The Way to Wellville and the Production of Health

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  • Esther Dyson, EDventure Holdings & HiCCup

  • Esther Dyson, EDventure Holdings & HiCCup

Speaker

Esther Dyson
Chairman, Edventure


Kirkpatrick: Now, to continue on the healthcare theme, Esther Dyson, who is one of the great technology visionaries of modern economy, and—when did you write that book that—I’m not interviewing you, right? You’re talking?

Dyson: No, but, you can. I’d be happy to.

Kirkpatrick: No, no, no, I want you to talk. But when did you write that book?

Dyson: 1996.

Kirkpatrick: And what was it called?

Dyson: It was called “Release 2.0: A Design for Living in the Digital Age.”

Kirkpatrick: Yes, Esther’s vision has been really big for a really long time. She sort of inspired me to do tech conferences, among other things. And now she’s, among being an investor and a continue pundit and a lot of other things, she’s really getting deep into healthcare reform, and I’d love to hear what she’s up to, maybe any thoughts she has about what Mark’s doing. So Esther, please, take it away.

Dyson: Thank you. Great. And I purposely did not—I have some notes here, but I did not prepare a speech, because I really wanted to hear what Mark had to say, and I wasn’t sure whether I was going to say, “Yes, but…” or, “Yes, and…” And it’s, “Yes, and.” I’m doing something now that’s called the Way to Wellville. It’s really like a small town version of what Aetna is trying to do on a much bigger scale, and I think we’re extremely complementary. It was great to hear what he had to say.

So the Way to Wellville, we’re a nonprofit. It was founded by me. You’ll be interested, David, it was actually funded by Mark Zuckerberg, though he doesn’t know it.

Kirkpatrick: Really?

Dyson: Yes, I have some Facebook stock.

So anyway, I founded it, I have some Facebook stock that’s funding it, though we’ll be looking for other funders. And I did the smart thing that tech CEOs should all do if they’re not brilliant CEOs, I hired a CEO. So he’s actually making the thing work and I’m out talking about it. We are now called the Wellville Accelerator, and what we’re doing is we are accelerating five small community enterprises that are in the business of producing health. And kind of going on from Mark’s economic analysis, we really see health as an asset. Some assets produce income, other assets make your assets more productive. Health makes people more productive. The people are not an asset. The idea of investing in people is great. The challenge is sometimes they leave, so it’s probably going to be harder to explain that to the tax accountants in Washington. But health is an asset. It’s a community asset. Individuals can have an impact on their health, but something like 80% of an individual’s health is due to their community. Maybe a small fraction is due to their genes, but a very, very small fraction is due to healthcare. Healthcare is a repair job when you’ve lost the asset of health, because you rented it rather than investing in it.

So a little more specific on Wellville, we’ve got five communities. We did not—it’s not a nice white lady from New York going out and telling people how to live. It was a call for applications, and we got 42 applications from around the country of communities that were under 100,000 people, because we wanted to work in a small place. Since we have limited resources, we also wanted to minimize the political, just the overall scale of what we were trying to. We wanted to have a critical density in a small place where people didn’t go in or out too much, so whatever you did in the community stayed in the community. Goes back to Mark’s single payer per community. You can’t do a subset of the community. You really have to do the whole thing, change the food supply, do things at scale on this small scale.

So we got 42 applications, visited 10 places last summer, and picked five, one of which is your neighbor, Detroit, Muskegon. For those of you who aren’t from here, if you start at Detroit and you go west to Ann Arbor, Lansing, Grand Rapids, then you hit Muskegon, which is on the lake, and it’s across from Milwaukee. So Muskegon is a beautiful place, but like so many places in America, it’s kind of lost its middle class. There’s a lot of sick people, and just as social determinants determine health, so does health actually determine the economic vitality and a lot of other things around the community. They really interact.

So Muskegon; Lake County, California; Clatsop County, Oregon; Niagara Falls, New York; and Spartanburg, South Carolina, where I was yesterday. Our mission is to go beyond healthcare and help create the environment that produces health, starting with prenatal care, the sorts of things that Mark said Humana is doing, but perhaps on an even broader scale.

And we’re extremely focused on outcomes. It’s not enough to have a nice food program or an obesity program. What are your outcomes? So I’m going to tell a short story about Muskegon, just to give you an idea of how we think. Walgreens came to us—we’re working with corporate partners because we believe, even though we’re nonprofit, we want the production of health to be financially sustainable. We want it to be profitmaking as much as possible. It’s a challenge, because the people who benefit aren’t always the ones who pay, so you need to figure out how you can get a government, through Medicaid, or an insurer to sponsor some of these upfront investments for those long-term results.

So Walgreens said to us, “Suppose we gave you 1,000 flu shots for each of your communities?” And we said, “Not really. I don’t think that would have much impact. How about 20,000 for one community, and how about 20,000 in Muskegon because there’s lots of Walgreens there?” So they didn’t quite come up with 20,000. And this is something in progress, and I’m not sure I should be talking about it, but our ethos is indeed take risks, be open and transparent, and, yes, be accountable, even if you fail. So we’re right in the middle, and this is Muskegon doing this. This is not us. We’re helping Muskegon, we’re bringing in people like Walgreens, but it’s them running it. Shout out to Jamie Helsen from County Public health.

So from a kind of no impact 1,000, it’s, “Let’s do 20,000.” And then we thought, “This is great, we can break the Guinness Book of Records if we do 20,000 flu shots in one day in one place.” But it turns out the logistics are crazy. And that really wasn’t what we wanted. Our goal is not the Guinness Book of Records. Our goal is an impact. So it’s now more a two-week campaign in lots of different locations, and our mission is to collect data, to collect data up front, what is the baseline, how many people were vaccinated last year and the years before, what increment can we get this year, and then what is the impact going to be on sick days, on school days off, complications from flu, or the flu aggravating an existing disease. All those things are measurable, and we’re going to be measuring the outcomes. Because that’s what makes things happen. In business, you don’t look at your expenses. Well, you look at your expenses, but you really look at your look at your sales and your value and how much you created and what will people pay for.

So our outcomes long term are going to be reductions in diabetes, but they’re also going to be high school graduation rates, housing prices, the sorts of things you’re seeing happen in Detroit. We’re coming in from the point of view of health, frankly, because we think that’s probably politically the best way to achieve a lot of what Mark Bertolini’s also talking about.

So in our small communities, we can do things as collective action, and the big question I want to leave you with is whether some of it’s going to require government interference long run. Thank you very much.

I have a minute for questions if you—

Kirkpatrick: Well, just really quick. I mean you were nicely efficient. Thank you.

Dyson: The women always are.

Kirkpatrick: Well, maybe a question from the audience instead of me. Anybody got a quick question for Esther? Because my question would be, you must be wanting to work with the Aetna’s of the world to really scale this—

Dyson: Oh yes, we do.

Kirkpatrick: Because it sounds like the vision is surprisingly parallel. If he’s building farms because he wants people to eat better, this is so along the lines of what you’re doing.

Dyson: Yes. I mean, if I ran Aetna, I would try and do what he did. But, unfortunately, Aetna’s not in any of our communities, so we’re trying to persuade people, yes, you will get a return on this investment. Because, it’s not just your healthcare costs will go down, but the overall economy of your community will go up and you will get better at the inalienable American right, which is the pursuit of happiness.

Kirkpatrick: Well, it’s wonderful to see big companies—

Dyson: Little companies, yes.

Kirkpatrick: —and entrepreneurs like yourself thinking about this thing we’ve all known for our whole lives: American healthcare is really screwed up. We need to focus more on wellness. I’m so glad you’re doing it, and I think it’s very promising, so than you very much.

Dyson: Thank you.

Kirkpatrick: Thank you for being here, Esther.

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