They could re-invent healthcare – but will they?

Now that the Amazon, Berkshire Hathaway, JP Morgan healthcare venture has hired a CEO, Dr. Atul Gawande, what should we expect?  Right after the announcement of the non-profit venture, there was buzz about how the group could make a significant impact on healthcare…we’ll see.

Their initial announcement sparked slides in shares of existing healthcare companies.  However, whether significant change or even disruption could come from this group is yet to be seen.  Their direction is still unclear in their public statements (and perhaps in their internal discussions).

The stated goal of this venture is, ‘forming a not-for-profit health care venture to lower health care costs for their U.S. employees’.  In recent comments from them, there were references to ‘value based care’. A recent article in Modern Healthcare mentioned that, “Gawande’s writings offer some insight on how he may curb costs”.  It then listed some positions advocated by Gawande such as making physicians more aware of cost of care plus taking the profit motive out of healthcare.  In the summary of his ideas it also mentioned using checklists to minimize risk and balancing quality of life with life-saving procedures which may be costly.  Some of these ideas sound more incremental (even common sense) than disruptive.  But of course any change in healthcare is likely seen as disruptive.

Maybe this venture will change healthcare but in a different way than the headlines infer.  The venture does have the benefit of not having the baggage of a legacy healthcare organization.  No hospitals, no groups of providers, no investment in brick and mortar, no established processes, no charge master, no health plans or high deductible insurance offerings, etc.  They have the opportunity to follow a ‘blue ocean’ strategy, create a new process for delivering care that focuses on consumers.

Some other not so well known organizations are already experimenting in this space and may be the ones who deliver the new ideas we need to ‘fix’ healthcare.  Stay tuned!

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-308-0239 (cell), Email:


Creating the ‘New Healthcare’ – Should we blow it up and start from scratch

There is innovation, then there is ‘INNOVATION’.  Much of the innovation happening today is ‘coloring between the lines with different colored crayons’.  Incremental change.  Trying to improve an existing system that may not be salvageable.  Healthcare remains a typically ‘siloed’ enterprise even within a single system.  ‘Human nature’ hates change and healthcare exhibits this trait well.  Do we have time to tweak the system and try to evolve it?  Will it bankrupt us before we can make any meaningful change?

Even the ACA was not significant change regarding what healthcare in the U.S. is and how it works.  ACA primarily changed ‘insurance’ – we still have a ‘sick care’ system not a ‘health care’ system.  Yes there are a few leading institutions that have embraced value based care, ACOs, and population health, but the majority of healthcare organizations are still just thinking about these changes – with great anxiety.  In 2016 , MedScape published the results of a Health Affairs study reporting that 95% of provider visits still used fee for service payments (  Long way to go to change that statistic.

Will the ‘consumerization’ trend in healthcare drive more change?  Individuals are shouldering more of the cost of care through high deductible health plans and ever increasing premiums for health insurance.  More than once I have asked myself if it is worth having insurance that costs almost $20,000 per year in premiums, plus responsibility for a $6,000+ deductible (each!).  Really!  The results have been that hospitals and health systems are seeing significant increases in consumer bad debt with little expertise in how to handle this trend.  Consumers are not able to be good ‘consumers’ of healthcare because information about price, quality, and performance are not easily available.  You can argue that quality and performance data are available – perhaps so much so that it is confusing – but understandable price data is still well hidden in the dark recesses of the chargemaster.  And the most helpful information, out of pocket cost estimates for a particular procedure or service, are scarce and are very difficult to provide.

Healthcare still generally treats all patients the same with ‘one size fits all’ messaging and wonders why patients don’t do what they should do regarding compliance with medications, care plans and follow up care.  Sorry physicians, recent research on healthcare consumers identifies about 13% of consumers who obediently will follow ‘what the doctor says to do’ – so you are only ‘miscommunicating’ with 87 of your patients!!

Recent articles are promoting the use of all variety of care coaches, care navigators, even family caregivers.  Great idea, it works, but what is the cost of inserting care coaches at multiple levels throughout the care continuum?  Who will pay for this?  Hospitals that are now laying off workers to make ends meet?

So how do we get to the ‘new healthcare’?  The more I think about it the more I think we should start from scratch – blank sheet of paper – zero based budgeting – blue field!  Okay we cannot change an industry that accounts for about 18% of the U.S. economy overnight.  But I think we need some very aggressive programs to try new approaches on a larger scale.  Perhaps offer incentives for experimentation by larger populations of patients to try new care models, even beyond current ACOs, incorporating more focus on keeping people healthy from an early age instead of treating them after they become chronically ill.  Could some insurers take up the challenge?  Perhaps – since their current business model does not seem to be doing so well regarding affordability.  Could some leading health organizations who are already integrated and delivering coordinated care step up to the plate – hope so.  Could even a state or two be courageous enough to take the plunge – Wow that would be something to watch!  I am a fan of experimentation and change to find new ideas and new ways to be better – and now is the time for healthcare to be bold!

Anybody else on board for TRANSFORMATIOINAL CHANGE?!

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:

CRISPR – the future for curing disease

Just attended a presentation that outlined the likely future for curing disease.  Executives from Intellia Therapeutics visited Matter, the business start up incubator in Chicago, to describe the amazing work they are doing in ‘gene editing’.  This process can disrupt a gene to make it behave (express) differently such as making changes to a gene that stops an unwanted result in the host organism.  The unwanted result may be a disease that can be ‘edited’ or cured.

The process involves creating a ‘scissors’ (called the CAS9 protein) and sending it to a specific ‘zip code’ (gene location) to cut that RNA and turn it off, or cut the gene and insert a new gene in that location to change how it functions.  Sounds like ‘Frankenstein science’ – yikes!.

The mission of Intellia as listed on their website ( is ‘Developing potentially curative genome editing treatments that can positively transform the lives of people living with severe and life-threatening diseases.’  Intellia  says they plan on doing (and are doing in research mode) both in vivo gene editing (within the body) and ex vivo editing (editing genes outside the body, such as in blood and then putting the blood/genes back into the body to have the desired effect).

Likely initial types of diseases to treat would be those affecting the liver, eyes, central nervous system, and muscles.  They anticipate being able to begin treating humans with certain diseases by 2018.

Amazing potential to cure disease at the genetic level!

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:




Blood collection goes ‘ouchless’

Some of my family members have a real problem with being the subject of a ‘blood draw’ for laboratory testing.  To be sure having a needle stuck into your arm or other area of your body to draw blood likely does not put a smile on anyone’s face.

Well today may finally be a day to smile about blood draws.  There is a new method of drawing blood that doe not require the infamous needle stick.  The TAP device developed by Seventh Sense Biosystems is placed on the upper arm and with a push of a button, 30 microneedles are plunged into and out of the skin very rapidly, so rapidly that the patient feels very little discomfort compared to a venipuncture.  The blood is then collected, treated with anticoagulants, and stored in the TAP, ready for a trip to the lab for testing.

While the sample of blood collected (about 100 microliters) is much smaller than a standard venipuncture, it follows an effort by the healthcare industry to make the process of collecting blood for testing a much better patient experience.  Also much of the blood collected by using venipuncture is wasted since only a small amount is needed for actual lab testing.

Almost makes you want to think about some tests you may want to have done now that the ‘ouch’ is gone.

The TAP is FDA approved currently only for testing of blood sugar levels, however the company is hoping to gain approval for other tests than can be conducted using blood collected using the TAP device.

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:


Snapshot #1: Up and Coming ideas in Healthcare Innovation

Following is a sampling of healthcare innovations that are being developed by new, start up companies.

  1. Enables patients and caregivers to assess changes in cognitive health performance over time and following acute trauma incidents.
  2. Makes it easy for patients to select in-network and cost effective providers
    by delivering price transparency information within minutes of receiving a referral from their doctor.
  3. Building a dynamic infrastructure capable of integrating millions of full patient records, claims, files, and disparate systems into a single, secure-access environment.
  4. Provides a pre-hospital and ambulance triage system that enables hospitals and EMS
    to accelerate life-saving emergency care.
  5. Removes the barriers to efficiently delivering personalized medications at scale by automating and standardizing the pharmacy compounding process using 3D printing
  6. A power user provisioning system that ensures users gain access only to those applications required as part of their job function. Reduces the time and effort by automating processes and streamlining work flow required to set up new employees, propagate changes to employee security privileges, and remove privileges for terminated employees.

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:, Blog:

Higher Productivity = Lower cost, higher value healthcare

As organizations struggle to lower the cost of healthcare, one of the key inputs to cost is the productivity of the healthcare workforce. Without significantly increasing staff productivity, healthcare organizations will not be able to keep up with the pressures of shrinking reimbursement and the imperative to provide more value with less cost.

Because of the complexity of what healthcare providers do, boosting the productivity of healthcare providers, if not done creatively, can put more pressure on providers to the point of diminishing job performance and job satisfaction.  This can cause dissatisfaction and turnover among the workforce.

One of the solutions to increasing provider productivity is to offer tools to healthcare workers that improve their ability to be productive.  A key is the incorporation of automation into healthcare process workflows.  Automation should be a looked upon as a way to complement staff work and drive productivity and quality and patient experience.

There are many new companies working on automation that can help providers do their jobs more efficiently and effectively.  Many new automation/digital tools focus on handling and analyzing data that may have been done manually before or not done at all.  Other tools help clinical processes be more efficient such as scheduling, communications, sharing of data among multiple providers (and patients) , and improving patient flow.

Opportunities for improving productivity abound in healthcare and providers and administrators should be open to new approaches, and yes seek out new, innovative ways to get things done.

This reminds me of a quote that seems appropriate, “The only way you survive is to continuously transform into something else.”

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:, Blog:

Just back from Health:Further in Nashville

Just returning from he second annual Health:Further conference in Nashville.  This conference was created to ‘to be the gathering for people passionate about creating the best healthcare possible.’

This conference was created by Vic Gatto, Founder and CEO of JumpStart Foundry, a seed-stage healthcare innovation fund based in Nashville.

The conference was held at Music City Center, a new convention venue in Nashville.  There were a number of speakers from well known healthcare organizations such as Mayo Clinic, CMS, HealthTrust, Xerox, Salesforce, Johnson & Johnson and others providing interesting insights on the future direction of healthcare.  The first day included a number of keynote speakers and the second day was organized into multiple tracks focusing on Consumer & Employer, Venture Zone, New Horizons, and Provider.

In addition, there were exhibits from a number of ‘innovator’ companies offering innovative new products, services, processes and ideas for improving the effectiveness of healthcare.  Another area of exhibits introduced early stage start up companies.  I spoke with several of these companies and several had intriguing concepts for improving healthcare.

Always of high value is the opportunity to network with the other attendees who represented investors, healthcare provider organizations, insurers, entrepreneurs, and consulting organizations.  The conversations and ideas were free flowing and I suspect some new business relationships were developed!

If you are focused on bringing innovation to healthcare, as I am, I would recommend you consider attending Health:Further in 2017 which will be held on Aug. 23-24 in Nashville at Music City Center (again).

James DiGiorgio, President, Applied Knowledge, LLC, Tel: 630-219-4118, Email:, Blog: