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jayparkinsonmd: Organizing people in real time in a community to improve health. I had the pleasure of meeting with Joe Edelman at Groundcrew this week. Groundcrew is a new service that matches need with human ability in real time in a given location. It can connect to Twitter, Facebook, and Foursquare. Groundcrew is agnostic. It can be used for any reason to organize real time meetups. How can we leverage Groundcrew to improve health? Emergently disseminating vaccines to a community.Organizing emergency services in disasters.Organizing pick up games for sports.Sellers at urban farmers markets can announce their crops. There are always many other use cases. Super excited to see where this platform goes. Click for high-res photo

jayparkinsonmd:

Organizing people in real time in a community to improve health.

I had the pleasure of meeting with Joe Edelman at Groundcrew this week. Groundcrew is a new service that matches need with human ability in real time in a given location. It can connect to Twitter, Facebook, and Foursquare. Groundcrew is agnostic. It can be used for any reason to organize real time meetups.

How can we leverage Groundcrew to improve health?

Emergently disseminating vaccines to a community.
Organizing emergency services in disasters.
Organizing pick up games for sports.
Sellers at urban farmers markets can announce their crops.

There are always many other use cases. Super excited to see where this platform goes.


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“
Even more troubling is the fact that Anthem obviously believes it can raise its rates by as much as 39 percent without losing every one of its remaining customers with average or even somewhat above-average medical needs. The only way it could possibly raise its rates so high and expect to keep its customers would be if Anthem’s customers have no other choice. In other words, Anthem’s strategy makes sense only if Anthem faces little or no competition from other health insurers. I wouldn’t be surprised if this were the case. Insurers, remember, are exempt from the federal antitrust laws. And WellPoint, Anthem’s parent, is the largest insurer in America.
Robert Reich: The National Anthem — And Why We Need Health Care Reform So Desperately (via squashed)

Why we started The Future Well.

jayparkinsonmd:

I’ve started a new company called The Future Well. We are a design and innovation consulting firm for health and happiness. The best way to describe what we do is we play “film producer” to gather the dream team of creatives, design, and build an optimally pleasant health experience. We design services, products, experiences, strategies, identities, brand positioning, and business models that make a positive impact on health and happiness. We also consult and help companies understand the health space.

The site went live one week ago. I’ll be doing a ton of writing at The Future Well as we ramp up. So please visit The Future Well which was designed by Ghava and built by Fangohr (except the footer, it was designed by Live From Brooklyn). The site will focus on design, culture, ads, and technology that make health and sickness a humanizing, more pleasant and beautiful experience.

Health needs a redesign. So follow us on Twitter, subscribe to our feed, or fan us on Facebook to stay updated. And if you’d like to be a part of our network of experts or creatives, let us know at info@thefuturewell.com. Let’s talk!

Whole Foods Puts Its Mouth Where the Money Is

jayparkinsonmd:

Whole Foods CEO John Mackey, who recently published a controversial op-ed on health care, announced that the company will soon offer higher store discounts for healthier employees. The company will consider blood pressure, cholesterol, smoking status, and body mass index (BMI) in determining the discount level. “Our intention for all of these lifestyle programs is that they are empowering and fun for Team Members who enjoy a challenge,” Mackey wrote in a letter to employees. “In offering the higher discounts to Team Members who choose to participate, we take nothing away from Team Members who choose not to do so…”

This is cool except for the BMI.  For me to get to my “correct” BMI, I would have to go anorexic.  Am looking forward to a day when we find better metrics for healthy weight.

Post-Katrina New Orleans safety-net clinic patients report more efficient, affordable health care

excerpt:

A new Commonwealth Fund survey of safety-net clinic patients in New Orleans finds that, despite being disproportionately low-income and uninsured, these patients had fewer problems affording care and fewer instances of medical debt and inefficient care than most U.S. adults. In fact, the report, Coming Out of Crisis: Patient Experiences In Primary Care In New Orleans, Four Years Post Katrina, finds that, among the clinic patients surveyed, only 27 percent went without needed health care because of cost, compared with 41 percent of adults across the country.

According to the authors, this shows that the post-Katrina primary care pilot program—a system that relies primarily on a large network of local clinics funded by federal and local government, and given financial incentives to improve care—could serve as a national model for providing primary care to vulnerable groups.

smarterplanet: Welcome to the Decade of Smart Eight hospitals and 470 primary care clinics in Spain implemented smarter healthcare systems across their facilities—by making information available at the point of care to healthcare practitioners and applying insights into organizational performance. They improved clinical results and operational efficiency by up to 10 percent. Click for high-res photo

smarterplanet:

Welcome to the Decade of Smart

Eight hospitals and 470 primary care clinics in Spain implemented smarter healthcare systems across their facilities—by making information available at the point of care to healthcare practitioners and applying insights into organizational performance. They improved clinical results and operational efficiency by up to 10 percent.


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hiten: (via dataviz) Click for high-res photo

hiten:

(via dataviz)


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Study Shows Health Care Spending Spurs Economic Growth

excerpted from NCSU Newsroom:

As the national discussion of health care focuses on costs, a new study from North Carolina State University shows that it might be more accurate to think of health care spending as an investment that can spur economic growth. The study also shows that government projections of health care costs and financing may be unduly pessimistic.

“Health care spending should be viewed as an investment in future capital, contributing to a productive workforce, rather than merely as an expenditure,” says Dr. Al Headen, associate professor of economics at NC State and a co-author of a paper appearing in the Dec. 15 issue of Proceedings of the National Academy of Sciences. The paper was co-authored by researchers from Duke University, Brigham Young University and the National Council of Spinal Cord Injury Association.

People are living longer, Headen says, and are retaining their ability to be productive members of society – they are able to work, pay taxes, consume goods and go on vacation. “But a lot of projections by the government of the future work force are not accounting for improved health and productivity of older Americans. People will be paying into government programs, such as Medicare, for a longer time – while simultaneously delaying the point where they need to draw on those programs. Our research suggests that if the government’s projections had accounted for this improved productivity, those projections would have been less pessimistic.”

For example, the researchers found the Congressional Budget Office’s (CBO) projected costs for Medicare and Medicaid from 1994-2004 to be substantially overestimated. In 1994, CBO projections of Medicare expenditures for 2004 for persons 65 and older were $361 billion, but the actual 2004 expenditure was only $268 billion – an error of 35 percent.

Yesteryear’s healthcare pilot projects are inadequate for today’s problems.

jayparkinsonmd:

I just finished reading Atul Gawande’s latest article in the New Yorker, Testing, Testing: The healthcare bill has no master plan for controlling costs. Is that a bad thing?

He draws parallels to the history of agriculture in America:

At the start of the twentieth century, another indispensable but unmanageably costly sector was strangling the country: agriculture. In 1900, more than forty per cent of a family’s income went to paying for food. At the same time, farming was hugely labor-intensive, tying up almost half the American workforce. We were, partly as a result, still a poor nation. Only by improving the productivity of farming could we raise our standard of living and emerge as an industrial power. We had to reduce food costs, so that families could spend money on other goods, and resources could flow to other economic sectors. And we had to make farming less labor-dependent, so that more of the population could enter non-farming occupations and support economic growth and development.

The economic similarities sure do make sense. Food was bankrupting us. And a hundred years later, after many pilot projects:

“What seemed like a hodgepodge eventually cohered into a whole. The government never took over agriculture, but the government didn’t leave it alone, either. It shaped a feedback loop of experiment and learning and encouragement for farmers across the country. The results were beyond what anyone could have imagined. Productivity went way up, outpacing that of other Western countries. Prices fell by half. By 1930, food absorbed just twenty-four per cent of family spending and twenty per cent of the workforce. Today, food accounts for just eight per cent of household income and two per cent of the labor force. It is produced on no more land than was devoted to it a century ago, and with far greater variety and abundance than ever before in history.”

The government acted as a 20th Century platform to enable our farmers to do their jobs better. This is a perfect example of Government 2.0 existing in the 1.0 world…the government as platform.

I’ve been saying for quite some time that this should be the age of experimentation with the government acting as VC fund for hundreds to thousands of these pilot projects that foster disruptive innovation.

One major difference between today and 1903 when the government started to move in the agriculture space, is that they had decades to solve the problem with successful results over 100 years later. I personally don’t believe we have this kind of time in healthcare. In the next 10 years, insurance premiums will rise over 160% and even more so the decade after that. It doesn’t take long to understand that very few people will be able to afford those costs in 10 years.

So how can we put these experiments in hyperspeed? How can we learn what we need to learn in just a few years? And how can we empower those doctors and hospitals who want to experiment with payment and delivery processes with the tools, the time, and the money to do so? Can we take lessons from agile development and apply them to healthcare delivery? Can we create a Gov 2.0 platform to analyze new payment and delivery methods to quickly understand if they’re working and whether or not they’ll be profitable in the near future? Can this platform quickly and fluidly organize doctors into virtual groups to provide new collaborative ways of delivering healthcare? Can this platform gather the requisite data to make sense of success or failure?

But then again, it’s been quite a challenge building Hello Health. One of the biggest challenges has been concurrently building new technology to power new ways of delivering healthcare. Building smart, high quality, robust, and secure software takes serious time. And learning through real life healthcare delivery that we need to redo something or rethink something that took months to develop has been frustrating. We’ve done our best and we’re going to shine, but it’s been very, very difficult. After being open for nearly a year and a half, things are getting better and better. But how long did it take Amazon to figure out their technology and their physical processes? How long did it take them to do the same thing we’re doing in healthcare? How many times was Bezos laughed out of VC pitches because he had what sounded like an impossible idea? How long did it take Amazon to be profitable?

Seven years.

Delivering healthcare to a large population of people in totally new ways paid for by totally different methods is uber complex, much harder than selling books online. Large scale pilot projects in healthcare have traditionally been much shorter than seven years. Why? Multiple reasons but mostly because pilot projects to rethink healthcare have been half-baked and small grant funded. Also, the amount of money people are potentially losing through experimentation is too large to risk a seven year investment and there’s little incentive to buck the system and create new ways of paying for or delivering healthcare. All of the healthcare success stories we have in America— like Kaiser, Geisinger, and Intermountain— evolved from thoughtful leaders that bucked the traditional system because they knew tradition didn’t make sense. How can we foster this kind of innovation in physicians all over the US who know things are broken and there’s got to be a better way?

Healthcare experiments and pilot projects need to be rethought. We need the government to foster new platforms that markedly reduce communication overhead, much like Hello Health and the NHIN are doing. We need the government to create innovative new ways to act like a VC fund, much like Rafe Furst is trying to rethink funding:

Inspired by Nassim Nicholas Taleb’s book The Black Swan, some friends and I have begun to rethink how to most effectively fund innovation, whether it be purely for profit, not-for-profit or social entrepreneurship.

As it stands today, the market for venture seed capital is broken. Most individual angel/seed investors will only do on average one deal per year. Their portfolios lose money 40% of the time due to insufficient diversification. Even premier angel groups like the Band of Angels say they only do about 8 deals per year. Our math and simulations say you need to do 125 to achieve good diversification. On the other side of the table, only 14% of innovators who want seed funding will find it. Those that do will spend about 6 months looking for money instead of building their businesses. All-in-all this is a sorry state of affairs for a market where the overall annual return is roughly 25%.

To address the gap we are working on four new models which complement one another:

  1. Black Swan Fund - Index-style equity investment for startups needing $250K - $1M, prior to a VC round or cash flow positivity.
  2. Equity Micro-Funds - Smaller versions of (1) for startups needing $25K - $100K.
  3. Nano-Investments - One-off, option-on-equity investment for pre-startup pilot projects lasting 1-3 months needing $5K-$25K.
  4. Personal Investment Contracts - One-off, lifetime equity investments in individual superstars at the beginning of their careers.

Feeding a population is a bit simpler than delivering healthcare. The strategy the government used 100 years ago in farming needs to be leveraged today, but updated with today’s potential. We don’t have another 100 years of financial solvency to deal with healthcare. Forty five thousand people are dying every year due to lack of insurance. One million people have been forced into bankruptcy. There is a healthcare famine in America today that needs to be solved quickly.

“
In their 2009 report to Congress, the Medicare trustees estimate that the 10-year cost of Medicare Part D is as high as $1.2 trillion. That figure—just for prescription-drug coverage that people over 65 still have to pay a lot of money for—dwarfs the $848 billion cost of the Senate bill. The price of prescription coverage continues to escalate because the law explicitly bars the government from using its market power to negotiate drug prices with manufacturers or establishing a formulary with approved medications. And unlike the Democratic bills, which the Congressional Budget Office says won’t add to the deficit, the bill George W. Bush signed was financed entirely through deficit spending. Former comptroller general David M. Walker has called it “probably the most fiscally irresponsible piece of legislation since the 1960s.” Of the 28 remaining Republicans who were in the Senate back in 2003, 24 voted for the Medicare prescription-drug benefit. Of 122 Republicans still in the House, 108 voted for it. This hall of shame includes Alexander of Tennessee, Enzi of Wyoming, Brownback of Kansas, and Hatch of Utah.
Weisberg, on the GOP’s health-care hypocrisy. (via newsweek) (via mikehudack)

Reading the bill would be alot easier if it had links in it.  i.e.,

(c) Eligibility- For purposes of this section, the term `eligible individual’ means an individual who meets the requirements of subsection (i)(1)—

(1) who—

(A) is not eligible for—

(i) benefits under title XVIII, XIX, or XXI of the Social Security Act; or

(ii) coverage under an employment-based health plan (not including coverage under a COBRA continuation provision, as defined in section 107(d)(1)); and

(B) who—

(i) is an eligible individual under section 2741(b) of the Public Health Service Act; or

H.R.3962: Affordable Health Care for America Act

Calendar No. 210
111th CONGRESS 1st Session

H. R. 3962

IN THE SENATE OF THE UNITED STATES

November 10, 2009

Received and read the first time

November 16, 2009

Read the second time and placed on the calendar

========================================

[snip]

TITLE I—IMMEDIATE REFORMS

Sec. 101. National high-risk pool program.

Sec. 102. Ensuring value and lower premiums.

Sec. 103. Ending health insurance rescission abuse.

Sec. 104. Sunshine on price gouging by health insurance issuers.

Sec. 105. Requiring the option of extension of dependent coverage for uninsured young adults.

Sec. 106. Limitations on preexisting condition exclusions in group health plans in advance of applicability of new prohibition of preexisting condition exclusions.

Sec. 107. Prohibiting acts of domestic violence from being treated as preexisting conditions.

Sec. 108. Ending health insurance denials and delays of necessary treatment for children with deformities.

Sec. 109. Elimination of lifetime limits.

Sec. 110. Prohibition against postretirement reductions of retiree health benefits by group health plans.

Sec. 111. Reinsurance program for retirees.

Sec. 112. Wellness program grants.

Sec. 113. Extension of COBRA continuation coverage.

Sec. 114. State Health Access Program grants.

Sec. 115. Administrative simplification.

(via The Library of Congress & THOMAS)

looks good so far ;)

Healthcare Reform Legislation

Because I can’t sift through all the hoopla & don’t really know who to trust, I’m reading the darn thing myself.

Anyone else interested in doing so can find it here.

“
If Ms. Totten and Mr. Hirshberg are correct, the potential for health care savings is huge. A study in the January-February 2009 issue of the journal Health Affairs concluded that 75 percent of the country’s $2.5 trillion in health care spending has to do with four increasingly prevalent chronic diseases: obesity, Type 2 diabetes, heart disease and cancer. Most cases of these diseases, the report stated, are preventable because they are caused by behaviors like poor diets, inadequate exercise and smoking. Obesity alone threatens to overwhelm the system. In a recent study, Kenneth Thorpe, chairman of the department of health policy and management at the Rollins School of Public Health at Emory University, found that if trends continued, annual health care costs related to obesity would total $344 billion by 2018, or more than 20 percent of total health care spending. (It now accounts for 9 percent.) Dr. Thorpe also said that if the incidence of obesity fell to its 1987 level, it would free enough money to cover the nation’s uninsured population.

Health Care Savings May Start in Employee Diets - NYTimes.com (via evangotlib)

Saving healthcare will start with individuals taking responsibility for their own lives and improving their behavior.  (via jayparkinsonmd)

If it were only that easy.  We are social beings surrounded by so many conflicting signals and requests for input.  If we lived in a society where being poor did not effect the kinds and types of food we could purchase, if we lived in a society where we were not inundated daily with requests to purchase bad food, if we lived in a society where we actually understood the mechanisms which fueled our self-destructive behavior….  I could go on and on.

The problem is systemic as well.  The sooner we acknowledge that, the sooner we can begin to offer true healing.

mikehudack:

“Let’s be honest. The goal isn’t to see whether I can pass this through the executive board of the Brookings Institution. I’m passing it through the United States Congress with people who represent constituents. I’m sure there are a lot of people sitting in the shade at the Aspen Institute — my brother being one of them — who will tell you what the ideal plan is. Great, fascinating. You have the art of the possible measured against the ideal.”

— Rahm Emanuel on healthcare reform (via langer) (via soupsoup)

What he said.

But we shouldn’t have to settle for mediocre.  (Not that what these academic / “intellectuals” propose is ideal.  If it were ideal, the plan would include how to get around the folks that need turning around.)