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What Can We Learn from the UK Health System?

There’s no perfect health system in the world, at least not that we’ve heard of. The US is plagued by high costs and uneven coverage across the country. Other systems like those in Canada and the UK have long wait times and can be glacially slow to adopt new technologies (aka pilotitis). However, taking a closer look into those systems can provide an interesting alternate viewpoint, and yet, so much is strangely familiar especially in the struggle to address the health problems of an unfit and aging population. We’ve recently been turned on to the Inside Health podcast from the BBC where topics range from those of national healthcare administration and benefits to specific health issues. Unlike many health publications, Inside Health frequently features patients talking about their experiences with the system.

Here’s a snapshot of questions posed on recent episodes:

  • Should medical screening with MRIs and CT scans be done proactively? This session talked about the risk of over-screening patients who are not visibly ill. While early detection is key to catch and treat many types of cancer, the screens often catch issues like tumors that would have gone away on their own, and therefore cause undue stress, cost, and discomfort to patients.
  • Should fruit juice be removed from food guidelines? Citing that calories that are drunk rather than eaten are not recognized by the body (aka empty calories) and that most fruit juice has all the fiber (aka the best part of the fruit) removed, the guest argued that fruit juice should not be part of the 5-6 services of fruit and vegetables recommended per day.
  • How should private hospitals be regulated? This story was particularly interesting, as it seems that the many private hospitals that are cropping up to take excess demand from the UK’s National Health Service, are not regulated in the same way as government-run hospitals. In this episode they examined some cases of knee and hip replacements gone wrong due to the lack of proper follow-on care. Since private often denotes more expensive and hopefully better quality it was curious to hear that they were not following standards.
  • Should healthcare professionals be fit? This controversial question was asked about whether healthcare professionals should be held to higher health standards, especially with respect to obesity, to set a good example for patients.
  • Should doctors be paid based on specific quality measures? This segment examined financial incentives for primary care physicians to complete certain tests and concluded that doctors will ignore financial incentives if they don’t believe the tests are in the best interests of the patients. However, in the example they cited, the incentive was $50 for doing a standard depression screening test which might be argued is not enough compensation for the hassle of the additional charting and follow up that the depression screen would have caused, not to mention the impact on patients who might not have actually been depressed.

You may notice a slightly paternalistic (or is that maternalistic?) bent to these topics, which is understandable as the UK has a national health system. However, all of them are topical and relevant to discussion occurring in the US right now. (Remember the uproar over soda sizes in New York?) Segments are short and conversational and feature real patients. Plus they are all delivered with the dulcet tones of the BBC broadcasters so you feel smarter just by listening. If you’re looking for insight, and inquiry in healthcare, this is a great podcast to add to your list.

Posted in: Healthcare motivation, Healthcare transformation

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Healthcare is part of our supply chain: The Boeing Company

The Health Innovator’s Collaborative sponsored by the University of Washington and the WBBA is entering it’s second year and continuing to gain momentum bringing together providers, payers, and health innovators from education, public sector, and industry to discuss hot topics in health. This week marked the second talk in the new season, delivered by Greg Marchand, Director of Benefits and Policy Strategy at The Boeing Company.

BoBoeing is a data-driven company that makes big bets and takes big risks to bring their products to market. This philosophy extends to how they provide employee benefits, and Marchand and team have taken a data-driven approach to healthcare benefits. In the same way that the principles of lean, data-driven decision making, and cost/risk benefit drive decisions across Boeings supply chain, the same rigor has been applied to healthcare benefits. Marchand knows that Boeing’s human resources are a key part of their success and wants to ensure they are working at optimum productivity. The best way to do that is to make sure they are healthy and that they receive the best benefits available. Quality, innovation, advocacy, and service are the influencers of Boeing’s strategy and the differentiators of their benefits.

Boeing made headlines for their “ACO” approach where they contract directly with healthcare providers and negotiate for service and Marchand came to the Health Innovator’s Collaborative to describe how they did it and why this is the model for the future.

Washington Hospitals, Boeing Strike ACO Deal

Boeing Signs Shared Savings Deal With Washington Hospitals

Boeing-Marchand2Marchand kicked off his talk with a personal example of a “defect” in the healthcare system, to his mind a result of healthcare organizations not having a consumer focus. A few years ago, his wife needed to make a doctor’s appointment for their child. She called for an appointment and was told that she could book a time two weeks from that day, which happened to be a Tuesday. Depending on whether you’re going to see a specialist, 2-weeks could be considered an acceptable wait time for an appointment, however, that wasn’t the problem. The problem was that if she wanted to book an appointment for another day, say 2 weeks from Wednesday, she’d have to call back on Wednesday to book it. Marchand asked the audience to try to imagine what might happen to a retailer like Nordstrom if they used this archane booking system for their personal shoppers. The system had a flaw, and it’s this type of flaw that Marchand and team are on a mission to correct.

boeing-marchand4To do so, they have partnered with UWMedicine and Swedish/Providence in Washington State to provide care for Boeing employees. They also rely on Cleveland Clinic as a Center of Excellence for cardiovascular care. While Marchand says that he doesn’t want employees to have to travel for care, he also wants them to have the most effective care, which is what drove the partnership. (You could tell that this statement was specifically aimed at attendees from the event’s host: the subtext being that it was possible for them to win this business for Boeing.) Boeing’s “triple aim” is quality, experience, and cost with the goal of improving the employee experience and passing any savings as a result of the new ACO model onto employees. Their expectation is that healthcare partners have these same goals and the same data-driven approach. The challenge for Marchand is the need to find partners in all states where Boeing has employees. While Boeing has a lot of clout with $2.5B in annual healthcare spend covering 500K employees, they don’t have the same economies of scale in all states based on employee number. (ACOs looking to pilot new ideas and test data-driven approaches should definitely consider reaching out to work with Boeing: they are looking for solutions.)

Finding the Defects

Marchand’s focus is on continually improving defects in the system and that includes the patient/provider relationship: making sure patients do what they are supposed to do. It also includes using the appropriate forms of communication and care for the situation. Here he gave two examples: using a house call service from Seattle-based Carena for non-emergency issues, especially with children, and being able to email or text your doctor with simple questions, like how to deal with side effects from prescribed medication. Both of these examples provided a higher level of service to the end-user and also lower costs to the entire system. A Carena house-call is 1/3 of the cost of an emergency room visit and email and texting is more efficient and less expensive than a phone call and most certainly than an office visit.

Understanding Cost Drivers

From all the data analysis, Boeing understands very well where its largest cost drivers are coming from and ways to improve, and from Marchand’s talk it was clear that they were very much in the driver seat in pushing their healthcare partners to innovate. Areas of focus include improving the usability of patient communication tools, managing population health, providing easily actionable data for the clinical team, and using the most appropriate and cost effective methods for care. Marchand gave the example of how incentives need to be better aligned to spend money on physical therapy rather than back surgery: again a situation where the patient experience is dramatically improved and costs are lowered, however incentives must be aligned because today, hospitals make more money on surgery than preventative care. Boeing and the ACO vision of the future changes that of course.

The Q&A portion of the event was quite lively and extended far beyond the allotted time. One notable question was about why other employers are not taking the same approach as The Boeing Company. Marchand wishes they would but acknowledged it’s a lot of effort and certainly the data-driven approach is in Boeing’s DNA. As well, only the largest companies have the resources for this type of undertaking.

If you’re in Seattle and interested in the massive changes coming in health and looking for a community of like-minded people plus lively debate, then we recommend you check out the series. Talks are the first Tuesday of every month. We’ll see you there!

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Lean Healthcare, Seattle, Telemedicine

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23 and Who? The results

This post is the 2nd in a 2-part series on our experiences with 23andMe.

Wellpepper: What made you want to try 23andMe?

Anne Weiler: I wanted to see what the customer experience was like. It seemed so simple. $99 and they promise to tell you about your ancestry and DNA.

Jacquie Scarlett: I was really interested in getting back the results and seeing if the information I received from 23andMe was consistent with what I already knew about myself and my family history.

Wellpepper: What did you think you would learn?

Anne: I was curious about my ancestry. I had a theory that somewhere in my family someone was Jewish. They weren’t.

Jacquie: I figured that I would get confirmation that I was mostly European and that arthritis ran deep in my history and would be a high risk for me.

Wellpepper: Were you surprised by the results?

Anne: Originally, I was surprised at being 99.9% European. People are always asking where I’m from and they aren’t satisfied with “Canada” as an answer. When I was travelling in Nepal people thought I was half Nepalese. However, since I originally received results, they have been refined, and I’m now only 99.5.% European. I am not sure if that explains anything though.Anne Weiler Ancestry from 23andMe

Jacquie: I wasn’t overly surprised by the results, but found some items very interesting. I knew that I would be mostly European, and I was – 99.7% (mostly British and Irish) – but it was fun to find out that I was .1% Jewish and .1% Native American.  It was also pretty cool to see 479 DNA relatives pop up in my results from all over North America and the UK.

Wellpepper: What was the most surprising result?

Anne: Most surprising were results that contradict my actual experience. For example, 23andMe says I’m at reduced risk for Psoriasis, a hereditary disease that runs in my family and that I do in fact have. This does make me question other results.

Jacquie: There were a few illnesses in the Elevated Risk section that took me back for a moment, but then when I dove into the results I realized that I was merely a few % points above the average for all people and I relaxed. It is a bit surprising to see those illnesses listed in front of you.

Wellpepper: What was the least surprising?

Anne: That I’m at risk for glaucoma. It’s hereditary and I’m familiar with my family history.

Jacquie: High risk for arthritis – very prevalent in my family history and I already have the illness.

Wellpepper: What is your understanding of the accuracy of this test?

Anne: I don’t know the statistical accuracy, but I know that 23andMe was trying to get to 1M DNA records sampled so that they could claim accuracy. I also saw the NY Times article showing the discrepancies between tests. Based on some of my results that are wrong it’s hard to know. The brain is funny though: I definitely want to believe that the results showing low risk for Parkinson’s or MS are correct even though I have other results that are incorrect based on my personal experience.

Jacquie:  I do not know. I have the understanding that the more DNA they receive from the population, the more accurate the results will be and the more information they will be able to find out. I took this as an opportunity to learn more about DNA and the possibilities of what you could learn versus that this is the absolute truth.

Wellpepper: What was it like to receive your results?

Anne: Anne Weiler Norovirus ResistanceIt was addictive. We all want to know about ourselves, and here it was, in great detail. I really loved the random things I found out, like I’m resistant to Norovirus (stomach flu) or that I am likely to sneeze in bright sunlight. I intuitively sensed those things, but had no idea they were genetic.

Jacquie: It was pretty fun and interesting. I love learning more about myself and family history. Even though there was a lot of information, I found myself wanting more and wanting to dive deeper. Every time there was an unknown listed – I wanted the answer – this is what keeps me coming back to the site.

Wellpepper: Since you have received your results how have you engaged with 23andMe?

Anne: They are very good at pulling you back in, either through relatives who want to connect or by releasing new test results. That’s the really interesting (and scary) part. Once your DNA is analyzed it remains on file and they run new tests or more accurate versions of previous tests on it. I didn’t realize that it was going to be such a sticky experience.Anne Weiler DNA Relatives

Jacquie: I have checked in from time to time to see if any of my results have been updated. I also really enjoy doing the surveys – I am very interested in the research that 23andMe is doing and want to help in any way I can.

Wellpepper: Have you shared your information with anyone? Who and how?

Anne: I’ve connected with two 2nd or 3rd cousins on the 23andMe website. I’m interested in finding my maternal grandmother’s family. We don’t know as much about them.

Jacquie: I have shared my results with close friends and family, mostly with family to entice them to do the test as well.

Wellpepper: Would you share it with your doctor?

Anne: If I thought it was relevant to symptoms I was experiencing yes, but otherwise not unless my doctor asked. Doctors are being overloaded with data these days.

Jacquie: I would share the results with them if they would find it helpful.

Wellpepper: Do you think 23andMe will continue to engage you?

Anne: I don’t seem myself using it all the time, but as I mentioned before they do a good job of bringing you back in, and maybe I’ll become more interested in genealogy as I get older.

Jacquie: I will check in here and there. I imagine that if I have a health situation, it will be helpful to be able to pull these results when needed.Anne Weiler Asparagus 23andMe

Wellpepper: Do you think people should have access to this type of personal health information? Is it dangerous?

Anne: They should definitely have access. I thought 23andMe did a good job of presenting potentially disturbing results with the appropriate cautions. For results for chronic and debilitating diseases they make everyone read information about the disease before they tell you if you have the marker for it. I think it could be dangerous if someone started to make changes before talking to their doctor, except for some basic things like avoiding tobacco or caffeine, which are good for you regardless of the markers you have.

Jacquie: Absolutely! I think it’s very beneficial for people to have the most information possible so that they know more about themselves and feel empowered to take care of themselves and their health.

Wellpepper: Based on receiving your results, will you make any personal changes?

Anne:  I will be more helpful to people with stomach flu since I know I can’t catch it, and I’ll be even more strict on my caffeine in the morning only policy.

Jacquie: The results weren’t surprising enough to cause any personal changes.

 

Posted in: Behavior Change, Health Regulations, Healthcare Disruption, Healthcare Technology

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Social Media Tips for Healthcare Professionals

In 2009, Google launched its Flu Tracker application to map the spread of infectious disease by monitoring search keywords by geography. More recently, researchers at Johns Hopkins claimed that they could track the spread of the flu using Twitter significantly faster than the CDC could predict. Its like the town crier amplified by a million. Individually, there have been examples of doctors learning more about their patients on social media that has lead to either diagnosis, or follow-up visits. In previous posts we explored how social media can play a role in recovery for patients. Now, we’ll take a look at social media for healthcare professionals.

Ways in which healthcare practitioners can benefit from social media:

icanhazpdf

icanhazpdf hashtag for finding research documents

  • Research. There is a ton of information being shared through social media, including studies that might be otherwise hard to find. Did you know there’s a Twitter hashtag where you can ask for a publication? If someone in your network has a copy that is allowed to be shared, you can usually find it. #icanhazpdf
  • Connect with your peers. There are people from all over the world participating in conversations about treatments and best practices.
  • Connect with your clients and potential clients. Social media is an easy, and inexpensive marketing and patient engagement tool.

A few simple Do’s and Don’ts for healthcare practitioners for engaging on social media:

Do

  • Do: Use social media to build your reputation and practice. Can patients and potential patients find you on Twitter, Facebook, LinkedIn? Can patients who love you easily recommend your services? The Mayo clinic offers a course in social media for healthcare practitioners. They also monitor which social media sites are used by healthcare organizations
  • Do: Use social media to research, connect with your peers, and spread best practices. Did you know that there’s a weekly Twitter chat where physical therapists discuss business issues related to their profession? Tune in to #solvePT at 9PM EST to see what it’s about.
  • Do: Take advantage of the immediacy of social media. Jointworks Chiropractics, for example, uses Twitter to fill last-minute cancellations.
  • Do: Start slowly. Managing social media can take a lot of time. Make sure you know how you want to participate. Start by watching what similar practices or people are doing.
  • Do: Keep learning. The methods of communication are changing constantly and are going to keep evolving.

Don’t

  • Don’t: Ever share patient identifiable information on social media. If you learn something helpful about a patient on social media, follow up privately. An individual can share whatever they like about their health, but you cannot, so even if they post something on your Facebook page, you still need to answer privately. Even email may not be private enough for HIPAA standards. All communication needs to be encrypted. 
  • Don’t: Share information about yourself on public networks that you wouldn’t want patients or colleagues to know
  • Don’t: Criticize patients on social media. Yes, they can rate you and criticize you, but it doesn’t go both ways.
  • Don’t: Be afraid to show some of your personality. It will help patients connect with you and you might have more effective visits.
  • Don’t:  Underestimate the impact that social media has and will have on health.

If you’re interested in this topic, here are a few additional articles you might want to take a look at.

Should Doctors and Patients Be Friends? from the Wall Street Journal

A survey of physicians last May by Epocrates inc., which develops medical reference apps for physicians, found that 82% were using social networks to engage with other physicians, while just 8% were doing so with patients.

Teenagers, Social Media, and Health Information Privacy from ihealthbeat.org

Teens “do not seem to associate their personal identity with their diagnosis. They identify who they are by their friends, school, interests, etc. It is in this context that some of them mentioned that they don’t talk about their diagnosis or treatment on Facebook because they don’t want to be perceived as ‘attention-seekers,

How Facebook is Transforming Science and Public Health from Wired

The logic is a simple one: Everyone on Facebook, all 1 billion-plus people, will have an illness at some point in their lives. And, as Facebook’s social creatures are in the habit of doing, that mass of people will share their experience battling disease, ask questions of their friends, and field advice from outsiders

 

Posted in: Healthcare Social Media, Uncategorized

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