From Promising Developments to New Definitions: Technology and Terminology Advancements for Healthcare – Belle’s Q&A with Victor Villagra

Dr. Victor Villagra is a seasoned healthcare leader with a wide range of experience, including leadership positions within Gesinger Medical Center and Cigna. For the past two decades, he has served as founder and president of Health & Technology Vector (H&TV), a consulting company whose mission is to decrease, eliminate, or postpone the physical, mental and financial consequences of illness among all people. He also currently serves on Belle’ strategic advisory board. Belle caught up recently with Dr. Villagra to get his take on several interesting healthcare trends. Here’s what he had to say.

There has been a lot of excitement and discussion related to artificial intelligence in healthcare. What is the most promising development you have seen?

I regularly review research proposals for a national funding entity. For the past couple of years, an increasing number of applications featured AI as a centerpiece of the research. Applicants include some the most esteemed medical and healthcare academic organizations in the country, such as Harvard, Stanford and Johns Hopkins. The research seeks to leverage big data and the analytical capabilities of AI to greatly accelerate basic science discoveries, medical technological advances and build the evidence needed to make the industry more efficient and effective.  There is also interest in leveraging AI to reduce healthcare disparities. These are some of the more exciting, and promising, areas of AI in healthcare.

What trend has you most optimistic and excited?

The most exciting trends so far are in the basic biomedical sciences, the development of advanced diagnostics (for example, matching and, at times, surpassing physicians’ accuracy) and therapeutics. These advances span wide domains within the healthcare sector from cell therapy to immunology to neurological science to the possibility of curing disease such as Huntington’s and Parkinson’s.

When it comes to managing chronic disease, what is the best path forward?

Purchasers should think about chronic conditions as a collection of multiple interrelated phenomena. Therefore, chronic conditions (often several simultaneously) cannot be managed effectively with a “disease d’ jour” approach. That includes specialty care poorly coordinated with primary care, mental health and so-called “social determinants of health”.

By that I mean deploying a diabetes disease management and renal care programs poorly integrated with each other, by stand-alone vendors or providers in competing health systems that do not communicate with each other. That is a simplistic perspective of how human health and disease states behave. People with chronic conditions, present an extremely complex management challenge of interconnected genetic, environmental, and behavioral factors. None of these factors are static; they change over time (including one’s genetics) requiring continuity and coordination of care. However, despite great efforts by the delivery system to provide that type of care, our healthcare payment system is poorly structured to support it.

You believe there is a tremendous amount of promise in peer-to-peer outreach. Can you talk more about that?

Yes, I believe you are speaking about peer-to-peer (P2P) support by lay people. Lay person P2P programs have been leveraged domestically and internationally showing  positive clinical and economic outcome.  Examples abound in mental health, substance use disorder, type 2 diabetes, HIV/AIDS Parkinson’s and countless others. The organization “Patients Like Me” has over 850,000 members supporting more than 2,800 health conditions.

The most important contributions are providing emotional, information exchanges, and practical real-life support. With the advent of social media and mass communication technologies the use of P2P- with careful monitoring and management of misinformation- is and will continue to be a key ingredient of improved quality and affordability of care.

A great example is a program that uses a network of teenage volunteers to be on call for other teenagers with mental health concerns who seek support and understanding. The volunteers are supervised and have access to state-of-the-art technology to guide them. But the magic is in the peer-to-peer cultural affinity and the instant trust that comes with it. We’ve seen this type of strategy deployed with barbers and hair stylists, with pastors and sport coaches. There is also an intermediate model that leverages especially trained health care personnel to deliver narrowly defined services such as certified community health workers and medical translators.

Social determinants of health is a popular topic within healthcare circles. But you have an issue at a very basic level. Can you elaborate?

Yes, I do. It has to do with the terminology we are using. The word “determinant” in the case of SDoH, means “factors”. But let me dig a bit deeper. The word is related to the concept of “determinism”, which connotes immutability, destiny. I have asked a some of my healthcare friends if they view Black race or of Hispanic ethnicity as a SDoH. Most respond “yes”.  I don’t disagree that race and ethnicity have been important “factors” in perpetuating enormous disparities. However, the word “determinant” stealthily normalizes the assumption that race or ethnicity amounts to one’s inevitable fate. It cannot be a foregone assumption that that a Black pregnant woman should have four times higher risk of maternal mortality.  So how could we change our language? A colleague of mine suggested “Social Drivers of….” and I quickly added “…of Wellbeing” not just “health” because people aspire to much more than good healthy.

Are there any final thoughts you’d like to leave us with that might serve as food for thought?

I have learned that in many Asian countries, people adhere to the philosophy that “what is best for each of us may not be what is best for all our us”. In the West, we live in a constant tension between respecting individual rights while trying to promote the collective good. This formula does not seem to be working very well. When it comes to health and wellbeing I believe there must be a balance where both are more equally valued. It confers the stability and harmony needed for societal progress.

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