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What if you could improve health care across the three intransigent parameters of cost, access and quality by 15%? That's the challenge GE has set out for itself in the form of its current five-year Healthymagination campaign, and it's investing $6 billion in the effort. I caught up with GE's VP for Healthymagination, Mike Barber, recently, and I invite you to listen in on our conversation about GE's efforts in the US and globally, within GE's health care business unit and beyond, to roll out this major investment -- which, obviously, GE expects to yield a return in the future.
HealthBlawg :: David Harlow’s Health Care Law Blog
Interview of Mike Barber, VP, Healthymagination, GE
June 10, 2010
David Harlow: This is David Harlow on HealthBlawg and I have with me today Mike Barber, who is the VP for Healthymagination at GE. Hello Mike, and welcome to HealthBlawg.
Mike Barber: Hi David. Thanks for having me.
David Harlow: Mike, I’ve read the Annual Report that was put out recently for Healthymagination at the end of first full year of the operation. But let me ask you if you could provide some highlights for our listeners and readers. First up, what is Healthymagination and what are the accomplishments in the past year that you see as having the greatest promise either on their own account or sort of as first or baby steps towards some greater future promise?
Mike Barber: Sure. A year ago, GE launched Healthymagination. We view it as a strategy and we’re pledging to deliver better health for more people. We want to do that through lowering cost through technology and innovation, improving access and improving quality. So, it’s a long-term commitment. Right now, we’re looking at some goals that we’ve put together between now and 2015, in terms of what we’re going to do. That includes investing about $3 billion in product development targeted at products which improve cost, quality and access; $2 billion of financing looking at health care technologies, financing solutions in underserved markets; and $1 billion in technology and content which would be related to reaching consumers in new and different ways, whether it be NBC Universal content or through water technologies and other properties that are part of the GE portfolio. We want to improve each of those by at least 15% and as you said, we’ve just completed our first annual report and we’ve made some key progress. We’re very excited about the progress that we’ve made, that investment -- it’s been about $700 million in R&D towards those health innovations, then we’ve validated 24 products, and when I say validated, we have an outside firm which comes in and takes third-party, peer-reviewed information to see in fact, did this product meet the claims in terms of improving cost, quality or access by at least 15%.
So, we have 24 of those products that have been reviewed, so we’re well on our way to target of up to 100 innovations by 2015. And then we have financing, a stimulus simplicity program to help hospitals, doctors who want to start down the IT journey earlier; as you know with the stimulus package, there’s been incentives that have been identified, some of those incentives start in late 2010, 2011 in terms of doing that. We want people to start taking and getting their value out of IT immediately. So, we’ve come out with a program to provide them bridge loans until those incentives become available, to be able to start using IT systems right now, we guarantee that we’ll meet any meaningful use criteria that comes through the regulations. Also, we have a $250 million fund, equity fund that we’ve launched, the Healthymagination Fund, where we’re looking to invest and co-invest in different start-up companies that are in relevant spaces strategically for GE Healthcare, as well as good value for the investment dollars.
David Harlow: I’ve read about an initial investment through that fund. Could you tell us a little bit about that company?
Mike Barber: That’s right. Cardio DX is a company that we’ve invested in and it is one that is in the area that we call high-value diagnostics, areas where there’s in-vivo tests that can help stratify patients in terms of what follow-up diagnostic treatment is most appropriate and so in the area of cardiology is where the Cardio DX team is focused on initially, and they have some unique algorithms and biomarker tests in the area of cardiology that we feel are very exciting and then can marry and provide better overall outcomes and cost, if you look at what again follow-up tests and vivo tests that might be necessary through imaging and then into treatments for patients. So, combining the strengths of in-vivo and in-vitro diagnostics is something we’re very excited about.
David Harlow: Now you mentioned earlier that you’re looking for an improvement in cost, quality and access by 15% and you mentioned some third party verification, so you’re looking at improvements on a particular product, on a particular service? How are you measuring this 15%? What’s the idea there?
Mike Barber: The way that we looked at this, really through the eyes, the external eyes. So, it’s not about just what we do from a product perspective, but how does our product enable the ability to improve the cost of a overall procedure or the continuum of care a patient might have by 15%. So, if you’re talking about having a better diagnostic or a diagnostic which can lead to a more targeted therapy, where you can differentiate and understand that if a person has cancer, what stage their cancer is at. Therefore, being more pinpoint, more targeted at what their therapies are, as you know, there’s many cancer treatments that are coming out that are very expensive and they don’t work on everyone in the population. So, being able to identify those patients or those conditions where this procedure would work versus ones that wouldn’t are ways that you can reduce the overall system cost and that’s what we’re looking at when we talk about cost reduction.
David Harlow: You mentioned there a couple dozen innovations that have been certified in this first year. I wonder if you could give a couple of examples.
Mike Barber: We have an example of a health care IT product which helps with decision support or looking at the appropriateness of imaging procedures, so a hospital administrator can use it to see based on the issues, the symptoms that a patient has, are the appropriate kinds of tests being run from an imaging perspective? There’s another one looking at asset management and if you think about a hospital and all the different infusion pumps and other kinds of devices they have that are necessary and we have RFID tracking along with software to help manage and so we’ve had customers’ CFOs show this outside firm their operating statements that show that net of purchasing this software they’re able to save on their operating expenses by 15% in the area of procurement as well as maintenance for really understanding where those assets exist and how they can be best leveraged. Products like our Discovery CT750 has been launched looking at reducing the dose in a CT scan by over 50%, across body and heart procedures where we’ve had clinical studies done to show that the diagnostic confidence and the speed of diagnosis that the radiologists use, the clinicians use, stays the same the same, but in fact being able to have 50% less dose to the patient; and then for access products like a handheld, portable EKG machine which can travel to the patient, so it’s leveraged in many developing countries where you know if somebody traveling and they need an EKG, they might have to, you know, travel several hundred kilometers to a hospital kind of setting, but being able to have this in a battery-powered, portable, very rugged package, it’s something that can exist in rural villages and a clinician can carry it out with them as they go see the patients. So, bringing healthcare technology which is important such that somebody in a rural village has the right symptoms, sometimes they get the EKG and then back and should travel for a follow-up care. They travel 50 or 100 kilometers as necessary but those that don’t need or can be treated locally don’t have to do that. So, those kinds of products have been shown to increase access to health care technology.
David Harlow: Great. Let’s talk a little bit more, if we could, about the diagnostic imaging innovations, similar to what you just described, that are detailed in the annual report, focused on India and China in particular. Do those in-country efforts hold promise for lower-cost innovations in the US?
Mike Barber: Potentially, it’s clear at this point we’re focused on what are the needs of those markets like you talked about, India and China, where access to health care professionals might not be the same as it is in a developed market, looking at what is again the essential elements which are needed and it’s focused around that, but clearly, we can see a day where you can leverage some of those technologies and innovations and put it into a package that could be appropriate in the US or other parts of the world, something that might be able to be in a physician’s office versus being in a hospital setting that can provide targeted kind of diagnostics, that could be appropriate. I talked about that EKG machine, there is a version of that, that is under development, that could be in a physician’s office or be in a rural clinic in the US, where it could be appropriate. So, even in places in the US and Europe and developed markets you find that urban settings versus rural settings there are different needs that can be there and so these products that are developed primarily for India and China, we do believe could have a place in the US in certain segments of the health care system.
David Harlow: Could you explore further the degree of coordination or integration across business units in implementing Healthymagination. It sounds like it’s not simply an effort of GE Healthcare; you mentioned GE Water and other business units as well.
Mike Barber: That’s correct. It’s really looking at the health sector as a mega market and how can we leverage the various assets of the General Electric Company in that market, for instance. So, one of the biggest that we’ve looked at it is, how do we reach consumers in new and different ways and clearly the NBC Universal team has a lot of expertise and ability to do that. So, we’ve leveraged that platform and we’ll continue to leverage that platform to understand that. They’re launching a campaign on nutritional literacy, something that’s important for all of us to understand and so will be leveraging them in that area. As you mentioned GE Water, you think about the foundation of health – it’s clean water and so wastewater reuse technology, as well as, you know water filtration are things that we’re looking at with that business. Our research labs are looking at new and innovative ways to, again, in the diagnostics space and life sciences space, as to what’s possible how do, you know, leverage our various technologies which can be in a developing market to provide better access to care again to people that are in those markets. And then, GE Capital. GE Capital, we financed MR and CT machines for many years but can we leverage the capital business to look at, you know, financing of IT systems, something that we’ve started to do, as well as look at new markets like community health clinics and other places which have a different profile than some of our standard customers, but again, could be a way to leverage the capital infrastructure to provide better access to care for technologies and products that can serve patients and consumers.
David Harlow: Right. And you mentioned earlier that there is a $2 billion commitment to serve as bridge financing for HIT systems.
Mike Barber: That 2 billion is not all for HIT.
David Harlow: Oh okay. What other sorts of technology would be financed through that fund and do you see that as a revolving fund or sort of short term bridge loan as you mentioned ?
Mike Barber: No, there are various aspects. The $2 billion commitment is in total from what we call our GE Capital portfolio. Of that, there is a $250 million fund which was started and that fund will look at technologies which are in the life sciences space, health care IT space or the diagnostic imaging space. So, the bulk, the rest of that, other things that we’re looking at is the bridge loans that we talked about is something that we launched last year and again, it will have a limited life because the incentives will then be available directly from the government, but we looked at that and then we’re looking at expanding the portfolio of financing that we do to community health centers, we’re looking at more financing on the international side of the business, potentially looking, you know, at markets which are growing and doing local currency financing as appropriate in some of those markets. So, given this is a long term commitment and journey between now and 2015, everything is not defined today, but as we learn, as we really get into these markets and understand what’s the need, what the needs are and what are the key issues we have to solve, we’ll adopt and adapt but the commitment at the top levels is one that we’re going to reach.
David Harlow: So, you’ve set yourself quite an ambitious goal for a 5 year, 6 year time horizon. Particularly, I’m just thinking about the commitment to improve along the parameters of cost, quality and access which is something that payers, providers and governments have been struggling with for decades and I’m wondering what, I guess to put it bluntly, what gives you the confidence that you can be successful in this arena where success has eluded so many people for so long.
Mike Barber: Well, there’s confidence and this isn’t GE standing alone doing all this, we’re working in partnerships with many of the stakeholder groups which you’ve talked about, but it is going to take people coming together and fundamentally we have a strong belief and confidence that investments in the right technologies and the right solutions can provide that kind of improvement and so it’s really leveraging and focusing our own investments in areas that are well focused around cost, quality and access. We’re working with those stakeholders groups which you talked about to understand what are the real needs and issues, how can we leverage, there’s been you know, lots of discussion around Health Care IT and how IT can help us solve this problem, putting in decision support, making sure through e-health collaboration can happen between clinicians to make things more efficient so you hear about duplicate tests being run on patients that potentially aren’t necessary. You think about looking at payers and governments and we’ve worked with them in many parts of our market, we’re a global company, so we sell products today and to marketplaces which are, you know fully public, some fully private, mixture of both and some of it’s, we feel it’s our ability to interact with those stakeholders, leverage our deep understanding of the technology and of the innovations that are necessary and work with those stakeholders, use the complete power of the General Electric Company to get those stakeholders together that gives us the confidence that we can do this and we’ve proven that in the area of Ecomagination in environment, we’ve been able to do this in another mega market in a large societal issue and so, health is the next one that’s key for our businesses, we want to be in the health, we plan to be in health business for many decades in the future and so we want to be a key part of making it better.
David Harlow: Great. I was about to ask about Ecomagination and just sort of wondering whether this effort is modeled on the Ecomagination effort, are there similarities beyond the name and if you could speak to that a little bit more.
Mike Barber: Well clearly, Ecomagination was a similar commitment from, that was in 2004, 2005 time frame, where GE as a large industrial company, but in many businesses, which touches the environment and looking at, you know, renewable energies and power generation and carbon emissions and again wanting to be in those marketplaces for decades into the future just like we’ve been for decades into our past, we know that there’s needs, determined there were needs that were needed to be viewed and looked at in new and different ways and commitments that we could make. So, commitments were made to increase our funding for products which improve the environment, green products, looked at increasing our revenues and growing our business in those products with our customers, looked at our own greenhouse gas emissions and commitments in reducing those and then being open and transparent in working with partners on that, so if you, if that at top level, the same kind of words, yes can be applied to Healthymagination in terms of partnership, in terms of commitment for investment in R&D in particular area and for commitments for ourselves, we have a program with our employees that we call Health Ahead and to look at from our own employee health, how we get the maximum, maximize the value that our employees get, as well as reduce the cost that we have as a company, as a self-insured company, so there’s been several parallels between Ecomagination and Healthymagination.
David Harlow: Very good. Well, I thank you very much for your time today. I’ve been speaking with Mike Barber, VP for Healthymagination at GE. Thanks again, Mike.
A surgeon can’t operate without the proper equipment. A clinician can’t
achieve meaningful use of electronic health records without an EHR that
is designed to improve patient care and practice efficiency. -- David Blumenthal
Today, David Blumenthal, Steve Posnack and Carol Bean of the ONC announced the publication of the final (albeit temporary) EHR certification rule. The actual publication date in the Federal Register will be June 24. (Here is the display copy of the EHR Certification Rule; a permanent rule will be forthcoming later this year.)
The technical standards were glossed over on a conference call with ONC this afternoon; the focus, instead, was on getting testing and certification rolling. Organizations or consortia may apply for recognition as testing and/or certification organizations as soon as the rule is published; the goal is to have these entities approved by the end of the summer, so as to keep this train moving. Notably, CCHIT will have to apply, along with everyone else, and CCHIT-certified EHRs are not grandfathered (despite the requests of many commenters.)
Of course, today's action begs the question of when the meaningful use regulation will be finalized (though clearly certification needs to come first).
The question I didn't get to ask on the conference call today (snubbed again!) was whether ONC has been collaborating with the FDA (which has asserted jurisdiction over EHRs as "devices") so that certification under ONC standards will ultimately satisfy FDA as well. I wonder whether FDA will be as willing as ONC to delegate the testing and certification functions out to private entities. One would hope that this will be addressed in the permanent EHR certification regulations coming out soon.
"In my many years I have come to a conclusion that one useless man is a
shame, two is a law firm, and three or more is a congress." -- John Adams*
Welcome to the Flag Day 2010 edition of Blawg Review, the weekly law blog carnival. If you need to get your bearings, feel free to peruse previous HealthBlawg-hosted editions of Blawg Review: #88, #129, #154 and #211.
John Adams is a person of interest for this edition, because he made his home in Quincy, MA.
Quincy is a point of interest because not only did Adams give it to his son as a middle name, it also happens to be the home of the longest-running Flag Day parade and celebration in these United States. (It was rained out this year, but check out the, um, boring video of last year's parade.)
Quincy is also the home of the granite quarries that produced the Bunker Hill Monument, and that lay empty and then full of rainwater for years, inviting foolhardy divers -- many of whom died -- until the quarries were filled with dirt dug up from the Big Dig ... but I digress. The quarries also bring to mind The Quarrymen, but hey, that's probably grist for a whole 'nother post.
Back to Quincy and John Adams.
One of Adams' notable achievements for the Commonwealth of Massachusetts -- setting aside his many achievements on behalf of the US of A -- was drafting its Constitution, a document which predates the US Constitution, and served as its model in many respects. Dating from 1780, it is the world's oldest functioning constitution.
Given the recent doings of the Supremes, he may well be turning in his grave. Before penning the Massachusetts constitution, Adams put some patriots' noses out of joint by representing the redcoats implicated in the Boston Massacre. He had a strong belief in the right to counsel, a right (together with the right to avoid self-incrimination) that has recently taken a giant step backwards, courtesy of Justice Kennedy and, yes, Elena Kagan. Check out Scott Greenfield's post on Berghuis v. Thompkins at Simple Justice, and the Huffington Post piece that explicates the role of "The Tenth Justice" in significantly rolling back Miranda protections in this case. Once he got A Round Tuit at Infamy or Praise, Colin Samuels deftly compared the Court's logic to a couple of classic Monty Python sketches.
Adams once wrote, "National defense is one of the cardinal duties of a statesman." We haven't heard of any 18th-century waterboarding incidents under the watchful eye of the Continental Army, or on Adams' watch. They managed quite well without resorting to such tactics. This week, though, word has come out alleging secret human subject research at the hands of the CIA. More precisely, Steve Vladeck writes at PrawfsBlog, a report recently issued by Physicians for Human Rights calls for a US government investigation, because most of the information that could prove or disprove such an allegation is classified. (Unlike another recently reported claim against the CIA, the human subject research issue is far from frivolous.) Adams would be concerned. As he wrote, "a Constitution of Government once changed from Freedom, can never be restored. Liberty, once lost, is lost forever."
A great deal of virtual ink is spilled these days in examining the doings of Apple, Facebook and Twitter. Brad Burnham, a VC at Union Square Ventures, writes this week that he finds it helpful to think of these global web platforms as governments, rather than ecosystems -- and they aren't democracies. Adams found participation in democracy to be personally ruinous; upon accepting a seat in the Massachusetts legislature, he wrote to his wife Abigail the he had thereby "consented to my own ruin, to your ruin, and the ruin of our children. I give you this warning, that you may prepare your mind for your fate." One would think he would despair at the rise of the global corporations that are, in effect, an oligarchy -- at least within certain spheres of influence. (As I write this, my son is working on a school paper about Globalization: Promise or Peril.)
Over at Popehat, great gnashing of teeth is going on due to Rep. James ("Tex") Sensenbrenner's (R-WI) apparent conflict of interest in dealing with the BP oil spill. Late in life, John Adams was also fed up with what he saw played out on the public stage: "Public affairs go on pretty much as usual: perpetual chicanery and
rather more personal abuse than there used to be... Our American
Chivalry is the worst in the world. It has no Laws, no bounds, no
definitions; it seems to be all a Caprice." While back in the day Adams probably had more to say about tea than about coffee, I thought I'd share this cautionary tale about a BP coffee spill.
Some would prefer to see Tex muzzled on this issue. And some physicians would like to see their patients muzzled. New information on the innards of the Medical Justice approach to stifling negative feedback by patients on internet ratings sites (patient assigns copyright in comment to doc, so doc can send DMCA takedown notice to review site) motivated Evan Falchuck to add to the discussion on this practice at See First.
When patients are steamed due to a potential medical error, a clear-thinking physician or hospital administrator will initiate a medical apology. In this context, as in others, the perceived sincerity of the apology is key. On that front, Matt McCusker writes at Deliberations that BP and Toyota have a lot to learn ... from a baseball umpire.
While we're in the health care arena, let's visit a moment with Dr. Rob, who offers a practicing physician's view of the HITECH Act - that part of the Recovery Act that promises to inject tens of billions of dollars into the health IT economy for "meaningful use" of "certified" electronic health records systems - at his blog, Musings of a Distractible Mind. He illustrates his issues with meaningful use by taking a look at the effects of the No Child Left Behind law.
The TV show Glee, co-created by Evan Falchuk's brother, Brad, provides fodder for two posts on copyright law this week. Check out Peter Black's post at Freedom to Differ, which considers and responds to Christina Mulligan's post at Balkinization: Copyright: The Elephant in the Middle of the Glee Club. Writes Mulligan:
You might be tempted to assume that [the] tension
[between intellectual property rights on the one hand and self-discovery through hommage and reinterpretation on the other] isn’t a big deal because copyright holders won’t go after creative
kids or amateurs. But they do: In the 1990s, the American Society of
Composers, Authors and Publishers (ASCAP) asked members of the American
Camping Association, including Girl Scout troops,to
pay royalties for singing copyrighted songs at camp. In 2004, the
Beatles’ copyright holders tried to prevent the release of The Grey Album
– a mash-up of Jay-Z’s Black Album and the Beatles’ White Album — and
only gave up after massive civil disobedience resulted in the album’s
Ah, the Beatles. The Fab Four bring us back to Quincy, as an early incarnation of that fabled quartet was first let loose upon the world as ... the Quarrymen.
Keene Trial Consulting let us know that a court in Fresno, California is taking voire dire to a whole new level, where prospective jurors in a gang tattoo case involving a minor were recently asked if they have tattoos. This case leads my musical memory down two divergent paths: It brings to mind Greg Allman's I'm No Angel ("Let me show you my tattoo") and also Kermit the Frog channeling a member of a performing quartet that predated the Quarrymen (Groucho Marx, for you young 'uns) singing Lydia, The Tattooed Lady (featuring, appropriately enough for Flag Day, the Stars and Stripes ... look for it.)
But is it art? Brian Cuban handicaps a future 9th Circuit First Amendment appeal on zoning vs. tattoo.
US District Court Judge John Kane spoke at his law school class' 50th reunion about the broken social contract between young lawyers and many large law firms, but also managed to cite St. Francis, Buddha, Mohammed, Maimonides, Aristotle ("the only way to assure yourself happiness is to give happiness") and the CEO of The Onion. Maxwell Kennerly offered his observations on the speech, which had been previously posted at Idealawg.
For the inside baseball post of the week, Norm Pattis pulls back the curtain on an IRL blawger get-together, and essentially concludes that, well, nostalgia isn't what it used to be, and then retreats behind metaphorical wax in the ears, resisting the siren song (squeal?) of a new cadre of blawgers.
To end this edition on an uplifting note, I will leave you with John Adams' view on the coming decline and fall: "Remember democracy never lasts long. It soon wastes, exhausts, and
murders itself. There never was a democracy yet that did not commit
suicide." Nah, scratch that; better get a little more uplifting.... Adams wrote the following to Abigail, in 1780 -- something to think about on this Flag Day 2010:
I must study politics and war that my sons may have liberty to study
mathematics and philosophy. My sons ought to study mathematics and
philosophy, geography, natural history and naval architecture,
navigation, commerce and agriculture, in order to give their children a
right to study painting, poetry, music, architecture, statuary,
tapestry, and porcelain.
Blawg Review has
information about next week's host, and instructions on how to get your
blawg posts reviewed in upcoming issues.
* Don't believe everything you read on the internet .... The "useless man" quote at the top of this post was said, not by the historical John Adams, but by the character John Adams in the Broadway musical, 1776. The other Adams quotes are courtesy of a variety of easily located online quotation sites. And don't forget that Wednesday June 16th is Bloomsday.
My apologies to regular readers of HealthBlawg for sporadic posting as of late. Things should pick up this week with an edition of Blawg Review and a podcast interview at the very least. If you aren't already following me on Twitter, then I heartily recommend you give it a try; when I don't blog, at least I tweet. (If you aren't ready to commit, you could add a feed of my tweets to your RSS reader here.)
I've been spending some time over the past month or so preparing for, and now teaching, a course in Health Law and Business Ethics at The Heller School for Social Policy and Management at Brandeis University, as part of the MD/MBA dual degree program offered jointly with the Tufts University School of Medicine.
This has - somehow - eaten into blogging time.
Most gratifying student comment so far: "Why isn't this course required for all med students?"
Anything you think the MD/MBA students need to hear before the end of the course? Leave a comment.
I've also been spending more time on the bike, training for the Pan-Mass Challenge, a two-day, 200-mile bike ride fundraiser for the Dana Farber Cancer Institute, held the first weekend in August. I'm riding for the seventh time this year. I invite you to join me in supporting the Dana Farber by sponsoring my ride (just follow the link above; 100% of funds donated go directly to the Dana Farber.) Last year, 5000 of us cyclists helped raise $30 million for the cause; we hope to top that figure this year. I also invite you to join my Facebook group and follow my training for the ride (warning: may include photos of the HealthBlawger in biking spandex). See you on the road!