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#431599 8 Ways AI Will Transform Our Cities by ...
How will AI shape the average North American city by 2030? A panel of experts assembled as part of a century-long study into the impact of AI thinks its effects will be profound.
The One Hundred Year Study on Artificial Intelligence is the brainchild of Eric Horvitz, technical fellow and a managing director at Microsoft Research.
Every five years a panel of experts will assess the current state of AI and its future directions. The first panel, comprised of experts in AI, law, political science, policy, and economics, was launched last fall and decided to frame their report around the impact AI will have on the average American city. Here’s how they think it will affect eight key domains of city life in the next fifteen years.
1. Transportation
The speed of the transition to AI-guided transport may catch the public by surprise. Self-driving vehicles will be widely adopted by 2020, and it won’t just be cars — driverless delivery trucks, autonomous delivery drones, and personal robots will also be commonplace.
Uber-style “cars as a service” are likely to replace car ownership, which may displace public transport or see it transition towards similar on-demand approaches. Commutes will become a time to relax or work productively, encouraging people to live further from home, which could combine with reduced need for parking to drastically change the face of modern cities.
Mountains of data from increasing numbers of sensors will allow administrators to model individuals’ movements, preferences, and goals, which could have major impact on the design city infrastructure.
Humans won’t be out of the loop, though. Algorithms that allow machines to learn from human input and coordinate with them will be crucial to ensuring autonomous transport operates smoothly. Getting this right will be key as this will be the public’s first experience with physically embodied AI systems and will strongly influence public perception.
2. Home and Service Robots
Robots that do things like deliver packages and clean offices will become much more common in the next 15 years. Mobile chipmakers are already squeezing the power of last century’s supercomputers into systems-on-a-chip, drastically boosting robots’ on-board computing capacity.
Cloud-connected robots will be able to share data to accelerate learning. Low-cost 3D sensors like Microsoft’s Kinect will speed the development of perceptual technology, while advances in speech comprehension will enhance robots’ interactions with humans. Robot arms in research labs today are likely to evolve into consumer devices around 2025.
But the cost and complexity of reliable hardware and the difficulty of implementing perceptual algorithms in the real world mean general-purpose robots are still some way off. Robots are likely to remain constrained to narrow commercial applications for the foreseeable future.
3. Healthcare
AI’s impact on healthcare in the next 15 years will depend more on regulation than technology. The most transformative possibilities of AI in healthcare require access to data, but the FDA has failed to find solutions to the difficult problem of balancing privacy and access to data. Implementation of electronic health records has also been poor.
If these hurdles can be cleared, AI could automate the legwork of diagnostics by mining patient records and the scientific literature. This kind of digital assistant could allow doctors to focus on the human dimensions of care while using their intuition and experience to guide the process.
At the population level, data from patient records, wearables, mobile apps, and personal genome sequencing will make personalized medicine a reality. While fully automated radiology is unlikely, access to huge datasets of medical imaging will enable training of machine learning algorithms that can “triage” or check scans, reducing the workload of doctors.
Intelligent walkers, wheelchairs, and exoskeletons will help keep the elderly active while smart home technology will be able to support and monitor them to keep them independent. Robots may begin to enter hospitals carrying out simple tasks like delivering goods to the right room or doing sutures once the needle is correctly placed, but these tasks will only be semi-automated and will require collaboration between humans and robots.
4. Education
The line between the classroom and individual learning will be blurred by 2030. Massive open online courses (MOOCs) will interact with intelligent tutors and other AI technologies to allow personalized education at scale. Computer-based learning won’t replace the classroom, but online tools will help students learn at their own pace using techniques that work for them.
AI-enabled education systems will learn individuals’ preferences, but by aggregating this data they’ll also accelerate education research and the development of new tools. Online teaching will increasingly widen educational access, making learning lifelong, enabling people to retrain, and increasing access to top-quality education in developing countries.
Sophisticated virtual reality will allow students to immerse themselves in historical and fictional worlds or explore environments and scientific objects difficult to engage with in the real world. Digital reading devices will become much smarter too, linking to supplementary information and translating between languages.
5. Low-Resource Communities
In contrast to the dystopian visions of sci-fi, by 2030 AI will help improve life for the poorest members of society. Predictive analytics will let government agencies better allocate limited resources by helping them forecast environmental hazards or building code violations. AI planning could help distribute excess food from restaurants to food banks and shelters before it spoils.
Investment in these areas is under-funded though, so how quickly these capabilities will appear is uncertain. There are fears valueless machine learning could inadvertently discriminate by correlating things with race or gender, or surrogate factors like zip codes. But AI programs are easier to hold accountable than humans, so they’re more likely to help weed out discrimination.
6. Public Safety and Security
By 2030 cities are likely to rely heavily on AI technologies to detect and predict crime. Automatic processing of CCTV and drone footage will make it possible to rapidly spot anomalous behavior. This will not only allow law enforcement to react quickly but also forecast when and where crimes will be committed. Fears that bias and error could lead to people being unduly targeted are justified, but well-thought-out systems could actually counteract human bias and highlight police malpractice.
Techniques like speech and gait analysis could help interrogators and security guards detect suspicious behavior. Contrary to concerns about overly pervasive law enforcement, AI is likely to make policing more targeted and therefore less overbearing.
7. Employment and Workplace
The effects of AI will be felt most profoundly in the workplace. By 2030 AI will be encroaching on skilled professionals like lawyers, financial advisers, and radiologists. As it becomes capable of taking on more roles, organizations will be able to scale rapidly with relatively small workforces.
AI is more likely to replace tasks rather than jobs in the near term, and it will also create new jobs and markets, even if it’s hard to imagine what those will be right now. While it may reduce incomes and job prospects, increasing automation will also lower the cost of goods and services, effectively making everyone richer.
These structural shifts in the economy will require political rather than purely economic responses to ensure these riches are shared. In the short run, this may include resources being pumped into education and re-training, but longer term may require a far more comprehensive social safety net or radical approaches like a guaranteed basic income.
8. Entertainment
Entertainment in 2030 will be interactive, personalized, and immeasurably more engaging than today. Breakthroughs in sensors and hardware will see virtual reality, haptics and companion robots increasingly enter the home. Users will be able to interact with entertainment systems conversationally, and they will show emotion, empathy, and the ability to adapt to environmental cues like the time of day.
Social networks already allow personalized entertainment channels, but the reams of data being collected on usage patterns and preferences will allow media providers to personalize entertainment to unprecedented levels. There are concerns this could endow media conglomerates with unprecedented control over people’s online experiences and the ideas to which they are exposed.
But advances in AI will also make creating your own entertainment far easier and more engaging, whether by helping to compose music or choreograph dances using an avatar. Democratizing the production of high-quality entertainment makes it nearly impossible to predict how highly fluid human tastes for entertainment will develop.
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#431592 Reactive Content Will Get to Know You ...
The best storytellers react to their audience. They look for smiles, signs of awe, or boredom; they simultaneously and skillfully read both the story and their sitters. Kevin Brooks, a seasoned storyteller working for Motorola’s Human Interface Labs, explains, “As the storyteller begins, they must tune in to… the audience’s energy. Based on this energy, the storyteller will adjust their timing, their posture, their characterizations, and sometimes even the events of the story. There is a dialog between audience and storyteller.”
Shortly after I read the script to Melita, the latest virtual reality experience from Madrid-based immersive storytelling company Future Lighthouse, CEO Nicolas Alcalá explained to me that the piece is an example of “reactive content,” a concept he’s been working on since his days at Singularity University.
For the first time in history, we have access to technology that can merge the reactive and affective elements of oral storytelling with the affordances of digital media, weaving stunning visuals, rich soundtracks, and complex meta-narratives in a story arena that has the capability to know you more intimately than any conventional storyteller could.
It’s no understatement to say that the storytelling potential here is phenomenal.
In short, we can refer to content as reactive if it reads and reacts to users based on their body rhythms, emotions, preferences, and data points. Artificial intelligence is used to analyze users’ behavior or preferences to sculpt unique storylines and narratives, essentially allowing for a story that changes in real time based on who you are and how you feel.
The development of reactive content will allow those working in the industry to go one step further than simply translating the essence of oral storytelling into VR. Rather than having a narrative experience with a digital storyteller who can read you, reactive content has the potential to create an experience with a storyteller who knows you.
This means being able to subtly insert minor personal details that have a specific meaning to the viewer. When we talk to our friends we often use experiences we’ve shared in the past or knowledge of our audience to give our story as much resonance as possible. Targeting personal memories and aspects of our lives is a highly effective way to elicit emotions and aid in visualizing narratives. When you can do this with the addition of visuals, music, and characters—all lifted from someone’s past—you have the potential for overwhelmingly engaging and emotionally-charged content.
Future Lighthouse inform me that for now, reactive content will rely primarily on biometric feedback technology such as breathing, heartbeat, and eye tracking sensors. A simple example would be a story in which parts of the environment or soundscape change in sync with the user’s heartbeat and breathing, or characters who call you out for not paying attention.
The next step would be characters and situations that react to the user’s emotions, wherein algorithms analyze biometric information to make inferences about states of emotional arousal (“why are you so nervous?” etc.). Another example would be implementing the use of “arousal parameters,” where the audience can choose what level of “fear” they want from a VR horror story before algorithms modulate the experience using information from biometric feedback devices.
The company’s long-term goal is to gather research on storytelling conventions and produce a catalogue of story “wireframes.” This entails distilling the basic formula to different genres so they can then be fleshed out with visuals, character traits, and soundtracks that are tailored for individual users based on their deep data, preferences, and biometric information.
The development of reactive content will go hand in hand with a renewed exploration of diverging, dynamic storylines, and multi-narratives, a concept that hasn’t had much impact in the movie world thus far. In theory, the idea of having a story that changes and mutates is captivating largely because of our love affair with serendipity and unpredictability, a cultural condition theorist Arthur Kroker refers to as the “hypertextual imagination.” This feeling of stepping into the unknown with the possibility of deviation from the habitual translates as a comforting reminder that our own lives can take exciting and unexpected turns at any moment.
The inception of the concept into mainstream culture dates to the classic Choose Your Own Adventure book series that launched in the late 70s, which in its literary form had great success. However, filmic takes on the theme have made somewhat less of an impression. DVDs like I’m Your Man (1998) and Switching (2003) both use scene selection tools to determine the direction of the storyline.
A more recent example comes from Kino Industries, who claim to have developed the technology to allow filmmakers to produce interactive films in which viewers can use smartphones to quickly vote on which direction the narrative takes at numerous decision points throughout the film.
The main problem with diverging narrative films has been the stop-start nature of the interactive element: when I’m immersed in a story I don’t want to have to pick up a controller or remote to select what’s going to happen next. Every time the audience is given the option to take a new path (“press this button”, “vote on X, Y, Z”) the narrative— and immersion within that narrative—is temporarily halted, and it takes the mind a while to get back into this state of immersion.
Reactive content has the potential to resolve these issues by enabling passive interactivity—that is, input and output without having to pause and actively make decisions or engage with the hardware. This will result in diverging, dynamic narratives that will unfold seamlessly while being dependent on and unique to the specific user and their emotions. Passive interactivity will also remove the game feel that can often be a symptom of interactive experiences and put a viewer somewhere in the middle: still firmly ensconced in an interactive dynamic narrative, but in a much subtler way.
While reading the Melita script I was particularly struck by a scene in which the characters start to engage with the user and there’s a synchronicity between the user’s heartbeat and objects in the virtual world. As the narrative unwinds and the words of Melita’s character get more profound, parts of the landscape, which seemed to be flashing and pulsating at random, come together and start to mimic the user’s heartbeat.
In 2013, Jane Aspell of Anglia Ruskin University (UK) and Lukas Heydrich of the Swiss Federal Institute of Technology proved that a user’s sense of presence and identification with a virtual avatar could be dramatically increased by syncing the on-screen character with the heartbeat of the user. The relationship between bio-digital synchronicity, immersion, and emotional engagement is something that will surely have revolutionary narrative and storytelling potential.
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#431559 Drug Discovery AI to Scour a Universe of ...
On a dark night, away from city lights, the stars of the Milky Way can seem uncountable. Yet from any given location no more than 4,500 are visible to the naked eye. Meanwhile, our galaxy has 100–400 billion stars, and there are even more galaxies in the universe.
The numbers of the night sky are humbling. And they give us a deep perspective…on drugs.
Yes, this includes wow-the-stars-are-freaking-amazing-tonight drugs, but also the kinds of drugs that make us well again when we’re sick. The number of possible organic compounds with “drug-like” properties dwarfs the number of stars in the universe by over 30 orders of magnitude.
Next to this multiverse of possibility, the chemical configurations scientists have made into actual medicines are like the smattering of stars you’d glimpse downtown.
But for good reason.
Exploring all that potential drug-space is as humanly impossible as exploring all of physical space, and even if we could, most of what we’d find wouldn’t fit our purposes. Still, the idea that wonder drugs must surely lurk amid the multitudes is too tantalizing to ignore.
Which is why, Alex Zhavoronkov said at Singularity University’s Exponential Medicine in San Diego last week, we should use artificial intelligence to do more of the legwork and speed discovery. This, he said, could be one of the next big medical applications for AI.
Dogs, Diagnosis, and Drugs
Zhavoronkov is CEO of Insilico Medicine and CSO of the Biogerontology Research Foundation. Insilico is one of a number of AI startups aiming to accelerate drug discovery with AI.
In recent years, Zhavoronkov said, the now-famous machine learning technique, deep learning, has made progress on a number of fronts. Algorithms that can teach themselves to play games—like DeepMind’s AlphaGo Zero or Carnegie Mellon’s poker playing AI—are perhaps the most headline-grabbing of the bunch. But pattern recognition was the thing that kicked deep learning into overdrive early on, when machine learning algorithms went from struggling to tell dogs and cats apart to outperforming their peers and then their makers in quick succession.
[Watch this video for an AI update from Neil Jacobstein, chair of Artificial Intelligence and Robotics at Singularity University.]
In medicine, deep learning algorithms trained on databases of medical images can spot life-threatening disease with equal or greater accuracy than human professionals. There’s even speculation that AI, if we learn to trust it, could be invaluable in diagnosing disease. And, as Zhavoronkov noted, with more applications and a longer track record that trust is coming.
“Tesla is already putting cars on the street,” Zhavoronkov said. “Three-year, four-year-old technology is already carrying passengers from point A to point B, at 100 miles an hour, and one mistake and you’re dead. But people are trusting their lives to this technology.”
“So, why don’t we do it in pharma?”
Trial and Error and Try Again
AI wouldn’t drive the car in pharmaceutical research. It’d be an assistant that, when paired with a chemist or two, could fast-track discovery by screening more possibilities for better candidates.
There’s plenty of room to make things more efficient, according to Zhavoronkov.
Drug discovery is arduous and expensive. Chemists sift tens of thousands of candidate compounds for the most promising to synthesize. Of these, a handful will go on to further research, fewer will make it to human clinical trials, and a fraction of those will be approved.
The whole process can take many years and cost hundreds of millions of dollars.
This is a big data problem if ever there was one, and deep learning thrives on big data. Early applications have shown their worth unearthing subtle patterns in huge training databases. Although drug-makers already use software to sift compounds, such software requires explicit rules written by chemists. AI’s allure is its ability to learn and improve on its own.
“There are two strategies for AI-driven innovation in pharma to ensure you get better molecules and much faster approvals,” Zhavoronkov said. “One is looking for the needle in the haystack, and another one is creating a new needle.”
To find the needle in the haystack, algorithms are trained on large databases of molecules. Then they go looking for molecules with attractive properties. But creating a new needle? That’s a possibility enabled by the generative adversarial networks Zhavoronkov specializes in.
Such algorithms pit two neural networks against each other. One generates meaningful output while the other judges whether this output is true or false, Zhavoronkov said. Together, the networks generate new objects like text, images, or in this case, molecular structures.
“We started employing this particular technology to make deep neural networks imagine new molecules, to make it perfect right from the start. So, to come up with really perfect needles,” Zhavoronkov said. “[You] can essentially go to this [generative adversarial network] and ask it to create molecules that inhibit protein X at concentration Y, with the highest viability, specific characteristics, and minimal side effects.”
Zhavoronkov believes AI can find or fabricate more needles from the array of molecular possibilities, freeing human chemists to focus on synthesizing only the most promising. If it works, he hopes we can increase hits, minimize misses, and generally speed the process up.
Proof’s in the Pudding
Insilico isn’t alone on its drug-discovery quest, nor is it a brand new area of interest.
Last year, a Harvard group published a paper on an AI that similarly suggests drug candidates. The software trained on 250,000 drug-like molecules and used its experience to generate new molecules that blended existing drugs and made suggestions based on desired properties.
An MIT Technology Review article on the subject highlighted a few of the challenges such systems may still face. The results returned aren’t always meaningful or easy to synthesize in the lab, and the quality of these results, as always, is only as good as the data dined upon.
Stanford chemistry professor and Andreesen Horowitz partner, Vijay Pande, said that images, speech, and text—three of the areas deep learning’s made quick strides in—have better, cleaner data. Chemical data, on the other hand, is still being optimized for deep learning. Also, while there are public databases, much data still lives behind closed doors at private companies.
To overcome the challenges and prove their worth, Zhavoronkov said, his company is very focused on validating the tech. But this year, skepticism in the pharmaceutical industry seems to be easing into interest and investment.
AI drug discovery startup Exscientia inked a deal with Sanofi for $280 million and GlaxoSmithKline for $42 million. Insilico is also partnering with GlaxoSmithKline, and Numerate is working with Takeda Pharmaceutical. Even Google may jump in. According to an article in Nature outlining the field, the firm’s deep learning project, Google Brain, is growing its biosciences team, and industry watchers wouldn’t be surprised to see them target drug discovery.
With AI and the hardware running it advancing rapidly, the greatest potential may yet be ahead. Perhaps, one day, all 1060 molecules in drug-space will be at our disposal. “You should take all the data you have, build n new models, and search as much of that 1060 as possible” before every decision you make, Brandon Allgood, CTO at Numerate, told Nature.
Today’s projects need to live up to their promises, of course, but Zhavoronkov believes AI will have a big impact in the coming years, and now’s the time to integrate it. “If you are working for a pharma company, and you’re still thinking, ‘Okay, where is the proof?’ Once there is a proof, and once you can see it to believe it—it’s going to be too late,” he said.
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#431543 China Is an Entrepreneurial Hotbed That ...
Last week, Eric Schmidt, chairman of Alphabet, predicted that China will rapidly overtake the US in artificial intelligence…in as little as five years.
Last month, China announced plans to open a $10 billion quantum computing research center in 2020.
Bottom line, China is aggressively investing in exponential technologies, pursuing a bold goal of becoming the global AI superpower by 2030.
Based on what I’ve observed from China’s entrepreneurial scene, I believe they have a real shot of hitting that goal.
As I described in a previous tech blog, I recently traveled to China with a group of my Abundance 360 members, where I was hosted by my friend Kai-Fu Lee, the founder, chairman, and CEO of Sinovation Ventures.
On one of our first nights, Kai-Fu invited us to a special dinner at Da Dong Roast, which specializes in Peking duck, where we shared an 18-course meal.
The meal was amazing, and Kai-Fu’s dinner conversation provided us priceless insights on Chinese entrepreneurs.
Three topics opened my eyes. Here’s the wisdom I’d like to share with you.
1. The Entrepreneurial Culture in China
Chinese entrepreneurship has exploded onto the scene and changed significantly over the past 10 years.
In my opinion, one significant way that Chinese entrepreneurs vary from their American counterparts is in work ethic. The mantra I found in the startups I visited in Beijing and Shanghai was “9-9-6”—meaning the employees only needed to work from 9 am to 9 pm, 6 days a week.
Another concept Kai-Fu shared over dinner was the almost ‘dictatorial’ leadership of the founder/CEO. In China, it’s not uncommon for the Founder/CEO to own the majority of the company, or at least 30–40 percent. It’s also the case that what the CEO says is gospel. Period, no debate. There is no minority or dissenting opinion. When the CEO says “march,” the company asks, “which way?”
When Kai-Fu started Sinovation (his $1 billion+ venture fund), there were few active angel investors. Today, China has a rich ecosystem of angel, venture capital, and government-funded innovation parks.
As venture capital in China has evolved, so too has the mindset of the entrepreneur.
Kai -Fu recalled an early investment he made in which, after an unfortunate streak, the entrepreneur came to him, almost in tears, apologizing for losing his money and promising he would earn it back for him in another way. Kai-Fu comforted the entrepreneur and said there was no such need.
Only a few years later, the situation was vastly different. An entrepreneur who was going through a similar unfortunate streak came to Kai Fu and told him he only had $2 million left of his initial $12 million investment. He informed him he saw no value in returning the money and instead was going to take the last $2 million and use it as a final push to see if the company could succeed. He then promised Kai-Fu if he failed, he would remember what Kai-Fu did for him and, as such, possibly give Sinovation an opportunity to invest in him with his next company.
2. Chinese Companies Are No Longer Just ‘Copycats’
During dinner, Kai-Fu lamented that 10 years ago, it would be fair to call Chinese companies copycats of American companies. Five years ago, the claim would be controversial. Today, however, Kai-Fu is clear that claim is entirely false.
While smart Chinese startups will still look at what American companies are doing and build on trends, today it’s becoming a wise business practice for American tech giants to analyze Chinese companies. If you look at many new features of Facebook’s Messenger, it seems to very closely mirror TenCent’s WeChat.
Interestingly, tight government controls in China have actually spurred innovation. Take TV, for example, a highly regulated industry. Because of this regulation, most entertainment in China is consumed on the internet or by phone. Game shows, reality shows, and more will be entirely centered online.
Kai-Fu told us about one of his investments in a company that helps create Chinese singing sensations. They take girls in from a young age, school them, and regardless of talent, help build their presence and brand as singers. Once ready, these singers are pushed across all the available platforms, and superstars are born. The company recognizes its role in this superstar status, though, which is why it takes a 50 percent cut of all earnings.
This company is just one example of how Chinese entrepreneurs take advantage of China’s unique position, market, and culture.
3. China’s Artificial Intelligence Play
Kai-Fu wrapped up his talk with a brief introduction into the expansive AI industry in China. I previously discussed Face++, a Sinovation investment, which is creating radically efficient facial recognition technology. Face++ is light years ahead of anyone else globally at recognition in live videos. However, Face++ is just one of the incredible advances in AI coming out of China.
Baidu, one of China’s most valuable tech companies, started out as just a search company. However, they now run one of the country’s leading self-driving car programs.
Baidu’s goal is to create a software suite atop existing hardware that will control all self-driving aspects of a vehicle but also be able to provide additional services such as HD mapping and more.
Another interesting application came from another of Sinovation’s investments, Smart Finance Group (SFG). Given most payments are mobile (through WeChat or Alipay), only ~20 percent of the population in China have a credit history. This makes it very difficult for individuals in China to acquire a loan.
SFG’s mobile application takes in user data (as much as the user allows) and, based on the information provided, uses an AI agent to create a financial profile with the power to offer an instant loan. This loan can be deposited directly into their WeChat or Alipay account and is typically approved in minutes. Unlike American loan companies, they avoid default and long-term debt by only providing a one-month loan with 10% interest. Borrow $200, and you pay back $220 by the following month.
Artificial intelligence is exploding in China, and Kai-Fu believes it will touch every single industry.
The only constant is change, and the rate of change is constantly increasing.
In the next 10 years, we’ll see tremendous changes on the geopolitical front and the global entrepreneurial scene caused by technological empowerment.
China is an entrepreneurial hotbed that cannot be ignored. I’m monitoring it closely. Are you?
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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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