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In the era in which wellness vendors were still claiming an ROI on wellness (and more and more are not), I asked a number of them how they calculated the ROI. Not one calculated the ROI in a way that a steely-eyed CFO would endorse.

Below is a partial list of costs wellness vendors should be considering, but rarely if ever do consider. If you have a wellness program and want to look for an ROI please start with this list:

  • Wellness vendor fees
  • Communication costs
  • Investments in materials (i.e. Fitbit) and facilities (i.e. onsite fitness centers)
  • The cost of biometric tests and health assessments

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I have spent years whining that no one is doing a good job helping people navigate through the maze of health care. And a survey out last week from my old firm Harris paid for by Accolade confirms that people need help. Doctors don’t and can’t do this. 71% of people said they trusted their doctors, but only 16% said their doctors had time to understand their life circumstances. Yet last summer a touted Silicon Valley startup called Better failed to make a go of a service doing just that.

Somehow Accolade seems to be threading this needle. They’ve raised more than $125m (including another $30m late last year beyond what I discuss in this interview). While they’re helping patients they’re charging their employers and insurers for the service. Late last summer I met Accolade’s EVP Amy Loftus. In this interview she explains what they do, and how it works.

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“’Normal’ is one of the most powerful words a radiologist can use”: Curtis P. Langlotz MD PhD, Professor of Radiology, Stanford University

After I used “clinically correlate” thrice in a row in my report, the attending radiologist asked, “How would you feel if the referring clinician said on the requisition for the study “correlate with images”? When you ask them to clinically correlate, you’re reminding them to do their job.”

I had been a radiology resident for six months – too soon to master radiology but not too soon to master radiology’s bad habits. I had acquired several habits, tics to be precise. These tics included saying “seminal vesicles are unremarkable,” which I stated remorselessly on the CT of the abdomen in males, even if the clinical question was portal vein thrombosis, sending, I suspect, several young men to existential despair. But the tic that really got under my attending’s skin was “cannot exclude.”The attending was Curtis P. Langlotz, the author of The Radiology Report, a book about writing effective radiology reports.

Ubiquitous in clinical care, and sometimes parody, radiology reports are enigmatic. What’s most striking about radiology reports is their variability. Reports vary in length, tone, precision and frequency of disclaimers. Reports vary in strength of recommendations for further imaging.

One radiologist may say “small pancreatic cyst, recommend MRI to exclude neoplasm.”Another, aware that the patient may cross St. Peter’s gate sooner rather than later, may bury the findings in the bowels of the report, hoping the clinician will spots its irrelevancy. Yet another, eager to be non-judgmental,might say “small pancreatic cyst, likely benign, but MRI may be considered if clinically indicated,” which, Langlotz notes, is vacuous because with pancreatic cysts there’s nothing clinically the clinician can anchor that recommendation on.

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flying cadeuciiThis past December after eight months of formal work the Senate Finance Committee’s “Bipartisan Chronic Care Working Group” released for comment a 30-page memo outlining 23 policy options to improve chronic care quality, patient outcomes and cost efficiency. While the Committee is not endorsing any of the options identified members will likely not stray far from this list when they move to drafting legislative language next month at least in part because members insist the bill must be cost neutral. Committee members and staff should be applauded for their effort to date since both political parties have been disinterested in adding policies to improve the Medicare program. (Last year’s MACRA bill was largely unpaid for and aptly described by Henry Aaron in the New England Journal of Medicine as a log rolling exercise.) On balance, the Committee’s effort should leave Medicare stakeholders cautiously hopeful. While some of the proposed options are obvious and incrementally beneficial, others might aid in innovating care delivery and in advancing CMS’s efforts to improve quality and value payment.

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10 Year Global Retrospective Graphic_Option 1 Final

Health 2.0 announced today its  “10 Year Global Retrospective”, a platform to recognize outstanding achievements in health tech over the past ten years.

For nearly a decade, Health 2.0 has served as the preeminent thought-leader in the health tech sector and showcased and connected with thousands of technologies, companies, innovators, and patient-activists through an array of events and conferences, challenges, code-a-thons, and more. Since its first conference in 2007, Health 2.0 has grown into a global movement with over 100,000 entrepreneurs, developers, and healthcare stakeholders, and 110+ chapters on six continents.

In recognition of its 10th year, Health 2.0 will honor the superstars of the health tech community over the past decade through the global retrospective, a platform which will poll the collective insight of its vast network of health tech stakeholders who will nominate and vote for the top influencers in four categories.

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Screen Shot 2016-02-11 at 10.07.58 AMWe have been talking about Precision Medicine for a long time now but so far we are still in the infancy of using genetics to impact medical decision making. The human genome was sequenced in 2003,with the promise of rapid medical advances and genetically tailored treatments.  However, development and adoption of these treatments has been slow. Today with the advent of large cohorts, and in particular, the construction of the US Government’s Precision Medicine Cohort,[1] conditions are being set up for precision medicine to flourish.  In the PMI infographic,it states three reasons for ‘Why now?’ – sequencing of the human genome, improved technologies for biomedical analysis, and new tools for using large data sets. While I agree this is progress, I believe there area few fundamental other areas to be tackled in order to really get to the promise of precision medicine.

  1. The concept of protocols is designed for mass production not mass personalization

Medicine is practiced using protocols and documented in EHRs. When written down they can look like a cook book or a choose-your-own-adventure story book. The intent is to codify medical knowledge into a guide that can be consistently used by all physicians to obtain the ideal outcome. But as a result of strict adherence to medical practice standards, they inherently choose paths that are well defined based on the assumption that most people are similar in their response to treatments. So over time the protocol is enhanced to suggest which decision is the right one to make with a given patient and a protocol will more often than not be ‘anti-precision,’ just in the same way that a factory is designed to make one size of jeans at a time rather than make a custom set of jeans for each customer visiting the store.

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flying cadeuciiNew data just released on cancer surgery volume in California hospitals advance an important and complex discussion about how the frequency with which a cancer surgery is performed at a hospital might influence patient, care team and hospital decisions. An effort funded by the California HealthCare Foundation has recently made these data available for the first time for 341 California hospitals on www.CalQualityCare.org. Having these data readily available opens the door to important inquiries the hospital community is investigating closely. Transparency about cancer surgery volume is, however, just one step toward better understanding and practice. More data and close deliberation are needed, and we must take caution to avoid premature conclusions with insufficient evidence.

Accompanying the release of these data is a new report, Safety in Numbers: Cancer Surgeries in California Hospitals,highlighting important findings about the frequency and location of surgeries for 11 types of cancer.The report reveals that many hospitals performed certain cancer surgeries only once or twice in 2014 and that many cancer patients were within 50 miles of another hospital performing their needed surgery with greater frequency. The report is spurring productive discussion.  However,as it is descriptive of cancer surgery volume alone and does not capture patient outcome, it calls on the hospital community to gather more evidence to inform decision-making. As conveners and catalysts for hospital improvement, the California Hospital Association and the Hospital Quality Institute, along with other leaders, are capturing this opportunity to advance the research and dialogue on cancer surgery volume.

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Seth Sternberg was a founder at instant message service Meebo, which was acquired by Google in 2012, and like many tech guys he’s next decided to try to change the health care experience. But unlike many others the aspect he wanted to change was the in home caregiving market, following a bad experience with his own mother. Honor came out from under wraps last year, raised $20m, and is currently operating in Los Angeles and San Francisco. It’s not only a market place where you can hire caregivers for a loved one, but it also allows the client, whether they be the person receiving the care or their loved one–that daughter out of town–to manage the process end to end including booking and paying, and allows the caregiver to report on what they are doing, and follow a careplan.

But beyond that Sternberg is on a mission to “professionalize” the caregivers by not only increasing their pay, but accurately matching them to client needs, and increasing their control over their own situation. To that end Honor recently backed off the Uber independent contractor model and made its caregivers full employees (with stock options!). Very interesting guy with an interesting model. Here’s the interview: