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In the next 30 years, virtually all net population growth will occur in urban regions of developing countries. At the same time, worldwide food production will become increasingly limited by the availability of land, water, and energy. These constraints will be further worsened by climate change and the expected addition of two billion people to today’s four billion now living in urban regions. Meanwhile, current urban food ecosystems in the developing world are inefficient and critically inadequate to meet the challenges of the future.
Combined, these trends could have catastrophic economic and political consequences. A new path forward for urban food ecosystems needs to be found. But what is that path?
New technologies, coupled with new business models and supportive government policies, can create more resilient urban food ecosystems in the coming decades. These tech-enabled systems can sustainably link rural, peri-urban (areas just outside cities), and urban producers and consumers, increase overall food production, and generate opportunities for new businesses and jobs (Figure 1).
Figure 1: The urban food value chain nodes from rural, peri-urban and urban producers
to servicing end customers in urban and peri-urban markets.
Here’s a glimpse of the changes technology may bring to the systems feeding cities in the future.
A technology-linked urban food ecosystem would create unprecedented opportunities for small farms to reach wider markets and progress from subsistence farming to commercially producing niche cash crops and animal protein, such as poultry, fish, pork, and insects.
Meanwhile, new opportunities within cities will appear with the creation of vertical farms and other controlled-environment agricultural systems as well as production of plant-based and 3D printed foods and cultured meat. Uberized facilitation of production and distribution of food will reduce bottlenecks and provide new business opportunities and jobs. Off-the-shelf precision agriculture technology will increasingly be the new norm, from smallholders to larger producers.
As part of Agricultural Revolution 4.0, all this will be integrated into the larger collaborative economy—connected by digital platforms, the cloud, and the Internet of Things and powered by artificial intelligence. It will more efficiently and effectively use resources and people to connect the nexus of food, water, energy, nutrition, and human health. It will also aid in the development of a circular economy that is designed to be restorative and regenerative, minimizing waste and maximizing recycling and reuse to build economic, natural, and social capital.
In short, technology will enable transformation of urban food ecosystems, from expanded production in cities to more efficient and inclusive distribution and closer connections with rural farmers. Here’s a closer look at seven tech-driven trends that will help feed tomorrow’s cities.
1. Worldwide Connectivity: Information, Learning, and Markets
Connectivity from simple cell phone SMS communication to internet-enabled smartphones and cloud services are providing platforms for the increasingly powerful technologies enabling development of a new agricultural revolution. Internet connections currently reach more than 4 billion people, about 55% of the global population. That number will grow fast in coming years.
These information and communications technologies connect food producers to consumers with just-in-time data, enhanced good agricultural practices, mobile money and credit, telecommunications, market information and merchandising, and greater transparency and traceability of goods and services throughout the value chain. Text messages on mobile devices have become the one-stop-shop for small farmers to place orders, gain technology information for best management practices, and access market information to increase profitability.
Hershey’s CocoaLink in Ghana, for example, uses text and voice messages with cocoa industry experts and small farm producers. Digital Green is a technology-enabled communication system in Asia and Africa to bring needed agricultural and management practices to small farmers in their own language by filming and recording successful farmers in their own communities. MFarm is a mobile app that connects Kenyan farmers with urban markets via text messaging.
2. Blockchain Technology: Greater Access to Basic Financial Services and Enhanced Food Safety
Gaining access to credit and executing financial transactions have been persistent constraints for small farm producers. Blockchain promises to help the unbanked access basic financial services.
The Gates Foundation has released an open source platform, Mojaloop, to allow software developers and banks and financial service providers to build secure digital payment platforms at scale. Mojaloop software uses more secure blockchain technology to enable urban food system players in the developing world to conduct business and trade. The free software reduces complexity and cost in building payment platforms to connect small farmers with customers, merchants, banks, and mobile money providers. Such digital financial services will allow small farm producers in the developing world to conduct business without a brick-and-mortar bank.
Blockchain is also important for traceability and transparency requirements to meet food regulatory and consumer requirement during the production, post-harvest, shipping, processing and distribution to consumers. Combining blockchain with RFID technologies also will enhance food safety.
3. Uberized Services: On-Demand Equipment, Storage, and More
Uberized services can advance development of the urban food ecosystem across the spectrum, from rural to peri-urban to urban food production and distribution. Whereas Uber and Airbnb enable sharing of rides and homes, the model can be extended in the developing world to include on-demand use of expensive equipment, such as farm machinery, or storage space.
This includes uberization of planting and harvesting equipment (Hello Tractor), transportation vehicles, refrigeration facilities for temporary storage of perishable product, and “cloud kitchens” (EasyAppetite in Nigeria, FoodCourt in Rwanda, and Swiggy and Zomto in India) that produce fresh meals to be delivered to urban customers, enabling young people with motorbikes and cell phones to become entrepreneurs or contractors delivering meals to urban customers.
Another uberized service is marketing and distributing “ugly food” or imperfect produce to reduce food waste. About a third of the world’s food goes to waste, often because of appearance; this is enough to feed two billion people. Such services supply consumers with cheaper, nutritious, tasty, healthy fruits and vegetables that would normally be discarded as culls due to imperfections in shape or size.
4. Technology for Producing Plant-Based Foods in Cities
We need to change diet choices through education and marketing and by developing tasty plant-based substitutes. This is not only critical for environmental sustainability, but also offers opportunities for new businesses and services. It turns out that current agricultural production systems for “red meat” have a far greater detrimental impact on the environment than automobiles.
There have been great advances in plant-based foods, like the Impossible Burger and Beyond Meat, that can satisfy the consumer’s experience and perception of meat. Rather than giving up the experience of eating red meat, technology is enabling marketable, attractive plant-based products that can potentially drastically reduce world per capita consumption of red meat.
5. Cellular Agriculture, Lab-Grown Meat, and 3D Printed Food
Lab-grown meat, literally meat grown from cultured cells, may radically change where and how protein and food is produced, including the cities where it is consumed. There is a wide range of innovative alternatives to traditional meats that can supplement the need for livestock, farms, and butchers. The history of innovation is about getting rid of the bottleneck in the system, and with meat, the bottleneck is the animal. Finless Foods is a new company trying to replicate fish fillets, for example, while Memphis meats is working on beef and poultry.
3D printing or additive manufacturing is a “general purpose technology” used for making, plastic toys, human tissues, aircraft parts, and buildings. 3D printing can also be used to convert alternative ingredients such as proteins from algae, beet leaves, or insects into tasty and healthy products that can be produced by small, inexpensive printers in home kitchens. The food can be customized for individual health needs as well as preferences. 3D printing can also contribute to the food ecosystem by making possible on-demand replacement parts—which are badly needed in the developing world for tractors, pumps, and other equipment. Catapult Design 3D prints tractor replacement parts as well as corn shellers, cart designs, prosthetic limbs, and rolling water barrels for the Indian market.
6. Alt Farming: Vertical Farms to Produce Food in Urban Centers
Urban food ecosystem production systems will rely not only on field-grown crops, but also on production of food within cities. There are a host of new, alternative production systems using “controlled environmental agriculture.” These include low-cost, protected poly hoop houses, greenhouses, roof-top and sack/container gardens, and vertical farming in buildings using artificial lighting. Vertical farms enable year-round production of selected crops, regardless of weather—which will be increasingly important in response to climate change—and without concern for deteriorating soil conditions that affect crop quality and productivity. AeroFarms claims 390 times more productivity per square foot than normal field production.
7. Biotechnology and Nanotechnology for Sustainable Intensification of Agriculture
CRISPR is a promising gene editing technology that can be used to enhance crop productivity while avoiding societal concerns about GMOs. CRISPR can accelerate traditional breeding and selection programs for developing new climate and disease-resistant, higher-yielding, nutritious crops and animals.
Plant-derived coating materials, developed with nanotechnology, can decrease waste, extend shelf-life and transportability of fruits and vegetables, and significantly reduce post-harvest crop loss in developing countries that lack adequate refrigeration. Nanotechnology is also used in polymers to coat seeds to increase their shelf-life and increase their germination success and production for niche, high-value crops.
Putting It All Together
The next generation “urban food industry” will be part of the larger collaborative economy that is connected by digital platforms, the cloud, and the Internet of Things. A tech-enabled urban food ecosystem integrated with new business models and smart agricultural policies offers the opportunity for sustainable intensification (doing more with less) of agriculture to feed a rapidly growing global urban population—while also creating viable economic opportunities for rural and peri-urban as well as urban producers and value-chain players.
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Recently, I picked up Kai-Fu Lee’s newest book, AI Superpowers.
Kai-Fu Lee is one of the most plugged-in AI investors on the planet, managing over $2 billion between six funds and over 300 portfolio companies in the US and China.
Drawing from his pioneering work in AI, executive leadership at Microsoft, Apple, and Google (where he served as founding president of Google China), and his founding of VC fund Sinovation Ventures, Lee shares invaluable insights about:
The four factors driving today’s AI ecosystems;
China’s extraordinary inroads in AI implementation;
Where autonomous systems are headed;
How we’ll need to adapt.
With a foothold in both Beijing and Silicon Valley, Lee looks at the power balance between Chinese and US tech behemoths—each turbocharging new applications of deep learning and sweeping up global markets in the process.
In this post, I’ll be discussing Lee’s “Four Waves of AI,” an excellent framework for discussing where AI is today and where it’s going. I’ll also be featuring some of the hottest Chinese tech companies leading the charge, worth watching right now.
I’m super excited that this Tuesday, I’ve scored the opportunity to sit down with Kai-Fu Lee to discuss his book in detail via a webinar.
With Sino-US competition heating up, who will own the future of technology?
Let’s dive in.
The First Wave: Internet AI
In this first stage of AI deployment, we’re dealing primarily with recommendation engines—algorithmic systems that learn from masses of user data to curate online content personalized to each one of us.
Think Amazon’s spot-on product recommendations, or that “Up Next” YouTube video you just have to watch before getting back to work, or Facebook ads that seem to know what you’ll buy before you do.
Powered by the data flowing through our networks, internet AI leverages the fact that users automatically label data as we browse. Clicking versus not clicking; lingering on a web page longer than we did on another; hovering over a Facebook video to see what happens at the end.
These cascades of labeled data build a detailed picture of our personalities, habits, demands, and desires: the perfect recipe for more tailored content to keep us on a given platform.
Currently, Lee estimates that Chinese and American companies stand head-to-head when it comes to deployment of internet AI. But given China’s data advantage, he predicts that Chinese tech giants will have a slight lead (60-40) over their US counterparts in the next five years.
While you’ve most definitely heard of Alibaba and Baidu, you’ve probably never stumbled upon Toutiao.
Starting out as a copycat of America’s wildly popular Buzzfeed, Toutiao reached a valuation of $20 billion by 2017, dwarfing Buzzfeed’s valuation by more than a factor of 10. But with almost 120 million daily active users, Toutiao doesn’t just stop at creating viral content.
Equipped with natural-language processing and computer vision, Toutiao’s AI engines survey a vast network of different sites and contributors, rewriting headlines to optimize for user engagement, and processing each user’s online behavior—clicks, comments, engagement time—to curate individualized news feeds for millions of consumers.
And as users grow more engaged with Toutiao’s content, the company’s algorithms get better and better at recommending content, optimizing headlines, and delivering a truly personalized feed.
It’s this kind of positive feedback loop that fuels today’s AI giants surfing the wave of internet AI.
The Second Wave: Business AI
While internet AI takes advantage of the fact that netizens are constantly labeling data via clicks and other engagement metrics, business AI jumps on the data that traditional companies have already labeled in the past.
Think banks issuing loans and recording repayment rates; hospitals archiving diagnoses, imaging data, and subsequent health outcomes; or courts noting conviction history, recidivism, and flight.
While we humans make predictions based on obvious root causes (strong features), AI algorithms can process thousands of weakly correlated variables (weak features) that may have much more to do with a given outcome than the usual suspects.
By scouting out hidden correlations that escape our linear cause-and-effect logic, business AI leverages labeled data to train algorithms that outperform even the most veteran of experts.
Apply these data-trained AI engines to banking, insurance, and legal sentencing, and you get minimized default rates, optimized premiums, and plummeting recidivism rates.
While Lee confidently places America in the lead (90-10) for business AI, China’s substantial lag in structured industry data could actually work in its favor going forward.
In industries where Chinese startups can leapfrog over legacy systems, China has a major advantage.
Take Chinese app Smart Finance, for instance.
While Americans embraced credit and debit cards in the 1970s, China was still in the throes of its Cultural Revolution, largely missing the bus on this technology.
Fast forward to 2017, and China’s mobile payment spending outnumbered that of Americans’ by a ratio of 50 to 1. Without the competition of deeply entrenched credit cards, mobile payments were an obvious upgrade to China’s cash-heavy economy, embraced by 70 percent of China’s 753 million smartphone users by the end of 2017.
But by leapfrogging over credit cards and into mobile payments, China largely left behind the notion of credit.
And here’s where Smart Finance comes in.
An AI-powered app for microfinance, Smart Finance depends almost exclusively on its algorithms to make millions of microloans. For each potential borrower, the app simply requests access to a portion of the user’s phone data.
On the basis of variables as subtle as your typing speed and battery percentage, Smart Finance can predict with astounding accuracy your likelihood of repaying a $300 loan.
Such deployments of business AI and internet AI are already revolutionizing our industries and individual lifestyles. But still on the horizon lie two even more monumental waves— perception AI and autonomous AI.
The Third Wave: Perception AI
In this wave, AI gets an upgrade with eyes, ears, and myriad other senses, merging the digital world with our physical environments.
As sensors and smart devices proliferate through our homes and cities, we are on the verge of entering a trillion-sensor economy.
Companies like China’s Xiaomi are putting out millions of IoT-connected devices, and teams of researchers have already begun prototyping smart dust—solar cell- and sensor-geared particulates that can store and communicate troves of data anywhere, anytime.
As Kai-Fu explains, perception AI “will bring the convenience and abundance of the online world into our offline reality.” Sensor-enabled hardware devices will turn everything from hospitals to cars to schools into online-merge-offline (OMO) environments.
Imagine walking into a grocery store, scanning your face to pull up your most common purchases, and then picking up a virtual assistant (VA) shopping cart. Having pre-loaded your data, the cart adjusts your usual grocery list with voice input, reminds you to get your spouse’s favorite wine for an upcoming anniversary, and guides you through a personalized store route.
While we haven’t yet leveraged the full potential of perception AI, China and the US are already making incredible strides. Given China’s hardware advantage, Lee predicts China currently has a 60-40 edge over its American tech counterparts.
Now the go-to city for startups building robots, drones, wearable technology, and IoT infrastructure, Shenzhen has turned into a powerhouse for intelligent hardware, as I discussed last week. Turbocharging output of sensors and electronic parts via thousands of factories, Shenzhen’s skilled engineers can prototype and iterate new products at unprecedented scale and speed.
With the added fuel of Chinese government support and a relaxed Chinese attitude toward data privacy, China’s lead may even reach 80-20 in the next five years.
Jumping on this wave are companies like Xiaomi, which aims to turn bathrooms, kitchens, and living rooms into smart OMO environments. Having invested in 220 companies and incubated 29 startups that produce its products, Xiaomi surpassed 85 million intelligent home devices by the end of 2017, making it the world’s largest network of these connected products.
One KFC restaurant in China has even teamed up with Alipay (Alibaba’s mobile payments platform) to pioneer a ‘pay-with-your-face’ feature. Forget cash, cards, and cell phones, and let OMO do the work.
The Fourth Wave: Autonomous AI
But the most monumental—and unpredictable—wave is the fourth and final: autonomous AI.
Integrating all previous waves, autonomous AI gives machines the ability to sense and respond to the world around them, enabling AI to move and act productively.
While today’s machines can outperform us on repetitive tasks in structured and even unstructured environments (think Boston Dynamics’ humanoid Atlas or oncoming autonomous vehicles), machines with the power to see, hear, touch and optimize data will be a whole new ballgame.
Think: swarms of drones that can selectively spray and harvest entire farms with computer vision and remarkable dexterity, heat-resistant drones that can put out forest fires 100X more efficiently, or Level 5 autonomous vehicles that navigate smart roads and traffic systems all on their own.
While autonomous AI will first involve robots that create direct economic value—automating tasks on a one-to-one replacement basis—these intelligent machines will ultimately revamp entire industries from the ground up.
Kai-Fu Lee currently puts America in a commanding lead of 90-10 in autonomous AI, especially when it comes to self-driving vehicles. But Chinese government efforts are quickly ramping up the competition.
Already in China’s Zhejiang province, highway regulators and government officials have plans to build China’s first intelligent superhighway, outfitted with sensors, road-embedded solar panels and wireless communication between cars, roads and drivers.
Aimed at increasing transit efficiency by up to 30 percent while minimizing fatalities, the project may one day allow autonomous electric vehicles to continuously charge as they drive.
A similar government-fueled project involves Beijing’s new neighbor Xiong’an. Projected to take in over $580 billion in infrastructure spending over the next 20 years, Xiong’an New Area could one day become the world’s first city built around autonomous vehicles.
Baidu is already working with Xiong’an’s local government to build out this AI city with an environmental focus. Possibilities include sensor-geared cement, computer vision-enabled traffic lights, intersections with facial recognition, and parking lots-turned parks.
Lastly, Lee predicts China will almost certainly lead the charge in autonomous drones. Already, Shenzhen is home to premier drone maker DJI—a company I’ll be visiting with 24 top executives later this month as part of my annual China Platinum Trip.
Named “the best company I have ever encountered” by Chris Anderson, DJI owns an estimated 50 percent of the North American drone market, supercharged by Shenzhen’s extraordinary maker movement.
While the long-term Sino-US competitive balance in fourth wave AI remains to be seen, one thing is certain: in a matter of decades, we will witness the rise of AI-embedded cityscapes and autonomous machines that can interact with the real world and help solve today’s most pressing grand challenges.
Webinar with Dr. Kai-Fu Lee: Dr. Kai-Fu Lee — one of the world’s most respected experts on AI — and I will discuss his latest book AI Superpowers: China, Silicon Valley, and the New World Order. Artificial Intelligence is reshaping the world as we know it. With U.S.-Sino competition heating up, who will own the future of technology? Register here for the free webinar on September 4th, 2018 from 11:00am–12:30pm PST.
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OptoForce Sensors Providing Industrial Robots with
a “Sense of Touch” to Advance Manufacturing Automation
Global efforts to expand the capabilities of industrial robots are on the rise, as the demand from manufacturing companies to strengthen their operations and improve performance grows.
Hungary-based OptoForce, with a North American office in Charlotte, North Carolina, is one company that continues to support organizations with new robotic capabilities, as evidenced by its several new applications released in 2017.
The company, a leading robotics technology provider of multi-axis force and torque sensors, delivers 6 degrees of freedom force and torque measurement for industrial automation, and provides sensors for most of the currently-used industrial robots.
It recently developed and brought to market three new applications for KUKA industrial robots.
The new applications are hand guiding, presence detection, and center pointing and will be utilized by both end users and systems integrators. Each application is summarized below and what they provide for KUKA robots, along with video demonstrations to show how they operate.
Photo By: www.optoforce.com
Hand Guiding: With OptoForce’s Hand Guiding application, KUKA robots can easily and smoothly move in an assigned direction and selected route. This video shows specifically how to program the robot for hand guiding.
Presence Detection: This application allows KUKA robots to detect the presence of a specific object and to find the object even if it has moved. Visit here to learn more about presence detection.
Center Pointing: With this application, the OptoForce sensor helps the KUKA robot find the center point of an object by providing the robot with a sense of touch. This solution also works with glossy metal objects where a vision system would not be able to define its position. This video shows in detail how the center pointing application works.
The company’s CEO explained how these applications help KUKA robots and industrial automation.
Photo By: www.optoforce.com
“OptoForce’s new applications for KUKA robots pave the way for substantial improvements in industrial automation for both end users and systems integrators,” said Ákos Dömötör, CEO of OptoForce. “Our 6-axis force/torque sensors are combined with highly functional hardware and a comprehensive software package, which include the pre-programmed industrial applications. Essentially, we’re adding a ‘sense of touch’ to KUKA robot arms, enabling these robots to have abilities similar to a human hand, and opening up numerous new capabilities in industrial automation.”
Along with these new applications recently released for KUKA robots, OptoForce sensors are also being used by various companies on numerous industrial robots and manufacturing automation projects around the world. Examples of other uses include: path recording, polishing plastic and metal, box insertion, placing pins in holes, stacking/destacking, palletizing, and metal part sanding.
Specifically, some of the projects current underway by companies include: a plastic parting line removal; an obstacle detection for a major car manufacturing company; and a center point insertion application for a car part supplier, where the task of the robot is to insert a mirror, completely centered, onto a side mirror housing.
For more information, visit www.optoforce.com.
This post was provided by: OptoForce
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Robotiq Updates FT 300 Sensitivity For High Precision Tasks With Universal RobotsForce Torque Sensor feeds data to Universal Robots force mode
Quebec City, Canada, November 13, 2017 – Robotiq launches a 10 times more sensitive version of its FT 300 Force Torque Sensor. With Plug + Play integration on all Universal Robots, the FT 300 performs highly repeatable precision force control tasks such as finishing, product testing, assembly and precise part insertion.
This force torque sensor comes with an updated free URCap software able to feed data to the Universal Robots Force Mode. “This new feature allows the user to perform precise force insertion assembly and many finishing applications where force control with high sensitivity is required” explains Robotiq CTO Jean-Philippe Jobin*.
The URCap also includes a new calibration routine. “We’ve integrated a step-by-step procedure that guides the user through the process, which takes less than 2 minutes” adds Jobin. “A new dashboard also provides real-time force and moment readings on all 6 axes. Moreover, pre-built programming functions are now embedded in the URCap for intuitive programming.”
See some of the FT 300’s new capabilities in the following demo videos:
#1 How to calibrate with the FT 300 URCap Dashboard
#2 Linear search demo
#3 Path recording demo
Visit the FT 300 webpage or get a quote here
Get the FT 300 specs here
Get more info in the FAQ
Get free Skills to accelerate robot programming of force control tasks.
Get free robot cell deployment resources on leanrobotics.org
* Available with Universal Robots CB3.1 controller only
Robotiq’s Lean Robotics methodology and products enable manufacturers to deploy productive robot cells across their factory. They leverage the Lean Robotics methodology for faster time to production and increased productivity from their robots. Production engineers standardize on Robotiq’s Plug + Play components for their ease of programming, built-in integration, and adaptability to many processes. They rely on the Flow software suite to accelerate robot projects and optimize robot performance once in production.
Robotiq is the humans behind the robots: an employee-owned business with a passionate team and an international partner network.
David Maltais, Communications and Public Relations Coordinator
Press Release Provided by: Robotiq.Com
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Technology has the potential to solve some of our most intractable healthcare problems. In fact, it’s already doing so, with inventions getting us closer to a medical Tricorder, and progress toward 3D printed organs, and AIs that can do point-of-care diagnosis.
No doubt these applications of cutting-edge tech will continue to push the needle on progress in medicine, diagnosis, and treatment. But what if some of the healthcare hacks we need most aren’t high-tech at all?
According to Dr. Darshak Sanghavi, this is exactly the case. In a talk at Singularity University’s Exponential Medicine last week, Sanghavi told the audience, “We often think in extremely complex ways, but I think a lot of the improvements in health at scale can be done in an analog way.”
Sanghavi is the chief medical officer and senior vice president of translation at OptumLabs, and was previously director of preventive and population health at the Center for Medicare and Medicaid Innovation, where he oversaw the development of large pilot programs aimed at improving healthcare costs and quality.
“How can we improve health at scale, not for only a small number of people, but for entire populations?” Sanghavi asked. With programs that benefit a small group of people, he explained, what tends to happen is that the average health of a population improves, but the disparities across the group worsen.
“My mantra became, ‘The denominator is everybody,’” he said. He shared details of some low-tech but crucial fixes he believes could vastly benefit the US healthcare system.
1. Regulatory Hacking
Healthcare regulations are ultimately what drive many aspects of patient care, for better or worse. Worse because the mind-boggling complexity of regulations (exhibit A: the Affordable Care Act is reportedly about 20,000 pages long) can make it hard for people to get the care they need at a cost they can afford, but better because, as Sanghavi explained, tweaking these regulations in the right way can result in across-the-board improvements in a given population’s health.
An adjustment to Medicare hospitalization rules makes for a relevant example. The code was updated to state that if people who left the hospital were re-admitted within 30 days, that hospital had to pay a penalty. The result was hospitals taking more care to ensure patients were released not only in good health, but also with a solid understanding of what they had to do to take care of themselves going forward. “Here, arguably the writing of a few lines of regulatory code resulted in a remarkable decrease in 30-day re-admissions, and the savings of several billion dollars,” Sanghavi said.
2. Long-Term Focus
It’s easy to focus on healthcare hacks that have immediate, visible results—but what about fixes whose benefits take years to manifest? How can we motivate hospitals, regulators, and doctors to take action when they know they won’t see changes anytime soon?
“I call this the reality TV problem,” Sanghavi said. “Reality shows don’t really care about who’s the most talented recording artist—they care about getting the most viewers. That is exactly how we think about health care.”
Sanghavi’s team wanted to address this problem for heart attacks. They found they could reliably determine someone’s 10-year risk of having a heart attack based on a simple risk profile. Rather than monitoring patients’ cholesterol, blood pressure, weight, and other individual factors, the team took the average 10-year risk across entire provider panels, then made providers responsible for controlling those populations.
“Every percentage point you lower that risk, by hook or by crook, you get some people to stop smoking, you get some people on cholesterol medication. It’s patient-centered decision-making, and the provider then makes money. This is the world’s first predictive analytic model, at scale, that’s actually being paid for at scale,” he said.
3. Aligned Incentives
If hospitals are held accountable for the health of the communities they’re based in, those hospitals need to have the right incentives to follow through. “Hospitals have to spend money on community benefit, but linking that benefit to a meaningful population health metric can catalyze significant improvements,” Sanghavi said.
Darshak Sanghavi speaking at Singularity University’s 2017 Exponential Medicine Summit in San Diego, CA.
He used smoking cessation as an example. His team designed a program where hospitals were given a score (determined by the Centers for Disease Control and Prevention) based on the smoking rate in the counties where they’re located, then given monetary incentives to improve their score. Improving their score, in turn, resulted in better health for their communities, which meant fewer patients to treat for smoking-related health problems.
4. Social Determinants of Health
Social determinants of health include factors like housing, income, family, and food security. The answer to getting people to pay attention to these factors at scale, and creating aligned incentives, Sanghavi said, is “Very simple. We just have to measure it to start with, and measure it universally.”
His team was behind a $157 million pilot program called Accountable Health Communities that went live this year. The program requires all Medicare and Medicaid beneficiaries get screened for various social determinants of health. With all that data being collected, analysts can pinpoint local trends, then target funds to address the underlying problem, whether it’s job training, drug use, or nutritional education. “You’re then free to invest the dollars where they’re needed…this is how we can improve health at scale, with very simple changes in the incentive structures that are created,” he said.
5. ‘Securitizing’ Public Health
Sanghavi’s final point tied back to his discussion of aligning incentives. As misguided as it may seem, the reality is that financial incentives can make a huge difference in healthcare outcomes, from both a patient and a provider perspective.
Sanghavi’s team did an experiment in which they created outcome benchmarks for three major health problems that exist across geographically diverse areas: smoking, adolescent pregnancy, and binge drinking. The team proposed measuring the baseline of these issues then creating what they called a social impact bond. If communities were able to lower their frequency of these conditions by a given percent within a stated period of time, they’d get paid for it.
“What that did was essentially say, ‘you have a buyer for this outcome if you can achieve it,’” Sanghavi said. “And you can try to get there in any way you like.” The program is currently in CMS clearance.
AI and Robots Not Required
Using robots to perform surgery and artificial intelligence to diagnose disease will undoubtedly benefit doctors and patients around the US and the world. But Sanghavi’s talk made it clear that our healthcare system needs much more than this, and that improving population health on a large scale is really a low-tech project—one involving more regulatory and financial innovation than technological innovation.
“The things that get measured are the things that get changed,” he said. “If we choose the right outcomes to predict long-term benefit, and we pay for those outcomes, that’s the way to make progress.”
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