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The Future of
value-based Health care
7:45 AM - 9:30 am
THOMAS KNIGHT M.D.
CHIEF MEDICAL OFFICER
ST. DAVID'S HEALTHCARE
Dr. Thomas Knight is the Chief Medical Officer and Senior Vice President at St. David’s Healthcare, a six hospital system in Austin, TX. In addition, he serves as the Division Chief Medical Officer for the eight hospitals in the Central and West Texas Division of HCA. He has extensive experience in quality, safety, clinical integration, and disease/population management and has served as a vice president, medical director and consultant in these areas for the past 25 years in multiple provider based organizations across the United States.
Dr Knight has a long-time affiliation with the National Committee for Quality Assurance serving as a surveyor since 1991, a faculty member at many of their conferences, and a member of the Review Oversight Committee since 2000. He served on the committee that developed the standards that served as the basis of the Patient Centered Medical Home and currently is one of the physicians nationally that do the final certification for NCQA. He served on the Diabetes Physician Recognition Program Steering Committee. Most recently, he assisted in the development of Accreditation standards for Accountable Care Organizations and serves as both a surveyor and Oversight Committee member for these surveys.
Serving as Medical Director of Quality and Disease Management for Forsyth Medical Group, he led their successful competitive bid to be chosen as one of 12 physician groups in the nation to participate in the CMS Large Physician Group Demonstration project and subsequently served as Medical Director for the project. His group also received national attention for having many practitioners recognized in the ADA/NCQA Diabetes Physician Recognition Program and AHA/NCQA Heart/Stroke Recognition Programs, leading the nation in the number of practitioners recognized in both programs. He was a major contributor to a system wide project to reduce drug complications related to Coumadin therapy, which won a Codman award from the JCAHO in 2004.
Serving as Vice President of Quality at California Pacific Medical Center (CPMC) in San Francisco, California, CPMC achieved numerous honors and awards under his leadership. These include multiple recognitions for AMI care, CHF care, Pneumonia care, and Surgery care from the VHA Western Region. CPMC was chosen as one of Leapfrog’s top 50 hospitals in the nation in 2006 and one of Leapfrog’s top 41 hospitals for Quality and Safety for 2007, one of only 17 to achieve the recognition two years in a row. In addition, in 2008, CPMC was chosen by HealthGrades as a Distinguished Hospital for Clinical Excellence. Most recently, CPMC achieved US News and World Report Top Hospital status in 2008.
Serving as Chief Quality Officer and Senior Vice President at The Methodist Hospital System in Houston, Texas he had responsibility for quality and safety at the 5 hospitals, the physician organization, the research institute, and the international division. He also served as CEO and President of the Methodist Physician’s Alliance for Quality. In this role he had responsibility for leading, developing, and implementing the clinical integration strategy of the system. During his time at Methodist, awards include the 2009 US News and World Report Honor Roll of “America’s Best Hospitals,” and a top 10 ranking for quality and safety from the University Healthcare Consortium. Methodist hospitals also have achieved multiple awards from HealthGrades including the Distinguished Hospital for Clinical Excellence and Outstanding Patient Experience awards.
During his tenure at St. David’s, the organization was chosen as one of the top 15 healthcare systems in the US by Truven Health and 4 of 8 hospitals have been ranked in the Truven Top 100 for multiple years. In addition, 4 of 8 hospitals have received the HealthGrades Distinguished Hospital for Clinical Excellence award on multiple occasions. Seven of eight hospitals are ranked “A” in the latest Leapfrog scoring. Heart Hospital of Austin as part of Saint David’s Medical Center has been ranked in the Truven Top 50 Cardiovascular Hospitals for the past seven years. Recently, Consumer Reports ranked St. David’s Medical Center as the safest hospital in the United States. St. David’s Healthcare as a system was awarded the 2014 Malcolm Baldrige National Quality Award.
In 2010, Dr. Knight was the subject of a chapter in the book, Reengineering Healthcare by New York Times bestselling author, Jim Champy. Dr Knight completed medical school at the University of Texas at Houston and his internal medicine residency at the University of North Carolina at Chapel Hill.
ELIZABETH TEISBERG PhD
EXECUTIVE DIRECTOR OF THE VALUE INSTITUTE FOR HEALTH AND CARE
DELL MEDICAL SCHOOL
Elizabeth Teisberg, PhD, co-creator of the idea of value-based health care strategy, serves as Executive Director of the Value Institute for Health and Care. The Value Institute creates curriculum for transforming strategy, culture and measurement in health care to improve health outcomes and reduce costs. Its translational research puts into practice thought-leading work on value-based health care delivery. The Value Institute also provides leadership for Dell Medical School’s patient outcome measurement. An internationally recognized author and professor, Dr. Teisberg has won the Wachovia Award for outstanding research, the Frederick S. Morton Award for Leadership, and the Book of the Year Award from the American College of Health Care Executives.
TEXAS CARE ALLIANCE
George H. Terrazas currently serves as President of Texas Care Alliance, an organization comprised of 12 leading health care systems across the state of Texas. In this role, he works with member organizations to facilitate the individual and collective pursuit of the triple aim objectives – improving the experience of care, improving population health, and reducing the per capita costs of care. Supported by a shared commitment to adopt common metrics, measure performance, and share clinical and administrative best practices, George works with members of the Texas Care Alliance as they seek to improve and integrate the key pieces of the healthcare value chain through a collaborative focus on better quality and efficiency in care delivery.
Prior to working with the Texas Care Alliance, George served as a Senior Associate at Nexus Health Capital, a boutique healthcare investment bank with offices in New York, NY and Dallas, TX. In this role, he effectively addressed complex strategic and financial needs of high-quality growth stage and middle market healthcare organizations via successful day-to-day transaction leadership.
In 2004, George was selected as the Boone Powell, Sr. Fellow in Healthcare Administration at Baylor Health Care System. Upon completion of the program, he served as a management consultant at Baylor Health Care System, where he managed several strategic business support projects on a corporate/system wide level.
George received his Bachelor's Degree from the University of Texas at Austin, and his MBA from Baylor University. He is also involved in the local Dallas/Fort Worth community, where he recently served as President of the Dallas Regional Chamber Young Professionals, a dynamic group of 350+ emerging leaders ages 25 – 40. He is also a member of the American College of Healthcare Executives, the Baylor Business Network, and the Dallas Texas Exes organizations.
JANIS POWERS - Moderator
DIRECTOR - PROGRAM DESIGN
AVANZA HEALTHCARE STRATEGIES
Janis Powers is a health care strategist with a focus on provider side care delivery. Over the course of her career she has consulted for providers of all shapes and sizes, including the nation’s largest integrated delivery system, the largest for-profit and not-for-profit health systems, rural hospitals, physician practices and federally qualified health clinics. In support of her due diligence and operational turn-around work, Janis has analyzed every department along the continuum of care including surgery, imaging, emergency services, inpatient capacity analysis and pharmacy. Janis currently works in the outpatient arena, supporting clients in their efforts to navigate shifts in payer dynamics, including value-based care. She has also served as director of business development for a health tech start-up focused on patient access.
Janis has an undergraduate degree from Yale and masters’ degrees in business and architecture from the University of Michigan. Her views on health care are published regularly in media outlets. She has written a novel and is now working on her second book, Health Care: Meet the American Dream, which is a proposal to redefine the health care payment and delivery systems. You can also see her featured articles in Hospitals & Health Networks, Healthcare Financial Management, Becker's Healthcare and The Huffington Post.
HIGHLIGHTS FROM THE DISRUPTION + INNOVATION CONFERENCE
Harnessing the Power of Linked Data in Healthcare
What if a universe of data were suddenly available, all in the same place and free of charge? Hurt, co-founder of data.world believes it would unleash the creativity of problem solvers to combine different datasets - public and private - to develop innovative solutions to innumerable challenges.
That is the thinking behind data.world, which compiles data in one space, on its website. Data.world has datasets in health, education, finance, government, public safety, agriculture and weather. It enables users to do a deep data dive for a project and connects them with other knowledgeable people who may become collaborators.
How could tapping into this data play out in the health care world? Imagine if doctors and researchers in countries hit hard by the Zika virus could learn relevant data faster. They could protect vulnerable populations better and potentially save lives.
“Let's not count on serendipity for our future,” Hurt said. “Let's take control.”
As data.world continues to add datasets to its website, Hurt envisions artificial intelligence, or machine learning, using it to unearth connections and draw “all sorts of interesting conclusions.”
Panel 1 - Solutions For Healthier Employees & Lower Coverage Costs
This panel addressed trends in what employers are doing to keep workers healthy and to lower their health care spending.
Marianne Fazen, Ph.D - President & Chief Executive Officer, Texas Business Group on Health
"Productivity comes from a culture of health."
Consolidation in other industries tends to lead to decreased cost. In health care, it's the opposite, and satisfaction also declines.
"You're doing everything right from a social standpoint - eating right, exercising - but there should be more in terms of competition."
Telemedicine is great but people aren't used to using something like this to get answers. "The whole delivery system is having to adapt to the new ways in which people are taking care of themselves (WebMD, etc.)."
"If [health care providers] don't do something, tech companies are going to step into that space and start providing what patients need."
Technology companies are taking over health care which is a good thing. … Benefits managers don't have the bandwidth to absorb all the good options being offered.
Esteban Lòpez, M.D. - Chief Medical Officer and SW Texas Market President, Blue Cross Blue Shield of Texas
"We are not good health care consumers." We trust our doctors and follow their advice. We don't shop around. "We don't realize that doctors aren't good health care consumers."
Example: In one ZIP code, MRI costs range from $600-$3K. "We are conditioned to see lower cost options as lower quality."
The goal is to improve health care consumerism.
Electronic health records are optimized to improve billing, not outcomes.
"Austin is the healthiest biggest city in Texas, but it's the most expensive health care market in the state." Why? There is less competition. "You have to embrace consumerism and competition. You have to embrace value. It requires a change in how people look at health care in Austin."
People will continue to get health information online and from family and friends. The trend in self-diagnosis will continue, “but they are still going to need physicians, mid-level providers and a health care system.” That system needs to “empower people to take care of themselves."
Jennifer Speer - Director of Wellness & Health Risk Management, Higginbotham
The biggest way to lower costs - We want employees to go to their primary doctor." The younger generation is relatively healthy, on their parent's insurance and on high deductible health plans. "They don't want to spend money." A lot of issues could be avoided if people would go to yearly physicals or (if they were placed in) a managed care program. "They're so ill-informed and they are cheap!"
High-deductible plans are a deterrent to young employees. Employers need to offer ways for employees to start building relationships with their doctors.
Loss of productivity due to broken health care systems causes stress for employers and patients.
The trend of employers offering employees incentives to be healthier are different in Austin/San Antonio than North Texas or Houston because workers’ needs are different in those areas. For example, in Austin, workers want farmer's markets, group community events, on-site exercise, and yoga studios.
Moderator – Mary Anne Connolly – Founder + Chief Creative, MACMedia
Panel 2 - The Medical School Revolution
Innovation, spurred by technology and new models of patient care, is seeping into medical schools as new institutions and long-established schools make changes in how they educate future doctors. It’s the first major disruption in medical education in 100 years, and time will tell how well it’s working,
Clay Johnston, M.D. - Dean and Vice President of Medical Affairs, UT-Austin, Dell Medical School
Johnston sees the newly opened Dell Medical School as an integral player in helping to transform health-care delivery in Austin.
The school works in partnership with the Seton Healthcare Family and Central Health (Travis County’s public hospital district) – to improve health care in the community and provide care to indigent Travis County residents. It works with technology businesses on better ways to deliver care.
Innovations in the curriculum at the school include having students work in multi-disciplinary teams to solve problems instead of listening to lectures during class time. The traditional two years of science courses have been reduced to one, and students will have a third year to dedicate to exploring a project or another degree program.
It’s too early to tell how it’s all working out, Johnston said, but he’s optimistic the school is on the right track.
Johnston stressed the opportunity and need for supporting health care innovation and liberating social entrepreneurs, who could be within the university or in the community, working in businesses or non-profits. New investment models are needed to nurture innovations to be tested in the health care system.
The United States has the most expensive health care system in the world but ranks behind many of its peers in the quality of care it provides, Johnston said. The school’s goal is to develop physician leaders and a health system that improves care but costs less.
Marschall Runge, M.D. - Dean and Executive Vice President of Medical Affairs, University of Michigan Medical School
Like Dell Medical School, the University of Michigan Medical School also has made changes in the curriculum to develop the next generation of physician leaders. Students there also spend less time on science but now have the opportunity to take courses in innovation, entrepreneurship and global health.
Runge said that medical students in Michigan see patients immediately in the first year, rather than getting that access in the third year, as traditional schools do. This gives them a chance to observe how technology influences patient care.
Runge discussed the need for better integration of data to improve analysis of health care problems. For example, linking social research data to observed disparities in health care would help doctors address chronic health problems, such as opioid addiction.
Medical school partnerships and links to the business community and entrepreneurs are vital, Runge said. He challenged the entrepreneurs in the audience to be the first to develop an innovation that can measure pain, rather than doctors relying on patients to describe their pain by such subjective measures as using a scale from one to 10.
Susan Skochelak, M.D. - Group Vice President for Medical Education, American Medical Association
The AMA, the nation’s largest physicians’ organization, has been involved in medical education since 1947 and has affiliates that accredit medical schools. In -more recent years, the AMA, saw the need for tomorrow’s doctors to learn new skills centered on improving patient outcomes and keeping people healthy.
In 2013, the AMA offered competitive grants and teamed up with 11 medical schools to launch its Accelerating Change in Medical Education Consortium. The consortium now has 32 schools, including Dell and Michigan, who are testing innovations and sharing ideas that work.
Skochelak remarked that Dell and Michigan are two of her favorite schools in the innovation group.
She mentioned other exciting innovations underway at other schools, such as training medical students to act as patient navigators at Pennsylvania State University and educating students at UT’s Rio Grande Valley School of Medicine how to communicate better and use technology to meet the needs of patients and diverse groups in South Texas. While the innovations are welcome, Skochelak acknowledged that changes in the accreditation process have yet to catch up.
Partnerships with businesses and outside groups help the students derive research questions, perform studies and assess outcomes as they focus on the health of the communities they serve.
Skochelak also discussed the need for national curricula with online components that can be adapted by medical schools to advance students’ social learning and their ability to meet community health needs.
The panel agreed that medical schools have the opportunity to continue innovating to reduce costs and improve outcomes; to provide leadership to treat the whole arc of health in communities; and to open up a platform for community-level interventions.
The panel expects technology, including AI and robotics, to become increasingly influential in health care and medical education. AI will be used more in fields such as radiology and pathology. Robots will reduce costs and assist nurses by performing tasks such as stocking supplies. And new tools, including avatars and simulations, will facilitate lifelong learning with new methods for competency-based education and assessment approaches.
Moderator – Mary Ann Roser – Founder and CEO, Roser Prose
From Start-up to $100 Million Dollar Companies
After a frustrating and costly search for a medical expert to help his daughter, Phillips got the idea to form a company to aid families like his: 2nd.MD.
2nd.MD provides patients and families with access to a second opinion from medical experts at leading hospitals via video hook-up from the comfort of home. Phillips believes that 2nd.MD has become a game changer, saving lives with major corporations as clients.
While 2nd.MD deals with complex cases, his newest company, Medici, is a telemedicine platform that focuses on simple interactions between doctors and patients. Individuals can get access to health care providers, from physicians to veterinarians to nutritionists, by text, video and phone call. Medici’s features includes: access/communications; financial; patient management; security; vault/record; compliance; malpractice coverage; analytics; artificial intelligence and integration capabilities.
Phillips offered insights to entrepreneurs considering starting a company that is disruptive and innovative:
· Know YOURSELF
o Ask why – a lot – as to your purpose
o What do you love?
o What do you hate?
· Know the GAME
o The language of startups to get financing – speak the language
o Learn how to raise money
o How to get help
· Know the INDUSTRY
o Welcome outsiders
o Know your competition
o Know your stakeholders
Panel – 3 Improving Patient Outcomes – Opportunities and Growing Pains
Charles Barnett – President, Healthcare Group, Cognitive Scale
Barnett stressed –the importance of putting patients at the center of the health care system so that, in addition to treatment, they also receive support and information. He believes technology will continue to augment, rather than replace, health care providers.
Technology can empower patients to take better care of themselves and maintain their autonomy, while better tools and methods are needed to engage, activate and support patients in self-management, Barnett said.
Technology innovation and disruption opportunities include:
· The need for big data analysis for contextual insights – analyzing signals vs. noise
· Development of actionable insights to affect patient behaviors
· Ways to foster informed and empowered patients ready to act as partners in their own careTools to help patients – and health care providers focus on a better quality of life, using medical, social and contextual data with intuitive UI/UX applications. Those data need to be displayed in useful ways that present actionable choices with associated outcomes.
· Ways to advance telemedicine/telehealth with clinicians, nurses and physician assistants to improve outcomes and quality of life for patients in long-term care. Priority should be given to keeping the patient in their home as long as possible. There should be minimal disruption and involvement from their social and family support systems.
· The need to provide a continuum of care from birth to death while engaging and activating patients in the process
· Creation of an educational pathway for nurses, asand clinicians close to retirementfeaturingtools, applications and methods that provide mentoring and ‘just in time’ clinician support.
Yvonne VanDyke – Chief Nursing Officer, Seton Healthcare Family and Ascension Texas
With nurses again in short supply, there’s an increasing need to better engage patients in ‘self-care,’VanDyke said. Nurses should be motivated to learn about a patient’s condition and treatment modalities to facilitate this self-care.
Robots are helping to plug some gaps in the shortage. They are performing tasks such as replacing supplies, while other kinds of technology spares nursing from room oversight by doing monitoring in patient’s rooms and personalized voice-activated prompts.
At the same time, she said, medical professionals need a better understanding of the social determinants that affect health and that facilitate patient engagement.
Technology also is being used to empower patients in rural or remote areas. And it is enabling other individuals to stay in their homes longer while connecting with family members who may also monitor their loved one remotely.
Kevin Warren - President & Chief Executive Officer, Texas Health Care Association
As chief of an association largely made up of nursing homes, Warren said potential changes in health care funding could have a big effect on skilled nursing homes and long-term care services. He noted that 70 percent of nursing home residents have their care covered by Medicaid. In addition, workforce shortages are a problem as facilities compete for staff with acute-care and the food and beverage industry. Turnover rates also are high.
Long-term care payments in Texas cover less than the actual costs. And while significant funding is available for acute and ambulatory care and associated technologies, it is not there for long-term care facilities.
Long-term care must get away from the traditional medical model and move toward a family model or social model to save costs, Warren said. He stressed that the health care system needs to focus on providing a continuum of care, from birth to grave.
Human touch has proven to be important in caring for the elderly, as well as including families in discussions of patient care plans, he said. But technology also has a role. It can help in monitoring, directing and supporting patients, he said.
Technology also helps connect families to their loved ones in new ways; provides enjoyable ways to boost memory, such as music programs; and provides telemedicine services and applications that can help reduce repeat costly and disruptive hospitalizations for long-term care residents.
Moderator – Barbary Brunner – CEO, Austin Technology Council
KEYNOTE Speakers and PANELISTS
Click On Picture To See Bio
President, Healthcare Group
Marianne Fazen Ph.D
President & Chief Executive Officer
Texas Business Group on Health
Chief Executive Officer and Co-Founder
Clay Johnston M.D.
Dean and Vice President of Medical Affairs
UT-Austin, Dell Medical School
Esteban Lòpez M.D.
Chief Medical Officer
Blue Cross Blue Shield of Texas
Founder and Chief Executive Officer
Marschall Runge M.D.
Dean and Executive Vice President of Medical Affairs
University of Michigan Medical School
Susan Skochelak M.D.
Group Vice President for Medical Education
American Medical Association
Director, Wellness and Health Risk Management
Yvonne Van Dyke
Chief Nursing Officer
Seton HealthCare Family
Ascension Texas Ministry
Texas Health Care Association
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