Untangled Health

Consumers Unite To Drive The Changes We Need

Tag: @healthvault

An advocate gets busy while every politician and “talking head” takes credit for healthcare model ideas published long ago.

Reconciling data in my six health portals

Reconciling data in my six health portals

I watched Barbara Starfield again last night. She passed away in 2011 but it seamed as though she was sitting in my living room telling me everything will be alright but many of us will never get our way. Barbara spent several decades studying the characteristics of health systems all over the world. Her final conclusions were simple and easy to implement as long as social agreements were made between consumers of healthcare services and their providers. The contract (sort of) is that my primary care doctor will be available when needed if I promise to contact his or her office before going to the ER for an earache or other non-emergent condition; my doctor also agrees to follow my care as I transition through life stages and address all mental and physical health conditions as they arise by assuring I connect with the correct specialist if required. The specialists in return are in constant contact with my primary care doctor so the primary care clinic is coordinating continuous and comprehensive care and reviewing all interactions between myself and other medical environments. Like I said earlier this week. Someone to watch over me. I first learned of Dr. Starfield in 2001 and followed her publications. Funny, she was never accepted to sit on any best-practice boards but the scientific community considered her work to be spectacular in terms of statistical approach and quality. In other words, she looked for the null hypothesis also.

Again…concerns over repeal and replace.

Some more diatribe with hope at sarcastic humor is written for you below. Please follow through to the end as I pasted a really cool graphic pointing you to a new society of consumers and professionals that might fix the system over the long run.

The conversation doesn’t stop at my dinner table, on my phone, through IM or Facebook. It seems as though my popularity index took a healthy bump after November 8th, 2016. I wish I could be happy about the reasons for the traffic.
“Jeff, you are on Medicare are you concerned?”

Well yes; you see, as we become older the likelihood of needing assistance from case managers, specialists, short stays in skilled nursing or rehabilitation facilities increases. Same with home health services which is always the preferred place to recover from the self-inflicted fractured hip that occurred while my masculine ego informed me of my capacity to clean out my gutters.
One of the most important changes to the clinical language coming from Obamacare is the right for all patients cared for by primary care doctors with Medicare contracts to receive “Coordinated, Comprehensive Care”. Lately you might have heard the terms: “Patient Centered Care” or “Medical Home”. You probably heard President Elect Trump mention “Patient Centered” or a new commercial by Humana presented by a handsome young doctor stating that Humana’s system of Patient Centered Care is superior because of their capacity to coordinate your care within their “medical community”. Then you will watch a local conservative pundit state: “those stupid narrow networks tried through Obamacare didn’t work: here is a toast to repeal and replace.
This stuff cracks me up for the same proponents of patient centered care realize that closely collaborating narrow networks can provide you with clinical personnel that understand your needs better than anyone else! In fact, they have the same attributes of a Patient Centered Care Team using a single medical record and plan of care to increase safety and minimize mistakes. Yet you will hear no one (perhaps save me and a few of us that are tired of scraping the poop off our boots) tell you that the words Patient Centered, Narrow Network, Accountable Outcomes, Value Added Payment, Medical Homes, and all other terms implying a tightly coordinated, error free clinical team surrounding all patients are not original concepts. In fact, they are in place in many of our successful neighbor nations who provide universal enrollment and have always demonstrated lower reliance on emergency room services for basic medicine, better health outcomes and no difference in treatment effectiveness for cancer, diabetes, cardiovascular disease and other leading causes of premature mortality. Our own CMS (The Centers for Medicare and Medicaid Services) have published the policy here July 2016:
So all of a sudden the administration of 2017 will be using terminology invented by others to describe care models that work after years of academic surveillance by healthcare policy analysists and already written into The Patient Protection Affordable Care Act or what the opponents call “Obama-Care”.
My prediction is we will keep the new payment systems for coordinated care and chronic disease care management. However, the credit for the success will fall under a new Trump label. My fears is that the same three insurance companies comprising the oligopoly of payers for American Healthcare will recoup their lost profits of mandated care without premium inflation for the chronically ill by shifting the premiums higher for those with pre-existing conditions. So here is another question from the week:
“Jeff, what will I do now I couldn’t get covered because of my history of cancer before the ACA?” “What if “Trump-care” requires coverage for pre-existing illnesses but allows insurance companies to include the illness in the premium pricing model? “ My response to this question was “not sure, my cost in the NC High Risk Insurance Pool for my diabetes prior to Obamacare was $1200.00 per month not including co-pays. Today it is $350.00.
More on Patient Centered Care AKA Medical Homes AKA Integrated Care AKA Chronic Illness Care.
I discussed the integrated care model and its payment adjustments to my Men’s group on Thursday night as they requested a primer on planning for their last ten years of life. Their hope was that our system of care had evolved and they would not have to lose their homes to cover the long-term care charges. Many of the guys in my group neglected to buy long term care insurance when they were young and healthy, had since suffered a chronic disease diagnosis and episode of treatment and no longer qualified for long term care insurance. They could however place $10 K per month into an account to pre-pay up to one year of long term care. This is what my father did: In 2006 he entered into a contract with a transitional care organization. He paid them $350,000 for full access to assisted living and long term care until his death. They also allowed him to live in the attached apartment complex for independent seniors for an additional rent of $3200 per month including one meal per day. Not a bad deal eh? Oh yeah…one more oversight: My friends ; all retired upper middle class professionals had no idea that Medicare didn’t pay for long term custodial care either in home or inpatient facility.
Now, like I said the other day, I am a bit tired of shouting the truth to those who were unfortunate enough to buy into the following promise: “Oh we will have the most wonderful healthcare system in the world” and “We promise to repeal the expensive policies and replace with something better.
We were on our way folks: The biggest mistake, President Obama’s team was denied the necessary Medicaid expansion for ALL not SOME States by our supreme courts. If you don’t understand the math I will be pleased to describe it in another column. Basically when the folks that would have had access to Medicaid don’t receive the insurance they still consume services. The loss of revenue winds up on the balance sheets of hospitals and providers and they respond by increasing their cost per service. The insurance companies pay more and your premiums increase. So… my neighbors policy (55 year old male) in NC costs $11,000 per year. The very same policy in New Hampshire where they expanded Medicaid costs $5,500 per year. As Mr. Obama leaves keep in mind that the rate of increase in health costs since the inception of Obama Care is the lowest it has been in 40 years.
Somehow, someway; we need to cover everybody. If we do not we cannot cover the losses incurred in the private sector without the Magical Thinking that has been sold you for so many decade. Hide the losses, get others to pay for the losses through modest increases in cost of living and blame the doctors, and hospitals who give away more free care than you could ever imagine.
What would happen if our incredible consumer driven internet harnessed the decision support technology that we use daily on Amazon and instantly brings the right service to you when needed should you or a loved one become ill? What if we harnessed IBM Watson to make the diagnosis thereby reducing error rates and reducing unnecessary utilization of expensive diagnostic procedures?
What if we didn’t need insurance companies any more to assess population risk and perform preauthorization services while we waited for our new medication?
Since we have all of the data connecting lifestyle, culture, nutrition, infection and the human genome can anyone appreciate where we are headed with our capacity to discover the cause of disease and effect of treatment? This is not decades from now my friends; it is within the reach of our children’s lifetime. I have wonderful friends with incredible scientific minds that are creating open source technologies to accomplish human collaboration like humankind has never witnessed. The only barrier to their success is a loss of priority to cure disease, increase well-being and expand the functional-years of human life.
Or…we can keep these technologies secret, forget those we have developed through the natural sequestration of competing private enterprise and traditional silo thinking. If this is where we are headed then the best investment to assure a painless end of life if you are not surrounded by humanitarian friends is my undying support for the second amendment. If you catch my drift.

Check out Right Care Folks!

Right Care Now

Right Care Now

Doctor Price? Should we run for the hills?

A serene day in St. Croix

 

His history might clue you in.

Tom Price on healthcare: What should we expect?

What happens when you strip coordinated care incentives through repeal of the PPACA. One outcome is certain: orthopedic surgeons like Dr. Price perform more amputations for which they receive several thousand dollars for a fifteen minute procedure.

What happens when you strip coordinated care incentives through repeal of the PPACA.
One outcome is certain: orthopedic surgeons like Dr. Price perform more amputations for which they receive several thousand dollars for a fifteen minute procedure.

Click link above to access Dr. Price’s priorities. First please read my fears, doubts and insecurities below?

 

 

 

Pres. Elect Trump hired Rep. Tom Price as the new Director of US HHS today.
Mr. Price is a vocal supporter of Mr. Trump when other republicans were not. It appears Mr. Trump continues to hire loyalists.
Dr. Price is a successful physician having authored numerous bills to replace PPACA. When hired he stated his objective is to repeal and replace.
The bills authored by Price do have language that sounds attractive e.g. Patient Empowerment but when read…show a clear intent to remove the most important economic controls on health cost escalation in the PPACA. These include: DME competitive bidding for items such as prosthetics, motorized wheelchairs etc. Competitive bidding on drugs purchased by Medicaid and Medicare, Removal of our veto on using genetic data to derive insurance premiums for individuals and many more.

I have long thought that it is weird that Americans who place so much emphasis on pure free market tactics in all industries vote for politicians that author bills to veto competitive pricing virtually eliminating 100 million people from hiring a government payer to reduce the cost of medicine.

Now, I always suggest we follow the money.
Dr. Price’s three leading PACs and individual campaign contributors fall within these industry’s.
Physician Membership Organizations
Hospital Systems including HCA ( brought to testify on anti trust and fraud several times in front of congressional committees)
Pharmaceutical Industry
Insurance Industry

Where I have worked for HCA, consulted to the American Academy of Family Practice, Anthem Blue Cross, NY BC, and State Government I am confident in my conclusions about their business objectives. If you trust me and want more info please feel free to call on me.

I highly suggest that everyone who voted for PETUS look at who has been appointed to lead US agencies and fill important cabinet posts. My prediction and I hope to eat my words is that the middle class is about to be dealt a final death-blow that will eliminate any hope of having enough left over at our death to pass on to future generations.
I am suggesting people like myself: aging with chronic illness describe what they hope for quality of life in their final years and make preparations. The only way to do this is to understand how necessities are priced and determine individual bargains strength.
We had Price transparency tools created through the PPACA. My guess is they will disappear in short order .

My colleagues who believe in universal enrollment for defined evidence based public health and personal health interventions will be fighting any changes that do not provide consumer-facing competitive shopping tools that dispense with confusing terminology commonly used by healthcare institutions and insurance organizations. I also look to the millennial to jump in since they have a future at stake.
Tony Antony Williams may be right in his suggestion that PETUS is a liar.

Doing my best to stay healthy enough to escalate beyond the occasional battle into a Full Blown War against Wall Street.

The War in DC is for campaign reform and term limits.

“Oh what a drag it is getting old”

Patient commits suicide faulting pharmaceutical prior authorization rules as the cause.

Many untold stories

 

Patient commits suicide claiming prior authorization pharmaceutical rules as the cause.

Melt down, do you ever have them?

Well I will share mine with the world in this very moment.

I have carried hepatitis c for thirty-eight years now. That is until two days ago when my blood work returned the result of no detectable virus.

My family’s cheer is magnificent as everyone had considered this diagnosis to be the reason for my premature demise.

The medication I am taking (Harvoni) was approved for 90 days by the Federal Blue Cross program and I am now completing the second month of therapy. The protocol calls for 12 weeks of therapy due to a history of viral re-emergence using an 8 week protocol. We were lucky to get the medication as one course of therapy is $100,000! That is in the USA of course. In Egypt it is $1000.

CVS Care Mark was denied my refill as the date of the prior authorization expiration is tomorrow. That’s right TOMORROW!!!

It turns out that the Blue Cross administered program has a 24 hour lead time required for refills. Their internal processes begin flagging patients for cancellation one day before the actual term date!

So here I sit, just another patient with a life threatening illness who was given the hope of cure one week ago and now is pedaling as fast as he can to get help from his physician to extend the authorization of a medicine that is –on paper- still authorized!

They tell us patients with chronic disease that we are subject to depression. Feelings of hopelessness, loss of energy, inability to concentrate, suicidal ideation: Well I have all of them now. After 48 years of chronic disease, a 33 year career in healthcare where I operated at executive levels high enough to find out some ‘very ugly truths’ regarding this sector of the free market I feel ready to throw in the towel.

So for the next generation of patients: know this…you are on your own. This means it is up to you to find the best team of physicians, nurses, employers, insurance companies and friends to respond to your needs. It will be up to you to command them. It is time to stop being a passenger in the system.

I am the captain of my vessel. I have a wonderful team who is trying their hardest to get me the final dose of medication needed to save my life. I have just been wounded brother and sister so I will lay here for a while and bleed. Then –with your help; I will stand-up and continue telling my truth.

The truth that spills forth in the form of factual events involving actual people making life and death decisions has been held back until this point. I still try to earn a few dollars in the industry and do not want to become one of the untouchables. Perhaps it is time to execute my right to free speech.

When I am done I will rest and figure out another strategy for supplemental income in retirement.  It might be time to close this chapter and dance.

An expression of gratitude for my first $28,000 bottle of Harvoni!

Can believe NC?

Can believe NC?

Last week I published my offer to not accept resuscitation services in exchange for a full course of treatment with Harvoni, the new Direct Acting Antiviral from Gilead that has demonstrated a 95% cure rate in Hepatitis C patients with genotype 1.

In most cases insurance companies, Medicaid and Medicare is not paying for the medication unless the patient has end stage cirrhosis and is queued for transplant. The reason is easy to understand from an economic perspective yet certainly Draconian when it comes to well over 2 million people in the US who suffer with this debilitating illness. Furthermore the price discrepancy between countries is 94 X when comparing egypt and the USA for example. 

In the US a 1 month supply of Harvoni is $30,000; in Egypt it is $320.00

For more, please see my slide presentation below. For now, I want to thank Federal Employee Blue Cross for covering this medication as well as my much needed continuous ambulatory blood sugar equipment which makes this diabetic completely able bodied when away from home and alone.

 

 

I do not know how or why I was approved. Neither does my hepatology doctor. Both he and I were in tears when the fax came in through his prior approval desk. I am now in my third day of therapy. 

All I did was write a story on my blog and link it to facebook, linkedin, twitter etc. Within 24 hours my friends at Humana had retweeted my message and called me to see if they could help. They were not even my insurance company but this is a great example of how some payers are monitoring the internet for clients in need. 

Human did not get back to me but within two more days we had the approval from Federal Employee Blue Cross (my wifes health insurance). Since they are acting as secondary to my Ordinary Medicare the authorization was up to them. 

So whoever you are at Blue Cross, this is one lucky American who thanks you for the generosity to step outside most payers protocol and save my life. 

What a Christmas Present. 

 

THE POST FROM LAST WEEK

I will happily select a DNR status if you pay for my Hep C Treatment 

Hopeful

Hopeful

An economic model for exchange of value between patient and payer.

 Dear America,

I have been notified by both Medicare and Blue Cross that the technology I use for tracking my blood sugar trends will no longer be covered.

I have been notified by both Medicare and Blue Cross that the antiviral medication which has come on the market to cure my Hepatitis C will not be covered.

I would like to negotiate for coverage of these technologies using my history as a patient and known economic data regarding the cost of care at the end of life as a proposed value exchange. 

I understand that the insurance industry AND public sector should grind their teeth when presented with the $1000 per pill cost of the new therapy’s. I also imagine payers are stratifying patients needing transplant for first access to care since the drugs work on damaged livers. What I do not understand is the 287/1 disparity in cost between America and Egypt?

 

More on the land of Oz (North Carolina)

Heck! With health insurance we can afford a cup of coffee!

Heck! With health insurance we can afford a cup of coffee!

It is so unfortunate that the Senate has demonstrated such ignorance of the systems in NC that have provided frequently cited information on the cost benefit associated with Medical Homes.

I came here in 2001 to work with Community Care of NC following the sale of my company to Aetna Health. The technology we sold allowed Medicare Advantage Programs to identify, target and engage at-risk seniors through referral to primary care case management. It was clear at that time that the lessons learned from the world of HMO managed care had reached the end of their useful life as physicians had learned about the concepts of cost control through limiting redundant procedures and using evidence based guidelines in the 1980’s. The 1990’s brought us minimal returns in Disease Management which was the initial model deployed by Carolina Access’s efforts in Asthma and Diabetes population management activities. Those in the US that were on the cusp of ‘the next big thing’ were organizing for Primary Care Case Management through regional networks. I had spent 1999-2001 making presentations to the likes of Aetna, United Health Care, PACE and Empire Blue Cross to sell our intellectual property. If the commercial insurance industry understood the value of the marriage of technology with Medical Homes in 2001 it was a sure bet that our entire delivery system was on the verge of major payment reform.

Having had these successes in the private sector, my wife and I moved to NC after learning about the evolving Medicaid program which ultimately was titled Community Care of NC. We had a sincere desire to see a replication of a successful private industry venture through the public systems of care.

Since I was from the ‘evil private sector ‘I often heard ridicule from folks working in public programs here in NC. However; the willingness of these people to adopt information technologies that would increase their understanding of the Medicaid population and facilitate the design of delivery systems to tackle specific risks for the State of NC and separate regionally-managed community centered action plans for twelve regional networks was undoubtedly supported by the experts and General Assembly alike. Since that time it has become clear to all who work in the field of population health and disease management that the involvement of local providers, patients, payers and institutions in the creation of these programs is critical to the success in terms of both return on investment and quality of care.

So here we are: Those of us fortunate enough to work with these teams learned many lessons. When I left CCNC in 2006 I worked nationally, implementing similar programs across multiple states. I frequently heard how impressed various leaders in healthcare were with North Carolina’s success at improving the health of persons with diabetes and asthma as well as making a significant dent in the inflation rate in NC Medicaid when compared with other States.

So why would the Senate disband a working solution. I witnessed the reports from various budget experts at the public forums held last spring and noted a general lack of proper methodology when reporting cost data. For example: There was no evidence of proper control group selection and illness burden adjustment. When I stated to a former Senate member who happened to be a surgeon the errors in the reports used by the committee to compare cost benefit he agreed with me and stated “We really are not sure what questions to ask”: Yet the citizens of NC place their trust in this group to reform Medicaid.

Of course, when the public was asked for input, the decision was made to keep the existing program. Obviously many became clearer on the benefits. Then, out of left field comes enough controversy and distrust to once again, throw out the baby with the bath water.

Now that I am retired the muzzle of political correctness is no longer relevant. So here is some more feedback that is based on actual happenings in my life since working in NC.

I returned two weeks ago from the Patient Centered Primary Care Collaborative, a 10 year old group spawned from the private sector in response to the escalating costs of care in this country along with the fact that we are rated far down the line in healthcare outcomes when compared with at least seven other industrialized nations; few of whom conform to what we like to think of as traditional socialist thinking. I hold a co-chair position with this group and have gratitude for hearing the current thinking of the ‘best and brightest’   a club of economists and CEOs which I certainly do not qualify for membership.

During the conference a lead executive in a fortune 100 company along with several others from other organizations respected by all who read the Wall Street Journal told me that he had been asked to consult with the Governor’s office after the GA changed its mind about Medicaid outsourcing. He asked me what I thought and I gave him feedback on my personal observations of the successes achieved by Community Care of NC and told him a story about a similar plan assembled in Chicago in 2007 where I had a consulting contract. The Chicago plan failed since the commercial HMO and technology vendor had not developed succinct written requirements. I recall the meetings as if they were yesterday: Especially the frustration I exhibited in public when I found out that the HMO had not connected with the Medicaid primary care providers in Chicago prior to submitting their proposal. So here I had evidence of a public –private partnership success story in NC and private failure in Chicago.

My business friends that had reviewed the politics and business cases in NC for our Governor had all recommended that the State keep CCNC and the Accountable Care Organization models that had been promised only two months ago. Unfortunately their actual comment to me was: “Sorry Jeff, we do not understand the logic, the drivers appear to be something other than cost and quality. Perhaps it is time for you to leave.

What more can I say. The Senate’s budget is counter-intuitive yet those who are emotionally trapped by their opinions concerning the ACA seem unwilling to discuss the details as to why it makes no sense.

Does the GA realize that the Triad had a huge problem with mothers using the emergency room when their children became dehydrated from GI influenza and that the local CCNC network assembled a clinic to educate mothers to master the task of orally rehydrating their kids when they were sick which brought down the ER visit rate to almost nil?  How do they think an HMO will be able to address local needs with such specific detail and provide educational resources?

I have had diabetes for 48 years. I remember when Blue Cross sent my refrigerator magnets to remind me to have tests performed and monitor my blood-sugar. I have no idea how much my employer paid for that Disease Management Service but I do know that I had to argue for my insulin pump in 1984: The one tool that I attribute my lifespan to today.

I will close with this:

For the last six months I have been working with some private practice ophthalmologists who are willing to treat Medicaid diabetics. Many specialists will not treat Medicaid patients due to the lower reimbursement but these folks are a dream team. I assembled a program description and took it to the NC Medicaid Medical Home leadership to get their feedback. They were very pleased to see local people getting involved with creating specialty networks that would treat their patients. Why? Well we have a problem with diabetics becoming blind if they are on Medicaid due to inadequate access to specialty care. So here I was offering a bundled service at ½ the commercial rate charged by the hospital next door.

Unfortunately, I have had to place the project on hold. One of our major criteria for inclusion in the retina service for diabetics is that they are tethered to a Medical Home. As of a few weeks ago I can no longer assume we will have a relationship with a Medical Home enterprise.

Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial | Patient-Centered Primary Care Collaborative

Please visit my friends at Patient Centered Primary Care Collaborative; they are stepping up to remodel medicine for you and I.

As you know: Untangled Health is deeply committed to the Medical Home Concept. Had I not fought to establish these types of relationships with my primary care providers throug the years I would not have the health I enjoy today in spite of my chronic disease.

Quality and Efficiency in Small Practices Transitioning to Patient Centered Medical Homes: A Randomized Trial | Patient-Centered Primary Care Collaborative.

Trouble Across the Pond. Once again, no one to blame but everyone. Look at the entire system for your answers.

A good day

Once again my friends, any system which places organizational success in the media, executive bonus, or ridiculous ‘service excellence’ survey results over clear-cut measures of process, and medical outcomes first will lead to suffering. Suffering of patients, families…our identity?
Recently, in Raleigh NC a large hospital system has been cited for Medicare fraud (Wake Medical). As the story unfolds the CEO stated that a single mid-level manager from Patient Services changed physician’s orders to charge Medicare for multiple episodes of care as opposed to observation days only. I find the sacrifice of lower level employees horrific. I also know this to be a common behavior in the US.

These problems are systemic and global. They specifically speak to a decline in the humanity of ‘human services’.

There is a lesson in this video from across the pond.
Pay attention to the proposed Standards and compare to what we have or do not have at home.
Consumers of services (yes us patients):

Please do not accept lip service as transparent publications on safety and quality and cost are promised under the new health-reform act. Scream out for standard reporting, standard methods of measurement and reliable statistics.

Allscripts abandons physicians in North Carolina

I read an article today published in the News and Observer Raleigh NC: “Docs feel a little sting over records” was written by John Murawski on Sunday November 4, 2012! Two days before our presidential election he passively critiques the Obama administration for ‘forcing doctors to purchase electronic health record systems. Little is mentioned regarding the history of the legislation or improvements we will all experience through the adoption of interoperable health records. The most important comment comes later in the article where Mr. Murawski informs the reader that the well-known Allscripts EMR vendor is abandoning a product sold to numerous physicians in our State; forcing them to replace and re-deploy with another vendor. The product they are abandoning is only a few years old and the tragedy of the increased costs and inefficiencies will be felt by our physicians and us patients.

 

I retired this year after a 32 year career in America’s healthcare system. My work took me through an amazing series of learning experiences as a technologist, therapist and program manager for people suffering with chronic disease and health informatics specialist these last fifteen years. My work in healthcare was stimulated by my experience as a person with diabetes since the age of ten. As a patient I wanted to work in the system which had nurtured me into a place of independence as a young child.

With the advent of prospective payment and HMOs in 1980 I remember borrowing money to purchase glucose monitoring strips from physician friends. These were not covered at the time but the evidence had been published regarding the importance of blood sugar control. Through generous friends I was able to purchase one of the first insulin pumps in 1984. With a salary of $22,000 I would never have been able to select an advanced therapy. The outcome…well after all these years I have had some problems and have just now become  disabled but I had a wonderful, productive career and look forward to many more as a community ‘helper’.

My concern is that articles focusing on the negative experiences of advances in healthcare policy (taken out of context) are easily used to strengthen political and economic arguments to steer the uninformed citizen. I would like to clarify some facts regarding electronic health records for the readers. I am qualified to offer these as I entered this field in 1997 along with a rehabilitation physician to design a community wide record with clinical decision support to offer better care and safety for the elderly.

We patented the web-native technology in 2001, sold the company and I moved to North Carolina to assist the State with the design and deployment of a single system used to coordinate the care for the entire Medicaid population. Through the collaborative efforts of fourteen networks –now known as Community Care, they began using this system in 2002. As patients migrated or changed providers their care managers were able efficiently share care plans, save the State millions of dollars through prevention of duplicative testing, reductions in pharmaceutical expense and hospitalization or emergency room costs. The most important thing to remember about this experiment is the fact that it was collaborative and placed patient safety and quality of care first. The financial achievements were a natural extension of well over 3000 physicians working together to re-engineer the management of healthcare for less fortunate individuals. Today, the Community Care Physicians use a modernized version of the system to evaluate patient and system outcomes. North Carolina should be very proud to have led the way with the use of health information technology and community re-engineering to improve the health of its citizens.

Herein lays the rub. Now that I am out I can make observations and judgments about the industry that can be verified with my-own collection of source data, e-mails, and project-notes. I can attest to the fact that the commercial industry is now flooding the gates with products that were engineered with loose standards if any at all and are quickly revising these products or integrating them now that the source of payment is guaranteed. When my physician friend, the lead architect from Lotus Development and myself worked on the first Care-System health record in 1997 we hoped to make a fortune like any red-blooded American Entrepreneur. The difference is that our primary purpose in the beginning was entirely clinical wherein we were attempting to repair a system that was broken by industrial fragmentation and loss of communication between professional care providers, patients, families, insurance companies and employers. We borrowed family money and at times paid our salaries with our credit cards. When we needed ‘big capital’ we went to the Venture Capital world and sold our knowledge and three years’ work to the highest bidder. In the end, the company was acquired for $2.5M. I received $25K, the founders a few bucks more and the loans were repaid  The acquiring company integrated the knowledge and technology of several small acquisitions and sold their entire operation to a large insurance interest for $465M.  The sale was obviously an internal ‘good buddy deal’ as the valuation was grossly inflated over the projected sales of $40M in product. Anyone caring to research M&A from 2000-2003 will find the transaction. These deals have served to multiply the true cost of healthcare in the USA and the only benefit in my opinion was to the venture capitalists and top-tier management. Everyone has their own definition of success and justification for behavior I suppose… but I wish they would keep it isolated to discretionary purchases of unessential products and services.

 

I find myself discouraged at the end of my career. I have now worked in both commercial and public sectors and have come to the conclusion that the very nature of the free-market; where each individual acts in his or her self-interest; simply does not fit in medicine. The following two experiences in the insurance sector and a local county health department along the coast of NC summarize it all:

 

  • From a vice president of a company insuring 20M lives in NYC in 2007 during a closed meeting: 
    •  “We do not use combined quality of care indicators like the Dartmouth Atlas, we care about return on share-holder equity only”.
  • From a public health, county education supervisor in 2012:
    • “I think you are asking me to evaluate my program…this is above my pay-grade”.
  • Heck, I will throw in another from the director of marketing in one of the many electronic health record company’s prior to a presentation to a potential customer.
    • “Tell me what smoke and mirror story I should use, heck I can sell anything” 

 

 

 

 

 

 

The public should know that the legislation mandating electronic health records started with the Bush Administration. In fact…if we trace the health reform language back to the 1940s we will find attempts to adopt universal coverage from the Truman and Nixon administrations. We have never allowed this to occur since we unleashed the natural instinct for self-preservation into our code of ethics regarding how Americans get health treatment in 1910. It is naïve to assume that the IT product manufacturers  will consider the needs of the sick: As a species we simply have not evolved to that point. I have only witnessed compassionate behavior in this business sector two times in my career.

So now, we have good intention: A reform act which provides economic stimulus to adopt technology that improves clinical outcomes reduces cost and increases patient safety. We even developed and continue to revise standards which force mechanisms for data exchange between competitors. Yet, since the industry waited over a decade to solve the problems that would arise from security issues, technical complexity and a complete lack of matched financial incentives we are burdened with the cost of replacing systems purchased by physicians and clinics within the last five years. Ask me about the 6000 clinical records lost in 2009 from a poorly led electronic medical record system implementation when an understaffed Federally Qualified Health Center was abandoned by an unethical vendor.

 

The article in the News and Observer points to a well-known vendor of physician medical records. Allscripts is a dominant force in our State and they have now abandoned one of their acquired products forcing physicians to replace it. Shame on them…

 

I hope we can see this as a human problem as opposed to political incompatibility. We are the folks that engineered and enjoy the fruits of the free market.  Along with the fruits come the problems of greed and poor planning to return quick reward to the investors. In the end, we as consumers pay a hefty price yet we do not hold the correct people accountable. Here is a novel idea let’s work together to figure out a solution as the consumers of medical services: Please do not think that the healthcare industry, schools of public health, government or industrial think-tanks will solve this for your children. This is probably the best opportunity for self-examination as a society that will emerge in the next fifty years.

Consumers… step up to the plate and state your needs; also please visit and join the “Society for Participatory Medicine” on the web!

 

With respect for all, Jeffrey Harris Raleigh, NC.

 

 

 

A National Message: Your Physician is Waiting To Help You Untangle Your Own Healthcare

 

The prevalence of incorrect information in healthcare records becomes frighteningly clear when a new doctor asks you how long you have had the brain-tumor that you didn’t know about! (Personal experience last year, luckily I was able to inform her of the fact that I did not have a brain tumor)

This presentation clearly illustrates the importance of patient and family familiarity with their physician’s medical record notes.

For those of us who have difficulty remembering numerous encounters with the medical profession, the names of our medications and the procedures we have required; we now have an opportunity to both improve our care and prevent hazardous errors.

I anticipate the maturation of secure communication and documentation technology across the web over the last decade will significantly reduce morbidity and mortality once consumers weave the electronic health record process into their lives to the degree they now engage social media services. I encourage all of the patients I work with to become part of the solution through self-advocacy and engaging with on-line organizations such as #The Society for Participatory Medicine.

Please enjoy the video below and this new Forbes post:

Patient Advocates! New tools to step up and remotely monitor emotional components of chronic disease along with standard physical indicators

As you all know: Disease or Dis…Ease… is comprised of four components to be addressed by patients and their care-giving support groups. These domains include: Disease, Impairment, Disability ad Handicap. For example: A blind diabetic presents as follows:

  1. Disease: Diabetic Retinopathy
  2. Impairment: Vision
  3. Disability: Blindness
  4. Handicap: Cannot read LCD screen on insulin pump.

If all are not considered as part of a treatment plan we tend to place our head in the sand and lose the patient to depression induced suicide while being fixated on BMI and A1C. Well here is something exciting!!!!!

 

The convergence of psychosocial data (adjustment scales, depression index, mood, pain etc.) with other digitized remote biometric data e.g. interstitial glucose will add great value to examining the correlation of emotional/behavioral patterns and glycemic control for diabetics as well as give insight into correlations in many other diseases.  This is a big deal for me as a diabetic and even bigger as I consider the research we could do. In the 1990s our team introduced patient-family group visits to our ambulatory COPD management program and reduced hospital in-patient days by 70% (N=300). In the virtual world we have a way to accomplish the same objective (Care, Share and Never be alone and afraid).

I have been reviewing various tools for self-management and secure communication for diabetes, heart failure, COPD, Addiction and so on as success in managing these conditions relates to social support and data vigilance. I am also trying to get large pharmacy providers off their feet and please consider adding a remote retinal camera and Apple I Phone to their diabetes management programs as a pilot. In NC I have a group of physicians willing to read the retinal photos if I can get a camera ($10K) and head out into the woods where our indigent are losing vision and functional capacity early in life due to lack of linkage to primary care. Imagine what could be done with bio-psycho-social monitoring. Of course we will need funding for interventions but we can drive off that bridge when we get to it.

So please take a look at this project THE GINGER IO COLLABORATIVE  http://ginger.io/the-platform/

 

 

 

Jeff Harris

Untangled HealthCare LLC