Next Things First


Limeade Makes Progress on Productivity Measures … by Rob Coppedge
March 2, 2009, 5:41 pm
Filed under: seattle market, start-ups, wellness | Tags: ,

imageprovideraspxFor those who are unlucky enough to go to health care conferences regularly, there are certain old saws that get played again and again: the 80/20 rule, the astronomical growth rates in health care spend, the explosion in the numbers of elderly Americans …

The one I like best is about the significant costs related to productivity-related issues: absenteeism, presenteeism, etc.

I like it best because it has been hard (if not impossible) to baseline these conditions and costs and measure improvement.

The disease management and wellness companies would reference this stuff, but much like quantum physics one had to mix faith with reason to believe in all this unmeasurable dark matter (or to give the DM companies the benefit of any supposed improvements).

So, it is with some excitement that I have followed Limeade‘s work with productivity-related measures. They’ve just released the first findings from their recent study, and they contain some interesting bits:

Companies keep rolling out these Health Risk Assessments (HRA), thinking that they really help predict productivity.  Well, they kinda sorta do.  A little bit.

But as it turns out, there are much, MUCH better predictors out there.  In fact, the health risk factors from our study barely crack the Top 10 predictors of productivity.

What does?  Things like job satisfaction, belief in your company, meaningful work, the ability to manage depression (OK, that counts as a health risk) – even “openness & optimism” – trump more “conventional wisdom” wellness measures like heart health and nutrition.

The Limeade well-being assessment covers work, personal and health factors, and predicts productivity more than ten times better than health risk factors alone, per our recent study of over 9,000 participants.  There is quite a bit of fancy math behind this, which we will find a way to publish soon.

You can find the full posting on Limeade’s blog. I look forward to reading more of their findings – cracking the code on productivity measures (enabling employer action to improve the supposedly sorry state of affairs) will present huge opportunities.

Posted by RobC

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Beyond the Partners Health Article: Looking at the Bigger Picture (From Howard Luks, MD) by charlottegee
November 19, 2008, 4:46 pm
Filed under: innovation, quality, wellness | Tags: , ,

The recent article in the Boston Globe regarding the perceived inequity of payments to the Partners system by local payors serves as notice on where the press and perhaps the public is going to come down on this issue. In the article, the authors assumed their conclusion and skewered Partners. I believe the authors missed a huge opportunity to explore the bigger picture. One of the more glaring problems I have with the article is that the authors begin with the assumption that institutional compensation (in medicine) is linked to quality.

Health care (medicine) is big business, the largest the world has ever known. The “average” successful hospital’s margin is 2%-2.5% at best. The payors are only interested in managing shareholder value and revenues and the effect of reimbursement on their valuation. How can the authors of the article find fault with Partners and their ability to negotiate from a position of strength, while they note that other local institutions are struggling and running in the red even prior to the enormous cuts that will come down from the state over the next quarter? How can they fault Partners’ quest for a profit to fund the next generation of technological advances, capital improvements and to fund care for the indigent and under-insured? Another interesting consideration is how the reporters gained access to the fees paid to institutions. There is NO transparency in this space. Confidentiality agreements between payors and institutions are SOP—which leaves one to imagine who wanted this article published in the first place.

The bigger picture that was not explored by the reporters is measuring quality and somehow tying quality measures to compensation. Measuring “quality” is a burgeoning practice (industry) that is trying to define and align itself in this highly fragmented and well-entrenched space. The definition of *success* and *quality*is the first of many roadblocks that exist. Is it a length of stay issue? Complication rate issue? Quality of life issue? Mechanical issue (healed rotator cuff in a patient who remains in pain)? Which of the overlapping systems are we referring to: the environmental level, the level of the health care organization, or the interface between clinicians and patients? There are numerous opportunities that exist within existing industry standards and industries that are just starting to emerge to enhance/streamline/incentivize (and profit from) the focus on *quality*.

A small, but certainly not exhaustive list of opportunities that exist are in various areas of the health care system:

Enabling rapid advances in health care: The need for federal, state and local governments to come together and guide reform platforms.

Health care delivery redesign: In order to provide safer, more reproducible, higher *quality* care, the environment in which health care is delivered needs to change. This will need to address, amongst other issues, management practices, workforce capability, work design and organizational safety culture.

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DailyPill4u.net, version 2.0 by charlottegee

The Health 2.0 conference took place in San Francisco yesterday and today (take a look at all those sleek, pretty sponsor logos: http://www.health2con.com/sf08.html).

The “traditional” definition of Health 2.0 is “the use of social software and light-weight tools to promote collaboration between patients, their caregivers, medical professionals, and other stakeholders in health.”

We’ve all seen these websites. A few of us may even use (and benefit from) them. More likely, the majority of us have just read about them on blogs or in newspapers and wondered: “Does anyone actually use those sites? Why would anyone want to add yet-another social networking site to his list of bookmarks?”

At any rate, there certainly seems to be a never-ending crop of Health 2.0 sites popping up on the web … targeted either for particular professions or diseases and conditions or goals like weight loss, increased physical activity and smoking cessation. And someone is giving them lots of money.

Capitalizing on this trend (and perhaps fulfilling its own prophecy), this week’s Health 2.0 conference has generated a lot of interest, with a SRO audience of 1,000. Over at The Health Care Blog, Matthew Holt writes of the buzz:

Tonight the party starts, the beautiful (and not so beautiful) people gather, and the shows under way—and that’s just the Health 2.0 team! There’s also 900 + speakers, guests, media, volunteers and the community is buzzing. Wall Street may be going crazy, the election may be a cakewalk (or not) but in health care interest in combining user-generated content with personalization based on data is growing. Last year around 500 people got together to find out what Health 2.0 was. Really, we only had about 35 decent options from which to choose our eventual 25 demo panelists (and one or two of those were a little of a stretch).

This year he says they chose from over 250 (!) presenters.

All of this buzz does raise some questions. What do we do with all of this user-generated content? Which platforms and features (and, yes, gadgets and widgits) work and which don’t? How does a consumer, a physician or a caregiver go about separating the wheat from the chaff, with so many options out there?

Oh, and, what about traditional health care services (remember that “legacy” business: the actual provision of care?). One might wonder if all this Health 2.0 stuff is on the periphery having little-to-no effect on the delivery of care, or whether there is more of an impact on established models. For instance, for someone just diagnosed with diabetes, does having an online social network have any real impact on her health outcomes? How does her interaction in an online community affect her relationship with her caregivers and the facility? Does anyone know?

Thoughts on where we go from here? The floor is open.

[We will be posting comments and perspective from our friends, readers (and even those we think are totally off base) over the course of the next week. Let us know what you think.]

Posted by CharlotteGee and RobC



Everything but Touch and Smell by charlottegee
October 2, 2008, 9:57 am
Filed under: finance/revenue cycle, health it, wellness | Tags: , ,

The Minneapolis-St.Paul Star Tribune had an article yesterday titled “If you think HMOs were different, just you wait.” The author brought up some of the recent trends (“experiments” they are called) going on in the health care industry — ones that specifically impact health care consumers. None of these are new, but it’s interesting to see that these ideas and practices have indeed reached the mainstream. Sort of like when you hear Cat Power cover David Bowie for a Lincoln car ad.

First, the article discusses telemedicine, and, how with CMS reimbursements changing in January, people are taking another look at its benefits:

Dr. Thomas Harman has been caring for some very sick patients for the past two months. Including some he’s never met.

From miles away, the Mayo Clinic family doctor listens to their hearts — instructing patients at home to hold a stethoscope to their chests while Harman dons headphones to listen via a computer.

On a special touchscreen, they answer his questions about how they feel and input their weights, temperatures and other vital readings. Some have diabetes or chronic lung disease or are obese. …

The devices are made by AmericanTeleCare of Eden Prairie. Its devices have been used by astronauts on space missions and by the Centers for Disease Control and Prevention in remote corners of the world. There are about 3,000 of the devices across the country, about one-third used by the U.S. Department of Veterans Affairs.

“You can do pretty much everything except touch and smell the patient,” said Dr. Randall Moore, chief executive of AmericanTeleCare.

Also discussed are the now ubiquitous employee wellness programs, including onsite clinics that conduct screenings and coordinate care with worker’s primary care doctors (“a shift from illness treatment to wellness treatment”).

And then there are the machines that act like ATMs, but dispense meds instead of moolah:

InstyMeds Corp. of Eden Prairie makes a refrigerator-sized machine that dispenses prescriptions. Doctors give patients a prescription and a personal identification number to punch into the machine, usually located in the doctor’s office, an urgent care clinic or emergency room.

The drug “ATM” dispenses common pain medication and antibiotics, “things that help people right now,” said Robert Bang, InstyMeds director of sales and marketing. The bottles are prepacked, and scanners check the bar code three times before the drugs are dispensed.

Finally, the upfront payment trend is mentioned, with a warning to consumers to get ready to pay upfront for care.

Now some doctors are looking at installing kiosks and other devices to swipe a credit card upfront — just like at hotels and car rental companies. The card is charged only after a service has been performed and the insurer clarifies how much is owed.

We’ve already seen the backlash against upfront payments. How will these other “experiments in efficiency” pan out? Any change in procedure, especially with something as personal as health care, is often looked at with wary eyes. But my guess is that if these experiments actually save the patient precious time and prevent the frustration of, say, standing in line at the hospital pharmacy for half an hour after you’ve had a procedure and just want to go home, they might be welcomed with open arms.

Posted by CharlotteGee



The Office on a Diet by charlottegee
September 28, 2008, 4:18 pm
Filed under: wellness | Tags:

The season premiere of “The Office” (9/25/08) entered the world of employer-sponsored wellness initiatives*, with the main office in New York announcing a “Biggest Loser”-type contest: The branch that loses the most weight earns extra vacation days. Let the games begin!

Every week over the summer, “The Office” employees are weighed on a freight scale in the warehouse. Things soon get a bit out of hand, of course. Some employees take the challenge too far by forcing coworkers to walk five miles or purposely ingest tapeworms to lose weight (not a tapeworm). They–very sadly–eat fruit at birthday parties (but soon sneak some cake), one goes on a Master Cleanse diet and passes out, they turn up the heat in the office to create their own sweat lodge. You get the idea.

Eventually HR steps in, sending a memo saying this kind of behavior is not supported, and Michael the Branch Boss winds up in a fat suit, telling the employees that big is beautiful.

All of this is funny, but raises some interesting questions. With team-based competitions and employee wellness programs popping up all over the place now, how do organizations ensure that they don’t let things go too far? For example, Shape Up The Nation is a workplace team-based competition, where employees track and post various things online such as weight loss and pedometer steps. What’s to keep someone from getting a bit out of control? From walking miles and miles a day (instead of working) just to win the competition?

And, what about (gasp!) cheating? Sally said she walked 200,000 steps, but how can we be sure?

Taking a step back, BusinessWeek’s The Debate Room recently featured a pro and con argument about wellness programs in general: Employee Wellness Is Ill-Conceived / Businesses should stop trying to meddle in their workers’ health and fitness habits. Pro or con? As expected, interesting points on both sides.

No matter where you come down on this issue, two things seem pretty clear. First, a program’s incentive structure must be appropriately constructed with the organization’s (and the employees’) unique needs and wants in mind. And, secondly, there must be some ground rules set from the beginning to avoid participants going to extremes, which are never healthy anyway.

*Note: Employer-sponsored wellness initiatives are based on the idea that healthier employees are more productive and cost less in terms of health care claims costs. Obesity, smoking and lack of activity are all usual suspects targeted with these programs.

Posted by CharlotteGee



But, But, It’s Recession-Resistant, Right? by charlottegee
September 26, 2008, 9:24 am
Filed under: economy, pharmaceuticals, wellness | Tags: , ,

From WSJ

From WSJ

We’ve all declared it and/or heard it and/or believed it: Health care is a recession-resistant industry. If people need care, and have the means to get it, well, they’ll get it, right? Surgeries will go on; prescriptions will keep being written and filled; patients will go see their doctors when something is wrong or they need a check-up. But, according to the Wall Street Journal:

As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on health care, a sector once thought to be invulnerable to recession. Spending on everything from doctors’ appointments to preventive tests to prescription drugs is under pressure.

The number of prescriptions filled in the U.S. fell 0.5% in the first quarter and a steeper 1.97% in the second, compared with the same periods in 2007 — the first negative quarters in at least a decade, according to data from market researcher IMS Health. Despite an aging and growing U.S. population, the number of physician office visits also has been declining since the end of 2006. Between July 2007 and 2008, the most recent month for which data are available, visits fell 1.2%, according to IMS.

This is scary stuff. And the article notes some scary anecdotes to go along with the stats: women not going to the OB/GYN as often for preventive care; a woman delaying surgery for a cataract, which will only get worse with time; people not following up with the bloodwork or treatments that their doctors ordered; a schoolteacher skipping her asthma medication to save on prescription costs.

In sum:

“That says to me that people are just deferring care if it’s not acute,” says Laboratory Corp.’s chief executive, David King.

As noted time and again when discussing the uninsured, lack of preventive care and lack of primary care services to take care of health problems from the get-go only result in sicker patients with more acute issues, which are, of course, more costly to treat. (Not to mention the effects this decrease in utilization will have on the health care companies/organizations providing all these services.)

What can health care players — doctors, hospitals, payors, pharma companies, drug stores, organizations with wellness companies, etc. — do to help ensure people continue to receive the care they need? Ideas?

Here’s one, from the article:

Speaking at an investor conference this month, Walgreens Co. Chief Executive Jeffrey Rein said the U.S. is experiencing the “tightest prescription market” in his 27-year career, as more cash-strapped patients skip their pills or take half doses. He said the company has looked at different ways to get people to fill prescriptions. For example, pharmacists are reaching out to patients through phone calls and emotional appeals such as, “Do they want to be around when their kids grow up, or their grandkids?” Mr. Rein said.

Posted by CharlotteGee



So What If? by charlottegee
September 24, 2008, 3:55 pm
Filed under: uninsured/underinsured, wellness | Tags: ,

HealthLeaders Media recently compiled 10 mini-articles dealing with various scenarios: What if safety-net hospitals start to fail? What if the uninsured hit 75 million? What if people actually start taking care of themselves? And the like.

An interesting editorial concept, because, really, who knows what will happen next? All 10 scenarios are based on current (actual) trends, and the authors just take them to their extremes. And while doing so, shed some light on potential innovations that could help a system that seems to be cracking more and more every day.

Consider: What if primary care physicians become extinct? The writer covering this scenario summarizes the important role primary care physicians play, after telling us that they might disappear because of, guess what, money (or “the growing compensation disparities between specialists and primary-care doctors”):

… Sure, nurse practitioners and physician assistants can handle some of the preventive care if that [the disappearance of PCPs] happens. Primary-care doctors often cite routine cancer screenings and immunizations among their irreplaceable preventive services, but those can and will be handled by nonphysicians. It’s when a patient has multiple severe medical problems that the primary-care doctor’s coordination will be missed. Specialists can individually treat hypertension, diabetes, arthritis, and depression, but when one patient has all four conditions, how will they be managed? They won’t.

The piece also provides an interesting perspective on wellness:

What if Americans listened to their doctors and exercised, ate healthier, and stopped smoking? The trend of chronically ill Americans-more than 130 million people-would be reversed. The country’s healthcare system could actually change its focus from sickness to health. …

“We have to be very careful how we analyze this, because one person’s benefit will be another person’s detriment,” says David B. Nash, MD, MBA, chair of the department of health policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia.

The biggest winners in a healthier society would be patients and employers. Healthier Americans would live longer lives. Employers would not have to pay an increasing percentage of their budgets on healthcare, but could allocate the money into salaries, products, and infrastructure. …

But what about providers? Nash says only 3% of the American population follow four basic wellness goals: Don’t smoke, stay close to your ideal body weight, exercise three times a week for at least 20 minutes, and eat fruits and vegetables regularly. If that percentage increased to a mere 9% of the population, Nash says, hospitals would see a large drop in admissions for bronchitis and upper respiratory problems, heart attacks and strokes, and diabetes. In short, healthier Americans would force physicians and hospitals to make changes.

Want one more? What if universal health care happens?

… who would provide care for all the newly insured patients? Massachusetts, which has one of the highest rates of physicians per capita, doesn’t have enough primary-care docs to meet the demand. So imagine what might happen in Texas, a state with one of the lowest rates of docs per capita and more than 5.5 million uninsured, or 25% of the population.

“It may push providers, hospitals, and the government to start thinking more about efficiency, cost effectiveness, and controlling costs,” says [Michael] Doonan.

Read 10 Events That Could Change Healthcare.