After years interviewing people at HIMSS, I got interviewed by a patient (as in putting up with me, not sick!) Fred Goldstein. My pearls of wisdom include the history of EMRs, eHealth, and how much money HIMSS makes by not buying food! Thanks to Greg Masters of Health Innovation Media for this and all he does!–Matthew Holt
LIVE from @HiMSS 2016 | Meet Matt Holt @boltyboy Co-chair @Health2con from Health Innovation Media on Vimeo.
That we are experiencing a “consumer revolution” in healthcare is a durable meme in the media and in policy circles just now. When you hear the word “consumer”, it conjures images of someone with a cart and a credit card happily weaving their way through Best Buy. It is, however, a less than useful way of thinking about the patient’s experience in the health system.
A persistent critique of our country’s high cost health system is that because patients are insulated from the cost of care by health insurance, they freely “consume” it without regard to its value, and are absolved of the need to manage their own health. In effect, this view ascribes our very high health costs to moral failure on the part of patients.
Market-oriented policy advocates believe that if we “empower”patients as consumers by asking them to pay more of the bill, market forces will help us tame the ever rising cost of care. If patients have “skin in the game” when they use the health system and also “transparency” of health providers’ prices and performance, patients can deploy their own dollars more sensibly.
This concept played a major role in the otherwise “progressive” Affordable Care Act. The 13 million people who signed up for coverage this year through the Affordable Care Act’s Health Exchanges opted overwhelmingly for subsidized policies with very high deductibles and out-of-pocket cost limits. The “skin in the game” argument has also heavily influenced corporate health benefits decisions. More than 30 million workers and their families receive high deductible plans through employers.
For decades and decades we have been counting the number of doctors in America. For decades and decades we have been coming up short compared to other developed nations, and some less developed ones as well. A poorly educated person may be tempted to suggest that we should “make” more doctors. After all, there is hardly a shortage of young people willing and able to undergo the rigors of a medical education. But luckily we are not poorly educated, so we devised much smarter solutions.
It was Boxing Day weekend. The consultant surgeon summoned the on-call team. “We face a calamity,” he said. The house officer had called in sick. The locum wasn’t going to arrive for another 12 hours. This meant that I, the senior house officer, would have to be the house officer. The registrar would take my place. The consultant, looking tense, would have to be the registrar—i.e. a junior doctor again.
“Junior doctor” is a misnomer because it implies a master and an apprentice. Running the National Health Service (NHS) are apprentices who become Jedis very quickly, and without a Ben Kenobi showing them the ropes.
I’ll never forget my first night on-call in the emergency room (ER). I was one of two junior doctors managing a busy inner city ER in London from midnight to 8 am. Just a year earlier, I was an errant medical student bunking lectures. Now I had to see people with heart attacks, strokes, and broken bones. Seeing the terror on my face, the senior nurse reassured me. “Just look as if you know what you’re doing. We’ll handle the rest.”
Several years ago both Microsoft and Google invested millions of dollars on a flawed assumption: If they built a useful and free healthcare application, people would flock to it. In both cases, the effort failed. At its peak Microsoft HealthVault was only able to enroll a few thousand—largely inactive—users. Google Health was discontinued after a few years.
The problem was (and is) that unlike almost any other business, healthcare is a negative good.
Even if it’s “free,” as was the case with both the Microsoft and Google offerings, most people find tracking their health to be, in some sense, an admission of frailty, imperfection and mortality. Except for occasional blips related more to vanity (weight loss is the prime example), when it comes to our health most of us are in denial. So when people talk about technology for patient engagement, I tend to pause and wonder: Should we be building apps and services just for patients, or for the people who care about them too?
In my last blog I riffed on prospect theory and how it applies to health care data sharing. In essence, prospect theory suggests two categories:
1. People are extremely unwilling to accept risk when the consequences are unknown (patients avoid sharing data if they don’t know how it will benefit or harm them)
2. People are more willing to accept the risk when the reward is achievable, and the alternative is very harmful (patients with severe illnesses would readily share data when there is a possibility it could save their life or eliminate significant suffering)
Scenario 1, risk adversion, is more common across all constituents including providers, healthy patients and families, political leaders and philanthropists. Generally, the benefits of sharing health care data are foggy and unclear, while the alternatives to keeping the data private are not life threatening.
As you think about claims data, the information is capturing the services provided to a patient by a healthcare provider for preventive care or for the diagnosis or the treatment of a condition.
This information can be grouped by different cohorts—those getting preventive exams, those examining categories of care, or those that seeing specific physicians and/or hospitals for conditions. These data, for example, can be grouped by diagnoses, called a diagnosis related group, involving a hospital stay.
However, all claims data is just a collection of medical bills. Medical bills do not contain a complete look at the patient, such as important information as a patient’s prognosis. That’s a gap. Thus, it is important to set appropriate expectations on the use of the data.
Donald Trump recently released a healthcare reform plan. If only he had spent as much time crafting it as he does his hair.
The GOP frontrunner is right that Obamacare has failed to fix what ails America’s healthcare system. As Trump put it, the Affordable Care Act has “tragically but predictably resulted in runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.” He famously said that he wants to “repeal and replace with something terrific.”
But “terrific” his plan is not.
Take, for instance, his proposal to legalize the importation of “safe and dependable [prescription] drugs from overseas.”
Importing cheaper drugs from other countries may seem like a great way to reduce the cost of medicine for Americans. But there are important reasons why it’s currently prohibited.
For most Americans, $280,000 might represent the price of a home or perhaps their entire retirement savings. But for the 1.3 million people in this country stricken by rheumatoid arthritis (RA)that quarter million dollars could be their drug bill.
Rheumatoid arthritis is a debilitating disease that causes painful inflammation and swelling of the joints. Left untreated, it can lead to permanent disability. Thankfully medications such as Enbrel, Humira and Zeljanzcan keep patients healthy enough to stay active and keep working. Yet the price tag is quickly becoming out of reach.
One recent report from Express Scripts found that spending on drugs that treat inflammatory conditions such as arthritis rose 25 percent in the last year alone. The annual cost of treating the nation’s RA sufferers is expected to reach $9.3 billion by 2020 – a 45 percent jump from 2013.
For a 45-year-old patient recently diagnosed with RA, the lifetime cost of medication is likely to exceed $1.4 million. Even if that person has 80 percent of their costs covered through insurance, the math works out to $280,000 in copays alone.
There’s something out of kilter when families may be forced to choose between investing in a home or easing a loved one’s pain. Yet that is exactly the sort of Catch-22 some will face if we do not find a sensible way to price drugs.
When I started medical school, my South Asian immigrant parents quietly hoped I would find my way to cardiology or another glamorous specialty. Instead, I spent a decade — first as a medical student, then as an intern and resident in internal medicine — focused on advancing the right to health among poor people and others with little access to quality health care.
Through high-impact nonprofit organizations, political campaigns, and grassroots organizing in urban communities and among health professionals, I was part of an incredible community focused on making American medicine better, safer, and affordable to all.
So when it came time for me to find a “real job” after my residency, I assumed it would be in a nonprofit organization with a laser-like focus on transforming underserved health. Imagine my astonishment, then, to discover my life’s work in Iora Health — a private sector, venture-backed, for-profit primary care startup.
Profit and medicine
Critics have said that for-profit medicine makes money by finding ways to avoid caring for sick people “in their time of greatest need.” It’s also been pointed out that the Hippocratic oath doesn’t mention “money, financing, or making a profit.”
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