Dr. Joseph Smith Chief Medical Officer of West Health Institute

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, there is a lot of buzz in Washington over the
st
looming start of open enrollment for the insurance excha nges . October 1 is the
first day but it's also the start of the n ew fiscal year for the federal government.

Margaret Flinter: Well, the countdown has begun on both counts and some
Republicans in Congress are making good on threa t s to find a way to de - fund
Obamacare by holding up approval of the federal budget.

Mark Masselli: And there are targeted efforts underway in a number of states to
find ways to block funding of the health care law . But in spite of this lingering
op position , the law is moving forward . California has tested their computer
system th at will handle the influx of new insurance customers , and have given
the signal that all system s are go ing .

Margaret Flinter: Well that’s great news because the y are such uncharted waters
for a lot of states Mark , states that in particular had to update antiquated system s
so th at department s that oversee Medicaid can communicate with revenue
service departments . It's to be expected there will be some growing pains as
these systems get off the ground an d this is definitely a case where the people
who upgraded early have an advantage.

Mark Masselli: They certainly do . And speaking of Medicaid, there will be an
expanded eligibility for Medicaid coverage under the Affordable Care Act
including folks w ith incomes up to 138% of the federal poverty line. But an
interesting study was done on who will be taking advantage of the Medicaid
expansion.

Margaret Flinter: Well, that’s right , Mark . And the Kaiser Family Foundation
which has done such a great jo b in this area did a study and found that those
taking advantage of expanding Medicaid are likely to be younger white males
and that’s a group that ’s generally healthier than the typical Medicaid recipient.

Mark Masselli: Very interesting . And the study also showed that the average
age of Medicaid recipients is going to drop by three years from 39 years to 36
years of age.

Margaret Flinter: Well another interesting aspect of this young adult population is
that they are definitely more comfortable consu ming products online and
shopping online and interacting via mobile devices . So , as we see this
generation going into the health insurance exchanges , it may feel more natural to
them and may also help propel the advance of mobile health and telemedicine
p rotocols , something our guest today is very familiar with.

Mark Masselli: Dr. Joseph Smith is with the West Health Institute , which is
dedicated to improving health outcomes and bringing down health cost by
promoting the growth of mobile health technolog ies.

Margaret Flinter: The institute is studying the ways that mobile health , telehealth
and genomics are poised to really transform health care in the United States and
across the world.

Mark Masselli: And we will hear from Lori Robertson who checks i n from
FactCheck.org to set the record straight about miss ed and misstatements about
the health care law.

Margaret Flinter: And no matter what the topic, you can hear all of our shows by
Googling CHC Radio , and as always , if you have comments , please ema il us at
www.chcradio.com or find us on Facebook or Twitter because we love hear ing
from you.
Mark Masselli: We will get to our interview with Dr. Joseph Smith in just a
moment but first , here is our producer Mari anne O'Hare with this week’s Headline
News.
(Music) Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines. House Republicans are moving ahead with efforts to find a way , if only
symbolically , to de - fund the health care law. House Repu blicans have tried 40
times unsuccessfully with separate measures to de - fund Obama c are . This latest
measure would tie approval of stop gap funding of the federal government to a
measure that would de - fund the health care law , forcing the Democratic -
contro l led senate to actually vote on the measure. A recent poll showed only 6%
of those survey ed felt the health care law should be defunded and that holding
up funding of the federal government in the new fiscal year would have negati v e
consequences for the G OP.
Meanwhile , corporations are shifting some pieces on their benefits chessboard in
response to the health care law and its changes. IBM has announced it's dumping its retiree health benefits on to the exchanges , no t the Obama care
exchanges but on Medic are exchange . Medicare eligible retirees will no longer
be eligible for IBM’s company health plan , instead they will get a subsidy to buy
supplementary Medicare cov erage . This is the continuation of a trend . Time
Warner has announced a similar move rece ntly as has General Electric last year.

Kn o w someone who is trying to quit smoking ? You might have a new motivating
weapon , graphic television commercials showing real smokers dealing with the
devastating e ffects of long term exposure to the habit. It's part of the federal

government ’s Tips from Former Smokers Ad Campaign, in which graphic images
of smokers who ha d suffered from throat or o ther cancers , inserting false teeth ,
placing speaker boxes in the i r tracheotomy hole , talking about why you should
q uit. A study show s that o f f the nation ’ s 45 million smokers , 1.6 million tr ied to
quit after seeing the ad and 13% were successful in staying smoke - free.
Historically , about half the nation ’ s 45 million smokers try to quit every year and
yet cessation ra tes still only h over around 5% annually.

I am Marianne O'Hare with these Health Care Headlines.

( Music)

Mark Masselli: We are speaking today with Dr. Joseph Smith , Chief Medical and
Science Officer at West Health , which includes the West Health Institu te a n d the
West Health Policy Center , non - profit entities founded by philanthropist Gary and
Mary West , dedicated to advancing technology in health care that will lead to a
lower cost and better health outcomes. Dr. Smith is the Former Vice President of
E merging Technologies for Johnson & Johnson , and also served as Chief
Medical Officer for Boston Scientific . He was name d by Health Leaders
Magazine as one of the 20 people who make health care better . Dr. Smith ,
welcome to Conversations on Health Care.

D r. Joseph Smith: That’s a pleasure . Thank you so much for having me.

Mark Masselli: We always seem to be at some critical juncture in health care in
America , and certainly over the recent years , the cost for health care ha s
skyrocketed . It accounts fo r about 18% of our g ross domestic product , and
people say it's been growing at an unstable rate , and yet , we have the passage
of the Affordable Care Act , created a lot of new opportunities not only for
including more Americans in the health care system but also for generating
discussions about the need to contain cost . Share with us and our listeners your
goal at West Health of lowering health care cost s but also improving patient
outcomes.

Dr. Joseph Smith: Well you know it's funny you talk about how we always seem
to be at a critical juncture in health care. I am not sure that we have always
faced the challenges that we currently face. I was reading a report a little while
ago that says that if things continue as they are , by 2030 , the median family
i ncome will equal the median family expense o n health care including insurance
and out - of - pocket expenses. And I don’t think we are actually going to head
there . I think we know that we need to be in a different spot and I think all of the
national focus on health care reform I think is timely , it's essential , it's probably
overd ue. I would point out that much of the Accountable Care Act is reform
about how health care is paid for and not so much about how health care is
delivered. And that’s really wher e we think there needs to be a much sharper
focus and I think there is an opportunity to decentralize , perhaps democratize ,

and in the process , maybe even demystify some of health care delivery. We see
four different areas for impact that draw a lot of at tention for us. The first is in an
effort to create more of an efficient medical marketplace, you would not think of
going into a restaurant and having the maitre d' decide what you should have for
dinner and then send you the bill three months later. I mean ye t, that’s the way
health care gets apportioned , delivered and paid for. And so we need to take
advantage of all of the natural skills we have in assessing value in the things we
need and we purchase and apply those to health care.

Margaret Flinter : So Dr. Smith , you are trained as and practiced as a cardiologist
but you also have an extensive medical engineering background , and you said
that we are at this fertile intersection between engineering and medicine. Tell us
more about that . What are t he collaborations at this intersection that you are
tracking out at West Health?

Dr. Joseph Smith: I love this space . I have spen t my whole career at this what I
think is a wonderful intersection between engineers who are inherently problem -
solvers and health care which is really not short at all of problems. And so I think
there is a tremendous opportunity to make a differen ce. Technology itself , when
appropriately applied , has dramatic opportunity to lower health care cost s . We
are working under the rubric at the moment that chronic diseases ought to be
managed apathetically at e ncounters in doctors ’ officers or emergency rooms or
hospitals as opposed to when a patient needs to be seen. And I think we can
completely change that paradigm of chronic d isease management. I mean when
you have complex equipment , you don’t wait for it to start making a funny noise
in order to service it. We have dashboards on our cars that tell us how things are
going so that we can make those interval changes to keep it functioning well. We
have all of that for technology that we care about and yet we don’t do that for
chronic disease management where we really could . And so the notion of using
little bit s of technology to look in o n patients who aren't in front of a do ctor , who
are in their normal activities of daily living or who are sleeping , and look in using
relatively simple bits of technology , to get a dashboard on how is that person
doing. So that patient with heart failure , if they have gained a couple pounds a nd
when they walk up a flight of steps it's a little bit slower for them, all of that
information is readily accessible , and if we just bothered to look at it and use
smart systems that we have in place for other complex machinery , we would be
able to iden tify those people who are beginning to fail a s oppose d to waiting for
them to get so sick.

Mark Masselli: Well, let's pull the thread a little on that and talk about mobile
technology . And with billions of people possessing cell phones in the world , you
say we are just not utilizing this platform for delivering better health care in a
meaningful way yet. You s ay that we need to move our health care system from
moving the patients to moving the data to serve the patients . So how do we
achieve the ends w hen we have a relatively siloed health care system at
present ?

Dr. Joseph Smith: So siloed is perhaps an understatement and I do think that
speaks immediately to the need here. I think we have an inherent problem which
I think we have lots of systems th at each manage data different ways and store
and transmit and query and answer differently . And so this notion that if you are
a Mac use r, as I am , the notion of every time you get another piece of Mac
hardware , the other hardware works with it just fine. And it was all easy , it was
all functionally interoperable immediately , and we have none of that benefit in
health care . We have every different vendor making information slow , using their
own proprietary formats and processes in part because we have th is desire to
make sure that health care information is both secure and timely , but I think one
of the downsides is that we have created every different company that makes
one of these gadgets has its own way of moving information around . And that
frustrat es the notion of the value proposition of the puerility of these solutions s o
that we longer depend on each device alone to manage all of the concerns
around a patient but we can use a smarter net of devices th at can all talk to each
other to get a better more holistic view of how a n individual patient is doing or
populations of patients are doing. We have it in terms of an Internet backbone ;
you don’t need to buy a specific computer or a specific cell phone to get on the
Internet . We do not have that for wireless medical devices or electronic medical
records. It's all be e n siloed up and diced up with lots of little proprietary walled
gardens that are really getting in our way at this point.

Margaret Flinter: One of the things Dr. Smith in clinical faci lities specifically
seems to be this whole issue as you pointed out there about the wireless
revolution that has come. And clinical facilities are challenge d to provide a
system that’s both secure and it's high functioning and you have noted that there
is these three elements impacting broadband use in the clinical setting . You
have got the patient monitoring system obviously critical , two you have the
technology that handles the business and the data side , and three we have got
that Wi - Fi user walking in the door everyday. So how do you envision these
three tiers being e ffectively manage d either in the health care facilities of today or
the clinical facilities that we are trying to build for the future?

Dr. Joseph Smith: Well, I think the good news is people are readily admitting that
there is an issue and a concern here . You would like not at all to have the young
grandson of a patient downloading a video in the waiting room and have him use
up the critical bandwidth that’s necessary for monitoring hi s granddad in an
intensive care unit , right. So on one hand , you w ould say well I am sure that
doesn’t happen , but if in fact we are all using a shared resource without some
notion of prioritization , that can of course occur. And so one of the fellows
wo rking with us here use d to be president in a wireless private company before
but now is working with us in a nonprofit setting. He ’ s architected what we call
Medical Grade Wireless Utility , and it's a solution for that issue that manages the
appropriate r esource distribution in hospitals a nd it's something that we have
archite cted and ma d e really available for hospitals . And Ed ha s now worked

with , he tells me , I think almost a 100 hospitals and trying to get them up to
speed. So there is this notion th a t wireless communication can be as
dependable and reliable as power and oxygen and lighting in a hospital.

Mark Masselli: We are speaking today with Dr. Joseph Smith , Chief Medical and
Science Officer at West Health , which includes the West Health Instit ute in San
Diego and the West Health Policy Center in DC , nonprofit entities dedicated to
advancing technology in health care that will lead to lower cost and better health
outcomes. Dr. Smith is a fellow at the American College of Cardiology . Dr.
Smith , you mentioned just a few minutes ago , liberating health data and I was
thinking about our good friend Todd Park , who is now the Chief Technology
Officer . And tell us a little more about what the bigger picture is of how you are
going to liberate data and how that’s going to help us build a sufficient , effective
and elegant health care system with just in time delivery of health information
when you need it.

Dr. Joseph Smith: Well, it's a t a ll order and I think almost anyone ’ s enthusiasm
would pale next to Todd Park .

Mark Masselli: We agree.

Dr. Joseph Smith: I have watched him talking ; he gets up in a la ther , and I think
it's because there is this remarkable opportunity . When you look at what the
good Mr. Park has open to him in terms of data that M edicare and Medicaid has
collected over processes and procedures they have paid for and then outcomes
they c an track, I think there is an opportunity to ask all sorts of questions ,
p articularly when you introduce new technologies and you can determine how
they are used but then whether or not the outcome is in fact represented in a
larger cohort in a real world scenario. And so I think we have one of our fellows
working closely with Todd to see if there is an opportunity to enhance the clarity
and the tran sparency associated with large datasets and see where there may
be the greatest possible opportunity to make a difference.

Margaret Flinter: Dr. Smith , your colleague at West Health that we referenced a
little while ago , Dr. Eric Topol spoke about the ne ed for training the next
generation of health care providers . That’s a subject near and dear to our hearts
in primary care , and to train them to understand these emerging areas of
genomics and telemedicine and other innovations in care that are contributi ng to
the transformation of health care . Tell us about how you at West Health are
approaching innovation in health professional training in your fellowships and
how might these fellowships and the training that you are doing disrupt the
traditional model of health profession ’ s education.

Dr. Joseph Smith: We have talked about how fertile this intersection is between
technology and medicine , and it does require energized individuals . We are
lucky to have a couple of these present with us at (15:24 inaudi ble) Wireless

Health Scholars . This is the notion of taking folks who are already trained
physicians , many board certified , exposing them to the engineers and kind of the
technology that may be amenable to use in clinical scenarios where people really
hav en’t explored the f ull opportunity . And then we also have a fellowship with the
UCSB here as well . As energized as they are , they are still too few. So we are
trying to set an example of how to do this . And one of them came up with a
really cool idea a nd we have been able to provide enough resources that here in
the near term that’s likely going to be its own little startup company because the
idea looks like it could really make a big difference. And so we love this
opportunity . It is again this fasc inating coll ision between energetic people and a
tremendous need , an unmet need to make health care much more affordable .
And so San Diego is a terrific environment for that because unlike the East Coast
where I did all my training where the model is one more of excellence through
local competition , here there is more of a model of excellence through
collaboration. And so of course it takes smart people in the middle and so we
are delighted to have these fellows take advantage of the opportunity.

Mark Ma sselli: Well you not only have smart people but you have a sweet
organizational design at West Health and you ha ve two not - for - profit branches
and you also have two for - profit branches , th e West Health Investment Fund and
the West Health Incubator . We ar e always it seems at the garage ph a s e of
innovation around health care . And it looks like you have got a nice collaboration
that goes on to support the activities that go on . Tell us about some of the
promising investments that you have made as well as o ther innovations that are
underway at West Health.

Dr. Joseph Smith: The structure that we have adopted with the four
organizations is not accidental. If you come up with a good idea , or if you see
other people with them , how do you then go the next ste p ? And so part of that is
small business incubation . If you think about an innovative and entrepreneurial
community , it's really everywhere , and so how do you accelerate the work of
others , and that got to us to starting an investment fund. And then ult imately , it
doesn’t really matter if you come up with a great solution if the public policy
environment or the incentives for payment aren't aligned so that they can be
appropriately used , and so th at got us to be quite active in Washington DC at a
policy center.

To spend a moment on the investments , all of the investment proceeds go back
to the charitable mission and all four of th e s e organization s sh are the same
vision and mission which is how to lower health care cost in United States . Along
the Big Da ta th eme, we have a small investment in Humedica . It's a Boston -
based company that’s looking really hard to make sure that when you look at Big
Data , collected from multiple hospital systems , you are not going to get kind of
waylaid by casual descriptions of patients . And they do natural language
processing of doctors ’ notes to better understand that when someone gets coded

a s having diabetes do they really have diabetes , or if they are expose d to a
particular therapy are they really taking it . So we lik e them for the Big Data play.

In terms of health care transparency , particularly transparency around pricing , we
like a small company that we invested in called Change Healthcare . And they
are working with large employers to make sure that when their emp loyee
population needs to make a health care decision , that they understand the price
and as best they can t he value. And then when we think about this notion of
taking care of people with chronic diseases when they are not in the hospital , we
have invest ed in a small Minnesota Company called Health sense . And they
work very hard to look at these kind of continuing care models of retirement
communities w here you will have a spectrum of different forms of living scenarios
on one campus to instrument the apa rtments and the people ’ s home s so that it's
easy to look in on them either from the vantage point of the organization or even
from their family t o make sure that mom is up out of bed , she is taking her
medicine and everything is pretty much okay , or not. And that gives you a way to
prioritize who you need to check in on any given day and so this notion of less
intrusive but appropriate at distance monitoring to make sure that people are
doing okay with their chronic diseases . We like that as an opportunit y going
forward.

Margaret Flinter: We have been speaking today with Dr. Joseph Smith , the Chief
Medical and Science Officer at West Health whose unique mission is to advance
innovative and cost e ffective technology , innovations and solutions that will lo wer
the cost of health care in America. You can find out more about the work they do
by going to www.westhealth.org and follow them at West Health. Dr. Smith ,
thank you so much for joining us on Conversations to day.
Dr. Joseph Smith: And thank you today . It's been a real pleasure.
(Music) Mark Masselli: At Conversations on Health Care, 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 US politics. Lori, what have you got for us this
week?

Lori Robertson: Well , over t he years , we have debunked the claim that Congress
was exempt from the Affordable Care Act. It wasn’t true in 2010 when the law
was being debated and it's not true now either. Congress is n’t exempt from the
l aw’s requirement to have insurance or pay a pe nalty if you don’t. In fact , the law
places an additional and unusual requirement on members of Congress and their
staff. It says that members and staff ers must get their insurance through the
exchanges created by the law starting in 2014. They can't ge t insurance , like

they do now , or like other federal employees , through the Federal Employees
Health Benefits Program . This provision was added by a Republican
amendment with the idea that if the exchanges were good enough for other
Americans they should be good enough for Congress .

There is a problem though . The provision doesn’t say anything about the federal
government being able to continue to contribute to premiums of staffers and
lawmakers just as many employers do for their workers. In August , th e Office of
Personnel Management, which administers the Federal Employees Health
Benefits Program, i ssued a proposed rule saying that the government would be
able to continue to make those premium contributions a nd the contributions
couldn’t be greater tha n what the government provides under the Health Benefits
Program for other federal employees. That prompted new claims o f Congress
being exempt from the law or getting a special subsidy. But th e suppose d
special subsidy is simply the premium contribution that Congress’s employer , the
federal government , has long made to the health plans of its employees. And
that’s my fact check for this week . I am Lori Robertson, Managing Editor of
FactCheck.org .

Margaret Flinter: FactCheck.org is committed to factua l accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked, email us at www.chcradi o.com . We will have FactCheck.org ’s Lori
Robertson check it out for you here on Conversations on Health Care.
(Music) Margaret Flinter: Each week , Conversations highlights a bright idea about how
to make wellness a part of our communities and everyday lives. Sitting down , it
seems , can be as potentially deadly as smoking if done for long periods of time
and over a long period of time , and that’s not good news because we are a
nation of sedentary sitters . And it turns out sitting is a big contribut or to our
obesity epidemic , to the rise in diabetes and heart disease and a host of other
illnesses. So when Steve Bordley was injured in an accident a few years ago ,
the act ive former elite athlete ended up sitting in a wheelchair for almost two
years , and during that time , he gained a lot of weight . And when he had to learn
to walk again , this former distance runner began to see the health benefits of just
walking n ot intensely but consistently throughout the day . Now the s urgeon
general recommends 10,000 steps a day to maintain good health.
Steve Bordley : 10,000 steps a day is kind of the benchmark that the s urgeon
general has set for the minimal amount of steps that an American should take.
And the University of Tennessee , about two years ago , did a s tudy and found
that the average American walks less than half of that amount. So we are
actually deteriorating if we are walking less than that.

Margaret Flinter: And when he was able to go back to work , he worried he was
going to slide back into the pi tfalls of sitting. His solution , he created the
TrekDesk. Bordley designed a modular standing desk that fits over any exercise
machine , the idea being if you just walk slowly but consistently , the e ffects w ould
be tremendous.

Steve Bordley : I was liter ally walking 10 hours a day , very slowly , and within a
period of about six weeks I lost more than 25 pounds , my back problems went
away and I was sleeping like I did when I was in my 20s. I felt tremendous.

Margaret Flinter: And so me research to da te be ar s him out. Walking slowly
throughout the day does seem to do remarkable things for your he alth, reduce
your chan ces of getting type II diabetes , reduce the risk of certain cancers and
maybe even reduce the inciden ce of first heart attacks. And it runs about $500 ,
maybe 10% of the cost of some high end models for exercising out there , and it
can be assembled in under an hour.

Steve Bordley : People s hould at least move throughout the day . Whatever they
can do to move is critical to their health and tha t’s really the message that we are
trying to get out . $10,000 steps at a minimum , everybody should know the
amount of steps they are taking during the day.

Margaret Flinter: The TrekDesk, a simple reconfiguration of the typical
workspace but one that al lows for purposeful movement throughout the day ,
improving health and well - being and cognitive skills , now that’s a bright idea.

Margaret Flinter: This is Conversations on Health care. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, pea ce and health.

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