TED and Optum partnered to cultivate the dialogue and collaboration that’s needed to understand and guide changes in healthcare. (Photo: Marla Aufmuth / TED)

Healthcare is at a turning point. Big data, evolving consumer preferences and shifting cost structures are just a few of the many complex factors shaping the opportunities and challenges that will define the future. How can we all become forces for positive change and progress?

For the first time, TED partnered with Optum, a health services and innovation company, for a salon focused on what happens when we trust our ideas to change health and healthcare for the better. At the salon, held on July 31 at the ARIA Las Vegas, six speakers and a performer shared fresh thinking on how we can make a health system that works better for everyone.

Empathy shouldn’t be a nice-to-have, says Adrienne Boissy — it’s a hard skill that should be integrated into everything we do. (Photo: Marla Aufmuth / TED)

How we can put empathy back in healthcare. Many in healthcare believe that empathy — imagining another person’s feelings and then doing something to help them — is a “soft skill,” and not an important factor in the success or failure of medical treatments. But according to Adrienne Boissy, chief experience officer for the Cleveland Clinic Health System, empathy is a critical part of healthcare that, when cultivated, delivers proven, positive impacts to everything from controlling high blood pressure to the outcomes of diabetes. Best of all, it’s something that healthcare workers can learn, in order to “bake caring fixes back into every single part of the healthcare system.” Boissy knows that patients and doctors both suffer under current healthcare systems and their long wait times, communications gaps, and the endemic pressures that lead to staff burnout. To address these problems in her health system, Boissy implemented some big fixes, like same-day appointments for patients, communications training for doctors and less bureaucratic pressure. Her strategies are designed to build empathy back into the healthcare system and “transform the human experience into something much more humane.”

The myth of obesity and the need for a social movement. The global obesity crisis has reached epidemic proportions — but its root cause may not be what you think. Obesity expert Lee Kaplan has studied the issue for nearly 20 years, and the misconceptions around obesity have remained fairly constant throughout: if people simply ate less and exercised more, the thinking goes, they’d be able to control their weight. But the reality is much more complex. “Numerous studies demonstrate that each of our bodies has a powerful, and very accurate, system for seeking and maintaining the right amount of fat,” Kaplan says. “Obesity is the disease in which that finely tuned system goes awry.” There are many types of obesity, with many causes — genetics, brain damage, sleep deprivation, medications that promote weight gain — but in the end, all obesity reflects the disruption of this internal system (controlled by the body’s adipostat). In order to begin solving this massive health crisis, Kaplan calls for us to stop stigmatizing obesity and take collective action to improve the lives of those affected. “We need to change the public perception of blame and responsibility, and support a social movement that will lead to real progress,” Kaplan says. “In so doing, we will begin to see society shrink before our eyes.”

If we design healthcare systems with trust, innovation and ambition, says Dr. Andrew Bastawrous, we can create solutions that change the lives of millions of people worldwide. (Photo: Marla Aufmuth / TED)

Innovating the healthcare funding and distribution model. While working in an eye care clinic in Kenya, Andrew Bastawrous was frustrated to find that because of rigid funding regulations, he wasn’t able to help people in desperate need who didn’t have “the right problems.” Though specific resource allocation makes business sense, Bastawrous says, inflexible rules often block healthcare organizations from adapting to shifting situations on the ground. This makes it difficult to deliver even simple medical treatments — for example, though we’ve had glasses for over 700 years, 2.5 billion people still don’t have access to them. That’s why Peek Vision, the eye care organization Bastawrous co-founded and leads, is set up as both a company and a charity — an innovation that allows them to sustainably create healthcare products and serve the communities who need them most. Peek Vision’s successful partnership with the Botswana government to screen and treat every child in the country by 2021 shows that this model can work — now, it needs to be scaled globally. If we design health care systems with trust, innovation and ambition, Bastawrous says, we can create solutions that fulfill the needs of financial partners and improve the lives of millions of people worldwide.

One pill to rule them all? We live in the age of the “quantified self,” where it’s possible to measure, monitor and track much of our physiology and behavior with a few taps of a finger. (Think smartwatches and fitness trackers.) With all this information, says Daniel Kraft, we should be able to make the shift into “quantified health” and design truly personalized medicine that allows us to synthesize many of our medications into a single pill. Onstage, Kraft revealed a prototype that would not only engender an easier time taking medications but also print the drugs he envisions right in the home. “I’m hopeful that with the help of novel approaches like this, we can move from an era of intermittent data, reactive one-size-fits-all therapy,” he says, “improving health and medicine across the planet.”

When it comes to health, we’re not as divided as we think we are, says Rebecca Onie. (Photo: Marla Aufmuth / TED)

Divided on healthcare, united on health. The American conversation around healthcare has long been divisive. Yet as health services innovator Rebecca Onie reveals in new research, people in the US are not as polarized as they think. She launched a new initiative to ask voters around the country one question: “What do you need to be healthy?” As it turns out, across economic, political and racial divides, Americans are aligned when it comes to their healthcare priorities: healthy food, safe housing and good wages. “When you ask the right questions, it becomes pretty clear: our country may be fractured on healthcare, but we are unified on health,” she says. The insights from her research demonstrate how our common experience can inform our approach to pressing healthcare questions — and even bring people across the political spectrum together.

Medicine isn’t made by miracles. Our narratives of our greatest medical and healthcare advances all follow the same script, Darshak Sanghavi says: “The heroes are either swashbuckling doctors fighting big odds and taking big risks, or miracle drugs found in the unlikeliest of places.” We love to hear — and tell — stories based on this script. But these stories cause us to redirect our resources toward creating hero doctors and revolutionary medications, and by doing so, “we potentially harm more people than we help,” Sanghavi says. He believes we should turn away from these myths and focus on what really matters: teamwork. Incremental refinements in treatments, painstakingly assembled by healthcare workers pooling their resources over time, are what really lead to improved survival rates and higher-quality lives for patients. “We don’t need to wait for a hero in order to make our lives better,” Sanghavi says. “We already know what to do. Small steps over time will get us where we need to go.”

Jessica Care Moore performs her poem “Gratitude Is a Recipe for Survival” to close out the salon. (Photo: Marla Aufmuth / TED)

She has decided to live. Poet, performer and artist Jessica Care Moore closes out the salon with a performance of “Gratitude Is a Recipe for Survival” — a vigorous, personal, lyrical journey through the mind and life of a professional poet raising a young son in a thankless world.

At TEDMED 2012, Rebecca Onie stunned the audience with her blockbuster talk on a new vision for health care. She is the founder of Health Leads, an organization that brings an elite, competitive team of college volunteers into hospitals and clinics — a team that connects patients to services that help provide food, housing, insurance and other services that, for most conditions, are far more important to overall health than medications and procedures.

TED’s Ben Lillie caught up with her after the talk to learn more about the nature of Health Leads, and her optimism for the future. Watch her talk, featured today on TED.com, and read the interview below.

I love the sports metaphor — the idea that we can ask a tremendous amount of college students and make an elite volunteer squad. Taking on health care is an enormous task, but do you think it can expand even beyond that?

Absolutely. We would never assert that college students are the universal solution around addressing these basic resource needs. It’s more of a model that, if we recruit folks who are really committed to the work regardless of their background, give them excellent supervision and training, and have the right technology backbone, then those three things can be quite effective at addressing their basic resource needs. But our goal is to be able to use this non-clinical lay workforce to create more leverage for the existing clinical workforce. Especially as more and more patients enter the health care system. As there are expansions in coverage, the imperative to get the most of your workforce only increases.

What’s the training like? How intense and selective is it?

We run a competitive application process each year several times. And in some cycles we accept as few as 10 percent of the students who apply. They go through a 13- to 18-hour training that’s on everything from cultural competency to the resource landscape in their communities to, frankly, how do you talk to patients about difficult and sensitive issues. Then they make a minimum of a seven-hour-a-week commitment for an academic year – about three to four hours a week in the clinic, three to four hours a week doing follow-up with their patients, and then a required hour a week of what we call reflection sessions, which are essentially additional training, context setting.

If you’re going to work with college students in particular, part of what is essential is that they are intentionally exposed to the broader context of the relationship between health and poverty, what are the challenges and assets in the communities where they’re working. So often college campuses are the classic bubble. And students have real appetite to go beyond it, but we certainly feel an enormous sense of responsibility to make sure that, if that is going to happen, that they are really well-supported in doing so.

What kind of majors do your students tend to come from?

About 65 percent of the students are premed or otherwise intend to go into health care. But we recruit a diverse pool of students, partly because what we want to model is what an interdisciplinary team looks like in health care.

Do you have a favorite story of a volunteer student to whom something happened?

Sure. A mom brings her child in finally to see his pediatrician. He’s been in the E.R. with asthma. He’s come in three times in the past month or so with asthma-related visits. As the pediatrician digs further, it is revealed that they’re living with a dozen other people in this dilapidated brownstone in Baltimore, which is just terrible housing because there’s asbestos and lead paint. It’s also the middle of the winter and the heat got turned off, and cold air is an asthma trigger. It becomes so evident in that conversation that refilling the child’s controller medication, asthma controller medication, if done alone would be like a tree falling in the forest. This is at a clinic at Johns Hopkins Medical Center, so the family gets these dual prescriptions, both the controller medication, which of course is critical, but also for Health Leads.

Then one of our volunteers works with the family — connecting them with food because they’re running out of food at the end of the month, getting heat turned back on, actually getting them insurance so those visits to the doctor don’t cost the family as much, but actually, probably most importantly, getting mom connected to a job training program. Over time she’s able to secure them safe housing.

What do you feel like the volunteers take away from it? And are they going on to found other stuff?

I guess I would say two things. There’s the part that relates to their professional trajectories, and I think increasingly medical schools are looking at Health Leads on a resume as evidence of a real commitment to under-served patient populations and to primary care, and also just folks who are willing to commit to quite a rigorous experience.

I would say, at least as important, if not more important, is this combination of both a real sense of efficacy with respect to these issues – a sense of “I know I can do something” with respect to a challenge that’s often experienced as intractable — but pairing that efficacy with a real depth of understanding of how challenging the issues really are. Indeed, when folks have looked at why med students, for example, don’t go on to pursue primary care careers, it’s often because they, early on, discern that the social issues are such a huge part of what it means to be a primary care doctor, but don’t feel well equipped to deal with them, whereas our volunteers do.

And so a lot of the students leave, I think appropriately, frustrated with the existing systems in this country. And part of our aspiration is that they’ll walk away with both that sense of efficacy and an appetite to do real advocacy work. Those things paired together is what actually sets them on a more transformative trajectory. The goal is for them to be both inspired and pissed.

So what has your first class, from 1996, gone on to do?

Of that very first class of 10 volunteers, it’s really interesting. One of them has gone on to do health policy work on the Hill. One of them is now an attending physician at Children’s Hospital in Boston, with a research focus on asthma and housing. One of them is now also an attending physician at Brigham and Women’s at the neonatal unit with a focus on breastfeeding, especially in non-white patient populations. So it’s the set of things you would expect in some ways.

What happens if a volunteer’s working with a family and something goes horribly wrong? Is there a support system for them when that happens?

The volunteers are supervised on a day-to-day basis by our full-time staff who are physically located in the clinics with the volunteers. And the staff both play the role of integrating the model into the clinic and building relationships with the rest of the staff, but also providing direct support and supervision. Those program managers have case management or social work experience, and  they’re there to do exactly as you say, to help the students identify when the cases are of a complexity that’s beyond their training. And a not-insignificant number of those are, but we always say that we train the volunteers as intensively in what they don’t do as what they do do.

What’s a case that’s too complex?

It could be anything from domestic violence to maternal depression. These are families that are living in extremely complicated living situations often, and I think this is where working in tandem with the social work is really powerful. The social worker is probably is the best position to deal with maternal depression issues. And at the same time, those issues will never really be alleviated unless Mom gets out of a shelter. We help the social worker to delegate that resource need to the volunteer, and continue to work with Mom on the therapeutic need.

Do you have a volunteer who came to you in some really unexpected way? 

I had this really powerful conversation with one of our volunteers who had emigrated in 2006 from Belarus and came to the United States speaking literally not a word of English, and took ESL classes for a year and then did TOEFL and then applied to college and is now a premed student. She spoke so powerfully about how much her own family could have benefitted from a Health Leads desk. And her imperative to deliver excellence in working with her clients is so obviously motivated by a deeply personal understanding of what it means to come to a new country and be completely overwhelmed, and to feel in such need of assistance in navigating the systems and the landscape. I think that, frankly, whether our clients have actually immigrated to the United States or are just in marginalized communities within the United States, that that experience is pervasive.

Do you have anyone who was part of your system who then went on to college and became a volunteer?

Oh, that’s interesting. Not that I know of. Oftentimes our clients – not always, certainly – but oftentimes our clients are themselves young mothers. And so we’ll have volunteers who are working with clients who are their same age, with parallel life experiences. The volunteers, needless to say, learn an enormous amount from working with these clients, from the clients – and ideally vice versa.

What was the one thing you really wish you could have gotten in to your talk that didn’t make it in?

I guess what I would say is that I think this is a moment of enormous optimism around how financial incentives are evolving in ways that, from my perspective, are non-partisan. They have to do with a growing understanding that our health care costs are out of control and that, while government can influence it, there are other forces, like market forces, that are equally as powerful. I think there’s a real awakening around how we could fundamentally align those incentives with that co-aspiration for health care that I was referring to in my talk. And I think there’s a real need to embrace those incentives — it’s there for the taking in many ways.

It’s critical that we have an authentic sense of efficacy with respect to the design of our system: that it’s not just something that happens to us, that there are a set of choices that are being made and an opportunity to influence those choices. And I think that, frankly, in ways that haven’t been true historically, there is now an opportunity to influence some of those financial decisions. So that should be a source of hope.