Category Archives: EF

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A pinch of prevention will prevent a pound of turnstile medicine

 

http://www.afr.com/p/opinion/pinch_of_prevention_will_prevent_cTMfa5vns8VzT46UA8cigJ

JOHN DWYER

A pinch of prevention will prevent a pound of turnstile medicine

PUBLISHED: 12 HOURS 58 MINUTES AGO | UPDATE: 12 HOURS 38 MINUTES AGO

 

A pinch of prevention will prevent a pound of turnstile medicineA lack of infrastructure in Australia to care for more people in a community, rather than a hospital, costs us dearly. Photo: Louie Douvis

JOHN DWYER

Poorly considered and obviously unacceptable policies have forced the government to go back to the drawing board to consider ways to improve the cost effectiveness and sustainability of our health care system. This time let’s move beyond the government’s focus on having us pay more for a visit to our GP to concentrate on the evidence-based structural reforms we should be discussing. This time broad consultations are promised. Hopefully, the following facts and suggestions will influence decisions.

A good start would see the government stop talking about the fiscal sustainability of Medicare. Were it not for the destructive division of health care responsibilities shouldered by State and Federal governments, Canberra would not be looking at Medicare as if were isolated from the rest of the health care system. Hospital expenditure, at nearly $60 billion a year, dwarfs Medicare spending ($19 billion a year) and is increasing more rapidly. The immediate catalyst for changes to Medicare is not a fiscal crisis – our 9.3 per cent of GDP spent on health is about average for the OECD –but rather the unsatisfactory health outcomes delivered that are fuelling the growth in hospital care. A lack of any real infrastructure to provide our community with an improved capacity to prevent illness and care for more people in a community rather than hospital setting is costing us dearly.

More than 600,000 admissions to hospital each year (average cost more than $5000 per episode) could be avoided by a timely community intervention in the three weeks prior to admission. There is no doubt that the future of cost-effective, readily available hospital care is dependent on a reduction in the demand for hospital services. That must be the goal of a restructured Primary Care system. Last year Australians forked out $29 billion to supplement their health care (second only to the US in terms of out of pocket expenses). Much of this was spent on paying for surgery in the private sector. Public hospitals are swamped with complex medical patients seriously reducing their capacity to offer timely surgical services. Reducing medical admissions and restoring timely surgical services is a key to reigning in surgical costs and better educating the next generation of surgeons.

This time could our new health minister and her department open their eyes to international trends in cost effective health care that are producing better health outcomes. There is now an abundance of evidence that a focus on prevention in a personalised health system improves outcomes while slashing costs. Some systems have reduced hospital admissions by 42 per cent over the last decade. The British government has just been presented with a review that concluded that an extra 72 million ($132 million) spent on improving primary care in the community would save the system 1.9 billion ($3.5 billion) by 2020. The data available provides the government with a clear message that it does not want to hear. Only by spending more money on arestructuredMedicare will significant system wide savings be achievable.

A competent government would be looking at a timetable for introducing the highly successful Medical Home model of Primary Care, where teams of health professionals populate a practice and are available to enrolled patients. The infrastructure is available to help people avoid illness, have potential problems recognised earlier, offer co-ordinated in house care for people with chronic problems and care for many in the community currently sent to hospital. International experience tells us that a decade is required for the completion of necessary changes. We need to start on that journey and, fortunately, can do so without any panic about current health expenditure.

There is another related imperative that needs urgent action. Only 13 per cent of young doctors express any interest in becoming a GP. Only 1 per cent are contemplating a career as a rural GP. Primary Care training is rigorous and GPs are true specialists. How does all the rhetoric from Canberra about the pivotal role they play sit with the proposed $31 fee for a standard consultation. The discrepancy in the income potential for GPs when compared to that of other specialists is now huge.

Young doctors looking at the professional life of our GPs are uncomfortable with the current “fee for service” model that encourages turnstile medicine that is so professionally unfulfilling. Many GPs join corporate Primary Care providers preferring a salary. In New Zealand the government has facilitated 85 per cent of the nation’s GPs moving away from fee for service payments. The same is true for 65 per cent of US Primary Care physicians. Throughout the OECD health systems recognising the perverse incentives associated with fee for service remuneration are exploring changes that increase a GP’s remuneration for keeping people well.

There are numerous cost impositions in our health system that should be addressed before we are asked to pay more. Nine departments of health for 23 million people. A $5 billion dollar cost for the private health insurance rebate that could be better spent on achieving the above goals. $20 billion dollars spent on poor value or unnecessary procedures. The government asks: “if you don’t like our ideas then what would you do?” Well, here come the suggestions, please listen.

John Dwyer isEmeritus Professor of Medicine at the University of NSW.

The Australian Financial Review

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Data is just a shadow of human experience. We still need to connect the dots – Roni Zeiger

http://eepurl.com/-rUf9

“Data is just a shadow of human experience. We still need to connect the dots,” Smart Patients founder and Rock Health entrepreneur Roni Zeiger argued last week. Luckily, healthcare may finally be ready for big data—just so long as the algorithms don’t ruin your life.

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Cth DoH look to disinvestment in low value care

 

http://www.theaustralian.com.au/national-affairs/health/health-eyes-15bn-payoff-from-war-on-waste/story-fn59nokw-1227183948925

Health eyes $15bn payoff from war on waste

EXCLUSIVE – SEAN PARNELL – HEALTH EDITOR

Ten per cent of all health expenditure — as much as $15 billion a year — could be saved through a concerted effort to reduce wasteful programs, marginal treatments and avoidable errors, senior officials in the Department of Health have revealed. The department’s Strategic Policy Group was examining large-scale savings — including an evidence-based campaign of “disinvestment” in low-value programs, drugs and therapies — long before the Abbott government committed to its unpopular GP co-payment.

Documents obtained by The Australian under Freedom of Information laws show the group of deputy secretaries and other officials wanted to reduce spending on low-value interventions and get serious about combating avoidable side-effects, mistakes and infections.

“Members expressed strong interest in holding further discussions on the impact of waste and adverse events,’’ minutes from a November 2013 meeting state. “The discussions could be informed by work already under way in the department on disinvestment and by ongoing work by the Australian Commission for Safety and Quality in Health Care.”

Out of the public eye, the group — which reports directly to the secretary of the department — established an Optimising Value in Health Investment Working Group and talked with Treasury officials. The bureaucrats were keen to redirect money away from areas where there was minimal benefit and potential harm. The FOI documents shed new light on the workings of government and go some way to dispelling the myth that health bureaucrats have not recognised the need to pursue efficiencies and efficacy.

A department spokeswoman yesterday confirmed the work was ongoing. The Grattan Institute has called for more work to be done on the cost of hospital admissions and procedures, noting the cost of a hip replacement in NSW public hospitals varies by more than $16,000. It has estimated savings of $1bn a year from targeting such inefficiencies, as well as $500 million a year from workforce reform — making better use of highly skilled workers — and up to $500m a year through greater use of generic medicines. Some in government believe higher co-payments for drugs and services will make consumers spend less on unproven therapies and, with more of a financial stake in health, be more accepting of limits on access and subsidies.

There are questions about the cost of subsidising new and expensive drugs, especially those with few recipients and limited efficacy, with a Senate committee soon to report on the timing and affordability of access to cancer drugs.

The last federal budget committed to a controversial co-payment that has since been reworked. It also outlined plans to merge the safety and quality commission and five other agencies into a new Health Productivity and Performance Commission — a move that has already halted work on new performance reporting for emergency departments, elective surgery and infections — and replace Medicare Locals with a new primary care structure.

The budget did not take up the commission of audit’s recommendation for a broader, 12-month review of health policies and programs. The government has yet to finalise outstanding reviews into mental health, alcohol and drug services, after-hours GP services, super clinics and unproven natural therapies benefiting from the health insurance rebate. The government believed the health architecture established by Labor needed to be disassembled, price signals put in place for consumers, and growth opportunities given to the private sector before other savings could be pursued. Plans for a reworked $5 copayment — estimated to save $3.5bn by 2017-18 — will start to play out from Monday, when regulations setting new time frames for consultations come into effect.

The government wants GPs to focus on more serious cases, requiring longer consultations, but the Australian Medical Association has warned of $20 co-payments for shorter consultations. About 40,000 people have signed a petition against the copayment and new Health Minister Sussan Ley has yet to start the sales pitch, amid speculation the regulations could be disallowed by the Senate.

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

Palantir functions and clients

 

Leaked Palantir Doc Reveals Uses, Specific Functions And Key Clients

Leaked Palantir Doc Reveals Uses, Specific Functions And Key Clients

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Rumors Swirl That Adam Bain Will Be The Next Twitter CEO, But Costolo’s Not Going Anywhere Yet

Since its founding in 2004, Palantir has managed to grow into a billion dollar company while being very surreptitious about what it does exactly. Conjecture abounds. The vague facts dredged up by reporters confirm that Palantir has created a data mining system used extensively by law enforcement agencies and security companies to connect the dots between known criminals.

TechCrunch has received a private document from 2013 which reveals the company’s extensive trove of data analysis tools and lists many of its key clients. The document is currently being passed around as an investor prospectus for a new secondary round.

In short, the description above is in part correct. But, thanks to this leaked information, we now know far more about the secretive company.

Palantir’s data analysis solution targets three industries: government, the finance sector and legal research. Each of these industries must wrestle with massive sets of data. To do this, Palantir’s toolsets are aimed at massive data caches, allowing litigators and the police to make connections otherwise invisible. For example, a firm hired by the Securities Investment Protection Corporation used Palantir’s software to sort through the mountains of data, over 40 years of records, to convict Ponzi schemer Bernie Madoff (of all things).

Palantir’s software sits on top of existing data sets and provides users with what seems like a revolutionary interface. Users do not have to use SQL queries or employ engineers to write strings in order to search petabytes of data. Instead, natural language is used to query data and results are returned in real-time.

Clients include the Los Angeles Police Department which used Palantir to parse and connect 160 data sets: Everyone from detectives to transit cops to homeland security officials uses Palantir at the LAPD. According to the document, Palantir provides a timeline of events and has helped the massive police department sort its records.

The leaked report quotes Sergeant Peter Jackson of the LAPD stating: “Detectives love the type of information it [Palantir] provides. They can now do things that we could not do before. They can now exactly see great information and the links between events and people. It’s brought great success to LAPD. It supports the cops on the streets and the officers doing the investigations. It is a great tool. They are becoming more efficient and more effective cops. Palantir is allowing them to better serve the public.”

Screen Shot 2015-01-11 at 3.55.49 PM

Palantir explains that it is a toolset for use in human analysis on its website. However, we now understand that the service is a smarter way of displaying data for analysis by humans. It is capable of building comprehensive models of activity to detect suspicious anomalies and is even able to provide immunity to fraud thanks to strategies the founders learned while still at PayPal.

Palantir’s anti-fraud system uses algorithms to detect and isolate patterns designated by analysts. This approach was inspired by combating adaptive threats at PayPal, the leaked document states. Four out of the five people on the Palantir management team worked at PayPal. Palantir co-founder Peter Thiel was also a PayPal co-founder.

The document confirms that Palantir is employed by multiple US Government agencies. One of the company’s first contracts was with the Joint IED Defeat Organization in 2006. From 2007-2009 Palantir’s work in Washington expanded from eight pilots to more than 50 programs.

As of 2013, Palantir was used by at least 12 groups within the US Government including the CIA, DHS, NSA, FBI, the CDC, the Marine Corps, the Air Force, Special Operations Command, West Point, the Joint IED-defeat organization and Allies, the Recovery Accountability and Transparency Board and the National Center for Missing and Exploited Children. The Centers for Medicaid and Medicare Services were planning on pilot testing the use of Palantir in 2013 to investigate tips received through a hotline. A second test was run by the same organization to identify potentially fraudulent medical providers in the Southern region of the US.

However, as of 2013, not all parts of the military used Palantir. The U.S. Army developed its own data analysis tool called the Distributed Common Ground System at a cost of $2.3 billion, but it is believed that it is not very popular. The leaked document cites a 2012 study where 96% of the surveyed war fighters in Afghanistan recommended Palantir.

The prospectus holds that the US military used Palantir with great success. The Pentagon used the software to track patterns in roadside bomb deployment and was able to conclude that garage-door openers were being used as remote detonators. With Palantir, the Marines are now able to upload DNA samples from remote locations and tap into information gathered from years of collecting fingerprints and DNA evidence. The results are returned almost immediately. Without Palantir, the suspects would have already moved onto a different location by the time the field agents received the results.

Samuel Reading, a former Marine who works in Afghanistan for NEK Advanced Securities Group, a U.S. military contractor, was quoted in the document as saying It’s the combination of every analytical tool you could ever dream of. You will know every single bad guy in your area.”

“It’s the combination of every analytical tool you could ever dream of. You will know every single bad guy in your area.”

—

The U.S. spy agencies also employed Palantir to connect databases across departments. Before this, most of the databases used by the CIA and FBI were siloed, forcing users to search each database individually. Now everything is linked together using Palantir. In fact, cyber analysts working for the now-defunct Information Warfare Monitor used the system to mine data on the China-based cyber groups GhostNet and The Shadow Network.

Yet Palantir is not exclusively used by governments or law enforcement agencies. The company’s data solution works equally as well in more pedestrian pursuits.

The International Consortium of Investigative Journalists uses Palantir to gain insight into the global trade and illegal trafficking of human tissue. And, as we mentioned before, the K2 Intelligence firm was employed by the SIPC to conquer the 20 terabytes of data in its case against Bernie Madoff. The leaked report quotes Jeremy Kroll, CEO and Co-founder of K2, saying that Palantir was able to construct a story around several key events in the Madoff saga in just a couple of hours.

In the business of dealing with some of the world’s most sensitive sets of data, secrecy is clearly important to Palantir’s success. This document likely only gives a glimpse into Palantir’s true capability and reach, especially since it was current just over a year and a half ago. There’s probably a great deal of Palantir information still out there, waiting to be discovered — More than a Madoff’s worth.

Middle image via aki51

data saving lives, EF, rapid learning health systems

Outsourced health analytics deal

 

http://www.forbes.com/sites/neilversel/2015/01/06/108m-analytics-outsourcing-deal-puts-health-catalyst-at-risk-for-allina-health-outcomes/

$108M Analytics Outsourcing Deal Puts Health Catalyst At Risk For Allina Health Outcomes

A major Minnesota health system is outsourcing its entire analytics operation in a 10-year, $108 million deal with a twist: The technology vendor has a financial incentive to assure that Minneapolis-based Allina Health actually improves patient outcomes and reduces the cost of care.

Under the terms of the contract, announced Tuesday, Allina is sending its data warehousing, analytics, performance improvement technology, clinical knowledge and all of its related employees to privately held healthcare analytics company Health Catalyst.

In return, Allina receives full subscription rights to Health Catalyst’s technology, as well as an unspecified equity stake in Health Catalyst, which grew out of clinical improvement efforts at Intermountain Healthcare in Salt Lake City.

About 20 percent of the contract value is dependent on Allina showing better outcomes and lower costs. A committee that will govern the Health Catalyst-Allina partnership will annually make a list of clinical improvement projects, setting measurable outcomes goals, the vendor says.

“It’s really a shared-risk contract,” Health Catalyst CEO Dan Burton tells Forbes.com. “It’s the first example that we’re aware of in healthcare” in which the analytics vendor’s payments are dependent on the client’s performance, Burton adds.

Health Catalyst envisions Allina Health’s 12 hospitals and nearly 100 outpatient clinics becoming a “living laboratory” for healthcare improvement. “We expect that this process of using analytics to prioritize projects, in combination with risk-sharing economics, will encourage far more focus and alignment than is found in traditional health system-vendor relationships,” Allina CFO Duncan Gallagher says in a press release.

“We hope that this becomes a trend in the industry,” Burton says.

Providers themselves have had to become accountable to insurance companies, including the federal Medicare program. The Patient Protection and Affordable Care Act offers incentives for healthcare entities to form “accountable care organizations,” and private payers as well as state governments have followed suit.

This deal, with its performance-based component, brings accountability to a vendor, according to Burton. “The healthcare industry has invested tens of billions of dollars in upgrading their technology without holding their technology vendors accountable.”

Allina actually was Health Catalyst’s first customer in 2008, but ran out of projects for the vendor two years later. The two reconnected in 2013, having discussions that led to this 10-year contract.

complex adaptive systems, EF, healthy habits, policy, politics, storytelling

The Economist: The end of the population pyramid

http://www.economist.com/blogs/graphicdetail/2014/11/daily-chart-10?fsrc=scn/fb/wl/dc/vi/endofpopulationpyramid

Daily chart: The end of the population pyramid | The Economist

Graphic detail
Charts, maps and infographics
Daily chart

The end of the population pyramid

The shape of the world’s demography is changing

THE pyramid is a traditional way of visualising and explaining the age structure of a society. If you draw a chart with each age group represented by a bar, and each bar ranged one above the other—youngest at the bottom, oldest at the top, and with the sexes separated—that is the shape you get. The pyramid was characteristic of human populations since the day organised societies emerged. With lifespans short and mortality rates high, children were always the most numerous group, and old people the least. Now the shape of the global population is changing. Between 1970 and 2015 the dominating influence on the global population was the fertility rate, the number of children a woman would typically bear during her lifetime. It fell dramatically over the period, meaning that the world shifted from having larger to smaller families. The age groups start to become markedly smaller only about the age of 40, so the incline starts much further up the chart than with the pyramid. The shape looks more like the dome of the Capitol building in Washington, DC. Between 2015 and 2060 the biggest influence upon the population will be ageing. Small families are already becoming the norm, the fall in fertility is slowing down and now almost everyone is living longer than their parents—dramatically so in developing countries. So, by 2060, the dome will have come and gone and the shape of the population will look more like a column (or perhaps an old-fashioned beehive).

Read the full article from The World In 2015.

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Bloomberg: Omada Health Pitch

  • Digital Therapeutics — “Prevent”
  • Digitally-mediated behavioural change
  • Business Model: Charge on success
  • Enterprise Customers

http://www.bloomberg.com/video/take-face-to-face-medicine-to-digital-omada-health-ceo-luSxUqctQcqbjUMc6Wf41g.html

Transcript:

Thanks for joining us on “bottom line.” tell me what your company does.

What is digital therapeutics?

Digital therapeutics is the idea that medicine in the past was conducted in a face-to-face setting.

On the web and social and mobile on the way we can create digital expenses is allowing us to be done digitally.

We take proven lifestyle and behavioral medicine interventions from face-to-face to digital.

That is what we do.

This could help me — well, i don’t smoke, but if i did, it could help me quit and eat healthier, which i don’t do.

Is that the idea — lose weight, quit smoking?

Matt, we can help you with that, and if you want a free pass to our program, let me know . our program helps people with high risk of type two diabetes lose weight and make lifestyle changes over the course of 16 weeks and it is conducted entirely digitally.

I use my iphone or ipad and this will actually work?

Is that the case?

That is the idea.

It can help people proven at risk for type two.

If you help them in a high-tech fashion, our program is digital, a small group environment, where you are paired with others like you and you see how others are doing and we get android and iphone apps and we have a whole bunch of things to make you successful.

Every time i want a delicious cherry coke at lunch, you suggest something that won’t give me diabetes?

The idea is that that moment you want that delicious cherry coke, you think of your health coach and your groups going on with you and maybe you will get a water instead of something better for you.

Very smart man , mark andreessen, is a big backer of you guys.

What is the future of this company?

What does he see there as far as growth is concerned?

You know, i think the interesting bit is what is happening from the company landscape is that you get folks like me with tech and health care backgrounds will bring companies.

I studied neuroscience and i worked at google for a well and went to harvard medical school.

My passion has always been tech plus health care.

I think andreessen horowitz saw a consumer grade, rich product and experience, but to an enterprise customer set with a unique business well behind it that got them excited and that is what led them to pull the trigger on the deal.

$23 million?

What’s next?

Next for us is working with customers.

We have an innovative business model and that we only charge our employer and health plan customers if we are successful with members . because of that model, we have had a lot of demand coming in and it is just scale, scale, scale.

You sold me with harvard med school and you are a neuroscientist with an nba paper you have competition out there — but you’d have competition out there.

What are the barriers?

We do have competition.

The biggest barrier is for entrepreneurs and companies like myself is figuring out health care.

It is incredibly complex.

But so far, so good.

We want competition.

This is a space where there is a lot of people at me.

One third of the adult population has prediabetes, the latest stats from the cdc.

Let’s have a lot of people take a bite.

I wonder about results.

How can you prove that your programs give people the results they want in order to pay money up front and center for your courses — sign up for your courses?

The first is in the world of behavioral medicine.

There are a lot of published studies that show you what you need to achieve from the results standpoint, and then because of the element in our program like the digital scale, the cell phone chip, we can determine if people are successful and show the results in a very transparent and authentic way to our enterprise partners.

Diabetes is obviously a huge and growing problem.

I am certainly at risk for it.

But the weight loss thing is where i guess you will make the big money.

Type 2 diabetes is correlated to being overweight but it is not the only thing good genetics comes into play as well.

As a country, if we are to avoid the stats the cdc put out, 40% of adults of finding out at some point in their life that they are thank you, there needs to be weight loss and lifestyle intervention programs.

I’m just saying that if your marketing materials show that i lost 10 pounds in weeks with this outcome everyone will sign up.

It’s fascinating, what happens when we work with a self-interested employer is that employees who go through a program and become successful rave about it and tell their colleagues and they get colleagues to sign up.

Thanks very much.