Author Archives: Hamish MacDonald
ACO’s: Creating a more efficient US Healthcare System at last?
“Obamacare” can be boiled down to three things, according to our Chairman Dr Stanley Pappelbaum; 1) HIE, 2) HIT and 3) ACOs. Whether the Republican dominated House manages to fiscally starve any or all of these “pillars” of health reform is a topic for the future, however ACOs have been around for a few years now (before the time of the current health reforms), and are already displaying some useful outcomes for the US Health System.
Accountable Care Organizations essentially incentivise physicians and clinicians to keep their clients healthy and reduce length of illness and disease by paying them a bonus share of system savings that the ACO earns for providing overall cost savings within their population base. ACOs can be created for populations of just 5,000 people or more, which is small enough to allow for some really innovative and localised ACO models to be set up to cater to the unique healthcare needs of various population subsets.
It is well accepted that a primary reason for the spiralling costs in US Healthcare year after year is due to fractured healthcare silos, where “more healthcare delivered = greater profits”. By tying together outcomes for physicians and clinicians in primary and secondary care through a “Medical Home” delivery mechanism, ACOs can potentially radically alter the existing dynamic to one where “less healthcare delivered = greater profits”. Less healthcare delivered appears counter-intuitive, but simply means providing the optimal level of care required to get people well as quickly as possible, and then keep them healthy. The integrated Medical Home mechanism of providing care within an ACO has to be a more sane approach than encouraging more and more spending amongst each of the parts.
Lifetime Health Diary™ assists in synchronizing asynchronous data between different medical silos such as pharmacy, lab tests, physicians, caregivers and patients. As such, we are looking forward to the continued growth of ACOs, and helping them deliver appropriate healthcare, in a more timely fashion, for less overall resources. Now that is something all players in the healthcare system who want better outcomes for people can an look forward to!
Yours in health,
Hamish
To PHR or not to PHR
According to the statistics in a previous post, only about 7 percent of the US population uses a Personal Health Record (PHR). The low adoption tells us that levels of patient empowerment and engagement are low, there is a lack of education about PHRs, and a lack of communication with the end-user about the benefits of using such a tool.
But let’s face it; we all live in a digital world, broadband connections are streaming across nations around the world, the level of penetration of smart phones is so high that predictions are for 1.4 billion smart phones by 2015 (that’s almost 1/3 of the world’s population!). We all read news, most of us use the internet, we are connecting with our friends through Facebook, we Twit, Digg, shop online, etc. Word of mouth is so powerful because we use these apps and tools if something new and exciting appears on the market – we definitely will twit about or ‘like’ it on Facebook, or tell our friends over the phone.
What this means for PHR vendors is that probably their products do not carry that required level of excitement and/or utility (whether usability, design, features, visible benefits, or some perks from usage) for ‘early adopters’ to start spreading the word about the product because they LOVE it. In the case of PHRs – chronic patients should be ideal early adopters. These patients are the ones who should embrace PHRs to make their life easier by executing daily health management and monitoring, better communication with care providers, storage of health data, etc. However, PHRs are not yet used extensively by these groups so obviously there is a problem with current PHRs.
Seems to me people do not need just another PHR, but more than that; a collaborative care tool, wellness, networking, goals, rewards, health and medication info, ease of use, beneficial features, privacy, lab tests and results automatically downloaded. Users are clever when it comes to adopting technology that helps them with some aspect of their life. if something adds value to daily routines — they will jump on the product!
And what’s the bet that we don’t end up calling it a “PHR” in the end…
Yours in health,
Hamish
Why Drugs Don’t Work. Adherence, Compliance and MTM
“These Drugs don’t work”. We hear that all the time. Yes, some of them unfortunately don’t. However, most of the time drugs do not work simply because they do not interact in a beneficial way with each other. Secondly, the majority of patients do not adhere (only 25% of patients take their medications exactly and for as long as prescribed (American Hearth Association: Statistics you need to know.). The other 75% cost the healthcare system up to $290 billion in avoidable costs (The New England Journal of Medicine ).
For these 2 reasons, drugs don’t work. The question is really why do these two reasons exist in the first place? When the drug is prescribed relatively few health professionals discuss with their patients possible interactions with other medications or herbal supplements (for example, a survey of 100 patients taking the anticoagulant warfarin found that 69% of patients take of some kind of herbal or dietary supplement, but only 35% report that their healthcare provider asked them about supplements).
And why do patients not adhere? Although I am not an expert in the field, my homework in this area indicates a lack of medication reconciliation on the clinician side and lack of incentives on the patient side, further fueled by a lack of education and guidance from the experts (including pharmacists and providers).
The first problem, medication reconciliation, is well summed up by a recent post by John Halamka about Smart Medication Reconciliation and Problem Lists: patients (his parents) received unnecessary medications as well as did not receive necessary ones because of the challenges of retrieving their history of active as well as non-active medications. Disparate data silos across our healthcare systems DO NOT talk with each other: Neither physicians nor pharmacists are able to grasp the whole picture of a medication history; herbal supplements taken by many are not discussed with the healthcare provider; discharged inpatients do not discuss the medications s/he is still on with their local physician/pharmacist who prescribes and dispense new drugs, etc. etc. – there are many examples of how different databases do not exchange patent’s related and holistic health information.
The problem of non-adherence comes down to a lack of communication, guidance, education, and support, as well as lack of time, human resources, an inappropriate reimbursement system and lack of “smart” technical tools to assist and help the providers. Communication, guidance, education etc. can easily be performed by a community pharmacist – a certified provider who often already has a personal relationship with his/her patients.
“Smart” decision-support tools available to the pharmacist, ongoing personal/phone communication and follow ups, medication review/reconciliation/optimization/suggestion, educational materials, support 24/7/365 through alerts going directly to the provider, a shift from time- and cost-inefficiency, labour-intensity and limitations of current MTM (Medication Therapy Management) services to a comprehensive, outcomes-based, personalized therapy which considers lifestyle and wellness factors while determining the most appropriate therapy. A wise and timely combination of all these activities will deliver results: improve adherence (reducing overall healthcare costs) and better health outcomes while putting the pharmacist – a trained medication professional – at the forefront and letting him/her effectively utilize valuable skills for the benefit of all the parties involved.
Yours in health,
Hamish
Drugs, surgery and (sometimes) psychiatry. It isn’t enough!
One of the members of our Advisory Board, Dr. Stanley Pappelbaum (former CEO of Scripps hospital chain in San Diego, California) has a very succinct way of putting things.
Sometimes it can seem as though there are so many treatment paths in medicine, that it all gets overwhelming. However, as Stan says,
There are essentially just three interventions in medicine; drugs, surgery and sometimes psychiatry.
The implications of this simple statement are quite profound. Given that 75% of cost of the US Healthcare system is now due to chronic illness and disease, how much of this figure can be helped by drugs, surgery and psychiatry? By the time you need these interventions for chronic illness in a very real sense it is too late; you already have it!
This reminds me the number of 6,000+ billing codes in the US Healthcare system related to reimbursement for procedures that are given for prevention; zero!
This all gives one pause to think, doesn’t it?
Yours in Health,
Hamish
Unraveling the US Healthcare Puzzle
It has been a couple of weeks since the last time I updated the blog – lots of going on here, traveling around the US, and uncovering new problems/opportunities in the US healthcare system, meeting new people and attending a few other conferences besides Health 2.0 in San Francisco.
A few days ago I attended some sessions at the AdvaMed Convention in Washington DC. Really enjoyed a session at the NZ Embassy with AdvaMed participants as well as attending the International Delegates Forum where 30 odd companies got a chance to introduce themselves and facilitate networking and possibilities of new partnerships. Even though most attendees were from the medical device industry, AdvaMed was an excellent place to learn about new emerging technologies, problems those devices are trying to solve and find possible synergies for LHD with some of them. Was impressed by how NZTE (New Zealand Trade and Enterprise) are doing an excellent job of helping NZ innovative companies attain entry into the US market, get them up to speed with current legislation and obstacles, and expand their networks.
After that was the NCPA Convention (National Community Pharmacists Association) in Philadelphia. It was an excellent expo and invaluable day spent walking around, talking with people, learning more about Medicare Part D and MTM (Medication Therapy Management), discovering that it is such a new and therefore quite flexible market with so many opportunities and ways to go particularly in MTM services and retail chains. Everyone I was talking to are seeing retail chains being a new “one stop shop” for all kinds of healthcare services including receiving healthcare and medication review/optimization services. Lots of going on in this area, though it still seems to be quite vague in terms of best practices (probably a good thing in terms of opportunities). The main problem though is still reimbursement, i.e. who pays the pharmacist or any other qualified care provider for MTM services? And how much ? (especially taking into account all the complex cases where chronic or elderly patients are on multiple medications, and the review/reconciliation/risk management, optimization for complex cases can take over 2 hours while providers are reimbursed maximum for 1 hour, etc). I was able to meet with a few market leaders in the industry, and got very good insights.
Last stop before I head back to NZ is San Diego. Seems like my company is moving in the right direction and I have some interesting developments to announce soon in terms of our US operations and business. On November 3 I arrive in Wellington, NZ to attend the annual HINZ conference - the major NZ exhibition for Health IT. I am very much looking forward to that. As some of you may know NZ is a very innovative country yet with a small market NZ companies need pipelines to enter the vast US market. These past 4 weeks in the USA have gone a long way to creating our own pipeline for LHD into the US market.
Yours in health,
Hamish
Health 2.0 Conference Highlights
It was a very patient-oriented conference. Intense, collaborative and lots of social networking. The “Patient 2.0” session concentrated on themes such as how to engage a broader population in healthy life. Behavioral change. Connecting with real people using their language. ROI on the patient, outcomes, data…
The entire conference was full of innovation. Many young companies with clever and promising ideas. Doubtful as to whether the ecosystem can support all of them, but some will end up being transformational. For example, many companies were focused on consumer compliance for medications, which is an area that has been worked on for 30 years, with mixed results.
Using aggregated data; the US Government is very keen to open data to the public, Health and Human Services CTO Todd Park is a driving force behind making that happen. Making sense of narrative data is a challenge for now, but everyone looks forward to that.Transforming data to information to knowledge to action. Ron Zeiger of Google Health spoke about
“Finding an easy and fun way to collect data, open systems. Collaborative Health Records”.
There was an excellent Venture Capital Panel (Don Case, Esther Dyson, Lisa Suennen, Mitch Kapor, Bryan Roberts) at the end of the 2nd day: About half seemed not overly keen in investing in health IT (Esther was a notable exception) because it is still a rather vague industry and the ROI is often not immediate. However, Esther Dyson made some telling points; the Health IT world has changed because ubiquitous mobile technology and ubiquitous sensors are disruptive forces that allow creators to go straight to patients and clinicians with their products and services, bypassing hospitals and bureaucratic health systems.
It was invaluable to hear some of the great advice from the investors, such as 1) tell the story about your company, why it matters, what will it do for the system. 2) Short but deep advice from Esther:
“Be imperfect”, read VC suggestions before approaching them; “Be considerate of what the other person wants to hear, not what you want to tell”.
Overall, it was a great event to attend, get a feeling for the industry, meet with innovative, visionary people, chat formally and informally, brainstorm and develop new ideas. Looking forward to keeping in touch with everyone!
Yours in health,
Hamish
Health 2.0 Conference
Our theme today is the Health 2.0 Conference, taking place this week in San Francisco.
I will be in San Francisco Oct 6-10 for Health 2.0
San Diego 10-14 (Biotech and Pharma)
DC / Penn / NY? And Boston? 15 – 24
The conferences I hope to attend in this time include AdvaMed, Connected Health, and maybe the NCPA 112th Annual Convention and Trade Exposition
Health 2.0 – is the first on the list. Katerina and I will attend the Patient 2.0 session on Wednesday:
Time: 3pm-6pm, October 6
Place: San Francisco Hilton
Advocates include:
- Regina Holliday, Medical Mural Advocacy Project
- Amy Tenderich, DiabetesMine
- Nicole Boice, The Children’s Rare Disease Network
- Ian Eslick, MIT Media Lab
- Gary Wolf, Quantified Self
- Gilles Frydman, ACOR
- ePatient Dave de Bronkart, Laugh, Sing and Eat Like a Pig
- James O’Leary, Genetic Alliance
There will be a stream of tweets, the conference official hash tag is #health2con. Katerina will be tweeting updates as well from @katekson
- Here is the agenda
- This year’s main theme is “the emergence of the data utility layer”, which will include the changing landscape of Healthcare, social media, patient empowerment through knowledge, self-tracking and engagement.
- I am looking forward to the demos by new companies, commentaries from leaders in the industry on different issues such as data mining and analyzing, patient communities, consumer-centric healthcare etc. I should be in San Francisco until late Saturday.
By the way, good news…we finally finished applying for patent in the US, and are pleased to announce our new B2B product LHD MedView™ – which we will be looking forward to talking about with people during the conferences. Here is link to our info sheet for this new product
I am really excited and looking forward to connecting with people in the US the next 3 weeks. We’ll be posting blog updates every other day or more often directly from the conferences.
Yours in health,
Hamish
Solving the Unsolvable? Putting Pharmacy data in front of everyone at once
You would think Pharmacy data would be easy – after all, how difficult can it be to capture a person’s medicine regime and display it to the health professionals who need to see it?
Well, if the physicians, pharmacists and specialists are all on different software and systems, and the patient has no access at all, it is close to being unsolvable.
Thanks to sterling support from the pharmacists and pharmacologists in New Zealand we have been working with, we have managed to convert pharmacy data into not only a more easily comprehendible display, but allow that display to be viewed in real-time by any health professional the patient chooses to authorize. Yes, that’s right; the patient owns the record, and is able to authorize the relevant health professionals to view it. With clinicians in New Zealand, we are collecting initial consent from the patient at community pharmacies, which are motivated through the writing of regular prescriptions to have repeat customers collect medications at their store.
The more we work on this, the more we find out the problems people are having with the current system that keeps patients effectively in the dark. We are creating a small brochure to describe LHD MedView™, and the printer who we are using for the job spent a few minutes telling me about his wife who is on a real cocktail of medicines, hardly any of which he could remember as she was whisked to hospital suddenly a couple of weeks back. It also turned out that when her regime was analyzed, it was not optimal to begin with and the hospital instigated a number of changes. Changes which her next GP visit will probably not have easy or even any access to!
It is staggering to think how much inefficiency, wastage and suboptimal outcomes occur simply because patient’s medicine regimes are not well stored nor tracked, nor optimized over time.
We are very happy to be able to release the beta of our new product, LHD MedView™, which we hope will go some way to help solving these issues. I will write about LHD MedView™ next week – I should also be able to include a live link to the product by then as well.
There are quite a few acquaintances in the USA waiting to see this product, so next week I will jet off to the USA to visit them. If you are in or near San Francisco, Los Angeles, San Diego, Washington DC or Boston area (possibly NY too), then let me know. I would be happy to meet up to chat a bit more about it and find out if it can be of benefit for you.
Yours in health,
Hamish
Tools to assemble all the pieces of primary care data together – Part 2
Last Thursday (see my post from last week) I gave a talk to the General Practice Research Group at Otago University. one of the two main medical schools in New Zealand. It was a really interesting discussion, with much the interest being centered around providing General Practitioners with the ability to view medication regimes in a more easily and quickly comprehensible format.
There was also interest in using Lifetime Health Diary™ in extreme patient cases, where it can be difficult to draw up a complete patient background and keep track of it – particularly when a patient is seeing multiple practitioners and specialists. Some of the GPs present said they would like to try using it with some of their “problem patients”.
Perhaps unsurprisingly, there was also interest in Lifetime Health Diary™ assisting with smoother handoffs between different care settings and providers (including a better follow up and communication tool after discharge). One concrete example mentioned of interest was helping community pharmacies reconcile health and medication regimes of patients and providing a strong link between nursing homes, GPs and pharmacists. In other words, a genuine Health Reconciliation Tool.
This ties in strongly with another theme of interest – Distance Medicine and Rural Health. Rural pharmacies, as the only dispensary for many miles around, have the potential to serve as a pure source of community pharmacy usage – unlike in cities, where consumer choice in using any pharmacy creates data silos between patient and the various pharmacies and GPs they frequent.
I look forward to being able to release the view of our new medication optimisation tool in the next few days, I will post that on next week’s blog, and discuss why clinicians we have spoken to are looking forward to using it.
Yours in health,
Hamish
Tools to assemble all the pieces of primary care data together
This coming Thursday I give a talk to the General Practice Research Group at Otago University.
Otago University is one of the two main medical schools in New Zealand, and is highly regarded internationally for its innovative research and education of top class clinicians.
Some of the General Practitioners in the Department have expressed interest in Lifetime Health Diary™, especially as we are now beginning to be used on the ground by registered nurses in community health settings. Anything that can alleviate pressure points in healthcare delivery, particularly around early interventions and patient engagement, is something of interest to General Practice and I look forward to the opportunity to demonstrate what our product can do.
Topics I will be covering will include…
- How to improve communication between patient, community care provider & General Practitioner.
- Smoother handoffs between different care settings and providers (including better follow up and communication tool after discharge.
- Provide better and quicker understanding of poly-medication regimes.
- Medication Optimisation and measuring patient progress by regimes.
- Health Reconciliation Tool between rest homes, GPs and pharmacists.
- Distance medicine / Rural health.
- Green prescriptions (i.e. exercise and lifestyle recommendations), patient health management & patient safety.
- Preparing for the upcoming 40-year bulge of aging Baby Boomers
I look forward to writing up some notes about GP reaction, comments, and generally what happened at the talk next week.
Yours in health,
Hamish
