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The Need for Agile, Collaborative Leaders

Change has arrived in the insurance industry—and it has decided to stay a while and get comfortable. In this recap of a general session from The Institutes CPCU Society 2016 Annual Meeting, industry executives spoke about the ramifications of today’s landscape of change and the need for insurance and risk management professionals to stay on top of the latest technologies and technological issues, such as cyber risk, and to embrace ACE: agility, collaboration and education.

The insurance and risk management industry is constantly evolving and, like many of the industries it insures, is currently at an introspective point, as change is all around.

Much of this change is driven by the increasing use of technology, which is having a profound effect on businesses, individuals and society as a whole. Cyber risk, for example, is a major concern for insurers. With nearly half of insurance professionals planning to retire in the next 10 years, developing a new generation of leadership is essential.

To be an insurance and risk management leader in today’s environment requires continuing education. That was the consensus of a panel of industry chief executive officers who discussed at The Institutes CPCU Society 2016 Annual Meeting in Hawaii emerging trends in insurance and risk management and how to be a leader in the modern work environment.

I had the pleasure of moderating the panel, “CEO Conversations, Becoming a Leader,” which included Jeffrey Bowman, FCCA, senior adviser in Deloitte Insurance Consulting Practice and chairman of The Institutes’ Board of Trustees; Albert “Skip” Counselman, CPCU, chairman and chief executive officer of Riggs, Counselman, Michaels & Downes; Alan Krapf, CPCU, president of the Property and Casualty Insurance Group at USAA; and Christine Sears, CPA, CPCU, president and chief executive officer of Penn National Insurance.

See also: Best Insurance? A Leadership Pipeline  

All of the panelists have experience managing change in the industry and implementing new technologies, regulations and working practices. As great leaders themselves, they have helped others grow into leadership roles within their own organizations. They also serve as board members of The Institutes, which has given me the pleasure of knowing them for many years.

The panelists agreed that for the industry and its professionals, honing critical thinking skills and maintaining knowledge of emerging issues—such as growing technology and data analytics—and then being able to use and apply that knowledge are critical to future success. Regardless of professionals’ comfort level with technology, lifelong learning about it, as well as about economics, societal changes and other new developments, is vital to the advancement of both their careers and the industry.

Understanding New Technology

In regard to new technology, the panelists noted that, though it can help facilitate communications, analysis and efficiency, it also poses a large risk. For example, Bowman said that understanding, preventing and insuring cyber risk is a major concern that professionals are still trying to determine how to insure.

Because it is evolving quickly, is very complicated and has many elements, “nobody really has this right at the moment,” he said, adding that companies also have to be aware of third-party risks: “It brings in a whole realm of issues around compliance, regulation and governance that everybody has to be aware of.”

Counselman noted that cyber crime does not discriminate, but affects everyone: individuals, large businesses and small businesses. “You can buy insurance, you can transfer the risk, but transferring the risk isn’t the entire answer,” he said. “What’s really the answer is being vigilant and educated, learning and trying to stay one step ahead. And that’s the message we have to get across, because just as we thought about fire insurance and general liability insurance for years and years as being the mainstay of what we were doing and telling our clients about, this cyber risk can shut down a client and put a client out of business very quickly if the appropriate safeguards aren’t enforced.”

Chief among corporate cyber risks is reputational risk. Krapf said: “It’s not just about protecting the data and the financials. It’s also about the brand. How do I protect the reputation of my company, too?”

Sears added that reputational damage from cyber crimes can cause billions of dollars in damage. “What is really key is that you have a plan in place for when that happens,” she said. “And so, all of us should have a crisis management plan in place so we know that when it happens—because it really is more a matter of when—we know exactly what the processes are that we’re going to follow.” Accordingly, she said, companies should have a plan in place to quickly handle a public relations crisis.

ACE in the Hole: Remaining Agile, Collaborative and Educated

The panelists all agreed that, to address the rapid changes in technology and other spheres, continuing education and agility are essential.

“Really, what is happening today is a fourth industrial revolution: technology in the insurance industry,” Bowman said. “To deal with the changes that are coming in and the changes that have to happen within organizations, you have to have qualified staff.”

Panelists also discussed how collaboration across departments is key to dealing with the fast pace of technological change.

“To be successful in observing and understanding change, deciding what to do about change and implementing change, you need to collaborate today,” Counselman said. “You can’t just make your own plans within your one division or within your one department. You need to collaborate. You need to have input from people who might be involved on a daily basis in property-casualty coverages and risk management advice, in IT advice and financial planning. You need all of that, and you need to be effective at giving everyone the opportunity to understand the issue that you’re trying to approach and determine your strategy—and you need that input across divisions.”

Diversity can enhance collaboration, the panelists asserted. With a diverse workforce comes diverse perspectives, which can aid in everything from product development, customer relationships and risk management.

“Diversity lets you come up with richer and better decisions and allows you to come up with an answer that’s not just the answer that’s always been out there,” Krapf said.

Allowing Professionals to Shine

Part of facilitating collaboration across departments is the move to more decentralized organizations. Decentralized organizations are often flatter and less bureaucratic, thereby helping empower employees to be more involved in decision-making processes.

Krapf added that institutional success further depends on a clear explanation of the mission. “You have to make sure you’re clear with all of your employees about what you are trying to accomplish and then let them make decisions.”

To be well-equipped to make proper decisions in today’s rapidly changing landscape, insurance professionals must continue to learn. Gaining information and ensuring a solid understanding of that information are competitive advantages in the workplace. This idea was reinforced by Sears, who said, “Lifelong learning is absolutely what got me to the position that I’m in today.”

With nearly half of insurance professionals expected to retire from the industry in the next decade, the industry needs insightful and capable new professionals. The good news for the industry, and specifically CPCUs, is that they have proven their commitment to lifelong learning and staying on top of industry issues.

Changes in insurance, business and society present both opportunities and challenges for ensuring professional growth and leadership development and for grooming a generation of professionals with different working styles. From the panel’s perspective, insurance professionals are clearly going to have to work harder than ever to keep up with new developments and best practices and to develop creative solutions. This will enable them to thrive within the industry’s dynamic work environment and help the industry evolve.

See also: Better Way to Think About Leadership  

Looking out from my moderator’s chair at the hundreds of new and veteran CPCUs in the audience, meeting with many more at the CPCU Society Annual Meeting and interacting daily with members of the industry, I am optimistic about the future and excited about the opportunities in front of all of us.

The insurance industry plays a vital role in making people’s lives easier. Insurance offers the promise that, if you pay your premiums, you will be protected from certain forms of catastrophic risk, thereby allowing you to engage in risk management. Through mutual trust, insurance also provides the peace of mind needed for families to buy a house or car, entrepreneurs to start a business and large companies to expand overseas. In this way, insurance helps oil the wheels of the economy.

As holders of the industry’s premier designation, CPCUs are the insurance industry’s natural leaders and role models for continuing education. To this point, Counselman told attendees, “The most important thing you can do is commit yourself to lifelong learning. Getting your CPCU designation is only the beginning.”

CPCUs should take great pride in their industry, hard work and accomplishments to date. There will be many opportunities ahead. I encourage CPCUs to raise their hands and seek these out. Find a mentor. And always keep learning.

What Next for GOP Healthcare Plan?

The irony of all ironies. The GOP healthcare plan defeated by the GOP! And I’m glad, given all the well-documented problems with the bill.

The Congressional Budget Office or CBO estimated that 17 million to 24 million Americans would lose their health insurance under the GOP repeal and replace plan. I would have been on top of the list, because I am over 60 but not old enough for Medicare. My grandfather was a Marine in World War I. Both my parents and all of my uncles served in World War II. My grandparents on my mother’s side came to Ellis Island a century ago. I am a red-blooded, patriotic American. How dare they try to take away my health insurance.

See also: Is U.S. Healthcare Ready for ‘All Payer’?  

I get that the ACA has major issues and needs fixes. I, too, have several issues with the ACA, including the employer mandate and how small employers are charged premiums under the ACA. (See: “A Quiet ACA Waiver — and Needed Change,” from April 2014.) I am on board with healthcare reform but not when it’s done on the backs of small employers.

Americans do need sound options for affordable healthcare coverage based on their needs. I get it.

The American public is sick of this political nightmare. The GOP thinks they need to repeal Obamacare to get reelected. Hello, the American public was 56% to 17% against the GOP plan. It is time for a bipartisan approach to healthcare reform. 46 U.S. Democratic senators just signed a letter that they be open to bi-partisan discussions to improve and provide fixes to the ACA, as long as the outright repeal of the ACA is not part of the deal. President Trump also just stated he’d be very open to discussions with the Democrats. Where does it say in the Constitution that to pass a bill in Congress all the votes have to come from one political party?

In addition, several moderate GOP congressmen were not in favor of the bill. My congressman, Rodney Frelinghuysen (R-11th NJ District), and three other Republican congressman from the Garden State announced opposition to the GOP bill for the right reason. It would have hurt the poor, the elderly and working families in their districts. Their offices were flooded with constituents opposed to the plan, along with powerhouses like the AARP.

The bottom line and reality is healthcare costs are never going down. We have an aging population of baby boomers with a ton of health problems, now and coming up. One of the major problems with the ACA is that the costs cannot currently be sustained, and a major reason is that 45% of the millennials ages 18 to 30 have not signed up, even though the overwhelming majority voted for President Obama and the Democratic party.

We have the best healthcare in the world in the U.S. Hands down. However, it is terribly wasteful, inefficient and fragmented. We still rely basically on a fee-for-service system that results in unnecessary and even harmful medical care. (See: “Unnecessary Surgery: When Will It End?” from October 2015.)

The only way to a lasting bipartisan agreement is to find common ground one issue at a time:

–Start with the major premise of the ACA, that Americans cannot be denied coverage for a pre-existing condition. Check.

–Next, help small employers hurt by the ACA and rising premiums.

–There appears to be widespread agreement to allow small employers to ban together in risk pools similar to workers’ compensation.

–Chuck Schumer just indicated a willingness to give the 50 state healthcare commissioners more power and control over premiums in their state. Remember healthcare, like politics, is all local.

–Consider tort reform based on the use of documented medical protocols by medical professionals. Millions of unnecessary tests are performed every day due to medical providers’ fear of a potential malpractice claim.

–Pass a bill to help medical students with their tuition and student loans if they will help serve as primary care providers in poor or rural neighborhoods for a year or two.

See also: Healthcare: Asking the Wrong Question  

There are a ton of good ideas out there that we spend our healthcare dollars on, including prevention and wellness and not sick care.

The time for bipartisan reform is now.

5 Breakthrough Healthcare Startups

The 2016 HITLAB Innovators Summit and World Cup was held once again at Columbia University in New York. There were 74 technology companies that entered the competition, and five finalists were selected. All of these startups that entered the competition and others that help sponsor this annual event have the potential to help improve the way healthcare is delivered now and in the future through innovative technologies.

Near Infrared Imaging (NII), based in Wrentham, MA, has developed a technology for the enhanced visualization of veins. This technology, called the Vein-Eye, is a hands-free, non-invasive hospital cart that provides real-time imaging of the veins below the surface of the skin. Michael Feeney, president of Near Infrared Imaging, said, “Vein punctures can be very painful, especially for difficult patients who may be obese, very young, very old and/or have dark skin.” Multiple attempts to puncture a vein result in a very negative experience for both the patient and the provider.

The first specific successful application of the Vein-Eye is varicose vein treatment. The Vein-Eye is also targeting patients receiving dialysis, patients with severe burns, patients with Thalassemia Major Disorder and patients undergoing FLAP surgery, which is a technique involving lifting a tissue from a donor site to a recipient site. Roughly 25% of all patients, regardless of healthcare setting or illness, have delayed care due to the inability of a healthcare provider to establish an IV access to the patient’s vein. NII is also working to develop a patented technology that will detect real-time bleeding in the brain at the scene of the injury.

MedLogiq, based in Hazlet, NJ is bringing technology originally developed and used by the automotive and aviation industries to testing and monitoring product quality and performance in the medical device marketplace. This proven technology comes at a time of increased concerns about product defects in a wide range of medical-devices, resulting in serious injuries to patients and massive product liability lawsuits. The FDA has expressed serious concerns with these adverse events and has significantly increased actions against medical device manufacturers.

See also: 5 Apps That May Transform Healthcare  

Bill Acevedo, the CEO of MedLogiq, said: “Our solution provides value from proof of concept through end of life for medical device manufacturers and any other stakeholder.” Acevedo went on to say; “Medical device manufacturers don’t know what they don’t know.” There are many key questions that need to be asked and independently verified about medical devices. Is there a design defect? Was it built correctly? Is there a potential for patient harm or product liability? What data points are needed for continued monitoring of quality outcomes?

Jim Zerka, CFO, said: “Our main objective is to improve patient care and outcomes by reducing adverse events.” Acevedo closed his presentation by stating that this quality control technology was used by Ford to ensure manufacturing quality of every car coming off their assembly lines worldwide.

MedLogiq, along with their technology partner MAHLE Test Systems, has been granted access to the intellectual property for the generic infusion pump (GIP) from the PRECISE Center at the University of Pennsylvania to integrate their solution as the “maintenance processor” to accurately measure and report device performance. The GIP was built by the PRECISE Center to the FDA specifications to enhance safety monitoring, performance testing and event data recording capabilities for infusion pumps designed to administer fluids and medications to patients in a precise manner.

Green Sun Medical, based in Fort Collins, CO is revolutionizing the treatment of adolescent idiopathic scoliosis (AIS). AIS is a condition resulting from a curvature and rotational deformity of the spine. This condition develops in 3% of children under the age of 16. This results in the incorrect rotation of the spine and creates a prominent rib hump in these children. Most patients are diagnosed because of this rib hump, and when it progresses past 30 degrees they are prescribed a traditional brace. Current braces involve a 40-year-old technology, which is a rigid brace that the child must wear as much as 23 hours a day. Needless to say, these traditional braces are terribly uncomfortable and can create pressure sores, also known as bedsores or pressure ulcers, that can result in severe infections and must be worn until the child becomes skeletally mature. If the condition progresses past 50 degrees, surgical intervention is required, with the average cost exceeding $150,000. In addition, surgical intervention results in a 50% complication rate over the patients’ lifetimes.

This new solution is transforming spinal bracing technology and treatment options for spinal deformities through the use of a comfortable dynamic brace with built-in sensors linked to an iPad that provides physicians and family members comprehensive brace pressure information and compliance data in real time through a “report card.” This report card allows for corrections and adjustments to the brace. This technology will prevent children from the pain and suffering of antiquated braces and prevent needless surgeries.

In addition, Green Sun Medical has created a new dynamic brace to help both adults and children with Kyphosis. Kyphosis is a forward rounding of the back and can result in a much exaggerated and very painful rounding. This can occur to anyone at any age but is most common in elderly women.

Green Sun Medical won the award at the Wilson Sonsini Goodrich & Rosati Medical Device Conference in June 2016 as the #1 new medical device in the U.S.

EarID, based in Cambridge, MA, screens and diagnoses ear infections with higher sensitivity and specificity than existing clinical methods by using new 3D imaging and data analytics on a cloud-based platform. EarID assists in ear infections monitoring and management by minimizing unnecessary antibiotic prescriptions and time lost from work by parents and from school by children. Ear infections are the #3 reason for absence from school by children and most likely cause a parent to also miss work.

See also: AI: The Next Stage in Healthcare  

Anshuman Das, a post-doctoral associate at the MIT Media Lab and MIT Tata Center for Technology+ Design, noted that the primary screening tools for ear infections has not changed since the 1800s, and his research has found that accurate diagnosis of ear infections is not currently met in pediatric care. The current diagnosis of ear infections relies on visual inspection of the eardrum, which is performed by a device called the otoscope, which gives very little quantitative information about the actual health of the ear. EarID overcomes these challenges by integrating the conventional otoscope with a structured illumination system that greatly enhances optical and anatomical information about a patient’s ear drum. In addition, the technology with enhanced diagnostic capabilities helps address the overprescribing of antibiotics, which is a well-known public health crisis. (https://tatacenter.mit.edu/portfolio/earid-smart-ear-imaging/)

UE LIfeSciences, based in Philadelphia, PA, is on a mission to make effective breast cancer screening accessible in the developing world and was the winner of the 2016 World Cup. Matthew Campisi, CTO and co-founder, noted that 50% of the breast cancer diagnosed today is in the developing world, with 70% in the Pacific Rim/Southeast Asia, where two-thirds of cases are first diagnosed in stage 3. The company’s technology is currently being used in India, where the death rate from breast cancer is twice that of the U.S. This technology provides a battery-powered handheld wireless device that can store and send data and is accessible anywhere in the world. It is painless and radiation-free and allows for early detection of breast cancer.

UE Life Sciences’ first product, NoTouch BreastScan, is an FDA-cleared device and in a recent clinical trial detected early stage breast cancer with 87% accuracy. The second product, iBreastExam, is a handheld breast scanner that uses a smart phone as its monitor. The development of this technology was funded by the PA Department of Health to address the fact that 90% of the developing world and millions of women do not have access to breast cancer early detection.

Exhibitors at the HITLAB Summit included several other healthcare technology companies such as AdhereTech, based in New York, which has invented a smart wireless pill bottle. AdhereTech was the winner of the first HITLAB World Cup in 2013. Its “smart” pill bottles are being used by patients in pharmaceutical and research engagements and can collect and send data in real time. This system automatically analyzes information, and, if the patient misses a required dose, he receives customized alerts and targeted interventions by cell phone, text messages, etc. This amazing technology requires zero patient setup and recharges just like a cell phone and lasts as long as 5 years. Josh Stein, the CEO, told me the entire purpose is “to see that patients are taking the correct medication at the right time. This is particularly critical for patients diagnosed with cancer.” (www.adheretech.com)

Citus Health, also based in New York, has created a solution named “Call Bell” to help revolutionize how home infusion companies connect with patients. Melissa Kozak, CEO, told me she invented this technology after spending seven years as an on-call nurse for a home infusion company “to help keep my patients out of the hospital.” Kozak experienced firsthand how home infusion patients often needlessly face tremendous anxiety along with many potential adverse events such as delays in receiving antibiotics, chemotherapy, nutrition etc. when patients’ home infusion care process breaks down. The current system typically involves after-hours call centers that are inefficient and typically provide an answering service, not a certified nursing expert. Call Bell allows patients to get answers quickly in real time to address IV support questions and troubleshooting along with answers to questions like, when will my nurse arrive, or when is my next delivery? In addition, this technology provides home infusion companies with accurate patient home infusion supply counts with vastly improved patient support and communications. Call Bell was designed to address the Holy Grail of healthcare, better patient care and better outcomes at a reduced cost.

See also: Consumer-Friendly Healthcare Model  

It was a real pleasure once again to meet so many amazing people developing state-of-the art solutions for an array of global public health issues through new technology. I wish them all continued success and look forward to the 2017 HITLAB Innovators Summit, Nov. 28 -30, 2017 held once again at Columbia University.

5 Apps That May Transform Healthcare

The third annual HITLAB Innovators Summit and World Cup Competition will be held at Columbia University in New York on Nov. 29 to Dec. 1. This outstanding summit brings together the best and the brightest from the emerging healthcare technology industry, academia, medicine, public health and healthcare business leaders. This year’s summit is titled; “Opportunities and Obstacles in Digital Health Diffusion,” and it will include a panel of experts who will also serve as judges when the summit culminates in the HITLAB World Cup global health innovation competition.

Five finalists will be named, and they will present their vision for an emerging technology innovation to help address global public health issues. An overall winner will be named at the close of the summit.

As we wait to see what this year presents, let’s look at how last year’s five finalists are doing. In a word, they are thriving.


Last year’s HITLAB World Cup winner, Ceeable, has developed a digital vision care mobile app designed to help prevent blindness and other eye diseases. Since last year’s competition, Ceeable has had an incredible year, including winning multiple national awards. New patents for this automated detection and analysis of visual field test results for optic nerve and retinal disease have just been issued in the past few weeks to Caltech. Ceeable now has an exclusive license to this technology from Caltech.

“These patents are a powerful application of machine learning and offer an ability to aid in the automated detection of eye disease on a digital platform,” says Dr. Wolfgang Fink, chief technology officer and inventor of the Ceeable technology. Ceeable was among the top-3 finalists at this year’s American Medical Association’s Healthier Nation Innovation Challenge as one of the “Best New Ideas for Creating a Healthier Nation” and has been profiled in Ophthalmology Times.

There are more than 300 million people worldwide who suffer from retinal disease. This technology platform — known as the Ceeable Visual Field Analyzer (CVFA) — has the potential to reach more people in need than ever before. All you need is a laptop, or tablet and connection to the internet.

See also: Virtual Reality: A Role in Insurance?  

This technology is now in use in some of the leading medical centers in the U.St. Ceeable is now actively establishing sales and marketing channels for the commercial launch this quarter.


Rubitection, based in Pittsburgh, has won many healthcare technology awards and placed second in last year’s competition. Sanna Gaspard, PhD and CEO/founder, has developed the technology to modernize early bedsore detection and management to help reduce the risks and improve patient care through a reliable, low-cost handheld diagnostic tool.

Bedsores, also known as pressure ulcers or pressure sores, have been a patient safety issue dating back at least to Florence Nightingale in the 19th century. In the U.S. alone, bedsores affect approximately 2.5 to three million adults each year, with related complications and infections leading to 60,000 deaths and a cost of $11 billion. One alarming study found that 60% of elderly patients with a diagnosis of bedsores die within one year of discharge from the hospital.

At that rate, an estimated 160 people a day in the U.S. will die from complications caused by infections because of bedsores, making these pressure ulcers one of the most prolific dangers facing an elderly patient today. Many medical researchers believe the problem is actually getting worse because of the aging population and a nursing shortage, along with our continued fragmented healthcare system. Many nursing professionals believe that bedsores developed after patient admission are a sign of negligent nursing care, or, as Florence Nightingale said in 1859, “If the patient has a bedsore, it’s generally not the fault of the disease, but of nursing.” Modern nursing professionals call the development of bedsores post-admission to a hospital or nursing home “inexcusable.”

Rubitection is supported by Carnegie Mellon University through the Project Olympus incubator program. The current goal of Sanna Gaspard and Rubitection is to help raise awareness and to continue to build relationships with nursing homes, hospitals and insurance companies looking for solutions to prevent bedsores from occurring in the first place and early detection to prevent infections and complications that can have devastating results.


Ristcall is another 2015 HITLAB finalist that is supported by Carnegie Mellon University through the Project Olympus incubator program. Srinath Vaddepally from Ristcall has created what I refer to as a “mobile smartwatch nursing station.” Ristcall has now upgraded and tested both the hardware and software involved with this very promising wireless wearable technology. It is designed to help nurses more effectively handle the multiple tasks of providing quality patient care and to better prioritizing their precious time. Vaddepally came up with idea when, as a hospital patient, he fell and could not reach his call button to get help.

See also: 5 Apps That May Transform Healthcare  

Slips and falls in hospitals and nursing homes are a major patient safety issue and major liability issue. It is estimated that 700,000 to 1 million falls occur every year among patients, visitors, nurses and facility support staff. These facilities face both liability issues and reduced payment from Medicare as a result.

The Ristcall smartwatch allows nurses to respond and prioritize patient care in real time. As I have said before, nurses rock! They are the heart, soul and backbone of our healthcare system. And I think nurses are going to love this technology. The Ristcall technology is now being used by patients and nurses in both a nursing home and an acute-care hospital in Pittsburgh.


Noninvasix, another 2015 HITLAB World Cup finalist, is pursuing simply remarkable technology with the potential to reduce brain injuries in premature newborns by 90%. Graham Randall, PhD, the CEO of Noninvasix, and his medical research team have made a major pivot this year to focus this technology solely on monitoring oxygen levels in premature babies in neonatal intensive care units. Noninvasix is now developing a final version of this technology that will undergo a FDA 510k clearance review within three years.

Noninvasix commissioned a third-party value analysis, which estimated health insurers could save between $2.4 million and $6.2 million in annual costs to care for children with cerebral palsy resulting from the lack of sufficient oxygen in the brain by using this technology. More importantly, Randall states the entire key to preventing birth defects such as cerebral palsy is being able to monitor premature baby oxygen levels in the brain in real time to allow prompt intervention to dramatically reduce the risk and number of brain injuries caused by the lack of oxygen.

Gary Hankins, MD, the vice chair of the American College of Obstetrics and Gynecology Task Force on Neonatal Encephalopathy and Cerebral Palsy, stated: “This technology has the potential to eliminate 90% of the cases of hypoxic ischemic encephalopathy and subsequent permanent injuries such as cerebral palsy.”

This new technology will, I hope, replace current technologies such as fetal heart monitors that obviously monitor heart rates but do not accurately measure the levels of oxygen in the brain and produce results that are indeterminate or unknown 80% of the time. The lack of oxygen, or hypoxia, is thought to be responsible for nearly 25% of neonatal mortality in the world.

Now all the extraordinary work from these 2015 finalists is exactly the type of technological innovation the HITLAB World Cup is all about.


Wellopp has had a remarkable year. Wellopp is focused on the major problem of hospital re-admissions and ineffective discharge planning. It is estimated that $26 billion is spent annually in the U.S. because of hospital readmissions. The reduction of readmission rates is a major initiative both within HHS and Obamacare and the Joint Commission on Accreditation of Hospitals.

Wellopp has designed interactive software for hospital patients, health plan payers and hospital discharge planners. Joe Gough, the CEO and founder, mentioned last year that most hospital discharge plans are thrown in the wastebasket. This digital discharge technology requires the patient to take ownership and help design his or her own shared post-discharge recovery goals through a patient dashboard that provides a daily care path in a real-time, three-way interactive process. In addition, this patient-centric program includes the Wellopp rewards program, where patients get points toward a tangible prize (such as a smart phone) depending on their risk level and adherence to medication and other recommended post-discharge recovery regiments. This three-way, interactive digital approach, which sends patient care messages regarding achieving and rewarding goals, has already achieved incredible results.

Wellopp is working with the largest health system in Michigan and has reduced readmissions 48% for pneumonia patients covered under the health plan. Next, in the first quarter of 2017, Wellopp will be working with a large regional health insurance plan in Ohio and will be conducting a pilot and joint venture with an Ohio Accountable Care Organization (ACO).

(Note: Gough rebranded the original company, “Homeward Healthcare,” after a major launch this year for this consumer-directed brand.)

I have spent the past 35 years attending and speaking at conferences around the country and have enjoyed virtually every one of them — but there is nothing like the HITLAB summit. Most conferences discuss current events and vendors/sponsors showcase their current capabilities. At HITLAB, you will have the opportunity to see where healthcare is going to be 10-20 years from now and how emerging technologies can help address global public health issues like never before.

See also: Not Your Mama’s Recipe for Healthcare

Lauren Alviti McGlade, the director of the HITLAB summit, stated, “We are searching for original ideas to improve healthcare access, delivery and outcomes through technology.” HITLAB will be accepting applications for the World Cup competition through Nov. 11. For more information, contact worldcup@hitlab.org.

My goal is to continue to try to help promote this amazing collaboration surrounding the HITLAB Summit, the sponsors, medical researchers, emerging technologies and the startup companies presenting. Some technologies may be 10 to 20 years down the road, but others, like last year’s finalists, are available now or in the very near future. Why wait?

A Horror Story on Health Insurance

A few months ago, all I knew about glaucoma was that it was a disease of the eye and, by definition, couldn’t be a good thing. I have been wearing glasses since fifth grade and have been tested for glaucoma every time I got new glasses. I was always told that I had very healthy eyes but was near-sighted — growing up, I didn’t know you were supposed to be able to see the kids across the street, but I could read a book.

I found out the hard way that glaucoma was the leading cause of preventable blindness — and that bit of knowledge was just the start of a disastrous journey through the healthcare and health insurance system.

Think of glaucoma as causing your eyes to act like a kitchen sink whose drain is blocked. In your eyes, IOP (intraocular pressure) can build up from fluids that don’t drain properly, causing permanent optic nerve damage and vision loss. That is why someone invented Drano for kitchen sinks and, luckily, optometrists and ophthalmologists for me.

My introduction to glaucoma came when I stepped on my glasses after they fell off my dresser. Swell. I called my health insurance company to see if I was covered. No problem. And a network optometrist/eye glass store is walking distance away. Everything seemed routine until the eye doctor asked me back to take more tests. Turns out I had a bad reading on the glaucoma test for increased pressure. The normal IOP range is 18-21 (mm Hg). My reading was 24 in both eyes. That can’t be good, I thought.

At that point, I needed to see an ophthalmologist specialist for more testing. I learned that I was at risk for developing glaucoma. Still no problem. There were eye drops I could take, and the eye clinic I needed to go to was also right down the block.

This is where I began to experience the nightmare known as managed care.

I couldn’t get an appointment with the eye specialist without prior authorization from my primary care physician. Two problems: I don’t have a primary care physician, and why should I need “authorization” when a certified optometrist in my network referred me to a network specialist right down the street?

Fine, I thought. It was time to get a primary care physician (PCP) anyway. It took me a week or so to get an appointment with my new PCP. Great guy. He basically says, yes, you ought to get your eyes checked out. Now, after this delay, I have to wait a month before I can get an appointment with the specialist for further testing. I am not a happy camper. I have researched glaucoma at this point and found out this isn’t good.

I finally got a thorough eye examination and multiple tests with all the latest technology. I was told the eye specialist wanted to see me in a private examination room. I couldn’t help but notice that all the staff technicians who tested me were in the room. One of them wouldn’t look at me. I saw the equivalent of an MRI of my eyeballs. Where my right eye ball should be all white, it was mostly blackish grey. Severe glaucoma, advanced stage. I had already lost 50% of the use of my right eye and 10% of my left eye. The damage is irreversible, and there is no cure. Scared the wits out of me.

I just took early retirement and was looking forward to enjoying the summer. I am in great health. I work out six days a week. I don’t take any medications and haven’t needed to see a doctor in years. I feel great. But the doctor wanted to do laser eye surgery immediately on my right eye, so, okay, let’s have the surgery now.

Guess what? I am told I need to have the laser surgery pre-authorized, and that will take another month. In the meantime, I get a prescription for eye drops. What’s your pharmacy? I don’t have one, remember? I don’t take any medications.

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I get my eye drops and immediately get mad. Why do I have to wait for pre-authorization? My specialist, who I just got referred to by my new PCP, says I need laser-eye surgery today.

I began my career designing health benefit programs 35 years ago. I spent my entire career in the employee benefits consulting industry. I know health benefits like Lebron James knows basketball. I call the 800# on my benefit card and ask to speak to a patient advocate and ask for a reason. This requirement for pre-authorization can’t be right.

Staying calm, I explained the basic fact: Without laser surgery and prescription eye drops, I will go blind. It’s that simple. (The good news is that my doctor says laser eye surgery is successful 80% of the time. There is no cure, but the laser can basically try to open the clocked drain in my eyes.)

I set up a three-way call with my health insurance company and the eye specialist’s office to see if I can speed up the pre-authorization process. I make great progress. My patient advocate explains that the health insurer can pre-authorize the laser eye surgery within three to five days if my specialist states it is urgent, and he has said the need is urgent.

But I get a call back from the specialist’s office. I have to make another appointment with my PCP to get the laser surgery pre-authorized. I couldn’t believe it. I just waited a month to have the glaucoma testing pre-authorized. Now I have to go through the process again?

I get in to see my PCP the next day. He completes a patient history and physical and approves the need for laser eye surgery both in writing and in the health insurer’s computer data base. I immediately hand deliver the pre-authorization letter to the eye specialist’s office with instructions to fax it to the insurer’s UR/Pre-Certification department. This a now a done deal, right?

After receiving no word for a week, I decide to call. No pre-authorization has been requested or approved. Even though I had hand delivered the pre-authorization report a week before, the insurer tells me: “Never got it. Besides, that is not what we needed.” I am told a much simpler pre-authorization request, similar to a RX script, is all that is required.

I’m now six weeks into this, but at least I now have someone who knows how to handle the process. He assured me that my PCP’s office would be contacted within 24 hours to get pre-authorization (for the third time). Sure enough, the next day I get the call back: I am pre-authorized for both eyes.

I asked why pre-authorization took so long. The answer floored me: “No pre-authorization was actually required in the first place because your eye specialist was already in your network.”

Great managed care communications. The actual reason it took so long to get prior authorization for my in-office laser eye surgery was because I didn’t need it in the first place!

This is not what I had in mind when I designed the first second surgical opinion programs in the employee benefits health industry.

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With both laser eye surgeries scheduled, I began using the eye drops every morning as prescribed, one drop in each eye. The problem was that putting drops in my eye was new to me. My natural reaction is not to put anything in my eyes, so half the time the drops ended up on my cheek instead of in my eyes. My prescription was just a little bottle, with drops that were supposed to be a 31-day supply. On day 21, still awaiting laser eye surgery, I ran out of drops.

I called the pharmacy, which said I couldn’t get more drops for 10 days. The pharmacist asked: “What are you doing with the drops?” Like I am selling them on the black market or something. I replied: “I put them in my eyes, but I miss a lot.”

The pharmacy called back to say my health insurer still wouldn’t cover the prescription, but they only cost $3.99; could I pay cash? Quickest $3.99 I ever spent.

Can you imagine? The health insurer would prefer I go blind rather than spend $3.99 10 days sooner than expected.

The Glaucoma Research Foundation and my eye specialist went out of their way to state how important it is for me to use the drops every day without fail for the rest of my life and to always have an extra bottle handy. Try telling that to my health insurer.

Now the good news. I had laser eye surgery in both eyes, and I have a spare bottle of eye drops — but don’t tell anybody at the pre-authorization department that I am self–insuring my spare bottle.

More good news. Although my peripheral vision in my right eye is shot, I can see straight ahead just fine for now. I will likely need to have laser eye surgery every 90 days on both eyes, one at a time, and use eye drops every day to keep my glaucoma in check and save my vision. (Before Obamacare, I may have been told: You have a pre-existing condition; too bad, but you are not covered.)

The Moral of the Story

The moral of the story is to get your eyes checked for glaucoma. It’s simple and painless and not just for people who wear glasses. Anyone who has had a head concussion (which I decided was the root of my problem) should also have their eyes checked on a regular basis for several years. There are no real symptoms in early stages, and you don’t feel the increased pressure in your eyes. There are millions of nerve fibers that run from the retina to the optic nerve that send signals to the brain. As fluids build up in the eye, the increased pressure can damage the optic nerve and result in vision loss, which can be sudden and without warning. With regular eye exams, early detection and treatment, vision loss can be prevented.

Who gets glaucoma? Anyone can at any age, but the highest risks include; a family history, diabetes, age 60-plus, severely nearsighted (myopic), extensive steroid users and people of African, Asian or Hispanic descent. Obviously, anyone with high IOP is at high risk, although people with normal pressure can experience glaucoma and vision loss, too.

When should you get checked? Every two to four years before age 40, every one to three years between age 40 and 54, every one to two years from 55 to 64 and every six months to a year over age 65.

As for me, I’m just glad I stepped on my glasses.

Ironically, I had been trying to help Chris Adams, CEO of Ceeable, the recent winner of both the 2015 HITLAB Healthcare Technology Award and NASA Science Award, to launch a technology designed to help prevent blindness. He asked for my help, and I wanted to do what I could for a great cause. I never thought it would be me in severe danger of going blind a week later.

I want to thank my outstanding medical team, Dr. Alan S Gellerstein (PCP), Dr. Reena A. Patel (optometrist) and Douglas K. Grayson, MD, FACS (medical director and chief of glaucoma and cataract surgery — Omni Eye Services).

For more information contact The Glaucoma Research Foundation and Catalyst for a Cure (CFC) based in San Francisco.