Failure to Launch: How to Avoid the 5 Common Mistakes That Cause Digital Health Ventures to Crash and Burn

Elena Lipson

The digital health market in the first quarter of 2017 enjoyed continued momentum, with 71 deals totaling over $1B (which by some accounts, is actually a conservative estimate).[1]  But don’t let the steady deal flow fool you – it’s extremely challenging to successfully launch a digital health venture and even tougher to sustain it over the long-term.

Many first-time founders and even serial entrepreneurs new to digital health expect to employ a lot of the tactics they learned in business school or had success with in other industries.  They craft well-meaning plans to develop a minimum viable product (MVP) and launch some pilots, and anticipate that the customers and deal flow will follow.  And sometimes it does.  But more often than not these founders encounter unexpected delays and hiccups due to the complex and highly regulated nature of healthcare.

Here are the top five mistakes I’ve seen digital health founders make that can lead to their early demise:

  1. Confusing personal experience with a broader market need: Healthcare is deeply personal and many founders decide to enter this space because they or a loved one has had an unsatisfactory encounter with the healthcare system. While that passion and personal experience can be an attribute, it can also blind founders from seeing other viewpoints and trick them into believing they have the best and/or only solution that solves that problem.  Just because you have experienced something first-hand, does not mean that your problem is going to translate into a broader market need.
  2.  Failing to clearly differentiate and communicate where your solution fits in the larger ecosystem:  Today’s digital health ecosystem is much different than it was 5-10 years ago, when barriers to entry were higher, categories for products and services were more defined and only bigger companies could afford to launch a new solution.  As a result, there are literally thousands of companies vying for customer revenue dollars and it can be hard for a smaller start-up to distinguish itself from competitors. If you fail to differentiate your solution and rise above the noise in the market, you will have a tough time getting anyone’s attention.
  3. Inadequately identifying a paying customer:  It’s also hard to get customers to pay for a digital health solution. In healthcare, consumers rarely believe they should have to pay for a product or service.  It can also be really tough to convince insurance companies that they should pay. So founders are caught between a rock and a hard place. Because the categories in digital health can be blurry at best and it’s hard to define a paying customer, it can be hard to generate awareness and adoption for your solution.
  4. Underestimating the length of the sales cycle: Typically deals in healthcare take about 6-18 months due to the complexity of the ecosystem and the sheer number of stakeholders.  It’s unlikely that you’re going to be that “special” company that lines up pilots, partners and customer much faster.
  5. Oversimplifying the complexities of the regulatory and scientific validation processes:  This one is more common for entrepreneurs who don’t have a healthcare background and may not be aware of how much regulations and clinical validation can slow down your product roadmap and market launch.  There are few shortcuts here to speed things along, although if you’re new to healthcare, a good advisor who can guide you always helps.

Most of these mistakes can be avoided or mitigated if founders would just slow down in the beginning, which ultimately allows them to move faster later on.

Many founders are so eager to develop their MVP or solution and go to market that they gloss over a lot of the upfront work that sets the foundation for their business.  By taking the time at the beginning to focus on their business model, founders will likely uncover many of these challenges and can possibly mitigate them before they destroy what they are trying to build.

Some entrepreneurs may shudder at the idea of spending precious time that could be used on product development to develop their business model.  But I’m not talking about a 50-page business plan that sits on the shelf and collects dust.  Rather, I’m talking about the foundational components for your entire business, including who your customer is; the problems you’re solving for them; your product/market fit; revenue model; and key activities, resources, partners and costs.  In fact, these components should really be driving the product development; you are doing yourself a disservice if you skip over them or only give them cursory consideration.

But let me caution you – this upfront work to define your business model is not fast or easy.

It requires you to go into the market and actually talk with prospective customers and, more importantly, listen with an open mind to the problems that are most important to them.  These insights will help drive you towards a solution that solves their problems, rather than designing a solution and then trying to find a customer with a problem to sell it to.

You also need to have a deep and realistic understanding of where your offering falls in relation to other offerings in the market.  In most cases, there are going to be products and services that are similar (or even perceived to be the same as yours) on the market.  You need to take the time to understand what solutions already exist, as well as what may have failed before you, and position your solution differently to rise above the noise in the crowded market.

This deep understanding of your customer and their problems, coupled with your intimate knowledge of your product/market fit, will help you develop a differentiated value proposition so you don’t get lost amongst a sea of “me too” products and services.

It’s also critical to map out the key activities and resources needed to deliver your value proposition.  This is where you need to go deep and dive into any regulatory requirements (i.e., HIPAA, FDA clearance, reimbursement policies, etc.) along with whether your solution requires clinical trials, which can be lengthy process.  These dependencies need to be built into your activities, resources and costs.

Once you have a good sense of who you are serving and how, you can also develop a revenue model, taking care to identify who is actually going to pay for your solution.

I’ve only really begun to scratch the surface about how to avoid these 5 common pitfalls of digital health entrepreneurs.  In reality, it’s even more nuanced than what I have described and it can also bring up a lot of emotions for founders, causing them to question their assumptions and even their confidence in their solution.  Like I said, this isn’t easy.

If you’d like to learn more, please feel free to reach out to me at elipson@mosaicgrowth.com or on LinkedIn.



[1] Rock Health, “Q1 2017: Business as usual for digital health.”

 


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The time is now: Addressing health inequities in rural minority populations

Marva Williams-Lowe, PharmD, MHA

In 1966 Dr. Martin Luther King Jr. gave a speech to the Medical Committee for Human Rights and said “of all the forms of inequality, injustice in healthcare is the most shocking and inhumane.” In 2017 inequality in healthcare still exists and the consequences are striking.

Health inequities or disparities in urban communities are well known and in some cases more resources may be available to address them than in a rural community. In rural previously homogenous communities these issues are even more significant as the minority community begins to grow but the healthcare systems have not changed or are not moving fast enough to keep pace with diversity.

Ethnic disparities in health care cost the U.S. billions of dollars. African Americans, Hispanics and Native American Indians experience higher rates of chronic diseases like diabetes and hypertension than other populations.  In many cases, these increased costs and reduced quality of life and mortality are preventable with wellness programs or disease state management that takes into account the specific population needs.

A May 2017 data summary from the  Centers for Disease Control and Prevention (CDC) shows African Americans ages 18-49 are twice as likely to die from heart disease than whites and African Americans ages 35-64 years are 50% more likely to have high blood pressure than whites. The data shows that African Americans are dying younger from diseases like cancer, diabetes and heart disease than whites. 1

The US spends trillions of dollars on health care each year yet not everyone can afford to access health care when they need it and some populations are more challenged than others in accessing care. If you are able to seek care when you need it, you may or may not be able to afford your medications. If given the choice between paying rent, buying food or getting medication for a chronic illness some patients will choose not to fill their prescriptions. If the prescription is filled, in some cases they will not take them consistently if they believe they can save money in the short term. Drug prices and the impact on patients when they cannot afford medications is a significant issue for our country and contributes to the long term increasing health costs and poor health outcomes. This adds an additional complexity to the rural locations, poverty, race and issues that contribute to an unequal distribution of preventative care, disease management and access to overall healthcare.

Our neighborhoods and communities affect how we live, our daily lives and our well -being. In rural communities where the minority populations are growing and they are underrepresented in healthcare professional and provider positions; gaps are likely to exist. In these communities, health care providers are often not aware of the challenges that these minorities face to access health care or the challenges they face when they meet a provider who is not aware of their economic, environmental, social or cultural challenges.

Consider the story of Janice, an African American who visited a healthcare provider in a rural community. Janice rarely accesses the health care system and when she does, her experiences have not given her confidence that the providers recognize the importance of her difference as a minority. On her last healthcare visit, the provider was not familiar with a rash that she had on her skin which she describes as commonly seen in the African American population. When Janice previously saw a provider in a city well populated with minorities, the provider was familiar with her skin condition, was able to assist and Janice had a positive outcome.

Roberta is an African American who was seen for the first time by a gynecologist in a rural community. After the visit, Roberta reviewed her chart and noticed that the provider incorrectly documented her as Caucasian. Roberta wondered if this was a default setting in the electronic medical record since she lives in a community that was primarily white but is now experiencing a growing population of minorities. Roberta wants her provider to “see” her and recognize her difference as she knows that race can play an important role in how some disease are diagnosed and treated.

While these are not major examples of issues with healthcare interactions in a rural community they do provide an inside view of why minorities may be hesitant to visit a provider, may not be confident that they will be understood or that their differences will be recognized. Ethnic and racial differences have a significant impact on health outcome. The challenges faced by minorities in seeking care can negatively affect their ability to lead healthy lifestyles.

To begin to address these issues we need to create equal opportunities for health at the community level as it affects the overall health status and costs for our nation. Community engagement and partnership with key stakeholders will be a necessary element to create and sustain change. Understanding specific populations, individual culture and barriers are necessary components to establish healthy communities to reduce and one day eliminate inequities in health.

The journey to health equity in the rural locations will require community partnership with health care organizations and the development of programs and policies to address access to services for minority populations. Community discussions, assessments and the development of cultural competencies will be key elements for this journey in rural populations. It will require the creation of equal opportunities for all races and populations to access and participate in healthcare and to experience no gaps in health outcomes. It will be a worthwhile journey to a worthwhile goal.

Dr. Marva Williams-Lowe is the Regional Pharmacy Director for the Dartmouth-Hitchcock Health System. She has responsibility for hospital pharmacy practice and operations including purchasing and inventory management, budget, personnel, medication-related policies and procedures and regulatory compliance. 

 

  1. (2017, May 2). National Center from Chronic Disease Prevention and Health Promotion. African American Health. Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html


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Saving a life through health IT

Jeri Koester

I recently watched Jimmy Kimmel share a personal story about his new son on live television. His son, Billy Kimmel, was born with an undetected heart defect that required immediate surgery. Because of the great healthcare his son received, Billy lives to see his future.  While my heart ached as I listened to Jimmy’s emotional message, I was overcome with appreciation for all the work medical professionals do within healthcare.

I think of the compassion and care that clinicians provide every day for patient-centered care – within our own healthcare system and beyond.  These prestigious professionals have humanity as their foundation. This also represents my passion within healthcare IT leadership and what drives me to support top-notch patient care.

I witness the daily operations of my colleagues who are responsible for providing IT solutions and services to our healthcare system. These vary from electronic health record (EHR) adoption, medication dispensing solution, enterprise data strategies, cyber security and much more. But above all, we create, implement and improve technology that may help save patient lives.

The solution we create flags a medication that could cause an allergic reaction for a patient. This may save a life.

A reminder system that notifies patients of needed preventive screenings or tests for disease development instead of waiting until the symptoms appear. This may save a life.

A risk model that shows patients most at risk of a heart attack based on algorithms allows clinicians to intervene and engage with the patient before a life-threatening situation occurs. This may save a life.

A completely redundant infrastructure with zero unexpected downtime so a patient waiting for a discussion with their clinician regarding a cancer diagnosis does not have to hear, “We need to reschedule your appointment because our system is down.” This may save a life.

Healthcare IT leadership has never been more important.  Technology is no longer just a tool, but a part of the strategic initiative in moving organizations forward in the ever-evolving healthcare field.  In conversations regarding EHR, interoperability, blockchain, cloud-based applications, and more, care and compassion need to remain at the center. We need to advocate for the safety of our patients when introducing technology.

This can be accomplished in many ways. We can start by talking about it openly.  Our organization is moving forward with strategic initiatives that includes implementing hospital systems, re-platforming legacy applications and supporting shared services efficiencies. In one of our recent meetings, the project manager highlighted our project purpose and objectives to the number of applications we need to retire.  This alone sounds arduous; however, shifting the intent of the meeting to how this is important to our patients restored vision and determination.  The engagement from employees on the project increased significantly when our conversation focused implementing a system safely for our patients.

Additionally, our operational services can benefit from this shift in thinking as well.  We are in the process of implementing lean techniques to how we work.  When discussing the value stream, we place the patient in the center of our “True north” and have established measures to track success as it relates to our customers and patients.  This concept creates a meaning as to why our decisions are important because we can help save lives.

Within our organization, we are expected to deliver solutions for provider efficiency and patient safety. In doing so, we share the same mission and vision of our health system, which is to enrich patient lives. And at the center of our days are patients who need care and compassion. We work to safely implement systems and ensure important data is present when it’s needed most.  Healthcare IT leaders should openly discuss the effect technology has on patient care, to support the humanity of healthcare.

As healthcare leaders are continuously asked to control costs and deliver more, I have found that focusing on the very thing that keeps our hearts warm is a way to move mountains.  And as the amazing providers and staff worked their miracle to save Billy Kimmel, we were all there.  Ensuring the programs ran, the information was available and doing what we can to help save lives.

Jeri Koester is vice president of IT business management at Marshfield Clinic Information Services (MCIS, Inc.). 

 

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Sparking Inspiration in Front Line Leaders

Chantel Johnson, PhD, RN

As an operation leader in ambulatory healthcare, my days are filled with “fire-fighting”—staffing the clinics, managing physician schedules, moving improvement work forward, etc.  Little time is spent on individual leadership development.  Let me be more honest–no part of my day is usually spent thinking about leadership.  Yet, it is absolutely essential for all of us to carve out time to further develop ourselves as leaders.

Over the years, I have benefited from various forms of leadership development.   Whether from structured classes, coaching, or making tough mistakes, these experiences have shaped me as a leader.  This year my organization sponsored me to be an inaugural member of the Carol Emmott Fellowship (CEF).  While sitting amongst the other fellows in our first session, I was struck by the deep learning that I was experiencing.   The rich discussions with my colleagues gave me new perspectives on leadership and stretched my thinking.

I went back to work after the first CEF convergence session inspired!  I wanted the leaders under me to be similarly stimulated.  I searched within my company for existing leadership offerings.  Yes, the fundamentals of management were covered well in new manager orientation classes.  How to hire the best, how to use project management skills, how to give presentations were covered nicely by existing programs.  On the other hand, I didn’t see anything like the content I was exposed to at CEF.  I abandoned the idea and felt disappointed for my managers.

A light bulb went on for me a few weeks later while I was having a 1-1 with one of my managers.  I brought up issues of gender in leadership from what I learned in CEF.  I asked her what she has noticed about women leaders in our organization.  I explored her observations on how women leaders behave, how others behave around them.  Interestingly, she hadn’t really thought about it before.  We talked well past our meeting time.  When I was leaving she said that she’d love to have another leadership discussion our next 1-1.  This was the lightbulb moment.  I can bring my managers together and have inspired discussions.  What had held me back was thinking that I needed to be some type of leadership guru.  I thought I needed a degree in leadership or to be an expert on the topics.  I am none of those things. I am not a leadership development expert or professional coach.  However, I have learned some things over my years in leadership.  I am an expert in my own life and experience and that’s enough.

I decided to host a lunch with my managers to talk about gender and leadership.  Gender is a hot topic that most people avoid, either intentionally or because they think gender doesn’t matter anymore.   I invited my managers to this 1 hour “Leadership Lunch and Learn” session.  I sent out a couple of quick homework items before the session.  I asked them to read a short article and watch a Ted Talk video to prime their thinking.  During the session, I gave a 20 minute overview on the gender, women in leadership, and why the topic was important.  We spent the rest of the time in discussion.  I prepared several conversation starters based on the homework and my overview.  I asked them about how gender differences show up in their leadership teams.  I shared my own struggles with being a woman leader with the assumptions and double standards sometimes put on us.  My team came alive with such a dynamic discussion!  One of my managers shared strategies she uses to command more of a leadership presence in meetings.  She does small things like standing up straight and avoiding inflections in her voice.  Another manager jumped in and said she has been struggling with the same issue and wants to try those ideas. They weren’t just talking to me.  They were talking to each other. They were inspiring each other!

For the second offering, I chose the topics of power and influence.  I talked about different forms of power and why influence is such an important leadership quality.  In preparation for the session, I reached out to our executive team.  I gathered their tips for how to: 1) gain influence and 2) how they have effectively used power or seen others misuse it.   My executives appreciated the chance to have their ideas shared with the front line leaders.  My managers loved these tips.  They started guessing which senior leader had given each tip, as a way of connecting to them and matching their impression of them with their words.   I have the third Leadership Lunch and Learn scheduled to talk about our personal leadership philosophies.

The feedback about my sessions have been overwhelmingly positive.  My managers have extended these meeting invitations to their colleagues and supervisors so they can benefit from the content.  My managers shared that they feel valued because I have taken time to offer the sessions.  They said they can tell I really care about them and want to support their growth.

Even more inspiring is that I have noticed my managers are putting their learning into action.  I notice subtle changes in how they present themselves in group, utilizing strategies that increase their presence.   Another example great example of the impact of this type of learning was seen when a manager was recruiting for a supervisor.  She was surprised that one of her star employees hadn’t applied for the position.  From our Lunch and Learn session, my manager understood that frequently women do not apply for promotions when their qualifications are not a perfect match for the position.  She used that information to directly reach out to her star employee and have a discussion with her, ultimately encouraging her to apply.  These are just a few examples of the ripples from the Lunch and Learn sessions.

I have learned so much in this process!  I learned to give myself permission to own my expertise and share it with others.  I learned that I don’t have to wait for someone else to give me “permission” to mentor and coach people.  I don’t have to be a world renowned expert on a topic to still provide meaningful information and spark enlightened conversation.  My team learn more from each other than they do from me.  My role is to help facilitate and guide, prime the pump with some reading and ideas.  I also learned that I don’t have to make it complicated.  No, the Lunch and Learns are not a comprehensive leadership development course.  Grassroots leadership development can be small and still create a huge difference.

I suggest other leaders to give this a try.  Ask your team to join you for lunch.  Pick a leadership topic and dive in.

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On Becoming a (Positively) Disruptive Woman, and Passing It on to Others

Christine Malcolm

When I was 22 years old, I received my A.B. honors from the University of Chicago.  I had been taught that the world was entirely open to me.  I wanted to pursue a career in public health and healthcare, and began an intensive job search.  My heart was set on an Administrative Internship at Hennepin County Medical Center – an organization that fit well with my passion for health equity.

I was told by my interviewer that I couldn’t apply for the position because I was female.  He added that the field of health leadership was limited to men, nuns and nurses, and I wasn’t any of them, so I should rethink my career options.  I was stunned.  He told me matter-of-factly what was available to me – a clerical slot – the only position open to a woman who wasn’t clinically trained.  I needed the job, accepted the position, and vowed to prove him wrong.  I then promptly set about “disrupting” the fixed ideas about what was possible for health care, for me, and especially for women like me.

Disrupt Yourself - First, I disrupted myself – I decided to return to the University of Chicago Business School, a place that had always eschewed bias of any kind.   I was one of the 20 percent of the class that was female, and the one of the few who were married. After graduation, I took a challenging job in management consulting, traveling 5 days a week with clients of all kinds, and starting a health strategy practice at what is now Price Waterhouse Coopers.

Accept Disruptive Help - There were several men who opened the door, or sponsored me, starting with my first boss (who made me department administrator).  There were almost no women in leadership, so without men’s help, I would have been stymied.  One of them gave me a raise while I was off on maternity leave – talk about a positive disruptor!  They told me they had confidence in me, and trusted and advised me along the way.  My husband served as a rock of confidence and support – committed to being a two-career family – and we worked hard at helping each other become a success.

Find Other Disruptors, and Support Each Other - Over time, I have been fortunate to be part of two remarkable networks of leaders in the field – first, 20 years in a very senior network of men and women in health, and more recently, with the Women of Impact – a group of health leaders committed to creating positive transformation in the health field.  These networks sustained me, opened my mind, and expanded my notion of what is possible through collective action.  They have continued to positively disrupt my life and purpose.

Align Around a Crystal Clear Disruptive Goal - One woman I met in the last decade was Carol Emmott.  Carol had been a stand for women and diversity throughout her career – in government, in search, as a luminary in the field.  She was committed to leadership development and innovation – founding the California and Massachusetts Health Leadership Colleges, and the CEO Roundtable.  She tragically passed from cancer far too young – and in her last days, asked her family and friends to join together and form the Carol Emmott Fellowship for Leaders in Healthcare.  She wished to ensure that the experiences of our generation would not be repeated – and that women would never feel the sting of having their dreams dashed by limiting beliefs and behaviors.

Seize the Moment for Disruption - Discouragingly, equality statistics reflect a worsening situation over the last eight years.  The latest studies show it may take more than 100 years for women to catch up, and the prospects for women of color are even worse.  Love for Carol, combined with frustration as to the lack of progress that has taken place, motivated the national leaders on our Advisory Board, to work to make this innovative program a reality.

Powerfully Support the Future Generation of Disruptors - We have a remarkable class of 15 mid-career leaders in health who are in our inaugural class – they hold senior positions at some of the leading healthcare providers in the country – including Yale New Haven, Penn Medicine, Henry Ford Health System, University of Miami Health System, Lahey, Carilion, Marshfield Health System, Rush University Medical Center, Palo Alto Medical Foundation, Duke Health System, John Muir and Dartmouth-Hitchcock. Our class includes chief operating officers, physicians, deans, chairs, physician practice leaders, plus people from a variety of other clinical and administrative roles.  They each have committed themselves to creating change that makes health care better by taking on an ambitious Impact Project during their fellowship.  They have the powerful support of their sponsors and champions within their institutions.

Enlist the Assistance of People Who Are Known for Positive Disruption - We have been blessed with the tireless support of over a hundred very senior male and female volunteers – many of whom are “household names” in health care – serving as mentors, leading presentations to the fellows, hosting them in Washington, Chicago, Scottsdale and San Francisco. They demonstrate how when we stand together and for each other, behind huge goals, anything is possible.

This week, the fellows are in Washington DC, where they will learn more about how to create broader impact through advocacy.  They will meet with the Women of Impact, a partner organization, to explore more deeply what might be possible for the fellows as they complete their fellowship and go into the world – together, and in concert with other leaders committed to positive change in our field.  Robin Strongin, a Woman of Impact, has kindly offered this week of posts on Disruptive Women to introduce a few of the fellows and explore how we might jointly move beyond bias.  Thank you, Robin – for being the original Disruptive Woman in Healthcare.

We are certain you will be impressed with our fellows – and their commitment to making healthcare better.  Please join our movement to create a health field where bias and disparities of all kinds will finally be overcome!

 

 

 

 

 

 

 

 

 

 

Carol Emmott Fellowship 2016 Launch from Carol Emmott Fellowship on Vimeo.

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Increasing the Diversity of the Physician Workforce

Cynthia Boyd, MD, MBA

“Any economist will tell you that diversification is the key to a secure portfolio. Any geneticist will tell you that diversification is key to maintaining hardy species of plants and animals. But somehow, when it comes to racial politics, the virtues of diversity are lost. Diversity in healthcare is not about fair representation – it is about saving lives.”

– Commissioner George Strait, Associate Vice Chancellor for Public Affairs,

University of California, Berkeley

A more diverse physician workforce is critical in health care and medical education in order to further promote excellence in medical education and accessible, quality health care, particularly to those populations that are underserved and bear the greater burden of health disparities.

For purposes of this discussion the Association of American Medical Colleges (AAMC) and Sullivan Commission definition is used of racial and ethnic diversity in the health care workforce.  This encompasses several characteristics including: (1) the representation of all racial and ethnic groups from the community served within a given health care agency, institution, or system; (2) the system-wide incorporation of diverse skills, talents, and ideas from those racial and ethnic groups; and (3) the sharing of professional-development opportunities and resources, as well as responsibilities and power among all racial and ethnic groups and at all levels of a given agency, institution, or system. [1]

While the basic concept of “diversity” among human beings encompasses numerous dimensions and characteristics such as socioeconomic status, gender, sexual orientation, race, ethnicity, religion, and disabilities, the specific focus of this discussion is to address the problematic state of racial and ethnic diversity in the physician workforce and to highlight practices at the medical school admissions level that could facilitate expansion of diversity within this workforce. Accordingly, diversity is defined here quantitatively as the numeric representation of all racial and ethnic populations.

The following is a quantitative summation of the state of diversity in today’s physician workforce with an overview of the current race and ethnicity demographic trends in medical education. Overall, numbers of racial and ethnic minorities among medical school applicants, matriculants, graduates, as well as full-time faculty, have remained relatively stable over the past five years.  The 2015 medical school acceptance rate is 41.1%. Acceptance rates differ among select racial and ethnic subgroups. White (44%), Asian (42%), and Hispanic or Latino (42%) applicants all have comparatively similar acceptance rates. African American or Black applicants have a lower acceptance rate of 34%.[2]

The figures below from the AAMC highlight both single year data from 2015 and longitudinal data over time to provide a more robust understanding of diversity and inclusion medical education trends.  While Whites are 47.8% of applicants, the percentage of accepted White applicants is 51.2%. This reflects, in Figure 1, a 44% acceptance rate for White applicants. Asians are 19.6% and Hispanics or Latinos are 6.3% of accepted medical students. Asian and Hispanic or Latino applicants both have a 42% acceptance rate. Blacks or African Americans make up 6.4% of accepted applicants, a decline from 7.8% of all applicants. The Black or African American acceptance rate of 34% is lower than White, Asian, and Hispanic or Latino acceptance rates.[3]

boyd_figure 1

                                                    Figure 1: AAMC 2016

The medical school acceptance rate is a pivotal data point for applicants, undergraduate advisors, medical school admissions committees, and medical education policymakers.  Percentages of medical school graduates by race and ethnicity have remained consistent over time. Whites (58.8%) and Asians (19.8%) continue to represent the largest proportion of medical school graduates, with the two groups composing more than three-quarters of medical students graduating in 2015. Also for 2015, Whites make up 47.8% of applicants and 51.2% of matriculants and remain the majority of graduates. As noted in Figure 2 below, the 2015 medical school graduates comprise 5.7% Black or African Americans and 4.6% Hispanic or Latinos. [4]

boyd_figure 2

Figure 2: AAMC 2016

Medical school applicants, students, and graduates are not the only stakeholder groups for which medical education leaders wish to increase diversity, inclusion, and equity. The medical education professoriate must also strive to become more diverse. An increase in female medical school graduates has been met with a rising number of full-time female medical school faculty.

                

boyd_figure 3Figure 3: AAMC 2016

Currently, 39% of full-time faculties are female; however, as noted in Figure 3, female faculty from some racial and ethnic minority groups continue to be underrepresented in academic medicine. Only 4% of full-time faculty identify as Black or African American, Latino or Hispanic, Native American or Alaska Native, or Native Hawaiian or Pacific Islander females.  This stark racial and ethnic disparity among full-time faculty is mirrored at the department chair level, with women of color representing only 3% of department chairs in academic medicine.[5]

It is clear from these very disparate data that the leadership of our academic institutions have a responsibility and must be held accountable as key stakeholders in improving the diversity of the physician workforce.  The admissions process and Admissions Committees at our medical schools represent the gateway to medicine.  It is the initial and most critical step in determining who will have the opportunity to become a future physician and who will not.  Admissions committees play a very important and significant role in identifying and developing meaningful policies, procedures, and strategies for increasing the racial and ethnic diversity in the student body.

Here are some of the key elements and components that medical school admissions committees should employ and utilize as a foundation in order to enroll a more diverse student body:

  • The medical school’s leadership and other key stakeholders are vital in connection with efforts to achieve diversity goals
  • Making certain that enrolling and training a diverse class of medical students is central to one’s medical school’s educational missions
  • Developing policy statements that articulate the benefits associated with a diverse student body, including with respect to race and ethnicity
  • An admissions committee mission statement that is aligned with that of the medical school;
  • A diversity statement that defines the diversity and inclusion goals of the committee
    • A committee membership that broadly represents the diverse interests of the medical school, including representation of basic scientists and clinical faculty members, men and women, and based on institutional policies other persons, including students, residents and community members at large.
    • And, since a diverse student body makes up a core value in medical education, the admissions committee should also include groups underrepresented in medicine
  • Policies and procedures that support the diversity goals of the medical school, including holistic review
  • Ongoing review of data related to the students who are enrolled (or not) at the medical school

It takes time and patience to implement many of these changes.  The holistic review in admissions process requires ongoing education and training.   As noted in the AAMC’s Roadmap to Diversity, “effective development of and implementation of diversity-related policies depend in part on a clear articulation of policies designed to advance those goals and a process of continual examination regarding the educational goals medical schools seek and the ways in which race or ethnicity policies advance these goals.”[6]  In my work as dean for admissions and recruitment I am fortunate to assist in the enrollment of some incredible students who are committed to addressing and improving health disparities and making a difference in the lives of  individuals who are underserved in our local communities and our nation.  I continue to strive to do everything I can possibly do to contribute and to make certain that the gate is open as widely as possible when they are ready to take that next crucial step towards a career in medicine.

Dr. Cynthia Boyd is vice president for corporate compliance and chief compliance officer at Rush University Medical Center. She is associate professor of medicine on the faculty at Rush Medical College of Rush University and currently serves as the dean for admissions and recruitment for Rush Medical College.

 


[1] Missing Persons: Minorities in the Health Professions – A Report of the Sullivan Commission on Diversity in the Healthcare Workforce 2004 and AAMC Underrepresented Definition: https://www.aamc.org/initiatives/urm/

[2] Diversity in medical education: facts and figures2016.  Washington, DC: AAMC;2011,2015 http://www.aamcdiversityfactsandfigures2016.org/report-section/section-3/

[3] ibid

[4] ibid

[5] Lautenberger D, Moses A, Castillo-Page LC. An overview of women full-time medical school faculty of color.

AAMC Analysis in Brief. 2016;16(4):1-2.

[6] Roadmap to Diversity: Key Legal and Educational Policy Foundations for Medical School, AAMC 2008


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Finding a place

Doug Riddle

I grew up in the middle of Orange County, California. A neighborhood so homogenous that I saw the Catholic kids in their plaid skirts and white shirts as alien and exotic. We passed on the sidewalk beside the parochial school playground with caution and wonderment. I was 14 and in high school before I realized that my friend, Buzz, was Jewish. This was the 1950s and early 1960s and sensitivity to differences meant not picking on the red-headed kid.

In fits and starts, I found my eyes and ears opened to the reality of a different world–a larger world–than mine. In August of 1966, the Southeast L.A. community of Watts exploded and at 16 I was glued to the radio for six nights, reading the newspaper and trying to understand what was so wrong that tens of thousands of people would take the streets in rage. A few years later, I found myself spending a year in Washington, D.C., at Howard University in my ongoing quest to make sense of this larger world.

It came as a shock to discover that as a white kid in a blue-collar home, I had led a life of privilege. I was free to pursue whatever course my intelligence, talent, and character would choose. That consciousness only emerged because I was confronted repeatedly by the constraints that faced my friends and colleagues who were African-American or Hispanic or female. I was on the swim team at Howard and I remember traveling with the team and the feelings of pained anger and embarrassment every time a white waitress would seek out my table first, the only one with a white kid, to take a breakfast order. The shock turned into determination to actively pursue justice in whatever ways I could.

It turns out not everyone was thrilled by my growing commitment to fairness and equal access. In 1972 I took some time off from seminary to work on the quadrennial conference of the newly merged United Methodist Church. I was able to arrange free office space in the regional headquarters of the church so we could make arrangements for the thousands of youth and young adults we hoped to bring to Atlanta to experience the church in action. I still have a vivid memory of an administrator, his face red, mouth twisted into an angry grimace, yelling at me for betraying this favor. My sin? I shared the opportunity with the Black and the Women’s caucuses.

I’m still struggling with what the appropriate contribution of a privileged white male is to justice in work and society. It’s easy to believe in equal access and opportunity. It’s not hard to speak out for it. The challenges have to do with finding the right roles. For the Carol Emmott Fellowship for Women in Healthcare, I serve as a designer and facilitator of the curriculum. In that role, I bring my expertise in creating learning experiences but I am clearly not an expert in women’s leadership. I don’t teach these brilliant women leaders how to be better leaders because I’m not in a position to teach. What I can do is create a relatively safe and challenging space in which they can reflect, connect, build community, and decide how to apply their considerable gifts.

So what is a privileged older white male to do? I’m following a few clues but I think the ongoing conversation is more important than what I’ve figured out so far, but here are three ideas:

  1. We all have to speak out for justice, equity, and fairness. In so many of the organizations with whom I work, one of the only minority senior roles is the chief diversity and inclusion officer. Is this the consequence of the bias that injustice is “their problem,” and not a problem for us all? I have to be visible and active in asserting that justice is a human issue and its absence harms everyone.
  2. I have to challenge my assumptions every day. Unconscious bias, stereotypes, and old habits conspire to keep me from the most useful role, which is as student. I want to always be a better student and owning my ignorance makes me easier to teach and faster to learn. Curiosity and a willingness to engage in the conversations of mutual discovery seem fundamental to moving beyond the limiting assumptions.
  3. I can speak to people like me. There are plenty of people in my demographic who are in charge of things, sometimes holding on for dear life to their control. I can be a voice for change, for understanding, for the creation of a more just and inclusive organization. I can be a voice for equity and correcting past injustice for those who need to hear it.

As an older white male, I’m in a good place to ensure that commitment to justice is not seen as the exclusive obligation of those who are faced with injustice. This society belongs to all of us and we are all diminished if anyone is limited because of race or gender or origin or handicap or sexual orientation or any other factor besides their ability and willingness to contribute. We can all be leaders in ending limits to justice.

 

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Turn Down The Radio So You Can See Better: Distractions in Healthcare

Thomasine Gorry

The scene is familiar to any ophthalmologist: Your long-time patient, Mrs. Howell, sits centered in the grand exam chair. She is elderly but not frail. Today she is unusually nervous. Her daughter and son (whom I have never previously met) occupy the bench that lines right wall of every exam room. On my left, a familiar Pennsylvania Department of Motor Vehicles form rests on the computer keyboard– a place where my technicians know it won’t be overlooked.

Everyone knows good vision is essential for safe driving.   Vision is critical and vision is measurable.   Eye doctors are, therefore, routinely asked to assess a patient’s ability to drive.   That “simple” DMV form asks a monumental question.  Can this patient safely perform the complex 360 degree task of driving?  It is a task that occurs in motion, endowed with horsepower, gasoline and governed by human decision making.  The assessment is complex but our instruments are blunt. So we begin by measuring the visual acuity.  This means, in basic terms, how far down the eye chart the patient can read.  The smaller the letter, the better the vision.   Like many complex assessments, what is measurable is only part of the assessment.   It is a greater challenge to measure the qualitative experience.   Understanding Mrs. Howell’s ability to drive demands far more than vision alone.  If you really want to assess her driving, ask her about the most challenging situation—driving in the rain at night where headlights confront the driver directly.  Glare bounces off a wet road into the eye and contrast reduction turns lines into shadows.  “How do you manage that?” I ask.

Her answer:        “I turn down the radio so I can see better.”

I smile at the irony but I never ignore the insight.   In challenging situations, eliminate distractions.  Focus.  You will perform better.

We in healthcare are driving at night in the rain.  Challenges abound.  Just like driving, the face to face medical encounter is a complex, 360 degree task.  It occurs in motion, is endowed with intellectual power, emotion and is ultimately governed by human decision making.  We drive along a course set by the patient and the healthcare system in which we work.

Like highways, these systems can be well designed but remain full of hazards.  None can be completely eliminated.  Some hazards we create ourselves.  Some we simply allow to continue.  These hazards — that we create and ignore — need our attention now so that they do not deplete our attention when patients need it.    Consider the competing demands for the attention of a primary care physician.  A 2010 study showed that, in addition to a full patient schedule, primary care doctors spent 27% of the day on phone calls, received 17 patient related emails, 12 medication refill requests, 20 lab results and reviewed 13 consult reports.  The roads are busy and full of distractions.  Healthcare is not unique.  Industries and individuals themselves share  this “Age of Distraction.”    We face busy screens showing thousands of data points.    Well meaning alarms, alerts, and advisories flash incessantly.  The initial impact is just a nuisance.  But if distractions accumulate, we may inadvertently find electronics more compelling than the patient.

Many industries have begun to examine the problem.  “Alarm Fatigue” is now a recognized patient safety concern by The Joint Commission and the National Patient Safety Foundation.  Some studies showing that 72 to 99% of inpatient alarms are false. A 2015 Microsoft advertising study demonstrated that the human attention span endures for only 8 seconds, famously less than that of a goldfish.  When limited attention span meets hundreds of distractions, it creates an environment ripe for medical errors. Worse, it insidiously generates feelings of isolation in patients and providers.   Somedays I fearfully wonder if I might get better Press Ganey scores if we surveyed the computer and not the patient.

So what is the answer?   It is not to offer blanket criticism of Electronic Health Records (EHR).  Rather, it is a time for harsh editing.  Remove the extraneous.  Clinicians must actively engage with our operations and technology teams so that we “meaningfully” adapt to this new world.  This is a call for further engagement, for scientific design and use of health information technology to enhance the eternal elements of medicine, which remains at it’s core, an ancient healing profession, most successful when it is unfettered by distraction.

It is time to return to the patient and take Mrs. Howell’s sage advice:  “Turn down the radio so you can see better.”

Thomasine Gorry, MD, MGA is a practicing ophthalmologist and Vice Chair for Quality at the Scheie Eye Institute. She also leads the Quality Domain of Clinical Operations for the Clinical Practices of the University of Pennsylvania Health System.


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Honoring Carol Emmott, PhD: Meet the Fellows Coming to Washington, DC

Robin Strongin

The statistics are draining. We know that while “women comprise over 75% of the healthcare workforce, only 8% of the top 100 hospitals in the US are led by a female CEO.”  It isn’t just hospitals, of course. All you have to do is look at the numbers across the board (and in board rooms), in venture funding, in pay disparities, and all through-out the health care sector, and it is hard not to be frustrated and outraged. As Disruptive Women in Health Care, we are also driven to action.

One of the best ways to drive change is to highlight the great work of others and jump in and collaborate. In that spirit, we will be highlighting a week-long series of blog posts from a remarkable group of women leaders: they are part of the class of 2016-17 Carol Emmott Fellows.

I was honored to be named a Woman of Impact (WOI) and through that phenomenal network was introduced by another WOI, Christine Malcolm, to the Carol Emmott Fellowship.

CAROL B. EMMOTT, PHD

emmott image

1946-2015

Carol B. Emmott helped pioneer the significant expansion of the role of women in careers in the health profession. She completed her Ph.D. in Health Policy in 1975 at a time of great transformation in both the health industry and in professional prospects for women. Learn more about Dr. Emmott and the Fellowship project: http://carolemmottfellowship.org/

Carol B. Emmott Fellowship for Emerging Female Health Leaders from Joey Xanders on Vimeo.






















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Age Out Loud

Glenna Crooks

May is Older Americans Month. The theme this year, established by the Administration for Community Living is Age Out Loud. It encourages wellness, knowing rights, remaining engaged and exploring new things.

I like the idea of “exploring new things” and the one I’d suggest we explore the support people need to age-well-in-place. Aging challenges faced by older people throughout history are increasingly complicated as traditional “villages” support has eroded and, for many people, no longer exist. This happened for several reasons, among them:

  • Changes in family size and structure. Families today are smaller and family structures are disrupted. Only 20% of families are once-married couples with children, the remainder are single-parent families and divorced-and-remarried families, often in complicated configurations. In addition, 14 million seniors are “elder orphans,” aging alone with no family. That number will grow, not just because of the size of the Boomer generation but because one-third of Boomers never had children.
  • Mobility. The US is the most mobile country in the world, often separating families geographically:  40% of people move, on average, 676 miles away from where they were raised, and 20% of seniors want to relocate during retirement, often at distances from family who could support them.
  • Employment for women outside the home. Women, traditionally caregivers for others, are now in the workforce and unavailable to provide uncompensated care

These factors are further complicated by lives three decades longer, with legal, financial and health matters far more complex than in times past. The consequences? Economic losses from higher costs and lower productivity.

  • When outside help is necessary, annual and on average, seniors and/or their families incur non-reimbursable annual costs of $40,000 for in-home aides (per 8-hour shift, Adult Day Care costs of $17,250, assisted living costs of $43,200 annually and nursing home costs of $82,000 – $92,000. Though Medicare and Medicaid covers some types of long-term care and some people have LTC insurance, those are rarely adequate.
  • Families who turn to agencies for planning help to determine care needs and identify community resources pay $1,000 for an initial assessment and $200 per hour for ongoing consultations.
  • Family caregivers, on average, lose $142,700 in wages, $131,350 in Social Security benefits, and $50,000 in pension payments when they reduce hours or leave the workforce to provide care.
  • Employer-paid health costs for family-caregiving employees are 8% higher than for non-caregiving employees, due to the health impact of caregiving: depression, diabetes, hypertension and pulmonary disease, adding $13 billion to annual employer health care costs.
  • Employers suffer productivity losses. Employed caregivers miss seven days of work more than other employees, a substantial burden for small or lean businesses with little staff redundancy or when employees hold mission-critical positions. Employed caregiving employees are also less “present” at work, using work hours to make appointments, coordinate with other caregivers and manage crises.
  • Hospitals are penalized when Medicare patients are readmitted for the same cause within 30 days of discharge even when factors outside the control of the healthcare system are the cause, as when patients don’t have help to take medicines properly, coordinate care or get transportation to shop for healthy food.
  • Local, state and national governments incur costs as they adapt and provide safety nets. For example, transportation once provided by family and friends, is increasingly provided by local transit authorities. The estimated cost impact to operate transportation for older people nationally now stands at $4.2 billion, with the biggest cost increase falling on local governments, community-based organizations and rural areas. The greatest government costs are incurred when caregivers exhaust their abilities and older adults become eligible for nursing home coverage through Medicaid.

In my work these days, I see people who are far better prepared for the eventuality of their death than for the reality that they will live an additional three decades of life and often, without the village support their ancestors took for granted.

That makes this a good time to go “exploring the new thing” of a “new era” villages.

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Tales, Tips and Love from Women Caregivers

Women have always been caregivers. Whether looking after small children, elders, other family members or friends in small communities, tending to others in urban settings with limited support systems, or acting as professional caregivers in institutional settings, we have been the primary providers of physical care and emotional support in a variety of settings and circumstances throughout the ages.

Today that remains true, and being the main caregiver may be more vital than ever. As women have children later and elders live longer, we are challenged by competing demands and shrinking resources. Many of us have elderly parents living in a time of growing dementia or increasing frailty; others have parents who need supervision in nursing homes. At the same time, we are parenting children who often have their own physical or emotional challenges. We may also have spouses in failing health who need our attention. And who among us would not be there for an ill friend or family member?

TakeCareWhether we are younger women focused on child care, older women charged with being there for a sick spouse or parent, or women in the Sandwich Generation who are called upon to take care of children and parents simultaneously, many of us find ourselves in the caregiver role well before we expected to be there and often feeling less prepared than we wish.  We are all caregivers at some stage of our lives, and we all have stories to tell about what that has meant for us.

It’s important to emphasize women as caregivers because while men and women are both likely to fulfill caregiving roles, female caregivers spend many more hours providing care. They spend an average of 680 hours per year providing care, 160 more hours on average than male caregivers. Female caregivers may spend as much as 50% more time providing care than male caregivers.

That’s partly because men tend to manage care rather than administer it. A man is more likely to hire someone to help with tasks such as bathing or dressing or other daily activities because they are not as comfortable as women providing personal care.

According to the Family Care Giving Alliance, 80% of long-term care in the US is provided by unpaid or informal caregivers. Of these, 61% are women, most have reached middle age, and 59% have jobs.  The average caregiver is a 49-year old woman, caring for a mother who doesn’t live with her. She is married and employed.

An estimated 15.5 million caregivers provided 17.7 billion hours of unpaid care for an aging family member with dementia alone in 2013. Most of these caregivers for aging loved ones were daughters and daughters-in-law. The value of all the informal care that women provide ranges from $148 billion to $188 billion annually. Women, who provide the majority of informal care, play many roles while caregiving, from hands-on health provider & care manager to surrogate decision-maker and advocate.

Caregivers who leave the workforce to care for a family member lose on average over $304,000 in wages and benefits over their lifetime. Women caregivers are less likely than others to attend to their own health and self-care needs. They often suffer from stress, isolation, fatigue, and depression. Thirty-five percent of them report finding it difficult to make time for themselves, and 29% report difficulty balancing work and family issues.

Because of these issues, I compiled a collection of prose and poetry by women caregivers that give testimony to what caretaking has meant for contemporary women, whose lives are complex enough to begin with.  The anthology is called TAKE CARE: Tales, Tips and Love from Women Caregivers and it will be published this spring. Here is an excerpt by Kate Gray called “All the Longing Left in the Body.”

“It could be you stopping me. It could be you quite a few years from now, half of your face a little lower than the other, your hair turned gray and your clothes neatly tucked. You would probably do the same thing she did in the women’s restroom, if you were in her shoes.

“It could be any of us, waiting outside a bathroom stall, overcoming the body’s instinct to grimace at the acrid smells, taking a diaper much bigger than the one used for an infant, carrying it carefully, disposing of it. It could be any of us, bending down to hug our spouse or partner, wrap our arms under their arms, straighten our legs to lift the two of us to standing. It could be you loving someone so much that you take him into the women’s room with you, that you find a way to make a dance out of changing a diaper, that you don’t mind doing what you have to do, as long as you are two together.”

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Loneliness: A Silent Epidemic

Robin Strongin

Loneliness.  It is an epidemic that has silently gripped the nation. And it is not going away.  I wrote about the issue back in February: http://www.disruptivewomen.net/2017/02/23/loneliness-and-its-impact-on-health-share-your-story/.  In that post, we announced that we were looking for ways to help.  And we found one!

art and healingDr. Jeremy Nobel, Founding CEO at the Foundation for Art and Healing, is spearheading The Creatively Connected Film Festival, which involves a film contest, digital platform, public health outreach, and evening of celebration in New York City on May 9, 2017.  Sharing information about the Foundation for Art & Healing’s UnLoneliness Project, and the Creatively Connected Online Film Festival. http://artandhealing.org/join-our-festival-launch-celebration/

Why Feeling Connected Is More Important than Ever. Isolation and loneliness, a burden born by so many and in so many circumstances, is rapidly increasing and a threat to health. According to a recent study by the AARP, over one-third of American adults are lonely. Emerging research indicates that in addition to depression, substance abuse and suicide, isolation and loneliness is associated with increased risk of early death from heart disease and cancer of 30%: a risk on par with smoking 15 cigarettes a day.

Introducing The Creatively Connected Online Film Festival. The Creatively Connected Online Film Festival is an online exploration of loneliness and isolation, drawing on the time-tested power of creative arts expression to powerfully share the stories that “connect us.” • The Festival, an initiative of The Foundation for Art & Healing’s UnLoneliness Project, embraces the healing power of sharing stories with a cinematically rich and diverse collection of short narrative and documentary films. • Intended as a widely accessible experience through our online showcase and network of strategic partners, the Festival aims to give over one million viewers the chance to explore isolation and loneliness, revealing ways we can help ourselves meet those challenges. • The range of selected works highlight specifically affected groups, including older adults, those with major illness, caregivers, military veterans, youth and young adults, and minority populations including LGBTQ and immigrants. • Festival films are juried with winners selected by guest juror Mike Paseornek, President of Production at Lionsgate Motion Picture Group, a major global producer and distributor of independent feature films.

The Festival will be launched with two events in New York City on May 9, 2017, both held at the New York University Law School in the West Village in Manhattan: • Public Conference. Free and open to everyone (advanced registration required), this afternoon event will include film excerpts and expert panel discussions on loneliness and isolation in various contexts. • Festival Launch Celebration. This festive invitational and ticketed evening event will be co-hosted by Steven Safyer, MD the CEO of Montefiore Health System and Lionsgate’s President, Mike Paseornek. Arts, medicine, and public policy luminaries will join guests for screenings of winning films, awards presentations, light refreshment and conversation. Our Goal Through the Festival and the UnLoneliness Project, we aim to increase awareness and understanding of loneliness and isolation. We’re taking steps to support, build upon, and expand efforts to address the root causes of loneliness by encouraging community outreach and collaboration. The Foundation for Art & Healing is a 501c3 non-profit organization founded in 2004.

 

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Disruptive Women Mourns the Loss of 2017 Woman to Watch Trish Vradenburg

Robin Strongin

2017 Disruptive Woman to Watch Trish Vradenburg, who was the Co-Founder and Vice-Chair of UsAgainstAlzheimer’s, died on Monday. Disruptive Women offers its sincerest condolences to the Vradenburg family and the UsAgainstAlzheimer’s community. The following is a statement issued today by UsAgainstAlzheimer’s.

 

 

 

UsAgainstAlzheimer’s Mourns Passing Of Adored And Inspirational Co-Founder And Vice-Chair Trish Vradenburg

Trish’s Deep-Rooted and Unflinching Passion to Fight Alzheimer’s Creates Admirable and Aspirational Legacy

WASHINGTON, DC, April 18, 2017 – UsAgainstAlzheimer’s Co-Founder and Vice Chair Trish Vradenburg’s unflinching spirit – her creativity and imagination, quick-witted humor, empathy, generosity and her exceptional tenacity to stop the suffering of others – was captured in her every action. It is with immense sadness that UsAgainstAlzheimer’s announces her passing, and it is with the utmost gratitude that the organization cherishes her legacy and forges ahead in her memory.Trish Vradenburg photo

Trish’s life was an inspiring portrait of creativity and versatility, employing her gifts of writing and storytelling throughout a successful professional career. She began her career as a speechwriter in the U.S. Senate. She wrote for various television shows, including Designing Women, Family Ties and Kate and Allie. Trish’s novel, Liberated Lady, was chosen as Literary Guild and Doubleday Book Club selections and has been translated into three foreign languages.

As a journalist, she wrote extensively for The New York Daily News, The Boston Globe, The Washington Post, Ladies’ Home Journal and Women’s Day. Surviving Grace, Trish’s quasi-autobiographical play about a sitcom writer and her mom battling Alzheimer’s disease together, was produced at The Kennedy Center in Washington, D.C., and Off Broadway at the Union Square Theater. It is now being performed at various community theaters throughout the country, as well as in Brazil.

Founded with her husband George Vradenburg, UsAgainstAlzheimer’s was born out of their passion to fight back against Alzheimer’s disease, which Trish’s mother Bea Lerner, the wife of her father Joseph H. Lerner, succumbed to in 1992. Trish’s unique whimsical style, the perfect complement to George’s more serious side, was instrumental in leading the organization on a path to make meaningful progress against a disease that caused their family so much pain.

Trish was a gifted and relentless advocate. She helped achieve increased funding for Alzheimer’s research and build a growing public-private consensus that a cure for the disease must be reached by the year 2025. Recently, she spearheaded the launch of the Alzheimer’s Party, imploring members of Congress to join a bipartisan movement to end Alzheimer’s disease.

Trish also served on the Council of Theater J and on the boards of DC Vote and the Vradenburg Foundation.

She is survived by her adoring husband George; daughter Alissa Vradenburg and son-in-law Michael Sheresky of Los Angeles, CA; son Tyler Vradenburg and daughter-in-law Jeannine Cacioppe Vradenburg of Chicago IL; grandchildren Harrison Sheresky, Skyler Sheresky, May Vradenburg and Gavin Vradenburg; and her brother Rabbi Michael Lerner and sister-in-law Cat Zavis of Berkeley, CA. She was preceded in death by her father, Judge Joseph H. Lerner, and mother, Bea Lerner.

Private family funeral services will take place later this week in Los Angeles, followed by a public memorial service in Washington, D.C., on May 9 at a venue to be determined. Family and friends will be honoring Trish’s legacy; details will be shared as they become available.

 

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Taking on Women’s Heart Health the Old-Fashioned Way

Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN

This editorial was originally published by Morning Consult on 4/14.

Heart disease claims the lives of more women than any other illness — more than all types of cancer combined — so let’s set straight the myth that heart disease is a man’s disease. While an estimated 80 percent of heart disease is preventable, cardiovascular disease among women remains an invisible disease in the national conversation. It’s time we focus more attention on the unacceptable number of mothers, daughters and sisters we have lost, and spread awareness of this silent killer of women.

Every 80 seconds a woman dies of heart disease; that’s 400,000 women each year. Tragically, my own mother was one of them. One week after learning she had high blood pressure, my mom had a stroke in front of me when I was 15. Her death, like those of so many other women, was preventable. At the time of her death, her prescription for blood pressure medication was still in her purse.

Heart disease affects women differently than men, and it’s imperative that clinicians — nurses, physicians assistants and doctors — be equipped with the knowledge that can help guide more effective treatment and prevention options. As conversations in government focus on health, we must work with federal and state leaders to make sure education about women’s heart health is a national priority.

Until these actions occur, we need to make progress the old-fashioned way, reaching one woman — and the men who care about them — at a time. Across the country, working with communities and campuses, we should be conducting biometric screenings, starting with young women. In February, at Ohio State University, we hosted biometric screenings for faculty, staff and 500 students; and since 2013, we have reached out to more than 150 health sciences colleges and professional as well as community organizations to conduct screenings on more than 54,000 Americans nationwide.

In addition, in partnership with the Women’s Heart Alliance, we shared our model for heart checks with colleges and schools of nursing and hospitals in Nashville, Tenn., so they in turn can screen their young women and caregivers. The model consists of large-scale screenings and education sessions using nursing faculty and students as the primary screeners. Screenings include a blood pressure measurement; a height, weight, heart rate, and body mass index calculation; and a stress screen and lipid panel in select individuals with certain cardiovascular risk factors. The goals are to identify early cardiovascular disease and refer those individuals for treatment.

We also must continue to encourage students and young people to adopt healthy lifestyles: Be active, eat healthy, avoid tobacco and manage stress. Eighty percent of heart disease is preventable with these four healthy lifestyle behaviors. This model needs to be replicated so we can reach greater numbers of women.

It is impossible to overstate the importance of learning more about this illness and passing that information along to family members, friends and colleagues. A little knowledge can go a long way. For example, women often don’t realize they’re having a heart attack because their symptoms, often taking the form of nausea or back pain, are different from those that men experience. That may be why women wait an average of 54 hours — more than three times as long as men — from the time they start experiencing symptoms to the moment they seek treatment. That time lag translates into far too many avoidable deaths.

I urge everyone, especially health care providers, to be proactive in teaching their patients how heart disease affects women and men differently, and counseling everyone to prevent it with healthy lifestyle behaviors.

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The Children of Medicaid

This article was originally published on Complex Child. 

Compiled by Susan Agrawal

I’ve been continually surprised by how many people think Medicaid is just for poor families on welfare. Those of us who parent children with complex medical needs know that Medicaid is so much more than that. After all, 72% of Medicaid enrollees are children, people with disabilities, and the elderly, and these groups account for 84% of spending.

Medicaid provides vital services for children, including home nursing care and therapies, that are not otherwise covered. In this article, we will share just a few of the children with medical conditions who have received life-changing benefits, thanks to Medicaid.

Carter

Diagnosed with spastic quadriplegic cerebral palsy and associated conditions, Carter requires a tracheostomy and ventilator to help him breathe. He is covered by both private insurance and Medicaid through the state of Wisconsin. Initially, he participated in an optional Medicaid program for children with extraordinary needs called a Katie Beckett waiver, but he now receives services through a Medicaid waiver for children with physical disabilities. Carter has significant physical disabilities and medical needs that make him fully dependent on his caregivers, but is cognitively intact.

Medicaid has paid for part or all of Carter’s surgeries, medications, durable medical equipment, formula, and occupational and physical therapies. Even more importantly, it provides coverage for home nursing, allowing Carter to maintain the same two independent nurses for the past 12 years.

Medicaid allows Carter’s mother, Kathy, to work part time and take care of her other children. As Kathy says, “Without these programs, despite both of us working, my husband and I would be financially bankrupt and our son would have to go without many of the surgeries, medications, and supplies that improve his quality of life.”

Johnny

Johnny is an adorable little boy who is the only person in the United States diagnosed with Maple Syrup Urine Disease (a metabolic disorder) and Cystic Fibrosis. Like many children with complex medical conditions, Johnny has both private insurance and secondary Medicaid, through a state-based loophole in Pennsylvania that ensures children with extraordinary medical needs have access to Medicaid.

While private insurance pays the bulk of his expenses, Medicaid covers special medications related to his rare condition and other special therapies. It also covers his substantial out-of-pocket insurance expenses, such as copays and deductibles. His medications and therapies are life-saving for him, and without Medicaid, he would not have access to them.

Simply put, Medicaid keeps him alive.

Ikaika

Ikaika is diagnosed with CHARGE association, a genetic condition that comes with a wide range of congenital medical conditions. He also was born with a hole between his esophagus and trachea, has a feeding tube for nutrition, and had a tracheostomy tube to help him breathe for the first eight years of his life. Currently, Ikaika has private insurance plus a secondary Medicaid waiver, due to his extensive medical needs.

During the time Ikaika had his trach, Medicaid paid for home nursing care, allowing his mother to return to work full time. Medicaid also covers his school-based nursing services, his therapies, his feeding therapy, his     feeding tube formula, and his feeding tube supplies, all of which are not covered by his private insurance. In addition, Medicaid pays the bulk of the cost for his specialized bone conduction hearing aids. If he didn’t have Medicaid, he would be denied the fundamental right to hear. His family would literally be drowning in debt from his uncovered medical expenses.

Ikaika will likely outgrow many of his medical needs as he gets older, and will grow up to attend college, have a family, and pay taxes. As his mother Amanda says, “Ikaika is thriving and growing into a caring, responsible, co ntributing citizen of our country and the world.”

Medicaid allows Ikaika to hear, attend school, and thrive!

Jojo

Born with complex congenital heart defects and heterotaxy syndrome, Jojo was previously covered by private insurance. But the severity of his medical needs forced his mother Elizabeth to leave her job, which left h im uninsured. Thankfully, he was able to receive Medicaid plus additional services through California Children’s Services (CCS), a special program for children with qualifying medical diagnoses.

Currently, Medicaid pays for his primary care, specialty care, surgeries, hospitals stays, feeding tube, formula, physical therapy, and developmental therapy. Jojo is able to have all his need s me t between Medicaid and CCS.

As his mother says, “Medicaid has allowed Jojo to not only survive, but thrive, because it means we don’t have to worry about how to afford quality care. Caring for a medically complex child is stressful enough as it is, but the Medicaid program has given us some peace of mind.”

Mason

Mason was a charming young man adopted from foster care, who passed away in 2015. He was diagnosed with cerebral palsy, and was nonverbal, used a wheelchair, and had a feeding tube. Like many foster kids with complex medical conditions, Mason had been hard to place, and did not find a permanent home until age six. His adoption was only possible because it came with a guarantee of Medicaid coverage, which covered most all of his medical expenses.

He participated in a special Medicaid program called Consumer Directed Community Supports that allowed his family to purchase necessary medical equipment, helped to make his home wheelchair accessible, and paid for his feeding supplies, medical formula, diapers, and medications. In addition, this program paid for personal care aide hours, allowing his mother to continue working part time. Medicaid also helped the family with travel expenses, which w ere especially important when Mason was hospitalized for months four hours away from home in the last months of his life.

Medicaid allowed Mason to have an adoptive family for the last two years of his life.

Miracle

Miracle is exactly what her name describes—a miracle child. Diagnosed with VACTERL Syndrome, a collection of congenital defects that affect almost every body system, Miracle has many medical needs that cannot be met by insurance. She is covered by both private insurance and Medicaid. For example, she requires a feeding tube, as well as ongoing feeding tube supplies and formula, but her private insurance does not cover these expenses. Medicaid also cove rs her home-based therapies, such as physical and speech therapy.

As her mother Destiny says, “Medicaid gives us less stress knowing we won’t be in dire financial situations with household and medical bills.” Miracle’s needs require around-the-clock attention, but Medicaid makes it possible for their entire family to live healthy, productive lives, with lots of love and attention.

Medicaid helps Miracle’s family to avoid financial ruin.

Emma and Lily

Identical twins Emma and Lily were born with a mosaic form of Down syndrome that affects them very differently. While both girls have fantastic private insurance, they would still have hundreds to thousands of dollars of medical and therapy bills per month without Medicaid.

Initially, both girls had Medicaid, but now only one requires it due to her ongoing medical needs. It pays for her occupational therapy, speech therapy, and physical therapy. It has also helped cover the costs of specialty care, including visits to an endocrinologist, ophthalmologist, audiologist, and feeding specialist. Finally, Medicaid has paid for important home medical equipment, such as a nebulizer, that keeps one twin with ongoing lung infection issues at home instead of in the ER or hospitalized.

Medicaid means that Emma and Lily’s mother Lauren is financially able to stay at home to care for them, taking them to medical visits and being available for weekly therapies. As Lauren says, “It helps us to thrive as a family and get wonderful medical care and therapy for our daughters!”

Aiden

Aiden has an excellent private insurance plan, but it still does not meet his needs. Diagnosed with cerebral palsy, alpha thalassemia x-linked mental retardation, and many associated medical conditions, he requires multiple therapies and personal care services that his insurance does not cover. Fortunately, his medical condition qualifies him for a Texas Medicaid waiver program, allowing him to have access to Medicaid coverage for therapies, personal care services, and other benefits.

Aiden has recently seen cuts to his Medicaid services, since Texas received a waiver of a federal law that now allows Aiden to be placed in a managed care program. His state has already cut his therapies by two hours per week. It has already become challenging to cut through the red tape in order to receive the services he needs.

Aiden’s story shows the importance of a strong Medicaid program with appropriate federal regulations that make sure he receives all his medically necessary care.

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