Imagine a good fraction of all health care and technology hype you’ve heard recently getting dissected, debated and debunked by scientists and entrepreneurs instead of politicians.
That’s exactly what happened last week, as hundreds of experts assembled at UC San Francisco’s Mission Bay campus on the Kauffman Foundation’s dime to sit in on what became part lecture, part discussion, and part free-form intellectual improvisation on the idea of reducing health care costs through technology.
University of California’s Berkeley School of Engineering and its system-wide California Institute for Quantitive Biosciences — or QB3 — hosted the conference.
“Shankar and Andy are roaming,” joked former Intel CEO Andy Grove about elderly versions of UC Berkeley’s dean of engineering Shankar Sastry and himself, evoking an image of the two escaping their assisted living facility and having digital sensors go off.
Because paying to have ’round-the-clock monitoring can be the priciest part of health care, having remote sensors is one way technology can make health care cheaper.
“Silicon Valley should be the testing ground for digital home care,” Grove said, further suggesting that the University of California create a new degree program combining health care and technology to accelerate adoption.
Experts raised ideas about the intersection of cost, scientific research, policy, and human behavior. They discussed the analytical benefits — or lack thereof — of the human genome project, questioned what the expected human lifespan should be, talked about using technology to treat rural patients remotely, and brought up the conflict between statistics-based health care and personalized medicine.
They touched on why research fails to focus on cheaper solutions and suggested the National Institutes of Health may be trying to slowly change its funding to encourage just that.
Speakers included experts from Microsoft, the National Institutes of Health, Cisco Systems, Qualcomm, UC Berkeley and UC San Francisco.
SCIENCE SHOULD INCLUDE CASH IN MEASURING OUTCOMES
QB3’s director Regis Kelly was on stage through much of the conference. He admitted that in previous years, his organization’s goal had been to convert science to social benefit as quickly — not as economically — as possible.
“We’re technologists, we don’t do the science on these things,” Kelly said he once told politician Don Perata in response to what QB3 was doing to mitigate health care costs. But this year, in light of those rapidly increasing costs, the institute is thinking differently.
Despite all intentions of fostering a conference about technology, participants — mostly from bioengineering and computer science — returned to the idea that the high cost of medicine can be reduced with more information and better data analysis.
“We will not reimburse anything unless you fill it out this way,” said Noam Ziv, vice president of engineering for Qualcomm. He was responding to an utter lack of public data on health costs and outcomes and suggested Medicare and Medicaid are in a position to demand a single format for all medical data.
Safeway CEO Steve Burd described what this means to a company trying to insure its employees.
“You cannot call a single institution and ask, ‘What does it cost for a colonoscopy?’” Burd said. Safeway has had the ear of some in the U.S. Congress lately because the grocery chain provides its own health insurance and keeps data on how much it pays for standard procedures.
Unlike the rest of the nation, Safeway’s health care costs have held steady over recent years, according to Burd, who presented extensive data.
“We will have flat health care costs for 10 years,” he further proclaimed about his company.
One of the main findings from Safeway’s data? No transparency means it’s a market gone wild.
Burd showed that health care providers billed Safeway anywhere from less than $900 to more than $7,000 for the same type of colonoscopy, a standard procedure for people over 50.
“We’re not looking at list prices, these are checks we actually wrote,” Burd said.
He said obesity is one of the biggest drivers in costs and is linked to all four of the most common conditions. “Unless you reduce the obesity trends in this country you will not lower health care costs.”
On almost every level, experts said, better data would help, whether creating consumer choice, optimizing health outcomes, managing government costs, or modeling the system.
In engineering, it’s always “build a model first,” said Alex Bangles, CEO for biopharmaceutical company Entelos, offering airplane design as an analogy.
“Boeing would build 10 and then the one that didn’t crash was the one they would sell,” Bangles said. The model goes in the middle, between data and application, but in health care, there’s insufficient data to build a model to test out first.
Information is lacking on every level, even for chemicals and drugs.
“It’s the kind of thing NIH has really — excuse the analogy — gotten religion on,” said Christopher Austin, director of chemical genomics at the National Institutes of Health. The institutes fund more than a trillion dollars in health-related research every year.
Even when the data is available, health care systems are slow to do anything. Panelists expressed frustration at how the health care system fails to pursue known, effective cost-cutting processes.
“It’s not about the technology, it’s about who controls the technology,” said S. Claiborne Johnston, a physician and director of Clinical and Translational Science at UCSF.
“If you empower a patient to do something that a physician previously was able to do, you’ve reduced cost,” he said. For example, currently diabetic patients monitor blood sugar at home and take insulin as needed.
Johnston suggested that this should also be done with blood pressure medicine, which he called safer than aspirin.
“Here’s an example where the health care industry confounds patients’ ability to do anything about it.” Patients could be monitoring their own blood pressure and adjusting their medicine at home, avoiding visits to the doctor.
Johnston said that in this case, the cardinal rule that only a doctor can issue changes in the prescription is “silly.”
“Why hasn’t that happened?” Austin asked about such changes, noting that in other industries, cost cutting would happen rapidly.
“We’ve got a totally screwed up set of incentives,” said Mickey Urdea, founder of Tethys Bioscience.
In addition to poorly instituted incentives, panelists found that goals were undefined. Should health care aim to extend life, or health, or healthy life, and how can one define these?
“Most physicians are nervous of valuing life,” Johnston said.
“Is it cost effective for us to actually develop technologies to extend life?” Kelly, QB3’s director, later asked Austin.
The NIH employee said there are two schools of thought on longevity: that focusing on life extension will lower cost because it will minimize chronic disease, or focusing on life extension will just prolong diseased life. “They’ll just live longer with their Alzheimer’s disease,” Austin explained.
The upshot is that — once again — data is missing. People fail to measure extending “healthy life” rather than life.
Austin pointed to an entire field of longevity, and noted that, though there’s a 100 percent chance of death, no one has determined the absolute limit to human life, “where the human being will collapse into the dust.”
Health care has avoided defining a planned obsolescence, the idea that ultimate failure is inherent in the design, even though failure is inherent to the human body.
“Some people think it’s 150 years,” Austin said about researchers. “Some people think it’s 120 years.”
Johnston, the UCSF physician, encouraged the audience to look beyond dollar values for research outcomes.
“Almost all clinical trials result in cost to the health care system,” he said. “But almost all benefit life and lengthen life.”
TECHNOLOGY IN ACTION
Remote health care is one example of new technology that’s benefiting life regardless of cost. Trials in California are currently being funded in part by an unusual source, the Federal Communications Commission.
Paul Wright, UC Berkeley professor and director of Cal’s Center for Information Technology Research in the Interest of Society, said the FCC has given $22 million for a rural health care experiment through the California Telehealth Network.
Doctors are connected through the computer with rural patients who would otherwise be unable to access specialized medical professionals.
Wright said he watched city doctors remotely diagnose a baby in Boron, California, giving the go ahead to defibrillate the baby and bring her back to life.
“Without the telehealth link,” Wright said, “that baby would not be with us.”
Webcast of the conference can be viewed here.