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Coaching and Leadership Training Can Help Med Students Avoid Burnout

Jack Penner
JP Mikhaie
Margaret Cary

By MARGARET CARY, JACK PENNER, and JP MIKHAIE

Burnout is one of the biggest problems physicians face today. We believe that addressing it early — in medical school — through coaching gives physicians the tools they need to maintain balance and meaning in their personal and professional lives.

We say that after reading comments from participants in our coaching program, “A Whole New Doctor,” developed at Georgetown University School of Medicine. This program, born almost by chance, provides executive coaching and leadership training to medical students, who are exactly the right audience for it.

Medical students tend to begin their education as optimistic 20-somethings, eager to learn and eager to see patients. After spending one or two years on the academic study of medicine, they move to the wards where they observe the hidden curriculum — a set of norms, values, and behaviors conveyed in implicit and explicit ways in the clinical learning environment.

In the hospital, convenience and expediency, deference to specialists, and factual knowledge tend to replace the holistic and patient-centered care that is lauded during the preclinical years. This new culture nudges some students to the brink of burnout and depression. Some consider suicide.

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The Folly of Self Referral

By HANS DUVEFELT, MD

A lot of Americans think they should be able to make an appointment with a specialist on their own, and view the referral from a primary care provider as an unnecessary roadblock.

This “system” often doesn’t work, because of the way medical specialties are divided up.

If belly pain is due to gallbladder problems you need a general surgeon. If it’s due to pancreas cancer, you need an oncologic surgeon. If the cause is Crohn’s disease, any gastroenterologist will do, but with Sphincter of Oddi problems, you’ll need a gastroenterologist who does ERCPs, and not all of them do. Now, of course, if you’re a woman, that abdominal pain may actually be referred pain from an ovarian cancer, best treated by a GYN-oncology surgeon, which anywhere in Maine means a drive down to Portland.

The other day I saw an older man for a second opinion. He had been through one hand surgery for a small tumor many years ago in Boston, and another unrelated operation for a fracture in Bangor a few years ago. Then, after a non surgical injury, he developed stabbing pains in the same hand. Someone referred him to a neurologist for EMG testing, which was normal, and the man told me that was all the neurologist did, not a full consultation.

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Health in 2 Point 00, Episode 80 | Takeover Edition!

Today on Health in 2 Point 00, where am I?! In Episode 80, Bayer’s Eugene Borukhovich is here to answer Jess’s questions—but don’t worry, he’s channeling his inner “Matthew”. Get Eugene’s take on Jawbone’s $65 million raise after its relaunch and find out if he disagrees with me about Noom’s recent $60 million raise. Jess also picks Eugene’s brain about what G4A is looking for in their challenge applications, so don’t miss out — Matthew Holt

Health Care is Coming Home

SPONSORED POST

By DIANA CHEN

In an AARP survey of 2000 adults, 6 out of 10 respondents indicated they prefer to stay in their home and community for as long as possible. This desire increases with age; more than 75% of adults over 50 would rather remain in a familiar environment where they have strong connections to friends, neighbors, and businesses. However, for the elderly and people with chronic illness or disabilities, remaining at home can be difficult. These populations require services that are often provided at long term care facilities (e.g. nursing homes) and/or formal medical settings– which can be costly, inconvenient, and inefficient. 

Individuals of all ages across the health spectrum have also expressed interest in receiving health services in the home or community as a means to access higher quality and convenient care. With consumer demand for patient-centered care, the U.S. healthcare system has steadily steered away from institutional services in favor of home and community-based services (HCBS). Since 2013, Medicaid expenditures for HCBS has continued to exceed spending for institutional services. HCBS now accounts for 55% of Medicaid Long Term Care spending.

As the largest payor for healthcare in the United States, the Center for Medicare and Medicaid Services (CMS), is often the first to experiment and adopt new care delivery models. With Medicaid’s perceived benefits with HCBS, the CMS has also changed what is covered under Medicare Advantage (MA) to accommodate for the transition towards home and community based care. In 2018, CMS added “non-medical in-home care” as a supplemental benefit for 2019 MA plans. This year, CMS continued to broaden the range of supplemental benefits for MA 2020 to cover any benefits “that have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions or illnesses.

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NEW: HardCore Health Podcast, Episode 1

By MATTHEW HOLT

Apparently, podcasts are new, all the rage and minting billionaires every day!  So, of course, THCB had to have its own podcast, and here it is: HardCore Health

Now I’ve been doing “podcasts” (otherwise known as audio or video interviews) on THCB since before people actually had iPods (remember those, kids?). But apparently these days any punter can do an interview, call it a podcast and shove it up on Spotify. Hardcore Health is going to be a little bit different…

Hardcore Health will feature multiple guests, topics, and interludes brought to you by many co-hosts starting off with Jessica DaMassa and me. We’ll embed some (familiar) tidbits into the show including: Health in 2 Point 00, THCB Spotlights, and the WTF Health Show as well as some newer segments, including banter sessions between guests & rant sessions from health care experts. This first episode features Brian Kalis, Accenture’s “post” Digital Health expert & Niko Skievaski from Redox, and a little more.

I hope you enjoy our first episode below!

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site.

Reducing Churn to Increase Value in Health Care: Solutions for Payers, Providers, and Policymakers

Saeed Aminzadeh
Niko Lehman-White

By NIKO LEHMAN-WHITE and SAEED AMINZADEH

Introduction
Every day and in every corner of the country, innovative health care leaders are conceiving of strategies and programs to manage their patients’ health, as an alternative to treating their sickness (see Figure 1).

The value-based contracts that have proliferated in this country over the past decade and which now account for about half of the money spent on healthcare allow these wellness investments to make good financial sense in addition to benefiting patient health.

However, a phenomenon in health coverage in the US is increasing costs, destabilizing care continuity and holding back the potential of value-based care. It prevents us from making the long-term investments we desperately need.

Understanding Churn

Churn refers to gaining, losing, or moving between sources of coverage. Every year, approximately a quarter of the US population switches out of their health plan. Reasons can be voluntary or involuntary from the perspective of the beneficiary (see Table 1) and vary from changes in job status, eligibility, insurance offerings, and preference, to non-payment of premiums, to unawareness of pending coverage termination.

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Calling All Tech Companies & Early Stage Innovators Health 2.0 Annual Conference Applications Are Open!

SPONSORED POST

By IRENA LUO

Considered a major hallmark of the Health 2.0 Annual Conference, these two opportunities for tech presentations are a chance for entrepreneurs and startups to gain visibility for their products with potential investors, partners and peers. The conference—scheduled from September 16–18 in Santa Clara, California—is now accepting applications from companies who want to demo their health tech innovations or pitch for a chance to be named Startup Champion at the HIMSS event.

Health 2.0 Live Tech Demos

Applications close June 7, 2019

Last year at the 2018 Health 2.0 Annual Conference, more than 100 innovative companies, including Aaptiv, Healthify, and Heart Flow, showcased products designed to help transform healthcare. In 2019, the Health 2.0 team is changing things up and reworking their breakout session schedule to allow more focus around the main stage programming. What does this mean for our demos? With more streamlined programming, we’re upping the ante for our tech demo applicants and selecting the most intriguing, adaptable, applicable products to be featured at the 13th year of the conference. Chosen companies will either demo their tech in standalone presentations or as part of larger panel sessions.

How to apply:

  1. Go to the application page
  2. Create a login
  3. Click “Health 2.0 Live Demos 2019”

Health 2.0 VentureConnect Pitch Competition

Applications close July 8, 2019

For startups and entrepreneurs, the rapid-fire pitch competition is an opportunity to get valuable exposure for their products, make connections with some of health tech’s biggest and most active investors, and ultimately win the title of Most Fundable Startup. Last year, 60 companies competed in the competition. Mira and Avhana Health won in the contest’s consumer and provider tracks, respectively.

The Health 2.0 VentureConnect Pitch competition brings together vetted seed companies through raising Series A companies to pitch their innovative product live on stage during rapid-fire presentations. The prize? Being named the most promising startup by the venture capitalists and corporate investors judging the competition. Six competition finalists—three consumer-facing startups and three provider-facing ones—will compete to win in their category.

How to apply:

  1. Go to the application page
  2. Create a login
  3. Click “Health 2.0 Pitch Competition 2019”

Irena Luo is a Producer at the Health 2.0 Annual Conference, A HIMSS Event

We Are Not A Dashboard: Contesting The Tyranny Of Metrics, Measurement, And Managerialism

By DAVID SHAYWITZ

The dashboard is the potent symbol of our age. It offers the elegant visualization of data, and is intended to capture and represent the performance of a system, revealing at a glance current status, and pointing out potential emerging concerns. Dashboards are a prominent feature of most every “big data” project I can think of, offered by every vendor, and constructed to provide a powerful sense of control to the viewer. It seemed fitting that Novartis CEO Dr. Vas Narasimhan, a former McKinsey consultant, would build (then tweet enthusiastically about) “our new ‘control tower’” – essentially a multi-screen super dashboard – “to track, analyse and predict the status of all our clinical studies. 500+ active trials, 70+ countries, 80 000+ patients – transformative for how we develop medicines.” Dashboards are the physical manifestation of the ideology of big data, the idea that if you can measure it you can manage it.

I am increasingly concerned, however, that the ideology of big data has taken on a life of it’s own, assuming a sense of both inevitability and self-justification. From measurement in service of people, we increasingly seem to be measuring in service of data, setting up systems and organizations where constant measurement often appears to be an end in itself.

My worries, it turns out, are hardly original. I’ve been delighted to discover over the past year what feels like an underground movement of dissidents who question the direction we seem to be heading, and who’ve thoughtfully discussed many of the issues that I stumbled upon. (Special hat-tip to “The Accad & Koka Report” podcast, an independent and original voice in the healthcare podcast universe, for introducing me to several of these thinkers, including Jerry Muller and Gary Klein.)

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Health in 2 Point 00, Episode 79 | Noom, DispatchHealth and Kaiser Permanente

Today on Health in 2 Point 00, Jess is in Italy…and has me up far too early in the morning for this episode. On Episode 79, Jess asks me for an update on uBiome after their raid by the FBI. We also talk about nutrition startup Noom’s $58 million raise and clinician house-call platform DispatchHealth’s $33 million raise. In other news, Kaiser Permanente is launching a network to integrate the social determinants of health with their EHR. –Matthew Holt

Last Month in Oncology with Dr. Bishal Gyawali: April 2019

By BISHAL GYAWALI, MD

Keynote speech on the JAVELIN not going far enough to improve survival

The treatment landscape for metastatic renal-cell carcinoma has changed dramatically with the introduction of immunotherapies. Unfortunately though, we are promoting combinations over single agents without having much idea of added benefit of each drug. This is an important issue because when we combine two drugs, the only thing we are certain of are the added toxicities. PD-1 inhibitor nivolumab had improved OS when given in second line, however nivolumab was tested in combination with ipilimumab (not as a nivolumab monotherapy) in the first line trial. Now, pembrolizumab and avelumab have followed suit, although their combination partner was axitinib – a VEGF inhibitor. The control arm was sunitinib for both of the trials of pembrolizumab plus axitinib (KEYNOTE 426) and avelumab plus axitinib (Javelin 101). This is a little surprising because we are testing A B versus C, where both A and B haven’t been approved for the given setting – axitinib was approved for RCC in second line. Both these combinations improved PFS versus sunitinib but only the pembrolizumab combination has shown improved OS. However, I have doubts about the contribution of axitinib to these results. What would the outcome be if pembrolizumab alone is followed by sunitinib in second line? It is important to note that only one third of patients who discontinued sunitinib received PD-1 inhibitor subsequently in the KEYNOTE 426 trial. The important question for patients and clinicians would be to consider a survival difference had most of these patients received a PD-1 inhibitor subsequently. As for avelumab, the JAVELIN trial hasn’t reached as far as pembrolizumab and nivolumab have reached: The OS benchmark – so let’s reserve this combination until we see that benefit.

Have we successfully landed on the COMET?

We should remember that this combo-mania with PD-1/PD-L1 inhibitors may also backfire. Previously, the RCTs of nivolumab and pembrolizumab combos were halted in multiple myeloma for higher deaths in the combo arms. Another RCT IMblaze 370 also reports that atezolizumab, alone or in combination with cobimetinib, failed to improve survival versus regorafenib in patients with metastatic colorectal cancer.  This time again A B failed versus C although C in itself is a drug with very marginal benefits in this setting. Also, I don’t understand testing A plus B combo when both A and B are unapproved for the disease.

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