Category Archives: healthy habits

data saving lives, healthy habits

Anosmia predicts longevity…

 

http://www.medicalobserver.com.au/news/noses-know-about-longevity

Noses know about longevity

A A A
3rd Oct 2014

Rada Rouse   all articles by this author

AN ELDERLY person who cannot accurately distinguish the smell of peppermint or fish may be staring death in the face, research suggests.

A study among a nationally representative sample of adults aged 57–85 found those who lost their sense of smell and were already at high risk from medical conditions had more than double the risk of dying in the next five years.

The cohort of 3000 provided baseline data by trying to identify odours, which were, in order of increasing difficulty to pinpoint, peppermint, fish, orange, rose and leather.

Five years later, the researchers assessed which participants were still alive.

Some 430, or 12.5% of the original cohort, had died.

People noted as anosmic in the first survey had a threefold increased risk of death when other factors including age, race and health were taken into consideration, the researchers said.

They noted a “dose-dependent” relationship between sense of smell and risk of death, with anosmic individuals having a greatly increased risk compared to hyposmic individuals, and the latter being more likely to die than those with a normal or “healthy” sense of smell.

The study showed 39% of anosmic individuals identified in the first test had died before the second survey. 

This compared to 19% of hyposmic people and 10% of those with a normal sense of smell.

“We believe olfaction is the canary in the coalmine of human health, not that its decline directly causes death,” the researchers wrote.

Assessment of olfactory function may be useful to help identify patients at high risk of mortality, they said.

PLoS ONE 2014; online 1 Oct

cool, healthy habits, nutrition, policy, rapid learning health systems

MIT launches wellness advancing technology program…

Potentially very interesting work…

http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2014/09/media-lab-to-launch-wellness-initiative-with–1-million-grant-fr.html

Media Lab to Launch Wellness Initiative with $1 Million Grant from the Robert Wood Johnson Foundation

New program, Advancing Wellness, combines academics with on-the-ground initiatives to prompt cultural shifts toward better health.

Princeton, N.J.—The MIT Media Lab this week launched a wellness initiative designed to spark innovation in the area of health and wellbeing, and to promote healthier workplace and lifestyle behaviors.

With support from the Robert Wood Johnson Foundation (RWJF), which is providing a $1 million, one-year grant, the new initiative will address the role of technology in shaping our health, and explore new approaches and solutions to wellbeing. The program is built around education and student mentoring; prototyping tools and technologies that support physical, mental, social, and emotional wellbeing; and community initiatives that will originate at the Lab, but be designed to scale.

The program begins with the fall course Tools for Wellbeing, followed by Health Change Lab in the spring. In addition to concept and technology development, these courses will feature seminars by noted experts who will address a wide range of topics related to wellness. These talks will be open to the public, and made available online. Speakers include such experts as Walter Willett, noted nutrition and clinical medicine researcher; Chuck Czeisler, physician and sleep expert; Ben Sawyer, game developer for health applications; Matthew Nock, expert in suicide prevention; Dinesh John, researcher on health sciences and workplace activity; Lisa Mosconi, neuroscientist studying the prevention of Alzheimer’s; and Martin Seligman, one of the founders of the field of positive psychology. More information about the courses, speakers, and presentation topics and dates can be found here.

The RWJF grant will also support five graduate-level Research Fellows from the Program in Media Arts and Sciences, who will be part of a year-long training program. The funding will enable each Fellow to design, build and deploy novel tools to promote wellbeing and health behavior change at the Lab in a living lab environment, and then at scale.

One of the significant ways that this program will impact Media Lab culture is in the review of all thesis proposals submitted by students in the Media Arts and Sciences program. The Media Lab faculty recently added a new requirement that all thesis proposals consider the impact of the proposed thesis work on human wellbeing.

Other Lab-wide aspects of the initiative include:

  • A monthly health challenge that would engage the entire Lab, with review and analysis of each month’s deployment to help inform the next month’s initiative
  • A buddy system to pair students at the Lab with one another—to build an awareness of wellbeing as a social function, and not just a personal one, and to draw on people’s inclination to solve the problems of others differently than we would solve our own.
  • The Media Lab will host a special event on October 23, 2014, when the creators of the X-Prize convene at MIT, presenting on a new X-Prize for Wellbeing.

“Wellbeing is a very hard problem that has yet to be solved by psychologists, psychiatrists, neuroscientists, biologists or other experts in the scientific community,” said Rosalind Picard, professor of Media Arts and Sciences and one of the three principal investigators on the initiative. “It’s time to bring MIT ingenuity to the challenge.”

“RWJF is working to build a culture of health in the U.S., where all people have opportunities to make healthy choices and lead healthy lifestyles. Technology has long shaped the patterns of everyday life and it is these patterns—of how we work, eat, sleep, socialize, recreate and get from place to place—that largely determine our health,” said Stephen Downs, chief techonology and information officer at RWJF. “We’re excited to see the Media Lab turn its creative talents and its significant influence to the challenge of developing technologies that will make these patterns of everyday life more healthy.”

The three principal investigators on the Advancing Wellness initiative are: Rosalind Picard, professor of Media Arts and Sciences; Pattie Maes, the Alex W. Dreyfoos Professor of Media Arts and Sciences; and Kevin Slavin, assistant professor.  PhD candidate Karthik Dinakar, Reid Hoffman Fellow at the Media Lab, will co-teach the two courses with the three principal investigators.  Susan Silbey, Leon and Anne Goldberg Professor of Humanities, Sociology and Anthropology, will also create independent assessments through the year on the impact of this project.

ABOUT THE ROBERT WOOD JOHNSON FOUNDATION

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national Culture of Health that will enable all Americans to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.

healthy habits, nutrition

On preventing dementia…

 

Jane Tolman. I don’t want to get Dementia.

Jane Tolman. I don’t want to get Dementia.

Posted on 09/15/2014 by John Menadue

Dementia is what many of us fear most, and the effective risk is largely related to age.   The statistics say that at 65 years of age, only 2% have dementia.  But this figure doubles with the passage of each five year period.  By 90, the risk of having dementia is about one in four.  Because of the “survivor effect” (those with the fewest risks will live to old age), the subsequent risk no longer increases at this rate.

There is no guarantee that dementia can be avoided, whatever we do.  But what does the evidence say about what strategies can reduce the risk? Genes account for only a small percentage of those with dementia, especially among the elderly.

There is now evidence that the risk can be reduced, and that this will lead to fewer people with dementia.  In fact, we think that if the onset of dementia could be delayed by five years, then the numbers would be halved (Dementia Risk Reduction, prepared for Alzheimer’s Australia, 2007).

Despite much controversy in recent years about the exact cause of Alzheimer’s disease- the most common form of dementia in the western world- it turns out that the factors which protect against heart disease also protect against dementia. The UK Blackfriars consensus produced this year suggested that within two decades up to 20% of predicted new cases of dementia could be prevented with lifestyle alterations designed to reduce blood pressure, obesity, cholesterol and diabetes.

So what can we do to minimise the risk of developing dementia?

The brain is arguably the most important organ and should be treated with respect at all times. “Getting knocked out” sounds bad, and it is. We are now aware that episodes of concussion are bad for the brain and there are reports that head injuries contribute to dementia.  Protect your brain, and not just from toxic substances.

It’s never too early to start with life style changes. Both physical and mental activity are critical, and the earlier they start, the better. Regular is good- say 30 minutes every day of sustained physical exercise.  Patterns established in youth are harder to break in old age.  When it comes to mental exercise, repetition of familiar tasks is not particularly useful (such as Sudoku or crosswords); there must be real stimulation and challenging to the brain. Learning a language or taking a university course in a new field is what’s needed.

Connectivity is the new buzz word for dementia.  This relates to the structure of the brain (how nerves connect with each other) and the disruption of neuronal connectivity is emerging as a key component in the impairment of brain function. But it also relates to social connections. People don’t thrive in isolation and neither do brains. As we age, we lose social connections (people die) so it’s necessary to have a large social network when we are younger. Being with people- having relationships, joining groups, developing interests which involve human contact- these will all improve brain function and help to reduce the dementia risk.  Ideally, you should have friends who are younger than you are, but at least a mixture of ages.

Nurturing the senses is about maximising the inputs to the brain.  Good vision and hearing are among the important predictive factors for a good memory in old age.  Fifty percent of older people have an incorrect prescription for their spectacles, and while most very elderly people have some deafness, hearing aids are often not worn. Now is the time- however young or old you are- to have a check and correct any sensory deficits as soon as possible.

What should you eat? Moderation and balance will usually do the trick.    Having a healthy weight before old age is critical: in older age weight loss means losing muscle, and this is a sure way of triggering falls, impairing the circulation and immune function. For most older people, care needs to be taken to maintain weight, and to have protein at the centre of every meal.  Salt is bad for the brain as it contributes to hypertension which itself causes damage.  Fats are essential, but are best in balance; avoid saturated fats as these may double the risk of dementia.  Fruits and vegetables are associated with longevity, but also promote good bowel function.  Constipation in old age is the enemy of health, happiness and functioning well, each of which helps us to live the dementia journey better. Broccoli and cauliflower also contain Vitamin E which is thought to be protective against dementia. If you need more guidance, the Mediterranean diet has recognised benefits.

Alcohol in moderation may be protective, but with excessive amounts (regular consumption in excess of two drinks a day or four in a single session) come increased risks for hypertension, cardiovascular disease and dementia.  Binge drinking may increase the risk of dementia three fold after 65.

Smoking is a serious risk for a range of illnesses, and if you survive cancers, chronic lung diseases (especially emphysema) and vascular disease (heart attacks and strokes) then dementia is also more likely in your old age.

Regular blood pressure checks and careful control are essential, as hypertension is the enemy of brain health. Avoiding diabetes, similarly dangerous for brains, means a healthy diet, weight control and regular screens.  See your doctor if there are any new symptoms, especially lethargy, blurred vision, increased hunger, unexplained weight loss or increased thirst.  If you have diabetes, keep the sugars under control.

Your psyche should be as important to you as your physical health. The responsibility for your state of mind rests with you, and while stress might not be avoidable, how you deal with it is up to you.  If you need help, get it.  Whether you get dementia is not up to you.  But there are ways to reduce the risk, and to make the journey less traumatic if you are unlucky.  What is up to you, is what you know (keep up to date) and your attitude to your health (be positive).  Reducing your risks for dementia is a lifelong undertaking and will make you a happier and healthier person.

 

Jane Tolman is Director of Aged Care, Royal Hobart Hospital.

data saving lives, entrepreneurship, health market quality, healthcare, healthy habits, nutrition, policy, quantified self, rapid learning health systems

Bloomberg: Big Data Knows You’ve Got Diabetes Before You Do

 

http://www.bloomberg.com/news/2014-09-11/how-big-data-peers-inside-your-medicine-chest.html

Did You Know You Had Diabetes? It’s All Over the Internet

By Shannon Pettypiece and Jordan Robertson Sep 12, 2014 6:07 AM ET

Photographer: Rick McFarland/Bloomberg

The headquarters of Acxiom Corp. in Little Rock, Arkansas. The Acxiom list was compiled by various sources, including… Read More

Photographer: Joshua Roberts/Bloomberg

An electronic medical records system.

Photographer: Joe Raedle/Getty Images

An elderly man reached for medication in Florida.

Photographer: Joe Raedle/Getty Images

An elderly woman with her medication in Maine.

The 42-year-old information technology worker’s name recently showed up in a database of millions of people with “diabetes interest” sold by Acxiom Corp. (ACXM), one of the world’s biggest data brokers. One buyer, data reseller Exact Data, posted Abate’s name and address online, along with 100 others, under the header Sample Diabetes Mailing List. It’s just one of hundreds of medical databases up for sale to marketers.

In a year when former National Security Agency contractor Edward Snowden’s revelations about the collection of U.S. phone data have sparked privacy fears, data miners have been quietly using their tools to peek into America’s medicine cabinets. Tapping social media, health-related phone apps and medical websites, data aggregators are scooping up bits and pieces of tens of millions of Americans’ medical histories. Even a purchase at the pharmacy can land a shopper on a health list.

“People would be shocked if they knew they were on some of these lists,” said Pam Dixon, president of the non-profit advocacy group World Privacy Forum, who has testified before Congress on the data broker industry. “Yet millions are.”

They’re showing up in directories with names like “Suffering Seniors” or “Aching and Ailing,” according to a Bloomberg review of this little-known corner of the data mining industry. Other lists are categorized by diagnosis, including groupings of 2.3 million cancer patients, 14 million depression sufferers and 600,000 homes where a child or other member of the household has autism or attention deficit disorder.

The lists typically sell for about 15 cents per name and can be broken down into sub-categories, like ethnicity, income level and geography for a few pennies more.

Diaper Coupons

Some consumers may benefit, like those who find out about a new drug or service that could improve their health. And Americans are already used to being sliced and diced along demographic lines. Lawn-care ads for new homeowners and diaper coupons for expecting moms are as predictable as the arrival of the AARP magazine on the doorsteps of the just-turned 50 set. Yet collecting massive quantities of intimate health data is new territory and many privacy experts say it has gone too far.

“It is outrageous and unfair to consumers that companies profiting off the collection and sale of individuals’ health information operate behind a veil of secrecy,” said U.S. Senator Jay Rockefeller, a West Virginia Democrat. “Consumers deserve to know who is profiting.”

Senators’ Attention

Rockefeller and U.S. Senator Edward Markey, a Democrat from Massachusetts, introducedlegislation in February that would allow consumers to see what information has been collected on them and make it easier to opt out of being included on such lists. In May, the Federal Trade Commission recommended Congress put more protections around the collection of health and other sensitive information to ensure consumers know how the details they are sharing are going to be used.

The companies selling the data say it’s secure and contains only information from consumers who want it shared with marketers so they can learn more about their condition. The data broker trade group, the Direct Marketing Association, said it has its own set of mandatory guidelines to ensure the data is ethically collected and used. It also has a website to allow consumers to opt out of receiving marketing material.

“We have very strong self regulation, we have for more than 40 years,” said Rachel Nyswander Thomas, vice president for government affairs for the DMA. “Regardless of how the practices are evolving, the self-regulation is as strong as ever.”

Yet the ease with which data is discoverable in a simple Google search along with Bloomberg interviews with people who showed up in one such database suggest the process isn’t always secure or transparent.

Open Access

Dan Abate said he never agreed to be included in any list related to diabetes. Two other people on the same mailing list said they didn’t have diabetes either and weren’t aware of consenting to offer their information.

In Abate’s case, neither he nor anyone in his family or household has diabetes and the only connection he can think of for landing on the list are a few cycling events he participated in for a group that raises money for the disease.

“I could understand if I was voluntarily putting this medical information out there,” Abate said. “But I don’t have diabetes, and I don’t want my information out there to be sold.”

Bloomberg found the diabetes mailing list on the website of Exact Data in a section for sample lists that included dozens of other categories, like gamblers and pregnant women. The diabetes list contained 100 names, addresses and e-mails. Bloomberg sent e-mails to all of them, and three consented to interviews. There were no restrictions on who could access the list, available on search engines like Google.

Online Surveys

Exact Data’s Chief Executive Officer Larry Organ said the list posted on its website shouldn’t have included last names and street addresses, and the company has since deleted any identifiable information. He said the data came from Acxiom and Exact Data was reselling it.

The Acxiom list was compiled by various sources, including surveys, registrations, or summaries of retail purchases that indicated someone in the household has an interest in diabetes, said Ines Gutzmer, a spokeswoman for the Little Rock, Arkansas-based company. While Gutzmer said consumers can visit the Acxiom website to see some of the information that has been collected on them, she declined to comment about how any one individual was placed on the list.

Acxiom shares rose less than 1 percent, to $18.66 at the close of New York trading. The company has lost 29 percent of its value in the past 12 months.

Sharing Information

One of the more common ways to end up on a health list is by sharing health information on a mail or online survey, according to interviews with data brokers and the review of dozens of health-related lists. In some cases the surveys are tied to discounts or sweepstakes. Others are sent by a company seeking customer feedback after a purchase. The information is then sold to data brokers who repackage and resell it.

Epsilon, which has data on 54 million households based on information gathered from its Shopper’s Voice survey, has lists containing information on 447,000 households in which someone has Alzheimer’s, 146,000 with Parkinson’s disease, and 41,000 with Lou Gehrig’s disease. The Irving, Texas-based company provides survey respondents with coupons and a chance to win $10,000 in exchange for information on their household’s spending habits and health.

The company will share with individual consumers specific information it has gathered, said Jeanette Fitzgerald, Epsilon’s chief privacy officer.

Suffering Seniors

KBM Group, one of the largest collectors of consumer health data based in Richardson, Texas, has health information on at least 82 million consumers categorized by more than 100 medical conditions obtained from surveys conducted by third-party contractors. The company declined to provide an example of the surveys. KBM uses the information for its own marketing clients, and sells it to other data brokers, said Gary Laben, chief executive officer of KBM.

“None of our clients wants to engage with consumers or businesses who don’t want to engage with them,” he said. “Our business is about creating mutual value and if there is none, the process doesn’t work.”

Data repackaging is extensive and pervasive. The Suffering Seniors Mailing List help marketers push everything from lawn care to financial products. It consists of the names, addresses, and health information of 4.7 million “suffering seniors,” according to promotional material for the list. Beach List Direct Inc. sells the information for 15 cents a name. Marketed as “the perfect list for mailers targeting the ailing elderly,” it contains a breakdown of those with diseases like depression, cancer and Alzheimer’s, according to its seller’s website.

Clay Beach, the contact on Beach List’s website, did not return calls and e-mails over the past month.

‘Confidential’ Clients

Little is known about who buys medical lists since data brokers say their clients are confidential, Rockefeller said at a hearing on the issue in December.

Promotional material for the Suffering Seniors data found by Bloomberg on Beach List’s website initially included a list of users. The names of those users have since been removed.

One customer was magazine publisher Meredith Corp. (MDP), which used the list in a test for a subscription offer for Diabetic Living magazine, said Jenny McCoy, a spokeswoman. Other users have included the American Diabetes Association, which said a small portion of names from the list was given to one of its local chapters, and Remedy Health Media, a publisher of medical websites.

Magazine Advertising

Remedy Health may have used the list to advertise one of its magazines, which has been defunct for several years, said David Lee, the company’s executive vice president of publishing.

A growing source of data fodder are website registration forms that ask for health information in order for a user to access the site or receive an e-mail newsletter.

One such site is Primehealthsolutions.com, which provides basic health information on a variety of conditions. It makes money by collecting data on diseases its users have been diagnosed with and medications they are taking, which people disclose when signing up for the site’s e-mail newsletter.

The site has more than three dozen lists for sale, including a tally of 2.2 million people with depression, 267,000 with Alzheimer’s, 553,000 with impotence, and 2.1 million women going through menopause.

Jason Rines, a co-owner of Prime Health Solutions, said he will share the lists only with those marketing health-related products, like pharmaceutical or medical device makers.

Purchasing Trail

Acxiom said it uses retail purchase history or magazine subscriptions to make assessments about whether someone has a particular disease interest.

Health data collection is troubling to people like Rebecca Price, who has early-stage Alzheimer’s disease. While she now makes no secret of her disease and serves as a member of the Alzheimer’s Association’s early stage advisory group, that wasn’t always the case. Price, a 62-year-old former doctor, said she initially didn’t even tell her husband of her condition for fear word would get out and harm her personally and financially.

“It is a very, very personal diagnosis,” Price said.

Social media is another potential way information can be collected on patients, said Dixon, of the World Privacy Forum, who warns patients to be more careful about what they share on sites like Facebook.

“Don’t ‘like’ the hospital website or comment ‘thank you for the great breast cancer screening you gave me,’” she said. “Under the Facebook policy that is public information and it is in the wild and if someone goes to that site and pulls it off, it is totally public.”

Facebook Policy

While it would be possible for data miners to scrape ‘likes’ and public comments from Facebook Inc. (FB)’s social network, the company said such practice is against company policy and, if discovered, would be blocked.

“We don’t allow third-party data providers to scrape or collect information without our permission,” said Facebook spokeswoman Elisabeth Diana. “Third-party data providers that work with Facebook don’t collect personally identifiable information and are subject to our policies.”

For consumers who want to know what list they may be on, there are limited options. KBM for example doesn’t have the technological capabilities to look up an individual by name and tell them what lists they are on, though they can purge a name from all their lists if requested to do so, said CEO Laben.

Acxiom started a website last year that allows people to view some of the information it has on them. Those who choose to can correct or remove their data.

Epsilon’s Fitzgerald says the best way for consumers to protect themselves is to be more aware of where they are sharing their information and pay more attention to website privacy policies.

“If people are concerned, don’t put the information out there,” Fitzgerald said. “Consumers would be better served if they were educated more on what is going on on the web.”

(A previous version of the story mistated the name of the Direct Marketing Association and corrected the spelling of Facebook spokeswoman Elisabeth Diana.)

To contact the reporters on this story: Shannon Pettypiece in New York atspettypiece@bloomberg.net; Jordan Robertson in San Francisco atjrobertson40@bloomberg.net

To contact the editors responsible for this story: Rick Schine at eschine@bloomberg.net Drew Armstrong

facts & data points, health market quality, healthcare, healthy habits, policy, politics

Nearly half of all Americans will get type 2 diabetes

 

http://www.theguardian.com/society/the-shape-we-are-in-blog/2014/aug/13/diabetes-usdomesticpolicy

Nearly half of all Americans will get type 2 diabetes, says study

Type 2 diabetes, linked in 90% of cases to overweight and obesity, is soaring. New research shows 40% of Americans and 50% of Hispanics and non-Hispanic black women will get the disease at some point in their life and the numbers are unlikely to be much different elsewhere in the developed world

A patient undergoes a blood test for diabetes

A patient undergoes a blood test for diabetes, a condition which brings icnreased risk of stroke and heart failure. Photograph: Hugo Philpott/PA

How much worse can the type 2 diabetes epidemic get? Shockingly, a new study published by a leading medical journal says that 40% of the adult population of the USA is expected to be diagnosed with the disease at some point in their lifetime. And among Hispanic men and women and non-Hispanic black women, the chances are even higher – one in two appear to be destined to get type 2 diabetes.

As Public Health England spelled out in a recent report urging local authorities to take action, 90% of people with type 2 diabetes are overweight or obese. There is no mystery behind the rise in diagnoses – they match the soaring weight of the population. The climb dates back to the 1980s and is associated with our more sedentary lifestyles and changing eating habits – more food, containing more calories, more often. It is those things that will have to be tackled if the epidemic is to be contained.

The new study in The Lancet Diabetes & Endocrinology journal, from a team of researchers from the Centers for Disease Control and Prevention in Atlanta, shows that the risk of developing type 2 diabetes for the average 20 year-old American rose from 20% for men and 27% for women in 1985–1989, to 40% for men and 39% for women in 2000–2011. The study was big – involving data including interviews and death certificates from 600,000 Americans.

Americans are generally living longer, which is a factor in their increased lifetime chance of developing type 2 diabetes. They are also not dying in the same proportions that they were, because of better treatment. However, that means they are going to spend far more years of their lives suffering from type 2 diabetes, which can lead to blindness and foot amputations as well as heart problems.

This is very bad news for the US healthcare system, says Dr Edward Gregg, study leader and chief of the epidemiology and statistics branch of the Division of Diabetes Translation at CDC:

As the number of diabetes cases continue to increase and patients live longer there will be a growing demand for health services and extensive costs. More effective lifestyle interventions are urgently needed to reduce the number of new cases in the USA and other developed nations.

Both he and Canada-based Dr Lorraine Lipscombe, who has written a commentary on the study, point out that the situation in the US is unlikely to be much different from that elsewhere in the developed world. Dr Lipscombe, from Women’s College Hospital and the University of Toronto, writes:

The trends reported by Gregg and colleagues are probably similar across the developed world, where large increases in diabetes prevalence in the past two decades have been reported.

Primary prevention strategies are urgently needed. Excellent evidence has shown that diabetes can be prevented with lifestyle changes. However, provision of these interventions on an individual basis might not be sustainable.

Only a population-based approach to prevention can address a problem of this magnitude. Prevention strategies should include optimisation of urban planning, food-marketing policies, and work and school environments that enable individuals to make healthier lifestyle choices. With an increased focus on interventions aimed at children and their families, there might still be time to change the fate of our future generations by lowering their risk of type 2 diabetes.

data saving lives, entrepreneurship, health market quality, healthcare, healthy habits, nutrition, policy, quantified self, rapid learning health systems

What Uber for healthcare might look like

Interesting take on imagining the future of healthcare.

http://www.kevinmd.com/blog/2014/08/uber-health-care-will-look-like.html

What the Uber of health care will look like

 | POLICY | AUGUST 5, 2014

For a very long time, one of the most valuable business assets in New York City was a yellow cab taxi medallion. With recent value in the $1 million dollar range, ownership of the medallion was a virtual cash annuity, combined with equity growth (in 2004 medallion prices were in the mid $200,000 range and have increased in value 15% year over year in the 9 years since). As one owner once put it, “it even makes money for me while I sleep,” since the cars can be rented when the owner is off shift.

 

Medallion owners tend to fall into two categories: private practitioners and fleet owners. Private practitioners own their own car, have responsibility for maintenance, gas and insurance, and tend to use the cash flow to live while allowing the medallion to appreciate over the course of their career. They then cash out as part of their retirement plan.

Fleet owners have dozens of medallions; they lease or buy fleets of automobiles and often have their own mechanics, car washes and gas pumps. They either hire drivers as employees or, more often, rent their cars to licensed taxi drivers who get to keep the balance of their earnings after their car and gas payments.

In London, taxi drivers have to invest 2 to 4 years of apprenticeship before they can take and pass a test called “The Knowledge.” However, like NYC, finally getting that a licence to operate a Black Cab in London is a hard-working but stable way to earn a living.

Now imagine that someone comes along that can offer all the services of the NYC yellow cab or the London Black Cab directly to the general public, but does not have to own the medallion, own the car or employ the driver. With as much as 70% lower overhead, they provide the same service to the consumer; in fact they are so consumer friendly that they become the virtual gatekeeper for all the taxi and car service business in the community.

How, you ask? Outsourcing the overhead and just-in-time inventory management; they convince thousands of people to drive around in their own cars with the promise of a potential payment for services driving someone from point A to point B. All these drivers have to do is meet certain standards of quality and safety. This new company does all the marketing and uses technology to make the connection between the currently active drivers and those in need of a ride; they provide simple and transparent access to a host of cars circulating in your neighborhood, let you know the price and send a picture and customer rating of the driver, all before he or she arrives, and they process the payment so no money ever changes hands.

This is the premise behind Uber, a very disruptive take on the taxi business. As a recent article in Bloomberg noted, the slower rate of growth in medallion value is already attribute to the very young company; a recent protest by Black Cab drivers in London resulting in an eight-fold increase in Uber registrations.

Now imagine that a new health care services company comes to your community offering population health management services on a bundled payment or risk basis. They guarantee otherwise inaccessible metrics of quality and safety to both large employers and individual consumers. They employ only a handful of doctors, but do not own any hospitals, imaging centers or ambulatory care facilities.

However, they are masters at consumer engagement, creating levels of affinity and loyalty usually found with consumer products and soft drinks. They use a don’t make me think approach to their technology, seamlessly integrating analytics and communications platforms into their customers lives, and offer consumers without a digital footprint a host of options for communications, including access to information and services via their land lines or their cable TV box. They leverage high-level marketing analytics to determine who will be responsive to non-personal tools for engagement, like digital coaching, and who requires a human touch.

Care planning is done based on clinical stratification and evidence; population specific data is used to determine the actual resources required to achieve clinical, quality and financial goals. (A Midwest ACO has more problems with underweight than obesity, do they need to maintain their bariatric surgery center?) Physicians serve as “clinical intelligence officers,” creating standing orders across the entire population, implemented by non-clinical personnel; they also create criteria for escalation and de-escalation of services and resource allocation based on individual patients progress towards goals. They employ former actors and actresses as health coaches and navigators, invest heavily in home care and nurse care managers and use dieticians in local supermarkets to support lifestyle changes (while accessing and analyzing the patients point-of-purchase data to see what they are really buying).

The primary relationship between patients and their health systems is with a low cost, personal health concierge: Primary care physicians are only accessed based on predetermined eligibility criteria and only with those physician who agree to standards of quality and accountability are in the network. Multi-tiered scenario planning for emergencies is built into the system. For professional resources only required on an as-needed basis, such as hospital beds, surgeons and medical specialists, access is negotiated in advance based on a formula of quality standards and best pricing but only used on a just-in-time basis.

They are not a payer, although a professional relationship with them is on a business-to-business basis. They are a completely new type of health system, guaranteeing health and well being, transparent in their operations and choosing their vendors based on their willingness and ability to achieve those goals. In doing so, they significantly reduce the resources necessary to achieve goals for quality of care and quality of health across the entire population; they treat quality achievement as an operational challenge and manage their supply chain accordingly.

Am I suggesting this a new model of care? No, I am personally an advocate for physician-driven systems of care. But this kind of system is very possible, and there are companies working on models of national ACOs using many of these principles.

The Uber of health care will have much less to do with the mobile app; and far more to do with creating value by minimizing overhead, designing flexible operations, supporting goal-directed innovation and bringing supply-chain discipline to the idea of resource-managed care delivery. It will involve embracing models of care delivery that leverage emerging evidence on non-clinical approaches to health status and quality improvement, and focusing on designing goal-directed interactions between people, platforms, programs and partners.

I can hear more than a few of you creating very good reasons why it wont work (“You can’t put an ICU bed out to bid!”), but these scenarios are very doable. If we want to revitalize the experience of care for patients and professionals, we must be willing to acknowledge and embrace dramatically different, often counter-intuitive, new operating models for care that will require new competencies, forms of collaboration and reengineering the roles and responsibilities of those who comprise a patients’ health resource community.

Steven Merahn is director, Center for Population Health Management, Clinovations. He blogs at MedCanto.

complex adaptive systems, entrepreneurship, health market quality, healthcare, healthy habits, management and leadership, musings, policy, politics, quotes & aphorisms, rapid learning health systems, research methodology

Outsource physician behaviour change to the experts: Big Pharma

So pay for performance doesn’t work. This is hardly surprising when you see the compromise and mediocrity forced upon policy makers to get ideas through. There have been instances of success in health care. Indeed, one could argue that the exemplary success of big pharma in changing physician behaviour has provided a rod for its own back. Why not harness this expertise in getting under the skin of doctors, and pay big pharma sales outfits to guide physician practice in constructive directions, rather than being distracted by flogging pills that don’t really work that well anyway, and potentially harm? Might have a chat with Christian.

http://www.nytimes.com/2014/07/29/upshot/the-problem-with-pay-for-performance-in-medicine.html

THE NEW HEALTH CARE

The Problem With ‘Pay for Performance’ in Medicine

Magoz

Aaron E. Carroll

@aaronecarroll

“Pay for performance” is one of those slogans that seem to upset no one. To most people it’s a no-brainer that we should pay for quality and not quantity. We all know that paying doctors based on the amount of care they provide, as we do with a traditional fee-for-service setup, creates incentives for them to give more care. It leads to increased health care spending. Changing the payment structure to pay them for achieving goals instead should reduce wasteful spending.

So it’s no surprise that pay for performance has been an important part of recent reform efforts. But in reality we’re seeing disappointingly mixed results. Sometimes it’s because providers don’t change the way they practice medicine; sometimes it’s because even when they do, outcomes don’t really improve.

The idea behind pay for performance is simple. We will give providers more money for achieving a goal. The goal can be defined in various ways, but at its heart, we want to see the system hit some target. This could be a certain number of patients receiving preventive care, a certain percentage of people whose chronic disease is being properly managed or even a certain number of people avoiding a bad outcome. Providers who reach these targets earn more money.

The problem, one I’ve noted before, is that changing physician behavior is hard. Sure, it’s possible to find a study in the medical literature that shows that pay for performance worked in some small way here or there. For instance, a study published last fall found that paying doctors $200 more per patient for hitting certain performance criteria resulted in improvements in care. It found that the rate of recommendations for aspirin or for prescriptions for medications to prevent clotting for people who needed it increased 6 percent in clinics without pay for performance but 12 percent in clinics with it.

Good blood pressure control increased 4.3 percent in clinics without pay for performance but 9.7 percent in clinics with it. But even in the pay-for-performance clinics, 35 percent of patients still didn’t have the appropriate anti-clotting advice or prescriptions, and 38 percent of patients didn’t have proper hypertensive care. And that’s success!

It’s also worth noting that the study was only for one year, and many improvements in actual outcomes would need to be sustained for much longer to matter. It’s not clear whether that will happen. A study published in Health Affairs examined the effects of a government partnership with Premier Inc., a national hospital system, and found that while the improvements seen in 260 hospitals in a pay-for-performance project outpaced those of 780 not in the project, five years later all those differences were gone.

The studies showing failure are also compelling. A study in The New England Journal of Medicine looked at 30-day mortality in the hospitals in the Premier pay-for-performance program compared with 3,363 hospitals that weren’t part of a pay-per-performance intervention. We’re talking about a study of millions of patients taking place over a six-year period in 12 states. Researchers found that 30-day mortality, or the rate at which people died within a month after receiving certain procedures or care, was similar at the start of the study between the two groups, and that the decline in mortality over the next six years was also similar.

Moreover, they found that even among the conditions that were explicitly linked to incentives, like heart attacks and coronary artery bypass grafts, pay for performance resulted in no improvements compared with conditions without financial incentives.

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. The program made no difference at all in physician practice or patient outcomes, and this was with a much larger financial incentive than most programs in the United States offer.

Even refusing to pay for bad outcomes doesn’t appear to work as well as you might think. A 2012 study published in The New England Journal of Medicine looked at how the 2008 Medicare policy to refuse to pay for certain hospital-acquired conditions affected the rates of such infections. Those who devised the policy imagined that it would lead hospitals to improve their care of patients to prevent these infections. That didn’t happen. The policy had almost no measurable effect.

There have even been two systematic reviews in this area. The first of them suggested that there is some evidence that pay for performance could change physicians’ behavior. It acknowledged, though, that the studies were limited in how they could be generalized and might not be able to be replicated. It also noted there was no evidence that pay for performance improved patient outcomes, which is what we really care about. The secondreview found that with respect to primary care physicians, there was no evidence that pay for performance could even change physician behavior, let alone patient outcomes.

One of the reasons that paying for quality is hard is that we don’t even really know how to define “quality.” What is it, really? Far too often we approach quality like a drunkard’s search, looking where it’s easy rather than where it’s necessary. But it’s very hard to measure the things we really care about, like quality of life and improvements in functioning.

In fact, the way we keep setting up pay for performance demands easy-to-obtain metrics. Otherwise, the cost of data gathering could overwhelm any incentives. Unfortunately, as a recent New York Times article described, this has drawbacks.

The National Quality Forum, described in the article as an influential nonprofit, nonpartisan organization that endorses health care standards, reported that the metrics chosen by Medicare for their programs included measurements that were outside the control of a provider. In other words, factors like income, housing and education can affect the metrics more than what doctors and hospitals do.

This means that hospitals in resource-starved settings, caring for the poor, might be penalized because what we measure is out of their hands. A panel commissioned by the Obama administration recommended that the Department of Health and Human Services change the program to acknowledge the flaw. To date, it hasn’t agreed to do so.

Some fear that pay for performance could even backfire. Studies in other fields show that offering extrinsic rewards (like financial incentives) can undermine intrinsic motivations (like a desire to help people). Many physicians choose to do what they do because of the latter. It would be a tragedy if pay for performance wound up doing more harm than good.

Aaron E. Carroll is a professor of pediatrics at Indiana University School of Medicine. He blogs on health research and policy at The Incidental Economist, and you can follow him on Twitter at @aaronecarroll. The Upshot provides news, analysis and graphics about politics, policy and everyday life. Follow us on Facebook and Twitter.
complex adaptive systems, cool, family matters, healthy habits, meaning, quotes & aphorisms, rapid learning health systems, storytelling

Catfish Quote

They used to take cod from Alaska all the way to China. They’d keep them in vats in the ship. By the time the codfish reached China, the flesh was mush and tasteless. So this guy came up with the idea that if you put these cods in these big vats, put some catfish in with them and the catfish will keep the cod agile. And there are those people who are catfish in life. And they keep you on your toes. They keep you guessing, they keep you thinking, they keep you fresh. And I thank go for the catfish because we would be droll, boring and dull if we didn’t have somebody nipping at our fin.

Vince Pierce – Catfish (The Movie)

 

catfish_quote_wp_ss_20140725_0003

healthy habits, nutrition, policy, politics

UK privatising public health messaging – what could possibly go wrong?

 

 

http://www.londonlovesbusiness.com/8431.article?mobilesite=enabled

Source PDF: PHE-StrategyDoc-2014-10

Sophie Hobson: All public health messaging is now officially up for sale. Yes, you should be worried

3 July 2014 | By Sophie Hobson

Skull and cross-bones

The government has quietly announced a major change – but you need to know about it

Sophie Hobson is the editor of LondonlovesBusiness.com. Tweet her@sophiehobson

The government is making a radical change to the way it delivers public health campaigns.

It is a shift in the modus operandi that has been creeping in over the last couple of years, and has now been made universal in a new publication on Public Health England’s Marketing Strategy for 2014-17.

All government public health campaigns will now be launched in partnership with another organisation – as cheerily announced in a section titled “We will only ever work in partnership”.

Some of these organisations will be NGOs. (The government has worked in partnership with NGOs since 2002.)

But many will be corporations, paying for their involvement in public health messaging.

To give you an idea of the pace of the shift towards corporate-funded public health messaging, the report states that five years ago, the Change4Life campaign had only 10 commercial sector partners.

Today, it has more than 200 (including PepsiCo, hardly known for its healthy image).

The story has been uncovered by Russell Parsons at Marketing Week, and full credit to him, because Public Health England (PHE) is yet to release its forthcoming marketing strategy online at time of writing – though it has sent us a copy, which you can view by clicking on the ‘related files’ on the right (see pg. 22).

Why does this change matter so much?

Take a look at this chart from the report, which shows how financial/in-kind contribution from partners to the Change4Life campaign has now actually surpassed the amount of money the government is putting in:

PHE report - chart

If commercial partners are fronting up more cash for certain campaigns than the government itself, it’s not unreasonable to deduce that they will have as much – if not more – influence over the messaging of campaigns.

Who do you think is going to be most likely to put up the resources and cash for these public health campaigns?

I don’t think it’s far-fetched to suggest it might be those companies that need to clean up their reputation when it comes to health.

After all, Coca-Cola and McDonald’s didn’t pay mega-millions for worldwide sponsorship rights for the London 2012 Olympics out of the goodness of their corporate hearts.

This up-shift in government strategy opens the door to possibilities riddled with conflicts of interest: healthy eating campaigns brought to us in partnership with PepsiCo (see example above), obesity adverts supported by junk food multinationals…

So why is the government doing this?

In short, PHE needs the money.

PHE will invest £53m in the year to March 2015 into public health marketing campaigns.

In the year ahead, it aims to raise £25m of in-kind support from partners. This gives you an idea of how significant that external funding is.

As it happens, PHE has the largest partnerships team in government and works with 214 key national and 70,000 local partners.

And while the report claims that external partners are “interested in, and stand to benefit from, a healthier England”, I believe this new strategy puts the nation’s health at serious risk from influences that don’t necessarily have our best interests at heart.

Public health messaging should be in the interest of citizens, not corporates. It should not be up for sale.

If you agree, tweet me @sophiehobson or let me know in comments below.

READERS’ COMMENTS (1)

  • Rebecca Hobson

    Rebecca Hobson | Thu, 3 Jul 2014 12:17 pm

    Great, thought provoking piece – but I’m not sure I agree. I imagine there’ll be stringent measures in place around any corporate sponsorship of public health messaging, and effectively, these brands will end up subsiding PHE – which it badly needs? Also, if PHE puts out a message saying ‘drink only one can of pop a day’, say, won’t it be more powerful if it’s sponsored by the pop brand itself? Ppl are far more likely to listen to Pepsi than the government.

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