Lifetime Health Diary
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
Redesigning Medical Data
We all know information is a powerful tool, particularly when it is displayed in a way that informs, educates, engages and eventually leads to behavior change. We all know when crafting a Power Point Presentation we need to keep in mind our audience and tailor it accordingly to their needs if we want appeal to them and convince them. Techniques we are using for information presentation have become second nature and utilize the latest software developments…However, when it comes to health and medical information we rely on old-fashioned and outdated ways to display and share the information, ways that neither inform or educate and most often are time consuming for both the patient and health professionals.
When it comes to redesigning health and medical data, I would like to refer to Thomas Goetz talk during TED Conference back in October. While I may not agree with some points, overall I do believe Goetz outlines an interesting and timely solution which may lead to patient’s behavior change, and eventually improve health outcomes…
An informed patient is an armed patient.
New “body browser” tool
Got a sneak preview of a Google tool called “Body Browser” thanks to Desiree Miloshevic from #webGLCamp2 .
Watch the video.
Now how do you think this might fit into the Lifetime Health Diary App?
Suggestions Please
Awareness drives health improvements
As with so many other things in life, improved awareness can make a positive change to your health.
Here’s a nice study where US barber shops installed blood pressure check machines and it was found that for men with hypertension, their conditions improved if they chose to get checked after their haircut.
Sounds trivial – but there’s an expense in the machinery which is paid back in the health outcome.
LHD hopes to harness the same effect by encouraging tracking and management of personal lifestyle and health. We are working particularly on community care situations at present…. hopefully we can give you news of a trial using community nurses soon.
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
Did you know that… Health 2.0 NYC Meetup recap
Did you know that since 2006 health category searches have been outpacing overall internet search growth by almost 4 times? Did you also know that Americans conduct over 651 Million health related searches a month? – Well, me neither until I got a chance to view a presentation by John Mangano from ComScore during the Health 2.0 NYC meetup last Thursday. (A BIG THANK YOU to Alex Fair for organizing this monthly meetup event, having great presenters (always exciting to see new companies joining the industry) and keeping it always interesting).
Not that I was surprised to see the figures, yet, it was quite interesting to find out that Americans prefer online search resource to family/friends opinions and advices when it comes to healthcare.
Below I included few pictures with slides presented by John about physician and patient behavior online
I just wonder though if 80% of Americans refer to online search when it comes to health, why does the adoption of PHRs remain so low (~7%)? (taking in account availability and variety (cloud-based, mobile apps, with/without automatic uploads, alert, etc.) of these tools
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
Health should not be a burdensome task on our daily “to-do list”
A year ago I knew nothing about our healthcare (besides few facts such as having to co-pay $5 every time I visit my dentist and having to wait for my appointment for at least 1 hour before I see a nurse for 5 minutes and my physician for another 3 minutes). But look at me now: I read healthcare and HIT news daily (not that I understand 100% everything. Well… in my defense, our Healthcare system is too complicated and disconnected that it makes it difficult to digest all the current news), with the same frequency I visit patient advocate blogs, I twit recent news, I tell my friends about PHRs and EHRs (not that they understand what I am talking about. As other 93% of our population they are too busy with a daily routine, and thinking of taking another responsibility such as engaging in their own health makes them feel overwhelmed), I attend monthly Health 2.0 Meetups in NYC where tech savvy and passionate about healthcare people discuss current issues, present demos of new patient-centric tools and connect to each other; I also attended Health 2.0 Conference in SF in October (where I had a pleasure to meet even more people passionate about healthcare transformation, and where I got to see demos of even more patient-centric tools).
However, this is my experience. I probably would not be engaged in healthcare and my own health unless I gotten evolved in the company where I am at now. Look at my friends – they still do not understand what I am doing and why do they need having their health records available to them all the time wherever they are. (Yes, they like to use a few iPhone apps which help them track fitness and diet progress though). They just do not get it! And looking at the current statistics most of our population does not get it either (e.g. only 7% currently use PHRs).
What it tells me is this is a time to finally start rolling out campaigns directed on the patients (I purposely do not use “consumers”) to bring awareness, education, engagement and, finally empowerment. Health is local - so let’s start educate and talk to people at where they are at now, talk to them in their “language”, show the demos of available patient-centric tools to them, let people know that no doctors will help them to be healthier unless they make a decision themselves to do so. Health should not be a burdensome task on our daily “to-do list”. It should rather be an enjoyable part of our daily lives (taking in account all these cool HIT gadgets available our there, and, yes, people actually like cool gadgets – we just need to be aware of them) reducing the stress, time and money spent on the doctors, preventing preventable diseases and helping us create healthy, engaged and conscious population.
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
