• The First Mile on the Marathon of Reform

    Posted over 4 years ago
    by pnblog}

    Last June, I became a regular contributor to The Washington Post’s “Health Care Rx” blog, which provided space for me and other experts from across the industry to comment on the current state of the health system and offer real-world insights into how to improve health care. Now, given the recent passage of health reform legislation, the blog will come to a close. The final question came on Monday:

     

    This week, President Obama plans to sign into law a budget "reconciliation" bill that includes the final changes to the new health-care overhaul. What is your assessment of the now-complete health law and its implications for the future?

     

    My response, The First Mile on the Marathon of Reform, is below:

     

    The mainstream reform debate has been primarily focused on access -- the millions of Americans who don't have insurance. We heard heartbreaking story after heartbreaking story day after day for nearly a year. And this bill tackles that enormous problem!

     

    But there are the other big problems -- skyrocketing costs, misaligned incentives, inferior and inconsistent care, and so on -- all stemming from the fact that our health delivery model has remained what is essentially an acute, episodic care business model from the 19th century; a traditional fee-for-service model based on patients visiting hospitals and physicians' offices when they're sick. We have a system that hasn't evolved to keep up with the way our nation's health has changed -- toward chronic care. Nor has it progressed to use health data in an effective way to drive better decision-making and improved methods. It's not set up to enable the kind of broad-scale innovation and consumer-focus that has transformed nearly every other industry that touches our lives. Nor is it poised to keep up with and take advantage of advances in medicine, especially to deliver on the promise of personalized medicine.

     

    In the context of these massive structural problems, while the bill is a positive step forward, it seems like it's just the first mile on the marathon of reform.

     

    There are other good "ideas" from "experts" in the bill besides access to address some of these problems -- an Innovation Center within CMS to pilot payment reform, a Patient-Centered Outcomes Research Institute to identify and carry out national research priorities to drive "evidence-based" medicine, a Medicare shared savings program to pilot cost-savings for accountable care organizations, and so on. But these will require doing a fundamentally better job of running pilot and demonstration programs in Medicare. Right now, we evaluate the reforms over 8 to 10 years. We need to lower that dramatically to accelerate the path for these ideas to 'scale' and become common practice -- driving the kind of wholesale transformation needed.

     

    Most people recognize that it will take several years to get reform "right"-- we have an opportunity to do even more to drive innovation and shift the system to drive real value for every dollar spent. I hope that we will continue to work at driving the right combination of structural change, innovation, and use of technology to create a better system for our generation and those to come.

  • The Ups and Downs of Managing my Own Health

    Posted over 4 years ago
    by pnblog}

    I learned about the importance of diet and health very early in life as my Dad had his first heart attack when I was 12, and subsequently, my Mom made dramatic changes to our 1960’s diet at home.  Since my college years, I’ve always been a bit of a health nut -- careful with my diet and disciplined about working out.   During my 30’s and 40’s, I relied on my supposedly high degree of exercise/fitness to manage my cholesterol levels…while my older brothers started on statins in their late 30’s.  One of my brothers warned me that everything gets harder after 50, so I focused on continuing to make a combination of subtle shifts in diet, stress and exercise, which have led to my chart below -- from the Mayo Clinic Health Manager. 

     

    Just about Christmas time last year, the trend wasn’t looking good, so my doctor strongly suggested starting on statins (he’d been suggesting it regularly in the past but had left it up to me).  I’d heard a lot about taking them versus not -- but I thought the pros and cons were especially well summarized at a panel on which I spoke at the Partners’ Connected Health Conference in Boston.  John Halamka, John Glaser, and I were on the panel, and an audience member posed a question about tools to do research and manage one’s health -- I can’t quite remember it specifically -- but I do remember the specifics of the answers from the two John’s -- two distinctly different answers.  John Halamka talked about how his doc had suggested statins, but after doing some research, he decided to pursue a difficult personal course of action -- to shift his behaviors, change his eating habits, lose weight, and exercise more.  He actually became a vegan -- quite a dramatic shift!  John Glaser, on the other hand, didn’t want to give up his burger, so he chose the med route.  And BOTH are doing well! 

     

    For me, I decided to try the Halamka route.  For the past three months, I’ve aggressively modified my diet -- cutting out eggs and red meat, eating oatmeal every morning, eating lots of green vegetables, salads and chicken for dinner.  My doctor and I had agreed on a three month retest, and I just got my results back, which are reflected in the chart below.  While I have reversed the trend and have bent the curves in the right direction, I still need to work on improving my LDL levels, which are not yet where they need to be to lower my risk levels.  However, I am still not yet prepared to start a statin regimen.  It seems clear that my DNA and biology create higher than ‘recommended’ cholesterol levels -- the question though -- is this fact creating a potential health problem or not?  I wish the genetic understanding and testing had reached a point where it could definitively answer this question!

     

    Peters cholesterol tracker

     

  • Going Beyond Insurance Reform

    Posted over 4 years ago
    by pnblog}
     

    This week's question for the Washington Post Health Care Rx blog was:

     

    Last week, President Obama admonished insurance company executives for excessive rate increases. He is taking aim at them again in his speech in Philadelphia right now. How much of our problem rests with insurance companies and how much is the result of other facets of the health-care system?

     

    My response, Going Beyond Insurance Reform, is posted below. 

     

    In 2009, the United States spent an estimated $2.5 trillion on health care. That same year, the profits for the top five for-profit health insurance companies totaled around $10 billion, generally 3-4 percent of their revenues -- a fraction of total health-care costs. So, while insurance reform is important, fixing our health care system will clearly require more.

    We need to think more broadly about redesigning today's health-care system to drive innovation, better value and improved outcomes to be able to increase access. Our current system is based on a fee-for-service model that primarily addresses acute care issues versus today's health concerns, which are dominated by chronic conditions. The CDC estimates that more than 75 percent of America's health-care costs stem from six chronic disease states. And the number of people with chronic diseases continues to rise. Today, about 133 million Americans (nearly half of all adults) live with at least one chronic illness - and most chronic diseases require a lifetime of ongoing care. As the population ages, we must evolve our health-care system to more effectively address the needs of chronic disease patients -- improving care and managing costs. Further, we have to engage consumers in managing their own health - providing tools and information to support informed choices and holding consumers more accountable.

    To support a redesigned health delivery system, we need the right types of insurance. Let's remember that insurance companies are designed to spread risk, but health insurance is unique because it's used for routine as well as catastrophic needs. People expect their health insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care and only tap into health insurance when they need to cover major, unpredictable issues.

    Key to reforming health insurance is separating it from employment, which would guarantee that individuals would not lose their insurance even if they were to change or lose their jobs. Most importantly, it would encourage new innovation in the health insurance industry.

    If people were responsible for paying for routine visits and procedures, they would demand greater transparency around the costs and effectiveness of their care, be more engaged in their health and consider more fully how their choices impact themselves and others. This would enable more innovation in insurance and health delivery and make health care more affordable for all.

     

     

  • Liberate the Data Part II – Perspectives from Eclipsys and Microsoft

    Posted over 4 years ago
    by pnblog}

    It was just about a year ago at last year’s HIMSS that I posted about the need to “liberate the data” within health IT systems – separating data from applications and making it available for reuse in different contexts.  What I said then holds true now.  For health enterprises and consumers, health data is a vital asset that can move us toward a more efficient, higher quality, evidence-based future for medicine.

    While we still have a long way to go, a year later I’m encouraged by a couple of developments that indicate we’re moving in the right direction – and actually making some real progress!

    First, the draft regulations on “meaningful use” include a focus on the exchange of data – acknowledging that physicians need real-time access to comprehensive patient data to improve quality, safety and efficiency, and to coordinate care effectively.  The draft legislation also recognizes that engaging patients and families in managing their own health is paramount – requiring that providers make patient data accessible soon after those visits happen.  For the first time, the proposed rule-making puts a stake in the ground with real ‘sticks’ and ‘carrots’ – a significant milestone in putting the foundational drivers for change in place. 

    Second, I’m very excited about the strategic alliance with Eclipsys that we announced last week.    This is a key milestone for two leaders in the health IT space to be a driving force in enabling data to become liquid.  Both companies share a common vision – of an open architecture for future-flexible IT – which is critical for our customers and their customers to improve the care they provide.  As part of the partnership, a richer set of data from Eclipsys systems will be available within Amalga UIS.  Using their expertise in developing healthcare applications, Eclipsys will offer modules that run on top of Amalga.  The combination of these Eclipsys products and Amalga UIS will give customers access to data across the enterprise and support workflows that leverage this liberated data.   

     

    I’ve invited Phil Pead, CEO, Eclipsys to share his thoughts on the partnership.

     

    The alliance we have created with Microsoft is part of an overall strategy by Eclipsys to break away from the tradition of closed, proprietary systems in healthcare. This notion that in order to have one patient one record everything must be purchased from a single vendor burdens healthcare with making unnecessary investments and limits the pace of innovation. Eclipsys has used the Microsoft .NET Platform technology to deliver its software applications since 2003. This agreement between our two companies marks a second, staged reversal from closed, proprietary monolithic systems. By opening our platform to third-party companies, such as Microsoft, we can deliver the choice and flexibility that hospitals need and want to improve health information technology in a demanding and dynamic healthcare environment. 

    The new federal regulations surrounding the American Recovery and Reinvestment Act of 2009 and achieving “meaningful use” are a tipping point that is causing rapid change in how healthcare information is accessed. In addition, clinicians have been frustrated by not having critical information available to them at the point of care because either the information was spread across disparate systems, or they were unaware the patient data was available. These factors, among others, are creating higher costs and less time for patient care.

    Our new agreement with Peter and his team brings Eclipsys one step closer to delivering on a vision of healthcare data set free. We plan to integrate key components of Eclipsys’ award winning Sunrise Enterprise suite of integrated software applications with Microsoft Amalga Unified Intelligence System (UIS).  The integration will further enhance the analytic capabilities we provide to our clients and allow clinicians within any hospital to have access to patient data regardless of the system in which it resides. No other industry relies upon a single vendor to do it all. We think it is time to stop this fundamentally flawed approach in healthcare.

    We also are inviting other healthcare industry leaders, as well as small, entrepreneurial companies to build on our platform. So hospitals have the opportunity to use our suite of applications, keep their best of breed solutions, while benefiting from newer, innovative systems— all on one platform. We think this is the future of health technology.