All posts by blackfriar

health market quality, healthcare, policy, politics

Better prostate ca. markers in seminal fluid than PSA

The urologists will not be happy, ‘fuckers:

The men tested were already considered to be candidates for prostate cancer according to their prostate-specific-antigen (PSA) test results. Biopsy later confirmed that 32 of the men had cancer and 28 did not.

http://www.medicalobserver.com.au/news/seminal-fluid-markers-more-accurate-than-psa

Seminal fluid markers more accurate than PSA

Emily Dunn   all articles by this author

BIOMARKERS in seminal fluid have been found to be a more accurate indicator of prostate cancer than standard PSA testing, according to results from an Australian study.

Researchers from the Freemasons Foundation Centre for Men’s Health at the University of Adelaide tested semen samples from 60 men for a range of ribonucleic acid (RNA) molecules or microRNAs that are known to be increased in prostate tumours.

The men tested were already considered to be candidates for prostate cancer according to their prostate-specific-antigen (PSA) test results. Biopsy later confirmed that 32 of the men had cancer and 28 did not.

University of Adelaide research fellow and lead author of the study, Dr Luke Selth said that the results of the study indicated that, in the men tested, each of the micro-RNAs alone was a better predictor of a cancer diagnosis via biopsy than the PSA test. In addition, several of the micro-RNAs, when added to the PSA test results, were a better predictor of the presence of cancer than the PSA test alone.

Dr Selth said the results were promising both in terms of detecting the presence of cancer and identifying aggressive subtypes which could help to reduce both over-diagnosis and over-treatment of suspected prostate cancer.

“The presence of these microRNAs enabled us to more accurately discriminate between patients who had cancer and those who didn’t, compared with a standard PSA test,” Dr Selth said.

“We also found that the one specific microRNA, miR-200b, could distinguish between men with low grade and higher grade tumours. This is important because, as a potential prognostic tool, it will help to indicate the urgency and type of treatment required.”

The results add to previous research which indicated that microRNAs in blood can predict men who are likely to relapse after surgery for prostate cancer. The team have now applied for funding for a larger study into the role of microRNA biomarkers in predicting prostate cancer.

“We are not at the stage where we can say there is a new test for prostate cancer just around the corner,” Dr Selth said. “While these results are encouraging and exciting, we need to validate them in a much larger cohort.”

Endocr Relat Cancer 2014; online 23 May 

health market quality

Endemic upcoding in the US

PDF: oei-04-10-00181_HHS Physician Overpayment

http://www.healthleadersmedia.com/content/HEP-305080/Medicare-Overpaid-Physicians-67B-For-Miscoded-Claims

Medicare Overpaid Physicians $6.7B For Miscoded Claims

Cheryl Clark, for HealthLeaders Media , May 30, 2014

An examination of medical claims records by federal officials finds that more than half of doctors’ claims for patient evaluations and related services had incorrect codes or lacked the necessary documentation.

Suggesting physician upcoding practices on a major scale, an Office of Inspector General report Thursday said Medicare overpaid physicians $6.7 billion in 2010.

The overpayments were claims reimbursements for evaluation and management (E/M) services submitted with frequently exaggerated severity codes, the report said.

After examining medical records for a large sample of those claims, the OIG found that 26% of the claims were upcoded to reflect a higher level of severity than what was justified by the patient’s record, amounting to $4.6 billion in overpayments. Another 14.5% were downcoded, reflecting a lower level of severity than what was warranted, for an underpayment of $1.8 billion.

Another 12% of the claims were insufficiently documented, which meant Medicare overpaid $2.6 billion and 7% were undocumented, representing $2 billion in overpayments. About 2% of claims had other coding errors, amounting to about $500 million in overpayments.

In all, 55% of claims for E/M services had incorrect codes or lacked the necessary documentation.

Medicare paid $32.3 billion for E/M services in 2010, an amount that represented 30% of all Part B payments that year.

Severity CPT coding or Current Procedural Terminology, is determined by federal guidelines, and is based on seven factors: patient history, physical examination, medical decision-making complexity, counseling, coordination of care, the nature of the patient’s problems, and the amount of time.

The OIG looked at claims from two types of physicians to draw its conclusions. The first group comprised a sample from 828,646 claims billed by physicians with a history of high-coded claims. The doctors in this group were in the top 1% of their primary specialties and billed at the two highest level codes (4 and 5) for E/M services at least 95% of the time.

The second and larger group sampled nearly 369 million claims from doctors without a history of high coding. Physicians can score CPT codes at levels from one to five, but for this review, the OIG limited its scrutiny to those visits coded at level 3, 4, or 5.

From both groups, a sample of 673 claims were examined in detail to determine the justification for higher codes.

The OIG review found more inappropriate coding within the first group of doctors—those with a history of submitting high-coded claims.

The report informed the Centers for Medicare & Medicaid Services that it should do a better job to

  • Educate physicians on coding and documentation requirements, including consolidation of two somewhat different CMS Documentation Guideline manuals issued in 1995 and 1997.
  • Continue to encourage audit contractors to review E/M service billings from physicians with a history of high coding claims
  • Follow up on claims for E/M services to correct errors.

In a response, attached to the OIG report, CMS Administrator Marilyn Tavenner said she did not agree that CMS should encourage contractors to target physicians with a history of high-coding practices, saying such a practice “has resulted in a negative return on investment to CMS.”

The agency also said that the per-claim overpayment amount is “approximately $33,” and since four-year claim reopening period window is about to close for this period covering 2010, the OIG should turn over to the agency the provider number, claim payment amount, correct code for each claim, overpayment amount, Medicare contractor number, claim paid date and other details.

After that information is received, CMS said, it would “analyze each overpayment to determine which claims exceed CMS recovery threshold and can be collected consistent with agency’s policies and procedures.”

Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists. 
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Copyright © HealthleadersMedia, 2014

health market quality, management and leadership, musings, politics

On the Good Occupational Sociopath

 

From: http://aushealthit.blogspot.sg/2014/06/senate-estimates-hearing-june-3-2014-e.html

The modus operandi of ‘good’ occupational sociopaths is to convince everyone that all is well, “trust us we know what we are doing”. 

The underlying goal is to create as much havoc and confusion as possible, to frustrate, undermine and destroy, whilst on the surface all the while going about their business in a way that looks like we all think they know what the are doing.

Quod erat demonstrandum

business, complex adaptive systems, data saving lives, entrepreneurship, health market quality, healthcare, management and leadership, policy, rapid learning health systems

McKinsey: Feeding consumer decisions…

Will be useful to plug this into our health market quality explorations…

PDF: Digitizing the consumer decision journey McKinsey

http://www.mckinsey.com/Insights/Marketing_Sales/Digitizing_the_consumer_decision_journey?cid=DigitalEdge-eml-alt-mip-mck-oth-1406

Digitizing the consumer decision journey

In a world where physical and virtual environments are rapidly converging, companies need to meet customer needs anytime, anywhere. Here’s how.

June 2014 | byEdwin van Bommel, David Edelman, and Kelly Ungerman

Many of the executives we speak with in banking, retail, and other sectors are still struggling to devise the perfect cross-channel experiences for their customers—experiences that take advantage of digitization to provide customers with targeted, just-in-time product or service information in an effective and seamless way.

Video

How consumer behavior keeps changing

McKinsey’s David Edelman explains how purchasing decisions are made in a digital world.

This quest for marketing perfection is not in vain—during the next five years or so, we’re likely to see a radical integration of the consumer experience across physical and virtual environments. Already, the consumer decision journey has been altered by the ubiquity of big data, the Internet of Things, and advances in web coding and design.1 Customers now have endless online and off-line options for researching and buying new products and services, all at their fingertips 24/7. Under this scenario, digital channels no longer just represent “a cheaper way” to interact with customers; they are critical for executing promotions, stimulating sales, and increasing market share. By 2016, the web will influence more than half of all retail transactions, representing a potential sales opportunity of almost $2 trillion.2

Companies can be lulled into thinking they’re already doing everything right. Most know how to think through customer search needs or have ramped up their use of social media. Some are even “engineering” advocacy—creating easy, automatic ways for consumers to post reviews or otherwise characterize their engagement with a brand.

Yet tools and standards are changing faster than companies can react. Customers will soon be able to search for products by image, voice, and gesture; automatically participate in others’ transactions; and find new opportunities via devices that augment their reality (think Google Glass). How companies engage customers in these digital channels matters profoundly—not just because of the immediate opportunities to convert interest to sales but because two-thirds of the decisions customers make are informed by the quality of their experiences all along their journey, according to research by our colleagues.3

To keep up with rapid technology cycles and improve their multiplatform marketing efforts, companies need to take a different approach to managing the consumer decision journey—one that embraces the speed that digitization brings and focuses on capabilities in three areas:

  • Discover. Many of the executives we’ve spoken with admit they are still more facile with data capture than data crunching. Companies must apply advanced analytics to the large amount of structured and unstructured data at their disposal to gain a 360-degree view of their customers. Their engagement strategies should be based on an empirical analysis of customers’ recent behaviors and past experiences with the company, as well as the signals embedded in customers’ mobile or social-media data.
  • Design. Consumers now have much more control over where they will focus their attention, so companies need to craft a compelling customer experience in which all interactions are expressly tailored to a customer’s stage in his or her decision journey.
  • Deliver. “Always on” marketing programs, in which companies engage with customers in exactly the right way at any contact point along the journey, require agile teams of experts in analytics and information technologies, marketing, and experience design. These cross-functional teams need strong collaborative and communication skills and a relentless commitment to iterative testing, learning, and scaling—at a pace that many companies may find challenging.

Let’s consider what an optimized cross-channel experience could look like when companies target improved capabilities in these three areas.

A new normal …

Imagine that a couple has just bought its first home and is now looking to purchase a washer and a dryer. Mike and Linda start their journey by visiting several big-box retailers’ websites. At one store’s site, they identify three models they are interested in and save them to a “wish list.” Because space in their starter home is limited—and because it is a relatively big purchase in their eyes—they decide they need to see the items in person.

Under an optimized cross-channel experience, the couple could find the nearest physical outlet on the retailer’s website, get directions using Google Maps, and drive over to view the desired products. Even before they walk through the doors, a transmitter mounted at the retailer’s entrance identifies Mike and Linda and sends a push alert to their cell phones welcoming them and providing them with personalized offers and recommendations based on their history with the store. In this case, they receive quick links to the wish list they created, as well as updated specs and prices for the washers and dryers that they had shown interest in (captured in their click trails on the store’s website). Additionally, they receive notification of a sale—“15 percent off selected brand appliances, today only”—that applies to two of the items they had added to their wish list.

When they tap on the wish list, the app provides a store map directing Mike and Linda to the appliances section and a “call button” to speak with an expert. They meet with the salesperson, ask some questions, take some measurements, and close in on a particular model and brand of washer and dryer. Because the store employs sophisticated tagging technologies, information about the washer and dryer has automatically been synced with other applications on the couple’s mobile phones—they can scan reviews using their Consumer Reports app, text their parents for advice, ask Facebook friends to weigh in on the purchase, and compare the retailer’s prices against others. Mike and Linda can also take advantage of a “virtual designer” function on the retailer’s mobile app that, with the entry of just a few key pieces of information about room size and decor, allows them to preview how the washer and dryer might look in their home.

All the input is favorable, so the couple decides to take advantage of the 15 percent offer and buy the appliances. They use Mike’s “smartwatch” to authenticate payment. They walk out of the store with a date and time for delivery; a week later, on the designated day, they receive confirmation that a truck is in their area and that they will be texted within a half hour of arrival time—no need to cancel other plans just to wait for the washer and dryer to arrive. Three weeks after that, the couple gets a message from the retailer with offers for other appliances and home-improvement services tailored toward first-year home owners. And the cycle begins again.

… requires new capabilities

As this example makes clear, the forces enabling consumers to expect real-time engagement are unstoppable. Across the entire customer journey, every touchpoint is a brand experience and an opportunity to engage the consumer—and digital touchpoints just keep multiplying. To maximize digital channels, companies need to focus on improving their “3-D” capabilities.

Discover: Build an analytic engine

Even in this era of big data and widespread digitization of customer information, some companies still lack a 360-degree view of the people who buy their products and services. They typically measure the performance of direct sales activities such as product pitches and encourage downloads using “last-action attribution” analyses, which assess campaigns in isolation rather than in the context of the entire cross-channel consumer decision journey. Usually these data will have been stored in disparate locations and legacy systems rather than in a central server. Complicating matters further is the range and quantity of unstructured data out there—information about consumers’ behaviors and preferences that is, for instance, captured in online reviews and social-media posts. In our experience, this type of data is usually the least understood and therefore the least utilized by companies.

To get the full customer portrait rather than just a series of snapshots, companies need a central data mart that combines all the contacts a customer has with a brand: basic consumer data plus information about transactions, browsing history, and customer-service interactions (for an illustrative example of how companies can lose potential customers by failing to optimize digital channels, see exhibit). Tools like Clickfox and Teradata can help marketers gather these data and begin to pinpoint opportunities to engage more effectively with consumers across the decision journey. This collection effort requires input from people across multiple functions—a complex undertaking, to be sure, but the payoff can be big. Our work in this area suggests that the growth rate of earnings before interest, tax, depreciation, and amortization of grocers that focus on customer analytics is 11 percent, compared with just 3 percent on average for their main competitors. For big-box retailers, the difference is 10 percent compared with 2 percent.4

Exhibit

Failure to optimize digital channels may result in underperformance.

With a comprehensive data set in hand, companies can undertake the sort of quick-hit “shop diagnostics” that many tell us is lacking in their marketing and e-commerce programs. Using analytic applications such as SAS and R, and by applying various algorithms and models to longitudinal data, companies can better model the cost of their marketing efforts, find the most effective journey patterns, spot potential dropout points, and identify new customer segments. Based on its analysis of click-through behaviors, for instance, one regional retailer saw that a particular set of customers preferred digital shopping over physical and always read e-mail on Saturdays, and so the retailer altered its e-mail campaign to send this cohort online offers only on Saturdays.

Additionally, by using business-process software and services from vendors such as Adobe Systems, ExactTarget, Pegasystems, and Responsys, companies can identify in real time the basic “triggers” for what individual customers need and value—regardless of the product or service—and personalize their approach when making cross- or up-sell offers. They can also use these tools to generate automated reports that track customer trends and key performance indicators. For instance, the regional retailer’s analytics suggested that two of the customers who read their e-mail only on Saturdays were in the midst of a career change; both had revised their profiles on LinkedIn within the past three days. Based on its analytics efforts, the company was able to create targeted offers for each—one received information about laptop bags (based on her previous purchases) while the other received information about suits (based on his previous purchases).

Already, the companies employing these types of advanced analytics have seen significantly improved click-through rates and higher conversion rates (between three and ten times the average). Additionally, McKinsey analysis shows that using data to make better marketing decisions can increase marketing productivity by between 15 and 20 percent—that’s as much as $200 billion given the average annual global marketing spend of $1 trillion.5

Design: Create frictionless experiences

Careful orchestration of the consumer decision journey is incredibly complex given the varying expectations, messages, and capabilities associated with each channel. According to published reports, 48 percent of US consumers believe companies need to do a better job of integrating their online and off-line experiences. There is a premium for getting this right. One major bank unlocked more than $300 million in additional margins by making better use of digital channels. It tapped into underutilized customer data and delivered targeted marketing messages at various points in the purchase-decision process. The bank used the data, plus various personalization and testing tools, to inform changes in marketing campaigns for certain product lines; every next step for every customer was progressively tailored to help the customer take the best action.

Digital natives such as Amazon, eBay, and Google have been leading the pack in resetting consumers’ expectations for cross-channel convenience. (Think of eBay’s Now mobile app, which provides one-touch ordering from any of eBay’s retail partners and same-day delivery in some US cities, or Amazon’s recent incorporation of a help button in the company’s latest-generation Kindle Fire tablet, linking users to a live help-desk representative.) These players have perfected the ability to test new user experiences and constantly evolve their offers—often for segments of one.

This lean, start-up approach might sound counterintuitive to large, entrenched marketing organizations in which decisions are made at a snail’s pace, but test-and-learn methods can help companies decide how best to optimize (and customize) critical design attributes of the consumer decision journey at various points along the way. In the appliances example discussed earlier, the retailer’s customer analytics allowed it to design an experience for the couple that was completely customized to their context—from their initial online searches to their physical and virtual interactions at the store and to their follow-up with the company postpurchase. Rather than push what could be construed as intrusive (even creepy) messaging, the retailer provided Mike and Linda with the most useful information at every point in their decision journey and offered the easiest possible path to purchase and delivery.

To create similarly frictionless experiences, some companies have created 24/7 digital “window shops” to test product ideas and customer interactions and collect rapid feedback without the need for additional labor or inventory. Several companies that offer inherently complex products or services have incorporated “gaming” elements into their experiences—tweaking the navigation, content architecture, and visual presentation to allow consumers to trade off and test various options and prices associated with a product before making a decision. One financial-services firm redesigned its mobile app for collecting credit-card applications to incorporate the customer context. Previously it had a one-size-fits-all interface; in the redesigned version, various elements of the mobile app’s interface—such as pricing, stage of process, and designated credit limits—are dynamically generated based on existing customer information. And the app’s page layout and navigation are rendered simply, allowing for easy completion within just a few clicks. The result has been a significant uptick in online applications.

Deliver: Build a more agile organization

In our experience, too many companies are afraid to launch “good enough” campaigns—ones that are continually refined as customers’ purchase behaviors and stated preferences change. Under the direction of conservative senior leaders, teams tend to launch campaigns that take too long to get off the ground and end up revealing few new insights. Instead, they must be willing to conduct lots of small-scale experiments with cloud or proxy website services to pilot new designs and prove their value for investment.

These types of agile, data-driven activities must be supported by an organization that has the right people, tools, and processes. Many companies will have some of the talent required, but not all, and executives will inevitably face resistance when it comes to introducing lean tools and techniques into their sales, marketing, and IT processes. The most successful omnichannel marketers we’ve seen have established centers of excellence in both analytics and digital marketing, and they practice end-to-end management of microcampaigns. Their campaign-building processes typically include systematic calendaring, brainstorming, and evaluation sessions to allow for one-week and two-week turnaround times. And roles and responsibilities are clearly defined. Far from creating a rigid, hierarchical process, this model frees up individuals to iterate quickly—what is sometimes called “failing fast forward” in the world of high tech.

At one bank, for instance, business-unit leaders gather each month to talk about their progress in improving different consumer journeys. As new products and campaigns are launched, the team places a laminated card illustrating the journey at the center of the conference-room table and discusses its assumptions about the flow of the experience for different segments and about how the various functional groups need to contribute: Where does customer data need to be captured and reused later? How will the design of the campaign flow from mass media to social media and then on to the website? What is the follow-up experience once a customer sets up an account? The team has also appointed dedicated mobile and social-media executives to become evangelists for strengthening the omnichannel experience, helping business units raise their game along a range of consumer interactions. The company’s first wave of fixes and new programs generated tens of millions of dollars in the first six months, and the team expects it to continue scaling beyond $100 million in added annual margins.

Building an agile marketing organization will take time, of course. Companies should start by assembling a “scrum team” that will bring the right people together to test, learn, and scale. The team should incorporate cross-functional perspectives (marketing, e-commerce, IT, channel management, finance, and legal), and its members must adopt a war-room mentality—for instance, making tough calls about which campaigns are working and which aren’t, and which messages should take priority for which segments; launching new tests every week rather than every six months; and mustering the IT and design resources to create content for every possible type of interaction.

Companies likely will need to hire people with skills that differ from the ones they rely on now. Some organizations have developed innovative, venture capital–like strategies for finding and recruiting the people they need. Staples, for instance, has built an e-commerce innovation center in Cambridge, Massachusetts, to better recruit technology talent from nearby Harvard University and MIT, and it recently bought conversion-marketing start-up Runa to act as a talent hub on the West Coast.

New types of information systems may also be required. The best technology solutions will vary according to a company’s starting point and objectives. Generally, though, companies will get the best results from tools that enable large-scale data management and the integration of databases; the generation of next-best-action and other types of advanced analyses; and simpler campaign testing, execution, and metrics.

Companies need to make strategic decisions about the best pathways to build customer value. Many cite digital as one of their top three priorities in this regard, but few have taken the time to measure the level of digital maturity their organization has achieved. A company’s digital quotient (DQ) is a function of how well defined its long-term digital strategy is, its effectiveness in implementing that strategy, and the strength of its organizational infrastructure and information technologies. The companies that incorporate the notion of DQ into their short list of performance metrics can more effectively monitor their progress across the digital capabilities we’ve outlined here, enabling more targeted investments and accelerated rates of digital growth.

Indeed, the companies that ultimately succeed in omnichannel marketing and sales will likely resemble tech companies and, interestingly, publishers—effectively using big data and digital touchpoints to drive growth and reduce costs, while producing and managing a variety of content (catalogs, coupons, web pages, mobile apps, and user-generated content) in real time across multiple platforms to create breakthrough customer experiences. This means rethinking the analytics that inform their segmentation strategies, the flow of the experiences they design, and the way they set up their internal operations for faster iteration and delivery of service.

About the authors

Edwin van Bommel is a principal in McKinsey’s Amsterdam office, David Edelman is a principal in the Boston office, and Kelly Ungerman is a principal in the Dallas office. They are leaders in McKinsey’s revenue enhancement through digital (RED) initiative, which redesigns the consumer decision journey to encompass all commercial levers, across all channels and touchpoints, thereby creating growth in revenue and profits.

business, complex adaptive systems, data saving lives, health market quality, healthcare, healthy habits, musings, nutrition, policy, politics, quantified self, quotes & aphorisms, rapid learning health systems

The Hospital of the Future is not a Hospital

Great insights into where capital is being invested in US healthcare…

http://www.healthleadersmedia.com/print/LED-305089/The-Hospital-of-the-Future-is-Not-a-Hospital

The Hospital of the Future is Not a Hospital

Philip Betbeze, for HealthLeaders Media , May 30, 2014

Pursuing expensive inpatient volume in the traditional sense is a strategic dead end. Any new construction undertaken by hospitals and health systems should be based on adaptability, patient flow, and efficiency gains—not bed count.

I’ve spent a good deal of time the past several weeks interviewing senior healthcare leaders for my story in the May issue of HealthLeaders magazine about the hospital of the future. But in truth, that headline might be a bit of a tease.

As it turns out, the hospital of the future doesn’t look much like a hospital at all. Instead, it’s a cohesive amalgamation of plenty of outpatient modalities that represent growth in healthcare. Inpatient care, increasingly, represents stagnation and shrinkage, in the business sense.

In the past, a story about the hospital of the future has meant investigating healthcare organizations’ access to capital, and their ability to fund expensive new patient bed towers with all-private rooms and top technologies, in a race to grab volume from competitors.

Under that operating scenario, the sky was the limit, in terms of what organizations were willing to do to attract volume.

That calculus has changed drastically.

In a recent survey on healthcare design trends conducted by Minneapolis-based Mortenson Construction, 95% of the healthcare organizations surveyed said most of the projects they are undertaking are predominantly ambulatory in nature.

“If, in theory, the [Patient Protection and Affordable Care Act] has now got 7 million people engaged in healthcare insurance who didn’t have that previously, the inrush of patients will be outpatient-based,” says Larry Arndt, general manager of healthcare in the company’s Chicago offices. “What’s not needed is bed space or heavy procedural space.”

A Strategic Dead End
The PPACA, employers, and commercial health plans have made clear that pursuing expensive inpatient volume in the traditional sense is a strategic dead end. That doesn’t mean new patient towers won’t go up, but it does mean their construction will be based on adaptability, patient flow, and efficiency gains, not bed count.

As few as five to seven years ago, says Arndt, a healthcare leadership team would take a capital improvement project through a planning and programming phase in which they followed a traditional approach. The team would utilize widely standardized metrics and program their building based on what they’re doing now, with no consideration of the future, Arndt says.

By contrast, within the last five years, more leaders have been embracing the concept of lean operational improvement.

In order to be competitive in a limited amount of reimbursements, they have had to become more efficient. So instead of the traditional approach of programming new construction based on how the organization operates today, instead, it attempts to map out its current patient flows and discover how to become more efficient. Only then will the team look at how to build around that improved and more efficient model.

Indeed, a whopping 22% of respondents to Mortenson’s February survey said they were “doing nothing” construction-related right now, and only 5% were planning for a traditional replacement hospital.

Instead, a majority said they are focusing new construction on building clinics that can feature just about any outpatient modality except surgery, Arndt says.

Healthcare Shifts to Outside
They’re focusing on combining dialysis, radiology and other treatments that can be provided in one location. And they’re funneling more of their capital budget to items that are outside the realm of new construction, like home health and what Arndt calls e-home healthcare—in other words, technological solutions that help patients access their caregivers outside of any facility.

“Our customer understands that healthcare is moving more toward healthcare outside a facility,” says Arndt. “That means more money is being invested in health information technology. Also, you see more constellation or satellite projects, for example, a small 15,000-20,000 square-foot clinic in a neighborhood. That allows patients to travel a shorter distance to a less congested environment, but yet allows connection to the bigger facility if needed.”

Modular construction is a trend that Arndt sees developing quickly. It’s in the process of designing a clinic for a client that will feature modular walls, to make it more flexible for the changes in care protocols that are assured, but that healthcare’s leaders aren’t sure how will ultimately affect their competitive offerings.

In one clinic, doctors want to be able to meet with patients in groups, for example. Modular walls mean physicians can occasionally meet with groups of patients instead of individually, or vice-versa. Their space is less limiting.

“The clinic can adapt,” says Arndt.

Prefabricating buildings is also gaining steam in healthcare, he says.

“Money is being invested much more wisely than it has been in the past,” he says. “For the design/construction field, we have to be more lean too.”

Part of that lean attitude means offering customers 3-D modeling that starts with design partners, such as the people who will be staffing the building, to optimize work flow.

Adapting Takes Time
“We can prefab things we couldn’t years ago,” he says. An example might be a bathroom “pod” that can be built offsite and installed on site. Full exam rooms can be prepared the same way, and models can be constructed to test care protocols with the team that will be working there.

Arndt’s customers, he says, can be categorized two ways. Either they’re thinking broadly about adapting to the future without knowing exactly what it’s going to bring, or they’re standing idly on the sideline until they understand better how the PPACA and other drastic changes in how healthcare is provided and paid for will affect their bottom lines.

Neither approach is necessarily better than the other, but waiting just puts off the action that needs to be taken. It can be a prudent approach, but even in healthcare, what works can change quickly. Designing, building, and adapting still takes time.

Don’t wait too long.

Philip Betbeze is senior leadership editor with HealthLeaders Media. 

data saving lives, facts & data points, healthcare, healthy habits, musings, nutrition, policy, quantified self, rapid learning health systems

Apples cocks up HealthKit slide at WWDC…

It’s already starting to seem a lot like HSG, except less credible…!

 

http://rockhealth.com/2014/06/digital-health-entrepreneurs-thoughts-healthkit/

Embedded image permalink

A digital health entrepreneur’s thoughts on HealthKit

Guest Contributor
June 03, 2014

Tags: 

This morning, Apple made its much-anticipated move into healthcare with HealthKit (aka, the formerly rumored HealthBook.) With a typically dissonant and ever-growing ecosystem of health apps, devices and data, digital health needs a major player to enter to integrate these products and tools. We’re excited about what the largest company in the world is capable of doing for digital health. Here’s some perspective on what a seasoned digital health entrepreneur had to say about today.

Aaron Rowe
HealthKit is really exciting. Putting all of this information in one place, in a gorgeous app that will reach a ton of people, could do wonders for public health. But it won’t do much good if the on-screen content is designed without input from people who deeply understand health metrics. It looks like Apple or one of its partners made some technical mistakes on a slide that was shown during the big reveal of their new health app.

The slide, which appeared toward the end of the HealthKit segment of today’s WWDC keynote, neatly displays four key metrics for diabetes management: glucose, carbs, walking, and diabetes medication adherence. The numbers and units that Apple used as examples to illustrate their vision don’t make sense. When you measure your glucose with a personal blood sugar meter, it is measured in mg/dL— but the example shown by Apple displayed these numbers in mL/dL. Whoops!

What’s worse, the app screen features an SMS-style message from a particularly photogenic doctor who says, “You’re making great progress with your diet and exercise. Keep it up.” While the graph above this message shows a steady and very unhealthy looking uptrend in the users glucose readings. The current reading shown on the app is 122 “mL/dL”.

“People with a fasting glucose level of 100 to 125 mg/dL have impaired fasting glucose (IFG), or prediabetes,” according to a National Institute of Diabetes and Digestive and Kidney Diseases website. “A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.

It strikes me as particularly unusual that Apple would make these mistakes, since they are known for their intense attention to detail. Perhaps this kerfuffle happened because none of the folks who were involved with the WWDC keynote know what medical details should look like—is there some disconnect within the group that is building HealthKit?  Have the designers who worked on this screen had enough contact with Apple’s partners at the Mayo Clinic or recently hired health experts? Not long ago, the Cupertino-based company onboarded several noninvasive glucose-monitoring experts from the wearable Raman spectrometer company C8 MediSensors and an early employee of Rock Health’s own Sano Intelligence.

I hope HealthKit will help patients understand and react to the results of every common blood test that is done in the home and medical labs–from cholesterol to creatinine. This could be one of the greatest ways in which Apple can make the world a better place. But they may need to sync internally to refine their understanding of these numbers, before they release this potentially lifesaving product into the wild.

Aaron Rowe is a research director at Integrated Plasmonics, a San Francisco startup that has developed a new class of spectrometer and surface plasmon resonance sensor chips. He and his colleagues are exploring ways to expand the scope of chronic disease management programs, enhance the success of new medications, and increase the usefulness of telemedicine by bringing a wide variety of in vitro diagnostics devices into the home and workplace. You can follow him on Twitter at @soychemist

 

health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Esther Dyson on the population health rampage!

 

http://www.healthleadersmedia.com/print/TEC-303509/Esther-Dyson-Launches-Population-Health-Challenge

Esther Dyson Launches Population Health Challenge

Scott Mace, for HealthLeaders Media , April 15, 2014

A tech investor with a proven track record of attracting innovation and money to a variety of endeavors is looking for a few good communities to compete for the greatest improvement in five measures of health and economic vitality.

Wellville

Healthcare ladies and gentlemen, start your communities.

That was the call on April 10 from angel investor and tech advisor Esther Dyson, whose population health dream has taken a big step toward reality with the launch of the Way to Wellvillecompetition.

From now until May 23, Dyson’s nonprofit startup, HICCup, is inviting communities to apply to be one of five contestants in a five-year-long competition to get healthy using everything from the latest fitness gadgets to reality TV. Dyson is HICCup’s founder and chairman of EDventure Holdings.

The 20-page application form is not for the casual applicant. Individuals or consultants need not apply – we’re talking community health organizations, other nonprofits or perhaps the local Better Business Bureau.

Esther Dyson’s Population Health Dream

Why bother? Several reasons. Dyson is an early investor in all sorts of innovative startups, with a proven track record of attracting innovation and money to a variety of endeavors over the past 25 years. She also is a great listener, having convened various listening sessions around the country last fall to get this latest idea off the ground.

Dyson’s fledgling organization, HICCup, found its footing in those sessions, and also a CEO, Rick Brush, who spent nearly a decade at Cigna, where he was chief strategy and marketing officer for the national employer segment and launched the payer’s Communities of Health venture.

Esther Dyson

Esther Dyson
Photo: courtesy of Joi on Flickr.

At one of those early scoping sessions, Brush asked the kinds of tough questions about what Way to Wellville should be measuring that landed the answers in HICCup’s FAQ and himself in the CEO’s chair, Dyson tells me.

A ‘Learning Lab for Health’
“What we’re trying to do is almost create a learning lab for health with subsidiary projects and contests along with the five-year marathon,” Dyson says.

Back to that lengthy application, which goes beyond asking about a community’s healthcare, straight to the health of a community, seeking such metrics as percentage of temporary residents, household income, poverty levels, and a slew of outcomes data – percentages of a community with diabetes, heart disease, asthma, smoking status, obesity and more.

Applicants also have to describe their top previous successes and failures trying to improve community health, healthcare financing innovations such as ACOs, patient-centered medical homes, population health, bundled payments, and so on.

In other words, it’s a lot of the things that HealthLeaders readers are currently embarking on both individually and collectively. And if the prestige of being selected for the first-of-its-kind national competition of sorts doesn’t intrigue you, there are a couple of other things to consider.

First is the cash prize at the end of the five years. HICCup itself won’t be rewarding such a prize, but hopes to raise $5 million for it. “Honestly, contestants are going to have to spend $15 to $50 million as a community to do this, so you’re not doing this for the prize, though of course it matters to some extent,” Dyson says.

Second, and more importantly, Way to Wellville contestants will become part of a larger community amongst the five competing communities. They will meet face-to-face in September at an annual conference, Next Step to Wellville, about a month after the five competing communities are selected.

The actual judging of who wins in 2019 has yet to be decided, but it will be a third party for legal and fiduciary reasons. Dyson emphasizes that the organization doesn’t have all the answers yet.

Metrics Matter
If you believe, like I do, that healthcare is closer than ever to some tectonic shakeups courtesy of technology, then Way to Wellville is likely to be a great observation post. Innovative medical hardware and software companies are already flocking to a variety of competitions such as this. Way to Wellville is just taking a bigger view of what kind of population health solutions will ultimately be necessary.

Expect also a lot of intermediate measurements and competitions.

“We’re hoping that some of these quantified self vendors will come in and donate devices to the communities and so we’ll have Fitbit and Fuelband contests,” Dyson says. “[Add to that] the county health rankings and all of these sorts of official measures, most of which are a year or two old, and we’re all going to get a lot more real-time data.”

“You can’t report transitions to diabetes every month,” Dyson says, “so there will be some health measures that are kind of yearly, but then there are, the outcomes measures tend to be slow. The input measures, like the percentage of school lunches that contain no French fries or something, you can measure in more real time.”

The $15 to $50 million table stakes per community sounds daunting to me. “It’s not the community goes and gets a $50 million grant from somebody,” Dyson says. “It’s more than they get a $10 million grant for, let’s say, heart health. There’s a $2 million program for food subsidies for fruits and vegetables. There are accountable care organizations that find an investor to improve the health so that their costs go down. There are social impact bonds.”

Philanthropists Wanted
“So it’s a combination of a large number of different kinds of funding from donors, from social investors, from vendors giving in-kind services or goods, and maybe in outer years, the school board raises a bond to do something with the school lunch. Each community is going to need to get money and support from a variety of courses in a variety of funds.

“We’ll be looking for people who want to invest in various ways of producing health. We’re also looking for donors [and] philanthropists.”

And of course, Dyson is reaching out to her famous set of angel investor friends. The goal, of course, is to go beyond that. Another way to maintain excitement on Dyson’s agenda is “a cheesy reality TV show” and perhaps a documentary.

As we see more and more crowdfunded efforts springing up in healthcare technology, Dyson’s approach has some similarities – with perhaps a crowd with deeper pockets, or at least one that’s been around the startup block a time or two.

Dyson hopes for up to 50 applicants for the five spots, and already has solid interest from several communities. Her population health dream is alive, and by this fall we should start to see some manifestations of it.

Scott Mace is senior technology editor at HealthLeaders Media. 

cool, data saving lives, health market quality, healthcare, healthy habits, policy, rapid learning health systems

Russian bank rewards customer exercise…

Now we’re talking… very Russian, no mucking around… even if it was developed by an ad agency. Go team…

http://www.springwise.com/russian-bank-rewards-customers-sweat-higher-interest-rates/

Russian bank rewards customers’ sweat with higher interest rates

The Alfa-Bank in Russia has created a new account with a high interest rate of 6% per annum, which users can only pay into by exercising with a fitness tracker.

Russia 4 Jun 2014alttext

There are countless initiatives designed to get the public fitter and healthier, but (perhaps unsurprisingly), it’s often those that offer a financial incentive that prove the most effective. We’ve already seen gym classes which become cheaper the more the user works out, and Nike’s Facebook app which enables runners to pay for products with kilometers they have run. Taking the link between financial savings and health benefits to an even more literal level, we’ve now come across a Russian bank offering a new account which rewards customers for every step they take.

To take advantage of Alfa-Bank’s fitness account, and it’s high interest rate of 6% per annum, users first need to sync their Jawbone, RunKeeper or Fitbit fitness tracker to the bank. Then, using the new Activity™ software, the user decides how much their activity is worth. They can select for every step or meter they walk or run to transfer between 1 to 50 cents into the fitness savings account to enjoy the high interest rate. In essence, the more the user walks, sweats, and exercises, the more they’ll save. The video below shows the initiative in action:

Created with Moscow-based advertising agency and marketing consultancy 42 Agency, the idea is already proving a hit with beta testers. How else could banks take a greater role in their customers’ lives for the better?

Website: www.activity.alfabank.ru/Activity/
Contact: activity@alfabank.ru