Tag Archives: Fred Goldstein

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.
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Mindfulness: Is This the Way to Improve our Eating Habits and Reduce Smoking?

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This week we had Judson “Jud” Brewer, MD, PhD from Claritas Mind join us on PopHealth Week. I have recently gotten into Mindfulness and have used HeadSpace (which has been very good) daily for over a month. I’ll discuss Headspace in another post. More recently I started Eat Right Now developed by Claritas Mind and have used it daily as well. Eat Right Now states it’s “a program that utilizes a proven scientific approach to help you control your food cravings.”

It has surprised me how much of an impact mindfulness can have on my thinking and behavior. Continue reading

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Casino Healthcare – An Interview with Dan Munro

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I recently interviewed Dan Munro on PopHealth Week and we discussed his book Casino Healthcare. dan-munro-picWe all know about the high costs and poorer outcomes associated with American Healthcare.  In Casino Healthcare Dan explains his view of how our system, one built with Selective Health Coverage is like a casino; or really three casino’s, the insurer casino, provider casino and pharmaceutical casino.

Dan explores each of these areas and explains how they work to maximize revenue through a system of complex transactions and systems.

As an example, on the Provider side Dan explains a little known group called the AMA/Relative Value Scale Update Committee  or “RUC” as its more affectionately known.   Continue reading

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Is Text Messaging being Overlooked as an Engagement Tool in Healthcare?

 

the-holy-grailImproving the consumer’s engagement in their health has become the holy grail; we’re all searching for it. It seems every week some company is coming out with a new app, system or program claiming they’ve developed an incredible engagement tool that will finally get people involved in their health. Most have stumbled.

Could it be that we are overlooking something because it’s just not cool and there are potential HIPAA concerns? That something is SMS text messaging. Think about it, everyone has a cell phone and text is typically unlimited and has become the new way to communicate.

It also turns out, there are some very good studies to support text messaging to be effective and much more likely to be read and responded to than an app, phone call or email. As for HIPAA, there are ways to use a “text first” approach and stay HIPAA compliant.  ken-saitow

Listen to this episode of PopHealth Week  with Ken Saitow of CareWire as he provides insights into text messaging, HIPAA compliance and use cases. He even touches upon seniors and Medicaid, both of whom respond well to text messaging.

 

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Healthcare Industry Transition to Value-Based Care

I recently moderated a panel for HITECH Answers titled Healthcare Industry Transition to Value-Based Care: A Virtual Panel Discussion with Industry Thought Leaders. The Panel included Sean Cassidy, VP of Value Based Care for Zirmed, Tom Lee, President/Founder SA Ignite and Robert Tennant, Director, Health Information Technology Policy, at the Medical Group Management Association (MGMA).

You can watch it here:

 

 

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