Category Archives: politics

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US Healthcare Price Transparency

An interesting observation – unintended consequence of non-universal healthcare?: As consumers are being asked to pay more, so they’re trying to become better health-care shoppers.

  • states have passed transparency laws
  • medicare has started to dump raw service cost data
  • private firms are developing their own transparency tools
  • a report recommends:
    • total estimated price
    • out-of-pocket costs
    • patient safety and clinical outcome data

“Care providers, employers and health plans have negotiated rates, which isn’t necessarily something they want out in the public. They warn making those negotiations publicly could actually discourage negotiations for lower prices — naturally, there are conflicting opinions on this point.”

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2014/04/16/price-transparency-stinks-in-health-care-heres-how-the-industry-wants-to-change-that/

Price transparency stinks in health care. Here’s how the industry wants to change that.

By Jason Millman Updated: April 16

There’s been much written in the past year about just how hard it is to get a simple price for a basic health-care procedure. The industry has heard the rumblings, and now it’s responding.

About two dozen industry stakeholders, including main lobbying groups for hospitals and health insurers, this morning are issuing new recommendations for how they can provide the cost of health-care services to patients.

The focus on health-care price transparency — discussed in Steven Brill’s 26,000-word opus on medical bills for Time last year — has intensified, not surprisingly, as people are picking up more of the tab for their health care. Employers are shifting more costs onto their workers, and many new health plans under Obamacare feature high out-of-pocket costs.

The health care-industry has some serious catching up to do on the transparency front. States have passed their own health price transparency laws, Medicare has started to dump raw data on the cost of services and what doctors get paid, and private firms have developed their own transparency tools.

“We need to own this as an industry. We need to step up,” said Joseph Fifer, president and CEO of the Healthcare Financial Management Association, who coordinated the group issuing the report this morning. The stakeholder group includes hospitals, consumer advocates, doctors and health systems.

Their recommendations delineate who in the health-care system should be responsible for providing pricing information and what kind of information to provide depending on a person’s insurance status. Just getting the different stakeholders on the same page was difficult enough in the past, said Rich Umbdenstock, president and CEO of the American Hospital Association.

“We couldn’t agree on whose role was what. We were using terms differently,” he said.

The report’s major recommendations include how to provide patients with:

  • the total estimated price of the service
  • a clear indication of whether the provider is in-network or where to find an in-network provider
  • a patient’s out-of-pocket costs
  • and other relevant information, like patient safety scores and clinical outcomes.

“I think that the focus now, unlike three years ago when it was on access, the focus is about affordability,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “What are the prices being charged? It leads consumers to want to know, ‘How do I evaluate all that?'”

To give a sense of just how murky health pricing can be, one of the group’s recommendations is for providers to offer uninsured patients their estimated cost for a standard procedure and to make clear how complications could increase the price. You would think that shouldn’t be too hard — there’s no insurer to deal with, no contracts to consult.

But previous research points out just how difficult it can be to get the price for a basic, uncomplicated procedure. In a study published this past December, researchers found that just three out of 20 hospitals could say how much an uninsured person should expect to pay for a simple test measuring heartbeat rate.

The group’s recommendations also touches on limits to transparency and the “unintended consequences” of too much data being public. Care providers, employers and health plans have negotiated rates, which isn’t necessarily something they want out in the public. They warn making those negotiations publicly could actually discourage negotiations for lower prices — naturally, there are conflicting opinions on this point.

The report nods to other ways at achieving transparency. For example, it talks about “reference pricing” in self-funded employer health plans, in which employers limit what they’ll pay for an employee’s health-care services — thus setting the reference price.

“The employer communicates to employees a list of the providers who have agreed to accept the reference price (or less) for their services. If an employee chooses a provider who has not accepted the reference price, the employee is responsible for the amount the provider charges above the reference price,” the report reads, noting that Safeway grocery stores implemented a successful pilot program that expanded a few years ago.

Perhaps what’s most significant about these recommendations is the stakeholders’ acknowledgement that the health-care market is changing. Consumers are being asked to pay more, so they’re trying to become better health-care shoppers

AHIP’s Ignagni said most insurers already provide cost calculator tools and quality data on their Web sites. Providers, said the AHA’s Umbdenstock, need to be more accommodating to patients’ price-sensitivity.

“‘We can’t answer your question’ may have worked in the past, but it doesn’t fly any longer,” said Mark Rukavina, principal with Community Health Advisors and a report contributor. “This [report] basically lays out the principles for creating a new response to the question.”

Jason Millman covers all things health policy, with a focus on Obamacare implementation. He previously covered health policy for Politico. He is an unapologetic fan of the New York Yankees and Giants, though the Nationals and Teddy Roosevelt hold a small place in his heart. He’s on Twitter.

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Katz on managing severe obesity

good, balanced diatribe..

http://www.linkedin.com/today/post/article/20140408142414-23027997-severe-obesity-let-em-eat-kale

Severe Obesity? Let ‘Em Eat Kale!

April 08, 2014

The tale of aristocratic indifference on the part of Marie Antoinette, Queen of France at the time of the French Revolution, wife of Louis XVI, is, we now know, likely apocryphal. Still, like many historical distortions, this one reverberates through modern culture just the same, and harbors meaning as archetype, if not as reliably archived fact. You no doubt know the tale:

The peasants were starving and had no bread. Marie allegedly suggested: “let them eat cake!”

We find a modern day analogue in the advice dispensed by foodie elite who suggest that the masses should just eat “real” food. The definition of “real” is generally left open to interpretation- but of course, Marie never said what kind of cake, either.

The connotations of “real” are clear enough: pure, unpackaged foods; those icons of nutritional virtue about which the wholesome truth is so self-evident that ingredient lists and nutrition fact panels are superfluous. Wild salmon comes to mind. And broccoli, presumably organic. And fresh berries.

In other words, since the people have no whole-grain bread: let ‘em eat kale!

Now, frankly, I’m quite partial to kale. And, for that matter, the potentially even more nutritious fiddlehead ferns. But I have a real antipathy for fiddling around, or issuing jejune exhortations, while Rome is burning. And burning, it is.

For those inclined to celebrate the recent and radically distorted ping about childhood obesity rates ‘plummeting,’ came this week’s predictably countervailing pong: they have not plummeted after all. More importantly, the most recent paper on childhood obesity trends shows that severe obesity is rising disproportionately.

That’s worth reiterating: whatever is happening to overall obesity rates, rates of severe obesity are rising briskly in children. Prior research had already indicated that was true in both children and adults, so speaking of cake, this is really just icing on what was already well baked. But we seemed in need of a timely reminder.

Fundamentally, this means that it may no longer help us much to ask and answer: how many Americans are overweight or obese? That number, or percentage, may now be level and rather uninteresting, if only because it is pressed up against the ceiling. To gauge the severity of hyperendemic obesity in our culture, we may now need to ask: how overweight and obese are the many?

The answer, ever more often, is: severely.

That severe obesity rates are rising steadily and perhaps steeply has two flagrant implications. The first is that we are not doing nearly enough at the level of our culture to make eating well, being active, and thereby controlling weight the prevailing norm. These two behaviors and one outcome remain exception rather than rule, costing us dearly- in every currency that matters, human potential above all.

The second implication is that we need good treatments for severe obesity, since it is already well established among us.

I have first hand experience with severe obesity, in adults and kids alike. Unlike garden-variety weight gain, severe obesity generally occurs in the context of diverse hardships. Sometimes, there is the duress of a dysfunctional family dynamic. Sometimes there is an underlying mental health problem. Sometimes the propagating factors are preferentially, if not exclusively, socioeconomic: a rough neighborhood, with lack of access to “real” food and recreational opportunities, and the inevitable clustering of fast food franchises. That latter peril makes me think of wolves surrounding the most vulnerable member of a herd. Almost inevitably, there is ridicule, disparagement, and disadvantage; the literal, daily addition of insult to injury.

Bariatric surgery is effective treatment for severe obesity, and I have long advocated strenuously that it should be available, and reimbursable, for all who truly need it. But meaning no disrespect to the surgeons who provide or patients who receive it, it’s a rather poor option and should be a last resort, not a first, especially for children. The surgery is potentially major, and thus encumbered by all of the customary risks. The long-term effects are far from perfect, and substantially unknown for children. The monetary costs are apt to be unmanageable if this becomes the “go to” solution for an increasingly prevalent problem.

And most importantly: nobody learns anything under general anesthesia. The root causes of severe obesity are not addressed with scalpels. There is no way to share the benefits of a redirected gastrointestinal tract. In contrast, “skillpower” can be shared. A systematic effort to empower those most in need with the skills and resources needed to eat well, be active, lose weight, and find health- physical and mental- would allow for paying it forward, to family and friends, and the next generation. The good of surgery is contained within a body. The good of propagating skills and resources for healthy living reverberates throughout the body politic.

My friend David Freedman, the highly accomplished health journalist, and I have had a spirited and fairly public exchange on the topic of “getting there” from here. When Mr. Freedman suggested that better junk food could be part of the answer, I protested: anything that is genuinely part of the solution is, by definition, no longer junk. When I emphasized the importance of knowing what dietary pattern is best for health, Mr. Freedman parried back that I might be diverting attention from the critical need to pave a way of getting there from here, accessible in particular for those currently most forestalled.

But in the end, our private exchanges indicated that our public argument was mostly smoke and just about no fire. We both agree that we can’t have good diets supporting good health if we don’t acknowledge we know what a good diet is. And we both agree that knowing that “real” food is good does just about nothing to help modify and improve the diets and health of real people.

For that, we need an expansive cultural commitment; a movement; perhaps even a revolution. We need approaches to severe obesity that don’t just fix it after it happens. Big Surgery and Big Pharma may be beneficiaries of this, but the rest of us will be in one helluva fix. The better way is introducing innovative solutions that confront it at its origins and spread of their own accord.

We need to reorient our cultural attitude about obesity so it is not an excuse to argue the respective merits of personal responsibility and public policy. Rather, if we are to fix it at its origins, we need to acknowledge that people who are empowered are most capable, and most inclined, to exercise responsibility. So let’s build it, and see what comes.

We can, and should, empower people to trade up the food choices they are already making.Better chips may not satisfy the purists, but the evidence is in hand that improving food choices- even among the homely fare that comes in bags, boxes, bottles, jars, and cans- adds up to make a truly important difference for populations, and individuals alike. This can be done without spending more money, urban legend to the contrary notwithstanding. Still, we could likely accomplish far more by combining nutrition guidance systems with financial incentives that encourage their use.

Among such approaches, too, are community and New-Age approaches to gardening that might even allow many more of us to grow our own kale- and perhaps fiddlehead ferns.

But “let ‘em eat kale” simply won’t do. It’s fatuous, unrealistic, elitist nonsense. It’s fiddling around. And all the while, Rome burns.

-fin

Dr. David L

healthy habits, musings, nutrition, policy, politics

Is Big Food the new Tobacco?

Finally commented on the Food Politics blog. Excitement.

APR172014

Is Big Food the new Tobacco?

Thanks to Maggie Hennessy at FoodNavigator-USA for her report on a meeting I wish I’d been able to attend—the Perrin Conference on “Challenges Facing the Food and Beverage Industries in Complex Consumer Litigations.”

Hennessey quotes from a speech by Steven Parrish, of the Steve Parrish Consulting Group describing parallels between tobacco and food litigation.

From the first lawsuit filed against [tobacco] industry member in 1953 to mid-1990s, the industry never lost or settled a smoking and health product liability suit. In the mid ‘90s the eggs hit the fan because the industry for all those decades had smugly thought it had a legal problem. But over time, it came to realize it had a society problem. Litigation was a symptom of the disease, not the disease itself.

…When it came time to resolve the litigation, we couldn’t just sit in a room and say, ‘how much money do you want?…A lot had nothing to do with money. It had to do with reining the industry in…We spent so much time early on talking to ourselves about greedy trial lawyers, out-of-touch regulators, media-addicted elected officials and public health people who didn’t know how to run a business. At the end of the day, it didn’t matter. We would have been much better off recognizing these people had legitimate agendas.”

… Maybe there are some parallels, but I urge people not to succumb to the temptation to say, ‘cigarettes kill you, cigarettes are addictive. But mac and cheese, coffee, and Oscar Meyers wieners don’t. That may be true, but there are still risks for the industry.

The article also quotes Michael Reese, plaintiff’s attorney for Reese Richman LLP, talking about the increasingly accusatory tone of media coverage of Big Food:

There’s this idea, which has picked up steam in the media, that large food companies are manipulating ingredients to hook people on food. It hasn’t been manifest in litigation yet, but we’re seeing it with legislative initiatives, like Mayor Bloomberg in New York City saying sugar hooks people and causes diabetes. We’ve seen some with GMOs, though most of that legislation is about consumers’ right to know. But there’s this overarching concept that Big Food is somehow manipulating our food supply and as a result, giving us non-food.

Sounds like the message is getting across loud and clear.

Thoughts?

  • Paul • a minute ago

    If I smoke a cigarette right this minute, I am no more likely to die than if I drink a bucket of soda. But if I repeat these activities sufficiently frequently and over a long enough period of time, I will most certainly be harmed, and in time, killed.

    To deny these realities because there are no clear differences in types of food, or to claim that we need to eat, while smoking is optional, plays directly into the hands of the spivs fighting for the status quo.

    Drop the academic pretensions and start fighting the good fight, just like Prof Nestle and Mayor Bloomberg.

  • Avatar
    Jennie • 17 hours ago

    Tobacco and food are too dissimilar to succeed with the same strategy. It was realistic to insist all tobacco products should be avoided and to legislate against smokers. People have a choice between not smoking or smoking while standing outdoors only. And of course there was second hand smoke to up the ante. With food there is no secondhand smoke and we all must eat something. Can we successfully vilify all food and all eaters. Maybe we can make everyone eat outside if they insist upon eating at all. It is so impractical I wonder why anyone would try to pattern food legislation after tobacco legislation. I certainly wonder what the agenda really is because to outlaw some food and some eaters implies there will be specially anointed experts to distinguish the “bad” foods from the “acceptable” foods. Who will be wearing the badges to get this accomplished? It just sounds too creepy somehow. Or maybe just lazy and ignorant.

  • Avatar
    kalihikai • 9 hours ago

    There are profound similarities between how the Tobacco industry hid toxicity findings to human health and that of big aquaculture, particularly salmon and shrimp farming. As you may know, by traveling to Norway–where there are no longer any wild salmon due to pollution and disease from farmed salmon in the migratory Fjords, farmed salmon preferentially accumulate dioxin-like PCBs to such an extent that a recommended 200 gram serving exceeds the WHO’s tolerable daily intake for dioxins. Just like tobacco, salmon aquaculture across Norway, Scotland, Canada and Chile promote their product as “healthy” when it is anything but. We have known the contamination since 2004 with Dr. Hites landmark publication in the journal Science. Today, we have pediatricians, pathologists and academic diabetes researchers in Norway calling for revising the national guidelines to reduce farmed salmon consumption, especially for pregnant women and children. The similarities are clear, if you really look.

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an idea of earth shattering significance

ok.

been looking for alignment between a significant industry sector and human health. it’s a surprisingly difficult alignment to find… go figure?

but I had lunch with joran laird from nab health today, and something amazing dawned on me, on the back of the AIA Vitality launch.

Life (not health) insurance is the vehicle. The longer you pay premiums, the more money they make.

AMAZING… AN ALIGNMENT!!!

This puts the pressure on prevention advocates to put their money where their mouth is.

If they can extend healthy life by a second, how many billions of dollars does that make for life insurers?

imagine, a health intervention that doesn’t actually involve the blundering health system!!?? PERFECT!!!

And Australia’s the perfect test bed given the opt out status of life insurance and superannuation.

Joran wants to introduce me to the MLC guys.

What could possibly go wrong??????

data saving lives, policy, politics, quantified self, rapid learning health systems

Illumina’s $1000 genome

This article nice frames the immaturity of the technology in the context of population health and prevention (vs. specific disease management), and even references the behaviour of evil corporations in its final paragraphs.

 

Cost breakdown for Illumina’s $1,000 genome:

Reagent* cost per genome — $797

Hardware price — $137**

DNA extraction, sample prep and labor — $55-$65

Total Price = $989-$999

* Starting materials for chemical reactions

** Assumes a four-year depreciation with 116 runs per year, per system. Each run can sequence 16 genomes.

http://recode.net/2014/03/25/illuminas-ceo-on-the-promise-of-the-1000-genome-and-the-work-that-remains/

Illumina’s CEO on the Promise of the $1,000 Genome — And the Work That Remains

March 25, 2014, 2:18 PM PDT

By James Temple

Illumina seized the science world’s attention at the outset of the year by announcing it had achieved the $1,000 genome, crossing a long-sought threshold expected to accelerate advances in research and personalized medicine.

The San Diego company unveiled the HiSeqX Ten Sequencing System at the J.P. Morgan Healthcare Conference in January. It said “state-of-the art optics and faster chemistry” enabled a 10-fold increase in daily throughput over its earlier machines and made possible the analysis of entire human genomes for just under $1,000.

Plummeting prices should broaden the applications and appeal of such tests, in turn enabling large-scale studies that may someday lead to scientific breakthroughs.

The new sequencers are making their way into the marketplace, with samples now running on a handful of systems that have reached early customers, Chief Executive Jay Flatley said in an interview with Re/code last week. Illumina plans to begin “shipping in volume” during the second quarter, he said.

The Human Genome Project, the international effort to map out the entire sequence of human DNA completed in 2003, cost $2.7 billion. Depending on whose metaphor you pick, the $1,000 price point for lab sequencing is akin to breaking the sound barrier or the four-minute mile — a psychological threshold where expectations and, in this case, economics change.

Specifically, a full genomic workup of a person’s three billion DNA base pairs starts to look relatively affordable even for healthy patients. It offers orders of magnitude more information than the so-called SNPs test provided by companies like 23andMe for $99 or so, which just looks at the approximately 10 million “single-nucleotide polymorphisms” that are different in an individual.

With more data, scientists expect to gain greater insights into the relationship between genetic makeup and observable characteristics — including what genes are implicated in which diseases. Among other things, it should improve our understanding of the influences of DNA that doesn’t directly code proteins (once but no longer thought of as junk DNA) and create new research pathways for treatments and cures.

“The $1,000 genome has been the Holy Grail for scientific research for now over a decade,” Flatley said. “It’s enabled a whole new round of very large-scale discovery to get kicked off.”

Cost breakdown for Illumina’s $1,000 genome:

Reagent* cost per genome — $797

Hardware price — $137**

DNA extraction, sample prep and labor — $55-$65

Total Price = $989-$999

* Starting materials for chemical reactions

** Assumes a four-year depreciation with 116 runs per year, per system. Each run can sequence 16 genomes.

Source: Illumina

Some have questioned the $1,000 claim, with Nature noting research centers have to buy 10 systems for a minimum of $10 million — and that the math requires including machine depreciation and excluding the cost of lab overhead.

But Flatley defended the figure, saying it’s impossible to add in overhead since it will vary at every research facility.

“Our math was totally transparent and it is exactly the math used by the (National Human Genome Research Institute),” he said. “It’s a fully apples-to-apples comparison to how people have talked historically about the $1,000 genome.”

He also questioned the conclusions of a recent study published in the Journal of the American Medical Association, where researchers at Stanford University Medical Center compared results of adults who underwent next-generation whole genome sequencing by Illumina and Complete Genomics, the Mountain View, Calif., company acquired last year by BGI.

They found insertions or deletions of DNA base pairs only concurred between 53 percent and 59 percent of the time. In addition, depending on the test, 10 percent to 19 percent of inherited disease genes were not sequenced to accepted standards.

“The use of [whole genome sequencing] was associated with incomplete coverage of inherited disease genes, low reproducibility of detection of genetic variation with the highest potential clinical effects, and uncertainty about clinically reportable findings,” the researchers wrote.

Or as co-author Euan Ashley put it to me: “The test needs some tough love to get it to the point where it’s clinical grade.”

Flatley responded that the sample size was small and that the sequencing platforms were several years old. But he did acknowledge they are still grappling with technology limitations.

“What’s hard is to determine whether there’s a base inserted or deleted,” he said. “That’s abioinformatics problem, not a sequencing problem. That’s a software issue that we and others and the whole world is trying to work on.”

But, he stressed, that shortcoming doesn’t undermine the value of what the tests doread accurately.

“There are many, many, many things where it’s clinically useful today,” he said.

Flatley pointed to several areas where we’re already seeing real-world applications of improving sequencing technology, including cancer treatments targeted to the specific DNA of the tumor rather than the place where it shows up in the body. There are also blood tests under development that can sequence cancer cells, potentially avoiding the need for biopsies, including one from Guardant Health.

Another promising area is noninvasive prenatal testing, which allows expecting parents to screen for genetic defects such as Down syndrome through a blood draw rather than an amniocentesis procedure.

The technology can delineate the DNA from the fetus circulating within the mother’s bloodstream. It’s less invasive and dangerous than amniocentesis, which involves inserting a needle into the amniotic sac and carries a slight risk of miscarriage. Because of that risk it’s generally reserved for high-risk pregnancies, including for women 35 and older.

Illumina, which offers the blood screening for out-of-pocket costs of around $1,500, recently funded a study published in the New England Journal of Medicine that found the so-called cell-free fetal DNA tests produced more accurate results than traditional tests for Down syndrome and Trisomy 18, a more life-threatening condition known as Edwards syndrome.

“It gives some earlier indicators to women in the average risk population if their babies have those problems,” Flatley said. “I think that it will broaden the overall market, and there are other tests that can be added over time.”

But there are ethical issues that arise as prenatal genetic tests become more popular and revealing, including whether parents will one day terminate pregnancies based on intelligence, height, eye color, hair color or minor diseases.

For that reason, Illumnia refuses to disclose those traits that are decipherable in the genome today.

But Flatley said they couldn’t stop purchasers of its machines from doing so, nor competitors like BGI of China (for more on that issue see Michael Specter’s fascinating profile of the company in the New Yorker ). Flatley said there needs to be a public debate on these issues, and he expects that new laws will be put into place establishing commonsense boundaries in the months or years ahead.

“This isn’t something we think we can arbitrate,” he said. “But we won’t be involved directly in delivering [results] that would cross those ethical boundaries.”

healthy habits, nutrition, policy, politics

A public health policy disgrace…

A tale of public health advocates double-crossed by big food. Not for the first time, nor will it be the last…

In a sense, this is a battle between altruism and profit. Hardly a fair fight really?

http://www.abc.net.au/radionational/programs/backgroundbriefing/2014-03-30/5350092

Big food fight continues after Senator Fiona Nash controversy

Sunday 30 March 2014 8:05AM

 

The controversy surrounding a plan to put nutrition rating labels on processed foods has already claimed the job of the Assistant Minister for Health’s chief of staff. The stoush has revealed the deep links between ‘big food’ and the government, writes Ann Arnold.

Related story: RN Breakfast report (6 mins)

It sounds innocuous enough—a plan to have clear labelling about the health qualities of processed foods, so that consumers have a better sense of what they’re buying.

But a system that would see star ratings on the front of most edible items on supermarket shelves hit a spectacular hurdle in Parliament House last month.

In what became one of the biggest parliamentary stoushes so far this year, Senator Fiona Nash was forced to defend her chief of staff, Alastair Furnival, after he rang the Department of Health and ordered it to take down a new website that was to be part of the health star ratings system.

We put in a huge amount of time and effort, and did it in good faith, and dealt with this particular section of industry in good faith. Now we see a turning away from that and the use of that standard political tactic when you don’t want something to happen, of delay.

MICHAEL MOORE, AUSTRALIAN PUBLIC HEALTH ASSOCIATION CEO

Alastair Furnival was quickly exposed as a lobbyist for the food industry who had not resigned as a director from his lobbying company, Australian Public Affairs, nor sold his half share in it, while he worked for the Assistant Minister for Health. He subsequently resigned from his job and Senator Nash was censured in the Senate by Labor and the Greens for misleading Parliament.

That whole episode, however, was just the tip of an iceberg. For two years there has been a battle fought out over front of pack labelling. It’s a tale of industry and political connections, expectations dashed and influence wielded.

In one camp are health and consumer advocates concerned about the fact that diet-related illness—or dietary risk—is now the leading cause of death in the world.

In the other camp are some sectors of the food industry: mainly the larger, multinational companies, or ‘big food’, who say the expense of changing their packaging is onerous and business should not have to bear the brunt of it.

The traditionally warring groups were brought together by the federal Labor government in 2012 to thrash out a new labelling system. It was a revolutionary move. Food enemies were sitting at the same table.

Michael Moore, chief executive officer of the Australian Public Health Association, recalls: ‘Actually at the start of the process I think there was quite a lot of trepidation. As the process went on through the first year, I think we all grew in confidence, a great deal of confidence, because we really were working hard to try and find a compromise that would work.

‘When we came up with the star labelling system, because it works on white goods, because it works on movies, because it works on hotels, it would be easy to understand. It would give an overview of the healthiness of the food. I think our optimism grew.’

Soon, his view would change. The Australian Food and Grocery Council, the powerful peak body for the manufactured food industry, had been involved in developing the scheme.

But around the middle of last year, the council started to publicly criticise it. Various anomalies were raised about how particular foods were rated—issues which Mr Moore said were being dealt with by the committees in which the council was represented.

The AFGC also wanted a cost benefit analysis, and ‘more work’ to be done.

Mr Moore told Background Briefing he felt betrayed. ‘We put in a huge amount of time and effort, and did it in good faith, and dealt with this particular section of industry in good faith. Now we see a turning away from that and the use of that standard political tactic when you don’t want something to happen, of delay.’

How does he feel about that whole process now? ‘Oh well, shafted of course.’

This article represents part of a larger Background Briefing investigation. Listen to Ann Arnold’s full report on Sunday at 8.05 am or use the podcast links above after broadcast

The apparent change of heart by the AFGC came after a meeting in June last year of the nation’s health ministers, which, by vote, approved the star rating system. Big business was spooked by the health ministers’ surprise decision to make the voluntary system mandatory within two years if not enough companies had taken it up.

In an interview recorded by ABC TV’s 7.30 in February, Gary Dawson, the AFGC’s CEO, said: ‘It’s a voluntary start up, but it’s a clear threat to force this on food companies from June next year. That’s written up in the decision and so the cost impact is real.’

Processed food is Australia’s largest manufacturing industry, and it’s growing. A Deloitte report released this week forecasts food processing as one of the future growth waves for Australia. Although hit at the moment by a strong Australian dollar, it is poised to make a big impact on the Asian market.

‘We know it [health star labelling] will cost individual companies millions of dollars and of course the industry; we’d estimate around $200 million industry-wide,’ Mr Dawson said.

‘So it’s a significant cost, particularly on an industry that’s in a financial squeeze at the moment. Profits are declining. Companies like SPC or Simplot can hardly afford spending millions of dollars on a scheme where the benefits are far from well understood or proven.’

The managing director of Simplot Australia is Terry O’Brien, who became the chair of the AFGC in February last year. He is a veteran of the Australian food industry, and was previously employed by Cadbury-Schweppes.

Simplot is an American-owned private company whose Australian brands include Edgell, Leggo’s and Chiko (as in Chiko Roll). Background Briefing sought an interview with Mr O’Brien, but he declined.

He was quoted in The Australian in December citing the cost of the new labelling to hiscompany at an estimated $2.5 million.

Simplot was at that stage faced with closing its factory at Bathurst, in NSW. The company has since announced nearly 300 jobs will be cut from Bathurst and another base at Devonport, Tasmania, over the next few years.

The Australian reported that late last year, the AFGC was actively lobbying National Party MPs about the star ratings system.

The former chief of staff to Senator Fiona Nash, Alastair Furnival, was well connected to the AFGC. He had previously worked with at least two companies—Cadbury and Mondelez—whose leaders are on the board of the council.

Gary Dawson, the council’s CEO, had been a senior member of John Howard’s staff.

‘So he would have dealt very regularly with many, many of the members of Parliament who were likely to be ministers, and who have become ministers,’ says Michael Moore.

Mr Dawson told the 7.30 program in February that he did phone Senator Nash’s office on the day the health star ratings website came down.

‘We’ve been in contact with them regularly over a considerable period … so on the day, yes, we expressed the view that it was premature…. we thought it was a sensible decision to take it down while the work is done.’

Mr Dawson said the website should never have gone up without the industry having prior notice. ‘This is a process that has been running for the best part of two years, and to launch the website without any notification of industry we thought was very odd,’ he said.

In fact all parties involved were notified at the same time—the day the website went up and came down. Background Briefing has seen the email from the Department of Health announcing that the new site was now live. Among the 81 addresses are Gary Dawson, Geoffrey Annison; the Food and Grocery Council’s deputy CEO, and others in the industry people who had been involved in the planning.

Mr Dawson, in a part of his recorded interview with 7.30 that was not broadcast, said too much fuss was made about Mr Furnival’s role in taking the website down.

‘Well I think that was a bit of confected outrage, to be honest. People move in and out of political jobs from all sorts of backgrounds. It was a political overreaction. It underlined to me how quickly commonsense can be lost in these food fights.’

The Australia Food and Grocery Council declined to speak to Background Briefing, because, a spokesman said, Gary Dawson is a member of the food labelling oversight committee, where there was agreement at a meeting several weeks ago to limit media debate on this issue.

Food labelling ‘more important than ever’

Honest, simple healthy food labelling is more important than ever, according to veteran nutritionist, educator and campaigner Rosemary Stanton.

‘Australians are not eating well at the moment,’ she said. ‘And whereas when I started working back in the 1960s we had between 600 and 800 foods available, the average supermarket now stocks something in the order of 30,000 different foods, including almost 2,000 snack foods.

‘So, whereas people used to be able to find out very easily what was in their food, and there wasn’t such a huge array to choose from; these days there are so many foods that nobody is going to be able to go around the supermarket and have the time to read the back of the pack.’

Senior South Australian health bureaucrat Kevin Buckett, the current chair of the labelling oversight committee, gave some examples of how foods would fare under the star rating system at a recent food policy forum organised in Sydney by NSW Health.

‘Amongst yoghurts and other cheeses, you’ve got low-fat yoghurt at five stars. And 98% fat-free yoghurt gets two stars, which tells you something about the sugar that is being added there.’

‘And one of the reasons that you do need this sort of system is to cut through some of the marketing hype that would indicate a food is healthy when perhaps it might not be as healthy as you think.’

Business, he says, should not feel threatened.

‘Because if your food is healthy you will get a star rating system with a highly credible government sanctioned label on it, which will be accepted and trusted by the consumer to indicate that the product actually is healthy. If it isn’t a healthy product, stop telling people it is.’

Ann Arnold

 

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Reporter
Ann Arnold
Researcher
Anna Whitfeld
Supervising Producer
Linda McGinness
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Leila Shunnar
Executive Producer
Chris Bullock
data saving lives, entrepreneurship, healthcare, healthy habits, meaning, nutrition, policy, politics, quantified self, quotes & aphorisms, rapid learning health systems

Ornish on Digital Health

The limitations of high-tech medicine are becoming clearer—e.g., angioplasty, stents, and bypass surgery don’t prolong life or prevent heart attacks in stable patient; only one out of 49 men treated for prostate cancer benefit from the treatment, and the other 48 often become impotent, incontinent or both; and drug treatments of type 2 diabetes don’t work nearly as well as lifestyle changes in preventing the horrible complications.

http://www.forbes.com/sites/johnnosta/2014/03/17/the-stat-ten-dean-ornish-on-digital-health-wisdom-and-the-value-of-meaningful-connections/

3/17/2014 @ 11:09AM |1,095 views

The STAT Ten: Dean Ornish On Digital Health, Wisdom And The Value Of Meaningful Connections

STAT Ten is intended to give a voice to those in digital health. From those resonant voices in the headlines to quiet innovators and thinkers behind the scenes, it’s my intent to feature those individuals who are driving innovation–in both thought and deed. And while it’s not an exhaustive interview, STAT Ten asks 10 quick questions to give this individual a chance to be heard.  

Dean Ornish, MD is a fascinating and important leader in healthcare.  His vision has dared to question convention and look at health and wellness from a comprehensive and unique perspective.  He is a Clinical Professor of Medicine, UCSF Founder & President, nonprofit Preventive Medicine Research Institute.

Dr. Ornish’s pioneering research was the first to prove that lifestyle changes may stop or even reverse the progression of heart disease and early-stage prostate cancer and even change gene expression, “turning on” disease-preventing genes and “turning off” genes that promote cancer, heart disease and premature aging. Recently, Medicare agreed to provide coverage for his program, the first time that Medicare has covered an integrative medicine program. He is the author of six bestselling books and was recently appointed by President Obama to the White House Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. He is a member of the boards of directors of the San Francisco Food Bank and the J. Craig Venter Institute. The Ornish diet was rated #1 for heart health by U.S. News & World Report in 2011 and 2012. He was selected as one of the “TIME 100” in integrative medicine, honored as “one of the 125 most extraordinary University of Texas alumni in the past 125 years,” recognized by LIFE magazine as “one of the 50 most influential members of his generation” and by Forbes magazine as “one of the 7 most powerful teachers in the world.”

The lexicon of his career is filled with words that include innovator, teacher and game-changer.  And with this impressive career and his well-established ability to look at health and medicine in a new light, I thought i would be fun–and informative–to ask Dr. Ornish some questions about digital health.

Dean Ornish, MD

Dean Ornish, MD

 1. Digital health—many definitions and misconceptions.  How would describe this health movement in a sentence or two?

“Digital health” usually refers to the idea that having more quantitative information about your health from various devices will improve your health by changing your behaviors.  Information is important but it’s not usually sufficient to motivate most people to make meaningful and lasting changes in healthful behaviors.  If it were, no one would smoke cigarettes.

2. You’ve spoken of building deep and authentic connection among  patients as key element of your wellness programs.  Can digital health foster that connection or drive more “techno-disconnection”?

Both.  What matters most is the quality and meaning of the interaction, not whether it’s digital or analog (in person).  Study after study have shown that people who are lonely, depressed, and isolated are three to ten times more likely to get sick and die prematurely compared to those who have a strong sense of love and community.  Intimacy is healing.  In our support groups, we create a safe environment in which people can let down their emotional defenses and communicate openly and authentically about what’s really going on in their lives without fear they’ll be rejected, abandoned, or betrayed.  The quality and meaning of this sense of community is often life-transforming.  It can be done digitally, but it’s more effective in person.  A digital hug is not quite as fulfilling, but it’s much better than being alone and feeling lonely.

3. How can we connect clinical validation to the current pop culture trends of “fitness gadgets”?

Awareness is the first step in healing.  In that context, information can raise awareness, but it’s only the first step.

 4. Can digital health help link mind and body wellness?

Yes.  Nicholas Christakis’ research found that if your friends are obese, your risk of obesity if 45% higher.  If your friends’ friends are obese, your risk of obesity if 25% higher.  If your friends’ friends’ friends are obese, your risk is 10% higher—even if you’ve never met them.  That’s how interconnected we are.  Their study also showed that social distance is more important than geographic distance.  Long distance is the next best thing to being there (and in some families, even better…).

5. Are there any particular area of medicine and wellness that might best fit in the context of digital health (diet, exercise, compliance, etc.)?

They all do.

6. There is much talk on the empowerment of the individual and the “democratization of data”.  From your perspective are patients becoming more engaged and involved in their care?

Patients are becoming more empowered in all areas of life, not just with their health care.  Having access to one’s clinical data can be useful, but even more empowering is access to tools and programs that enable people to use the experience of suffering as a catalyst and doorway for transforming their lives for the better.  That’s what our lifestyle program provides.

 7. Is digital health “sticking” in the medical community?  Or are advances being driven more by patients?

Electronic medical records are finally being embraced, in part due to financial incentives.  Also, telemedicine is about to take off, as it allows both health care professionals and patients to leverage their time and resources more efficiently and effectively.  But most doctors are not prescribing digital health devices for their patients.  Not yet.

 8. Do you personally use any devices?  Any success (or failure) stories?

I weigh myself every day, and I work out regularly using weight machines and a treadmill desk.  I feel overloaded by information much of the day, so I haven’t found devices such as FitBit, Nike Plus, and others to be useful.  These days, I find wisdom to be a more precious commodity than information.

 9. What are some of the exciting areas of digital health that you see on the horizon?

The capacity for intimacy using digital platforms is virtually unlimited, but, so far, we’ve only scratched the surface of what’s possible.  It’s a testimony to how primal our need is for love and intimacy that even the rather superficial intimacy of Facebook (or, before that, the chat rooms in AOL, or the lounges in Starbucks) created multi-billion-dollar businesses.

My wife, Anne, is a multidimensional genius who is developing ways of creating intimate and meaningful relationships using the interface of digital technologies and real-world healing environments.  She also designed our web site (www.ornish.com) and created and appears in the guided meditations there; Anne has a unique gift of making everyone and everything around her beautiful.

 10. Medicare is now covering Dr. Dean Ornish’s Program for Reversing Heart Disease as a branded program–a landmark event–and you recently formed a partnership with Healthways to train health care professionals, hospitals, and clinics nationwide.  Why now?

We’re creating a new paradigm of health care—Lifestyle Medicine—instead of sick care, based on lifestyle changes astreatment, not just as prevention.  Lifestyle changes often work better than drugs and surgery at a fraction of the cost—and the only side-effects are good ones.  Like an electric car or an iPhone, this is a disruptive innovation.  After 37 years of doing work in this area, this is the right idea at the right time.

The limitations of high-tech medicine are becoming clearer—e.g., angioplasty, stents, and bypass surgery don’t prolong life or prevent heart attacks in stable patient; only one out of 49 men treated for prostate cancer benefit from the treatment, and the other 48 often become impotent, incontinent or both; and drug treatments of type 2 diabetes don’t work nearly as well as lifestyle changes in preventing the horrible complications.

At the same time, the power of comprehensive lifestyle changes is becoming more well-documented.  In our studies, we proved, for the first time, that intensive lifestyle changes can reverse the progression of coronary heart disease and slow, stop, or reverse the progression of early-stage prostate cancer.  Also, we found that changing your lifestyle changes your genes—turning on hundreds of good genes that protect you while downregulating hundreds of genes that promote heart disease, cancer, and other chronic diseases.  Our most recent research found that these lifestyle changes may begin to reverse aging at a cellular level by lengthening our telomeres, the ends of our chromosomes that control how long we live.

Finally, Obamacare turns economic incentives on their ear, so it becomes economically sustainable for physicians to offer training in comprehensive lifestyle changes to their patients, especially now that CMS is providing Medicare reimbursement and insurance companies such as WellPoint are also doing so.  Ben Leedle, CEO of Healthways, is a visionary leader who has the experience, resources, and infrastructure for us to quickly scale our program to those who most need it.  Recently, we trained UCLA, The Cleveland Clinic, and the Beth Israel Medical Center in New York in our program, and many more are on the way.

 

business, healthcare, policy, politics

On bureaucracies

The American economist William A. Niskanen considered the organisation of bureaucracies and proposed a budget maximising model now influential in public choice theory. It stated that rational bureaucrats will “always and everywhere seek to increase their budgets in order to increase their own power.”

An unfettered bureaucracy was predicted to grow to twice the size of a comparable firm that faces market discipline, incurring twice the cost.

http://theconversation.com/reform-australian-universities-by-cutting-their-bureaucracies-12781

Reform Australian universities by cutting their bureaucracies

Australian universities need to trim down their bureaucracies. University image from www.shutterstock.com

Universities drive a knowledge economy, generate new ideas and teach people how to think critically. Anything other than strong investment in them will likely harm Australia.

But as Australian politicians are preparing to reform the university sector, there is an opportunity to take a closer look at the large and powerful university bureaucracy.

Adam Smith argued it would be preferable for students to directly pay academics for their tuition, rather than involve university bureaucrats. In earlier times, Oxford dons received all tuition revenue from their students and it’s been suggested that they paid between 15% and 20% for their rooms and administration. Subsequent central collection of tuition fees removed incentives for teachers to teach and led to the rise of the university bureaucracy.

Today, the bureaucracy is very large in Australian universities and only one third of university spending is allocated to academic salaries.

 

The money (in billions) spent by the top ten Australian research universities from 2003 to 2010 (taken from published financial statements).Authors
Click to enlarge

 

Across all the universities in Australia, the average proportion of full-time non-academic staff is 55%. This figure is relatively consistent over time and by university grouping (see graph below).

Australia is not alone as data for the United Kingdom shows a similar staffing profile with 48% classed as academics. A recent analysis of US universities’ spending argues:

Boards of trustees and presidents need to put their collective foot down on the growth of support and administrative costs. Those costs have grown faster than the cost of instruction across most campuses. In no other industry would overhead costs be allowed to grow at this rate – executives would lose their jobs.

We know universities employ more non-academics than academics. But, of course, “non-academic” is a heterogeneous grouping. Many of those classified as “non-academic” directly produce academic outputs, but this rubs both ways with academics often required to produce bureaucratic outputs.

An explanation for this strange spending allocation is that academics desire a large bureaucracy to support their research efforts and for coping with external regulatory requirements such as the Excellence in Research for Australia (ERA) initiative, theAustralian Qualifications Framework (AQF) and the Tertiary Education Quality and Standards Agency (TEQSA).

 

Staffing profile (% of total FTE classed as academic) of Australian universities 2001-2010, overall and by university groupings/ alliances.Authors

 

Another explanation is that university bureaucracies enjoy being big and engage in many non-academic transactions to perpetuate their large budget and influence.

The theory to support the latter view came from Cyril Northcote Parkinson, a naval historian who studied the workings of the British civil service. While not an economist, he had great insight into bureaucracy and suggested:

There need be little or no relationship between the work to be done and the size of the staff to which it may be assigned.

Parkinson’s Law rests on two ideas: an official wants to multiply subordinates, not rivals; and, officials make work for each other. Inefficient bureaucracy is likely not restricted to universities but pervades government and non-government organisations who escape traditional market forces.

Using Admiralty Statistics for the period between 1934 and 1955, Parkinson calculated a mean annual growth rate of spending on bureaucrats to be 5.9%. The top ten Australian research universities between 2003 and 2010 report mean annual growth in spending on non-academic salary costs of 8.8%. After adjusting for inflation the annual growth rate is 5.9%.

The American economist William A. Niskanen considered the organisation of bureaucracies and proposed a budget maximising model now influential in public choice theory. It stated that rational bureaucrats will “always and everywhere seek to increase their budgets in order to increase their own power.”

An unfettered bureaucracy was predicted to grow to twice the size of a comparable firm that faces market discipline, incurring twice the cost. Some insight and anecdotal evidence to support this comes from a recent analysis of the paperwork required for doctoral students to progress from admission to graduation at an Australian university.

In that analysis, the two authors of this article (Clarke and Graves) found that 270 unique data items were requested on average 2.27 times for 13 different forms. This implies the bureaucracy was operating at more than twice the size it needs to. The university we studied has since slimmed down the process.

Further costs from a large bureaucracy arise because academics are expected to participate in activities initiated by the bureaucracy. These tend to generate low or zero academic output. Some academics also adopt the behaviour of bureaucrats and stop or dramatically scale back their academic work.

The irony is that those in leadership positions, such as heads of departments, are most vulnerable, yet they must have been academically successful to achieve their position.

Evidence of this can be seen from the publication statistics of the professors who are heads of schools among nine of the top ten Australian research universities. Between 2006 and 2011, these senior academics published an average of 1.22 papers per year per person as first author.

This level of output would not be acceptable for an active health researcher at a professor, associate professor or even lecturer level.

The nine heads of school are likely tied up with administrative tasks, and hence their potential academic outputs are lost to signing forms, attending meetings and pushing bits of paper round their university.

If spending on the costs of employing non-academics could be reduced by 50% in line with a Niskanen level of over-supply, universities could employ additional academic staff. A further boost to productivity could be expected as old and new staff benefit from a decrease in the amount of time they must dedicate to bureaucratic transactions.

If all Australian universities adopted the staffing profile of the “Group of 8” institutions, which have the highest percentage of academics (at 51.6%), there would have been up to nearly 6,500 extra academics in 2010.

While no economist would question the need for some administration, there needs to be a focus on incentives to ensure efficient operation. It’s possible to run a tight ship in academic research as shown by Alan Trounson, president of the California Institute for Regenerative Medicine (CIRM).

In 2009, Trounson pledged to spend less than 6% of revenues on administration costs, a figure that is better than most firms competing in markets. So far, this commitment has been met.

It’s clear then that finding solutions to problems in modern Australian universities calls for a better understanding of economics and a reduction in bureaucracy.