The Health Care Blog – Page 200 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Announcing Winners for the RWJF Innovation Challenges

Sep 25, 2019• 1

The Opportunity in Disruption, Part 3: The Shape of Things to Come

Sep 24, 2019

By JOE FLOWER

Picture, if you will, a healthcare sector that costs less, whose share of the national economy is more like it is in other advanced economies—let’s imagine 9% or 10% rather than 18% or 19%.

A big part of this drop is a vast reduction in overtreatment because non-fee-for-service payment systems are far less likely to pay for things that don’t help the patient. Another part of this drop is the greater efficiency of every procedure and process as providers get better at knowing their true costs and cutting out waste. The third major factor is that new payment systems and business models actually drive toward true value for the buyers and healthcare consumers. This includes giving a return on the investment for prevention, population health management, and building healthier communities. This incentive would reduce the large percentage of healthcare costs due to preventable and manageable diseases, trauma, and addictions.

Picture, if you will, a healthcare sector in which prices are real, known, and reliable. Price outliers that today may be two, three, five times the industry median have rapidly disappeared. Prices for comparable procedures have normalized in a narrower range well below today’s median prices. Most prices are bundled, a single price for an entire procedure or process, in ways that can be compared across the entire industry. Prices are guaranteed. There are no circumstances under which a healthcare provider can decide after the fact how much to charge, or a health insurer can decide after the fact that the procedure was not covered, or that the unconscious heart attack victim should have been taken to a different emergency department farther away.

Picture a well-informed, savvy healthcare consumer, with active support and incentives from their employers and payors, who is far more willing and eager to find out what their choices are and exercise that choice. They want the same level of service, quality, and financial choices they get from almost every other industry. And as their financial burden increases, so do their demands.

Picture a reversing of consolidation, ending a providers’ ability to demand full-network contracting with opaque price agreements—and encouraging new market entrants capable of facilitating a yeasty market for competition. Picture growing disintermediation and decentralization of healthcare, with buyers increasingly able to act like real customers, picking and choosing particular services based on price and quality.

Picture an industry whose processes are as revolutionized by new technologies as the news industry has been, or gaming, or energy. Picture a healthcare industry in which you simply cannot compete using yesterday’s technologies—not just clinical technologies but data, communications, and transaction technologies.

WTF are Digital Therapeutics? | Digital Therapeutics Alliance Executive Director, Megan Coder

Sep 24, 2019

By JESSICA DaMASSA, WTF HEALTH

Digital therapeutics has exploded as the new hot buzzword in digital health. But how are digital therapeutics different from digital health applications, applied health signals, or m-health technologies? The Digital Therapeutics Alliance was formed to answer that exact question. DTA Executive Director Megan Coder sets the record straight, hint: it involves software algorithms.

Filmed at JP Morgan Healthcare in San Francisco, CA, January 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.

How Are Hospitals Supposed to Reduce Readmissions? | Part I

Sep 24, 2019• 4

By KIP SULLIVAN

The notion that hospital readmission rates are a “quality” measure reached the status of conventional wisdom by the late 2000s. In their 2007 and 2008 reports to Congress, the Medicare Payment Advisory Commission (MedPAC) recommended that Congress authorize a program that would punish hospitals for “excess readmissions” of Medicare fee-for-service (FFS) enrollees. In 2010, Congress accepted MedPAC’s recommendation and, in Section 3025 of the Affordable Care Act (ACA) (p. 328), ordered the Centers for Medicare and Medicaid Services (CMS) to start the Hospital Readmissions Reduction Program (HRRP). Section 3025 instructed CMS to target heart failure (HF) and other diseases MedPAC listed in their 2007 report. [1] State Medicaid programs and the insurance industry followed suit.

Today, twelve years after MedPAC recommended the HRRP and seven years after CMS implemented it, it is still not clear how hospitals are supposed to reduce the readmissions targeted by the HRRP, which are all unplanned readmissions that follow discharges within 30 days of patients diagnosed with HF and five other conditions. It is not even clear that hospitals have reduced return visits to hospitals within 30 days of discharge. The ten highly respected organizations that participated in CMS’s first “accountable care organization” (ACO) demonstration, the Physician Group Practice (PGP) Demonstration (which ran from 2005 to 2010), were unable to reduce readmissions (see Table 9.3 p. 147 of the final evaluation) The research consistently shows, however, that at some point in the 2000s many hospitals began to cut 30-day readmissions of Medicare FFS patients. But research also suggests that this decline in readmissions was achieved in part by diverting patients to emergency rooms and observation units, and that the rising rate of ER visits and observation stays may be putting sicker patients at risk [2] Responses like this to incentives imposed by regulators, employers, etc. are often called “unintended consequences” and “gaming.”

To determine whether hospitals are gaming the HRRP, it would help to know, first of all, whether it’s possible for hospitals to reduce readmissions, as the HRRP defines them, without gaming. If there are few or no proven methods of reducing readmissions by improving quality of care (as opposed to gaming), it is reasonable to assume the HRRP has induced gaming. If, on the other hand, (a) proven interventions exist that reduce readmissions as the HRRP defines them, and (b) those interventions cost less than, or no more than, the savings hospitals would reap from the intervention (in the form of avoided penalties or shared savings), then we should expect much less gaming. (As long as risk-adjustment of readmission rates remains crude, we cannot expect gaming to disappear completely even if both conditions are met.)

Announcing GuideWell’s Caring for Caregivers Challenge

Sep 23, 2019

Consumerism is the answer to health care? Maybe not

Sep 21, 2019• 4

By MATTHEW HOLT

After 3 days at the Health 2.0 conference, everyone is agreed with Jane Sarasohn-Kahn that more consumer choice and better transparency and an “Amazon like shopping experience” would improve health care. In fact in her wonderful book, HealthConsuming, Jane talks a lot about the dark side of putting this much pressure on consumers, but I just had an experience that revealed what might go wrong. Bear with me, this does get back to health care…

The short answer is that BestBuy‘s home appliance service delivery and fulfillment seriously sucks. It has gone off the rails in a massively bad way. You’d think they’d have a multi-platform CRM that worked but it’s a disaster

The story. The washer in an apartment I used to live in but now rent out broke after 9 years–fair enough. And I spent a long time on a customer IM chat with Best Buy figuring out if there was an available washer that would stack under the still working dryer (which was stacked on top of it). But the answer was no.

So in the same IM chat the Best Buy agent suggests a replacement washer and dryer, and all the stuff required to put it in, and added installation and delivery. And he gets me a page where I can fill in my details, credit card and buy it all, then return to the chat to set a delivery date. Pretty snazzy BUT apparently the agent forgot to add removing the old ones to the order (even though most of the conversation was about the old ones!) Remember that for later…

Health in 2 Point 00, Episode 95 | Health 2.0 Wrap-Up Edition

Sep 20, 2019

Jess and I are at Health 2.0 for Episode 95 of Health in 2 Point 00! To wrap up the conference, Jess and I talk about Jonathan Bush’s reappearance in health care on the stage at Health 2.0, with Firefly Health, with echoes of this direction in primary care by Tony Miller on the insurance panel. We talk about all the winners at Health 2.0, including the RWJF Challenge winners, Ooney with Prehab Pal and Social AI Impact Lab, and Omny who won Launch. My favorites from the conference were Indu Subaiya’s Unacceptables panel with two amazing speakers, Melissa Hanna, CEO of Mahmee & Joia Crear Perry, Founder and President of the National Birth Equity Collaborative. Catch highlights from Jess’s panel on social movements in health care as well! —Matthew Holt

Health 2.0: Why I’m (Freaking) Excited…and a (Bit) Concerned

Sep 20, 2019

By DAVE LEVIN, MD

The 2019 Health 2.0 conference just wrapped up after several days of compelling presentations, panels, and networking. As in the past, attendees were a cross section of the industry: providers, payers, health IT (HIT) companies, investors, and others who are passionate about innovation in healthcare.

Tech-enabled Services

One of the more refreshing themes of the conference was an emphasis on how health IT can enable the delivery of services. This is a welcome perspective as too often organizations believe that simply deploying technology will solve their problems. In my 30+ years in healthcare, I’ve never seen that work. What does work is careful attention to the iron triad of people, process, and technology. Neglect one of these and you will fall short of your goals. Framing opportunities as services that are enabled and enhanced by technology helps us avoid the common pitfall of believing “Tech = Solution” and forces us to account for process and people.

Provider Burn-out and Health IT

Several sessions focused on the impact technology is having on end-users, especially clinicians. One session featured a “reverse-pitch” where practicing physicians “pitched” to health IT experts on the challenges they face, especially with EHRs, and what they need in order to do their job and have a life. This was summed up elegantly by a physician participant as, “Please make all the stupid sh*t stop!” There’s increasing evidence that the deployment of EHRs is a major factor for clinician burnout and the impassioned pleas of the attendees resonated throughout the conference.

Other sessions explored how to we might address these problems with improvements in user-interface design, workflow, and interoperability. Demonstrations of advanced technologies like voice-driven interfaces, artificial intelligence, enhanced communications, and smart devices show where we are headed and hold out the promise of a more efficient and pleasing HIT for providers and patients.

We Can Stop America’s Surge in Opioid-Dependent Babies

Sep 18, 2019

By STUART H. SMITH

Imagine a massive public health crisis in the United States that affects tens of thousands of people. Now imagine that the government had a simple tool at its disposal that could prevent this kind of physical and psychological trauma. You might think that I’m writing about America’s deadly outbreak of gun violence, which has made headlines this summer from Dayton to El Paso.

But actually I’m talking about a different crisis that affects even more people – all of them children — and which could be sharply reduced with one simple step that lacks the bitter political animus of the gun debate. The issue at hand involves babies born to mothers who used opioids during pregnancy – babies who tend to develop a condition called Neonatal Abstinence Syndrome, or NAS.

Experts say that state and federal governments have grossly underestimated the number of NAS babies currently born in the United States, as the addiction crisis triggered by Big Pharma’s greed in pushing painkillers refuses to fade. They say an accurate accounting would find a minimum of 250,000 children — and possibly two or three times that every year born with NAS. These kids will face chronic symptoms such as trembling and seizures, gastrointestinal problems, and an inability to sleep. Their numbers are more than eight times higher than the last official estimate from the government.

For more than a year now, I’ve been working with a team of attorneyscalled the Opioid Justice Team who are fighting for any settlement of the massive court fight pitting more than 2,000 localities against Big Pharma to include a medical monitoring fund for the estimated hundreds of thousands of kids born with NAS syndrome. But our team has also been pushing for radical measures that would prevent many of these unfortunate cases.