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Healthcare portals following financial services models

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Healthcare portals following financial services models

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1. Focus group on new agency prototype to get their input and cocreate agency of the future

2. Scientiists and commercial teams together brainstorming drugs of the future

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See former First Lady Michelle Obama at MUSE New York

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An evening of captivating captivating performances, spectacular food, and riveting storytelling.

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ResearchKit helps medical researchers gather robust data for studies. And CareKit lets individuals manage their own medical conditions.

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TechDirt: good site for comment on disruptive technologies 

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TechDirt: good site for comment on disruptive technologies 

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The latest entrant on the decentralized transportation scene is the suddenly-ubiquitous electric scooters that are taking over San Francisco and other cities. Their appearance has triggered the inevitable controversy, with some saying they are ruining cities while others laud their convenience for urbanites. And, of course, a regulatory battle wasn't far behind. On this week's episode, we discuss the e-scooter trend and its many pros and cons.

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The latest entrant on the decentralized transportation scene is the suddenly-ubiquitous electric scooters that are taking over San Francisco and other cities. Their appearance has triggered the inevitable controversy, with some saying they are ruining cities while others laud their convenience for urbanites. And, of course, a regulatory battle wasn't far behind.

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Andres :Marquez-Lara participatory action research (PAR), human-centered design/design thinking, action learning

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Andres :Marquez-Lara participatory action research (PAR), human-centered design/design thinking, action learning

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The sprint is a 5-day process for answering critical business questions through design, prototyping, and testing with customers. Learn to run your own sprints, and read about our book on sprints.

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Cancer care designed by google design sprint

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Cancer care designed by google design sprint

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Foundation Medicine is leading a transformation in cancer care, where each patient's treatment is informed by a deep understanding of the molecular changes that contribute to their disease.

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Lean canvas and dashboard in innovation accounting,espmatingn

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Lean canvas and dashboard in innovation accounting,espmatingn

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MIT Hacking Medicine connects MIT and the health ecosystem to launch the next generation of healthcare solutions to solve the biggest challenges.

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MIT Hacking Medicine's mission is to infect, energize and teach

Healthcare Entrepreneurship and digital strategies to scale medicine

to attack and solve health problems globally.

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MIT Hacking Medicine's mission is to infect, energize and teach Healthcare Entrepreneurship and digital strategies to scale medicine to attack and solve health problems globally.

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CreateHealth

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MIT Hacking Medicine's mission is to infect, energize and teach

Healthcare Entrepreneurship and digital strategies to scale medicine

to attack and solve health problems globally.

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MIT Hacking Medicine's mission is to infect, energize and teach Healthcare Entrepreneurship and digital strategies to scale medicine to attack and solve health problems globally.

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Social innovation for employee engagement

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Social innovation for employee engagement

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Online communities are helping companies engage with employees to accelerate change.

New lessons are emerging for executives striving to harness the power of social media in the cause of wider employee participation. Clearly, there's more to success than just investing heavily in the latest Enterprise 2.0 technology platforms. Large-scale engagement of the workforce requires, first and foremost, a firm grasp of organizational culture and its social dynamics, a psychological understanding of what triggers new behavior, a determination by management to loosen if not relinquish its traditional top-down approach, and an ability to demonstrate how digital activities complement offline or other real-world events.

Those attributes are often absent, so we find that many companies struggle to maintain the momentum of initiatives to encourage broad- and digitally based employee involvement. Indeed, that's true whether these efforts focus on the formulation of strategy, transformational change, customer service, or other business contexts where fresh ideas or new ways of working are needed for competitiveness. Some initiatives fail to "mobilize the masses" to any significant degree, dissipating energy and effort as the message gets stuck in middle management. Others get going but never reach the organization's perimeter, thereby missing an opportunity to collect valuable feedback and ideas from the front line.

Four ways to drive change

Here we present four specific approaches to the creation of what we call digital "hives"-electronic hubs bristling with collective activity and designed to solve a particular problem or set of problems, to drive new habits, and to encourage organizational change (exhibit). Digital tools to facilitate networking and collaboration propel these "horizontal" cascades, which at their best can weave new patterns of engagement across geographic and other organizational boundaries. In this way, they make it possible to have new conversations around problem solving, unlock previously tacit knowledge, and speed up execution.

1. Engaging the workforce in better strategy

Best practice in the formulation of strategy and in organizational change has long been to craft a "story" at the top and then to cascade it through lower echelons of the organization. Some companies refine the message in the light of feedback from middle managers, but however well communicated the refined story may be, it is still management's second attempt. Employees on the shop or office floor often feel like passive recipients.

That's beginning to change, though, thanks to social technologies. In a 2012 Quarterly article, we described the emergence of an approach that provides for extensive employee input and modifications. Telling thus equates with sharing, so the narrative grows as it diffuses throughout the organization. There are still relatively few social strategy-development processes, but the tools are getting more powerful, and the scale and scope of such efforts are more impressive.

Using the "management hackathon" concept-an integrated multistage platform that allows participants to discuss ideas, express opinions, and contribute expertise collectively -a successful consumer-goods company recently involved its entire organization in an open-source strategy process. This effort started with an organization-wide online discussion about risks to the company's growth engine from higher input costs, stagnant industry growth, and a growing competitive threat from imitators to certain products and the business model. These risks then formed the basis for a bottom-up process that spawned over a thousand new strategic insights using a combination of in-person meetings and workshops as well as online channels.

These insights were aggregated into roughly ten strategic themes-from reengineering the retail experience and digital technology to creating service ecosystems around the company's strongest brands. All employees were asked, via an online platform, to provide a rank order for these insights and to suggest specific business ideas embodying them. The input from the hive helped management to narrow the strategic themes down to three and to identify several high-priority opportunities. The company is currently developing them, leveraging both online and offline channels to harvest more insights from across the organization and to identify volunteers who want to be involved.

Early experience suggests that better results follow when a problem is presented in stages to avoid overwhelming the participants, when a company uses volunteers rather than conscripts, when it offers training on how to think about innovation, when energy- and community-building offline events (such as workshops or weekly cafeteria sessions) supplement the online discussions, and when executives strike an authentic tone.

2. Connecting silos with a social chain

One of the biggest organizational challenges is to break siloed behavior and get employees talking to one another and cooperating across intracompany boundaries. It's one thing to diagnose a problem and aspire to collaboration. It's quite another, once the initial excitement wears off, to maintain momentum through mechanisms that underpin the new behavior and prevent managers and employees from slipping back into old habits.

One promising social-technology experiment we've observed is what we call the "social chain": a digital platform that links everyone working in a particular value chain inside a company. (Value chains often comprise people in different silos or departments working, say, to fulfill a customer order.) The social chain allows employees to work "out loud" online by sharing how they do things. It also encourages people who were previously isolated in part of the chain to identify areas where they depend on others and to tackle problems or bottlenecks collaboratively. Chain leaders can monitor these conversations and inject their own insights when appropriate. The chain can help them to expose old behavior and to highlight the sort of tacit understanding that drives more efficient operations.

The Dutch bank ABN AMRO has been a pioneer in using social chains. The banking crisis, a merger with Fortis, and the ensuing nationalization saw the company embark on a sweeping change program to cut costs, increase the efficiency of the value chain, and make employees more responsive. In the group's wholesale arm, for example, senior managers discovered that there was no uniform approach to tracking and reporting problems: employees could detect defects at the customer end more quickly through the Internet than through the company's internal systems. Needing a way to stimulate proactive, real-time problem solving, ABN AMRO introduced a social chain dedicated to employees working in its Acquiring and Issuing Cards unit, who spanned different silos, including IT, customer service, and operations. To push people into the hive, managers discouraged communication through meetings and e-mail.

Eighteen months later, the results were clear. ABN AMRO's social chain had enabled its employees to share their expertise, in real time, beyond a narrow circle of peers. They could therefore become true ambassadors for, and identify with, the chain as a whole.

3. Enlisting key customers to improve the proposition

A company's most regular and trusted customers-a group we call the "client rim"-can be a powerful force for change when they provide feedback on service standards or product quality. The opinion of these customers counts; they have extensive experience with the company and its ways of working, are generally committed to its success, know the people, and are typically both its most enthusiastic ambassadors and its strongest critics. Thanks to the power of social technologies, a company that mobilizes such people can solicit specific ideas for improving its customer proposition and demonstrate its client-centricity more broadly.

KLM, the Dutch airline, has successfully used this approach to foster a stronger client-centric mind-set among its employees. Operating in a highly competitive market with tight margins, the airline decided to target the lucrative segment of small and midsize enterprises directly. This approach required a significant shift in perceptions, not least because KLM traditionally focused on larger corporate clients and was often seen as distant, even arrogant, by smaller businesses.

Rather than taking the traditional focus-group route to find new ways to improve the offering, the company's executives opted for a large-scale digital dialogue between KLM and its emerging customers in this segment. The resulting Bluelab idea-management platform involved 1,500 participants from small and midsize businesses, who generated more than 1,000 concrete ideas and 4,000 other contributions. Both management and customer-facing staff from KLM Netherlands actively participated in these discussions. According to one senior executive, the initiative has "opened our eyes to the possibilities of social media to build a far stronger customer focus among our staff." KLM has since become one of the airline industry's foremost social-media exponents.

Companies can embrace key customers in a variety of ways. Mobile apps can transmit a continually updated stream of client quotes on the product and service experience. A buddy system can allow individual customers and employees to have online conversations-preceded, perhaps, by a customer-experience event at which clients and employees explore new paths to common goals. Idea-management platforms can solicit customers' help in solving vexing problems. Or a company might create social "mystery shoppers" who follow internal conversations anonymously and comment on them.

4. Uniting a dispersed sales force to drive higher sales

We're all creatures of habit, often reluctant to ditch comfortable routines and to apply new ways of doing things. The desire to address exactly this problem recently prompted a leading beverage company in Africa to employ social media to engage with its far-flung sales force (1,000 reps servicing around 100,000 individual outlets) and win back market share. These reps traditionally had spent several weeks at a time on the road, rarely checking in with the head office and therefore operating in a feedback and knowledge vacuum. Inevitably, they had become disconnected from the organization, and performance suffered.

The turnaround started after the company implemented a simple, low-budget system that uses the hive's collective wisdom to give each sales rep and call-center agent regular, real-time, and personalized information. Given time pressures, cash constraints, and concerns over the rate of thefts in African townships, the company opted to issue simple mobiles rather than the latest smartphones with a specialized app.

Staff at the center collected ideas based on intelligence gleaned from the calls and e-mails of the sales reps themselves and from district managers familiar with current issues in the beverage trade. The company also analyzed customer data highlighting pockets of fiercer-than-normal competition or SKUs that were selling particularly well. Such insights were then shared with reps and agents, who each received two or three personalized SMS messages a day. Managers could further use this rudimentary social platform to communicate with the sales force by, for example, congratulating teams when they hit milestones and generally celebrating success. The company also created a call-center "leaderboard" allowing executives to track the agents most responsive to the new information at their disposal. The executives then freed up time for these "early adopters" to coach their peers, provide feedback, and strengthen the system with additional insights.

The new network, implemented at minimal cost, puts collective expertise in the hands of each of the frontline reps, binds them more closely to the organization, and generates faster performance feedback. Within a year of the start, the company has increased cross- and upselling rates to more than 50 percent, from 4 percent, realizing an increase in gross margins of $25 million.

A new mind-set for senior managers

The examples in this article illustrate the range of business contexts in which executives are increasingly making use of social media's growing influence in their employees' private lives and their increased familiarity with new digital-communication tools. As managers contemplate how to drive broader and deeper employee engagement in their companies, they should bear in mind the following considerations:

Leading while letting go

Digital hives involve large numbers of previously "disenfranchised" employees in setting strategy, company-wide transformations, and customer-outreach initiatives. Creating these hives requires a delicate balancing act-not least a willingness by top managers to let go. Managers should not be afraid to commit themselves explicitly to acting on the results of these initiatives and should encourage unrestrained participation, however unpredictable the consequences.

But that doesn't mean playing a passive role. Our research consistently shows that without substantial involvement by the CEO or other top leaders, the vast majority of such initiatives fail to achieve their objectives. What's more, change programs that involve large numbers of people are up to two times more successful than those that do not. When we ask change leaders what they would do differently next time, the top three responses always include spending more effort on engaging people and on developing and communicating change stories.

Looking inward

The growing use of social tools to drive employee engagement provides particular opportunities for senior executives to improve role modeling. When people reflect on their behavior, they tend to rely on their own often sketchy perceptions and faulty memories. With many digital technologies, however, people can now track their behavioral footprint-for example, by analyzing conversational threads in microblogs and comparing their actual behavior with the leadership style to which they aspire. Managers at an international insurance company we know did so and found a clear gap between the effect they thought they were creating as leaders and the actual results.

Becoming more responsive

Mobilizing a crowd requires companies to anticipate the crowd's expectations. Executives can maintain pace and encourage deeper engagement only through transparent feedback and rapid follow-up. We often see companies respond too slowly and erratically, so that employees can only guess what comes next. Radio silence or a prolonged hiatus strongly diminishes any sense of urgency and disrupts the rhythm, or pulse, of participation. Worse, it may spark lingering skepticism. Unleashing collective intelligence through a hive will be more successful if managers think ahead and develop an agile, scrum-like response capability outpacing that of smaller offline programs.

Given the speed of technology's development, we recognize that digital hives are still an area of fertile experimentation and that new models will evolve over time. What we know already is that the hive's transparent, inclusive, and egalitarian nature amplifies well-established psychological mechanisms, such as peer pressure and social recognition. Out in the limelight, with clear rules of engagement and a level playing field, people tend to stimulate and encourage others, perform well, and seek recognition. Collective adoption and participation can grow in hives as each one of them becomes a catalyst for change and causes a wider ripple effect throughout the organization.

About the author(s)

Arne Gast is a principal in McKinsey's Kuala Lumpur office, and Raul Lansink is a senior adviser to the firm on digital change who is based in Amsterdam.

The authors wish to thank Wesley Smith, a consultant in McKinsey's Johannesburg office, and Michele Zanini, a Boston office alumnus who is managing director of the Management Information eXchange (MIX).

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Digital hives: Creating a surge around change

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Online communities are helping companies engage with employees to accelerate change. New lessons are emerging for executives striving to harness the power of social media in the cause of wider employee participation.

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Fraggl is a daily email of the 10 must read links on selected topics, brought to you by a surprising combination of smart computers and interesting people.

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Welcome to the d.school's Virtual Crash Course!

We know not everyone can make a trip to the d.school to experience how we teach design thinking. So, we created this online version of one of our most frequently sought after learning tools. Using the video, handouts, and facilitation tips below, we will take you step by step through the process of hosting or participating in a 90 minute design challenge.

Through this experience we hope you will take away some of the basic principles of Design Thinking and start to adapt them into your personal and professional routines.

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A Virtual Crash Course in Design Thinking

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This is an online version of one of our most frequently sought after introductory learning experiences. Using a video, worksheets, and facilitation tips we will take you step by step through the process of hosting or participating in a 90 minute design challenge.

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We Believe

We are in the midst of a digital revolution that is redefining medicine. New ways to gather, store and use health data are developed every day. It is not always clear how to use these new approaches. At Sage Bionetworks, we believe that we can learn more by learning from each other. We partner with researchers, patients, and healthcare innovators to drive collaborative data-driven science to improve health. We advance biomedicine by making science more open, collaborative, and inclusive.

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We are in the midst of a digital revolution that is redefining medicine. New ways to gather, store and use health data are developed every day. It is not always clear how to use these new approaches. At Sage Bionetworks, we believe that we can learn more by learning from each other.

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Share the Journey: patients as research partners

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Share the Journey: patients as research partners

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Share The Journey: Mind, Body, and Wellness after Breast Cancer (Sage Bionetworks)

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It has been more than one year since the launch of the Share the Journey study and mobile application. We couldn't have gotten this far without you! Thank you for participating and making this research stronger. You have joined a community of over 2,800 women sharing their experience with breast cancer treatment and supporting those who undergo treatment.

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We are a multidisciplinary agency, helping our clients achieve change. This is the future of research.

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Edward de Bono - Inventor of Lateral Thinking and Strategic Brain Training

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Learn about Edward de Bono the father of Lateral thinking, a brain training pioneer, author of six thinking hats and creative thinking expert. Find out more.

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This webinar demonstrates the opportunities offered by mobile technology in delivering "in-the-moment" market research to the global pharmaceutical industry.

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data that health insurers will need

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Technology partners Apple and IBM have cemented their relationship with the launch of Watson Health Cloud, a secure online platform for storing health-related data.

Designed to support Apple's HealthKit and ResearchKit apps the database is intended for use by researchers, physicians and insurers and will be able to make sense of information whether it be drawn from personal fitness trackers or official medical records.

The cloud based system has been born out of a need to make sense of the growing maelstrom of data generated by a burgeoning health industry of apps and trackers and satiate the demands of even the most hypochondriac of users.

An IBM spokesperson said: "The future of health is all about the individual. With the increasing prevalence of personal fitness trackers, connected medical devices, implantables and other sensors that collect real-time information, the average person is likely to generate more than one million gigabytes of health-related data in their lifetime (the equivalent of more than 300 million books).

"However, it is difficult to connect these dynamic and constantly growing pools of information with more traditional sources such as doctor-created medical records, clinical research and individual genomes --- data sets that are fragmented and not easily shared. A highly scalable and secure global information platform is essential to pull out individualized insights to help people and providers make timely, evidence-based decisions about health-related issues."

It follows a prediction made by IBM director Steve Abrams that Watson represents the 'Third Era of computing.'

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IBM and Apple launch Watson Health Cloud

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Technology partners Apple and IBM have cemented their relationship with the launch of Watson Health Cloud, a secure online platform for storing health-related data. Designed to support Apple's HealthKit and ResearchKit apps the database is intended for use by researchers, physicians and insurers and will be able to make sense of information whether it be drawn from personal fitness trackers or official medical records.

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See former First Lady Michelle Obama at MUSE New York

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An evening of captivating captivating performances, spectacular food, and riveting storytelling.

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Our network collaborates with startups, life sciences companies, non-profits, agencies, government and all types of organizations across health care. WEGO Health offers enterprise and on-demand solutions that allow organizations to leverage patient experience and expertise in the design, development and promotion of their products and services.

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WEGO Health is a mission-driven company connecting healthcare with the experience, skills and insights of patient leaders. We are the world's largest network of patient leaders, working across virtually all health conditions and topics. Our network collaborates with startups, life sciences companies, non-profits, agencies, government and all types of organizations across health care.

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By PricewaterhouseCoopers' projection, the biggest sectors of the "sharing economy" - including transportation and travel companies like Uber, Zipcar and Airbnb - could be pulling in as much as $335 billion in global revenue by 2025. That's a massive number (PwC puts it today at about $15 billion), and it reflects according to a market analysis the company published this week some fundamental shifts in consumer behavior. "Access is the new ownership," and such.

A lot of the trends PwC explores won't be novel to anyone who's been offering services or spending money in this space. Young adults, 18 to 24, who are more interested in having experiences than owning things, are "most excited" about the sharing economy. And of people PwC surveyed who are familiar with it, large majorities say the sharing economy makes life more affordable (86 percent) and more convenient (83 percent). Those qualities likely also have more to do with the growth of companies like Airbnb than the vague allure of "community."

PwC does point out one trend in the report that's a little more revelatory: We're witnessing the rise of companies predicated on trust among strangers at the same time as general trust in society is actually falling. Only 29 percent of consumers PwC surveyed said they trust people more today than they did in the past. And 62 percent said they trust brands less today.

National survey data meanwhile confirms that trust in other people is lower now in America than at any point in the last four decades. The General Social Survey conducted by NORC at the University of Chicago has been asking a random national sample of adults since 1972 this same question: "Generally speaking, would you say that most people can be trusted or that you can't be too careful in dealing with people?" Here are the results, from a Washington Post analysis:

So, what gives? Why are hundreds of thousands of people letting strangers rent their bedrooms or drive their cars if society is growing more cynical? Why would you trust a company that ships you a dress worn by another woman last week if you don't actually trust people all that much? How is the economy suddenly creating billion-dollar businesses around the idea of communal consumption at a time when we're not feeling communitarian at all?

Here is PwC's smart answer: "If trust in individuals and institutions is waning or at best holding steady, faith in the aggregate is growing."

In other words, I don't trust you, Random Guy Giving Me a Ride Home, but I do trust the 4.9-star average rating of all the people who've been in your car before. Maybe I don't have all that much trust in one woman renting her home on Airbnb, but I do trust the aggregated input of the 24 people who've given her high marks.

This is an important distinction (especially if you're a company trying to chase after all this sharing stuff): Confidence in the sharing economy is not so much about trust between individual strangers - or even one person and one company - as it is about trust between one person and the crowd. And the Internet has done as much to make that kind of reputation crowdsourcing possible as it has to facilitate the actual logistics of renting a stranger's car.

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Who millennials trust, and don't trust, is driving the new economy

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By PricewaterhouseCoopers' projection, the biggest sectors of the "sharing economy" - including transportation and travel companies like Uber, Zipcar and Airbnb - could be pulling in as much as $335 billion in global revenue by 2025.

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As wonderful as patient sharing access to their information is, along with new tools to self-manage and things like telemedicine that allow patients to receive care outside the traditional system, in a world of high copays you are going to see some patients making some very bad choices. In the old days, the sick patient had to go see a doctor. Now they can go to MinuteClinic. Or they can Google their symptoms. I wouldn’t want to turn back the clock, but it raises the question, “When is self-management a bad choice?”

As health care finally goes digital, some people believe that it’s no different than travel or banking. But no one is getting harmed by using TripAdvisor or Fidelity. I think you could argue that health care is fundamentally different.

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It's an important question. It's not natural for them the way it is for the next generation and beyond. But most older people are at least using email and know how to surf the Web. Silicon Valley has woken up and realized this is a huge market. As consumer-oriented tech companies enter the health care field, I think they're going to design tools and technology and ways of interfacing that make it seamless for the people who need to become engaged. This will allow older patients to at least do the basic stuff, like renewing their medications, the stuff that's just incredibly annoying in the paper world.
In your book, you talk about moving away from fee-for-service payments to doctors and hospitals and toward payments based on a population of people, adjusted for their baseline health. From a patient perspective, will that change how they pay for their care? At the most basic level, could that finally mean the end of incomprehensible "explanation of benefits" insurance forms, for example?
I wish I were more hopeful. Of all the nuts we have to crack, this is the one I'm least optimistic about.

If everybody is in an accountable care organization or the like, providers get a single payment when they treat someone. But as long as they're still doing an adjustment for the relative sickness of the patients, the organization will need to account for all of the details. And I'm afraid the patient may also still see a confusing itemized bill, unless we can get to a point in which you've paid for the year and you're done.

The movement away from piecemeal payments is hopeful, and so are the digitization of health care and the entry of Silicon Valley companies with a consumer sensibility. I guess the question is: Do all of those trends - when woven together - lead to something that's more user friendly? When it comes to clinical care, I think the answer is yes. I see how we can get to a much happier place, with better care through digital medicine, in five to seven years. But the idea that you could get a simple, clear insurance bill that you pay with one click... that still feels like a moon shot to me. So maybe in 10 to 15 years.
To what extent can technology really help people comparison shop for health care? To date, we've seen that it seems to work best for procedures like colonoscopies or MRIs, where the service performed is fairly comparable. Could people really comparison shop for cancer treatment? Would we want them to?
Sure, why not? Some of this comes down to your fundamental belief in capitalism and the market. But we do have to pay some attention to fundamental differences between health care and other markets. For example, in health care, we can't accept haves and have-nots, while we readily accept this with other luxury goods. That said, I'm pretty convinced that if you create an environment where patients have the information they need to make those decisions, that the market will help them make good choices.

The area I worry about is the science. How do we really know that one doctor or hospital is better than another? Most aspects of quality measurement are not very advanced.

Another real challenge is fragmentation. If I get my colonoscopy at one place because it's the best and cheapest but it's in a different system than the one my primary care doctor is in, that's a problem if the electronic records don't talk to each other. As a patient, I've got to think about the advantage of receiving the cheapest procedure compared to the negative consequences of no one doctor having a complete view of my health.
Do you think the federal health law requirement that people have health insurance positively affects their engagement in their own health care or the health care system?
I think everybody should have health insurance. The system works better and people have better health and health care with universal insurance. And the law was the most politically feasible way to make that happen, so I support it. When people have health insurance, it creates a connection to a system that is largely mediated through a primary care doctor. To have 40 to 50 million people floating outside the system - able to access the system only episodically and when they're very ill - is crazy.

Has having insurance increased their engagement? Yes, but at a level that's pretty wimpy. Now you can see a primary care doctor to manage your blood pressure in an office visit every six months, but is that the level of engagement we should aspire to? Nowhere near it. The hope is that by having everybody part of an organized health care system, now it's in the interest of the system to have engaged patients - since that engagement should lead to fewer office visits, ER visits, and hospitalizations. But this is the sort of thing that takes years, if not decades, to develop.
What about initiatives like OpenNotes that allow patients to read their doctors' electronic notes about their care? How do they change the patient-doctor relationship?
OpenNotes illustrates the democratization of the health care system, which is going to challenge all of the system's fundamental underpinnings. Digitization is an enabler. It's changing the relationship between doctors and their patients from an extraordinarily paternalistic one to one that is more democratic. In the new world, a patient's choice is no longer just, "Do I see doctor A or B?" but "Do I even need to see a doctor at all?" OpenNotes is part of this trend.

As wonderful as patient sharing access to their information is, along with new tools to self-manage and things like telemedicine that allow patients to receive care outside the traditional system, in a world of high copays you are going to see some patients making some very bad choices. In the old days, the sick patient had to go see a doctor. Now they can go to MinuteClinic. Or they can Google their symptoms. I wouldn't want to turn back the clock, but it raises the question, "When is self-management a bad choice?"

As health care finally goes digital, some people believe that it's no different than travel or banking. But no one is getting harmed by using TripAdvisor or Fidelity. I think you could argue that health care is fundamentally different.

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Digital Tools for Health Come With 'Hope, Hype and Harm'

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It's an important question. It's not natural for them the way it is for the next generation and beyond. But most older people are at least using email and know how to surf the Web. Silicon Valley has woken up and realized this is a huge market.

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Oh, there's a lot of opportunities
If you know when to take them, you know?
There's a lot of opportunities
If there aren't, you can make them
Make or break them

-Pet Shop Boys, Opportunities (Let's Make Lots of Money!)

I am fortunate in that I get asked to speak at a lot of events, public and private. It is a great opportunity to hang out with smart people and tell the world my view of how things should be. One of the most common questions I get asked at these events is this: if you were investing in the healthcare world today, where exactly would you be placing your bets?

I get asked this because I spent much of the last couple of decades being a healthcare venture investor, but also because I am still fortunate to be at the nexus of a lot of interesting healthcare companies and developments at a particularly interesting time. The scope of market change in healthcare is big and fast, at least as compared to the last 25-30 years since I started in the field. And if you are an investor, massive market changes make you salivate. It is the rare established large company that survives this kind of market upheaval, and that means there is a big, fat world of growth available to the upstarts that are able to cook up their own batch of secret sauce and pour it on the waiting dish of market demand.

I was in a really interesting meeting last week with representatives from a number of large family offices and related entities, all of which have an interest in exploring where the best money-making opportunities are across the big wide world of healthcare. Once again, this question came up, "if you had money to invest right now in healthcare, where would you put it?" So I figured I'd reiterate my answer here for those with interest (or those who feel a burning desire to give me money).

Note that I automatically rule out deep science-based drug/genomics/biopharma type stuff, because that is really not my bailiwick. My science degree is in political science, so you can understand why. That leaves me to favor ideas that capitalize on five meta-trends that are happening throughout the American healthcare system and which, in almost every case, also have correlates or are directly relevant outside of the U.S. as well.

Here are the five big trends that I believe offer the most opportunity for those smart enough (and lucky enough) to play them the right way:

1. Migration of the locus of care from the hospital to ambulatory settings, including the home. There is much talk about "the medical home" and it seems to me that this should be the actual home whenever possible. Short of that, hospitals are under so much pressure due to cost and inefficiency that their best remaining business model might be burning down the buildings and collecting the insurance money. Meanwhile, all manner of interesting ambulatory and home-based services and technologies will revolutionize how, where and when people access care. I note that this week Kaiser Permanente announced they will open clinics at Target Stores. I rest my case.

2. Providers are becoming payers, or at least financial and clinical risk managers. And speaking of medical homes, or ACOs or whatever entity or acronym is popular at the moment of conversation, it is irrefutable that the provider community and big health systems in particular are getting a crash course in the world of insurance and coming to school without the tools to succeed. While most provider organizations are still making most of their money through old school fee-for-service, those days are clearly numbered for the bulk of them. Everyone is talking about the shift from volume to value and there is real money to be made in providing the tools and services necessary to make that shift successful. The last time the industry tried this, in the provider practice management (PPM) days of the 1990s, the provider world was rocked by bankruptcies borne out of poor risk management (among other things). Somewhere out there students may be undertaking an archaeological dig of the ruins of those PPM societies, Pompeii-style Today we have the technology and know-how to make this work better, albeit the secret sauce is in helping guide the culture change that is surely a necessary ingredient in the recipe for success.

3. Patients are becoming consumers and, as such, looking for a true retail experience a la Amazon.com or Nordstrom. People are armed with money (often huge deductibles that they must spend down before accessing their actual insurance benefits) and an expectation that when they spend that money they will get good, or at least comprehensible, services. When you go to Amazon, you can identify what you want from a full array of options, compare it, get reviews, purchase it and get it conveniently delivered with a few clicks and a personalized, low hassle experience. Anything that can help healthcare follow that same model will surely prosper. Anything that makes consumers feel like they know what the hell is going on will make them weep with gratitude.

4. Pharmaceutical and medical device companies are looking for solutions beyond the pill/widget, by which I mean products, technologies and services that make traditional devices and drugs more meaningful, data-driven and personalized. Recognizing the increasing role of the consumer, these companies are looking for tools to establish that relationship and to expand their brand beyond the doctor-salesman relationship. These companies are also looking to enhance revenue models in a world of generics and in recognition that payers will provide richer reimbursement for better management of diseases, not just momentary symptom relief.

5. And all the while, the population is aging. For the next 20 years we will be watching the Baby Boomer cohort move like a big meal through a proverbial snake. There is no opportunity larger than ensuring that this massive population's healthcare demands don't tank the economies of most of the leading nations around the world. And the challenge is particularly interesting since this group has far less experience and comfort with the technologies that might make their lives better. Thus, this is a real opportunity for consumer-friendly solutions that capitalize on the four concepts noted above in a market that represents about 1/3 of the US population and similarly large numbers among our global economic partners. Healthcare entrepreneurs: hug a grandma, it may be the best money you ever make.

I am sure that others have lists of investment ideas that are far more specific than these, but to me it is good to step back and look at ideas through the lens of the big trends rather from inside smaller micro categories, such as wearables, telemedicine, and/or digital therapeutics. Any one of these might be the nouns associated with great investment opportunities, but if you are looking for the world's best wearable, you might just miss the world's best implantable or non-wearable passive sensor delivering a better solution to the same problem.

Recently I was working with a group that is developing a new venture fund and where some of the participants in the process were trying to get extremely specific about the kinds of deals they were going to seek. They were developing long lists of criteria and drilling down into subcategories to try to develop a list of investment ideas that would make the process of vetting deal flow "easier." While it's important to know the themes you think important and to understand key markets within those areas of interest, if you get too micro, you will miss the big ideas that came out of nowhere. The greatest innovations often take you by surprise-you just didn't see coming that particular way of solving a market problem. Often those are the best opportunities and yet they don't lend thems elves to being on a checklist, unless the checklist includes "wild-ass idea no sane person would have thought to do, but now that I think about it.."

I'd welcome your thoughts on what I missed and where you think the greatest investment opportunities are today. Use the comments section and weigh in!

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Ante Up! Where I'd Place My Healthcare Bets

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Oh, there's a lot of opportunities If you know when to take them, you know? There's a lot of opportunities If there aren't, you can make them Make or break them -Pet Shop Boys, Opportunities (Let's Make Lots of Money!)

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An unlikely set of partners teamed up to capitalize on a gathering flood of health-related personal information.

International Business Machines Corp. unveiled on Monday a partnership with Apple Inc., Johnson & Johnson and Medtronic Inc., as well as the acquisition of two medical-data software companies. Known as Watson Health, the effort transfers IBM's experience in data processing to the sensitive field of health care, part of an evolving strategy to pool and analyze data from other companies, such as Twitter Inc. and...

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IBM Positions Itself as Large Broker of Health Data

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An unlikely set of partners teamed up to capitalize on a gathering flood of health-related personal information. International Business Machines Corp. unveiled on Monday a partnership with Apple Inc., Johnson & Johnson and Medtronic Inc., as well as the acquisition of two medical-data software companies.

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Hello, All!

Please join us for our inaugural Stanford Medicine X ( http://medicinex.stanford.edu/) Los Angeles Pop-Up Event.

We are thrilled to partner with Karten Design ( http://www.kartendesign.com/) and Maker City Los Angeles ( http://makercityla.com/) for an evening devoted to a key aspect of healthcare innovation: Patient-Centered Design.

The evening will kick off with an ignite talk from a local Medicine X ePatient Scholar, followed by a presentation from Stuart Karten, founder of Karten Design, and a panel discussion with alumni of the Medicine X IDEO Design Challenge. Furthermore, Larry Chu, MD, founder and executive director of Medicine X is coming in from Stanford to spend the evening with us!

We are looking forward to interacting with and fielding questions and comments from our audience members-both in-person, and in great Medicine X tradition, via Twitter and the #MedX hashtag.

Light refreshments and snacks will be served, including matcha tea and matcha tea lattes from Matcha Source (please see below).

Speakers include:

Stuart Karten, founder of Karten Design

Britt Johnson, Medicine X Executive Board Member

Nikki Estanol, Medicine X ePatient scholar

The Panel Discussion will be moderated by Liza Bernstein, Medicine X Community Organizer, LA.

About the evening's partners:

About Stanford Medicine X:

Stanford Medicine X programs aim to connect all stakeholders to innovate healthcare at the intersection of emerging technologies and medicine.

Medicine X is a catalyst for new ideas about the future of medicine and health care. The initiative explores how emerging technologies will advance the practice of medicine, improve health, empower patients to be active participants in their own care, and more.

https://www.youtube.com/watch?v=tNi8BIIH-xo

About Karten Design:

Karten Design is an award-winning product design and innovation consultancy based in Los Angeles, CA. Since 1984, Karten Design has partnered with medical device manufacturers to build their businesses through strategic design. Driven by deep market understanding and user empathy, Karten Design helps companies seize new opportunities and create compelling products that resonate with end users, increasing adoption and enabling better patient outcomes.

About Maker City LA:

Maker City LA, a workspace collective for creative businesses, makers, and entrepreneurs, is housed on the 11th floor of The Reef in downtown Los Angeles. We are dedicated to serving the needs of LA's creative community by providing inspiring workspace, essential tools of the trade, classes, unique events, and a collaborative environment - all in one place.

Our mission is to foster a hotbed of innovation that serves, inspires and supports the artists, designers, thinkers, and makers of Los Angeles. We are passionate about creating a community-centered workspace that provides the real tools that creators need to be successful today.

The Evening's Purveyors Include:

Matcha Source:

Matcha Source will be serving traditional matcha tea whisked in a ceramic tea bowl and hand-crafted green tea lattes made with home-made almond-milk.

Matcha Source is a purveyor or premium grade matcha teas and accessories. We offer both traditional and modern utensils as well as starter kits and gift sets. Our retail boutique in Beverly Grove is soon to open as Matcha Box, LA's first matcha tea bar. Visit us online at matchasource.com ( http://matchasource.com/) and discover the tea that inspired a ceremony.

Special Thanks:

Special thanks to the LA chapters of the Society of Physician Entrepreneurs and Quantified Self for their support!

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First Medicine X Los Angeles Pop Up Event: Patient-Centered Design

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Hello, All! Please join us for our inaugural Stanford Medicine X ( http://medicinex.stanford.edu/) Los Angeles Pop-Up Event. We are thrilled to partner with Karten Design ( http://www.kartendesign.com/) and Maker City Los Angeles ( http://makercityla.com/) for an evening devoted to a key aspect of healthcare innovation: Patient-Centered Design.

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First Medicine X Los Angeles Pop Up Event: Patient-Centered Design

Wednesday, May 6, 2015, 7:00 PM

Maker City LA
1933 S Broadway 11th Floor Los Angeles, CA
160 Members Went

Hello, All! Please join us for our inaugural Stanford Medicine X Los Angeles Pop-Up Event. We are thrilled to partner with Karten Design and Maker City Los Angeles for an evening devoted to a key aspect of healthcare innovation: Patient-Centered Design. The evening will kick off with an ignite talk from a local Medicine X ePatient Scholar, followed...

Check out this Meetup →

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Tie up with Apple and med tech companies

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Experts in health care and information technology agree on the future's biggest opportunity: the creation of a new computational model that will link together all of the massive computers that now hold medical information. The question remains: who will build it, and how?

is today staking its claim to be a major player in creating that cloud, and to use its Watson artificial intelligence - the one that won on the TV game show Jeopardy - to make sense of the flood of medical data that will result. The new effort uses new, innovative systems to keep data secure, IBM executives say, even while allowing software to use them remotely.

"We are convinced that by the size and scale of what we're doing we can transform this industry," says John Kelley, Senior Vice President, IBM Research. "I'm convinced that now is the time."

Big Blue is certainly putting some muscle into medicine. Some 2,000 employees will be involved in a new Watson-in-medicine business unit. The Armonk, N.Y.-based computing giant is making two acquisitions, too, buying Cleveland's Explorys, an analytics company that has access to 50 million medical records from U.S. patients, and Dallas' Phytel, a healthcare services head of IBM's Life Science company that provides feedback to doctors and patients for follow-up care. Deal prices were not disclosed.

It is also announcing some big partnerships:

* will work to integrate Watson-based apps into its HealthKit and ResearchKit tool systems for developers, which allow the collection of personal health data and the use of such data in clinical trials.

* Johnson & Johnson, which is one of the largest makers of knee and hip implants, will use Watson to create a personal concierge service to prepare patients for knee surgery and to help them deal with its after effects.

* , the maker of implantable heart devices and diabetes products, will use Watson to create an "internet of things" around its medical gadgets, collecting data both for patients' personal use and, once it's anonymized, for understanding how well the devices are working. Initially, the focus is on diabetes.

IBM's pitch is that it will be able to create a new middle layer in the health care system - linking the old electronic records systems, some of which have components dating back to the 1970s, with a new, cloud-based architecture, because of its deep breadth of experience.

And there is no doubt that there is a need for data science that can parse the explosion of information that will soon be created by every patient. Already, there is too much information for the human brain. "If you're an oncologist there are 170,000 clinical trials going on in the world every year," says Steve Gold, VP, IBM Watson.

The question is how ready Watson is to take on the challenge. IBM isn't the only one that sees opportunity here. The billionaire Patrick Soon-Shiong is aiming to create a system to do many of the same things with his NantHealth startup. Flatiron Health, a hot startup in New York, is creating analytics for cancer. The existing health IT giants, Cerner and Epic, both certainly have their eyes on trying to capture some of this new, interconnected market, lest it make them obsolete.

So far, Watson has been a black box when it comes to healthcare. IBM has announced collaborations with Anthem, the health insurer, and medical centers including M.D. Anderson, Memorial Sloan-Kettering Cancer Center, and The Cleveland Clinic. There are lots of positive anecdotal reports, but so far the major published paper from Watson is a computer science paper published by the Baylor College of Medicine that identified proteins that could be useful drug targets.

"I think that ultimately somebody's going to figure out how to integrate all these sources of data, analyze them, sort the signal to noise, and when someone can do that, it will improve the health care system," says Robert Wachter, the author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine's Computer Age and associate chair of medicine UCSF.

"Does this do that tomorrow? No. But do we need to create the infrastructure to do that? Yes. And are they probably the best-positioned company with the best track record to do this? I think so."
--Sarah Hedgecock contributed reporting to this story.

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IBM Announces Deals With Apple, Johnson And Johnson, And Medtronic In Bid To Transform Health Care

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Experts in health care and information technology agree on the future's biggest opportunity: the creation of a new computational model that will link together all of the massive computers that now hold medical information. The question remains: who will build it, and how? IBM is today staking its claim to be [...]

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People powered healthcare Innovation Unit

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People powered healthcare Innovation Unit

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We kick-start things. We're not a strategy consultancy, a branding company, a product design studio, a mobile developer, an advertising agency or a data analytics business. But we do all of those things because they, in combination, get businesses growing.
See also:
http://albiondrive.com/services/

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10 idea from innovation unit: people powered health

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10 idea from innovation unit: people powered health

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What is stifling creativity in schools is same as what is stifling creativity in big corporations

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Find Xerox blogs on a variety of subjects with focus on trends, technologies and services to simplify how work gets done.

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Creativity and innovation in organisations

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Human Economies Powered by Technology

Across a range of sectors and geographies, from the West Coast to Western Europe, our first list of venture capital’s next billion-dollar companies demonstrates the wide reach of technology and its potential to bring communities together in new ways, all towards the transformation of old industries. Whether it is new technology applied to sectors living in the analog, new business models, or fresh attempts at old ideas, tech companies today have the opportunity to be massive, and impact every aspect of the global economy.

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If we can learn anything from the inaugural Next Billion-Dollar Startup List, it's that no industry is safe from the possibility, and reality, of disruption. Many of the companies on the List are tackling problems or inefficiencies in food delivery, lending, auto sales, or shopping, and most are stationed in Silicon Valley with a handful in New York, London, or Germany. So which industries are these next-generation startups overturning, and what are the new markets created as a result of their innovation?

We zeroed in on a few trends weaving together 25 of tech 's fastest growing, next-gen startups and found the following: a revolution in e-commerce coupled with newly defined marketplaces; a strong need for simple and local meal delivery, as well as enhanced food discovery; a concerted effort to disrupt traditional institutions like banks; and a strategic capitalization of open-source platforms to redefine enterprise and mobile.

Read on to learn about the industries most upturned by these innovative companies, some of which may become billion-dollar household names.
By The Numbers
The average age of the companies on the Next Billion Dollar Startup List is just under five years, with an average of about four funding rounds (including angel or seed financing). These next-generation tech companies collectively raised well over $3.5 billion of equity and debt, or $161 million each on average, while 22 of the 25 companies raised a round of financing in the last twelve months.

While we cannot disclose all individual company data, of those 18 companies with valuations that are public, the average valuation is an estimated $630 million. Not surprisingly, most of the 25 startups hail from California (16), with two in New York (Blue Apron and Orchard Platform), two in Boston (SimpliVity and Affirmed Networks), two in Europe (Deliveroo and Kreditech Holding), and one in Seattle (Redfin).

Overall, the list is almost exactly split between consumer and enterprise companies.

E-Commerce and New Marketplaces: The Death of Brick and Mortar

E-commerce companies took the lead in the 2013 exit market, with Zulily making a smash debut in the public markets and giants , Amazon, and Wal-Mart following with several acquisitions. Since then, some might say that e-commerce has slouched. But several companies on the List are helping to keep e-commerce in the game by demonstrating its versatility.

Companies like Raise, Beepi, and Thumbtack all offer unique takes on an e-commerce business by introducing new, modernized concepts of the traditional marketplace.

As an online marketplace for buyers and sellers to trade gift cards at a discount, Raise (co-founded by CEO George Bousis) is tackling a market of potentially $80 billion of unused gift card value. Meanwhile, co-founder/CEO Alejandro "Ale" Resnik of Beepi is connecting buyers and sellers safely, cheaply, and painlessly in an industry that history has known to be anything but: used car sales. And in a slightly different spin on the marketplace, Thumbtack acts as a Yellow Pages in reverse by providing an online platform for local pros to search for a customer's service request and bid for his/her business.

Another company, Teespring, is also leading a new wave in e-commerce with a Kickstarter-inspired social selling platform. Founded by Walker Williams and Evan Stites-Clayton in 2011, Teespring allows anyone to launch a social campaign around a product, custom design their apparel, and sell their products directly to buyers at no upfront cost - a direct result of buyers and sellers working together to produce what they need.
Food Delivery 2.0: Food and Tech Are Back in Vogue
According to CB Insights, U.S. food tech companies raised over $1.0 billion in venture funding throughout 2014, at a growth of 272% year-over-year. And that's not including the international push to replicate the success of U.S.-based companies like GrubHub, which saw its shares rise 31% in its public market debut.

With a range of niche sectors, including food delivery (like DoorDash), food discovery (like GrubHub), restaurant tech (like Reserve), and food replacements (such as Hampton Creek or Soylent), food tech has an all-inclusive menu.

One of many food fighters in the competitive space is San Francisco's DoorDash, the local restaurant delivery service founded in a Stanford dorm room by four students. Backed by a number of prominent investors, including KPCB, Sequoia Capital, and Silicon Valley's resident food tech firm, Khosla Ventures, DoorDash has fast outgrown its campus roots and expanded into eight major cities nationwide.

Similarly, delivery startup Deliveroo is helping to evangelize food tech across the pond, giving Londoners a fast alternative to fast-food. Founded by childhood friends William Shu and Greg Orlowski, Deliveroo began out of necessity after Shu, formerly a Morgan Stanley investment banker in New York, transferred to London and grew tired of take-out options limited to Burger King.

And in another pocket of the food tech industry is Blue Apron, the New York-based meal kit subscription company on a mission to make fresh food and home-cooked, original recipes much more convenient, with co-founders Matt Salzberg (CEO and former VC at Bessemer Venture Partners), CTO Ilia Papas, and Chef Matthew Wadiak at the helm.

Perhaps most exciting about this industry is that founders are no longer intimidated by the challenges of food delivery. Given the lowered costs of starting a tech-enabled company, and technology's permeation across industries, founders are willing to revitalize business ideas through improved methods and lessons gained from past mistakes.
Fintech and the Unbundling of Banks: Gunning for Wall Street
In the credit drought left by the 2008 financial crisis, startups specializing in financial services technology (fintech) have arrived in a downpour, each with different means towards the same end: to disrupt the current banking model. Nowhere has this been more apparent than in lending.

Beginning in 2005 with UK-based Zopa and culminating last year in Lending Club's soaring public exit, the online lending marketplace entered this year on a Gold Rush high. But even though its roots are in the model of "peer-to-peer lending," simply defined as the practice of one individual or institution lending to another without traditional intermediaries (mainly banks), the ecosystem of next-gen lenders today is sprouting a number of niches. One of those niches is student loan refinancing and, more recently, mortgages.

Founded in 2011 by four Stanford business students, Social Finance (SoFi) began as a marketplace connecting recent graduates with alumni from the same alma mater, with the goal to create a pool of money for alumni to lend and pocket a share of the interest. Two years and over $2.0 billion in loans later, CEO Mike Cagney is now taking on home mortgages across more than 20 states in the U.S.

As another company out to revamp lending, Orchard is looking holistically at the entire lending ecosystem instead of tackling a single niche. Rather than connect with borrowers directly, Orchard uses the growing complexity of the marketplace lending landscape (what it calls the "lendscape") to its advantage by providing a support structure for the individuals and institutions within it. Through its investment and analytics platform, Orchard connects institutional investors (including family offices, hedge funds, and now, even banks) with origination platforms like Lending Club, Prosper, and OnDeck Capital, allowing both parties the chance to assess their options and deploy capital at scale.

But the unbundling of banks doesn't stop with lending marketplaces. One more fintech company on our list, Zenefits, is targeting both traditional payroll management and health insurance brokers with its free all-in-one HR platform for small businesses. Founded by CEO Parker Conrad and CTO Laks Srini, Zenefits hit a $1.0 million revenue run rate after just eight months, with the potential to hit a run rate revenue of $100 million at the end of this year.

And finally, two more fintech companies on our list - one based in the U.S. (Avant) and one in Europe (Kreditech) - are using data and machine learning to rethink and recalculate credit ratings in a way no bank ever has.

Avant, founded in 2012, offers installment loans not to high-end, low-risk consumers or to super subprime borrowers, but to those in between: near-prime borrowers with FICO scores between 600 and 700, who have been left largely ignored by banks and other traditional lenders. Rather than limit their scoring to FICO, Avant processes thousands of other variables to assess each customer's risk, giving borrowers the second chance on their loans that banks could not grant.

Like Avant, the Hamburg-based Kreditech aims to serve the underbanked. But even more ambitious than the fintech startups before it, Kreditech isn't exactly "unbundling" banks-it's re-bundling discrete financial services into one fully automated, real-time, multi-channel "bank." Started in 2012 by CEO Sebastian Diemer and CTO Alexander Graubner-Müller, Kreditech deploys machine-learning algorithms to tackle 20,000 dynamic data points. Just three years later, Kreditech now operates in nine countries, offering an assortment of products and services including micro loans, virtual credit cards, and physical credit cards through its subsidiaries.

For all the attention that's been tuned into the sector, fintech companies are not just turning heads in Silicon Valley-they are also fast drawing the gaze of Wall Street. Just last week, JP Morgan Chase CEO Jamie Dimon warned shareholders that "Silicon Valley is coming," and that new startups with significant capital and expertise are thriving in areas like payments and lending. This level of attention validates that the companies being built are real, and even the largest incumbents are on their toes.
Open Source Origins: Give It Away
As Index Venture Partners' Mike Volpi writes for Re/Code, a profitable company might seem like the antithesis of the open source community. But for three of this year's next-gen startups at least, open source projects have been the basis for redefining the enterprise and mobile operating systems.

As Volpi argues, the technology market has become ripe for open source companies to succeed as businesses. Compared to 50 years ago when the software industry was pushing bulky, packaged software onto users and making costly upgrades, the open source movement rose out of necessity for a community-driven product that could implement changes swiftly and cheaply.

The only problem was that open source projects at the time were made by techies, for techies-they were hard to translate into an enterprise environment without additional structure and control.

Today, that environment has changed. Open source projects and communities (like Docker, Apache Cassandra, Cyanogenmod, and MongoDB) remain cheap to produce but secure and scalable enough to introduce to the enterprise. And several companies, walking in the footsteps of open source provider Red Hat, are aiming to fulfill the promise that the open source communities first created.

Before the Docker community arose in 2013, and before company CEO Ben Golub climbed aboard, Docker was an internal technology developed by dotCloud, the platform-as-a-service provider now acting as the Docker commercial entity, Docker Inc. Today, with a partner base ranging from fellow startups like Orchard and DoorDash to software giants like Microsoft, eBay, and Google, Docker and its developer community have created an unforgettable brand as much as an indispensable technology for the cloud infrastructure of many companies.

DataStax, built on the open source, NoSQL database Apache Cassandra, is taking aim at incumbent enterprise infrastructure firms by packaging and servicing the enterprise use of the Cassandra project. Led by CEO Billy Bosworth, DataStax has grown from 19 to 400 team members and now has a customer roster that includes Netflix and eBay. And with co-founder Jonathan Ellis sitting as the Apache Cassandra project chair, DataStax appears well prepared to stay true to the open source community even in the context of the enterprise.

And beginning in 2009 like any quintessential tech startup should - as a late-night hacking hobby - the open source project Cyanogenmod did not evolve into Cyanogen, the company, until much later. Started by Steve Kondik and a core team of developers, Cyanogenmod began with Android's free-to-download operating system and evolved into an ideal product that Kondik and his team had in mind, but with no one available to make it: Cyanogen OS.

Now with the help of CEO Kirt McMaster, the Cyanogenmod community has given birth to Cyanogen, Inc. And even though it's no longer just a hobby but now a multi-million dollar company, Cyanogen has kept its main goal intact: to make "your mobile device" truly yours again, and give users another option when it comes to their mobile operating system.
Human Economies Powered by Technology
Across a range of sectors and geographies, from the West Coast to Western Europe, our first list of venture capital's next billion-dollar companies demonstrates the wide reach of technology and its potential to bring communities together in new ways, all towards the transformation of old industries. Whether it is new technology applied to sectors living in the analog, new business models, or fresh attempts at old ideas, tech companies today have the opportunity to be massive, and impact every aspect of the global economy.
Click here for more coverage on the Next Billion Dollar Startups. Follow us on Twitter @TrueBridgeCP

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4 Big Industries And Their Next Generation Tech Disruptors

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If we can learn anything from the inaugural Next Billion-Dollar Startup List, it's that no industry is safe from the possibility, and reality, of disruption. Many of the companies on the List are tackling problems or inefficiencies in food delivery, lending, auto sales, or shopping, and most are stationed in [...]

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We work with brands, agencies and organisations to craft space, technology and living matter into visionary experiences that act as an interface between the familiar and the unknown. Through a highly collaborative and creative process we help companies identify the key insights that could impact their business and develop 'brand fictions' to probe into possible futures.

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The taskrabbit of home care

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HomeTouch - Transform your loved one's life with live in care

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HomeTouch private home care provides a better alternative to care homes. Regulated by CQC (Care Quality Commission). Contact us to book a free consultation with an expert care advisor today!

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Health insurance card

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Your health insurance card is like a security blanket in a wallet, acting as a tangible gateway into today's complex health care system. Yet, its design is very utilitarian, flimsy and cold; it hardly conveys the idea of security. The information on the card and the transactions it facilitates are mostly geared toward health care providers with little relevant information for consumers to help them feel confident in their coverage for receiving care.

As the health care system becomes increasingly fractured and intangible, and the insurance card basically remains the only concrete connection people have to their health care, shouldn't the card and the experience it engenders be more thoughtfully designed? We think so.

While most of the world continues to shift from analog to digital, our research with consumers confirms that health care is one area they want to retain some tangibility. So we asked ourselves an important question:

How can we remake the health I.D. card in order to celebrate the security of its physical form while also making it more useful and meaningful to patients?

In addition, is there an opportunity to give patients a stronger sense of empowerment and control in the navigation of their health care by providing useful information targeted at them, in addition to providers?

Although having a physical manifestation of your health care through the card was important, we didn't want to ignore the opportunity for depth of information that digital solutions can provide. So we came up with a design concept that bridges the gap between analog and digital to create a more meaningful health care experience.

Patients come first

The card, now a simple, clean object designed to be cherished and feel personal to you, only contains the information that matters to you most (i.e. your name and health insurance number). To enhance the significance of the card within the wallet, we subtly altered its form to make it feel more comforting and stand out from the other cards. The card would also come in a range of more durable materials that the user picks when joining the insurance plan, making it feel even more tailored and personal.

Behind the card, though, you find a door to a deeper digital experience.

We envision an app designed with patients in mind to help make navigating health insurance and health care easier for them, and to make their information more accessible, whether they're at home or on-the-go. As you put the card next to your phone, it unlocks detailed information about your health and your insurance (such as information about the places near you where care is covered, or more info on your policy, co-pays, deductibles, etc.).

In the doctor's office, it becomes a tool to share information around your health history. By simply placing the card on the "basic" side of the card reader, your payment information is instantly transferred to the clinic to enable more efficient and error-free processing. No more manual inputs, which leads to costly errors.

The card also acts as a medium to have more of a dialogue about your care with your physician, which creates a stronger sense of engagement. When placed on the "full" access side of the reader, the card provides more detailed information to the doctor, which can be shared on a large screen to foster a more open dialogue about your health and promote better engagement in our care.

Vision for tomorrow

As we strive toward creating more integrated solutions, we believe that the health card should play an important role. Its emotional significance makes it a key touchpoint in someone's care. And in today's connected world, it has the potential to deliver a lot more value to patients, payers, and providers.

While it may be some years before we see a solution as seamless as what we have proposed here, incremental changes, such as the card redesign itself, can be rolled out today to deliver more meaning to patients and serve as an important step toward a more seamless health care system experience.
This concept was profiled in Fast Company. Designs and images courtesy of Smart Design's Russell Blanchard, Director, and Maya Lee, Senior Communication Designer.

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Making Health Care Tangible In An Increasingly Intangible World | Smart Design

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Your health insurance card is like a security blanket in a wallet, acting as a tangible gateway into today's complex health care system. Yet, its design is very utilitarian, flimsy and cold; it hardly conveys the idea of security.

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Apps to manage risk in lifestyle

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fraggl post-

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Why Do We Need Innovation in Health Care? | Commonwealth Fund

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Some health systems are working to bridge the divide between tech entrepreneurs, designers, and developers and the clinicians who work on the front lines of care through the creation of health care delivery innovation centers.

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Non health aquirers heatign up digital health M&A activity

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Non health aquirers heatign up digital health M&A activity

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Stephanie Liu, Strategy Fellow, Rock Health

What does it mean for companies looking to get acquired?
With M&A heating up in the digital health space, it's no wonder non-healthcare companies also want to get a piece of the action. In Q1 2015, we saw consumer athletic wear company Under Armour make a $475M acquisition of MyFitnessPal and $85M acquisition of Endomondo. Last year we also saw the largest disclosed acquisition by a non-healthcare acquirer: Outsourcing services company Cognizant bought payer administration company TriZetto for $2.7B. Several non-healthcare companies have gone on to acquire a number of Rock Health portfolio companies-MyFitnessPal acquired Sessions, Weight Watchers bought Wello, and Google purchased Lift Labs -just to name a few.

Why so much activity from non-traditional players?
The trend of non-traditional players investing in digital health indicates that healthcare is no longer a silo as these players identify value of incorporating healthcare into their business model. The growth of consumers willing to pay out of pocket for healthcare-related expenses, whether that's medical or wellness-oriented, is creating an attractive market for B2C models. Since Rock Health began tracking M&A deals in digital health in 2013, non-healthcare company acquisitions in digital health account for close to 20% of all M&A deals (compared to 23% by traditional healthcare companies) with a total of 33 deals and $5.2B in disclosed digital health acquisitions. Non-traditional players also invested more heavily in the consumer health space such as personal health tools and tracking.

How do traditional healthcare players see things differently?
The trend of consumer health seems inevitable; however, in traditional healthcare such as pharma, medical device, payers and providers, the role of digital health is a little less clear. The customer has historically never been the "paying" consumer, with one of the industry players bearing the costs as an intermediary. "Because digital health is so new and there haven't been big IPO winners that have defined the space so far, I think that a lot of people are still hesitant about the role of digital health," said Leslie Silverglide co-founder of Wello and now VP of Product Management at Weight Watchers. Wello was Weight Watchers' first acquisition in the company's history.

This uncertainty means traditional players like medical device company Abbott are often less amenable to acquisitions and view partnerships as a less risky, preferred alternative, according to Jeff Royal, Director of Licensing & Acquisitions at Abbott Vascular.

While traditional healthcare companies tend to be more conservative in their approach to innovation, they do have a competitive advantage of a broader reach and stronger brand with healthcare customers and substantial experience and knowledge navigating the healthcare regulatory environment. These facets make traditional stakeholders important partners for startups tackling disruptive healthcare solutions.

Steven Rubis, a sell-side equity research analyst at investment banking firm Stifel, is optimistic that pharma will play a large role in the consolidation of digital innovation in niche markets. "[Pharma] is moving beyond identifying a disease, running a trial, and running statistical significance," said Rubis. "They are looking at [mobile health] to drive a more complete solution and protect pricing at the end of the day." Pharma made five acquisitions of digital health companies in 2014.

So, what should digital health companies think about if they want to be acquired?

Key tenets for identifying the right digital health acquirer are the same for potential non-traditional and traditional healthcare acquirers:

1. Align with a company with similar mission/vision: "I wouldn't have done the deal if there wasn't an aligned vision. From the first meeting, it was clear they cared about exactly the same things we did," said Nick Crocker, co-founder of behavioral coaching company Sessions and now Product Lead at MyFitnessPal. Sessions was acquired by MyFitnessPal before the Under Armour acquisition.

2. Understand strategic motivations of potential acquirer: Each organization has different reasons for acquiring. Existing partnerships or mutual investors can foster the right relationships for a future acquisition and also provide insight into an acquirer's strategy and vision for the future.

3. Know when the time is right: Sometimes the right acquisition requires a bit of luck or at least an understanding of the changing market landscape. "When we started, we were on a highway by ourselves. It wasn't until later however that we saw this proliferation of fitness start-ups," said Silverglide. "Many companies were raising huge rounds of financing and it looked like it was going to be a fight defined by marketing spend to acquire customers." At that point, an acquisition by a larger brand to leverage scale made sense for Wello.

4. Create a sense of urgency: If you are only courting one buyer, that can often slow the process as the acquirer conducts a long evaluation or chooses to weaken the target's position by dragging out the conversation. Soliciting multiple buyers can help accelerate timelines for a potential acquirer to act (just as in raising a venture round). It is important to note, however, especially with larger companies, that the pace is slower than what most startups are used to.

5. Exude the qualities of a successful standalone company: Building on existing partnerships now opens up relationships with potential acquirers down the road. "The path to getting acquired and the path to building a successful company are the same," said Crocker.

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Non-healthcare acquirers heating up digital health M&A activity | Rock Health

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Stephanie Liu, Strategy Fellow, Rock Health What does it mean for companies looking to get acquired? With M&A heating up in the digital health space, it's no wonder non-healthcare companies also want to get a piece of the action. In Q1 2015, we saw consumer athletic wear company Under Armour make a $475M acquisition of MyFitnessPal and $85M acquisition of Endomondo.

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Yesterday's 9to5Mac - a highly-regarded rumor website - offered a remarkably detailed look into the Healthbook application that may (or may not) be incorporated into iOS8, the next operating system update.

The app - organized like the current Passbook app - offers "cards" corresponding to a range of functionalities, including blood work, heart rate, hydration, nutrition, sleep, and blood glucose, among others. It's not clear at this point where these measurements are expected to come from: perhaps 3 rd party device makers like Withings or Jawbone - thought for at least some functionalities, Apple is believed to be developing sensors of its own.

It's a long path from sensor data to actionable information - and a long way from there to significantly improved health (to say nothing of reduced healthcare costs). The vast majority of people are unlikely to derive significant health benefit from tracking their heart rate or hydration level - even if these were measured with reasonable accuracy (not a given); the same goes for many of other quantified parameters.

In some cases, however, the impact is likely to be profound and immediate - blood glucose monitoring in diabetics, for example. It's difficult to find the parent of a child with type 1 diabetes who isn't frustrated by the difficulty of collecting and aggregating the data from the various blood glucose monitors a typical child might use - the interfaces are generally described as "awful" and "atrocious." By creating a common platform to which blood glucose data must be exported, Healthbook may catalyze the rapid, customer-friendly evolution of this critical area of biomedical sensors - and immediately improve patient care. (This assumes Healthbook could be used to track the health data of loved ones, older as well as younger - a capability I'd view as essential.)

This "common platform" model could well be Healthbook's path to impact; right now, the consumer sensor ecosystem is a veritable Tower of Babel (equally true inside hospitals, by the way); interoperability and information sharing are major problems (my own example from wearables here).

Presumably, most sensor companies will decide it's in their enlightened self-interest to play nicely with this platform, given its likely ubiquity. This will enable Healthbook to consolidate data from a range of devices (a huge advance in itself), and provide a de facto minimal interoperability standard that new sensors will need to clear if they want to gain traction in the market.

I suspect there might be a less obvious but equally important upside to Healthbook as well. Despite the diligent efforts of many companies, most patients still don't "own" their personal health data in the way they own other important information; many are still content to have this information maintained and managed by doctors and staff, clinics and hospitals. Healthbook may help catalyze an important perceptual transition here, and may help more patients realize that their health data is truly theirs, and not their physicians'.

Historically, such a transfer of responsibility might have appeared both foreign and overwhelming; yet Healthbook may make ownership of personal health data familiar and comfortable - a critical step in patient empowerment.

Moreover, if greater ownership of health data leads us to feel a greater sense of ownership of our health, a sense that we have the ability not only to maintain our health information, but also to influence, through our behavior, the data that's collected - what a powerful and beneficial transformation this could be.

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In Brief: Why Apple's Healthbook Is So Important

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Yesterday's 9to5Mac - a highly-regarded rumor website - offered a remarkably detailed look into the Healthbook application that may (or may not) be incorporated into iOS8, the next operating system update. The app - organized like the current Passbook app - offers "cards" corresponding to a range of functionalities, including blood work, heart rate, hydration, nutrition, sleep, and blood glucose, among others.

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e-engage with patients as people through more responsive, empathetic behaviors.

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Back in 2012 I wrote a blog post called SXSW: Woodstock for Geeks, which became the opening chapter of Tech Tonics, the book I wrote with David Shaywitz. In this piece, I pointed out the marked differences between SXSW vs. HIMSS, both of which I had recently experienced. I said that HIMSS was best described as "a festival of old-school techno weenies recognizable in the wild by their big company expense accounts and the blue and gray suits that barely cover their pocket protectors." In contrast, I experienced SXSW as an event that "would blanche at the thought of being called a conference. SXSW is more of a happening. Rather than suits (the costume is old jeans and rock and roll t-shirts), the primary thing that comes in blue is hair." My conclusion of the 2012 piece was this:
"In a perfect world, the ideal HIT gathering would be somewhere psychologically between HIMSS and SXSW: fewer gray suits, less purple hair, more next generation technology, more business models that work. If we could do a little cross breeding between species here, we just might make it work. Or we could accidentally end up with the Monster from Young Frankenstein. Wait a minute, my God it's brilliant! He might actually be perfect! The Monster had both a gray suit AND a green head. If he knows how to code, we have a winner. Oh, sweet mystery of life at last I've found you!"
It seems I need to write a new book opening.

I have just returned from HIMSS 2015 where I found that this hypothetical hybrid Monster has come to life, much to my surprise. In three short years, HIMSS has gone from an event where electronic medical records (EMRs) took center stage to one where the focus was very much on the patient/consumer, a voice that was entirely missing in the HIMSS of 2012. And I even saw a guy with blue hair wandering about.

The change that has come over HIMSS was really noticeable. First of all, HIMSS 2015 had over 42,000 attendees, a big increase vs. the 37,000 of 2012. That's quite a jump, and one that is amplified by the investment attention being paid to health IT these days. Back in 2012 I reported that the prior year saw about $600 Million of venture investment in health IT; in 2014, the latest year for which we now have statistics, over $4 Billion, with a "B" was invested in health IT. And of that $4 billion, the bulk was in the deals one would more readily call "digital health, " a term that was barely in vogue back in 2012. Back then we were still arguing about whether to call it mHealth or mobile health or connected health or whatever, but regardless of the name, today's health IT means far more than it used to, sweeping in products that are intended to serve everyone in the healthcare world: patients, payers, providers, retailers, you name it. There is even a robust pet health category which, mercifully, was not a leading theme of HIMSS15 but was present in a big way at the newest entrant to this healthcare IT/digital health conference fray: CES 2015. FitBark anyone?

As I padded around the 2.5 million square feet of HIMSS at Chicago's McCormick Place this year-and the throbbing in my own feet would suggest I touched each and every one of those square feet-I was particularly struck by how much of the agenda was focused on what the EMR companies are doing wrong (in 2012, by contrast, the EMR companies' agendas dominated). The primary focus of this energy has become how fed up everyone is with poor interoperability and lack of transparency-in other words: why can't I, as a patient, get my own damn data whenever I want it? Former head of the Office of the National Coordinator of Health IT in the Department of Health and Human Services, Dr. Farzad Mostashari, was at HIMSS pounding the podium and calling for patients to rise up in a "Day of Action" where at least 1 million people requested their own patient data simultaneously.

This attitude belied a big contrast to 2012 where the biggest draw on the show floor was Epic's booth; it included a full-blown sports bar complete with beer tap. In contrast, the big exhibit floor draw at this year's event was Walgreen's Connected Patient Gallery, chock-a-block with digital health offerings focused on improving the patient's experience of the health system in terms of convenience, personalization and mobile technology. Wait, there's those patients again! In fact, it was gratifying to see HISTalk sponsoring the presence of a number of patients/patient advocates at HIMSS, as well as the advancing army of Regina Holliday's Walking Gallery jackets representing meaningful patient stories.

It's worth noting that the world was still hoping that health systems would adopt EMRs back in 2012, taking advantage of newly created financial incentives to do so. Now, three years later, that mission is largely accomplished, but we left out that pesky middle part...the part about how these systems had to help, not further encumber, the patient experience. One of the more notable stories I read reported on the vast number of information errors contained within the EMR. Garbage in, garbage out, as they say. I suppose if the data itself is bad, the lack of interoperability is a blessing.

To many, Meaningful Use for EMRs has been well, meaningless and useless, stopping far short of enabling the use of data to actually improve care outcomes. Fortunately, many of the young companies present at HIMSS are taking a swipe at that problem, figuring out ways to co-mingle disparate data sets and overlay a palette of analytics and tools against the data coat of many colors in order to find one shade that blends. The goal of these efforts might actually be to turn the mountains of data into something a doctor can use to make a patient better or something a consumer can use to make better choices when purchasing within the healthcare system. Let's hope that's the case, as never have so many tried to do so much with so little actual information.

The front and center presence of so many young companies was another difference from the HIMSS of old, and particularly young companies focused on how patients can fare better in a rapidly changing healthcare system. Digital health upstarts, including many consumer-facing entities, were noticeably present as if they had made a wrong turn at Austin and ended up at McCormick Place. I had the pleasure of managing and emceeing the HX360 Innovation Challenge which featured digital health companies that are explicitly seeking to improve the experience for patients who must come into contact with the health system. The four finalists who presented at the live event were WiserCare, Ginger.io, Wellframe and ClockwiseMD (WiserCare and Ginger.io were declared the winners). These are four startups with cool ideas and energetic leaders that would still have looked very out of place at HIMSS 2012. But this year they were just four of the many young upstarts looking to tell a new story about how health IT can actually make a difference for patients and consumers. There were hundreds of others there in their newfound hipster t-shirts and logo wear standing in stark contrast to the army of suits still ever-present. One of my funniest moments at HIMSS occurred as I stepped on stage to moderate a panel of four senior hospital-based venture fund leaders, all of whom showed up in identical blue blazers. It prompted me to introduce our group as Gladys Knight and the Pips.

And it's not just the upstart startups that make HIMSS look new, it's also the big companies coming from outside healthcare to act as game-changers. While Apple and Google were noticeably not present despite their active role in disrupting the healthcare old guard, companies like CVS and Walgreens and IBM/Watson and Samsung and Box were visible and relatively new to the party, or at least far more visible than several years back when McKesson and Epic and Allscripts and Cerner were the center of the HIMSS universe. Not that these companies aren't still omnipresent-they are-but there was a sense that they are no longer setting the agenda for health IT as they once did, particularly as patient experience becomes more and more the focus of attention.

The half day Patient Engagement Forum was a (nearly) new concept, featuring talks from people like Jane Sarasohn-Kahn and J ack Barrette and about patient-generated data, social networking, peer-to-peer and crowd-sourced health information, among other newfangled ideas, such as putting the consumer at the center. All of these topics would be expected at SXSW but are now, mercifully, becoming mainstream at HIMSS. One of the sessions featured the results of a patient engagement survey which highlighted one of the key problems in improving outcome: doctors, technologists and patients all view patient engagement differently, pointing their fingers at each other as key to making it better and having different views about the importance of high tech vs. high touch in the overall experience.

If we are ever going to move this ball forward, patients, providers and chief information officers are going to have to go into the woods and do some sort of Outward Bound program together, or at least get onto the same playing field. The "real" consumer-focused businesses, like Apple and Samsung and Walgreens and CVS, are far more accustomed to thinking about the patient as center of the customer universe and that is why they may be halfway through the lunch of some of the old health IT stalwarts.

In a study released by HIMSS at the conference (26 th Annual HIMSS Leadership Survey of health IT professionals), "72% of respondents said that consumer and patient considerations - such as patient engagement, satisfaction and care quality - would be the business issue that would most effect their organization over the next two years. Indeed, 87% of respondents said that patient satisfaction would be the top business priority at their organization over the next 12 months."

There is, in my opinion, no way in the world that the healthcare vendors of today can become the most trusted consumer brands of tomorrow solely through advancements in technology. There is going to have to be a swing back towards humanity if those HIMSS survey business requirements are going to be met. Patient-centered design, patient-reported dat a, personalization are all great technological inputs, but if patients aren't treated like people when they show up at the doctor's office, none of it really matters. The go-to-guy of the moment on this topic is Dr. Atul Gawande, famed physician author of the recent book Being Mortal. I read an interview he did with another famed physician author, Dr. Robert Wachter today, and to me it perfectly highlights this topic. Said Gawande:
"The very first place we've gone is to non-technology innovations. Such as, what are the 19 critical things that have to happen when the patient comes in an operating room and goes under anesthesia? When the incision is made? Before the incision is made? Before the patient leaves the room? It's like that early phase of the aviation world, when it was just a basic set of checklists. In all of the cases, the most fundamental, most valuable, most critical innovations have nothing to do with technology. They have to do with asking some very simple, very basic questions that we never ask. Asking people who are near the end of life what their goals are. Or making sure that clinicians wash their hands."
One of my favorite companies that participated in the HX360 Innovation Challenge was one that might be deemed pretty old school, in that most of their effort is delivered by people, not on cell phones or tablets. The company, Empathetics, trains medical professionals in using empathy and interpersonal skills to improve patient experience and thus improve health system efficiency and clinical outcome. It may be kind of old school in its delivery, but it's pretty new school to apply research in the neurobiology and physiology of empathy to create better outcomes for patients and the hospital's bottom line. This kind of training should be a priority of all those delivering care to patients.

During the HX360 portion of HIMSS I sat in on a session where chief innovation and medical officers of major health systems talked about initiatives they were undertaking to do exactly this kind of thing: re-engage with patients as people through more responsive, empathetic behaviors. The attendees were riveted to the speakers', their peers, descriptions of successful initiatives at increasing the trusted human-to-human relationship between hospitals and their patients. On example that drew much attention was one where a p atient complained about how the nurse call button by the bed was the last thing to be cleaned in the room but the one thing the patient often touched; the nurse took notice and worked with the hospital housekeeping staff to change the room cleaning protocol to respond to this simple patient need to feel their interests were at the center of the hospital process.

Perhaps this kind of interaction points to why SXSW is such an interesting venue for conversation about healthcare experiences-you can't help but notice the individuality of humans walking around Austin striving to be different, be noticed, be heard, be themselves, and be accepted for it. This is precisely what patients want, albeit they don't seek to achieve it through piercings and tattoos. Rather, they seek to achieve it through being listened to in their time of need and being cared for as individuals despite the great equalizers of technology and time management. It is gratifying to see the rest of the healthcare system starting to sit up and pay attention at HIMSS and elsewhere. There is no doubt a long road ahead, but at least we have started our engines.

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Back in 2012 I wrote a blog post called SXSW: Woodstock for Geeks, which became the opening chapter of Tech Tonics, the book I wrote with David Shaywitz. In this piece, I pointed out the marked differences between SXSW vs. HIMSS, both of which I had recently experienced.

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Yesterday's 9to5Mac - a highly-regarded rumor website - offered a remarkably detailed look into the Healthbook application that may (or may not) be incorporated into iOS8, the next operating system update.

The app - organized like the current Passbook app - offers "cards" corresponding to a range of functionalities, including blood work, heart rate, hydration, nutrition, sleep, and blood glucose, among others. It's not clear at this point where these measurements are expected to come from: perhaps 3 rd party device makers like Withings or Jawbone - thought for at least some functionalities, Apple is believed to be developing sensors of its own.

It's a long path from sensor data to actionable information - and a long way from there to significantly improved health (to say nothing of reduced healthcare costs). The vast majority of people are unlikely to derive significant health benefit from tracking their heart rate or hydration level - even if these were measured with reasonable accuracy (not a given); the same goes for many of other quantified parameters.

In some cases, however, the impact is likely to be profound and immediate - blood glucose monitoring in diabetics, for example. It's difficult to find the parent of a child with type 1 diabetes who isn't frustrated by the difficulty of collecting and aggregating the data from the various blood glucose monitors a typical child might use - the interfaces are generally described as "awful" and "atrocious." By creating a common platform to which blood glucose data must be exported, Healthbook may catalyze the rapid, customer-friendly evolution of this critical area of biomedical sensors - and immediately improve patient care. (This assumes Healthbook could be used to track the health data of loved ones, older as well as younger - a capability I'd view as essential.)

This "common platform" model could well be Healthbook's path to impact; right now, the consumer sensor ecosystem is a veritable Tower of Babel (equally true inside hospitals, by the way); interoperability and information sharing are major problems (my own example from wearables here).

Presumably, most sensor companies will decide it's in their enlightened self-interest to play nicely with this platform, given its likely ubiquity. This will enable Healthbook to consolidate data from a range of devices (a huge advance in itself), and provide a de facto minimal interoperability standard that new sensors will need to clear if they want to gain traction in the market.

I suspect there might be a less obvious but equally important upside to Healthbook as well. Despite the diligent efforts of many companies, most patients still don't "own" their personal health data in the way they own other important information; many are still content to have this information maintained and managed by doctors and staff, clinics and hospitals. Healthbook may help catalyze an important perceptual transition here, and may help more patients realize that their health data is truly theirs, and not their physicians'.

Historically, such a transfer of responsibility might have appeared both foreign and overwhelming; yet Healthbook may make ownership of personal health data familiar and comfortable - a critical step in patient empowerment.

Moreover, if greater ownership of health data leads us to feel a greater sense of ownership of our health, a sense that we have the ability not only to maintain our health information, but also to influence, through our behavior, the data that's collected - what a powerful and beneficial transformation this could be.

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In Brief: Why Apple's Healthbook Is So Important

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Yesterday's 9to5Mac - a highly-regarded rumor website - offered a remarkably detailed look into the Healthbook application that may (or may not) be incorporated into iOS8, the next operating system update. The app - organized like the current Passbook app - offers "cards" corresponding to a range of functionalities, including blood work, heart rate, hydration, nutrition, sleep, and blood glucose, among others.

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participants will be far more likely to share their data than academics might be, resulting in the opportunity for profound new insights that can help patients immediately (perhaps by connecting two families trying to cope with extremely rare genetic conditions), as well as contribute to the rich integrated data sets likely to drive profound scientific advances in the future

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This is emerging as a glorious week - really a glorious year -- for patient empowerment, and for participatory science.

The opening salvo, perhaps, was the publication of Eric Topol's The Patient Will See You Now, offering the perspective of a "techno-optimist" (his term) on the disruptive potential of the smart phone specifically, and technology more generally (my Wall Street Journal review here).

Next, we watched Congressional committees struggle to come to terms with the inherent lack of interoperability and data accessibility within healthcare - a problem painfully captured by New York Times reporter Elizabeth Rosenthal as she described a patient's attempts to access his own medical records.

While the Congressional debates tended to focus on the electronic medical records (EMRs) themselves, it has become abundantly clear to almost everyone that medical centers, including (some would say especially) academic medical centers are not especially inclined to share data, as the difficulty of exporting data is often viewed by executives as a competitive advantage, as I noted here. To their credit, many in Congress have recognized the problem of interoperability (e.g. Bill Cassidy), and have noted the adverse implications for precision medicine (e.g. Lamar Alexander) (note both links = PoliticoPro eHealth/$).

On the other hand, many attendees at this year's HIMSS health technology meeting were surprised that this once-dreary event had been revitalized with the focus swinging away from platforms and towards patients, as nicely captured by my Tech Tonics collaborator Lisa Suennen here.

This year has also brought us a captivating, innovative genetics project called Genes For Good (see this nice article by Buzzfeed's Virgina Hughes), where a team of researchers from the University of Michigan utilize Facebook to recruit and engage participants in a study of health behaviors and (if a spit-kit is returned) genetics. The study returns to participants not only ancestry information but also the raw data (or more precisely, a slightly processed file called a VCF containing a list of detected variants) because, as the investigators write, "although research studies traditionally have not returned raw genetic information to participants, we believe you have the right to your information."

Which brings us to this week, which has featured two breathtaking articles about 's new ResearchKit, a platform that essentially turns Apple devices into trusted middleware (to borrow BIDMC CIO John Halamka's apt term) that can integrate data obtained from a range of devices. David Pogue, writing at , does a better job than anyone I've seen of capturing the potential of ResearchKit to measure medically-relevant phenotypes using digital health technologies, while Antonio Regalado breaks the story in Technology Review that ResearchKit might also be used to capture genetic data as well. In both cases, Apple wouldn't own or apparently even be able to access the data; their goal seems to be to operate at the center of a vital health ecosystem that places the patient front and center (as anticipated here).

The most important enabling "technology" for ResearchKit - and for participatory research more generally - may well be the forward-thinking eConsent form developed by John Wilbanks and his colleagues at Sage Bionetworks, a non-profit organization that also provides a trusted data sharing and collaboration platform for several ResearchKit-associated apps. (Disclosure: I was a founding advisor of Sage, but have no financial associations with the organization - though I continue to strongly support their open science mission. As a reminder, I'm also Chief Medical Officer of DNAnexus, a genomic data management platform.)

The key limitation to the sort of patient-led change Sage and others have long advocated has traditionally been the difficulties of scaling - the challenges of getting beyond the ultra-engaged quantified selfers and the severely afflicted patients (and associated stakeholders). ResearchKit (in partnership with Sage) offers the possibility of changing this, and bringing participatory research to the masses (those with an iPhone, anyway), and extracting at least a measure of control from the medical centers who have dominated it in the past.

I've been struck by the traction participatory science has already attracted, as it's become increasingly clear to everyone from pharma companies to patient advocacy groups that medical centers may no longer be the only game in town, the gateway through which all robust patient information must inevitably pass. Even many academic researchers - frustrated by the often byzantine processes that dominate their own institutions - seem excited, nay delighted, by the changes that seem to be in the offing.

Expect the transition of power to be tumultuous, as threatened incumbents seek to retain the control to which they've grown accustomed, and as participants acclimate to the challenges and responsibilities associated with asserting data ownership.

But this adjustment, difficult as it will be, is also going to be one for the best, as I expect participants will be far more likely to share their data than academics might be, resulting in the opportunity for profound new insights that can help patients immediately (perhaps by connecting two families trying to cope with extremely rare genetic conditions), as well as contribute to the rich integrated data sets likely to drive profound scientific advances in the future.

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Year Of The Participant -- Brought To You By Apple's ResearchKit

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The key limitation to the sort of patient-led change Sage and others have long advocated has traditionally been the difficulties of scaling - the challenges of getting beyond the ultra-engaged quantified selfers and the severely afflicted patients (and associated stakeholders).

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A medical research study launched Tuesday aims to screen the genes of at least 20,000 people. Part of a surging tide of genetic research, this project would be unremarkable if not for the place it's recruiting and communicating with volunteers: Facebook.

The scientists behind the project, Genes for Good, hope that Facebook users will send a tube of their spit to a laboratory at the University of Michigan and use a free Facebook app to fill out periodic surveys about their health, habits, and moods.

The scientists will screen the volunteers' DNA to try to discover new links between certain genetic variants, health, and disease. To rigorously establish these links, the researchers will need to enlist tens of thousands of volunteers from a wide variety of backgrounds.

"We're really hoping that the main reason people will join is to say, 'Hey, my health and genetic information is valuable. I would like to share it and put it to good use,'" Gonçalo Abecasis, professor of biostatistics at the University of Michigan and one of the leaders of the project, told BuzzFeed News. "Hopefully that will be the major motivator."

Abecasis and his colleagues stress that the Facebook app is a digital portal, and that Facebook will not have access to volunteers' personal information. From the scientists' perspective, Facebook is simply a communication service: a smart way to recruit the massive number of volunteers needed to carry out complex genetic studies. "The standard ways of collecting information on people don't really scale," Abecasis said.

Genes for Good could go viral if it taps into the public's altruistic streak - as did Facebook's organ donation status field, get out the vote campaigns, and the Ice Bucket Challenge.

On the other hand, some people are growing wary of Facebook's reach into seemingly every aspect of life, and all of the privacy and security concerns that come with that. What's more, the new app comes at a time when the Food and Drug Administration (FDA) is beginning to crack down on genetic tests of all sorts.

"Some people are going to freak out about this," Michelle Meyer, an assistant professor at the Union Graduate College-Mt. Sinai Bioethics Program, told BuzzFeed News. "DNA and Facebook are two words that most people do not want to hear in the same sentence."

People who sign up for the new app will be able to track their health and learn some things about their genomes.

They will be able to track how their answers to surveys - such as the age that they smoked their first cigarette, what time they went to sleep the night before, and how extroverted they are - compare to other volunteers.

They'll also get some insight into their genomes. The researchers will extract DNA from each saliva sample and screen it for about half a million genetic markers. Some of these give clues about ancestry, which the researchers will interpret for volunteers. For example, the Facebook app creates a pie chart showing the proportion of the volunteer's ancestors who came from Europe, Africa, East Asia, and other areas of the world.

The researchers are keenly interested in markers with medical relevance, and will begin by taking a close look at about 100 genes. Certain genetic variants in the APOE gene, for example, increase the risk of Alzheimer's disease.

For now, following recommendations of the project's ethical review board, the researchers aren't going to tell study volunteers anything about their genetic risk of disease. Participants will be able to download an encrypted file with all of their raw genetic data, however, and those who are savvy about genetics could dig into their health-related DNA markers.

"There are rogue websites out there where you can upload genetic data and get some kind of interpretation back about disease risks," Scott Vrieze, an assistant professor of psychology and neuroscience at the University of Colorado, Boulder, and co-leader of the new app, told BuzzFeed News. Promethease and SNPedia offer such a service by working in concert to take raw data from a person's genome and tie it to information from peer-reviewed scientific publications.

In future versions of the app, Vrieze and Abecasis want to be more directly involved in helping participants interpret their genetic risks of disease.

"Our plan is to have a section of the app where people will give an extra level of consent," Abecasis said, allowing participants to decide whether they want to find out about their genetic predispositions.

"We think it's people's data and they should do with it what they want," Abecasis said. The researchers are still discussing this plan with the project's ethical review board, he added.

There's nothing revolutionary about sharing health information online, Robert Green, a medical geneticist at Brigham and Women's Hospital in Boston, told BuzzFeed News. "There are all sorts of health apps being built right now that allow you to share your exercise or Fitbit information or whatever you want to share with your social network."

But when it comes to genetic disease risks, sharing information outside of a doctor's office is hugely contentious. Some ethicists, doctors, and genetic counselors worry that telling people about their potential genetic risks could lead to unwarranted fears or misunderstandings. The FDA, meanwhile, is getting more aggressive about regulating the genetic testing industry.

Consider 23andMe, a genetic testing company in Mountain View, California. The company's $99 "spit kits" used to provide customers with information about genetic ancestry and risk of disease. In late 2013, however, the FDA decided that 23andMe's medical interpretations of the genome violated federal law, and the company stopped offering them.

The Genes for Good scientists say they have not discussed the project with the FDA. "We were hoping that this is a little different because it's a research project," Abecasis said. When doing research, he added, "you can do a wider range of things" than if selling a product or creating a proprietary database.

But industry experts point out that the FDA is also wading into academic research. Several projects aiming to sequence the genomes of newborns, for example, have been held up by the FDA. Green, who is involved in several of these projects, confirmed that discussions with the agency are ongoing, though he declined to disclose any details.

"The FDA seems to constantly be saying, we have this hammer and everything looks like a nail," Misha Angrist, an associate professor at the Social Science Research Institute at Duke University, told BuzzFeed News.

Angrist hopes the Genes for Good project succeeds, but suspects it will run into regulatory trouble. "To just say, 'Hey, we're research and we're free' is not going to satisfy the paternalists of the world," he said.

Genes for Good will only take off if people share their involvement with Facebook friends.

The app allows users to post a message to their Facebook wall announcing that they've joined the project, as well as directly invite their Facebook friends to join.

There is no button to easily share specific health or genetic results, though the researchers plan to add one to future versions of the app.

"They're clearly trying to harness people's familiarity with and enjoyment of social media, and our tendency to mimic people in our social circles," Meyer, the bioethicist, said. "I mostly think this is OK," she added, "but research as entertainment is a bit of a new paradigm."

Other ethicists may raise eyebrows at this approach, Meyer said. That's because, in order to give meaningful consent, research participants are supposed to be fully informed and make their choice voluntarily. They shouldn't be coerced or persuaded into participating. "The gray area becomes, well, when is an incentive undue? And when is persuasion unacceptable?" Meyer said.

Ethical conundrums aside, there are also practical questions of whether volunteers will want to share so much information about personal health, and whether they will get bored of the project with time, Green said.

The researchers are planning to share their findings in large networks outside of Facebook as well. They will strip the genetic data of all identifiable information and submit it to public resources such as dbGaP, a large database run by the National Institutes of Health. These databases are open to any credible scientist, including those who work for pharmaceutical companies.

"We're not planning to sell the data," Abecasis said, "but we would like people to use it and we're very open to commercial places using it based on the same basis as everybody else."

After they've completed the initial genetic testing, the researchers will freeze the DNA samples and store them in the lab indefinitely. They could then use them for more comprehensive screenings - such as whole-genome sequencing - in the future.

Although the researchers are taking precautions to protect volunteers' genetic privacy, they admit they can't make any absolute guarantees.

"None of these things are completely risk-free in that sense," Abecasis said. But "I'm of the belief that the more widely you can make data available, the more quickly advances will come around."

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A New Facebook App Wants To Test Your DNA

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A medical research study launched Tuesday aims to screen the genes of at least 20,000 people. Part of a surging tide of genetic research, this project would be unremarkable if not for the place it's recruiting and communicating with volunteers: Facebook.

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Start up wellness programmes for insurers

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Start up wellness programmes for insurers

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To nudge people into healthier behavior, Welltok offers its clients a menu of programs, from rewarding participants with cash or gift cards for completing biometric screenings to providing recommendations through IBM’s cognitive computer Watson, based on a person’s preferences

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So-called population health management companies are hot. Coming on the heels of IBM's recent purchase of Phytel and Explorys, Welltok bought health analytics start-up Predilytics for an undisclosed sum. The Denver-based start-up manages health programs for insurers and employers to encourage people to lead healthy lifestyles- whether it's exercising regularly or eating a balanced diet. It has raised more than $90 million in venture capital to date.

Wellness programs are a $6 billion business. According to consulting firm Mercer, nearly 90% of large employers offer such benefits from a slew of companies such as UnitedHealth's Rally Health, Limeade, and Keas. Whether those plans deliver on their promise to ultimately lower health care costs by keeping employees healthy and out of the hospital, remains to be seen.

To nudge people into healthier behavior, Welltok offers its clients a menu of programs, from rewarding participants with cash or gift cards for completing biometric screenings to providing recommendations through IBM's cognitive computer Watson, based on a person's preferences. Welltok's chief executive Jeff Margolis says that more than 1 million people use the company's programs. It has upwards of 20 customers, including IBM, Centura Health and Aetna.

Still, signing up people and keeping them engaged is a challenge. Although wellness programs are now widespread in the corporate world, less than half of employees use them, according to a Rand study. "You need to understand what people want to accomplish and why, as opposed to what an organization wants to foist upon them," says Margolis, who sat on Predilytics board. "You have to look at a person as a consumer, and less as a medical specimen."

Four-year-old Predilytics, which raised more than $20 million from investors such as Qualcomm Ventures, Google Ventures, and Flybridge Partners, dives deeper into consumer behavior. It identifies who is most likely to respond, say, to biometric screening. It pulls hundreds of clues from a variety of sources, including a person's zip code, ethnicity, age, and purchases to help health plans acquire and retain customers at lower cost. Or, it can serve up a tailored diet and exercise program that takes into account a person's traveling schedule.

"The measures of success in engagement are still being written," says Margolis. "We really believe that the right measure is whether consumers achieve their goal."

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Welltok Gets Deeper Into Personalized Health Programs With Predilytics Acquisition

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So-called population health management companies are hot. Coming on the heels of IBM's recent purchase of Phytel and Explorys, Welltok bought health analytics start-up Predilytics for an undisclosed sum. The Denver-based start-up manages health programs for insurers and employers to encourage people to lead healthy lifestyles- whether it's exercising regularly [...]

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Start-ups in caregiver networks for elderly care

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Start-ups in caregiver networks for elderly care

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a picture of a network that’s a combination ofTaskRabbit and a support network for volunteers and focusing on people with a good heart rather than experience

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McKinsey report

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CEO Adrian Gore describes how the South African company has been shaking up its industry through business-model innovation and explains what helps to catalyze new ideas.
In 1992, Adrian Gore founded Discovery with an idea for a health-insurance model that would make people healthier. The South African start-up quickly grew into a global player, with a market cap of over $8 billion and a foothold in major markets, including the United Kingdom and China. In the commentary that follows, Gore reflects on the Discovery Group's sources of innovative energy and on the organizational efforts required to maintain that energy as the company grows. (For more on these issues, see "The eight essentials of innovation.") One key, says Gore, is that rewards and risk taking go hand in hand at Discovery, which puts its money where its mouth is by making an innovation score part of each manager's performance evaluation and by conducting an annual competition to identify creative new ideas.
Adrian Gore biography

When I started out as a young actuary in a life-insurance company, South Africa was moving from an apartheid state to a proper democracy and facing some serious challenges, particularly in healthcare. There was an undersupply of doctors, an unusual combination of disease burdens, and a new regulatory environment that had zero tolerance for the discrimination of the past, and rightly so. This meant you couldn't rate customers on preexisting conditions. Finally, unlike most countries, where a national system partially covers risk, there was no unified public health-insurance system at that time.

When you put those four things together, sustainably financing healthcare becomes a very complex undertaking. When we formed Discovery, we asked the question, "How do you innovate and build a health-insurance system that can work in this kind of environment?"

Our gut instinct was that if you can make people healthier, you can offer more sustainable insurance. It turns out that three lifestyle choices (smoking, poor nutrition, and poor physical activity) contribute to four conditions (diabetes, cancer, heart disease, and lung disease) that drive over 50 percent of mortality every year. So lifestyle choices are fundamental to any social-insurance system. The behavioral science tells us that people need incentives to make a change. But that wasn't universally known at the time; we were just a start-up acting on a hunch.

When we were starting out, a massive gym chain approached us with the idea to sell our health insurance to their membership base-a classic cross-sales strategy. Our breakthrough came when we flipped this idea around: What if you can use the gyms when you get your insurance from us? But we couldn't figure out how to afford it.

Then we thought, "Well, what if you earn points by doing healthy things? Then those points give you access to cool rewards and a discount on your premium?" That idea was the catalyst for everything, which I think is true of innovation. It's a moment in time. It's not always a revelation in a laboratory. In my experience, it's right there in front of you. Once you get it, you run with it.

The genesis of Vitality

That initial idea was the genesis of our Vitality program, which has evolved into a complete wellness system that tracks everything from physical activity to nutrition over the course of a person's life. For instance, customers earn points by logging their workouts with fitness devices from Nike+, Fitbit, and others. These sync up with Vitality directly, through a computer, or with mobile apps on smartphones. When you go to our partner grocery stores, the healthy food is clearly demarcated on the shelf, and you get a 25 percent discount at the register when you swipe your Vitality card. When we first launched the program, we were criticized for wasting healthcare dollars on incentives, but customers went berserk for it.

Today, Vitality is the foundation of our business model, driving every one of our offerings. Take life insurance. It seemed to us that the system was broken. What happens when you fill out an application? They basically cut you in half for a detailed health analysis-blood tests, medicals. From that, they derive a very sophisticated rating that often comes with a rate guaranteed for life. But how does it make any sense to set a rate at a certain point in time, when a change in your behavior could shift the underlying risk throughout your life?

So we decided to offer a new, competitive model. The beauty of it is the shared value it creates for our customers, our company, and society. Our customers are given an incentive to become healthier, lowering their premiums. And we are able to operate with better actuarial dynamics and profitability.

In 2001, we rolled out Discovery Life on this basis, and soon became the number-one provider of life insurance in South Africa. Our competitors have been around for more than a hundred years, but they don't have Vitality. If you understand the scale of the program, you can see it's not a capability that could easily be copied. We log 70,000 gym visits per day; people have bought a hundred million dollars' worth of healthy food in the last few years through our structure. Vitality has provided a competitive advantage that has served us well both inside our home country and beyond it.

The flexibility of Vitality's structure allows us to enter markets where we could never become the main insurer; the barriers to entry are just too high. We can instead partner with established insurers in those markets by scaling our Vitality model as needed. In the United Kingdom, we worked with Prudential initially but recently acquired full ownership of our health- and life-insurance businesses there. In the Asia-Pacific region, we are now rolling out our model across some of AIA's markets. We also have an equity stake in Ping An Health, working with one of China's largest insurers, Ping An. Just this year, we've established a new partnership with John Hancock Life Insurance in the United States, and we're developing one with Generali in Europe, as well.

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The model that keeps on giving

Just as Vitality has allowed us to expand geographically, it has also been an additive model that can accommodate other dimensions. For instance, we found that most motor insurance suffers from the same irrationalities as healthcare and life insurance: people underconsume wellness, which in this case means safe driving.

We saw an opportunity to develop a standard vehicle-tracking device that monitors not only the location of a car but also how people are driving-the acceleration, G forces. Rory Byrne, a South African engineer who designed cars for the racing driver Michael Schumacher, has helped us with the telematics to build a Formula One-level analysis of a person's driving behavior. But that requires a complex black-box install in the car. So, we've been working with a company founded by two MIT professors to build an application that also works directly through your smartphone. It has given us some amazing insights into what we call "driving DNA." We can immediately tell if someone else is driving your car or if you've gotten into an accident, just by the deviation in data, which raises a red flag. The Vitalitydrive program allows us to track our customers, to reward them for good driving with a lower premium and a discount on gas, and to provide real-time emergency assistance.

A cycle for innovation

We're often asked, "Can you keep innovating?" The truth is, I find that the more you innovate, the more you can innovate. Most innovation in companies is event based. A competitor comes up with something, and the company responds. We do the opposite. Our leaders are always on a treadmill to create and launch new ideas. For example, every year we have a rock-star launch where we're presenting something new to thousands of our intermediaries who own sales. Our guys know the date is booked. The concert's happening. You just better write the music.

We have growth metrics for a lot of what we do. Our earnings per share have grown by 25 percent a year, compounded, for the last two decades, with little capital. But my personal view is that the rationales behind innovation and earnings targets are not really great bedfellows. You have to invest in innovation, even if you don't know where it will end up. But with a growth-target mind-set, you're always thinking, "Oh, we can't do this, because it's going to undermine our margins" or whatever. You ought to do both well, but it's challenging to balance those two parts of your brain.

To push ourselves to find the next idea, we have an internal competition every year called Inspiring Excellence, where our top one thousand leaders break into teams of two to four people and work on new concepts. Throughout the year, we hold contests until we've narrowed down to the top five teams, who present at our annual management conference. Even ideas that don't win often prove to be winners later on, when we roll them out. This program provides us with a strong inventory of possibilities, which are continually replenished.

Twice a year, our remuneration committee looks at each business and gives it an innovation score. So the take-home bonus of a thousand people is based on a subjective review of the success of their launches. But even beyond that pool, all our employees are involved in this time-based cycle, working on projects. Across the organization, there's a natural metronome of our innovation.

I genuinely believe that the smartest people work for the organizations they believe are doing good. At Discovery, our people have built innovative businesses that are good not only for the company but also for our customers. I'm dedicated to Discovery's work in building South Africa and communities around the world. I want South Africans to look at Discovery with hope, to feel the future is certain.

About the author(s)

Adrian Gore is the founder and CEO of Discovery. This commentary was adapted from an interview conducted by Jill Hellman.

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CEO Adrian Gore describes how the South African company has been shaking up its industry through business-model innovation and explains what helps to catalyze new ideas. In 1992, Adrian Gore founded Discovery with an idea for a health-insurance model that would make people healthier.