Source: The Science Fiction Effect
Dave Chase is the founder and CEO of Avado, a TechCrunch Disrupt NYC finalist. Previously he was a management consultant for Accenture’s healthcare practice and was the founder of Microsoft’s Health business. This is Part II of a two-part post. You can follow him on Twitter @chasedave.
- Protesting Healthcare Taxation with Bureaucratization
- New Care & Payment Models Spurring New Health IT Categories
- Cautionary Tales For Healthcare Companies from Telco and Newspaper Industry
Convergence of Factors Driving Industry Disruption
Consider the following convergence of factors to comprehend the scale of the need for innovation in healthcare:
- Over 1/3 of the workforce is expected to be permanent freelancers, contractors, consultants and entrepreneurs with zero expectation of employer provider insurance. They have high motivation to become literate on health economics when paying directly for their own health plan. Health plans are still designed and sold to groups rather than individuals even though nearly half the population will be buying health plans directly rather than receiving them via their employer.
- 110MM Americans are covered under what are called Self-funded Plans. What that means is a large employer directly pays for their employees healthcare versus having an insurance company manage the risk. They are aggressively pursing their own DIY Health Reform and aren’t waiting around for DC.
- As has been seen in Massachusetts with their health reform, a massive new wave of people will be brought officially into the healthcare system when insurance mandates kick in 2014. This particularly strains the pre-existing shortage of primary care physicians.
- It’s well understood that aging Baby Boomers will strain the system like nothing before it.
- Nearly half of all Americans have a chronic disease. This consumes 75% of all healthcare spending for a total of $1.8 Trillion (yes, with a “T”).
- Over half of people don’t follow their doctor’s care plan. While some are explicitly ignoring their doctor’s advice, most simply forget or misunderstand the directions they were given.
The only hope to address this convergence of factors is to reshape how care is delivered and paid for. Among other things, it’s imperative that there’s greater efficiency — an area where technology has demonstrated it can play a role time and again. Whereas technology has brought incremental efficiency in healthcare, organizations such as Qliance and OneMedical have utilized technology for radical transformation.
It’s no coincidence that they are backed by the founders of Amazon, aQuantive, Dell, Expedia, and venture firms such as Benchmark — all organizations that dramatically altered their sectors using technology to disrupt their industries. The graphic below shows how Qliance has earned a Net Promoter score higher than Google or Apple in a sector that has the lowest average Net Promoter Score of any industry. You can also see Yelp reviews for Qliance and MedLion to get further anecdotes.
More Time Spent with Patients Translates to Better Health Outcomes and Less Time &
Interestingly, in the transformative models described earlier, doctors consistently tell me that half to two-thirds of their patient interaction time doesn’t need to be face-to-face (the legacy insurance reimbursement model requires face-to-face appointments for the doctor to get paid). They can deliver high quality medicine without being in the same room as them. By spending less time on insurance bureaucracy, they are able to spend 2 to 8 times more time with patients and still make a reasonable living. These longer appointments aren’t simply a luxury. They’ve demonstrated they can save money and improve outcomes. In the legacy model, a typical 7-minute appointment only allows the doctor enough time to address one symptom with limited time to address the underlying issue.
One doctor operating in a non-insurance primary care model gave me the example of a female patient describing symptoms of terrible headaches. He said that in the old model, he would have ordered an expensive CT scan to understand if there was something going on. Instead, over the course of a longer discussion, he found that the lady’s mother-in-law had recently moved into her house. Instead, he “prescribed” setting boundaries, going for walks and other stress-relieving measures.
Implications of Government-driven Health Reform
Of course, the reshaping of healthcare isn’t limited to the DIY Health Reform movement. McKinsey just released a study of employer reaction to the new health law as reported in an article entitled, “Is Employer Sponsored Health Care the Next Jurassic Park?”
If employers have been looking for an exit to employer-sponsored health benefits, they may have found one in the new health reform law. According to the just released employer survey by McKinsey and Company, upwards of 30% of the 1,300 employers surveyed “definitely or probably” will drop health coverage altogether and instead pay the $2,000 per employee government mandated fine. The flee rate gets even higher when focused on those employers with a high awareness of the new law – more than half (50%+) employers indicating plans to exit health benefits.
Putting aside the political issues, the implication is that even more people will become healthcare consumers where they’d previously had that decision handled for them. While I’d expect that the impact of the DIY Health Reformers will be more immediate, the opportunity only increases with government-driven health reform. The CTO of the U.S. recently laid out just how big the opportunity is in the video below.
Time for Health IT Entrepreneurs/Investors to Jump Back in the Water
Due to the scorched earth in Health IT for startups, it’s understandable why mainstream venture investors have been reluctant to invest. Despite my own heavy background in Health IT, I intentionally stayed away as I’ve stated to many people “health IT is where startups go to die” as the pace of decision making and go-to-market challenges have been epic. Many people’s reaction to healthcare in the U.S. is similar to MidEast Peace. That is, they know it’s a severe issue but it seems almost hopeless. Let me leave you with a final thought of how this country solved another seemingly intractable problem starting about 100 years ago.
At the start of the twentieth century, another indispensable but unmanageably costly sector was strangling the country: agriculture. In 1900, more than forty per cent of a family’s income went to paying for food. At the same time, farming was hugely labor-intensive, tying up almost half the American workforce. We were, partly as a result, still a poor nation.
As Atul Gawande’s Testing, Testing article goes on to describe, the U.S. addressed that massive issue to the point where we now spend 8% on food and only 2% of the workforce.
TechCrunch contributor and venture capitalist Mark Suster has repeatedly stated that entrepreneurs should be solving the truly big challenges in our society — health, education and energy — instead of creating yet another social tool, location-based service or trivial application. As economist Laura Tyson so eloquently put it, “We do not have a debt problem in the US economy, we have a healthcare problem.” Sticking with the legacy fee-for-service insurance model for day-to-day healthcare threatens individual, business, and government budgets. The lowest hanging fruit is removing the 40% “insurance bureaucrat tax” which is why the Declaration of Insurance Independence will unleash the wave of innovative new care and payment models that will be powered by innovation of the technology industry. Get busy!
theodp writes “In its just-published patent application for Adapting Parasites to Combat Disease, Microsoft lays out plans to unleash ‘altered parasitic organisms’ on humans, including mosquitoes, fleas, ticks, bed bugs, leeches, pinworms, tapeworms, hookworms, heart worms, roundworms, lice (head, body, and pubic), and the like. ‘Irradiated mosquitoes can be used to deliver damaged Plasmodium to individuals,’ explains Microsoft. ‘Instead of contracting malaria, an individual receiving the damaged Plasmodium develops an immune response that renders the individual resistant to contracting malaria.’ Don’t worry about runaway breeding, advises Microsoft — ‘a termination feature [that] can include programmed death’ makes this impossible. As David Spade might say, I liked this movie the first time I saw it — when it was called Jurassic Park.”
Tyrannosaurus—the name brings to mind the towering T. rex with its giant teeth and tiny arms, hunting humans in Jurassic Park or standing reconstructed in the natural history museum. This king predator dominates our imaginations, and because of that it is the most heavily studied dinosaur there is. In the last decade, and even in the last year, new studies have shown us that T. rex’s lineage stretches back to Tyrannosaurus ancestors that stood no taller than us for nearly 100 million years. In the journal Science this week, paleontologists lay out all the recent discoveries that reveal the story of the world’s favorite ancient monster.
Stephen Brusatte of the American Museum of Natural History in New York, one of the study leaders, says:
“Up until about ten years ago we only knew about T. rex and a handful of its closest relatives — all colossal, apex predators from the end Cretaceous in North America,” Brusatte explained. “Now we know of about 20 tyrannosaur species that span a time period of 100 million years, most of which are very small.” [MSNBC]
Indeed, just in the last year scientists have discovered six new species. The team writes in the study that one of those newly discovered species was “100 million years older and 1/100 the size of T. rex.”
University of Maryland tyrannosaur expert Thomas Holtz, Jr., added: “I like to call [early tyrannosaurs] the jackals of the Jurassic and Early Cretaceous. “They were tough little guys, but they were little guys, sort of hanging out in the wings and taking out young dinosaurs and small dinosaurs but leaving the big prey to things like Allosaurus,” said Holtz, who was not involved in the new review. [National Geographic]
T. rex showed up late and burned out fast. Tyrannosaurs, for the first about 80 to 85 million years of their existence, grew no larger than a modern-day human. About 80 million years ago these dinosaurs hit a growth spurt, perhaps because giant competitors died off, and the great dinky-armed predator emerged. Because the worldwide dinosaur extinction event happened 65 million years ago, T. rex had a short run compared to its Tyrannosaur ancestors.
According to Mark Norell, another member of the study team, the flood of new Tyrannosaurus knowledge isn’t limited to finding new species.
Biologists who study the biomechanics of elephants or chemists who study proteins in bone have turned their attention to T. rex fossils. They’ve refined its posture. They’ve determined the length of its adolescence — 10 to 15 years — and its rate of growth — as much as 5 pounds a day. They also may have found remains of T. rex tissue, though that’s still in question. “What I find really interesting is what you can do with sort of an eclectic and diverse group of scientists all focused on one animal,” says Norell. [NPR]
If you’ve got Friday dino fever, Norell also co-wrote the DISCOVER feature “The Bone Collector,” on T. rex fossil hunter—and philanderer, and spy—Barnum Brown.
Image: Brusatte et. al / Science
An international team of researchers has discovered how to extract DNA from fossilized bird eggs–including the eggshell of the enormous elephant bird that went extinct four centuries ago.
In a research breakthrough, scientists were able to isolate DNA from the eggshells of not just the extinct giant moa bird from New Zealand, but also a 19,000-year-old emu from Australia and the extinct elephant bird of Madagascar. The elephant bird’s egg is the largest known bird egg, with 160 times the volume of a chicken’s egg [New Scientist].
The discovery of these birds’ DNA could help scientists understand how they lived, and why they became extinct. The DNA was extracted from desiccated inner membranes in fossil eggshells, found in 13 locations in Australia, Madagascar and New Zealand [PhysOrg], and the work was published in the Proceedings of the Royal Society B.
For years scientists have been trying to extract DNA from old eggshells without success, because their approach, scientists admit, was faulty. Charlotte Oskam and Michael Bunce of Murdoch University in Perth, Western Australia, who isolated the DNA, say researchers (including themselves) were using techniques designed to extract DNA from bone, not eggshells. They even threw out the most DNA-hardy bits of eggshell [New Scientist]. Bunce explains that extracting DNA from bone involves sucking out the bone’s calcium and discarding it.
In the new study, the researchers figured out that the DNA was stuck in the eggshell’s calcium carbonate matrix–which they then proceeded to draw out. Because eggshells attract fewer bacteria than bone, researchers say their DNA samples from ancient eggs are less likely to be contaminated.
With this new method of extracting bird DNA in hand, scientists are hopeful that they can piece together the story of how these ancient birds lived, evolved, and went extinct. For example, the elephant bird, which weighed about 900 pounds and stood ten feet tall, became extinct at the same time that humans colonized the island of Madagascar, but there have been no signs that the birds were hunted by humans. Says archaeologist Mike Parker Pearson: “There’s not even evidence that they ate the eggs — even though each one could make omelets for 30 people” [BBC]. By studying the elephant bird’s genetics, scientists can look for clues about the bird’s physiology and diet that may help them understand what made the giant avian go the way of the dodo. But the researchers caution that so far, the new technique allows for the extraction of only a tiny amount of DNA–just 250 base pairs, the “rungs” on the ladder-like genetic code, and this is less than a fraction of one percent of the bird’s genome [PhysOrg].
So can we expect these extinct birds to be brought back to life like the dinosaurs in Jurassic Park? Says Bunce: “We can reassemble the genome to get an idea of what an extinct species looked like. But (resurrecting it) is still in the realm of science fiction. It’s completely hypothetical, and frankly not a debate I really want to have.” [PhysOrg].
Until or unless we can create a Jurassic Park and build dinosaurs from DNA , the best way to study them may be to build
That’s what a team did for a new study in the Proceedings of the National Academies of Sciences. To figure out how the 120-million-year-old winged dinosaur Microraptor gui took to the skies, the researchers used a well-preserved fossil to build their own. “We went back and forth. We thought, maybe we’ll do 3-D graphics and it’ll look really cool. But it’s more accurate to do the modeling directly from the specimen,” said Dave Burnham, a paleontologist at the University of Kansas [Wired.com].
The micoraptor’s flight configuration has confounded scientists studying it, because no modern vertebrate flies with the hind legs “functioning as independent, fully developed wings,” so there’s no living analog for comparison. Previous studies suggested that the animal walked on the ground, but Burnham’s team argues that the feathered back legs would have prevented this. A 2007 study, also in PNAS, said the dino probably flew with its two sets of legs set parallel, like a biplane. But Burnham, whose team did glider tests with their model microraptor’s wings in three different positions, says the biplane formation would have put too much weight on the creature’s head.
Instead, he argues, the dinosaur would’ve taken off from the trees and glided like a flying squirrel. “The controversy was that these animals couldn’t spread their hind wings to glide,” Burnham says. “But we’ve been able to articulate the bones in their hip socket to show that they could fly” [LiveScience].
The study adds to the debate over how flight evolved in the earliest ancestors of birds–did flight begin when some ground-dwelling creatures hopped and leaped upwards, or when tree-dwelling creatures began to glide between branches? This new study of the microraptor, which is poised on the boundary between dinosaurs and birds, suggests that the arboreal, or tree-living, idea may be correct [LiveScience]. However, co-author David Alexander notes, the controversy probably won’t end here.
Image: University of Kansas
Earlier this month DISCOVER covered the 213-million-year-old fossils of the theropod Tawa hallae, a dinosaur ancestor that could show how early dinos spread around the world. Now, in a study (in press) in the Proceedings of the National Academy of Sciences, another research team has uncovered a surprise in the bones of a theropod from almost 100 million years later. By that time, these creatures may have adopted a clever new weapon: venom.
Sinornithosaurus lived 125 million years ago in what’s now China, and while it might have been covered in feathers (and the size of a turkey), the researchers say it attacked like modern rear-fanged snakes. Rear-fanged snakes don’t inject venom. Instead, the toxin flows down a telltale groove in a fang’s surface and into the bite wound, inducing a state of shock [National Geographic].
Looking at the dinosaur’s skull, study author David Burnham says his team found a pocket that they believe Sinornithosaurus could have used to store venom. A groove runs from there to the base of the fang, the team says. Like rear-fanged snakes, the venom Sinornithosaurus used was probably not lethal. The researchers suggest it instead caused rapid shock, allowing the dinosaur to subdue its prey [BBC News]. Today’s komodo dragons may use a similar blast of venom to weaken their targets.
Burnham says the dinosaur probably ate the birds that lived in the forests of that time and place. Short front teeth were probably used “to pluck the feathers off their victims,” wrote the researchers, who suggest that other members of Sinornithosaurus‘ family, including the velociraptors of Jurassic Park fame, had the same venomous capabilities [Wired.com]. What Burnham doesn’t know is how far back venom goes—if dinosaurs 125 million years ago possessed the ability, it possibly could date to even earlier reptiles.
Image: National Academy of Sciences