Innovating Across Public and Private Health Systems: Dr. Anne Snowdon, Chair of World Health Innovation Network

Anne Snowdon

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Mark Marcelle: This is conversations on healthcare. I’m Mark Marcelle.

Margret Flinter: And I’m Margaret Flin t er.

Mark Marcelle: Well Margaret we see that the House of Representatives Speaker Paul Ryan has
announced that he’s not seeking re - election this year; seems to be part of a larger trend. Both
prominent Democrats and Republicans have announced they’re not seeking re - election in 2018 and it
may reflect a turning tide on the number of issues including healthcare.

Margret Flinter: And it’s very interesting, because the GOP mantra has been pretty clear since the
passage of the Affordable Care Act; repeal it or repeal and replace it. But, according to an analysis that’s
been done by the Washington Post, you would be hard pressed to find any wording now about repeal of
Obama Care.

Mark Marcelle: Actions taken though by the White House though have diminished the infrastructure of
the Affordable Care Act. The President announced work requirements might become the norm across
the country fo r those seeking Medicaid . A nd states like Iowa and Idaho are seeking to create market
exchange plans that don’t cover the essential benefits.

Margret Flinter: Well the nations consumers are starting to register their concern for the loss of health
coverag e protections, and I think, consumers are starting to understand that the recent actions being
taken by Congress are leading to higher premiums for those who get coverage on the individual market.
I really don’t ever recall so many incumbent candidates ch oosing not to seek re - election.

Mark Marcelle: It looks like we’re reverting back to more of a patchwork quilt in terms of insurance
coverage from state to state.

Margret Flinter: Even while we are concerned about and tracking all of these ongoing policy c hallenges,
there are so many exciting innovations happening in the global health arena. And that brings us to our
guest today, Dr. . Anne Snowdon , Chair of the World Health Innovation Network at the University of
Windsor , Ontario . S he is partnering with a number of countries around the world to share best
practices in improving health care delivery , outcomes and costs . A nd she has a very interesting
collaboration s to talk about .

Mark Marcelle: A nd Laurie Robertson also checks in . S he's the managing edito r of factcheck.org . But no
matter what the topic you can hear all of our shows by going to CHC Radio . com .

Margret Flinter: And as always if you have comments please e - mail us at C HCR adio @CHC1. com or find
us on Facebook or Twitter , because we'd love to hear from you . N ow we'll get to our interview with Dr. .
Anne Snowden in just a moment .

Mark Marcelle: B ut first , here's our producer , Marion O'Hare , with this week's headlines.

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Anne Snowdon

Marianne: I'm Marianne O'Hare with the healthcare headlines . Amazon may be rethinking its entry
into the drug business . A ccording to reports , Amazon announced it was pulling out a plan to sell drugs
in bulk to large hospitals through their Amazon business platform . Amazon's biggest hurdle reportedly
was many larg e hospital organizations refusing to give up their existing partnerships with
pharmaceutical distributors . Amazon recently announced a partnership with Berkshire Hathaway and
J.P. Morgan Chase to form an entity aimed at bringing down the hi gh cost of Ame rican healthcare.

Meanwhile drug rehab is becoming a big business for an extremely vulnerable population in need of
treatment . Google had suspended ads last year for drug treatment facilities after it was found many
fraudulent entities were utilizing th e platform to market . Google is allowing the lucrative ads back on
the platform , but only after entities have been thoroughly vetted by an independent analyst . L egit
S cript will evaluate treatment providers on a number of criteria including criminal back ground checks
and license and insurance verification . A ddiction experts feel it's a good measure to put bad actors on
notice , and ensure that families seeking help will get the help they need .

Ebola may have a new weapon . D eadly pandemic swept through several West African nations a few
years ago leaving a trail of death and fear . A ccording to a recently published study a vaccine created by
the pharmaceutical company Merck seems to show long term protective effects from the virus . T hose
who were given the experimental vaccine continued to show antibodies up to two years after injection .
T hey're encouraged they have , what seems to be , a viable way to protect researchers and scientists
studying the pathogen . F irst line gl obal health responders like Doct ors Without Borders and community
members living near where an outbreak might have occurred .

I’m Marianne O'Hare with these health care headlines.

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Mark Marcelle: We're speaking today with Dr. . Anne Snowdon , S cientific D irector and C.E.O. of supply
chain advancement network . S can H ealth , a Canadian network of centers of excellence in international
knowledge and translation platforms . She is chair and professor of the World Health Innovation
Network WIN at the University of Windsor Ontario . Dr. . Snowdon was recently inducted into the
American Academy of nursing . She earned her bachelors of science and nursing at the University of
Western Ontario , h er Masters of Science at McGill University in Montreal , and Per Ph D. i n nursing at the
University of Michigan . Dr. . Snowden, w elcome to conversations on health care .

Dr. Anne Snowdon: T hank you so much .

Mark Marcelle: A t S can H ealth you've been focusing on advancing supply chain capacity in global health .
D esigning systems that will help clinicians b etter assess the maturity of their supply chain infrastructure .
I’m wondering i f you could help our listeners understand why supply chain improvement is so vital to
improving care delivery and outcomes ; something all of us are seeking to achieve .

Dr. Anne Snowdon: E very health care system in the world is challenge d by delivering the best
possible care to every population they serve . P roducts that we use in care , come from all over the

Anne Snowdon

world ; g lobal national companies and local companies in each country . H ere's the challenge we don't
have this system infrastructure that allows us to really critically understand what are the best outcomes
for patients ? H ow are we achieving them ? With what products ? So a company that makes
pacemakers , recalls a pacemaker because it's not functioning well .

T oday in global health systems we are not able to quickly and easily identify exactly which patients got
that particular lot and batch number of pacemaker , and how do we contact to make sure we can reduce
any risks they m ay now be facing ?

Margret Flinter: Well Dr. . Snowdon , I understand that at the recent and huge health information
management system society conference in Las Vegas , also known as him HIMS.

Dr. Anne Snowdon: Yeah.

Margret Flinter: CEO Howe Wolfe announced that they were partnering with your organization , S can
H ealth in the development of this clinical tool that you've created as Scan called the H - sim . T his is a
clinical tool I understand that you're developing . T ell our listeners about th at .

Dr. Anne Snowdon: S o we at the Scan Health have designed and created this health supply chain
maturity tool which essentially helps organizations identify how far advanced is your supply chain . HIMS
a phenomenal partner in terms of being able to reach seventy three thousand partners across multiple
countries globally , s o they are really playing the role of helping build awareness and knowledge among
health information management . S upply chain infrastructure and health systems is all about creating
tha t data in our health system to track and trace every patient , every product , and every outcome were
achieving .

Mark Marcelle: Dr. Snowdon we had the opportunity of having Dr. Peter Pronovost on our show talked
about medical errors noting that there are the third leading cause of death in North America . Y ou say
that building the highly visible health care system is central to mitigating this real feeling in modern
health care . H ow do we create a more responsive system capable of reducing harm and health ca re ,
and even with checklist s and team huddles we still have errors and what's missing ?

Dr. Anne Snowdon: W hen you think about error in our health systems , you know , we have adverse
events that get voluntarily reported by clinician teams . A nd then we work with families to try and make
sure that those errors never happen again . I f we don't have the supply chain infrastructure in our
systems to create the double checks for our clinician to prevent errors , then I’m not sure that we're
going to overcome this v ery , very significant level of error .

A s a nurse I used to give out medications to my patients in hospital . The patient may have six or eight
medications . M ost nurses have six to eight patients they are caring for . T hink about barcode scanning
like we use in the grocery store . You scan that patient's identification , and the system automatically
tells me with a great big green checkmark that's the right dose , right patient , right drug, right route; a ll
those things automatically . S o supply chain infrastructure creates those double checks . I t tells me if it's
the wrong medication before I give that drug and prevents that error . I f I'm taking a patient into an

Anne Snowdon

operating room , and I have barcode scanned that patients ID band and it makes sure that we've got that
right patient going into the right operating room to receive the correct surgery .

S o supply chain infrastructure creates those double checks in the systems for clinicians , and in the house
systems I've already studied that have gone down thi s road they are reporting significant drop in very
serious medical errors called ‘n ever events ’ u pwards of seventy percent .

Margret Flinter: W ell Dr. Snowdon your early experience was as an emergency department nurse in
Canada and you saw so many children entering the emergency room with serious injuries from car
accidents . Y ou partnered with the auto industry to devise a better more effective booster seat . A nd
then , I understand , sort of took all of that learning and focus ed your attention on all sorts o f challenges
within the health care system .

T ell us a little bit about this trajectory from frontline nurse to innovator , and , and what are your
thoughts on how we better leverage the unique clinical experiences of nurses to help in Inform and
advance this innovation process ?

Dr. Anne Snowdon: Y ou know , clinicians have the advantage of seeing patterns over time . S o in
emergency room , I saw one after another after another of these children coming in with these terrible
injuries , s o we have the ability to kno w what are the challenges the health systems desperately need to
solve . S o it we often think about innovation as a new technology , a new software , a new app , and I
don't see clinicians front and center on how those new technologies are actually designed s o that we are
absolutely sure they work in those clinical settings . S o in the supply chain infrastructure a simple scan of
a barcode is really quick and easy for a clinician . C linicians have far more time to spend with their
patients when we automate tho se environments . Innovation teams need to absolutely put clinicians
front and center because they're the only group in health systems that have a very clear sense of what
are the big challenges we need to overcome ? A nd how innovative tool technologies ne eds to work in
clinical settings ? S o it makes it easy for clinicians to use those new innovations . A nd to when clinicians
are not involved in innovative projects it usually fail s, so in my research , but also in my experience ,
clinicians have a very , very key leadership role to play .

Mark Marcelle: W e're speaking today with Dr. Anne Snowdon , scientific director and C.E.O. of Scan
Health. S he is also chair and professor of the World Health Innovation Network at the University of
Windsor . Dr. Snowdon , Unit ed States unfortunately has one of the most expensive health systems in
the world and yet we see that cost of health care and public systems such as Ca nada and elsewhere are
rising at unsustainable rates . A nd you just returned from a meeting wi th your col laborators in Australia .
A country with a public health system similar to Canada's . And yet you've noted that they seem to be
doing a much better job with outcomes and lower costs . W hat might we learn from the Australian
example ? W hat can other countri es get right from their example ?

Dr. Anne Snowdon: T hey are spending almost half of what Canada's spending per capita on health
systems , and yet their performance outcomes and quality safety and access to care are better than ours ;
quite frankly . T hey h ave a national digital strategy that is funded by their federal government , so they
have a very focused set of resorts is on how do we make sure all health systems linked together to

Anne Snowdon

inform patients ? T hey're about to launch an national patient portal . M e aning every Australian citizen
can go online , download and pull all of their health records to help them better understand their care
and to help inform their decisions . I don't know of another country that's been able to achieve that
nationally , but the value of that opportunity is very , very significant .

T he other thing Australia does is a wonderful job of highly integrated care . I visited a children's hospital
where the experts on children's health were looking after children , not just in the hospital setting when
they become ill , but in their homes , in the community . S o wherever children are , they had a great line
of sight to what support they needed and where they could add value for children and in their homes .
The third t hing that Australia has t hat we don't have in Canada is twenty four seven primary care
services .

S o no matter where you live and when you happen to get ill , you can reach a primary care provider or
team twenty four hours a day seven days a week . I n our country in Canada , if you become ill on
weekends after hours then you're pretty much have to rely on either an emergency room or maybe a
walk in clinic if it’s open, a nd that's been a real challenge for us . S o if it's not available to citizens around
the clock , then it's not as strong as a system in terms of helping people stay healthy and well . A nd
making sure they don't become so ill they require hospital care . S o those are just the couple of the real
key advantages I see in the Australian system .

Margret Fl inter: Y ou know , I'm curious what your thoughts are about what's the implication of the kind
of work that you're doing for prevention and for population health ? P articularly the management of
chronic illness , how do we innovate for better prevention and better population health management ?

Dr. Anne Snowdon: R ecently , and in the last few years , but probably much more likely as we move
forward we have this thing called precision medicine . D rug companies and new innovators are creating
these very tailor mad e therapies for patients that have these very challenging illnesses. I f we're not
tracking in tracing which precision therapy or medicine is achieving value for which sectors of our
population , then we won't know what the best care processes and therapies are for which groups of
patients .

I t's very clear today a new drug , or a new biologic , or a new therapy doesn't work exactly the same way
in every person in our population s. U ntil we get to that point where we're tracking and tracing every
therapy we're using with every patient , then we simply aren't going to know what's the best way to
manage chronic illness outcomes. So prevention is critical , so we know what kind of risk factors there
are for , you know , dementia and diabetes and heart disease . F or e xample , keeping your blood pressure
down .

I f we identified population segments that were , you know , had a bit of average blood pressures . I f we
worked with them very early in that high blood pressure sort of trajectory , we would actually be able to
reduce cardiovascular heart disease outcomes that we see far too commonly. And there is even
evidence now that if you get manage blood pressure very , very well you'd reduce a large percentage of
dementia . So the tracking and traceability needs to reach right across health system organizations right

Anne Snowdon

into the community to identify what's working best for whom , and who are those groups of patients
that we need to work with very early .

Mark Marcelle: O ur privat e system , as you know in America , we are very much a public/ private
arrangement . And you've been trying to find that commercial and market solutions for the public
Canadian health system , and taken some good natured flak from some Canadian colleagues for aligning
the corporate entities to address some of the shortcomings within your system . B ut you say Canada
needs to get over the private sector is a bad thing idea. A nd as you continue your collaborative work at
the World Health Innovation Network what k ind of high functioning health systems can be achieved by
building and coalescing the successes together ?

Dr. Anne Snowdon: W e're one of the very few countries that doesn't have the alternative of that
private health care system , and it's largely based on Canadians absolute passion that identity . W e see
ourselves as a country that health care must be available to all Canadians , but forty percent of health
services in Canada are part of a private sector because the public system can't pay for absolutely al l
health services like , you know , dentistry or physio therapy .

I think , the high functioning health system and is well developed collaborative partnerships so that we
engage the expertise of the private sector to help the public side and public system lea rn that public
health system experts and leaders work closely with the private sectors to help them understand what
are the real challenges ? R eally the ones we see day to day , one of the areas of work we're doing at the
World Health Innovation Network is , processes around how the health systems procure innovation ?
Not procure products , but how do we go out to the market as a health system and say look we have
some real challenges in this particular program .

L et's say cardiovascular health ; go out to the market and procure their best solution s that could embed
and scale across that system . A nd then work with us to make sure we have the best efficiency , the best
productivity. S o innovation procurement is actually a way for public systems like Canadian sy stems to
engage industry to bring those solutions to us and share th e risk and share the value when they do
work . N ot worrying so much about the privatization, but en gaging private sector expertise to help us
create much more high performing health systems . I'm not sure we're working as closely with them as
we could be , and models like procuring innovation may be one way to do that .

Margret Flinter: W e've been speaking to day with Dr. Anne Snowdon , S cientific D irector and C.E.O. of
the supply chain advancement network or Scan Health and chair of the World Health Innovation
Network at the University of Windsor Ontario . Y ou can learn more about their work by going to
scanhea lth.ca or follow their work on Twitter at scan_health. Dr. Snowden , thank you so much for your
work and for joining us on conversations on health care today .

Dr. Anne Snowdon: T hank you ever so much it was an absolute pleasure.

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Anne Snowdon

Mark Marcelle: The conversations in healthcare we want our audience to be truly in the know when it
comes to the facts about health care reform and policy . Laurie Robertson is an award winning journalist
and Managing Editor at factcheck.org; a nonpartisan , nonprofit consume r advocate for voters that aim
to reduce the level of deception in U.S. politics. Laurie, what have you got f or us this week ?

L; W e recently published our latest edition of what we called , Trump's N umbers . A quarterly look
at how things have changed sin ce President Trump took office . One s tatistical measure is the number of
the uninsured . T he number of people lacking health insurance has gone up somewhat under Trump
though millions more are expected to drop or lose coverage next year and in subsequent years .

T he most recent report from the National Health Interview Survey estimates that during the first nine
months of last year , 28.9 million people were uninsured . T hat's an increase of only three hundred
thousand from 2016 and still 19.7 million fewer than were uninsured in 2010 the year then President
Obama signed the Affordable Care Act . M ore recent polling by the Gallup organization found a larger
increase estimating that 3.2 million Americans entered the ranks of the uninsured in 2017.

Trump failed to repeal and replace the Affordable Care Act as he promised to do , but in December he
signed a tax bill that will end the ACAs tax penalty for people who fail to obtain coverage ; that mandate ,
as it's called , and in 2019. T he number of people who signed up in December through the AC A
exchanges for coverage in 2018 dropped only slightly to 11.8 million . T hat's down from 12.2 million in
2017 and 12.6 million in 2016, but ending the mandate penalty is expected to have a much bigger
impact in coming ye ars .

A ccording to an estimate by the nonpartisan Congressional Budget Office , the end of the mandate next
year will cause four million people to lose or drop coverage in 2019 rising to 12 million two years later
and 13 million in 2025. CBO said that endin g the mandate would cause policy premiums for those
buying individual policies to rise ten percent in most years . H ealthier people would be less likely to
obtain insurance and the resulting increases in premiums would cause more people to not purchase
ins urance.

And that's my Fact Check for this week for more on various statistical measures of Trump's presidency ,
see our website . I'm Laurie Robertson M anaging E ditor of factcheck.org.

Margret Flinter: Factcheck. org is committed to factual accuracy from t he country's major political players
and is a project of the Annenberg Public Policy Center at the University of Pennsylvania . I f you have a
fact that you'd like checked, e - mail us at CHCRadio.com. We'll have factcheck.org’s Laurie Robertson
check it out for you here on Conversations on Healthcare.

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Mark Marcelle: Each week Conversations highlights a bright idea about how to make wellness a part of
our communities and everyday lives . F or all the pe ople in the world without limbs, acquiring prosthetics
can be costly and out of reach . I t's especially challenging to make prosthetics for children since they are
in a constant state of growth . Rochester Institute of Technology scientist , Dr. John Schule , stumbled

Anne Snowdon

upon a clever and affordable solution . P rovided online open source templates to anyone anywhere in
the world who has access to a 3D p rinter and provide prosthetic hands for next to nothing .

Dr. Schule: I've made this Google Maps match up. I f you have a 3D p rinter and you'd like to h elp ,
put yourself on the map . A nd if you know someone who needs a hand put yourself on this mapt.

Mark Marcelle: S o he founded the E - Nable N etwork which has mass ed thousands of volunteer makers
in upwards of forty countries around the world providing chea p , but functional prosthetics for Children
In n eed .

Dr. Schule: I think we're currently pushing fifty eight hundred identified members in our Google
plus community , and we have a following s in the thousands more . W e know that we've delivered about
eight h undred hands devices , and we suspect that is comparable number had been downloaded by
people we can't track because we put all of our design on the Internet .

Mark Marcelle: The simple limb designs have become more sophisticated recipients of the prosthetic
devices provide feedback for designers to make more efficient devices .

Dr. Schule: We 're still working on opposable thumbs . T hese things grip or un - grip , so they're much
less functional than our biological hands, but for kids it's huge . A nd , you know , o ur hands don't even
pretend to look like regular h and s. T hey look like superhero , Iron Man h and s, and for that very reason
they're very popular with kids.

Mark Marcelle: E - Nable, a gl obal collaborative network of open source designs linking to makers with
3D p rinters to provide low cost prosthetic limbs to children and adults around the world . Now that’s a
bright idea .

Margret Flinter: This is conversations on healthcare . I’m Margret Flinter.

Mark Marcelle: And I’m Mark Marcelle, peace and health.

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Recording: Conversations on Healthcare broadcast from W E S U at Wesleyan University streaming
live at W. E.S.U. F.M. dot org , and brought to you by the community health center.

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