Dr. Chileshe Nkonde-Price, Social Media Lab UPENN School of Medicine

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret the numbers have been enrolled that Americans
continue to climb. The administration announced that over 8 million Americans
have signed out for coverage of their insurance exchanges.

Margaret Flinter: And there is another estimate Mark , that about 8 million
Americans signed up for covera ge with private insurers , and of these enrollees
it's believed that about five - and - a - half million were previously uninsured, lot of
new customers.

Mark Masselli: But there were millions of Americans who are now covered as
well under the expanded Medicaid program . In 25 states that chose to expand it.
However , in states like Virginia and Florida, there are louder drum beats tardy ing
the merits of expanded coverage for those living near poverty. It’s becoming a
more consistent theme and more red States who refused to consider the
Medicare expansion.

Margaret Flinter: Well as our listeners might remember Mark, we have been
predicting that among others, the health care industry professionals in these
States would be exerting pressure on the politi cians to tap into the billions of
health care dollars that are available to treat this uncovered population . That’s
real money and it's being left on the table by those States that refuse to expand
Medica id .

Mark Masselli: On another note Margaret we ar e marking something of a
milestone this year. It was 30 years ago this month that a press conference was
held announcing the virus that was believed to be causing this new epidemic
‘AIDS’ , were far from a cure on this epidemic.

Margaret Flinter: There i s a powerful article in Time Magazine featuring Dr.
Robert Gallo who figures so prominently in the discovery of the virus and the
initiation of treatment back in 1984 . And you know he remains skeptical 30 years
later that we will zero in our cure anytime soon.

Mark Masselli: HIV positive folks are living longer with the advancement of better
drugs , Margaret. But the rate of new infections continues to pose a great global
health challenge. Prevention and testing are the best weapons at the moment
and wi ll continue to be so.

Margaret Flinter: And the best hope according to Dr. Gallo remains a workable
vaccine but we are nowhere there yet.

Mark Masselli: This scourge has a great impact on the economically challenged
in greater numbers , and in minority populations as well.

Margaret Flinter: And minority populations -- are population that our guest today
is very focused on. Dr. Chileshe Nkonde Price is a cardiologist at UPENN. She
has developed a digital platform to assist African - Americans in tacklin g their
higher rates of cardiovascular disease , and beginning to reduce their risks.

Mark Masselli: We are also have a visit from managing editor of factcheck.org
Laurie Robertson. She is breaking down some of the rumors about enrollment
numbers on the insurance exchanges.

Margaret Flinter: Remember no matter what the topic you can hear all of our
shows by going to CHC Radio.

Mark Masselli: And as always, if you have comments, please email us at
www.chcradio.com or find us on Facebook or Twitter because we would love to
hear from you.
Margaret Flinter: We will get to our interview with Dr. Price 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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Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines. Another high ranking health official is leaving his post at the Centers for Medicare
and Medicate . CMS Principal Deputy Administrative , Jonathan Bl u m is ste p ping
down after five years. Under Bl u m ’ s leadership CMS moved ahead with
programs creating accountable care organizations , and revisiting Medica re
Advantage to promote competitive bidding . And recently, Bl u m helped oversee
the unprecedented release of detailed Medicare payment data for 880 firms and
physicians. Meanawhile another CMS news , officials are looking to smaller
vendors to take over the healthcare .gov website once the one year contract is
up with the original ven dor Accenture. They are specifically looking to create an RFP for smaller vendors who are more highly specialized in web portal development and management. The latest tally of the numbers of new release
on insurance exchange s across the nation created un der the Affordable Care Act
8 million and counting , add to that the roughly 8 million Americans who so ught
insurance in private market places. That’s a significant number of Americans who have gained coverage . Although only a percentage of those were
pre viously uninsured. Just say no to Mox d uo , a key government panel voted
unanimously against approval of a powerful opioid prescription painkiller intended
to provide faster relief with fewer side - effects. The Food and Drug Administration

voted 14 to 0 against recommending the agency approve Mox d uo , the first drug
to combine morphine and oxycodone in one capsule. Prescription drug
overdoses are responsible for thousands of deaths per year and are proving a
gateway to an up - take in heroin abuse. Addicti on experts fear Mox d uo would
simply add flame to that fire with its acute potency. I am Marianne O'Hare with
these health care headlines.

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Mark Masselli: We are speaking today with Dr. Chileshe Nkonde Price a
cardiologist at Robert Wood Johnson Foundation . US Department of Veteran
Affair Clinical Scholar , Dr. Price is a research fellow at the Social Media Lab at
the University o f Pennsylvania School o f M edicine . She ’s also a Senior Fellow at
Pen n’ s Le onard Davis Institute for Health Economics . And is a creator of the
digital health project ‘Change My Steps’ program utilizing gamification in social
media to improve heart health among African - American women. Dr. Price
earned her medical degree from the University College in London and then
wor ked for the National Hea lth Services in England for three years , b efore
continuing her training in US . She was Chief Resident at Drexel University and
served her Cardiology Fellowship at Yale School of Medicine. Dr. Price welcome
to Conversations on Heal th Care .

Chileshe Nkonde Price: Thank you. It’s a pleasure to be here.

Mark Masselli: You know April is a national minority health month , and obviously
an area that you are quite passionate about , and you see the negative effects of
health disparities and disproportionately higher rates of cardiovascular disease in
early death amongst African - American women. Help our listeners understand
the nature of cardiovascular health disparity and paint a pi cture for us if you will
about the successes that we have had and also the road that we have to travel ?

Chileshe Nkonde Price: It’s important to realize that cardiovascular disease in
the US is actually a success story. Over the past 30 years, there hav e been
dramatic declines in mortality and mo r bi d ity from the cardiovascular diseases
when you look at the population as a whole . But when you break it down by
gender and race groups, you see that it really isn’t a success for all patient
groups , and it's here that I am really emphasizing that when you look at black
patients as a whole, we are not making those dramatic declines . And we really
find that in cardiovascular disease when it comes to black patients especially
black women there is a higher preval ence of cardiovascular risk factors. I am
talking about smoking, diabetes, physical inactivity and healthy diet . The
American Association publishes a statistical update s every year . And it says if
you know copying and pasting the same paragraph , but it’ s not . It’s just that this
is n’t new information. And this is really wh y I st arted to place a little bit of my
interest, and little bit of my work , thinking about how can we be creative about the
response to this long standing fact ? How can we think outside of the health care

system ? And it’s in that kind of thought that I decided to do community based
work . And when we think about agencies surrounding the hospital four walls ,
that could maybe move the needle on th e risk factors iss ue. So that’s where I
think the creative responses stand.

Margaret Flinter: Well Dr. Price as a Research Fellow at the Social Media Lab at
The Centre for Healthcare Innovation at PENN , you’ve really been able to take
your own creativity and your interes t in using social media and mobile
technologies as a strategy and innovative strategy to promote better health
practices among minority populations . And I want to talk about one of them that
you’ve been gaining quite a bit of attention for , and that’s th e digital project you
developed called ‘Change My Steps’ , which seeks to engage black women in the
dialogue about finding solutions that work. I think , I ’ve heard that you conceived
this project w hile sitting in a hair - saloon w here so much social interaction and
bonding occurs. So , tell us the story of the genesis of the program, who you are
reaching with it ? And maybe a little bit about the kind of techno logy and social
media platforms that you are enlisting ?

Chileshe Nkonde Price: What I was really looking for was really trying to get to
the fabric of what is it about African - American women a nd cardiovascular
disease. I wanted to think about where I am going to get the truth ? Where am I
going to be able to have the opportunity to talk with a demographic diverse
sample of African American women ? I attended a seminar at the University of
Pennsylvania called the ‘Politics of Black Hair’ and I heard Melissa Harris Perry
speak there , and I also heard Dr. G il speak there too. Dr. G il has done a lot of
work on the physiology of the American beauty shop , and really talked about the
hair - saloon as like a central place of social activation in the African - American
community , a place where ideas are naturally exchanged, where African -
American women gat her, naturally share secret s and solve problems.
Concurrent with that experience and then listening to Regina Benjamin who was
a surgeon general at that time --

Margaret Flinter: Of course --

Chileshe Nkonde Price: -- MPR[PH] . And she is something really wonderful
about the impact of the obesity epidemic in African - American women and she, I
think it was quote where she said, “ We have to go to where the people are at .
And it’s with those two kind of experiences that I am sitting in the hair - saloon
myself . I am hearing these conversations of barrier s and access . I am also
hearing conversations of solutions . And I put those three things together and I
thought this is where the truth is . That this is a place where naturally black
women gathers and that’s where the genesis of the program came from . And
that’s where I made the decision that I would as a cardiologist go out side world of
the hospital and seek this real world sample , and we decided that we would try
and gain the concept of local density , and select a few hair saloons to identify
areas in Philadelphia that were high , middle, and low income and then actually

going in ground choosing those zip codes . And actually I managed to partner
with three hair salons . And I spen t a lot of time befor e they changed my steps
but it actually got going, spending time with in these communities. You can't just
walk into a community and start asking questions. There really had to be some
agency from the hair salon owners and stylist themselves, and also the client ,
and getting to know the influences. What I mean by the influences are those
people who are directing conversations not just about health but about
commerce and about finances and about relationships. It’s a market place of
ideas , and an original study design was to go and ask African - American women
and ask them about these cardiovascular risk factors . Ask them what it would
take to change your step s? But it’s really together that we created - how c an we
use something a piece of technolo gy that w ere already all using to create more
healthy behavior s , and that’s where the second project , the change my steps
walking challenge was developed . Where social support was a huge aspect of
what allowed people to live a healthy life . And by offici al support I mean if
somebody else is eating healthy, then you are more likely to do it yourself. So
we got the women to go into group s of their own so cial network s . So they picked
the network. We got them to download digital pedometers on to their smart
phones , and then we gamified the experience by using the internet and Twitter
and me and my research (inaudible 12:13) emailing them not to encourage them,
to try and walk 10,000 steps a day.

Mark Masselli: We are sort of at inter section of techno logy and patient
engagement , and that is an exciting place to do it in. Talk to us a little bit more
about what you’ve learn ed, and tell us about your research about older
participants in the study ? How does this project blossom in the work s that you
are doing at the social media lab at UPENN Medical School as well ?

Chileshe Nkonde Price: Sure. So , our experience was that it was really a range
of tech sav v iness . You know , not just constrained to the younger element , but
some of the older women actuall y adopted the technology and did great . And
some of them struggled . You know , we actually know from empirical data that
pe w internet life and research project has looked at older adults than has looked
at the internet use . And has shown that internet use amongst the older adults is
actually on the increase , and, you know , on c e older adults do get engaged in
internet use, they tend to use the internet on a daily basis. But one thing that I
found especially interesting was to not assume that older adult s are not engaged.
Those older adults that are engaged tend to be the healthy ones. The pew data
does show that those older adults that have disabilities or health conditions are
less likely to either have internet “ activit y” is not same for access to di gital
applications. So, you ask ed me a question about scaling . And that I was
fortunate to capture older ladies who did a great job in the most part . But when
we’re really scaling into the health care setting it’s really important to understand
the empi rical data across e specially represent ative samples of older adults that
we are all going to face challenges . And think about that before we design
studies that they will be target population. You know the concept of if we build it

will they come , don’t just build and ask people what they need arranged ? I found
a similar ex perience that we’ve had in the Social Media and Health Innovation
Lab when a merchant who leads that Labrone [PH] project called ‘ The My Heart
Map Challenge’. They were trying t o map AEDs automatic external disability
across – in the city of Philadelphia , where they had digital applications, used
geography to identify them . And they ran a contest and the winners of that
contest were in the older age group. So , you can't really assume that smart
phones and digital Apps are just the things for younger folks.

Margaret Flinter: We are speaking today with Dr. Chileshe Nkonde Price a
cardiologist at Robert Wood Johnson Foundation , US Department of Veteran
Affairs c linical scholar. Dr. Price is the creator of the digital health project
‘Change My Steps’. So Dr. Price I want to pull the thread on geography a little
bit. You recently participated in a TEDMEDd Great Challengers webinar, on the
way population health c an be identified by something as simple perhaps as zip
codes , and how that data can be used to create very targeted solutions to health
disparities ? How do we move the needle using zip code based data ? Then
maybe you could share with our listeners some o f the programs discussed during
that TEDMED Great Challenges webinar ?

Chileshe Nkonde Price: Your zip code is more than a string of digits. It’s really a
analogy for your community. Those things that you have acces s to that are
creating health opportunities for you . And you know the second thing that we
came across there was a really lot of what Dr. Ga i l Christopher emphasized a
number of times across the web inar was something that’s really difficult to
measure , which is really having that conv ersation about asking our old
populations worth intervention s . I mean I was really challenged by her
comments on the web inar and it really got me thinking after wards, that we can do
a lot of things, we can ask a lot of questions, we can design creative ch allenges .
But there ’s something really tough that is a fabric behind this . The fabric of --
there has been a lot of inequality here in the United States. I think , she used the
term ‘A Heart to Change’ where people say that the most vulnerable population s
are worth the interventions. So let’s use a specific example that means that
when we are designing mobile applications and digital technologies targeted at
the least privileged population. We need to think about number 1 going and
asking them , what the y want ? Number 2 representing them on every level and is
about giving vulnerable population the wor th in every step of the conversation.
Some of the projects -- and the main project that we t alked about was the
concept of promise that were developed by the US Department Health and
Human Services . And the promise being one of those areas where the
government has really defined that it’s go i ng to create opportunity across
agencies to improve and help education and the concept of promise own just to
say we ll can we create promise through opportunity and can opportunity then
translate into better outcomes.

Mark Masselli: You know I want to get your thoughts Dr. Price not only about
across subgroups or across agencies , but really across the pon d, because yo u
were raised in England , where you did your early medical training and you were
steeped in the National Health Care s ystem , where access is not the issue that
we faced here in the United States. So share with our listeners how health
matrix differ betwee n the two countries when it comes to access and outcomes?

Chileshe Nkonde Price: Yes. The National Health System as you said , that
universal access to health care for all. But still when you look at national data in
the United Kingdom, there are disparities across social class and economic lines
which is to be expected. One thing that you find living in the United Kingdom,
working within the National Health Services is that the re really is by having this
single system, greater integration with health care and the social care or patients
interact with the health care system . And it’s just something that when I first
came to United States, I noticed was present but fragmented, le ss universal, and
it’s actually if I am really honest with you one of the reasons I stayed in the
United States , because I felt like, this could be better. I ’ve seen it done better .
And I ’ll give you an example just from my -- you know , from my own specia lty
cardiology . Recently new guidelines produced for the definition of cardiovascular
risk. The US calculat or used standard matrix that we know for risk factors , which
were , you know , a patient’s age and their cholesterol and their gender and their
race . But the joint British Cardiovascular Society recently released th eir
calculator , and one of the things within that calculator – if you can press the
button where you define what your health looks like , that’s with the risk
calculator . And the reason why that’s extremely powerful as it goes back to my
point about where you live and your community to find your help . That’s not in
the US calculator. The UK gets that. I felt that that really crystallized the idea
that social care and health care are very tightly integrated . And the point being
th ere is it’s something I ’ve often said is that it takes everybody. It takes the
doctors, it takes the health care system, it takes government, it takes community
leaders. The last thing I ’ll say is my e xperience working in the NH S . When I was
there, you could see that having a single healthcare system, you can imagine the
healthcare records are more readily available across hospitals. It is easier for
health care professionals and people in the communi ty to communicate. But
recently the United Kingdom has decided to make this health care records
available for research . I nformation we already have in the medical record. We
can understand the predictors of disease . And we are not there yet in the Unit ed
States. I am giving you a glimpse to my vision of how we can think about, what
are the key determinants of poor outcomes. I think the United Kingdom is a head
of the ga m e.

Margaret Flinter: We have been speaking today with Dr. Chileshe Nkonde Price
c ardiologist a t Robert Wood Johnson Foundation , US Department of Veteran
Affairs clinical scholar . You can learn more about her work by going to
www.changemysteps.com . Dr. Price thank you so much for being with us today.

Chileshe Nkonde Price: Thank you so much.

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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 Robertson is an award - winni ng journalist and managing editor of
FactCheck.org, a non - partisan, non - profit 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: It ’s well known by now that P resident Obama’s claim that if you
like d your health care plan , you can keep your health care plan , wasn’t true . And
we ’ve seen many ads in 2014 saying that millions have lost their health
insurance. But how many millions of insured Americans have their plans
cancelled and how does that compare with the millions of uninsured Americans
who have gained coverage under the law. There is evidence that far more have
gained coverage than have their policies cancelled. Those how had policies
cancelled were on t he individual market. Many of these individual s were likely
eligible for federal subsidies if they brought plans on the exchanges instead.
How many have their policies cancelled? Researchers from the Urban Institute
say roughly 2.6 million people based on a nationwide poll how many have gained
insurance. One survey conducted by the Urban Institute says 5.4 million of the
previously uninsured gained coverage between September and the beginning of
March. Another said 9.3 million adults had gained coverage as of mid March.
The Obama administration has said that 8 million signed up for insurance on the
exchanges but that total would include both the previously uninsured and those
who already had cov erage . 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 factual accuracy from the
country’s major political players and is a project of the Annenberg Public P olicy
Center at the 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 o n Health Care.
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Mark Masselli: Each week, Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives. Outgoing New York City Mayor , Michael Bloomberg is leaving his post with another public
health feather in his cap. Launched in May of 2013, the city bike sharing program has in a few short months reached a milestone. In the first 5 months since the program launched, city bike users h ave logged over 10 million miles and over 5 million rides far outstripping similar programs in other cities throughout the United States. It's a program funded by Citibank allow

subscribers to join either on an annual fee of $ 95 .00 . They are reaching an
average daily ridership of 35,000. The estimated number of calories burnt since
the program began in May is 403 million. Since taking off as Mayor , Bloomberg
has launched the first citywide smoking ban in buildings and lounges, the first in
the nation ba n on transfat in restaurants. Both programs have had a dramatic
impact on the health of the population reducing exposure to a secondhand
smoke and dangerous food additives. The city has plans to scale the program
up to all 5 b o r oughs adding 100s of miles bike trails and 1000s of bikes to newly
developed bike stations. Chicago and Washington DC have similar programs
and have plans to scale up their efforts as well. An affordable bike sharing
program that has encouraged hundreds and th ousands of city dwellers and
visitors to exercise their way to their destination. Now that’s a bright idea.

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

Mark Masselli: And I am Mark Masselli, peace and healt h.

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