I’m a supporter of the Society for Participatory Medicine’s second annual conference on Oct. 17 in Boston. This article taken from the SPM “ePatients” blog tells you about just one of the great speakers who’ll be there. Please come join us Register here.–Matthew Holt
Here’s the latest in our series of posts by and about the outstanding speakers we’ve lined up for the Society for Participatory Medicine’s second annual conference on Oct. 17 in Boston, attached to the prestigious Connected Health conference. Register here. (Our #SPM2018 blog series has more about the speakers and activities.)
Since my earliest days in this work – even before our Society was formed – Dr. Patricia Flatley Brennan RN, PhD, FAAN, FACMI (or “Patti,” as she’s known to her many friends and fans) has been one of the most optimistic voices. She’s always been a dedicated, enlightened researcher, academic (at the University of Wisconsin, Madison) and voice of patient participation. On top of that, she was the director of the Robert Wood Johnson Foundation’s terrific Project HealthDesign: Rethinking the Power and Potential of Personal Health Records, which ran from 2006-2014, an absolutely pivotal period in the onset of personal health data. Patti knows that knowledge is power, and that patient power is naturally optimized when patient knowledge is optimized.
So you can imagine how thrilled I was when, in 2016, she was appointed the next Director of America’s National Library of Medicine (NLM). In addition to being extremely participatory, perhaps it’s no coincidence that she’s the first woman nurse and the first nurse in the post.
In a moment I’ll say more about the history of this position, and its significance in the timeline that led to SPM. For now, consider this about her topic at our conference, “the care between the care,” particularly the NLM’s role.Continue reading…
Hardly a day goes by that I don’t read the term “Disruptive Innovation” cited in relation to health care delivery. This might seem like a good thing, given that our expensive, wasteful, and in some cases frightfully ineffective traditional delivery model is in dire need of transformation. However, the term is frequently misunderstood to refer to any innovation representing a radical departure from an industry’s prior best offerings. In fact, it actually has a very specific definition.
Disruptive Innovation is the phenomenon by which an innovation transforms an existing market or sector by introducing simplicity, convenience, accessibility, and affordability where complication and high cost have become the status quo—eventually completely redefining the industry. It has played out in markets from home entertainment to teeth whitening, and it could make health care delivery more effective by making providers’ care processes, as well as individuals’ own self-care regimes easier and less costly. This, in turn, would reduce the need for both more, and more expensive, interventions over time.
Unfortunately, disruption has been slow to emerge in the health care sector. It’s been thwarted by the broader health care industry’s unique structure, which tends to prioritize the needs of commercial insurers and large employers (who pay the most for consumercare) over those of health care consumers themselves. It also stacks the deck against disruptive entrepreneurs, since established providers effectively control professional licensing requirements, and (along with insurers) access to patients & key delivery partners.
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed Ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for certain drugs, PAs boil down to yet another cost-cutting measure implemented by insurers to stand between patients and certain costly drugs.
The PA process usually takes from 48-72 hours, and it’s not infrequent for requests to be denied, even when the physician has demonstrated an undeniable medical need for the drug in question.
Join me at the 2nd annual Society for Participatory Medicine (SPM) conference, co-located with the Connected Health Conference at the World Trade Center in Boston. It’s magical and very inexpensive–Matthew Holt
DEMOCRATIZING HEALTH CARE! Me. You. Us. Healthocracy.
Don’t hesitate another minute! Avoid severe FOMO (fear of missing out) and regrets by registering for the second annual SPM conference!
Hear from amazing speakers Patti Brennan, Rasu Shrestha, Bill Marder, Sarah Krüg, Ivan Handler, Casey Quinlan, Jason Bobe, Brennen Hodge, as well as mother/daughter heroes, Angela & Grace Kennedy, and Kristina & Kate Sheridan. Help create a Participatory Medicine Manifesto in the afternoon. Patients Included!
Spotlight on Casey Quinlan, Mighty Casey Media
Casey’s work in standup comedy, network news and health policy will entertain, enlighten and inform. After a cancer diagnosis 5 years ago, Casey wrote Cancer for Christmas: Making the Most of a Daunting Gift and produces the Podcast Healthcare Is HILARIOUS. Her favorite people to work with are those who want to fix the system, not serve the status quo.
Everyone agrees that health care is bankrupting the nation. The prevailing winds have carried the argument that a system that pays per unit of health care delivered and thus favors volume over value is responsible. The problem, you see, was the doctors. They were just incentivized to do too much. This incontrovertible fact was the basis for changes in the healthcare system that favored hospital employment and have made the salaried physician the new normal. Yet, health care costs remain ascendant.
It turns out overutilization in the US healthcare system isn’t what its cracked up to be.
Figure 1. Utilization rates in different health care systems
A recent analysis (Figure 1) by Papanicolas et al., in JAMA demonstrates that while the United States is no slouch with regards to volume of imaging and procedures in a variety of different categories, it does not explain a health care system twice as expensive as its nearest competitor. The problem turns out not to be volume, rather its the unit price of healthcare in the United States.
Health Care Costs and Glass Houses
There are many stones cast by all the various players in healthcare when it comes to cost, and of course, everyone bears some degree of responsibility, but it’s also clear that some folks live in larger glass houses than others. The most beautiful of all the glass houses are those built by hospitals. From 1996 to 2013, it was not population growth, health status, doctors visits, or prescription drugs that drove spending increases. Sixty-three percent of the increase in cost over an almost 20-year time span can be attributed to hospital stays and testing during doctor visits. Consider that the average hospital stay in the US costs $18,142, and lasts 4.9 days compared to other industrialized countries where average hospital stays last 7.7 days, and cost $6,222. But despite these exorbitant prices hospital systems in the United States complain they barely stay afloat.
Apologies on the hiatus for posting on THCB. As many of you know, I was running around getting Health 2.0 in order this past weekend. Today we are featuring a piece on understanding how machine learning can actually work in health care today-Matthew Holt
By LEONARD D’ AVOLIO, PhD
There’s plenty of coverage on what machine learning may do for healthcare and when. Painfully little has been written for non-technical healthcare leaders whose job it is to successfully execute in the real world with real returns. It’s time to address that gap for two reasons.
First, if you are responsible for improving care, operations, and/or the bottom line in a value-based environment, you will soon be forced to make decisions related to machine learning. Second, the way this stuff actually works is incredibly inconsistent with the way it’s being sold and the way we’re used to using data/information technology in healthcare.
I’ve been fortunate to have spent the past dozen years designing machine learning-powered solutions for healthcare across hundreds of academic medical centers, international public health projects, and health plans as a researcher, consultant, director, and CEO. Here’s a list of what I wish I had known years ago.
Earlier this month, the Centers for Medicare and Medicaid Services Administrator Seema Verma proposed bold changes to Medicare’s Accountable Care Organizations (ACOs), with the goal of accelerating America’s progress toward a value-based healthcare system—that is, one in which providers are paid for the quality and cost-effectiveness of care delivered, rather than volume delivered.
CMS has created a number of ACO programs over the last six years in an effort to improve care quality and reduce care costs across its Fee-for-Service Medicare population. In a Medicare ACO, hospital systems, physician practices and other voluntarily band together and assume responsibility for the quality and cost of care for beneficiaries assigned to them by Medicare. All ACOs meeting quality targets at the end of a given year receive a share of any savings generated relative to a predetermined cost benchmark; and depending on the type of ACO, some incur a financial penalty if they exceed the benchmark.
According to CMS’ recent analyses, ACOs that take on higher financial risk are more successful in improving quality and reducing costs over time. So one important objective of CMS’ proposed changes is to increase the rate at which ACOs assume financial risk for their beneficiaries’ care.
In July 2009, the family of Massachusetts teenager Yarushka Rivera went to their local Walgreens to pick up Topomax, an anti-seizure drug that had been keeping her epilepsy in check for years. Rivera had insurance coverage through MassHealth, the state’s Medicaid insurance program for low-income children, and never ran into obstacles obtaining this life-saving medication. But in July of 2009, she turned 19, and when, shortly after her birthday, her family went to pick up the medicine, the pharmacist told them they’d either have to shell out $399.99 to purchase Topomax out-of-pocket or obtain a so-called “prior authorization” in order to have the prescription filled.
Prior authorizations, or PAs as they are often referred to, are bureaucratic hoops that insurance companies require doctors to jump through before pharmacists can fulfill prescriptions for certain drugs. Basically, they boil down to yet another risky cost-cutting measure created by insurance companies, in keeping with their tried-and-true penny-pinching logic: The more hurdles the insurance companies places between patients and their care, the more people who will give up along the way, and the better the insurers’ bottom line.
PAs have been a fixture of our health care system for a while, but the number of drugs that require one seems to be escalating exponentially. Insurance companies claim that PAs are fast and easy. They say pharmacists can electronically forward physicians the necessary paperwork with the click of a mouse, and that doctors shouldn’t need more than 10 minutes to complete the approval process.
In most other human activities there are two speeds, fast and slow. Usually, one dominates. Think firefighting versus bridge design. Healthcare spans from one extreme to the other. Think Code Blue versus diabetes care.
Primary Care was once a place where you treated things like earaches and unexplained weight loss in appointments of different length with documentation of different complexity. By doing both in the same clinic over the lifespan of patients, an aggregate picture of each patient was created and curated.
A patient with an earache used to be in and out in less than five minutes. That doesn’t happen anymore. Not that doctors and clinics wouldn’t love to work that way, but we are severely penalized for providing quick access and focused care for our well-established patients.
In May Philip Alston, the United Nation’s Special Rapporteur on Extreme Poverty, and John Norton Pomeroy Professor of Law at New York University Law School released his, “Report of the Special Rapporteur On Extreme Poverty and Human Rights on His Mission to the United States.” The 20-page report was based, in part, on Alston’s visits this past December to California, Georgia, Puerto Rico, West Virginia and Washington, D.C. After reading the report and the response to it, one is again forced to question how legitimate is our concern for the health and well being of the poor, or those disproportionately burdened with disease.
The UN report found over 40 million Americans live in poverty, or upwards of 14% of the population. Those living in extreme poverty number 18.5 million and 5.3 million live in 3rd World absolute poverty. Among other related statistics, Alston cites the fact the US has the highest comparable infant mortality rate, 50% higher than the OECD mean, due in part to an African American mortality rate that is 2.3 times higher than that of whites. The US has the highest youth poverty rate in the OECD. In 2016, 18% of children were living in poverty comprising 33% of all people in living poverty and 21% of those were homeless. These facts are explained in part by the report noting between 1995 and 2012 there was a 750% increase in the number of children of single mothers experiencing annual $2-a-day poverty. US poverty, the report explains is due in part to the continuing growth in income and wealth inequality. The report found in 2016 the top 1% possessed 39% of the nation’s wealth while the bottom 90% lost 25% of its share of wealth and income. Since 1980 annual income for the top 1% has risen 205% and for the top .1% by 636% while annual wages for the bottom 50% have stagnated. The report reminds us the US has approximately 5% of the world’s population but 25% of its billionaires. The US in sum ranks 18th out of 21 wealthy countries in labor markets, poverty rates, safety nets, wealth inequality and economic mobility.