Author Archives

Matthew Holt

A Prescription For Doctors

Oct 16, 2010• 21

By THOMAS GOETZ

Enough about patients: What is a doctor to do?

In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a role to play. But thankfully, those have been rare exceptions. Most doctors I’ve spent time with have been eager to hear about new tools that might engage their patients, and they’ve been eager to share well-earned advice on where there’s work to be done. It has been a delight and an education to talk about the potential of healthcare with these physicians who are, after all, doing the hard work of providing medical care every day.

A high point in my continuing education came a couple weeks ago, when I was invited to speak at the Minneapolis Heart Institute Foundation‘s Fall Nursing Conference, where I met a number of nurses who are eager to help patients gain some control over their health. A few days later I gave a lecture on patient engagement at the University of Minnesota Medical Center. The invitation came from Dr. David Rothenberger, an esteemed surgeon who has consistently emphasized the importance of innovative thinking in medicine. Dr. Rothenberger also runs a program for physicians with promising leadership potential, and part of my day involved talking with them about the changing nature of clinical medicine, and the challenge of engaging patients in their healthcare.

These were good doctors, deeply motivated to help their patients, and there was scant resistance to the notion of an empowered patient who might seek to engage in their care and treatment. Indeed, they seemed to relish the opportunity to work with such patients.

San Francisco 2010: Regina Holliday Presents her Painting

Oct 15, 2010• 11

By Bianca Grogan

On the last day of the Health 2.0 Fall Conference in San Francisco, October 7-8, 2010, Regina Holliday presented the painting that she worked on for the full two days of the conference. She titled her painting Bridging the Great Divide, in reference to how we communicate, bridge communities, and combine left and right brain thinking.

What’s Your Platform?

Oct 15, 2010• 3

By JONATHAN BUSH

We’ve done some heavy dipping into the world of policy recently. In mid-September, I spent a day in Washington, D.C., with friend and advisor Tom Scully meeting researchers, senators, and a congressman. We heard from “ONCHIT” that “CCHIT”—which, as you know is an “ATCB”—granted us Stage 1 MU! This is great news for me, mostly because some competitors didn’t get it! (How’s that for starting a policy blog with some serious ABCs?!)

I met with some amazingly smart and engaged reporters who now (I think, get called “researchers,” since their newspapers can no longer afford them) work for the Henry J. Kaiser Family Foundation or NPR. They’re the real deal. They needed much less initial grounding in the problems we try to solve than most of the journalists we meet. They had taken on board the assumption that the move toward ACOs means less waste (which it could for some) and can get everybody in the clinical supply chain on one system (which has been seen to work at times).

But none of them appears to have considered the idea that there is a relationship between a healthy integrated health information ecosystem and a health information exchange marketplace. It’s still surprising to me, but precious few people correlate sustainability of any social good with the existence of a healthy marketplace with enough room for flexibility to allow innovation over time. It’s like the single economic condition responsible for ALMOST ALL of the social progress of this nation since inception, but in health care it’s still kind of a new idea.

Hospitalists as Extensivists

Oct 15, 2010• 5

By PAUL LEVY

I had heard something about this, but couldn’t find it. A colleague here finally tracked it down. The story is about Caremore, a California based organization. Hospitalists generally are internal medicine doctors based in the hospital; but here they care for frail elderly members at high risk of hospital admission or readmission in skilled nursing facilities and in outpatient settings both before and after a hospital stay. Here’s an article on the AHRQ Innovations Exchange website.

An excerpt:

A Medicare Advantage plan expanded the role of its employed hospitalists, using them to continue following and caring for recently discharged members until their condition stabilizes, as well as other members at high risk of a hospital admission. Known as “extensivists” and supported by sophisticated information technology (IT) systems, these physicians generally split their time between the hospital, where they round on a small group of members each day, and an outpatient clinic, where they see recently discharged members and other members at high risk of an admission. Once or twice a week, these physicians also see members in SNFs.

The results:

The program reduced readmission rates and has led to low LOS (lengths of stay) and to below-average inpatient utilization in a high-acuity population.

Is this worth considering more broadly? What are the conditions for success? I welcome your thoughts.

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so. For the past three years he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.

NDM-1: Why Should the U.S. Care?

Oct 14, 2010• 3

By RAMANAN LAXMINARAYAN and HELLEN GELBAND

Why should the United States care about health problems in distant, poor countries when there are pressing priorities here at home? It’s a classic question. People trying to influence policy have never trusted humanitarianism to carry the day and have instead appealed to the self-interest of U.S. citizens. When it comes to health, U.S. travelers heading to foreign lands for tourism or work need protection from disease or at least the promise of a cure when they return home. Of utmost concern, the military sends large numbers of troops where they are in danger not only from armed conflict, but also from exotic (and often dangerous) diseases.

But no tropical disease can make as clear a case for U.S. self-interest as antibiotic resistance can: witness the furor over NDM-1—the resistance gene that seems to have arisen in patients on the Indian subcontinent. Was the furor over a health problem in India and Pakistan? No. The news that hit U.S. and European newspapers was over the report about NDM-1 in Lancet Infectious Diseases that identified people in England who had had surgery in India—“medical tourists”—as victims, and warned that the UK National Health Service might suffer financially because patients coming home had to be hospitalized and treated with expensive antibiotics to cure their infections. These just as easily could have been Americans—and now they are: NDM-1 was found in three U.S. medical tourists (and one Japanese man) on their return from India.

Care Coordination Metrics: One Can of Worms that NEEDS to be Opened

Oct 14, 2010

By VINCE KURAITIS

“Track who is on a care team — and share info with the patient.”

That’s just one of the summary recommendations coming from expert testimony given in a recent public hearing on how to improve care coordination through the use of health information technology. The Meaningful Use workgroup and Quality Measures workgroups are now wrestling with how to translate this recommendation into meaningful use criteria for HITECH Stages 2 and 3.

Seems like a good idea — simple, straightforward — perhaps even obvious. The EHR (electronic health record) could be a great tool for keeping care team members in the loop and on the same page about a patient’s care.

But then I thought about this for a few minutes, and the complexities started dawning. This seemingly simple recommendation — “Track who is on a care team and share info with the patient” — is the proverbial can of worms.

ACOs and the Looming Antitrust Crisis

Oct 14, 2010• 2

By DAVID DRANOVE

The Federal Trade Commission recently held a day-long workshop focusing on Accountable Care Organizations. ACOs will vertically integrate hospitals and doctors and, in the process, achieve what previous incarnations of vertical integration could not. Let’s forget about whether ACOs will actually fulfill the dream of efficient healthcare delivery and focus on the FTC angle – will the creation of ACOs require the creation of provider market power and should he FTC therefore look the other way?

Many health economists have documented the perils of provider market power. Some of my own research has been instrumental in turning the tide against providers, whose monopolizing tendencies used to get a free pass from the courts. But as policy makers move ACOs to the fore, providers are hoping to sweep antitrust under the rug.

The latest salvo comes from the AHA, which last week released a study challenging two recent studies of hospital market power and then strains to connect their findings to ACOs. The AHA report goes a bit overboard in its criticism of these studies. One study consists of little more than anecdotes and should not be criticized for being anything else. The other study is more complex and the criticism is equally complex, mostly along the lines of “if you had measured things slightly differently, your results would have been slightly different.” The AHA report would have readers believe that these two studies represent the entire body of knowledge about hospital mergers. Having summarily dismissed them, the argument against FTC enforcement would seem complete.

The True Health 2.0 Unmentionables

Oct 14, 2010• 3

By MICHAEL MILLENSON

At the recent Health 2.0 Conference, an unusual session highlighted the health importance of such “unmentionables” as job stress, marital worries and sexual dysfunction. However, despite the moderator’s inexplicable pride in a panelist’s mention of “vagina” – a topic certainly not lacking for Internet attention, albeit under more colloquial synonyms – the truly unmentionable subject was not sex, but the link between social class and health.

Unlike sex, talking openly about age and class distinctions makes most Americans squirm uncomfortably. Still, a number of speakers showed they understood that one of Health 2.0’s biggest challenges is proving itself useful to the population most in need of its help.

To start with, that means the elderly. Age brings an increased susceptibility to disease: half of Medicare beneficiaries are receiving care for one of six chronic conditions. Similarly, income is one of the most powerful predictors of health status. Those in the bottom 80 percent of adult income earners have an adjusted life expectancy almost 6 years shorter than those in the top 20 percent.

From that population perspective, two presentations stood out. The first was the partnership between Geisinger Health System and dLife. The second, for very different reasons, was the unveiling of Sharecare.

Republican Economics as Social Darwinism

Oct 14, 2010• 27

By ROBERT REICH

John Boehner, the Republican House leader who will become Speaker if Democrats lose control of the House in the upcoming midterms, recently offered his solution to the current economic crisis: “Liquidate labor, liquidate stocks, liquidate the farmer, liquidate real estate. It will purge the rottenness out of the system. People will work harder, lead a more moral life.”

Actually, those weren’t Boehner’s words. They were uttered by Herbert Hoover’s treasury secretary, millionaire industrialist Andrew Mellon, after the Great Crash of 1929.

But they might as well have been Boehner’s because Hoover’s and Mellon’s means of purging the rottenness was by doing exactly what Boehner and his colleagues are now calling for: shrink government, cut the federal deficit, reduce the national debt, and balance the budget.

And we all know what happened after 1929, at least until FDR reversed course.

San Francisco 2010: First Life Research at Health 2.0

Oct 14, 2010• 1

By Bianca Grogan

In the coming days and weeks we’re going to start rolling out a lot of video from last week’s Health 2.0 Conference held in San Francisco, CA on October 7-8, 2010. There is a ton of material to show you. But we’re going to start with one of the more remarkable demos at the conference. This is Gideon Mantel, Co-Founder and Chairman of First Life Research showing his company’s search capabilities which are able to comb millions of user-generated posts and comments to spot emergent trends in health experiences. His two examples are early detection of side effects in pharmaceuticals, but when you understand what they are doing, you’ll be amazed not only at the technology but also at the potential for converting messy narrative into actionable information.