(This is the fourth in a series of excerpts from Terry’s new book, Physician-Led Healthcare Reform: a New Approach to Medicare for All, published by the American Association for Physician Leadership.)
Many other countries’ healthcare systems outperform ours for one simple reason: They place a much greater emphasis on primary care, which occupies the central place in their systems. “The evidence is that where you have more primary care physicians, where you coordinate care, and where you pay to keep people healthy, you get better outcomes at lower cost,” says David Nash, MD, founding dean of the College of Population Health, part of Thomas Jefferson University in Philadelphia.
The evidence that Nash mentions includes studies by Barbara Starfield and her colleagues at Johns Hopkins University. In a 2005 Health Affairs paper, they showed that a higher ratio of primary care physicians to the population is associated with a lower mortality rate from all causes and from heart disease and cancer; in contrast, having more specialists in a particular area does not decrease the overall mortality rate or deaths from cancer and heart disease.
Another study of Medicare data found that states where a higher percentage of physicians were PCPs had higher quality care and lower cost per beneficiary. This factor alone accounted for nearly half of the variation in Medicare spending from one state to another. A separate study found that in the areas of the country that had the most primary care providers, the average Medicare cost per beneficiary was a third lower than in areas with the least PCPs.
One reason for this is that primary care doctors provide comprehensive, continuous care, including preventive and routine chronic care. Chronic illnesses drive 90% of health costs, and some studies show that intensive primary care can reduce ER visits and hospital admissions and improve the health of chronically ill people.
The New York Times had an article that surprised me: Current Job: Award Winning Chef. Education: IHOP.The article, by food writer Priya Krishna, profiled how many high-end chefs credit their training in — gasp! — chain restaurants, such as IHOP, as being invaluable for their success.
Ms. Krishna mentions several well-known chefs “who prize the lessons
they learned — many as teenagers — in the scaled-up, streamlined world of chain
restaurants.” In addition to IHOP, chefs mentioned experiences at
chains such as Applebee’s, California Pizza Kitchen, Chipotle, Hillstone,
Houston’s, Howard Johnson’s, Olive Garden, Panda Express, Pappas, Red Lobster,
Waffle House, and Wendy’s.
Some of the lessons learned are
instructive. “It was pretty much that the customer is always
right,” one chef mentioned. Another said she learned “how to be
quick, have a good memory, and know the timing of everything.” A
third spoke to the focus that was drilled into all employees: “Hot food
hot. Cold food cold. Money to the bank. Clean restrooms,”
There I was, my 10th-grade science fair. My mother made
sure I had a tie that fit properly and a shirt that was perfectly pressed. I stood among my peers
with our cardboard presentation displays highlighting what we did to make it to
this point. I was a little nervous but also extremely proud of myself and
excited to see the looks on the judge’s faces when they saw what my project was
of Enzymes on DNA”
Boom. Oh, I wasn’t doing something that many people had seen
already — I was working inside an NIH facility with a brilliant scientist
mentor/coach, to get this done. The memories of taking multiple modes of
transportation after school throughout the week for what seemed like forever
wore me down enough to make sure that I knew this was going to be worth it. And
then after the judges were introduced to all of our concepts and families
poured throughout the gymnasium to see what we all came up with — now was the
moment of truth.
Sweaty palms and teenage anxiety wouldn’t deter me. First place goes to….oh ok, yeah of
course, they deserved that. They worked really hard I’m sure. Second place goes to….oh wow, I didn’t make
second place? At least, I’ll get something. After a third place winner was
announced and the applause faded. I looked, stunned, over at my mother in the
audience whose face was covered in tears. I was ready for the night to be over.
Did I not wear the right tie? Did I seem
too confident? Not confident enough? The questions would consume me until
later that evening when my science teacher told me that the judges thought I cheated or didn’t actually do any
of the work.
Medical Alley has been bringing together Minnesota’s biggest healthcare players for 35 years, leading collaborative conversations that include the largest health insurance company in the US, United Healthcare, and leading care innovators like Mayo Clinic and Medtronic. So what’s the word on the street…er, alley? Shaye Mandle, President & CEO of Medical Alley, dishes on the neighborhood gossip: the challenge of defining the cost of care delivery, who’s leading the conversation on innovation, and which neighbors are missed at this Minnesota party (looking at you Target and Best Buy — come on over!)
Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando, Florida, February 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
On Oct 19, I will begin to MC the health equity hackathon in Austin TX, which will focus on addressing healthcare disparity issues. Specifically, we will be using healthcare data to try and make an impact on those problems. Our planning team has spent months thinking about how to run a hackathon fairly, especially after the release of a report that harshly criticized how hackathons are typically run.
They argue that hackathons have become a way for corporations to trick legions of technologists into working for free. To a sociologist, that looks like exploitation, and it is hard to see how they are wrong.
After reading the article, I was struck by how many things about typical hackathons are backward:
Hackathons romanticize workaholism and celebrate insomnia – With hackathons typically running 24-72 hours straight, sleep is for the weak. Those who don’t sleep are seen as heroes.
Junk food is the only option – Most hackathons provide unhealthy snacks, high in fructose and low in protein. Participants are expected to fuel their unpaid work sprints with sugar and caffeine. These are frequently the only eating options available.
Healthy work patterns ensure that there are breaks. Opportunities to chat, or walk and take a break from work. And the idea of encouraging people to get up and move, let alone stretch, is unheard of at these hackathons. Hundreds of geeks, unable to shower, or leave the room, can create a pretty bad smell.
Judging is at best arbitrary, and in some cases completely rigged, with winners sometimes chosen in advance.
On occasion, I have seen harder stimulants used. Although I have never seen anyone on cocaine win, it does make for super-engaging project presentations. The presentations were not good, mind you, just engaging… In the “Holy Moses, this guy is about to present when he is clearly high AF” sense.
You’ve probably heard of Bitcoin, but we doubt you’ve heard of Dentacoin, MedTokens, or Curecoin.
These are healthcare specific cryptocurrencies born from Initial Coin Offerings or ICOs. In this article, we’ll briefly recap the trend of ICOs (aka token offerings) and provide you with a summary financial analysis of how this trend has played out among 138 healthcare ICOs. The results to-date are enlightening, but disappointing. We believe there’s still potential for some projects to be successful.
What’s an ICO? Here’s a quick take from Wikipedia and we’ll point you to an Appendix that will guide you to additional resources:
An ICO is a type of funding using cryptocurrencies…In an ICO, a quantity of cryptocurrency is sold in the form of “tokens” (“coins”) to speculators or investors, in exchange for legal tender or other cryptocurrencies. The tokens sold are promoted as future functional units of currency if or when the ICO’s funding goal is met and the project launches.
Autonomous Research found that ICOs raised over $7 billion in 2017 and are slated to raise $12 billion in 2018, with some mega projects raising billions of dollars each.
An Irish software expert who’d been helping companies sell on eBay walks into a room with a Slovenian inventor who’d built a world-class company in the “accelerator beam diagnostics market.” (Don’t ask.) What they share is not just foreign birth, but “immigration” to health care from other fields. Both have come to the MedCity Invest conference in Chicago seeking funding for start-ups focused on patient engagement. They’re not alone in their “immigrant” status, and their experience holds some important lessons.
Eamonn Costello, chief executive officer of patientMpower, works out of a rehabbed brick building in Dublin next to the famed Guinness brewery at St. James Gate. An electronic engineer who’s worked at companies like Tellabs, Costello became interested in healthcare in 2012 when his father was in and out of the hospital with pancreatic cancer. What struck him was the lack of any monitoring on how patients fared between doctor appointments or hospitalizations.
When in 2014 a friend working in healthcare approached him, they looked at building an app for different illnesses.Continue reading…
The US Federal Communication Commission’s reversal of Obama-era net neutrality regulations sets the stage for broadband internet service providers (ISPs) to slow or block certain content from reaching their customer’s screens. This is likely to have a significant and potentially negative impact on a healthcare system poised to go fully virtual in the coming years.
Healthcare consumers already depend heavily on internet search results for advice when making healthcare purchases. Coupling preferred content with existing search engine optimization strategies will undoubtably steer consumer behavior. What will be the result? The American healthcare market is unique, both in its expense (higher than any other nation), and its shocking lack of value. Some of this is due to misinformed consumers swayed by direct-to-consumer marketing. Arguably, repealing net neutrality may amplify the problem.
Even more troubling is the prospect of an ISP partnering with a health delivery system. Telehealth – the use of electronic communication technology for healthcare delivery – will become standard of care in the coming years. National telehealth have already managed to get a foothold in today’s highly competitive healthcare market, supplying a disruptive and potentially cost-containing force in the healthcare market. With the elimination of net neutrality, larger, more well-established healthcare delivery systems, seeking to defend or expand their marketshare, can now partner with ISPs to preserve internet “fast lanes” for realtime video doctor’s visits. Smaller, possibly disruptive companies, unable to make these same financial commitment to ISPs, may be marginalized or lost.
On June 14, 2016 a Federal Court ruled that broadband internet is as essential to American as phones, electricity, water and sewer systems and should be available to all Americans as a utility, rather than a luxury that doesn’t need close government supervision.
In the United States, public utilities are often natural monopolies because the infrastructure required producing and delivering a product such as electricity or water is very expensive to build and maintain. As a result, they are often government monopolies, or if privately owned, the sectors are specially regulated by a public utilities commission which severely limits the profits for the private utility company and the associated costs passed on to consumers of that utility.
There is nothing more essential to the lives and well being of Americans than health insurance and therefore healthcare is the ultimate utility.
A recent contributor to this blog wondered about the correctness of “health care” versus “healthcare.” I’d like to answer that question by channeling my inner William Safire (the late, great New York Times language maven). If you’ll stick with me, I’ll also disclose why the Centers for Medicare & Medicaid Services is not abbreviated as CMMS and reveal something you may not have known about God – linguistically, if not theologically.
The two-word rule for “health care” is followed by major news organizations (New York Times, Washington Post, Wall Street Journal) and medical journals (New England Journal of Medicine, JAMA, Annals of Internal Medicine). Their decision seems consistent with the way most references to the word “care” are handled.
Even the editorial writers of Modern Healthcare magazine do not inveigh against errors in medical care driving up costs in acutecare hospitals and nursinghomes. They write about “medical care,” “acute care” and “nursing homes,” separating the adjectives from the nouns they modify. Some in the general media go even farther, applying the traditional rule of hyphenating adjectival phrases; hence, “health-care reform,” just as you’d write “general-interest magazine” or “old-fashioned editor.”