Monthly Archives: January 2015

complex adaptive systems, health market quality, healthcare, policy, politics

Blumenthal on Health Reform: Foolish, Courageous, or Both

http://www.commonwealthfund.org/publications/blog/2014/dec/health-reform-foolish-courageous

Health Reform: Foolish, Courageous, or Both

Thursday, December 4, 2014

By David Blumenthal, M.D.

Some supporters of the Affordable Care Act (ACA) are worried they’re paying a political price for health care reform. The political fallout should come as no surprise.

The history of comprehensive health reform shows unequivocally that it’s a short-term political disaster. That’s why so many political leaders have either avoided the issue, or regretted engaging it. Franklin D. Roosevelt, arguably one of our most politically adept presidents, turned his back on national health insurance in 1934 when advisors argued for including it in the Social Security program. He continued to dodge it for most of his long presidency. Both Jimmy Carter and Bill Clinton paid heavy political prices for their proposed national health care programs.

Health reform’s political toxicity is all about math and voting.  Even prior to the ACA, more than 80 percent of Americans under 65 had health insurance, and most were satisfied with their coverage and regular care. These are people—better educated, employed, with middle to higher incomes—who vote, especially in mid-terms. The elderly, of course, have Medicare and they too are generally satisfied with their insurance and care. The 20 percent who didn’t have insurance before the law was passed were—and are—much less likely to show up at the polls. They tend to be younger, less-educated, and less well-off.

Then there’s the nature of health care as an issue: highly personal, highly consequential, and incredibly complex and confusing. Health care is about people’s deepest hopes and fears, for themselves and for their loved ones. And the health care system has become a multi-layered maze of huge insurance chains, enormous and acquisitive provider organizations, government regulation, and constantly changing therapeutics.

This makes it easy for opponents of health reform to stir opposition by arguing—fairly or not—that any new program will make things worse for people who are satisfied with their insurance and their care. This is precisely why President Obama felt the need to promise, inaccurately as it turned out, that every American who liked their insurance plan would be able to keep it under the ACA.

And supporters of reform have difficulty explaining any new program and motivating its beneficiaries to take advantage of it. Witness the large numbers of uninsured Americans who remain unaware of the availability of subsidized insurance through the ACA marketplaces.

So, to put it crudely, why would any sane politician push a program likely to scare and confuse large numbers of people who vote, in order to help small numbers who don’t?

There are two possible responses. One is that it’s the right thing to do, since a lack of insurance is essentially a death sentence for millions of Americans. Doing the right thing, however, can be politically costly: when Lyndon Johnson pushed through the Civil Rights Act in 1965, he gave away the southern United States to the other party for a generation.

A second argument for braving health reform is practical: it simply has to be done to make our health system viable. The private health insurance industry in the United States, and our health system as a whole, have been in a downward spiral that threatens the interests of all Americans, including the now contentedly insured. Prior to the ACA’s enactment, more and more people were losing insurance, or being forced—because of huge premium increases—to purchase coverage that offers less and less protection.

For some years now, insured Americans have been the proverbial frog in the cooking pot, barely noticing as the water slowly approaches the boiling point. A health care system in which, year after year, the cost of insurancerises faster than workers’ wages is not sustainable for anyone.

Relatively little attention has been paid to ACA reforms that attempt to make the system sustainable by tackling fundamental problems with the health care delivery system and with the structure of the private insurance markets. The reason may be that insurance markets and delivery systems—their problems and solutions—are complex and much less interesting than the political battles surrounding covering uninsured Americans, and whether currently insured Americans may face cancellation of their plans. While the major long-term political gains to supporters of health reform may lie in these delivery system and insurance reforms, President Obama and many current congressmen and senators will likely be long gone when and if those gains materialize.

So ACA supporters have every right to be concerned about the politics of health reform. Each will have to decide for themselves whether health reform was foolish, courageous, or both.

In the meantime, millions of Americans now have health insurance who didn’t before, and the cost of health care is increasing at the lowest rate in 50 years.

health market quality, healthy habits, nutrition, policy, rapid learning health systems

Croakey: Impact of big food health washing

 

http://blogs.crikey.com.au/croakey/2014/12/01/as-nutritionists-enable-health-washing-by-coca-cola-a-call-to-end-unhealthy-sponsorship/

As nutritionists enable health-washing by Coca-Cola, a call to end unhealthy sponsorship

MELISSA SWEET | DEC 01, 2014 10:00AM | | PRINT

When Big Food companies engage in health-washing tactics, what are the consequences for the reputations of the health organisations and health professionals involved?

It’s a question the Nutrition Society of Australia and its members might be pondering, after having Coca-Cola as a gold sponsor of their recent annual scientific meeting.

As the World Cancer Congress in Melbourne this week puts the spotlight on the implications of rising obesity rates for cancer, health advocate Todd Harper highlights the contribution of soft drinks to obesity, and argues that health organisations need to look for healthier funding sources.

***

Todd Harper, CEO of Cancer Council Victoria, writes:

No sporting club or health event would accept sponsorship from a tobacco company in Australia today, even if it was allowed.

We know that smoking kills, and so do everything possible to reduce its visibility to ensure younger people aren’t encouraged to take up the habit.

Obesity is also a known risk factor for many cancers, as well as other chronic diseases, yet organisations and events continue to accept sponsorship from the very companies peddling products that contribute to this significant health issue.

Despite this, some organisations focused on health, and particularly healthy kids, see little problem in holding their hands out for money from soft drink companies.

Our recent Cancer in Victoria: Statistics and Trends 2013 report revealed uterine cancer rates are steadily rising; a cancer for which obesity is a principal risk factor. Obesity is also a risk factor for breast, bowel, oesophageal, pancreas, uterine, kidney, gallbladder and thyroid cancers.

In fact, we recently learned from the World Health Organization (WHO) that nearly half a million new cancer cases around the world can be attributed to high Body Mass Index each year – including more than 7000 in Australia. (A new study by the International Agency for Research on Cancer found that nearly half a million new cancer cases per year can be attributed to high body mass index (BMI). The study was published on November 26 in The Lancet Oncology. Using its methodology, more than 7000 new cancer cases in Australia per year can be attributed to high BMI.)

The number of Victorians diagnosed with cancer is projected to double by 2024-2028 to more than 41,000 cases a year, with obesity considered a significant contributor to this. It’s a problem that we can’t ignore.

Many people are aware of the dangers of smoking, and the link between smoking and cancer – which is why we’ve seen such a rapid decline in smoking rates. At the same time we are seeing an equally rapid rise in the number of people who are overweight or obese. We need the same awareness about this as a risk factor if we are to stop more cancers before they start.

Drinking soft drinks contributes to higher kilojoule intake, weight gain and obesity. With one can of Coke containing 10 teaspoons of sugar, each can consumed increases the risk of being overweight.

The WHO recommends the consumption of sugary drinks should be restricted, as do Australia’s recently reviewed dietary guidelines, while the World Cancer Research Fund recommends consumption should be avoided entirely. Leaders in cancer control are meeting in Melbourne this week for the World Cancer Congress, and the challenges related to rising global obesity will be firmly on the agenda.

In the meantime, Coca-Cola continues to sugar-coat its image; fooling the community into believing it is part of the solution to the obesity epidemic.

Rather than being part of the solution like it claims, this multi-billion dollar company is trying to veil the impact of its products by positioning itself as a promoter of physical activity. This is merely a distraction from the fact that it continues to promote its sugary drinks as being part of a healthy diet.

Disturbingly, the company has aligned itself with organisations that encourage healthy active lifestyles, such as the Bicycle Network.

The decision by Bicycle Network to enter into a partnership with Coca-Cola attracted strong criticism from public health experts after a piece in Croakey a year ago, yet the partnership continues. This is especially problematic considering the ‘Happiness’ program is targeting teenagers, a group particularly susceptible to marketing and the highest consumers of these drinks.

Similarly, the Nutrition Society of Australia, the peak scientific nutrition group in the country, has Coca-Cola as a gold sponsor for its Annual Scientific Meeting underway in Tasmania.

This is disappointing on a number of levels, not least of all the fact that one of the themes for the conference is ‘Diet and cancer: what does the evidence show?’

Coca-Cola’s attempts to link itself with these organisations won’t reduce the consumption of sugary beverages and won’t make a gram of difference in reducing overweight and obesity.

Wouldn’t it be better to create alternative sponsorship sources for health-promoting organisations?

As was done with the banning of tobacco sponsorship and the creation of alternative funding sources through VicHealth, it’s time for some similarly creative thinking.

Creative thinking that will kick Coca-Cola out of sponsoring health-promoting activities, and create healthier options for organisations like the Nutrition Society and Bicycle Network.

My fear is that unless we take such action, we run the risk of limiting the impact of important health programs such as the Rethink Sugary Drinkcampaign, encouraging a switch to water and reduced-fat milk; and theLiveLighter campaign, which aims to help people make simple lifestyle choices to improve their overall health and cut their cancer risk.

These programs are vital yet are minnows in the campaign to win the healthy hearts and minds of the public when faced with the corporate might of the highly processed food and drink companies, but with some creative thinking and political will, the scales can be tipped in favour of a healthier way.

• Todd Harper is CEO of Cancer Council Victoria.

cool

Pyrmont vacant lots to be sold off for charity

PDF: Wakil family property sell-off_ $200m raised for charitable foundation

http://www.smh.com.au/nsw/wakil-family-property-selloff-200m-raised-for-charitable-foundation-20141212-125bq7.html

Wakil family property sell-off: $200m raised for charitable foundation

December 13, 2014

Anne Davies

The Wakils sold the Griffiths Teas building in Surry Hills for $22 million last month.

The Wakils sold the Griffiths Teas building in Surry Hills for $22 million last month. Photo: Steven Siewert

The Wakils, owners of many of Sydney’s mysterious derelict buildings in Pyrmont and the CBD, have begun selling off their vast property portfolio with plans to set up a major charitable foundation.

The off-market sell-off has already raised $200 million with more properties, some vacant since the 1970s, under negotiation.

In a city where housing is at a premium and areas such as Pyrmont have become rapidly gentrified, the Wakil’s decision to sit on their property portfolio was controversial and provided many a squatter’s opportunity.

"Scariest eviction ever": The vacant and overgrown Terminus Hotel in Pyrmont.“Scariest eviction ever”: The vacant and overgrown Terminus Hotel in Pyrmont. Photo: Steven Siewert

The elderly couple had once planned to restore the portfolio of historic buildings they own. But according to Karbon Properties agent, Joshua Watts, who has handled some of the sales, the renovations “became beyond them” and Isaac and Susan Wakil, now in their late 80s, have opted to give back to Sydney in another way.

The purpose of the foundation they are planning has not yet been made clear.

The Wakils have no children and the only known relative is a nephew.

Old advertising signs still on display at the derelict Terminus Hotel.Old advertising signs still on display at the derelict Terminus Hotel. Photo: Steven Siewert

The famous Griffiths Tea Warehouse, in Wentworth Avenue, Surry Hills,  sold in November for $22 million to Cornerstone Property group.  Its new owner plans to turn the iconic Sydney landmark into New York style  apartments.The nearby Key College building, sold for an undisclosed sum to a group of investors including Michael Teplitsky, who has plans for a boutique hotel development. A vast warehouse and vacant lot at 100 Harris Street, Pyrmont near the Star Casino has sold for over $90 million.

Other famous mouldering landmarks, such as the Terminus Hotel, also in Harris Street, once owned by the father of a bikie killed in the Milperra bikie massacre, and empty for more than 30 years, are under negotiation. The pub still displays its original beer posters and is covered with vines that have snaked through the brickwork.

A vast bond store covered in ferns and moss, also within a stone’s throw of the casino, is on the market too.

Susan and Isaac Wakil at a gala night at the Opera House.Susan and Isaac Wakil at a gala night at the Opera House.

The Wakils made their money in the garment trade and were once  patrons of the arts and the opera in Sydney.

Mrs Wakil who was born in the then Romanian province of Bessarabia in 1932, told the Herald in 1961 she still remembered her father being dragged to a Siberian gulag for being a capitalist land owner when she was seven.

After imprisonment in a Soviet concentration camp, her mother died and the young Susan and her aunt escaped to Australia. Her father migrated here after his release.  Mr Wakil was born in Baghdad in Iraq.

The Wakil property portfolio.The Wakil property portfolio.

In the 1970s and 1980s the Wakils, like many successful migrants,  began investing in property. They favoured stone buildings and big old brick warehouses in then unfashionable parts of the city, like Pyrmont and the fringes of the CBD near Central. In Pyrmont alone, they have more than 10  properties.

But unlike most property developers, the Wakils didn’t renovate, sell, or even rent them out, even though they displayed “For Lease” signs, sometimes with numbers so old they did not include the 9 that Sydney numbers have had for 20 years.

The only building which was tenanted was 100 Harris Street, Pyrmont, where the Wakils had the office of their company. In the 1990s and early 2000s the  Wakils’ cream Rolls-Royce could be seen most days parked in the driveway of Citilease.  But in recent years the  Wakils have seldom ventured from their Vaucluse home.

Susan Wakil at the Randwick races.Susan Wakil at the Randwick races.

In a city where housing is at a premium and areas such as Pyrmont have rapidly gentrified, the Wakil’s decision to just sit on their property portfolio was controversial.

Local Pyrmont business owners told of their frustration at being unable to rent some of the most prominent sites, and instead having to watch them deteriorate.

The Herald reported in 2000 that squatters also met their match. Mickie Quick, a co-founder of the squatter’s group Squatspace told how his group taken up digs in the Terminus Hotel. “We got inside once and changed the locks but we only lasted a few weeks. It was one of the scariest evictions I had ever had. Two hired guns came in with sledgehammers in the night.”

management and leadership

HBR Blog: Social CEOs

 

https://hbr.org/2014/12/the-7-attributes-of-ceos-who-get-social-media/

The 7 Attributes of CEOs Who Get Social Media

DECEMBER 3, 2014

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Peter Aceto, the CEO of Tangerine, recently said in The Globe and Mail, “I would rather engage in a Twitter conversation with a single customer than see our company attempt to attract the attention of millions in a coveted Superbowl commercial.”

This is the preference of a truly social CEO. Unfortunately, chief executives that embrace and understand the promise of social media are rare, so rare that we call them “blue unicorns” in our book, A World Gone Social. Why blue unicorns? Because CEOs that embrace social as much as leaders like Aceto are still so uncommon that we aren’t just looking for any unicorn, we’re looking for a specific color of unicorn.

Five years ago, when boards were searching for a leader, social media competency wasn’t even on the radar. Now, according to the board members and CEOs we interviewed for our book, a strong social presence is often high on the list of factors they consider when vetting CEO candidates.

And five years from now? With the positive aspects of being a social CEOroutinely splashed across the business pages, social fluency will likely be on almost every board’s list of must-have leadership skills. Already, given a choice between similarly strong candidates — one with an impressive social presence, the other without – the choice is easy: boards increasingly prefer the modern leader.

According to recent research conducted by Domo, 30% of Fortune 500 CEOs have a presence on at least one social channel. And on paper, especially considering the Social Age is only six years old, 3 in 10 may not seem too bad a ratio. But even these so-called “social CEOs” aren’t that social.

A quick glance at their activity on LinkedIn, Facebook, or Twitter shows:

  • The vast majority is using social media as a broadcast channel — a digital billboard to hawk their company’s products and services — not as a way to connect.
  • For those who appear to be attempting to engage, their social activity feels impersonal and generic, as if a junior member of the marketing team is managing their social accounts and speaking for them. Of course, the CEOs who approach social in this manner are missing the point entirely.

So how do we know that a CEO is actually — personally — engaging on social media? What attributes do we recognize in truly social CEOs like Richard Branson, Pete Cashmore, Arianna Huffington and Peter Aceto? Here are the top seven traits we’ve observed over the five years we spent trend-watching and interviewing leaders:

  1. They Have an Insatiable Curiosity

Truly social CEOs are deeply curious. And that curiosity leads them to wonder, “What are people saying about our company? Our competitors? About their wants, needs, and aspirations that no one is fulfilling right now?” Many social CEOs are first drawn to social to listen. After all, there is no better way than social to collect real-time market intelligence, both through social monitoring and engaging followers.

  1. They Have a DIY Mindset

The same CEOs who look up information on Google rather than asking an assistant to do it are flocking to social. They don’t want to hear input from customers filtered through 13 layers of management. They don’t want to see a summary report on employee morale or customer satisfaction. They want their input raw and without any manipulation.

  1. They Have a “Bias for Action”

In 1982, we learned from Tom Peters and Robert Waterman in their book, In Search of Excellence, about how the best leaders had “a bias for action.” They live by a “ready, fire, aim” mentality and in the Social Age, this has never been more necessary – the 24/7 social conversation waits for no focus group or budget cycle. Sure, the marketing team supports their activity; they may even have a person dedicated to social monitoring of their accounts. But when the situation or sense of urgency dictates, they aren’t afraid of getting their hands dirty. Just watch truly social CEOs like Basecamp’s Jason Fried and Havas Media’s Paul Frampton: they’re often online, live, in the moment, and thus ready to respond and engage in real time.

  1. They Are Relentless Givers

Many social CEOs aren’t social just because they have a company to run; they see value in being social in every aspect of their lives. They care about more than the bottom line. They give back, they mentor, and they care about real social issues that have nothing to do with Twitter, Facebook and LinkedIn. We refer to those who act consistently in a collaborative, generous way as “relentless givers.” They constantly share what they know, connect others and — often for no other reason than because it is the right thing to do — they do good. One standout example isOCLC’s Skip Prichard, who blogs on leadership and shares insights from his favorite authors – often with no direct benefit to him or his organization.

  1. They Connect Instead of Promote

Want to spot an antisocial CEO? Read what they’re sharing on social media. Are they spreading the good word about their company while also interacting with others, from famous influencers to humble social newcomers? Or is their feed clearly a spigot of self-promotion? Are they answering questions from concerned stakeholders? Or are they only saying what investors want to hear? Social CEOs put down the digital megaphone and they build relationships.

  1. They’re the Company’s No. 1 Brand Ambassador

We have always looked to the boss as the face of the company. We admire the leaders whose brands, both personal and corporate, are led responsibly – and revile those whose company is seen as autocratic, self-serving and non-caring. As goes the personal brand of a CEO, so goes the brand. A study by Weber Shandwick backs up this observation: About two-thirds of customers say their perception of a CEO directly impacts their perception of the company. Social CEOs are building their personal brand whenever they engage on social media, and when they do it in an authentic and generous way, they’re also improving the company brand.

  1. They Lead with an OPEN Mindset

“OPEN” – short for Ordinary People, Extraordinary Network – means that no one person, even the highest-level leader, can have all the answers. Instead, we deliberately build personal relationships with those willing to help us discover the answers, together. Whether it’s managing a crisis, or rising up to meet an opportunity, a social CEO taps into her network’s combined expertise. Embracing the concept of OPEN is perhaps the purest indicator that a leader is truly social.

Writer Kare Anderson takes OPEN to the next level as she talks routinely of mutuality and deliberately becoming an opportunity maker. She said in herrecent TED talk, “Each one of us is better than anybody else at something… which disproves the popular notion that if you’re the smartest person in the room, you’re in the wrong room.”

No leader can afford to lead as they did in the Industrial Age. This is a new era with new rules. All around us, the entire world is flattening, democratizing, andsocializing. It’s quite possible that as the social age matures, there will be only two types of business leaders: social … and retired.

Ted Coiné is a serial business founder and CEO, among Inc.’s Top 100 Leadership and Management Experts and Forbes’ Top 10 Social Media Influencers. His latest book, A World Gone Social: How Companies Must Adapt to Survive, is about leading in the Social Age.

Mark Babbitt is co-author of A World Gone Social: How Companies Must Adapt to Survive (AMACOM), a keynote speaker, and prolific blogger. He serves as CEO and founder of YouTern, president of Switch and Shift and is a co-founder of ForwardHeroes.org.

policy, politics, rapid learning health systems

DoH command and control

 

What’s wrong with Health? Lessons from capability review

What’s wrong with Health? Lessons from capability review

by

15.12.2014

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DEPARTMENTSDepartment of Health

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The Department of Health has nowhere near the strategic policy capability it needs. While it has a strong track record of delivery, overworked and unappreciated staff need a break.

The Department of Health is a long way from where it needs to be, according to its recent capability review, which found it in dire need of the capacity to produce an overall strategic policy for Australia’s federated health system. That doesn’t come as a surprise to people who understand how the department works.

The process of developing a white paper on reform of the federation, the likelihood of the current fiscally restrained environment continuing and the High Court’s decision on the legitimacy of federally funded school chaplains — which could have implications for hospitals — are all listed as factors that presage a need for a transformation of the department and its role. The reviewers say the federation reform process, which progressed on Friday with the release of an issues paper on roles and responsibilities in health, is “a significant opportunity for the department to exercise strategic influence on future health system thinking and strategy”.

The department has been highly dependable when it comes to delivering on complex reforms and projects it has been tasked with, but the Australian Public Service Commission’s review team says its “strong focus on tactical, transactional and reactive delivery distracts from the development of a proactive, long-term and system-wide strategy”.

Of the 10 capabilities assessed, two are in urgent need of attention: there is almost nothing in place to motivate Health’s overworked and unappreciated staff, and it lacks an overarching “outcome-focused strategy”. UNSW associate professor of medicine and health policy expert Dr Tom Keating, who has considerable experience working with the department, says the review is “a pretty substantial indictment of the organisation”, but also a valuable tool for its leaders.

“I certainly think there is an issue there with overall strategic capacity.”

“I think it’s a very, very useful review, which I hope the department takes on board and responds to,” he told The Mandarin. “I certainly think there is an issue there with overall strategic capacity. They need that, and they also need leadership from government. Government needs to be interested in and be prepared to develop an overall strategic perspective on where they want to take health, and they’re not there now. To be fair, the last government, after their first year, wouldn’t have been anywhere near it either and they put in place processes to get there.”

It was the National Health and Hospitals Reform Commission, in which the Health Department was just one contributor, that ushered in the more “well-integrated overall policy framework”. “For instance,” said Keating, “the primary care policy of the last government was very well articulated, put together on the basis of really substantial consultation with the sector, and was highly supported.” He suggests the Coalition’s current lack of a coherent federal health policy might make the task of reforming the department even trickier.

“I suspect these things are quite deep-seated and they’re endemic to the organisation in a way, but some of it may be related to the current situation as far as government is concerned, because the current government doesn’t have a coherent, overall health policy — it deliberately went to the last election without one — and now its initiatives are piecemeal, unrelated and pretty incoherent,” said Keating. “So in a way, it’s not surprising that the department might be the same, but I think the review, while it’s been done within the last 12 months, probably reflects some deeper things within the department; that it’s not well-geared to develop a coherent, overall policy framework.”

The review found a need to “better connect sources of evidence across the organisation to support the development of a high-level whole-of-health-system view … in an increasingly contested policy environment” and that despite the establishment of a Strategic Policy Unit, “policy discussions are largely constrained within work silos”. The reviewers comment:

“There is broad acknowledgement that the growing prevalence of chronic disease, continued disparity in health outcomes, increasing citizen expectations and unsustainable long-term rate of growth of government health expenditure are some of the many challenges facing the health system. However, notwithstanding the existence of a Corporate Plan 2014–17, the department has not engaged with its authorising environment to help develop a high-level strategy to seek to address these and other systemic issues.”

Until the review, Health was apparently unaware that government and stakeholders expected it to come up with such an overarching strategic policy:

“The department maintains the belief that policy strategy is not sought by stakeholders or the Government. This view is not supported by evidence gathered as part of this review.”

The Department of Health is highlighted. According to the review: "Evidence demonstrates that high demand–low control workplaces face an elevated risk of ill health among employees."

Delivering services at all costs

On motivation, the review found employees “intrinsically” motivated by their own interest in working at Health, but little else. A very strong track record of delivery has come at a cost. Employees described a “results over people” culture and there is a widespread belief among the various staff and stakeholders interviewed for the review that it can’t go on this way:

“Going forward, many employees and stakeholders commented that the requirement to deliver at all costs on all commitments is increasingly unsustainable in an environment of declining resources. Employees report that they work long hours and under immense pressure to deliver. This is a workplace health and safety risk.”

The immense respect commanded by former secretary Jane Halton came through in the process, but there was criticism of the “command and control” leadership style in the department she led for 12 years. Interviewees variously described senior leaders as “risk averse, outwardly defensive and internally siloed”. Keating says “you can see that reflected from the outside”. The review cautions:

“While this approach may be appropriate in responding to a crisis or national emergency … its application in day-to-day management has resulted in the disempowerment and poor use of its workforce, reinforced vertical silos, limited corporate ownership and potentially hampered innovation.”

The reviewers heard that SES staff work extremely long hours, duplicating each other’s work due to inefficient systems and processes. As a consequence, executive level staff are in no hurry to join them in the upper echelon. As well, the report states that “employees at all levels have overwhelmingly reported that the Executive Leadership Team had zero tolerance for bad news or failure”:

“Employees reported they are fearful of making a mistake or failing to deliver. They report that that this has encouraged a departmental culture of compliance and self-censorship, influencing avoidance behaviours such as the escalation of decisions and a reluctance to report ‘red lights’.”

“My experience of working with the department,” said Keating, “mainly on policy and program review related work, is that it’s populated by a large number of young, highly intelligent, well motivated people, who know next to nothing about health and who move around fairly quickly. Down through the body of the organisation, that’s the sort of profile, and then higher in the organisation you’ve got people who tend to have been there a very long period of time, and so can lose that critical perspective on the organisation.

“So I think that there might be some organisational characteristics that contribute to the failure to identify these things as organisational risk.”

While the capability review process only began in 2011, Keating says the methodology is solid and its results can be relied on.

“When you’re in a department, it’s hard to see the broader view,” he added. “And one of the striking things for me is that — I’ve done a lot of work and a lot of my research around the functioning of complex organisations, and the things which are described here, such as an organisational culture which doesn’t sufficiently value people, a lack of overall strategic view, problems in governance, problems around managing risk; these are the hallmarks of large, complex organisations.

“This is not an unfamiliar thing but it’s so common with large, complex organisations, [that] if you were running one you would expect to have to address these issues. And the interesting thing for me is they seem not to have put in place strategies to address these as risks within their organisational framework.”

More at The Mandarin: Agency report cards: Health, A-G’s, Veterans’ Affairs review

data saving lives, EF, health market quality, policy, quantified self, rapid learning health systems

Creepy data

 

http://www.theguardian.com/technology/2014/dec/05/when-data-gets-creepy-secrets-were-giving-away

When data gets creepy: the secrets we don’t realise we’re giving away

We all worry about digital spies stealing our data – but now even the things we thought we were happy to share are being used in ways we don’t like. Why aren’t we making more of a fuss?
ben goldacre illustration data security
We have few sound intuitions into what is safe and what is flimsy when it comes to securing our digital lives – let alone what is ethical and what is creepy. Photograph: Darrel Rees/Heart Agency for the Guardian

Ben Goldacre

But these are straightforward failures of security. At the same time, something much more interesting has been happening. Information we have happily shared in public is increasingly being used in ways that make us queasy, because our intuitions about security and privacy have failed to keep up with technology. Nuggets of personal information that seem trivial, individually, can now be aggregated, indexed and processed. When this happens, simple pieces of computer code can produce insights and intrusions that creep us out, or even do us harm. But most of us haven’t noticed yet: for a lack of nerd skills, we are exposing ourselves.

At the simplest level, even the act of putting lots of data in one place – and making it searchable – can change its accessibility. As a doctor, I have been to the house ofa newspaper hoarder; as a researcher, I have been to the British Library newspaper archive. The difference between the two is not the amount of information, but rather the index. I recently found myself in the quiet coach on a train, near a stranger shouting into her phone. Between London and York she shared her (unusual) name, her plan to move jobs, her plan to steal a client list, and her wish that she’d snogged her boss. Her entire sense of privacy was predicated on an outdated model: none of what she said had any special interest to the people in coach H. One tweet with her name in would have changed that, and been searchable for ever.

An interesting side-effect of public data being indexed and searchable is that you only have to be sloppy once, for your privacy to be compromised. The computer program Creepy makes good fodder for panic. Put in someone’s username from Twitter, or Flickr, and Creepy will churn through every photo hosting service it knows, trying to find every picture they’ve ever posted. Cameras – especially phone cameras – often store the location where the picture was taken in the picture data. Creepy grabs all this geo-location data and puts pins on a map for you. Most of the time, you probably remember to get the privacy settings right. But if you get it wrong just once – maybe the first time you used a new app, maybe before your friend showed you how to change the settings – Creepy will find it, and your home is marked on a map. All because you tweeted a photo of something funny your cat did, in your kitchen.

medical records

Pinterest
Many people will soon be able to access their full medical records online – but some might get some nasty surprises. Photograph: Sean Justice/Getty

Some of these services are specifically created to scare people about their leakiness, and nudge us back to common sense: PleaseRobMe.com, for example,checks to see if you’re sharing your location publicly on Twitter and FourSquare (with sadistic section headings such as “recent empty homes” and “new opportunities”).

Some are less benevolent. The Girls Around Me app took freely shared social data – intended to help friends get together – and repurposed it for ruthless, data-driven sleaziness. Using FourSquare and Facebook data, it drew neat maps with the faces of nearby women pasted on. With your Facebook profile linked, I could research your interests before approaching you. Are all the women visible on Girls Around Me willingly consenting to having their faces mapped across bars or workplaces or at home – with links to their social media profiles – just by accepting the default privacy settings? Are they foolish to not foresee that someone might process this data and present them like products in a store?

But beyond mere indexing comes an even bigger new horizon. Once aggregated, these individual fragments of information can be processed and combined, and the resulting data can give away more about our character than our intuitions are able to spot.

Last month the Samaritans launched a suicide app. The idea was simple: they monitor the tweets of people you follow, analyse them, and alert you if your friends seem to be making comments suggestive of very low mood, or worse. A brief psychodrama ensued. One camp were up in arms: this is intrusive, they said. You’re monitoring mood, you need to ask permission before you send alerts about me to strangers. Worse, they said, it will be misused. People with bad intentions will monitor vulnerable people, and attack when their enemies are at their lowest ebb. And anyway, it’s just creepy. On the other side, plenty of people couldn’t even conceive of any misuse. This is clearly a beneficent idea, they said. And anyway, your tweets are public property, so any analysis of your mood is fair game. The Samaritans sided with the second team and said, to those worried about the intrusion: tough. Two weeks later they listened, and pulled the app, but the squabble illustrates how much we can disagree on the rights and wrongs around this kind of processing.

The Samaritans app, to be fair, was crude, as many of these sites currently are:analyzewords.com, for example, claims to spot personality characteristics by analysing your tweets, but the results are unimpressive. This may not last. Many people are guarded about their sexuality: but a paper from 2013 [pdf donwload] looked at the Facebook likes of 58,000 volunteers and found that, after generating algorithms by looking at the patterns in this dataset, they were able to correctly discriminate between homosexual and heterosexual men 88% of the time. Liking “Colbert” and “Science” were, incidentally, among the best predictors of high IQ.

Sometimes, even when people have good intentions and clear permission, data analysis can throw up odd ethical quandaries. Recently, for example, the government has asked family GPs to produce a list of people they think are likely to die in the next year. In itself, this is a good idea: a flag appears on the system reminding the doctor to have a conversation, at the next consultation, about planning “end of life care”. In my day job, I spend a lot of time working on interesting uses of health data. My boss suggested that we could look at automatically analysing medical records in order to instantly identify people who are soon to die. This is also a good idea.

But add in one final ingredient and the conclusion isn’t so clear. We are entering an age – which we should welcome with open arms – when patients will finally have access to their own full medical records online. So suddenly we have a new problem. One day, you log in to your medical records, and there’s a new entry on your file: “Likely to die in the next year.” We spend a lot of time teaching medical students to be skilful around breaking bad news. A box ticked on your medical records is not empathic communication. Would we hide the box? Is that ethical? Or are “derived variables” such as these, on a medical record, something doctors should share like anything else? Here, again, different people have different intuitions.

shopping centre

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Many shopping centres can now use your mobile data to track you as you walk from shop to shop. Photograph: Christian Sinibaldi/Guardian

Then there’s the information you didn’t know you were leaking. Every device with Wi-Fi has a unique “MAC address”, which is broadcast constantly as long as wireless networking is switched on. It’s a boring technical aspect of the way Wi-Fi works, and you wouldn’t really care if anyone saw your MAC address on the airwaves as you walk past their router. But again, the issue is not the leakiness of one piece of information, but rather the ability to connect together a thread. Many shops and shopping centres, for example, now use multiple Wi-Fi sensors, monitoring the strength of connections, to triangulate your position, and track how you walk around the shop. By matching the signal to the security video, they get to know what you look like. If you give an email address in order to use the free in-store Wi-Fi, they have that too.

In some respects, this is no different to an online retailer such as Amazon tracking your movement around their website. The difference, perhaps, is that it feels creepier to be tracked when you walk around in physical space. Maybe you don’t care. Or maybe you didn’t know. But crucially: I doubt that everyone you know agrees about what is right or wrong here, let alone what is obvious or surprising, creepy or friendly.

It’s also interesting to see how peoples’ limits shift. I felt OK about in-store tracking, for example, but my intuitions shifted when I realised that I’m traced over much wider spaces. Turnstyle, for example, stretches right across Toronto – a city I love – tracing individuals as they move from one part of town to another. For businesses, this is great intelligence: if your lunchtime coffeeshop customers also visit a Whole Foods store near home after work, you should offer more salads. For the individual, I’m suddenly starting to think: can you stop following me, please? Half of Turnstyle’s infrastructure is outside Canada. They know what country I’m in. This crosses my own, personal creepiness threshold. Maybe you think I’m being precious.

There is an extraordinary textbook written by Ross Anderson, professor of computer security at University of Cambridge. It’s called Security Engineering, and despite being more than 1,000 pages long, it’s one of the most readable pop-science slogs of the decade. Firstly, Anderson sets out the basic truisms of security. You could, after all, make your house incredibly secure by fitting reinforced metal shutters over every window, and 10 locks on a single reinforced front door; but it would take a very long time to get in and out, or see the sunshine in the morning.

Digital security is the same: we all make a trade-off between security and convenience, but there is a crucial difference between security in the old-fashioned physical domain, and security today. You can kick a door and feel the weight. You can wiggle a lock, and marvel at the detail on the key. But as you wade through the examples in Anderson’s book – learning about the mechanics of passwords, simple electronic garage door keys, and then banks, encryption, medical records and more – the reality gradually dawns on you that for almost everything we do today that requires security, that security is done digitally. And yet to most of us, this entire world is opaque, like a series of black boxes into which we entrust our money, our privacy and everything else we might hope to have under lock and key. We have no clear sight into this world, and we have few sound intuitions into what is safe and what is flimsy – let alone what is ethical and what is creepy. We are left operating on blind, ignorant, misplaced trust; meanwhile, all around us, without our even noticing, choices are being made.

• Ben Goldacre’s new book, I Think You’ll Find It’s a Bit More Complicated Than That, is published by Fourth Estate. Buy it for £11.99 at bookshop.theguardian.com

Topics

data saving lives, EF, health market quality, healthy habits, nutrition, research methodology

Jeffrey Braithwaite on Microlifes and Micromorts

Punchy.

http://www.jeffreybraithwaite.com/new-blog/2014/11/20/youll-be-dying-to-hear-about-this

You’ll be dying to hear about this

There’s lots of death in the world. Transport is risky, for instance—planes, automobiles, trains and ships can crash, maiming or killing passengers. You don’t have to go much further than seeing the road toll, or hearing about Malaysian Airlines Flight MH17 shot down over the Ukraine, or watching the TV scenes of the Costa Concordia, run aground just off Isola del Giglio near the coast of Italy, to appreciate that death is never far away.

Then there’s infectious diseases. You can all-too-readily catch a cold, or the flu, or TB, or lately, the Ebola virus. And there seem to be never-ending wars and skirmishes in the Middle East; and terror, spread by fundamentalists.

Each of these, depending on fate, can hasten someone’s demise. Wrong place, wrong time, wrong circumstances.

Lifestyle issues can cause problems for your risk profile too—but these are slower, and more stealthy. Think of smoking, drinking too much, eating yourself into a coma or just gross obesity, or the more insidious dangers of sitting at a computer for years on end with little exercise. These can translate over time into heart or lung disease, diabetes, and cancer.

Whether you are active or passive, things you do or don’t do can shorten your lifespan, or kill you a little or a lot faster than you would otherwise last. So what levels of risk do you actually, quantitatively, face in your own life?

*****

Stanford University decision scientist Ron Howard in the 1970s presented a novel way to calculate this risk. He introduced the idea of the micromort, defined as a one-in-a-million likelihood of death.  This is such an evocative unit of measurement that it deserves a little further attention.

If you live in the US or another relatively rich, OECD-style country, with good law and order, legislation that keeps society relatively risk free (such as with environmental and public health issues sorted out, effective building codes, and so forth), a well-educated population, access to health care, and a buoyant GDP, you can expect a micromort of one on any particular day. Another way of saying this is that’s the standard expected death rate for any individual today in any one 24 hour period: a microprobability of one in a million is your index of baseline risk.

These are great odds for you, today, as you read this; you are very likely to get through it. Congratulations if you do.

What circumstances lead to an elevated risk? Say if you do dangerous things or even just live life to the full? How does your micromort level get upgraded?

In the United States, you accumulate an extra 16 micromorts each time you ride a motorcycle 100 miles, for instance. Or 0.7 micromorts are added for each day you go skiing; so go for a week and you’ve added five more.

Or you might decide to do something a little more strenuous. With hangliding, the additional risk of dying equates to eight micromorts per flight; or skydiving, nine per freefall.

They are relatively benign compared to moving up to base-jumping. Do so, and you rapidly earn many more risk points: 430 micromorts per jump, in fact.

Marathon running, anyone? That will be seven micromorts to your debit account for each run. Even walking 17 miles adds one micromort, as does a 230 mile car trip, and add another one for every 6,000 mile train trip. But the puzzle is, it’s not always clear how to treat these: the walking introduces an element of risk (you could be out and about and get run over, or be struck by lightning) but it’s also beneficial (it contributes to improved health).

Perhaps even more interesting, there are microprobabilities associated with accumulated chronic risks in contrast to these other single-shot event risks. These are lifestyle choices and behaviors that incrementally add a little more risk through exposure. They won’t kill you if you have bad luck on a given day, but will slowly have an effect—and may claim you in the end.

Every half a liter of wine exposes you to a micromort because it can accrue into cirrhosis of the liver. Each one and a half cigarettes does the same, but the menace here is cancer or heart disease. Even eating 100 char-broiled steaks, 40 tablespoons of peanut butter or 1,000 bananas sneaks up on you in the form, respectively, of cancer risk from benzopyrene, liver cancer risk from aflatoxin B or cancer risk from radioactive potassium-40.

*****

Hang on though. I doubt I’ve done much to help anyone.

Because a clear problem is that people aren’t very good at doing these kinds of statistics, or applying them to their own lives—and are even less capable of acting on them. We can readily appreciate that skiing or motorcycling add some risk for the time you are doing them compared to the everyday activities of being at work or hanging out at home, yet many people are undeterred. People even cheerfully find ways of taking on more risk, such as by climbing Everest, driving fast cars, or having unsafe sex.

Everyone knows about that steadily accumulated risk, too: not too many of us are blind to the fact that drinking too much alcohol can lead to liver disease or smoking to lung cancer over time. And although both have been falling for decades, this hasn’t stopped millions of people indulging. There’s 42.1 million US smokers at last count, or 18.1% of the population, and on average each adult US citizen consumes 8.6 liters of alcohol annually.

This is not the best performance internationally but is by no means high by international standards, and Eastern Europeans smoke more heavily, and really give hard booze like vodka a nudge.  Nevertheless, both activities contribute to what public health people quaintly call excess deaths and the rest of us know by “their drinking or smoking (or both) killed them eventually.”

But what does it actually mean that you expose yourself to increased risk if you go out walking regularly or eat bananas?  We need another way of looking at this, because it’s too hard to do the sums.

*****

Enter the University of Cambridge medical statistician David Spiegelhalter and his colleague Alejandro Leiva who invented the idea of a microlife. This is another unit of risk which has the calculation built in for you. It is half an hour of your life.

If you increase your risk by one micromort, then this shortens your life by half an hour. These calculations apply to people on average, and work out for entire populations, but any one of us might be lucky or unlucky, depending on our individual characteristics. Any particular risk doesn’t convert exactly to the specific individual. But with enough people in the US (beyond 316 million now) and on the planet (7 billion and rising), there’s a relentlessness accuracy about the statistics.

So now let’s do some life expectancy math with Spiegelhalter. Smoke a pack a day? You lose up to five hours a day. Accumulated, that’s up to eight years off your life. Have six drinks a day and that binge costs you one half hour allocation—a shortened life by ten months or so. Stay eleven pounds overweight and you sacrifice half an hour every day you do so (another ten months across your lifespan), as you do if you watch TV for two hours. Your coffee habit at 2-3 cups daily takes away another half hour lot. So does every portion of red meat each day. Another ten months each time.

It’s not all negative. There’s good news. Eat five serves of fruit and vegetables every day and you gain up to a couple of hours each time. You get three years back. Exercise and the first 20 minutes per day earns you a surprising hour (there’s a good investment—a year and a half), and each subsequent 40 minutes adds up to one more half hour bonus to your credit (a bit more work but that seems a pretty good deal, too, to get a ten month return).

If you have a hobby, activity or diet and it’s not been dealt with so far, you can fill in some of the gaps with some good guesstimates. Do you have passive pursuits, akin to watching TV? This is a net deficit. Do you do active, exercise-oriented activities, such as weekly amateur netball, soccer, bowling or basketball—or just walking regularly? Add some lifespan.

These half hour allocations alter somewhat depending on your genetics of course (you can have lucky or unlucky genes) or your socioeconomic status (wealthy people typically live longer than poorer folks) or your gender (women on the whole live longer than men). That said, with this idea you are now able to alter your risk profile by changing your behavior with a tangible, calculable return.

*****

There’s a punchline to this, and it may be already occurring to you as you reflect on your own lifestyle and lifespan. There are a million microlives in fifty seven years of existence. That, for many of us, is roughly the adult allocation.

Let’s call that your life expectancy baseline. We can assume that you have had a reasonably healthy childhood (not so for everyone, of course, but true for many US children, and true for most readers). Then, from that point on, a large part of your healthy adult life is now measureable.

So: come out of your teens, reach your 21st birthday, and as the “jolly good fellow” and “happy birthday to you” songs subside, imagine you then have 57 years to go. That is, you have an allocation of 78 years in total, maybe a little longer, maybe a little shorter.

Yes, all sorts of unexpected things might happen along the way, but to some degree your lifespan is now no longer vague, but quantifiable. The actual life expectancy in the US indeed hovers around this: it’s 79.8 years overall, 77.4 for males and 82.2 for females. (It’s higher in some northern European countries and Japan, but that’s a story for another day).

However, you might be reading this thinking: Yikes. I’m not 21: I’m a bit older than that. In this case, you’ve already used up a proportion of your time left. Console yourself. At least you got through the riskiest stage of all: being a baby, up to one year of age, and childhood, up to six or so, when many things can go wrong.

But have you used what you were given so far, well? Or do you have a fair bit of regret?

To make an obvious point, however, this isn’t Doctor Who. You don’t have a Tardis to go back in time and fix the past. So stop any lamentations. Look forward.

By now, if you’ve come to value more readily each half hour and especially the cumulative effect of your lifestyle choices to date, don’t listen to me preaching. Feel completely empowered. You know what to do and how to alter your own numbers.

Now, all that’s left is to do the math. You’ll have a much clearer picture of your life and potential death than ever before. It’s your move: what’s next?

Further reading

Blastland, Michael and Spiegelhalter, David (2014). The Norm Chronicles: Stories and Numbers About Danger and Death. New York: Basic Books.

Howard, Ronald (1984). On fates comparable to death. Management Science 30 (4): 407–422.

Spiegelhalter, David (2012). Using speed of ageing and “microlives” to communicate the effects of lifetime habits and environment. British Medical Journal 345: e8223.

Spiegelhalter, David (2014). The power of the MicroMort. BJOG: An International Journal of Obstetrics & Gynaecology 121 (6): 662–663.

EF, health market quality, policy

FBI employing analytics in healthcare fraud investigations

 

http://www.fiercehealthpayer.com/antifraud/story/data-analysis-adds-new-dimension-old-school-fraud-investigations/2015-01-13

Data analysis adds new dimension to old-school fraud investigations

Billing data has become a useful tool in detecting hints of healthcare fraud, and then leading investigators in the right direction
January 13, 2015 | By

In 2010, the FBI organized an undercover sting of a Brooklyn medical clinic that was suspected of Medicare fraud. Agents installed a hidden camera in an air conditioning vent and watched employees pay kickbacks to patients in exchange for Medicare identification numbers, which they used to bill Medicare $50 million in fraudulent claims.

Agents eventually arrested 16 people in connection with the scheme and used the video evidence, along with audio and video from wired elderly clients, in their prosecution. However, it was data analytics that led them to the Brooklyn clinic in the first place, according to The Times.

Data analytics has helped investigators build cases and uncover fraud faster and easier, particularly in areas such as Detroit and Miami that have been hotspots for fraud schemes. In some cases, data mining has helped stop fraud even before criminal charges come to light.

“The idea of using real-time data to generate fraud cases is unique,” Leslie Caldwell, chief of the Department of Justice (DOJ) criminal division, told the newspaper.  “We have the ability to suspend–[when] there’s reasonable suspicion–[those] who are engaged in fraud even before they are prosecuted and indicted.”

The article points to the recruitment of Kirk Ogrosky, who spent time as a federal prosecutor in Miami. In 2006, the DOJ asked him to head the healthcare unit. Ogrosky accepted on the condition that the agency would “rethink the way they prosecute healthcare fraud, with an emphasis on real-time prosecutions.” Ogrosky began by searching for postal codes in which patient spending was three or four times the national average, and then employing old-school detective tactics to further the investigation.

“Most times, those zip codes would help generate a list of providers that had what I would call ‘medically impossible’ claims,” he told The Times. “[It was] like peeling an onion ring by ring–and yes, it always burnt my eyes at some point.”

Data analytics have since been used to uncover schemes related to chemotherapy drugs, home healthcare, and durable medical equipment. In Indiana, data-driven investigations have saved the state $85 million. FierceHealthPayer: AntiFraud previously reported on predictive models and algorithms such as the government’s Fraud Prevention System (FPS), which has led to more than $50 million in actual and projected savings in two years.

For more:
– read The Financial Times article

data saving lives, EF, entrepreneurship, health market quality, healthcare, rapid learning health systems

Health Analytics Intrapreneurial JV

Teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Extrapreneurial energy turns intrapreneurial analytics initiatives into companies in which healthcare enterprises retain some equity, remain customers, and benefit other healthcare enterprises who wish to purchase analytics technology and services.

Involves a definitive ten-year agreement valued at more than $100 million, to combine technologies, some of which Allina developed since becoming the first customer of Health Catalyst technology in 2008.

“We have a lot of confidence in our partner in Health Catalyst. Eighty percent of that [$100 million] is standard, but 20% of it is at risk, based on how we perform on key indicators, like how well the tools perform, for example, on reducing readmissions or unnecessary admissions for people who can spend nights in their own bed.

Wheeler says use of Health Catalyst technology has permitted Allina clinicians to significantly reduce readmissions, elective inductions of labor, time required to diagnose breast concerns, and sepsis rates.

http://www.healthleadersmedia.com/print/TEC-312328/Allina-Health-and-Health-Catalysts-Unusual-Deal

Allina Health and Health Catalyst’s Unusual Deal

Scott Mace, for HealthLeaders Media , January 20, 2015

Teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Follow the money, they say. It’s not always easy. “Terms of the transaction were not disclosed” is the common coin of many a deal. But despite this, some deals are harbingers of bigger things.

To make my point, I will appropriate a word: extrapreneur. It’s a word that you won’t find in most dictionaries. In 1992, the American Heritage Dictionary defined intrapreneur as “a person within a large corporation who takes direct responsibility for turning an idea into a profitable finished product through assertive risk-taking and innovation.”

So what’s an extrapreneur? One suggestion from England: Someone who shares information among organizations that they wouldn’t share among themselves.

That’s a good place to start when trying to understand what is occurring at Cleveland Clinic, Geisinger Health System, and, most recently, Allina Health, where teams building analytics technology for healthcare organizations find themselves jointly holding intellectual property and equity in new arrangements not seen before in healthcare.

Extrapreneurial energy turns intrapreneurial analytics initiatives into companies in which healthcare enterprises retain some equity, remain customers, and benefit other healthcare enterprises who wish to purchase analytics technology and services.

The term extrapreneurial also reminds me of extranets, the early e-commerce concept that extended intranets (internal TCP/IP-based corporate networks) to business partners as supply chains started being built when the World Wide Web was young.

In 2009, Cleveland Clinic’s extrapreneurial initiative spawned Explorys, an analytics platform which now counts numerous large healthcare systems among its clients. Yet, for quite some time, Explorys remained located on the Cleveland Clinic campus. And Cleveland Clinic remains an investor.

Geisinger created xG Health “to bring Geisinger’s expertise in healthcare delivery transformation to organizations nationwide,” according to xG’s Web site. xG describes itself as the primary provider of Geisinger’s health performance improvement intellectual property.

Launched in 2013 with $40 million of financing from venture capital partner Oak Investment Partners, and located in Columbia, Maryland, xG is not far from Geisinger’s Pennsylvania base of operations.

Allina and Health Catalyst
Then, on January 6, Allina Health joined the extrapreneurial ranks. A few terms of the agreement are intriguing the entire analytics industry. Allina took an undisclosed stake in analytics firm Health Catalyst.

Health Catalyst had just come off an impressive year, having raised $41 million in funding in January 2014, and convening a conference of its own rapidly-growing healthcare system analysts last fall in Salt Lake City, where the company is located.

But back to those interesting terms between Allina and Health Catalyst. It’s a definitive ten-year agreement valued at more than $100 million, to combine technologies, some of which Allina developed since becoming the first customer of Health Catalyst technology in 2008.

Once a year, a governing committee of the Allina / Health Catalyst partnership will identify a prioritized list of improvement projects, each designed to provide measurable care improvement and financial value to Allina. As the partnership achieves each goal, both partners will share in the benefits of that success.

The deal also means that Allina is outsourcing its data warehousing, analytics, performance improvement technology, content, and personnel to Health Catalyst to accelerate advances. Beginning this month, in phases, Allina employees working in these areas—some 60 in all—will become onsite Health Catalyst team members.

When you have a partnership of this magnitude, extrapreneurial forces also allow each partner to remain agile rather than locked into an arrangement that has the possibility of souring due to the changing vicissitudes of technology and healthcare.

The $100 million represents the cost of what the staff and tools were costing Allina, says Penny Wheeler, MD, president and CEO of Allina Health, a $3.7 billion not-for-profit organization whose more than 90 clinics, 12 hospitals, and related healthcare services provide care for nearly 1 million people across Minnesota and western Wisconsin.

Use the Best Tool
“We weren’t falling back on hope as a strategy,” Wheeler says. “We have a lot of confidence in our partner in Health Catalyst. Eighty percent of that [$100 million] is standard, but 20% of it is at risk, based on how we perform on key indicators, like how well the tools perform, for example, on reducing readmissions or unnecessary admissions for people who can spend nights in their own bed.

Wheeler says use of Health Catalyst technology has permitted Allina clinicians to significantly reduce readmissions, elective inductions of labor, time required to diagnose breast concerns, and sepsis rates.

“Our agreement with Health Catalyst says that if we find a better tool out there, we can use it,” she says. “So, for example, if [Epic analytics software] Cogito excels at the capabilities that we work with, then we use that,” she says.

“So it’s more about what can you use the best to improve care than any exclusivity. That just speaks to the confidence level we both have in our ability to partner and make things better, despite what else is out in the market.

“I’m pretty confident that we’re going to have a ten-year agreement and beyond,” Wheeler says.

“The margins in healthcare right now are so razor-thin, and that’s pretty apparent at Allina, given some of their recent financials. But they want to be able to create a little bit of a for-profit business around this core competency they’ve built in terms of managing their clinical performance with IT, which is what’s going on here,” notes Judy Hanover, research director of provider IT transformation at IDC Health Insights.

In the era of extrapreneurs, it’s all part of doing business.

Scott Mace is senior technology editor at HealthLeaders Media.

complex adaptive systems, data saving lives, EF, health market quality, healthcare, healthy habits, rapid learning health systems

Population Health: A riddle wrapped in an enigma

PN: The health sector is very happy to take full responsibility for the health of the population for as long as substantial monies are tied to that claim. The moment the health sector is asked to account for it, they get nervous.

Tying funding to value is a terrifying prospect for the health sector as having to account for the benefit they deliver would inevitably lead to a diminution in income and status.

“Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.”

http://www.modernhealthcare.com/article/20150108/BLOG/301089997/population-health-improvement-still-a-riddle-wrapped-in-an-enigma

Population health improvement still a riddle wrapped in an enigma

By Melanie Evans  | January 8, 2015
Population Health
New England Journal of Medicine
The push to invest more of the healthcare industry’s time and money into promoting good health is, so far, uneven and uncertain in terms of effectiveness. Perhaps nowhere is that more apparent than in federal initiatives to broadly improve health by extending care beyond clinics and pharmacies into neighborhoods and homes.Federal funding for population-health efforts—the management of health and medical care for an entire group of patients or a community—has expanded under the Affordable Care Act. It’s included financing for states and providers to experiment with ways to better coordinate healthcare and other needs that affect health, such as housing and transportation. But the initiatives are not without risk or challenges, a point three federal officials underscored in the latest issue of the New England Journal of Medicine.

Efforts are still underway to identify what works and how to make widespread use of the most effective strategies, write Dr. William Kassler, Naomi Tomoyasu and Dr. Patrick Conway of the agency that oversees Medicare and Medicaid. The CMS Innovation Center, in a report to Congress last month, also said results were largely not yet available for nearly two dozen initiatives to bolster population health, improve quality and increase efficiency in healthcare, financed with $2.6 billion through last year.

Calculating a dividend from those investments presents another challenge, the trio wrote. Kassler is one of the CMS’ chief medical officers; Tomoyasu is deputy director of the prevention and population health care models group within the CMS Innovation Center; and Conway is the CMS’ deputy administrator for innovation and quality.

The return on any investment in prevention will necessarily take time, raising the risk that “current actuarial methods used to evaluate return on investment may underestimate potential savings,” they warned.

Investment at the federal level is not small. Medicare and Medicaid—which combined account for $1 of every $3 the nation spends on healthcare—have increasingly poured money into strategies for disease prevention and health promotion.

Those strategies extend the reach of healthcare beyond hospitals, clinics and pharmacies into neighborhoods, homes and schools. Such extended investment can include help with housing, transportation, literacy, day care and groceries, the officials wrote.

But with that expanded reach comes a debate “regarding the specific population-based activities that fall within healthcare providers’ scope of practice,” wrote the CMS officials. “Because so many factors lie outside clinicians’ control, we need to understand what factors the healthcare system can reasonably be expected to act on, given professionals’ training, infrastructure and scope of practice,” they said. “We also need to determine the appropriate levels of health system accountability for population health outcomes.”

Follow Melanie Evans on Twitter: @MHmevans