The Digital Health Revolution

ACKNOWLEDGMENTS

First and foremost, I want to express my love and gratitude to my

wife Beth. I often tell people that she knows more than anyone does

about health care, because that is absolutely and completely true. She

came to it because she is someone who cares deeply about people and

miraculously, she cares about me too. I also want to express my love

and thanks to our wonderful daughter Megan, who also caught the

health care “bug” and who now works as a consultant in the field.

Without the support of Beth and Megan, this book would never have

happened.

I express profound gratitude to all the experts who contributed

their views to this book, enriching it miles beyond what it would have

been without them. They took what was an interesting book and

made it exceptional.

I would also like to thank just about everyone I have ever worked

with over the course of my career. In their own ways, each of them

shaped and changed me as a health care thinker and professional. And

let me give special thanks to Rick Lee, my collaborator and co-founder

of TranscendIT Health.

I thank Barry Lenson, the writer and editor who helped me turn

a lot of ideas and plans into this book. We had fun and became good

friends in the process, and I thank him for that.

Last, I would like to thank you, my readers. You and I will enter

an amazing new world of connected care in the years ahead, an amazing

and healthy journey we will take together. Thank you for joining

me, and welcome aboard!

CONTENTS

Acknowledgments.......................................................................VII

Foreword......................................................................................XI

Introduction...................................................................................1

Chapter One: Our System Is Broken, But Who Cares?................... 5

Chapter Two: Tell Me Where It Hurts.........................................49

Chapter Three: The Rise of Digital Health....................................83

Chapter Four: The Road Back from Broken.................................107

Chapter Five: The Real Value of Connecting............................... 137

Chapter Six: Data-Gathering Devices and

How We Use Them....................................................................149

Chapter Seven: Bright Minds, Big Ideas,

New Ventures and Success.......................................................... 183

Chapter Eight: Doing Well by Doing Good -

Rebuilding the Consumer/Provider Bond in

the New World of Digital Health................................................. 193

Afterword - A Day in the Life.....................................................223

Index......................................................................................... 229

Contributors............................................................................... 233

About the Author........................................................................241

 xi

FOREWORD

By Penny Moore

Partner, Commonwealth Health Advisors

Digital Health Enthusiast

Stop for a moment and think about the mobile apps you access on

your smartphone more than five times a day. Text messaging. Email.

LinkedIn. Facebook. CNN Newsfeed. Would you say these mobile

apps are embedded into your daily routine? Would you say they have

impacted your approach to life? No doubt, they have.

Now imagine a program designed to help individuals with chronic

conditions change their lifestyle habits and get healthier by sustaining

an average of 5.2 daily interactions with its participants over 16 weeks.

Impossible, you say?

It is happening! I have seen it.

The Digital Health Revolution explores how progressive technology

advancements are democratizing health care for the consumer.

New digital technologies, big data analytics, and sophisticated AI are

now innovating health care delivery with powerful digital apps. It is

the contemporary creative digital design that draws an individual in to

easily consume clinical evidence-based medicine in actionable methods

that naturally become part of daily living.

I am a seasoned health behavioral change skeptic! The hardest

thing to do is to get people with chronic conditions from lifestyle etiologies

to change their behavior. Even people with the best of intentions

fail at sustaining healthy behaviors.

For more than twenty years, I have dedicated my professional life

to the evolution of population health and disease management. My

passion has been driven by the sobering realization that during the last

century we were dying from diseases and viruses we caught when we

left our homes. Now, it is from things we do to ourselves. Our daily

lifestyle choices matter, and they all add up over time.

xii | THE DIGITAL HEALTH REVOLUTION

Since 2011, I have immersed my focus on the advancement of

behavioral change programs by the digital revolution. I am awestruck

by the exponential improvement that consumer-centric digital design,

machine learning, and conversational bots can have on achieving what

clinicians, behavioral scientists, and others have only imagined for

over twenty years.

For over three decades, physicians have been taught that the

first line of therapy for type 2 diabetes and early stage cardiovascular

disease is diet and exercise. It seems physicians have given up on people

changing their lifestyle contributors to disease. Many societal and

health care trends have played into that. It is much easier for physician

and patient to utilize drugs to manage these chronic conditions and

slow their progression.

Current digital and technological advances are making it

possible for lifestyle behavioral change to not be dependent solely on

individual willpower. Today’s digital tools, leveraging modern data

application, are empowering consumers to put skillpower to work

changing their lives. To sustain behavioral change, people need consistent

input. They need the right information, timed to a meaningful,

teachable moment, suggesting actions based on their own data to build

skills and routines that shift their daily approach to living. Consumers

are quickly catching on that these digital tools are creating sustained

changes in their lives that are relieving them from the burden of a life

sentence of taking drugs to stay healthy.

So, plug in - get connected to The Digital Health Revolution

and benefit from the insights of how health care is now transforming from

physician-driven care to empowered patient-physician partnerships.

Foreword | xiii

ABOUT PENNY MOORE

Penny Moore is a partner with Commonwealth Health Advisors. She

has devoted her career to providing leadership to growth-oriented

companies that are transforming population health through innovation

with digital technology. Most recently, Penny has led the commercialization

for early stage digital health start-ups Kurbo Health

and Better Therapeutics. As the Chief Revenue Officer for ShapeUp,

a venture-backed company that pioneered social wellness, Penny’s

leadership created a high-quality book of global business opportunities

that paved the path to a successful exit. She has held executive

leadership roles with large health plans such as Kaiser Permanente,

UnitedHealthcare and Aetna.

1

INTRODUCTION

When I was a kid growing up in a rural New England farming community,

my mom always had her hands full. My two sisters Patricia

and Karen had already pretty much grown up and moved out, but

three boys remained, constantly challenging one another and pushing

against every boundary we encountered. My older brother Bob was

the rebel. He was the reason rules existed. He pounded on us mercilessly

to the point where my younger brother and I had no choice

but to band together in mutual protection. We learned early that to be

fast meant not getting pounded. My mom’s time-honored method for

refereeing the indoor skirmishes was constantly telling us to go outside

and play. That’s exactly what we did.

If you have never spent much time in the country, you probably

have little appreciation for how you keep yourself entertained there.

We had no cinemas or shopping malls. We rode our bikes around

town looking for enough kids to play baseball, basketball or football,

depending on the season. Not all of us were into sports and when you

grow up in a town of about 800 residents, you learn to diversify your

activities. Fishing was probably the most popular. We would pedal

our bikes down to Norton’s Hardware in downtown Fair Haven,

Vermont, purchase just enough bait for the afternoon and let old

Ralph Norton check our poles to make sure everything was in working

order. Then off we would ride.

Mendon Pond was about five miles outside of town and to get

there we had to either take a busy two-lane highway called 22a, which

connected the thriving metropolitan area of Fair Haven to a point

just south of Burlington. My dad used to call 22a the “Ass” highway

because when you looked at 22a in the mirror, that’s what it spelled.

I still think that’s funny. What made it seem like a busy road even

by Vermont standards was that it was winding and narrow. It always

had big freight trucks on it which sometimes honked or swerved at

the kids on bikes to scare them. Sick and twisted, I know, but hey,

2 | THE DIGITAL HEALTH REVOLUTION

welcome to Vermont. We typically opted for the dirt roads that jutted

up one side of Rattlesnake Ridge, cutting across the orchards and

slate quarries that brought early settlers this far up north back in the

day. Of course, going the back way made it a longer haul and the dirt

roads meant constantly dodging potholes and rocks big enough to

send you flying over the handlebars. On good days, we would bring

home the booty. Nobody needed to tell us how to catch and clean

fish. It was hardwired into the DNA of every kid, big or small, growing

up in Fair Haven. On bad days, we would raid Sheldon’s Orchard

and bring home just enough Macintosh apples for our moms to bake

cakes and turnovers.

With every passing season came a new activity. New England

isn’t for the faint of heart. Those seeing the fall colors and thinking,

“What a lovely place,” have never shoveled snow. Sure, they see it

coming down and think it’s beautiful…the first couple times. Those of

us who grew up there knew better. In the winter, the boys’ job was to

shovel out the driveway. I always got out there first and took the part

close to the garage. It was where the basketball hoops were located,

and my incentive was being able to shoot hoops all year long. I was

meticulous about how clear I kept it. I mean, not a bit of snow was

ever left on this part of the driveway. My dad was always proud. I took

the largest section and cared for it like a drill sergeant on new recruits.

My dad happily bought me about three or four rubber basketballs

as a reward. He knew how to keep me motivated. In the winter when

the temperatures dropped, I would store them near the radiators. If

you’ve ever visited a home built in the 1800’s, you’ve seen these big

monstrous-looking metal things in every room. They dominated the

décor. You don’t have to be a Tom Brady fan to know what happens

to the air pressure in anything inflated when the temperatures drop. I

shot hoops while my brothers did the rest of the driveway. When the

ball lost its bounce, I would simply go inside and get another one and

put my Brady ball back near the radiator. I would repeat this while

watching my brothers finish the driveway.

Foreword | 3

I always took the largest section because it was the easiest to do.

My older brother Bob took the middle. It was the smallest section, and

he thought he was getting a good deal. Heck, he would have made our

lives miserable if he thought otherwise. Younger brother Dave always

got the shortest part of the driveway, and the shortest end of the stick.

He got the part closest to the road. It was all good until the snowplows

came by to clear the street. To this day, I still hear stories from my

neighbors who could hear from three blocks away my dad bellowing,

“David Michael Pereau—get out here right now!” I don’t think my

younger brother has forgotten or forgiven me to this day J.

In the springtime, it was planting season. Since I never took to

hunting in the fall, this was one special activity that I did with my

father. I was a gym rat growing up. There wasn’t a sport I didn’t play,

and my dad was always there for me. I was playing catch, shooting

baskets or throwing the football. I always wore the old man out, and

helping him plant and weed the garden was the least I could do. It

was our quality time. He got plenty of that with Bob and Dave during

hunting season. He and I spent many hours out in our back yard and

he let me plant anything I wanted. From strawberries to rhubarb to

pumpkins, I had my own section, but I had to care for it all season

long. Our neighbor had the biggest patch of raspberries, blackberries

and blueberries I had ever seen. We were never hurting for munchies.

We just went out back or next door and ate until we were full. Food

was fuel to a growing boy, and we were constantly on the move.

Come summer time, my brothers and I would scrape our nickels

and dimes together until we had just enough money to rent a boat on

Lake Bomoseen. We were too young to rent anything with a motor, so

we would row out to the island. It was famous for decades as a retreat

for Hollywood stars like the Marx Brothers, Marylyn Monroe and

others. Believe me, there was quite the ambiance when eating out in

beautiful downtown Fair Haven. Truthfully, we didn’t care about any

of that. Years earlier, the older kids had tied a rope to a tree overhanging

the cliffs. We rowed our boat out to jump off those cliffs. We were

4 | THE DIGITAL HEALTH REVOLUTION

too scared to dive, so we all just jumped in feet first. Anyone boasting

about doing any different was lying. Today, there is an eagle’s nest on

the rocks we used to jump off. The tire swing is long gone, as are the

Hollywood stars who used to frequent the Algonquin Club located on

the island.

By autumn, we were in full leaf-raking mode. There were no

blowers back then, and no sacks for stuffing the leaves for a later pick

up. This was pre-environmental anything, so we burned the leaves on

the side of the road in the space between the blacktop and the hunks

of slab used as sidewalks. They were too imperfect for anything else,

and I still remember the horses and trailers hauling them up from the

slate-cutting shops and laying them down along our streets. Nothing

says New England like shuffling through the leaves on a slate sidewalk.

When my mom was overcome with debilitating dementia and

Alzheimer’s disease, I would walk her to the corner and back. She felt

like a kid again.

Looking back, I wouldn’t change a thing about how I grew up.

We were never bored. We had no smart phones, no electronic gadgets

of any kind, and we only played indoor games when it rained. We

were active, we ate healthy foods and we participated in a variety of

activities that kept us moving and kept life interesting.

We resided at the original corner of happy and healthy. Heck, we

probably inspired that as a Walgreen tagline.

Sitting in a health care conference years later listening to the

speakers drone on about chronic conditions and how inefficiencies in

our health care delivery system were contributing to chronic conditions

that were overwhelming our health care capabilities, my mind

wandered back to my childhood. I had the mother of all epiphanies:

We can absolutely fix our broken health care system . . .

and I knew exactly how to do it.

5

CHAP TER ONE

OUR SYSTEM IS BROKEN, BUT WHO CARES?

Have you ever had a friend who constantly asked why things are done

the way they are done? I was definitely that kid. When I first shifted

my professional focus from technology and management consulting to

health care, I was a nonstop “But Why?” machine.

I must have driven my poor wife crazy. She has logged more than

30 years in the health care industry, where she came up through the

ranks. There isn’t an aspect of how insurers intersect with our lives

that she can’t go into the weeds to discuss. She started in underwriting,

later moved into account management, then did sales and before

long, moved into management and was running regions. Okay, I

glossed over quite a bit there because she is a woman and it took her

twice as long and she had to work twice as hard as her male counterparts

to finally become president of a multibillion-dollar region, and

then CEO. If her name were Bob, we would probably be living on

an island already. But you get the picture. She knows the health care

industry backwards and forwards, inside and out. Forget the fact that

she is only one of a handful of women in leadership roles. That is a

story for another day. She has given me an insider’s perspective into all

things health care and C-level connections any digital health startup

would covet. From health care consumption to servicing, I have seen

it all—and it isn’t always pretty.

AN EARLY VENTURE I MADE IN HEALTH CARE

When some former tech colleagues approached me about an idea they

had about starting a health scoring company, I was intrigued. I had