From Why to How

My Next Steps Toward Empowering Patients

I like making things and I like to work at scale, empowering people to live their healthiest, best lives. Patient empowerment is my North Star. I’ve pursued it in the federal government, the foundation world, and the private sector, most recently consulting for companies large and small in the digital health area. Now my North Star has led me to join a digital health startup, moving from the “why” to the “how” of patient engagement. In some ways it’s a big change (it’s true — startups actually use Slack instead of email!), but it’s also a natural continuation of my work. I’m switching seats, again, within the community of people and organizations building toward a shared vision in which people are genuinely at the center of their own health and healthcare, supported by human caregivers and digital tools.

Why Now?

As I see it, the conditions are finally right in three important areas to make me shift my energy from “why” — making the case for empowering patients, to “how” — actually doing it.

Culture

Ten years ago empowering patients was a fringe concept that made many people from the traditional healthcare system uneasy. “Patients are not trained, not interested, and not to be trusted,” some said. Today, thanks to the work of outspoken pioneers including patients and other groundbreakers with a similar perspective, “patient engagement” has become a buzzword. The good thing about that is that it indicates growing acceptance conceptually that health and healthcare depend on a partnership with patients, not just efforts on their behalf. On the other hand, there is still little understanding of what real person-focused health and healthcare looks like in practice.

Technology

You already know this part. Digital technology’s power and availability continue to grow exponentially. Most Americans have smartphones. Many use apps and wearables for their health. Social media gives more people than ever before in history an amplified voice. There are new sources of data related to health — like direct-to-consumer genetic testing — and a growing capacity to aggregate, analyze, and apply it for better decision-making. The scope and pace of change is both dizzying and exciting.

Policy

Thanks largely to federal “Meaningful Use” incentives, in the last few years medical records have switched from paper to digital. Better yet, individual people have the capacity to access and use their own health data, though we haven’t fully realized the value of that yet — it will go so far beyond patient portals! The groundwork has finally been laid for mashing up traditional health data with new data sources in actionable ways. With mainstream consumer tech companies like Apple, Google, and Amazon recently entering the digital health fray (they are just a fraction of the 84% of Fortune 50 companies now in healthcare), plus consistently growing venture capital investments in digital health, the landscape is evolving quickly.

From the 30-thousand foot view of health policy, even more important than digitizing data is the continuing shift from fee-for-service to value-based payment models for healthcare. I believe that significant improvement in health outcomes requires both leveraging technology and empowering consumers, who make the bulk of the decisions that influence their health.

Why Carium?

A tech startup is just one way to move from the “why” to the “how” of patient engagement, but it’s the one that appeals to me most. Unlike many established companies, a successful startup has the flexibility — and the imperative, even — to learn and adapt fast. I hadn’t heard of Carium. It’s just six months old. But here’s what impressed me about it:

A Diverse Dream Team

Everybody thinks their own team is special. But this team was special enough to compel me to want to join them, despite the fact that I didn’t know a single one of them until last summer. Several core team members have collaboratively built and run three or four successful tech platform companies outside of healthcare, one of which was acquired by Cisco for $6 billion. As non-healthcare people, they were wise enough to hire an experienced and extremely innovative Chief Medical Officer right out of the gate. Not to mention one of Indonesia’s top programmers, a UX designer from United Airlines, a UI designer from Facebook (Instagram), and a data-scientist from Pandora. It’s a collection of the strongest talent, regardless of geographic location — we are about half in California, half virtual.

Momentum

The Carium team knows how to design both a product and an organization for growth, and the professionalism and seriousness of intent are palpable. The product (yes, there is a product, imminently up and running and in-use by a health system in Petaluma) is designed to be modular and customizable. And even though there is only one official Board member so far, Carium holds formal monthly Board meetings to internalize the habit and the cadence. People approach their work with a combination of quiet mastery of their own domain and a humility and eagerness to learn. That, and just the right dose of light-hearted playfulness. It’s a company that’s going somewhere, and it’s determined to both get there and enjoy the road.

A Commitment to Putting People at the Center of Health, for Real

For years I’ve been obsessed with this data from the New England Journal of Medicine that shows the factors that contribute to health:

Health is determined by multiple factors, including everyday behavioral patterns, genetics, and other aspects of the individual and their life in their community. Traditional healthcare is addressing just 10% of the determinants! And unfortunately, today the traditional healthcare system, in addition to other challenges — like its high cost and inconsistent value — doesn’t smoothly integrate its services with the rest of life.

My colleagues and I at Carium are using technology to reimagine health and wellness from the point of view of the individual person, taking into account each slice of this pie. Imagine a life record — not an EHR or a PHR, but a record of you, and your whole health, from your perspective, not that of your doctor or anyone else. What if that record were not just a repository, but a guide, simplifying the navigation of your life and the steps you need to take to protect and enhance your health. That’s what we’re working on building — and I’m hoping you may want to help us.

Join Us

We are looking for partners who are already embracing innovation and a person-centric view of health, and who don’t shy away from the cutting edge. We seek co-developers of a future we can all be proud of. Help us refine our vision and our product. We don’t pretend to have all the answers, and we believe changing healthcare and empowering individuals will continue to take a great big virtual village.

While our platform is on the verge of up and running in a health system, we are looking for partnerships with other healthcare providers, community-based organizations, employers, payors, and other partners — including, of course, patient advocacy organizations — who can help us along our shared journey. Please reach out if you’d like to learn more. Thanks to all of you who have shared my journey toward empowering patients so far: I look forward to continuing to collaborate with you and many more in the next chapter!

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Note: This article is cross-posted on the Carium blog.