Dr. Indu Subayia, Co-Chairman of Health 2.0

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Mark Masselli: This is Conversations on Healthcare, I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Well Margaret officials are gearing up for the next round of open
enrollment under the Affordable Care Act. And while the transition maybe smooth for
some customers it could be confusing for others.

Margaret Flinter: That's right Mark, millions of customers who signed up for automatic
renewal during the first open enrollment are begging to get those renewal notices in the
mail already.

Mark Masselli: The Department of Health and Human Services has recommending that
anyone who purchased insurance through an exchange during the first open enrollment
should check to make sure they are current with all their informatio n. They also may
find plans that are more to their liking during the next round of open enrollment which
th
starts November 15 .

Margaret Flinter: And here is where it can get tricky Mark, it's the second open
enrollment season but it's the first renewal p eriod on the exchanges and it's the first
time the health subsidies will factor into to tax season.

Mark Masselli: And certainly they'll be help by health insurance navigators who will stay
busy during this open enrollment period. But the good news is ex perts don’t anticipate
the same insurance exchange meltdowns that occurred during the first open enrollment
and that's a positive note.

Margaret Flinter: Meanwhile all of this online interaction in the name of healthcare is a
relatively new phenomenon. Ma rk, health information technology is poise to become the
st
single biggest growth area in the healthcare industry as we engage in 21 century
practices a very rapidly evolving field.

Mark Masselli: In fact we're just coming off national health IT week where virtual
community of health information technology professionals and enthusiast got together
virtually to promote policies that will help the health IT landscape in the midst of rapid
development in innovation.

Margaret Flinter: Our guest today is at the forefront of this emerging discipline in
healthcare. Indu Subayia, co - founded Health 2.0 in 2006 when the idea of matching
web 2.0 concepts to healthcare challenges seem like something of a fringe idea. Nine
years later their work is clearly in the main stream.

Mark Masselli: Their global conference are noted for show casing the most innovative
ideas that are bound to have the impact on healthcare for the future, a great
conversation ahead.

Margaret Flinter: But no matter what the topic you can hear all of our shows by going to
chcradio.com.

Mark Masselli: And as always if you have comments please email us at chcradio.com
or find us on Facebook or Twitter because we love hearing from you.

Margaret Flinter: We'll get to our interview with Indu Subayia i n just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

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Marianne O'Hare: I'm Marianne O'Hare with these Healthcare Headlines. The Obama
Administration is engaging in fights on a number of fr iends globally with 3000 military
personnel heading to West Africa where the Ebola epidemic continues to spiral out of
control. With 2200 dead including many health workers and thousands more infected
beleaguered officials and NGOs on the ground have call for a global response to the
emerging crisis. The military personnel will coordinate logistical support to
overwhelmed healthcare systems and boost a number of beds needed for the growing
number of victims. This comes in the wake of concerns the out of control virus could
mutate into a more quickly transmittable disease.

There are many reasons kids in this country are prescribed antibiotics and although the
American Academy of Pediatricians has urged a rollback of prescriptions for things like
earaches o r colds apparently providers are reluctant to scale back on their prescribing
habits. According to a recent study while only 27% of ear and throat infections are
bacterial children are being prescribed antibiotics close to 60% at a time which
translates i nto about 11 million needless antibiotic prescriptions being build out each
year.

The numbers of uninsured Americans continues to go down in a wake of the Affordable
Care Act 3.8 million Americans gaining coverage in the first half of this year according t o
recent estimates from the Department of Health and Human Services. Meanwhile as
officials prepared for the next round of open enrollment under the ACA there's a new
marketing campaign of foot expect more testimonials from real people who gained
affordab le coverage and more hard information about important datelines that need to
be met to gain coverage and sustain it as well.

And while many providers remain skeptical of the healthcare law, their mood about the
profession is on the rise. Doctors are over extended skeptical of changes brought by
the federal health law but more optimistic about the future of medicine than they were
two years ago. That according to a survey of 20,000 US physicians 71% of those pole
said they would chose to become doctors aga in if they were making a choice today up
from 66% two years ago. And 50% would recommend it to their children compared with
42% in 2012. I'm Marianne O'Hare with these Healthcare Headlines.

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Margaret Flinter: We're speaking today with Dr. Indu Su bayia a Co - Founder and a Co -
Chair of Health 2.0 which promotes and showcases emerging health tech innovations
through a worldwide series of conferences price challenges and Code - a - Thons. Dr.
Subayia is a recognized thought leader in health innovation indu stries having earned
her MD at Stony Brook University School of Medicine and her MBA from UC Berkeley.
Indu welcome to Conversations on Healthcare.

Dr. Indu Subayia: Thank you so much it's great to be here.

Mark Masselli: You and co - chair Matthew Holt f ormed a Health 2.0 back in 2006. You
sort of describe this is pretty close to the fringe sort of an initiative and you held your
first ever health conference in 2007 and your first ever Health Hackathon in 2010 in a
few short years the intersection of hea lth and tech has become very much mainstream.
What was the genesis for starting the movement of applying web 2.0 concepts to the
healthcare space and who are the primary participants and stakeholders driving the
Health 2.0 experience?

Dr. Indu Subayia: S o if you recall all the way back to 2007 this was the year right after
Twitter launch it was the year the iPhone ---

Mark Masselli: Hard to believe that it's that short of a time -- ancient history now.

Dr. Indu Subayia: It is and it was the year we have the iPhone but we did not have the
app store. So this is either really, really early days in this new wave of web and mobile
technologies. And what Matthew and I notice at the time was that there were a lot of
social sharing going on among patients livi ng with diseases on the internet outside of
the traditional healthcare system. And they were using online communities much like
Facebook. And we thought that's really interesting that people are self - organizing in
healthcare outside of the mainstream hea lthcare organizations using social media. And
so at our first event a company called Patients Like Me, one of the very first online
patient communities that people with very, very serious conditions demonstrated as did
Google Health and (inaudible 7:01 ) f ederation. And (inaudible 7:03 ) sprit of the first
conference people using the web in new ways to connect with each other kind of

outside of the doctor's office and that's why we called ourselves more of a fringy
movement because this didn’t come, you know, from the hospital or from the health plan
it really keep from people.

Margaret Flinter: For those of us that are operating within the healthcare space the
share amount of new technology emerging into the market place can be pretty
overwhelming in its scope. How do you determine which technological innovations are
likely to have a significant impact on healthcare delivery or cost or outcomes. Maybe
you could share some of your success stories with us.

Dr. Indu Subayia: So we are looking at the sp ace now and following about 3000
companies in this early stage (inaudible 7:46 ). And it's staggering considering that at
our first conference there were maybe about 30 companies and we classify them into
categories based on stakeholder that they're servin g. And so a large number of
companies offered consumers spent many, many companies in this space are also a
tool to doctors, nurses, healthcare administrators, policy officials basically tool that are
using data lightweight technology those are our criter ia. So what we consider to be
Health 2.0 technology. Well one of the things that we need to take clear up a Health 2.0
is if we don’t actually place based on companies. We like to showcase what's new,
what's kind of pushing the envelope even if it's not quite making money yet really what
changing the game, what's going to make us see things in a new light. And sometimes
those companies don’t like more than a few years but they give us an example and they
certainly inspire others to follow on.

Mark Masse lli: You know, we've always been fascinated with Hackathon but for those
who dwell outside the tech innovation space what is the process like how does it
accelerate the process of innovation and product development?

Dr. Indu Subayia: So Hackathon sometim es just a one day event where programmers
gather in a room and people sub organized into teams to solve particular problems.
And by the end of the day actually have live working solutions which is really staggering
or something -- when I first saw it I re ally couldn’t believe how fast. So we find that
teams that have a patient on them those are the types of interdisciplinary teams that
really build the best solutions. So we'll have doctors in the room, we'll have people
living with conditions in the room and we let people select their own topic so at the start
of the day a few people will go up to the (inaudible 9:36 ) and say I'm working on, you
know, a solution for people movement disorder and I'd like to use the Xbox Kinect and
we've actually had this h appened in one of our event. And at the end of the day they've
used a gaming system to help people with movement disorders that's really everything.
And often they would go on to be real products and one example I'll give you is we were
in San Diego duri ng one of these -- with the department of health and at the end of the

weekend they hired the team as it built a mobile application for all of San Diegans to
follow their health and that team actually got a job at the end of the (Cross Talk)

Margaret Flint er: You've said that we're at this huge moment where we're now stacking
data from multiple sources and that the patients themselves are the source of that data
often with wearable devices, electronic scales. Your approach to designing for Health
2.0 is i n creating interfaces that work between this what you called data utility layers and
the health interface layers. Tell us more about this concept.

Dr. Indu Subayia: There needed to be a term that really encompass tools and
technologies that went beyond t he phone. And so we actually did a poll of the audience
and people voted on the term the health interface layer because if you think about it
today your car might be a dashboard that has sensors for your health. And so there are
platforms now in health t hat have the ability to aggregate data across millions of
records. So an example might be, you know, Samsung and Apple coming into
healthcare they reach millions and millions of folks and what would it mean to have data
at that scale. So we think of thos e platforms working side by side with the devices
answers saying in our environment that capture data and together that's kind of building
this ecosystem that we consider, you know, the boundaries of Health 2.0

Mark Masselli: We're speaking today with Dr. Indu Subayia Co - Founder and Co - Chair
of Health 2.0 a coalition of 85 chapters. Now in five continents that offer leading market
intelligence on new health technology companies. You and Co - Founder Matthew Holt
have spend some years in the health future s pace anticipating which technology stand
poise to have a the most transformative impact on care delivery. We were just out in
the west coast at a -- the first international meta project ECHO event. You've seen
Telehealth in action and tell us what tech i nnovations have caught your attention and
what needs to be done to spur our government policies to support of these
technologies.

Dr. Indu Subayia: I think we're looking at technologies that are low cost so I think the
role of a remote health and whether that's coming by the way of a kiosk. T here is now
many of these around the country involved, in public places that don’t have a health
professional attached, that's something that we find excitingly you can go and get your
vital signs done at a little station and that data is sent to a care provider. Also looking at
the category of non - invasive d iagnostic pet and an example that we just saw recently
coming out of New York was a device that kind of looks like a plastic, you know, water
gun if you will and you can hold it to someone's eye and within a few seconds get the
results of an eye exam that would actually in clinical trials comparable to that bulky
equipment you see at your optometrist office. If you think of eye disease around the
world it's a leading cause a blindness and these types of low cost technologies that can
be substitute in some cases for very expensive things that (inaudible 13:33 ) that’s very

promising . And there's also a new company called (inaudible 13:38 ) that has claimed
that it can from just a pin prick or just one drop of blood run a lot of the same lab test
that you now need to collect, you know, four and five tube s of blood that you go to for
your physical and that take days and days to analyze. And so I think they -- looking to
the category of lightweight diagnostic testing that can send the result to a provider who
is far away and get the answers back quickly that's going to change things a lot for a lot
of folks.

Margaret Flinter: Well I think we can take as part of the take on message on this the
world of apps is exploding. The world of wearables is exploding over a 100,000 health
and wellness apps currently on the market. And we all can see the benefit just from the
examples you just gave of using apps to help us make healthcare more accessible and
available. And it seem to me from whether I've read you are also becoming a bit of an
interface for developers and angel investors to facilitate this process of moving from
concept to market place. And tell us more about that, tell us about how does that
collaboration work in the global Health 2.0 community in terms of interface between
developers and investors they can really help take some of these potentially very
beneficial products to scale into market.

Dr. Indu Subayia: Sure and I think one of the trends we've seen most recently is that
people investing in the sp ace are not just financial investors but they are often providers
themselves or large technology companies. There's been a great increase in the
number of corporate investors in digital health technology which I think is very
interesting. So there are nu mber of different ways that Health 2.0 facilitate those
interaction s . We have events that actually are a little bit more fancy but speed dating
but effectively allow companies to meet with investors based on the criteria the
investors asks for. Often interesting partnerships and investment to come out of that we
find if we're more -- if we really prepare a pool of companies for investors ahead of time
and showcase the ones that really match their interest that's something that does
worked well. And also run a number of 6 and 12 months online challenges and so an
example might be a hospital that is looking to purchase the technology for its senior
citizen to help them decrease loneliness in home. An example right there with Palo Alto
Medical Foundation they put up money for the best companies that could solve that
problem and they then have a competition. They chose the winner that makes the most
(inaudible 16:17 ) for them, they award a small amount of price money and then they
pilot that technology. And so we find that this combination of smaller investment but
actual a ccess to piloting sometime it's just work better than a big amount of money
invested in an early stage companies that then takes years to figure out what it's doing.
So this concept of competition , platforms and early stage can (inaudible 16:43 )
changing things.

Mark Masselli: Always interested in how you spread this wealth of information you've
got a Health 2.0 conference getting underway in San Francisco later this month. Your
earlier conferences had just probably in a telephone booth but now you have thousands
who come and sort of a wide range I note that our good friend Eric Topol has come in to
be one of your speakers there. But talk to us about the themes this year and also is this
streamed out?

Dr. Indu Subayia: No we tried streaming it and you kind of have to mix experience with
that so I believe we're not streaming this year.

Mark Masselli: Okay.

Dr. Indu Subayia: But we wo rk very hard to make very accessible to anyone who wants
to come in if you are a patient it's actually free to attend He alth 2.0. If you're a startup
we offer a very, very (inaudible 17:35 ) configuration , so it's really meant to be an
inclusive conference for everyone. And we do post all of our videos online right after
the conference and there's a very active Twitter str eam that anyone can follow remotely.
And this year boy there is a lot to look forward to this year Dr. Eric Topol keynotes will
be one to watch. I'll be interviewing the President of Samsung Electronics, P r esident
Young Sohn will talk about their strategy in the space. The founders of MyFitnessPal
probably the largest platform now for soft tracking around the world , (inaudible 18:10 )
attendance in an interview on the first day. We're also having Bernard Tyson the new
CEO of Kaiser he I think has a strong imperative around underserved communities so I
think we'll be seeing that message coming out of Kaiser and as you know their model
for many health systems around the country so a lot of impact there. And there's going
to be a wearable fashion runway (Cross Talk) a fun experience people actually
modeling some of the technology from smart T - shirt to actually a pair of socks this year
that can track whether you're going uphill or downhill on your run , so we will be showing
that off. Qualcomm is likely to be a new type of wearable with possibly a guaranteed
[PH] attached to Medtronic is going to give you a new type of diabetic sensor that will
connect to a mobile technology. So that's always exciting in Health 2.0 , we launch new
companies every year more than ten with IBM is brin g ing Watson figuratively. And
Watson will not only possibly make the rest of (inaudible 19:17 ) but will also tell us how
it is solving the challenge of keeping up with journal articles, you know, a lot o f doctors
just don’t get to read as much as they want to about the scientific literature and Watson
is going to demonstrate how they can take (inaudible 19:32 ) humans a year.

Mark Masselli: No chess matches with Watson.

Dr. Indu Subayia: No chess right, right the unshared (inaudible 19:37 ) yeah it should be
a fun show.

Margaret Flinter: We've been speaking today with Dr. Indu Subayia Co - Founder and
Co - Chair of Health 2.0, a coalition of 85 chapters worldwide that offer leading market
inte lligence on new health technology companies. You can learn more about her work
by going to www.health2con.com and that's the number two. And you can follow her on
Twitter by going to Blue Topaz. Indu thank you s o much for joining us on Conversations
on Healthcare today.

Dr. Indu Subayia: It is wonderful to be here.

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 po licy. Lori Robertson is
an award - 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 birth control have become an issue in a few senath races across
the country. And some republican candidates are proposing the sale of oral
contraceptives or the pill over the counter without a prescription. The idea isn't new
reproductive health organization formed a working group to explore the issue a decade
ago. They support over the counter birth control pills as a way to increase access for
women. But congress can't make this happen instead it's up to a drug manufacturer to
submit an applic ation to the food and drug administration and the FDA to then review
and approve it. And when it comes to the pill there are many different brands and
formulations that would have to go through the same process.

In Colorado republican Cory Gardner has bee n pushing the idea and says over the
counter sales would make the pill cheaper. But it's not clear whether that would be the
case, the available research is mixed and it doesn’t specifically address the pill.
Research from 2005 found out of pocket cost d ecrease for antihistamine but a 2002
study found consumers cost went up for certain drugs that move from prescription to
over the counter status. Emergency contraception or morning and after pill went up a
bit in price when it became available without a p rescription.

Under the Affordable Care Act most private insurance plans are required to cover the
full cost of female contraception including the pill, sterilization, IUDs and more with no
cost sharing. What would happen if the pill were sold over the cou nter? Gardner's
campaign says he wants women to be able to be reimbursed through their insurance.
But that didn’t stop Planned Parenthood votes from saying in the TV ad that he wants
women to "pay for all of it" that's not what Gardner has proposed, and t hat's my fact
check for this week I'm 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 t he

University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com. We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health c are.

Mark Masselli: Each week conversations hi ghlight some bright idea about how to make
wellness a part of our communities and to everyday lives. In the emergency room or
the ICU clinicians are confronted with (inaudible 23:03 ) unpredictable medical crisis that
sometimes can be challenging to diagno se. Most of these clinicians are now
communicating with colleagues via their smart phones often sending images of a
patient's unique symptoms or chest X - rays to one another for shared diagnosis. ICU
physician Dr. Josh Landy was noticing a growing trend o f image sharing via smart
phones to crowd source second opinions from friends and 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 I nstagram 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 hospi tal settings but around the world
where someone might have superior expertise 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 virus MERS. Dr. Landy says the apps get abo ut a half a million image views a
day with about 80 million total view 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
secure HIPAA compliant image sharing among clinicians around the world to reduce the
time it takes to zero in on a diagnose by tapping the collective expert instantly, now that
is a bright idea.

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Margaret Fli nter: This is Conversations on Healthcare, I'm Margaret Flinter.

Mark Masselli: And I'm 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 t o you by the Community
Health Center.