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Integrating mental health into primary care: an idea ready for the mainstream

Friday, November 8, 2013

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CIHS infographic
Image courtesy of thenationalcouncil.org

At Ginger.io, we hope for a future where mental health is central to managing a community’s health. As we discussed in our last post, addressing mental health is particularly crucial for helping patients manage other chronic diseases like diabetes, lung disease and cancer. Our dream is for our technology to be a part of the revolution integrating behavioral health as an essential component of any well-functioning primary care system.

If you follow our blog posts, you probably already know how much we care about mental health. It’s still sobering to think of how broadly mental health problems affect our country: a 2008 report estimated that 26% of Americans suffer from a mental health disorder, and that 6% have a severe disorder. This adds up to nearly 60 million people in America with a mental health disorder. That’s staggering.

These statistics aren’t just faceless numbers, either. I encounter the reality of the burden of mental illness in my clinical work every day. It’s the young man with untreated multiple sclerosis with progressive pain and weakness because of an undiagnosed mental illness manifesting as uncontrollable irritability and anger that no physician had tried to treat before. Or the middle-aged Dominican woman with depression and knee arthritis who didn’t treat either problem and bounced from primary care practice to primary care practice because no one could find her a Spanish-speaking therapist. A common story I hear from patients is that it was just too hard to find a mental health professional, so they stopped looking.

The most credible proposal to fix the problem of mental health access is fundamentally changing how mental health care is delivered. Instead of piecemeal access for whoever is lucky enough to have a psychiatrist, psychologist or social worker nearby, health systems across the country are transforming their primary care infrastructure to integrate mental health care directly into primary care. This makes sense for a number of reasons:

1) In the US, Primary care providers are the frontline for medical care. They are better suited than anyone to address mental health in their communities. It has been estimated that up to 70% of primary care visits stem from psychosocial issues. In addition, diagnosing and treating mild or even moderate mental illness is not too complex for primary care physicians. However, it makes practicing much easier to have the support of a behavioral health infrastructure to back up your decisions and help with complicated cases.

2) Payment reform and the Accountable Care Organization movement means that treating mental health doesn’t mean losing money. In most markets today, mental health care reimburses poorly, leading to closure of psychiatric facilities and prompting health systems to avoid developing a strong mental health infrastructure. However, payment models are increasingly switching from purely “fee-for-service”, where physicians get paid for every service they provide, to a “bundled payment” model, where physicians get paid a fixed sum to take care of a large population of patients. At a high level, the overall incentive in the bundled payment model is for physicians to save money by improving their populations’ health to reduce avoidable health care use. And it turns out that treating mental illness is a very effective way to avoid excessive health care utilization.

3) There is also accumulating evidence that primary care and behavioral health can do amazing things when they work in the same place. The most widespread model is the IMPACT program, which involves integrating a psychiatrist and population care manager into primary care to manage depression.  This team, together with the primary care physician, can provide much more comprehensive management and follow-up for patients with depression. The model has spread to over 500 clinics across the country.

4) There’s also legislation to help increase mental health access for all: in Massachusetts, a bill is being proposed the would compensate psychiatrists for electronic visits at the same rate as an in-person visit, which could be transformative. There are also pilots of electronic psychiatry visits, or “telepsychiatry” being piloted in over 40 states.

I’ve seen all of these factors in play firsthand. My clinic happens to be one of those great places where primary care and behavioral health can work together. On my clinical team, there’s a social worker who meets with our population manager and a psychiatrist weekly to coordinate care for all of our patients with mental health needs. If I meet a new patient who has a mental health need (and many do), I have them fill out a comprehensive form and then our social worker helps to find the right place for their mental health care. Together with the social worker on my team, we have helped almost all of my patients with serious mental health needs into the loop of the best mental health professional they needed. And once that loop is established, we are in continuous contact about how to thread together our patients’ mental and medical health care. By integrating behavioral health into primary care, we are able to treat the whole patient, not just the symptoms.

How do you integrate mental health into primary care? Join the discussion on twitter by letting us know at @ginger_io!

Why Mood Matters

Monday, September 30, 2013

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Note: This was cross-posted by our partners at UCSF’s Health eHeart study. Sign up today to contribute to the fight against heart disease!

health eheart question

A New York Times article by Columbia’s Dr. Eric Kandel makes a convincing argument for the “New Science of Mind,” which posits that our minds are directly connected with the biology of the brain.  Along with Ginger.io, we believe that our minds are also connected with the biology of the body. Understanding our mental health, not only our physical vital signs, is critical.

This may not seem intuitive at first — it’s easy to understand how an objective physical measure like blood pressure or heart rate impacts a condition like heart disease.  It can be harder to make the connection between a “soft” question about something like mood and a chronic condition. However, a new body of research is convincingly making the case that mental and physical health are closely linked.  Understanding mood change could very well help us understand why some people develop a chronic condition, or respond better to treatment.

In particular, a number of studies looking at the impact of depression and anxiety that are co-morbid (or present with) chronic conditions have found a real connection to quality and cost of care.  In general, people living with chronic conditions have rates of co-morbid depression ranging from 25-50%.1 This translates to a real personal and economic impact — undiagnosed patients are less likely to be adherent to treatment protocols, which can lead to costly complications.

For example, research has shown elevated levels of depression after diagnosis in cancer patients (and their spouses).  Similarly, people living with diabetes are at high risk for depression (as well as stress and anxiety).  For heart disease, it’s a similar relationship, with both a higher prevalence of depression (40 to 60%) among heart disease patients, as well as a possible biological rationale for that number in how our bodies react to stress.2

And the relationship goes both ways. In addition to chronic conditions leading to elevated levels of depression, depression can also impact whether someone may develop a chronic condition.  According to a recent study, “depressed older adults (defined as those over age 50) were more than twice as likely to develop vascular dementia and 65 percent more likely to develop Alzheimer’s disease than similarly aged people who weren’t depressed.”3 These statistics hold for conditions like heart disease, where “30 to 50 percent of patients who suffer clinical depression are at risk of developing cardiovascular disease.”4

Given this clear relationship between mental and physical health, how do we measure something that seems so subjective?  Self-report questions can be a good starting point.  Ginger.io’s research, done at MIT Media Lab shows that you can use self-report answers to train a model to find patterns in sensor data — like the movement and communication data from your phone — that suggests when someone might be feeling down.

So that’s why we ask mood and related questions — to help us better understand the relationship between mental and physical health.  With your help, we can make providing the best care for both mental and physical well-being part of how we treat chronic, and often go untreated.  In addition to the psychic cost of conditions.

Want to get involved? You can sign up for UCSF’s Health eHeart study and contribute to our understanding of CHF today. Or join the conversation on twitter at @ginger_io and @Health_eHeart.

Looking for more information? If you or a loved one is currently struggling with co-morbid depression, this booklet from the Behavioral Diabetes Institute is a good source of information.

References
1http://publications.milliman.com/research/health-rr/pdfs/chronic-conditions-and-comorbid-RR07-01-08.pdf
2http://www.sciencedaily.com/releases/2013/02/130219121604.htm
3http://newoldage.blogs.nytimes.com/2013/05/01/does-depression-contribute-to-dementia/
4http://www.sciencedaily.com/releases/2013/02/130219121604.htm

What we learned on our summer co-op

Friday, September 6, 2013

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This past summer, Jennifer Blight and Jonathan Acevedo, students at the University of Waterloo, joined us as engineering interns.  While they were here, we all learned a lot about Canada.  We asked them to reflect in turn on what they learned from us.

Ginger.io interns

The grumblings of Samuel Clemens aside, San Franciscan summers still have nothing on Canadian winters. It’s been an amazing four months for the Waterloo interns here.  We both feel that we’ve learned a lot in a very short time. Hopefully we have become better developers for it; but often the biggest challenges are not about writing code. These are a few of the ‘life lessons’ that will accompany us as we return to the frozen North.

Ask Stupid Questions

Everyone here has their own area of expertise, no one knows everything, and the whole team is open to questions from anyone about anything. You’re not just encouraged to ask questions, you’re expected to; because you learn faster, and produce better results more efficiently if you get the right information quickly, rather than fumbling around by yourself. So ask questions. Ask about your work, ask about other people’s work, ask questions even when you think no one has time for them.

(and ask “Why?”)

Understand the logic that goes into each decision. Be critical. Why am building this? Why do we do it this way instead of that way? The answers to those questions aren’t just for your information; the act of explaining makes the answerer accountable for their reasoning.

Your Opinion Matters

Your opinion matters more than you think. One of the first things that we were told is: “Everyone on this team will treat you as a full time employee.” This has been true throughout our entire internship. Overhear someone talking about the product you built? Feel free to step in. Brainstorming new product ideas? Jump in. Racing to the finish line for the team scavenger hunt? Sprint ahead.

The entire team is constantly striving to learn, innovate, and to better themselves. Everyone is trusted to be in charge of their schedules, and the work that they do.

Own Your Work

Perhaps one of the hardest things about being an intern is unlearning the instincts of a student. There are no predefined requirements, no rubrics and, often, no right answers. You’ll be given a lot of autonomy and expected to make your own decisions about scope and direction. We have many mentors, but often there’s no direct supervisor. You have to be self-directed, explore, figure things out, and occasionally take leaps. The result is a project that is completely and uniquely your own; something you have nurtured from its inception and something that you will be reluctant to leave.

Want to join the conversation? Let us know what you think at @ginger_io. And check out our team (and our openings) 

Learning from our partners and from each other

Wednesday, September 4, 2013

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At Ginger.io, we believe that our product is only as strong as our people.  From the team members who work tirelessly to build something that fills a need to the clinicians who use our dashboard to the individuals on our app, our technology is about enabling people to provide and receive better care.

As we’ve grown, it’s been really important to listen to all of our people to find out what motivates them and how we can make them successful.  Cincinnati Children’s Hospital and the C3N Network, with whom we’ve been working for over a year, have been essential partners in this process.  We recently launched a big project with them to study Inflammatory Bowel Disease in adolescents. As part of that launch, we featured those who were contributing to science by using the Ginger.io app.  Today, we also wanted to highlight some of the other people who have helped make Ginger.io (and our work in IBD) what it is today.

Dr. Shehzad SaaedThe Doctor

Dr.  Shehzad Saeed of the Cincinnati Children’s Hospital has been treating patients with IBD for the past 15 years.

His challenges: Over those years, he’s seen his patients struggle with self-management skills and the transition to adult care. He himself has faced challenges around access to real time patient data that would allow him to provide effective care to engaged patients.

Why Ginger.io: Given these concerns, he’s excited about how Ginger.io can provide a snapshot of how each patient is doing so that visits can be much more effective.

What we’ve learned from Dr. Saeed: He’s given us great feedback around how to drive more effective pre-visit planning and empower patients.

Cathy Reeder-McIntosh, MPH, BSN, RN, CDE

The Educator

We’ve been working with Cathy Reeder-McIntosh, MPH, BSN, RN, CDE, through our partnership with Novant Health for over six months.

Her Challenges: While her work focuses primarily on at-risk people living with diabetes, she faces similar issues to the C3N team. One of the biggest challenges she faces is figuring out which patients need to be reached out to each day.

Why Ginger.io: As a nurse, Ginger.io has the potential to increase her impact by letting her talk to the right patients each day. Additionally, in her personal life, she uses Ginger.io to help her manage her own diabetes. She likes that it gives her a chance to stop and think about how she’s doing every day.

What we’ve learned from Cathy: Cathy has been a very important partner in helping us think through how to design tools that are easy to use and empower the clinician.  We’ve even named our latest dashboard prototype after her!

Jimmy Do

The Engineer

Jimmy Do, co-founder of the mobile health startup Pipette, joined Ginger.io about a year ago. He works primarily on our mobile apps.

His Challenges: Jimmy is constantly thinking about how to build products that provide greater context and intelligence to doctors and nurses to enable them to better help patients. He relies on the data gathered from participants in our studies to make the tools he builds more accurate and useful. He also uses that data to decide what not to build, which is always a challenge for a company with a lot of ideas.

Why Ginger.io: Jimmy joined Ginger.io because he was excited about the idea of working on a product that could dramatically improve health care. His ultimate vision is of a company that replaces the paperwork and manual processes of helping patients recover and stay healthy.

What we’ve learned from Jimmy: Jimmy thinks empathy needs to be a part of everything we do. He keeps us honest about putting people first as we work together to build Ginger.io.

Are you excited by what Dr. Saaed, Cathy and Jimmy are doing?  We need your help and we want to learn from you!

If you or someone you know is living with IBD and is age 13-25, learn more and sign up (or share) today!

 

True reflections on a summer at Ginger.io

Sunday, September 1, 2013

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Chad Kamisugi joined us from Stanford as a patient engagement intern.  You can read more about his adventures at Ginger.io and as a member of True Venture’s TEC program here, and see what he learned below.

With every end comes a new beginning. I could not have imagined the amount of learning, new experiences, and relationships I would have made this summer at Ginger.io. From the moment I walked into the office for my interview to the moment I said my goodbyes, it has been the people that have made this experience so meaningful.

I have been reminded of how important it is to surround yourself with quality people. By the end of the summer, every member of the Ginger.io team felt like family and brought such a unique perspective to the table. Each personality and idiosyncrasy added to the vitality of the work environment and pushed me to think and grow in unexplored ways. Whether it was a conversation about the technical challenges of building a new dashboard, the mathematical principles behind the building of an igloo, or how to make the most of college, every moment together was full of learning.

Perhaps what I appreciated most about Ginger.io was the thoughtfulness. Decisions were approached very rationally. We spent a lot of time making sure that there was solid reasoning behind each course of action. This dedication to rigorously examining ideas permeated through the culture of the organization. In particular, feedback was an essential component of the Ginger.io fabric and I was constantly pushed to think about what was going well, and what could be improved. I appreciated the sincerity with which feedback was sought, and the safety I felt to share my opinions.

In my role working on patient engagement and account management, I had the opportunity to interact with different partners and users to better understand their needs and how we can best meet them. It was moving to hear the stories of some of our users and the hope Ginger.io has given them. It was during these conversations that I began to understand both the enormity of the problems we are trying to tackle, but also the great potential we have to improve the quality of life for so many people. It was moving to reflect upon the potential impact of our work and energizing to think about the talent and ambition of those on the Ginger.io team to solve these problems.

I feel so grateful to have had the privilege of working to solve such an important problem alongside such diverse, thoughtful, talented, and empathetic people. I return to school for my junior year with a much broadened perspective and understanding of not only the healthcare space but also life in a startup. Though my official summer internship at Ginger.io has ended, the meaningful relationships that were forged during my time there have just begun.

 

Understanding the AMA’s newest “disease”

Tuesday, August 13, 2013

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Last month, the American Medical Association voted for the first time to call obesity a disease, classifying over 78 million adults and 12 million children as “sick.” This comes after a rash of articles attempting to better understand contributing factors and proposing individual and societal solutions.

With multiple partnerships in diabetes, we’ve become very interested in understanding how diabetes, and the related condition of obesity, can impact overall health.  However, with all the new information out there,  this can be a daunting task. For our own benefit — and hopefully yours — we’ve taken a pass at sorting through the research and understanding what it means for us as individuals.

genesskinnyjeans

Genes and skinny jeans

In July, researchers at Boston Children’s Hospital announced they had found a gene in rats that, when deleted, made those rats extremely obese.  Interestingly, the gene seemed to affect the relationship between calories consumed and weight gain; rats without the gene could eat 15% less than their control peers and gain the same amount of weight.  While these types of gene mutations and deletions are thought to be relatively rare, this research helps us better understand the link between genetics and obesity.

What it means for us: Unfortunately, not much today, as much as we’d like to blame our genes.  Longer-term, research like this could help us better understand the mechanics of obesity and potentially devise treatments that can help us protect against weight gain.

Fighting fat with fat

In February, a New York Times Magazine headline promised an introduction to “The Extraordinary Science of Addictive Junk Food,” and how the fast food industry has conspired to make bad for us foods irresistible.  Just a few months later, The Atlantic countered with “How Junk Food Can End Obesity,” discussing how “demonizing processed food may be dooming many to obesity and disease.” It’s enough to give the consumer whiplash.

Both articles agree that “junk food,” available at the drive-thru or in the check-out line, is bad for our health.  Where they differ is on whether the current junk food producers, the McDonald’s and Nestles of the world, actually have the potential to become sources of nutritious, low-calorie processed-food for people who may not otherwise have access to healthy options.

What it means for us: The conversation about the responsibilities of corporations in fighting obesity is on-going.  In the short-term, everything in moderation, and keep an eye out for healthier options on fast food menus and shelves.

Bugs?

You may have heard of the microbiome, or the constellation of bacteria in the human body that work in a way that allows us to function. Now, scientists are actively trying to “map” these organisms to understand what they are and how they work together.  While we have a way to go, research shows that the function of these tiny bugs in our intestinal tract – our gut biome –  may impact how we gain and lose weight.

One study looked at the relationship between antibiotics and obesity, finding that mice who received antibiotics early in life had higher total fat masses. Another area of research looks at how the gut biome changes after we change the body. A study looking at bariatric surgery patients found clear changes in their bacterial makeup.

What it means for us: This is still early research, but it is possible that someday soon our medical teams will tell us to “take 10,000 bugs and call us in the morning.”

What do you think of this new research? Let us know @ginger_io or leave us a comment!

Three things I learned working at Ginger.io

Tuesday, July 30, 2013

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MIT senior Sneha Kannan joined Ginger.io as our Patient Engagement Intern during the spring of 2013.  As she wraps up her time with us and prepares to head off to med school at Penn in the fall (go Sneha!), we asked her to reflect on what she learned.

SNEHA2

I’m continually amazed at how fast time flies. I wanted to close with a few thoughts about what I learned as an intern working for my first start-up.

Everyone has to wear many hats — and you choose what hats to try on.

I’m entering medical school in the fall, so I’m gearing up to go into a career with hierarchy and a defined role for every person in that hierarchy. I didn’t expect Ginger.io to be so flat and collaborative. As an intern, I could listen in on any calls I thought I could learn something from and ask about any project I wished. If I had any ideas to contribute, I could hop in.

I was particularly impressed watching the rest of team switch from idea to idea, project to project, client to client. The sheer size of the skill set everyone developed by working on a little bit of everything was amazing to me (and something I got to pick up too). The nice thing about healthcare is that the business end and tech end are tightly intertwined.  I got to observe and learn from so much more than just the couple projects I was brought in to work on.

It helps to be okay with just diving in with few instructions.

At Ginger.io, there were no instructions, no problem sets, no syllabi, and certainly no rubrics to tell you what an ‘A’ outcome looked like. The instruction was to present a report or document, and the rubric was “does this help Ginger.io?” The in-between was often a mystery. I thought I’d have a hard time adapting to that, but I found I loved it. I learned so much more by muddling around and having conversations to figure out the best way to help the team. I may have been doing more work because I wasn’t sure which way the project was going to go, but it meant more learning.

I think the enduring lessons from the past few months have come from what I wasn’t supposed to do just as much what I was. Experimentation was stressful and a lot of pressure. But figuring out that right combination to help our patients was worth it in the end. It’s been so gratifying and humbling for me to see the team build on the work I’ve done.

The ideas are great, but the people make the job worth it.

I love healthcare, but ideas can only take you so far. Great companies are made by the people. I’ve heard it said before, and I didn’t fully believe it until I was a part of Ginger.io. While Ginger.io is built on some solid medicine and technology, the passion, the energy, and the innovation of each individual with whom I’ve worked has amazed and inspired me to go make the world better.

What makes the Ginger.io team special? It’s the way the entire Ginger.io group was on my team and working with me on whatever I was doing. Within a few hours of officially signing on, my mentor Julia didn’t rest until I had met every member of the team virtually or in person. I was encouraged to send any important finding to the entire company, whether or not everyone knew what I was working on. I would send out reports and I’d hear feedback from people who were only tangentially involved. You’d think it would be hard to mesh with 15 people, but at Ginger.io it felt simple. That’s no easy feat, and that’s certainly what I’ll miss the most about my internship.

For me, my time at Ginger.io showed me that elusive you-don’t-know-what-it-feels-like-until-you’ve-worked-in-it start-up culture. But I think the team takes it a step further. Healthcare is a highly regulated industry with a lot of rules and set practices. While Ginger.io follows every single one, they’ve opened my eyes to how healthcare can be different even within that framework. How patients can hack their own health. How they can take control of their wellness into their own hands. How technology fits into healthcare. And how to identify unique places where I can make a difference throughout my career.

Questions? Thoughts? Want to hear how Sneha’s career progresses? Follow her on twitter at @SnehaTKannan.

Help us #ImproveCareNow with C3N and Ginger.io

Thursday, July 18, 2013

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C3N signupBy 2018, research suggests that remote patient monitoring systems such as Ginger.io will save the world’s healthcare systems up to $36 billion. This may seem far away, but you can be a part of that shift now!

If you’ve been following us on Twitter lately, you’ll have noticed a lot of chatter about our work with The C3N Project.  Ginger.io is partnering with C3N to study Inflammatory Bowel Disease (IBD). We’ll use the sensors in your smartphone to provide you — and the C3N team — with a better sense of how you’re doing. Together, we can improve the quality of care for you and people like you.

If you would like to join our study with C3N and help us better understand IBD, sign up today! 

P.S. Read more about Juniper Research’s predictions about the future of patient monitoring.

Staying true to the best you

Wednesday, June 19, 2013

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At Ginger.io, we spend a lot of time thinking about overall well-being. While sharing our summer plans, we realized that while we were all excited for sunshine, the barbecues, beach days, and other social events of the season gave us feelings of “so many new people.”

So much sunshine, so many people!

To help think through how to be our best selves in the face of summer’s social stress, Ginger.io team member Julia sat down with Ed Batista, an executive coach and Instructor at Stanford’s Graduate School of Business. Ed, who is a thought-leader on the topics of personal growth and empowerment, is writing a book on self-coaching for Harvard Business Review Press.

Ed had a number of thoughts on how we can be our best social selves but also find time to reflect. This is just the beginning of the conversation – let us know at @ginger_io what resonated with you and how you find time for yourself over the summer — and in any social situation.

Be open to using social situations as a chance to grow
Our self-perception can have a huge impact on how we act. Ed is a big fan (and we are too) of the work of Stanford psychologist Carol Dweck on mindset. Dweck’s research has found that most people have either a fixed mindset or growth mindset. With a fixed mindset, we view our talents and capabilities as things we can’t change. In a growth mindset, we view our capabilities as flexible and responsive. People in a fixed mindset are less resilient and persistent in the face of obstacles, and more likely to be self-critical, whereas people in a growth mindset are focused on finding opportunities for improvement.

In social situations, a fixed mindset can increase our fear of mistakes and lead to social anxiety. We all know that feeling of being tongue-tied because we’re afraid to say the wrong thing. The work of Michigan State psychologist Jason Moser shows that when we screw up, we have two brain responses — the initial, emotional “oh no!” and the subsequent review of the incident. People in a fixed mindset are less likely to spend time on the latter, whereas those in a growth mindset are curious about screw ups and focus on using them to learn. If we give ourselves permission to make mistakes, we open ourselves up to being more in the moment and able to enjoy those social conversations.

Take control, but have compassion for yourself
Having a growth mindset and learning from mistakes is self-empowering. It means saying I am in control of my reactions, and have the ability to change. The flipside of this, however, is that sometimes self-empowerment can become self-doubt in the face of those things it takes time to change or that we can’t affect. This is especially true when there are emotional or physical factors affecting how we feel.

Thus, having compassion for yourself is an important part of self-empowerment. Recognizing that if we have patience with ourselves we will not only open ourselves up to others but make it easier to learn is an important part of becoming comfortable and reducing our social stress. Ed suggests finding the happiness strategy that may be right for you, whether it be smiling or another approach.

Find your way of finding time to reflect
Self-empowerment and growth are hard work, and require time for reflection. Reflection can be solitary, through journals, writing or digital tools like Ginger.io. Ed uses his blog and book as a way to capture his thoughts and often asks the people he works with to journal.

Reflection can also happen through the relationships that challenge us to challenge ourselves. Finding a support network or coaching team of people who you can talk to can also help you find the time you need to focus on yourself and the relationships that matter to you in the midst of a busy summer season.

Big Behavior — The 40% Problem

Thursday, June 13, 2013

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Gopal Pai joins Ginger.io from the University of Michigan’s Medical School and Wharton, where he is jointly studying for a MD/MBA. Given his background, we’ve asked him to take a periodic look at the clinical issues underlying our work.

We eagerly tore through Mary Meeker’s much anticipated annual report on internet trends. As a behavioral analytics start-up, we stopped short on slide 25, on which Meeker discusses the relation between behavior and mortality. According to a 2007 New England Journal of Medicine (NEJM) article she cites, peoples’ behaviors, including smoking, obesity, inactivity and alcohol, account for ~40% of premature death in the United States.

Given Ginger.io’s strong focus on behavior and health, we wanted to dig a little deeper into that 40% number. In the NEJM article, entitled “We Can Do Better – Improving the Health of the American People,” Dr. Steven Schroeder contends that:

“When it comes to reducing early deaths, medical care has a relatively minor role. Even if the entire U.S. population had access to excellent medical care — which it does not — only a small fraction of these deaths could be prevented. The single greatest opportunity to improve health and reduce premature deaths lies in personal behavior.” (1)

Mokdad AH, Marks JS, Stroup JS, Gerberding JL. Actual causes of death in the United States, 2000. JAMA 2004;291:1238-45. [Errata, JAMA 2005;293:293-4, 298.]

While Schroeder admits that the exact number of deaths attributed to inactivity and obesity is slightly ambiguous to determine, the magnitude of the behavioral component to premature death is impressive. Prior work performed by Mokdad et al. breaks down the number of deaths attributable to various behaviors to find that obesity and smoking continue to be the major drivers. (2)

At Ginger.io, we think about behavior at a more granular level than the broad label of something like obesity, or smoking. We look at the patterns of everyday activity that roll up in broader lifestyle concerns. This often means understanding not only the symptomatology of a disease but the underlying impact on and from things like mental health.

From this context, the NEJM article makes another argument that is particularly compelling for Ginger.io. In addressing behavior change and tobacco use, the NEJM article referenced a 2000 JAMA article by Lasser et.al. that examined connections between smoking and mental illness. The study found that participants who reported mental illness in the past month were 2.7 times more likely to have smoked in their lifetime. In addition, smokers with a history of mental illness had a significantly decreased quit rate when compared to smokers without mental illness. (3)

The research thus suggests that mental illness, physical illness and behaviors will continue to prove themselves to be intertwined. This creates many opportunities for a technology like Ginger.io’s platform to address some of that 40% of deaths that Meeker highlights.

Behavior is a huge part of health and we’re happy to be working toward providing behavior transparency for our members.

What do you think? Should we be focusing on behavior as a cause of death, or looking at other causes? Tweet us at @ginger_io with your thoughts!