Dan Munro

Writer

Nick Adkins and the #Pinksocks Tribe

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Traveling to a healthcare event last year, I shared a long ride from Amsterdam’s Schiphol airport to Nijmegen with Nick Adkins. Nick is one of those larger than life characters in healthcare that’s amassed a sizeable and loyal following — both in real life and on social media channels like Twitter. To that point, we had only traded tweets — so it was a great chance to meet him in person. If there’s an opposite to the character of a grifter or con artist it’s a gifter — someone who gives freely of their time and energy. That’s probably the best single description I can think of for Nick. He’s a gifter.

So just what is his gift? He has many (including some amazing stories), but as an extension of his overall generosity, he freely and liberally gives out pairs of pink socks wherever he goes — and pretty much to anyone who will accept the gift. At major healthcare events (and some minor ones), he has boxes shipped in and they’re usually available as a part of a speaking engagement — mostly where Nick is talking about building a tribe of people that wear pink socks.

There’s a twitter hashtag #pinksocks, a website, and the interwebs are littered with pictures of this growing tribe. Maybe you’ve seen the tweets, the people, the pictures — or even wear a pair yourself. Here’s just one example.

The tribe is growing — and officially includes Royalty — literally. Here’s Nick gifting a pair to Princess Laurentien of The Netherlands.

Nick gave me a pair as well, of course, but I was both hesitant and skeptical of the meaning and purpose behind the gift. By wearing pink socks, what I am signing up for? What cause or group am I visually endorsing? Who pays — and who benefits? It’s a reporter’s instinct — at times a curse — but it also comes from years of covering healthcare where truly free gifts are rare (valet parking?) and many of the stories I seem to come across are variations of horrific or criminal abuse — often at scale.

And then recently I came across a story that was published years ago on Reddit — and it made me think of Nick and his pink socks. Absent a formal meaning I think the Reddit story is a worthy contender for what the #pinksocks could mean. At least it is to me. It’s also a great road story — for all of us on the journey ahead. Maybe you’ve already seen it (originally posted here), but it’s well worth another read.

This past year I have had 3 instances of car trouble. A blow out on a freeway a bunch of blown fuses and an out of gas situation. All of them were while driving other people’s cars which, for some reason, makes it worse on an emotional level. It makes it worse on a practical level as well, what with the fact that I carry things like a jack and extra fuses in my car, and know enough not to park, facing downhill, on a steep incline with less than a gallon of fuel.

Anyway, each of these times this shit happened I was DISGUSTED with how people would not bother to help me. I spent hours on the side of the freeway waiting, watching roadside assistance vehicles blow past me, for AAA to show. The 4 gas stations I asked for a gas can at told me that they couldn’t loan them out “for my safety” but I could buy a really shitty 1-gallon one with no cap for $15. It was enough, each time, to make you say shit like “this country is going to hell in a handbasket.”

But you know who came to my rescue all three times? Immigrants. Mexican immigrants. None of them spoke a lick of the language. But one of those dudes had a profound effect on me.

He was the guy that stopped to help me with a blow out with his whole family of 6 in tow. I was on the side of the road for close to 4 hours. Big jeep, blown rear tire, had a spare but no jack. I had signs in the windows of the car, big signs that said NEED A JACK and offered money. No dice. Right as I am about to give up and just hitch out of there a van pulls over and dude bounds out. He sizes the situation up and calls for his youngest daughter who speaks English. He conveys through her that he has a jack but it is too small for the Jeep so we will need to brace it. He produces a saw from the van and cuts a log out of a downed tree on the side of the road. We rolled it over; put his jack on top, and bam, in business. I start taking the wheel off and, if you can believe it, I broke his tire iron. It was one of those collapsible ones and I wasn’t careful and I snapped the head I needed clean off. Fuck.

No worries. He runs to the van, gives it to his wife and she is gone in a flash, down the road to buy a tire iron. She is back in 15 minutes, we finish the job with a little sweat and cussing (stupid log was starting to give), and I am a very happy man. We are both filthy and sweaty. The wife produces a large water jug for us to wash our hands in. I tried to put a $20 in the man’s hand but he wouldn’t take it so I instead gave it to his wife as quietly as I could. I thanked them up one side and down the other. I asked the little girl where they lived, thinking maybe I could send them a gift for being so awesome. She says they live in Mexico. They are here so mommy and daddy can pick peaches for the next few weeks. After that they are going to pick cherries then go back home. She asks if I have had lunch and when I told her no she gave me a tamale from their cooler, the best fucking tamale I have ever had.

So, to clarify, a family that is undoubtedly poorer than you, me, and just about everyone else on that stretch of road, working on a seasonal basis where time is money, took an hour or two out of their day to help some strange dude on the side of the road when people in tow trucks were just passing me by. Wow.

But we aren’t done yet. I thank them again and walk back to my car and open the foil on the tamale cause I am starving at this point and what do I find inside? My fucking $20 bill! I whirl around and run up to the van and the guy rolls his window down. He sees the $20 in my hand and just shaking his head no like he won’t take it. All I can think to say is “Por Favor, Por Favor, Por Favor” with my hands out.

Dude just smiles, shakes his head and, with what looked like great concentration, tried his hardest to speak to me in English: ‘Today you … tomorrow me.’

In our travels, sometimes gifters present with a car jack and a tamale. Other times it’s a simple pair of socks to remind us of our humanity and vulnerability. Often their handiwork isn’t visible beyond a single act of unseen kindness, but sometimes we can see it in something as simple as an article of clothing. If you happen to come across someone wearing a pair of #pinksocks, just remember — it’s likely because a lone gifter named Nick decided to make a tribe out of people who were actually presented with more than just a pair of colorful socks. They were also presented with a free and simple choice. To join.

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Targeting the ‘Superusers’ of Healthcare with Telehealth

By

Peter Fine – CEO of Banner Health

The consumer version of “telehealth” is both easy to imagine and easy to use. Faced with a healthcare event or condition (that isn’t 911), a consumer uses a smartphone, tablet or desktop connection to engage clinical care in real‒time. The cost is relatively affordable (even outside of insurance) and it saves an annoying trip to either a walk‒in clinic or the local urgent care. It’s the video equivalent of “1‒800‒doctor” or the nursing call center.

It’s an important consumer category of primary care, of course, but what about the so‒called “superusers?” These are the 5% of patients ‒ often elderly ‒ that have multiple chronic conditions and account for up to 50% of all healthcare spending. For this group, healthcare needs and remote care management are vastly different. These solutions need to be industrial‒strength and much broader in scope. Not just from the technology side, but also from the business side of care delivery.

With facilities in 7 states, Banner Health employs over 46,000 people and is Arizona’s largest private employer. It’s also one of the largest secular, nonprofit healthcare systems in the U.S. with more than $5 billion in annual revenue.

While Banner’s formal commitment to remote care (often called “telehealth” or “telemedicine”) dates back to 2006, the results around a recent pilot with 135 “in home” patients is a strong endorsement for using technology as a strategic mechanism for the remote care of superusers. Banner and Philips announced the results of the pilot (started in 2013) earlier today at the opening of the 20th annual Telemedicine Meeting and Trade Show in Los Angeles.

  • 27% reduction in cost of care
  • 32% reduction in acute and long-term care costs
  • 45% reduction in hospitalizations

The only real doubt about the future of this type of remote care delivery is the moniker itself ‒ “telehealth.”

In a conscious effort to drop the dated reference, Banner calls this version of their remote home care program Banner iCare™. It’s been so successful that they recently upped the dosage to 500 patients ‒ 90% of which are Medicare age.

A key requirement for patients in the iCare program is that they must have at least 5 chronic health conditions. The program also matches patients with health coaches, nurses, social workers, pharmacists and primary care “intensivist’s” in a way that delivers near‒instant access to patients by an entire care team. Combining team-based continuous care with remote delivery is a key part of the success. This isn’t consumer‒grade, episodic care by a single specialist working in isolation.

Telehealth has helped us move beyond the limitations of geography, access to specialists and constraints on time. First it was the technology which changed the paradigm and opened up new ways of serving patients. What has happened as a result is vastly improved patient care, not only because of increased access and efficiency, but also because of a new integrated team approach which came out of having a centralized hub of physicians, specialists, nurses and pharmacists. Telehealth, at its best, improves the physician/health care provider experience and improves not only the measurable care patients receive, but the care experience as well. Hargobind Khurana, MD ‒ Senior Medical Director of Health Management at Banner Health

The Philips supplied hardware includes an Android tablet, custom software and a range of biometric sensors for blood pressure, oxygen saturation, weight, and heart rate measurements. Also included is Philips Lifeline ‒ a personal emergency response device with automatic fall detection.

Banner pays directly for the home monitoring tools (no reimbursement through CMS) and patients like Marion Berg (turning 102 in July) are a great example of the “triple‒aim” benefits (better care, better health and lower cost).

While being around for a while, Telehealth has gotten a new lease on life with the advent of digital technologies, like wearables, two-way video and big data. We see a tremendous interest in telehealth models where people suffering from chronic conditions are monitored from their homes and cared for by multi-disciplinary teams of professionals. By taking a holistic, patient-centric approach and by leveraging digital technology, we foresee widespread clinical change to save lives, reduce costs and create a better patient experience. Our work with health systems, including our collaboration with Banner, demonstrates that telehealth can transform how care is delivered, while also helping organizations reduce costs and more effectively manage patient populations. Jeroen Tas, CEO ‒ Healthcare Informatics Solutions and Services, Philips

All of which is just one of three significant Banner commitments to remote care. The second is their TeleICU program for monitoring over 450 beds across 24 facilities in Arizona, Colorado, Nebraska, Nevada and Wyoming. While the primary TeleICU operations facility is tucked away in a fairly nondescript building located in Mesa Arizona, all of the equipment is state‒of‒the art ‒ including electronically controlled standing desks for round‒the‒clock clinical staff.

Telemedicine is becoming increasingly attractive to a health care industry that is re-inventing itself to provide better care at lower costs. At Banner we’ve experienced outstanding results in multiple settings where telemedicine is used – from ICUs to inside the home. Not only have we realized improved care outcomes, but we’ve seen cost reductions through reduced days in ICUs and a decrease in avoidable hospital readmissions. Peter S. Fine, President and CEO, Banner Health

A third program at Banner ‒ called TeleAcute ‒ is used by expert nurses in a separate Remote Operations Center for all adult medical/surgical patients associated with a select group of Arizona facilities. This program isn’t targeted at superusers per‒se, but at other patients that also benefit from watchful monitoring during their hospital stay.

There’s still a big disconnect between hospital systems like Banner that are able to lower their cost of care and consumers who don’t see this translate into lower premiums, but the results of the iCare pilot are impressive in terms of keeping patients healthy at home ‒ away from the high‒risk and high‒expense of the hospital itself. In combination, all three programs ‒ iCare, TeleICU and TeleAcute ‒ represent a significant commitment to enterprise-scale telehealth at the very heart of big healthcare delivery.

Now if we can just drop the antiquated prefix. The history dates back to 1837 and the French invention of the telegraph ‒ which pre-dated the telephone by almost 40 years. John Sculley is right ‒ the only future for anything “tele” is the “one ringy‒dingy” from Ernestine (Lily Tomlin) on Saturday Night Live reruns.

This article first appeared in Forbes (May – 2015)
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