Posting in Cancer
The technology at this week's HIMSS show is aimed at reducing the need for intravenous permission, and limiting that permission to what is most likely to deliver value.
Health costs are skyrocketing because doctors have what marketing guru Seth Godin 10 years ago called "intravenous permission."
When the ambulance comes, or you arrive at the emergency room, docs can sell you whatever they want, at whatever price they want, and you have no say in the matter. The needle in the arm is your permission.
The technology at this week's HIMSS show is aimed at addressing this power imbalance. It's about reducing the need for intravenous permission, and limiting that permission to what is most likely to deliver value.
(Shown are Microsoft executive Peter Neupert and the Cleveland Clinic's Martin Harris, at HIMSS this week.)
There are two main ways this is done:
- Combining electronic medical records (EMRs) with practical knowledge, as with GE's Qualibria, can put best practices, the most cost-effective procedures, at the patient's bedside.
- Combining these records with a patient portal, as with Microsoft's HealthVault, can empower people to do their own medical tests, see the practical advantage of following the doctor's advice, and get better care with fewer office visits.
Both of these are important. So is the EMR's ability to avoid mistakes, as NCHIT David Blumenthal described in his HIMSS keynote on Tuesday. Technology can automate checklists, which also reduces mistakes.
But none of this will really work unless we first understand the power of the word no.
As in, "no, we won't pay for that expensive test." As in, "no, we won't cover you at that price if you keep smoking, or drinking like a fish, or turn yourself into a beached whale."
This is the essential difference between the American system, which covers only four in five of us for 17% of our gross domestic product, and the health systems in other countries, which cover everyone for around 10-12% of GDP.
Other countries regulate what can be done with medical dollars. They have formularies, and don't accept new procedures until they're proven, not just to work, but to deliver value for money.
Once you're in the American system, whether you're poor on Medicaid, or old on Medicare, or a VA hero, or lucky enough to have good health insurance, the mission is always to take care of you. Doctors have intravenous permission not only from you, but from the people paying the bills.
Attempts were made in the 1990s to cut this out, through what was called "managed care." It didn't work. Hospitals won back their pricing power. The power to price is also the power to grow. When you're selling and not buying -- as most hospitals are -- selling more is the route to profit.
Systems like Intermountain Health, which sell insurance as well as care, have different incentives. So they practice evidence-based care. They have best practices, based on data from their computer systems, to inform doctors and nurses on what they should do for each patient at every stage of the process.
This is what comparative effectiveness is all about. Gather the data, see what works, and do that first. Yet that was the first thing tossed out of health reform, even before the stimulus passed, because of conservative claims it would "kill grandma."
The second leg of health reform is convincing you to change your nasty habits. The idea is to move care down the permission ladder, so you are subscribing to wellness services or transacting for them. This gives buyers more power than they have with a drip line.
The idea is that health services get a per-patient fee for wellness. They use this to give patients data on themselves, helping them collect the data, get them eating better and exercising and taking responsibility for their own health. An ounce of prevention over a pound of cure.
But this interferes with freedom, we're told. Smoking is legal, liquor is legal, McDonald's is legal, exercise is a choice. You're Communists, Nazis, trying to tell me what to do.
I argue that's not freedom, it's license.
But rather than have an argument, I suggest, sign here. Go in peace. You and Ayn Rand have a grand old time. But when you get cancer, or heart disease, or diabetes, I think that contract should say that when the drip line goes into your vein you pay cash. Or accept responsibility for your choices and drop dead.
Those are the two legs of real health reform. Data tells us what to do, so we can say no and stand our ground. Data tells us as individuals what to do, so the system can be protected from your fat ass demanding a quadruple bypass when we told you and told you to stop stuffing your stupid face with cheeseburgers.
It doesn't matter who pays. That's the focus of the current health care debate, who pays. And that's the wrong focus.
We should ask, instead, how much, and what we're willing to do, as patients and as people, to cut that cost. Ask not what our health system can do for you, ask what you can do for our health system.
Mar 3, 2010
This is Digital Socialism, where we lose the ability to control our own destiny- God help us by delivering us from the mass of elitist socialists and communists that now are empowered in both Congress and in the White House. Dana, tell your beliefs to Ted Kennedy, the granddaddy of healthcare reform, who when he had an inoperable, incurable brain tumor still chose to go to the best hospital in the USA, get operated by the best neurosurgeons, and even got experimental chemotherapy which has yet to show a significant prolongation in survival in the type of tumor that he had. Teddy didn't chose to take Obama's "little red pill," so neither should we, the masses. I don't believe in this hypocrisy and in the "do as I say, not as I do situation" of those in Congress who voted for the healthcare bill and hopefully will soon be voted out of office. Lastly, if we do end up in "the power of no" situation, then I agree with Senator Grassley that all in Congress should participate fully, by force, exactly like what they are doing to their constituents. Al
The Power of Better Information http://thomasconcannon.blogspot.com/2010/03/power-of-better-information.html
No Ayn Rand fan would balk at being responsible for their own lifestyle choices, or having to pay for their own medical care. It's being forced to pay for anyone else's that is wrong. That and the government dictating what kinds of insurance may be offered or purchased. In short, the Ayn Rand solution to the health care crisis is to get the government out of it.
Dana, concerning that part of your blog you have outlined as the second leg of health reform was nonsensical and indicated to me you are rather uninformed, and simple minded. What if some clever scientist discovers that the currently understood means of healthy living was not in balance and leads to certain other ailments in older age? Should the heath care system you invasion no longer take care of you for your past behavior when you were not fully aware of future consequences? Further are you suggesting that all those people with cancer for example brought this onto themselves due to life style choices and therefore not entitled to the same level of care as the rest and at the same cost? Or should those that believe they must or due to geographic location or education perform dangerous or high health risk jobs not be covered due to their bad behavior or pay more? I know of many people who have smoked, or drank or eaten things you seem to consider inappropriate however they are older and as healthy as their population mean. What proof do you have that doing those thing will lead those with this behavior to worse aliments in older age? It has been proven in Italy that a community of people there have genes that prevent them from suffering the consequences you propose all will succumb to if smoking or drinking or eating certain foods. In other words our genes help regulate how things will affect us and what affects someone of us in a negative ways has little to not affect on others. Look at the Canadian system, it regulates health care costs better than the U.S. system however it does not demonize anyone for their behavior or refuse to treat any patient as a means to regulate its costs, In fact it is illegal to do so in that system. It is not perfect however it is a much better solution to some of the problems you outline in the current U.S. system without requiring the state or system to become some form of fascist Orwellian dictator of behavior, rights and entitlements. People do have responsibilities to themselves and to others however we do not have a right to play God (god if you like) or deny people the right to life regardless of their stupid behaviors, that is immoral. We do have a right to let the person know before and after the fact of their consequence to be careful and think of the dangers and possible future outcome(s) to themselves and their love ones. Money is meaningless when it comes to a human life and no dollar value should be placed on it. If you want a sustainable health care system start by writing articles on how the U.S. can fund the best system by printing its own money debt free as one very import means or by better regulating doctors fees since that is the major cost to any health care system (yon touched on this). Regulate how much is paid for health care equipment, purchase the majority of goods you consume made in the U.S. by better paid and better taxed goods, workers and companies. Fight for better service sector wages. Dana, you cannot expose absolutists statements in a relative world, that is ignorant. You should try thinking before writing.