Category Archives: healthcare

healthcare, nutrition, policy

BBC Horizon: The Truth About Fat

Yet another BBC documentary on obesity, this time featuring an emaciated looking surgeon who specialises in removing skin lesions. It was an excellent exposition of how broken and inappropriate it is to apply a reductionist, scientific lens to a problem of this kind.

A bunch of Imperial College scientists banging on about grellin and PPY and twin studies and epigenetics and fMRI and finishing up with a mandatory reference to bariatric surgery as the only successful intervention that actually changes the way your mind thinks about food.

If only there was a more expensive and complicated way to intervene?

Are we going to get to the point where bariatric surgery becomes a standard procedure, like desexing a dog?

The more of these programs I watch, the more distasteful and disappointing they seem.

If the end goal is to stop people eating crap, and also feel fuller quicker, then there has to be a better, more positive, less invasive way to achieve this than with surgery or a pill.

 

 

Program Site: http://www.bbc.co.uk/programmes/b01dzfgb
Video Source: http://vimeo.com/64960883

 

healthcare, policy

NYT: GE pursuing medical home in the US to contain costs…

  • GE are using their market power to experiment with different health care delivery
  • Pushing strongly for the introduction of medical homes
  • Early results are promising: patients enrolled in medical homes had 3.5 percent fewer visits to the emergency room and 14 percent fewer hospital admissions over the four years from 2008 through 2012
As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path

CINCINNATI — Although the new federal health care law is designed to help people buying individual policies, even people with employer-provided policies are beginning to see changes in their coverage as companies rethink health care for their workers, discontinuing it in a few cases and redesigning it in many others.

They are motivated by a need to rein in health care costs, which continue to rise faster than overall inflation, but the federal health care law is also changing how some view their obligations to their employees.

Some major firms, like Walgreen, the drugstore chain, are giving those who qualify money to buy insurance on a private health exchange. Aon Hewitt, a benefits consultant that will oversee health plans on Walgreen’s behalf, said 18 large employers had signed up so far, including Sears and Darden Restaurants.

But here in Cincinnati, General Electric is taking the opposite approach.

One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this — where its giant aviation business gives it a major presence — to work directly with doctors and hospitals to improve care and reduce costs.

“I don’t know anybody who isn’t trying almost everything,” said Helen Darling, president of the National Business Group on Health, which represents employers providing benefits. “We’re going to see a lot of activity in the next couple of years.”

Over the last few years, G.E. has pushed for the creation of so-called medical homes, in which an individual medical practice closely coordinates a patient’s care by having access to all of the patient’s medical records.

In Cincinnati, about 118 doctors’ practices have converted to medical homes, and all five of the major health systems are making their primary care practices move in that direction. G.E. has also pushed for greater transparency of results.

“If we don’t take accountability ourselves for figuring this out, we’re part of the problem,” said Sue Siegel, a senior executive at G.E., who sees transformation of health care both as a business opportunity and a business necessity.

“We have to be involved in the solution,” she said. “We can’t just wait for someone to tell us that it is going to be fixed.”

What distinguishes the effort by G.E. is its direct focus on hospitals and doctors. Companies looking to the private exchanges are largely hoping to save money and want to be freed from the headache of administering health benefits.

In Walgreen’s case, the company says it doesn’t plan to lower its share of its workers’ health care costs but hopes to foster more competition among insurers, leading to better prices and more choice for employees.

In Cincinnati, G.E. took on both a cheerleading and coordinating role. In early 2010, Jeffrey R. Immelt, its chief executive, addressed local business leaders and urged them to think strategically and align their efforts to make more of a difference. There were already significant efforts under way to foster medical homes, for example, and G.E. pushed to find more financing to expand the concept to more medical practices and keep the focus on that initiative.

“The ever-present vigilance of the employers help nudge things along,” said Craig Brammer, chief executive of three area health care coalitions, including the Greater Cincinnati Health Council, which is made up of the area’s hospitals, health plans and employers.

The city’s health systems say they recognize that insurers and employers are increasingly going to reward them for better tracking their patients in and out of the hospital. “We are clearly gearing up to change directions from fee for service for what I’ll call payment for value,” said Will Groneman, an executive vice president for TriHealth, one of the systems.

The medical home also appears to resonate with employees. When Mary Farris, a 44-year-old marketing executive for G.E., found herself going to a local urgent care center because she could never get an appointment with her physician, she switched to a practice that had become a medical home.

What strikes Ms. Farris was how much time the doctor and medical assistant spent gathering her medical history and making sure there weren’t additional medical issues. While she came in for a spider bite, the focus was on her well-being as a working mother whose father was seriously ill at the time. “The picture was more on all of me as opposed to one isolated incident,” she said. “Somebody was trying to connect the dots.”

In Cincinnati, there are beginning to be grudging signs of success. Early results are promising: patients enrolled in medical homes had 3.5 percent fewer visits to the emergency room and 14 percent fewer hospital admissions over the four years from 2008 through 2012. G.E. plans to ask an outside firm to do a more detailed analysis.

But employers looking to adapt a similar strategy will find “it’s hard to do,” said David Lansky, the chief executive of the Pacific Business Group on Health, which represents West Coast employers. While “the opportunity is significant,” he said, companies may not have the time or resources to work in too many of their locations, with different hospitals and health plans in each market.

Some companies — Trader Joe’s for example — decided to send at least some employees to the new public exchanges. Trader Joe’s has left coverage for three-quarters of its work force untouched but is giving part-time workers a contribution of $500 to buy policies in the newly created state marketplaces. Because of the employees’ low incomes, the company says it believes many will be eligible for federal subsidies to help them afford coverage.

But a few major employers are taking even more aggressive stances and are trying to reshape how health care is delivered in this country.

They are increasingly looking to make direct connections with health systems, particularly well-regarded institutions that can deliver good care for what can be very expensive back or heart problems. G.E. recently signed an agreement with Hospital for Special Surgery in New York, a high-volume orthopedic hospital, to oversee the care of some employees getting hip and knee replacements. Last year, Walmart contracted with health systems like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need transplants, heart and spine care. The company says it will soon expand the program to other centers of excellence.

The decision doesn’t always sit well with the home team. In Cincinnati, the UC Health System, which includes an academic medical center that also serves the area’s major source of care for the uninsured, says it would welcome a similar opportunity to provide joint replacements for G.E., but executives say they simply cannot afford to offer significant discounts. “We don’t have the resources to cut deals,” said Dr. Myles Pensak, an executive for UC Health.

G.E. is unapologetic. The company says it will continue to try a variety of approaches until it finds a way to tame health care costs even more than the annual growth rate achieved so far of under 3 percent. “You’ll see many, many experiments across the board,” Ms. Seigel said.

data saving lives, healthcare, rapid learning health systems, technology

Hammerbacher heads big data at Mt Sinai

  • accountable care is a system in which hospitals are paid to keep people healthy
  • the new economic incentives drive a need for data regarding the population being treated
  • Joel Dudley (Director of Informatics at Mount Sinai Medical School) is running diabetic patient data through an algorithm to cluster them according to phenotype and genotype.
  • This work aims to to replace the general guidelines doctors often use in deciding how to treat diabetics and replace them with risk models—powered by genomics, lab tests, billing records, and demographics—making up-to-date predictions about the individual patient a doctor is seeing, not unlike how a Web ad is tailored according to who you are and sites you’ve visited recently.

Source: http://www.technologyreview.com/news/518916/a-hospital-takes-its-own-big-data-medicine/

MIT Technology Review Report: A Cure for Health Care Costs (good infographics)

A Hospital Takes Its Own Big-Data Medicine

The person leading the design of the new computer is Jeff Hammerbacher, a 30-year-old known for being Facebook’s first data scientist. Now Hammerbacher is applying the same data-crunching techniques used to target online advertisements, but this time for a powerful engine that will suck in medical information and spit out predictions that could cut the cost of health care.

With $3 trillion spent annually on health care in the U.S., it could easily be the biggest job for “big data” yet. “We’re going out on a limb—we’re saying this can deliver value to the hospital,” says Hammerbacher.

Mount Sinai has 1,406 beds plus a medical school and treats half a million patients per year. Increasingly, it’s run like an information business: it’s assembled a biobank with 26,735 patient DNA and plasma samples, it finished installing a $120 million electronic medical records system this year, and it has been spending heavily to recruit computing experts like Hammerbacher.

It’s all part of a “monstrously large bet that [data] is going to matter,” says Eric Schadt, the computational biologist who runs Mount Sinai’s Icahn Institute for Genomics and Multiscale Biology, where Hammerbacher is based, and who was himself recruited from the gene sequencing company Pacific Biosciences two years ago.

Mount Sinai hopes data will let it succeed in a health-care system that’s shifting dramatically. Perversely, because hospitals bill by the procedure, they tend to earn more the sicker their patients become. But health-care reform in Washington is pushing hospitals toward a new model, called “accountable care,” in which they will instead be paid to keep people healthy.

Mount Sinai is already part of an experiment that the federal agency overseeing Medicare has organized to test these economic ideas. Last year it joined 250 U.S. doctor’s practices, clinics, and other hospitals in agreeing to track patients more closely. If the medical organizations can cut costs with better results, they’ll share in the savings. If costs go up, they can face penalties.

The new economic incentives, says Schadt, help explain the hospital’s sudden hunger for data, and its heavy spending to hire 150 people during the last year just in the institute he runs. “It’s become ‘Hey, use all your resources and data to better assess the population you are treating,’” he says.

One way Mount Sinai is doing that already is with a computer model where factors like disease, past hospital visits, even race, are used to predict which patients stand the highest chance of returning to the hospital. That model, built using hospital claims data, tells caregivers which chronically ill people need to be showered with follow-up calls and extra help. In a pilot study, the program cut readmissions by half; now the risk score is being used throughout the hospital.

Hammerbacher’s new computing facility is designed to supercharge the discovery of such insights. It will run a version of Hadoop, software that spreads data across many computers and is popular in industries, like e-commerce, that generate large amounts of quick-changing information.

Patient data are slim by comparison, and not very dynamic. Records get added to infrequently—not at all if a patient visits another hospital. That’s a limitation, Hammerbacher says. Yet he hopes big-data technology will be used to search for connections between, say, hospital infections and the DNA of microbes present in an ICU, or to track data streaming in from patients who use at-home monitors.

One person he’ll be working with is Joel Dudley, director of biomedical informatics at Mount Sinai’s medical school. Dudley has been running information gathered on diabetes patients (like blood sugar levels, height, weight, and age) through an algorithm that clusters them into a weblike network of nodes. In “hot spots” where diabetic patients appear similar, he’s then trying to find out if they share genetic attributes. That way DNA information might add to predictions about patients, too.

A goal of this work, which is still unpublished, is to replace the general guidelines doctors often use in deciding how to treat diabetics. Instead, new risk models—powered by genomics, lab tests, billing records, and demographics—could make up-to-date predictions about the individual patient a doctor is seeing, not unlike how a Web ad is tailored according to who you are and sites you’ve visited recently.

That is where the big data comes in. In the future, every patient will be represented by what Dudley calls “large dossier of data.” And before they are treated, or even diagnosed, the goal will be to “compare that to every patient that’s ever walked in the door at Mount Sinai,” he says. “[Then] you can say quantitatively what’s the risk for this person based on all the other patients we’ve seen.”

healthcare, policy, rapid learning health systems

The inevitable evolution of medical care delivery…

  • medicine is an information intensive industry
  • HIT uptake is growing rapidly due to policy incentives
  • Healthcare looks similar to the retail sector from the 1980s
  • Retail worker productivity grew 4% per year since 1995
  • The biggest changes are likely to come from re-imagining the role of the patient – the single most underused person in healthcare, currently considered as close to a nuisance
  • Health care will be less frustrating when the power shifts from sellers to buyers
  • The Institute of Medicine suggests that inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Source: http://www.technologyreview.com/news/518906/why-medicine-will-be-more-like-walmart/

Why Medicine Will Be More Like Walmart

What health care will look like after the information technology revolution.

The idea that technology will change medicine is as old as the electronic computer itself. Actually, even older. In 1945, Vannevar Bush, the man with the vision for the National Institutes of Health, foresaw a Memex computer program that would allow access to past books and records. A lone physician searching for a diagnosis in far-flung case histories was one of the applications Bush imagined.

Medicine is an information intensive industry. Yet there’s still no medical Memex. Even though the Internet teems with health information, study after study shows that medical care often differs greatly from what the guidelines say—when there are guidelines. Doctors frequently rely on their own experience, rather than the experience of millions of patients who have seen thousands of doctors. Not only is the past lost, the present is missing. How many times has a patient received a drug that causes an allergic reaction, just because that information is not available at the time it is needed?

Bit by bit, this situation is changing. The 2009 American Recovery and Reinvestment Act (aka the stimulus bill), created the HiTech program, which allocates billions of dollars for doctors and hospitals to buy electronic health records systems. Since the program was enacted, rates of ownership of such systems have tripled among hospitals and quadrupled among physicians. In just a few years, it is reasonable to think that the entire medical system will be wired.

What will happen then? The introduction of information technology into the core operations of hospitals and doctors’ offices is likely to make health care much more like the retail sector or financial services. Health care will be provided by big institutions, in a more standardized fashion, with less overall cost, but less of a personal touch.

medicine Walmart chart

Health care today looks a lot like the retail sector did in the early 1980s, when clothes and household products were sold by many local stores and small chains. Quality was haphazard, prices were higher, and buyers’ experiences were mixed. Consumers had only the information they could see in the store or the Sunday paper.

Retail firms got larger when information technology became widespread. Walmart replaced the corner drug store and Amazon put the local book shop out of business because large firms can use information technology better than small ones—to manage inventories, create consistency, automate routine activities, and lower prices. Output per worker grew over 4 percent annually in the retail sector since 1995. Output per worker has fallen in health care over the same time period.

When the medical Memex finally arrives, look for health care to follow the retail track. The solo practitioner is likely to be the first to go. He or she will have to decide whether to try to become an IT manager as well as a doctor, or join a larger group of doctors. For most, the choice will be easy. The chance that a doctor over 65 works alone or in a two-person practice is about 40 percent. For young doctors, it’s less than 5 percent.

Small hospitals will suffer the same fate. Already, small hospitals that have seen the price tag of medical records systems—$20 million or more to purchase, then millions to maintain—are seeking shelter in the arms of their big neighbors. I suspect most cities will go from 10 to 15 independent institutions a decade ago to three to five large health-care systems a decade hence. These systems will do everything: checkups, nursing the elderly, treating heart failure, and dispensing allergy pills.

Who treats us, and where, will change as well. With an electronic backbone in place, one doesn’t need to see a doctor for every issue. There is little the primary care doctor does that can’t—and increasingly isn’t—being done by a nurse practitioner, perhaps at a clinic in a Walmart or CVS. Routine prescriptions for medication refills can be handled online, with an electronic doctor watching. Even high-end services can be spread widely, with specialized centers coördinating the treatment of patients far from its walls.

medicine Walmart chart

The biggest changes are likely to come from reimagining the role of the patient—the single most underused person in health care. Today, patients are thought of as close to a nuisance (“I told him to take his pills …”). But imagine that the patient was a participant and contributor to the medical Memex. Blood-pressure cuffs can be in the house of every person with high blood pressure; the daily pressure would be transmitted to the doctor’s electronic record and monitored by a computer for outlying values. Decision-support software might allow people with localized cancer to choose between surgery, radiation, and watchful waiting—decisions which are, today, heavily influenced by doctors (and none too objectively).

Information technology is going to change the game because it will affect how people view themselves, their illness, and the people who care for them. Amazon’s loyalty comes in no small part because it uses our past searches and the searches of people like us to predict what we will want. The customer is part of Amazon’s Memex. Health care will be less frustrating when the power shifts from sellers to buyers, and when patients are more in charge.

Some worry that a health-care system that’s concentrated like retail will drive up costs. But it’s also true that organizational changes are easier when more doctors work together in one system. According to the Institute of Medicine, inappropriate care, lack of adequate prevention, administrative waste, and prices that are too high account for nearly one-third of medical spending. Just the billing and collection operations in health care account for 25 percent of total costs; Walmart and Amazon spend an order of magnitude less on administration. Prices have fallen across the board in the retail sector.

Norman Rockwell’s classic painting, “Doctor and the Doll,” is memorable for how the doctor is comforting the little girl by listening to her doll’s heart. Norman Rockwell’s doctor knew everything about the girl and her family. The doctor of the future will not. Rather than being a living electronic record consulting an internal Memex, tomorrow’s doctor will be there to direct patients to the right specialized resources, to reassure those in need, and to comfort the terminally ill. This life may not be as exciting as the surgeons or diagnostic sleuths one sees on TV, but it is a noble calling nonetheless.

David Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University and author of the forthcoming, The Quality Cure: How Focusing on Health Care Quality Can Save Your Life and Lower Spending Too.

entrepreneurship, healthcare, healthy habits, nutrition, policy

New Jamie Oliver ministry to open in Sydney

Good to see this, aligned with Riot Health mission… potential partnering opportunity?

Source: http://www.goodfood.com.au/good-food/food-news/new-jamie-oliver-ministry-to-open-in-sydney-20131022-2vz6i.html

New Jamie Oliver ministry to open in Sydney

  • October 22, 2013
Passionate about encouraging people to eat more healthily: Jamie Oliver.

On a mission … Jamie Oliver is opening a Ministry of Food in western Sydney.

For many years Jamie Oliver has been on a crusade to fight obesity and bad eating habits, with the aim to equip people the world over with cooking skills and a greater appreciation of fresh food.

Sydneysiders have witnessed his mission through numerous television shows, campaigns and cookbooks. Now it’s closer to home, with the announcement of the first Ministry of Food centre in NSW.

The British chef will open a cooking school in August to teach basic kitchen skills. It will be at the Stockland Shopping Centre at Wetherill Park in western Sydney, which is undergoing a $222 million redevelopment. It will be Oliver’s fifth Ministry of Food kitchen in Australia.

“Obesity is not just a diet-related disease. It’s the biggest killer in Australia and what the Ministry of Food is, it’s a fix and response that really does transform people’s confidence in the kitchens,” Oliver said.

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The cooking classes, funded by the not-for-profit arm of electrical goods retailer The Good Guys, will focus on basic cooking skills, nutrition, budgeting, meal planning and shopping tips.

Oliver said recipes would be healthy and tasty and would include desserts.

“We all love ice-cream. Life is about ice-cream and sometimes people get confused with some of my messaging,” he said.

“Of course we want to be as healthy as possible but we don’t want to edit out things in life. Life is about having beautiful treats and cakes and things like that.”

He said the problems began when parents gave in to their child’s requests for more soft drinks and desserts. “That’s the sort of repetition that gets us into trouble. Absolutely I give my kids ice-cream but my wife is fairly strict about when and how much.”

This year, the Australian Diabetes Council revealed that a diabetes epidemic had gripped the western suburbs of Sydney, with Liverpool in the south labelled as the suburb with the highest number of people with the disease.

Of the 10 suburbs with the highest incidence of diabetes, seven were in Sydney’s west, said head researcher, Alan Barclay. This includes Liverpool, Mount Druitt, Campbelltown, Westmead and Blacktown.

The high rates could be drastically reduced with a combination of improved primary healthcare and better knowledge of healthy cooking, he said in July.

“People need to know more about food and how to prepare it,” Barclay said. “We have to start doing more in schools and in the local community.”

The co-host of Channel Nine’s Today show, Lisa Wilkinson, will be the ambassador of the Ministry of Food centre.

healthcare, policy, politics

Diabetes set to become the largest epidemic in human history…

  • 600 million will suffer diabetes in 20 years, 2.3 million in Australia
  • Will kill one person every 6 seocnds (5.1 million people this year)
  • Affects developing economies just as much as developed economies
  • The US spends USD263 billion annually on diabetes
  • In 2013, AU will spend AUD11.4 billion, with 1 in 10 adults afflicted and 9500 deaths attributed.
  • Indigenous Australians have prevalence around 30%
  •  Western Pacific Islands have prevalence over 35%
  • Middle East (Saudi, Qatar, Kuwait) has a diabetes prevalence of 24%

 

Source: http://www.medicalobserver.com.au/news/largest-epidemic-in-human-history

‘Largest epidemic in human history’

DIABETES is likely to be “the largest epidemic in human history” with the number of people with diabetes predicted to surge to nearly 600 million in 20 years, including 2.3 million in Australia, experts say.

The latest edition of the International Diabetes Federation’s Diabetes Atlas, published today on World Diabetes Day, estimated that diabetes kills one person every six seconds and it will cause the deaths of 5.1 million people this year.

Professor Paul Zimmet, director emeritus of the Baker IDI Heart and Diabetes Institute, said the Diabetes Atlas group predicted 20 years ago that there would be 200 million people in the world with diabetes, but the predicted numbers for 2035 are almost double.

“Diabetes is likely to be the biggest health problem, the largest epidemic in human history,” he said.

The data showed that the majority of the 382 million people with diabetes today are aged between 40 and 59 and 80% of them live in low- and middle-income countries.

Professor Jonathan Shaw, associate director of Baker IDI Heart and Diabetes Institute, said the data debunked the historical idea that diabetes was a rich man’s disease.

“It really is not, when we look at the distributions across the world because the largest numbers of people with it are clearly in the developing world, particularly in our region with 138 million [in the Western Pacific] and 72 million in South Asia,” he said.

In contrast, around 37 million have diabetes in North America and 56 million in Europe.

However, health expenditure on diabetes in North American was 263 billion, higher than any other region in the world.

Australia spent $11.4 billion on diabetes care in 2013, with one in 10 adults now having diabetes, and more than 9500 people died from diabetes in Australia in 2013.

Comparative prevalence rates were highest in the Western Pacific Islands, where 37% of the population in Tokelau had diabetes, 35% in the Marshall Islands and 35% in Micronesia.

However, comparative prevalence rates had also surged in the Middle East where around 24% of the population in Kuwait, Saudi Arabia and Qatar have diabetes.

These prevalence rates were similar to that seen in Aboriginal and Torres Strait Islanders, where more than 30% of the population had diabetes, and high prevalence rates were common in indigenous people around the world.

data saving lives, entrepreneurship, healthcare, healthy habits, quantified self, rapid learning health systems, research methodology

sharing drives behaviour change

http://medcitynews.com/2013/10/calico-communities-legislation-tech-drive-new-era-health/

  • peer support is a powerful model to support behaviour change
  • social media-backed sharing of progress reinforces achievements
  • Stevens is the CEO of KEAS > workplace health interventions

Calico, communities, legislation and tech drive a new era of health

October 14, 2013 12:45 pm by  | 0 Comments

America’s healthcare system has historically taken only baby steps to empower individual health and wellness ownership – until now. Recent events are about to alter existing healthcare paradigms and I believe this to be the most pivotal of moments. With Google’s Calico, the Affordable Care Act (ACA), Penn State’s wellness debacle and the rise of health-oriented social, healthcare entities are now taking a microscope to existing practices and infrastructures. What will they find? An industry destined for a radical makeover that will result in a prevention-based and consumer-driven healthcare network.

 Let’s take a look at the players involved, from the good (social networking and technology), the bad (Penn State’s wellness initiative) and the TBD (Calico and the ACA).

The Emerging Models
Legislation, technology, communities, and social networking are forcing a healthcare overhaul. Consider Google’s Calico: It has the opportunity to create the largest online community to share health information, turning personal health on its head. With a greater global consumer reach than any other organization, Google has the access and resources to throw at this opportunity, making it the ideal company to coordinate this effort – and being led by Art Levinson, the Bill Gates of biotech, doesn’t hurt.

Addressing the issue of aging in a share- and prevention-oriented effort is a response to the growing presence of the “empowered patient.” Calico could finally deliver on the promise for people to have the ability to seize proactive command over their health with a full understanding of their health data and risk factors. Previously constrained by outdated regulations and a healthcare system that doesn’t prioritize prevention, the tables are finally turning. The potential can live up to the hype.

The October 1 launch of ACA-mandated healthcare exchanges is another step toward preventative care and information sharing. While the ACA is polarizing on both sides, (the outcome of its execution remains yet to be seen) the core of the ACA will impact the resulting healthcare industry in a way that empowers individuals to own their well-being and fosters collaboration with all patient caregivers.

The Anti-Model 
Pennsylvania State University recently (and wisely) repealed a recent decision that established apunitive-based health and wellness program. Love or hate it, even the ACA agrees with the ‘carrot’ versus the ‘stick’ (companies can offer a reward of up to 30 percent of health costs for employees who participate in programs like risk assessment). Given the backlash and media attention Penn state received, it was an unfortunate way to learn what not to do.

Additionally, HIPAA is about to be a relic. Designed in a bygone era, HIPAA will be rendered obsolete thanks to the ACA. Because the ACA will provide benefits to those with pre-existing conditions, HIPAA’s privacy laws will only exist as roadblocks to individual health and wellness. The future of healthcare is driven by information sharing. It’s time for HIPAA to die

The Proven Models
Peer support in healthcare is proving to be wildly successful. As consumers, we increasingly seek the wisdom of crowds to create and sustain meaningful behavior change. El Camino Hospital in Mountain View, CA, recently launched a healthcare program for its employees in which social networking was a one of the tent poles in the program. During an 8-week time frame, over 1,000 participants lost over 1,000 pounds and began eating more fruits and vegetables. What was the number one motivating factor? Sharing progress updates with colleagues.

Today, 80 percent of healthcare costs are associated with preventable illnesses such as obesity, diabetes, hypertension and high cholesterol. It’s no wonder people are demanding to take back ownership of their health. Social networking, communities, technology and legislation are propelling old school healthcare into a consumer-driven and preventative-based model. I say bring it on — it’s about time.

complex adaptive systems, healthcare, healthy habits, nutrition, policy, rapid learning health systems, research methodology

NYT: The Challenge of Diabetes for Doctor and Patient

..or why managing diabetes doesn’t fit with how doctors have been taught, and therefore generally like, to treat patients >>> we need a radically new approach not involving doctors, busy doing other things – see Iora Health post re. health coaches.

The good news: lifestyle change for the obese or those with prediabetes may have lower progression to diabetes
http://archinte.jamanetwork.com/article.aspx?articleid=1485081

The average news: childhood obesity is plateauing [PN: ??from a scandalously high base]
http://www.nytimes.com/2012/12/11/health/childhood-obesity-drops-in-new-york-and-philadelphia.html?_r=0

The bad news: Intensive lifestyle change for diabetics did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs.

Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

 

OCTOBER 17, 2013, 3:43 PM

The Challenge of Diabetes for Doctor and Patient

By DANIELLE OFRI, M.D.

My patient was miserable — parched with thirst, exhausted and jumping up to go to the bathroom every few minutes. His vision was blurry and he’d been losing weight the last few weeks, despite eating voraciously. I’d only just met him, but I was able to diagnose diabetes in about a minute. What was unusual was that this was a scheduled office visit; usually, patients with such overwhelming symptoms are the provenance of emergency departments and urgent care centers.

A quick shot of insulin and five glasses of water and my patient felt like a new man, with no need to go to the E.R. But now, of course, the hard work would begin. A new diagnosis of diabetes is an enormous undertaking — lots to explain, major life changes to contemplate, myths to dispel, consultations with a nutritionist and a diabetes nurse.

Two days later I had another new patient for a scheduled visit — thirsty, tired, losing weight, eating and drinking like mad, eyes so blurred he could hardly see. We’d barely gotten past the introductions before I’d made another new diagnosis of diabetes. Another shot of insulin, another five glasses of water, and then the plunge into the thicket of diabetes education.

Most of my regular office visits with diabetic patients — even newly diagnosed patients — don’t involve such dramatic presentations. More often the disease is found when we screen patients who have risk factors like obesity or a family history of the disease, or who have commonly co-occurring illnesses like hypertension, heart disease or elevated cholesterol.

These two patients highlighted the outsized role that diabetes plays in the primary care setting. The tidal wave of diabetes over the last two decades has made it one of the most common diseases that internists and family doctors treat. Right now feels like a good-news-bad-news time on the diabetes front, which in a general medical clinic can sometimes feel like the only front there is.

The good news is that childhood obesity rates have begun to inch downward in some cities, including among poor children, the first positive sign in the obesity epidemic in years. Obese children are potential future diabetic patients, so even incremental progress is a public health victory to celebrate.

Also good news is a study in which adults with obesity and pre-diabetes were able to lose weight with sensible lifestyle changes and coaching. This took place in a primary care setting, not a research setting, so this also suggests that we might be able to bend the curve of new diagnoses of diabetes.

But there’s also bad news. Intensive lifestyle changes for patients with diabetes, disappointingly, did not reduce the risk of stroke or heart attack, even though these patients were able to lose weight, improve their overall quality of life, take fewer medications and even decrease costs. Lifestyle changes — diet and exercise — require huge and ongoing investment efforts for patients; we’d like to think it pays off for the big-ticket clinical outcomes. Hopefully future studies will show benefits.

Even with all the research and new treatments available, combating diabetes can feel like a Sisyphean task. The bizarre contradiction of junk food being cheaper than healthy food, combined with a bombardment of advertising — especially toward children — make it a challenge even for motivated people to eat healthfully. Sugary drinks in monster-size containers abound. And our fixation with screens large and small keeps us increasingly sedentary.

But even with all the uphill challenges, there are successes, even if not perfect ones. Both of my patients who came to my office with florid diabetes that week have improved. Perhaps it was the concreteness of their symptoms that motivated them, but they have both made steady progress getting their diabetes under control.

Over the past few months they’ve been eating more moderately, and exercising more regularly. We’ve been calibrating their medications so that their blood sugars have left the stratospheric levels and are now only moderately elevated. Medication side effects, cost of glucose meter supplies, real-life logistics, and concomitant issues of blood pressure and cholesterol control have made it a challenge to get to normal. We’d still be dinged as “failures” in the quality-measures department for not achieving the recommended clinical goals, but both patients feel vastly better and are much healthier now.

So there’s bad news and good news. But the real news for these two patients – and for many, many more like them — is that diabetes is a marathon, not a sprint. Although there have been a flurry of life changes right now, diabetes is something they will live with for the rest of their lives. They will always have to be cognizant of what they eat. They will have to keep track of medications, glucose levels, carbohydrate intake, doctors’ appointments, exercise, and weight.  They will have to be on the lookout for the many complications that diabetes can bring. This of course is not news to anyone who has diabetes or treats diabetes, but for these two patients this was news.

Now, we gear up for the long haul, the messy, complicated, occasionally gratifying business of living with a lifelong chronic illness.

Dr. Danielle Ofri’s newest book is “What Doctors Feel: How Emotions Affect the Practice of Medicine.” She is an associate professor of medicine at NYU School of Medicine and editor in chief of the Bellevue Literary Review.

http://well.blogs.nytimes.com/2013/10/17/the-challenge-of-diabetes-for-doctor-and-patient

data saving lives, healthcare, rapid learning health systems, research methodology

What doctors can learn from each other – value based healthcare

http://www.ted.com/talks/stefan_larsson_what_doctors_can_learn_from_each_other.html

http://www.ichom.org

  • 17-fold difference in outcomes for prostate surgery in Germany (5% vs 50%)
  • Continuous improvement not only improves quality of care over time, but also improves the quality of care for all who participate in it
  • Agents of change are the clinicians
  • Physicians are always very competitive – “always best in class”
  • They are extremely motivated to improve if they are shown not to be the best.
  • Physicians also thrive from peer recognition – “if one cardiologist calls another cardiologist at a competing [lagging] hospital and asks how they can improve, the leading cardiologist will share”
  • These qualities and dynamics establish an environment supportive of continuous cycle improvement
  • BCG have formed the International Consortium for Health Outcomes Measurement (ICHOM) with Michael Porter (Harvard Business School) and Karolinska Institute (Sweden) but reps from UK, USA, HK, BEL, SWE, NO, DK, DE, NL, AU, SG, Switzerland
  • They will establish data sets providing international outcome comparisons: 4 (2013), 8 (2014), 16 (2015) – 40% of disease burden in 4 years.
  • measuring value (vs costs) in healthcare – the things that matter to patients – will make clinicians part of the solution, not the problem

ContinuousCycleImprovement