The Health Care Blog – Page 389 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

A Blue Jumps the Wellness Shark

Nov 21, 2015• 4

By AL LEWIS

I know it’s not always about me (my ex-wife was quite clear on that point), but I was deeply saddened to see one of the Blues – specifically, Blue Cross of Tennessee — descending into the fabricated-wellness-outcomes abyss.

By way of background, regular readers of this irregular column and/or www.theysaidwhat.net have seen multitudinous examples of vendors telling lies that any fifth-grader could see through. Perhaps the best two examples on this site are Staywell and Mercer reporting mathematically impossible savings for British Petroleum and Health Fitness Corporation admitting they lied about saving the lives of cancer victims in Nebraska.Continue reading…

The Limitations of Healthcare Science

Nov 21, 2015• 2

By SIDNEY LE

Every once in awhile on the wards, one of the attending physicians will approach me and ask me to perform a literature review on a particular clinical question. It might be a question like “What does the evidence say about how long should Bactrim should be given for a UTI?” or “Which is more effective in the management of atrial fibrillation, rate control or rhythm control?” A chill usually runs down my spine, like that feeling one gets when a cop siren wails from behind while one is driving. But thankfully, summarizing what we know about a subject is actually a pretty formulaic exercise, involving a PubMed search followed by an evaluation of the various studies with consideration for generalizability, bias, and confounding.

A more interesting question, in my opinion, is to ask why we do not know what we do not know. To delve into is a question requires some understanding of how research is conducted, and it has implications for how clinicians make decisions with their patients. Below, I hope to provide some insights into the ways in which clinical research is limited. In doing so, I hope to illustrate why some topics we know less about, and why some questions are perhaps even unknowable.Continue reading…

Academic Tossers

Nov 21, 2015• 7

By SAURABH JHA, MD

When John Milton (Al Pacino) chuckled in the Devil’s Advocate “vanity, definitely my favorite sin,” he may have been referring to academics, not attorneys.

In academia skins are thin, hairs are split, emails are long, humor is self-congratulatory, and everyone cites themselves thinking that they’re Shakespeare. In the land of geniuses pettiness lies next to godliness. Wallace Sayre, a political scientist, once said that academic politics is vicious because the stakes are so low.

The iconoclast, Nassim Taleb, reserves special derision for academics. He took Steven Pinker to task for claiming that violence has progressively declined because of a decline in religion. According to Taleb, Pinker was ignoring fat tails – or the long lull before the storm. Pinker responded by saying that Taleb was being fooled by belligerence.

UnitedHealth Threatens to Pull the Plug. Why? The Obamacare Business Model Does Not Work

Nov 19, 2015• 9

By ROBERT LASZEWSKI

It’s official. The Obamacare insurance company business model does not work.

UnitedHealth Group just announced they expect to lose $450 million in the Obamacare exchanges and are seriously considering withdrawing from the program in the coming year.

This morning, the Wall Street Journal reported just about everybody else is losing their shirts in Obamacare as well:

Several other big publicly traded insurers also flagged problems with their exchange business in their third-quarter earnings Anthem Inc. said enrollment is less than expected, though it is making a profit Aetna Inc. said it expects to lose money on its exchange business this year, but hopes to improve the result in 2016. Humana Inc. and Cigna Corp. also flagged challenges…

There are signs that broad pattern has continued–and in some cases worsened–this year. A Goldman Sachs Group Inc. analysis of state filings for 30 not-for-profit Blue Cross and Blue Shield insurers found that their overall company wide results were “barely break-even” for the first half of 2015.

Three Rules For a Healthy mHealth App

Nov 19, 2015• 1

By JAAN SIDOROV, MD

According to this Wall Street Journal article, the prospect that “your doctor may soon prescribe you a smartphone app” is ushering in a new era of m-healthiness.

e-Researchers from marquee academic institutions are assessing the impact of handheld apps on medication use, symptom management, risk reduction and provider-patient communication. There’s not only an technology platform but an accompanying library of tailored e-prompts, e-reminders, e-pop-ups, e-recommendations, e-messaging, e-images and e-videos.

In other words, mix one part app with one part patient and bake until quality goes up and costs go down.

Yes, People Shop for Health care. But are they Good at it?

Nov 19, 2015• 16

By JEANNE PINDER

We used to hear “no one shops for health care.” But we know that not to be true;here’s a blog post I wrote about how people are doing just that.

So, now that we know they do shop, do they do it well? That’s a good question too.

A recent study from some Berkeley economists found that people on high deductible plans don’t shop well. Sarah Kliff, writing about it in Vox, says the study “shows that when faced with a higher deductible, patients did not price shop for a better deal. Instead, both healthy and sick patients simply used way less health care.”

I read the paper, by Zarek C. Brot-Goldberg, Amitabh Chandra, Benjamin R. Handel and Jonathan T. Kolstad, and had some questions and thoughts: First, the company studied has relatively well-paid workers — “employees at the firm are relatively high income (median income $125,000-$150,000),” we are told. Higher income=Less price sensitivity.

Also, we know women shop more for health care and men shop less; women make 80 to 90 percent of the health care decisions in the U.S., and they are deeply in touch with this issue, while men aren’t. I did not see a gender breakdown in the methodology. So I wonder: Men or women?

Also, we learn that workers got tools to use to assess care, but we don’t see those tools — and believe me, I have seen some terrible ones. For example, here’s a post from one of our partners, Elana Gordon at WHYY public radio in Philadelphia, about how bad one insurer’s tools were for one couple.

Also, we don’t know what kind of education on their new system the workers got, so it’s a little bit murky (though the original study is incredibly long).

Bringing a Complex Health care system Into Alignment

Nov 19, 2015

By BRETT DAVIS

Ask the chief medical officer of a major health system about the issues that keep them up at night and he or she will talk about the need to understand outcomes in complex populations, the need to engage in new business models, novel collaborations with other stakeholders, and engaging “customers” i.e. patients in new ways, all while addressing increasing cost pressures and safety concerns.

Sit down with a franchise leader in oncology at a pharmaceutical or biotech innovator and ask the same questions, and the response will pretty much be the same.

The convergence of business imperatives is largely driven by two factors: 1) the shift to value based healthcare reimbursement from volume, and 2) our rapidly advancing understanding of the causes of disease and health that holds promise to accelerate further because of the proliferation of electronic health information coupled with continued scientific innovation.Continue reading…

When it Comes to Healthcare IT Success Stories, Don’t Count out the Little Guy

Nov 18, 2015

By TOM GIANNULLI, MD

Today’s healthcare information technology headlines are littered with how large delivery networks are scaling up and successfully building and using IT infrastructure. But the real success story is hiding in the shadows of these large enterprise deployments, in the small and independent practices across the US. The recent ICD-10 transition, that had been foretold to drive small enterprise into financial despair due to their lack of IT savvy and infrastructure, has shown just the opposite. A report from a leading provider of billing software that was based on government and private payer claims analysis for the past 30 days shows a different story.Continue reading…

“Winning” by Defeating the Triple Aim

Nov 16, 2015• 13

By JOE FLOWER

You follow movies? That is, not just watching them but thinking about how they are built, looking at the structure? In classic movie structure there is a moment near the end of the first act. We’ve established the situation, met our hero, witnessed some good action where he or she can display amazing talents but also what may be a fatal weakness.

Then comes the moment: Some grizzled veteran or stern authority brings the hero up short. Think of Casino Royale, that scene where Daniel Craig’s Bond (after those brutal opening scenes) is back in London and is confronted by Judy Dench’s M. Or Obi Wan Kenobi challenging Luke: “You must learn the Force.” Or that moment in the classic Westerns when the tired, angry old sheriff rips off his badge and throws it on the desk, leaving the whole problem to the young upstart deputy. But before he stomps out the door he turns and says to the young upstart, “You know what your problem is, kid?”

And then he tells him what the problem is: not just the kid’s problem, but the problem at the core of the whole movie. He just lays it out, plain as day.

In healthcare, this is that moment. We are near the end of the first act of whatever you want to calloutthis vast change we are going through.

And where are we? Across America, the cry of the age is “Volume to value.” At conferences we all stand hand over heart and pledge allegiance to the Institute of Health Improvement’s Triple Aim of providing a better care experience, improving the health of populations, and reducing per capita costs of health care.

But in each market, some major players are throwing their muscle into winning against the competition by defeating the Triple Aim, by increasing their volume, raising their prices, doing more wasteful overtreatment, and taking on little or no risk for the health of populations. At least in the short term, the predatory strategies of these players are making it more difficult for the rest of us to survive and serve.

First, we Devalued Doctors; Now, Technology Struggles to Replace Them

Nov 16, 2015• 4

By DAVID SHAYWITZ, MD

The key to driving behavior change, a seasoned marketing executive turned digital health investor told a panel on patient engagement that I moderated this week, is to get beyond the demographics of customers, and to understand the “why” – what are their distinct motivations and drivers?

Customers with similar demographic characteristics might be motivated in very distinct ways, he explained; sophisticated, quantitative market research can help define the different “personalities” present in a particular market.

Healthcare businesses, he emphasized, need to recognize these differences, and customize their approaches based on this nuanced understanding.

On the one hand, it occurred to me he was describing the behavioral component of precision medicine; in the same way it’s important to match an oncology drug with the right biochemical pathway, it’s also essential to customize the motivational approach to the characteristics of each individual.

On the other hand, I realized there was something that seemed a little sad about the idea of developing extensive market analytics and fancy digital engagement tools to simulate what the best doctors have done for years – deeply know their patients and suggest treatments informed by this understanding.

Instead, it seems, we’ve slashed the time physicians get to spend with patients, protocolized and algorithmitized almost every moment of this brief encounter, and insisted the balance of time is used for point-and-click data entry and perhaps a rushed dictation. We’ve industrialized the physician-doctor encounter – the process and the paperwork — but eviscerated the human relationship; it’s value, unable to translate easily to an excel spreadsheet, was discounted and dismissed.

As I look at the extensive analytic efforts to categorize patients, and the many digital health platforms designed to motivate behavior, it’s hard not to ask whether we’re painfully trying — at scale but without heart — to re-create something we might have been better off not destroying in the first place.

David Shaywitz is based in Mountain View, California. He is Chief Medical Officer at DNAnexus, a Mountain View based company and holds an adjunct appointment, Visiting Scientist, in the Department of Biomedical Informatics at Harvard Medical School.