The Health Care Blog – Page 478 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What Twitter Tells Us about the War on Cancer

Jun 2, 2014• 1

By Brian Reid

The American Society of Clinical Oncology recently made public nearly all of the abstracts — more than 5,000 pieces of research — that were selected for the ASCO annual meeting, which kicked off in Chicago on the last day of May.

Sifting through those 5,000 abstracts would be an almost inhuman task: each abstract contains 2,000 characters. That’s 10 million characters of information about oncology created by experts that’s now available for the public to parse.

But as remarkable as the ASCO abstract drop is, that research is not the only overwhelming trove of communication on cancer created by doctors. One ASCO abstract (based on research by me and W2O colleagues Greg Matthews and Kayla Rodriguez) tells story of how, over the course of 2013, U.S. doctors tweeted about cancer 82,383 times. At 140 characters a tweet, that’s nearly 12 million characters.

We know there were 82,383 tweets because we counted them. Using our MDigitalLife database, which matches Twitter handles with verified profiles from the government’s physician database, we scanned all tweets by doctors for mentions of dozens of keywords associated with cancer over the course of calendar year 2013.

Should Health Consumers Be Paid for Performance Too?

Jun 2, 2014• 23

By MICHELLE SNYDER

Meaningful Use and Pay for Performance – two of the most talked about programs in healthcare IT over the past several years. They are both based on the premise that if you want to drive behavior change among providers and improve quality of care, you need to offer financial rewards to get results.

But what about the consumer? We have now entered a new era in healthcare where the consumer is rightfully front and center – AHIP is even calling 2014 the “Year of the Consumer.” Payers, and other population health managers, who until recently viewed consumers as claims, now want to “engage,” “motivate” and “delight” them.

The challenge, however, is that we are giving consumers more responsibility, but not making them accountable for the quality of care they provide for themselves.

As a country we have spent tens of billions of dollars on Meaningful Use incentives and Pay for Performance programs for clinicians. Providers need to demonstrate they are making the best choices for patients, being efficient and coordinating care.

They need to educate patients and give them access to information based on the belief that if patients are informed, they will take responsibility and action. Unfortunately, this seems like a “Field of Dreams” spinoff – “If we say it, they will act.”

However, that movie has a different ending. The intentions are good, but the flaw is that consumers don’t simply need more information. They need personalized guidance and support, and they need to feel like they have a financial stake in the game.

So the big question is – why aren’t we spending more time thinking about how the concepts behind “meaningful use” and “pay for performance” could be used as a way to get consumers engaged in their health? Yes, clinicians are important as they direct approximately 80 percent of the healthcare spend in our “sick-care” health system.

However, what most people do not realize is that 75 percent of healthcare costs are driven by preventable conditions like heart disease and type-2 diabetes. And while some consumers may throw up their hands and blame genetics for the majority of their health issues, it’s a fact that 50 percent of what makes us healthy is under our control – as opposed to 20 percent for genetics.

So what if we made wearable technologies such as FitBit more “meaningful” for the consumer? Instead of just tracking steps, what if consumers were financially rewarded for taking steps to improve their health (pun intended) through health premium reductions, copay waivers or even gift cards?

Consider a scenario where an individual who was identified as being pre-diabetic and then took action to prevent the onset of diabetes. What if we required that proactive person to pay less in premiums than someone who was not taking any initiative to improve their health? That would clearly be very motivating.

Upgrading the Value of Data Transparency in the Health Sector

Jun 2, 2014• 1

By Darshak Sanghavi, MD & Joshua Bleiberg

Recently the Centers for Medicare and Medicaid (CMS) made troves of data publically available. CMS released data on hospital charges, physician utilization, in addition to other data sets. Journalists and academics were excited to potentially confirm their theories on healthcare spending.

We at The Engelberg Center hosted an event, Hacking America’s Health where experts from the Brookings Institution and the government spoke to participants regarding the impacts of data transparency on the nation’s healthcare system. The purpose of the festival is to focus on “innovators from around the world and their transformative solutions to global challenges.”

Out of this discussion emerged a consensus that data transparency could spur disruptive innovation in the health sector but overcoming several key barriers was essential to maximizing the benefits to the public.

Benefits of Data Transparency

1. Help Consumers Make Informed Decisions

Open data offers numerous benefits to consumers. The CMS data unveils the enormous variation in the cost of different treatments. Enabling consumers to find high value care providers improves the efficiency of the market. Price transparency can also uncover providers that charge unusually high prices and puts pressure on them to lower those charges. Finally utilization can reveal if a doctor uses a rare treatment with regularity. All of these data empower health care consumers to choose wisely.

2. Identify Vulnerable Patients

CMS has used open data for numerous projects to help patients. One project involves collaboration with local and state governments. Using Medicare claims information they identified specific patients who could be in special danger in the aftermath of a natural disaster. Without electricity it’s impossible to operate a lifesaving device like a ventilator or nebulizer. The claims data allows emergency officials to notify such individuals about the locations of shelters.

3. Data Mashups

Combining together data sets could help identify bad actors in the health system. For example merging data from the Sunshine Act which describe payments and items given to physicians combined together with utilization data from CMS. This could identify doctors who were using a drug or procedure due to a financial relationship rather than best practice. Other data mashups could also uncover unexpected patterns.

Before Privatizing the VA, Publicize It

Jun 1, 2014• 26

By LEAH BINDER

The Veterans Affairs (VA) hospital scandal has policymakers calling for VA Secretary Eric Shinseki’s head, and this week they got it, when President Obama accepted the Secretary’s resignation.

Some policymakers are also calling for privatizing VA hospitals, allowing them to be owned and operated by the same entities that own and operate the hospitals the rest of us use. This idea assumes the hospital community as a whole performs better than the VA, and the sad truth is we don’t have any evidence of that.

We know that on average, other hospitals are not doing a great job. Upwards of 500 people each day die from preventable errors in American hospitals, one in 20 admitted patients will get an infection, and one in four inpatients suffer some form of harm unrelated to the reason they went to the hospital in the first place.

Evidence suggests waiting lists like the VA’s may be common, as well.

So how does the VA compare? We don’t know. We don’t have much data publicly available to begin with, and we have virtually nothing that compares VA hospitals with other American hospitals.

To be clear, data is being collected—it’s just not typically available to humble souls like you and me and the rest of the American citizenry. Hospitals get accredited to receive Medicare and Medicaid payments, but accreditation reports are not made public by hospital. Health plans collect claims data, but most of that is never released to the public. The Centers for Disease Control, the Centers for Medicare and Medicaid Services, and other federal agencies collect reams of data, but much of it is not made public, either.

This dearth of information is why employers and other purchasers of health care formed my organization (The Leapfrog Group), to ask hospitals to report on data they can’t get anywhere else. Their support means it’s free for hospitals to publicly report and free for consumers to access information about hospitals in their community. But only about a third of hospitals participate.

Will the Shinseki Resignation Turn around the VA?

May 30, 2014• 28

By MARK GRABAN

As I wrote on LinkedIn, instead of blaming “bad managers” or a “lack of integrity” at local VA sites, like Phoenix, we have to look at the system.

Dr. W. Edwards Deming always said that senior management is responsible for the system. We need to ask who designed, set in place (or tolerated) things like:

“Unrealistic” 14-day waiting time goals (says the VA Inspector General)
Bonuses and financial incentives driven by hitting these targets
A culture where people can’t ask for help (“don’t make things look bad”)
An environment that tolerates not having enough capacity to meet demand

In circumstances like that, being pressured by distant leaders to hit an unrealistic target… I would GUARANTEE that there would be some level of cheating. And, more than 40 VA sites are under investigation by the Inspector General. This is systemic. It’s too simplistic to label people as “bad” and to then fire them. “Gaming the numbers” is very predictable human behavior (and it happens in other countries’ healthcare systems too).

In his statement, Shinseki did point fingers at himself on one level:

At the end of a speech to an annual conference of the National Coalition for Homeless Veterans in Washington, Shinseki addressed a new interim report on the VA health-care system’s problems. He said he now knows that the problems are “systemic,” rather than isolated as he thought in the past.

“That breach of integrity is irresponsible,” he told the largely supportive audience. “It is indefensible and unacceptable to me.” He said he was “too trusting” of some top officials and “accepted as accurate reports that I now know to have been misleading with regard to patient wait times.”

President Reagan famously quoted an old Russian maxim, “Trust, but verify.” That’s good advice for leaders anywhere.

Toyota’s Taiichi Ohno also famously said:

“Data is of course important in manufacturing, but I place the greatest emphasis on facts.”

“Data” might include spreadsheets and reports on the web. Data are too easily gamed, faked, and fudged. People can manipulate data in many ways and leaders need to be aware of that.

“Facts” are things you can see with your own eyes. Lean leaders “go to the Gemba” (or the actual workplace) to see first hand and to talk to the people who are doing the work. A Lean VA leader would visit locations (or send people) to help verify that data is not being manipulated and that processes are being followed. You’d talk to veterans to see if they have complaints about long waits that aren’t showing up in the data.Continue reading…

Optimal Positioning Strategy and the “Quantified Relationship” in Baseball and Health Care

May 30, 2014• 2

By CHARLIE GROSS

Strategy in baseball used to be a fairly straightforward matter. A few strategy rules – a right handed pitcher was more successful against a right handed batter, lefty against lefty, no left handers at infield positions except for first base, don’t hold the runner at first with two outs and a left handed batter, and sacrifice bunt to move a runner at first with less than two outs- were taken as gospel and practiced by the community.

It was baseball’s version of the 10 commandments, written in stone and for the first century of baseball, unchangeable.

The world changed, though few knew it, in 1946 when Cleveland manager Lou Boudreau moved his shortstop to the right of second base against the legendary dead pull hitter Ted Williams of the Boston Red Sox.

However, like many innovations, it is only with the advent of large data sets that the revolution that started that July day in Cleveland impacted day to day strategy.

A players position on the field is no longer the result of the manager’s intuitive hunch, or even the result of consulting a written document of the past several encounters between a particular pitcher and a particular batter- a scatter gram of where this batter is likely to hit the ball. Instead, major league teams are increasingly relying on sophisticated, large data sets that are housed on remote servers.

These data sets run complex algorithms predicting the best solution for a particular ecosystem- elements of which include – batter, pitcher and all the defensive players and their particular gifts, skills and tendencies- and even the weather and time of day.

A Policy Model For Telehealth Technologies

May 30, 2014• 5

By JOSEPH KVEDAR, MD

The nation’s ongoing battle to strike a delicate balance between increasing access to quality health care for all Americans and reducing overall health care spending just scored one of its most substantial victories.

In late April, after several months of thoughtful and robust collaboration, the Federation of State Medical Boards (FSMB) ratified a new model national policy – the Appropriate Use of Telemedicine in the Practice of Medicine – at its annual meeting in Denver.

This marks the first time the medical community has unilaterally acknowledged the impact technology has had on the practice of medicine, and the ability telemedicine — or connected health — has to facilitate and improve the delivery of health care.

Let us first put this in perspective. We all know health care is at a critical juncture. The implementation of the Affordable Care Act means millions of newly eligible Americans will seek access to an already over-burdened health care system.

The nation faces a serious shortage of primary care providers, specialty care is becoming more diversified, and access to care in rural areas is an ongoing challenge. All of these issues are on the rise.

Technology-enabled Care

Enter technology-enabled care. Real-time video encounters between patients and providers reverse the burden on patients to seek care in a hospital or doctor’s office by bringing health care directly to them, in their home. At the same time, remote monitoring, sensors, mobile health and other technologies are helping to reduce hospital readmissions, and improving adherence to care plans and clinical outcomes, as well as patient satisfaction.

Connected health tools also support preventative care efforts for chronic care patients and can empower individuals to make positive lifestyle changes to improve their overall health and wellness.

Momentum for telehealth is accelerating at an undeniable rate. As of March, twenty states and the District of Columbia have passed mandates for coverage of commercially provided telehealth services; 46 states offer some type of Medicaid reimbursement for services provided via telehealth.

A study by Deloitte predicts that this year alone, there will be 100 million eVisits globally, potentially saving over $5 billion when compared to the cost of face-to-face doctor visits. This represents a growth of 400 percent in video-based virtual visits from 2012 levels, and the greatest usage is predicted to occur in North America, where there could be up to 75 million visits in 2014. This would represent 25 percent of the addressable market.

Health Datapalooza Exclusive Interview: Dwayne Spradlin, CEO, Health Data Consortium

May 30, 2014

Interview by Matthew Holt, Co-Chairman, Health 2.0

In just two days, Health 2.0 will be attending Health Datapalooza in Washington, D.C. from June 1-3. In this exclusive interview, Dwayne Spradlin, CEO, Health Data Consortium will highlight the new sessions, panels, workshops, and speakers you can look forward to at Health Datapalooza! As an additional bonus, Spradlin gives insight on how data is driving health care innovation, and sheds light on new and on-going projects of the Health Data Consortium.

Three Reasons AstraZeneca Were Right to Reject Pfizer

May 30, 2014• 4

By BECKY BAINES

The transatlantic stand-off between the two pharmaceutical giants, Pfizer and AstraZeneca, is over; possibly for good. With Pfizer having failed to conclude a £69bn deal with the British-Swedish multinational pharmaceutical firm, almost £7bn was wiped from AstraZeneca’s share value.

AstraZeneca’s board, which decided that Pfizer’s bid was inadequate, has subsequently been criticised by major shareholders for “failing to engage”. Pfizer meanwhile, has been accused of being driven purely by the lure of lower taxes, job cuts and budget reductions. We have rounded up the reasons why we think that Astra Zeneca were right to reject the takeover bid from Pfizer.

Jobs Threatened

The proposed takeover had major implications for several sectors. From major health and pharmaceutical recruiters to manufacturers and research companies, all would have been affected by Pfizer’s huge takeover bid. Despite repeated initial assurances from Pfizer’s CEO, Ian Read, both AstraZeneca and Pfizer finally acknowledged in last week’s parliamentary select committee meeting that there would be cuts to both jobs and research.

Indeed, even before the failure of the bid, many academics, scientists and even union leaders were accusing Pfizer of being driven purely by the possibilities of a lower taxes and reductions to the research budget. Pfizer had already been described by a former boss of AstraZeneca as a “praying mantis” ready to “suck the lifeblood out of their prey”.

However, AstraZeneca’s current chairman, Leif Johansson said that the deal represented “a significant risk to shareholders.”

Samsung Throws Kitchen Sink onto the Wrist

May 29, 2014

BY MATTHEW HOLT

Yesterday phone and electronics giant Samsung rushed out its next step in health related hardware. Samsung was clearly trying to get this out the door and in the press before Apple’s forthcoming announcement of something health-related –or I assume that’s what their industrial espionage told them Apple was about to reveal (just kidding guys!). And some people (well, Techcrunch) were clearly unimpressed.

The most compelling moment which I captured (poorly) in the video above was the demo of the new SIMBAND–albeit a concept rather than an available product. (In fact a couple of their partners told me that no-one outside the company has one). In the SIMBAND are a stack of new sensors which attempt to use the wrist to monitor not only heart rate, but blood pressure, temperature, EKG and do it all continuously. You can see a rather better video of the demo from Gizmodo, which I cued up to start at the right place.

They also announced a fully open platform (what at Health 2.0 we dub the Data Utility Layer) called Samsung Architecture Multimodal Interactions (SAMI) to accept and spit out all types of health related data.

This is all potentially very impressive. Samsung’s first two attempts at Smart Watches have fizzled, but they tend to keep coming back, and now are pretty much the best at Smart Phones. (You fan bois can keep your teeny iPhone screens!) But can they make the health related smartwatch work? I’ve three quick assessments/questions.