Economist: eat steak and cream

http://www.economist.com/news/books-and-arts/21602984-why-everything-you-heard-about-fat-wrong-case-eating-steak-and-cream?fsrc=scn/fb/te/pe/ed/steakandcream

Healthy eating

The case for eating steak and cream

Why everything you heard about fat is wrong

The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. By Nina Teicholz. Simon & Schuster; 479 pages; $27.99. Buy from Amazon.com, Amazon.co.uk

“EATING foods that contain saturated fats raises the level of cholesterol in your blood,” according to the American Heart Association (AHA). “High levels of blood cholesterol increase your risk of heart disease and stroke.” So goes the warning from the AHA, the supposed authority on the subject. Governments and doctors wag their fingers to this tune the world over. Gobble too much bacon and butter and you may well die young. But what if that were wrong?

The case against fat would seem simple. Fat contains more calories, per gram, than do carbohydrates. Eating saturated fat raises cholesterol levels, which in turn is thought to bring on cardiovascular problems. Ms Teicholz dissects this argument slowly. Her book, which includes well over 100 pages of notes and citations, covers decades of nutrition research, including careful explorations of academics’ methodology. This is not an obvious page-turner. But it is.

Ms Teicholz describes the early academics who demonised fat and those who have kept up the crusade. Top among them was Ancel Keys, a professor at the University of Minnesota, whose work landed him on the cover of Time magazine in 1961. He provided an answer to why middle-aged men were dropping dead from heart attacks, as well as a solution: eat less fat. Work by Keys and others propelled the American government’s first set of dietary guidelines, in 1980. Cut back on red meat, whole milk and other sources of saturated fat. The few sceptics of this theory were, for decades, marginalised.

But the vilification of fat, argues Ms Teicholz, does not stand up to closer examination. She pokes holes in famous pieces of research—the Framingham heart study, the Seven Countries study, the Los Angeles Veterans Trial, to name a few—describing methodological problems or overlooked results, until the foundations of this nutritional advice look increasingly shaky.

The opinions of academics and governments, as presented, led to real change. Food companies were happy to replace animal fats with less expensive vegetable oils. They have now begun abolishing trans fats from their food products and replacing them with polyunsaturated vegetable oils that, when heated, may be as harmful. Advice for keeping to a low-fat diet also played directly into food companies’ sweet spot of biscuits, cereals and confectionery; when people eat less fat, they are hungry for something else. Indeed, as recently as 1995 the AHA itself recommended snacks of “low-fat cookies, low-fat crackers…hard candy, gum drops, sugar, syrup, honey” and other carbohydrate-laden foods. Americans consumed nearly 25% more carbohydrates in 2000 than they had in 1971.

In the past decade a growing number of studies have questioned the anti-fat orthodoxy. Ms Teicholz’s book follows the work of Gary Taubes, a science journalist who has cast doubts on the link between saturated fat and health for well over a decade—and been much disparaged for his pains. There is increasing evidence that a bigger culprit is most likely insulin, a hormone; insulin levels rise when one eats carbohydrates. Yet even now, with more attention devoted to the dangers posed by sugar, saturated fat remains maligned. “It seems now that what sustains it,” argues Ms Teicholz, “is not so much science as generations of bias and habit.”

Bloomberg: Omada Health Pitch

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

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

Transcript:

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

What is digital therapeutics?

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

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

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

That is what we do.

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

Is that the idea — lose weight, quit smoking?

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

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

Is that the case?

That is the idea.

It can help people proven at risk for type two.

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

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

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

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

What is the future of this company?

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

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

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

My passion has always been tech plus health care.

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

$23 million?

What’s next?

Next for us is working with customers.

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

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

What are the barriers?

We do have competition.

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

It is incredibly complex.

But so far, so good.

We want competition.

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

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

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

I wonder about results.

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

The first is in the world of behavioral medicine.

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

Diabetes is obviously a huge and growing problem.

I am certainly at risk for it.

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

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

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

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

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

Thanks very much.

HBR: What the Insurance Industry Can Do to Fix Health Care

PHI driven implementation of value based health care…

https://hbr.org/2014/12/what-the-health-insurance-industry-can-do-to-fix-health-care

What the Insurance Industry Can Do to Fix Health Care

DECEMBER 23, 2014

Health insurance companies are uniquely positioned to save the day in our ailing health system. Yes, you heard me correctly: health insurers.

Health insurers — or “payers” — are reviled nearly universally. Confused by “explanation of benefits” forms and denials of coverage and frustrated by rising deductibles, co-pays, and costs of care, consumers rank their experiences with health insurers below those with cable companies and internet service providers. Physicians and other care providers — who are constantly negotiating price of services and filling out piles of paperwork — don’t like payers much either.

All this makes insurers unlikely heroes. But we need someone to cut through the complexity of the current system, demand true value from providers, and create better options for consumers. Insurers increasingly look like the folks who can do the job and reinvent their business at the same time.

How? They can use their market power (they direct the bulk of health care dollars) and understanding of different consumer segments to create innovative products, services, and partnerships that address consumers’ needs. In the process, they can help move us all toward a low-cost, value-based health care system. Here are some specific ideas on what payers could do:

Act as true partners to value-based providers. Most payers today are piloting new economic models that pay providers not for the services they provide but for the value they create. Most, however, are neglecting a key opportunity: helping providers change their operating model. To succeed in value-based care, providers need data, analytics, smart clinical-care teams, and managerial support. Insurers are well-positioned to provide all this. They can also help providers become more efficient and assist them in navigating the tricky financial transition from fee-for-service to fee-for-value economics. Most important, insurers can help the very best provider organizations succeed by using them as the core of attractive, competitively priced insurance products.

Offer options for low-cost, convenient care. One area of waste in health care is the use of physician offices and hospital emergency departments to treat minor conditions such as sore throats, urinary infections, and allergies. Payers can make it easy for their members to get care 24/7 in more appropriate settings by partnering with retail, urgent care clinics, and telehealth providers. They can also offer the data connectivity needed to keep the consumer’s primary care provider in the loop. Oscar, the New York health insurance company launched last year, received fanfare in the press over its sleek offering, which includes unlimited phone and video calls with physicians and a “doctor on call” service that provides prescriptions by phone or e-visits. A number of retail pharmacy chains are also actively pursuing retail health and wellness clinics in stores to boost growth.  Walmart has been piloting low-cost care clinics offering a $40 office visit that could dramatically reset the cost bar if scaled broadly.

Cover new wellness- and prevention-oriented treatments. Such options can serve as effective adjuncts to traditional benefits and encourage the trend toward more self-care. Aetna, for example, has offered mindfulness and yoga training to 6,000 of its employees. Its research shows that lower employee stress improved productivity by 69 minutes per week and gave an 11:1 return on investment. Similarly, articles in The New York Times, TIME, Scientific American, JAMA, and The Huffington Post cite growing evidence of the efficacy of meditation programs.

Explode the PPO model. Today the gold standard for health insurance is a preferred provider organization, a huge collection of doctors assembled to provide something for everyone but no special benefit to anyone. Insurers can do a better job for consumers and create real value by developing hassle-free mass customization. In this new model, consumers can choose from lifestyle-based curated options that offer trade-offs across risk level, health-savings options, primary-care models, alternative networks, network breadth, coaching and navigation programs, rewards programs, contract length, and incentive structures. Transparency tools and crowd-sourced reviews will spotlight value and multi-modal coordinated care delivery (think care teams that seamlessly work with telehealth providers, health coaches, and retail clinics) will help cut costs considerably. Consumers will be able to trade their own health engagement into benefit dollars and rewards that they can use seamlessly. While true à la carte insurance customization is not yet a reality, private exchange platforms are starting to provide a stepping stone to get there. For example, Maxwell Health, a new private exchange platform, presents a beautiful interface with lifestyle-focused packages that make product selection simple and tailored for you.

Sell convenience and personalized service. Most health care could hardly be less convenient. Now that consumers have unprecedented purchasing power (rise of public and private exchanges) and bear unprecedented costs (mounting high deductibles and premiums), they expect iPhone-like service. There is tremendous opportunity for payers to make the health care experience simpler and more supportive with online appointment scheduling, clear data and reviews, personalized suggestions, navigation apps with predictive decision support, reward programs, peer-to-peer support, and many other tools. Making the consumer experience better is smart for payers too. They can build stickier consumer relationships and generate new opportunities to address consumers’ growing health and lifestyle needs.

Power healthy behavior change. Some 50% of the determinants of health are driven by lifestyle and personal behaviors. Changing people’s behavior is a tall order but is necessary to improve health care. There are already examples of innovators that are succeeding, such as Omada Health with weight loss for pre-diabetics and Zipongo with healthy eating. We’ve only begun to deploy behavioral science, advanced wearable/monitoring technologies, and machine learning to understand the behaviors and motivations of different groups to predict and prevent acute events and connect people with the solutions that work best for them.

Serve as the bridge between new tools and consumers. In the first half of 2014,venture capital investment in digital health grew by 176%, spawning new consumer-centric companies with interesting approaches to consumer health. But there’s a chasm between these unscaled point solutions and the consumers who could use them. Payers can bridge the gap, using Amazon-style analytics and personalization to better understand consumer types and then connect them at the right place and time to the best-suited offerings. Better yet, payers don’t need to build the bridge themselves: A growing set of powerful consumer-engagement platforms (e.g., WellTok and Optum’s Rally) are moving along this path.

Payers have economic incentives to do everything I’ve described. The Affordable Care Act puts limits on the margins they can earn from their traditional business (Oliver Wyman estimates payer margins may shrink by a third), and an evolving marketplace means that they will face significantly more competition — from each other, health care providers, and new entrants that see an opportunity to capture growth in a $3 trillion market. The options I’ve described would let payers move into non-regulated markets and potentially generate revenue from discretionary consumer spending — a growing pot of money they have not accessed much.

Can they win consumers over? One advantage of being in an industry people don’t like is that there are many opportunities to pleasantly surprise the consumer. The good news is that the things that will make consumers happy — more convenience, customization, support for doctors, coordination of care — can all contribute to attractive new business opportunities while making the health care system more efficient, effective, humane, and sustainable.


Sukanya Soderland is a partner in Oliver Wyman’s Health and Life Sciences practice and a leader in the firm’s Health Innovation Center.

 

Surgical performance data released by NHS

encouraging progress from NHS…

 

http://www.telegraph.co.uk/health/nhs/11240241/PIC-AND-HOLD-Just-three-surgeons-named-as-having-high-death-rates.html

Just three surgeons named as having high death rates

New data comparing death rates of 5,000 surgeons identifies just three with death rates higher than they should

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The figures show that almost every surgeon in the country has been found to be operating within “the expected range” of performance

The figures show that almost every surgeon in the country has been found to be operating within “the expected range” of performance Photo: Alamy

Just three surgeons have been named as performing more poorly than they should be under new data comparing the death rates of 5,000 surgeons in England.

Data published today on a central NHS website has been hailed as part of a “world leading transparency drive”.

The figures show that almost every surgeon in the country has been found to be operating within “the expected range” of performance.

NHS England said the findings should reassure the public.

But critics questioned whether the limits were set too widely, allowing surgeons to be labelled as “okay” when their performance was worryingly poor.

Just three surgeons were named today as “outliers” – meaning that their death rates were found to be significantly worse than average over the periods examined.

Dynesh Rittoo, a vascular surgeon at the Royal Bournemouth and Christchurch Hospitals foundation trust was found to have a risk-adjusted mortality rate of 10.4 per cent over three years for carotid endarterectomies – a procedure to reduce the risk of stroke. The national average for the same procedure was 2 per cent.

In a statement agreed by the consultant, the trust said: “The overall 3-year rate for Mr Rittoo reflects a series of strokes in 2011. The rate of strokes / deaths within 30 days for Mr Rittoo between October 2011 and September 2013 is 6.4 per cent, and this rate is consistent with the outcomes of other vascular surgeons.”

Jonathan Hyde, a heart surgeon at Royal Sussex County Hospital, was found to have a a risk-adjusted hospital mortality rate of 6.63 per cent over a three-year period in which he performed more than 500 operations on adults.

Mr Hyde said he had taken action to improve his mortality rates, with more recent figures suggesting a significant improvement.

He said: “The data shown reflect higher mortality rates from my practice predominantly in the years 2011 and 2012 and therefore refer to outcomes from more than 18 months ago.

“In the light of these outcomes, I have reviewed my practice in detail with the support of an Individual Review from the Royal College of Surgeons. The mortality for my surgery for the period April 2013 to October 2014 has been 1.8 per cent prior to any adjustment for individual patient risk.”

Jeff Garner, a colorectal surgeon at Rotherham NHS Foundation trust, with a mortality rate of 14 per cent for surgery over the 18 months examined. Of 50 patients treated by Mr Garner, six died.

The trust said: “This Trust has acknowledged its outlier status and that of one of its surgeons. It has confirmed that measures have been taken to improve outcomes with a comprehensive overhaul of the colorectal service in 2012-2013 and close scrutiny of any deaths to identify potential surgical or system failings. The cumulative nature of data reporting means that it is likely to be at least another year before the Trust and surgeon cease to be outliers.”

Roger Taylor, co-founder of data analysts Dr Foster, said it was “misleading” to suggest that there were only three surgeons in the country who were performing significantly worse than the rest.

“If you asked any surgeon whether they thought there were only three in the country who were significantly worse than the rest of them, I think they would laugh,” he said.

He criticised the way the analysis had been done, which he said appeared designed to hide poor performance

Mr Taylor said: “What is being said is that this will help people to identify good and poor performing individuals. This actually looks like it has been designed to avoid identifying good or poor outcomes.”

He said surgeons should not have been allowed to come up with their own methods to assess performance, which had set limits too broadly. He also said it would have been more sensible to examine performance over longer periods, where trends would be more likely to be revealed.

Professor Sir Bruce Keogh, NHS Medical Director said: “This represents another major step forward on the transparency journey. It will help drive up standards, and we are committed to expanding publication into other areas.”

“The results demonstrate that surgery in this country is as good as anywhere in the western world and, in some specialities, it is better. The surgical community in this country deserves a great deal of credit for being a world leader in this area.”