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#431906 Low-Cost Soft Robot Muscles Can Lift 200 ...

Jerky mechanical robots are staples of science fiction, but to seamlessly integrate into everyday life they’ll need the precise yet powerful motor control of humans. Now scientists have created a new class of artificial muscles that could soon make that a reality.
The advance is the latest breakthrough in the field of soft robotics. Scientists are increasingly designing robots using soft materials that more closely resemble biological systems, which can be more adaptable and better suited to working in close proximity to humans.
One of the main challenges has been creating soft components that match the power and control of the rigid actuators that drive mechanical robots—things like motors and pistons. Now researchers at the University of Colorado Boulder have built a series of low-cost artificial muscles—as little as 10 cents per device—using soft plastic pouches filled with electrically insulating liquids that contract with the force and speed of mammalian skeletal muscles when a voltage is applied to them.

Three different designs of the so-called hydraulically amplified self-healing electrostatic (HASEL) actuators were detailed in two papers in the journals Science and Science Robotics last week. They could carry out a variety of tasks, from gently picking up delicate objects like eggs or raspberries to lifting objects many times their own weight, such as a gallon of water, at rapid repetition rates.
“We draw our inspiration from the astonishing capabilities of biological muscle,” Christoph Keplinger, an assistant professor at UC Boulder and senior author of both papers, said in a press release. “Just like biological muscle, HASEL actuators can reproduce the adaptability of an octopus arm, the speed of a hummingbird and the strength of an elephant.”
The artificial muscles work by applying a voltage to hydrogel electrodes on either side of pouches filled with liquid insulators, which can be as simple as canola oil. This creates an attraction between the two electrodes, pulling them together and displacing the liquid. This causes a change of shape that can push or pull levers, arms or any other articulated component.
The design is essentially a synthesis of two leading approaches to actuating soft robots. Pneumatic and hydraulic actuators that pump fluids around have been popular due to their high forces, easy fabrication and ability to mimic a variety of natural motions. But they tend to be bulky and relatively slow.
Dielectric elastomer actuators apply an electric field across a solid insulating layer to make it flex. These can mimic the responsiveness of biological muscle. But they are not very versatile and can also fail catastrophically, because the high voltages required can cause a bolt of electricity to blast through the insulator, destroying it. The likelihood of this happening increases in line with the size of their electrodes, which makes it hard to scale them up. By combining the two approaches, researchers get the best of both worlds, with the power, versatility and easy fabrication of a fluid-based system and the responsiveness of electrically-powered actuators.
One of the designs holds particular promise for robotics applications, as it behaves a lot like biological muscle. The so-called Peano-HASEL actuators are made up of multiple rectangular pouches connected in series, which allows them to contract linearly, just like real muscle. They can lift more than 200 times their weight, but being electrically powered, they exceed the flexing speed of human muscle.
As the name suggests, the HASEL actuators are also self-healing. They are still prone to the same kind of electrical damage as dielectric elastomer actuators, but the liquid insulator is able to immediately self-heal by redistributing itself and regaining its insulating properties.
The muscles can even monitor the amount of strain they’re under to provide the same kind of feedback biological systems would. The muscle’s capacitance—its ability to store an electric charge—changes as the device stretches, which makes it possible to power the arm while simultaneously measuring what position it’s in.
The researchers say this could imbue robots with a similar sense of proprioception or body-awareness to that found in plants and animals. “Self-sensing allows for the development of closed-loop feedback controllers to design highly advanced and precise robots for diverse applications,” Shane Mitchell, a PhD student in Keplinger’s lab and an author on both papers, said in an email.
The researchers say the high voltages required are an ongoing challenge, though they’ve already designed devices in the lab that use a fifth of the voltage of those features in the recent papers.
In most of their demonstrations, these soft actuators were being used to power rigid arms and levers, pointing to the fact that future robots are likely to combine both rigid and soft components, much like animals do. The potential applications for the technology range from more realistic prosthetics to much more dextrous robots that can work easily alongside humans.
It will take some work before these devices appear in commercial robots. But the combination of high-performance with simple and inexpensive fabrication methods mean other researchers are likely to jump in, so innovation could be rapid.
Image Credit: Keplinger Research Group/University of Colorado Continue reading

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#431873 Why the World Is Still Getting ...

If you read or watch the news, you’ll likely think the world is falling to pieces. Trends like terrorism, climate change, and a growing population straining the planet’s finite resources can easily lead you to think our world is in crisis.
But there’s another story, a story the news doesn’t often report. This story is backed by data, and it says we’re actually living in the most peaceful, abundant time in history, and things are likely to continue getting better.
The News vs. the Data
The reality that’s often clouded by a constant stream of bad news is we’re actually seeing a massive drop in poverty, fewer deaths from violent crime and preventable diseases. On top of that, we’re the most educated populace to ever walk the planet.
“Violence has been in decline for thousands of years, and today we may be living in the most peaceful era in the existence of our species.” –Steven Pinker
In the last hundred years, we’ve seen the average human life expectancy nearly double, the global GDP per capita rise exponentially, and childhood mortality drop 10-fold.

That’s pretty good progress! Maybe the world isn’t all gloom and doom.If you’re still not convinced the world is getting better, check out the charts in this article from Vox and on Peter Diamandis’ website for a lot more data.
Abundance for All Is Possible
So now that you know the world isn’t so bad after all, here’s another thing to think about: it can get much better, very soon.
In their book Abundance: The Future Is Better Than You Think, Steven Kotler and Peter Diamandis suggest it may be possible for us to meet and even exceed the basic needs of all the people living on the planet today.
“In the hands of smart and driven innovators, science and technology take things which were once scarce and make them abundant and accessible to all.”
This means making sure every single person in the world has adequate food, water and shelter, as well as a good education, access to healthcare, and personal freedom.
This might seem unimaginable, especially if you tend to think the world is only getting worse. But given how much progress we’ve already made in the last few hundred years, coupled with the recent explosion of information sharing and new, powerful technologies, abundance for all is not as out of reach as you might believe.
Throughout history, we’ve seen that in the hands of smart and driven innovators, science and technology take things which were once scarce and make them abundant and accessible to all.
Napoleon III
In Abundance, Diamandis and Kotler tell the story of how aluminum went from being one of the rarest metals on the planet to being one of the most abundant…
In the 1800s, aluminum was more valuable than silver and gold because it was rarer. So when Napoleon III entertained the King of Siam, the king and his guests were honored by being given aluminum utensils, while the rest of the dinner party ate with gold.
But aluminum is not really rare.
In fact, aluminum is the third most abundant element in the Earth’s crust, making up 8.3% of the weight of our planet. But it wasn’t until chemists Charles Martin Hall and Paul Héroult discovered how to use electrolysis to cheaply separate aluminum from surrounding materials that the element became suddenly abundant.
The problems keeping us from achieving a world where everyone’s basic needs are met may seem like resource problems — when in reality, many are accessibility problems.
The Engine Driving Us Toward Abundance: Exponential Technology
History is full of examples like the aluminum story. The most powerful one of the last few decades is information technology. Think about all the things that computers and the internet made abundant that were previously far less accessible because of cost or availability … Here are just a few examples:

Easy access to the world’s information
Ability to share information freely with anyone and everyone
Free/cheap long-distance communication
Buying and selling goods/services regardless of location

Less than two decades ago, when someone reached a certain level of economic stability, they could spend somewhere around $10K on stereos, cameras, entertainment systems, etc — today, we have all that equipment in the palm of our hand.
Now, there is a new generation of technologies heavily dependant on information technology and, therefore, similarly riding the wave of exponential growth. When put to the right use, emerging technologies like artificial intelligence, robotics, digital manufacturing, nano-materials and digital biology make it possible for us to drastically raise the standard of living for every person on the planet.

These are just some of the innovations which are unlocking currently scarce resources:

IBM’s Watson Health is being trained and used in medical facilities like the Cleveland Clinic to help doctors diagnose disease. In the future, it’s likely we’ll trust AI just as much, if not more than humans to diagnose disease, allowing people all over the world to have access to great diagnostic tools regardless of whether there is a well-trained doctor near them.

Solar power is now cheaper than fossil fuels in some parts of the world, and with advances in new materials and storage, the cost may decrease further. This could eventually lead to nearly-free, clean energy for people across the world.

Google’s GMNT network can now translate languages as well as a human, unlocking the ability for people to communicate globally as we never have before.

Self-driving cars are already on the roads of several American cities and will be coming to a road near you in the next couple years. Considering the average American spends nearly two hours driving every day, not having to drive would free up an increasingly scarce resource: time.

The Change-Makers
Today’s innovators can create enormous change because they have these incredible tools—which would have once been available only to big organizations—at their fingertips. And, as a result of our hyper-connected world, there is an unprecedented ability for people across the planet to work together to create solutions to some of our most pressing problems today.
“In today’s hyperlinked world, solving problems anywhere, solves problems everywhere.” –Peter Diamandis and Steven Kotler, Abundance
According to Diamandis and Kotler, there are three groups of people accelerating positive change.

DIY InnovatorsIn the 1970s and 1980s, the Homebrew Computer Club was a meeting place of “do-it-yourself” computer enthusiasts who shared ideas and spare parts. By the 1990s and 2000s, that little club became known as an inception point for the personal computer industry — dozens of companies, including Apple Computer, can directly trace their origins back to Homebrew. Since then, we’ve seen the rise of the social entrepreneur, the Maker Movement and the DIY Bio movement, which have similar ambitions to democratize social reform, manufacturing, and biology, the way Homebrew democratized computers. These are the people who look for new opportunities and aren’t afraid to take risks to create something new that will change the status-quo.
Techno-PhilanthropistsUnlike the robber barons of the 19th and early 20th centuries, today’s “techno-philanthropists” are not just giving away some of their wealth for a new museum, they are using their wealth to solve global problems and investing in social entrepreneurs aiming to do the same. The Bill and Melinda Gates Foundation has given away at least $28 billion, with a strong focus on ending diseases like polio, malaria, and measles for good. Jeff Skoll, after cashing out of eBay with $2 billion in 1998, went on to create the Skoll Foundation, which funds social entrepreneurs across the world. And last year, Mark Zuckerberg and Priscilla Chan pledged to give away 99% of their $46 billion in Facebook stock during their lifetimes.
The Rising BillionCisco estimates that by 2020, there will be 4.1 billion people connected to the internet, up from 3 billion in 2015. This number might even be higher, given the efforts of companies like Facebook, Google, Virgin Group, and SpaceX to bring internet access to the world. That’s a billion new people in the next several years who will be connected to the global conversation, looking to learn, create and better their own lives and communities.In his book, Fortune at the Bottom of the Pyramid, C.K. Pahalad writes that finding co-creative ways to serve this rising market can help lift people out of poverty while creating viable businesses for inventive companies.

The Path to Abundance
Eager to create change, innovators armed with powerful technologies can accomplish incredible feats. Kotler and Diamandis imagine that the path to abundance occurs in three tiers:

Basic Needs (food, water, shelter)
Tools of Growth (energy, education, access to information)
Ideal Health and Freedom

Of course, progress doesn’t always happen in a straight, logical way, but having a framework to visualize the needs is helpful.
Many people don’t believe it’s possible to end the persistent global problems we’re facing. However, looking at history, we can see many examples where technological tools have unlocked resources that previously seemed scarce.
Technological solutions are not always the answer, and we need social change and policy solutions as much as we need technology solutions. But we have seen time and time again, that powerful tools in the hands of innovative, driven change-makers can make the seemingly impossible happen.

You can download the full “Path to Abundance” infographic here. It was created under a CC BY-NC-ND license. If you share, please attribute to Singularity University.
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#431869 When Will We Finally Achieve True ...

The field of artificial intelligence goes back a long way, but many consider it was officially born when a group of scientists at Dartmouth College got together for a summer, back in 1956. Computers had, over the last few decades, come on in incredible leaps and bounds; they could now perform calculations far faster than humans. Optimism, given the incredible progress that had been made, was rational. Genius computer scientist Alan Turing had already mooted the idea of thinking machines just a few years before. The scientists had a fairly simple idea: intelligence is, after all, just a mathematical process. The human brain was a type of machine. Pick apart that process, and you can make a machine simulate it.
The problem didn’t seem too hard: the Dartmouth scientists wrote, “We think that a significant advance can be made in one or more of these problems if a carefully selected group of scientists work on it together for a summer.” This research proposal, by the way, contains one of the earliest uses of the term artificial intelligence. They had a number of ideas—maybe simulating the human brain’s pattern of neurons could work and teaching machines the abstract rules of human language would be important.
The scientists were optimistic, and their efforts were rewarded. Before too long, they had computer programs that seemed to understand human language and could solve algebra problems. People were confidently predicting there would be a human-level intelligent machine built within, oh, let’s say, the next twenty years.
It’s fitting that the industry of predicting when we’d have human-level intelligent AI was born at around the same time as the AI industry itself. In fact, it goes all the way back to Turing’s first paper on “thinking machines,” where he predicted that the Turing Test—machines that could convince humans they were human—would be passed in 50 years, by 2000. Nowadays, of course, people are still predicting it will happen within the next 20 years, perhaps most famously Ray Kurzweil. There are so many different surveys of experts and analyses that you almost wonder if AI researchers aren’t tempted to come up with an auto reply: “I’ve already predicted what your question will be, and no, I can’t really predict that.”
The issue with trying to predict the exact date of human-level AI is that we don’t know how far is left to go. This is unlike Moore’s Law. Moore’s Law, the doubling of processing power roughly every couple of years, makes a very concrete prediction about a very specific phenomenon. We understand roughly how to get there—improved engineering of silicon wafers—and we know we’re not at the fundamental limits of our current approach (at least, not until you’re trying to work on chips at the atomic scale). You cannot say the same about artificial intelligence.
Common Mistakes
Stuart Armstrong’s survey looked for trends in these predictions. Specifically, there were two major cognitive biases he was looking for. The first was the idea that AI experts predict true AI will arrive (and make them immortal) conveniently just before they’d be due to die. This is the “Rapture of the Nerds” criticism people have leveled at Kurzweil—his predictions are motivated by fear of death, desire for immortality, and are fundamentally irrational. The ability to create a superintelligence is taken as an article of faith. There are also criticisms by people working in the AI field who know first-hand the frustrations and limitations of today’s AI.
The second was the idea that people always pick a time span of 15 to 20 years. That’s enough to convince people they’re working on something that could prove revolutionary very soon (people are less impressed by efforts that will lead to tangible results centuries down the line), but not enough for you to be embarrassingly proved wrong. Of the two, Armstrong found more evidence for the second one—people were perfectly happy to predict AI after they died, although most didn’t, but there was a clear bias towards “15–20 years from now” in predictions throughout history.
Measuring Progress
Armstrong points out that, if you want to assess the validity of a specific prediction, there are plenty of parameters you can look at. For example, the idea that human-level intelligence will be developed by simulating the human brain does at least give you a clear pathway that allows you to assess progress. Every time we get a more detailed map of the brain, or successfully simulate another part of it, we can tell that we are progressing towards this eventual goal, which will presumably end in human-level AI. We may not be 20 years away on that path, but at least you can scientifically evaluate the progress.
Compare this to those that say AI, or else consciousness, will “emerge” if a network is sufficiently complex, given enough processing power. This might be how we imagine human intelligence and consciousness emerged during evolution—although evolution had billions of years, not just decades. The issue with this is that we have no empirical evidence: we have never seen consciousness manifest itself out of a complex network. Not only do we not know if this is possible, we cannot know how far away we are from reaching this, as we can’t even measure progress along the way.
There is an immense difficulty in understanding which tasks are hard, which has continued from the birth of AI to the present day. Just look at that original research proposal, where understanding human language, randomness and creativity, and self-improvement are all mentioned in the same breath. We have great natural language processing, but do our computers understand what they’re processing? We have AI that can randomly vary to be “creative,” but is it creative? Exponential self-improvement of the kind the singularity often relies on seems far away.
We also struggle to understand what’s meant by intelligence. For example, AI experts consistently underestimated the ability of AI to play Go. Many thought, in 2015, it would take until 2027. In the end, it took two years, not twelve. But does that mean AI is any closer to being able to write the Great American Novel, say? Does it mean it’s any closer to conceptually understanding the world around it? Does it mean that it’s any closer to human-level intelligence? That’s not necessarily clear.
Not Human, But Smarter Than Humans
But perhaps we’ve been looking at the wrong problem. For example, the Turing test has not yet been passed in the sense that AI cannot convince people it’s human in conversation; but of course the calculating ability, and perhaps soon the ability to perform other tasks like pattern recognition and driving cars, far exceed human levels. As “weak” AI algorithms make more decisions, and Internet of Things evangelists and tech optimists seek to find more ways to feed more data into more algorithms, the impact on society from this “artificial intelligence” can only grow.
It may be that we don’t yet have the mechanism for human-level intelligence, but it’s also true that we don’t know how far we can go with the current generation of algorithms. Those scary surveys that state automation will disrupt society and change it in fundamental ways don’t rely on nearly as many assumptions about some nebulous superintelligence.
Then there are those that point out we should be worried about AI for other reasons. Just because we can’t say for sure if human-level AI will arrive this century, or never, it doesn’t mean we shouldn’t prepare for the possibility that the optimistic predictors could be correct. We need to ensure that human values are programmed into these algorithms, so that they understand the value of human life and can act in “moral, responsible” ways.
Phil Torres, at the Project for Future Human Flourishing, expressed it well in an interview with me. He points out that if we suddenly decided, as a society, that we had to solve the problem of morality—determine what was right and wrong and feed it into a machine—in the next twenty years…would we even be able to do it?
So, we should take predictions with a grain of salt. Remember, it turned out the problems the AI pioneers foresaw were far more complicated than they anticipated. The same could be true today. At the same time, we cannot be unprepared. We should understand the risks and take our precautions. When those scientists met in Dartmouth in 1956, they had no idea of the vast, foggy terrain before them. Sixty years later, we still don’t know how much further there is to go, or how far we can go. But we’re going somewhere.
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#431689 Robotic Materials Will Distribute ...

The classical view of a robot as a mechanical body with a central “brain” that controls its behavior could soon be on its way out. The authors of a recent article in Science Robotics argue that future robots will have intelligence distributed throughout their bodies.
The concept, and the emerging discipline behind it, are variously referred to as “material robotics” or “robotic materials” and are essentially a synthesis of ideas from robotics and materials science. Proponents say advances in both fields are making it possible to create composite materials capable of combining sensing, actuation, computation, and communication and operating independently of a central processing unit.
Much of the inspiration for the field comes from nature, with practitioners pointing to the adaptive camouflage of the cuttlefish’s skin, the ability of bird wings to morph in response to different maneuvers, or the banyan tree’s ability to grow roots above ground to support new branches.
Adaptive camouflage and morphing wings have clear applications in the defense and aerospace sector, but the authors say similar principles could be used to create everything from smart tires able to calculate the traction needed for specific surfaces to grippers that can tailor their force to the kind of object they are grasping.
“Material robotics represents an acknowledgment that materials can absorb some of the challenges of acting and reacting to an uncertain world,” the authors write. “Embedding distributed sensors and actuators directly into the material of the robot’s body engages computational capabilities and offloads the rigid information and computational requirements from the central processing system.”
The idea of making materials more adaptive is not new, and there are already a host of “smart materials” that can respond to stimuli like heat, mechanical stress, or magnetic fields by doing things like producing a voltage or changing shape. These properties can be carefully tuned to create materials capable of a wide variety of functions such as movement, self-repair, or sensing.
The authors say synthesizing these kinds of smart materials, alongside other advanced materials like biocompatible conductors or biodegradable elastomers, is foundational to material robotics. But the approach also involves integration of many different capabilities in the same material, careful mechanical design to make the most of mechanical capabilities, and closing the loop between sensing and control within the materials themselves.
While there are stand-alone applications for such materials in the near term, like smart fabrics or robotic grippers, the long-term promise of the field is to distribute decision-making in future advanced robots. As they are imbued with ever more senses and capabilities, these machines will be required to shuttle huge amounts of control and feedback data to and fro, placing a strain on both their communication and computation abilities.
Materials that can process sensor data at the source and either autonomously react to it or filter the most relevant information to be passed on to the central processing unit could significantly ease this bottleneck. In a press release related to an earlier study, Nikolaus Correll, an assistant professor of computer science at the University of Colorado Boulder who is also an author of the current paper, pointed out this is a tactic used by the human body.
“The human sensory system automatically filters out things like the feeling of clothing rubbing on the skin,” he said. “An artificial skin with possibly thousands of sensors could do the same thing, and only report to a central ‘brain’ if it touches something new.”
There are still considerable challenges to realizing this vision, though, the authors say, noting that so far the young field has only produced proof of concepts. The biggest challenge remains manufacturing robotic materials in a way that combines all these capabilities in a small enough package at an affordable cost.
Luckily, the authors note, the field can draw on convergent advances in both materials science, such as the development of new bulk materials with inherent multifunctionality, and robotics, such as the ever tighter integration of components.
And they predict that doing away with the prevailing dichotomy of “brain versus body” could lay the foundations for the emergence of “robots with brains in their bodies—the foundation of inexpensive and ubiquitous robots that will step into the real world.”
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#431427 Why the Best Healthcare Hacks Are the ...

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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