Interview with Matt Holt about Health 2.0

Matthew Holt is the eccentric Co-Chairman of the Health 2.0 Conference.  Before helping launch the Health 2.0 movement, Matt was a survey researcher at Harris Interactive, as well as being involved with the Institute for the Future.  In 2003, he started The Health Care Blog, one of the first blogs of its kind to specifically address the trials and tribulations of health care. Matt has an undergraduate degree from the University of Cambridge and a Master of Science degree in Health Services Research from Stanford University.

1) Often great innovation is figuring out what will not change over time (in contrast to being “disruptive”). In that spirit, what are three commonalities of companies/innovators that you have seen have successful longevity in the health technology space?

One, companies that have developed for the inpatient side of the hospital and grow from there. Put more broadly, you need to get embedded properly in an organization, which does not change dramatically over time and is willing to adopt you. The two obvious examples are Neil Patterson with Cerner and Judy Faulkner with Epic. The industry on this side of things does not move that fast, so if you are lucky enough to get your foot in the door, your company is inherently going to have longevity. Getting the timing right is very important as well.

Two, the need for care is not going away, so companies that make care more accessible. I believe telehealth will have longevity for this reason. Teladoc has been around 15 years, MDLive has been around at least a decade. These companies have longevity because they have an expansive model, which works for health plans, pharmacy chains, providers as well as direct-to-consumer. Provide a solution to a long-standing problem, and you should do relatively well.

Three, companies that build broad-based platforms. Additionally, you need to figure out your user interface and experience so it is good enough that a lot of people adopt it. Companies that build quality technology to track activity, diet and other lifestyle choices [like the companies Under Armour scooped up in this space] are good examples.

2) Insurers are starting to fund the tracking of consumer consumption of healthy activities that support personal well-being (e.g. United/Fitbit, Aetna/Apple, etc). How do you see this flow of capital effecting consumer health technology in the foreseeable future?

The good and bad reality of this situation is that as a consumer product good, health wearables are getting so cheap they are becoming ubiquitous; however, they are also getting commoditized. The commitment is low — similar to a gym membership — and like a gym membership, you see a lot of drop off after the initial purchase.

Insurers are getting involved because the costs of entry are lower and they are looking for any way to motivate us — if even by a nudge — toward healthier behaviors. There is discourse in the wellness space if this stuff actually makes a difference. That said, this trend is a win for most in the chain. Manufacturers sell more devices, payers are not investing much and get to see if this moves the needle, employers get to say they are doing something, and employees get these devices for next to nothing. In short, I agree it’s a trend. I think that we’ll see more of this kind of stuff as we try to figure it out whether there are real rewards to tracking behavior beyond professional athletes and peak performers and condition-specific wearables, where I believe there is enough evidence to make the assertion that wearables add a lot of value.

3) Currently, there are unprecedented health technology advancements (e.g. CRISPR) that have the potential to significantly accelerate human evolution. In this context, how do you believe health technology will redefine what it means to be human over the next generation?

This is a question better suited for Daniel Kraft, but I’ll give it a try. I always used to joke that I thought that the future of health care was when most people could email their doctor, which many of us still cannot do effectively yet we want to move on to cure Cancer and using Big Data.

Let’s start that we know that if we exercise and eat better, that’s half the battle. I have little doubt that eventually technology is going to make that easier, better, faster and make it more effortless. In that sense, the construct of willpower might change.

It is important to consider how this technology is affecting our environments, too. It is changing how we think about providing service to people. Something as simple as improving food portability could help change our eating habits for the better. Maybe CRISPR can change your genetics so that sugar tastes bad. Who knows?

The next generation will see us aiming at improving the impact and efficacy of drugs on diseases by manipulating the drugs and/or the genome to improve outcomes. At some point we might start designing humans to avoid disease all together and to live longer, but that will be a while. For those interested in that, I recommend checking out Aubrey de Grey’s stuff. He outlines eight things we need to fix to make this happen. It is worth watching if this topic interests you.

4) There have been a lot of digital health products that purport they can change user behavior. However, history suggests that many of these products and services have overpromised and under-delivered on their claims. What is a good example of a company getting it right in the “behavior change” genre, and what can we learn from them?

Companies that are doing this well have pervasive mechanisms for compliance. Medisafe is one that I like in this area. Good companies look at deliberately getting you from X to Y. However, some areas are hard. For instance, nutrition is particularly hard, and even with great technology, the truth is people just do not keep up with that type of change because technology has not solved the problem that some behavior change is hard.

That said, technology around cognitive behavior therapy treatments — treating things like anxiety, depression, PTSD and insomnia — seem to be making headway. A British company called Big Health has come out with a program called Sleepio that is really interesting.

Canary Health is also another interesting example. They have created technology to bring Kate Lorig’s work on self-management to a broader audience, and that has helped people with diabetes change their lives for the better — so there are examples of success in this space.

5) What is the last thing you remember regarding Health 2.0 that made you sincerely say to yourself, “this changes everything” and why?

Okay, I am going to steal my answer here from Indu Subaiya. It is the advancements in Google Home and Amazon’s Alexa in combination with FHIR. This is really exciting her.

If you split up the various layers of interoperability — and say maybe voice is the first layer — FHIR can then get into the data and stick it in to any functional layer you want. In fact, FHIR (if it works), may actually change how we deliver care and how patients experience care.

That’s the big picture excitement. Small picture, there’s a real cool company called Medal we had on last year, which figured out how you get data out of a EMR by basically printing it using the print driver from a standard computer. Super clever idea, totally bypassing the need for APIs. One more, which was shown this year, is a company called Suggestic. They have got this super cool augmented reality, where you hold your phone up over a menu and it makes you aware of the things you can and cannot have based on your dietary restrictions.