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Duke Health Sector Management Second Annual Medical Innovations and Strategies Conference 2010 Podcast Preview Series

An Interview with Richard Migliori, MD

Listen to the Interview:

Read the Transcript:


Dr. Richard Migliori, MD
Chief Medical Officer, OptumHealth

Aaron B. Joslow
Duke Health Sector Management MBA Program


Aaron Joslow

Hello, everyone. The Duke Health Sector Management Program is on the cutting edge of new wireless and healthcare technology. Its upcoming conference on consumer healthcare and wireless technologies is bringing together the best minds in business, education and information systems to discuss one of the most pressing concerns in public policy.

Joining us to the preview the conference is Dr. Richard Migliori, the Chief Medical Officer at Optum Health and one of the event's featured speakers. Welcome, Dr. Migliori.

My first question to you is: what makes wireless technology an issue of great concern to the health management community?

Dr. Richard Migliori

I describe it not as much as concern as an opportunity.

Two things in healthcare that are important, and have always been a challenge within the healthcare space. One of which is getting people engaged, and in order to do that, we have to be part of their life. Wireless is clearly becoming part of more and more people's lives. So, it's a real opportunity for us and it to be finding our way into their lives.

The second component is… is wireless is a great medium for us to provide them with something they've never had, which is very important, which is a personalized decision support system. And the wireless technology enables both of those things, which could be transformational in healthcare.

Aaron Joslow

Terrific. And my next question for you is: can you give a specific example or two of how wireless technology is used in the marketplace today?

Dr. Richard Migliori

Well, let's talk about the wireless component itself.

We have, from time to time, the need to reach out to people who are enrolled in a healthcare program to provide them words with encouragement, to provide them alerts, to provide them with coaching and to provide them with assistance in making choices about their… either their health and lifestyle, or the way in which they're pursuing healthcare, etc.

But many people, particularly in the commercially insured environment, are employed. And in order to reach those individuals, we're typically trying to reach them at night or before work and all kind of awkward times. By relying on a wireless technology, a technology that many of them carry with them in the course of their day-to-day work, or in their day-to-day life tasks, we have the opportunity to reach them at a time which is perhaps more convenient, and certainly with greater ease of access and more productivity.

The technology that we rely upon in order to engage these people, however, is really the heart and soul of this. It's a decision support system that's personalized for them. If you look at what drives the American healthcare consumption, you realize that [it] is [driven by] the day-to-day decisions made by patients and their physicians in the exam rooms, in the emergency rooms, in the operating rooms, etc. across America.

But many times those decisions are influenced by three factors that can be challenging.

First of which is they don't have all available data about those individuals. The second is is that the science of medicine is rapidly and wonderfully evolving. Unfortunately, the ability for a practicing physician to keep pace with it can be a challenge. The third area of the challenge is the decisions that are made by patients and their physicians is [limited by] their ability to track progress.

Many times after a decision is made, the likelihood that decision will be followed through, or there'll be compliance, is challenged by such things such as in pharmaceuticals. About one in five people who are given a prescription never fill that prescription. Likewise, of those people who do fill those prescriptions, 50 percent of them will stop taking them on their own at about 6 months, by about 6 months rather.

And when you look at those 2 issues, many times a physician is no longer aware that prescription adherence is not taking place--that people are not following those same guidances.

What we have done is to provide solutions to the issue of patient availability, patient data availability, the currency of the evidence-based medicine that guides those physicians, and our ability to track those decisions as they are made, and once the patient leaves the exam room, to feed back to both the patient and to their physician the progress that's being made.

What we've done is we've built something called eSync. It's a platform that we use that constantly looks at the entire population that we serve looking for opportunities to cause a decision to be made.

And the way the tool works is it looks at several streams of data, including patient claims data, pharmacy data, laboratory data, health assessment--and there's a lot of these other healthcare datasets of the whole population--and then builds a composite view of each individual that we serve. That composite view is then compared to scientific rules from evidence-based medicine, current science, if you will.

Some 950 rules that will generate for each individual a list of healthcare opportunities, tasks, if you will, in prioritized fashion that people can use on their own to continue to improve their health and wellness.

Well, the real gem within eSync is our ability to take those messages and to personalize them - not only for the way in which the message generated, or the content that's being offered, or the language being used but also through the media by which it's conveyed.

An active person, a power user on wireless tools, can have access to their information sent directly to them through their smartphone, or through even an SMS texting device, that allows them to recognize that there is an opportunity to be undertaken and to get directions on how to clarify what that opportunity [is], and ways in which they can track it.

The other thing we do with that same information is to share it with their physician. So, both a patient and physician are working off the same to-do list. And what we find when we've done that the likelihood that people follow through is improved some 20 percent.

So essentially, wireless has enabled us to take our eSync decision support platform and to make it work for each individual.

Aaron Joslow

That's terrific. And moving on to another topic, what do you think is the biggest misperception or blind spot people have when joining this wireless conversation?

Dr. Richard Migliori

I think that the issue is that people as yet may not be aware, first off about the availability of such personalized information for their use, nor how to access it.

And I think the biggest challenge they face is wireless. It's just the absence of awareness of this capability not to provide people with these personalized messages. The issue itself, I don't think, is a matter of difficulty with utility. These are pretty simple devices, with pretty intuitive messaging capabilities. It's just an absence of awareness that this kind of support is there and available to them.

The second is the issue of data privacy and data security. These are highly secure and highly privatized and well protected data transmissions that go without… that can go without restriction to the individual, but in a safe and secure way, and with the patient's permission also to include their physician. But I think the challenge there is really giving people confidence and awareness that this very personalized data is secure as it's transmitted to them--that we only share this information when we have confidence about the security of the communicating channel.

Aaron Joslow

Very good. And my final question for you, Dr. Migliori, is: what makes the Duke Health Sector Management Consumer Healthcare and Wireless Technologies Conference appealing?

Dr. Richard Migliori

Oh, we see this as appealing because it brings together sectors that typically don't talk to each other.

We have, for a long time, been able to build and hone our capabilities on understanding what needs to be done by individuals through all of our healthcare data acquisition and analytic capabilities and talents.

As we start looking to other sectors that have been closer to providing consumer tools for greater utility and communication, we've become excited to realize how quickly and readily adaptable our content is through their assistance.

And so that we don't have to learn by ourselves and on our own. Joining conferences such as this gives us the opportunity to share information about what the technology brings in terms of capability and ways in which we can adapt it to bring more effective content for healthcare.

Aaron Joslow

Thank you so much, Dr. Migliori, for that insight.

This concludes our podcast preview of the Duke Health Sector Management Program's Conference. To register or learn more, please visit us online. Thank you for listening, and we hope to see you September 15th on the Duke Campus at the Second Annual Medical Innovation and Strategies Conference on Consumer Healthcare and Wireless Technologies.

Upcoming conferences

Previous conferences

  • Delivering on the Value Proposition for Connectivity and Health IT – April 23, 2009

This conference focused on connectivity and industry strategies for health information technology in response to related provisions in the American Recovery and Reinvestment Act of 2009 (ARRA). Discussions helped raise the awareness and the need for a clinical informatics management program. Participants included informaticists, healthcare providers, vendors, payers, policymakers, and educators. Among the companies represented were IBM Healthcare and Life Sciences, McKesson, Perot Systems, and Siemens Medical Solutions.

  • Medical Innovation and Strategies Conference, Wireless and Consumer Healthcare – September 23, 2009

This meeting focused on identifying and discussing fundamental drivers of connectivity in healthcare IT and ways the Fuqua community can participate in the development and implementation of wireless and consumer healthcare. Participants included healthcare providers, members of the medical device industry, innovators in wireless healthcare, and venture/investment professionals and students of Fuqua’s Health Sector Management program. Among the companies represented were IBM Healthcare and Life Sciences, Microsoft Corporation, General Electric/NBC Universal, and Medtronic.

For more information, please contact:

Ana Quinn
Associate Director, Business Development
Health Sector Management
Phone: 919‐660‐7900