Category: Uncategorized

How to Talk to Clinicians: Forget Workflows, Just Tell Us How Things Work

Feb 28, 2022

BY HANS DUVEFELT

Workflows are all the rage with EMR people. But doctors, NPs and PAs are smart. Nothing burns us out as fast or as completely as being told how to do things instead of why. We are not circus animals.

Let me explain:

If we had no professional education at all, we would have clinical workflows memorized instead of clinical knowledge. For example, two weeks after starting an ACE inhibitor like lisinopril, order a basic metabolic profile. That sounds pretty straightforward, but if you add up all the possible clinical workflows we would need if we didn’t know medicine at all, that would be a huge burden – a massive amount of seemingly random and senseless rules.

Pithiatism Redux

Feb 25, 2022

BY MARTIN SAMUELS

Those of us in medicine have all seen the famous painting of the Tuesday afternoon lessons at the Salpȇtrière in Paris in the 19^th century. In Pierre Aristide André Brouillet’s painting, one can clearly see the great professor, Jean-Martin Charcot, holding forth while the patient, Blanche Whitman, is being supported by a tall young man, Joseph Jules Francois Felix Babinski, the Chef de Clinique (the chief resident) and allegedly the favorite to succeed Charcot. He never did as he was failed repeatedly on the exam necessary to become a faculty member at the university by a jealous, xenophobic, anti-immigrant rival, Charles Bouchard. Babinski was born in France and served in the army twice, but his name was Polish as his parents had emigrated to France to escape bias in Poland (sound familiar?). Ironically almost no one remembers Bouchard (his only contribution being the Charcot-Bouchard aneurysm which may be the cause of some intracerebral hemorrhages), but there is no doctor on earth who does not know Babinski’s name. This is one of many reasons why Babinski is my neurological hero.

*A Clinical Lesson at the Salpêtrière*, Pierre Aristide Andé Brouillet

Get Ready for (Healthcare) Microgrids

Feb 22, 2022• 1

BY KIM BELLARD

We depend on it. Indeed, our daily lives are unimaginable without it. The trouble is, it’s become unreliable. Lives have been lost because it wasn’t performing when it needed to be. It’s built around large facilities that are often decades old. Parts of it don’t communicate/coordinate well with others. Its workforce is aging and burnt out. There is no person or agency charged with ensuring its resiliency. It badly needs to be rethought for the 21^st century.

Oh, you thought I was talking about our nation’s power grid? I was talking about our healthcare system.

The parallels are striking, and concerning. They’re huge industries, based on early 20^th century approaches, and beset by 21st-century challenges to which they may not be easily adaptable. If we don’t manage their evolution to the 21^st century right, we’re dead. Literally.

What Would Newt Do? Making Value-Based Care Victorious

Feb 21, 2022

By MICHAEL MILLENSON

Health care’s much-trumpeted transition “from volume to value” care remains more tepid than transformational, according to a new study. Looking at 22 health systems nationwide, RAND researchers found that compensation continues to be “dominated by volume-based incentives designed to maximize health systems revenue.”

Although confusing payment schemes bear part of the blame, there are deeper problems that appeared in sharp relief when I chanced upon a long-ago PowerPoint from a prominent political strategist and early advocate of “data-driven reimbursement.”

I refer, of course, to Newt Gingrich. His recommendations from 2007 about designing transformational change in health care provide a perspective that remains useful today in addressing what is ultimately a political problem. Frankly, value-based care (VBC) advocates perform dismally.

Going Along the Gingrich Roadmap

Back in 2004, Gingrich and I both served on a commission seeking to improve the quality of long-term care. This was during a period when a neutered Newt, out of power, was undergoing a political makeover by championing bipartisan health reform ideas such as electronic health records (EHRs) and evidence-based care. He even shared an award from NCQA with then-New York Sen. Hillary Clinton.

What Gingrich also shared, often, were his thoughts about what was necessary to drive the kind of sweeping alteration of the status quo represented by his leading Republicans to their first House majority in decades. Reviewing that roadmap, it’s not surprising that VBC advocates remain far from their destination.

The journey starts off in the right direction, with VBC advocates following Gingrich’s advice to “focus on large changes.” Trying to upend the way physicians have been paid since Hippocrates made his first house call certainly qualifies. But ambition has to be articulated as part of an organizing and attractive vision.

In 1997, in a book called Demanding Medical Excellence, I summarized the urgency of what we now call value-based care this way:

Tens of thousands of patients have died or been injured years after year because readily available information was not used – and is not being used today – to guide their care….(The health care delivery system) must be restructured according to evidence-based medical practice, regular assessment of the quality of care, and accountability.

In a similar vein, Gingrich in 2007 emphasized “a clear and compelling vision for quality” that would appeal to patients and medical professionals by promising safe care (no preventable deaths or injuries); consistent clinical excellence (appropriate and effective evidence-based care); and clinicians and staff partnering with patients.

Language That’s Bureaucratic, Not Bold

In contrast, the coalition sponsoring last month’s Health Care Value Week positioned transformation as a series of “models” addressing a bureaucratic checklist of health care “challenges.” The same type of language is used by the Centers for Medicare & Medicaid Services.

#HealthTechDeals Episode 11: MindMaze, Memora Health, Ro, PriorAuthNow, and Equip

Feb 18, 2022

On this episode of Health Tech Deals, Ian Morrison is pinch-hitting for Jessica DaMassa! Ian and I worked together 25+ years ago, and he’s been sitting in Silicon Valley looking at the American health care system for a long long time. Some deals – MindMaze raises $105M; Memora Health raises $40M; Ro raises $150M; PriorAuthNow raises $25M; Equip raises $58M. Ian also shares his opinions on the American health system and the digital health space–Matthew Holt

TRANSCRIPT

Ian Morrison:

Hi there, I’m Jess DaMassa. Actually, no, Jess DaMassa. Jess DaMassa is a friend of mine and I am no Jess DaMassa. I am Ian Morrison. I am pinch hitting for Jess DaMassa, how could I possibly pinch hit? Matthew told me I had to go and put my kilt on and spruce myself up a bit. But anyway, it’s an honor, a deep honor to be here for the February 18th episode of Health Teach Deals.

Matthew Holt:

So Ian, it’s a Dan Quayle line. No, it’s not the Dan Quayle, it’s the Lloyd Bentsen line about Dan Quayle.

Ian Morrison:

Exactly.

What the Pandemic Taught Us About Value-based Care

Feb 17, 2022• 4

By RICHARD ISAACS

You’ll recall that we ran a long piece (pt 1, pt 2) about Medicare Advantage from former Kaiser Permanente CEO George Halvorson earlier this year. Here’s a somewhat related piece from the current head of The Permanente Medical Group about what actually happened there and elsewhere during the pandemic–Matthew Holt

The COVID-19 pandemic has provided important lessons regarding the structure and delivery of health care in the United States, and one of the most significant takeaways has been the need to shift to value-based models of care.

The urgency for this transformation was clear from the pandemic’s earliest days, as shelter-in-place orders caused patient visits to brick-and-mortar facilities to plummet. That decline dealt a financial blow to many fee-for-service health care providers, who are paid per patient visit, treatment or test performed — regardless of the patient’s health outcome.

Prepaid, value-based health care systems, on the other hand, have demonstrated that they are better equipped to respond to a continually evolving health care landscape. Because they are integrated, with a focus on seamless care coordination, and they are accountable for both the quality of care and cost, these systems can leverage technologies in different ways to rapidly adapt to major disruptions and other market dynamics. Priorities are in the right place: the patient’s best interests. Value is generated by delivering the right level of care, in the right setting, at the right time.

Because value-based care focuses on avoiding chronic disease and helping patients recover from illnesses and injuries more quickly, it has the promise to significantly reduce overall costs in the United States, where nearly 18% of gross domestic product was spent on health care before the pandemic — significantly more than comparable countries. That figure rose to nearly 20% in 2020 during the pandemic.

While providers may need to spend more time on implementing new, prevention-based services and technologies, they will spend less time on managing chronic diseases. And thanks to the preventive approach of value-based health care organizations, society benefits because less money is spent managing chronic diseases, costly hospitalizations and medical emergencies.

Value-based organizations drive additional societal benefits. They understand that building trust with patients requires cultural competency — tailoring services to an individual’s cultural and language preferences. During the pandemic, building trust was especially important with underserved communities, where mistrust of health care systems is prevalent.

Aledade: Mandy Cohen joins, Farzad speaks

Feb 16, 2022

Aledade is the “build an ACO out of small independent primary care practices” company. It was founded by former ONC Director Farzad Mostashari and has been growing fast and profitably in the last few years, having raised just shy of $300m. Farzad recently both tweeted out the latest and put up a slide deck about their financial and business progress. Aledade also announced a major star signing in Mandy Cohen, previously Secretary of HHS in North Carolina, who is becoming CEO of a new division called Aledade Care Solutions. I had a wide ranging conversation with both of them about what Aledade has done and what it is going to do, as well as the general state of play in primary care and risk taking–Matthew Holt

TRANSCRIPT (lightly edited for clarity)

Matthew Holt:

Okay, it’s Matthew Holt with THCB Spotlight. I’m really thrilled to have Farzard Mostashari and Mandy Cohen with me. So, both of these two doctors have spent a lot of their time in public, much of their career in public service, Farzad for many years was in New York City, and then later was at ONC. Mandy was at CMS, and more recently, was Secretary for Health in North Carolina. In fact, towards the end of the Obama administration, Farzad was doing venture capitalism in a bar and got given a check and founded Aledade. And the news just recently, was that Mandy, who has just finished her term in North Carolina, is now going to join Aledade and start a new division there. So, I thought we would chat about how Aledade’s doing, what it’s doing, and what it’s going to do in the future and hopefully, yeah.

#HealthTechDeal Episode 10: ANDHealth, Ada Health, Minded, Expressable, and Curve Health

Feb 15, 2022

Valentine’s day…is awful. Check out this episode of HealthTechDeals to get Jessica’s and my more in-depth thoughts on the holiday. But let’s see which companies got some financial love this episode: ANDHealth gets $57 million; Ada Health gets another $30m; Minded gets $25 million; Expressable gets $15 million; Curve Health gets $12 million.

-By Matthew Holt

TRANSCRIPT

Jessica DaMassa:

Matthew Holt, was your Valentine’s Day filled with love and kisses and candies and flowers. Uh oh, I take it by the look on your face that’s a big fat no. It’s the February 15th episode of Health Tech Deals. So maybe these startups will feel a little bit more love than you feel right now. What happened?

Matthew Holt:

It’s just that Valentine’s Day in America is stupid, because your kids, I don’t remember this when you were young, because it was a long time ago, but your kids have to take Valentines to everyone in their class. It’s stupid.

Imaging a Different Future

Feb 15, 2022

By KIM BELLARD

Two articles have me thinking this week. One sets up the problem healthcare has (although healthcare is not explicitly mentioned), while the other illustrates it. They share being about how we view the future.

The two articles are Ezra Klein’s Can Democrats See What’s Coming? in The New York Times Opinion pages and Derek Thompson’s Why Does America Make It So Hard to Be a Doctor? in The Atlantic. Both are well worth a read.

Mr. Klein struck a nerve for me by asking why, when it comes to social insurance programs, Democrats seem so insistent on replicating what has been done before, especially in Western Europe. He asks: “But what about building here that which does not already exist there?” He worries “that the Biden administration’s supply-side agenda is stuck in the past and not yet imagining the future.”

Those are exactly the right questions we should be asking about healthcare.

Will Microbes Finally Force Modernization of the American Health Care System?

Feb 14, 2022

BY MIKE MAGEE

Science has a way of punishing humans for their arrogance.

In 1996, Dr. Michael Osterholm found himself rather lonely and isolated in medical research circles. This was the adrenaline-infused decade of blockbuster pharmaceuticals focused squarely on chronic debilitating diseases of aging.

And yet, there was Osterholm, in Congressional testimony delivering this message: “I am here to bring you the sobering and unfortunate news that our ability to detect and monitor infectious disease threats to health in this country is in serious jeopardy…For 12 of the States or territories, there is no one who is responsible for food or water-borne surveillance. You could sink the Titanic in their back yard and they would not know they had water.”

Osterholm’s choice of metaphor perhaps reflected his own frustration and inability to alter the course of the medical-industrial complex despite microbial icebergs directly ahead.