It Takes a Village by Kevin Pereau

ACKNOWLEDGMENTS
Above all, I want to express my love and gratitude to my wife Beth and my daughter Megan. Without their love and support, this book would never have happened.
I also would like to express profound gratitude to all the experts who contributed their views to this book, enriching it miles beyond what it could ever have been without them.
Thanks too to Alan Dino Hebel and his team at BookDesigners.com. They took some general ideas for what I wanted the design and the cover to be and turned them into a work of expressive and appropriate art.
I thank Barry Lenson, the editor who helped me turn a lot of ideas and plans into this book. We had fun and became good friends in the process. Thanks too to Varsana Tikovsky, a keen and insightful editor who proofread the manuscript and corrected a number of editorial issues that needed attention.
Last, I would like to thank you, my readers. In the pages ahead, you and I will enter an astonishing new world of connected care, an amazing and healthy journey we will take together.
Thank you for joining me, and welcome aboard!
Let’s all plug in!

FOREWORD
BY BRAD FLUEGEL
How is healthcare changing and who is benefitting? You are a consumer of healthcare services, and so am I. What plans should we be making and what do we need to be thinking about?
I approach those questions from the perspective that first of all, human beings don’t live in the healthcare universe. They live in the real world. Even people who are dealing with diabetes or other chronic conditions are not exclusively focused on healthcare 24 hours a day. They are driving their cars to the grocery store or taking their kids to school.
In fact, most people are going to think only periodically about even chronic conditions. They have their lives to live. We have to meet them where they are and not force them to conform to the requirements of the healthcare system.
We do see that some wealthier people have the ability to devote more of their time, attention, and resources to managing their health and use expensive technologies. Unless you’re a rich venture capitalist in Silicon Valley and can afford to be obsessed with all kinds of newfangled technologies that help you track fitness and health, chances are you won’t. Most people don’t have the time or money or energy.
I have noticed that the various stakeholders in the healthcare universe honestly care deeply about helping people. They do not only care about making a lot of money, even though many people in our society believe they do. The costs of insurance, prescription drugs, hospitals and physicians can be quite high, which reinforces that perception. Yet in my experience, most everyone in the world of healthcare is honestly trying to do good. They just don’t know how to integrate into patients’ lives and connect everythingall together—their lives as both people and patients.
So, when I think about what the future holds for healthcare, I think we will see an integration of all the new technologies and data from various sources into people’s lives on a moment-by-moment basis to support the goal of making lives and health better.
In practical terms, how will that be reached? I believe that, to engage consumers, everyone in healthcare needs to put a support system around consumers that interacts with them as part of their daily lives. We need to meet people where they are using tools, technologies and the places they are familiar with and already using.
That’s a great place for digital health companies and retail organizations to play a role. One thing they can do is to develop technologies that can remotely monitor patients in their homes—in effect, to monitor how people are doing and alerting them and their care teams if a problem is detected.
Apple and many others are trying to do that with wearables, apps and other technologies. There are a whole slew of other companies, some of which are profiled in this book, that are trying to use technology supported by services to help people live healthier lives and better manage their chronic conditions.
Retailers are also diving deep into this. We have to remember that although customers are going online more and more, they still go to stores a lot. That is not going away. So companies like Walgreens and CVS are creating what CVS calls health hubs and what Walgreens calls health destinations within some of their stores. In them, people can now meet with a clinician for urgent issues, as well as for more chronic concerns, get lab tests, discuss their diets and get other services as well.
But at the end of the day, retailers and technology companies can’t do it all by themselves. Traditional players have to lead on this as well. Doctors and health systems will continue to have an important role to play, because they’re still most trusted by the patients who are under their care. And so some of the tools, whether they are services from retailers or technology companies, will need to be integrated with the services that physicians are providing to their patients, so that these newer telehealth and digital services don’t sit on an island that is disconnected from the regular care pathways that many patients might be on. Patients often look to and trust their primary care providers and specialist physicians, and that will not change.
We have seen that happen during Covid-19. To be sure the pandemic brought about a lot of change in healthcare, but one of the things that I found most interesting was that although there was a big spike in telehealth visits to telehealth providers, there was also a massive increase in the telehealth offerings from traditional providers—people still wanted to interact with physicians they knew and trusted. Telehealth did not cause people to turn away from that. They still wanted to have a relationship with someone, often their doctor, or with someone in their doctor’s practice. They didn’t want to get advice or care from some random doctor, or some technology portal other than perhaps for some kind of kind of acute issue that emerged. The acceptance of telehealth from traditional providers was the real game-changer and will open the door to more convenient care for patients and improve outcomes. They will need technology to help them connect it all.
Another important change during the pandemic was that there came to be reimbursement parity between online and in-person visits. Whether you saw your physician during a telemedicine session or in his or her office, the provider received the same amount of money. That drove a massive cultural shift within providers that I think is going to stick. I believe that in the long term that change will be better for patients. Telemedicine is not going to replace in-person visits. But I think it represents a step change in usage for the traditional systems.
The fact that more people were working remotely during the pandemic brought about change in employer-provided programs too. There were suddenly more employees working from home, sometimes part-time, and often with children at home too. This led to stress that was exacerbated by the isolation and loneliness that accompanied the lockdowns. Mental health issues and access to care became issues that employers and health plans had to address. Here again technology and connection have an important role to play.
Yet it is surprising that during the pandemic, the overall number of mental health visits came down—virtual visits were way up but more than offset by the decline in physical visits. I think that’s going to create a big crisis, particularly for kids. The prevalence of eating disorders and anxiety and depression among young people who haven’t been able to go to school or be socialized is a concern. There could be a huge wave of adverse events just waiting to happen down the road. That’s something the industry has to anticipate and find ways to fix.
I’m also concerned that preventive screenings and care delayed during the pandemic may lead to a spike in illnesses and costs over the longer term. Technologies like those described in this book will be critical to addressing all of these issues.
And then lastly, I’d say with regard to health plans, they’re all trying to get closer to patients and closer to their members. And I think they’ll continue to do that. Over time, they will stitch together a system across not just traditional healthcare providers, but technologies, non-traditional business partners and others that are interacting with their members. They have an important navigational role to play in the future healthcare system. That’s not possible without the connectedness advocated in this book.
So, what does all this innovation mean? Not much if you don’t connect to it, which is what this book explores. It has been said that our smartphones are democratizing healthcare in much the same way that Gutenberg’s printing press did the written word back in the 14th century. While regulation has slowly caught up to how to better integrate new technologies into our reimbursement workflows, It Takes a Village explains how you can tap in to take advantage and take control of your health. There is a cornucopia of resources available to you today that you never had before. You can’t benefit unless you plug in and get connected. All you need is your smartphone. To your health!

ABOUT BRAD FLUEGEL
Brad Fluegel currently advises healthcare organizations, entrepreneurs, private equity firms and other participants in healthcare. He recently retired from being the Senior Vice President and Chief Strategy Officer at Walgreens based in Deerfield, IL.
Brad now serves on the Board of Directors at Metropolitan Jewish Health System in New York City, Performant Financial Corporation, Premera Blue Cross and Alight Solutions. He served on the board of Fitbit until its sale to Google in early 2021.
Brad earned a master’s degree in public policy from Harvard University’s Kennedy School of Government and a Bachelor of Arts in business administration from the University of Washington. He also serves as a lecturer at the University of Pennsylvania’s Wharton School of Business.

INTRODUCTION
Welcome to It Takes a Village—the continuing story of how healthcare technology is better connecting you with all the resources you need to get and stay healthy. Since the Affordable Care Act was first enacted, we have seen an amazing technology explosion in healthcare. Over the last 10 years, we have made monumental strides in improving how we manage populations of health and creating a more consumer-like healthcare experience. We have broken down barriers and moved the needle in improving the health of our nation. We have also learned that technology alone won’t be enough to help us fix our healthcare crisis. As consumers of healthcare services, what will it take and what role can we play? Increasingly, the impetus for disruption and change is coming from the most unlikely of places: consumers!
My first book The Digital Health Revolution, focused on how our smart phones are changing the way you and I manage our health by better connecting us to our stakeholders in healthcare. Our smartphones have democratized healthcare the way Gutenberg’s printing press democratized the written word back in the 14th century. Patients are better involved in their recoveries because they are better informed and better connected. As the focus shifts from chronic care management to simply staying healthy, staying connected has never been easier and more important.
For this book, I interviewed 30 of healthcare’s top thought leaders. I caught up with who is innovating and how end-users can take advantage. We provide you with examples of how people with diabetes can now capture and share their blood values with their doctors while digital health tools help supply them with tips and tricks for managing their condition. These same principles can be applied to literally any population of health, including those who are trying to avoid that trip to the doctor in the first place. There were many epiphanies along the way, but the final summation is that we are now on the cusp of connected health where all of our health data is actionable. Simply said, expectations are changing. If we share our personal health data, it is because we expect an immediate benefit in return.
Actionable health data and a connected world are fascinating new concepts. It Takes a Village explores how digital health technologies are now extending what we have long thought of as healthcare and begs the question, what else needs to connect? We again feature insights from some of healthcare’s biggest names and thought leaders. From the emergence of retail health to everyday nutrition and fitness. We are also discovering that better managing the social determinants of health (SDOH) means activating and connecting schools, mental health facilities, recovery centers and gyms. It can’t happen without our participation and connecting has never been easier.
WHAT MOTIVATED ME TO WRITE THIS BOOK?
I was driven to start writing about healthcare after reconnecting with a couple of schoolmates in Vermont where I grew up. Both confided in me that they now have type 2 diabetes. Neither was remotely aware of the tools and devices that are now available for tracking, analyzing and better connecting them with the people who can help them thrive with their diabetes. I thought, what good is Virta Health (which has reversed diabetes in more than 50,000 patients) if nobody has ever heard of them? So much innovation has happened over the last ten years, it is time we all catch up. Healthcare companies of all kinds have been busy innovating and investing in solutions that are easy to use and integrated into your providers’ infrastructure capabilities as well as your Health Savings Account and Apple Health.

Health is the new wealth – it always has been - and it is a non-traditional group of new players who are emerging to help us get and stay healthy. Imagine walking into your local retail pharmacy to pick up a prescription. You have some time to kill so you wander over to their clinic where you spend a few moments talking to a nutritionist about the best foods that people with diabetes should avoid and what foods to embrace. Together, you build out a meal plan for the week. Each day, your meals are delivered right to your door by your local grocer. You are already using smart scales to capture your weight, BMI, and body fat. Couple that with your glucose readings, activity trackers and the meals you log every day, and you get a sense that not only can you manage your chronically monitored condition, but you can thrive with it or maybe even reverse it. Your provider now has a holistic look at how your diet and lifestyle come together to affect your health. You now have a better understanding of cause and effect and how our daily choices all add up to make a difference. You also have the tools for how to make better decisions. We are developing longitudinal relationships and better understanding of what drives poor health.
What are some of our lessons learned from this wave of digital health innovation? Much of what we do in healthcare focuses on our symptoms, but not the root causes of our problems. An eye-popping example of this is California’s Surgeon General Nadine Burke Harris’s realization that social determinants of health (SDOH) and adverse childhood experiences (ACE) are a huge contributor to poor health and require more than a doctor and a set of tech tools to manage. Because of that, we have included sensational input from Stevon Cook, Commissioner of the San Francisco Board of Education, and Austin Buettner from the Los Angeles Unified School District, on the roles that schools can play in ensuring the health of our students. Will it surprise anyone if mental health and social workers become an important
4 | CONNECTING HEALTHCARE: IT TAKES A VILLAGE
everyday resource for students, or become an integral part of your local school or pharmacy? As former CMS Director and Board Member at United States of Care and Townhall Ventures Andy Slavitt likes to say, “Healthy kids make for healthier adults.”

The term healthcare in itself is a bit of a misnomer. In reality, it has always been about sick care. We need to turn the corner and start focusing on how to get and stay healthy. My first healthcare company begged the question: what is good health? At its very core, it is a combination of who we are (our biometrics), what we do (our activities) and how we feel (our mental state of mind). In this book we will explore who is doing what to help us manage all three.
Perhaps the most exciting dynamic we have seen is the rise of retail health and the surge of new entrants into this space. The big data explosion is now transitioning us from backwards-looking analysis at what just happened to a forward-looking view at what we can do about preventing health problems in the first place. We now expect our health data to be actionable and we expect to be able to share our personal data with trusted sources who can help us stay healthy. Increasingly, those trusted sources are innovators who are already working with our providers and insurers. Nobody pulls that together quite like our local pharmacy.
When we first started writing It Takes a Village, we didn’t anticipate we would be working through a pandemic. Who could have anticipated that? Because of that, we checked in with Peter Lee of Covered California and Kevin Mullin from the Green Mountain Care Board in Vermont to see how anyone losing their employer-provided benefits due to the downturn in the economy could continue their healthcare benefits.