Adam Dole, Presidential Innovation Fellow

(Music)

Mark Masse ll i: This is Conversations on Healthc are . I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masse l li: Well Margaret, the Supreme Court closed out another session
with a bang, deciding in favor of a suit by the o wner of the Hobby Lobby chain
stores who argued that as a closely held company , they shouldn’t be forced to
provide certain types of contraception coverage to their employees based on the
religious believes.

Margaret Flinter: Well that 5/4 [PH] decision has evoked a firestorm of protest s
from a number of groups including the American Medical Association, the
American Nurses Association, Planned Parenthood among others. And those
delivering frontline medical care across the country, know this will have an effect
on women’s access to all contraceptive options that are generally open to them.

Mark Massel l i: It's a matter of women’s health , Margaret. And this will force
many women to pay out of pocket for the services that should have been free to
them und er the Affordable Care Act. It's going to particularly impact women who
are more economically challenged.

Margaret Flinter: Well that’s why these groups, the AMA, the American Nurses
Association and Planned Parenthood and others have sent a message to t he
White House that they really need to come up with the quick solution to the issue.
It's going to have ripple effects across the country as other companies,
corporations, with any degree of religious orientation or beliefs may follows suit .

Mark Massel li: The majority decisions stated that this was a narrow
interpretation saying that only closely held for - profit companies could legally
refuse to provide contraceptive coverage. But there is still a majority of
companies across the country. So this dec ision could impact millions of the
women down the line.

Margaret Flinter: And there are other contraception related law suits that are
waiting in the wings , so I think they will take some win at their sales from this. So
the story is far come over and i t's going to be very interesting to see what
innovative solutions might fill this coverage gap that will result from the Supreme
Court decision, Mark.

Mark Masselli: Well, speaking of innovations, from time to time, we like to
spotlight young innovators who are poi sed to make an impact in health care
industry. And our guest today is recent White House Fellow, working in health
data and former entrepreneur - in - residence at the Mayo Clinic.

Margaret Flinter: Adam Dole, he is considered an up - and - comer in t echnology
and in the health care space. He has got some interesting ideas about how to
improve patient interaction with their owned health data; also , how to improve the
flow between the patients and providers through the medium of their electronic
health records.

Mark Masselli: Lori Robertson, Managing Editor of FactCheck.org . , looks at
claims about pubic health crisis of gun violence on the school campuses. But no
matter what the topic, you can hear all of our shows by googling CHC Radio.

Margaret Fli nter: And as always, if you have comments, please e - mail us at
www.chcradio.com or find us on Facebook or Twitter because we love to hear
from you. Now we will get to our interview with Adam Dole 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 these Healthcare Headlines. Fall out continues from the Supreme Court decision to allow private for - profi t
companies to deny certain birth control coverage to their employees. Across the
country, women employers, insurers, and health care advocates are trying to adjust of the new legal landscape created by the Supreme Court ’s decision
allowing some for - profit companies to deny contraceptive coverage to employees
based on their religious faith. As the real life impact of the controversial ruling, slowly begins to play out questions about its breadth, scope and meaning continue to be debated in the 5 / 4 [PH] dec is ion.
The High Court rule two family - owned corporations did not want to cover birth
control in their Employee Health Insurance Plans has required under the so -
called contraceptive mandate provision in the Affordable Care Act . The Obama
Administration wi ll likely have to issue regulations twe aking the contraception rule
to allow some employers to opt out and to enable their workers to obtain coverage in other way. The compromise arrangement that involves passing responsibility to an insurer , however , is considered unacce ptable by some
religious groups. While free birth control coverage is required under Obama c are,
the insurance administrators providing it for workers of religious affiliated groups
say the current solution is left them stuck with the bill .
In other women’s health news, the American College of Physicians has issued a major change to screening guidelines for women’s well visits suggesting that
pelvic exam is no longer needed. The evidence - based study done at the
Minneapolis , VA , found test to be intrusive and could lead to more harm for many
women undergoing exams. The recommendation does not apply to pregnant women and women undergoing treatment for medical issues. The American

College of Obstetricians and Gynecologists released a statem ent saying the
group would continue to stand behind its current guidelines that an annual pelvic
exam is recommended for all patients over the age of 21.

Prescription drug overdoses lead all other drugs in deaths including heroine and
cocaine combined and the problem has been getting steadily worse. But there
are some pockets of improvement. Public health officials have identified a sharp
decline in overdose deaths involving prescription pain killers for the first time in a
decade , d eaths involving O x y C o ntin , V icodin and other narcotic pain killers
d ropped by 26% over two years in Florida after a crackdown on pain clinics that
dispensed high volumes of the medications. Law makers there borrowed doctors
and these pill meals from selling the drugs they pre scribed. I am Marianne
O'Hare with these Healthcare Headlines .

(Music)

Mark Masselli: We are speaking today with Adam Dole , Recent Fellow in the
Presidential Innovation Program at the White House which seeks the best and
st
brightest minds in the 21 Cen tury , t echnology and innovations skills to transform
the way government works for the people at serves. Mr. Dole is the former
entrepreneur - in - residence at the Mayo Clinic, where he helped develop new
ventures at the intersection of health and technology to improve care delivery.
Mr. Dole has held leadership positions at NASA, Human Factors Research
Division as well as several strategy and innovation consulting firms: Jump
Associates and Method, Inc. He earned his bachelor’s degree from Syracuse
and his masters in Design Strategy from the California College of Arts. Adam,
welcome to Conversation on Health c are .

Adam Dole : Well thank you very much Mark and Margaret. It's a pleasure to be
on the show today .

Mark Masselli: You know, our show is about in novation s in health care arena,
and you have got the attention at the White House ’s innovator in the health care
space. And the program has launched in 2012 to address of lack of culture of
innovation and entrepreneurship at government, and tell us about th e
Presidential Innovation Program and the collaborative process you are engaged
in.

Adam Dole : Well, the number one misconception that I had about government
prior to becoming President Innovation Fellow was that government could not
innovate and didn’t have innovat ed people. And I was pleasantly surprised to be
show n that both of those assumptions were wrong. So the purpose of the
Presidential Innovation Fellow program is to pay our private sector entrepreneur s
with government innovators. And I though t that that was not (inaudible 06:56), I
didn’t know that there were government educators, and lone behold, there are,
and they are spread across the government through different agencies at all

different levels. And the whole goal is to use the projects that we work on in the
government agencies as the (inaudible 7:13) for change, like to create more jobs,
save taxpayer dollars and ultimately, having a positive impact on the lives of all
Americans. And coming from the private sector, it is very rare wher e the
expectation right out of the gate, any time you do something , it's to impact all
people in our country. And the thing that drew me to the program is really the
opportunity to work at a scale that it's kind of unparallel to anything else. And I
ment ioned a few qualities of the fellows. The first thing is like many
entrepreneurs wearing multiple hats is a necessity but not for the sake of just
being able to have a lot of skills but really funneling those skills into being able to
build something . An other quality of the fellows was our ability to shorten
feedback loops . S o entrepreneur s are tend to be really good at shortening
feedback loops to optimize for what’s working. And then the last is not being
able to take no from somebody who can't give y ou yes, and this is particularly
interesting in government because there is a lot of people that’s our in
government and luckily there are enough people with a sense of urgency to
explore new things that it's just about finding those right people. So ther e are
projects, a bunch of open data projects, which the goal there is to unleash
government data sets in a way that make it easy for the private sector to take
that data and do something useful with it. And I would put the project that I
worked on in tha t camp Blue Button which is really all about empowering people
with access to their own data which is a very different type of projects from just
the identified open data set.

Margaret Flinter: I would like to ask you to talk maybe about your approach to
that one of the projects the Blue Button initiative and to expanding it's reach. We
have had several guests on this show who have had a direct influence on
MyData also known as Blue Button, we have had Todd Park, (inaudible 09:07)
among them. So Blue Bu tton has been a tremendous success in certain areas
like the VA but still far for being utilized in the mainstream. What challenges did
you see with Blue Button and what solutions were you working on, did you find
what successes did you have while at the White House ?

Adam Dole : Well, I was fortunate enough to get chance there to work very
closely without all three, some of those talented entrepreneurs in resident at the
government. So to talk about the some of the challenges most people know that
Blue B utton was star ted inside the VA. Everybody at the VA was really focused
on making sure that veterans had access to their electronic medical records at
any cost. But the problem is when you go outside of VA, most of those
experiences do not allow their pa tients to freely h ave access to their own records
a nd I would put that reason on the cultural issues that our health care systems
still had. The idea that somebody can get it in a machin e read able form is v ery
threatening to these health care organizations because there is a spirit that your
patient access to their aide, they don’t know what to do with it. And so that’s the
cultural barrier that getting in the way of Blue Button reaching in it's full potential.
And I think it's – and so I see more healt h ca re organization getting culturally

enlightened if you will, and I think we are going to see even more of that as we
see a Healthca re Payment Reform starting to incentivize things like outcomes.

And before this year, Blue Button had really focused on data that was coming out
of hospitals. So most people’s interactions with the traditional EMR are fairl y
limited and not really guide engaging today. So we had a hypotheses coming in
the year that if we could position or reposition Blue Button to be more rele vant to
a consumer mindset where the consumers feel empowered where they want to
spend their money and how they experience the good that they are going to pay
for. And so we approach the retail pharmacy chain as a way to catch this
hypothesis that the ret ail pharmacy chain to have a great opportunity to impacts
on healthcare at local level. There is a lot of touch points inside that the
pharmacy that we could really leverage to get peo ple care about their own
health care data. And then medication manageme nt is a huge cost to the system
and a huge cost to individual outcomes. So when you add those three things up
looking at expanding Blue Button into the pharmacy realm made a lot of sense.
And we saw a really interesting objects and interest in how indivi duals can
experience Blue Button in those contexts but a lot of interests from other
businesses.

The second thing that we did was we help to facilitate the technology standards.
The government’s role in setting the standards to facilitate the process of
bringing the right stakeholders in a lot of private sector organizations to the table
to figure out what standards should be. And the standards has fall into two
buckets, the content standard so how the healthcare information is being
communicated and the n the second set of standard is how that information, how
that content gets transmitted. And then the third thing that we did this year, we
made it easier for consumers or patients to find their own data and then we also
made it easier for organizations t hat wanted support Blue Button and to be able
to do that. We did that through two products that we built this year because we
wouldn’t be able to call ourselves entrepreneur s in residence we didn’t actually
build something tangible. And so we built somet hing called the Blue Button
Connector which is online tool that is now run by Health and Human Services
that allows individual s to go search for where their data might exist across the
spectrum of data holders. And it allows them to basically go to a prof ile page, not
unlike Facebook for that organization, and understand what organization is doing
on their behalf as it relate to their data and what types of features and functions
are available with their data from that organization. And then allows them t o click
through to sign into their portal from that organization. The second product that
we built was something that we are calling Blue Button Toolkit with all the Blue
Button resources so that an organization can self - identify it, you can go on to a
to olkit and consume all the resources that we have and help them to promote
patients’ engagement and evangelize purpose at Blue Button .

Mark Masselli: You know, I want to get back to your sort of thought that we
needed to embed cultural e nlightenment into the health care industry that’s a

great concept. And certainly, it's a land of steady habits and none of them are in
the health industry at this point (inaudible 14:00). And we recently have to go
around with open enrollment in the insurance exchanges tha t human behavior
has limitations in navigating new technologies especially when it comes to
something personal like healthcare . I loved your – one of your qualities of
building things that people can use and thinking from our own advantage point at
our or ganization, we always tell people build things that are efficient, effective
and elegant. And I think when we talk about elegance, we are talking about
design because design is so important. So why I am holding my iPhone right
now it's got design and it really attracts people to it. I wonder just how you are
thinking and how the President Innovation Fellows are thinking about this
transformation again getting back to the how we embed cultural enlightenment
into the healthcare industry. Design is so much an important part of this because
it's needed to bring the crosswalk between patients and providers, providers back
to patients. What’s your bigger thought process about the transformations that
needed to go on in the industry and to truly try to transfo rm a really (inaudible
15:10) industry on so many different levels, what do you see out there that
excites you ?

Adam Dole : I do believe that d esign with a big “D” is one of the critical things that
has been absent in our healthcare system. It goes far b eyond the looking feel of
the product, but it's really thinking holistically and systemically about how we
match the products and services that we are building with the unmatched needs
of the folks that need to engage in that product. And it does involve at the level
of ecstatic as well but most healthcare experience s do not take the need of the
patients into consideration. They think they do. But when you really dig into
what a lot of the healthcare systems today set up to do it's solving healthcare
sys tems grow. And it's forcing patients to get on board with the value chain that
is ultimately serving the healthcare system which is why we have fee - for - service,
why the experience of your explanation of benefits is still terrible when you get it
in the ma il. I mean there is very little patient centricity in the healthcare system
today at scale. Design is absent largely speaking.

That being said, I think we are sitting at a meeting time in history to be an
entrepreneur in healthcare to actually looking t o put more design into our
healthcare system to ultimately impact people’s quality of life and costing system
and the quality. For the first time, there is an increasing push to create more of a
consumer experience and this is driven through the Health In surance
Marketplace . We have more healthcare consumers that are thinking like
consumers now than we ever had before. And that’s I think going to become a
crowbar for a lot of other things that will have to match consumer grade
experience s. The second th ing is that we are starting to recognize different ways
to align our incentives, growing number of ACOs out there that are really
incentivized to look at outcomes. And then ultimately, we are seeing a greater
emphasize on products conservative and tools t hat are designed to keep people
well. I think we are only going to see more of that happen, not to mention of it

increasing data liquidity that we are seeing, it's only going in one direction, more
consumers are going to have more access to their data in more flexible formats.
So when you all those things up , we are sitting at an amazing time.

Margaret Flinter: We are speaking today with Adam Dole, Recent Fellow in the
Presidential Innovation Program at the White House , and former entrepreneur - in -
reside nce at the Mayo Clinic where he helped develop new ventures at the
intersection of health and technology to improve care delivery. Adam, you have
now left the Presidential Innovation Fellows program. We know you have moved
on to a new venture, tell us wh at’s up next for you and what will you take with you
from these previous experiences?

Adam Dole : So I am going to be rejoining the company that I helped to co - found
when I was an employee at Mayo Clinic, and we started a company called Better ,
and Better is a direct consumer personal health assistance service. The thing
that I am most excited about is that Better is actively putting the human elements
back into the healthcare system. We are seeing a lot of human elements be
taken out of the system and r eplaced with technology . And I think the underline
assumption and philosophy of Better is to develop human relationships and solve
real human problems that saved people’s time and money and having somebody
that’s fighting for them on their behalf no matte r where they are in the healthcare
continuum and coordinate an entire experience to imagine having a healthcare
advocate that’s always fighting on their behalf no matter what the issues are
because we don’t have a system that really supports that stay. An d so it's
actually been since Better has launched a few months ago, it's been really
interesting to see the types of problems that people are coming to Better for and
also the types of problems that Better is able to solve for people that might not
have ev er realized that they had those problems, helping people save money on
a health insurance plan that they didn’t realize that they could be saving money
on or dealing with medical billing and other administrative things. These are
expectations that we shou ld in our healthcare system but unfortunately , there
aren’t that many services out there that are doing that. So that’s what I am most
excited about and then we will probably start optimizing for some of the markets
that we think have the highest potentia l to see value right now in a new model.
And a lot of people don’t know what a Personal Health Assistant could do for
them. Their website is www.gettingbetter.com . I encourage everybody to go
check them out a nd the company is doing a free trial for everybody right now so
anyone can go and be assigned their own Personal Health Assistant and see what a Personal Health Assistant can do for them.

Mark Masselli: We have been speaking today with Adam Dole, Recent Fellow in the Presidential Innovation Program at the White House . You can learn more about his work by following him at Twitter at Adam Dole or you can follow him at
www.gettingbetter.com

. Adam , thank you so much for joining us today in this
enjoyable conversation .

Adam Dole : Well thank you very much for having me on . I really enjoyed our
conversation as well .

(Music)

Mark Masselli: At Conversations on Healthcare , we want our audience to be
truly in the know when it comes to the facts about healthcare reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
www. FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that
aim to reduce the level of deception in U . S . politics. Lori, what have you got for
us this week?

Lori Robertson: Have there been 74 school shootings since the 2012 Sandy
Hook Elementary in Connecticut. That’s what the group every town for gun
safety said but we found the true number of schoo l shootings is less than half
that. The group lists includes accidental discharges of guns, suicide attempts
and incidents in which no party involves was affiliated with the school. President
th
Obama appeared the referenced to groups report on June 10 wh en he said that
school shootings have been “once a week”. At that point, there had been 78
weeks since the Sandy Hook shooting. Every time for gun safety clearly
explained it's a broad definition of school shootings at the bottom of it's report
saying th at any publicly reported incident in which a fire alarm was discharged
inside a school or on school ground counted as a school shooting, and that
would include assaulted homicides as well as suicides and accidental
discharges.

We consulted the Brady Campa ign to prevent gun violence which defines a
major school shooting as any incident in which “ The shooter was directly linked
to the school and at least one person was shot on school property.” Using that
definition to evaluate every town lists, we found th at as of June 10, 2014, there
have been 34 school shootings, not 74 since the shooting at Sandy Hook on
December 14, 2012. 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
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, tha t you would like
checked, e - mail us at www.chcradio.com . We will have FactCheck.org's Lori
Robertson check it out for you here on Conversations on Healthcare .

(Music)

Mark Masselli : Each week, Conversations highlights a bright idea about how to
make wellness a part of our commun ities and everyday lives. In the emergency
room or the ICU, clinicians are confronted with narrative [PH] unpredictable
medical crisis that sometimes can be challenging to diagnose. Most of these

clinicians are now communicating with colleagues via their smartphones often
sending images of the patients’ unique symptoms or chest x - rays to one another
to share diagnoses. ICU physician Dr. Josh Landy was noticing a growing trend
of image sharing via smartphones to crowd source second opinions from friends
a nd colleagues across the country. But he also was concerned about the
potential violation of HIPAA Regulations. So he developed an app for that . He
created Figure 1, a sort of Instagram for doctors in which images can be
de - identified but shared across a dedicated social media platform that would
allow input from clinicians within their network. Doctors are using the app to
communicate not only with colleagues within their hospital settings but around
the world where someone might have superior expertis e with a certain condition.
The app was recently used to share a chest image of one of the patients who
presented with the Mid - Eastern V irus , MERS . Dr. Landy says the apps get about
half million image views a day with about 80 million total views so far. He sees
the potential for this platform only growing as more young digital natives enter the
medical workforce. Figure 1 is a free download through Apple App Stores and
Google Play. A free downloadable app offering secured HIPAA compliant image
sharing among clinicians around the world to reduce the time it takes the zero in
on a diagnose by tapping the collective expert instantly. Now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare . I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

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