Why A Silicon Valley Approach Can't Work for Health Tech

Imagine if I told you that there was a pool of close to 600,000 individuals in New York City who were ripe for innovative health technology integration. You probably wouldn’t believe me and say that it sounded too good to be true. This said pool does in fact exist and can be found concentrated within the city’s public housing.

While entrepreneurs, governmental leaders, and healthcare officials constantly speak of innovation and disruption, there seems to be a major disconnect between these words and actual creativity. This large, untapped pool of individuals who fall under the New York City Housing Authority’s (NYCHA) umbrella is one example of the lack of creative, and truly disruptive practices, that I see in today’s early stage ecosystem.

In health tech, we have all too readily accepted the Silicon Valley model of startups and attempted to force healthcare to fit within this mold. Startup mythology has encouraged us to look at disruption as a four step model: 

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  1. Develop a pitch deck and product
  2. Raise Money

  3. Experience success, a TechCrunch article, and wealth

  4. Exit out with acclaim and glamour

Time and time again this method has been shown not to work in the field of health tech, yet we continue to see entrepreneurs approach the ecosystem with this mindset. 

Health tech has a huge opportunity to impact the quality of life of countless individuals. It however, still needs to learn how to differentiate itself from the massive amount of convenience technology out there amongst the general startups and carve out its own niche. I believe that this niche should be one of creativity, affordability, and equal access. 

 

Reimagining the Health Tech Space

Many of the current public systems in the United States are poised for improvement and health tech has the ability to make said changes. You may say that I am simply echoing the 2008 Obama-era mindset of anything is possible, but I truly believe that by using a creative, and yes perhaps slightly paternalistic, perspective these systemic issues have potential solutions that are already sitting in the market. These pieces are just waiting to be combined into the right mix.

For a second, let’s just take a look at our often, and rightly criticized, public housing system.

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In a 2017 survey by the Center of Budget and Policy Priorities, it was found that over 5 million low-income households are users of federal rental assistance. NYCHA itself houses 1 in 14 New Yorkers. While recipients and users of these programs are better off than those stuck in a cycle of homelessness, these affordable housing projects and developments are not exactly pristine safe havens. Public housing over the years has become synonymous with concentrated poverty, crime, and inner-city struggles. Numerous studies have also demonstrated that there are correlations between poor public housing, housing insecurity, and negative health outcomes.

The money for large, physical development overhauls to help alleviate these symptoms does not seem to be appearing anytime soon due to overtaxed city and federal budgets. This however, does not mean that we need to continue accepting this systemic cycle of poverty and poor health. This is an opportunity for digital health companies to step-in and benefit both the greater community and also their own self-interests in terms of need for proof and engagement data.

One of the great thing about technology is that aside from time, much of the hard material costs of development are incredibly low. Easy downloads and online platform access can allow a singular entity to impact thousands with the click of a button. Taking this into consideration, what if there was a way to meaningfully impact the health of the individuals in public housing simply with the adoption of affordable tech-centric programming? 

 

A Theoretical Case Study

For this test case, I would like to purpose a theoretical “healthy living prescription”, that would involve 2 free digital applications and 2 Medicaid covered doctor visits, as a demonstration of the ability for creative health tech adoption to have large scale, cost-saving impact.

Public housing is one area that has the potential to be used as a platform for supportive services, which could be provided in part by digital health program integration. Right now, there seems to be a state existing where those of lower socioeconomic statuses are viewed only as disadvantaged, not as viable consumers. I would like to push back against that as even if you are on a restricted income, you still are a participant in the economic market, albeit on a smaller scale than those of unrestricted wealth. In my opinion, public housing provides health tech both a large pool of consumers and a real opportunity to invest in the public good.

Currently, NYCHA lists on their website their community health opportunities as being:

  1. Citi Bike Discounts
  2. Shape Up NYC exercise classes
  3. Connecting residents to a hotline and partnering health agencies for health insurance information
General Grant Houses in NYC

General Grant Houses in NYC

The detailing of these opportunities is by no means an attempt to call out NYCHA, as they truly are doing work for the greater good, but what if their interventions were expanded? Could you imagine if instead of simply connecting individuals with phone numbers, healthcare technology was brought directly to the homes of public housing residents as part of a comprehensive solution?

This is not some rose-colored glasses dream, but something that hypothetically could be readily achieved by changing our perspective of the issue at hand into a more flexible, creative one.

If we look at residents of public housing as consumers, this enables us to create a whole list of different jobs that they need completed – from pre- and post-natal health management to better medication adherence methods to substance abuse assistance – with a fairly minimal amount of expenditure. Analysis of each of these jobs, and associated needs, could enable the development of holistic programs, like the proposed healthy living prescription, that utilize digital health products as a means of affordability, access, and scalability.

Say a pregnant, single mother enters into a public housing development. Instead of being given a website link to a general health information page, she could be given a “new mom healthy living prescription” upon entrance into NYCHA supported housing. This prescription could detail actions steps to guide her and her family for the next year.

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Maybe one aspect of the prescription is giving her a referral to a partner neighborhood clinic, who when she goes in could give her a digital health product to monitor her pregnancy for irregularities and guide her through necessary appointments, so she does not have to take off work if it can be avoided. Maybe this prescription also includes a link to a free smartphone application that will help her with budgeting while participating in the SNAP program, connect her with neighborhood stores that accept SNAP EBTs, and suggest affordable grocery lists to create a healthy meal plan for her and her child.

Really, the opportunities for integration are endless especially since 64% of low-income individuals have smartphones. Then, perhaps, after the year passes and she goes to renew her place in public housing maybe a requirement of the lease renewal, and successful completion of her prescription, is that she and her children undergo their yearly physicals.

 

The Compounding Consequences of Small Changes

The above hypothetical situation is a unique, low-cost intervention involving 2 free digital health products, 2 government covered doctors’ visits, and 1 printed piece of paper with the written prescription. These small steps though could make a huge difference in health, and by consequence the economic outcomes for an entire household. Maybe now our mother misses less work for unnecessary doctor visits, thereby garnering extra wages that could raise her family's living standard. Her son could have access to more fruit and vegetables since she now has assistance in navigating her use of governmental benefits for food. This could mean that he has more energy, is generally healthier, and in turn misses less school and avoids falling behind in class.

Replicating this with families throughout an entire housing project could have incredible outcomes and opportunities. You may be grumbling about the idealistic nature of this example, and I of course acknowledge that in the real world outside of theoretics, other factors will impact what an actual program designs entail. Perhaps you are instead claiming the existence of such a program is too paternalistic and not the place of the housing system to intervene, so maybe that means that individuals need to opt into this health living prescription program instead of being mandated.

With further work these concerns could eventually all be mitigated, so it should not take away from the glimpse this one case helps provide into what it could look like if health tech begins to creatively focus more on integration into pre-existing systems and structures in need of improvements. 

 

Designing for All of America

Map showing the increase in poverty according to the 2010 Census.

Map showing the increase in poverty according to the 2010 Census.

It’s great to design boutique health services and flashy applications, but there are over 5-million low-income households who are barely able to afford their own housing. Beginning to put more time, money, and energy into innovations and partnerships that positively impact those on the bottom of our economic and health system is how health tech can develop a niche for themselves and truly unite together the guiding ethos of health and technology. Entrepreneurs in this space should begin to consider bottom-up design with the idea that if those of the lowest means can afford and utilize a product/program, then the compounding positive results will be greater than merely designing for the wealthy and hoping for a trickle down effect. All of American is not of the same wealth level and demographics as Silicon Valley, so we should not treat it as so in our design and our proposed implementation of health tech.

Looking at public housing interventions, and other social programs, may be a great way to begin to accomplish this.