1.1 Strategic Focus - Transcripts

Biodesign: What is an example of a technology innovation that has lead to more equitable and affordable health care delivery?

Margret Laws: We have actually supported a fantastic technology called the healthcare interpreter network, and its basically a voice video interpretation network for language interpretation for people who are having health care visits with a doctor, and don’t speak the language of the doctor; typically don’t speak English.  And it’s a network that basically connects 14 public hospitals around the state, and connects all the interpreters in those hospitals into a giant pool, so that any doctor doing an interpretation needs an interpretation in a specific language, Spanish, Cantonese, Oordoo, he or she can flip a switch and there’s a routing system that goes out and actually finds someone who speaks that language and delivers them to you on the video screen within 30 seconds, so if you’re in Salinas, you can have somebody in LA providing an interpretation for you within 30 seconds, and what’s been fantastic about it is that it allows all of these hospitals in this network to take advantage of all the language skills of the other hospitals, and to take advantage of places where for instance labor costs might be lower, so in LA there aren’t enough Spanish language interpreters, there’s a lot in the central valley, and often the LA facilities are using Spanish language interpreters from the central valley.  so what we’re seeing there is that patients are getting much more equitable access to language interpretation,.  Providers, physicians, others who are seeing patients, have a much better ability to communicate effectively with those patients and provide good care and the network does it in a very efficient way.  It allows resources to be shared among a geographically dispersed group of providers, and to be able to provide lower cost better quality care.

BioD: Where are some of the places to look for opportunities to create technologies that reduce costs?

Laws: One of the places that we've actually seen a demand for new technology, particularly to serve safety net patients, and to really benefit from a low cost benefit of care is in diagnostics.  One of the problems that we are seeing is that patients who are being seen in a community heath center or cliic or other primary care clinic needed diagnostic tests, and they can't get it because either the equipment that you need to do it or the specialists that you need to do it is expensive and scarce.  They're over at the hospital, they are over at the emergency department.  SO one of the things we're really interested in seeing technology being brought in to spur innovation, is in thinking about how diagnostic tests can be created that can be used at the point of care, that can be used by a primary care physician rather than a specialist.  So for instance diagnostic tests for heart function that can be done at a primary care setting rather than having those patients go to an emergency department or a cardiologist to get care, often we see particularly for safety net patients is that the waits for a cardiology appointment can be six months. So, really trying to figure out a way to use technology and technological advances to think about how to effectively diagnose people in a setting where you are able to see them.

BioD: Why isn't the best answer to cost containment just improvement in processes?

Laws:  One of the things we do at the Foundation is we try to do process improvement with incumbent providers, so we try to help them make incremental changes to the things that they do so that they can see one more patient an hour, or they can get one more surgery through a surgical suite or operating room.  The problem is that the demand so far outstrips the supply for any safety net settings that just doing minor incremental process improvement doesn't get you the results that you need, thats the first problem.  The second problem is that often without an enabling technology, a process improvement just asks people to work harder and faster, and what we see time and time again is that those people revert back to a kind of a stasis level at which they were working.  So they may work harder or faster for the few months that you were measuring them or that there were incentives provided, but over time it tends to go back to the level that they were at before.  So one of the things that we've been really interested in in this partnership with biodesign is in thinking about how a process improvement coupled with a technology that fundamentally changes the process rather than making it just a little bit better or a little bit faster can really create dramatic innovation ad really create dramatically improved access and dramatically improved opportunities for people to have access to care.