Peter Speyer, Chief Data and Technology Officer at IHME

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Mark Masselli: This is Conversation s on Healthcare . I am Mark Masselli .

Margaret Flinter: And I am Margaret Flin t er.

Mark Masselli: Well Margaret , some interesting numbers have come in. A study
just released by Robert Wood Johnson Foundatio n in Athena Research Division
of Athena Health shows that d ire w arnings of long delays at primary care facilities
due to the millions of newly insured Americans simply have not happened under
the Affordable Care Act.

Margaret Flinter: It is an interestin g data set Mark and part of an ongoing
partnership to check the true impact of the Affordable Care Act., it’s called the
ACA view and the aim is to provide a non - person analysis of the actual effect of
the Healthcare Law.

Mark Masselli: I ts advocating re al time patient and provider experience data
from Athena Health large patient database . T hey provide a health IT system for
52000 practitioner s. They are measuring some 35 metrics overtime are able to
rely on real time data for research and analysis.

Ma rgaret Flinter: It’s sure there is no significant wait time added to the patient
experience for those seeking primary care or other ambulatory services. That
was the direct prediction that came from the (inaudible 1:06) of the Healthcare
Law and certainl y there were some experience of that in Massachusetts years
ago. So other interesting finding s in the report as well should be of interest to
anybody in the care delivery or health policy if you look at it.

Mark Masselli: And there is another interestin g matter to note that is the direct
results of the Healthcare Law, insurer seem pretty happy with the outcomes so
far since the n ation’s uninsured rate dropped from 18% last year to 13.4% this
year. That means millions more customers for insurance compani es and there
will be another wave of newly insured during the next open (inaudible 1:38) , w e
are not too far – it’s around the corner Margaret.

Margaret Flinter: Very interesting to see just how many opportunities the
Healthcare Law is providing for gath ering real metrics on Healthcare System
hopefully on outcomes too. And that’s bound to have an impact on the actual
delivery of care.

Mark Masselli: That’s something our guest knows quite a bit about today,
Margaret. Peter S peyer is the Chief Data and Technology Officer at the Institute
of Health Metrics Evaluation at the University of Washington.

Margaret Flinter: They have developed a ground breaking report on the
collective health of over 200 countries around the globe. It’s called the global
burd en of disease. It’s the most detailed report to date on the causes of poor
health and death by country. Let me talk in about some of the fascinating health
transit, their report is real.

Mark Masselli: We also have our weekly visit with Lori Robertson, managing
editor of Factcheck.org .

Margaret Flinter: And no matter what the topic , you can hear a ll of our shows by
going to chcradio.com .

Mark Masselli: And a s always , if you have comments , please email us at
info@ chcradio.com or find us on Facebook or Twitter , we love hearing from you.

Margaret Flinter: We will get to our interview with Peter Speyer in just a moment.

Mark Masselli: But first , here is our producer , Marianne O'Hare with this week’ s
Headline N ews.

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Marianne O'Hare: I am Marianne O'Hare with these Healthcare Headlines. The
Healthcare Law by the numbers. A 10.6 million people , that’s the number of
Americans , who sort some kind of assistance signing up for insurance under the
Affordabl e Care Act. Some 28000 assisters help to guide those 10 million plus
Americans through insurance exchanges. Those online portals set up by the
ACA to provide insurance at market place. Eight million folks signed up for the
insurance ultimately and anoth er five million included in coverage through
expanded Medicaid. Folks living in states that created their own exchanges were
most likely to find assistance as well. And insurers did pretty well too. The
Nation’s uninsured rate peaked at 18% last year af ter the roll down of the first
open at the moment that percentage dropped down to 13.4% meaning millions of
new customers for the insurance industry. Hepatitis C finally has a vanquisher
but the regimen is cost prohibitive in most cases. The State of Ore gon appears
to be nearing what could be a first in the n ation’s stats limiting availability to
Medicaid patients of new hepatitis C treatments that offer great promise that at a
very high price , $ 84000 for three month ’ s treatment. On July 31, the state
co mmittee will consider guidelines intended to limit treatment only to patients
who face serious liver damage without the drug. And women in Detroit have a
worse chance of surviving maternity than women in Libya, Uruguay, or Vietnam.
The maternal death rat e in Detroit is 3 times the national average and is going up
according to recent data. Those working on the front lines of maternal health are
helping initiat ives in the Affordable Care Act will get high - risk women into more
prenatal care sooner. Better news in the stroke front. According to a study
looking at 20 years data, the incidence of stroke is down about 50% over two

decades and death by stroke reduced by 40%. The decline being attributed to
better control to high blood pressure reduced smoking rates and batter care
protocols. The rise in diabetes however made negatively impact that trend
overtime. I am Marianne O'Hare with these Healthcare Headlines.

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Mark Masselli: We are speaking today with Peter Speyer , Chief Data and
Technology Off ice r at the Institute for Health Metrics Evaluation at the University
of Washington where he oversees the infrastructure for global and public healt h
data gathering from Governments around the world that lead to the ground
breaking report global burden of disease. Before that Mr. Speyer was director of
global marketing strategies for Corbus [PH] at digital imaging managing
company which oversees the rights to over a 100 million images. In his native
Germany, peter worked as a senior consultant at (inaudib le 5:36). Peter holds
MBA from Temple University and a masters of business engineering from the
University of (inaudible 5:43) , Germany. Peter welcome to conversations on
Healthcare .

Peter Speyer : Hi Mark. Thanks and hello Margaret. It’s great to be here.

Mark Masselli: You have been at the forefront of this new era of big data
analytics which is really transforming global health and at The Institute of Health
Metrics Evaluation you are responsible for managing vast screens of data from
around the g lobe which measures disease and causes of death and over a 180
countries and we were fortunate to have the director Dr. Murray on the show.
We are talking about the initial report of (inaudible 6:12) . Tell our listeners how
you help create the secure inf rastructure that allowed the report to come into be .

Peter Speyer : So the global burden of disease study is a really large and
complex study, incorporating lot of data from very many different sources, what
we are trying to do in this study is to analyze to what extent our health is
impacted by different disease and injuries and so we are trying to express in life
year equivalent how many years we are loosing to these diseases both from
premature mortalities about 55 million people die every given the yea r around the
world and so we are summing up for every death how many life years we are
loosing from those as well as how diseases that ail us but don’t kill us i mpact our
lives or how much our health is impacted by those. And so we are creating a
metrics called feasibility adjusted life which is our current (inaudible 7:0 2 ) for
measuring overall health loss. We have knowledge which to model where we
are annually updating these numbers, so the analytic work is done here at the
institute and then we are wor king with about a 1000 experts in 100 countries that
help us looks at the data. So we run the analysis for about 300 diseases , 69 risk
factors that impact these diseases , and we are looking at 188 countries . So we
have really tried to incorporate everyth ing. I need dataset that has information on
health outcomes around the world . We are working with Census Data, survey

sort of collected, diseases registries for example cancer registry exist in so many
countries and collect information about cancer , h eal th record data from hospitals ,
and c laims data from insurances . S o we are incorporating about 30000 different
data sources in this most current update of GBD. So we are comprehensively
looking through the websites of ministries of health and the statisti cal
organizations, NGOs and others. In many cases we have to directly contact folks
at those organizations and negotiate access to data because as you can imagine
health data especially if it’s very deep, health and has information on individual, it
is ve ry sensitive and so it is a constant balance of trying to get access to these
data and make them available for research.

Margaret Flinter: Peter certainly gathering the data was just one of the number
of very daunting tasks required to complete the proje ct in addition you had to
come up with some new tools in ways of using them to assisting the data,
analysis and maybe you could share with us what kinds of innovations in big data
analytics made it possible for you approach all this information and useful ways
that maybe couldn’t have been done in the past and did some of the new
analysis revealed surprises about the state of global health and crises of
mortality around the globe?

Peter Speyer : We are starting with measuring all cause mortality around the
world. That means is for every age group (inaudible 8:42) around the world and
what that means is for every age group in every country we are trying to identify
exactly how many people died in that given year from a given cause and then we
are analyzing which causes are responsible for these deaths . So once we have
analyzed causes of death, we go on to analyze how diseases that ail but don’t kill
us and we are looking at the prevalence of different diseases and then we look at
risk factors and then putti ng it all together and as you can imaging with the
number of datasets we are to apply various statistical methods and given the
number of datasets and the complexity of the analysis we have actually built that
our own computer class there was about 10000 n otes so 10000 computers stuck
together and still it takes 4 to 5 days to run the analysis beginning to end. So
with this current duration of GBD we really innovated on each one of these steps
and developed new methods and I would say given that in more re cent times
much more data became available and the methods that we are deploying have
much more sophisticated that we have impacted a lot of change in terms of how
we can do these analysis. Let it be fine. We over the past 20 years made a
huge progress i n terms of reducing mortality in children. There were about 10
million deaths in children 1990 and we reduced it to about 7 million in 2010,
which shows how we reduced infectious and childhood diseases. So the second
big finding is that we are living lon ger, and getting older but we are living those
additional years, not in complete health. And then the third big inside is we are
looking at r isk factors besides disease burden and in 1990 leading risk factor was
childhood malnutrition. So most burden in the world was still caused by
malnutrition and in 2010 that changed to diet as leading risk factor. So we went
from having two little food to eating too much and the wrong things. In the west

diet is actually responsible for what 14% of total burden now, followed by
smoking and overweight. And we just recently unreleased the study on obesity
and overweight and shows that about 30% of the world population is overweight
or obese and in the US this number is actually 50%. So lots of these insights are
real ly instinct both on the disease side and the risk factor side.

Mark Masselli: Peter brings us the interesting intersection still daunting to be in
the Healthcare Industry. We have these rims of data, vast bodies of knowledge
and health information, but how do we access all the data? What do you plan for
disseminating all this complex health data that would make it user friendly to
improve health policy and practice?

Peter Speyer: So the GBD result is an extremely and complex and large data
set. We ha ve about a billion data points just in terms of results. And then we are
trying to make these results available to very different audiences, right. We want
other researchers to pick up our work and improve on it. We have often
addressed policy maker and decision makers, you know, the see suit at NGOs
and companies to use the aid for decision making. But then we also want to
reach you know, the casual user or general audiences that can use this
information to understand better how health is impacted arou nd the world. So
what we are trying to do is tailor kind of presentation of these results to the
different audiences and using very different mechanisms. So for one as I said all
the message that we are using for GBD are published in pre - reviewed papers so
reaching journalists through papers like the (inaudible 12:04) health analyst.
Then we are writing detailed reports both on how we did the analysis and in
some of the key insides and findings that we have from the study. We are going
to conferences t o present our findings as well as policy workshops to help policy
makers interpret and use these results correctly. The game change and the
biggest innovation in terms of outreach are these interactive data of
visualizations that are now available on our website, which is at health data .org.
Because those really make all the data available from a very high level of view to
a very elastic view of details and it basically allows our audiences to dwell into
the level of detail that they are comfortable with and so, what we are trying to do
is make these into it is enough that people can explore our data set, look at
patterns, look at trans across, you know, across country as well as in a given
country and our flex of visualization GBD compare uses very many different
visuals that you can then use in combination to re - dive into the data sets and its
typically , people spend, you know, minutes on websites at best and use it for
GBD compare rages between 30 minutes and an hour on average. So, people
are really g etting into the data and into interacting with these data and exploring
them and then last but not least, we have launched a platform called the global
data exchange and here we are cataloging all the input data as well as the result
data sets, to make it easy for other s that want to is similar analysis and then
basically obtain and work with these data themselves.

Margaret Flinter: I have a feeling that some one out there is taking your research
and now marrying it up to what we think of the social deter minants of health. The
poverty in a country or the educational level of attainment in a country, and I am
curious if you have seen and used in that way to drive policy change within the
ministries of health with countries around the globe and if there are an y examples
you might share whether report is being used to drive policy change.

Peter Speyer: So we are looking at social determinants as information in terms
of estimating health so we have a large database of things like to access to water
and sanit ation , e ducational status, income per capita and so on. In terms of
usage, we get a lot of interest from around the world. So we see on the website
that we have users from 200 plus countries and we have specific examples like
the Government in the UK tha t saw the results of our study and wanted to dive
deeper and look up nationally how different populations within the UK are
affected and so we have launched a project with them to go into more detail
there or the minister of health in Rhondda [PH] contacte d us and saying that
these visualizations are so useful that they are having recurring meetings where
they go through these and use the evidence that we have put together for the m
and those are just 2 examples, I mean there are so many more where we direct ly
engage with folks at ministries or nonprofit foundations across the UN and so on,
that we know, use our data, and interact with our tools and interact with our tools
and really use them in their day - to - day work to make decisions.

Mark Masselli: We are speaking to Peter Speyer chief data and technology
officer at the institute for health metrics evaluation at the university of Washington
where he oversees the infrastructure for global and public health data gathering
from governments around the world, w hich lead to ground ranking report, global
burden of disease and here we have entered this era of quantified staff where
patients are increasingly seeking information on whether it is on their genu or
tracking vital signs or wearing fit beds, what is your advice to practices as they
think about how to manage this generated information by individual s that might
help facilitate the two way flow of information , obviously the mobile phone being
able to bring people to new realizations about their own health?

P eter Speyer: This is a phenomenal trend and it is really interesting to see how it
is catching on really across the world. I myself I am tracking you know, activity
level, food intake, workouts and so on. And as people doing this more and more,
I think, this is really useful information at many levels. Actually physicians should
be using this. I mean, I should be able to with this to my doctor and let him or her
know about this data and they should use it for helping manage my health. I
think the probl em we are still seeing is that physicians come back to that with
answers that range from all that is so interesting, let’s have a look all the way to I
have where to put this in my system, so I think there is still this divide where now
we, have all these tools to collect all these data, but there is really no good
streamlined way of getting that into the day - to - day Healthcare System. I think for
now there is a lot of the burden on the individual , it’s kind of try and use these

data, obviously it is very u seful to track your activity. I myself, I am motivated to
move more and workout more because now I have a track record of how well I
actually did this. And that’s very useful tool for individual s to bring together all
the health data in one place like to have mixed of health law that has been
around for years that allows you to pull in your health record information and then
now increasingly data from these devices. But on the flip side, I think we will
need to be careful to look at, where do these resid es and how can we really
move across the health system as well as then make them available for analysis
right? And then maybe to take one step back, obviously these data are also very
important for analysis at the population level like we do GBD. So stat istical
activity is one of the risk factors we are tracking and getting more information
abut individual s and how active they are and getting these information is
somewhat streamlined way would obviously be hugely beneficial and make our
life easier, but w e are not quite there yet.

Margaret Flinter: Well Peter I think it so important that in addition to looking to
mortality and causes of death , it is the project brought into really look at the
chronic conditions have such a profound impact, I understand t hat you have
launched a price to improve public health by turning evidence in the global
burden of disease into successful programs that impact the public health
challenges which are so associated with these, which really are global epidemic
of chronic ill ness tells abo ut that pricing what you are hoping to accomplish.

Peter Speyer: We launched a price last year and it is called the root price on
tuning evidence into health impact. So this price was initiated and funded by
day (inaudible 18:17) with is a board member at the institute for (inaudible 18:22)
and it is basically promises a price of 100 thousand dollars for an organization or
an individual that use data from the GBD to impact health for a population. The
importance of this goes much beyond thi s, where we are trying to get all these
entries and examples of how people are using health data and we plan on
spreading information about these to inspire others to begin to collect all these
examples of how people are turning evidence into impact and re ally making a life
better for people around the world and then spreading examples and hoping that
others will use it as an example to also use more health data, use more evidence
to base their decisions on.

Mark Masselli: We are speaking today with Peter Speyer Chief Data and
Technology Officer at the Institute for Health Metrics Evaluation at the University
of Washington. You can learn more about of his work by going to healthdata.org.
Peter thank you so much for joining us on conversation on Healthcar e today.

Peter Speyer: It was my pleasure. Thank you very much.

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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 awa rd - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit 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 politicians from b oth parties are continuing to make false
claims about Medicare in an effort to scare seniors. In the Kentucky Senate and
add from democratic candidate Allison (inaudible 19:57) features the retired co -
m ine r who asks how senat or of Mitch McConnell could ha ve voted to raise its
Medicare cost by 6000$ but McConnell did no such thing and neither did any
other republican law maker. The claim is an old one about the 2011 budget plan
proposed by Representative Paul Ryan. It called for phasing out traditional
Me dicare and gradually replacing it with a premium support system of
government subsidized private insurance. A non participating conventional
budget office did estimate at the time that anyone enrolled in this private plans
would pay about 6000$ more in 20 - 20 and they would have under the client
system, but the retired co - miner in the add would have been affected by the plan.
He and anyone else aged 55 and older would have stayed on traditional
Medicare. More important Ryan has made scheduled changes to h is proposal
over the years and the model that he now supports, could produce savings for
seniors according to another CBO analysis. In addition, CBO says that its 2011
estimate was based on assumption about healthcare standing that turned to be
incorrect and it’s modeling of seniors and ensures behavior has improved.
Mc Connell responded to Ryan’s add with a misleading one his own, claiming that
the Affordable Care Act “touched $700 billion from seniors Medicare.” The bill
doesn’t slash 700 billion from t he current budget if it cuts in the future growth of
spending over a decade and the reduction of the price payments of hospitals and
other non - transition providers. Also that same 700 billion dollar in cuts is part of
the Ryan Budget Plan that McConnell v oted to consider. And that’s my fact
check for this week. I am Lori Robertson managing editor managing editor of
Factcheck.org.

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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 you have a fact that you would like
checked, email us at chcradio.com . We will have FactCheck.org ’s Lori
Robertson check it out f or you here on Conversations on Healthcare .
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Margaret Flinter: This is conversations on Healthcare . I am Margaret Flinter.

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

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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.

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Margaret Flinter: Each week conversations highlight a bright idea about how to
make wellness a part of our communities into everyday lives. It is a known fact
that the current generation of American children is more obese than any previous
generation. And at Washington DC Community Health Center, Unity Healthcare ,
a pediatrician was in a quandary over how to tackle this growing health serge.
He began with the unique solution targeted to a teen patient whose body mass
index or BMI had already landed her in the obese category, what he did was
write a prescription for getting of the bus one stop ear lier on her way to school,
which mad her walk the equivalent of one mile a day Dr. Roberts Zaire of Unity
Community Health Center understood without motivation to more, kids just might
not do it. The patient complied with the prescription and has move fro m the
obese down to the overweight category, certainly an improvement. He then
decided to expand this program by working with the DC parks department,
mapping out all the potential walks and play area kids have within the cities’
parks mapping 380 of them are.

Dr. Roberts Zaire: How to get there? Parking? Is parking available if someone
is going to drive? Bike racks, there is a section pets, park safety. Dr. Zaire rates
park prescriptions on special prescription pad in English and Spanish with the
wo rds Rx for outdoor activity and schedules like this. When and where will you
play outside this week? I like to listen and find out what it is my patient’s like to
do and then engage the parks that I prescribe based on their interests, based on
their sche dule, based on their things they willing to do. Ultimately Dr. Zaire says
with some 40% of his patient population grappling with overweight or obesity, he
wants to make the prescription for outdoor activity adaptable for all of his patients
and adaptable for pediatricians around the country. He plans to create an App
for his parks database where providers and patients alike can use it and one day
he would like to be able to track his patient’s activities in the parks. Rx for
outdoor activity pertinent cl inicians, park administrators, patients and the families ,
to move more yielding , fitter and healthier young people. Now that’s a bright
idea.

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

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