Every two years, the American Academy of Sleep Medicine (AASM) hosts Sleep Medicine Disruptors to “explore innovations that are poised to change the landscape of sleep health, patient care, and health care delivery.” This year, the meeting was located in beautiful Mountain View, California for in-person attendees, and the course was live streamed for remote participation, as well.
The exceptional presentations highlighted below – given by Zeev Neuwirth, MD, Dennis Hwang, MD, and Kaakpema “KP” Yelpaala, MPH, showcase not only their enthusiasm for exploring groundbreaking approaches to patient care, artificial intelligence (AI), and health equity but also their determination to disrupt conventional practices in both sleep medicine specifically and to the overall approach to healthcare.
Transforming the U.S. Healthcare Landscape
In the first highlighted presentation, Zeev Neuwirth, MD, presented insights from his book “Reframing Healthcare.” Both the book and presentation aim to guide leaders and organizations aspiring to be innovators in the rapidly evolving healthcare sector.
The presentation itself focused on understanding the underlying forces and trends reshaping healthcare. While advocating for a customer-centric, community-oriented, and value-based approach, Dr. Neuwirth addressed the dynamics and philosophical delivery differences between incumbents (for example, large health systems) and newer players (for example, commercial payors and retail corporations).
Per Dr. Neuwirth, the philosophy of large health systems often centers around the patient journey. This approach prioritizes medical outcomes and patient welfare, focusing on providing comprehensive care. This approach tends to be slower at adopting new technology and often does so only at the bequest of regulatory bodies (for example, EMR adoption with meaningful use) or fiduciary entities (for example, payors and home sleep testing). In contrast, payors and retail corporations tend to take a customer-centric approach emphasizing convenience, personalization, and cost-effectiveness.
Dr. Neuwirth also highlighted that newer players to the space prioritize agility and are more open to experimentation with cutting-edge technology, including telemedicine.
He mentioned that while many leaders in healthcare would agree that “the move fast and break things,” Silicon Valley mantra may not bode well for patients when taken literally, there is ample opportunity for increased adoption of technology within existing delivery paradigms. Dr. Neuwirth keyed in on changes to cost and price transparency, healthcare accessibility and inclusivity, and a renewed focus on wellness and preventive care as areas to consider for healthcare teams.
My major takeaway from the excellent conversation was that Dr. Neuwirth remains bullish on telemedicine and remote patient monitoring as a way to bring healthcare back to the patient’s home. He highlighted the benefits to the patient, including improved comfort, familiarity, and personalization, as well as reduced infection exposure and stress on involved family members. Of course, in-home healthcare isn’t suitable for every situation, but evolving business models and new technologies are making at-home care increasingly realistic.
For leadership teams in healthcare that are intent on improving their care model, you can find more of Dr. Neuwirth’s insights in his book.
Artificial Intelligence in Sleep Medicine
In the next highlighted presentation, Dennis Hwang, MD, Medical Director of Sleep Medicine, Kaiser Permanente, discussed numerous studies that his team examined which focused on CPAP adherence and patient engagement. Dr. Hwang demonstrated how machine learning (ML) algorithms, trained on patient PAP data, can effectively predict future adherence to sleep therapy after only 7 days of use.
In both the above presentation and at Sleep Medicine Disruptors, Dr. Hwang highlighted the improvements of the ML model over traditional prediction models and the potential of AI in pre-empting non-adherence and optimizing patient outcomes in sleep medicine.
Taking this concept one step further, Dr. Hwang discussed issues faced by providers with individualized care versus community-based care. All too often it appears that population health initiatives inadvertently harm one group while helping another.
One example provided by Dr. Hwang featured an administrative directive to stop overprescribing a certain medication, which unfortunately negatively impacts the individuals needing that particular medication. Dr. Hwang demonstrated how to leverage technology and focus on individualized care to help all patient populations. For example, in his research, he looks at underrepresented minority groups in his community with comparatively lower CPAP utilization.
By integrating a “chatbot” to encourage, help, and teach patients, his team leverages automated text messages (that are clinically reviewed ahead of time) and curtailed heuristics to increase utilization across both cohorts to achieve a more equitable healthcare outcome.
The result? All groups in the study, on average, used their CPAP device more.
Ultimately, I believe Dr. Hwang’s novel approach, which focuses on individualized support using automated technology, holds great potential for increasing patient CPAP adherence on a wider scale. This method introduces a fresh perspective and an innovative strategy for community-based healthcare, skillfully catering to each patient’s unique needs without unintended negative consequences.
Health Equity and Equitable Innovation: From Aspiration to Sustained Activity
The final presenter I’m highlighting from the 2023 Medicine Sleep Disruptors meeting is Kaakpema “KP” Yelpaala, MPH, Chair of the eHealth Commission at the Colorado Office of eHealth Innovation and Senior Fellow and Lecturer at the Yale School of Public Health. In his thought-provoking discussion, KP offered insightful perspectives on health equity.
KP encouraged the audience to push the boundaries of the traditional approach to healthcare equity. He highlighted the importance of not solely relying on racial factors to comprehend health equity, as they are frequently misinterpreted as encompassing all equity-related matters. He stressed the importance of considering the diverse intersections of identity, including socioeconomic status, gender identity, sexual orientation, disabilities, and race, when addressing the complexities of healthcare disparities.
He illustrated this point with an anecdote from a conversation with a healthcare executive, who expressed a belief that their patient population did not significantly include African Americans.
This statement revealed a common misconception equating healthcare equity solely with racial disparities, particularly in black communities. KP countered this view by raising the issue of access to gender-affirming care for LGBTIQA+ communities, thereby broadening the discussion to encompass a wider range of equity concerns.
KP concluded with a call for precision in language and definitions when discussing these topics. He acknowledged that these brief insights only begin to delve into the vast implications of health equity, particularly in the context of emerging technologies and their impact on healthcare. His closing remarks underlined the exciting yet challenging nature of addressing these critical issues not only in sleep medicine, but in healthcare more broadly.
For those looking to dive more into the topic of health equity in sleep medicine, KP’s other work and extensive experience is worth exploring further, and I encourage sleep professionals to check out his engaging podcast.
I’ll close by thanking the AASM for putting on another excellent conference and note that I look forward to continuing these discussions with anyone interested. You can find me on LinkedIn, so please reach out with any additional thoughts or takeaways.
Nicholas Orr is a senior account executive at EnsoData.
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