Enlightenment is a destructive process. It has nothing to do with becoming better or being happier. Enlightenment is the crumbling away of untruth. It’s seeing through the facade of pretence. It’s the complete eradicatin of everything we imagined to be true. Adyashanti
Plato: wise men speak because they have something to say; fools, because they have to say something
Another cracking, clean head shot from Terry… totally concur with this one!
http://www.afr.com/p/business/healthcare2-0/doctors_have_fat_co_payment_scheme_g9tVCa7kjp7RkGhXIHh3tN
PUBLISHED: 13 AUG 2014 00:05:00 | UPDATED: 20 AUG 2014 11:53:54
Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes. Photo: Glenn Hunt
TERRY BARNES
While relentlessly attacking the federal budget’s $7 co-payment on bulk-billed GP services measure as unfair, neurosurgeon and Australian Medical Association president Brian Owler asserts doctors’ rights to charge co-payments generally. His specialist members certainly do with gusto, and presumably he does too.
If he but realises it, Health Minister Peter Dutton is ideally placed to drive a hard bargain with the AMA on containing excessive out-of-pockets, especially given the doctors’ trade union is pressuring the government to dump the $5 cut to Medicare rebates intended to drive GPs to charge the co-payment.
The ace up Dutton’s sleeve is that doctors, particularly surgeons and specialists, depend on Medicare income like a smoker depends on his nicotine fix. Even if Medicare rebates don’t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes, especially the pensioners and fixed-income retirees who dominate the demand for medical services.
Given this financial reality, the government should use its domination of purchasing by Medicare on behalf of patients to bring the AMA to heel on excessive specialist charging. Doctors are entitled to a fair and reasonable fee above the Medicare schedule fee, and there’s no cap on what doctors can charge, but too many specialists have assumed this is carte blanche to gouge poor paying punters.
To end specialist billing rorts, the government can and should impose out-of-pocket capping that is simple, elegant, and transparent, using the AMA’s own benchmarks against it.
The AMA has its own private fee schedule, in which it determines what it considers appropriate prices for specific Medicare service items. AMA fees have long been an unofficial benchmark for doctors, the association stressing that it is staying on the right side of competition law by offering general advice to its members rather than giving them direction. The government’s published Medicare schedule fee observance and out-of-pocket data indicate that a great many doctors, notably GPs, apply the AMA recommended fee when they don’t bulk bill.
What’s more, specialist association submissions to the current Senate inquiry into patient out-of-pocket expenses repeatedly cite AMA recommended fees as being fair and reasonable, especially when compared with what they depict as woefully inadequate Medicare rebates.
With this in mind, the government should take doctors at their word and insist, as a condition of specialists’ access to Medicare, that patient contributions for any billed service that exceed AMA recommended fees will be prohibited. If doctors exceeds this cap, they could be fined have their Medicare billing rights suspended or cancelled, and be required to refund gouged patients their contributions plus credit care-level interest. The current but secret AMA recommended fee schedule would be published as a baseline, and subsequently indexed annually under a formula agreed by the government and the profession.
Recommended fees for future new items would be set by the AMA and relevant specialist colleges in consultation with the government.
Should a doctor want to be more competitive on price, there would be no prohibition on their charging a fee lower than the AMA’s recommendation.
But they would not be permitted to exceed it if they bill Medicare as their patients would expect.
Further, private health insurers should be permitted to cover the gap between specialist Medicare rebates and AMA recommended fees. This would be fairer to patients than current arrangements in which insurers have no gap, or no known gap deals with some specialists but not with others. It would also tackle those GPs and specialists, most notoriously anaesthetists, who blatantly ignore their patients’ rights to be informed of and consent to fees before a service is provided.
Private insurers also should be able to advise their members on the comparative performance of doctors, especially in relation to price. In a market for health services bedevilled by information asymmetry, insurers have a wealth of consumer knowledge that can be shared without compromising the privity of the doctor-patient relationship. Let them share it. For too long, medical specialists have got away with ripping off patients through excessive charging practices. Dutton, therefore, should use his negotiations with the AMA to take a stand for patients, call Owler’s bluff, and wield his own market power to bring the AMA to heel over specialists’ stubborn, arrogant and contemptuous disregard for their patients as customers. If the minister does take on the AMA over blatant fee-gouging, he’d be onto a political winner.
Terry Barnes authored the Australian Centre for Health Research’s $7 GP co-payment proposal.
The Australian Financial Review
http://www.theguardian.com/society/the-shape-we-are-in-blog/2014/aug/13/diabetes-usdomesticpolicy
How much worse can the type 2 diabetes epidemic get? Shockingly, a new study published by a leading medical journal says that 40% of the adult population of the USA is expected to be diagnosed with the disease at some point in their lifetime. And among Hispanic men and women and non-Hispanic black women, the chances are even higher – one in two appear to be destined to get type 2 diabetes.
As Public Health England spelled out in a recent report urging local authorities to take action, 90% of people with type 2 diabetes are overweight or obese. There is no mystery behind the rise in diagnoses – they match the soaring weight of the population. The climb dates back to the 1980s and is associated with our more sedentary lifestyles and changing eating habits – more food, containing more calories, more often. It is those things that will have to be tackled if the epidemic is to be contained.
The new study in The Lancet Diabetes & Endocrinology journal, from a team of researchers from the Centers for Disease Control and Prevention in Atlanta, shows that the risk of developing type 2 diabetes for the average 20 year-old American rose from 20% for men and 27% for women in 1985–1989, to 40% for men and 39% for women in 2000–2011. The study was big – involving data including interviews and death certificates from 600,000 Americans.
Americans are generally living longer, which is a factor in their increased lifetime chance of developing type 2 diabetes. They are also not dying in the same proportions that they were, because of better treatment. However, that means they are going to spend far more years of their lives suffering from type 2 diabetes, which can lead to blindness and foot amputations as well as heart problems.
This is very bad news for the US healthcare system, says Dr Edward Gregg, study leader and chief of the epidemiology and statistics branch of the Division of Diabetes Translation at CDC:
As the number of diabetes cases continue to increase and patients live longer there will be a growing demand for health services and extensive costs. More effective lifestyle interventions are urgently needed to reduce the number of new cases in the USA and other developed nations.
Both he and Canada-based Dr Lorraine Lipscombe, who has written a commentary on the study, point out that the situation in the US is unlikely to be much different from that elsewhere in the developed world. Dr Lipscombe, from Women’s College Hospital and the University of Toronto, writes:
The trends reported by Gregg and colleagues are probably similar across the developed world, where large increases in diabetes prevalence in the past two decades have been reported.
Primary prevention strategies are urgently needed. Excellent evidence has shown that diabetes can be prevented with lifestyle changes. However, provision of these interventions on an individual basis might not be sustainable.
Only a population-based approach to prevention can address a problem of this magnitude. Prevention strategies should include optimisation of urban planning, food-marketing policies, and work and school environments that enable individuals to make healthier lifestyle choices. With an increased focus on interventions aimed at children and their families, there might still be time to change the fate of our future generations by lowering their risk of type 2 diabetes.
http://www.themonthly.com.au/issue/2014/june/1401544800/richard-cooke/people-versus-political-class
“People of privilege will always risk their complete destruction rather than surrender any material part of their advantage.”
JK Galbraith
President Dwight Eisenhower’s Farewell Address to the nation January 17, 1961
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
….
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.
It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.
My fellow Americans:
Three days from now, after half a century in the service of our country, I shall lay down the responsibilities of office as, in traditional and solemn ceremony, the authority of the Presidency is vested in my successor.
This evening I come to you with a message of leave-taking and farewell, and to share a few final thoughts with you, my countrymen.
Like every other citizen, I wish the new President, and all who will labor with him, Godspeed. I pray that the coming years will be blessed with peace and prosperity for all.
Our people expect their President and the Congress to find essential agreement on issues of great moment, the wise resolution of which will better shape the future of the Nation.
My own relations with the Congress, which began on a remote and tenuous basis when, long ago, a member of the Senate appointed me to West Point, have since ranged to the intimate during the war and immediate post-war period, and, finally, to the mutually interdependent during these past eight years.
In this final relationship, the Congress and the Administration have, on most vital issues, cooperated well, to serve the national good rather than mere partisanship, and so have assured that the business of the Nation should go forward. So, my official relationship with the Congress ends in a feeling, on my part, of gratitude that we have been able to do so much together.
II
We now stand ten years past the midpoint of a century that has witnessed four major wars among great nations. Three of these involved our own country. Despite these holocausts America is today the strongest, the most influential and most productive nation in the world. Understandably proud of this pre-eminence, we yet realize that America’s leadership and prestige depend, not merely upon our unmatched material progress, riches and military strength, but on how we use our power in the interests of world peace and human betterment.
III
Throughout America’s adventure in free government, our basic purposes have been to keep the peace; to foster progress in human achievement, and to enhance liberty, dignity and integrity among people and among nations. To strive for less would be unworthy of a free and religious people. Any failure traceable to arrogance, or our lack of comprehension or readiness to sacrifice would inflict upon us grievous hurt both at home and abroad.
Progress toward these noble goals is persistently threatened by the conflict now engulfing the world. It commands our whole attention, absorbs our very beings. We face a hostile ideology-global in scope, atheistic in character, ruthless in purpose, and insidious in method. Unhappily the danger it poses promises to be of indefinite duration. To meet it successfully, there is called for, not so much the emotional and transitory sacrifices of crisis, but rather those which enable us to carry forward steadily, surely, and without complaint the burdens of a prolonged and complex struggle-with liberty at stake. Only thus shall we remain, despite every provocation, on our charted course toward permanent peace and human betterment.
Crises there will continue to be. In meeting them, whether foreign or domestic, great or small,there is a recurring temptation to feel that some spectacular and costly action could become the miraculous solution to all current difficulties. A huge increase in newer elements of our defense; development of unrealistic programs to cure every ill in agriculture; a dramatic expansion in basic and applied research-these and many other possibilities, each possibly promising in itself, may be suggested as the only way to the road we which to travel.
But each proposal must be weighed in the light of a broader consideration: the need to maintain balance in and among national programs-balance between the private and the public economy, balance between cost and hoped for advantage-balance between the clearly necessary and the comfortably desirable; balance between our essential requirements as a nation and the duties imposed by the nation upon the individual; balance between action of the moment and the national welfare of the future. Good judgment seeks balance and progress; lack of it eventually finds imbalance and frustration.
The record of many decades stands as proof that our people and their government have, in the main, understood these truths and have responded to them well, in the face of stress and threat. But threats, new in kind or degree, constantly arise. I mention two only.
IV
A vital element in keeping the peace is our military establishment. Our arms must be mighty, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction.
Our military organization today bears little relation to that known by any of my predecessors in peace time, or indeed by the fighting men of World War II or Korea.
Until the latest of our world conflicts, the United States had no armaments industry. American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. Added to this, three and a half million men and women are directly engaged in the defense establishment. We annually spend on military security more than the net income of all United State corporations.
This conjunction of an immense military establishment and a large arms industry is new in the American experience. The total influence-economic, political, even spiritual-is felt in every city, every state house, every office of the Federal government. We recognize the imperative need for this development. Yet we must not fail to comprehend its grave implications. Our toil, resources and livelihood are all involved; so is the very structure of our society.
In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.
We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted only an alert and knowledgeable citizenry can compel the proper meshing of huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.
Akin to, and largely responsible for the sweeping changes in our industrial-military posture, has been the technological revolution during recent decades.
In this revolution, research has become central; it also becomes more formalized, complex, and costly. A steadily increasing share is conducted for, by, or at the direction of, the Federal government.
Today, the solitary inventor, tinkering in his shop, has been over shadowed by task forces of scientists in laboratories and testing fields. In the same fashion, the free university, historically the fountainhead of free ideas and scientific discovery, has experienced a revolution in the conduct of research. Partly because of the huge costs involved, a government contract becomes virtually a substitute for intellectual curiosity. For every old blackboard there are now hundreds of new electronic computers.
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded.
Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of a scientific-technological elite.
It is the task of statesmanship to mold, to balance, and to integrate these and other forces, new and old, within the principles of our democratic system-ever aiming toward the supreme goals of our free society.
V
Another factor in maintaining balance involves the element of time. As we peer into society’s future, we-you and I, and our government-must avoid the impulse to live only for today, plundering, for our own ease and convenience, the precious resources of tomorrow. We cannot mortgage the material assets of our grandchildren without risking the loss also of their political and spiritual heritage. We want democracy to survive for all generations to come, not to become the insolvent phantom of tomorrow.
VI
Down the long lane of the history yet to be written America knows that this world of ours, ever growing smaller, must avoid becoming a community of dreadful fear and hate, and be, instead, a proud confederation of mutual trust and respect.
Such a confederation must be one of equals. The weakest must come to the conference table with the same confidence as do we, protected as we are by our moral, economic, and military strength. That table, though scarred by many past frustrations, cannot be abandoned for the certain agony of the battlefield.
Disarmament, with mutual honor and confidence, is a continuing imperative. Together we must learn how to compose difference, not with arms, but with intellect and decent purpose. Because this need is so sharp and apparent I confess that I lay down my official responsibilities in this field with a definite sense of disappointment. As one who has witnessed the horror and the lingering sadness of war-as one who knows that another war could utterly destroy this civilization which has been so slowly and painfully built over thousands of years-I wish I could say tonight that a lasting peace is in sight.
Happily, I can say that war has been avoided. Steady progress toward our ultimate goal has been made. But, so much remains to be done. As a private citizen, I shall never cease to do what little I can to help the world advance along that road.
VII
So-in this my last good night to you as your President-I thank you for the many opportunities you have given me for public service in war and peace. I trust that in that service you find somethings worthy; as for the rest of it, I know you will find ways to improve performance in the future.
You and I-my fellow citizens-need to be strong in our faith that all nations, under God, will reach the goal of peace with justice. May we be ever unswerving in devotion to principle, confident but humble with power, diligent in pursuit of the Nation’s great goals.
To all the peoples of the world, I once more give expression to America’s prayerful and continuing inspiration:
We pray that peoples of all faiths, all races, all nations, may have their great human needs satisfied; that those now denied opportunity shall come to enjoy it to the full; that all who yearn for freedom may experience its spiritual blessings; that those who have freedom will understand, also, its heavy responsibilities; that all who are insensitive to the needs of others will learn charity; that the scourges of poverty, disease and ignorance will be made to disappear from the earth, and that, in the goodness of time, all peoples will come to live together in a peace guaranteed by the binding force of mutual respect and love.
Transcription courtesy of the Dwight D. Eisenhower Presidential Library and Museum.
An excellent video that crystallizes concerns about how we are feeding our children… they even claim to be able to do something about it..!!
Strong4Life.com – Children’s Healthcare of Atlanta
this is a brilliant move….
http://www.futuregov.asia/articles/2014/aug/14/singapore-governments-first-chief-data-scientist-p/
From traffic updates to tax returns, cities and countries have more data than ever before – but how can they manage it?
FutureGov has exclusively interviewed Prabir Sen, Singapore government’s first Chief Data Scientist. He was appointed by the Infocomm Development Authority of Singapore (IDA) in January, and spoke on why his role was created, what he wants to achieve and the challenges he faces.
Vision to be a global analytics hub
Singapore aspires to be the world’s centre of data science and analytics. This vision required a dedicated team to guide the development of skills on data sciences and advanced analytic across the government and industry. The role of the Chief Data Scientist and his supporting team, called the Data Sciences Group, were created to drive the private and public sectors’ adoption of data analytics, said Sen.
Sen is excited about the potential for expanding Singapore’s work in this area: “I wonder if it is possible to invite the international sports and games industry, such as the Olympics Association, to collaborate with Singapore-based tech companies and talents on sports analytics right here in Singapore? Is it possible to attract aerospace and logistics companies here to do machine-to-machine data analytics? Is it possible to drive the multinational consumer good corporations to work with local small tech companies on advanced consumer insights?”
Using analytics to improve quality of decisions & lives
The government believes that data analytics has huge opportunities to impact government services and improve citizens’ lives in a wide range of areas, such as healthcare, transportation, education, retail and waste management.
A large volume of data is being generated from sensors and mobile devices today. This includes communication between person-to-person, person-to-machine and machine-to-machine, added Sen. He and his team are tasked to evaluate and apply advanced analytics techniques and models that can help organisations get a “360-degree view on people, technology and policies to improve the quality of decisions and improve citizens’ lives and journey of experience at various touch points.”
Cross agency data analytics
The greatest opportunity for using analytics within government is what Sen calls “cross data analysis”, where one agency can use data of another agency to solve their problem. “For example, the Ministry of Manpower can analyse healthcare data from Ministry of Health to determine skill gaps and future talent development requirements, or, transportation use environment to determine impact of weather in commuters’ behaviour” he said. “Such cross data analyses also require greater attention to and better governance of data protection, privacy and anonymity,” he added.
Some agencies are currently using this strategy and are achieving great results, he said, and the Singapore government is now encouraging them to explore more cross-agency data use.
Innovation therefore requires agencies to be even more ready to experiment: “Data analytics is fanning the flames of entrepreneurship in the Singapore government, to adopt a philosophy called ‘start up’. Government is obviously not a start up but initiatives to effect change are best thought of as start-ups where we should be more ready to trial and be comfortable with small failures.”
“Compare a project that takes months and costs a lot of money; with one that takes two persons and a couple of weeks of effort. If the former fail, it will be catastrophic, while a failure of a small trial is still acceptable. We can adopt a risk management methodology where the cost of failing becomes exceedingly tiny,” he said.
Developing analytics talent
One of Sen’s key performance indicators is to strengthen data talent locally. According to a recent IDA release, “McKinsey forecasts that there will be a shortage of 140,000 to 190,000 data sciences and analytics professionals by 2018 in just the US alone”.
Sen shared that the need to increase the local data talent pool is a real challenge. Most organisations are struggling to recruit enough candidates with the right skills. “We are shorthanded in several areas: data scientists who have both computational experience and business acumen, data visualisers who are skilled in both analytics and graphic design, analytics consultants who hold domain knowledge besides their analytics experience, and data engineers who can source and integrate data from disparate systems.”
Retaining this data talent is even more difficult, he continued. “Most of these data professionals are creative people. They require space and freedom and a stimulating environment to explore new approaches and insights that challenge them. So we need to facilitate and grow this local community, to drive engagement with them, pulling together users, data analytics companies, cloud providers to form an ecosystem to exchange ideas.”
To this end, IDA has launched a Massive Open Online Course (MOOC) on data science and analytics this month, offering locals the chance to develop the vital skills to respond to the growing demand for data professionals. The class has attracted more than 350 registrations from both the private and public sector.
Chief Data Officer vs Chief Data Scientist
Sen also clarified how his role is different from a Chief Data Officer. “A Chief Data Officer typically has responsibility to govern and protect data, and find ways to use data across the agencies. My role, on the other hand, is to find ways to build transformative products using data sciences, analytics and insights; drive rapid development and adoption of analytical techniques, and develop the local data and tech talent.”
The skills and experience that make a good Chief Data Scientist, Sen added, is not limited to quantitative and computation proficiency. The candidate must be good at understanding human behaviour, how people go about solving their problems and making decisions, and able to think laterally to engage in cross-cutting strategic dialogues. Most importantly, he must be able to learn, unlearn and relearn.
Learning will be vital as Singapore seeks to become a global hub for analytics. Agencies are being challenged to work together on trialling new approaches, while the government is seeking to build greater scientific communities and talent in the city state. Ultimately, though, these efforts could lead to greater personalisation of citizen services – a new way in which the government engage and does business with its customers.
Interesting take on imagining the future of healthcare.
http://www.kevinmd.com/blog/2014/08/uber-health-care-will-look-like.html
Medallion owners tend to fall into two categories: private practitioners and fleet owners. Private practitioners own their own car, have responsibility for maintenance, gas and insurance, and tend to use the cash flow to live while allowing the medallion to appreciate over the course of their career. They then cash out as part of their retirement plan.
Fleet owners have dozens of medallions; they lease or buy fleets of automobiles and often have their own mechanics, car washes and gas pumps. They either hire drivers as employees or, more often, rent their cars to licensed taxi drivers who get to keep the balance of their earnings after their car and gas payments.
In London, taxi drivers have to invest 2 to 4 years of apprenticeship before they can take and pass a test called “The Knowledge.” However, like NYC, finally getting that a licence to operate a Black Cab in London is a hard-working but stable way to earn a living.
Now imagine that someone comes along that can offer all the services of the NYC yellow cab or the London Black Cab directly to the general public, but does not have to own the medallion, own the car or employ the driver. With as much as 70% lower overhead, they provide the same service to the consumer; in fact they are so consumer friendly that they become the virtual gatekeeper for all the taxi and car service business in the community.
How, you ask? Outsourcing the overhead and just-in-time inventory management; they convince thousands of people to drive around in their own cars with the promise of a potential payment for services driving someone from point A to point B. All these drivers have to do is meet certain standards of quality and safety. This new company does all the marketing and uses technology to make the connection between the currently active drivers and those in need of a ride; they provide simple and transparent access to a host of cars circulating in your neighborhood, let you know the price and send a picture and customer rating of the driver, all before he or she arrives, and they process the payment so no money ever changes hands.
This is the premise behind Uber, a very disruptive take on the taxi business. As a recent article in Bloomberg noted, the slower rate of growth in medallion value is already attribute to the very young company; a recent protest by Black Cab drivers in London resulting in an eight-fold increase in Uber registrations.
Now imagine that a new health care services company comes to your community offering population health management services on a bundled payment or risk basis. They guarantee otherwise inaccessible metrics of quality and safety to both large employers and individual consumers. They employ only a handful of doctors, but do not own any hospitals, imaging centers or ambulatory care facilities.
However, they are masters at consumer engagement, creating levels of affinity and loyalty usually found with consumer products and soft drinks. They use a don’t make me think approach to their technology, seamlessly integrating analytics and communications platforms into their customers lives, and offer consumers without a digital footprint a host of options for communications, including access to information and services via their land lines or their cable TV box. They leverage high-level marketing analytics to determine who will be responsive to non-personal tools for engagement, like digital coaching, and who requires a human touch.
Care planning is done based on clinical stratification and evidence; population specific data is used to determine the actual resources required to achieve clinical, quality and financial goals. (A Midwest ACO has more problems with underweight than obesity, do they need to maintain their bariatric surgery center?) Physicians serve as “clinical intelligence officers,” creating standing orders across the entire population, implemented by non-clinical personnel; they also create criteria for escalation and de-escalation of services and resource allocation based on individual patients progress towards goals. They employ former actors and actresses as health coaches and navigators, invest heavily in home care and nurse care managers and use dieticians in local supermarkets to support lifestyle changes (while accessing and analyzing the patients point-of-purchase data to see what they are really buying).
The primary relationship between patients and their health systems is with a low cost, personal health concierge: Primary care physicians are only accessed based on predetermined eligibility criteria and only with those physician who agree to standards of quality and accountability are in the network. Multi-tiered scenario planning for emergencies is built into the system. For professional resources only required on an as-needed basis, such as hospital beds, surgeons and medical specialists, access is negotiated in advance based on a formula of quality standards and best pricing but only used on a just-in-time basis.
They are not a payer, although a professional relationship with them is on a business-to-business basis. They are a completely new type of health system, guaranteeing health and well being, transparent in their operations and choosing their vendors based on their willingness and ability to achieve those goals. In doing so, they significantly reduce the resources necessary to achieve goals for quality of care and quality of health across the entire population; they treat quality achievement as an operational challenge and manage their supply chain accordingly.
Am I suggesting this a new model of care? No, I am personally an advocate for physician-driven systems of care. But this kind of system is very possible, and there are companies working on models of national ACOs using many of these principles.
The Uber of health care will have much less to do with the mobile app; and far more to do with creating value by minimizing overhead, designing flexible operations, supporting goal-directed innovation and bringing supply-chain discipline to the idea of resource-managed care delivery. It will involve embracing models of care delivery that leverage emerging evidence on non-clinical approaches to health status and quality improvement, and focusing on designing goal-directed interactions between people, platforms, programs and partners.
I can hear more than a few of you creating very good reasons why it wont work (“You can’t put an ICU bed out to bid!”), but these scenarios are very doable. If we want to revitalize the experience of care for patients and professionals, we must be willing to acknowledge and embrace dramatically different, often counter-intuitive, new operating models for care that will require new competencies, forms of collaboration and reengineering the roles and responsibilities of those who comprise a patients’ health resource community.
Steven Merahn is director, Center for Population Health Management, Clinovations. He blogs at MedCanto.
