Category Archives: Uncategorized

The Triple Aim, Well Two Out of Three… Really is Bad

One of the Triple Aim‘s has gotten lost. Will anyone in the healthcare sector publicly declare that they are in fact working on the Double Aim?

The Triple Aim, that lofty set of goals that the healthcare system claims to have embraced:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and.
  • Reducing the per capita cost of health care.

I agree with them and believe they are appropriate and necessary.

Everyone it seems, says they are working towards the Triple Aim, and many have taken to adding Provider Satisfaction and saying we in fact need a Quadruple Aim. Well, before we go there, let’s see what we are actually doing on the initial three.

After attending a number of conferences and seeing what the system is in fact doing,  I’m fairly certain, that healthcare is not actually going after the Triple Aim. In fact, it appears that almost everyone has quietly agreed on the “Double Aim” in an effort to short-circuit any true progress and continue on the path we have been on.

What do I mean by the Double Aim? Here are some examples of things I saw, heard or didn’t hear at HIMSS 2018:

After listening to an excellent panel on innovation, by three leading health system executives who oversee their systems innovation area or department, I just had to ask a question:

“At what point does this innovation actually lower costs?” A murmur arose in the room.

Response one:

“Well we could spend a whole day on that one”

The next answer? Well, there wasn’t one.

At the conclusion of the session, Gregg Masters spoke with one of the panelists and asked if as part of their innovation center they were tasked with lowering costs.  Their response “no, that’s not part of our charge.”

Why wouldn’t an innovation center also be looking for innovation that reduces costs?

At a dinner panel one evening, a health plan association executive when asked if health plans were really lowering costs, pointed to the Medical Loss Ratio (MLR) Rule (which I have written about here) as a key contributor to holding costs down.  When I explained my belief that the MLR rule ensures costs go up because “who would want 15% of a lower number next year” there were audible chuckles of agreement in the room, a shocked look on the panelists face and the panel quickly switched to another topic. While the person who asked the original cost question, looked at me, raised his eyebrows and laughed.

I do not recall any booth or individual discussing programs that save money, in fact most were talking about revenue enhancement.

Only Kaveh Safavi of Accenture and one other presentation discussed the elephant in the room; that healthcare is the only industry where as it adds technology, the workforce gets less efficient.  I would call the behavior we exhibit in this regard, an addiction.  We continue to do it, even though the outcomes will be bad for us.

Do we not hear the clamor associated with the Amazon, Berkshire-Hathaway, JP Morgan?

“Healthcare is the Tapeworm of the American economy”

 

Or the announcement by Wal-Mart regarding their narrow network, in which they said that about 40% of people referred to their center of excellence for back surgery were told they don’t need it. How about the growing relevance of Dave Chase and the Health Rosetta and books like Dan Munro’s Casino Healthcare, or the Health Value Awards.

Even the esteemed Dr. David Nash of the Jefferson College of Population Health saying there are too many medical errors and too many tests being ordered and it was “time for doctors to look in the mirror”.  But not just doctors, all sectors of healthcare, especially hospital systems, health plans, device and pharmaceutical manufacturers and vendors. You may be thinking you can slip by with the Double Aim, but others are AIMing to knock the inappropriate costs out of the system, and if you don’t get involved it might be you.

And now when CMS announces their Pathways to Success, a new ACO requirement that pushes ACOs which have been living off of one-sided risk in the MSSP program, and showing no savings, to two-sided risk, the industry goes bonkers.

Avalere_Health_MSSP_Performance_Results_Versus_CBO_Projections

We know there are excesses in the system, everyone talks about that, everyone talks about the Triple Aim, but it seems in the case of doing things versus talking about the Triple Aim, we are truly only interested in the Double Aim.

Advertisements

Leave a comment

Filed under Healthcare Costs, Uncategorized

Webinar on SDoH and Geospatial Data

I recently the pleasure of participating in a Webinar with Joe Warbington of Qlik moderated by Mike Perkowski on

Visualizing population health: How geospatial and social determinant data informs preventive care

 

You can watch it here..

 

 

 

accountablehealth_logo_icon-registered-new.jpg

Leave a comment

Filed under Uncategorized

Population Health and the End of Life

“Health nuts are going to feel stupid someday, lying in hospitals dying of nothing.”
Red Foxx
 Dad and Fred
In population health we talk a lot about improving the health of those with chronic diseases, preventing other diseases and keeping the healthy people healthy, but what should population health’s role be at the end of life? In the end, even if we are wildly successful at maintaining, improving or preventing diseases and conditions, we will still face death.
If the Triple Aim is better outcomes, lower costs, and improved health of populations, how should that be applied at the end of life? I believe its role should be in ensuring dignity, education and appropriate personal decision-making.
Over three years ago my father, a physician passed away.  He had been living with Lewy Body Dementia, a form of Parkinson’s disease for almost two decades.  When first diagnosed, he made clear to us how his disease would progress and what he wanted to happen at the end.   No feeding tubes, no extraordinary measures, if he got pneumonia, he wanted no antibiotics. When his disease had really progressed and he was bed ridden in a memory care unit, post stroke and not always lucid, he did get that infection. The facility wanted him transferred to the hospital across the street where he would get treated for his pneumonia.  While they were  nervous about us not approving that based upon his Advanced Directives, they understood his wishes, worked with us and hospice and we made clear that we would not hold them in any way accountable.
The hospice service was fantastic as was the facility which allowed my mother and others to stay there with him.  During this three weeks, we would take him outside when he was able and we were there with him throughout.  It was a moving and gentle experience and I am happy to have spent that time with him, my family and some of his friends and colleagues. During this experience, not everyone in the immediate family was in agreement, or felt it was handled as they wanted, but they knew it was being done based on his clear wishes.
We all know the costs associated with healthcare at the end of life, but that is a secondary issue; it’s hard to say goodbye to someone you love. Knowing his disease and its course, we were able to prepare for a long time. Others have much less time to make decisions and say what they feel is an appropriate goodbye. This is why we should think of the how and what we want to happen for us early, and clearly discuss it with our loved ones.
Too often when the end of life is near, it’s not about the person reaching that end, but about those close to her or him, about their time with the person, perhaps their guilt, the belief that they need to do everything possible. While this may seem like the right thing to do, many times it just increases the pain and suffering of the person nearing the end of their life. In a number of instances, I have seen and discussed the guilt felt by those who had gone to great lengths to try to keep their loved one from death.  The hospitalizations, intubations, amputations, feeding tubes, more doses of chemo. Hindsight is 20/20 for better or worse.
In fact, one of the things that influenced my father and his decision, was the death of his father. He had really suffered during the last 6 months as the doctors did this and that to (for?) him in an effort to try to keep him alive.  My father had supported some of these efforts. They were not a good six months, certainly not six months worth living; in fact my grandfather on at least one occasion had stated that he was ready to die. But more was done. Back then there was little talk of options or hospice.  My father sometimes spoke of his father’s last 6 months, at times with a tinge of guilt.
With advanced directives, we have come a long way, but there is still more we need to do.
If population health is about the full continuum of care with the patient at the center, we have to ensure that end of life decisions becomes part of the discussion. That people and their loved ones are educated about their options, given an opportunity to prepare for the day, and given the support to make the decision’s as they see fit. For my Father and us, his decisions made a world of difference and the hospice and memory care unit did an incredible job taking us through this difficult time. He died and left us in peace with memories of a great man, who was loved deeply by his family and still is.
accountablehealth_logo_icon-registered-new.jpg

Leave a comment

Filed under Uncategorized

PopHealth Week with Prashant Natarajan – Big Data, Machine Learning and AI

Prashant Natarajan, Director of Business Strategy, Oracle Corporation

Discussing Big Data, Machine Learning, AI and Healthcare

PopHealthWeek-logo-TWTTR-sq

Prashant Natarajan on PopHealth Week

Prashant Natarajan is Director of Product Strategy at Oracle, where he is responsible for business strategy, product management, and go-to market solutions for a portfolio of Prashantinformatics products & cloud services for  population health, precision medicine, interoperability, and integrated little + big data analytics. Prashant received his chemical engineering degree from Mangalore University (India) in 1998 and his master’s degree in technical and professional communications from Auburn University (USA) in 2005. He is a prior recipient of the SBC/Chancellor’s Endowed Fellowship for graduate research.

Prashant is a lead author or contributor to 4 books on analytics, machine learning & AI, and precision medicine. He serves on the Board of Advisors for Council for Affordable Health Coverage. He is also Industry Advisor for Data Science & AI at UCSF/CIAPM. Prashant currently serves as Chairperson of the HIMSS NorCal Chapter’s annual Innovation Conference & Showcase.

Follow Prashant’s work via Big Data CXO.

 

PopHealth Week is Produced by Health Innovation Media

 

AccountableHealth_Logo_ICON-registered-new

Leave a comment

Filed under Uncategorized

Clean Living through “Forest Bathing” – Reasons Why Americans Need to Embrace What The Japanese Have Known For Decades

I recently wrote a Guest Blog Post for Hiking Trails for America and the Friends of the Florida Trail.  I have been on the Board of Friends of the Florida Trail since its founding by Jim Kern.  Jim is the founder of the Florida Trail and a number of non-profit hiking organizations.  His mission now is to complete the 10 National Scenic Trails that still have gaps or unprotected sections.  You can help support our efforts by signing the petition. There are many health benefits to getting out into nature and this Guest Post documents a few.

Here’s a picture from my recent trip along the Suwannee River on the Florida National Scenic Trail. Click on it to read the Post and please sign the petition.  Thanks!!

 

 

Leave a comment

Filed under Uncategorized