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It is Time for Clinicians to Engage: Let’s Criticize Less and Dare Greatly More

Sep 2, 2014• 104

By JOHN HAUGHOM, MD

When I write or speak about healthcare transformation, I am often asked why I do not criticize more. Criticize health system leadership. Criticize governmental policies. Criticize burdensome regulations. It’s a long list. Why avoid criticism? The answer is simple. Discerning emerging solutions is much more productive and fun.

We are living during a very interesting period in the history of health care. No doubt, it is a time of great transition. We are passing from one time to another. Transition periods are important, yet they are hard to define because it’s difficult to determine exactly when they start and when they end. To understand the transition healthcare is now experiencing, we must do our best to understand what is on either side of it.

The traditional approach to delivering care has served us well and accomplished great things over the past century. Yet, it is also being overwhelmed by complexity and producing inconsistent quality, unacceptable levels of harm, too much waste and spiraling costs.

The traditional method of delivering care is struggling and another is emerging to take its place. Because the traditional approach has served us well and accomplished great things, we want to believe that the present state will continue forever. Because conditions have changed, this will not happen. We are in need of a new approach. An approach that carries the best of the past forward, yet also addresses present day challenges. It just might be that on the other side of this current transition is potentially a time unmatched by any other in the history of healthcare. Thanks to visionary clinical leaders at institutions across the country, there is growing evidence this is not only possible; it is likely.

Who does the future belong to? If we look closely at other transition periods in history, two groups of people are apparent. The first are what we recognize as critics. They are people whose response to the need for change is criticism. Critics always exist, but in a time of transition they tend to multiply. What do they criticize? They criticize the new, they criticize the change, they criticize the change for being unnecessary or too fast, or they criticize the change for being too slow. They criticize anything and everything. Critics are abundant. The question we should consider is, “Will criticism solve problems?” Typically, it does not. While constructive criticism has its place, it alone is not likely to accomplish much especially when the world is yearning for innovative solutions.

Medicaid 2.0

Sep 2, 2014• 32

By CECI CONNOLLY

While fierce debate continues to envelop much of the Affordable Care Act, financial data for many of the nation’s health systems reveal one clear fact: the optional Medicaid expansion has resulted in hospital haves and have nots.

An analysis by PwC’s Health Research Institute (HRI) of newly released earnings and patient volume data shows a clear financial split between healthcare providers operating in states that expanded Medicaid and those that have not. The law as written would have provided Medicaid coverage to every American earning less than 138% of the federal poverty level ($16,105 for an individual). But a June 2012 Supreme Court ruling made the expansion optional for states, creating a patchwork of coverage.

Health systems and physician groups delivering care in the 26 states and the District of Columbia that have embraced the federally-funded expansion have reported a significant rise in patient volumes and paying consumers and a measureable reduction in uncompensated care levels.

This year alone LifePoint Hospitals has seen a 30.3% reduction in its uninsured and charity care patients, according to filings with the Securities and Exchange Commission. Tenet Healthcare, which operates in five Medicaid expansion states, saw uninsured and charity care admissions decline by 46% in the expansion states, coupled with a 20.5% increase in Medicaid inpatient admissions in those same states, according to an HRI analysis which will be released next week.

In all, HRI analyzed financial data from the nation’s five largest for-profit health systems—HCA Holdings, LifePoint, Tenet, Community Health Systems and Universal Health Services, representing 538 hospitals in 35 states. Our team also reviewed data from several mid-sized hospitals, government reportsand industry surveys.

PRICE INCREASE TODAY 9/2: Health 2.0 8th Annual Fall Conference

Sep 2, 2014• 1

Hope you had a fantastic Labor Day weekend! Now that you’re back, don’t forget the 8th Annual Fall Conference PRICE INCREASE is TODAY, Sept. 2! Join over 2,200 attendees as we showcase over 200 LIVE demos, innovative solutions and thought leadership on over 50 panels, with 150+ speakers over the course of four days on Sept. 21-24 at the Santa Clara Convention Center.

Highlights of speakers and sessions include:

Keynotes from Dr. Eric Topol (Scripps Health),Patrick Soon-Shiong (NantHealth), Indu Subaiya(Health 2.0), Matthew Holt (Health 2.0), Bernard J. Tyson (Kaiser Permanente)
Health Care Data Analytics will show how genomics, non-invasive diagnosis tools, and integrated data collections are uncovering new discoveries, promoting personalized medicine, and new care protocols.
Consumer Tech and Wearables: Powering Healthy Lifestyles showcasing the NEW Health 2.0 Wearable Tech Runway with new solutions from companies such as Adidas, OM Signal,Walgreens, Withings, WebMD, Samsung
Electronics, Qualcomm Life, and many more!
New Landscapes for Digital Diagnosis showcases tools for providers and consumers, while demonstrating new ways in which both communities are reaching the proper diagnosis.

New conference features:

Traction: Brings together series A ready companies center stage as they vie to get the nod as the most fundable startup from venture capitalists and corporate investors. Notable judges and mentors include:
- Jack Young, Qualcomm Life Ventures
- Esther Dyson, EDventure Holdings
- Andrew Colbert, Ziegler Corporate Finance
Pharma & Hospital Roundtables: During these invite-only sessions, participants will discuss how their institutions create and utilize cutting-edge technologies to tackle complex health care issues ranging from care coordination to data exchange and how digital health is changing the pharmaceutical landscape from the earliest phases of research to clinical trials to the way consumers interact with their products in the real world. Email Kim Krueger (ki**@********on.com) for more info.
Bootstrapped Bootcamp: Have less than $2M in total funding? This year’s exhibition hall includes premier space for companies with less than $2 Million in funding to get traction and visibility in front an audience of over 2,200 health care professionals, thought-leaders, venture capitalists, and entrepreneurs. Reserve your space to demo your technology LIVE in our exhibit hall and enjoy a pass to the conference.

including many more new panels, sessions, and speakers found on the agenda online!

Limited S tart –up rate applications are available – submit yours today. Really tight on budget or a student? Apply to volunteer.

A Crystal Ball for Medicine

Sep 2, 2014• 6

By BEN HAMLIN

Twenty years is a long time to rely on one measurement approach. Imagine if in this technology-centric world we still relied on dial-up to connect to the internet. That’s basically where we are on quality assessment today. But we don’t need to be.

Predictive risk calculations allow doctors to look into the future. A risk score tells doctors how likely their patient is to develop heart disease or have a stroke. Working with their patients, doctors can discuss options for lowering this risk with the goal of preventing such events from happening.

With data from electronic health records, we should be able to create risk profiles for individual patients that actually take into account the different factors affecting their personal health—not just their age and gender, but their family history, whether or not they smoke, what medications and treatments they are receiving, and their own perspective on how they feel.

But right now, a 50 year old woman’s risk of developing heart disease is determined by a threshold set for the entire population of women aged 50-65 across the country. That’s a crude science. Everyone is not built the same. We should create risk profiles that change as patients change: as they reduce their risk by losing weight, quit smoking, or lowering their high blood pressure, thus reducing their chances of a heart attack or other adverse event.

That’s the vision of NCQA’s Global Cardiovascular Risk Score (GCVR). Leveraging the pioneering risk prediction work of Archimedes, it extracts data from electronic health records and uses a sophisticated algorithm to generate a highly sensitive, patient-centric risk profile for each clinician. It works like this: the higher the score the less likely a clinician’s patient will develop heart problems in the next five years.

Why Physicians Are Turning to Startups

Sep 2, 2014• 35

By DAVID SHAYWITZ, MD

To appreciate the potential impact of the startup movement on health and medicine, you really need look no further than Drs. Rushika Fernandopulle and Farzad Mostashari (disclosure: I was colleagues with both at college and later at MGH).

Both are passionate about transforming healthcare – Fernandopulle has an M.D. and a public policy degree from Harvard, and was the first executive director of the Harvard Interfaculty Program for Health Systems Improvement; Mostashari served as Assistant Commissioner for NYC’s Department of Health, and more recently as the National Coordinator for Health Information Technology in the U.S. Department of Health and Human Services in the Obama administration. Both are committed to improving the delivery of patient care. And both have deliberately chosen to pursue their vision by creating a company as the vehicle to deliver the change they each believe in.

“The world of start-ups may not be the usual path for those leaving a senior federal post,” wroteMostashari about his new direction, “but it’s the right decision.”

Last month, Mostashari founded Aledade, which seeks to enable independent, primary care physicians to establish accountable care organizations.

A few years earlier, in 2010, Fernandopulle co-founded Iora Health, aninnovative model of direct primary care, and continues to serve as CEO.

Explains Fernandopulle,

“As a practicing physician it soon became obvious our current model of care delivery does not work; instead of simply complaining about it I felt I needed to try to fix it, but got frustrated trying to do it within existing health systems, and found studying the problem (in academics), working through the government, and consulting was not effective. I decided that the best way to make change happen quickly was to simply strike out myself and just do it- being an entrepreneur allows you to break what others think are the rules (they aren’t) and take change into your own hands.”

Fernandopulle and Mostashari aren’t alone – across the country (and the world), physicians from every specialty are creating, joining, or hoping to joinstartups. While many of these doctors are fairly junior, and have little (if any) substantive clinical experience, some are more seasoned – HealthLoop’s Jordan Shlain comes to mind, for example.

A Hospital That Is a World Leader On Transparency

Aug 31, 2014• 4

By LEAH BINDER

Jeremy Hunt, secretary of state for health in Britain, recently toured the Virginia Mason Medical Center in Seattle. He said the visit was “inspirational” and announced plans to have the British National Health Service (NHS) sign up “heart and soul” to a similar culture of safety and transparency. Hunt wants doctors and nurses in NHS to “say sorry” for mistakes and improve openness among hospitals in disclosing safety events.

I had a similar reaction to my tour of Virginia Mason. The hospital appears impressive—and truly gets impressive results. My nonprofit, the Leapfrog Group, annually takes a cold, hard look at the hospital’s data and named Virginia Mason one of two “top hospitals of the decade” in 2010. Every year, it ranks near the top of our national ratings.

Virginia Mason’s success is rooted in its famous application of the principles of Japanese manufacturing to disrupt how it delivered care, partly at the behest of one of Seattle’s flagship employers, Boeing. There are numerous media stories and a book recounting the culture of innovation Virginia Mason deployed to achieve its great results, so I won’t belabor the point here. But at its essence is Virginia Mason’s unusual approach to transparency. Employees are encouraged to “stop the line” – that is, report when there’s a near miss or error. Just as Toyota assembly workers are encouraged to stop production if they spot an engineering or safety problem, Virginia Mason looks for every opportunity to publicly disclose and closely track performance.

It is not normal for a hospital to clamor for such transparency. Exhibit A: the Leapfrog Hospital Survey, my organization’s free, voluntary national survey that publicly reports performance by hospital on a variety of quality and safety indicators. More than half of U.S. hospitals refuse the invitation of their regional business community to participate in Leapfrog, suggesting that transparency isn’t at the top of their agenda. But for Virginia Mason and an elite group of other hospital systems, not only is the transparency of Leapfrog a welcome feature, but they challenge us to report even more data, faster.

The Quantified Doctor

Aug 31, 2014• 12

By SAURABH JHA, MD

88.2 % of all statistics are made up on the spot
– Victor Reeves

There’s a growing movement in medicine in general and imaging in particular which wishes to attach a number to everything.

It no longer suffices to say: “you’re at moderate risk for pulmonary embolism (PE).”

We must quantify our qualification.

Either by an interval. “Your chances of PE are between 15 and 45 %.”

Or, preferably, a point estimate. “You have a 15 % chance of PE.”

If we can throw a decimal point, even better. “You have a 15.2 % chance of PE.”

The rationale is that numbers empower patients to make a more informed choice, optimizing patient-centered medicine and improving outcomes.

Sounds reasonable enough. Although I find it difficult to believe that patients will have this conversation with their physicians.

“Thank god doctor my risk of PE is 15.1 % not 15.2 %. Otherwise I’d be in real trouble.”

What’s the allure of precision? Let’s understand certain terms: risk and uncertainty; prediction and prophesy.

By certainty I mean one hundred percent certainty. Opposite of certainty is uncertainty. Frank Knight, the economist, divided uncertainty to Knightian risk and Knightian uncertainty (1).

What’s Knightian risk?

If you toss a double-headed coin you’re certain of heads. If you toss a coin with head on one and tail on the other side, chance of a head is 50 %, assuming it’s a fair coin toss. Although you don’t know for certain that the toss will yield head or tail, you do know for certain that the chance of a head is 50 %. This can be verified by multiple tosses.

Calling Mrs. Kafka

Aug 30, 2014• 9

By HANS DUVEFELT, MD

“Prior Authorizations, Mrs. Kafka. May I have your name and the patient’s policy number.”

“My name is Hans Duvefelt, and I don’t have the patient’s number but I have her husband’s – it is 123456789”.

“Thank you, Doctor. This is for Harry Black?”

“Well, no, it’s for his wife, Harriet. We asked for a PA for Lyrica for her, but it was approved for him instead, even though the forms we sent you clearly stated her name.”

“I see that Harry is approved for one year.”

“Yes, but he doesn’t need it. He has no diagnosis and no symptoms. Someone at your end reversed the names, because the application was for Harriet. I have a copy right here in front of me. So can we just get this approval switched over to her name instead?”

“I’m sorry, we can’t.”

“But why?”

“She’s a different patient.”

“But everything we sent in was on her. You were the ones who put it under his name instead. It was your mistake and I’m asking that you correct your mistake.”

“I’m sorry, but we have to process Harriet’s Prior Authorization separately. What is her diagnosis?”

(Sigh)

“Postherpetic neuralgia.”

“Is she currently taking Lyrica for this?”

“Yes.”

“I don’t see any pharmacy claims for Lyrica in her profile.”

XPRIZE Names 10 Finalists in Tricorder Competition

Aug 29, 2014• 1

By Kim Krueger

XPRIZE announced the 10 finalist teams competing for the $10M Qualcomm Tricorder XPRIZE, a 3.5-year global competition sponsored by the Qualcomm Foundation for teams to develop a consumer-focused, mobile device capable of diagnosing and interpreting a set of 15 medical conditions and capturing five vital health metrics. Launched in January 2012, the competition encourages the development of a device much like the medical Tricorder of Star Trek fame.

The Tricorder prize is something we’ve supported since its launch, and last year at the 7th Annual Health 2.0 Fall Conference, we got to host part of another XPRIZE competition: the Nokia Sensing CHALLENGE, a $2.25 million global competition to accelerate the development of sensors and sensing technology that is smaller, lighter, and capable of capturing true clinical data on a personal level. The teams on display were examples of how Health 2.0 technologies are pushing the boundaries of access, diagnosis, and discovery.

The recently announced finalists for the Tricorder prize promise to be equally impressive as they work to move the science fiction of the Star Trek Tricorder to science reality. The ten teams represent diverse backgrounds from non-profits to academia to start-ups, and include:

Aezon (Rockville, Md.), led by Tatiana Rypinski, a team of student engineers from Johns Hopkins University partnering with the Center for Bioengineering Innovation & Design.
CloudDX (Mississauga, Canada), a team from medical devices manufacturer Biosign and led by company chief medical officer, Dr. Sonny Kohli.
Danvantri (Chennai, India), a team from technology manufacturer American Megatrends India and led by company Director and CEO, Sridharan Mani.
DMI (Cambridge, Mass.), a team led by Dr. Eugene Y. Chan of the DNA Medicine Institute partnering with NASA, the National Institutes of Health and the Bill and Melinda Gates Foundation.
Dynamical Biomarkers Group (Zhongli City, Taiwan), a team of physicians, scientists and engineers led by Harvard Medical School professor Chung-Kang Peng.
Final Frontier Medical Devices (Paoli, Pa.), a team led by the founders of Basil Leaf Technologies—brothers Dr. Basil Harris, an emergency room physician, and George Harris, a network engineer.
MESI Simplifying diagnostics (Ljubljana, Slovenia), a team from diagnostic medical device manufacturer MESI and led by company CEO, Jakob Susteric.
SCANADU (Moffett Field, Calif.), a team from Silicon Valley-based start-up SCANADU led by technology entrepreneur and company co-founder and CEO, Walter De Brouwer.
SCANurse (London, England), a team from diagnostic medical manufacturer SCANurse and led by biomedical engineer and company founder, Anil Vaidya.
zensor (Belfast, Ireland), a team from clinical sensor and electrode company Intelesens and led by chief technology officer, Prof. Jim McLaughlin.

Matthew Holt had a chance to speak with Grant Campany, the Senior Director of the Qualcomm Tricorder XPRIZE and Nokia Sensing XCHALLENGE, about the finalists and the competition. We’re excited to follow these teams on their quest and see how their technologies change our world. To hear more, take a look at the interview below:

[youtube=http://www.youtube.com/watch?v=qAr3PKFbK7w]

Kim Krueger is a Research Analyst at Health 2.0.

Is It Possible That All Healthcare Needs to Know We All Learned In Kindergarten?

Aug 29, 2014• 10

By JOSEPH M. SMITH, MD

US Healthcare is sick and getting sicker, and while its chaotic complexity suggests to many that it will need to fail big before it can be rebuilt, some simple rules may help to get it back on track. As this the time of year when many of us prepare to send our children on grandchildren off to school in the hopes that they will learn what they need to succeed, I thought we could revisit the lessons of Kindergarten and their application to healthcare. The following list, initially from “ALL I REALLY NEED TO KNOW I LEARNED IN KINDERGARTEN” by Robert Fulghum. has been adapted (read ‘man-handled’) for applicability to US healthcare. You’ll find the original list here: http://www.robertfulghum.com/

Share everything – In healthcare, this means share ALL the data, all the information, all the acquired wisdom. Interoperable systems are essential. Price transparency is the right side of history. Automated, coordinated, connected systems are essential. Healthcare is too much of a team sport not to share all that we know, so that we can quickly understand what works, what doesn’t, and what it’s all going to cost.

Play fair – It isn’t fair when decisions are made without a person’s input. It isn’t fair that a patient should bear the risks, the pain, the scars and the costs without having unfettered access to all the relevant information. Shared decision making is part of playing fair in a world where healthcare is meant to happen for patients and with patients, but not to patients.

Don’t hit people. – We must avoid ‘hitting’ patients with costs they can’t bear, or complications they didn’t know could happen. We should avoid ‘hitting’ clinicians with unsophisticated systems that complicate their lives and distract them from their patients. We need to stop ‘hitting’ innovators with unanticipated or needlessly complicated regulatory hurdles. And we need to work hard to have all of us avoid the ‘hit’ of a financially and logistically unsustainable healthcare system.

Put things back where you found them. Except for things like an infected appendix or a malignant growth, this continues to make great sense. And as we go about transforming healthcare, we must recognize that wholesale, sweeping changes are easier to envision than execute. While progress requires change those changes that align with / enhance / expedite existing workflows will be easiest to achieve.

Clean up your own mess – Healthcare is big enough that there are messes everywhere. We should favor local control over central planning. Patients must bear some responsibility for the consequences of their life-style choices that might be reflected in their insurance costs. Hospitals must monitor and manage their own quality metrics. Medical boards need to step up their efforts to spotlight and sanction professional inadequacy. Our federal government must do a better job of limiting inappropriate payments in healthcare. If each of us cleans up after ourselves, things get better quickly.
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