Above the Fold

Wellness Programs Aren’t Working. Three Ideas That Could Help.

Apr 1, 2013• 29

By MIKE MIESEN

You’d be forgiven if, after reading last month’s Health Affairs, you came to the conclusion that all manner of wellness programs simply will not work; in it, a spate of articles documented myriad failures to make patients healthier, save money, or both.

Which is a shame, because – let’s face it – we need wellness programs to work and, in theory, they should. So I’d rather we figure out how to make wellness work. It seems that a combination of behavioral economics, technology, and networking theory provide a framework for creating, implementing, and sustaining programs to do just that.

Let’s define what we’re talking about. “Wellness program” is an umbrella term for a wide variety of initiatives – from paying for smoking cessation, to smartphone apps to track how much you walk or how well you comply with your plan of care, and everything in between. The term is almost too broad to be useful, but let’s go with it for now.

When we say “Wellness programs don’t work,” the word work does a lot of, well, work. If a wellness program makes people healthier but doesn’t save lives, is it “working”? What if it saves money but doesn’t make people healthier?

Why Become a Doctor?

Mar 31, 2013• 65

By Vineet Arora, MD

Recently, I was having a discussion with a colleague about being a doctor. She confided in me that if someone asked her about becoming a doctor, she would tell him or her to become a nurse practitioner. After reading the emotional open letter to our policymakers in Washington DC, it may sound like a reasonable suggestion. After all, why go into this much debt and spend so much time in training if your prospects are not much better? More recently, the New York Times article points out job prospects for radiology trainees are thinning, meaning the well known “ROAD” (Radiology, Ophthalmology, Anesthesiology, and Dermatology) to success may soon become a road to nowhere if there are no jobs.

There in lies the question, why become a doctor? If the answer is to make money or to have an easy life, then you probably need to look for a new profession. With healthcare payment reform, doctors can expect lower salaries as bundled payment and cost cutting measures are instituted. Moreover, the demand for healthcare will go up as more patients have insurance, leading to higher patient volumes and the expectation to see more patients with the same amount of time.

Shoe-Leather Epidemiology Needs More, Not Less Funding

Mar 29, 2013• 3

By Andi L. Shane, MD

Infections from contaminated steroid injections, influenza outbreaks, destruction from Sandy, West Nile Virus, measles and pertussis outbreaks. These are just a few of the public health crises we faced down in 2012, thanks to the tireless efforts of local and state health departments. Each outbreak takes tremendous resources on top of day to day surveillance activities, but public health is now facing its own crisis of funding: The sequestration will cripple local and state public health departments. Analysts calculate an effective funding reduction of 9%, with the Centers for Disease Control and Prevention losing $350 million. While every federal agency will have to tighten its belt, for public health there are no more belt holes.

“Sequestration would impact every CDC program and could increase the risk of disease outbreaks,” Centers for Disease Control and Prevention Director Thomas R. Frieden recently told CQ HealthBeat. “More than two-thirds of our budget goes out to boots-on-the-ground work at the state and local level to find and stop outbreaks and other health threats.”

A National Caregiver Corps: What the Administration Could Do

Mar 29, 2013• 20

By Janice Lynch Schuster

Nearly 40 years ago, when I was in elementary school, a controlling teacher would issue edicts about what we could and could not do: We could not talk at lunch time, nor could girls wear shorts. In both cases, my lawyer-father encouraged me to launch petitions. I wrote a paragraph about the unfair practices, stapled together a pile of loose-leaf paper, which I circulated at recess, in class, and on the bus. After a week or so, I presented the document—perhaps 100 children had signed, and some parents—to the principal. He was unaware of the rules! And, upon hearing them, reversed them. It was my first attempt at community organizing and pushing back against a policy that was making my life nearly unbearable.

It’s been years, and I’ve occasionally signed petitions exhorting various government agencies to act—or not act—on one issue or another. But until recently, my own petition-bearing days had ended.

The Tablet Transition

Mar 29, 2013• 7

By Leslie Kernisan, MD

I purchased my first tablet a few weeks ago, and have since been thinking more about tablets for seniors and caregivers. Like many, I’ve assumed that tablet-based tools will eventually make certain aspects of healthcare easier for clinicians, for older adults, and for their caregivers. But so far I’ve found the tablet harder to use than I’d expected.

Actually, technically this is my third tablet purchase. The first was an iPad last summer, which I promptly sent back after realizing that my laptop was much better suited to supporting me in my clinical work (read my full minority report here).

The second was a Nexus 7 which I purchased as a holiday gift for my 62 year old step-father, a structural engineer. (As he’s mildly uncomfortable figuring out new-fangled technology, I set up his device and helped get him started using it.)

Now, I finally have a tablet that I’ll be keeping for myself: a Samsung Galaxy Note 10.1.

Pandora’s Pillbox

Mar 29, 2013• 16

By J.D. KLEINKE

WASHINGTON — Oral contraceptives may be small, but they are proving to be tough pills for a vast number of Americans to swallow.

Last week, the Sunlight Foundation reported that the contraception provisions of President Obama’s health reform law garnered 147,000 comments from the public — more than on any other regulatory ruling, on any subject, in the history of the nation. Really.

The unprecedented flood of comments came from a wide range of organizations and individuals who support or oppose mandated contraception coverage as part of Obamacare.

Supporters, in general, want to extend coverage for this cornerstone of women’s health; oral contraceptives are used not just for birth control, but also for the treatment of pelvic pain, irregular periods, fibroid tumors, ovarian cysts, endometriosis, severe acne, mood disorders, and excessive menstrual bleeding that could lead to anemia. Opponents, in general, want to block this extension based on religious, moral or personal objections to women using pooled insurance resources to pay for pills that enable sex-for-fun — and that can be used, as it happens, for early termination of an unwanted pregnancy.

Stepping Up to the Long-Term Care Crisis

Mar 29, 2013• 11

By Bruce Chernof, MD

It starts with a call that a loved one is in the hospital after being in a serious accident. Sometimes it comes from having chronic health conditions that minimize daily functioning as one grows older. These life-changing events present individuals and their families with a new set of needs and challenges that require a variety of human capital and financial resources to redefine and maintain daily living on their terms.

The likelihood that you or someone you love will need this kind of support is greater than you may think. While nearly all Americans hope to remain in their homes as long as possible—enjoying good health and living independently—the reality is that 70 percent of people over 65 will need some form of support to assist them with daily activities at some point in their lives, for an average of three years.

Over the next two decades, Americans will reach that milestone at a rate of nearly 8,000 a day. The older people become, the more likely they will need long-term care, and with advances in medicine and technology, we are living well into our 80’s and 90’s.

App Prescribing: The Future of Patient-Centered Care

Mar 28, 2013• 4

By Ben Chodor

Dr. Leslie Kernisan recently wrote a great piece about app prescribing, asking, “Should I be prescribing apps, and if so, which ones?” Since Happtique is all about integrating apps into clinical practice, I jumped at the chance to add to this important discussion.

Dr. Kernisan is right to be concerned and somewhat skeptical about app prescribing. More than 40,000 health apps exist across multiple platforms. And unlike other aspects of the heavily-regulated healthcare marketplace, there is little to no barrier to entry into the health app market—so basically anyone with an idea and some programming skills can build a mobile health app. The easy entry into the app market offers incredible opportunity for healthcare innovation; however, the open market comes with certain serious concerns, namely, “how credible are the apps I am (or my patients are) using?”

The Data Diet: How I Lost 60 Pounds Using A Google Docs Spreadsheet

Mar 28, 2013• 14

By Paul Smalera

The author in early 2010 and mid 2011

I’ve been thinking about how to write this story for a long time. Should it be a book? A blog? A self-help guide? Ever since I realized I’d lost 60 pounds over the course of a year and a half, I knew I wanted to find a way to talk about it, and maybe help others. This is my first public attempt.

A note about the rounding of my roundness: My peak weight, shortly after I began weighing myself in 2010, was 242 lbs. My lowest weight since I started weighing myself has been 183.2 lbs — right in line with where I should be, at 6’3″ tall. I’m sure that I weighed more than 242 lbs. at peak, but frankly, I don’t care that I don’t have the data to account for those last 1.2 lbs.

Adam Davidson’s New York Times Magazine story, “How Economics Can Help You Lose Weight,” helped organize my thinking about how to finally write this. In his story, Adam explains that the rigid protocol his doctor puts him through acts as a kind of economic incentive for him to stay on the diet. I’m highly skeptical that the special liquid meals he can only buy directly through his dietician will help him keep off the weight. I tried all sorts of diets in the many years that I was overweight and though I never tried the Adam’s solution, it doesn’t sound like a recipe for long term success. At least twice, I lost weight and then gained it all, and more, back. (Meta note: I feel terrible writing that. Adam, I wish you the best. Maybe something you read here will help you keep off the weight you have already lost, and congratulations on that difficult achievement.)

Now that I’ve managed to make weight loss sound simple, and sound smug about my success (I’ve stayed within the 183-192-pound range for more than two years now), what’s my big secret? It’s data. Just like I said in the headline, I keep a Google Doc spreadsheet in which I’ve religiously logged my weight every morning for the last three-plus years, starting on January 1, 2010, when I knew I had to do something about my borderline obesity.

Why Patient Engagement Really Matters and Why So Many People Are Getting It Wrong (50)

By ROB LAMBERTS, MD

Like many of the big ideas that catch on in business, patient engagement is an elusive idea – too often used without much thought and wheeled out at meetings as the dramatic conclusion of a Powerpoint presentation. Too bad most of the people talking about patient engagement don’t have the first idea what they’re talking about. Dr. Rob Lamberts offers us all a little remedial patient engagement training.

Ready for O’Ryancare? (76)

By J.D. KLEINKE

Wisconsin senator Paul Ryan has built a career by standing next to Medicare spending charts and waving a pointer telegenically. When Ryan released his latest plan to save the country by saving Medicare last weekend, the critics were lit. The issue? Parts of the proposal rely on the administration’s approach to insurance exchanges to keep costs down. Which makes sense, argues economist JD Kleinke, after all the whole idea was a Republican idea. But don’t quote us on that.

Five Things Obamacare Got Right-
And What Experts Would Fix (35)

By DAN DIAMOND

“You have to pass the bill so we can find out what’s in it,” Nancy Pelosi once famously remarked. Now that Obamacare implementation is officially underway, it’s become clear that lawmakers may have been – shall we say – a little optimistic about some key assumptions behind the law. Analyst Dan Diamond talked to five health care visionaries, including former CMS head Don Berwick and Washington and Lee professor Timothy Jost, about what they think Obamacare got right and what might need a little gentle tweaking.

How the Media Portrayed the
CVS Wellness Program-and Got It Wrong (47)

By GREG JUHN

The news of a controversial wellness program at CVS led to a media storm with reports accusing the chain of discriminating against employees. Unfortunately, the media got it exactly backwards, argues Greg Juhn. The drug chain has exactly the right idea. So, what’s really going on?

The State of Self Tracking (13)

By ERNESTO RAMIREZ & GARY WOLF

Early adopters are high on the data driven-potential of tracking devices and gizmos that let users collect and interpret personal health data. New products are popping up everywhere, from the Apple store to the pages of health magazines. But how many people are really using these technologies? Quantified Selfers argue the numbers are higher. Wired Editor Gary Wolf responds to Pew research on the latest statistics.