Is excellent good enough?
As physicians, we are trained to diagnose and treat disease. We dedicate ourselves to searching for cures and perfecting procedures that will restore the health of our patients. Over the last 50 years, we’ve made some remarkable progress. We’ve reduced the death rate from heart disease by 32.5% with a better understanding of primary and secondary prevention and advances in treatment. We’ve made similar progress in cancer care with better treatment options through radiation, surgery, chemotherapy, and genomics. We’ve changed an HIV diagnosis from a hopeless death sentence with limited treatment options to a manageable, chronic condition.
These truly excellent accomplishments in medicine have been life-changing for millions of people. But is excellent good enough?
While we have made great strides in clinical care, the American dream is faltering. Americans are more obese, more medicated and more in debt than at any other time in the history of our nation. One-third of our nation’s total health-care spending, about $750 billion per year, is wasted on unnecessary treatments, redundant tests, and uncoordinated care . Health Care Reform will have limited impact on this waste. While the rate of increase of health care spending has slowed in recent years, the United States still spends 2.5 times more than most developed nations on health care . U.S. health care spending is on track to reach $4.8 trillion in 2021, almost 20% of our gross domestic product .
Continue reading “What Kind of Ancestor Will You Be?”
Filed Under: OP-ED, THCB
Tagged: FutureMed, health care delivery, Jack Cochran, Kaiser Permanente, Physicians, practice of medicine, The Permanente Foundation
Sep 26, 2013
We should have seen it coming, really. It was entirely predictable, and the most recent RAND report proves it.
We incentivized comprehensive IT adoption, making it easier to bill for every procedure, examination, aspirin, tongue depressor, kind word and gentle (or not) touch without first flipping the American healthcare paradigm on its head, if such a thing is even possible.
According to analysis by the New York Times, hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier. Overall, the Times says, “hospitals that received government incentives to adopt electronic records showed a 47 percent rise in Medicare payments at higher levels from 2006 to 2010 … compared with a 32 percent rise in hospitals that have not received any government incentives …”
To paraphrase the mantra of Bill Clinton’s successful 1992 presidential campaign: It’s the system, stupid. More specifically, it’s the business model, stupid, the fee-for-service system in which electronic health records are enabling tools.
It’s also the law of unintended consequences. You know … you take action, planning on this but instead you get that.
Like the introduction of cane toads in Australia to kill beetles (they couldn’t jump high enough). Like letting mongooses loose in Hawaii to manage the rat population (they preferred native bird eggs). Like Kudzu, the insatiable vine that’s devouring the South.
According to the authors of the RAND report, the problem is with the incentive structure that encourages more tests and procedures. Well, of course it is. Doctors and administrators have a clinic or hospital to run. They have expensive invoices from Epic and Cerner to pay. They can now track and bill for all this stuff they used to not get paid for. Are we surprised?
And meanwhile, fee-for-service leads us down a contradictory rat hole of massive healthcare costs and lousy public health. Continue reading “It’s the System, Stupid: Reversing the Law of Unintended Consequences”
Filed Under: Uncategorized
Tagged: ACOs, Cerner, Commonwealth Fund, Costs, Department of Veteran Affairs, Edmund Billings, EHR, Epic, Fee-for-service, Hospitals, Incentives, Intermountain Healthcare, Kaiser Permanente, RAND study
Feb 5, 2013
It wasn’t until I had read this.
A national shortage of critical care physicians and beds means difficult decisions for healthcare professionals: how to determine which of the sickest patients are most in need of access to the intensive care unit. What if patients’ electronic health records could help a physician determine ICU admission by reliably calculating which patient had the highest risk of death?
Emerging health technologies – including reliable methods to rate the severity of a patient’s condition – may provide powerful tools to efficiently use scarce and costly health resources, says a team of University of Michigan Health System researchers in the New England Journal of Medicine.
“The lack of critical care beds can be frustrating and scary when you have a patient who you think would benefit from critical care, but who can’t be accommodated quickly. Electronic health records – which provide us with rich, reliable clinical data – are untapped tools that may help us efficiently use valuable critical care resources,” says hospitalist and lead author Lena M. Chen, M.D., M.S., assistant professor in internal medicine at the University of Michigan and an investigator at the Center for Clinical Management Research(CCMR), VA Ann Arbor Healthcare System.
The UMHS and VA study referenced in the article finds that patients’ severity of illness is not always strongly associated with their likelihood of being admitted to the ICU, challenging the notion that limited and expensive critical care is reserved for the sickest patients. ICU admissions for non-cardiac patients closely reflected severity of illness (i.e., sicker patients were more likely to go to the ICU), but ICU admissions for cardiac patients did not, the study found. While the reasons for this are unclear, authors note that the ICU’s explicit role is to provide care for the sickest patients, not to respond to temporary staffing issues or unavailable recovery rooms. Continue reading “Building a Better Health Care System: Electronic Health Records Could Help Identify Which Patients Most Need ICU Resources”
Filed Under: THCB
Tagged: Brian Ahier, Costs, critical care, EHR, EHR Incentive Programs, ICU, Kaiser Permanente, Meaningful Use, NEJM, Patients, VA Medical System
Feb 4, 2013
It is often said that the one and only constant in life is change. This is certainly the case in business where every change in the external market or new initiative or idea brings some type of change to the organization. As leaders, our success or failure can hinge upon how well we are able to facilitate change and how well we help our members of our team adapt to and appreciate change.
As president of a large, national health care organization, like many other business leaders, I am involved in important decisions related not only to performance today, but also preparing the organization for what will be required in the future. This means I spend a lot of time thinking about change. What can we expect with change? How will people react to change? How can I help my team work through the change? How will change affect the way we operate or service our members? What will it cost us?
The reality is most people don’t like change because it can be stressful, especially when change happens unexpectedly. Change can be scary, and understandably so. It represents the unknown, taking us out of our comfort zones. Any time an organization embarks on a new initiative there is the risk of failure, which could have significant financial consequences. Yet, if we don’t change, failure is certain. As society evolves, we must too. Organizations that not only understand the importance of change, but embrace change, are the ones that will ultimately be most successful.
Continue reading “Embracing Change: Leading Through Transformation”
Filed Under: THCB
Tagged: Bernard Tyson, Change Management, Kaiser Permanente, Starbucks
Nov 6, 2012
Get healthier at this year’s first ever Body 2.0 health tech expo on Sunday, October 7 in San Francisco.
Health 2.0’s first ever public event will showcase the companies at the forefront of innovation in consumer health. From biometric sensors monitoring everything from your heart rate, to the miles you’ve walked and the hours you’ve slept, technology and health have never interfaced at this level before.
Body 2.0 is for those curious about getting healthier and those already fanatical about health. Regardless of where you fall on the spectrum you will learn something new.
Try out the latest tech from companies like Azumio, ChickRx, Lark, LumoBack, Explorence, and SoloHealth.
Leaders in the field will guide you on creating a fitter, stronger and more sustainable life. Keynotes include Dr. Arlene Blum, who was the first female to climb Mt Everest and is now the head of the Green Science Policy Institute, and Linda Fogg-Phillips, the leader of the Mobile Health Family. Also, hear from the innovators themselves like Amar Kendale from MC10, and Keith D’Amelio from Nike SPARQ.
Continue reading “Body 2.0 Health Tech Expo San Francisco”
Filed Under: Health 2.0, THCB
Tagged: Azumio, Body 2.0, ChickRx, Dr. Arlene Blum, Explorence, Fitbit, Kaiser Permanente, Lark, Linda Fogg-Phillips, LumoBack, SoloHealth
Oct 3, 2012
There is nothing more powerful than an idea whose time has come. There is nothing less powerful than an idea whose time has come and gone.
In 1846, and for more than 100 years after that, the American Medical Association as a nationwide organization for all physicians was a powerful idea whose time had come. It worked well for many things and OK for many more.
Then, in the 1970s, 80s, 90s, it came apart and now has the least representation of actual members of a widely diverse base than ever and shows few signs of recuperation. Recently, I advocated that ALL American physicians should become members of the AMA for their entire time in medicine.
Responses, both published and unpublished, were vigorous.
The divide between physicians who think that the AMA should fight for them and those who think that the AMA should fight for the health of the people seems too large to bridge in 2012.
Continue reading “How to Replace the AMA”
Filed Under: Physicians, THCB
Tagged: AMA, George Lundberg, Kaiser Permanente, Lobbying
Aug 29, 2012
While the nation has been focused on the recent Supreme Court ruling on the Affordable Care Act, innovations in hospitals and physician practices far from Capitol Hill have been triggering an historic transformation of our health care system. Propelled by a mix of urgency and vision, innovators at hospitals, physician groups and companies are remaking American health care by demonstrating that more effective and affordable care is achievable quite apart from statutory changes in Washington.
These organizations are working to achieve the Triple Aim: improve the health of the population; enhance the patient experience of care (including quality, access, and reliability); and reduce, or at least control, the per capita cost of care. This approach, developed by the Institute for Healthcare Improvement, is a sharp break with the traditional focus on single encounters with patients within the strict walls of health care delivery, typically addressing only the most immediate problems.
Continue reading “Health Care Innovations Hiding in Plain Sight”
Filed Under: THCB
Tagged: Atrius Health, Atul Gawande, Bellin Health, CareOregon, Charles Kenney, Costs, HealthPartners, Innovation, Institute for Healthcare Improvement, Intel, Kaiser Permanente, Maureen Bisagnano, Patient-centered care, Quality, The States, Triple Aim, UPMC, Virginia Mason Medical Center
Aug 28, 2012
Kaiser Permanente is a different kind of health system, as we all know. It has been a major funder of the HBO Series Weight of the Nation — reviewed by Kristin Molven in a companion piece on THCB today. Matthew Holt interviewed Raymond Baxter who is Kaiser’s Senior Vice President of Community Benefit, Research and Health Policy about the role KP plays in community and policy issues, and what we know and what we should can and should do about obesity.
Filed Under: Matthew Holt, THCB
Tagged: Baxter, Kaiser Permanente, Obesity
Aug 17, 2012
Kristin Molven is a medical student at The University of Olso. She is currently a student in the Norwegian Entrepreneurship Programme at UiO and UC Berkeley, and is interning at Health 2.0.
HBO’s documentary series The Weight of the Nation made me sad. I was left with the feeling that the wealth my parents have provided and all prior generations’ good intentions to make it easier for us to gather food and survive, and the technologies they developed to make our lives easier now are destroying us. My generation is short-circuiting. When looking to satisfy our needs, we meet no obstacles, no resistance. Everything is readily available to us, and we are fast-forwarding towards the negative consequences of constant access. And the food industry makes a profit off our misfortune.
The Weight of the Nation campaign consists of four main films, a dozen of extra short films and an accompanying book and website. It was launched in May by HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention, the National Institutes of Health, Michael & Susan Dell Foundation and Kaiser Permanente.
The campaign abandons the idea that obesity is an individual shortcoming or to results from a lack of self-control. Instead the campaign holds society responsible for today’s weight problems. Come to think of it, this is not unreasonable as humans have the same mental capabilities as former generations that were not obese. What has changed is our behavior and surroundings. Physical activity has been engineered out of our daily routine, while unhealthy tempting food has become cheaper and more accessible. Let’s not pretend that our grandparents had higher moral standards by avoiding sugar and fat and took the stairs instead of the elevator. They surely would have made the same choices as us if they had the chance. Given that nobody intends to become overweight or obese, we have designed a society where it is just too hard for most of us to maintain a healthy weight.
Consequences and Choices, the two first films of The Weight of the Nation series, examine the physiology and pathology of weight gain and obesity. Continue reading “The Weight of the Nation”
Filed Under: THCB
Tagged: Kaiser Permanente, Obesity, The Weight of the Nation
Aug 14, 2012
I’ve had a couple of meetings recently with leading figures in UK health policy – one of them a senior figure at a doctors’ organisation, the other at a private health company – who both talked excitedly about the lessons Britain could learn from the US.
That’s rarer than you might think. Our National Health Service may be cautiously embracing market-led reforms, but there’s still plenty of scepticism about the US’s full-on competitive system, and people here tend to be nervous about citing it as an inspiration.
Still, the two figures I am referring to, both leading players in the British Government’s NHS reform programme, were talking not about US healthcare as a whole, but about one particular organisation with something of a cult following on this side of the Atlantic.
I am referring to Kaiser Permanente, and its ideas are about to become very big over here.
Kaiser is one of those iconic organisations that aren’t just known for what they do, but whose names come to define their particular way of doing things – in Kaiser’s case, managed care.
It is the classic managed care organisation, running all the disparate parts of the local health system as a fully integrated whole, and deftly incentivising doctors to make sure patients receive their care in the part of the health system where it can be delivered most efficiently.
Continue reading “The KP Model in the UK”
Filed Under: The Business of Health Care
Tagged: Competition, Health Care Reform, Kaiser Permanente, Managed Care, managed care organisation, NHS, Pay for Performance, UK health system
Jun 17, 2012