Connected Health Expert Dr. Joseph Kvedar of Partners Health on Potential Impact of Technology on Caring for Aging Population

Dr. Joseph Kvedar – VP of Connected Health at Partners

[Music]

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, Open enrol l ment is official underway for those
seeking to purchase insurance under the Affordabl e Care Act . We want to
remind people who have purchased insurance on the exchange in previous years
t he process is essentially the same as it’s been in years passed except for the
short en enrol l ment period.

Margaret Flinter: Here in Connecticut, a State that created its own exchange , the
states around the country that rely on the federal exchange their residen ts go to
a federal website www.healthcare.gov , d on’t forget December 15 is the deadline
on the federal ex change.

Mark Masselli: You only have six weeks to sign up for coverage and if you miss
the deadline, you’ll miss the chance to gain coverage for 2018.

Margaret Flinter: And a number of hospital and medical associations are
concerned about what is most likely going to be an increase in uninsured
Americans this year and that will be to an increase in uncompensated care in the
Nation’s hospitals and loss of access to primary care and preventive services.
Most Americans who sign up get some kind of subsidy to offset the cost of
purchasing insurance.

Mark Masselli: Our guest today is someone who has been on the forefront of
taking healthcare into the 21 st century with connected health technology . Dr.
Joseph Kvedar is the founder and director of the Centre for Connected Health at
Partners HealthCare in Boston.

Margaret Flinter: And he has come out with a new book, ‘ The New Mobile Age:
How Technology Will Extend the Healthspan and Optimize the Lifespan ’.

Mark Masselli: Lori Robertson always stops by , the Managing Editor of
Fact Check.org, but no matter what the topic, you can hear all of our shows by
going to www.chcradio.com .

Margaret Flinter: We will get to our interview with Dr. Joseph Kvedar in just a
moment.

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

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Dr. Joseph Kvedar – VP of Connected Health at Partners

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines.
November 0 1 the first official day of open enro l lment for coverage during the
2018 calendar year , lot of Americans maybe confused about the Affordable Care
Act this year after so much effort in Congress to repeal Obama c are and the
current administration has made moves to underline some of the ACA stability.

President Trump slashed the enrollment period in half , c onsumers must sign up
for coverage by December 15 on the federal exchange or lose out on being
covered for the next year. They could purchase insurance elsewhere at a
greater cost and without the tax subsidies and other pr otection such as coverage
for the essential benefits. Auto enrollment kicks in December 16, the day after
this year’s open enrollment closes on the Federal exchange that could leave
those consumers out of luck for the following year .

And be very wary of businesses offering cheap short term plans , s uch plans
often cover very little and will not cover such things as the essential benefits
covered by the metal plans in the Affordable Care Act . In the State of Maine
where the Republican Governor denied the e xpansion of Medicaid to cover more
of the State’s poor population there is a movement of photo [PH] referendum on
this month’s ballot override Governor Le Pa ge’s refusal to expand the federally
funded health plan . About 80,000 Maine residents would become eligible for
coverage under the Medicaid expansion measure if it passes in the upcoming
vote .

New Jersey is joining a number of other states o f Municipality suing Purdue
P harma the maker of the Opioid Oxycontin saying the company heavily pushed
the drug o n the medical community knowing the highly addictive nature of the
drug . New Jersey Attorney General said , Perdue d eceive d doctors and patients
in to believ ing O xycontin could treat chronic pain over the long term as an
alternative to things such as Advil and Tylenol . P erdue has faced similar lawsuits
by at least nine other U.S States, several cities and Counties too. I am Marianne
O’Hare with these Healthcare Headlines.

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Mark Masselli: We are speaking today with Joseph Kvedar Vice President of
Connected Health at Partners HealthCare which seeks to create a new model of
care using Information Technology to move care from clinician ’s office to the
Patient’s lives . Dr. Kvedar is Program Chair for the Connected Health
Conference, h e is also a Board Certified Dermatologist and associate professor
of Dermatology at Harvard Medical School . Dr. Kvedar is the founder of
Healthrageous a health tech entity focus ing on supporting wellness. He is the
author of numerous articles and books and connected heal th including his latest
‘The New Mobile Age: How Technology Will Extend the Healthspan and Optimize

Dr. Joseph Kvedar – VP of Connected Health at Partners

the Lifespan ’. He received his MD at the University of Vermont College of
Medicine. Dr. K vedar , welcome back to Conversations on Healthcare .

Dr. Kvedar : Delighted to be with you.

Mark Masselli: Yeah , yeah , congratulations on another successful Connected
Health Conference . This year’s conference theme was the ‘life journey’ which is
also an important theme in your latest book ‘The New Mobile Age ’ and yo u make
a strong case for how health technology is going to make it far easier to address
the complex health needs of an aging population. In fact you have called the
21 st century I really like as this century of health span vs. l ife span , and I am
wonderi ng if you could share with our listeners what do you mean by that.

Dr. Kvedar : Over the 20 th century through Medical breakthroughs we added 25
years to our life span if you can believe it , so my father died in 2008 , he was 88 .
But what we haven’t really thought about is how we can harness those extra 25
years and add value back to society for each of us as we live into those years .
We tend to think about once you had 65 , well s ort of , maybe a few extra dollars
called social security and health plan cum Medicaid and pet you on the back , and
we have to bring those 25 years back into focus as productive healthy , happy
phase of life.

Margaret Flinter: Well you and your colleagues at Partners Center for Connected
Health have been working on some of these te chnology interfaces for quite a
number of years now . And you’ve had time to learn particularly from some of
these interactions with whole monitoring of patients w hat’s worked well and
maybe not so well and I think we all know it’s also about engaging pati ents and
making it easy and satisfying for them. So are there technologies that you found
are really more effective and what emerging technologies now look poised to
help advance thi s kind of connected health system?

Dr. Kvedar: Well the combination of wearable’s or sensors that allow us to
create dat a feedback loop s are an important part of that , and most people can
figure out how to buy something at Best Buy and connect it into their network so
they can get a reading of some component of their health t hat’s measurable .
And those forms of foundation for what you are talking about in terms of how we
better equip people to manage their own care in the privacy of their home as
opposed to having to travel to the hospital for everything , t he second component
of that is the engagement . So while feedback loops are important knowing your
blood pressure, keeps it top of mind, knowing your step, count allows you to
make certain maybe adjustments in your day so you might walk a little bit farther
and make those 10 ,000 steps. But over time we find that the actual numbers
kind of fade into the background if you don’t have some kind of engaging system
on top of that .

Dr. Joseph Kvedar – VP of Connected Health at Partners

And so we spen t a lot of years learning that and working with engagement and to
the point now where we have a whole design team now that designs very
specifically in collaboration with consumers and patients so that we design things
that are sticky and meaningful . And we still shamelessly from other industries
that have already figured out how to keep y ou glued to your phone ; s ocial
networking, gamification , all those things and so if you combine the feedback
loop with some sort of engagement tool that keeps you focused and engaged on
achieving goal you can actually inspire people to improve their own he alth.

We talk about some of this in our book , one of them is tools that allow a
computer to recognize the tone of your voice just simply the tonal signatures of
your voice and predict things about you. One company called Beyond Verbal out
of Israel showe d that people who are about to have a heart attack have a certain
vocal signature that they could pick up by computer and predict that [Inaudible
00:08:42 ] cardiac event , a nother company in Boston Sonde is doing similar kind
of work to predict emotional st ate. So when you think about voice, you can think
about facial recognition that’s becoming very very powerful .

And then the other technologies that I would throw in are all those tools that allow
us to extend our caregiving to a one - to - many model. We ar e running out of
young people to give care to our older folks by 2050 twice the number of people
will be over 65 as under five we are getting this lopsided demographic around the
planet. So the technology such as the Hasbro , Joy For All Companion which is a
$99 toy that’s designed to look like a cat or a dog but has a little artificial
intelligence engineered in it. And it becomes a very important interim companion
for your mom and dad that you can ’t visit and spend every day with , if you mix it
too up yo u can start to see how we can extend ourselves across many
individuals.

Mark Masselli: And I want to pull the thread a little on that fast growing senior
population that are living longer but the burden of c hronic diseases is growing
significantly as wel l. 30 million Americans have diabetes and there are 89 million
waiting in the win g s with pre - diabetes and we talked a little bit about technology
and the role it can play . And also there has just been this remarkable discovery
over the last couple of yea rs around gene editing the whole genetics field , h ow
do you see the interplay with the new discoveries that we ’ re finding daily now it
seems in the genetic world?

Dr. Kvedar: One of the first things I learned in college it was the idea of genotype
and ph enotype and so -- which leads to traits that we can observe how you look,
the color of your eyes, the color of your hair . These days of course phenotype is
much more than those things, things like how many steps you took today, your
mobile phone tracking your location data , m aybe the number of texts that you
sent to , the number of emails you sent, there is an indicator of your mood . So
with all these phenotypic traits that are simply coming off of your body by either

Dr. Joseph Kvedar – VP of Connected Health at Partners

wearable’s of the use of your mobile d evice we have a much more rich way of
really getting a unique digital signature for each one of us.

And the genotype part simply gives us a foundation for saying , if you were born
with this set of genetic information, you may be at certain higher risk for certain
conditions and we know that early on we can start to change the way we interact
with you and your family so try to prevent those things from happening . You
might be at higher risk for obesity because you have a satiety [PH] a set point
that’s off and we can start to help you deal with that . So the other way to think
about is they are both really important inputs into a big data equation or a
machine learning that gives us the unique signature of each one of us that we
can then use to promote heal thier behavior.

Margaret Flinter: Well Dr. Kvedar , there is so much that is changing and the
Connected Health Conference does a great job always bring it to the forefront ,
c ertainly the vo ice recognition technology like A lexa . I have heard many sort of
features say we ’ re going to in healthcare look back on our current time as maybe
the era of when pharmacology ended up being at the root of so much of what we
do and that the non drug interventions will really begin to mo ve to the forefront
treating certai nly some of the physiological and also the psychological and
behavioral problems like depression and PTS D using technologies like virtual
reality , maybe just talk with us about some of these technologies and how likely
they are to become widespread and inc orporated into the health system of the
future?

Dr. Kvedar : Well that really is where we are at the groundbreaking of many of
the concepts that you alluded to , o ne of them is now being bandied about as
digital therapeutics which simply means that softwar e when pro perly appl ied can
impact healthcare in some cases better than a chemical therapeutic. We have
seen this in diabetes with walking tools to encourage walking behavior , we have
seen it in teenage asthma where we created a Facebook group for teenage rs
with asthma and their asthma improved just by them being together on a social
Facebook group . So some very powerful stuff and a number of companies
bandied together to form something called the Digital Therapeutics Alliance
because they are all so exci ted about this future where not everything is cured by
a pill.

The business margins of pharmaceutical companies are high , they are -- not
surprisingly their businesses are fine - tuned to a certain way of doing business
and it involves discovery of new mole cules and then getting them into the market
place . And so for them to sort of change their model and start to be software
provider as opposed to chemical therapeutic providers I think we are ways off
from seeing that , but that’s certainly is a future . An d maybe there is just whole
new group of companies like Omada Health and others that are going to be in
the lead for new solutions that are disruptive to the pharmaceutical industry.

Dr. Joseph Kvedar – VP of Connected Health at Partners

Mark Masselli: We are speaking today with Joseph Kvedar , Vice President of
Connected Health at Partners HealthCare which seeks to create a new model of
care. Dr. Kvedar is the author of ‘The New Mobile Age ’ . We have had a number
of folks on the show who have been talking about empowering the patient e -
patient Dave and other s. We were just sort of referencing that you know we are
sort of in this digital therapeutic environment and not everything can be cured by
a pill . And obviously we need to have engaged patients , and I wonder you can
talk about that role of engaged patie nt and how we must enhance the health
system to better support that participation and what are you doing around that
area to vitalize this important element of their own healthcare?

Dr. Kvedar : Well it’s a really interesting conundrum because I am sure y ou have
heard that about 5% of people cost the system about 50% of health care cost
and most of those people have tragic complications like mental health or
substance use disorders and other determ inants of health maybe they are
homeless so they have chall enges with basic daily living . And so for them the
idea of tracking their steps or something it's the last thing they are thinking of ,
they are much m ore struggling with the basic Maslow's hierarchy of needs . And
we spen t a lot of energy as an industry t rying to create programs to keep them as
healthy as possible and help them with the help that they need.

The flip side of that 5% is , well I don’t know about 30 % or 40% of people who are
motivated to be healthy and getting back to what I said about wearab le’s earlier ,
that particular segment is the kind of segment that’s made Fitbit a public
company and allowed others to flourish in this era where monitoring something
as a feedback loop. If you are internally motivated yourself you don’t need that
motivat ional overlay that I talked about earlier because you want to be healthy . I
am a perfect example of that I have been using a Fitbit since it came out and I
am quite aware of why I use that tool and how I can use it to help me stay more
active. So it’s re ally the segment in the middle that we have I think the most
interest in because people could frankly go in either direction they could -- those
are the people where anything we can do to engage them and support them and
get them more in the driver seat of their own health , t echnology , particularly
mobile technology and mobile apps play a really important role in that.

Margaret Flinter: Well Dr. Kvedar , we haven’t touched on something that I think
is also poised to -- perhaps have a huge impact on health moving forward and
that’s Precision Medicine . In your book you touch on the ambitious Precision
Medicine Initiative underway the National Institutes of Health the All Of Us
Campaign something that we are engaged in here in our organization . And it
seeks a million part icipants who really reflect the enormous diversity on every
level of people in Am e rica and ask them to share their personal g e n o m ic health
lifestyle data to fuel large research protocol to better understand the impact and
the role of all thes e elements in health . So would you be so kind to just touch
upon the premise of the All of Us Campaign and you know what your thoughts
are on whether this is something that will help us scale up our understanding of

Dr. Joseph Kvedar – VP of Connected Health at Partners

how to diagnose and treat and most impo rtantly maybe prevent disease in the
future?

Dr. Kvedar : Well it’s an incredibly ambitious project and my heart goes off to the
people who envisioned it Eric Topol and colleague s sold it to the Government
they brought Eric Dishman who is a fabulous guy a nd so the reason it's so
exciting is because if you got a million people to participate these days in
anything the way all of these new data systems work which called deep learning
machine learning artificial intelligence they have one thing in common whic h is
the more data you feed them the smarter they get. So if you got a million people
with a million different kinds of things then you are able to create a data model
i.e. categorize them and feed them then inevitably that computing infrastructure
will b e coming up with associations that we didn’t know existed . And they will be
able to say , like I said earlier the idea that , well people are about to have a heart
attack who have a unique vocal signature , it will be something like that it will be
probably 50 or 100 insights like that where we’ll say well did you know that if you
have these characteristics we can predict that you might have this outcome and
that will be really powerful for us , so incredibly exciting stuff.

Mark Masselli: We are speaking today with Joseph Kvedar Vice President of
Connected Health at Partners HealthCare and co - author of the book ‘ The New
Mobile Age : How Technology Will Extend the Health s pan and Optimize the
Lifespan ’ . You can learn more about the book by going to
www.newmobileage.com and you can follow his work by going to
connectedhealth.partners.org or follow them on twitter @jkvedar. Dr. Kvedar ,
thank you for the important work you are doing and for joining us again on
Convers ations on Healthcare .

Dr. Kvedar: Really delighted to be with you today.

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Mark Masselli: At Conversations on Health c are, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertso n 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 U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: President Donald Trump says that branded prescription drugs
are generally cheaper outside the US , and that’s true , but he distorts the fact
when he says “ As usual the world is taking advantage of us ” , prescription drug
pricing expert say Trump’s complaint is with ph armaceutical companies and US
legislators who balk [PH] at such cost controlling measures as having the federal
government negotiate drug prices for Medicare . Trump made his comments on
the cost of prescription drugs during a cabinet meeting on October 16 , he said

Dr. Joseph Kvedar – VP of Connected Health at Partners

the US is paying prices that are double, triple, quadruple what other countries
pay . One expert told F ackcheck.org that branded prices on average are between
10% and 40% higher in the US compared with other industrialized countries.
Another thi ng to note is that this comparison doesn’t include cheaper generic
drugs which make up about 84% of prescription in the United States.

As for Trump’s claim that the world is taking advantage of the US , experts told us
the US is the one that’s responsible for high cost of drugs not other countries .
Most other developed countries have a centralized health care system that
allows the government to negotiate drug prices with the pharmaceutical
companies not the US . In fact a Medicare drug law passed in 2003 specifically
prohibited Medicare from negotiating prices with drug companies . Law makers ,
most ly republicans have resisted the idea , some say price controls would limit
research and development . Research found that drug companies spen d much
less on R&D th an steeper prices in the US could be potentially fund. Trump said
he wanted to “ Bring our prices down to what other countries are paying” but he
didn’t say what measures he was supporting to do that . And that’s my F actcheck
for this week , I’m Lori Robert son, 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 fa ct, 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.

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Mark Masselli: Each week Conversation s highlights a bright idea about how to
make wellness a part of our communities and everyday lives. Pregnancy is
normally an exciting time for most women but according to the research an
estimated 10% of prenatal women experience some kind of depression d uring
their pregnancy and many are reluctant to treat their depression with medication
for fear of harming the fetus.

Dr. Cynthia Battle : In fact a higher percentage are experiencing lower grade
depressive symptoms , and left untreated those mild to moder ate symptoms can
progress in some cases lead to a more serious postpartum depressions.

Mark Masselli: Dr. Cynthia Battle is a psychologist at Brown University with a
practice at women’s and infant’s hospital in Providence . She and her colleagues
decided to test a cohort of pregnant women to see if a targeted prenatal yoga
class might have a positive impact on women dealing with prenatal depression.

Dr. Cynthia Battle : That was a typical kind of Hatha Yoga breathing exercises
meditation and we enrolled 34 women who were pregnant who had clinical levels

Dr. Joseph Kvedar – VP of Connected Health at Partners

of depression and they would come to classes and we measured their change in
depressive symptoms over that period of time.

Mark Masselli: Not only were women able to manage their depressive incidents
the y also bonded with other pregnant women during the program and found
additional support from their group.

Dr. Cynthia Battle : And the initial signs from this research are really
encouraging , so we found that women on average were reporting that they were
reporting much less.

Mark Masselli: A larger study with controlled groups is being planned with the
assistance of the National Institute of Mental Health.

Dr. Cynthia Battle : Women who are depressed during pregnancy unfortunately
do often have less id eal birth outcome , so one thing we're interested in seeing is
when we provide prenatal yoga program can it improve mood and then can we
even see some positive effects in terms of the birth outcome s .

Mark Masselli: A guided non - medical yoga exercise progr am , designed to assist
pregnant women through depression symptoms , helping them successfully
navigate those symptoms without medication , ensuring a safer pregnancy and a
healthier outcome for mother and baby – now that’s a bright idea.

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Margaret F linter: This is conversations on health care. I’m Margaret Flinter.

Mark Masselli: And I’m Mark Masselli. Peace and health.

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