates of return on high risk?
• On Healthcare Reform - "Politics trump policy"
• On Price - "Transparency is helpful in any economic situation."

A few key slides:

6:05 p.m.

Closing Remarks
Retsef Levi, J. Spencer Standish (1945) Professor of Management and Professor of Operations Management

6:15 p.m.

Networking Reception & Innovation Showcase

Oct. 8, 2013 - 14th Annual Physician Leadership Symposium at UST with Don Berwick - "Fighting the Monsters" in Healthcare

Dr. Don Berwick, an important figure in the Healthcare Landscape in America, came to speak at the 14th Annual Physician Leadership Symposium at University of St. Thomas last night.  Local hospital CEO Penny Wheeler introduced him, and former Senator Dave Durenberger was also in attendance on behalf of UST.

Dr. Berwick's introduced his topic for the evening, The Future of Healthcare, by stating that "what America needs now is the mobilization of a "civil society" (like Europe.)  He then shared a lovely personal side to his life with one of his grandsons, showing how the grandson had grown over the past 4 years - the change in healthcare, like seeing a child grow, is like bread rising in the oven - you don't see it happen moment by moment, but if you check back over time, you see the growth over time.  Dr. Berwick also brought up Gloria Steinem in the feminism fight, and he adopted one of her first rules for fighting for change, and that is to Name the Enemy (in women's rights, one of the key enemies was date rape.)

One of the grandsons was afraid of monsters in the dark.  Dr. Berwick brilliantly outlined a set of 11 Healthcare "monsters" that we don't name in our fight to cure healthcare - the gist of Dr. Berwick's talk is that these unnamed creatures will keep us from advancing if we don't fight them.  The 11 monsters he brought up, in four categories and with great examples for each, are familiar to us all:

Uses of Knowledge
     1.  Lack of scientific basis for medical decisionmaking.  Randomized Controlled Trials are not the right
          tool for figuring out how to fix HC, but we need to figure out how to fix it.
     2.  Need to use Global Brains, not just American ones - a European cure...
     3.  We don't achieve learning in Large Systems - "Improvement" was a bad word (we should be perfect             already; don't imply we need to improve!  Quality "Assurance."

Nature of Waste and Excess
     4.  Waste - 50% of cardiac revascularizations are unnecessary, according to world famous CV surgeon
          and inventor of dilantin.  Cost effectiveness was thrown out of the ACA... The American public
          doesn't understand how much "too much" we have in the system.  A "Choosing Wisely" campaign
          has been launched to try to deal with this problem.
     5.  Profit vs. Greed - in a legal but morally reprehensible way, drug companies and others gouge the
          healthcare system for all it is worth.  Example: patenting an already OTC drug and increasing price
          from $300/dose to $25k/dose, costing Medicare millions.  Makena for Pre-term labor, Colcrys for
          Gout, EPO NOT used for dialysis, but nobody takes the drug cost out of the reimbursement that
          was established when the codes were created!
      6.  Innovations that don't help - more fiberoptics, etc. etc. etc.
      7.  The behavior of "Guilds" - physician socities and hosptial associations (AMA, AHA, etc.) that
           promote the well being of the provider over that of the system.

Priorities in Care
      8. Defending the Poor - Humphrey's Moral test 11/4/77 - a society is one that is judged by how it treats
          its young, elderly, and poor...
      9.  Palliative and EOL Care - each person will face EOL.  What do you want yours to look like?
     10.  Authentic Prevention - getting people to pay attention their health to prevent the need for care

Transition Planning
     11.  There is no business transition model, particularly for hospitals, to go from being paid for CARE vs.
            being paid for HEALTH.  How do we get people aligned around reducing hospitalizations?

My question, after reflecting on Dr. Berwick's points and his apparent appeal to moral codes and regulation to fight the monsters and fix the issues, is why can't we get the MARKET to figure out the right answers?  It is impossible to expect that government and "well meaning" oversight will ever kill the monsters; best to be indirect and let choice and following the money do the work!  Once people are insured, under the ACA, we can start to work the financial incentives with Patients, Providers, and Payers to help people make the most sensible decisions about their own care - PATIENTS CAN CHOOSE THEIR OWN PATH WHEN IT IS THEIR POCKETBOOK AND THEIR LIVES AT STAKE.  The market will create solutions that patients can choose - like online care, minute clinics, telemedicine, health care directives, hospital based vs. office based procedures (which insurers can help direct patients to with information about the cost to them and quality metrics for each, etc.).  Dr. Berwick's background is clearly "Preparation H" with a BA, Medical Degree, and Kennedy School of Gov't background, but he missed HBS - the Business School - in the mix.  Check out Herzlinger and Bohmer and Christenson and Gawande, and see what they might do to fight the monsters in healthcare, by applying manufacturing and business and innovation principles.  That might really work (if our government's current stalemate is any indicator of the efficacy of government in managing change!)

A great forum in all.... I just wonder if the folks in the middle really want to change healthcare, or just keep talking about it.

To give you a bit of background on Dr. Berwick:

Donald Berwick, M.D.

Born: September 9, 1946 (age 67), New York City, NYBooks: Escape fire, New Rules: Regulation, Markets, and the Quality of American Health CareEducation: Harvard University, Harvard Medical School, John F. Kennedy School of Government

Dr. Berwick is the United States’ leading advocate for high-quality healthcare. In December 2012, he stepped down as the administrator of the Centers for Medicare and Medicaid Services. For 22 years prior to that, he was the founding CEO of the Institute for Healthcare Improvement, a nonprofit organization dedicated to improving health care around the world. A pediatrician by background, he has also served on the faculties of the Harvard Medical School and the Harvard School of Public Health.

Donald M. Berwick (born 1946) is a former Administrator of the Centers for Medicare and Medicaid Services. Prior to his work in the administration, he was President and Chief Executive Officer of the Institute for Healthcare Improvement^[1] a not-for-profit organization helping to lead the improvement of health care throughout the world. On July 7, 2010, Barack Obama appointed Berwick to serve as the Administrator of CMS through a recess appointment. On December 2, 2011, he resigned because of heavy Republican opposition to his appointment and his potential inability to win a confirmation vote. On June 18, 2013, Berwick declared his candidacy for governor of Massachusetts.

Berwick has studied the management of health care systems, with emphasis on using scientific methods and evidence-based medicine and comparative effectiveness research to improve the tradeoff among quality, safety and costs.^[2][3][4] Among IHI's projects are online courses for health care professionals for reducing Clostridium difficile infections, lowering the number of heart failure readmissions or managing advanced disease and palliative care.^[5] In March 2012 he joined the Center for American Progress as a Senior Fellow. ^[6]

September 2013 - Real competition is coming to Healthcare... with Health Insurance Exchanges

In the first week of September 2013 the news started breaking on the actual costs for the new healthcare exchange insurance programs.  On average, a young single person in Minnesota could expect to pay ~ $300/month for insurance, for an annual cost of $3600.  There are various plan levels to choose from as well, and variables for age, family plans, etc.

Key to the operation of the whole system will be to enroll "young invicibles" into the insured pool to round out the risk base. For folks who haven't experienced any health problems in their lives, all of a sudden taking on a new expense for health insurance may not be all that easy to swallow.  I wish I could find the article in the StarTrib that quoted some people reacting to the rates - "why is health insurance so expensive?"  "I am just going to get the minimum coverage necessary."  etc.

I predict that the consumer-driven behavior of individuals required to buy health insurance will be the real force that moves the needle with the underlying cost of healthcare.  People will drive the premium payments down by choosing cheaper insurance options, insurers will compete with savvier plans, providers will need to re-engineer their operations to provide care at lower cost and compete for insurance company contracts, and service providers in the healthcare industry will revolutionize the way healthcare is delivered.  All due to the forces of market competition that happen when CONSUMER chooses how much they will PAY.

We are living in exciting times in healthcare.

June 24, 2013 - A rare opportunity to hear about medtech from Omar Ishrak, Medtronic CEO

We are fortunate to have LifeScience Alley (LSA), a non-profit organization dedicated to the medtech and biological industries, right here in Minnesota to stimulate discussion, education, and networking among the lifescience community.  Earl Bakken was a wise soul when he founded Medical Alley for the Minnesota / midwest region, a spinoff of the term "Silicon Valley," to brought our lifescience industry community together and then grew into LifeScience alley under Governor Tim Pawlenty's term.

I was reminded of how fortunate we are to have this group when LSA sponsored an interview forum on June 24, 2013 with the relatively new CEO of Medtronic, Omar Ishrak who hailed once from GE Medical.  Here is the LSA post-event email (and if you'd like, you can join MassDevice and listen to the podcast):

On June 24th, Medtronic CEO, Omar Isrhak, sat down for a live one-on-one interview with MassDevice.com publisher, Brian Johnson, to discuss the future of the medical device industry, emerging markets, the medical device tax, and what comes next for Medtronic. Thank you to everyone who joined LifeScience Alley, AdvaMed, and MassDevice.com this past Monday to hear Ishrak's interview live in St. Paul. In case you missed it, follow the link below for audio of the interview: Podcast: Medtronic CEO Omar Ishrak on emerging markets, economic value and the medtech tax

Wearing a pink shirt and tan suit that didn't really go with it, in my view, and with his bald head, glasses, and wide smile, my impression of Omar Ishrak is that he is a confident leader who reflects on how the moves he makes affects Medtronic as well as the world at large.  My main takeaways from the interview are:

• The "symbolic gift" Bill Hawkis received as CEO of Medtronic was a sword; Omar said his "symbolic gift" was the globe.  Very cool to think of medtech evolving in a truly global marketplace.
• The importance of data is growing in healthcare, and data sharing will get us to a place where everyone can benefit from it. (Yale Infuse study.)
• Time to leverage the assets we've grown under our country's financial support of the medtech industry to go to other places.  
• What is economic value?  All of those approaches.  Translation of clinical value to economic value in very granular terms.  Through that, the focus of R&D is figuring out where the value is captured.  What $ to bring to market.  Everything we do has a clinical value and a corresponding economic value.  Provide it in a way that hospitals and Doctors and Patients can relate to.  Granularity is important; generality can't do.
• I was reminded of my summer intern Zac Dalton's work at Guidant when we developed the value framework for heart failure sensors; as a brilliant former Intel engineer, he brought order to this equation with the following process diagram, which I have evolved in my work with MedLinX and WMDO:

• Helath care outcomes WW are incredibly different, but cost - if we improve outcomes, cost comes down, not up.  Improve care so we can bring cost down.
• Global markets?  We have to see what the markets want.  We have to know the value technology brings to those markets.
• What kind of better?  "Ending desire for better healthcare."
• Emerging markets: not technologies, but solutions in line with what people can afford (only 15% of people can afford Medtronic technologies now in emerging markets.)  But a $5 bn/year opportunity.  Remaining 85% - as middle class rises, government provides more so MDT's cost goes down; then there will be even bigger opportunities.
• How does the patient get the Rx?  Awareness - then Market Development!  (ala Dymedex Medical's market development methodology:

• Hospitals are around; training and awareness is missing.  (and referral development & care pathways.)
• What knowledge are you bringing back to the U.S.?  Learning the healthcare systems - the end market in China is way bigger than what we can do.
• When you leave Medtronic, what do you want the company to look like?  Transform from device co. to Healthcare Solutions company.  Pay for value better understood.  Equal access around the world.  Markets will be bigger, but not challenge the level of care that developing countries have.  

The forum also included a panel discussion by CEOs from the medtech industry including John Russell, my former boss at Guidant who is now CEO of Corventis, and the CEO of Orthocor Medical and Debra xxx from Advamed.  In general, my takeaways from this panel discussion is that regulatory and reimbursement challenges, in addition to the medical device tax, are squeezing small company's ability to innovate.  Their stories brought these messages home.  I hope we as a country can find the right balance to make innovation the cure for what ails our healthcare system.

Thank you again, LSA, and Omar Ishrak and the panel members.  A great evening.

2013 0410 Design of Medical Devices Conference - "The Future of Medical Devices", by Randy Schiestl, VP of R&D, Boston Scientific

The University of Minnesota hosts a world-class Design of Medical Devices conferences, targeted at inventors and engineers, near campus each year in April.  I was fortunate to attend one of the Luncheon Keynotes, an address by Randy Schiestl, VP of R&D (and rabid Gopher fan, being a graduate of both the undergraduate and MBA programs; and he is coaching his granddaughter Stella to be a future Gopher as well!) on "The Future of Medical Devices."

Mr. Schiestl's talk focused more on the process of innovation than the "what" in the future of medical devices, discussing the importance of a global approach to understanding markets & regulatory requirements, and collaboration being key to success.  He provided a glowing testimony to the value of collaboration between industry and the U of MN, through the "Medical Device Innovation Consortium" which allows industry to fund research and contract for future royalty value of technology that is developed.

One technology he highlighted was 3D computational modeling, specifically a heart model that can be constructed via MRI and CAT-scan images, that allows for a detailed understanding of navigational opportunities within the heart.  The work between BSC and the U of MN in this area was published in a recent IEEE article.  Technologies such as these, he said, will advance both quality and speed of device development, and reduce costs.

Although the talk was light on the "what" of what the future of medical devices will bring, Mr. Schiestl concluded with an insightful recap of what's important in the conceptualization and development process:

• Follow the $ --> Know the Payers
• Connect with Big Data --> Hospital Networks
• Recognize the demographics --> Assess Worldwide Markets (people are different around the world)
• Collaborate --> Develop Global R&D and Operations capabilities
• Partner with Regulators --> Ensure a Global Approach
• Drive Quality, Speed, and Efficiency --> for a Winning Culture

We are lucky to be in a place where so much wisdom about medical devices exists.  Thank you Randy Schiestl for sharing yours, and for doing so much to contribute to the community!

Jan. 31 2013 - Design Thinking Workshop by expert Ryan Armbruster, Dir. Innovation UHG

One of the greatest perks to being on the faculty as an Adjunct Instructor at the University of St. Thomas is being invited to wonderful faculty seminars and Health Care MBA program events.

This post comes from a faculty seminar which featured Ryan Armbruster (ryan.ambruster@gmail.com), Director of Innovation at United Health Group, who taught us the broad definition of Design Thinking and then led us through an exercise with a partner to design a better gift-giving experience.  I'll just post the slides I created as notes from this experience here to share with you; it was the easiest way for me to capture my learning.  THANK YOU RYAN - VERY INTERESTING AND FUN EXPERIENCE!