David Chase CEO/Founder of Avado

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Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, I am seeing a word crop up a lot lately in terms of
health care pricing. And it’s not one we ’re ac custom ed to see ing .

Margaret Flinter: And what would that be Mark?

Mark Masselli: Transparency – transparency in health care pricing.

Margaret Flinter: And that has really taken off as a trend in recent weeks since
we had Steven Brill on the sh ow talking about his Time Magazine piece on the
arbitrary nature of health care pricing. A number of organizations are starting to
bring their pricing out into t he light of day.

Mark Masselli: The Affordable Care Act is certainly spurring open pricing
i nformation on the insurance exchanges. We ’ve see i n states like New York and
California reveal insurance prices that are marke d ly lower than what was offered
on the individual market in the past.

Margaret Flinter: And did you see the General Accounting Office recently
released realms of health care pricing data at the request of Utah Senator Orrin
Hatch who want to know how the Affordable Care Act was impacting insurance
plan pricing on the e xchanges.

Mark Masselli: This is information that simply wasn ’t publicly available before
and well 20% of the nation ’ s insur ers di dn’t provide that data, 80% didn’t . We
now have a pretty clear document on health insurance pricing and how it differs
across the all 50 states.

Margaret Flinter: Well it’s going to b e so interesting to see if there is a direct
correlation mark ed between the increase and pricing transparency and a
decrease in cost. I don’t know that there will be, but it w ill certainly be great if
that happen ed .

Mark Masselli: Then another thing tha t’s overdo though many have tried creating
a system that clearly facilit at es patient engagement and ongoing communication
with their care providers another trend that is expected to grow.

Margaret Flinter: David Chase founded Microsoft’s Health Care busi ness which
start ed to create a user friendly patient portal. He has now launched his own
company Avado that offers a patient engagement system that he hopes will
facilitate the patient provider communication loop. He’s got his eye on

developments in the industry that are going to facilitate that incredibly important
and often overlooked intersection in health care .

Mark Masselli: Lori Robertson from FactCheck.org sha res another
misrepresented fact about health care reform but no matter what the topic yo u
can hear all of our shows by going to CHC radio.com.

Margaret Flinter: And as always, if you have comments, email us at
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you. W e’ll get to our interview with David Chase in just a moment.
Mark Masselli: But first, here is our producer Marianne O'Hare with this week’s Headline News.
( Music)
Marianne O'Hare: I am Marianne O'Hare with the se Health Care Headlines.
Confusion and the H ealth Care Law are contributing to the employment roles as
we draw closer to the October 1

st
deadline for insurance exchanges to be online
and ready for perusal. It makes the q uestion what you folks really know about
these exchanges and how w ill they work ? It t urns out thousands of folks are
being trained and paid right now to answer those and any other questions folks might have about the insurance exchanges. There has been a hiring boom of
insurance exchange navigators whose job it will be to provide t he confused and
uninitiated vital information to help them navigate those online insurance exchanges . Up to 9000 new hire r s are expected to meet the demand.
M eanwhile, another state is on the books with their insurance rates for the state
based insurance exchanges. Maryland ’s Insurance commissioner just revealed
rates that are coming in at more than 50% below the going rates on the individual
market. Nine companies are providing policies for consumers in Maryland which is p osting some of the most aggres sively lower ed insurance rates in the nation as
s ome of them are concern ed those rates will be unsustainable. Medicare that’s a
different story entirely . The number of doctors opting out of taking new Medicare
p atient s nearly tripled in the last three ye ars , as medical professionals citing poor
compensation rates and increased government restrictions as the reason s . Hard to argue we can a void harm by practicing prevention. A new study out of the
Cleveland Connect shows that one ounce of dark chocolate p rovides 16% of the
daily recommended allowance of magnesium , which promote s heart health and
onset prevention why not two or three. I am Marianne O'Hare with the se Health
Care Headlines.
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Mark Masselli: We ’re speaking today with David Chase foun der and CEO of
Avado , a Patient Portal & Relationship Management system aimed at bringing
the patient directly into the care team. Mr. Chase founded Microsof t’s Health

Care business guiding Microsoft to a market leading position in Health IT. He is
respo nsible for numerous health IT and consumer engagement startups and has
received or implemented over a 100 Health IT systems across the country from
small rural settings to large hospital systems. Mr. Chase earned his MBA from
the Kellogg School at Northwe stern and is a regular health industry contributor to
Forbes, TechCrunch, Washington Post and Reuters. Mr. Chase, welcome to the
Conversations on Health Care .

David Chase : Thank you so much for having me.

Mark Masselli: You know Dave, we seem to be re ally leaping off in a health care ,
very exciting crossroads . I think in health care w e a re always on an interesting
crossroads but right in front of us are the enormous polic y shifts that are coming
with the Affordable Care Act, lots of technological brea kthroughs are surrounding
us. And you say there were still w hat I sort of call the garage phase of innovation
in technology and you liking it to the early adoption of search engines like Google
that transformed how we utilize information on the internet . S o, from your days
at Microsoft to this current revolution in health care inf ormation technology , g ive
us a picture of how you see the m arket developing at the moment and also can
you tell me how you think the health care community is ready for this revol ution
culturally?

David Chase : Sure , I would say , you know , to begin with there is a term us ed in
health care that is becoming a big, big focus called the triple A and which is you
know , improve d outcomes, lower cost and improve d the patient or consumer
experience and that is driving the change and it r eally what’s driving that is the
incentives around reimbursement where it make s those things really central y ou
know, where as historically basically activity is being rewarded . And the way we
see things developing is in the past the health care system has been a very
siloed system where there is lack of coordination. We really see things become
more patient - cent ric more a ccountable and more coordinated. And the most
imp ortant medical instrument I put th at in quote s t he future is going to be
communicati on and that really squarely pu t s not only the various members of
your care team from a professional side but the kind of forgotten members of the
care team , the patient, the family and the 70 million caregi vers that are frankly
delivering the majority of health care today.

Margaret Flinter: Well , I think Dave that’s a great jumping off point to a chance to
ask you about patient relationship management which is a n area that you’ve
called the new frontier in Health IT and It strikes me that for th e s e last couple of
years we’ve had so much focus on the meaningful use s certainly of electronic
health records and of health information technology and we’re continuing to
struggle towards that triple aim of particul arly around prevention and managing
chronic illness. But you have said that what’s lacking across many of these
efforts is the infrastructure to engage that most important partner in health care ,

the patient and that’s the concept behind your new patient engagement tool at
Avado this patient relationship management. So tell us about that if you will .

Dave Chase: I guess it begin s with part of what I mention ed a moment ago that
the majority of health care is delivered by non - professionals and our tagline is
care beyond the clinic and we will say , the o ther 99% of your li f e that you ’ re not
in front of the doctor is really critical and it’s critical to really w eav e in the patient
to the family and caregivers a full fledge members of the care team. I mean i n
the old model a 100 or so systems that I have reviewed or implemented over the
years , I took a step back and thought about well what’s the purpose from a
Healt h IT perspective of a patient and systems and frankly it was to be a vessel
for billing codes . That’s what our incentive system rewarded and that’s what we
got. And the key insi ght that the organizations that are really I call them the triple
A in champs they are really doing the best job , is they recognize that for three
quarters of all the dolla rs we spent on health care it’s around chronic disease and
it’s actually not the professionals who make the majority of the decisions that
most influence outcome it’s the patient, the family , the care giver making
decisions like do I s ell a prescription com pleted, diet, exercise, lifestyle. All kinds
of things that there can be the best do ctor ing in the world but if those things don’t
get address ed and that, the other 99% when they’re not in front of the doctor and
you ’re a provider and you are paying on ou tcomes that becomes a disaster. So ,
it becomes natural to provide th e s e kind of tools that allow for a much greater
two - way communication and what has been provided in the past , our past has
been kind of one - way broadcast.

Mark Masselli: You know David back in 2009 , the Congress passed the HITECH
Act putting billions of dollars into health information exchanges and today there is
hundreds of different electronic health record systems out there for providers and
often times there a re problems integrating those electronic health record
systems. So , when it comes to personal health records focused on patients
nobody has really manage d to get them engaged. So , who do see leading the
effort to adopt your patient relationship management tools and what will be the
incentive for them to do so?

Dave Chase: I would say that when you get the incentives align ed it just
becomes a natural b y product of the care you provid e when you are in this
patient - centric , accountable , coordinated kind aligned model. When you a re in
that model whether it’s Stanmark or Kaiser Permanente or direct primary care
models, they do those things and when you are in the old model looking for
service quite frankly things like the PHR and secure email tends to get viewed as
just more unpa id work and that’s why you haven’t seen much success there . It’s
one of the reasons why you know company like ours it’s a relatively new entrant
you know we expound those niches that we think represent what will become the
mainstream as a whole and you get that alignment and then you know it just
becomes a natural way of doing business . It just becomes a logical efficient way
of doing things just like e very other area of life . Really health care has been the

out - wire there and it ’s been the incentive s more than anything that I ha d kept out
from going on and I mean as I say you know it’s about the money you know
reimbursement really matters and it takes two to tango and that being that if you
just you know pushed patients out the door and saying hey, you kno w get your
act together on health, and to do th e s e things and there is no follow - up and no
incentive by the provider , many patients , vast majority don’t actually know what
to do. So that’s I think why there has been a failure in the past.

Margaret Flint er: Well Dave, I’m going to ask you to maybe drill down one more
level on that . So I think you’re absolutely right this is the new frontier and I don’t
know if it’s one of your colleagues who dug t he empowered patient , the super
st
drug of the 21 century, that breakthrough we’ve all been looking for where w e’ ll
have a much bigger impact. But if you look at what’s out there in the
marketplace you know there is will on the part of the provider community and
then the IT companies have responded by having pat ient portals and certainly
iPhones have allowed us to communicate in more ways by text messaging and
so forth. But really when I look around the country I still don’t see a lot of patient
engagement through those strategies, through the patient portal, th rough
alternate ways of communicating with their providers. What do you see around
the country, around the world in this area of engag ing patients that you look at
and sa id , aha, you know that’s a great strategy to engage people?

Dave Chase: I mean ther e are a number of different exa mple s, certainly one that
I am bullish on is what’s called Direct Primary C are Concierge Medicine for the
m asses and where they have done that and they basically operate in a very
efficient low overhead manner and so by neces sity they do things to make it very
easy for patient s to track their health remotely. I am afraid in what we do today is
the equivalent of, we send patients to a foreign land called health care , you know
we give them directions in a second language and th en we push them out the
door. Doctors are time starved and then what do they do thousands of times a
year but e ssentially hit the replay button on the response to the FAQ to explain a
diagnosis with treatment and medication and what the smart ones are doi ng is ,
they don’t need to have skill but they will pull out your smartphone and shoot a
video that respon d to those questions. And then in that time that you have
between the patient and the p rovider they can have a more specific nuanced
conversation and you know there is no real cost to doing that I mean one doc tor
st
who has just used, I think he called at his 41 appointment that he would work
in to a schedule, and he just pull s out the phone and, you know, take three
minutes to answer some question he com monly get in a pretty short amount of
time he had a nice library of a personalize d content.

Mark Masselli: We’re speaking today with David Chase founder and CEO of
Avado a Patient Portal & Relationship Management system aimed at bringing the
patient dire ctly into the care team. He is responsible for numerous Health IT and
consumer engagement startup s . He has reviewed or implemented over a
hundred Health IT sy stems across the country. Dave , let’s take a look at some of

the early attempts to launch Inter active Personal Health Record systems and
Microsoft “ Vault ” c ontinues to evolve but the other big player Google Health didn’t
get far of f the launching pad before shutting down its operations. Where do you
think they went wrong in their approach and what have you learned from
observing that failure?

Dave Chase: One , there was a timing aspect where the incentives weren’t there
some years back and so that reduce d the motivation on a part of providers to do
that. But I actually think the biggest thing was there was too much work required
by the consumer and it was a one - sided product. I mean there needs to be a
provider side just as I mention ed earlier it doe s take two to tango and so while
you can come in from the outside and say health care is broken I’v e got a better
way, you do need to understand the n uances and the idiosyncras ies of health
care and how things a re paid and I think they just addressed one piece of the
puzzle rather than the entire mix and I think that’s really what has kept all of
those from getting any kind of meaning ad options.

Margaret Flinter: Dav e, you mention ed direct primary care a few moments back
and for our listeners some have called that concierge medicine where a patient ’ s
access health care outside the health insurance syst em or in addition to the
health insurance system by paying a membership fee basically to a primary care
provider and for that fee they gain access to their primary care provider anytime
they want. I know the founder of the micro financial micro loan a sys tem in Nobel
Prize winner has support ed that. But it ’ often thought of as a system for the
wealthy to sort of buy a higher level of care. And yet, I think you ’ve presented it
as possibly the opposite also way to signal innovative approach to health care
delivery of kind of do it yourself organizing your medicine. Can you tell us just a
little more about that and what do you sees is both the impact in this time of the
implementation of the Affordable Care Act but also beyond that?

Dave Chase: There is a very little amount of clause in the Affordable Care Act it
does a llow for the direct primary care medical homes to s i t inside of the health
insurance exchanges. You know that ’s sort of a coming things so in the
meantime they have go t ten off the ground an d you know historically a criticism of
concierge medicine is that it creates a two - tier health care system and for one the
price point generally is though you mention ed the one by the Nobel Peace prize
winner with Grameen America and they are initially add ressing the
undocumented immigrants who are borrowers , the re are 17 dollars borrowers of
th e s e micro loans in the US and it’s $10 a week which they can afford and that is
could be ec onomically self - sustaining model. And the irony is I have often
rejected this notion of creating a two - tier system because it ’s so affordable and
now I am sort of agreeing there is a two - tier system. It’s actually the lower
income people who have the direct primary care model are actually getting a
better quality care than the richer , middle and upper income people because they
are not subject to the seven - m inute drive - by appointment so it become a norm in
primary care. So it’s actually the lower income people not exclusively but in

t hese examples who a re getting great c are . I have seen no model that has
achieve d the Triple A better than t he direct primary care model in terms of
reducing cost , improving outcomes and they have patient satisfaction where it’s
better than Google or Apple . So, it’s really quite phenomenal what th ey’re doing.

Mark Masselli: But let ’ s ta ke a look at the future of tech - enable d health care and
t he engage d patient -- we ’ ve had forward thinkers on our show like Eric Topol
and e - Patient Dave sort of envision ing a future that fully embeds the engaged
pa tient as part of the care team and bypass is the older way of care delivery with
adoptive technologies . And so with so many systems em erging simultaneously
and the health care law d riving the population towards full cover age , how do you
see all of these f orces helping you achieve th e tipple A image you were just
talking about a s of better access, better outcomes in lower cost in health care for
the future?

Dave Chase: When you get into you know, we just spoke direct primary care
there is actually some Me dicare Advantage Program that has done phenomenal
work here. And the interesting thing is that they realize that if they take time with
patient and you know particularly with the elder l y with their family and caregivers
to explain their choices without be ing a gatekeeper like the old HMO model . In
many, many cases pr obably the majority of the time th ey actually choose the less
invasive route b ecause they ’ re informed of significant risk particularly when you
talk about the frail elderly where you know when you go in a sound surgery or
trans plant or whatever that is not what that is . And in many cases there are also
alternative s where the quality of life can be significantly better. And so if you took
those models that already exist in pockets around the c ountry and scale those up
you essentially don’t need to do anything else to essentially solve health care .
It’s just that’s not been brought together in the one integrated whole into one
place and I think that’s where there is a tremendous opportunity and some
exciting things going on and s ome communities like Tampa that are really trying
to step up and then be that place where that whole brought together.

Margaret Flinter: We’ve been speaking today with Davi d Chase founder and
CEO of Avado a Patient Por tal & Relationship Management system that’s aimed
at bringing the patient directly into the care team. You can learn more about his
new venture by going to www.avado.com a nd you can find him on LinkedIn.
Dave, thank you so much for joining us today on Conversations on Health Care .
Dave Chase: It’s been my pleasure
(Music) Mark Masselli: At C onversations on Health Care , we want our audience to be
truly in the know when it comes to the facts about health care refo rm and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a non - partisan, non - profit consumer advocate for voters that aim

to reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well Mark and Margaret, this week we’ll look at who is exempt
from the i ndividual mandate that’s part of the Affordable Care Act. This is the
requi rement that starting in 2014 people have to have health insurance or pay a
fine. So, who is exempt from this? Well, it’s mainly low income individuals such
as those who earn too little to be required to file tax return s . For 2012 that was
those earning under $ 9 , 750 a year or $ 19,500 for married couples. Also exempt
our employees who can’t afford their work based insurance. These are
employees who would have to pay more than eight percent of household income
for coverage and those who can’t get an affordable offer of coverage on the
insurance exchanges. There are also exemptions for hardsh ip s in obtaining
coverage and those are determined by the Secretary of Health & Human
Services. The la w also exempts those who have gaps in coverage of less than
three months, m ember s of Indian tribes, members of a health care sharing
ministry and m embers of certain religious groups that are already exempt from
social security tax es t hat last category is made up mainly of Anabaptist groups
such as Mennonites and Amish . Also exempt those who are in jail. A few
readers have asked us about American s who are living overseas. Those who
live abroad for a full calendar year are exempt but those who live in another
country temp orarily are not. Also residents of US territories do not have to
comply with the mandate. And that’s my fact check for this week. I am Lori
Robertson, managing editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
countries major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If y ou have a fact, that you would like
checked, e - mail us at chcradio.com. We will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health care .

( Music)

Margaret Flinter: Each week, Conversations highlights a bright idea a bout how
to make wellness a part of our communities and everyday lives. In one of the
most popular TEDtalks of all time game developer Dr. Jane McGonigal made a
pretty bold prediction.

Jane McGonigal: If you want to solve problems like hunger, poverty, climate
change, global conflict, obesity, I believe that we need to aspire to play games
online for at least 21 billion hours a week by the end of the next decade. No , I
am serious.

Margaret Flinter : McGonigal is the director of Games Research and
Dev elopment at the Institute of the Future. And she is a th ought leader in the
growing trend of the ga m ification of improving health and social wellbeing

through interactive video games. But she didn’t realize that he r prediction would
come home to roost on her own doorstep. After s uffering a severe concussion in
2009, she said come to the classic symptoms of traumatic brain injury, constant
pain, ch ronic headache s , fag, depression , even suicidal ideation.

Jane McGonigal: In all seriousness suicidal ideat ion is quite common with
traumatic brain injuries. It happens to one in three and it happen ed to me. My
brain started telling me Jane, you want to die?

Margaret Flinter: So she created the game super better. McGonigal ’s re search
shows that when people engage in gaming they are more likely to reach out for
health to empower themselves through their game avatar a nd to use the avatar
to slay the symptoms they are battling . So, McGonigal’s avatar became Jane the
concussion slayer.

Jane McGonigal: Within just a couple days of starting to play that fag of
depression and anxiety went away. It just vanished.

Margaret Flinter: Within a year the other symptoms dissipated and went away.
She decided to put the game online for anyone to access and the feedbac k
totally unexpected.

Jane McGonigal: Not everybody has a concussion, obviously, not everyone
wants to be "the slayer," so I renamed the game Super Better. And soon I
started hearing from people all over the world who were adopting their own
secret iden tity, recruiting their own allies, and they were getting "super better"
facing challenges like cancer and chronic pain, depression and Crohn's disease.

Margaret Flinter: She says that the game revealed the phenomena the scientist
called post traumatic gr owth. Well some people experience dramatic growth
after traumatic event. The game just seems to get people to that place more
quickly. Super Better , a simple online game that allows players grappling with all
kinds of conditions to battle those symptoms in order to better manage and
hopefully defeat their condition. Now that’s a bright idea.

( Music)

Margaret Flinter: This is Conversations on Health care . I am Margaret Flinter.

Mark Masselli: And I am M ar k Masselli. Peace and health.

Conversations on Health Care , broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org, and brought to you by
the Community Health C enter.