Category: Uncategorized

Like Air Traffic Control For Healthcare

Jan 2, 2015• 1

By THCBist

In December THCB asked insiders and pundits across health care to give us their armchair quarterback predictions for 2015. What tectonic trends do they see looming on the horizon? What’s overrated? What nasty little surprises do they see lying in wait? What will we all be talking about this time next year? Over the next week, we’ll be featuring their responses in a series of quick takes.

Jacob Reider MD, Former Deputy National Coordinator, HHS

As care providers increasingly embrace shared risk payment models, we will see a rapid growth of interest in care coordination and health IT tools that support shared decisions.

a) Care Coordination. While this remains a bit of a buzz word, the need for a toolset that helps a community of clinicians care for a group of people in a coordinated manner is obvious to anyone who has been on either end of the stethoscope. The current health IT tools and processes weren’t developed for this purpose – and therefore do a terrible job of it. 2015 will see the emergence of technology and services that help teams identify and maintain individual patient goals, optimal pathways toward those goals, and then manage the participants toward shared success. Think of this as “air-traffic control” for health care. If we know where we’re going. This toolset (and the humans who use it) can help make sure everyone arrives safely.

b) Do we know where we’re going? Have we made the right diagnosis? If so – do we have the right treatment plan? Clinical decisions need to be shared between care providers, patients, family members and other participants. 2015 will see the next step in the evolution of traditional provider-focused clinical decision support (CDS) tools toward tools that also offer research-based personalized care guidance. This patient’s unique needs can be defined, understood by all parties, and then acted upon. If care coordination is air-traffic control, perhaps this personalized decision support will be the Waze for health care. Like Waze, this will take years to reach the mainstream, but when it does, none of us will leave home without it.

2015: The Year Well-Designed Interfaces Will Transform Health IT?

Jan 2, 2015• 10

By THCBist

What else could lie in store? We talked with Nuance’s Nick Van Terheyden, who remains optimistic.

Nick van Terheyden, MD, CMIO, Nuance Communications

2015 will be the year well-designed interfaces will transform health IT legacy systems into sleeker, more intuitive, and cost-effective technology.

We know that good usability works hand-in-hand with accessibility to remove the burden from the end user, allowing her to focus on more important tasks— and nowhere is this more important than in healthcare. In the coming year, we will see a major uptick in the availability of secure health IT access on mobile devices that better support physicians in their natural, fast-paced environment, whether it is through clinical speech recognition technology, gestures, or touch. Physicians are consumers, too, and want and need the convenience of anywhere, anytime access to information.

We will also start to see the breakdown of silos in patient and physician technologies. The devices we rely on to track our vitals and help us stay active will begin to integrate in meaningful ways with clinical data, providing us with more awareness about our health and supplying our physicians with useful information about our health trends. Wearables will become a staple, leading to a healthier population and reducing overall healthcare costs. After all, what good is having a smart watch track all this data if it can’t help keep you healthier?

It’s Official: Aledade ACOs Up and Running

Jan 2, 2015• 1

By FARZAD MOSTASHARI, MD

We launched Aledade on June 18th, and by the end of July we had recruited 80 primary care physicians in 4 states to join us in creating the very first Aledade ACOs. We have been work together ever since- but haven’t been able to talk about our wonderful practices until the official notification from CMS that came today.

We are thrilled to announce that beginning January 1, our two newAledade ACOs will be taking accountability for the care of over 20,000 attributed Medicare patients, and stewardship of nearly a quarter of a billion dollars of health care expenditures each year. We’re building a new delivery system on the foundation of trust between patients and the physicians who have been caring for them in their communities for decades, and enabled and accelerated with cutting-edge technology and analytics.

One ACO will operate in the state of Delaware, in close collaboration with our physician partners and our field team, Quality Insights of Delaware. Our second ACO, the Primary Care ACO, will take the same model spanning three states — New York, Maryland, and Arkansas, where we are also working with local partners like the Arkansas Foundation for Medical Care. Our hand-picked ACOs physician partners are some of the most capable and inspiring primary care physicians in the country. They are leaders in their local, state and national physician associations; they are pioneers of Meaningful Use and Patient Centered Medical Homes; they are much-decorated top doctors in quality; but most of all, they are the pillars of their communities.Continue reading…

Revolutionizing Retail and Health – Walmart drives care into new settings

Jan 2, 2015• 9

BY MATTHEW HOLT

One cannot discuss consumer health without addressing the drastically changing environment of care. At Health 2.0 WinterTech: The New Consumer Health Landscape speakers from Walmart, Target, and Optum will join Matthew Holt to dive into how major retailers are disrupting the way millions of Americans not only access acute care services but also purchase prescriptions, access preventive health services, and more. Ben Wanamaker, Senior Manager of Strategy and Operations at Walmart sat down with Matthew last week to shed light on what 2015 will bring for Walmart’s Care Clinics.

Competing With Urgent Care

Jan 2, 2015• 11

By MARC-DAVID MUNK, MD

About seven years ago, the California Healthcare Roundtable and HealthAffairs sat down to prepare a white paper on the emerging “phenomenon” of urgent care centers, and what it might mean for primary care. At the time the group couldn’t agree that urgent care was a “disruptive” innovation, but it seemed clear to all participants that it represented a threat to primary care: The rise of UC, the group noted, would lead to 1) less preventive care and 2) concentrate acuity in primary care clinics. They wrote: “[Urgent care] means fewer patients per day, a higher intensity environment for providers, and potentially lower reimbursement.”

In particular, the group couldn’t understand if patients were choosing to leave primary care because they didn’t value having a PCP, or if they were settling for the inherent limitations of UC because cost and convenience outweighed its disadvantages.

Seventy-five percent [of UC customers] are women ages 28 to 42 and their children. Some hypothesize that this consumer group thinks of its health care relationships differently than do people of the baby boomer generation and older. The younger cohort often has no “medical home,” while baby boomers and older people tend to view the primary care physician as the center of their medical care. Discussants concurred that what the data do not reveal, however, is whether the medical “homelessness” of this younger group and its high relative use of retail clinics reflect how these consumers want to receive their care or is instead merely their experience (or is a function of the fact that they have fewer chronic conditions and thus need less care and care coordination).

Since the roundtable in 2007, there has been a flood of urgent care centers with ongoing rapid growth. The American Academy of Urgent Care estimates that there are around 9300 UCs nationally. Across the country, clinics are sprouting like flowers, sometimes fueled by private equity investors, but often by hospitals and health systems who are reflexively installing UCs in repurposed strip malls, sometimes without a clear strategy other than “keeping market share” in an otherwise low margin business.

The reasons for growth, according to the American Academy of Urgent Care? Primarily extended hours (as compared to primary care) and better wait times and lower prices than the ED.

As the private-equity fueled urgent care bubble expands, here’s my prediction on how this all plays out: Don’t bet the farm on UCs being the final answer to the consumer’s search for value. For all of UC’s utility, it’s also possible that urgent care may just get out- maneuvered by the next generation of primary care.

Will the Real Professor Katherine Baicker Please Stand Up?

Dec 31, 2014• 16

By AL LEWIS and VIK KHANNA

Harvard Professor Katherine Baicker is arguably most acclaimed health policy researcher at arguably the most acclaimed (and not even arguably, the best-endowed) school of public health in the country. Her seminal account of the effect of Medicaid coverage on utilization and health status is a classic. As luck would have it, in 2008 Oregon used a lottery to ration available Medicaid slots. A lottery controls for motivation and as such eliminates participant-non-participant bias, since everyone who enters the lottery wants to participate. That meant only one major variable was in play, which was enrollment in Medicaid or not.

Chance favors the well-prepared, and Professor Baicker jumped on this research windfall. She found that providing Medicaid–and thereby facilitating access to basic preventive medical care–for the previously uninsured did not improve physical health status, but did increase diagnoses and utilization. Because of the soundness of the methodology, the conclusion were unassailable – more access to medical care does not improve outcomes or optimize utilization, which is a proxy for spending. (We ourselves reached a similar conclusion based on a similar analysis on North Carolina Medicaid’s medical home model.)

Yet Professor Baicker herself used exactly the opposite methodology to reach the exact opposite conclusion for workplace wellness. And that’s where the identity crisis begins.

She and two colleagues published a meta-analysis in 2010 of participant-vs-non-participant workplace wellness programs. Somehow—despite her affinity for Oregon’s lottery control—she found this opposite methodology to be acceptable. She concluded that workplace wellness generated a very specific two significant-digit 3.27-to-1 ROI from health care claims reduction alone, with another 2.37-to-1 from absenteeism reduction. The title of the article–now celebrating its fifth anniversary as the only work by a well-credentialed author in a prestigious journal ever published in support of wellness ROI—was equally unambiguous: Workplace Wellness Can Generate Savings.

Matthew’s end of 2014 charity & issues letter

Dec 31, 2014• 2

By MATTHEW HOLT

I’ve been posting my personal end of year email on THCB for a few years now–here’s 2014’s edition–Matthew Holt

Dec 31 2014: Last year I claimed laziness and failed to write or send out my End of Year Issues email for the first time since I started in 2000. Perhaps it was the stress of being 50, or the fact that despite having 15,000 of my closest friends follow me on Twitter I cant seem to reach people on email, or people miss my Facebook posts. But this year I’ve been guilted back into it by altogether too many people asking me where it was?!

If you don’t know, this is a letter I write mostly to myself about what happened in the year and what I should do about it–mostly in terms of making donations while it’s still 2014. Obviously a few of you like reading it and hopefully one or two of them that does will put their hand into their pocket (or click on the link and use their Paypal account or whatever the electronic equivalent is). And if you don’t like it, well feel free to hit delete, or go onto the next picture of a cat being cute…and I love comments on the blogs/Facebook/Twitter or by email.

Rethinking The Gruber Controversy: Americans Aren’t Stupid, But They’re Often Ignorant — And Why

Dec 30, 2014• 31

By UWE REINHARDT

M.I.T. economist Jonathan Gruber, whom his colleagues in the profession hold in very high esteem for his prowess in economic analysis, recently appeared before the House Committee on Oversight and Government Reform. Gruber was called to explain several caustic remarks he had offered on tortured language and provisions in the Affordable Care Act (the ACA) that allegedly were designed to fool American voters into accepting the ACA.

Many of these linguistic contortions, however, were designed not so much to fool voters, but to force the Congressional Budget Office into scoring taxes as something else. But Gruber did call the American public “stupid” enough to be misled by such linguistic tricks and by other measures in the ACA — for example, taxing health insurers knowing full well that insurers would pass the tax on to the insured.

During the hearing, Gruber apologized profusely and on multiple occasions for his remarks. Although at least some economists apparently see no warrant for such an apology, I believe it was appropriate, as in hindsight Gruber does as well. “Stupid” is entirely the wrong word in this context; Gruber should have said “ignorant” instead.Continue reading…

2014 A Healthcare Odyssey

Dec 30, 2014• 13

By SAURABH JHA, MD

It might have been the best of times. It could have been the worst of times. But 2014 turned out to be the most mediocre of times. Here’s a recap.

Why did Sebelius resign?

Never make a promise to your kids that you can’t keep. And never project the number of people who will sign up for the exchanges and change your mind, unless you are the CBO. If you have read about the problem of uninsured in the US you might have considered CBO’s original projection that seven million people will sign up on the exchanges within six months of open enrollment a tad conservative. Weren’t there millions and millions, forty million apparently, gagging for healthcare coverage?

The CBO revised the projection to six million in February with the projection date of March 31^st coming tantalizingly close. Towards the end of March you could hear the cheers of “roll baby, enroll” getting louder.

On April Fools’ Day, the ACA remained intact, the country had not descended in to civil war and some eight million had signed up for Obamacare.

Sit. Stand. Stay. Good worker.

Dec 30, 2014• 5

By VIK KHANNA

Example A: The Fitbro

Businesswoman Nilofer Merchant wrote an essay for the Harvard Business Review Blog, which has gone on to become one of the most read posts on the HBR site this year, in which she parrots the convention that sitting too much is killing us, going so far as to equate sitting with smoking. Runner’s World has inexplicably also trod this path, which will not lead us to the land of data, logic, or even common sense.

Capricious furniture vendors, imitating their wellness brethren, have grabbed the theme even though it is demonstrably untrue. Take, for example, Varidesk, which uses this YouTube video to sells its signature product, a desk that adjusts vertically. The theoretical claim, supported by nary a data point, is that workers should stand rather than sit.

On their website, the Varidesk folks also make this claim: “The VARIDESK was developed to address the negative side-effects of being seated for the majority of the working day.”Continue reading…