Thứ Bảy, 26 tháng 3, 2016

Still Here!

I am still here and will do a huge post tomorrow.... Still kickin well as a matter of fact!

Thứ Sáu, 25 tháng 3, 2016

How the Candidates Can Weigh In on Population Health

Watching March Madness (Go Villanova!) ads and the accompanying Political Silly Season news have alerted the Population Health Blog to the very real possibility that its state's late primary may play a role in the presidential sweepstakes.

While the PHB ponders what to do with its vote, it naturally thought about the candidates' positions on "population health." 

In no particular order and as a public service to the campaigns' search for talking points (and "dog whistles"), the PHB offers the following statements for their consideration, just in case the topic comes up......

Mr. Trump: Believe me, I've studied this far greater than anyone else and population health would have terrible ratings if it weren't for me.

Bonus question on electronic health records (EHRs): We have to EHR how bad it was a disastrous deal amateur hour believe me.

Mr. Cruz: The words "population" and "health" do not appear in the U.S. Constitution and this will end on day 1 when I become president.

Bonus question on EHRs: I cannot find the letters "e," "h" or "r" in the U.S. Constitution either, and it's not just because of the handwriting.

Mr. KasichWe did population health in Ohio when I was governor and while I chaired the Ways and Means Committee in Congress

Bonus question on EHRs: We did EHRs in Ohio and while I chaired the Ways and Means Committee in Congress.

Ms. ClintonWe will build on the success of Obamacare by investing in population health through legislation that offers a tax credit to offset its cost that will be available through the exchange to assure that all families will not exceed a premium threshold under current law while incentivizing expansions of the program through all 50 states with a matching initiative over several years.

Bonus question on EHRs: I never knowingly sent confidential patient information or received anything marked HIPAA protected at any time. But under my plan, physicians will be able to use private email accounts to communicate with their patients.

Mr. Sanders: Population health, like a college education, solar power and frozen yogurt is a basic human right.

Bonus question on EHRs: That too.

Not to be undone, two other recent fixtures in the PHB television universe have weighed in on population health....

Charles Barkley (taking a break from his half-time college basketball commentary): It's turrible that people see that (unintelligible) Krispy Kreme that don't understand how if (unintelligible) people have eaten too much.

Joanna Gains of HGTV's Fixer Upper (a PHB spouse refuge from the TV craziness): Let's face it: Fixer-uppering chronic conditions with population health is possible with the affordable use of vintage twists that accent an existing space and give an illusion of depth with a favorite hue.  Try some mottos, mirrors and oversize remnants that group together and transform drabness to healthiness.

Thứ Năm, 24 tháng 3, 2016

The Latest Health Wonk Review Is Up!

 
This HWR is timed with the sixth anniversary of the Affordable Care Act.  Topics include narrow networks, assisted suicide, misprescribing, balance billing, healthcare workplace violence, moonshots and the controversies over morcellation.

No association, or cause and effect?  You be the judge!

Unity Farm Journal - Fourth Week of March 2016

I’ve returned from China and re-established my daily routine on the farm.  In my absence Kathy kept the animals safe and warm.   She watered and nurtured all the indoor and outdoor crops.   She served as point of contact for all the people in our lives.  She's remarkable.

All is perfect on the farm and it’s as if I never left.

Here’s what the hoop house beds look like as of the last week of March.


We had one last winter storm this week with 4 inches of wet sticky snow.   It melted quickly and the weather cleared with brilliant red sky at night.



Now that spring is here we’re completing those projects that require dry, thawed ground - building our summer pig paddock, putting up the blueberry netting, repairing fences, and pounding the poles for the hops trellis.  

The creatures on the farm are glad that all the humans have returned.   The pigs are getting the belly rubs, the dogs are getting their runs, and alpaca are getting their chopped alfalfa/molasses breakfast.


Soon the Shiitake mushrooms will begin to fruit and we’ll bottle the cider which has mellowed over the winter.  

I look forward to a bit less travel and a bountiful Spring in the months ahead.

Thứ Tư, 23 tháng 3, 2016

CareKit as an Enabler for Patient Generated Healthcare Data

As we move from fee for service to alternative payment models/value-based purchasing we will increasingly measure our progress based on outcomes and total medical expense.

HealthKit was an enabler that led Beth Israel Deaconess to create BIDMC@Home, an iPhone and iPad app that uploads internet of things (blood pressure cuff, glucometer, scale, activity, sleep data etc.) to our electronic health record.

CareKit, announced by Apple this week, takes us one step further on our wellness-focused journey.

Our vision is that objective data such as weight and blood pressure needs to be combined with subjective data such as activities of daily living, mood, and adherence to care plans in order to create a true measure of outcome.

If you take  your beta blocker for blood pressure control but feel listless and unmotivated, that is not a good outcome.

Apple’s middleware (HealthKit, Research kit , Carekit) has enabled us to connect devices in BIDMC patient homes and this Summer will enable us to collect answers to clinician generated questionnaires with dashboarding of the subjective and objective combined results.

We believe that mobile devices such as iPhones will become the predominant means by which patients interact with BIDMC.    Your phone will be the repository of your medical record, the means by which you collaborate with your provider, and the vehicle for submission of data to your care team.

Today, 80% of all BIDMC publicly available resources (websites, portals) are accessed via mobile devices.  The desktop is dead.   The phone is the future.

Kudos to Apple for enabling simple integration of devices in the home, collection of patient provided questionnaires, and bidirectional exchange of care plans.

I know that the current FBI/Apple security issues are controversial, but if we’re going to use the phone as the means for patients to coordinate healthcare, we need to ensure data integrity.   I support the idea of government entities obtaining cloud-based backups of devices when courts grant subpoenas.   I do not support the idea of compromising the integrity of phones when they are serving as the link between patient devices/patient sourced  healthcare data and providers.

The combination of sensors in the home, patient/family engagement, and security/data integrity is the secret to success in alternative payment models.   We look forward to piloting several new apps in 2016.

Thứ Năm, 17 tháng 3, 2016

Busting Through the Healthcare Performance Frontier

Breakthrough!
The costs of business performance - for example, customer delight, reputational excellence, high worker satisfaction, workplace safety, leadership diversity, environmental sustainability or reducing social disparities - are typically viewed through the lens of a zero-sum game. 

In this classic world view, achieving profitability means cutting performance, while pursuing high performance reduces profits. The relationship between the two variables can be displayed as a curve:



Population Health Blog readers can find out more about this here.

Most firms in the real world operate on the "A" curve.  Different firms under different circumstances make dozens, if not hundreds, of decisions on a day-to-day basis involving trade-offs that move them along the curve that extends along the profitability and performance continuum.

Examples of healthcare companies that moved up on the curve at the expense of performance include the Veterans Administration and Turing Pharmaceuticals.  At the other end of the curve, the understandable unwillingness of some hospitals to walk away from their community service obligations may have led them to bankruptcy.

The "B" curve represents the theoretical limit for greater profitability and performance using the current business model.  In other words, as companies maximize all opportunities and minimize all inefficiencies in their existing business models, they can move the curve up and to the right.  That is what all management, executives and boards can define and aspire to.  That "B" curve is known as the "performance frontier."

Examples of healthcare companies that moved toward the "B" curve? You can find more about them here.  If they're hospitals, they fill beds with short lengths of stay and high patient satisfaction.  If they're clinics, they maximize billing revenue and minimize waiting lists.  If they're an ACO, they manage risk by contracting for an actuarially optimum population while pursuing the Triple Aim.
  
The "C" curve beyond the established frontier is what becomes possible with transformational innovation, superb leadership or both. Examples outside of healthcare include Apple under Steve Jobs and Tesla under Elon Musk. Firms that create value by inspiring employees, new products and innovative processes not only benefit from even greater profitability, but offer enhanced performance

In "C" level healthcare settings, the top-line growth and decreasing costs would be accompanied by better measures of customer/patient well-being, community burden of disease, worker engagement, leadership diversity and improvements in social determinants of health.

While the Population Health Blog eagerly awaits reports of frontier-busting healthcare providers, it offers a few observations:

1. Healthcare organizations have generally not done a good job in defining and measuring their performance metrics.  They've also not made them part of the C-suite's DNA or placed them prominently on their governing boards' agendas. If they did, breakthroughs would become more likely.

2. The EHR's primary functions of billing and documentation will never get healthcare organizations to the C curve.  This is not part of a breakthrough strategy.

3. In contrast, big data, risk stratification, mHealth and machine intelligence have the economic/business potential to identify risk, channel the right care, circumvent high cost service options and rationalize decision-making, but could also increase performance through the engagement of consumers, increasing access to more care options, reducing disparities and minimizing provider busywork.  These are the ingredients for a breakthrough to C-curve level performance that is only just beginning.

4. By the way, another ingredient for high healthcare provider performance can be found here.

5. Last but not least, the leadership of many innovative health technology companies already intuit much of this.  They're looking for partners that are not just looking for "B" level performance, but want to bust through the performance frontier. 



Unity Farm Journal - Third Week of March 2016

Kathy has been running Unity Farm while I’ve been in Texas and China.  The weather in Sherborn has been mild with light rain.  The first round of newly germinated seeds is planted in the hoop house and enjoying the warmth of early Spring,  Kathy is watering everything at the end of the day to keep the seedlings moist.    The Rex Boston , Buttercrunch Bibb and Nancy Bibb lettuce is almost ready to harvest.



Carrots, beets, spinach, peas, and beans are growing fast.   The tomatoes, eggplant, and pepper seedlings are nearly ready to move from the germination trays to 4 inch jiffy pots.

All the creatures are doing well, although the dogs and pigs miss me.   I’m the one who meets them on their own terms - crawling through mud, rolling in hay, and petting bellies while rubbing noses.   Kathy is a good petting proxy, although she remains standing.



Kathy also tucks in the pigs every night.   Here are two pigs in their blanket


The geese continue to defend their territory chasing the ducks and chickens from their nests if they get too close.   Our geese are very kind in general, but we’ll have to watch their “spring fever”

The driveway project is beginning and the 25 year old asphalt is being scraped away today so that a new gravel bed can be installed and allowed to settle for a month.  It’s great that we left driveway rehab until the very last, since the truck traffic that accompanied the building of Unity Farm infrastructure over the past 4 years was rough on it.    At this point, we’re to the point we can just run the farm, reducing the cost and effort of creating new things.   For a summer that includes a wedding, a bountiful harvest, and adding a few hundred more Shiitake logs to the woodland crop area, fewer construction projects will be welcome.

I fly from Hong Kong today to Los Angeles to help my mother with home maintenance and keynote the American Dental Association conferencing where I’ll offer thoughts on the ideal shared dental/medical electronic record.   Then home on Monday morning.   No more travel until Friday in Canada and next week in London.  Logan airport is my second home this Spring.