Archive | August, 2014

Book: My Healthcare Is Killing Me

“A hospital bed is a parked taxi with the meter running.”  Groucho Marx

While I was flying last week, I had the chance to read My Healthcare Is Killing Me.  I could probably think of a few other titles for the book like:

  • Don’t let healthcare bankrupt you
  • Navigating the healthcare billing maze
  • Negotiating to better health
  • The $20 disenfranchisement fee

Those should give you a hint about the topic of the book.  It’s written by Chris Parks, Katrina Welty, and Robert Hendrick who are all part of the founding team at Change Healthcare.  If you’re not familiar with Change Healthcare, you should look at them and others in the transparency space.  (You can look at Jane Sarasohn-Kahn’s series on cost transparency for more information.)

Here’s a few of my notes from the book:

  • Hospitals and doctors view their patient’s bills as Days Sales Outstanding (which is why you can negotiate for prompt payment).
  • 22% of people have been contacted by a collection service for a medical bill
  • 60% of consumers that asked for discount on a medical bill were successful
  • The bill is NOT what the provider will (or expects) to get paid…It is the most that they will get paid
  • The chance of getting the right diagnosis and treatment on the first visit is 50% (scary)

The book has an interesting analogy from Patsy Kelly comparing healthcare to a restaurant:

“In healthcare, the patient does not order the service or have the primary responsibility for payment.  Additionally, the person who pays for the service does not order it or consume it, and the person who orders it does not pay for it or consume it.”

Another quote from Unity Stoakes was:

“We must arm ourselves with knowledge, wisdom and information.  Demand transparency in pricing by researching alternatives.  Negotiate!  Take control of your own healthcare now.  The more you know, the more power you have.”

The authors do a good job of simplifying down some of the complexities of the healthcare payment system.  Some things have changed with health reform, but the fundamentals are the same.  For someone taking on a large, complex condition which is likely to result in lots of costs, its worth reading.  For someone trying to change healthcare and understand the fundamentals, it’s also a great quick read which you can then follow-up on to see how this became the foundation for Change Healthcare. 

 

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Moon Shots in Healthcare

I think many of are familiar with Google’s use of the term “Moon Shots” and to a lesser degree their Google X projects.  I was inspired to see who in healthcare is using the term and think about a few moon shot ideas myself. 

I didn’t find much else out there (although I’m sure there is).

So, here’s some of my thoughts:

  1. Curing cancer.  But I think this is one many people think about.
  2. Creating a healthcare system that people actually understand.  That would be great!
  3. Making healthcare a positive experience.  Not easy, but it should be achievable in many settings.
  4. Preventing disease progression.  Maybe too simple, but there has to be some stretch about using data to predict risk and trigger proactive, personalized engagements that successfully change behavior.
  5. Integrated data.  The idea of interoperability of data across the care continuum with the ability to make it actionable would be great.
  6. Remote monitoring of people without them having to do anything.  The Internet of Things will make this much easier (some day), but the idea of simply integrating technology into our lives to monitor us and look for ways to improve our life is a great goal. 
  7. Integrated devices such that our decisions are improved would be great.  A device that knows I’m getting hungry and that I’m about to pass a McDonalds could suggest a healthy alternative. 
  8. Reducing global obesity by teaching kids about health.  This is a great one with complexity like addressing food deserts, sleep patterns, food selection, and general attitudes about health. 
  9. Eliminating negative stress in order to improve health.  This is another tricky one as our lives become more and more stressful.

I’ll leave the list open…what would you add?  I know there are some big stretch thinkers out there. 

  • Digital pills you can print in a 3D printer
  • “Doc in a box” solutions that could be in every home where the physician can get your vitals and interact with you all virtually.
  • Self-healing band-aids that turn into skin.
  • A pill that you take once a year, and it doses you ever day.
  • A machine that can actually diagnose you (like that mirror in the one cholesterol advertisement).
  • A pill to cure addition to cigarettes and other addictive substances.
  • Food that turns bad cholesterol into good cholesterol.

Book Review: Social Media In Clinical Practice

I finally had some time to read Dr. Bertalan Mesko’s book called Social Media in Clinical Practice.  I’m a big fan of his blog and a lot of the information he puts out.   I was intrigued to see what he thought was important for clinicians and then to compare that to what I know as someone active in the space. 

Overall, I thought it was a good, quick read for someone who knows very little about social media and all the options out there.  He quickly hits a lot of information:

  • Search engines
  • RSS
  • Facebook
  • E-Patients
  • Blogging
  • Twitter
  • Collaboration
  • Wikipedia
  • Second Life
  • Mobile
  • Videos and podcasts
  • E-mail

He provided some reinforcing references and laid out some key reasons for physicians to get involved such as:

  1. Keeping up to date
  2. Sharing and collaborating with other physicians
  3. Improving patient care

I was glad that he brought up the concept of “Information Therapy” which is a term I use a lot, and I think is really important for how providers can direct patients to quality content. 

While he spent a lot of time on Facebook and Google+, I personally would have expected more on Sermo or other physician specific networks. 

I thought the section on e-patients was really important for physicians to understand how to engage and work with them and creating a difference between a “Googler” and an e-patient. 

I knew it was possible, but it was good to see him provide the proper way of citing medical blogs and tweets in medical papers.

I was surprised to see a whole chapter on Second Life.  I never hear anyone talk about that anymore.  At the same time, there wasn’t any focus on LinkedIn or talk about tools like SlideShare.  I think there’s also a need for much more on mobile applications and use of SMS with patients along with a discussion on connected devices ranging from FitBit to more sophisticated tools with feedback and integration into the clinical systems. 

He did have some good suggestions on presentations such as looking at the Lessing Method, PechaKucha, and Guy Kawasaki’s 10/20/30 Rule. 

My overall summary would be that:

  1. If you’re new to the space, it’s a good quick read.
  2. If you’re in the space, you’ll learn a few things, but it’s probably not for you.

Of course, with technology and social media, things change really fast so it’s going to need to be come a more interactive version to keep up with the changes. 

Lessons Learned And MVPs

 I’m a big believer in trying to capture and learn from everything you do.  When you work in the start-up and turnaround space, not everything will be a clear success

After looking back on my time at my last turnaround, there are several clear takeaways:

  1. Demonstrate Incremental Benefits…All The Time.
    1. Taking on long-term projects is dangerous.  Sponsors change.  Markets change.  New technology comes out.  If you’re working on a multi-year transformation, you need to demonstrate incremental wins and have clear milestones.  You should assume you don’t have the next round of funding and build for success at each point.   I could say this is using an Agile approach, but it’s more than that. 
  2. FOCUS, FOCUS, FOCUS. 
    1. This one probably seems so obvious from the outside looking in, but it’s easy to get carried away with trying to take on too much.  In this particular case, we thought we had a 3-year timeframe to build and deliver on the vision.  We created a vision of care coordination that was really innovative, but we knew that no one had pulled it off before.  We then tried to coordinate care coordination and cost management which also hadn’t been done.  It would have been better to deliver one thing at a time and make ourselves incredibly sticky in that area.
  3. Know Your Customer…Really Well.
    1. When coming into a business, it’s so important to know the customer base and what they feel about the business.  Do they love it?  Do they engage regularly?  Is it just a commodity?  And why.  In this case, clients seemed to love the business, but it was because it was a massively customized business doing all the wrong things.  As we brought the business into compliance and created re-usable processes, it changed the relationship with the customers.  The relationships weren’t sticky, and we didn’t have clear alignment of goals.
  4. Partner Well.
    1. When you’re in the early stages of growth, it’s tempting to try to partner with people bigger and leverage their brand.  While that can help, it’s often a big distraction.  Some times, you commit to something that you can’t achieve putting pressure on a key relationship.  And, other times, you put so much at risk tied to the big company that when you realize that you’re not important to them then you have real challenges.  This gets back to the traditional understanding of buy, build, or partner and understanding your core competencies.
  5. Have A Clear Value Proposition.
    1. You’ll always find early adopters especially when you have a compelling vision, good sales people, and good management.  But, they won’t make your business for you if you can’t clearly demonstrate value.  You have to have access to data.  You have to be able to report on what you do and demonstrate how you’re creating a ROI.  In today’s competitive market, companies without a clear value proposition don’t last long.
  6. Be Different.
    1. This is a tough one.  We all watch the competition and see a path towards success, but as a younger company, trying to compete on price is a sure path to disaster.  Like the Blue Ocean Strategy, you want to compete in a different area.  Find your niche and do it better than anyone else in a way that is really different.  Trying to build something to just catch up always puts you behind. 
  7. Hire Slow and Fire Fast.
    1. This is something many people say, but they don’t always do.  It’s important to get the right team.  It’s important to hire in a logical sequence.  For example, getting a great sales team before your solution is built is great for the pipeline but frustrating to everyone in between.  On the flipside, in a smaller company, a toxic personality or someone that doesn’t fit can kill you.  You need to realize that quickly and let them go.  No one likes to do it, but you do a disservice to everyone else if you keep them. 

The past few years have been really interesting as I learned more about case management, disease management, utilization management, oncology, kidney care, and many other parts of our healthcare system.  The key is leveraging all of this as I move forward in my new role

I think another related topic to think about here is some of the lessons around MVPs (minimum viable products)

I always use the Apple 1 as my case study for an MVP.  

Apple Minimum Viable Product

Is There A Future For Community Oncology?

Cancer costs are expected to reach $174B in the US by 2020.  Right now, it’s about 10-11% of total healthcare spend which makes it a big area of focus within the healthcare industry.

The question is how to manage this spend:

  • Is it about site-of-care and where the care is provided?  (community oncology; Centers of Excellence; outpatient clinics; inpatient)
  • Is it about specialty drugs and how they are managed and charged?  (Buy-and-bill; white-bagging; brown-bagging; on-site pharmacy; 340B)
  • Is it about evidence-based care and following NCCN guidelines or clinical pathways?
  • Is it about palliative care and managing spend in the last 3-6 months of life?
  • Is it about personalized medicine?

One of the challenges is the survival of the community oncology practice (see ASCO report) that is an issue that physicians have struggled with in other specialties.  Over the past few years, we’ve seen continued consolidation of practices with many of them being acquired by hospitals and hospital systems.

In some cases, oncologists have seen a reduction in their income tied to a reduction in buy-and-bill and are looking to be employed in order to continue to maintain their incomes.  They are one of the few medical professions that have seen a reduction in income recently.  At the same time, this trend is also driven by hospitals taking advantage of the 340B pricing which allows them to generate approximately $1M in profit for every oncologist they employ.  And, the complexity of oncology treatment also is prompting the need for a more comprehensive care model which requires a broad set of services which is sometimes difficult for a small practice to provide.

Of course, this shift in care from community oncology to hospitals is driving up costs without a demonstrated improvement in outcomes.  This is driving a lot of payer focus and driving discussions of payment reform whether that’s in the form of ACOs, PCMHs, or bundled payments.  United Healthcare recently released some data from one of their pilots.

This seems like another classic example of misalignment across the industry.  Hospitals clearly see an opportunity to buy up more oncology practices while payers and others are going to push for reform around 340B and payment differences.  Oncologists are struggling to continue providing care but replace the income they were making of buy-and-bill of specialty medications.

I’ve talked to a lot of people about this struggle.  It doesn’t seem clear whether community oncologists are destined for extinction or will payers will find a way to enable them to survive.  The other question is how things like teleoncology, tumor boards, big data, and the focus on prevention and survivorship will ultimately change the care delivery approach to oncology which may impact the role of the community oncologist in the future.


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