High Tech and Personal Touch: Case Studies in
Chronic Care from United States and Africa
Steve Brown, Founder and Former CEO, Health Hero Network
On Lok Lifeways Conference, October 22, 2008
Sustainable Long Term Care: Ethics, Technology and International Perspectives
1 Lifeways Conference - Steve Brown 10/22/08

Agenda
 Background – Health Hero Network
 Chronic Care Models
 Example from US
 Example from Africa
 False Dichotomies in Chronic Care
 A Better Mental Model
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Background: Health Hero Network
We recognized a problem
Too much effort spent treating the complications of chronic disease, and not enough
on preventing them
We had an idea
A technology platform to enable a better model of care based on identifying problems
early and changing behavior
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Health Buddy in 2008: Patients receive
better support and monitoring at home
 Daily check-in starts
with “how are you
feeling today”
 Reporting symptoms
and device readings
like glucose and
weight
 Receiving supportive
feedback and
education
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Health Buddy 2008: Nurses can identify
problems early and prevent complications
 Dashboard to see
how all patients are
doing today.
 Patients needs are
triaged using red,
yellow, green coding
 Full picture includes
symptoms, behavior
and knowledge
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Why is innovation addressing the chronic
care problem so painfully slow?
 It is well known that
monitoring high risk patients at
home can improve care and
reduce hospitalizations.
 ABC World News Tonight
featured Health Buddy way
back in 1999 and predicted a
new model of care for the 21st
century.
 The business of healthcare –
especially in Medicare – still
rewards treating complications
far more than preventing them.
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Meanwhile in Rwanda Africa, necessity is
the mother of invention
 Community health
workers support and
monitor at-risk
patients at home
 Focus on the simple
things that have the
biggest impact
 Everything starts with
“how are you feeling
today”
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Partners in Health is a community-based
model focused on prevention and education
 The regional hospital
sees its mission as
preventing hospital
admissions
 Training community
health workers to
extend care into the
community
 Keeping organized and
tracking patients with
an open source
electronic medical
record system
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False Dichotomies in Chronic Care
 High Tech versus Personal Touch
 Improving Care versus Saving Money
 Information Technology versus Simplicity
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False Dichotomy: Tech versus Touch.
Explain the growth in social media!
Life can be richer when we share more of it.
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False Dichotomy: Improving Care versus
Saving Money
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False Dichotomy: Hi Tech versus Simplicity
How About a Better Mental Model!
Value
Potential Value
Cost
Opportunity
Realized
Value
Complexity
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Content can change the shape of the
Potential Value Curve
 Example:
congestive heart
failure, the leading
hospital admission
in Medicare
 Focus on areas
where you can
make a difference.
 Start with the
simple things first.
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Design can change the shape of the Realized
Value Curve
 Simplicity must be a strength
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Disruptive technology has radically changed
the shape of the Price Curve
 Cloud computing
and resources
 Open source tools
for everything
 Consumer
electronics with
open APIs
 Result: 100x or
greater capital
efficiency
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Conclusions
 High Tech can increase Personal Touch
 Technology is just a tool, not a transformation
 Apply the mental model to choose wisely
 We can gain insights and inspiration in how to improve
care and leverage technology from innovative models of
care in highly resource constrained environments.
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