Dr.Patricia Mechael, Executive Director of the mHealth Alliance

(Music)

Mark Masselli: This is C onversations on Health Care . I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Margaret, we’re a nation in mourning again. Another shattering
and senseless tragedy that resulted in the liv es of so many lost young people
and adults. It’s almost too much to bear this time.

Margaret Flinter: Our hearts go out to the families of the victims and to the
community of Sandy Hook in Newtown, and Mark indeed, the country and the
world; it seems th e entire world is engaged in grieving this terrible event.

Mark Masselli: And there’ll be lots of time to analyze the impact of this across
the country, certainly. Conversation will begin on gun control but now is the time
to really focus in on the heal ing and all of our prayers are out to the families and
the first responders, and the community that was impacted.

Margaret Flinter: We acknowledge and appreciate President Obama coming to
Connecticut on Sunday evening to be with the families and the fi rst responders
and to speak so eloquently to the lives that were lost on Friday at Sandy Hook
Elementary School, in Newtown, Connecticut.

Mark Masselli: Today we have Patricia Mechael, who is the Executive Director of
the mHealth Alliance, a division of the United Nations Foundation that is
committed to improving global health through mobile health technology.

Margaret Flinter: Dr. Mechael will be talking about the work her organization is
doing to bring together all the stakeholders in mobile health wi th the goal of
leveraging the potential that these technologies have for improving health care
around the world.

Mark Masselli: We’ll be looking forward to that, Margaret. We’ll also hear from
factcheck.org’s m anaging editor, Lori Robertson. She and her team get to the
truth of the matter when there are misstatements made in the political arena, but
no matter what the topic, you can hear all of our shows by Googling CHC Radio.

Margaret Flinter: And as always, please email us at CHCRadio.com or find us on
Facebook on Twitter. We do love to hear from you.

Mark Masselli: We’ll get to our interview wi th Dr. Mechael in just a moment.

Margaret Flinter: But first, here is our producer Marianne O’Hare with this week’s
headline news.

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Marianne O’Hare: I am Marianne O’Hare, with these health care headlines. The
aftermath of another mass shooting, calls are being made now to view two issues
differently; the nation’ s gun laws and access to behavioral health . California
Congresswoman Dianne Feinstein says she will submit a bill in the 2013 session
of Congress that will limit the sale and use of assault weapons. Gunshots wound
100,000 Americans a year; 30,000 die out of those and of those 10,000 are
outright murders.

Meanwhile, Congress passed a law in 2008 that places behavioral health
coverage on par with primary health issues but many who need treatment often
have difficulty finding behavioral health treatment c linicians or getting their
insurance to pay for it. President Obama discussed the need to look closer ways
we can address the behavioral health needs of this country and fill that gap.

Meanwhile, insurance exchange decisions are in this week and the fi nal tally, 32
states are refusing to set up their own insurance exchanges as directed by the
Affordable Care Act, to meet the handling of the newly insured. 18 states have
agreed to set them up, 19 have flat out refused and the remaining states are
leanin g towards a partnership with the Federal government which will have to
take on the full exchange responsibility for those states refusing to comply.

And the guy who’s helped give the gift of hearing to 200,000 folks around the
world and counting has die d. Dr. William House, inventor of the cochlear implant
has died at the age of 89. He created the first inner ear implant in 1961 which
the patient’s body eventually rejected and his first lasting device was implanted in
1969. The FDA did not give approv al for the device until 1984. I am Marianne
O’Hare, with these health care headlines.

(Music)

Mark Masselli: We’re speaking today with Dr. Patricia Mechael, Executive
Director of mHealth Alliance, a United Nations Foundation organization which
has bui lt a public - private coalition of mobile health groups. The mHealth Alliance
seeks to serve as a global catalyst for driving mHealth to sustainable scale,
unlocking the best possible benefits for public health in the developing countries.
Dr. Mechael is a global thought leader in the mHealth arena, earning one of the
first doctorates in mobile health at the London School of Hygiene and Tropical
Medicine in 2006. Dr. Mechael has done field work in over 30 countries around
the world and is co - author of mHea lth and Practice: Mobile Technology for
Health Promotion in the Developing World. Welcome to the Conversations on
Health C are.

Dr. Patricia Mechael: Thank you. I am really glad to be here.

Mark Masselli: Dr. Mechael, since you received your doctorat e in 2006, which
focused in on the role of mobile phones in relation to health in Egypt, the number
of global cell phone subscribers has grown exponentially; from around 2.5 billion
to nearly 6 billion. Now, the mHealth Alliance grew out of a meeting at B ellagio,
Italy back in 2008 and over those years what has been the biggest and most
exciting development in mobile technology in mHealth?

Dr. Patricia Mechael: The mHealth Alliance was created to help bring some and
sense and sensibility to a lot of the fragmentation that was happening in the use
of mobile technologies for health where you had the work being done by the
public sector, work being done by the private sector, a lot of mHealth pilots and
so really looking at what are the enabling environment issues that need to be put
into place, or what many of us call the mHealth comments, that’ll really help the
access to mobile technology and in the advancements in technology to really be
most effectively leveraged to reach as many as people as possible, p articularly in
developing countries where access to telecommunications infrastructure prior to
cell phones was practically non - existent.

Margaret Flinter: Dr. Mechael, as I look at your bio and listening to Mark’s
comments; the fact that you earned a d octorate focusing on mobile health at
such a remarkable institution kind of says that mobile health is here to stay. It’s
become a germane area for research and for a rigorous evaluation of the impact
that it’s having. Maybe you can tell us a little bit about your research and what
the results of that research are and how mHealth is making that impact.

Dr. Patricia Mechael : My current studies are focused on the natural progression
of cell phone use for health. My actual data collection happened in 2002 to 2003
in Egypt and so even then a lot of people in the general population were using
cell phones to access health insurance, to speak with their health care providers.
A lot of the health sector was using the cell phones to support things like disease
surveillance, readiness of health facilities to address emergencies, as well as
telemedicine or mobile telemedicine to access information.

What we’ve seen over time is just an increase in much more systematic use of
mobile technologies to support health , as well as real rise in applications both on
the phone itself, as well as servers that interact with individual cell phones either
through text messaging or interactive voice recognition systems and that sort of
thing. And so, more recently, in some of the research that I’ve done what we’ve
seen is that mobile technologies are showing some real positive impacts on
health, particularly in areas like treatment and prevention, remote patient
monitoring, as well as case management for different health issues and we’re
also starting to see a real rise in the studies that are coming out of developing
countries in publications like the Lanxess , so we now have studies on mHealth
for HIV, mHealth for Malaria, mHealth for Maternal, Newborn and Child Health,
and so it’s a really exciting time and we’re starting to get the data that’s really
pointing out at directions in which people should be investing.

Mark Masselli: Dr. Mechael, one of the annual events that Margaret and I have
enjoyed going to at mHealth Summit is the awarding of grants to innovators in
the field who’ve demonstrated programs that are utilizing mHealth technology to
make a difference in health of those of the underserved global populations. Tell
about this year’s recipients and what makes them st and out and also tell us the
likelihood of some of those programs cross - walking over and being deployed in
the United States.

Dr. Patricia Mechael: This year’s grantees range in everything from direct to
mothers and family messaging to support tools for health workers in countries
such as Malawi, Tanzania, India in a really breadth and depth that mobile
technology can and are being used to support the work of organizations who
address maternal and child health issues.

Margaret Flinter: Dr. Mechael, I’m so glad you referenced the maternal and child
health issue and you did it in the same breath with addressing workforce issues.
And these things go so hand in hand both in the United States of course and in
developing countries. Earlier this year, we spok e with some of the folks who’ve
been so involved with United Nation Millennium Development Goals and with the
project that came together with a number of leaders in government and
International Aid Organization Secretary of State Hillary Clinton spearheade d it,
but the banner was the Child Survival Call to Action which I’m sure you’ve been
very familiar with, and in looking at their work it seemed clear that mobile health
offered some real promising avenues as you’ve just described but yet the
workforce is sue doesn’t go away, right? There still has to be these linkages and
this training. Maybe tell us a little bit about how mHealth connects in that training
space, how you relate to those; whether it’s in the United States or it’s in a rural
village in Afr ica, how you bring mHealth to a new workforce and train health care
workers really in an entirely different paradigm than they may have been trained
in before.

Dr. Patricia Mechael: Sure. I mean, mHealth is becoming front and center of a
lot of the maj or initiatives; mostly because of one, as you mentioned earlier, just
the fact that there are 6 billion cell phones in a population of 7 billion people and
many of these cell phones are already in the hands of health workers, so what
we’re seeing is that o ften times, the health workers are trained; one, they are
posted to very isolated environments to serve populations with very limited
supplies, access to equipment, etc. So, the power of mobile in that environment
is quite significant. You can leverage t he mobile or mobile learning, which a
number of organizations have done. You can also position the phone or decision
support with the use of algorithms and smart algorithms for early detection and
treatment of malnutrition through the health workers.

T hen you can also leverage the technology to look at issues of supply chain
management and make sure that the frontline health workers have either the test

kit set they need or the supplies that they need, the medicines that they need, to
distribute and pro vide care in increasingly decentralized health systems.

Earlier this year, actually during the Child Survival Call to Action, we launched a
partnership with the US, the United States Agency for the National Development
called Empowering Frontline Health Workers, which is a partnership comprised
of ten partners that range from UNICEF to Qualcomm, Voda Phone,
GlaxoSmithKline and a number of others to look at how do we take all of the
content and the technologies that are out there that are being positioned to
support the work of health workers and bring them together, and then make them
more accessible to help scale up some of the frontline health worker programs.

There is a campaign to train and deploy one million new frontline health workers,
but in or der to do that I think technology is going to play a fundamental and
critical role.

Mark Masselli: We’re speaking today with Dr. Patricia Mechael, Executive
Director of the mHealth Alliance; a United Nations Foundation organization which
seeks to serve a s a global catalyst for driving mHealth to improve global health.
Dr. Mechael has done field work in over 30 countries ar ound the world and is a
co - autho r of mHealth and Practice: Mobile Technology for Health Promotion in
the Developing World.

Dr. Mecha el, as interest in mHealth initiatives in developing countries
accelerates, I think there is a need for research into best practices in using
mobile technologies to promote healthier behaviors. What best practices do you
see emerging and what research is being done, and sort of talk a little bit about
the theoretical framework that this research is based on.

Dr. Patricia Mechael: Sure. I think often times anecdotally, we fundamentally
believe that that mobile technology can play a very important role in behavior
change. And so a lot of health promotion and prevention work is predicated on
the fact that people can and will change their behaviors if they have access to the
right type of information; when and where they need that information and if it’s in
a very relatable way, and so we’re starting to see the real emergence of (13:14
inaudible) in the years of mobile of technology for health promotion and behavior
change, and there is a lot of work that has been done on things like user focus
design of tec hnologies, the use of field work and frame work to understand
people’s behavior to absorbing knowledge and then translating that knowledge
into actual change. But this has been one of the hardest areas, I think, in the
research space to really solely eval uate, because often times there are number
of confounding factors that will have an impact on people’s behaviors and then
it’s also very difficult to actually measure the health outcomes.

We’ve seen some really good work that has been done in this area around
smoking cessation with really large randomized controlled trials that have shown

the combination of mobile phone technology with support systems can generate
increases in the numbers of people who quit during the reduction have relapsed.
We’ve also seen that when technology is linked to a specific clinical outcome,
that is a lot easier as well to measure behavior change. So, with programs that
leverage most technology for remote patient monitoring for diabetes, for
example, it’s much easier to make the connection between changed behaviors;
whether they are behaviors in diets and eating, and sort of in relation to the
insulin levels or blood sugar levels, etc.

Margaret Flinter: Dr. Mechael, as we enter this brave new world of (inaudible
15:01); the prospect of certainly covering many more Americans, but also the
reality of Medicaid and Medicare and the stresses they have on their systems,
one has to think that the leaders of our both large private health insurance
industries but also our public insu rance programs are looking at this as a
potential solution. Could you share with us any of the conversations that are
going on in those sectors about how we can look at programs; certainly Text for
Baby was a great example of reaching out right in the Uni ted States to pregnant
women, trying to improve those outcomes but what’s the thinking at the
governmental level about how this tool fits in in a transformed health system post
the implementation of the Affordable Care Act?

Dr. Patricia Mechael: Sure. S o, there is a great deal of interest on the part of the
payers and using technology and leveraging mobile technology in particular to
move up towards more personalized and citizen - centered health care in an effort
to reduce the cost of health service deliv ery , as well as the burden on them, on
the payer’s side, and so there has been a number of (inaudible 16:03). One for
example that comes to mind is the work of WellDoc and their ability to show the
cost effectiveness of using mobile technology for diabete s management and to
make the case for why the insurance companies should actually be paying for
the service because it was going to save them money in the longer term from
more complicated cases of diabetes coming into the health system and really
catching as early on as possible and then not having to push them up to more
expensive sites of care.

And so we’re seeing this in a number critical areas where Medicaid are stepping
in particularly as some of the current patient monitoring systems are gearing
t hemselves towards the aging population and so how can you keep people in
their homes for a longer period of time and only have them come in to interface
with the health system when they absolutely need to interface with the health
system. Cutting out some of the routine visits by using remote patient monitoring
devices that only require people to interface with the health system when an alert
is triggered. And then on the prevention side with things like smoking cessation
programs like Text for Baby; agai n, an ounce of prevention is worth a pound of
cure. Is that how that goes?

Mark Masselli: Yes.

Margaret Flinter: Absolutely.

Dr. Patricia Mechael: I’m making it up, anyways, so there is a great deal of
interest in investing in more and more preventi on type services in an effort to
then again reduce the cost of care later on down the line.

Mark Masselli: Well I think we’ve heard in this interview that you’ve got a bird’s
eye view of what’s happening around the globe in mHealth partnerships and you
w orking with governments and NGOs and faith based groups all over but mobile
technology is also a big business, so tell us a little bit about the partnerships
you’ve forged with technology providers and how is mHealth Alliance working
with the business stak eholders to achieve the goals of your mission.

Dr. Patricia Mechael: Sure. We see industry and the private sector very much
as a critical partner in the work to advance in health scale. And then also, to
really think about sustainability. At the momen t right now, a lot of mHealth in
developing countries in particular is being financed by private philanthropies or
by a lot of organizations, but that funding is not necessarily going to be
sustainable over the long term and so we really think that industr y of West will
play a critical role in working together one, on a grand scale and then two, to
identify where some of the business models and some of the win - wins for
multiple parties are. We can start to see some revenue generation opportunities
on the c orporate side as well as critical health benefits and reach on the public
side and so it’s a really interesting time and dynamic to kind of think through
strategically how to broker these types of partnership relationships, etc., and
that’s really the spir it with which the mHealth Alliance was created in the first
place was to really help serve as a neutral broker that would bring together all the
critical stakeholders around these issues and help them in a way where the
person is at the center of the work and that their helping is really what we’re
aiming to do and then if there are ways to do that where revenue can be
generated in a responsible fashion, then everybody wins.

Margaret Flinter: We’ve been speaking today with Dr. Patricia Mechael, the
Execut ive Director of the mHealth Alliance, a United Nations Foundation
organization that’s dedicated to leveraging the power of mobile health technology
to improve the unmet health needs of the global population. You can learn more
about the work they do by go ing to mhealthalliance.org . Dr. Mechael, thank you
so much for joining us on Conversations on Health C are today.

Dr. Patricia Mechael: Thank you.

(Music)

Mark Masselli: At Conversations on Health C are, w e want our audience to be
truly in the know when it comes to the facts about health care reform and policy.

Lori Robertson is an award - winning journalist and managing editor of
factcheck.org ; a non - partisan, non - pr ofit consumer advocate for voters that aim
to reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well, Mark and Margaret, this week we’ll look at a new fee on
health insurance plans to help cover thos e with pre - existing conditions. A few
readers have asked us whether it was true that the Federal Health C are Law was
going to impose a $63 per capita fee on those buying insurance. It turns out it’s
true. Here are the details on what the Department of H ealth and Human
Services recently proposed: the insurance fee goes into a fund that helps
insurance companies cover those who are currently uninsured and have pre -
existing conditions. Starting in 2014, insurance companies must offer coverage
to anyone, re gardless of their medical histories. Though the health insurance
industry was in favor of this fund, but the money will come from a $5.25/month
fee; that works out to $63 for the year in 2014 on all health care payers . That’s
employers who provide covera ge or plans bought on the individual market. It will
continue through 2017 and then end, and the amount assessed will decline each
year. So it’s temporary and designed to ease the transition as those with medical
conditions get insurance, but for the thr ee years that’s in effect, it’s expected that
employers will largely pass along that fee to employees, increasing their health
care cost to help pay for coverage for those with pre - existing conditions. And
that’s my fact check for this week. I am Lori Ro bertson, manager editor of
factcheck.org .

Margaret Flinter: factcheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’d like
checked, email us at chcradio.com , we’ll have factcheck.org’ s Lori Robe rtson
check it out for you, here on Conversations on Health Care.

(Music)

Mark Masselli: Each week, Conversations highlights a bright idea about how to
make wellness a part of our community’s and everyday lives. When you think of
Detroit, you don’t i mmediately think of agricultural mecca but community activist
Ashley Atkinson is seeking to change that perception. Recently recognized by
the Robert Wood - Johnson Foundation as one of the nation’s top young leaders,
Atkinson’s vision is gaining some atten tion.

Currently, only about 2% of Motor City’s fruits and vegetable consumption is from
local gardens. Atkinson is seeking to dramatically alter that statistic by aiming to
achieve food sovereignty where most of the region’s produce production will take
place right in their backyard. Atkinson envisions a green revolution where the
economically depressed city with thousands of vacant lots will be transformed
into a network of community gardens. Already, her team has transitioned 135

acres of unused city land into 1,400 community gardens, tended by thousands of
families, school children, entrepreneurs; even whole communities are getting
involved.

Ashley Atkinson: Local farmers, Michigan farmers don’t have a lot of resources
to compete with industrial agr iculture and places like this actually bring together
consumers and producers trying to not only provide fresh fruits and vegetables to
the community but make a living.

Mark Masselli: The gardens are a network, so that production of produce is
balanced t o yield a more comprehensive and diversified crop. Her program is
growing. As Director of the Urban Agriculture and Open Space Green of Detroit,
she is seeking to demolish a score of dilapidated homes, replacing them with
more gardens and her system is b eing replicated in other cities as well. A
community driven effort to transform areas of urban decay into lush productive
gardens with the goal of providing that community with the abundance of locally
grown produce to improve the health of that community , now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

Mark Masselli: And I’m Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live wesufm.org and brought to you by the
Community Health Center .