Dr. Martin Kohn, Chief Scientific Officer of Jointly Health

( Music)

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

Margaret Flinter: A nd I am Margret Flinter .

Mark Masselli: Well Margaret, we are just a few weeks away from the next open
enrollment to purchase health insurance under the Affordable Care Act , and
while millions of Americans gained coverage during the first open enrollment
there are still millions who are uninsured leading into round two.

Margaret Flinter: The first open enrollment exceeded expectations by the
administ ration on how many Americans would sign up. Eight million people
signed up for coverage, about five million gained coverage under Medicaid
expansion, and millions of young adults w e re able to stay on their parent s ’ plan
up t hrough age 26.

Mark Masselli: According to the new poll just release d by Kaiser Family
Foundation, many of the currently uninsured Americans have the least amount of
knowledge about the upcoming enrollment .

Margaret Flinter: So that poll showed that this group was least informed abo ut
th
open enrollment details, and open enrollment begins on November 15 so it's still
a big job to do getting the word out in those communities and among those
individuals.

Mark Masselli: It maybe is sort of being lost in all of the noise , and certainly part
of that noise is the issues around Ebola . The administration has stepped up
safety protocols in the wake of the few Ebola cases in the United States . The
CDC has issued strict er guidelines for protective gear use , and has clarified
directions for ho w health facilities should deal with any cases that arrive on their
doorstep.

Margaret Flinter: Some of the guidelines , Mark, are commonsense, but really
commonsense always builds on preparedness . Having a cl ea r chain of
command and a well - rehearsed pla n and system in place i s critical . Make sure
that all individuals in the system are trained . These are all important elements.

Mark Masselli: This is actually great advice not just for Ebola but for any highly
contagious pathogens. There is a video on the CDC website that very clearly
outlines these new guidelines . It would be a good idea for any provider or health
care organization to watch this video and make sure they are complying.

Margaret Flinter: Well, let’s turn now to our gues t today . He i s an individual who
thinks that Big Data analytics and better use of h ealth technology can be an

incredible tool for monitoring population health both individually, also potentially
in the wake of any health crisis.

Mark Masselli: Dr. Mart y Kohn is Chief Medical Scientist at Jointly Health, which
is seeking to create a better platform for sharing personalized health data to
assist clinicians in improving population health. He also oversaw the IBM team
that built the supercomputer Watson.

Margaret Flinte r: Lori Robertson looks into false claims spoken about health
policy in the public domain. But no matter what the topic, you can hear all of our
shows by going to www.chcradio.com .
Mark Masselli: And as always, if you have comments, please e - mail us at CHC
Radio at www.chc1.com
, or find us on Facebook, on Twitter because we love
hearing from you.
Margaret Flinter: We will get to our interview with Dr. Mart y Kohn in just a
mom ent.
Mark Masselli: But first , here is our producer , Marianne O'Hare with this week’s
Headline News.
(Music) Marianne O'Hare: I am Marianne O'Hare with these Health Care Headlines . The
second open enrollment under the Affordable Care Act gets underwa y in a
couple of weeks . November 15

th
is the start date, and there is a flurry of activity
across the country as preparations look quite different depending upon where
you are. In Maryland, they are launching a new system this year having partnered with th e successful Access Health CT, Connecticut ’s e xchange that
ran so efficiently . So far it's testing out well. State of Oregon has cut its final ties
between Cover Oregon and Oracle , the company hired to build Oregon ’s state
health insurance exchange. T he state distance d itself from Oracle , instead
piggybacking onto the federal exchange.
Colorado wa s one of the states that created its own health exchange and it f ared
pretty well in the first go round . Roughly 300,000 signed up for coverage during
the f irst open enrollment , still a large number of folks in that state staying out of
the insurance market al together . So the Colorado Health Foundation hired
RAND Corporation to figure out why. They found consumers were confused
about Medicaid and subsidies available through the exchange for private
insurance .
The CDC has amped up its guidelines for handling Ebola in the clinical setting
releasing a video outlining those new guidelines , calling for extra layers for
protection , a buddy system to ensure protec tive gear is donned and disposed of

correctly , and better team coordination for handling active cases. Meanwhile, in
Liberia and other parts of West Africa, cases continue to mount , and there was
another downside to the deadly outbreak there ; children are n’t getting their
necessary vaccines now. Liberia had an active program in place that ha d got ten
that country to about 95% vaccination for all kids. Since the Ebola epidemic
began , those numbers have dropped to 27% . Public health officials are bracing
f or what they believe will be the next epidemic , preventable childhood diseases
like measles and scarlet fever which stand poised to kill many more children in
the future.

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

(Music)

Mark Masselli: We are speaking today with Dr . Mart y Kohn , Chief Medical
Scientist for Jointly Health, the collaboration of world - renowned clinicians,
scientists and mat hematicians dedicated to building a next generation remote
monitoring platform for health care. Recently, Dr. Kohn was Chief Medical
Scientist for Car e Delivery Systems at IBM Research , leading IBM’s quest to
transfer health care including overseeing the development of Watson for health
care. Dr. Kohn is co - author of numerous publications on health care
tran sformation including IBM’s white paper “Patient Centered Medical Home –
What, Why and How.” He is a Boar d Certified Emergency Physician. He is the
Fellow at the American College of Emergency Physicians as well as the
American College of Physician Executi ves . He earned his Bachelor ’ s in
Engineering at MIT , and his Medical Degree from Harvard. Dr . Kohn , welcome
to Conversations on Health Care .

Dr. Martin Kohn: Thank you.

Mark Masselli: We are really excited about your work and its focus , really this
i ntersection of improving medicine and developing data and technologies,
platforms that can help practitioners facilitate personalized medicine. Now your
focus has been on developing artificial intelligence tools that vastly improve
provider experience s , i ncluding the development of Watson, the first language
recognition supercomputer that earned so much popular attention by be at ing
Jeopardy’s all time best contestants. Could you describe your vision of how data
analytics is improving health care experienc e and how it's poised to transform
health care in the future?

Dr. Martin Kohn: We have recognized over the years certain limitations or
problems in the way health care is managed and delivered in the United States
and around the world. And one of the ke y components to supporting the
transformation of health care to something more patient - centered, more efficient
and safer is the ability to make better decisions, and in particular decisions that
are personalized , aimed at the individual . Everybody is a l ittle different . Not all

diabetics are the same. And so the more we can use all the information available
to us to make it easier, to make better decisions that are more directed for that
individual the more likely we are to make decisions that are helpf ul and effective
for that patient, and then improve health care overall.

Margaret Flinter: Well Dr. Kohn , one of those efforts to transform care ,
particularly in the primary care space has been the Patient - Centered Medical
Home concept, and your views on that were spelled out in a white paper that you
co - produced a few years ago titled the Patient Centered Medical Home – What,
Why and How. And you have said that data mining and remote monitoring are
big part of that agenda. What are some of the key prin ciples for PCMH model
that include better adoption and use of technology?

Dr. Martin Kohn: Yes, we are making progress. We are recognizing for example
that if we can monitor patients with chronic disease at their home and list their
active participation in managing their health situation that things improve. It fits in
with the Patient - Centered Medical Home in that one of the ir principles is what’s
sometimes called the Empowered Knowledge able Patient , a patient who
understands enough about his or her he alth situation and the options that they
themselves become better managers of their health care. So this patient -
focused idea of the patient being a better manager is a part of that, and the
theme is that any information we can collect from whatever sourc e that can be
shared with the patient in a way that the patient can understand and use,
improves th at working relationship with their primary care provider and improves
the overall outcome and cost s go down.

Mark Masselli: Dr. Kohn, we operate a primary care practice focusing on serving
special populations, and have been excited about the opportunity to participate in
the Patient - Centered Medical Home Initiative . I think one of the big challenges
that everyone has is how do you contain cost as primary ca re practitioners , and
what are your thoughts on that?

Dr. Martin Kohn: If we look at some expressions of the future of health care,
define d something as The Triple Aim, improving patient population health,
improving the patient experience and controlling cost. So we want all of that
now, and in order to do that, we need certain incentives in order to encourage
people to participate in that model. One of the concomitants of more
personalized is that you w ould be less likely to initiate an intervention , a costly
intervention that would not be helpful for this particular patient. Now if we are
going to get to that point where in ef f e ct participants in the health care system will
be rewarded for quality , for improved outcomes rather than how much they can
d o, then we need to change the way health care is paid , where the participants in
health care, the clinicians for example , are rewarded for improved quality and
controlled cost simultaneously .

So if we move to a structure where the participant s’ health car e are rewarded for
achieving both , then we have the foundation where these other support tools like
a clinician decision support and Big Data analytics to make it easier for the
clinicians and the patient , then we are going to be able to move forward. If we
stay with the fee - for - service model then these tools aren’t going to be very
helpful. So there is something called the Accountable Care Organization where
these health care systems have agreed to provide care to a large group of
patients for a specific amount of money that’s negotiated, and their obligation in
receiving that payment is to improve the health of that population and control
cost. So in that e nvironment, then these tools and the idea of the Patient -
Centered Medical Home makes sense.

Marga ret Flinter: Well you know, Dr. Kohn, as I look back over the past several
years, one of the areas where we have seen a persistent and accelerating trend
is certainly the movement of the country’s health care providers away from the
st
old paper records that we were raised on and towards a 21 Century mo de l of
electronic health records. But still we seem to lack a unified platform that brings
all the data together and makes it actionable at the point of care. What needs to
happen on the system development side to advance this use of personalized
health data?

Dr. Martin Kohn: There are many, many electronic health records out there.
Collecting data from different electronic health records is a bit of a challenge. So
the goal is platform - agnostic , develop tools that can work with any of the
electronic health records or other data storage systems that are out there. There
are efforts to get a common standard, but as one person said , the problem in
defining a standard the problem is too many standards , whic h makes it hard to
integrate all that information . So , there are organizations such as Jointly Health
which are designing their systems to be platform agnostic and to work with
different health care information systems , b ut I don’t think that in the near future
we are going to achieve that goal of having a single uniform standard. So I think
the effort is going to be creating analytic s systems that can work across the
different platform s.

Mark Masselli: We are speaking today with Dr. Mart y Kohn, Chief M edical
Scientist for Jointly Health, collaboration of world - renowned clinicians, scientists,
and mat hematicians dedicated to building a next generation remote monitoring
platform for health care. Until r ecently, Dr. Kohn was Chief Medical Scientist for
Ca re Delivery Systems at IBM Research including overseeing the development
of Watson for health care. Well, Dr. Kohn, you are probably rightfully proud of
the work that you and the whole team of people did in creating Watson, and I
think it was generally in troduced to the public at Jeopardy. Watson was sent
back to medical school to learn about book knowledge . I guess I always wonder
about the critical thinking element, does that exist in Watson or is Watson just a
large repository? Tell us more about it.

Dr. Martin Kohn: Watson is a tool that ’s using natural language , the typical
language of communication , and Watson analyzes written text - like information,
be it journal articles or national guidelines , and rather than a pass ive repository
[ph] where you just kind of look up information and search for information, it
actually reads and understands huge volumes of literature like tens of millions of
pages in a few seconds , c ollects information from written documents and offers
suggestions for the physician s to consider or the clinicians to consider based on
all its reading . And it uses a concept called cognitive computing where after a
fashion the computer actually thinks and analyzes and tries to decide how
relevant a particular fact or statement is, and it used that same approach in
pla ying Jeopardy .

In health care it’s a little different in that it doesn’t come back with a single
response, the way it was required to in Jeopardy, but comes back with
suggestions prioritizing the order in which Watson thin k it’s relevant to the
decision to be made. So it doesn’t make decisions for the clinicians; it gives
them access to huge volumes of literature that we would all like to read, but there
are hundreds of thousands of new articles published every year and yo u can’t
keep up with it. So Watson in effect is your library assistant, and then you use
that information as you would with any other information to make a decision. But
again, Watson focuses on that one component of information, and as I
mentioned befor e, our goal is to use all the information.

So for example, where we are working now with Jointly Health is we integrate
home monitoring data with other health care information data for patients with
complex multiple chronic diseases to identify patterns i n the information we see
that would allow us to identify a patient who is on the verge of getting sick but not
yet actually sick , and to get enough information to identify such patients and
come up with a simple intervention that will reduce the likelihood they actually will
get worse. It’s estimated that something on the order of a third of hospital
admissions for patients with chronic disease were actually avoidabl e. So Watson
works in one area and other analytic tools work in other areas. My ultimate goal,
my dream is that we will have a platform that can use all the different kinds of
information, the text information that right now Watson handles, image
information, laboratory info rmation, home monitoring data, the more likely we will
be able to make those personalized decisions that allow us to get into the
preventive mode of health care rather than reactive mode.

Margaret Flinter: As I look back on your work over the course of your career it's
very grounded in those years as an emergency room phys ician where of course
you saw all the consequences of poorly managed chronic illness. Then you were
at IBM and now you are at the startup. Maybe you could tell our listeners a little
bit about who you have partnered with at Jointly Health, how this will be
applicable across the broad spectrum of the industry, and I would be particularly
interested are you working with any practices now in kind of a real life simulation

to see how does this become actionable at the level of the people who are caring
for th e patients at the level of the team .

Dr. Martin Kohn: Right now, roughly three quarters of what ’s spent on health
care in the United States is for these patients with multiple chronic diseases. At
some point we would like to be able to prevent people fr om developing these
chronic diseases, and that idea is called primary prevention. We work with
organizations that are in this accountable care like mode where they have agreed
to take on the health management for a large group of patients with multiple
ch ronic diseases because if that dual objective weren’t there then there would
not be necessarily great deal of interest in what we have to offer because what
we are offering is reduced utilization of health care services and an improved
health. So we are w orking with three or four organizations about to actually start
monitoring large numbers of patients to demonstrate the value of this preventi ve
mode. The idea of home monitoring of patients with chronic disease has been
around for some time, but there is a lot to learn about the space so we are
collaborating with some research organizations as well as organizations that are
currently providing health care for large numbers of patients.

Mark Masselli: Dr. Kohn, you are participating in one of the more in teresting
conferences of the year run by Singularity University . This year’s theme is
Exponential Medicine , reinventing the future of health care and medicine, and in
addition to the many notable keynote speakers including yourself, winners of the
Nokia I nnovation Challenge and MEDy Award will be announced. So could you
share with our listeners a little more and describe Exponential Medicine and what
we can expect from this year ’s gathering?

Dr. Martin Kohn: Well, the Exponential Medicine is really an e xtraordinary
gathering of people working at the very edges of the future of health care, and it's
across all different areas of technology . So , things that have been described in
the past are mechanical support systems that allow paralyze d people to walk,
creating artificial organs, real organs, creating sheets of tissue that act like
normal l e ver. So it's a gathering of these people just to share ideas and what’s
been accomplish ed so far, and what the future might be, and within this meeting
th e re are pe ople that sponsor challenge pri z es , some of them with quite
substantial rewards if you can come up with systems that accomplish certain
tasks. If you offer this pri z e and the prestige of having won the pri z e that many
different small or large r organizatio ns will attempt to take on these challenges
and that out of it may be things that are very useful, very important for supporting
and encouraging the transformation of health care. So you get to meet and
speak with these people and share ideas , and it's ra ther extraordinary. It gives
you faith that there is enough ingenuity and creativity and initiative to actually
accomplish these things, and so I always kind of leave these meetings quite
enthused and optimistic.

Margaret Flinter: We have been speaking today with Dr. Mar ty Kohn, Chief
Medical Scientist for Jointly Health, a collaboration of world - renowned clinicians,
scientists and mat hematicians, dedicated to building a next generation remote
monitoring platform for health care. You can learn more abou t h is work by going
to www.jointlyhealth.com , and find him on Twitter @ MSK ohn. Dr. Kohn , thank
you so much for joining us on Conversations on Health Care today.

Dr. Martin Kohn: Well thank you. It's been a 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 Robertson is an award - winning journalist and managing editor of
FactChec k.org, a non - partisan, non - profit 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: How well did the Kentucky insurance marketplace do in terms of
covering the previously uninsured ? At a recent senate debate, Republican
Senator Mitch McConnell and Democrat Alison Lundergan Grimes disagreed on
that question. McConnell disputed that the state website called Connect had
insured 521,000 people. Grimes meanwhil e said those half a million people had
insurance for the first time. More than half a million have signed up for coverage
through the Connect website for both private insurance and Medicaid , b ut Grimes
is wrong to say they were all previously uninsured. Through the end of the open
enrollment period 75% of Kentuckians who had signed up for coverage indicated
they had been un insured prior to gaining insurance through Connect . That’s
according to the State Cabinet for Health and Family Services.

Between Oc tober 01, 2013 and April 15, 2014, the end of open enrollment ,
413,410 had enrolled in health coverage , most of them on Medicaid and 82,795
on private insurance . At the debate , McConnell questioned how many of those
gaining private insurance did so after their non - compliant policies were canceled.
We don’t know the answer to that. One Gallup poll though shows Kentucky has
experienced the second largest drop in the percentage of uninsured of all states .
The August poll shows the state ’ s percentage of uni nsured dropping from 20.4%
to 11.9%. 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 pr oject 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.chcradio.com . We will have FactCheck.org ’s Lori
Robertson check it out for you here on Conversations on Health Care.

(Music)

Mark Masselli: Each week, Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. In the emergency
room or the I.C.U., clinicians are confron ted with a myriad of unpredictable
medical crisis that sometimes can be challenging to diagnose. Most of these
clinicians are now communicating with colleagues via their smartphone s , often
sending images of the patients’ unique symptoms to one another for shared
diagnos i s. I.C.U. Physician Dr. Josh Landy was noticing a growing trend of
imag e sharing via smartphones to c rowd s ource [ph] second opinions from friends
and colleagues across the country. But he also was concerned about the
potential violation o f HIPAA regulations so he developed an app for that. He
created Figure 1 , a sort of Instagram for doctors in which images can be de -
identified but shared across a dedicated social media platform that would allow
input from clinicians within their network. Doctors are using the app to
communicate not only with colleagues within their hospital settings, but around
the world where someone might have superior expertise with a certain condition.

The app was recently used to share a chest image of one of the p atients who
presented with the Mid - Eastern virus MERS. Dr. Landy says the app s get about
half a million image views a day with about 80 million total views so far. He sees
the potential for this platform only growing as more young digital natives enter t he
medical workforce. Figure 1 is a free download through Apple App Store s and
Google Play. A free downloadable app offering secure HIPAA compliant image
sharing among clinicians around the world to reduce the time it takes to zero - in
on a diagnose by ta pping the collective expert instantly , now that i s a bright idea.

(Music)

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

Mark Masselli: And I am 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 brought to you by
the Community Health Center.