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Video: Farzad Mostashari on patient engagement, ‘physician ACOs’

As I alluded to earlier, I was leaving the press room one afternoon at HIMSS14, and there I see former national health IT coordinator Dr. Farzad Mostashari hanging around Gregg Masters and Dr. Pat Salber of Health Innovation Media. It turns out, Masters and Salber had just pulled Mostashari aside to do an interview on video, but they didn’t have anyone to interview him on camera, so they asked me right there on the spot to be the interviewer. Here is the result.

Mostashari, now a visiting fellow at the Engelberg Center for Health Care Reform at the Brookings Institute in Washington, discussed how the years of searching for a business model to coordinate care and engage patients is finally starting to pay off. Always the champion of the little guy in healthcare, Mostashari also brought up the notion of physician-led ACOs, or, as he called it, the “Davids going up against the Goliaths.”

 

I had pretty much no preparation for this interview. It probably shows. I still think it worked out well.

Here’s a link to Salber’s post about the interview because I don’t want to steal page views. :)

March 14, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Great news from Health eVillages

As a board member of Health eVillages, I’m proud to share this video from rural Lwala, Kenya, where clinicians and other health workers are harnessing the power of mobile technology to deliver better care and, for some people, the first real healthcare they have ever had. This video, from from when Health eVillages Co-Founder Donato Trumato and Program Manager Matt Linder trekked to Lwala in October, shows how mobile health is helping local women deliver healthy babies.

Subsequent to this trip, the Lwala Community Alliance highlighted the work of Health eVillages here. Then, at a Health eVillages board meeting in December, Trumato issued a challenge to raise $150,000 to construct a dedicated maternity ward at the hospital in Lwala by year’s end. Physicians Interactive, of which Trumato is CEO, pledged half that total, and then others far wealthier than I stepped up and helped Trumato met the goal by Dec. 26. Operating funds are still necessary, and Health eVillages (or “Heal the Villages,” as one partner has pointed out) wants to help more people, including some at a site in rural Louisiana.

Since 2012, Health eVillages has helped the Lwala Community Alliance cut early infant mortality in half (from 60 per 1,000 births to 31 per 1,000). However, the Lwala still area happens to have the highest HIV/AIDS rate in all of Kenya, so education, care and prevention are critical. Here’s an overview on the Health eVillages-Lwala Community Alliance partnership (.pdf). To donate, visit http://lwalacommunityalliance.org/donate/.

Thanks, and stay tuned for more updates.

January 26, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Escape Fire’ leaves out IT, ultimately disappoints

I finally got the opportunity to catch the documentary film “Escape Fire,” a good 15 months after it went into limited theatrical release and became available in digital formats. I thought it would be an eye-opening exposé of all that ills the American healthcare industry, particularly for those who somehow believe we have the greatest care in the world. I excitingly ran this graphic when I first mentioned the movie on this blog back in October 2012:

The well-paced, 99-minute film interviews some notable figures in the fight to improve American healthcare — safety guru and former CMS head Dr. Don Berwick, journalist Shannon Brownlee, integrative medicine advocates Dr. Andrew Weill and Dr. Dean Ornish — as well as some lesser-known people trying to make a difference. It goes through a laundry list of all the culprits in the overpriced, underperforming mess of a healthcare system we have now, and examines approaches that seem to be producing better care for lower cost.

I expected the movie to have a liberal slant, but it really stayed away from the political battles that have poisoned healthcare “reform” the last couple of years. About the only presence of specific politicians were clips of both President Obama and Senate Republican leader Mitch McConnell both praising a highly incentivized employee wellness program at grocery chain Safeway that reportedly kept the company’s health expenses flat from 2005 through 2009, a remarkable achievement in an era of escalating costs.

However, filmmakers Matthew Heineman and Susan Froemke did discuss all the lobbyists’ money presumably buying off enough votes in Washington and at the state level that has helped entrench the status quo. They even scored an interview with Wendell Potter, the former top media spokesman for Cigna, who became a public voice against abuses by health insurers because his conscience got the better of him. As Brownlee noted in the film’s opening, the industry “doesn’t want to stop making money.”

Other reasons given for why healthcare is so expensive, ineffective and, yes, dangerous include:

  • direct-to-consumer drug advertising leading to overmedication;
  • public companies needing to keep profits up;
  • fee-for-service reimbursement;
  • the uninsured using emergency departments as their safety net;
  • lack of preventive care and education about lifestyle changes;
  • a shortage of primary care physicians;
  • cheap junk food that encourages people to eat poorly; and
  • severe suffering among the wounded military ranks.

The filmmakers also kind of imply that there isn’t much in the way of disease management or continuity of care. Brownlee described a “disease care” system that doesn’t want people to die, nor does it want them to get well. It just wants people getting ongoing treatment for the same chronic conditions.

One physician depicted in the movie, Dr. Erin Martin, left a safety-net clinic in The Dalles, Ore., because the work had become “demoralizing.” The same people kept coming back over and over, but few got better because Martin had to rush them out the door without consulting on lifestyle choices, since she was so overscheduled. “I’m not interested in getting my productivity up,” an exasperated Martin said. “I’m interested in helping patients.”

Another patient in rural Ohio had received at least seven stents and had cardiac catheterization more than two dozen times, but never saw any improvement in her symptoms for heart disease or diabetes until she went to the Cleveland Clinic, where physicians are all on salary and the incentives are more aligned than they were in her home town. As Berwick importantly noted, “We create a public expectation that more is better.” In this patient’s case, she was over-catheterized and over-stented to address an acute condition, but not treated for the underlying chronic problems.

The film also examined how the U.S. military turned to acupuncture as an alternative to narcotics because so many wounded soldiers have become hooked on pain pills. One soldier, a self-described “hillbilly” from Louisiana, got off the dozens of meds he had become addicted to and took up yoga, meditation and acupuncture to recover from an explosion in Afghanistan that left him partially paralyzed and with a bad case of post-traumatic stress disorder. The only laugh I had in the movie was when he told the acupuncturist at Walter Reed Army Medical Center in Washington, “Let’s open up some chi.”

I kept waiting and waiting for some evidence of information technology making healthcare better, but I never got it. After leaving the Oregon clinic, Martin took a job at a small practice in Washington state where she was seen toting a laptop between exam rooms, but, for the most part, I saw paper charts, paper medication lists and verbal communication between clinicians.

What really bothered me, however, is the fact that there was no discussion of EHRs, health information exchange or clinical decision support, no mention of the problem of misdiagnosis, no explicit discussion of patient handoffs, continuity of care, medication reconciliation and so many other points where the system breaks down. You can’t truly fix healthcare until you address those areas.

 

January 21, 2014 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Late news, literally: A new national HIT coordinator

Karen DeSalvo, M.D.

 

I’m a little late to the party reporting on the naming of a new national health IT coordinator, Karen DeSalvo, M.D. HHS Secretary Kathleen Sebelius announced DeSalvo’s appointment on Dec. 19, two days after I boarded a plane out of the country for a much-needed vacation. I vowed not to respond to any work-related e-mail while away, and I stayed true to my word, so now I play catch-up.

I honestly know nothing of DeSalvo’s work as health commissioner of the City of New Orleans and senior health policy advisor to Mayor Mitchell Landrieu, even though I visited New Orleans twice in the early rebuilding stages after Hurricane Katrina in 2006 and 2007 to report on the state of the healthcare infrastructure. At the time, Ray Nagin was mayor, though Landrieu was Louisiana lieutenant gove

rnor and his sister, Mary, was and still is a U.S. senator representing the Pelican State.

During my visits, I met with several state and local healthcare officials, but never came across DeSalvo. She is the first national coordinator I did not know prior to taking over ONC, so I guess I’ll be doing some catch-up. From her biography, I see her background is in public health, much like her predecessor, Farzad Mostashari, M.D. That signals to me that there will be a continued strong focus on using IT to improve population health, one of the original 2004 goals of the first national coordinator, David Brailer, M.D.

While Stage 1 of Meaningful Use has been about installing EHRs, we should start to see connectivity and interoperability to help manage populations in Stage 2, which is just getting started, with an eye toward producing measurable outcomes in Stage 3, which probably won’t begin before 2017.

DeSalvo remains in New Orleans at the moment. She takes over at ONC Jan. 13. Acting national coordinator Jacob Reider, M.D., will go back to being ONC’s chief medical officer.

December 30, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

The ‘Hospital of Tomorrow’

WASHINGTON—I’ve just finished 2 1/2 days of helping US News and World Report cover its inaugural Hospital of Tomorrow conference. My assignment was to sit in on four of the breakout sessions, take notes, then write up a summary as quickly as possible, ostensibly for the benefit of attendees who had to pick from four options during each time slot and might have missed something they were interested in. Of course, it’s posted on a public site, so you didn’t have to be there to read the stories.

Here’s what I cranked out from Tuesday and Wednesday:

Session 202: A Close-Up Look at EHRs — ‘Taking a Close Look at Electronic Health Records”

Session 303: The Future of Academic Medical Centers — “Academic Medical Centers ‘Must Become More Nimble'”

Session 305: Preventing and Coping With Infections — “How Hospitals Can Better Prevent and Cope With Infections”

Session 401: Provider and Patient Engagement — “Hospitals Grapple With Patient Engagement”

The one on infection control was particularly interesting, in large part due to the panel, which included HCA Chief Medical Officer and former head of the Veterans Health Administration Jonathan Perlin, M.D., Johns Hopkins quality guru Peter Pronovost, M.D., and Denise Murphy, R.N., vice president for quality and patient safety at Main Line Health in suburban Philadelphia.

The session on patient engagement was kind of a follow-on to my first US News feature in September.

If you want to read more about the whole conference, including US News’ live blog, visit usnews.com/hospitaloftomorrow

November 7, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Comprehensive coverage of WTN Media’s Digital Health Conference

As you may know from at least one of my earlier posts, I was in Madison, Wis., last month for a great little health IT event called the Digital Health Conference, a production of the Wisconsin Technology Network and the affiliated WTN Media. In fact, WTN Media hired me to cover the conference for them, so I did, pretty comprehensively. In fact, I wrote eight stories over the last couple of weeks, seven of which have been published:

I still have an overview story that should go up this week.

Why do I say it’s a great little conference? The list of speakers was impressive for a meeting of its size, with about 200 attendees for the two-day main conference and 150 for a pre-conference day about startups and entrepreneurship.

Since it is practically in the backyard of Epic Systems, CEO Judy Faulkner is a fixture at this annual event, and this time she also sent the company’s vendor liaison. Informatics and process improvement guru Dr. Barry Chaiken came in from Boston to chair the conference and native Wisconsinite Judy Murphy, now deputy national coordinator for programs and policy at ONC, returned from Washington. Kaiser Permanente was represented, as was Gulfport (Miss.) Memorial Hospital. IBM’s chief medical scientist for care delivery systems, Dr. Marty Kohn, flew in from the West Coast, while Patient Privacy Rights Foundation founder Dr. Deborah Peel, made the trip from another great college town, Austin, Texas. (Too bad Peel and Faulkner weren’t part of the same session to discuss data control. That alone would be worth the price of admission.)

July 2, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

About that Friedman editorial

Did you happen to catch Thomas Friedman’s commentary in Sunday’s New York Times entitled, “Obamacare’s Other Surprise”?

On first read, I gave it a big “Duh!” for the explanation that the Patient Protection and Affordable Care Act (that’s how the law is officially known, Mr. Friedman) creates a “new industry” of innovation by encouraging the federal government to release of terabytes of health data — information already legally in the public domain — and then allowing the private sector to figure out how to structure, interpret and use the data. As you probably are, I’m well aware of digital health, Health Datapalooza, federal CTO Todd Park and some of the companies Friedman mentions. (Health Datapalooza IV is less than a week away.)

But on second read, I realized Friedman needed to write that column because America needs a lot of education about the Affordable Care Act, education that the Obama administration and its supporters don’t seem all that willing to provide. The public still thinks of Obamacare largely in terms of health insurance coverage. It’s much more than that, including, as Friedman points out, an attempt “to flip this fee-for-services system (which some insurance companies are emulating) to one where the government pays doctors and hospitals to keep Medicare patients healthy and the services they do render are reimbursed more for their value than volume.”

Coupled with the 2009 American Recovery and Reinvestment Act, which created the $27 billion EHR incentive program for “meaningful use” of electronic health records, the ACA takes some steps toward actual reform of actual care, not just insurance coverage. Friedman does not discuss Accountable Care Organizations, an experiment in realigning incentives around care coordination, nor does he mention the Medicare policy, dictated by the ACA, of not reimbursing for preventable hospital readmissions within 30 days of initial discharge for certain specific conditions, currently heart attack, congestive heart failure and pneumonia. Likewise, he fails to bring up outcomes research, another component of Obamacare. But at least he gets something out there that’s not about insurance coverage.

Unfortunately, many of the online comments posted in response to Friedman’s commentary predictably focus on insurance coverage or government control, but some actually discuss EHRs, population health, healthy behaviors and payment incentives. That’s good. Still, those are just people who read Friedman and the Times. Hyperpartisan conservatives — probably even some hyperpartisan liberals, even though the ACA is more centrist than a lot of folks wish to admit — and the less-educated won’t read the column and won’t comment on the Times site. Those are the people who misunderstand this imperfect but occasionally reform-minded law the most.

 

May 27, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Dentzer leaves Health Affairs, replaced by founding editor Iglehart

Susan Dentzer has stepped down as editor of influential policy journal Health Affairs and will be replaced on an interim basis by Founding Editor John Iglehart.

In a press release issued Friday, Health Affairs gave the usual, vague reason: Dentzer is “leaving to pursue a new opportunity.” Her brief Wikipedia entry says Dentzer “stepped down abruptly on April 11, 2013.”

I know no more than that, though the press release suggests it wasn’t acrimonious.”We thank Susan Dentzer for her contributions and wish her well in her new endeavor,” Project HOPE President and CEO Dr. John P. Howe III said in the release. Project HOPE publishes Health Affairs.

Iglehart returns after a nearly six-year absence. He retired in 2007 after leading the editorial side of Health Affairs since its inception in 1981. The journal says he will be working with Executive Editor Donald Metz and Executive Publisher Jane Hiebert-White to find a new editor.

 

 

April 14, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

I’m speaking at the Health Technology Forum in SF

If you’re in Northern California, or plan to be, I will be on a panel at the Health Technology Forum’s 2013 Innovation Conference: Platforms for the Underserved on Friday, April 19, in San Francisco. I’ll be sharing the podium with Jan Oldenburg, Aetna’s VP for provider and patient engagement, in a breakout session on patient engagement. (There will be at least one other panelist, still to be determined.)

We’re still working on the details, but I suspect this session will cover what it means to be an engaged patient, the 5 percent portal usage requirement in Stage 2 of meaningful use, the relationship of patient engagement to patient satisfaction and the technologies and strategies that are and are not working. Since it is an innovation conference, I might have to play the role of reality checker like I often do when I venture into the Bay Area. :)

 

March 29, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Automation is good. Robocalls are bad.

I just got a robocall from my primary care physician’s office asking first if this was actually me — not that anyone would actually lie — and then if I had received a flu vaccine this season. Well, the practice itself administered the vaccine last month, so they should have known that the answer was yes. I did say yes to the interactive voice-response system and also provided the month, as asked.

I realize it is good to make sure that patients get the  recommended preventive care and that it may be impossible for staff in a small practice to call every last patient, but robocalls are awfully impersonal. If the system had actually been connected to the practice’s EHR, I wouldn’t have needed to get the call in the first place. Or maybe someone forgot to enter the vaccination into the record? In either case, the process is imperfect.

Yes, it’s a small deal, but how many imperfect processes are there in medicine? Little things have a way of adding up.

December 11, 2012 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.