HHS CTO: Opioids, open data, kidney disease are key focus areas for department

By Jonah Comstock
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The Department of Health and Human Services’ position of Chief Technology Officer is a relatively new one. President Barack Obama created the role in 2009 and appointed the first three people to hold the post: Todd Park, Bryan Sivak, and Susannah Fox.

That makes Bruce Greenstein the first ever HHS CTO appointed by a Republican president, or even by a non-Obama president. But unlike many Executive Branch offices, Greenstein’s approach has been to build on the work of the previous administration.

“In the department we’re in a renaissance of opening data,” Greenstein told MobiHealthNews last week at HHS’s first Health Startup Day, held in Boston and organized by Pulse@MassChallenge. “So the last administration started in a number of initiatives. … We love it, so we’re taking that baton and running as fast as we can forward innovating based on the work that they did. To me this is a non-partisan issue. It's about doing the right thing and doing it wisely, deliberately, and thoughtfully.”

Greenstein said Open Data is an easy slogan to agree on, but a hard one to implement and his office has focused on opening up data in the areas that create the biggest impact.

“Take the opium epidemic for example,” Greenstein said. “So when I got there, CDC was still using data from 2015 to show what the number of deaths from overdose. And we had data — usually lag time in the CDC data set is about six, seven, eight months. Today you can go on the website a look at that death data. … And we need to do that because we can't afford to be guessing. We can't afford to hope that if we put a lot of money in one area maybe it will perform. We need every dollar to perform at its maximal rate and its absolute potential and we need to use the data as feedback to make sure that our policy prescriptions are as good as they can be.”

That same drive, to use technology to get more out of each healthcare dollar, also underpins HHS’s innovation efforts. And one area where Greenstein said the department sees tremendous untapped savings potential is kidney disease.

“Dialysis machines haven't innovated substantially in more than sixty years,” he said. “Compare that to say oncology or cardiology, that have made amazing advances at the same time. My mom died of kidney disease, of end-stage renal she died in 2007. She was on dialysis for 14 years. Her treatment looked exactly the same on her last day as it did on her first day. No innovation in that that space in that time.”

And the cost to the government is significant.

“Medicare spends spends more on kidney disease than the entire NASA budget or the entire Department of Commerce,” Greenstein said. “That one line of expenditure is bigger than the whole NIH, so that gives you a sense of the scale. And we’re the monopsony buyer, which means a market that has basically one buyer, and in the seller part of the market two companies make up a duopoly and they have maybe 83, 85 percent of the market, so a very large volume, and the rates that we pay are something where it doesn't cause a number of new entrants to commit because of the high costs provide barriers to entry.”

In the coming year, HHS will tackle this problem by launching a Kidney Disease X Prize. Greenstein said HHS has already raised $25 million for the prize, including from the American Nephrology Society.

Beyond that, HHS is working with the various agencies under its umbrella — including the FDA and the Center for Medicare and Medicaid Services — to help them streamline their operations in ways that encourage innovation and investment in innovation, both around kidney disease and for digital health more broadly.

“If you compress the timeline for discovery and approval at FDA and layer, at the same time, in a parallel process for CMS coverage policy and payment policy, all of a sudden investors look at [the space] a lot differently,” Greenstein said.