8 Things CFOs Must Know About Health Reform

Whether a Chief Financial Officer is running the fiscal operations of a hospital system, an insurance company or a company that simply employs individuals with health coverage, the decision-making process for sustainability is changing at a rapid pace. However, after years of hearing about reformation in the health system, broad, sweeping and revolutionary changes are finally happening. Major shifts are also occurring in the population, as well as technological advances that will disrupt the entire premise of a four-walled institution for care and the very model we use for health delivery.

Health care in the US is a business – a multi-billion dollar business – and understanding the financial implications of health reform will make or break every CFO. Knowing that health access, demand, quality and payment changes are inevitable there is an immediate need for CFOs across the ecosystems to embrace and plan for transformation.

1. You have too many beds.
   While many hospital leaders won’t accept this at face value due to lengthy wait times, surgical demands and desire to shift beds, the truth is there are too many beds in a lot of hospitals. Between transferals to the outpatient setting and telemedicine, the need for expensive inpatient beds is declining. Additionally, hospital leadership are increasingly finding that they face problems with state authorities when they apply to move beds. Most recently at the University of Chicago, where 338 beds were being used for a 304-person utilization pattern, the state rejected a University application to move surgical beds.
2. Food, housing and transportation of patients is your problem.
   As Americans begin to define and attempt to tackle community and population-based care, the access individuals have to quality food, affordable housing and efficient transit matter.  No one living in a food desert will have the same health outcomes as someone living next door to a Whole Foods, just as an individual with a new car will always be more consistent in making appointments and picking up prescriptions than someone who has to access three public transit buses for the same activities. Real patient engagement and activation begins with understanding the environment of each patient.
3. Your patient demographics are shifting, and so too should your leaderships. As the US continues to brown, hospital leadership must be representative of the population to understand and meet need. At a recent Modern Healthcare Top 25 Minority Executives session, an awardee remarked that the United States is now a country of minorities, and “our leadership as minorities is our future for health outcomes.” With this in mind, it is inevitable and paramount to success that the leadership of any organization resembles and represents those it serves, so it makes the financial investments and decisions that influence the community.
4. More bodies in beds will never work again.
   Value-based purchasing means that a warm body in a bed not only drives costs higher for the payer, but that the longer a patient remains in the hospital – or the more often they return – the more penalties that accrue. Therefore, the goal should not be for more bodies, but for cost-effective bodies. Depending on the community serviced, this can mean desire for more Masters Athletes, specialized services or elective services. Additionally, as we shift to a world where technology enables more clinical procedures and recovery to be done in the outpatient setting, or at home, and expensive inpatient procedures decrease in volume and reimbursements, hoping to fill beds is futile.
5. Alignment with physicians is nonnegotiable.
   No leader can effectively attain a goal without buy in from those who carry out the work.  However, it is important to be aware that “physician alignment” is a term that causes almost all physicians to turn and walk the other direction out of fear that this indicates buying their autonomy and dictating their day-to-day, moment-to-moment ability to practice. According to Healthcare Financial News the implications of physician behavior are so important in 2014 that more revenue than ever will be spent recruiting physicians who see the world the same way you do, which is not very different from how corporation CFOs think about their employee hires.
6. As consumers take on more and more pay responsibility, unexpected payment shifts will keep occurring.
   Many experts estimate that defined contribution, health insurance exchanges and the growing individual health insurance market means that patients will become more informed about spending their health care dollars, and therefore, more unwilling to spend. The future of reimbursements and pricing strategies is presently a puzzle wrapped in an enigma because of extreme uncertainty. However, it is general knowledge that Medicare and Medicaid reimbursements are going to continue decreasing, with the American Hospital Association and Moody’s already estimating an, “unequivocally negative” outlook for hospitals on the reimbursement fronts.
7. Technology and data utilization can save you money.
   While the learning curve with new technology can be excruciating and the meaningful utilization of collected information seems daunting, everything from workflow to health activities and employee/patient engagement can be monitored – and altered in real time – using new technology. Moreover, the more information that is known today, the better predictive analytics and behavioral change that can be made tomorrow. However, as the amount of technology available to leadership continues to grow exponentially, the purchasing of new tech will be a balancing act between what is a passing fad versus what is sustainable and transferable.
8. Your EHR is going to cost you. Big time.
   Now this seems obvious to most hospital CFOs, as they have already seen the initial price tags that come with implementing a “holistic” electronic system. However, the most costly elements may not yet be realized. As mergers and acquisitions continue, technology advances and EHR capabilities increase, the need to refresh systems will continue.  At present there is not one system that meets end-to-end patient or provider needs, leaving the ecosystem open for further disruption, which inherently includes more interoperability, more upgrades, more plugins and more costs.

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Health Insurance Benefits – Can You Have It Your Way?

As the percentage of large employers that consider a shift to defined contribution and/or private exchange increases, the number of options – and flexibility in those options – must also increase. Consideration for those options rose last year from 14% to 18% among large employers (500+ employees). Further, those who are considering the move to a private exchange want to because of their desire to offer more and better plan options, as well as realize cost-savings. Shifting to the defined contribution framework allows employers to moderate their subsidies to employees, and employees to make better trade-offs among plan options. Additionally, by increasing choices, defined contribution makes it easier for employers to integrate their health incentive and wellness programs by layering them “on top” of the defined contribution.

With this economic opportunity in the market, it is imperative that health plans and enrollment become more tailored to individual and company needs, in addition to the one-size-fits-all solutions of the past and present.

Private health exchanges, according to bswift, like their new Springboard Marketplace, could be the platform to give consumers that greater choice and increase individual decision-making. Given that most large employers who are considering a defined contribution will remain self-insured, bswift is taking a calculated gamble that employers will continue to invest in cost management solutions such as incentives, wellness programs, consumerism as opposed to simply shifting costs to employees under the “fix it and forget it” cost sharing approach suggested by some competitors.

Customize Your Cart

The Springboard Marketplace that bswift has created has the online functionality healthcare.gov could only have dreamed of, and the choice construction of a grocery store.  In fact, the terminology the company uses alludes to “Stocking the Shelves” with your benefit choices and “Shopping” for your ideal group of benefits. This is all done through the interactive benefits advisor, Emma, who walks employees through an online step-by-step process to fill their cart with health care options.

For those aware of bswift’s background as a tech company it may not be a surprise that the software and services offered are aimed at streamlining a very sophisticated system, and making the user experience easy. And for those that know the company’s Executive Director of Exchange Solutions Brad Wolfsen, the shopping experience and ease of transition into a new set of consumer options will easily resonate. Mr. Wolfsen, before joining the team, built and led Safeway’s wellness and retail strategy programs, and was the President of Safeway Health.

According to Mr. Wolfsen, the real benefit he sees to bswift’s products are that they, “allow employers to focus on equity for employees and shift to a retail view on providing health benefits.”  Or, as the Society for Human Resource Management labels it, From Parenting To Partnering.

New Plans Equal New Decisions

With a growing demand for health benefit options that resemble a choose your own adventure book, but with a set amount of money to spend, the development of software must also be functional for employers and employees. The Springboard Marketplace has been constructed so that functionality can simply be turned on and off, so that choices are simplified. Additionally, since there is not a standard approach to benefit choices and many legacy systems that have to be revamped due to mergers, acquisitions and partnerships, greater automation for employers means less paperwork for HR departments. By making workflow, reporting and administrative work more efficient through automation, cost-savings increase even further.

“The best and brightest clients are currently driving what is in the bswift system now,” says Mr. Wolfsen. “As we move towards expanding the suite of benefit options and meeting compliance standards, we are also investing in the shoppers experience.”

He, along with his colleagues at bswift, believe that their tech company is nimble in ways that others are not, and that with the help of their platform and Emma, more and more employers will begin the migration to defined contribution and private exchanges. If true, that growing shift could redefine how health benefit decision-making is done by employees in the future.

 

The Medical Home

I’m back, after an August filled with children, swimming, anniversaries and weddings.  Two weekends in a row of travel and I’m glad to be home.  Which reminds me of a subject I have long wanted to write about:  The Medical Home.

Here is how the US Department of Health and Human Services describes The Medical Home (TMH for short): “The medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place but as a model of the organization of primary care that delivers the core functions of primary health care.”  AHRQ says that medical homes provide care that is Comprehensive, Patient-Centered, Coordinated, Accessible, and has Quality and Safety measures.

Here’s how the Patient-Centered Primary Collaborative defines TMH:  “The medical home is best described as a model or philosophy of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible, and focused on quality and safety. It has become a widely accepted model for how primary care should be organized and delivered throughout the health care system, and is a philosophy of health care delivery that encourages providers and care teams to meet patients where they are, from the most simple to the most complex conditions. It is a place where patients are treated with respect, dignity, and compassion, and enable strong and trusting relationships with providers and staff. Above all, the medical home is not a final destination instead, it is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs.”  The collaborative claims improvements in cost, utilization, population health, prevention, access to care, and patient satisfaction.

If all this sounds familiar, that’s because it is essentially a re-wording of the push to control costs by having care channeled through primary care doctors back in the early 2000’s.  That initiative, widely implemented, resulted in a lot of jobs for paper pushers but not a lot of cost savings.  In fact, the idea of a medical home has been around since at least 1967, especially in the field of pediatrics.  I am not against the concept; the goals are all laudable. The problem is that “home” means different things to different people.

The Medical Parasite Host: If you live in a rural area, your medical home likely consists of one guy, or girl.  That MD or NP does everything.  That person is your home.

The Medical Grass Hut: In this home, everybody sits on the dirt floor and shares everything.  This happens in poor communities where a visit to the doctor takes all day and everyone hangs out in the waiting room with their kids and grandparents, sharing two overworked doctors and a medical student.  You pay with chickens or potatoes.

The Medical Motel Room:  This is where you stop in for some low-quality, one-the-go health care.  Like stand-alone clinics, urgent care centers, and pharmacies.  It’s quick, it’s cheap, and no one knows you were there.

The Medical Project:  Better than a grass hut.  It still takes all day to see a doctor, but now you have bathrooms.

The Medical Apartment: Here you get your own doctor.  Until your employer changes your insurance coverage.  Then you move and find another doctor.  It works as long as your medical problems fit in the back of a Ford Escort.

The Medical Single Family Home:  Its nice, its comfortable, its stable, you’re insured.  You have to drive into the city for your comprehensive, patient-centered, coordinated, accessible, quality healthcare, run by a healthcare conglomerate, but you have a car.  Or know someone who does.

The Medical Mansion:  You get all the care you want, when you want it.  It’ll cost you, but it’s worth it because you don’t have to wait like everyone else.

The Medical Estate:  The doctors come to your house.  With MRI machines in trailers.

The Medical Home is a nice idea, and it works well in areas of the country where people are insured and have reliable transportation to centers that provide all the services TMH  promises, that is, people in the middle.  Rich people can buy their homes.  Poor people either have low-quality homes provided for them or have no home at all.  They drag their health problems with them from place to place, staying in motel rooms when they can, visiting the grass hut when they can’t.  The ACA is trying to get everyone into at least an apartment.  Even if it’s in a bad neighborhood.

 

10 Things Hospital Leadership Need To Know About Social Media And Marketing

Building any brand can be difficult, but in the US, hospital identity and branding are paramount to success within a community. By listening to patients, getting feedback on wants and needs, engaging individuals and creating new incentives, a better reputation, greater trust and improved health outcomes can all be achieved.

Below are 10 things hospital leadership should keep in mind when thinking about marketing and strategy in 2014 and beyond. 

1. In 2013, it was estimated that 62% of emails were opened on a mobile device. Checking email is the top mobile activity among smartphone and tablet users. More people in the world own a mobile device than a toothbrush, so using email to inform patients about new services, community events and preventative care tactics is a must.
2. The brain processes visual data 60,000 times faster than text. Additionally, 90% of information transmitted to the brain is visual. Whether it’s growing your brand identity or improving medication adherence through visual instructions, images are key to interacting with, informing and empowering patients.
3. Surprisingly, Grandparents are the fastest growing demographic on Twitter.  Not only does this indicate that it is here to stay as a social media platform, but it’s a great place to target our aging population who consume the majority of our health services.
4. In 2014, more than 50% of Internet users, or 102.5 million people in the US, will redeem a digital coupon. There are many new partnerships with retail clinics, pharma companies and other service providers that can use coupon-like strategies for patient cost-savings and adherence.
5. The number of devices connected to the Internet now exceeds the number of humans on earth.  So don’t forget to market on multiple platforms and for many different devices. Top sites include Twitter, Facebook, Pinterest and Instagram.
6. Social media influences 93% of shoppers final purchase decisions. Further, 90% of consumers indicate that they trust peer recommendations. Therefore, previous patients are your greatest allies. Their reviews online matter more than you think.
7. More than 78% of US Internet users research products and services online, and every month, there are more than 10.3 billion Google searches, with most people clicking one of the top four links. What your top hits say about your organization, your providers and your quality of care can influence your bottom line.
8. Targeted, content marketing costs 62% less than traditional marketing, and, per dollar spent generates about 3 times as many leads. When creating a marketing strategy for a particular service line, service, or physician group, think about exactly who needs to see what ad and what information they will be looking for.
9. Consumers that receive email newsletters from companies spend 82% more with those companies. Think about what that says for brand loyalty following engagement, and about the ability of constant, relevant engagement. Patients are consumers, and like email, newsletters keep them informed.
10. 70% of people surveyed claim they would rather learn about a hospital or company through articles rather than direct advertisements. Therefore, not only are advertising campaigns important, but so are the patient experience testimonies, community reviews and Forbes articles that highlight the work being done inside and outside of your hospital.

 

Insurance Works. Sort of.

Where did I put that post I wrote on how Massachusetts has the highest health care costs?  I need it now, because apparently all that money is working.  Today I learned that since the mandatory health insurance law was passed in 2006 mortality has decreased by 3%.  Which is 3% more than any other state.

So this is good.  Changes in mortality can really only be measured over years with millions of patients, both of which this study, which came out today in the Annals of Internal Medicine, has.  And these results make a certain amount of sense.  What do people die of these days?  Heart disease, diabetes, infections, cancer.  All of these things, except maybe some forms of cancer, are things that can be treated if treatment is careful and consistent.  Which means a decent doctor, regular appointments, and faithful adherence to medications.  The chances of all three of those things happening definitely increases if patients have insurance.  It actually corresponds to the finding a few months ago that people are using more health care now than they were, even in emergency rooms.  If you take the money component away, they will come, to paraphrase Kevin Costner.

Remember the Oregon study?  It found that giving people insurance improved mental health and financial security, but not physical health.  This is not contradictory to the Massachusetts finding.  Remember that healthcare does not equal health, and lower mortality does not mean more health.  It just means that people with chronic conditions are being treated.  That’s a really good thing.

But.  If you treat more people, it costs more.  The ACA doesn’t do anything substantive to change that.  Health care costs will go up, even if less people die, because chronic, lifestyle- and genetically -based conditions will not go away by insuring people.  For that to happen we need much broader efforts at encouraging health, not encouraging health care.

 

American Heart Association Launches Accelerator To Find Internal Game Changers

Accelerator programs and incubators are growing rapidly in number within the health care industry, with most replicating standard tech incubator models. But one organization has worked to redefine what an accelerator program can look like in the health space by joining one of the country’s largest and most influential associations in its landmark effort to court healthcare innovation. Dr. Ross Tonkens, a cardiologist and Chief Medical Officer in Cary, North Carolina has directed the creation of the Science and Technology Accelerator Program inside the American Heart Association (AHA), that targets and supports ground-breaking ideas from residents to senior clinicians.

Breaking The Mold

Although the AHA is most well known for its Heart Walks, Heart Ball and various awareness efforts such as the Go Red campaign, with a growing accelerator program, the Association could soon be known for changing how health associations and organizations think about growing overall impact. Not only do new ideas, technologies, and products improve the branding and public relations of an association, but it also leads to innovation that improves cost-effective practices, patient experience and standards of care.

According to Dr. Donald Lloyd-Jones, Senior Associate Dean for Clinical and Translational Research at Northwestern University, “When the prevalence of atrial fibrillation is presently estimated between 2.5-6 million Americans, but also estimated to be 6-16 million by the end of 2015, we know invention and innovation are needed.”

The AHA’s 2020 Impact Goals are to reduce deaths from cardiovascular disease and stroke by 20% as well as improve cardiovascular health of all American’s by 20%. Lloyd-Jones said the kind of disruption and change necessary to make these goals achievable will have to come from newer and more effective ideas and products through the Accelerator program in addition to continued research funding.

Dr. Lloyd-Jones set the tone of the AHA’s “Get Pumped” efforts by highlighting that, “continuing to fund research efforts will ensure tomorrow’s health and science discoveries make it from bench to bedside.”

Dr. Tonkens adds that investments through the Accelerator program can encourage industry and venture capital interests to “pick up the baton and carry it to the finish line after we fund proof of concept clinical research.”

Funding

Presently, the AHA is the second largest funder of cardiovascular research after the federal government. AHA has spent over $3.5 billion in supporting basic science research, and continues to do so. The Accelerator on the other hand is focused on identifying the game changers that can be propelled to market as quickly as possible, and helping the industry and investors feel confident in having a lower amount of risk on innovative products.

While AHA gave an estimated  $134 million last fiscal year in research, the AHA Science and Technology Accelerator Program is independent. To date it has not collected money directly from AHA, but instead, relies solely on donations directed to the Accelerator through awareness and fundraising efforts.

While this can make funding difficult, it also means any return on investment by the Accelerator is used to drive game changers into the market faster; the gift that keeps on giving.

Challenging The Status Quo

The Accelerator program not only invests money, but also expertise in areas such as scientific research, regulatory issues, intellectual property and commercialization strategies. This is done to ensure that all ideas are solicited, vetted and implemented to the best of their abilities, even those from younger individuals in the AHA that may not have yet been granted government funding or published in journals.

At the Heart Innovation Forum in Chicago last October, Jill Seidman of Healthbox agreed. During a panel discussion on accelerating discovery to patient experience she examined to audience that it was ideal for Chicago to host the AHA Forum because it was on the forefront of young innovation. She explained that, “bridging academic medical centers (AMCs) with community centers and clinics is imperative to improving outcomes, and Chicago has more AMC and medical schools than any other region in the United States.”

Dr. Tonkens message was clear at that same Forum. He said that like Healthbox, the Science and Technology Accelerator within AHA could fund – and has – great ideas. As he put it, “small amounts of money can dramatically improve life expectancy and decrease death from heart attack and stroke when leveraged by the global expertise in science, medicine, IP, regulatory and commercialization strategies which AHA is uniquely capable of bringing to bear.

American Heart Month And Beyond

As February closes out National Heart Month it is important for American’s to think about the implications of the country’s most detrimental health condition, heart disease. As a nation we have a long way to go to improve overall outcomes as they pertain to cardiovascular health, and especially those of our minority populations.

Through initiatives that range from the new Get Pumped phone app to high-end fundraisers to advocacy campaigns, the AHA is working hard on its outreach, educational, and public policy efforts. “Funding research and encouraging technological innovation is critically important,” said AHA Illinois Government Relations Director Alex Meixner, “but we also work with stakeholders ranging from hospitals to local, state, and federal governments to ensure that today’s scientific breakthroughs become tomorrow’s universal standards of care.”

Further, the status quo must be disrupted, and must be met with acceptance by veteran clinicians. Although current best practices exist for a reason, there cannot be progress using older methods to care for our aging and changing population.

 

An Engineering Feat Gives Hearts Extra Life

With the release of their new HeartAssist5 heart pump, ReliantHeart is making real-time, personalized feedback possible for the millions of Americans suffering from heart failure. The new technology allows for real-time, remote monitoring of implantable devices, years of added life for patients, and flexibility to travel without a physician nearby. With a staggering projected 46% growth in heart failure by 2030, advances in heart failure innovation are on the forefront of changing medical treatment, policy, device research and physician reimbursements. Further, with heart failure and disease disproportionately affecting minorities in the US, advances in length and quality of life could be huge strides for medical equality.

Heart Failure In America

Approximately 7.5 million people in the United States currently suffer from heart failure, a figure that is increasing over time as more people survive heart attacks and various other heart conditions. According to the Heart Failure Society of America, an estimated 400,000 to 700,000 new cases of heart failure are diagnosed each year, with deaths averaging 250,000 annually, more than double since 1979. Even worse, an estimated one half of heart failure patients die within five years of diagnosis and 20% within the first year.

With a waiting list for heart transplants at an overwhelming 3,736 at publication, and less than 2,500 hearts donated annually, the need for a bridge between heart failure and transplant is literally life and death.

LVADs

Left ventricular assist devices (LVAD) are implantable heart pumps that were created to temporarily support patients with advanced heart failure as the bridge between diagnoses and transplant. However, with new scientific advancements, LVADs are becoming a long-term tool for improving heart function without transplant.

The right ventricle pumps blood to the lungs, but the left ventricle is responsible for pumping blood to the rest of the entire body, making it much more susceptible to failure. Therefore, LVADs have been the focus of most modern research to prolong and improve life saving implants.

Patient-Centered Care

Reliant’s system acts like your car’s dashboard. “If a patient’s pump has any sign of a challenge, like dehydration or low flow, the remote monitoring system signals the change to a data-collection center that notifies the transplant center as well as the individual,” ReliantHeart CEO Rodger Ford says. This is what makes the HeartAssist5 unique; at the first sign of a problem the right people are notified immediately.

Essentially, if the engine light goes on, the heart center and patient are notified to get the engine checked.

He also notes that the patients can set monitors to send text message notifications, thus making changes in blood flow, speed and power truly personalized. Individual blood flow is collected and transmitted every 5 minutes, making one’s own body the standard comparator.

The greatest importance to Founder and CTO Bryan Lynch is his ability to use his background as an engineer to, “Get involved in a project where you can actually see how you saved a life. While the docs and nurses are the real lifesavers, we give them the tool to make it possible.” He continues that it is vitally important for engineers and innovators to gain a patient-centered approach to get a real reduction in cost burden and improve quality of life.

Sailesh Saxena, CFO, continues highlighting the patient focus of the company by telling about the origination of the design of the VAD pack. “Bryan and I used to go to Schlotsky’s Deli ($BUNZ) for lunch,” he said, “and we used to see this man wearing a coat although it wasn’t cold out. Bryan noticed immediately that he was attempting to hide an LVAD controller and batteries. Well, this happened more than once, and we recognized that he was always concealing the VAD controller. So we decided that we needed to create a unique insert so that our LVAD control system could slip right into a Louis Vuitton ($LVMH) or Gucci ($GUC) bag unnoticed. It’s the small things that make the patient feel like we understand what they really want.”

Expanding The Geography Of Care

Remote monitoring, like other methods of telemedicine, is a key to expanding the geography of health care. “As technology matures, with the help of remote monitoring, the cardiologist and patient will feel safer with greater distances between them,” says Saxena.

This growth in telemedicine as a whole, and specifically in heart care, has major implications for the Centers for Medicare & Medicaid Services (CMS) as well as health care policy and reform. Because CMS is beginning to assign reimbursements and penalties based on patient outcomes instead of traditional fee-for-service metrics, it will become more and more important to have reimbursements reflect remote monitoring and its likely benefits.

Reimbursement codes also need to be reworked to genuinely target geographic discrepancies in care, which are fundamentally important for transplant centers. However, at present, CMS is slowly beginning to take growth rates of heart implants seriously based on the agency’s continued increases in payments, including their slight variations in geographic differences.

An Engineering Feat

In a recent study, researchers found that platelets flowing through the HeartAssist5 are exposed to significantly lower cumulative shear stress levels than in competitive devices tested. Ultimately, this means that the ReliantHeart product allows for what the CTO calls “a more physiologically normal cardiac output, including the pulse.”

What Bryan means is that people with failing hearts have low blood flow throughout the body, which is why they are so sick. When an LVAD is implanted, patients return to a more normal flow, but they also need blood flow that is as natural as possible. With the HeartAssist5, blood is not damaged and any pulse that the recovering heart produces is naturally transmitted to the body.

The LVAD and heart now work together to help the patient recover.

Although there are two other continuous flow LVADs on the market (THOR and HTRW), the ReliantHeart team claims their careful design capitalizes on working with the natural ventricle to the benefit of the patient, almost like a gym trainer for your heart.

Their “implantable flow probe” is also a revolutionary aspect of the HeartAssist5. This ultrasonic probe measures the blood flow from the LVAD in real-time providing critical feedback that is a one-of-a-kind technology providing data that makes the aforementioned remote monitoring so valuable. Ford says this ability to see patient-specific trends remotely in real time not only helps all patients improve quality of life, but the longevity of the HeartAssist5 creates a life support system, far beyond the “bridge” that the LVAD was originally created to be.

So this month, for American Heart Month, think about what innovation really is. It might be the ability to prolong and add quality of life for individuals and families across the nation, to share more time with loved ones.

 

Global Study Finds Majority Believe Traditional Hospitals Will Be Obsolete In The Near Future

A global study was released at the new year by the Intel Corporation indicating that around the world people’s health care wants and needs are principally focused on technology and personalization. The “Intel Health Innovation Barometer” found a consistent theme: customized care. At the intersection of health, care and technology, communities around the world consistently said they wanted to see their biological makeup and individual behaviors used to make receiving care more effective and efficient. This unsurprisingly was described by people through means such as telehealth, mobile health and the sharing of health information in real time. However, surprising methods of care were also common themes throughout the world such as ingestible monitoring systems and care that involves no utilization of hospitals.

Eric Dishman, Intel Fellow and Global General Manager of Health & Life Sciences at the company says the findings indicate that, “workflow, policy and culturally focused care are the most important ways we can improve health care.” Making care convenient, universally available and efficient through technological innovation is seen as more promising around the world than increasing the number of physicians or funding more academic research.

According to Senator Ron Wyden (D-Oregon), “People always talk about disruptors in terms of various kinds of practices in the American economy,” but “there’s nobody who’s done more disruption for the right reason than Eric Dishman.” With that kind of support to understand and advance the health care system, the Intel Health Innovation Barometer was conducted online by Penn Schoen Berland in Brazil, China, France, India, Indonesia, Italy, Japan and the United States. It was conducted among a representative sample of 12,000 adults aged 18 and older with a margin of error of +/- 0.89 percentage points.

Surprising Findings:

–       Traditional hospitals, according to 57% of people, will be obsolete in the future

–       Majority of people (84%) would be willing to share their personal health information to advance and lower costs in the health care system

–       More than 70% of people are receptive to using toilet sensors, prescription bottle sensors and swallowed health monitors

–       72% of those surveyed would be willing to see a doctor via video conference for non-urgent appointments

–       66% of people say they would prefer a care regimen that is designed specifically for them based on their genetic profile or biology

–       More than half of people (53%) would trust a test they personally administered as much or more than if that same test was performed by a doctor

–       About 30% of people would trust themselves to perform their own ultrasound

While wearable monitoring devices are commonly accepted in the US, global readiness for ingestible and sensory systems far exceeds that of Americans.  Acceptance of non-hospital care is also more appealing to those living outside the US. In remote areas of India, for example, extremely high percentages of people said that there is no need for traditional hospitalization.

Although in the US, a growing desire to care for the elderly at home gives hope to Eric Dishman that there could soon come a day that hospitals are obsolete. He cites changes in care seeking behaviors, policy and payment reform as incentives to move away from traditional hospitalization care. “The moment you signal pay for performance, people start thinking about how we misuse hospitals every single day,” says Dishman. That misuse of hospitalizations, and lack of formal hospitals in other countries, contributes greatly to the number of individuals worldwide who think the archaic system is not sustainable in the future.

Emerging Technologies For Innovation

Intel has been doing qualitative and quantitative research around the health care industry for many years. To date, the Intel Barometer is the most extensive survey it has conducted, and did reveal shifts in people’s increased desire to have access to emerging personal technology tools to become more active members of their care team.

Specifically, the Intel R&D teams are using ideology like Dishman’s to seek clarity and recognition of health advancements that unburden people from having to travel to a health care provider. “Care must occur at the home as the default model,” says Dishman. “It was also interesting,” he says of the survey, “to see people in emerging markets such as Brazil, China and India trusted themselves to use health monitoring technologies more than those in more technologically advanced economies like Japan and the United States.

Intel’s team of ethnographers used research in more than 1,000 homes and more than 250 hospitals across 20 countries to better understand the everyday lives of people, including those receiving and giving care.

The technologies that Intel’s survey received novel feedback on include items such as wearable and ingestible monitoring systems. While these hi-tech possibilities are new to all markets, the potential benefits could be felt across the entire health care arena as more thorough and patient-centered data is collected, driven by patient approval and demand.

Eric Dishman’s Personal Mission

In his pursuit of better health care technologies and home health care, Eric Dishman has been driven primarily from his in depth involvement with the health care system. As a student at the University of North Carolina, Dishman was told that he had months to live due to a rare kidney disease. Over twenty years later he has received a new kidney from a colleague at Intel thanks to sequencing his genes and finding that his diagnosis had been wrong his entire life.

Further, his grandmother’s progression of Alzheimer’s Disease drove his pursuit of innovation to keep her safe in her own home.  He found that keeping her health and dignity was a group effort. According to him, “Improving health care is a team effort, including patients and their families. Intel’s research shows that when people see benefits for them and their wider community, they are open to sharing sensitive information in an anonymous way.”

His approach seems to be gaining support based on the Health Innovation Barometer, which found that a higher percentage of people (47%) were willing to share their personal health records than their phone records (38%) or banking records (30%) to aid innovation.

If Dishman and Intel have their way, the new survey will move them to the head of the class by proving to health care leaders around the globe that massive disruption to the health care system is possible and supported by the large community. Smart devices that can connect patients and care givers in their home can lead to all kinds of health and policy change. Payment reform, independence and equal access might all be possible in the near future if individuals around the world are willing to use their own bodies and surroundings to educate and innovate the larger system.

 

NFL Players Host Concussion Summit Week Before Super Bowl, Despite Ongoing Litigation

Real innovation is often driven by those who think outside the box; those who take the obvious and make it an actionable reality. The week leading up to Super Bowl XLVIII, a group of entrepreneurs created a unique and transformative meeting of the minds. At the Coalition for Concussion Summit (#C4CT), Brewer Sports International and Amarantus BioScience Holdings, Inc. joined forces at the United Nations’ (UN) New York headquarters to bring scientists, biotech companies and professional athletes together, with the goal of building awareness and advancing scientific and medical opportunities for traumatic brain injury (TBI), chronic traumatic encephalopathy (CTE) and concussions. Add in the weight of immediate policy implications of the National Football League facing litigation for not properly informing or protecting players and Northwestern University’s football team attempting to unionize in hopes of improving athlete’s rights, and a perfect storm is created to demand change. Collectively, the week of the Super Bowl developed into an ideal time, location and platform for changing standards of health care and promoting developments in mental medical care that are patient-centric.

NFL Litigation

In the months preceding the 2014 Super Bowl, the NFL and the NFL Players Association (NFLPA) found themselves in a heated battle over the allegations that the NFL withheld information from the players about the depth and breadth of research indicating that concussions, memory loss and memory deterioration are linked. The NFL has since agreed to a $765 million settlement, which was recently denied by Judge Anita Brody who claims that the in the suit, “not all retired NFL football players who ultimately receive a qualifying diagnosis, or their related claimants, will be paid.”

While that decision is pending, more lawsuits are beginning to surface from individual players. Last Tuesday, former Detroit Lions running back Jahvid Best sued the NFL and helmet maker Riddell, claiming that concussion problems contributed to ending his career early

However, according to Robert Griffith, a 13-year veteran of the league, it doesn’t take a career-ending hit to significantly impact long-term functioning. “Guys suffer the same symptoms even after a few years in the league, including, sleep deprivation, depression, mood swings, addictions and self worth problems.”

The same week of the Super Bowl, the Northwestern University football team also dropped a bomb on the sports world, despite efforts from the National Collegiate Athletic Association (NCAA) to curb player concussions. The team wants to change the way university’s view, treat and educate student athletes, claiming more players’ rights are needed. This comes in tandem with a more than two-year long effort by several college players to sue the NCAA for failing to protect student athletes from concussions. An irony, pointed out by Chris Nowinski, author and former professional wrestler with World Wrestling Entertainment (WWE), who noted that “We have pitch counts for shoulders, even in high school, but we don’t have hit counts.”

Health Policy at the Forefront

When the NFL, the United States’ most powerful sports league, is on the hot seat for neglecting players’ mental and physical health, it is only a matter of time before public outrage requires policy change. Not only does the NFL itself have the ability to change health policy for the better, but the trickle down impact could save many young athletes around the country the trauma that current and past players have suffered.

Ultimately, a new standard of care is possible in the near future. Because, as Jermichael Finley told me, “100% or 50%, it doesn’t matter how one steps on the field. It isn’t if you get hurt, it’s when you’ll get hurt.” Further, as one conference goer attested, “We are speaking on the floor of the United Nations about brain trauma. This has never before been possible.”

With that in mind, researchers and clinicians such as Andrew Maas, MD, PhD, Robert Stern, PhD, Kim Heidenreich, PhD and Jay Clugston, MD came together with patients and biotech companies to discuss the current state of trauma, neuroscience, degenerative diseases, sports medicine and public policy.

Meeting Of The Minds

Despite the exorbitant power of the NFL, surprisingly little has been done to advance the conversation between athletes and the scientists who work diligently to understand and protect our brains. Until now.

As the nation’s best football players ascended upon New York and New Jersey, Brewer Sports International and Amarantus BioScience Holdings, Inc. gathered a room full of athletes and scientists to educate one another and discuss the real world of traumatic brain injury, concussions and memory loss.

“As a former NFL player, I am passionate about making strides to improve the health and safety of my fellow professional athletes, both former and current,” said Jack Brewer, CEO of Brewer Sports International. “Instead of pointing fingers, we have put together a world class panel of researchers to discuss TBI-induced neurodegeneration and CTE with those directly affected by and equally passionate about the cause as we strive to enhance awareness and work to find viable treatments.”

Gerald Commissiong, President and CEO of Amarantus reinforced the originality of the idea saying that, “The true innovation in #C4CT lies in bringing all of the stakeholders on the concussion issue into one forum. Conferences that are medical in nature almost always overlook key groups such as patients, caregivers and advocates. By allowing patients to be part of the process, we are creating a paradigm shift that we hope will galvanise the broader community into action.”

Brain Function

Despite Super Bowl caliber athletes having athletic abilities that are superior to most, the brains and vulnerabilities of these athletes are comparable to all others. The impact of one hard hit or one concussion can disrupt brain function forever. A point that resonates with Mixed Martial Arts (MMA) fighters as well. Just yesterday, boxing rivals met on Capitol Hill with Senators to support efforts of the Cleveland Clinic in studying brain health. They were backed by more than 400 of their peers who wanted to maintain their profession, but ensure that the future is brighter for other athletes.

Even veteran players such as Clinton Portis assert that he does not have regrets about his career but that he, “will not let my sons play contact football until at least high school,” due to the limited research that exists on TBI and concussions.

Those downstream effects, many at the summit contend, are highly linked to neurodegeneration, memory loss and long-term functioning. However, this is exceptionally hard to prove given how hard apples-to-apples comparisons are of brain damage and functioning. This association is further limited by the ability to compare impact enumeration and force due to the small sample size that are athletes.

Events such as the Coalition for Concussions Summit are becoming imperative to change health policy. When organizations, individuals, researchers and policymakers cannot fight the battle alone, it takes a meeting of the minds to advance a message. Hopefully, assembling key stakeholders to address health care problems will become a norm to improve health and care in the US.

 

The Innovation Center Will Now Demonstrate.

There are many provisions in the Affordable Care Act that people don’t know about.  Everybody is familiar with the health insurance part of it, but did you know the Centers for Medicare and Medicaid services (CMS) is giving $10 billion dollars to an organization called “The Innovation Center”?  The Innovation Center is charged with researching ways to most effectively deliver health care. Good goal.   The center’s website says “The Innovation Center develops new payment and service delivery models”. Oh.  Well, still good goal.

Here’s what the definition of a “model” is, according the the free online dictionary: A schematic description of a system, theory, or phenomenon that accounts for it’s known or inferred properties and may be used for further study of its characteristics.  So a model is not the thing.  It’s a smaller or schematic representation of the thing.  So what the Innovation Center is supposed to do is find or come up with schemes of payment and service delivery and try them out.  It has been doing this, so far, largely with “demonstration projects”.  A demonstration project tests an idea or group of ideas that might improve either payment systems or delivery systems, and then uses some complicated math to determine if things were better or worse before and after the idea is implemented.  Therefore, CMS is not looking for proven methods of improving payment or services, but testing ideas that might work.

There’s nothing wrong with this, by itself.  My 2-year-old does this all the time.  She peers up at the kitchen counter, determines she can’t see, drags a chair over, gets on it, and compares the view with the chair vs. the view without the chair.  Over time this has allowed her to develop a policy of always getting a chair if she wants to see what I’m doing.  She wouldn’t go get the chair if I just said “be a good girl and go get a chair”  and then praise her and give her a cookies if she does it.  If you go the the Innovation Center website what you mostly see is incentive programs for good behavior.  For example: The Comprehensive Primary Care Initiative is one of the Innovation Center’s projects.  This is how CMS describes this program:

“The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.”

Here’s another:  The Physician Group Practice Transition Demonstration:

‘The PGP Demonstration was the first pay-for-performance initiative for physicians under the Medicare program. Under the PGP Demonstration, physician group practices continued to be paid under regular Medicare fee schedules, but earned incentive payments for offering patients high-quality, coordinated healthcare that resulted in Medicare savings for the patient population they served.”

Another, the Medicare Health Care Quality Demonstration, goes straight to performance measures.  Three hospital/physician care systems in the US are being given money to test ideas that will improve performance measures.  Performance measures are not “performance” measures.  They are “quality” measures.  Doctor’s get up on stage and perform certain things, and judges evaluate whether their performance is a quality one.  As I have said before, measures of quality are things that are easily measured, quantifiable, and easy to find in an electronic medical record.

OK, to summarize so far:  CMS, i.e the federal government, is funding the Innovation Center, which is supposed to find better ways to pay for and deliver health care, but which is mostly doing pay-for-performance stuff.  Fine.  There are some people doing some fine work in health care delivery who could use the funding.  Some people are complaining that all the studies that the Innovation center are doing are demonstration studies, not randomized controlled trials (RCT).  RCT’s are the medical gold standard for proof, essentially.  It’s not true until an RCT says it is.  Why isn’t the Innovation center doing more RCTs?

I postulate several reasons: 1.  RCTs take a lot of time.  CMS, under the gun from ACA opponents, wants quicker results.  2. A good RCT has a very narrow research question, usually one or maybe two interventions compared to no change.  The researchers have to settle on a promising intervention and follow it up long-term.  It’s hard to decide what promising intervention is going to give the best results given how long the question will take to answer.  3. There are so many moving parts in health care.  It’s very hard to control for everything.  Some large RCTs that have affected national policy, such as the Tennessee study in the 1980’s, which found that smaller class sizes in early childhood translated into better long-term outcomes, changed only one variable and kept everything else the same.  Tennessee public schools are a closed system with relatively little short-term variability and relatively predictable human behaviors.  An RCT that, for instance, studies the effect of a specific intervention on re-admission rates to hospitals has to deal with the variability of disease process and progression, human behavior, emergency situations, dubious quality measures, record-keeping inconsistencies, the list goes on and on.

So, should the Innovation center be doing RCTs?  Absolutely.  Is CMS funding the way to get that done?  Probably not.  But you have to give the ACA an A for effort on this one.