Healthcare Disruption

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APTA 2014 Recap: Forging Ahead With Telehealth: A Roadmap for Physical Therapists

Presenters

Justin Elliott, NA

Matthew Elrod, PT, DPT, MEd, NCS

Alan Lee, PT, PhD, DPT, CWS, GCS

Christopher Peterson, DPT

Telehealth, which originated as a way to provide care to rural settings, has become an accepted way although not widely adopted method of delivering healthcare. Benefits include convenience for patients, the ability to access specialists in other locations, and being able to monitor chronic conditions at lower costs. Advances in technology, that have put powerful microcomputers in everyone’s pocket, have made telehealth significantly more in demand and more feasible than ever before and as a result the telehealth market is forecasted to grow to a 4.5B market by 2018.

The good news is that telerehabilitation is part of this growing market, and people are already practicing today. The bad news is there’s still a lot of confusion about reimbursement and regulation. A show of hands at the beginning of this session revealed that while 5 out of approximately 50 attendees were practicing telehealth, no one put their hand up when asked if they felt confident about the rules and regulations, and most people seemed to not be getting reimbursed.

The goal of the session was to provide some clarity on the definition of telehealth, examples of how it is used in physical therapy, a survey of the current regulatory and reimbursement situation, and a toolkit for those who are interested in moving forward with a telehealth practice.

Telehealth communication is used in two settings, between a healthcare provider in an office and a patient at home, or between two clinical settings where one healthcare provider wants to consult with or have the patient consult with a specialist in another clinical location.

Telehealth Scenarios

There are two types of telehealth:

  • Synchronous, or real-time where the two parties communicate directly via video conference.
  • Asynchronous, or store and forward where video, text, or voice communication is transmitted between the two parties but they do not respond to it in real time. Email, texting, and even voicemail are all forms of asynchronous communication. (Wellpepper is an example of asynchronous telehealth.)

Synchronous communication more closely resembles a typical clinic visit, as it is a dedicated and scheduled visit, with the difference being that the two parties are not in the same location. Asynchronous is better for remote patient monitoring, check-ins, and chronic disease management were the parties do not require constant face-to-face communications. In fact, one of the areas that telehealth has shown real promise is in chronic disease management, first because most of the management of chronic diseases occurs outside the clinic, and second because these patients often need access to specialists who are not local.

Telehealth should be considered a way to augment in person treatment but not replace it, especially in the musculoskeletal world where treatment is often hands-on. Follow-up treatment, home treatment plans, questions and answers, and consultations with specialists are all areas where telehealth can add value in treatment. Telehealth also provides more convenient options for patients, not just rural ones. With busy lives many patients find it difficult to get to a clinic to an in-person appointment. It can also help lower costs of care.

While telehealth has many benefits, there currently many potential blockers. For example, before embarking on a telehealth program, make sure you fully understand privacy laws. All communication needs to be encrypted, and tools like Skype, while very convenient, do not deliver the level of security required by healthcare law.

The elephant(s) in the room in the whole discussion are regulations and reimbursement. This session provided hope that these will be resolved: both the APTA and the The Federation of State Boards of Physical Therapy are working to define and eventually change the legislation to enable more widespread adoption of telehealth. Unfortunately, it seems that the change may be slower than consumer demand and certainly than innovations in technology.

Currently 21 states have private coverage legislation for telehealth billing and 11 states have Medicare billing with 6 more in proposal stage. This legislation applies to intra-state practice, that is the patient and the physical therapist are within the same state. Inter-state practice where the physical therapist and the patient are in different states is only possible if the physical therapist is licensed in the state where the patient resides. Note that Medicare does not include telehealth for PT, OT, Audiology, or Speech Therapy. Since some of the real power of telemedicine is being able to practice across state boundaries (and possible across country boundaries in the future), we need to solve this inter-state issue.

It’s not really feasible for physical therapists to get licensed in each state so that they can practice telemedicine regardless of patient location. There are two possible solutions to this problem. One is a “telemedicine license” which is a license to practice telemedicine in a particular state even if you don’t reside in that state. Louisiana is a state that has this license type. The other, and more practical long-term solution is to create an interstate licensure compact. This would enable the portability of licenses from one state to another. The most common example of this is the driver’s license. Your driver’s license may be granted by the state of Washington but it is recognized and honored in all the other states (as well as Canada). The Federation of State Boards of Physical Therapy is leading a committee to put forward a proposal for an interstate licensure compact, and there is some discussion at the global level as well. (Nurses are much further ahead in this area, 24 states have joined a nursing licensure compact that enables nurses to be licensed in their home state and practice in any of these states, which is great for both telehealth and for portability of nursing careers.)

With respect to billing, there are billing codes for telehealth for physical therapy but they vary depending on state and by insurer. Two state practice acts, Washington and Alaska, recognize telehealth. In California, physical therapists are covered under a general assembly bill that allows for telehealth. Arizona, Kentucky, Minnesota, Nebraska, and New Mexico, list physical therapy and/or telerehabilitation services in their Medicaid policies. Perhaps the most promising change that will move telehealth forward is the new “accountable care organization” and bundled payments. With bundled payments, the organization is paid based on patient diagnosis and outcome not by the number of procedures that are provided, so there is built-in incentive to focus on the most effective and cost effective way to get a great outcome.

If you’re interested in moving telehealth forward for the physical therapy profession, the APTA has a lot of great resources in their telehealth toolkit. At Wellpepper, we’re very excited about the prospects and look forward to working with you on these new ways of treatment.

Posted in: Healthcare Disruption, Healthcare Technology, M-health, Rehabilitation Business

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APTA 2014 Session Recap: The Success of the Profession Lies in the Consumer: Who Are They?

This post is part of our recap from attending the American Physical Therapy Association Combined Sections Meeting in Las Vegas Feb. 3-6.

Speakers:

Andy Lodato, MPT

Jerry Durham, PT

This session from Jerry Durham, cofounder of San Francisco Spine and Sport and Andy Lodato, cofounder of PhysioCarePT in the Private Practice section explored how the business of physical therapy needs to consider patients as consumers first, even in states where patients do not have direct access to physical therapy. The patient as consumer is a popular theme in healthcare these days, as high-deductible plans increase out-of-pocket costs and make patients more discerning about the cost-value relationship in their care, and many of the ideas in the session were appropriate to both private practice and hospital outpatient settings.

The session began with Andy talking about how he and his business partners transformed their business from the early days when they “said yes to everyone”, that is they accepted every patient even if the terms of that patients insurance caused them to operate at a loss. While this may seem like a great thing to do for patients, they also weren’t discerning in whether they accepted patients that appreciated the value that PhysioCarePT provided. This devalued their brand promise. Now Andy and team target the “conscious consumer”: the patient that connects with the value that Physiocare provides. Andy also talked about how the profession is so focused on measuring patient outcomes but does not measure business outcomes. His business turned around when he started applying this same rigor to the business.

After taking this approach, Andy and his partners started actively targeting patients that would appreciate the value that Physiocare provided. He works in an extremely competitive market, however, also a market that has a well-educated, athletic, and well-insured patient base.

Andy outlined some of the ways in which he and his staff cultivate relationships with patients as consumers. All of the physical therapists at the clinic are expected to network and market the value of the services they offer. Here are some of the ways they do that:

  • They share infrequently on Facebook: only when they have something important to say, for example, the most successful Facebook campaign included a pair of Nike running shoes designed  with the custom colors of PhysioCare’s branding. This attracted the most likes and shares of any campaign.
  • Similar to other best practices we’ve written about, PhysioCare created a “Solemate’s Running Group” that meets weekly. This serves two purposes, it shows patients that you care about their goals, and also keeps you top of mind when injuries occur, as they do for the majority of runners.
  • PhysioCare offers community lectures on topics like whether young ballerinas are ready to dance on point, corporate fitness programs, the right way to carry a baby to prevent back injuries. These events are a pure community service but also establish PhysioCare PTs as experts in topics “conscious consumers” care about.

Andy talked a bit about referrals from doctors, often a contentious topic: should you market to the doctors or their patients? First off, Andy said he never buys lunch, referring to the practice of sending gifts to doctor’s offices, he works on establishing a mutually beneficial relationship. He works with a group of 7 surgeons who refer patients to him, while his team refers patients to them if they think they require surgery. Surgeons would rather spend their time with patients who require surgery, so this provides them with well-qualified leads. Andy considered the relationship a success as his team had not even met some of the surgeons who had been referring patients back and forth.

Next up was the eminently tweetable Jerry Durham. The person beside me said that the whole profession would be moved forward if you could bottle Jerry. Jerry also has a “no lunches” policy. He wants to place his business in the center of a healthcare team, including doctors, nurses, nutritionists, and physical therapists. Sending over lunch devalues his organization as part of the team. (Disclosure, I once bought Jerry lunch: won’t be doing that again. 😉 )

While Jerry thinks constantly about the patient experience from the first contact with his office through billing, he does admit to marketing to the providers for referrals. However, similar to Andy, he also thinks about targeting the right type of “provider consumer” that is, a referring doctor who understands the value that a physical therapist can offer to the patient’s recovery or in preventing injuries. He focuses on what’s most important to these providers and to their patients, and makes sure his team delivers on it, and surprisingly, outcomes are often not the most important thing for patients.

He cited some basic things that make the difference to the patient:

None of these things have anything to do with outcomes or how knowledgable the physical therapist is. As Jerry puts it “outcomes are not a value proposition.” Patients expect outcomes, how they value the care they receive is comprised of a myriad of other factors. Do you know what your patients value?

Here’s a selection of our tweets from the session.

Tweets from the APTA Conference

Posted in: Healthcare Disruption, Rehabilitation Business

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Flipping the Clinic Visit

Doesn’t it seem like there’s never enough time? Nowhere is this more prevalent than with our healthcare system. We don’t have enough time to do things that keep us well, and increasingly doctors don’t have time to spend with us to thoroughly understand our issues. A spate of recent articles tries to blame the implementation of technology and the EMR as taking even more time away from the patient/doctor relationship.

Doctor and scribe, source New York Times

Doctor and scribe, source New York Times

Electronic health records have become a disease in need of a cure, as physicians do their best to diagnose and treat patients while continuously feeding the data-hungry computer. “A Busy Doctor’s Right Hand, Ever Ready to Type

This isn’t necessarily the fault of the EMR. It really stems back to money. One of the primary purposes of the EMR is to document for billing purposes and federal rebates. They weren’t designed to improve face-to-face care.

This New York Times article describes how scribes are helping to increase doctor face time with patients, but hiring another person to record what the patient is saying seems more like a band-aid solution.

Without much fanfare or planning, scribes have entered the scene in hundreds of clinics and emergency rooms. Physicians who use them say they feel liberated from the constant note-taking that modern electronic health records systems demand. Indeed, many of those doctors say that scribes have helped restore joy in the practice of medicine, which has been transformed — for good and for bad — by digital record-keeping.

What we really need is something like the “flipped doctor’s visit” being explored by the Robert Wood Johnson Foundation and inspired by Sal Khan, of the Khan Academy, an organization that has already made headway into education innovation by suggesting that classrooms are for homework and viewing lectures can be done at home. The idea of the flipped classroom is to maximize the interaction between teacher and pupil. The RWJF project suggests we need to do the same thing for the doctor’s visit.

The project is looking at ways that can turn the doctor’s visit on its head to get better results for patients and healthcare providers. While the example of EMR scribes seems like it might fit, to us it seems like a bit of a placebo. From personal experience, I had a doctor’s visit where an intern recorded my information and then read it back to the doctor and me. She had gotten some major facts wrong, for example, somehow she understood I worked in construction, not software. Open Notes and Blue Button, where patients see their own notes are two examples of trying to take this a step further. Who better than the patient to review what was written about them? We also need to return to documentation to improve patient care, not documentation for billing. The point of good documentation should be to accurately describe the situation and for continuity of care. Sadly, again technology is being blamed for an underlying issue of time, in this example the ability to copy and paste is being used for false records and billing. Again, it’s not the technology, it’s that people are pressed for time and again that time is money.

I recently had a few doctor visits that gave me time to pause and consider the flipped visit. The main thing that struck me is how different the doctor’s visit is from any other type of business interaction. As I was thinking about preparing for the visits with my list of things to make sure we cover, I thought about comparing this to a business meeting. The doctor had no agenda in advance, no idea why I was coming in, or even who she was meeting with until I walked in the room, and spent the first few minutes of a 10 minute visit looking at notes to try to remember who I was and what had happened before. Imagine you’d hired a consultant for a project (ie manage your health) who approached the project in this manner. You’d want your money back. You’d expect them to come to a meeting prepared. As the client you’d send them any pertinent information or updates for the project before the meeting. I was also trying to imagine the day of a doctor: every 10-15 minutes changing context with a new patient and no prep time while trying to care for patients and sometimes facing life-threatening decisions. Hairdressers have more insight into how their day is going to go: cut, color, cut, blow-out. We talk about moving to a preventative model for healthcare. First step would be to enable doctors to prepare to see patients and decrease the documentation burden after they see them.

We need better and more cost effective ways of communicating in healthcare. Ones that focus on patient care and are seamless for both patients and healthcare providers. We have applied technology for better communication and collaboration in business and in our personal lives, how can we extend this to healthcare? How can we flip the doctor’s visit and how can technology help?

If you’re interested, the Robert Wood Johnson Foundation is hosting a Google Hangout on the flipped clinic January 16 at 11:00 am PST.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology

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Wellpepper’s Top Health Tech Stories of 2013

It’s the time of year to reflect and make lists! It’s been a great year for Wellpepper: our first full year in business. We’ve enjoyed bringing new features to our users and learning more about the needs of both patients and healthcare providers. We’re committed to building useful tools that patients and providers love to use. We’ve been inspired at conferences meeting with end-users, hospital administrators, and other startups who share the same mission of changing how patients and providers engage around their health. We’ve experienced the power of social media, met new friends through Twitter, and learned so much from Tweetchats. As a young company, it’s been a year of firsts for us that, while monumental for us, pale in comparison with the changes going on in health IT, so rather than telling you more about us, let’s talk about the year in Health Tech.

There is no scientific basis to this list, just what we think stands out from the year in Health Tech.

Healthcare.gov

The beleaguered website was definitely the top Health IT story of the year. At Wellpepper we were unable to make it through the registration process ourselves, and ended up going to a broker to find out our healthcare options. As the news came out on why the site was so bad, it was pretty obvious there was a lack of accountability and no project management. It’s really unfortunate that the Affordable Care Act was mired in this mess of an implementation, but we’re very excited that former Microsoft exec Kurt DelBene is taking the reins. Ship It!

Quantified-Self Hits the Mainstream

tec-gift-guide-fitness-trackers.jpeg-1280x960Or, “everyone is tracking.” The mainstream press started writing about fitness gadgets and our Facebook feeds were full of friends who got new FitBits for Christmas. Not sure what this means about the trend though. We have found the FitBit to be really interesting to calibrate activities, for example, a game of Ultimate Frisbee but after you know how inactive or active you are do you really need to track? And do you become okay with your activity or lack thereof?

Meaningful Use Phase Delayed

The Centers for Medicare and Medicaid have delayed the deadlines for implementing Meaningful Use Stage 2. Stage 2 will be extended through 2016 and Stage 3 won’t begin until at least fiscal year 2017 for hospitals. Meaningful Use Stage 2 focuses on patient engagement, which is very minimally defined as patients interacting with healthcare information electronically. We’ve always said that electronic medical records vendors are not the best equipped to deliver tools that patients (ie consumers) want to use, so it’s not surprising that healthcare providers are struggling with this phase. That said, m-health is poised to deliver on these requirements.Wellpepper2-1195a

M-Health Comes of Age

While we can definitely debate where we are in the m-health hype cycle, there is no question that M-Health is a formidable category. The FDA is now monitoring and releasing guidelines, albeit with little clarification. Eric Topol made headlines by using an iPhone EKG on a plane to diagnose a heart attack and and advise the captain to make an emergency landing. Most positively, we’re hearing less talk of ‘apps’, and more talk of integrating mobile health into the overall patient experience and the official hospital records.

23andMe Ignores FDA

Source: Wikipedia commons

You might consider this one to be a bit specific, but it’s representative of a number of key stories in 2013: big data, the explosion of healthcare investing, and the dramatic gulf between current Health IT and other technologies, and between Silicon Valley and the FDA. 23andMe, which does cheap DNA testing, direct to consumer, was forced to stop providing genetic results and only include ancestry after effectively ignoring FDA warnings for over a year. Speculation is that they were trying to get to a million tests (they are at about 500K) so that they could prove their tests were valid and thereby circumvent long FDA approval processes. Those on the side of the FDA saw this as Silicon Valley thumbing their nose at patient safety and regulations. Those on the side of 23andMe saw this as tech disruption at its purest. As recipients of some of the last full genetic and ancestry tests before the shut-down, expect more from us on this topic. 😉

This one is not healthtech, but we’d be remiss if we didn’t mention the focus on costs of care. Time Magazine, and the New York Times both published rather scathing interactive features on the costs of healthcare in the US. One of Reddit’s top threads right now is about a $50,000 appendectomy. It’s great to see these issues called to light. Let’s hope we see progress in solving them in 2014.


NewYearWP

We’re pretty excited to see what 2014 brings Wellpepper and what new innovations, disruptions, and improvements are brought to the healthcare industry as a whole. Best to you and yours from all of us at Wellpepper!

Posted in: Health Regulations, Healthcare Disruption, Healthcare Technology, M-health

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Health 2.0 Europe “Tools for the Elderly”

Filming a patientPrior to the Health 2.0 Europe Conference there was a deep-dive 3 hour session called “Tools for the Elderly.” I was particularly interested in this session for two reasons, first we are doing some work with Boston University on a study using Wellpepper to manage the health of Parkinson’s patients the eldest of whom is 75 and second, a common criticism we hear from healthcare providers and investors is “old people can’t use technology.” We disagree wholeheartedly, but acknowledge that those who may have less than 20/20 vision or arthritic hands may require different types of interfaces and engagement than the stereotypical 20 year old developer is building for. Based on this, I was very interested to see what types of innovations and challenges this session presented.

Two of the most interesting were Many Happy Returns and Intelesant. Many Happy Returns is a memory, engagement, and conversation aid for people with dementia. It was developed originally as a not-for-profit by Sarah Reed who was introduced to the world of dementia when her mother was diagnosed over 10 years ago. Originally a card game, and now being developed into a mobile application, Many Happy Returns presents pictures from different decades to jog the memory of dementia sufferers and encourage inter-generational communication. People who have dementia have increasingly clear long-term memory with deteriorating short term memory and the cards provide the ability to have meaningful conversations with those with dementia and also learn family stories before they are lost. The app interface was simple and highly usable, and the benefit of using an iPad app over printed cards is huge: sound can be added, and sounds have proven to be very evocative for memory jogging, new card sets can be created by scanning and adding the person’s own photos, and finally, tracking can be done related to which photos, or sounds are most interesting to people.

Tools for the Elderly

Intelesant could have also been in the “unmentionables” session in the full conference. They provided an advance “end-of-life” care plan that was accessible by patients, their care givers, and could be shared with healthcare providers, especially in a care home setting. Too often this information is lost or not communicated clearly until it’s too late, and Intellesant aims to change this. What was compelling about the Intellesant presentation is that the interface, while capable of reporting clinical results, was designed for the patient and the caregiver who are really the most important constituents in this scenario.

There were also three startups that were focusing on building interfaces for the elderly, one to make it extremely simple to use a phone,  one to make it extremely simple to use a tablet, and one to make it extremely simple to have a conference call or telehealth chat through your TV. The first two were solving the problem that Android interfaces are generally a lot less usable than other interfaces, which really seems like 1. A short term problem and 2 something that should be addressed by Android OS developers. (Are you listening Samsung?). The third, SpeakSet was solving a problem that of course affects the elderly, but also everyone else. According to some former colleagues of mine at Microsoft (Skype), it takes 10 minutes on average for any conference call to get started. While there are definitely tools that can help the elderly manage their health and wellbeing, good usable design should be available to everyone. I’d love to use a big button that says “start conference call” and have it work immediately.

The AARP has gone on record asking Silicon Valley to start building tools for the aging population. Based on this session at Health 2.0 Europe, they may want to look further afield.

Posted in: Aging, Healthcare Disruption, Healthcare Technology, M-health

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Health 2.0 Europe “Improving and Enriching the Patient-Provider Relationship”

Last week, I had the opportunity to demonstrate Wellpepper and participate on a panel on “Improving and Enriching the Patient-Provider Relationship” at the Health 2.0 Europe Conference in London.  I’m grateful to the Washington Trade Association who funded a trade delegation to the conference and helped facilitate other meetings in London as well.

Health 2.0 Europe Panel

Health 2.0 Europe Panel

The panel format was that the moderator, in this case Health 2.0 CEO Indu Subaiya, and invited guests framed the conversation, and then invited companies to demonstrate their products related to the topic. After the demo, the panelists asked questions and discussed the implications and relevance of the product to the topic. The “Provider” view was represented by Dr Simon Brownlee, a primary care physician and Chief Medical Officer of Healthloop UK. The “Patient” view was represented by Susan Jones, a person living with ME also known as “chronic fatigue syndrome.” I spoke with Susan a bit backstage and learned that she was frustrated by the lack of knowledge about her condition, she took it upon herself to look for specialists and treatments outside of the UK, the epitome of an engaged patient.

Other startups on the panel were:

Mark Friess from WelVU, focused on patient education and engagement.

Nishant Bagadia from Nuehealth, helping patients find and connect to surgeons.

Tim Williams from myClinicalOutcomes, helping patients track and get information about long term conditions.

Interestingly, while we all focused on the patient-provider relationship, each took a different approach and the technologies ended up being complementary rather than competitive.

We discussed how patients are often confused by treatment plans and how care outside the clinic was becoming increasingly necessary as patient volumes increased. A recent study by Deloitte showed that elderly patients will increase the demand for in-person consultations by 33%. Given the expected shortage of healthcare providers, this isn’t going to be possible so we need new ways to engage. We also discussed the need to align outcomes between patients and providers. Oftentimes the patient has a very different view of a successful outcome as the provider, as outlined in this Harvard Business Review Infographic.

The conference was inspiring as healthcare providers, industry professionals, and startups acknowledged that we need to start doing things differently if we want to see better health outcomes. While there were similarities between the solutions presented across all the panels, there was actually very little duplication, which points to the vast challenges in healthcare today. Solutions came from all over the US, UK, and Europe and were tackling both local and international markets. The best solutions were on par with what you see coming out of Silicon Valley, and in particular we liked UMotif for it’s extremely usable approach to patient tracking and engagement and the as yet unreleased  “You app” from Health Puzzle of Finland, that enables collaborative health challenges with friends.

My favorite session was the “Unmentionables” where startups tackled problems that often weren’t discussed like sexually transmitted diseases and alcohol abuse. My panel featured 3 US based startup and one UK, this session was a representation of European innovation, and organizers were pleased so showcase so many more local talents than in previous years. Presenters represented their countries well, and moderator Matthew Holt, pointed out that true to form and stereotypes, a Norwegian presented a light-based solution for depression, an Italian for sex information, and a Brit for drinking.

Posted in: Healthcare Disruption, Healthcare Technology, M-health

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The Outcomes That Matter to Patients

As an industry, healthcare spends a lot of time measuring and reporting outcomes. Taking a consumer based approach would also consider the outcomes that matter to patients. This table from Harvard Business Review’s “The Strategy to Fix Healthcare” offers a patient-centered approach with the example of the patient’s view of a successful hip replacement.
The Outcomes That Matter To Patients

Posted in: Healthcare Disruption, Healthcare motivation, Rehabilitation Business

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Film review: Extraordinary Measures

“The football coach makes more than my annual research budget,” Harrison Ford as Dr. Tom Stonehill in Extraordinary Measures.

We recently attended a screening of the film Extraordinary Measures sponsored by the Washington Biotech Association (WBBA). The film is a semi-fictional account of the real life story of John Crowley’s determination to speed a new drug to market to help manage his childrens’ rare chronic disease. The film, released in 2010, was produced by Harrison Ford, and stars him as “Dr. Tom Stonehill”, an amalgamation of a number of doctors that John Crowley worked with in real life. John Crowley is played by Brendan Fraser. Keri Russell plays his wife Aileen Crowley, and we have no doubt that the real Aileen had a lot more to do in real life than poor Keri in this film who has to deliver unfortunate lines like “the medicines are working. “

Film critique aside, the true story is quite fascinating, and you can find out more on the Crowley family’s website and in the book by Pulitzer-prize winning journalist, Geeta Anand, The Cure. Two of the three Crowley family children, Megs and Patrick have Pompe disease, a rare condition that is related to muscular dystrophy. At the time the film starts, life expectancy for children with this disease is 9 years, and as Megs approaches her 8th birthday, John becomes driven to find a cure. Poring over research late at night, he finds some interesting theories by Dr. Tom Stonehill, and on impulse flies to Nebraska to try to meet the doctor, who turns out to be ornery and eccentric. Also on impulse John promises Dr. Stonehill that he will find funding. He does, and the two manage to set out building a company. However it becomes pretty clear that while Dr. Stonehill most likely has the right solution to manage Pompe, he knows nothing about bringing a drug to market, and while John understands the business side, like how much revenue a Pompe patient will generate over a lifetime, his experience usually takes over after all the manufacturing problems are solved.

The solution comes in the form of a large drug company that buys them out, mostly for Dr. Stonehill’s experience. John and Dr. Stonehill are now rich, and John buys a gigantic house but Dr. Stonehill doesn’t cash his check because he doesn’t believe has earned the money. It’s a bit disconcerting to see the Crowley’s in a multi-million dollar home when earlier in the film they mention that they have $40,000 monthly medical bills, and when earlier they were calling all their friends to fundraise for their foundation. It seems like there might be better uses for the money, and Aileen doesn’t seem all that comfortable with the home that John justifies as “the kids love it.” However, at this point he doesn’t know that a way to manage the disease will be found, so the rationale is probably that they should be happy in their short lives.

John and Dr. Stonehill both try to shake things up a bit at the drug company. John out of desperation to save his children’s lives, and Dr. Stonehill because he’s a maverick. What’s interesting about this segment is that while some of the drug company executives seem cold and clinical, they are trying to follow procedures for the safety of the general public, and John, while driven by love for his family and others like his does face some ethical issues with his close involvement in the drug trials.

If you have an interest in the pharma business or how drugs are brought to market, this is an interesting and enjoyable film. Unlike a similar film also based on true life adventures in big pharma, Love and Other Drugs, this one is suitable for the whole family and children will probably really enjoy it both because it’s based on a real life drama and for the bubbly and determined Megs Crowley who gets some of the best lines, like “My hobbies are video games and penguins.”

Definitely check out this short video featuring the real Crowleys that fills in some of the background details and shows how extraordinary the achievement really is.

If you do watch the film, be on the lookout for a cameo from the real John Crowley in one of the early fundraising meetings.

Posted in: Healthcare Disruption, Managing Chronic Disease

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Innovative Care Models for Prevention, Health Promotion, Fitness and Disease Management

Standing room only at the APTA 2013 Conference

Standing room only at the APTA 2013 Conference

It was a packed house for an excellent session on Innovative Care models at the American Physical Therapy association annual conference in Salt Lake City last week. Any of the 5 presenters could have held their own for the entire session. Together, they provided a powerhouse of enthusiasm, ideas, and motivation to change healthcare practice.

A common theme across all the presenters was that the time is now right for the types of innovative programs they were espousing. Many commented on how they are seeing a lot more acceptance of new ideas and new models of care than when they first embarked on this path. Another common theme was that the data doesn’t lie. Healthcare is in crisis due to the declining health of the American public. Our favorite quote of the session was from Mike Eisenhart from Pro-activity who said “Chronic disease is simply the accumulation of years of bad behavior.” Sad but true that most chronic disease in the United States is entirely preventable. Each presenter showed saddening statistics that supported this view.

Karen Kemmis kicked off the session by reviewing the triple aim of healthcare reform developed by the Institute for Healthcare Improvement:

Triple Aim for Healthcare Improvement

Triple Aim for Healthcare Improvement

She also described changes that are making new care models possible including:

  • Integrated care models, like Accountable Care Organizations
  • Expansion in coverage
  • Changing payment mechanisms
  • Outcome and quality based payments
  • Program integrity

Next up was Jennifer Gamboa, founder and President of Body Dynamics, Inc – a multi-disciplinary physical therapy and wellness center in Falls Church, Virginia. Dr. Gamboa outlined their consistent and unique approach to treating clients, where each healthcare professional applies the same rigorous screening process to access overall health and wellness. This approach recognized that clients choose their treatments, for example, many lower back-pain patients see a registered massage therapist first although they might be better helped by a physical therapist. Rather than bemoaning the lack of consumer awareness, Body Dynamics works with the consumer to access overall health and willingness to change regardless of how they found the clinic. It was a refreshing approach that creates a health team that includes a physical therapist, nutritionist, massage therapist, personal trainer, and counselor, and screens patients based on their movement quality, disease risk factors, fitness, and willingness to change. Body Dynamics is incubating the process now, so Dr Gamboa was not able to share outcomes or recommend how others might use her methodology yet but this is definitely a development to watch.

Jennifer was followed by Margaret O’Neil from Drexel University, who talked about health promotion strategies for children and their caregivers. Dr. O’Neil stressed the importance of motivational interviewing to support behavior change. Motivational interviewing includes expressing empathy, supporting self-efficicacy, accepting resistance, and avoiding argumentation. Open questions and active listening are tools in motivational interviewing. The point of the process is to determine where someone is in their willingness to change, and therefore, the type of intervention that is appropriate. Interventions might need to be psychological before physical. As well, the entire family needs to be involved and parents need to model healthy eating and activity. Dr. O’Neil mentioned that parents often believe that being overweight is inevitable, using the excuse “we’re just a big-boned family.”

Next up was Mike Eisenhart from Pro-Activity, who was the most provocative  and tweetable (hashtag #apta2013) of the group. He graduated as a physical therapist and immediately stopped calling himself one because he was told that physical therapists could only treat problems not help prevent them. Instead, Mike built a business around wellness and prevention, specifically in the workplace and now helps to manage the health of over 20,000 people. Pro-Activity provides health assessments and helps employees manage change, resulting in lower insurance costs for employers. Mike is really happy that he’s starting to see other physical therapists take proactive roles in health and wellness.

The final presenter was Cheryl Resnik who quipped that you should find out how funny the other presenters are before agreeing to a panel. She didn’t need to worry, as the story of the USC Fit Families program was extremely compelling. The program, which provides exercise programs and a free physical therapy clinic to low-income families, is located near USC campus in a neighborhood known for a gang with ties to the Mexican mafia and that is a “food desert”. A food desert is defined as an area where it is not possible to buy fresh food. Fast food is often the only or definitely the cheapest option. Resnik recounts needing to buy a scale that measured up to 1,000 pounds to weigh some of her participants, who were mostly teenagers! Fit Families provides individualized and group exercise programs, nutrition counselling, and assessments. It’s funded by grants and volunteer physical therapy students from USC. Students become so engaged in the program they often continue volunteering after they’ve received their credits.

This was one of the best sessions we attended at American Physical Therapy Conference in Salt Lake City. It was amazing to see so many people focused on prevention and wellness both in for-profit and not-for-profit scenarios. At the end of the session, Margaret O’Neil asked the audience how many were inspired to try their own programs, and a number of people who reported previously being discouraged said they were ready to give it a go. We can’t wait!

Posted in: Healthcare Disruption, Healthcare motivation, Managing Chronic Disease, Rehabilitation Business

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Abreast In A Boat

This weekend marks the 25th anniversary of the Vancouver Dragon Boat festival, the biggest festival of its type in North America. Over 100,000 people will watch 180 teams racing to the finish. Dragon boating started over 2000 years ago in China as a fertility ritual held during summer solstice. Today there are dragon boat races across the globe, including North America, Europe, and of course Asia. Dragon boating promotes team work and discipline as the crew typically consists of 22 people: 10 pairs of paddlers, a caller at the front of the boat and a steerer at the rear.

Dragon Boat Racing from Wikimedia.org

In Vancouver, one of the most colorful and long-paddling teams, A Breast In A Boat, is made up of breast cancer survivors. In 1996 Dr. Don Mackenzie, professor of Kineseology at the University of British Columbia, posted an ad looking for breast cancer survivors to participate in an exercise study. At the time, the common understanding was that women who had treatment for breast cancer should refrain from upper body exercise to avoid the risk of developing chronic lymphedema  which is a permanent and sometimes incapacitating swelling of the arm that can be caused by damage to or removal of the lymph nodes, which often occurs in cancer treatment. Although this was the wisdom of the time, there was actually no research to support the fear. Dr. Mackenzie’s studies in the area of exercise rehabilitation led him to believe that the current thinking might be wrong. Dragon boating is mainly a core and upper body workout, so it provided the perfect way to test the theory. Dr. Mackenzie formed a team in February 1996, and the team named itself Abreast in a Boat.

In 1998, Dr Mackenzie was able to publish a research study on the project in the Canadian Medical Association Journal on the success of the project, observing:

How important is the Abreast in a Boat project? It is an approach to promoting health and raising breast cancer awareness that is driven by women with the disease. It reaches out to other women and offers them a message of hope and support. It is helping to change attitudes toward “life after breast cancer,” and it encourages women to lead full and active lives. It is making a difference.

Breast cancer survivors dragon boat teams

Breast cancer survivors dragon boat teams

What’s interesting about this study is that 15 years later, there is still not enough widespread evidence for the value of physical therapy after cancer treatment, in particular for recovery of muscle weakness from radiation. A lot more could be done to educate on both the value and the necessity for physical therapy to help patients gain back strength, abilities, and hope.

Today there are more than 116 breast cancer survivor dragon boat teams worldwide including 41 in Canada, 29 in Australia, and 24 in the United States. So, if you’re out watching in Vancouver or the rest of the globe this weekend, cheer a bit harder for the ladies in pink. They have paddled farther than you’ll know.

To read more:

Abreast in a Boat

Machestic Dragons

Rio Tinto Vancouver Dragon Boat Festival

Wikipedia

Posted in: Exercise Physiology, Healthcare Disruption, Healthcare motivation

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How much for that appendix? In Russia?

The recent news about the cost of healthcare in the United States has gotten me thinking. While critics say that transparency will not lower costs, it’s hard to imagine how hospitals will be able to continue to justify dramatic differences in costs for procedures between organizations or between countries. With numbers like this, is it any wonder that medical tourism is on the increase?

According to the Atlantic magazine, “getting your appendix out can cost between $2,000 and $180,000Hip replacements run from $10,000 to more than $100,000″.

The New York Times shows comparative pricing between the US and other countries, in the article “The 2.7 Trillion Dollar Medical Bill

Comparative Procedure Costs

Comparative Procedure Costs from the NY Times

“In the U.S., we like to consider health care a free market,” said Dr. David Blumenthal, president of the Commonwealth Fund and a former adviser to President Obama. “But it is a very weird market, riddled with market failures.”

One of the things that makes this such a weird market is that healthcare can be one of the biggest household expenses and yet people have no idea of the costs. This is true in both socialized medicine and an insurance-based system like the US. A number of years ago, my friend Bob tore his Achilles and needed surgery. As Bob, our friend Henry, and I were chatting about the procedure, Henry asked how much it would cost. Bob had no idea: the thought had never crossed his mind. We all worked at Microsoft HQ in Washington state and at the time, Microsoft had bar-none the best healthcare plan in the United States. (Microsoft has since changed their plan from this all-you-can-eat service.) The surgery was probably in the $25K range but Bob had absolutely no idea because he knew his insurance would cover it.

Like me, Henry had been raised in Canada with socialized medicine and before anyone got smug about the problems in the US system, he pointed out that neither system held people accountable for costs or decisions. We had no idea how much the surgery would cost in Canada either. This was the first time I really thought about healthcare costs, the amount of money changing hands, and how the beneficiary of the service had no idea what was being paid.

A few years later, my friend Diana, held a wonderful party in Seattle to celebrate overcoming breast cancer. One of the activities at the party was a contest to guess how much her breast cancer had cost. Diana and her husband are teachers, and while their salaries may not be particularly high, they do have good insurance. Total bill: $250,000, or 5 times the average annual salary for a Washington state teacher.

As I mentioned, I grew up in Canada, where thanks to Tommy Douglas, there is universal healthcare. Canadians do not need to worry about going bankrupt if they get sick. Canadians also do not get the kind premium service that the best insurance plans in the United States offer, and if you look you’ll find plenty of skeletons in the closet about wait times for procedures and so on. Although the individual does not know the costs of treatments, the healthcare system as a whole does a good job of ingraining the need to “not overburden the system.”  What this means is that people often second guess whether they are sick enough to go to the doctor or hospital, often because there is guilt associated with using the system unnecessarily. My friend Harriet describes this perfectly this in her blog post about her son’s asthma.

“This really isn’t right;  I should take him to the hospital.” But I hushed my inner voice thinking that once daylight hit, things would improve. And besides, I didn’t want to waste the taxpayer’s money on an unnecessary ER visit.” http://seetheorun.com/2012/09/12/trust-your-gut/

Canadians are often smug about our healthcare, and I suppose considering that the entire country receives free healthcare at a cost lower than what the US spends, maybe there is some justification. However, in 2001 when I moved to the US and experienced the “Cadillac of healthcare programs” while working for Microsoft, I have to admit it was pretty amazing. Unexplained coughing? Let’s see a lung specialist for airway testing. Psoriasis? Here’s an appointment with an expert at University of Washington. Contrast that to Canada where specialist referrals need to be renewed every 6 months by your GP. When I finally saw a dermatologist, we talked about how ridiculous it was that he couldn’t continue to treat me for a chronic skin condition without a note from my GP. Now who’s wasting taxpayer dollars?

Like Harriet, I have also internalized the “you’re okay, don’t see a doctor” mentality, exemplified when I experienced severe abdominal pain while living in Russia in early 2010. I moved to Moscow in 2008 for a 3-year posting with Microsoft, and was still supported by the best healthcare a corporation can buy. At 3am, with 12 hours of severe abdominal pain, I was still second guessing whether there was really a problem. It took an instant messaging chat with a friend in San Francisco to convince me to go to the hospital.

Again, thinking it couldn’t be that bad, I didn’t call an ambulance, but drove myself to the European Medical Center, a private clinic catering to expats and wealthy Russians. To put things in perspective, the healthcare plan that my Russian Microsoft colleagues had did not enable them to go this clinic; it was out of reach for their coverage. Within half an hour, I had an EKG, blood tests, CT scan, and a differential diagnosis of appendicitis. By noon the next day, I was minus one appendix.

The author and her Russian team in Moscow

Now here’s where the story might start to seem a bit ridiculous to you. Once my appendix was out, the rest of my hospital stay was so pleasant I didn’t want to leave. It was quiet, clean, with attentive staff, and a extremely comfortable bed with a down duvet.  I had a shared room with a Swedish woman who said the food was some of the best she’d had. (I wasn’t allowed to eat sadly.)

The final bill? $3500 Euro ($4900 at that time). Seems pretty reasonable doesn’t it? For comparison, my follow up visit with the surgeon was $90 Euro which is not cheap for a 15-minute consultation. This was one of the best facilities in Moscow, out of reach for most of the population including my affluent colleagues, and yet the costs of my surgery were not outrageous. It wasn’t as cheap as the $2000 lowest price cited by the Atlantic article but nowhere near their high-end of $180,000 plus I had CT scan (which can start at $1200 in the US), general anesthesia, laparoscopic surgery,  time in the ICU, an overnight stay, and some pretty amazing pain drugs.

Where does this leave us? Socialized medicine isn’t perfect but the free market isn’t working either. Prices can’t vary so widely. People need to understand their options and the costs of those options. Price transparency will help stop the gouging that happens at the high-end. The Obamacare mandate to cover more people will require less expensive solutions. Prevention and less expensive ways to manage health are key. New ways of paying for outcomes rather than diagnosis and procedures could help too.

At Wellpepper we’re passionate about improving the value of healthcare delivery while decreasing costs by extending the reach of the healthcare professional outside the clinic. We believe that technology, used by caring healthcare professionals can provide some solutions to these problems and we’re hoping to be part of the solution.

Author’s Note June 4th: Maybe Harriet and her family are stoic, or maybe we have some more problems in the system. Today after finally demanding x-rays her husband found out he’d been walking on a broken ankle for a month. The first doctor gave him painkillers and sent him on his way.

Posted in: Healthcare Disruption, Healthcare Technology

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The Case for M-Health

M-Health has been touted as the next-big thing in healthcare. We believe it’s more than a big thing, we believe that it’s where people want to interact, and mobile provides the opportunity to influence people much more than simply e-health. It makes sense right? Even if you sit at a computer all day, your mobile device travels with you and is always on. Some people are even sleeping with their devices.

Don’t take our word for it though, we’ve compiled some really interesting information and statistics on the growth of mobile and why it’s so important for healthcare.

Mobile Usage and Demographics

Starting from usage, The Harvard Business Review has an interesting take on the Rise of the Mobile User.

“55 percent of Americans said they’d used a mobile device to access the internet in 2012. A surprisingly large number — 31 percent — of these mobile internet users say that’s the primary way they access the web.”

What’s interesting about this, is that it crosses income lines. When we first started Wellpepper, one of the common objections we heard to our mobile focus was that “poor or old people don’t have smartphones” so we couldn’t reach enough of the population. That’s proving not to be true, in particularly because of the types of offers that the carriers provide. People who are accessing the Internet only through their cell phones may have never owned a personal computer.

Tablet technology has also opened up computing to a larger group of people. The ubiquitous iPad is used by babies and grandparents alike. Mobile Marketing Watch reports that 53% of seniors are online, 33% use social media and 70% have a cell phone. Over 50% of people in the US have a smartphone and we know that number is going to keep growing.

“78 Million baby boomers use technology to stay in touch with loved ones, connect online and improve health.” Not really surprising is it?

Mobile for Health

Patient preferences for e-health communications

Patient preferences for e-health communications

According to an Accenture study of 1,100 people, 90% want to use digital to manage their healthcare. However, they see this as a way to augment in-person visits. 85% of those surveyed also want to communicate in-person with their doctors.

Consumers already understand the value of electronic and mobile communications to improve their healthcare: 63% of respondents to the Accenture study want to receive reminders for preventative or follow-up care on their mobile devices.

Research2Guidance reports that 500M people will be using healthcare mobile apps by 2015. Ralf-Gordon Jahns, Head of Research at research2guidance, points out “Our findings indicate that the long-expected mobile revolution in healthcare is set to happen. Both healthcare providers and consumers are embracing smartphones as a means to improving healthcare.”

The Pew Internet Foundation’s recent study looked at people who track health indicators. Tracking indicators is a positive way to improve health outcomes. They found that while up to 60% of people track some health indicator, only 21% of those who do this are using some form of technology to do so. Most people are keeping track in their head or on paper. Given the benefits of recording the information, like seeing progress overtime and being able to share that information with a loved one or healthcare professional, again, we think this is a trend that will only increase.

References

Is Healthcare Self-Service Enough to Satisfy Patients? Accenture

The Rise of the Mobile Only User Harvard Business Review

Tracking for Health Pew Internet Research

500M People to Use Mobile Apps for Tracking Health FastCompany summary

Mobile Health Report Research2Guidance

 

 

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Technology, M-health

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A Collaborative Approach to Healthcare

As an individual with a chronic condition, from time to time an incident occurs that makes me think what a wonder it would be if health professionals involved in my care would collaborate more. I am sure that such a collaboration would give me confidence that management of my health is in control.

Depending on my current status, I am seen by a number of healthcare professionals including a GP, urologist, endocrinologist, gynecologist as well as physical- and occupational therapists—I know what a challenge collaboration can be.  In 2011, I was asked to participate in a new program in collaborative care at UBC. The program was looking for mentors with chronic conditions to work with healthcare students from multiple disciplines. When I read that the goal of the program was to encourage health care collaboration, I thought that maybe this program was an opportunity to give back and possibly influence the direction of health care in the years to come.

Collaborative Health Mentors. Image source UBC

I am now in my second year of volunteering for the UBC Interprofessional Health Mentor’s Program. The program offers first year students from various health disciplines the opportunity to collaborate with each other and a chronically challenged individual like myself. In my group, I have first year students from medicine, nursing, physical- and occupational therapy (just 4 of 9 possible disciplines).  As the “expert” in my care and condition having lived with it for 62 years, my role is to help students learn how health care providers can support people with chronic conditions.

We meet 8 times over 16 months including an orientation, group sessions, and a symposium. In our group meetings we are presented with topics to discuss such as: words and meanings; living with and managing a chronic condition; experiences with the health care system; and partnerships, collaboration and shared decision making. It becomes more interesting as the year progresses because the students also bring their life experiences in to the table. They offer their observations gained from their practicums in various health care situations as real examples of how collaboration either works or not.

What do we learn? In the group sessions, I explain my knowledge and life experiences with my chronic condition and how I and the health professionals manage my needs and well-being. As you can imagine, each person in the group, including myself, come to understand the importance of the patient’s role as well of those of their health care professionals as real-life partners in the health care system.

The magnum opus is the symposium. We are encouraged to come up with a display that reflected what we have learned as a group. Try to imagine a hall with 50 poster boards illustrating various aspects of patient-/client-centred, interprofessional teamwork… it was mind-boggling. Subject matter covered the heath care gamut and more: lupus, communication, mental illness, stigma, and aphasia to list a few. To convey the impact of the posters in words is impossible, but all had a similar focus—the patient/user/client and the professional teamwork needed to support them. For a quick impression, here are some pictures of the event.

The program has been a resounding success. The first Health Mentor’s Program was piloted in the fall of 2011 with a 32 health mentors and 92 students from 6 different health and human service programs at UBC. In its second year, the program expanded to 51 mentors and 203 students and 9 disciplines.

For more information about the program, its objectives, participants, and contacts, see: http://www.chd.ubc.ca/dhcc/healthmentors

Posted in: Healthcare Disruption, Managing Chronic Disease

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Film Review: Escape Fire-The Fight to Rescue American Healthcare

We recently attended a screening of the documentary “Escape Fire: The Fight to Rescue American Healthcare”. The 2012 film shines a light on major issues with the US healthcare system, and positions that the only way to fix it is to build an “escape fire.” The literal definition of escape fire is a fire intentionally set to provide shelter from a larger uncontrolled blaze. Figuratively, it is an improvised, effective solution to a problem that can’t be solved by traditional methods.

The film makes a strong argument that US healthcare is beyond traditional methods of repair. Some of the damning evidence of this comes in stories of unsustainable or questionable practices:

  • The woman who by her mid-30s had 57 stents in her heart
  • The soldier on a bagful of painkillers
  • The mid-40s man whose only healthcare is the emergency room after he suffers another heart attack

On the macro level the statistics are worse:

  • The US spends almost as much on pharmaceuticals as the rest of the world combined. (Is there any correlation between this and the fact that the US is one of only two countries where drug companies can market directly to consumers?)
  • 65% of Americans are overweight
  • 75% of health costs are spent on preventable diseases

The film makes a very strong case that the solutions will not be found in the traditional models where the incentives are currently not aligned with keeping people healthy, and where doctors are surprised that patients react well when they are listened to. Solutions come in preventative healthcare measures, team based medicine, and alternative therapies. Again the film does a great job of showing surprising solutions to the problems presented in the first half.

  • The woman with the stents will have them forever, but she now works with a healthcare team from Cleveland Clinic who monitor her whole health to prevent future episodes. One way they do this is that they are paid on salary not per procedure so incentives are aligned with what’s best for the patient.
  • The soldier with the bag full of drugs is taught meditation and receives acupuncture. He goes home with only these tools to manage post traumatic stress and pain and says he’s a changed man.
  • One of the most surprising solutions came from Safeway. Since in the US employers share in much of the burden in rising healthcare costs, it’s in their best interest to try to lower them. The CEO of Safeway realized this a number of years ago and the transformations in employee wellness and Safeway’s health insurance costs are tremendous.

Overall the film was thought-provoking with some incredibly powerful personal stories that represented the larger issues. Our only criticism would be that it failed to even mention models of care in other countries. Yes, it was about the problems in the US, and yes there are some large problems but there are interesting models worldwide that could also serve as potential lessons for how to evolve healthcare. If you are interested in healthcare disruption, though, we would recommend seeing this documentary and exploring some of the resources on the Escape Fire website.

Posted in: Healthcare Disruption, Healthcare motivation

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A Disruptive Solution for Healthcare

In order to deliver healthcare for all, we need to reevaluate the ‘gold standard’ of healthcare delivery and look to new models of care.

This was the message of a talk a few of us from Wellpepper attended last week given by Dr Jason Hwang. Dr Hwang is an MD and also an MBA who collaborated with Harvard professor Clayton Christensen on the book “The Innovator’s Prescription: A Disruptive Solution for Health Care.

IBM 704 Mainframe Circa 1964. Source Wikipedia.

Dr. Hwang used the familiar story of disruption in technology from the mainframe to the PC and now smart phone to draw analogies between the current state of healthcare, and where it needs to go. He calls hospitals the “mainframes” of the healthcare system. Highly powerful, capable of delivering great output, but not necessarily convenient or accessible, just like mainframes used to be. Consumer clinics, for example a nurse practitioner working out of a storefront in Walmart can be seen to be more similar to the convenience of a smart phone.  However, the industry hasn’t changed processes and regulations to accommodate these new models causing unnecessary overhead and barriers. Does a storefront clinic with no doctors need the same levels of documentation and EMR as a hospital?

Disruption makes what was once inaccessible more accessible, and eventually delivers it into the hands of consumers. The ridiculously powerful computer that 50% of us have in our pocket or purse is the perfect example of that. This computer is also democratizing healthcare. There are approximately 17,000 medical applications that enable consumers to track and sometimes even diagnose health issues that previously required visits to specialists.

Any doctor that can be replaced by a computer deserves to be. The idea is not to replace doctors but to free them up to do the work they were trained to do.

The same could be said of specialist and generalist roles in healthcare. Nurse practitioners can take on a lot of responsibilities that were previously tasks of doctors. Medical aides can take responsibilities from nurses. Advances in technology are helping to make expensive diagnostic tools cheaper and more ubiquitous.

What does all this mean for physical therapists? Dr. Hwang stressed that it’s very difficult for those within the system to disrupt it. For example, once a hospital exists there become all types of reasons for it to continue to exist: shareholders, board of directors, senior management, employees. It’s very hard for a company to cannibalize itself. He believes that those in the wellness, prevention, health and fitness industries have a greater opportunity to cause this disruption. Physical therapists have the unique position of being within the industry but not at the center of “how things have been done.” As they move into looking at the whole health of the patient, and more important in preventing injuries, they can be part of this change in medicine.

An interesting example of this is physical therapy combined with other health and wellness; for example, a clinic that has an MD, naturopath, nutritionist, and physical therapy practice, or a “medical gym” which combines a physical therapy practice with a traditional fitness center. This would be the perfect place to practice preventative medicine.

We’ve seen a lot of chat on Twitter about how physical therapy can be part of the positive disruption that’s happening in healthcare. At Wellpepper hoping we can help you move forward new models for patient engagement and involvement.

Posted in: Healthcare Disruption

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Whole Health and Wellness in Physical Therapy

Physical therapists are uniquely positioned to look at the whole health of the patient, however,  many are still just treating the injury. Health promotion needs to be a key evolution of the profession.

These were themes  in a few sessions at APTA CSM 2013 last week in San Diego, particularly in “How Can We Integrate Wellness Into Orthopedic Physical Therapy?” and “Challenging PTs to Thrive in a Changing Healthcare Environment.”

Both sessions challenged physical therapists to think about how to expand their impact by focusing on whole wellness of the person, whether that is trying to understand other lifestyle factors that may affect their health, or how to keep people active after their treatment.  When they only focus on the injury, physical therapists get the patient to a certain point of recovery and then discharge. The patients then don’t continue their exercises and are likely to re-injure. The idea of “patients for life” was introduced, not that we want patients to be injured for life, but that patients can continue to look to their physical therapist for prevention of injuries and support for their general well being.

Behavior change was cited as a key tool in helping patients manage their entire health. It’s not enough to get them to do their exercises, they may also have to change their behaviors if these are also impacting their recovery. For example, diet might need to change. Physical therapists are urged to look at one unhealthy behavior and figure out how to change it.

7 Forms of Wellness from University of California Riverside

7 Forms of Wellness from University of California Riverside

Understanding the full picture of wellness, will help understand the full patient. The  University of California Riverside defines these 7 forms of wellness as:

  • Social
  • Physical
  • Emotional
  • Spiritual
  • Environmental
  • Occupational
  • Intellectual

Identifying whether any of these, besides physical, are inhibiting the patient from recovery is key. For example, a patient might be missing social support, like a friend who could go for walks with them, which could slow or impair overall recovery.

Although both talks were similar in their recommendation that physical therapists become more involved in helping the patient modify their behavior to get better, neither offered practical tips on how to do this in a clinical setting. As well, they both admitted that although physical therapists were uniquely suited to do this they didn’t have the right training or tools.

At Wellpepper, we’d say this is consistent with our experience during our research on patient exercise compliance. Some of the physical therapists we talked to had well-defined strategies for getting patients to do their exercises, for example, don’t assign too many exercises or get the patient to choose the time, while others just prescribed and hoped. Helping patients modify their behavior for positive outcomes is a key tenant of what we’re trying to do at Wellpepper, so we’d love help physical therapists take a more active role in this.

Both sessions also encouraged the profession to have a voice in public health on health promotion and wellness. Doing this could make health promotion a more systematic part of physical therapy practice, and give physical therapists a seat at the table in the larger health reform conversation. We’re all in favor of this, and hope we can help.

 

Posted in: Healthcare Disruption, Rehabilitation Business

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