flying cadeuciiThe world looks different when you’re eighteen and when you’re thirty – in some cases because your perspective has evolved, other times because the world has changed.  Men and women drawn to careers in medicine while in high school or college are finding that when they emerge on the other side, things aren’t quite what they expected.

Typically, this is portrayed as the (well-worn) “Narrative of Disillusionment” – i.e. idealistic youth drawn to help people discover the practice of medicine is more rushed/bureaucratic/corporate/burdensome than they were expecting, and now are searching for new opportunities.  While there’s a measure of truth to this arc, I’m not sure how different it is from any other career choice, which tend to be attractive in the abstract (A prosecutor!  A screenwriter!  A journalist!), perhaps less so when you’re actually doing it.

While there’s no doubt that practicing physicians face many (well-documented) challenges, many also continue to love what they do, and find the opportunity to help others — even with all the paperwork — still accessible, and still rewarding.

My hunch is that many of the physicians who leave medicine do so not because the negative externalities have become so bad, but rather because the range of potentially appealing alternatives has become so good.

A recent NPR blog focused on Bay area physicians leaving medicine to become entrepreneurs has sparked considerable dialog on social media (see here for my recent discussion of physicians-turned-entrepreneurs).  My sense is that many physicians are attracted to entrepreneurship not to escape medicine, but to deliver on their perception of medicine’s promise.  Frontline providers, as Aenor Sawyer of UCSF’s Center for Digital Health Innovation frequently emphasizes, offer vital insights into where the existing system may not be working, and where innovation is sorely needed.


ROB LAMBERTSThis weekend I attended (and spoke at) the Concierge Medicine Assembly in Atlanta.  My role was to give the perspective of a “successful” DPC practice.  This being the second such conference in three weeks, I’ve learned that my panel of 600+ patients and survival for two and a half years puts me in the higher ranks of solo DPC practices.  The Atlanta conference was actually a combination conference, catering to both the more recent “direct care” style of practices like mine, and the more traditional “concierge” practices, with their higher fees and smaller panels, both grouped together under the blanket term of “membership medicine.”

Technically, the difference between DPC and “concierge” care is not the cost or panel size, but the fact that DPC practices do not accept insurance for payment, while the concierge practices have a membership fee on top of what they can bill to third-party payors.  But in my eyes the main difference is the overall movements each of the practice types represent as defined by their patient demographics, and panel sizes.  Concierge practices, in general, are focused on giving high-quality care by limiting panel size and giving significantly increased access to their members.  In essence, they see fee-for-service medicine as something which gives inadequate care to a large number of people (which it does), and so choose to reduce panel size and give adequate care to a few.


I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)

Dan Burton is CEO of Health Catalyst which is a data warehousing and analytics company that’s seen remarkable growth by selling to big names like Kaiser, Partners & Allina. It’s raised over $150m and has even gone at risk with Allina over outcomes–to show how confident they are in their data and analytics. This is a very interesting interview about a company that’s at the crux of the world of clinical data management, with over $100m booked revenue in 2014.

Dan will also be interviewed at Health 2.0 this fall as one of our “3 CEOs”. (And FD Health Catalyst is a THCB sponsor, but as I tease Dan they’re also in the conference business themselves, running the Health Analytics Summit!)


flying cadeuciiAfter several attempts at trying to find doctors who accept my lame-o ACA health plan (Blue Cross Blue Shield advantage HMO), I finally reached my limit today when a rather important appointment got cancelled unless I wanted to pay cash, because “we don’t accept your policy”.  When I googled “none of my doctors accept my Obamacare health insurance”, your article came up.

Do you or does anyone else know if there is some kind of plan of action for doctors to be forced to accept these ACA plans?  This year alone, I have yet to visit ONE of my previous doctors who will accept an ACA plan (and I didn’t even get the cheapest plan!).  Having had past surgeries, I feel it imperative to “go with who you know”, in that I want to see my past surgeon when there is a problem a year later that might need to be addressed.  Beyond frustrated!  And I don’t even live in a small town!!  I am in Dallas, Texas, with thousands of doctors!


flying cadeuciiJoyce J wrote in with this to say after reading Steve Findlay’s post on Medicare’s 50th Anniversary last week.

“Just yesterday, I was on my last and final rant relative to the price of not only specialty drugs, but also Tier 3 drugs! So much of a rant that I considered writing my Congressman Tim Murphy. After much thought, I decided to suck it up, pay the price and let my congressman work on bigger issues.(before reading your article today!)

I realize that I am not he only pathetic one that this drug price debacle affects, but for some reason, as a hard worker my entire life (in, none other than the healthcare profession), an upstanding, tax paying, law abiding citizen, somehow I feel I am being raped by the system.

I am 66 years old. I am a widow for 20 years. I am on Medicare part A and part B.(?$104/month) My secondary insurance is Highmark PPO Blue. ($605.89/month). After retirement, I maintained my husband’s health insurance as my supplement because of 1 tier 3 drug that I currently use. Due to Multiple Sclerosis, Lupus, breast cancer (none of which I chose to have) I could essentially be using multiple specialty drugs. I’ve declined all, except for the one Tier 3 drug, brand name, Provigil.

It has been a miracle drug for me relative to severe fatigue and loss of concentration and overall, daily function.”


Screen Shot 2015-07-31 at 12.56.55 PMYou might be wondering why a Chief Technology Officer would be talking about aging. Isn’t tech a young person’s game?

First of all, I love Alan Kay’s definition: Technology is anything invented after you were born.

Second, my grandmother, who used a CB radio in the 1970s and bought one of the first Apple computers in the 1980s, inspires a different point of view. When I showed her the internet in 1995, she said, “I was born too soon.” Then she proved herself wrong by living another 11 years, a daily internet user. I learned to never assume that someone’s age determines his or her interest in or affinity for technology.

I also believe we can learn from older adults and their use of technology. Studies show that if a website is optimized for older users, younger users benefit too. When I was building online tools, I would bring my laptop over to my grandmother’s house in Baltimore. She was my best beta tester. If it didn’t make sense to her, I would change the navigation.

What does the future hold?

One possibility is that technology will start to disappear and become like electricity, something we don’t notice on a daily basis. For example, instead of all the gadgets we use today to track and measure our health, sensors might be sewn into our clothes.

Another possibility is that technology becomes ever more present and intrusive, asking more of our attention and requiring even better eyesight and dexterity than the current smartphones require.


“We are convinced the machine can do better than human anesthesiologists.”

This statement was made by a doctor. Not only a doctor but an anesthesiologist. Not just an anesthesiologist but a pediatric anesthesiologist. Not just any old pediatric anesthesiologist but one in charge of pediatric anesthesia research at the University of British Columbia medical school in Vancouver.

One can only assume that this guy has a pretty low estimation of what his colleagues can do. Must make for great break room conversation.

The doctor making this statement, one JM Ansermino, is co-creator of a new automated anesthesia system called, cutely, iControl-RP. This machine uses vital sign readings along with oxygen saturation levels and EEG monitoring to give anesthesia to patients undergoing surgery, without any human input. Thanks to my fellow blogger Karen Siebert for pointing this one out here and here.

iControl-RP is what the creators call “A scheme-based closed-loop anesthesia system”. Here’s what their paper says about it:

The system software in its entirety consists of approximately 22K lines of Scheme code and features a client-server implementation interfacing medical devices with portable graphical user interface. The strengths of the Scheme functional language have been leveraged to build a robust maintainable modular system with extensive testing facilities to mitigate the inherent safety hazards associated with the application.


I’m steadily getting all those interviews I did 3+ months ago at HIMSS up onto THCB. (For those of you not paying attention we had a bunch of tech issues at THCB needing a big change and had to forswear videos for a while. But we’re baaack…)

This interview is with Xerox’s Tamara StClaire (Chief Innovation Officer, Commercial Healthcare) and Gail Croall, Chief Medical Officer, Healthspot.

Xerox has a big business in inpatient analytics–I interviewed Justin Lanning who runs their Midas+ Division back in 2012, and does lots of government based claims-processing (especially for Medicaid) and customer service centers. It even was one of the many companies building health exchanges (and struggled like many others!). In May this year (after this interview was shot) Xerox bought a community based visualization company called the Healthy Communities Institute which sells dashboards about public health issues to towns and counties–and has been a big player both at Health 2.0’s Healthy Communities Data Summit but also winning a couple of our challenges.

In late 2014 Xerox invested in Healthspot a telehealth company that builds kiosks. That partnership is the main focus of this interview. Below the fold there’s another video which is a tour of the Healthspot hub that you can expect to see cropping up in RiteAid pharmacies across Ohio and later the nation.


Screen Shot 2015-07-30 at 2.31.16 PMHappy birthday Medicare and Medicaid!   Fifty years old today.   Middle age.  Congratulations.  You’ve survived a lot—and 76 million baby boomers and 60 million low-income Americans are mighty glad you’re still around, covering one in three Americans, with solvency until 2030 at last accounting.

Unfortunately, the challenges are not going to let up.  In fact, they’re likely to get worse.  Those challenges are discussed at length in several places that celebrate this milestone—most notably hereherehere,  in the current issue of the Journal of the American Medical Association   (subscription required for access to full articles); and in an Oxford Press book of 16 essays.

This piece focuses on one of the biggest challenges facing both programs: the increasing number of very expensive specialty drugs.

These are medicines made primary through bioengineering.  They are often referred to as biologics.  THCB readers will no doubt have heard of the hepatitis C drug Sovaldi, the current poster child of expensive drugs at $84,000 for a 12-week course of treatment.  More generally, specialty drug prices range from $2,000 to $10,000 a month.  One source pegs the average price at around $36,000 a year.

When there were just a few biologics, it was not a big problem.  But now there are a couple dozen.  Some treat rare diseases that afflict a small number of people, but an increasing number target cancer, multiple sclerosis, rheumatoid arthritis, immune system disorders, and even heart disease.


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Looking out the train window at a NJ Transit Coastline stop, I saw the future of shopping in health care. On the platform were side-by-side advertisements for health plans.

Typically the domain of Broadway shows, mobile carriers and whiskey makers, seeing not one, but two insurance companies vie for mind space among New York commuters was heartening (even astounding) to a digital health executive like me.

Let me explain. For years, the industry has talked about the promise shopping holds to reduce costs and improve quality. But the speed of most things in health care comes at a snail’s pace.

It makes sense that consumers’ first glimpse of an emerging health care economy is through insurance plan shopping. At 18-months old, health exchanges are nearing the end of their infancy. Individual health plans make up 40 percent of the insurance market – a major increase from the 10 percent they represented before the Affordable Care Act.

The problem with shopping for health insurance is that one plan doesn’t look much different from the next. On the exchange, the concocted metal distinctions – bronze, silver, gold, and platinum – delineate cost, but not unique selling propositions. That said the insurance exchanges have served in an important starter role towards coupling healthcare and shopping in the minds of consumers.