Healthcare Innovations

Double-edged Sword of Technology

Innovation guru Clay Christensen has been interviewed by Health Affairs, with the article only available to subscribers. However, we have some excerpts and analysis on Tim Gee's blog. What Christensen says about technology is especially insightful.

Medical Connectivity Consulting, 2007-Mar-13, by Tim Gee

There are two ways that technology can get deployed in health care. One is to help the experts in the health care system do even more sophisticated things that historically were not possible to do, so ultrasound or MRI [magnetic resonance imaging] screens allow people to see things in greater detail and at an earlier stage that historically just weren't possible. When you bring technology to the experts to do more sophisticated things, in fact, it does bring a lot of cost into the system. But when you deploy the technology to commoditize the caregiver, to enable a lower-cost provider to do something that historically had required higher cost, then it actually takes cost out of the system. So you can't just make a blanket statement about the technology. You have to be subtle about what kind of technology we are talking about and how it will be deployed in the business.

Promises, promises

And if you bought this I have a nice bridge in Brooklyn you'd be interested in....

Healthcare IT News: HHS launches IT-genomics initiative, 2007-Mar-23, by Bernie Monegain

Health and Human Services Secretary Michael Leavitt today outlined a course for achieving gene-based medical care combined with health information technology. The initiative could transform the quality, safety and value of healthcare for patients in the future, he said.

Moving Closer to Your Values

When innovating you should be moving closer to your ideals.

Commonwealth Fund: Case Study: Achieving a Culture of Patient- and Family-Centered Care at Bronson Methodist Hospital.

Bronson is focusing on patient- and family-centered care because hospital leaders believe it is the right thing to do for patients. "We've learned there are things we can do to transform the delivery of care from 'doing things to patients' to 'doing things with patients'—collaborating with them on their care," says the hospital's CEO, Frank Sardone. "We think that we can improve the patient experience measurably by incorporating patients' and families' ideas and input in the process."

The CEO and the Middle Manager

In Boston, the salaries of the CEOs of the major nonprofit hospitals are published every year, so I'm not sure how "brave" Paul Levy was to talk about it in his blog, but the comments show that he initiated a truly worthwhile discussion. Way to go, Paul.

Running a hospital: Do I get paid too much?. 2007-Jan-28, by Paul Levy

Along with the other commentors, I appreciate your open disclosure of your salary. As a BIDMC [Beth Israel Deaconess Medical Center in Boston] employee, though, I cannot help but reflect on my own salary. Working as a mid-level administrator in a not-for-profit hospital, I have come to terms with the fact that my salary is much lower than my counterparts in private industry. I accept this (along with my heavily regulated and equally small 1-3% annual raise) because I enjoy my work and feel rewarded by my service to the BIDMC patients and my fellow staff. Although it appears from previous comments that your salary is also much lower than your counterparts in private industry, I still find the $1M to be astounding. Have you considered better helping the administrators who dream of rising the ranks and "running a hospital" as well? The current tuition reimbursement at BIDMC (which is lower than any other Boston hospital – I’ve done my research) is $1500 per calendar year pre-tax. In my Masters program at $830 per credit hour, I am reimbursed each year for approximately half of one class. As I fall deeper in to debt, the rewards of helping my fellow man are quite overshadowed by my colleagues with similar jobs in private industry who receive full tuition reimbursement and higher base salaries. ...

Better Hospital Design

The Wall Street Journal has an overview of trends in hospital design which identifies one of the major forces to be The Center for Health Design.

The Center for Health Design: Pebble Project Overview

Launched in 2000, the Pebble Project is a joint research effort between The Center for Health Design, a nonprofit research and advocacy organization, and selected healthcare providers. The purpose of the work is to create a ripple effect in the healthcare community by providing researched and documented examples of healthcare facilities whose design has made a difference in the quality of care and financial performance of the institution.

WSJ Informed Patient Column: Hospitals Build a Better 'Healing Environment' , 2007-Mar-21, by Laura Landro (subscription required)

Amid a $200 billion construction boom to replace or rebuild aging and outdated hospitals over the next decade, health-care architects and designers are creating a new blueprint for a "healing environment," based on a growing body of evidence showing that the quality of a hospital's patient rooms, corridors and public spaces directly influences both the health outcomes of patients and the stress levels and efficiency of hospital staff.

More Services for Individual Payors

Springwise newsletter | Helping Consumer Cut Medical Costs. 2007-Mar-15

"The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the exact same procedure," said Timothy Cahill, president of My Medical Control. "A hospital chain with multiple locations may have 150 rates for the same procedure." (Source: nytimes.com.) Reimbursement rates are negotiated between health care providers and insurers, and are far from transparent. My Medical Control takes customers' medical claims, looks for over-charges and contacts the provider directly to discuss and settle the claim at a reduced amount. The entire process takes 7-10 days and My Medical Control charges a fee of 35% of the savings. Last but not least, MedBillManager is free software that consumers can use to manage their medical bills, but also to check aggregated data to see what other people in their area are paying for similar procedures.

Results Coming out for Eden Alternative

I first heard about the Eden Alternative in Fast Company magazine. They are attempting a radical renovation of elder care.

The Commonwealth Fund: Case Study: Elder Homes Replace Nursing Homes in Tupelo, Miss., 2007-Jan, by Artemis March, Ph.D.

The idea

The first Green Houses were built on Mississippi Methodist Senior Services' (MMSS) flagship campus in Tupelo. Thomas, founder of the Eden Alternative, an organization that seeks to transform assisted-living facilities into "vibrant centers of care and companionship," had the vision for creating Green Houses. Steve McAlilly, J.D., CEO of the 11-campus, multi-level, retirement community, spearheaded the Tupelo project. He worked closely with Thomas to flesh out the Green House concept and with Richard McCarty, an architect at The McCarty Company–Design Group P.A., to give it physical form. Jude Rabig, R.N., M.A., the first executive director of the Green House Project and currently an independent long-term care consultant, helped put Thomas' vision into practice, drawing on her experience delivering care to patients in their homes. To encourage replication of this model, the Green House Project team works with NCB Capital Impact, a national nonprofit organization, to provide access to capital and technical assistance to organizations that want to establish a Green House facility.

The early results

Green House staff have documented many examples of elders who are eating again, gaining weight, and less reliant on their wheelchairs than they were before moving into their new environment. Visitors also respond positively to the Green Houses, as seen in stories of children who had refused to visit their grandparents in traditional nursing facilities but know the names and rooms of every elder in their new home. Researchers have found that, as University of Minnesota's Rosalie Kane, Ph.D., puts it, "the Green Houses blow away the old model on every measure: quality of life, family satisfaction, staff satisfaction," with no detriment to nationally used quality indicators that measure clinical conditions.

How to Support DCA Research

Chicago Tribune (Columbia News Service): New drug to fight cancer may get the cold shoulder, 2007-Feb-27, by Denise Heckbert

A new treatment for cancer could cost as little as $2 a dose and be as easy to administer as taking a pill or getting a shot. But scientists fear that their struggles to find financing for further research could keep the treatment from ever reaching the public.

In January, scientists working at the University of Alberta discovered that dichloroacetate, or DCA, a drug long used to treat rare metabolic diseases, seemed to halt the spread of cancer.

The discovery has been met with cautious optimism by the medical community and with excitement among cancer patients eager to participate in clinical trials. However, because the drug is not patented and can be produced by multiple companies, it is unlikely to be profitable and therefore has yet to appeal to the pharmaceutical companies that researchers typically rely on to finance clinical trials.

"There is no real way a company could invest and get a return on this," said Dr. Evangelos Michelakis, whose team of scientists conducted the research.

Link: Official University of Alberta DCA Site.

In order to be absolutely certain that DCA is effective and safe in patients with cancer, studies involving thousands of patients with different cancers, from different hospitals and different countries have to be conducted. Often, direct comparisons of one experimental treatment with other standard therapies are required. These large-scale trials will take years to complete and will require hundreds of millions of dollars.

However, smaller and more focused trials can occur much faster. The funding required for such trials is less (in the range of hundreds of thousands of dollars) and the procedures are easier than in drugs that have never before tried in any human being. Still, protocols of such trials need to be approved by local and federal agencies and funding secured

A number of physicians and scientists from the University of Alberta and the Alberta Cancer Board have already started working together and have received commitment from the leadership of these institutions to help make these trials happen as soon as possible. We hope that initiation of trials will occur shortly, i.e. within a few months. We plan to post our progress towards this goal on this website.

How can I help?

We appreciate your interest, and support and we have been touched by your kind words. We also understand the agony in many of you that you see your loved ones in desperate need of a treatment or a hope. We have been working on this for at least 2 years now and we will continue to work hard in order to determine whether this drug can actually benefit human beings with cancer. Your continued support of research in general is greatly appreciated by all of us in this field and it is important since a great deal of funding comes directly from the people (tax payer money coming to us through federal funding agencies like CIHR or charities). If you want to directly support this effort (that at this time receives no financial support from “for profit” organizations, pharmaceutical or private companies), you can do so in this web site.

New Form of Drug Research

Here we have another new form of drug research. This method may turn out to be too inefficient, but it may very likely lead to other innovative forms of research.

Technology Review: Getting More from Drugs, 2007-Mar-8, bh Katherine Bourzac

A biotech company called CombinatoRx has found that at the right doses, thousands of counterintuitive drug pairs are synergistic. The Cambridge, MA, company has eight drug combinations in clinical trials and several more in preclinical development. In a few years, diabetics, instead of injecting insulin, might be prescribed a cholesterol drug and a pain medication to help control their blood sugar. People suffering from chronic pain might find relief through a combination of a steroid and an antidepressant, with fewer side effects than they experience with current therapies. Alexis Borisy, founder and CEO of the company, says his researchers take a brute-force approach to finding fruitful drug combinations. In the lab, they test combinations of several thousand drugs at several different doses on cellular models of diseases including cancer and arthritis--regardless of what diseases the drugs are currently approved for, if any. Then they feed the data into software that looks for synergies.

Prisoners of Our Preconceptions

Hospital Impact is one of the most intelligent blogs in all health care. Real healthcare professionals thinking real hard about what it all means.

Thought for the post: Does our entire approach to testing drugs cut us off from entire categories of possible healthcare solutions?

Hospital Impact: Shotgun or Silver Bullet?

In the article, Dueling Therapies: Is a Shotgun Better Than a Silver Bullet? By Nicholas Zamiska of the Wall Street Journal, dated Friday March 2, 2000, a wonderful announcement appears that, for many of us may be the beginning of a period of healing and enlightenment like we have never before seen in Western Medicine. On the other hand, it just may represent one tiny pee pee step forward in our sometimes ludicrously regulated world....

His fundamental question: Is it better to attack disease with one substance whose potency has been pinpointed? Or should treatments be administered, as the Chinese profess, by aiming a group of agents at the problem?

Traffic Soars

The Harvard School of Public Health should be lauded for throwing a bunch of stuff onto the wall. I'm too skeered to find out my disease risk, but I really like their program called "Cancer News in Context."

Harvard Center for Cancer Prevention: Your Disease Risk.

Welcome to Your Disease Risk, the source on prevention. Here, you can find out your risk of developing five of the most important diseases in the United States and get personalized tips for preventing them.

Developed over the past ten years by the Harvard Center for Cancer Prevention, Your Disease Risk collects the latest scientific evidence on disease risk factors into one easy-to-use tool.

Dreaming of Efficient Healthcare

He can dream, can't he?

HHS Sec. Leavitt touts Bush's value-driven healthcare initiative. 2006-Nov-20, by Diana Manos

Leavitt predicted that the pace will pick up for change as more companies voluntarily opt to abide by the Bush prescription for value-driven transparent healthcare. Leavitt predicted “scores” of employers will be on board by year’s end. HHS is focusing on recruiting the 200 top companies in the U.S. with 50,000 employees or more, Leavitt said. By the time the 2008 requests for proposals for federal contracts are issued, Leavitt expects 60 percent of the market to be on board with the President’s plan. Leavitt also predicted: • Within 2 years, there will be quality and cost competition within local markets for some healthcare procedures. • Within 5 years, value-driven healthcare will be the standard of care. • Within 10 years, value-driven healthcare based on the Bush plan for transparency will be nationwide.

Never Pay for Your Mistakes

We just can't go on this way.

Backlash at bills for medical mistakes | Chicago Tribune. 2006-Nov-16, by Bruce Japsen

Tired of paying for botched medical-care procedures and low-quality medical care, some of the nation's largest businesses Wednesday called on U.S. hospitals to agree to apologize and waive costs related to "never" events--medical errors these employers say should never happen. Both the Leapfrog Group, a national coalition of large health-care purchasers such as Boeing Co., General Motors Corp. and General Electric Co., and the Midwest Business Group on Health, a Chicago-based business coalition representing more than 80 local employers, said hospitals should commit to a new policy on 28 health-care "never" events as a way to make providers of medical care more accountable. Many of the errors, such as a surgery performed on the wrong body part or mixing up donor sperm for an artificial insemination, would seem obvious fodder for a malpractice suit and a settlement worth more than the bill for the procedure. But other errors on the list, such as "retention of a foreign object in a patient after surgery" or patient injury associated with "contaminated drugs, devices or biologics provided by the health-care facility," are probably more common and fixing them compounds the soaring cost of health care.

Forcing Employees into the Health Care Market

The answer isn't either/or, it's "only if."

Health Care Policy: How Whole Foods Can Help Wal-Mart Beat Scrooge Rap. Investor's Business Daily, 2006-Dec-17, by Sally C. Pipes

Costco pays an average wage of $16 an hour and offers a generous health care package. Wal-Mart, in comparison, pays on average only $10 an hour and covers roughly two-thirds of the cost of its employees' health care. Critics charge that many Wal-Mart employees work such few hours and make such little money that they burden the public system by signing up for Medicaid and other government health care programs.

Rising Costs

Both retailers ought to look to a third company: Whole Foods. The cutting-edge healthy-food retailer combines a zealous belief in the free market, a dedication to employees and a fierce focus on the customer. It's been wildly successful in the competitive grocery sector. Its CEO, John Mackey, thinks the company has found a workable solution to the high cost of employee health care -- health reimbursement accounts.

Healthy Living Credit Card

Healthcare treatments as a shopping reward? I dunno...seems to me botox maybe, mammogram not.

HealthShopper : Vimo Newsletter.

the Aetna Healthy Living credit card will have access to a base rewards program that offers one point for every qualifying retail dollar charged to the card and access to a wide variety of redemption options. Additionally, Aetna Healthy Living credit card members will be rewarded with the following unique features that provide incentives for healthy living. Earn points for money spent on certain health-related purchases including hospital treatments, doctor and dentist charges, sporting goods stores, fitness and weight loss centers, vitamin stores and more. Receive a discount on dozens of health-related items - gym equipment, spa set, bicycles, blood pressure monitors and more from the WorldPoints catalog. Redeem points to help pay for medical co-payments made with the Aetna Healthy Living credit card. Redeem points for cash rewards that can be used to help pay for health care and other expenses, or deposited to a checking account or a Health Savings Account. The credit card is currently available to Aetna's Small Group customers and will be expanded to other customer groups in 2007.

Authoritative Sources

Given that medicine is positioned as science, you would think that this would have happened long ago. But medicine really isn't science, it's practice, and the practitioners ought to clean up their act.

Hold the Hors d'Oeuvres - washingtonpost.com.

PharmedOut is one of about two dozen projects across the country designed to teach doctors and nurses to critically evaluate information about drugs and to direct them to unbiased information. The projects are funded by a $21 million grant through the Attorney General Consumer and Prescriber Grant Program, which was created as part of a 2004 settlement by Warner-Lambert involving the drugmaker's illegal promotion of the widely used epilepsy drug Neurontin. The second phase of the program, which is being administered by the Center for Evidence-Based Policy at the Oregon Health & Science University, will provide similar educational programs targeted at consumers. Interest in the overt and covert ways drug companies influence doctors has mushroomed in the past few years

Using the Right Hospital or Clinic

As medicine becomes more diverse, it becomes impossible for any one institution to provide all the services at an acceptable level. Doctors specialized. Now hospitals and clinics are specializing.

Study: Using fewer cancer-care providers saves lives - Houston Business Journal:.

Limiting who can administer certain cancer procedures not only saves lives, it can also keep spiraling health-care costs down, according to a study of health economics conducted at Baylor College of Medicine and Rice University. The study's findings were reported Friday in the Health Economics, Policy and Law journal.

Getting Innovations Adopted

It's hard enough to get doctors to keep up with new medical practices, much less business practices.  Hooray for Green and Savin.

Ideas at Work : Magazine Feature : A just-in-time approach to medical care.

Empirical studies have shown that managed-care and fee-for-service practices that follow advanced access can significantly reduce patient backlogs, and even make more money, by adhering to the approach’s unofficial motto: Do All of Today’s Work Today. However, the lack of specific implementation guidelines held back doctors who might otherwise have given advanced access a try. Professors Linda Green and Sergei Savin, working with physician Mark Murray, designed a mathematical model that allows doctors to apply the approach to their practices. The researchers’ elegant solution, in the form of a simple-to-use Excel spreadsheet, allows doctors to predict how many patients they can accommodate.