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Simon Nath

Mercer’s Hard-to-Find “Winning Streak”

ROGER COLLIER“The winning streak continues as employers predict another year of low health benefit cost growth in 2016.” – That’s the headline to the announcement from international benefits consultants Mercer Inc. of the preliminary findings from their latest employer survey.

Sounds good, right? Finally, healthcare costs are under control.

Unfortunately, reading the survey results gives another, very different impression.

What the survey actually found was that employers predict that health benefit costs per employee will rise by 4.2 percent on average in 2016—after they make planned changes such as raising deductibles or switching carriers.

The survey announcement enthuses about what it calls the “slow-down in the underlying cost growth”(that is, the increase ifno changes were made to employer plans). Specifically, without plan changes employer costs would have increased by 6.4 percent for 2016, and 7.1 percent in 2015. Mercer notes that the 2016 projection is the lowest rate of underlying cost growth seen since 2005, and that 2016 will be the fifth year of benefit cost growth below 5 percent.

So, is this good news?

Well, no. For three reasons.Continue reading…

Goldilocks and The Three Bearers of Value-Based Health Reform

Brian F

While serving as a panelist at a recent health care conference in New York, an audience member asked me how we’re advising clients to help them navigate the transition from volume to value-based systems.

So I talked about Goldilocks, using the time-honored children’s story as a metaphor for steering clear of extremes, maintaining a steady pace, and not going too fast or too slow. Heads nodded in agreement, a sign I was striking a responsive chord.

I’m not comparing the complexity of current health reform to a fairy tale. But, choosing the path that’s “just right,” to quote Goldilocks herself, is central to an organization’s ability to adapt to a value-based care system that relies on new and creative collaborations and data analytics to reduce cost and improve patient outcomes.

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The Measure of a Physician: Albert Schweitzer

GundermanThere are different ways to take the measure of a life.  John Rockefeller, the richest person in the history of mankind, once asked a neighbor, “Do you know the only thing that gives me pleasure?  It’s to see my dividends come in.”  Television magnate Ted Turner once said, “I don’t want my tombstone to read, ‘He never owned a network.’”  And musical artist Lady Gaga has described her quest as “mastering the art of fame.”  But wealth, power, and fame are not life’s only metrics, and September 4 marks the 50th anniversary of the death of one of the 20th century’s brightest counterexamples.

His name was Albert Schweitzer.  Winston Churchill once referred to him as a “genius of humanity,” and a 1947 issue of Time magazine dubbed him “the greatest man in the world.”  Though Schweitzer held four doctorates and achieved worldwide fame as a musician, theologian, medical missionary, and promoter of a philosophy of “reverence for life,” for which he received the 1952 Nobel Peace Prize, his most enduring contribution lies in his lifelong commitment — both theoretical and practical – to the suffering.

Schweitzer was born 1865 in the Alsace region of what is now eastern France, the son of a Lutheran pastor whose grandfathers were both accomplished organists.  Though already a world-renowned musician and writer, at age 30 Schweitzer decided to answer a call to missionary work, spending the next seven years of his life studying medicine.  Once he finished his medical studies, he and his new wife, Helene, traveled 4,000 miles to set up a missionary hospital in what is now Gabon in west central Africa.  There he spent most of the rest of his life, eventually dying there in 1965.

Continue reading…

Are Studies Overestimating the Cost of EHRs?

Screen Shot 2015-09-04 at 9.39.17 AMOn August 6, this article was posted, Are Electronic Medical Records Worth the Costs of Implementation?, in the American Action Forum. The article stated that there is value in the use of EHRs but the cost is significant. They estimated nearly $164,000 for a single physician and over $233,000 for a five provider practice.

I was surprised in 2015 to see this piece. Why? Because they used data from 2009 to 2011 on practices largely using server-based EHRs. The landscape of the EHR market has radically changed in the last 5 years. There are a wide range of more affordable, cloud-based EHRs today, including some that are free.

A free EHR doesn’t mean no cost, but it does make a big dent in the vendor related costs around hardware, software and implementation. This is often true for cloud-based EHRs that do charge a monthly per provider feeas well.

Continue reading…

The Phonemic Path: A Way to Measure Health That Can Lead to Health Improvement

flying cadeuciiWe know what improves health–but we’re simply years away from having the tools to achieve it. We know that we can reduce the chronic conditions plaguing the world’s populations by a subtle combination of:

  • Closely monitoring the behavior of individuals
  • Linking health goals to treatments and behavior changes
  • Upgrading the problems in communities that contribute to disease

Such activities call for supple and sophisticated ways to link together disparate types and sources of information–the subject of this article. Doing such linking requires a new way of approaching data that is lacking today in our health care system.

The process of developing the new data approach will have to be incremental (no “Health Data Manhattan Project” for us), will involve thousands of contributors in crowd sourced fashion, and will take unanticipated directions based on the insights of the contributors. I am not laying out a framework in this article, but just touching on the themes that the project will likely explore. I’ll also mention a few of the people working in this area, notably the Yosemite Project. I call this idea Phonemic Path, in reference to the extensive research biologists are carrying on to find genomic paths that explain disease.

Continue reading…

Clinical Research Rebooted

Screen Shot 2015-09-03 at 9.27.31 AMThe traditionally conducted clinical trial model requires increasing amounts of time, cost, and resources for both sponsors and sites. In fact, fewer than 10% of clinical trials are completed on time  due to poor patient recruitment, retention and protracted budget negotiations. And since 2008 per-patient, clinical trial costs in the US have risen an average of 70% across all development phases.

In March 2015, however, BLOOMBERG BUSINESS
reported “Stanford University researchers were stunned when they awoke Tuesday 10 March to find that 11,000 people had signed up for a cardiovascular study using Apple Inc.’s ResearchKit, less than 24 hours after the iPhone tool was introduced. ‘To get 10,000 people enrolled in a medical study normally, it would take a year and 50 medical centers around the country’ said Alan Yeung, medical director of Stanford Cardiovascular Health. ‘That’s the power of the phone.”‘

Rebuilt

At Scanadu, data collection and clinical studies are key to the development and deployment of our medical devices, and we’re fully aware of the kind of scale and speed and power we’re talking about here. And as a startup developing the next generation of medical devices for consumers, we had to innovate the clinical study process, while bucking the traditional assumptions of how a clinical study should operate.

Continue reading…

Value-based Telemedicine

Screen Shot 2015-09-02 at 7.45.56 PMWhen a family member was a new mom she called me concerned about her 7-day old baby’s breathing.I almost sent them to the ER. Then she asked me if we could FaceTime. What I saw was a warm, pink, dry baby looking around, looking quite well to me.  I was able to tell that she had no labored breathing, no retractions or nasal flaring.  She just had a little stuffy nose.  I had been answering questions, treating minor ailments and triaging the acutely ill for several years via text, but it was in that moment that I knew the iPhone and other smartphone devices would fundamentally and forever change the way physicians can deliver our services.

Fast forward to next year. An estimated 2 billion people will have smartphones across the world in 2016.  Industries are being transformed radically by the widespread uptake of these devices.  Healthcare will be no different and will continue to move toward more virtual care enabled by smartphones. As the example above demonstrates, it makes sense for both care and economics.Virtual care and telemedicine worldwide is expected to be a $34 B market by 2020 according to Mordor’s Market Intelligence, with the US accounting for 40% of that, nearing $15 Billion in the next five years. Several early stage tele-medicine companies have raised many millions of dollars in the last several months.

Payment reforms are driving the market toward value-based care and will only accelerate the use of telemedicine via smartphone.  Many new forms of payment for medical services are emerging that are not tied to the legacy fee-for-service reimbursement model.  Patients are paying more out of pocket and therefore have increasingly aligned interests with payers to reduce costs while achieving better overall health. These changes are, in turn, driving the empowered healthcare consumers’ demand for a better experience and convenience.

Continue reading…

Universal Patient Identifiers for the 21st Century

Healthcare is abuzz with calls for Universal Patient Identifiers. Universal people identifiers have been around for decades and experience can help us understand what, if anything, makes patients different from people. This post argues that surveillance may be a desirable side-effect of access to a health service but the use of unique patient identifiers for surveillance needs to be managed separately from the use of identifiers in a service relationship. Surveillance uses must always be clearly disclosed to the patient or their custodian each time they are sent by the service provider or “matched” by the surveillance agency. This includes health information exchanges or research data registries.

As a medical device entrepreneur, physician, engineer, and CTO of Patient Privacy Rights, I have decades of experience with patient identifier practices and standards. I feel particularly qualified to discuss patient identifiers because I serve on the Board and Management Council of the NIST-founded Identity Ecosystems Steering Group (IDESG) where I am the Privacy and Civil Liberties Delegate. I am also a core participant to industry standards groups Kantara-UMA and OpenID-HEART working on personal data and I consult on patient and citizen identity with public agencies.

Continue reading…

On Moving the Physician Movement Forward

Richard ReeceThere are always two parties, the party of the Past, and the party of the Future. The Establishment and the Movement.

— Ralph Waldo Emerson (1903-1882), Notes on Life and Letters of New England

On July 20-26, 2015, a new physician organization, the United Physicians and Surgeons (UPSA), held a conference, dubbed the Summit at the Summit, in Keystone, Colorado.

The conference featured over 40 speakers. Speakers represented many physicians and physician organizations, both bearing workable innovative ideas. The conference was designed to restore physician autonomy, protect the patient-physician relationship, and reset relationships between overreaching government and corporate entities.

Conference attendees were enthusiastic about this physician Movement to restore the voice of medicine.

But inevitable questions arose: Where do physicians go from here? How do we sustain the movement? Where will funding come from? What form will the Movement take? How will physicians inform hundreds of thousands of fellow physicians and millions of their patients about grievances of physicians, their ideas for the future, and what can be done to improve quality and convenience and confidentially of care?

Continue reading…

Reforming the Reformers

flying cadeucii

In the midst of sluggish economic growth, finding a sector of the economy growing from 15 percent of the economy up to 19 percent would normally be a cause of celebration, except that this is health care. The lack of good cheer about this growth is an indirect acknowledgement of a stark reality: We are not realizing much increased value as we spend more on health care because too much of our health dollars are going to ineffective (and often harmful) procedures.

Estimates of the waste from this overconsumption of health care range from 30 percent to 50 percent. While all of the experts talk about reducing this waste (the phrase of the day is “bending the cost curve”), the reality is that hospital administrators, pharmaceutical companies, device manufacturers, insurers, consultants, think tanks and government bureaucrats all are seeing their power, control and financial remuneration increase due to this medical-care consumption growth.

All of the reformers’ trendy ideas have failed and will likely continue to fail in spite of the experts telling us they will soon figure it out. Electronic health records are a hugely expensive disaster. So far, they decrease doctor efficiency, reduce quality and increasingly make patients fearful of sharing sensitive information with their doctors for fear hackers or others will access their private data. Accountable Care Organizations turn doctors into rationers, introducing a conflict of interest between doctor and patient. Price controls by Congress or bureaucrats or oligarchic insurers only reduce access to care, demoralize doctors and introduce the risk of game playing by health systems by “up-coding” (labeling a doctor visit as more complex than it is).

Continue reading…

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