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John Irvine

What the Atlanta HIV Data Tells Us About Public Health in America

Lamar Yarborough

“The night I found out, I slept one and a half hours,” recalls D, a 29-year-old black gay man.

He’s talking about being diagnosed with HIV, the virus that causes AIDS.

“Even though I work in public health and tell people daily that HIV is not a death sentence, that first night that’s all I could think of,” says D. “This has to be wrong, I thought. I work in public health. This can’t happen to me.”

D, who requested anonymity, says he contracted the virus when a condom broke during sex. Two weeks later, he was tested for two sexually transmitted infections (STIs) – chlamydia and gonorrhea – but not for HIV. Shortly afterward, he went back for an HIV test and found out that he had the virus.

Soon after his diagnosis, D moved to Atlanta, which also happens to be the epicenter of a re-emerging national HIV crisis.

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To Make Hospital Quality a Priority, Take a Page From Finance

Optimized-pronovostWhen you are a patient at a hospital, you want to know that the executives who run that facility put the safety and quality of care above all other concerns. Encouragingly, more of them are saying that safety is indeed their number-one priority—a fitting answer given that preventable patient harm may claim more than 400,000 lives a year in the United States.

Yet when you look at the way that most hospitals and corporate health systems are organized, weak infrastructure exists to support that priority. True, some hospital boards of trustees have made safety and quality their first order of business. At meetings, they might hear directly from a patient who suffered a medical error, sit through a case study of a unit that reduced complications, or get an overview of various efforts to boost the patient experience and improve outcomes.

Stories can inspire culture change. Sustained improvements, however, require health care organizations to institute top-to-bottom accountability for performance.

What would it look like if safety and quality truly were addressed this way? It might be something like how most hospitals’ finances are managed, from the board level to the smallest unit.Continue reading…

Why Doctors Quit (And What to Do About It)

John Haughom MD white

I got an e-mail from out of the blue the other day.

The e-mail informed me that a colleague, a man I respected greatly, had tendered his resignation at the hospital.  That coming Friday would be his last day. There would be an informal gathering for staff at the hospital cafeteria and that would be that.

I was shocked. The physician in question was an institution at our hospital. As far as I knew he was happy, his patients loved him, he was respected by his peers.   I could think of no earthly reason for him to go.  This did not did not sound like the old friend I knew.

I did what any friend would do: I picked up the phone and called him.

“I just got the e-mail. What’s going on?” I asked “Is something up at home? Is everything ok with Sarah and the kids?”

“Nothing’s wrong. I’ve just been doing a lot of thinking. I’ve decided I want to spend time with the kids and explore some outside projects.

Outside projects? What sort of outside projects?

My friend was the not kind of guy who you thought of as spontaneously quitting his job. I pressed him. He finally broke down and confessed. He was miserable at work.

“It’s the bean counters. They’re everywhere. Every day I get an e-mail that says I’m underperforming on this metric or that metric. It’s making me crazy. My self-esteem can’t take it. Last week, I got an e-mail that told me I need to do a better job of answering patient e-mails. I didn’t even know they were allowed to e-mail us. How long has this been going on? I tell you, I love my patients, but I just can’t take it anymore.”

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(Even) More Disruption, Please !!

Screen Shot 2015-07-08 at 10.04.02 AM

There are two questions I hear all the time from digital health care entrepreneurs: 1) How can I gain initial market traction? 2) How do I grow my client base?

Health care is an incredibly tough market to sell into. Even if you have a highly-differentiated solution with proven value, the barriers to access and scalability are extremely high.

For entrepreneurs trying to break in, the problem is two-fold.  First, the majority of providers are focused on patient care – getting on their radar is difficult. Second, even if an entrepreneur does gain buy-in and proves value to a single provider or group, it’s difficult to build upon that success. 

Negotiate Strategic Partnerships

The first lesson to get ahead: Learn how to spot a valuable partnership and negotiate a good deal—whether with an accelerator, incubator, or VC.

There are 87 accelerators (and counting) dedicated to jumpstarting the most promising health care startups in the country, and each is as differentiated as the companies they nurture. These accelerators vary in how structured their programs are, as well as the threshold of capital they invest.  Timeframes differ, the amount of equity required varies, the level of mentorship fluctuates, and the quality of contacts/potential clients runs the gamut. Despite the differences, the objective is the same: to help propel entrepreneurs into health care.

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The Health Care Handbook: Medical Malpractice


Aaron Carroll, “Meme-busting: Tort reform = cost control,” June 2011. Used with permission.

Aaron Carroll, “Meme-busting: Tort reform = cost control,” June 2011. Used with permission.

Patients who believe they have been injured in some way by a health care provider can file a medical malpractice claim. To prove malpractice, the patient must show that the injury was caused by the provider’s negligence, meaning that he or she didn’t practice medicine consistent with the accepted medico–legal standard of care.

If a patient wins a case or a favorable settlement, the health care provider, through insurance, may have to compensate the patient for loss of income due to injury and for noneconomic losses, such as pain and suffering. Although most malpractice claims are made against physicians, claims can be brought against any health care provider, including students. To protect against the financial risk of future malpractice lawsuits, most physicians purchase malpractice insurance. Hospitals and health care networks often purchase insurance for their employees, while independent physicians typically purchase their own policies.

Medical malpractice serves two goals: (1) to compensate victims of poor medical care, and (2) to encourage safe and responsible medical practice. Our current system is designed to accomplish both by punishing negligent providers through the court system (called “torts”). Some question whether it wouldn’t be better to handle each goal separately, and to focus on the system rather than on individuals.

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The Feminization of Health Care

Amy Compton-Phillips, MD

Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.

A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.

A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.

Continue reading…

Building a Corporate Venture Group That Matters

Screen Shot 2015-07-07 at 3.40.15 PM“Um…Who are you, and why are you in my office?”

This was the verbatim greeting we received from respected Sand Hill Road investors when we first introduced Merck’s Global Health Innovation Fund (GHI) in 2010.  However, since that time we’ve come a long way.  By investing in digital health, we’ve grown from a $125M venture fund to a $500M venture fund and have added a growth equity fund with M&A capabilities.

Today, these same investors remember our name and co-invest with us.

So how did we get here?  Certainly timing, luck and sponsorship are critical to anything done in a corporate environment.  Acting as a strategic and financial investor has also helped to earn the trust of entrepreneurs and fellow investors.  And, building a great team has been critical; but these are fairly obvious steps.

There are three other strategic maxims we found to be mandatory in building a corporate unit that’s successful.

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Yes, Expand Medicaid!

President Obama was right last week to pivot to two things in the wake of the Supreme Court’s Affordable Care Act (ACA) decision: (a) a plea to Republicans (yet again) to please, pretty please drop their opposition to the law and join him in tweaking it and fixing what remains broken in healthcare, and (b) Medicaid expansion.  

It’s probably too much to hope Republicans will drop their fierce attempts to trash, dismember or repeal the law—as the political season leading to the Nov. 2016 elections gets underway in earnest.  But Medicaid expansion could prove a fruitful path to concrete results.    

As a reminder, the 2012 Supreme Court decision on the ACA nullified the law’s provision compelling states to expand Medicaid.  Instead, it made such expansion voluntary. Continue reading…

Stealing a Page From Medicine’s Playbook: The American Board of Baseball

GundermanAs kids growing up in the Midwestern United States, my friends and I loved baseball.  We spent many hours each summer day playing the game, and when we weren’t out on the sandlot, we were reciting the stats of top players, arguing the merits of our favorite teams, and trading baseball cards.  Baseball is more than America’s pastime.  It is a sport on which millions of Americans have cut their athletic teeth, laying a lifelong foundation of physical fitness and instilling important lessons about competition and character.

Imagine my distress, then, in beholding the state of major league baseball in 2015.  Stalwart players such as Carlos Gonzalez of the Rockies and Robinson Cano of the Mariners have been posting career-worst numbers, and even a venerable team such as the Boston Red Sox, which boasts the fourth-highest payroll in all of baseball, is stuck in last place in its division.  And this problem of poor performance is not a fleeting phenomenon.  Consider the Chicago Cubs, who have the worst home field record of any team over the last 50 years, and haven’t won a World Series since 1908.

Clearly, the best interests of our youth, the American public, and baseball fans everywhere are not being well served by our current largely unregulated approach to baseball quality.  Poorly performing players are appearing in game after game, and losing teams keep showing up on opening day season after season.  This isn’t just a matter of pride.  The economic implications of Major League Baseball are huge – the Los Angeles Dodgers have a payroll of nearly $300 million, and the New York Yankees franchise has an estimated worth of over $3 billion.  Something has to change.

Continue reading…

Are Charts Dead?

Screen Shot 2015-07-05 at 9.34.36 AMIf flying an airplane without cockpit instruments is equivalent to having no data about healthcare delivery, then flying an airplane with an overwhelmingly complex cockpit data environment is probably just as dangerous.

In this compelling webinar (Online, Tues July 7th, 2-3 PM) you’ll learn strategies that will let you visually present data in the most powerful, attention-getting ways possible – giving you the tools to reach patients, clients and colleagues.

Learn the common mistakes that can confuse users, detract from your presentation and ultimately put quality care and patients at risk.


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