Category Archives: rapid learning health systems

complex adaptive systems, data saving lives, EF, health market quality, healthcare, policy, politics, rapid learning health systems

Medicity: Entering a new era of population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

http://www.healthcareitnews.com/news/entering-new-era-population-health?single-page=true

Entering a new era of population health

We have reached an inflection point in the history of health IT

February 18, 2015

In the six years since it became law, the HITECH Act has done much to advance the use of health information technology. And although the process of collecting and sharing health data has not yet significantly impacted care costs or quality, it has laid an important foundation for us to move toward population health management.

[See also: Population health success depends on good data]

There are important discussions underway to determine what’s needed to leverage health data to improve clinicaloutcomes and lower costs, and to extend those benefits across entire patient populations. Intelligent tools for population health will enable improvements in care quality, clinical outcomes and care cost.

Working through issues around health data exchange and patient engagement indicate the next challenges. We must construct a platform that will enable innovation in population health and analytics to thrive.

[See also: Pop health analytics top ACO priority]

Federal entities responsible for overseeing health and the healthcare industry in general are advancing rapidly toward a vision of interoperability and data sharing.

Congress taking a look

Congress is taking both near- and long-term actions regarding health IT innovation and standards. Near-term examples include recently directing the Office of the National Coordinator to report progress around interoperability and data sharing, and asking the Government Accountability Office to report on health information exchanges.

Congress has also launched the “21st Century Cures” initiative to help laws keep pace with health innovation. Among other measures, this initiative would consolidate meaningful use, quality reporting and value-based payments into one program – potentially the most significant move related to population health by Congress to date.

Federal Health IT Strategic Plan and Interoperability Roadmap

This past December, the Department of Health and Human Services released the Federal Health IT Strategic Plan, a coordinated effort among more than 35 federal departments and agencies to advance the collection, sharing and use of electronic health information – the cornerstones of population health management.

The HHS plan’s data-sharing section references the ONC’s Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, which was released at the end of January. The roadmap advances the ambitious goals to be reached by the end of 2017, including:

  • Establishing a coordinated governance framework and process for nationwide health IT interoperability;
  • Improving technical standards and implementation guidance for sharing and using a common clinical data set;
  • Enhancing incentives for sharing electronic health information according to common technical standards; and
  • Clarifying privacy and security requirements that enable interoperability.

In announcing the roadmap, HHS Secretary Sylvia Burwell called for “an interoperable health IT system where information can be collected, shared and used to improve health, facilitate research and inform clinical outcomes. This Roadmap explains what we can do over the next three years to get there.”

ONC Annual Meeting

At the February 2015 ONC Annual Meeting, titled “Interoperable Health IT for a Healthy Nation,” National Coordinator Karen DeSalvo, MD, told attendees that the agency’s focus is moving beyond meaningful use, toward interoperability and outcomes. This includes building out the IT infrastructure that will support health reform and enable better population health management.

A highlight of the ONC Annual Meeting was having all of the former national coordinators talk about the national state of health IT in the past, present and future.

David Brailer, MD, the nation’s first national coordinator, said the industry won’t be able to accomplish appropriate risk management, population health management or payment reform without interoperability. The ONC leaders shared a strong consensus that the intelligent use of technology will prevail in realizing population health goals.

Meaningful use is not dead

Despite the notion that it may be time to move beyond meaningful use, the program continues to drive electronic health record adoption, organizations have built incentive payments into their IT budgets and we continue to see program improvements.

At the time of this writing, proposed rules for Stage 3 meaningful user and 2015 Edition Standards and Certification Criteria were at the Office of Management and Budget for final review. The OMB announced of the proposed rules that “Stage 3 will focus on improving health care outcomes and further advance interoperability.”

Additional recent policy adjustments instituted or proposed include:

  • Simplifying satisfaction of the requirement for summary of care transmissions;
  • More realistic measures around the availability and actual viewing of patient information to satisfy patient engagement requirements; and
  • A potential new requirement to send electronic notification of significant patient health care events to patient care teams.

Measures such as these point to the importance of data sharing and enable achievable and meaningful progress toward population health management.

Payment models increasingly emphasize population health

Payers are primary drivers toward PHM, and the Centers for Medicare & Medicaid Services is accelerating its timeline for shifting Medicare to a value-based system. By the end of 2016, at least 30 percent of fee-for-service Medicare payments will be tied to value through alternative payment models such as accountable care organizations or bundled payment arrangements. By the end of 2018, that will increase to 50 percent.

As recently as 2011, Medicare made almost no payments through alternative payment models.

Among private payers, a group of major providers and insurers have formed the Health Care Transformation Task Force to shift 75 percent of operations to contracts designed to improve quality and lower costs by 2020. These very important public and private payer initiatives strongly underscore the need for critical health IT enablers of effective PHM.

Welcome to the new PHM era of health IT

We have reached an inflection point in the history of health IT, as we move beyond the HITECH era into this new era. We have come a long way in capturing health data, yet have only begun to share that data among providers, patients and payers. The opportunity ahead of us is to take major strides toward using that data to improve care and lower costs for the populace in general. We have been through an incredible decade of health IT. There is no sign of it slowing down.

Topics: Accountable Care, Analytics, Financial/Revenue Cycle Management, Population Health, Quality and Safety,Health Information Technology for Economic and Clinical Health (HITECH) Act, Clinical, Patient Engagement,Interoperability, Meaningful use, Department of Health & Human Services (HHS), The Office of the National Coordinator for Health Information Technology (ONC), Karen DeSalvo, Brailer, David, Electronic Health Record (EHR)
complex adaptive systems, cool, data saving lives, EF, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems, technology

Peter Hinssen: The Tiger and The Rock

EDxBrussels – Peter Hinssen – The TIGER & the ROCK

Why Extrapolating WON’T WORK & What it means for HEALTH http://www.tedxbrussels.eu About TEDx, x = independently organized event In the spirit of ideas worth…

http://wn.com/tedxbrussels_-_peter_hinssen_-_the_tiger_&_the_rock

8:20 – The Contiguous United States – macdonald’s proximity to people in the US

9:10 The Flip: Pharma moving to Health as a Service (no longer a product)

Institutions > Communities (trust)

Reactive > Proactive (attitude)

Hinssen_HealthMatrix

http://www.datapointed.net/visualizations/maps/distance-to-nearest-mcdonalds-sept-2010/

 

distance_to_mcdonalds_2010_l

complex adaptive systems, EF, facts & data points, healthcare, healthy habits, policy, rapid learning health systems

Living to 150…

Most of the recent change in life expectancy has been that sick men are having their life with sickness prolonged.

https://www.mja.com.au/insight/2015/6/will-cairns-living-150

Will Cairns: Living to 150

Will Cairns
Monday, 23 February, 2015

HUMAN life expectancy will increase to 150 years within this century. Really?

When I was a GP I used to visit my frail elderly nursing home patients in my lunch break. Frequently I found them fast asleep in front of Days of Our Lives. This gave me pause for thought about how we live out our final years.

In the past few weeks it has been interesting to see a number of commentators suggesting that before the end of this century the advance of technology will enable some people to live on to the age of 150.

Among the evidence cited for this is the observation that the average life expectancy has increased from about 40 years to 80 years in the past 150 or so years and that this trend will continue.

The facts tell us otherwise. This Kaplan–Meier graph drawn up from several different life tables shows the proportion of the population who have remained alive over the 100+ years from their birth.

Over the past 200 years or so the application of scientific discovery — public health measures, improved nutrition and, lately, disease treatment — have almost stopped us from dying as children and prolonged our lives as mature adults.

However, our numbers plummet as we approach 100 years of age because all of these interventions make no difference to the reality that we eventually wear out and die. Apart from the odd unverified outlier, only one person has ever been confirmed as living for more than 120 years.

Life tables for the US dating back to the 19th century show the limits of modern technology to deal with the failings of old age:

US white males 1850 2005
Life expectancy at birth 38.3 77.4
Life expectancy at age 50 71.6 80.7

So, in the past 150 years, in the most powerful nation in the world with the best that modern technology and affluence can throw at the challenge, while the average life expectancy at birth has risen by 39.1 years, the life expectancy of a 50-year-old has increased by only 9.1 years.

It used to be that the highest mortality was among children; now it is among the elderly. A man aged 65 years living in the UK in 2004‒2006 could expect to survive for another 16.9 years, of which 10.1 years (59.8%) were deemed to be healthy.

Life expectancy of 65-year-old males in UK
2004-2006 2007-2009
Total 16.9 years 17.6 years
Disability free 10.1 years 10.2 years

While the life expectancy of a 65-year-old man increased by 0.7 years between 2004‒2006 and 2007‒2009, the healthy life expectancy has increased by 0.1 years. Most of the recent change in life expectancy has been that sick men are having their life with sickness prolonged.

There have always been at least a few people who avoided fatal infections, childbirth, accidents, wars, worn-down teeth, cancer, heart disease, or even just wearing out earlier, and have lived to be more than 100 before they slow down and die.

More of us become centenarians now because we don’t die of other things earlier, but there has been no significant increase in the maximum time that people can remain alive.

For most of us our maximum life expectancy remains less than 100 years, and for some far less. There is no evidence that modern technology has been able to stop even people who get no particular disease from just grinding to a halt when their time is up.

We have not been able to put more sand into our hourglass to increase the number of the days of our lives.

Talk of living to 150 is a distraction. The real challenge for the community as a whole is to accept the inevitability of death and to reintegrate that acceptance into culture.

As health workers and health care managers, we can all play a vital role in that process, both in how we communicate our understanding of death as a normal part of life and in how we incorporate it into the care of our individual patients.
Associate Professor Will Cairns is Director of Palliative Care in Townsville and author of the eBookDeath rules — how death shapes life on earth, and what it means for us.

* Australia 2008-2010 – Males
USA 2006
England/Wales 1838-1854 – Males
South Australia 1891-1900 – Males
Sweden 1816-1840
Modelled !Krung
Australia 1946-1948

complex adaptive systems, data saving lives, EF, entrepreneurship, facts & data points, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Should we pay people to look after their health?

 

http://theconversation.com/should-we-pay-people-to-look-after-their-health-24012

Should we pay people to look after their health?

The key to using incentives may be to do so with a high enough frequency to create healthy habits. Health Gauge/Flickr, CC BY-SA

With the Tony Abbott government expressing concern about the growing health budget and emphasising personal responsibility, perhaps it’s time to consider some creative ways of curbing what Australia spends on ill health. One solution is to pay people to either get well or avoid becoming unwell in the first instance.

The United Kingdom is already doing this kind of thing with a current trial of giving mothers from disadvantaged suburbs A$340 worth of food vouchers for breastfeeding newborn babies. And from January 1 this year, employers in the United Statescan provide increasingly significant rewards to employees for having better health outcomes, as part of the Affordable Care Act.

But should people really be paid to make healthy choices? Shouldn’t they be motivated to improve their health on their own anyway?

Encouraging right decisions

People don’t do what’s in their best interest in the long term for many reasons. When making decisions we tend to take mental short cuts; we allow the desires and distractions of the moment get in the way of pursuing what’s best.

One such “irrationality” is our tendency to focus on the immediate benefits or costs of a situation while undervaluing future consequences. Known as present bias, this is evident every time you hit the snooze button instead of going for a morning jog.

Researchers have found effective incentive programs can offset present bias by providing rewards that make it more attractive to make the healthy choice in the present.

Research conducted in US workplaces, for instance, found people who were given US$750 to quit smoking were three times more successful than those who weren’t given any incentives. Even after the incentive was removed for six months, there was still a quit rate ratio of 2.6 between the incentive and control groups – 9.4% of the incentive group stayed cigarette-free versus only 3.6% of the control group.

A refined approach

Still, while research on using financial incentives to encourage healthy behaviours is promising, it isn’t as straightforward as doling out cash in exchange for good behaviour.

Standard economic theory posits that the higher the reward, the bigger the impact – but this is only one ingredient to success. Behavioural economics shows that when and how you distribute incentives can determine the success of the program.

Here are a few basic principles to consider. First, small rewards can have a big impact on behaviour if they’re provided frequently and soon after the healthy choice is made. We have found this to be true in the context of weight-loss programs, medication adherence, and even to quit the use of drugs such as cocaine.

Games of chance are an effective way of distributing rewards as research has found people tend to focus on the value of the reward rather than their chance of winning the prize. Many people think that a 0.0001 and a 0.0000001 chance of winning a prize are roughly equivalent even though in reality they are vastly different probabilities.

Finally, people are more influenced by the prospect of losses than by gains. Studies show people put much greater weight on losing something than gaining something of a similar value.

In one weight-loss experiment, for instance, participants were asked to place money into a deposit account. If they didn’t achieve their weight goals, the money would be forfeited, but if they were successful, the initial deposit would be doubled and theirs to keep.

Reluctant to lose their deposits, participants in the deposit group lost over three times more weight than the control group, who were simply weighed each month.

Creating good habits

Incentives are particularly effective at changing one-time behaviours, such as encouraging vaccination or attendance at health screenings. But with increasing rates of obesity and other lifestyle-related diseases, we need to focus on how incentives can be used to achieve habit formation and long-term sustained weight loss.

We know financial incentives can increase gym usage and positively impact weight, waist size and pulse rate, but how to sustain gym use after the incentive is removed? The key may be to use incentives to achieve a high frequency of attendance for long enough to create a healthy habit.

We also need to consider how we can leverage social incentives, such as peer support and recognition, together with new technologies to maximise the impact of incentive-based programs.

Innovative solutions, like paying people to encourage the right health choices, may help to reduce both the health and economic impact of Australia’s growing burden of disease.

EF, health market quality, healthcare, policy, politics, rapid learning health systems

50% of US Healthcare Payments to be based on value by 2018

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2015/01/26/the-obama-administration-wants-to-dramatically-change-how-doctors-are-paid/

Wonkblog

The Obama administration wants to dramatically change how doctors are paid

By Jason Millman January 26
The Obama administration is setting aggressive goals for reforming how Medicare reimburses health-care providers. (AP Photo/Jeff Barnard)

The Obama administration on Monday announced an ambitious goal to overhaul the way doctors are paid, tying their fees more closely to the quality of care rather than the quantity.

Rather than pay more money to Medicare doctors simply for every procedure they perform, the government will also evaluate whether patients are healthier, among other measures. The goal is for half of all Medicare payments to be handled this way by 2018.

Monday’s announcement marks the administration’s biggest effort yet to shape how doctors are compensated across the health-care system. As the country’s largest payer of health-care services, Medicare influences medical care generally, meaning the changes being initiated by the administration will likely be felt in doctor’s offices and hospitals across the country.

“As a very large payer in the system, we believe we have a responsibility to lead,” said Health and Human Services Secretary Sylvia Mathews Burwell in a press conference. “For the first time, we’re going to set clear goals and establish a clear timeline for moving from volume to value in the Medicare system.”

There’s widespread agreement among policymakers that the U.S. health-care system needs to move away from rewarding doctors and hospitals for volume and focus more on the value of the care being offered. Doctors typically get paid set fees for every procedure they perform, regardless of whether patients get better.

In addition to improving patient care, the government also hopes to cut wasteful spending. Medicare’s current payment system, known as fee-for-service, cost taxpayers $362 billion last year, between the program’s hospital insurance and medical insurance programs, according to the federal Centers for Medicare and Medicaid Services. Critics say the traditional payment scheme fails to discourage overuse of health-care services, without holding providers accountable for whether patients’ get healthier.

Medicare has been experimenting with payment models for more than a decade, and the 2010 Affordable Care Act tried to tackle the issue by expanding payment models that reward providers for the value of care they provide. The programs include lump sum payments for treating a patient throughout an episode of care, like a knee replacement surgery.

The most high-profile effort has been with accountable care organizations (ACOs), which are groups of providers who share in the savings – or losses – for managing patients on a budget. An estimated 7.8 million seniors enrolled in Medicare are currently being served by ACOs, according to the administration.

Farzad Mostashari, a former Obama administration official whose company has helped launch and run three Medicare ACOs, said some hospitals have been reluctant to adopt these alternative payment models because believe they can make more money by charging for each service. But he said the administration’s announcement sends a clear signal that the health-care system is quickly moving away from a system that allows for so much waste.

CMS said alternative payment structures now represent about 20 percent of Medicare payments, and that will rise to 30 percent by 2016 under the administration’s new goals. This marks the first time that Medicare has set specific targets for expanding the scope of alternative payment systems in the program, CMS said.

Debra Ness, president of the National Partnership for Women and Families, a consumer advocacy organization, said these payment models will force health-care providers to better coordinate care.

“We’re not just talking about payment that lowers costs,” she said. “The payment changes are designed to change the way that we deliver care in ways that will make that care work better for patients and families.”

This shift to value-based payments had already been taking place in the private sector before the ACA. About 20 percent of provider payments by Blue Cross insurers are through contracts that try to prioritize quality over quantity, their trade association reported last summer. Aetna says 28 percent of its reimbursements are now in valued-based contracts, and it expects that rate to jump to 75 percent by 2020.

Many have viewed this broader shift as long overdue, as health care spending has grown to about one-sixth of the U.S. economy. But it’s still uncertain how well these payment approaches work.

“We still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program,” concluded a 2014 Rand Corporation study funded by HHS. The report, which reviewed pay-for-performance models implemented over the past decade, said improvements were “typically modest” and often hard to evaluate.

Some early efforts to implement newer value-based payment programs have shown mixed results.

Two high-profile ACA programs encouraging health-care providers to work as accountable care organizations have resulted in modest savings to the Medicare program so far, about $877 million. But at least 13 of the 32 organizations that participated in the most ambitious of these efforts — the Pioneer ACO program — have dropped out of the program in the past two years. Most of these groups left to join programs with less financial risk.

Farzad Mostashari, a former Obama administration official who now advises three Medicare ACOs, said some hospitals have been reluctant to adopt these alternative payment models because believe they could make more money by charging for each service. But he said the administration’s announcement sends a clear signal that the health-care system is quickly moving away from this wasteful payment scheme.

“It’s not so much about the specific goal, because that can and will change,” Mostashari said. “It’s about the sense of commitment that [hospitals] are perceiving.”

A representative for the American Hospital Association said the trade group supports the administration’s goals. Robert Wah, president of the American Medical Association, said members of the country’s largest doctor’s group were “encouraged” by Medicare’s efforts to reform how care is delivered, as they’ve become increasingly concerned by bureaucratic requirements.

“There is a great deal of regulatory and administrative burden on [doctors] currently,” Wah said. “We’re in a period of great change, and great change causes anxiety.”

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico.
EF, health market quality, healthcare, policy, rapid learning health systems

Private Players Launch Value-based Task Force

 

http://www.healthleadersmedia.com/print/HEP-312643/Private-Players-Launch-Valuebased-Task-Force

Private Players Launch Value-based Task Force

John Commins, for HealthLeaders Media , January 29, 2015

Two days after HHS unveiled significant Medicare payment reforms, a group of commercial payers, providers, and industry partners says it is committed to putting 75% of its business into value-based models by 2020.

Some of the nation’s largest healthcare systems and payers on Wednesday launched theHealth Care Transformation Task Force, with an ambitious commitment to put 75% of their business into value-based models by 2020.

Steven Brill

Richard J. Gilfillan, MD
CEO of Trinity Health

The task force describes itself as a “private sector alliance dedicated to accelerating the transformation of the U.S. health care system to value-based business and clinical models aligned with improving outcomes and lowering costs.”   Members include commercial payers, providers, and partners.

The announcement comes just two days after Health and Human Services Secretary Sylvia Burwell announced plans to ramp up Medicare payment reforms featuring alternative payment models and value-based payments.

Richard J. Gilfillan, MD, CEO of Livonia, MI-based Trinity Health, is chairman of the task force, which he said is “committed to rapid, measurable change both for ourselves and our country that will improve quality and make healthcare more accessible for all American families.”

Gilfillan spoke with HealthLeaders Media on Wednesday about the task force and the goals and challenges it will face in the coming months and years. The following is an edited transcript.

HealthLeaders Media: What is your biggest concern about the value-based care rollout and how can your task force prevent it from happening?

Richard Gilfillan: My biggest concern is that as an organization we don’t get there in a timely way because we find ourselves having to respond to the pushes and pulls from all directions as opposed to a clear and smooth path forward.

My concern from the broader perspective of the industry is that this is an incredible time and a great opportunity to get to where we all want to get to. I’d hate for us to miss the opportunity because we can’t find a way to make it happen, and this kind of cooperation in setting goals and working together really gives us an optimal chance to transform our care system.

HLM: Are you concerned that the value-based rollout could become as disorganized as the HIT rollout?

RG: I wouldn’t want to come off as being critical of that specific issue and segment of the industry. From a provider standpoint I am concerned, and I used to be in the payer business as well. I know that we all—whether providers, payers, or employers, or advocates for patients—have our ideas and we think they are the best and only way.

This is hard work for providers and payers making this big transition. If we are pushing and pulling on 10 different paths to how we see it and what we think the timing should be, it’s even harder.

People will find themselves in this hedging scenario, one foot in the canoe and one on the dock. If we could get some commonality around time frame and consistency of approach then it is very doable.

HLM: Are you on the same page as HHS at this point on the value-based rollout?

RG: Secretary Burwell talked about two sets of metrics. One was for gauging the extent to which their payments are operating under these alternative contracts, which they defined as medical homes with triple-aim outcomes, bundled payment programs, ACO programs. That aligns directly with our thinking about our 75% commitment.

They also talked about how many of the dollars would be operating under the value-based payment systems, which is more the incentive-type arrangements that don’t necessarily have total cost of care included.

I understand that they needed to pay attention to that space. We are well-aligned in terms of the goals and the definitions. Hopefully, we’ll find that as the industry comes together to develop the best ways to get at that and define those models in more detail, that is where we will influence each other and come to an approach that works.

We would like to work with HHS and CMS to do the most we can to create a synergistic approach. There is a lot of potential for building momentum in the private sector as well.

HLM: Why do you believe this transition should be “rapid?”

RG: We have found as we have talked to other providers that it’s really hard to operate in two or three different ways. At first everyone said, ‘let me try a little alternative contracting, a little responsibility for total cost of care and better outcomes, but I want to keep my old way of doing things too.’

People realized that the halfway world is very difficult and disorienting for an organization and its people. That period of uncertainty, mixed messages, and confusion, is painful. Many of us have said, ‘let’s find our way to that sooner and be on a specific path so we can communicate in a straightforward way with our organization and people.’

We want to give them a clear message and a path forward and a sense of where we are going so that we can plan that out and execute on it in a logical thoughtful way. Most of us feel that it’s better to do it sooner rather than drag it out into an extended period of uncertainty.

HLM: So the mindset now is that this is going to happen so we might as well get it done?

RG: I think so. The other thing we are realizing is that it’s not just about cost, or quality, or health. It’s about all three. Nobody went into healthcare to deliver fragmented, uncoordinated, inaccessible, and unaffordable care. This is actually taking us back to why we went into healthcare. It’s exciting. Let’s get there sooner rather than later. The country needs this sooner rather than later from a lot of perspectives.

HLM: Did the timing of the HHS announcement on Monday affect your announcement?

RG: Our first meeting was in June and we were reaching out to people two or three months before that. This is almost a year’s work getting to this point. People in Washington have talked about there being a timeline from the federal government since 2009.

We heard from the secretary’s office a week and a half ago that there was going to be some announcement. They were putting a stake in the sand. We were invited to be part of an initial information session and then we were invited to join the secretary at the announcement.

We realized this is very much on a parallel track and one that works. It’s a great coming together of people’s thinking about what it would take to be successful.

HLM: Do you anticipate more disagreements within the task force as you address more specific details on how value-based care will work?

RG: The answer is yes. We do anticipate differences of perspective. The reason we need to do this is because there are multiple perspectives and those perspectives are different among providers and payers and across those groups.

We have already done some hard work in talking through those differences and creating what we think is a preferred set of principles and policies.

Our most immediate effort is going to be to provide comments in the episode-based payment space and in ACOs and we are working on that now. So yes, there will be differences, but that is the purpose of this.

We have to listen to each other and understand each other’s perspectives and this task force creates a context in which we can actually do that. We hope we can provide input for CMS along the way.

HLM: How did you come to decide upon 75% in value-based by 2020?  

RG: We knew that one of the key goals here was to put a stake in the ground that we all had to agree to and 75% and five years seemed reasonable.

HLM: How will the task force spend its time over the next few months?

RG: Organizationally, we just launched publically and we are still putting the logistics in place to operate the task force. It’s been up and operating, but we are trying to understand the best way to engage as many people and organizations as possible, so we are working through the best way to do that, and respond to what we see as a lot of interest.

There are a lot of people who are interested and I hope between this and the HHS announcement people will see it’s a good time to make that commitment organizationally.

HLM: Do you expect the task force to take on new members in the coming years?

RG: This is about folks coming together who hope and expect that others will be interested in signing on and working on this goal. I am already getting a fair number of inquiries from folks saying they’d like to be involved.

business, complex adaptive systems, cool, data saving lives, EF, entrepreneurship, file note, health market quality, healthcare, healthy habits, meaning, musings, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology, startup, storytelling, technology

Establishing markets in prevention and wellness – 3 examples

1. AIA Vitality Life Insurance

  • https://www.aiavitality.com.au/vmp-au/
  • Wendy Brown – University of Queensland wbrown@hms.uq.edu.au
  • Tracy Kolbe-Alexander – University of Queensland

2. Data Driven Healthcare Quality Markets

3. Abu Dhabi Health Authority – Weqaya

 

 

Vitality Institute Commission – Recommendation 3 http://thevitalityinstitute.org/commission/create-markets-for-health/

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems

Creating a Market for Disease Prevention

 

http://thevitalityinstitute.org/news/focus-on-pharma-creating-a-market-for-disease-prevention/

Focus on Pharma: Creating a Market for Disease Prevention

SustainAbility Newsletter “Radar” | Oct 30, 2014

Should pharmaceutical companies be in the business of producing pills, or of making people well? The answer is both. Elvira Thissen argues that with diminishing returns in medicines it is time for pharma companies to move away from philosophical discussions on prevention and adapt to new realities instead.

[…]

The Business Case for Prevention

A recent report by The Vitality Institute – founded by South Africa’s largest health insurance company – estimates potential annual savings in the US of $217–303 billion on healthcare costs by 2023 if evidence-based approaches to NCD prevention are rolled out.

At an estimated global cost of illness of nearly US$1.4 trillion in 2010 for cardiovascular disease and diabetes alone, there is a market for prevention. In the UK, the NHS spends 10% of its budget on treating diabetes, 80% of which goes to managing (partly preventable) complications. Reducing disease incidence represents a considerable value to governments, insurance companies and employers.

Some sectors are already eyeing the value of this market.

[…]

For access to the full article and SustainAbility newsletter, click here.

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, meaning, nutrition, policy, politics, rapid learning health systems, storytelling

Dr Atul Gawande – 2014 Reith Lectures

Lecture 1: Why Do Doctors Fail?

Lecture 2: The Century of the System

Lecture 3: The Problem of Hubris

Lecture 4: The Idea of Wellbeing

http://www.bbc.co.uk/programmes/articles/6F2X8TpsxrJpnsq82hggHW/dr-atul-gawande-2014-reith-lectures

Dr Atul Gawande – 2014 Reith Lectures

Atul Gawande, MD, MPH is a practicing surgeon at Brigham and Women’s Hospital and Professor at both the Harvard School of Public Health and Harvard Medical School.

In his lecture series, The Future of Medicine, Dr Atul Gawande will examine the nature of progress and failure in medicine, a field defined by what he calls ‘the messy intersection of science and human fallibility’.

Known for both his clear analysis and vivid storytelling, he will explore the growing importance of systems in medicine and argue that the future role of the medical profession in our lives should be bigger than simply assuring health and survival.

The 2014 Reith Lectures

The first lecture, Why do Doctors Fail?, will explore the nature of imperfection in medicine. In particular, Gawande will examine how much of failure in medicine remains due to ignorance (lack of knowledge) and how much is due to ineptitude (failure to use existing knowledge) and what that means for where medical progress will come from in the future.

In the second lecture, The Century of the System, Gawande will focus on the impact that the development of systems has had – and should have in the future – on medicine and overcoming failures of ineptitude. He will dissect systems of all kinds, from simple checklists to complex mechanisms of many parts. And he will argue for how they can be better designed to transform care from the richest parts of the world to the poorest.

The third lecture, The Problem of Hubris, will examine the great unfixable problems in life and healthcare – aging and death. Gawande will argue that the reluctance of society and medical institutions to recognise the limits of what professionals can do is producing widespread suffering. But research is revealing how this can change.

The fourth and final lecture, The Idea of Wellbeing, will argue that medicine must shift from a focus on health and survival to a focus on wellbeing – on protecting, insofar as possible, people’s abilities to pursue their highest priorities in life. And, as he will suggest from the story of his father’s life and death from cancer, those priorities are nearly always more complex than simply to live longer.

Five things to know about Dr Atul Gawande

Find out about Atul Gawande ahead of his 2014 Reith Lectures…

1.

In 2010, Time Magazine named him as one of the world’s most influential thinkers.

2.

His 2009 New Yorker article – The Cost Conundrum – made waves when it compared the health care of two towns in Texas and suggested that more expensive care is often worse care. Barack Obama cited the article during his attempt to get Obamacare passed by the US Congress.

3.

Atul Gawande’s 2012 TED talk – How do we heal medicine? – has been watched over 1m times.

4.

Atul Gawande has written three bestselling books: Complications, Better and The Checklist Manifesto.

The Checklist Manifesto is about the importance of having a process for whatever you are doing. Better focuses on the drive for better medicine and health care systems. Complications was based on his training as a surgeon.

5.

In 2013, Atul launched Ariadne Labs – a new health care innovation lab aiming ‘to provide scalable solutions that produce better care at the most critical moments in people’s lives everywhere’.

EF, health market quality, healthcare, policy, rapid learning health systems

 

Professor Guy Maddern’s tips on protecting yourself in surgery

1. If you are away from a major hospital, get yourself to one. A particular problem, Professor Maddern says, exists when rural patients resist transfers to major hospitals because they don’t want to leave their families.

2. Lose weight and don’t smoke.The proportion of deaths where obesity was a factor increased slightly this year. “An operation done on a thin person relative to a fat person can have a completely different outcome,” Professor Maddern says. This is particularly important for older people, who have the most operations.

3. Go to a hospital that performs a lot of the type of surgery you are going to have, particularly if it is complex. Remember, practice makes perfect.

http://www.canberratimes.com.au/national/health/one-in-10-surgery-deaths-due-to-flawed-care-or-injury-caused-by-treatment-20141203-11z5y1.html

One in 10 surgery deaths due to flawed care or injury caused by treatment

Date December 3, 2014

Health Editor, Sydney Morning Herald

View more articles from Amy Corderoy

Dangerous: Surgery risks can outweigh benefits.

Dangerous: Surgery risks can outweigh benefits. Photo: Nic Walker

More than one in 10 deaths during or after surgery involved flawed care or serious injury caused by the treatment, a national audit has found.

The Australian and New Zealand Audits of Surgical Mortality shows delays in treatment or decisions by surgeons to perform futile surgeries are still the most common problems linked to surgical deaths.

But surgery also appears to be getting a little safer, with the audit, which covers almost every surgery death in Australia, finding fewer faults with the medical care provided to patients than it has in the past.

Audit chair Guy Maddern said of the deaths where there were concerns, about 5 per cent involved serious adverse events that were likely to have contributed to the person’s death.

In about 8 per cent of cases, the audit found some area of care could have been delivered better.

“These are the sorts of deaths where it was a difficult surgery, and instead of going straight to an operation, maybe additional X-rays and imaging should have been pursued, or maybe the skill set of the team that was operating could have been more appropriate,” he said.

“Sometimes, of course, the result would have been exactly the same.”

Professor Maddern said some surgeons, particularly in general surgery, orthopaedics, and, to a lesser extent, neurosurgery, still needed to work on deciding not to proceed with surgeries where the risks outweighed the benefits.

“People are thinking a little bit longer and harder about whether an operation is really going to alter the outcome,” he said. “These are the types of cases where you know before you begin that it is not going to end well.”

However, in some areas with many patients with complex conditions, things were just more likely to go wrong.

The report, which includes data from nearly 18,600 deaths over five years, found in 2013 the decision to operate was the most common reason a death was reviewed.

Overall, delays in treatment, linked to issues such as patients needing to be transferred or surgeons delaying the decision to operate, were still the most common problem, and in about 26 per cent of the deaths no surgery was performed.

Between 2009 and 2013, the report shows a decrease in the proportion of patients who died with serious infection causing sepsis from 12 per cent to 9 per cent, while significant post-operative bleeding decreased from 12 per cent to 11 per cent. Serious adverse events halved from 6 per cent of deaths in 2009 to 3 per cent in 2013.

Every public hospital now participates in the audit, along with all private hospitals in every state except NSW. However, Professor Maddern said he was pleased NSW private hospitals had agreed to participate in future.

Doctors are now provided with regular case studies from the audit, in which de-identified information about the death is provided, so they can learn from any mistakes.

“What we are seeing is an overall decrease in deaths associated with surgical care, which may be due to many things, and we think the audit is helping,” he said. “It’s making people think twice.”

Professor Guy Maddern’s tips on protecting yourself in surgery

1. If you are away from a major hospital, get yourself to one. A particular problem, Professor Maddern says, exists when rural patients resist transfers to major hospitals because they don’t want to leave their families.

2. Lose weight and don’t smoke.The proportion of deaths where obesity was a factor increased slightly this year. “An operation done on a thin person relative to a fat person can have a completely different outcome,” Professor Maddern says. This is particularly important for older people, who have the most operations.

3. Go to a hospital that performs a lot of the type of surgery you are going to have, particularly if it is complex. Remember, practice makes perfect.