a cloud-based and more data-focused environment was going to be needed that required updating the authorities and the approach of the Office of the National Coordinator. It [also] requires the private sector to really lean in and make that a reality, because technology is less of the issue. [It’s] more about culture and incentives.
I think we are a few stitches away. I think of it like a fabric: weaving together the various interoperability platforms from the public and private sectors to have a “network of networks” model. You don’t have to recreate an IT infrastructure. Let’s weave together what’s already there.
X: One term that seems to be on the lips of many healthtech investors and entrepreneurs today is “social determinants” of health. Can you provide a definition and some examples of social determinants, and discuss why the concept seems to be so in vogue?
KD: The social determinants of health are reflective of where we live, learn, work, and play, and the environment in which we do these things. Examples would be the built environment—including housing and sidewalks and public transportation—or economic opportunity, or educational systems.
Data, [both] historically more recently, is telling us over and over again that the bulk of influence on your health and your life expectancy is your ZIP code, and not your genetic code. It’s about where you’re going to school and living and the relationships that you have. The healthcare system has a role to play in addressing the broad determinants of health. But it’s not the only actor.
I want to give you a historical example about social determinants and health. We think about tuberculosis as a terrible disease that was finally cured by great drugs that were able to treat people and reduce transmission. But in reality, housing policy made the biggest difference in reducing tuberculosis transmission rates. As we spaced people out and had better ventilation, and particularly tenements, that was the way we really tackled an important public health challenge. The idea that there’s a social determinant like housing that’s more influential on somebody’s health than, say, a drug for tuberculosis, is true in almost every disease.
The world is reawakening to the importance of this. For many in the healthcare system, it has to do with the bottom line. Healthcare systems and [insurers] are seeing that some 5 percent of patients account for half of their [total] costs. When you really begin to understand those patients, you see that it’s not just that they have a lot of medical needs, but they have a lot of social needs. They’re low-income. They may not have good housing. They may not have access to food at all, much less healthy food.
The healthcare system is now reaching out to social services, the business community, elected officials, and urban planners to say, “Let’s create a healthy environment, give people an opportunity to make healthy choices, and to mitigate not only the impact on health in today’s world but try to do more in prevention.”
This is spurring all kinds of activity in the payment world and models of care delivery, but also in technology. The VC community is really on fire about how to not only collect but [also] better use information about social determinants so that we can target high-risk folks and get them help that they need.
X: What are some of the venture-backed startups developing tools that could improve the status quo?
KD: There’s a suite of companies that are doing some work in trying to help identify and
