Saurav Patyal's Profile

Thank you for this post, Elizabeth! Noticed that you have referenced an earlier article coauthored by you as well – very cool!

You mention that “Finally, the regulatory outlook is uncertain, with hospitals lobbying for less stringent technology standards and President-elect Trump pledging to “modernize Medicare.” Inovalon must urgently work with providers to protect investments in technology infrastructure.” I’m surprised to hear that hospitals are lobbying for less stringent technology standards. Given instances such as this http://www.businessinsider.com/hospitals-are-becoming-targets-for-hackers-thanks-to-poor-security-2016-4 and https://krebsonsecurity.com/2016/10/europe-to-push-new-security-rules-amid-iot-mess/, do you think hospitals are wrongly trading off the extra cost of upgrading their technology vs having safe and secure data?

Thank you for the post, Taylor!

You mention that “Kaiser is both the insurer and provider, from primary care to hospitals. This model incentivizes them to lower the total cost of care and hence focus on preventative health and lower cost settings.” I had no idea about this and it seems like a great model if the system truly acts towards lowering the overall cost of care. However, don’t you think that there could be a possibility of conflicting goals when certain types of treatments / procedures would yield the maximum margin for KP overall but widely differing margins for the individual verticals of insurance and provision? I would imagine a situation in which the financial goals of both these verticals not be perfectly aligned at all times and I wonder how they manage for that.

Also, given that electronic medical records are such a core part of their business, do you know if they are doing anything special to build safety from hackers, given such instances – https://krebsonsecurity.com/2016/10/europe-to-push-new-security-rules-amid-iot-mess/ and http://www.businessinsider.com/hospitals-are-becoming-targets-for-hackers-thanks-to-poor-security-2016-4

Thank you for this post.

You ask that “Can telemedicine be the solution to ballooning healthcare costs?”. While I don’t have an answer to this question, I believe that telemedicine has a long way to go before it can become an effective mode of providing healthcare. For example, what if the patient who has already been seen by a doctor and advised a series of tests and gets them done only to discover that they were not needed in the first place because of a miscommunication between the doctor and patient while on videoconference? I personally feel that telemedicine is mainly a public health tool so that you can reach out to remote populations with basic diagnoses but the real checks and treatment will continue to happen live, and perhaps that’s a good thing.

Another consideration is how safe are the patient video-calls and health records? If you see this – https://krebsonsecurity.com/2016/10/europe-to-push-new-security-rules-amid-iot-mess/ – I fear that unless telemedicine providers beef up their systems so that patient data is extremely secure from hackers, the trust in telemedicine provision will never be built.

Thank you for this post, Ashwini!

You mention that “Electronic prescriptions and refills allow them to facilitate greater provider-patient communication through automatic notifications of unfilled prescriptions. This can then trigger additional conversations that may help avoid gaps in medication usage, furthering the company’s objective of providing high quality care.” I understand that patient compliance can be a critical challenge (I saw it across populations while I was working for a pharma company) and One Medical’s digital platform can probably help solve that in a significant manner. Two thoughts though:

1. Would it help to develop multiple language versions (if they don’t already exist) so that more people could be reached, esp those who don’t communicate in English and therefore, have a perhaps higher chance of not being compliant given English as the mode of communication?
2. Can this be rolled out to developing countries in a basic smartphone app mode? I believe that it would be very helpful to the efforts of organizations such as Gates and PHFI in India but not sure whether it would yield monetary benefits. What do you think?

Thank you for this post. You mention that “AthenaClinical is the Electronic Health records (EHR) system. EHRs allow doctors to connect with more patients, while still increasing the quality of care they are given. Doctors can access patients charts remotely, alert them of critical lab values or potential medication errors, and connect patients with their own health records in a safe a secure manner.”

Given that data security is a big challenge in IoT and therefore, especially so in digital health (see https://krebsonsecurity.com/2016/10/europe-to-push-new-security-rules-amid-iot-mess/ and http://www.businessinsider.com/hospitals-are-becoming-targets-for-hackers-thanks-to-poor-security-2016-4), is Athena doing anything to prevent hacks into its record databases? I would imagine this to be a critical concern for them given a core part of their business model depends on it.

You’re spot on — I hadn’t thought about the misalignment between food availability and supply as you point out. Something tells me though that that problem is more like what a government / groups of governments need to tackle unless they can offer Cargill an incentive to push forward on what may be more a social good than a benefit to its bottomline.

Fantastic suggestion, Ana! They should definitely be doing that. Not just that, like I responded to Javi above, they could even partner with biotech companies like Indigo agriculture to produce high nutrient / calorie crops in areas so as to account for variations in global food supply because of climate change!

That’s a great point, Javi! I hadn’t thought of that. Maybe they could even partner with companies like Indigo agriculture to boost the production of calorie dense crops in areas which are still capable of producing those crops after climate change impact!

Your post was very interesting and I fully agree that Nike should have equally rigorous carbon footprint goals as top and bottom line goals. However, I’m not quite sure I agree when you say “Furthermore, the rise of droughts in regions that produce cotton, means less cotton is produced, the price of cotton increases, and more market volatility is introduced, which all negatively the company’s bottom line.”

Droughts in regions that produce cotton may certainly result in lesser cotton being produced in that region but there will be another region (likely 1-2 latitudes higher) where more cotton will be produced given warmer weather. If you check this Risky Business Report – http://riskybusiness.org/report/national/ – it goes on to say that production of crops will change regions as some areas become warmer than they were and others that were colder, now suddenly become the right places to grow those crops.

I would therefore argue that one of the key things that Nike does is understand which locations in the world could have a higher proportion of cotton production that earlier and then plan for transport / production near that location if the economics work!

That’s a fair point, Rohit. Agree with you that consumer acceptance may be challenging but I would not go so far as to make the assumption that the cocoa sourced from the new places will not be good enough for consumers to accept. If accompanied by a good marketing campaign that raises consumer awareness and as long as the chocolate still tastes good (why would it not?), I think consumers may gladly accept and all may still be well 🙂

Wow, I had no idea that making apparel contributed so much to climate change! It’s interesting how you note that one of the impacts of climate change will be on cotton yield and that will make things difficult for Nike. While I agree with you that climate change will definitely impact cotton yield, I don’t think it will result in higher cotton prices for Nike.

If you check this Risky Business Report – http://riskybusiness.org/report/national/ – it goes on to say that production of crops will change regions as some areas become warmer than they were and others that were colder, now suddenly become the right places to grow those crops. So, in cotton’s case, maybe the production moves up by 1 or latitudes? If so, I would argue that maybe those regions which will in the future grow more cotton will help Nike and lower prices if those regions are close to Nike’s production facilities through lower transport costs.

I don’t know how climate change will play out on this – but it would certainly be interesting to see how companies like Nike plan for which geographic regions they should increase their manufacturing in!

Here’s the link to the Risky Business Report that I was mentioning earlier – http://riskybusiness.org/report/national/

This is very sad, Javi. I knew that climate change was having serious ecological impact but what saddens me is how the Australian government did a cover up. It makes the trade off between short term cost and long term value really stark, and if a country which is supposed to be one of the leaders of today’s free world makes such a pathetic decision, it makes you wonder what some of other nations that are known to not care much about the environment will do.

An interesting parallel that one can draw is to historical monuments, which face the same trade off between short term cost and long term value. Interestingly though, governments do seem to be cognizant of that. For example, take a look at this article -http://en.people.cn/90001/90782/6699745.html – which talks about India taking proactive steps to protect its historic monuments, even though I’m sure it came at a high cost. I think that if the citizens of a country start attaching national value / pride to natural wonders, as much as they do to man made things, perhaps the government too will be more open to considering a proactive measure in taking care and planning in advance to deal with climate change’s impact to these natural features.

You mention interesting points in the ways forward that ITC can manage for climate change’s impact. However, I think a key point that ITC will also need to account for is how its suppliers (specifically, farmers) will get impacted by climate change and what role ITC will need to play then, if at all it decides it wants to play a role. To elaborate, if temperatures rise, raw food grains will be produced at different parts of India than they currently are being produced, which will mean that farmers across the board will need to change sowing patterns or even the crop itself. In such a situation, ITC can choose to just go to different sets of farmers (who have the crop / supply they need) but do they have a responsibility towards their current supplier (the farmer) who is marginalized and fairly poor? I believe that ITC must proactively work with farmers and farmer support groups to educate them about what climate change may bring in terms of seasonal / precipitation variations and come up with ways to protect farmers’ incomes when things do start to go awry. Perhaps ITC can even be a leader and start a crop insurance / fixed price scheme? Only time will tell whether it focuses more on its bottomline or also towards its countrymen.

Climate change impacting cocoa production is scary because I, like many others I’m sure, love chocolate and don’t want it disappear or become too expensive in the future! While the information you have noted (such as a 2 d.c. rise in temperature) seems to suggest that cocoa production will be negatively impacted, I don’t necessarily agree. I believe that the production regions for cocoa will just shift from the African nations you mention to more higher latitudes with the right temperatures — who knows, Russia and North America may become cocoa production hubs! Some external reports such as the risky business report seem to suggest this for food grains and I assume it would hold true for cocoa as well. So, I would perhaps not worry so much about cocoa (thank god!) but instead, the livelihoods that would be lost if cocoa production moved from Africa to other regions!

It is impressive that Related has taken energy conservation and efficiency in its projects, especially in the Hudson one you’ve noted. I wonder though if this is move is genuine — whether it is driven by a desire to save the environment versus a regulatory requirement by the municipal corporation? This question’s relevance is perhaps not much in the developed world where breach of regulation is met with harsh legal action but in the developing world, where often breach of such regulations (especially in real estate development!) are covered up through corruption. I would then wonder that if Related were acting in a developing country, would it follow the same model, assuming that it could incur lesser capital costs by building properties that were not as energy efficient.

I also believe that Related should take up a more proactive, policy-developing approach — it could, for example, partner with local governments / policy makers to define real estate development standards in energy efficiency and then ways in which that could be implemented.