Optimized-MichaelPainterI’m reading the morning news on my iPad at 32,000 feet en route from New Jersey to Silicon Valley for the annual fall Health 2.0 meeting. I love coming to this place with its promise and hope pushing us toward better futures.

Of course, much of that hope is hitched to faster, smaller, cheaper driven by trusty Moore’s Law. Just when it seemed our Moore’s Law golden goose would soon be waddling a little more slowly, the New York Times reports today that IBM scientists may have found a way to keep the eggs coming. Apparently, they’ve discovered a chip manufacturing approach that may get around the looming laws of physics by using transistors with parallel rows of carbon nanotubes separated by a distance of just a few atoms. Whew.

In another Times article, Apple’s CEO, Tim Cook, takes us from that atomic level way up here to the macro where most of us live, work, learn and play. Business, Cook says—presumably especially the dynamic technology sector—has civic responsibilities beyond pushing profit.He and Apple, for instance, have made recent stands about equity, and he noted Apple would “continue to evangelize” about it.


Niam YaraghiWhen President George W. Bush issued an executive order in April 2004 to establish the Office of the National Coordinator for Health IT, he had a clear vision in mind: to create a secure, nationwide interoperable network that allows authorized users to access medical records of anyone at anytime and anywhere in the U.S. President Barack Obama knew very well that his plan for providing health insurance to all Americans would not be successful unless it was paired with a plan for controlling the quality and cost of health care services.

Ironically, Bush’s health IT network was (and remains) the instrumental element that guarantees the financial sustainability of Obamacare. It was no surprise that the economic stimulus package of 2009 allocated $25.9 billion for promoting the adoption and use of electronic health records systems among American physicians and hospitals. But a decade and $30 billion later, only half of the U.S. office-based physicians have adopted a basic electronic health records system and a mere 20 percent of them use such software, according to the latest statistics by Robert Wood Johnson Foundation.


Even before the first date, Anthem Inc. CEO Joe Swedish was smitten with Cigna Corp.

But as in any love story, there would be plenty of drama between then and the July 24 announcement of the two health insurance giants’ $54 billion engagement.

At one point, the Anthem board made Swedish break up with Cigna, but then three months later sent Swedish swooping back in with pleasantries and ultimately a bear hug that Cigna couldn’t refuse.

And along the way, both Anthem and Cigna flirted with Humana Inc., causing everyone to get jealous. And it appears that Cigna even entertained secret overtures from Minnesota-based UnitedHealth Group.


Martin Samuels“How much of the medicine that you now use, did you learn during medical school?”

My answer may be surprising. It is not the response given to me by my professors, when they were asked similar questions. I recall them telling me that virtually nothing that I was learning in medical school would be correct 20 years later.

I have thought about this since and will reveal my answer shortly, but before I do, we should pause for a moment to reflect on the process of medical education. I will refer here to natural selection as an analogue of this process, a concept that I have adapted from some ideas gleaned from David Dawkins and Susan Blackmore.

Darwinian natural selection is based on the concept that replicators (eg genes, viruses, prions) compete for their locus based on the phenotype produced. In the case of genes, these replications are done with high fidelity, but not perfectly, so that there are a few imperfect copies (mutations) produced, such that there are alternative genes meant for the same chromosomal locus (alleles). It is the competition among the alternative alleles, measured by their phenotypic expression that is the basis of natural selection.   This process accounts for all of the dramatic variation seen in nature, including the present state of the information processing hardware (the brain), but it does not account for more rapidly changing behaviors and beliefs (cultures).


Dale SandersAfter a recent talk, a client came up to me with a puzzled expression.

We made small talk. We talked about the weather. We talked about sports. Finally, he got to the point.

“When are you going to talk about Big Data?” he asked somewhat impatiently.

“I’m not,” I responded.

It transpired that he was expecting to hear about all of the miraculous things Big Data was going to do for his healthcare system. He had come expecting to hear my Big Data talk.

Apparently, this was something he had been looking forward to all week. He was to be disappointed.

As a matter of fact, I almost never talk about Big Data.

And for the most part, nobody at my company, HealthCatalyst, does either.

Which might seem a little strange for a company in the data and analytics business. You’d think we’d be singing the praises of Big Data from morning till night. But we aren’t. There’s a reason for that, which I think is important.


Screen Shot 2015-10-01 at 9.19.35 AM

Once, a farmer from a village in Bihar was diagnosed with colon cancer. He came to Patna, the capital city, to have the tumor removed. Because he was poor, my father recommended a young surgeon who trained in the UK. The surgeon was competent and idealistic. He was a Fellow of the Royal College of Surgeons. His charges were the lowest. He did not charge the extremely poor.

The farmer declined, saying “if this babu is treating patients for free, he can’t be a good surgeon.” The farmer chose the most famous surgeon in the city, whose charges were not astronomical in comparison, but certainly higher. The farmer paid full fare – there were no discounts for poverty. The practice accepted credit cards. He paid cash. Once the surgeon received half the payment, he made the incision. The surgery was uneventful. The farmer was cured.

This was a voluntary contract between surgeon and farmer. No middle man. No forms to submit. Cash for scalpel and the skill of its bearer. There is a resurgence of this model in the US, known as Direct Pay Medicine. Despite India’s socialist roots, paradoxically, much of medicine has always been direct pay, or private.


Screen Shot 2015-10-01 at 9.46.12 AMOn the surface, the proposition that medical care in India is a free market seems plausible.

Setting aside the perennially underfunded public healthcare system, there is a large second tier system where patients get care without any apparent oversight. Sure, laws and rules abound, but these are easily overcome with bribes paid to bureaucrats. A “cost of doing business,” you might say.

In that private system, the care rendered is up to the doctor and patient, and the terms of the transaction are simply decided on the basis of cash exchanging hands. What could be more free market than that? A libertarian paradise!

But Voltaire wisely advised debaters to define their terms, or else engage in fruitless conversations. So perhaps we should make it clear that a free market is not solely defined on the basis of voluntary exchanges, although I recognize the prevalence of that unfortunate misconception.


Screen Shot 2015-10-01 at 7.40.20 AMToday, the U.S. health care system moves to the International Classification of Diseases, 10th Revision – ICD-10. We’ve tested and retested our systems in anticipation of this day, and we’re ready to accept properly coded ICD-10 claims.

The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country. ICD-10 will help move the nation’s health care system to better, smarter care.

You may wonder when we’ll know how the transition is going. It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.

Even after submission, Medicare claims take several days to be processed, and Medicare – by law – must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle.


Screen Shot 2015-09-30 at 8.41.19 PM

If you want the real story about whether a wellness program or health product worked, you want valid, accurate measures.  Getting the real story is the topic of our lively panel discussion at Health 2.0 hosted by the Validation Institute.  By adhering to principles of objectivity and stringent validation processes, the Validation Institute provides healthcare industry consumers with sound and valid information, allowing them to evaluate companies with confidence.

I am a population health scientist with training in epidemiology, biostatistics, quality measures, and risk finance and I run Health Economy LLC.


Screen Shot 2015-09-30 at 3.00.31 PM

The cost of medical service provision in the United States is one of the most palpable strains on the healthcare system, but we must not forget that cost is the sibling of quality and access—without considering the three as such, we will undoubtedly fail to navigate our country’s healthcare quandary. Low quality care inevitably results in the need for more care in the form of readmissions, while lack of access to primary care leads to increases in the utilization of expensive, emergency services. Of particular concern in our country, a growing contributor to cost, and driven by low quality care and even less access to that care, is the systematic exclusion of undocumented patients. This was made very clear to me through the example of a single suffering patient, Mr. Gomez.