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Insights for innovators from a payer perspective at Healthcare's Grand Hackfest

Nicola Parry

At Healthcare’s Grand Hackfest: Idea to Breakthrough Innovation in One Weekend, at Massachusetts Institute of Technology, day two of the program began with presentations from a panel of keynote speakers who shared some words of wisdom for innovators in the group.

Dr. Rushika Fernandopulle, MD, Co-founder and Chief Executive Officer of Iora Health, kicked off the presentations, saying, “It’s hard to turn on the TV and not hear things about the crisis in healthcare.” To this end, he reminded innovators that the next couple of years will provide people with a huge opportunity to try to solve problems in the healthcare system.

He talked about how most people address healthcare problems using a top-down approach, by sitting waiting for government-directed solutions to be instituted. But he stressed that any real problem will, in fact, be solved bottom-up, “… by people in this room.”

Dr. Fernandopulle advised the group to work on problems that matter, saying that 10 percent of people drive two-thirds of the healthcare costs – these are patients who are old, sick, and poor. This is not only where the opportunities for innovators will be found, but it means these vulnerable patients will be helped, which inevitably also happens to be the right thing to do. But he also stressed that, given this patient population, although difficult to accomplish, it’s important for innovators to work on things that are cheap.

Dr. Sarika Aggarwal, MD, Senior Vice President and Chief Medical Officer of Fallon Community Health Plan (FCHP), provided some key insights from a payer perspective. She stressed the importance of remembering that patients’ social needs are as important to address as their medical conditions, and as a result of this, cost discipline plays a critical role in innovations.

Her perspective came from NaviCare®, FCHP’s special needs program - a Medicare managed care plan focused on certain vulnerable groups of Medicare beneficiaries, namely the dual-eligible patients with severe or disabling chronic conditions who qualify for both Medicare and Medicaid. She stressed that these patients aren’t just poor, but may also be old and frail, and about 70 percent of them are dealing with serious mental disease. A staggering $250 billion per year in healthcare goes into helping this special patient population.

So Dr. Aggarwal emphasized the need to be mindful of cost in innovations, highlighting that innovators should remember the social aspect of healthcare, not just the physical and mental aspects of medicine. She stated that “…the primary problem with these patients is engagement. So you can have telehealth, you can have texting, but if they’re living under a bridge, how do you get to them?” In these cases, all the fancy technology in the world won’t help the patient if healthcare providers can’t actually access them.

Dr. Aggarwal stated that, “…technology is great, it’s a tool, but one needs to understand that it’s not the whole picture.” In concluding, she reminded the group that problems can’t be solved by just one tool or person, “It takes a village.”

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