I'm Steve Malik. I've spent 30 years in the healthcare space working mostly in practice management, electronic health records, full risk manage care, and I'm the inventor of the patient portal. Iâm a serial entrepreneur who's currently running Medfusion, the leading patient engagement platform which I founded, grew and sold to Intuit before reacquiring the business. [BLANK AUDIO]. With my experience in the field, I'm challenging you to impact improving health outcomes. In the U.S. that means bringing cost in line with return. And in the developing world giving more people access. When people say health, what word is always after it? Care? Doesn't that mean something is wrong? People only care about their health when they're sick, they take doctor's views literally because people traditionally. Haven't had the access to the same information that doctors have. That's because people have a paternalistic view that doctors know best. We desperately need to get people thinking of their wellness, and staying healthy to improve outcomes. Walter Cronkite said, America's healthcare system is neither healthy, caring, nor a system. We've known about this problem for a long time. Think about your own experience or people close to you. People describe frustration, waiting rooms, doctors never being on time. And today that's quite a problem. They trust their doctor implicitly. I'm going to tell you a story, personally, about waiting for lab results. I had an experience where I had multiple biopsies. My doctor said, we'll have your results for you in a week. A week later I was anxiously waiting for the phone call. It didn't come. I put it out of my mind and when two weeks had passed I realized, oh my I better call the doctor. I've mentioned something to my wife, she said oh yeah they called, you're fine. [LAUGH] But how many nervous patients have been waiting for their lab results a long time? Aren't there better ways to get them their information? The U.S. ranks last of all wealthy nations in health outcomes. Despite being the most expensive per capita. Commonwealth fund and many others point to that data. Our spending is out of control. Our costs are up to 17% of GDP. That's $2.8 trillion in 2012. Chronic conditions are three quarters of the spend. Waste is estimated at 27% of that spend, $765 billion a year. From an individual perspective 25% of a family's budget now goes to health care. In the developing world over a billion people don't have access to health care 36 million deaths each year are caused by non communicable diseases, such as cardiovascular disease, cancer, diabetes, and chronic lung diseases. Almost two thirds of the estimated deaths in the world each year are from these causes and a quarter of these take place before the age of 60. Cardiovascular disease alone is the number one group that has an estimated 17.5 million patients that are dying each year. That's 30% of all global deaths. And over 80% of those deaths occur in middle and low income countries. Over 7 and a half million children under the age of five. Die from mal, from malnutrition and mostly preventable diseases each year. When you add that all up, that's more people that are dying from these diseases than are dying from conflict alone. Think about other industries. Banking and finance for instance. You go online, you have self service. I rarely go to a branch anymore. My bank's mobile app now has remote deposit, and I hope I never see the bank again. Think about that compared to the old days when if you wanted a stock quote you used to go in to the stockbroker and watch the ticker turn and actually make a trade there. They've certainly advanced a great deal. About travel. People go online. They check in online. Most people don't even use a kiosk anymore. The mobile apps for travel, if you're in a delay, they'll even reroute you. You know, they're quite amazing. And you compare that with going to a travel agent, which there hardly are any. Anymore. Cars. My car, actually tells the service center when it's due for service. We have Onstar where a person can come on and talk to you in the car. You can't buy a car these days without a navigation system in it. And if you're looking to shop for a car, you certainly go online and find out what the costs are, and you have a plethora of options you can choose from. Consumers in health care want the same kind of thing. A majority of consumers say they want access to tools when you see results repeatedly in the high seventies patients want their lab results, I know I do, as well as be able to request a prescription refill, ask a question. And these are the very basics. They certainly want a lot more, they want an experience like other industries that they're used to. Now that we've talked about the big problem, let me give you some suggestions for how to focus on solution. For instance, there's a huge lag in technology utilization in healthcare. Internet users continue to grow globally, with the fastest growth in developing markets like India, Indonesia, Nigeria. Smartphone subscribers are up 20% year over year. With strong growth and under penetrated markets like China, India, Brazil, and Indonesia. There are now 5.2 billion mobile phones in the world. When you think about that, it's a huge opportunity. There are also electronic health records for instance really for the first time in the US. The High Tech Act, part of the stimulus, allocated $35 billion to get doctors to meaningfully use their electronic health records. So more than just buy them, there were thresholds of use that really spurred significant impacts in digitization in the healthcare industry. Sensors for consumers. Are proliferating everywhere. Fitbit and other device trackers are the rage, while there're many more wearable sensors that are starting to appear on the market. There's rumors of an Apple iWatch. We're all waiting for that. But if you just look at the iPhone, the orignal iPhone came with three sensors. The current iPhone has 5 and there are Android devices that started out with 3 sensors that now have 10. It's a changing world. When you think about big data all these sensors are starting to derive information like continuous heart rate. Is there an opportunity for us to. Track onset of disease because we now have information we've never had before. The high tech act is driving consumers to actually have a longitudinal digitized health record for the first time in history. What can we do with that information, relative to clinical trials? When you think about all of the opportunities out there. It can blow your mind. The genome, for instance, used to cost tremendous dollars to sequence for an individual. Now it's down to under $2500. Apple and Google have both released in recent weeks their solutions to help consumers track all of their various devices. Particularly around fitness and wellness. Apple's HealthKit, and Google Fit in Google's case. These are great opportunities to work on solving health outcomes. There are also challenges in motivation. The US healthcare system, for instance, is upside down. It's profit driven. Employers pay but employees use the service. That's a problem right there. Payment reform, Obama Care, The Affordable Care Act, all the various names for the countries forced. Position into doing something about this problem, all try to start addressing those issues. The status quo, though, has very powerful interests to preserve. Voltaire said, the art of medicine consists of amusing the patient while nature cures the disease. You can see that times are a changing. Patients for instance, they don't pay in the U.S. and with more high deductible plans and health savings accounts being the fastest growing category of insurance, that's changing, and with that they're starting to demand price transparency, information on outcomes. Patient engagement as a whole is ri,rising, and companies are starting to be able to provide impactful return on investment evidence to support the fact that we know, we have to get patients involved in their care to significantly reduce cost, and get better outcomes. Today what it means to get the best care. Is that you got a referral from a friend, who liked their experience at the doctor. Really? Somebody was not first in their class, but at the bottom of their class. But, the patient experience may be good. And, that is not an outcome based experience. We need to change that. Payers. They've only recently begun to have requirements to manage their administrative costs, this part of healthcare reform. Countries, their priorities, many times, are not around healthcare. We've seen that public debate both nationally and globally. When you look at their ability to compete, that's when they start to do something. Economically compete, that's when they start to do something about it. In the US for instance, my own experience is Michigan, was one of the first to act to start adapting and adopting. Information technology. And really why is that? It's because healthcare became more than the cost of steel in a car. They had to do something to be competitive and that's what drove their motivation. Physicians. Today they're paid to treat versus cure. What's coming is a change in their payment. That is more based around managing populations, and much more about quality than about quantity. Hospitals likewise. But we all know that behavior modification is very difficult. [BLANK AUDIO]. Access to care is an issue even in the United States. In today's typical US family, mommy manages the care for the children, her spouse. And sometimes for elder care as well. If you ask them they'll tell you that they do it today either by having a shoe box that they stuff their super bill receipts into and EOBs from the insurance company, or they do nothing. This is a many to many problem. When you consider how many providers are involved for the typical family. They have primary care, specialty care. Acute hospital type care. Vision, dental, psych services, perhaps. And home care, if there's any elder care going on. That's a lot of complex relationships to gather the data for. But, for the first time, that's digital data. And, it's starting to create an opportunity for innovation. There's also shortages of doctors. Today being a doctor is not highly respected as it used to be. They have long hours, the pay is not as great as it used to be, and many physicians are choosing to enter specialty care rather than primary care because of the improved pay and certainly rural. Practice of care is an even larger challenge. Insurers can't operate across state lines. And physicians are only licensed to practice on a state by state basis. But there is rumbling that this could change. I challenge you to get on solving this issue. In the US, healthcare reform, Obama Care is driving opportunity. Things are changing. How can you innovate to a solution? Globally, technology is expanding access and changing preconceived notions, now is a once in a lifetime opportunity to impact the world's health outcomes.
