Quit Wasting My Healthcare

Obama’s Healthcare Plan

January 4, 2009 – 8:03 pm by ScottSchoenvogel
I get asked almost every other day what I think about Obama's healthcare plan.  You can read it yourself by following this link - http://www.barackobama.com/pdf/HealthPlanOverview.pdf. The most I can say about this plan is that it sounds nice.  I want there to be better healthcare technology and affordable health insurance.  It would also make our jobs at Compass easier if hospitals had to disclose true costs and meaningful quality metrics.  Unfortunately, these are all just platitudes and there are no plan specifics as to how these goals would be accomplished or funded. The reality is that new healthcare technology is overwhelming complex, expensive, and difficult to implement.  Revealing true costs to consumers would be nice if there weren't confidentiality agreements in place legally preventing costs from being shared.  Healthcare has only become more fragmented as physicians have continued to sub-specialize and open their own surgery centers.  To compete, hospitals have focused on patient experience and service thereby ...

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Strategy #14 for Improving Healthcare Value: With Healthcare IT–Less is More

December 19, 2008 – 9:07 am by DrEric
There is a big push to improve healthcare quality and cost-effectiveness through the use of electronic medical records, computerized physician order entry and personal health records.  As one speaker I heard say, “Healthcare IT is like mom and apple pie.  Everybody loves it.”  The problem is that every electronic medical record, physician order entry system and personal health record I’ve seen is so complex and over-designed that it is just too cumbersome to use effectively.  It has too many office notes.  It has too many lab results.  It has too many radiology reports.  It has too many options for how to order a test or medication.  No provider has the time or energy to sort through all of it.    Providers have a millions pieces of information coming at them from a million different places, every second every day.  Patients.  Nurses.  Medical assistants.  The chart.  Phone calls.  Faxes.  Mail.  Forms—oh, the ...

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Strategy #9 for Improving Healthcare Value: Watch Patients like a Hawk

December 15, 2008 – 10:14 am by DrEric
Yes, patients need to take responsibility for their health.  Yes, they need to be active participants in their care.  But, the reason they go to see the doctor is because they don’t know what’s wrong with them or they don’t know what to do about it.  And here is the kicker, about 50% of what I find wrong with people are things they didn’t even know were wrong—high blood pressure, high cholesterol, diabetes, hadn’t received a pneumonia vaccine, hadn’t been screened for colon cancer.  So you can’t just rely on the patient, the doctor has to identify and follow up on the unknown, unknowns before they cause a major problem—a stroke, heart attack, kidney damage, lung infection or metastatic cancer.   The key to delivering high value healthcare is not so much intelligence as it is diligence.  The health care provider just has to be relentless.  It’s double-booking your clinic visits so ...

Posted in Costs of Care | No Comments »

Strategy #7 for Improving Healthcare Value: It’s in the Systems

December 8, 2008 – 9:57 am by DrEric
You must support patients with Organized Systems. Let me start by painting a picture of low-value systems (or lack there of).  The patient has no primary care provider.  No one to call with questions.  No one to see on short notice.  The patient goes to the ER or an urgent care center when they are sick.  The patient self-refers to a cardiologist for chest pain, a gastroenterologist for heart burn and a rheumatologist for arthritis.  They order lots of tests and brand-name medications.  None of those doctors ever communicates with each other about the patient.  None of those doctors takes responsibility for all of the age-appropriate screening tests and immunizations for the patient.  The patient has a health event—severe headache with blurry vision—is hospitalized for three days, seen by the staff hospitalist who orders lots more tests and is discharged to the care of one of his three doctors—none of whom ...

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Strategy #4 to Improve Healthcare Value: Follow up on transfers-of-care

December 1, 2008 – 9:00 am by DrEric
Assume something will go wrong with every transfer-of-care.  When a person visits the ER, assume the lab and x-ray results never make it back to the primary care physician.  When a person is discharged from the hospital, assume that they do not fill half the prescriptions that are written.  When a person is referred by their primary care doctor to a specialist, assume the pertinent medical information is not communicated to the specialist.  When a person goes back to their primary care doctor after seeing a specialist, assume the specialist does not tell the primary care doctor what they think. If you make all these assumptions, you will probably be right.  Dr. Bob Wachter from the University of California at San Francisco--one of the nation's formost experts on hospital-based medicine--has written about the abysmal hand-off process in healthcare and it's negative results (http://www.the-hospitalist.org/blogs/wachters_world/archive/2007/12/25/fixing-fumbled-handoffs.aspx). When people move from Healthcare Provider A to Healthcare Provider B, they need to have an ...

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Healthcare CEOs Weigh In on a Fix

December 1, 2008 – 7:48 am by ScottSchoenvogel
The Washington Post wrote an article on Sunday (http://www.washingtonpost.com/wp-dyn/content/article/2008/11/29/AR2008112902182.html) that summarized a group of healthcare CEOs on the appropriate fix for healthcare costs: "A high-performance 21st-century health system, they say, must revolve around the central goal of paying for results. That will entail managing chronic illnesses better, adopting electronic medical records, coordinating care, researching what treatments work best, realigning financial incentives to reward success, encouraging prevention strategies and, most daunting but perhaps most important, saying no to expensive, unproven therapies." By empowering the consumer and providing key support tools such as pricing transparency, Compass is already accomplishing each of these goals with its members - a proven model for acheiving the above "21st Century" vision.

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Silver Bullet for Lower Healthcare Costs

November 18, 2008 – 8:46 am by DrEric
I write that title somewhat facetiously.  Of course there is no silver bullet to reduce health care costs and improve quality--or in other words, increase healthcare value.  But there is one thing that is as close to a silver bullet as I can think of: Bring value to the exam room decision making process between physician and patient. That's where the rubber hits the road.  Currently, that decision making process is largely low value.  What do I mean low value?  (1) It does not bring to bear current clinical best practices and (2) it does not attempt to be cost-effective without compromising care.  Here is an example of (1)--a June 2003 study from the New England Journal of Medicine (http://content.nejm.org/content/vol348/issue26/) found that physicians only followed their OWN best practices 50% of the time.  That means, roughly, 50% of the time patients are getting short changed.  Now sure, sometimes best practices should not be applied to ...

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A Risk with Health Risk Assessments

November 13, 2008 – 9:08 am by DrEric
When I have met recently with employers, wellness companies and companies that perform biometric testing, the first thing that comes to mind is--this information would be very helpful for their doctor AND if they don't have a doctor, then they need to get one and take this information to him or her.  Knowing that a person has elevated cholesterol, blood sugar or blood pressure is a trigger to have that person see a doctor.  They may have genetically high cholesterol, a condition called familial hypercholestrolemia that needs medication treatment.  They may have diabetes and need to be on medication.  They may have high blood pressure that has already started to cause kidney damage and need to be on medication. I have seen too many instances were people had information about one of these conditions and thought they could treat it adequately with diet and exercise--or worse, they go on the internet and read ...

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The Doctor is In: Two questions to ask the doctor to save you money.

October 22, 2008 – 5:42 am by DrEric
An article in the New York times today reports on how the current economic situation is causing people to stop taking their medications.  http://www.nytimes.com/2008/10/22/business/22drug.html?hp I posted the following comment on that article's site: There are many things that physicians can do to effectively lower the out-of-pocket costs for their patients without jeopardizing their health--prescribe a generic, do a more detailed physical exam to avoid a CT scan or MRI, enroll the patient in a medical assistance program (there are many sponsored by local governments, charities and yes, even drug companies). For those who are struggling financially with their healthcare, please speak up. Ask your doctor, "how much is this going to cost?" "Is there a lower cost alternative that would work for me?" The article mentions Lipitor. The maker of Lipitor--Pfizer--has a pharmacy assistance program and there are $4/month cholesterol medications available at Walmart, Target and grocery store pharmacies that are effective as ...

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A Company Who Got it Right

October 9, 2008 – 1:52 pm by ScottSchoenvogel
The Wall Street Journal (Matthews) recently reported in its article: The Open Enrollment Season: Beware of Out of Pocket Costs (http://online.wsj.com/article/SB122348910616316019.html): "Briggs & Stratton Corp., a Milwaukee-based maker of small engines and lawn mowers, has done away with most co-payments in its main plans -- a standard preferred-provider organization and a high-deductible option. In the standard PPO, workers pay 20% for all medical services with providers in the plan's network, including doctor visits. That comes with an in-network, out-of-pocket annual maximum of $5,500 for an individual and $11,000 for a family. "There's a much better case for shopping around" among medical providers if employees are paying a percentage of the cost of care, rather than a flat co-pay, says R. Craig Reynolds, the corporate director of employee benefits." Briggs & Stratton has consumer alignment figured out and so can you.  Call Compass for assistance designing the right type of benefits for you and ...

Posted in Behavior Change, Costs of Care | No Comments »