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A Patient Advocate’s Tips for Creating Equity | Gillian Mason, University of Newcastle

By JESSICA DAMASSA, WTF HEALTH

Imagine working full-time, finding health services, visiting multiple clinicians a week, and coordinating your health information. This is the reality of patients with one or more serious health conditions. Patients can have a lot on their plate, and sociocultural factors are often the cause to why patients may not follow their doctor’s orders. That’s why Gillian Mason, patient advocate and physio-rehabilitation researcher at the University of Newcastle, emphasizes looking from the patient perspective. How does she think we can better enable patients’ access to health services? Is the answer from Australia (and its nationalized healthcare system) DIFFERENT than it is when you ask patients in the U.S.? Tune in to find out!

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

Consumerism, washing machines, big data & health care

“all your stuff works together” Really!

By MATTHEW HOLT

Those of you who remember my BestBuy washer & dryer installation saga from a couple of weeks back may want to gird your loins. Because the saga continues. And it has even more relevance for consumerism in health care. So catch up on the prequel and come back.

When you left the story your hero had just arranged for Best Buy to attempt delivery on Tuesday afternoon last week. I was in SF for the “can’t miss” Rock Health Summit. I was waiting at the apartment when I got about 4 calls from the same random number in 3 minutes but when I answered no one was there. I called back, no answer. Then I got a voicemail saying the delivery team was outside. I ran outside! No they weren’t! At that point I gave up and had lunch. But then for now the 5th time I called Best Buy and lined up a new delivery. I stressed about 10 times that the delivery team could NOT leave next time without seeing me. There may have been some shouting…..

Monday was the next available day for delivery and it was day that Best Buy was going to finally get it right. I got an email saying they’d be there at 1.30pm

I was across town in a meeting at 12.30 and noticed 4 missed calls from the same number. Being of a very suspicious nature, I called the number, and yes it’s the delivery team. They were outside the apartment, and they were 60 mins early!  Thankfully the delivery crew agreed to wait, and I went over to meet them. So at 6th time of asking, the crew was there, the equipment was there, I was there, and we all went into the apartment.

What could possibly go wrong!?

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Primary Care Is at the Center of a Health Revolution

By KEVIN WANG, MD

If our urgent-care-as-healthcare culture isn’t killing us, it’s certainly wasting our time and resources. 

Consider these facts highlighted by Advanced Medical Reviews, based on various studies: 

  • U.S. physicians report that more than 20 percent of overall medical care is not needed.
  • The Congressional Budget Office recently estimated that up to 30 percent of the costs of medical care delivered in the U.S. pay for tests, procedures, doctor visits, hospital stays, and other services that may not actually improve patient health.
  • Unnecessary medical treatment impacts the healthcare industry through decreased physician productivity, increased cost of medical care, and additional work for front office staff and other healthcare professionals.

Most of today’s primary care is, in retail terms, a loss leader — a well-oiled doorway to the wildly expensive sick care system. For decades, practitioners have been forced into production factories, seeing as many patients, ordering as many tests, and sending as many referrals as possible to specialists. Patients, likewise, have avoided going in for regular visits for fear of the price tag attached, often waiting until they’re in such bad shape that urgent (and much more expensive) care is necessary.

The system as it stands isn’t delivering primary care in a way that serves patients, providers, employers, or insurers as well as it could. To improve health at individual and population levels, the system needs to be disrupted. Primary care needs to play a much larger role in healthcare, and it needs to be delivered in a way that doesn’t make patients feel isolated, neglected, or dismissed. 

Luckily, primary care is making a comeback — the kind that doesn’t just treat symptoms, but sees trust, engagement, and behavior change as a path to health.  

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How are hospitals supposed to reduce readmissions? Part II

By KIP SULLIVAN, JD

The notion that hospitals can reduce readmissions, and that punishing them for “excess” readmissions will get them to do that, became conventional wisdom during the 2000s on the basis of very little evidence. The Medicare Payment Advisory Commission (MedPAC) urged Congress to enact the Hospital Readmissions Reduction Program (HRRP) beginning in 2007, and in 2010 Congress did so. State Medicaid programs and private insurers quickly adopted similar programs.

The rapid adoption of readmission-penalty programs without evidence confirming they can work has created widespread concern that these programs are inducing hospitals to increase utilization of emergency rooms and observation units to reduce readmissions within 30 days of discharge (the measure adopted by the Centers for Medicare and Medicaid Services [CMS] in its final rule on the HRRP), and this in turn may be harming sicker patients. Determining whether hospitals are gaming the HRRP and other readmission-penalty schemes by diverting patients to ERs and observation units (and perhaps by other means) should be a high priority for policy-makers. [1]

In Part I of this series I proposed to address the question of whether hospitals are gaming the HRRP by asking (a) does research exist describing methods by which hospitals can reduce readmissions under the HRRP and, in the event the answer is yes, (b) does that research demonstrate that those methods cost no more than hospitals save. If the answer to the first question is no, that would lend credence to the argument that the HRRP and other readmission-penalty schemes are contributing to rising rates of emergency visits and observation stays. If the answer to second question is also no, that would lend even more credence to the argument that hospitals are gaming the HRRP.

In Part I, I noted that proponents of readmission penalties, including MedPAC and the Yale New Haven Health Services Corporation (hereafter the “Yale group”), have claimed or implied that hospitals have no excuse for not reducing readmission rates because research has already revealed numerous methods of reducing readmissions without gaming. I also noted many experts disagree, and quoted a 2019 statement by the Agency for Healthcare Research and Quality that “there is no consensus” on what it is hospitals are supposed to do to reduce readmissions.

In this article, I review the research MedPAC cited in its June 2007 report to Congress, the report that the authors of the Affordable Care Act (ACA) cited in Section 3025 (the section that instructed CMS to establish the HRRP). In Part III of this series I will review the studies cited by the Yale group in their 2011 report to CMS recommending the algorithm by which CMS calculates “excess” readmissions under the HRRP. We will see that the research these two groups relied upon did not justify support for the HRRP, and did not describe interventions hospitals could use to reduce readmissions as the HRRP defines “readmission.” The few studies cited by these groups that did describe an intervention that could reduce readmissions:

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Apply to Pilot your Tech and Transform Mental Health Services in California!

SPONSORED POST

By CATALYST @ HEALTH 2.0

According to the California Health Care Foundation, from 2012-2014, nearly 20% of Californian adults who sought mental health treatment did not receive it. It is believed that these figures may even be understated, as The Substance Abuse and Mental Health Services Administration (SAMHSA) has cited that nearly 60% of American adults with mental illness do not receive any treatment. Unmet mental health needs in California are attributed to a lack of access to appropriate services and providers, as well as the cost of care, a factor that is often exacerbated by a lack of health insurance.

While traditional mental health services play an important role in supporting those in need, novel technologies can complement standard care delivery and provide individuals and communities with more accessible and optimized mental health services that focus on prevention, early intervention, family support, and social connectedness.

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Health in 2 Point 00, Episode 96 | Amazon Care, Echo, OneDrop & more

Today on Health in 2 Point 00, Jess and I catch up on loads of news in health tech. In this episode, Jess asks me about Amazon Care, doing telehealth, house calls, urgent care, drug delivery for their employees—could it change health delivery? Also, Eko raises $20 million for their smart stethoscope; Bayer leads a $40 million round for OneDrop’s blood glucose meter; GoodRx buys telehealth company HeyDoctor; Rock Health investing $10M in InsideRx, and an undisclosed amount to Arine; and Peloton IPO’s today and everyone’s looking at it as a healthcare company (but no, it’s not). We end on some gossip, so tune in. —Matthew Holt

The Opportunity in Disruption, Part 4: Success Strategies for Provider and Payer CFOs

By JOE FLOWER

The system is unstable. We are already seeing the precursor waves of massive and multiple disturbances to come. Disruption at key leverage points, new entrants, shifting public awareness and serious political competition cast omens and signs of a highly changed future.

So what’s the frequency? What are the smart bets for a strategic chief financial officer at a payer or provider facing such a bumpy ride? They are radically different from today’s dominant consensus strategies. In this five-part series, Joe Flower lays out the argument, the nature of the instability, and the best-bet strategies.

Providers:

  • Cost. Get serious control of your costs. Most providers I talk to are dismissive. “Yeah, yeah, you’ve been saying that for 10 years. We’re on it, believe me.” But I don’t believe them. Observation of the industry makes it clear that most healthcare providers have not gone after costs with nearly the ferocity of other industries. Some providers that I have worked with and interviewed over recent years have gotten their full cost of ownership down to a level where they can survive on Medicaid rates (that’s not a typo, I mean Medicaid) and build bigger, stronger systems at the same time. They have proven it can be done. But this is far from the industry norm.
    In the new competition, getting your costs seriously down is not the way to win. It’s just the price of admission. In the new competition, any entity that can deliver any particular service at a lower price will steal that business from you. You need to be that entity.
  • Overtreatment and waste. Do a deep and honest analysis of how much of your book of business is actually not effective, not necessary, does not deliver value or satisfaction to the customer—because that book of business is likely to wither away under alternative financing arrangements. Keep in mind that among various studies, the low estimate of how much of healthcare delivers no real value to the customer (an estimate by doctors about their own specialties) is 20%. The high end (in a PricewaterhouseCoopers study) is 54.5%. Most studies and estimates cluster around 35%.
  • Abandon monopolistic practices. An “all system” fee-for-service contract hidden from public scrutiny is smart, but not wise. It may help this year, maybe next year, but in the longer run it creates vulnerability to political attack, legislation, and lawsuits, and also to shifts in the market. A semi-monopoly position allows you to charge a premium for your products, but it locks you into that ability to charge a premium. As the market shifts and finds ways around paying high prices, you will find that you will be forced to compete at the lower prices, but you will not have developed the partnerships, the strategies, and the product lines to do that. If there is no competition in your area, then compete with yourself to forestall lower-cost competition developing.
  • Birth your competition. The growth area in the new healthcare competition will be: “How to cut into the hospital’s bottom line by keeping people out of the hospital.” The most competitive business models in healthcare will be in the business of cutting off hospitals’ revenue streams upstream.
    Get into this business model, even if you are a hospital. Especially if you are a hospital. Get into this business and get better at it than any potential competition. Create high-performance bundled programs with deeply managed costs well below the industry median. Get into contracts with large buyers for particular niches in which you give financial and quality performance guarantees. If you can’t guarantee that you can drop the cost and improve the quality, you will lose that business to someone else who can show that track record and give that guarantee.
     
    Put yourself into all the business models that are disrupting you, such as outpatient clinics, community clinics, mobile vans, mini-hospitals, stand-alone emergency departments, onsite clinics, personalized management of complex cases, direct-pay primary care and others. Make these businesses able to compete for market share by unshackling them from hospital pricing and facilities fees.
     
    Risky? Sure, but you do not want to end up being just the super-expensive job shop at the end of the line that every single customer and buyer is making every effort to avoid.
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Healthcare’s ‘Copernican Moment’, Value-Based Health & The Future| Lucien Engelen, Transform.Health

By JESSICA DAMASSA, WTF HEALTH

Is a de-centralized, democratized tech-enabled health system closer than we think? Lucien Engelen, CEO of Transform.Health and Fellow for Deloitte Center for the Edge, talks about the Copernican moment in healthcare: when the industry realizes the world revolves around the patient and NOT the health system. How are the Big Tech companies like Apple, Amazon, and Google (who are sooo good at giving us what we want, when we want it, from the palm of our hand) helping to shift this reorientation of universal order and better empower health consumers? Listen in to find out….

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

A Change Management Guru’s Guide to Working with Clinicians | Dr. Margaret Kennedy, Gevity Inc.

By JESSICA DAMASSA, WTF HEALTH

One of the biggest challenges clinicians face in delivering good care is keeping up with today’s up-and-coming revolutionary health technology. Dr. Margaret Kennedy, Chief Nursing Informatics Officer at Gevity Consulting, is often charged with helping health systems change clinicians’ perspectives when it comes to digital health and tech. So, what has she learned? Among other things, it turns out that some clinicians are more inclined to accept technological change than others. Are there certain traits these ‘early adopters’ have in common? Or does it have to do with the way the healthcare organization sells the tech’s value prop? Hint, hint: You can never go wrong when you can appeal to a clinician’s desire to provide better care.

Filmed in the HISA Studio at HIC 2019 in Melbourne, Australia, August 2019.

Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew HoltGet a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.

AI competitions don’t produce useful models

By LUKE OAKDEN-RAYNER

A huge new CT brain dataset was released the other day, with the goal of training models to detect intracranial haemorrhage. So far, it looks pretty good, although I haven’t dug into it in detail yet (and the devil is often in the detail).

The dataset has been released for a competition, which obviously lead to the usual friendly rivalry on Twitter:

Of course, this lead to cynicism from the usual suspects as well.

And the conversation continued from there, with thoughts ranging from “but since there is a hold out test set, how can you overfit?” to “the proposed solutions are never intended to be applied directly” (the latter from a previous competition winner).

As the discussion progressed, I realised that while we “all know” that competition results are more than a bit dubious in a clinical sense, I’ve never really seen a compelling explanation for why this is so.

Hopefully that is what this post is, an explanation for why competitions are not really about building useful AI systems.

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