Skip to main content

Esther Dyson's Population Health Dream

 |  By smace@healthleadersmedia.com  
   May 14, 2013

The former Wall Street technology analyst turned key Silicon Valley investor believes city-wide ecosystems of health incentives and disincentives for unhealthy habits could have a significant positive effect on the nation's health.



Photo: CC copyright 2008
courtesy of Joi on Flickr.

Perhaps Esther Dyson has spent a bit too much time traveling, investing, and cosmonaut training in the former Soviet Union, becuase her latest pet project, for how healthcare and technology might start to fix America's health problems, can sound like a new spin on central planning, albeit with a twist.

Dyson, a former Wall Street technology analyst turned key Silicon Valley investor, helped jumpstart the current venture capital craze for healthcare technology startups. Her own investments include Medscape, PatientsLikeMe, HealthTap, PatientsKnowBest, and numerous others.

One can argue that even with Obamacare on the way, this country's response to lifestyle-generated epidemics of obesity and Type 2 adult diabetes are being addressed chiefly by the free market.

After all, fee-for-service care still accounts for 90 percent of healthcare in this country, and at Monday's Health:Refactored event, I heard the existing U.S. healthcare system described, not flatteringly, as "the mother of all adaptive systems." (The quote is attributed to Arnold Milstein MD, who directs Stanford's Clinical Excellence Research Center.)

That means big minds such as Dyson's are a bit stumped in 2013 about how free markets alone will solve some big healthcare problems. So they're taking a look at building city-wide ecosystems of health incentives and, equally, disincentives for unhealthy habits.

Imagine a city where people bent on unhealthy living encounter a series of interventions at their work, home, local eateries, and schools. Where healthful food is subsidized and a few extra-fatty meals are zapped from the local restaurant menu. Prize-laden contests would motivate citizens to be physically active. And technology would measure it all, from the activities and rewards to population's health indicators.

Dyson, the entrepreneur, plans to take a page from the Internet age, where user adoption typically starts at the price of free. Her initiative, launched at Health:Refactored, would approach the many makers of fitness devices and sensors with the following proposition. "If you give us your thing for free, we'll give you a population of 80,000 and we will promote it very heavily, and try and get everybody in town to use it," Dyson says.

Dyson's working title for this initiative, which she unsuccessfully tried to get funded by the XPrize Foundation, is HICCUP, for Health Intervention Coordinating Council, "and the UP is just because it needs something at the end," she told me in an interview Monday.

If Dyson is crazy, she's crazy like a fox. This is a country obsessed, after all, with the inter-city rivalries of its professional sports teams. She wants to tap into that frenzy, to seed five such communities to compete against each other, over 3 to 5 years, to demonstrate the huge difference she believes a coordinated, tech-powered community-wide healthy lifestyle push could make.

During our conversation, I was reminded that Dyson is not alone in her city-as-petri-dish subject focus. The CommonWell Health Alliance, announced at HIMSS, is targeting two cities, as yet unnamed, for its initial rollout of its health record exchange, says Arien Malec, co-founder of the Direct Project, and an executive at RelayHealth. Whether the topic is exercise, healthy eating, or health record exchanges, the city is shaping up to be the essential unit of measure.

Malec also spoke at last week's Health:Refactored conference in the heart of Silicon Valley, and revealed that the big launch of CommonWell's efforts is timed for HIMSS 2014. Details, and cities involved, remain unannounced. Yet when I told Dyson of CommonWell's city-scale plans, she seemed eager to explore possible synergies.

Elsewhere at this conference, I met a doctor who doubted that the current health gadget boom, and even coordinated care itself, could help those costing the system the most: older patients with multiple chronic diseases and co-morbidities, perhaps morbidly obese, who are unlike to strap on Fitbits and Nike FuelBand sensors and make dramatic strides.

Dyson concedes this. Her program is about prevention of these diseases, not cures. HICCUP itself is just one potential part of solving healthcare's problems. That doesn't mean it lacks value.

This experiment won't work in all towns, Dyson says. She's looking for communities where the inhabitants live, work, and go to school locally. Otherwise multiple communities will have to be involved. Towns with several large employers will be easier to test than communities with lots of smaller employers.

Her idea also needs money. Lots of it. A target community might spend a billion annually in healthcare costs. "Someone needs to be willing to spend, instead of $1 billion year after year, $1.2 billion the first year, in the belief that they're going to get that $200 million and more back in the fifth year, because it needs to be discounted," she says. "That's going to require either a very rich foundation, a benevolent billionaire, [or] some kind of social impact fund."

I started this column by gently presenting this notion as central planning reborn, but I really hope that HICCUP gets a chance to work, somewhere. The clinical trial system in this country is itself totally inadequate when it comes to establishing or proving the efficacy of the range of tech and social interventions Dyson describes.

The healthcare crisis is very real, and there's a danger that without showing dramatic, Biggest Loser-type results, the current craze of fitness and health-related gadgets will wilt like so many dot-coms did a dozen years ago. "Everybody's skeptical, with good reason," of these technologies, she says.

No single individual knows the ebb and flow of Silicon Valley technology waves, the investors who power those innovations, and the inner workings of healthcare like Dyson. If she says this is worth a try, I have to agree.

Dyson invites interested providers and other healthcare leaders to contact her. Perhaps her population health dreams are akin to your own. Maybe her interest in space travel is too.

Esther Dyson: Tales of Cosmonaut Training from Maker Faire on FORA.tv

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

Tagged Under:


Get the latest on healthcare leadership in your inbox.