In Lakeport, CA, a Population Health Laboratory is Born

A firsthand look at how a population takes on improving its population health.

The prospect of a bunch of healthcare investors investing in California's unhealthiest county as a business opportunity may strike you as a bit wacky.

But longtime readers of this column have seen this story unfolding as twice before I wrote about investor Esther Dyson's vision of lifting the health of an entire town through a combination of entrepreneurial spirit, a radical rethinking of healthcare, a dash of technology, and community organizing.

When I last visited Dyson's nonprofit startup, HICCup (for Health Initiative Coordinating Council), it had just put out its call for participants in a bold five-year experiment: Single out five communities of 100,000 population or less, then use those communities as hothouses of healthcare innovation, attracting investment capital and innovators to upend previous cultures of isolation and disease and replace them with cultures of cooperation and health.

Since then, HICCup selected the five communities out of an unexpectedly large pool of 42 applying communities applying from around the nation. Each had to complete an exhaustive 20-page application listing its resources, challenges, and sheer determination to improve the health of its entire population.

Four communities outside of California made the cut: Clatsop County, OR; Greater Muskegon, MI; Niagara Falls, NY; and Spartanburg, SC.

Last Friday, I traveled 120 miles north of San Francisco to the fifth community, Lakeport, the county seat of Lake County. The meeting, which took place in a large Seventh Day Adventist church, was not the first meeting between HICCup officials and the community, but it was the largest, and one attended by three HICCup officials, which prompted a healthy turnout.

The area is somewhat of a paradox. At the county's center is California's largest natural body of water, Clear Lake, long a favorite of the state's fishermen and women. But Lake County also has some statistics that are nothing to boast about. It is in the bottom 5 of California's 58 counties in the health of its residents' lungs, hearts, and livers. Drug-induced deaths and suicides are alarmingly high. The scourge of meth has taken a toll, according to one community organizer.

This, then, is one of the five places where HICCup's ideas will be put to the test over the next five years. But while I have described its Way to Wellville challenge as Dyson's population health dream, making big changes in Lake County will also require tackling social ills such as inactivity, unhealthy diet, school attendance issues, and overall economic issues.

In a vignette I would be hard-pressed to invent, when I arrived in town, I stopped first at the local Safeway, where a working mom and store employee in front of me was purchasing a single item: a ten-pound bag of sugar to bake holiday pies for her children. Type 2 diabetes is a big health issue in Lake County, as it is in many other unhealthy parts of the U.S.

Encouraged by the local yearning to turn all this around, HICCup is gearing up to practically swarm Lake County with resources, including piquing the interest of employers who might move jobs to a community should its healthcare fortunes be reversed. Dyson has made some important moves, such as hiring Rick Brush as CEO. Brush was at Cigna for nearly a decade, serving as chief strategy and marketing officer for Cigna's national employer segment. While there, he launched Cigna's Communities of Health venture.

For all that, Brush was humbled and impressed by the turnout in Lakeport. Paraphrasing Martin Luther King, Jr., he told the audience, "We may be crawling at times. We may be walking at times. We may be running. But we are making forward progress together."

But Brush was not the leadoff speaker. That honor belonged to Susan Jen, Way to Wellville's "ambassador" for Lake County and director of the Health Leadership Network of Lake County. Jen proudly displayed the first Way to Wellville coffee mugs produced by a local high school class.

"We have to ask ourselves, how long is it acceptable for us to live with these statistics, and how do we mobilize for action?" Jen asked the audience. "I don't know whether I want to call it a disaster, but it is very urgent."

Calls to action, tchotchkes, mission and vision statements…yes, Silicon Valley has arrived in Lake County. And with it came innovators, companies more commonly spotted at Health 2.0 or HIMSS, but now eager to associate themselves with Dyson's latest startup and a laboratory of health puzzles to solve.

Among those who made the trek to Lakeport last week were companies with technologies that build connections across patients, caretakers and providers; a healthy food website offering incentives and discounts; a commission that accelerates health measurement and promotes creation of markets for health; and a cloud-based behavioral health solution.

No one I heard there talked about the mobile phone being healthcare's salvation, as Eric Topol would; no doubt, my one-bar cellular reception would limit the ability of the smartphone to be the ubiquitous agent of change in Lake County. The day did not revolve around technology in any meaningful way. Instead, the town meeting was all about sounding the alarm and seizing the opportunity that HICCup's selection represents.

In truth, this town hall meeting was simply a rallying of stakeholders-—including the area's two major healthcare providers, Adventist Health and Sutter Health. The real work starts between now and January, when HICCup leaders introduce the five-year initiative to the Lake County population at large.

Between now and then, there are messages to craft, business proposals and websites to build, tips to share with the other Way to Wellville communities (including most of the 37 who were not chosen but wish to stay engaged) via a brand-new social network, and overtures to be made to investors and banks to share in the healthcare savings that these initiatives may contain.

Dyson's copious connections to tech and finance will open many doors, and her energy, and that of Brush, seem boundless at this point. Since the five communities are dispersed geographically, each represents a laboratory that might be worth your time to check out as each one launches. I found my day not only a reminder of the beauty that smaller communities contain—both naturally and in the spirit of their people—but also a reminder of the urgency of the task at hand, and the need to try just about anything to move the needle for better population health.