I’ve Moved

American Community Health now has its own domain and blog at

americancommunityhealth.org

You can find my ongoing bloging at AmericanCommunity Health Blog

See you there

Healthcare X Prize Twitterview

Getting the word out on the Heathcare X Prize. American Community Health is currently forming a team to compete for the prize.  Watch here for more details. The Twitterview below is originaly posted on http://healthblog.xprize.org/2009/05/blog-rally-transcript-for.html

On March 26, 2009 the leading health care bloggers throughout the blogosphere participate din a Blog Rally to raise awareness for public participation in the Healthcare X PRIZE design. Bertlan Mesko, leading Medicine 2.0 Advocate and author of the popular Science Roll blog, also conducted a “Twitterview” in support of the effort.

Berci:Can we start the twitterview now? I’d have 10 short questions, you may have 10 short answers. So everyone can enjoy it.

HealthXPRIZE: Thanks for taking the time. We appreciate your help in getting the word out. This Twitterview will complement the Blog Rally. Ready!

Berci: Great! First, what is the X PRIZE Foundation? What is the X PRIZE model?

HealthXPRIZE:The X PRIZE Foundation is a non profit organization that conceives and operates large incentivized prizes that lead to revolutionary breakthroughs. The X PRIZE model is based on leveraging a large purse, with a clear set of rules, that allows innovators to break through barriers.

Berci: Please tell us more about Healthcare X PRIZE!

HealthXPRIZE: The Healthcare X PRIZE is intended to be a competition to redefine health and demonstrate how new models of care can dramatically increase health value. We chose to focus on health value as opposed to a new wonder drug or device as our sponsor (WellPoint and WellPoint Foundation) & advisors were most interested in a systems prize. Systems prizes are much more difficult to conceive and operationalize than technical competitions like going to space or even replicating the genome rapidly. We are expecting that teams will need to innovate around health finance, care delivery, and individual incentives to increase health value. We are currently developing a clear set of rules, which provide the parameters of competition, as we believe that “creativity loves constraints”.

Berci:Reforming the US healthcare system is quite a brave mission, isn’t it? Why the focus on health value?

HealthXPRIZE:The US Health reform gets serious this summer and the HXP is well timed to actually demonstrate and prove in practice the principles of reform. Value is powerful organizing principle for reform efforts – we cannot just reduce costs, nor can we just attempt to improve quality without financial accountability. The focus on health value highlights the need to focus on both sides of the equation. Since Value =outcomes/cost, we are challenging teams to improve both simultaneously.

Berci: Why use an incentivized competition?

HealthXPRIZE: Incentivized competitions are very efficient, highly leveraged, and create an “X” factor within the competitive framework. Sponsors only pay the winner, a $10MM purse typical spurs >$100MM of investment, and the X factor creates global media attention to a key problem, inspire hero’s, encourage non-traditional thinking, and creates a powerful incentive for innovation.

Berci:And how can you properly measure health value? I guess you need pre-defined parameters. What are these?

HealthXPRIZE: Health Value has never really been measured within the US Health Care system. There are many efforts underway right now to properly define and measure health value. Many innovators are leading the way and we are attempt to build on their work or actively collaborate with new/ongoing initiatives (Dartmouth, IHI, AHRQ, etc) to solidify the health value measurement framework. In the context of competition, we are trying to make our measurement framework as concrete as possible by focusing on outcomes (mortality, specific morbidity, ED visits, hospitalizations, sick days etc.). Effectively communicating the notion of “health value” remains a challenge; we are considering focusing on aspects of health value (like decreased hospitalizations and sick days) as a more effective way to communicate to the public the hoped for prize breakthroughs.

Berci: How are the Teams and Test Communities Selected?

HealthXPRIZE: Teams will be selected by through a series of concept design and testing evaluations. They will be required to demonstrate or model the impact of their proposed interventions against test database provided by WellPoint. Independent judges will evaluate the merit/validity of the concept in order to advance. Communities will be selected based on specific criteria that are still being worked through. Intent is to have a defined population of 10K participants from which Teams will voluntarily enroll in the intervention. Test community will be matched against a geographically adjacent control group. Both the team and community selection requires further design, detailed analysis, and expert opinion which we are soliciting at this time through our network of national measurement experts.

Berci: When does this competition start and when will it end?

HealthXPRIZE: The “competition” has several phases: Design, Selection, Competition. We are currently in Design phase through our anticipated Launch later this fall. The Design phase includes soliciting public comment on how we can improve our initial concept/construct to create the most viable competition possible. After official “Launch”, we will begin recruiting teams to compete. Teams will then be narrowed as described above through late Spring 2011 when 5 finalist selected. After a brief integration period into test community, HXP competition is planned to officially begin in January 2012.

Berci: How does this shift the paradigm? What kind of outcome do you expect?

HealthXPRIZE: Great question – we believe the current paradigm is based on volume not value, on process not results, and incents the wrong behaviors while delivering bad outcomes. We want to shift the paradigm to rewarding the reduction of hospitalization / sick days and begin to pay for overall health improvement (this is the outcome we want!). We also want to not focus solely on disease care, and aren’t interested in just improving health care; but believe that we must move to an entirely new notion of engaged, activated health called “Vitality”. We want to demonstrate that this CAN be done at scale, with new entrants / new ideas, and want to set the HXP up as a framework from which these efforts can be tackled in the real world. By focusing on outcomes, instead of regimenting care processes or dictating care delivery, let providers/patients innovate and create rewards for those who obtain the best outcomes.

We believe incentivized competitions are a great vehicle from which we can accelerate change, shift the paradigm, and be a catalyst for the transformation that is required for the US healthcare system. We hope the outcome is a new way to think about health, measure health value, and demonstration of new models of care that demonstrate how to improve community health and individual vitality.

Berci: My last question, regarding X-PRIZE – first rockets, then genomics, now healthcare. What do you think? What’s next?

HealthXPRIZE:XPRIZE is a mission driven organization seeking to inspire the very best in human kind for the benefit of all – this isn’t just a nice quote. It is inherent in the DNA of the organization. We are attempting to be the catalyst in any “stuck” industry by creating incentivized competitions that can lead to radical breakthroughs to the grand challenges of humanity. HXP is now looking at education, energy (some really cool stuff), and developing world initiatives that can truly have major impacts. Fortunately for me, HXP is our focus for launch this year. It is quite challenging work, deals with multiple hard to think through issues, but includes the privilege to work with great people and teams including our sponsor WellPoint.

I have been thrilled with the level of commitment to this process and this prize development process has been tremendous experience. They have a very talented innovation team, led by Chad Pomeroy, who is fully supported by senior executives all the way up to Chief Executive Officer Angela Braly. They have been driving this initiative forward far beyond the $10MM prize purse; they are providing operational resources, sharing data, working to create appropriate test communities, altering business practices to accommodate the prize, and are committed to transparency as part of the HXP process. Their commitment to the project is the reason I became involved as I saw an unprecedented opportunity to really implement the innovation in an idealized but competitive test environment. We appreciate WellPoints leadership, foresight,and commitment to engage X PRIZE in developing the Healthcare X Prize for benefit of all. Very cool stuff.

Berci: Thank you very much for the interesting answers! I will publish the transcript on Scienceroll.com in a few minutes.

HealthXPRIZE: Berci, again, thank you for this twitterivew. We hope to have everyone visit our website, download the initial prize design, comment on our blog, and add their input to the Prize Design process.

Healthcare X Prize Blog Rally

From http://healthblog.xprize.org/

We are entering an unprecedented season of change for the United States health care system. Americans are united by their desire to fundamentally reform our current system into one that delivers on the promise of freedom, equity, and best outcomes for best value. In this season of reform, we will see all kinds of ideas presented from all across the political spectrum. Many of these ideas will be prescriptive, and don’t harness the power of innovation to create the dramatic breakthroughs required to create a next generation health system.

We believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute:

1. Download the Initial Prize Design
2. Share you comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and health care reform.
3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation

We hope this blog rally amplifies our efforts to solicit feedback from every source possible as we understand that innovation does not always have a corporate address. We hope your engagement starts a viral movement of interest driven by individual people who realize their voice can and must be included. Let’s ensure that all of us – and the people we love – can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

Special thanks to Paul Levy for both demonstrating the value of collaborative effort and suggesting we utilize a blog rally for this crowdsourcing effort.

Changing Demographics affect on Heathcare

The video below shows significant changes in population. Although the estimates use straight line calculations it is sobering to say the least. The estimates may overestimate the growth of immigrant population because as those population become more wealthy and stabilized in their new countries the birthrate drop significantly. The tone of the video is very negative and it is unclear what exeactly the “call to action” is. With that said the population shift and associated clash of cultures are on the horizon. It may be a mater of when not if.

Now what of the Islamic influence on providing health care. I am comforted that the Latino explosion in the U.S. has given us some experience in what having a changing demographic can mean. However Islam can be a much more dramatic shift in cultures.  All things to consider when advancing health care reform.

 

A prescription for HealthCare

I have seen much written about the problems with the U.S. health system. As I see it the core issues are: #1 Healthcare is ineffective in preventing and treating chronic diseases. #2 the care you receive is too expensive. The CDC reports that people with chronic disease account for 75% of all healthcare costs. It stands to reason that if chronic diseases were not allowed to become such an epidemic the healthcare industry would not be in the situation it is in today. Americans would be spending at least 50% less on healthcare. Insurance premiums would be substantially less, resulting in fewer numbers of uninsured people. If this was true then covering the uninsured would not cost the government nearly as much, if it became an issue at all. The illustration is overly simplified but the basic premise is solid. Chronic diseases are crippling our healthcare system, making health insurance extraordinarily expensive. Fixing the chronic disease problem will fix many of the biggest problems the healthcare industry is having. From the CDC web page on chronic disease:

“Today, chronic diseases—such as cardiovascular disease (primarily heart disease and stroke), cancer, and diabetes—are among the most prevalent, costly, and preventable of all health problems.”

To understand where the problem began we must go back to the Age of Enlightenment in the sixteenth and seventeenth centuries. The biomedical model was developed using Cartesian reductionism (Cottingham, 1998; Payer, 1988). Scientific reasoning that is mechanistic and linear. Health was reduced to mechanical functioning and established strict divisions between mind and body (Capra, 1982). Such reasons led to the establishment of the modern medical systems, a better understanding of human anatomy and physiology, advanced surgical procedures and the triumphs over the major infectious diseases of the day. Chronic diseases are a major challenge to the modern biomedical model that is primarily concerned with the mechanical functions of the body.

Cardiovascular diseases, many cancers, obesity and diabetes are all heavily influenced, if not out entirely created by our behaviors. The very natures of the diseases create a mismatch between the expertise of medical professionals and the conditions they are trying to treat. The movie Supersize Me makes a good illustration of the point. (the whole video is available on youtube). All three physicians that Morgan Spurlock used predicted only minor changes in his health status. It becomes obvious that their predictions underestimated the ill effects of the McDonalds diet. Just as dramatic was how surprised they where including the comment by the Gastroenterologist that “I would not have even thought about this.” The Cardiologist recommends not eating fast food for a year. I interpret that as saying “I have no idea how long it will take to recover.” If doctors in the movie represent the average medical professional then we must surmise that the underling science they have been taught does not adequately predict behavioral impact on health. Many such examples exist of how mismatched our system is. No surprise given the Cartesian reductionism embedded in the biomedical model they are trained in. To be clear I have no intention of Doc bashing, only pointing to limitations in the current system. In effect we are trying to fit the square reasoning of medical care in the round problem of chronic disease.

Reasonable solutions to current problems have certain characteristics.

First, an effective solution will begin to close the distance between medical and mental healthcare. We need a primary care system better able to handle the behavioral components of chronic disease. The understanding of how the body and mind functions must be based on a model that more accurately predicts outcomes and gets results.

Second, an effective solution would produce the more effective care at substantial savings over the current cost of production.

Third, an effective solution would reward providers for helping their populations stay healthy, as opposed to straight production based compensation.

Fourth, an effective solution would expand the engagement of healthy living to included groups of associated individuals, business communities, and governing bodies.

Many combinations of services could potentially meet these criteria. Many companies can claim that they have produced such a system. The best product with the best price and market position should compete to dominate the market. Healthcare reform should work to encourage and protect healthcare delivery innovation. The successful development of such a delivery system would constitute a disruptive innovation within the healthcare industry. Here in lies the final solution to our healthcare woes, the evolution of healthcare.

Healthcare XPrize

There’s nothing like a big chunk of money to get people motivated. On April 14 the X Prize Foundationannounced a $10+ Million Health care competition. The competition is still in the design phase. What brings me hope in this instance is the fact that at least one open thinker is included on the board of advisors. With Dean Ornish, MD on the board they at least have one known seasoned innovator in the group. I am this night exploring the idea of throwing my hat in the ring for the prize. I would be most disappointed if the usual sort of lackluster health innovators monopolized the event. It would do the U.S. a great disservice to say the least.

I also came across the Health reform pages from the Robert Woods Johnson Foundation. I agreed with the analysis. They suggest six primary areas of needed reforms in our health systems:

1. Cover the uninsured. Coverage must be affordable, open and fair to everyone; it must be continuous and portable. Individuals should contribute to the cost of coverage, but should not be forced to choose between health care and other basic necessities of life. The oversight, management and financing must be responsibilities shared among government, the private sector and individuals.
   

2. Improve the quality, value and equality of health care. Americans pay more for health care and receive poorer health outcomes than people living in all of the world’s other developed nations. Disparities of race, ethnicity, residence, education and income are persistent. It is bad public, fiscal and medical policy to cover the uninsured without also securing for them better quality care that is reliable, safe and fair and provided by professionals and institutions that are publicly accountable for performance and cost.
   

3. Bring down spending. First, ask what can we spend, rather than what does it cost. Then ask how to make health care more affordable. The short-term answer is to develop new business models based on value-added improvements to health and not simply “sick” services rendered. The longer-term answer is to reduce the demand for care by helping people lead healthier lives.
   

4. Prevent disease and promote healthier lifestyles. Whether or not a person stays well in the first place has little to do with seeing a doctor. Our aim should be to keep as many people healthy and out of the health care system as possible. Strategic investment in disease prevention and population health saves lives, strengthens families and the workforce, and reduces health care spending.
   

5. Strengthen public health’s capacity to protect our health. Public health is America’s first line of defense against disease and disaster. Yet, public health historically is under-resourced, has few champions, suffers from a fragile infrastructure and functions so far out of the public spotlight that no one pays attention until after the infrastructure is needed. No sector so critical to the health and security of our people is so casually neglected so often by policy-makers.
   

6. Address the social determinants of health. Treating illness one patient at a time does not improve the health of entire populations or communities. Where we live and work, buy groceries, go to school, who we know, and what we earn all shape our behavior and health. Improving nonclinical social forces affecting health—housing, education, transportation, the economy—may be our most vexing challenge.
   

 

My experience has been that 80% of the health reform chatter surrounds the issues of the uninsured and 20% on everything else. Yet 80% of the solution (or more) is in those other areas of needed reform, especially in the prevention category.  At the very least we are starting to ask the right questions. A brighter day for Health Care is coming, its only a mater of how long it will take till we see it.

Uninsured and American Business

Most Healthcare reform conversations hovers around financial issues. I can see why, as it is easy to understand and relate to something we all know about and are impacted by ….Money. The financial topics can be broken down into covering the uninsured/underinsured, the cost to patients, and the underlying cost of producing health services and goods. Granted the topics are intertwined however they are each monsters of there own and need to be addressed separately.

The debate of covering the uninsured requires an immediate moral judgment. Is this a human right or a service that can be afforded by only those to can afford it? I’ve been told that those with out insurance should just get jobs and work hard. That statement insinuates that somehow they do not deserve access to health services. I’ve also been told that it’s not the government’s job to cover everyone. The creep toward socialism is often cited as a fear that “socialized medicine” in any form is dangerous. Let’s examine this a bit further.

First of all the uninsured and underinsured are made up of working class folks. The back bone of the American economy is made up of small businesses who find it ever more expensive to fund employee health insurance. Half of all small companies of 10 employees or less do not even offer insurance benefits. I personally know of 20 such businesses within a ½ mile of me. How many people are not staring new businesses or are willing to be employed by small businesses because they cannot afford to lose their insurance. By adding significant risk to everyone involved in small businesses, lack of insurance is eating at the very fiber of what makes America great. Having universal health coverage will not solve all of our economic woes. It will ease some stress from would be innovators of today that are needed to create a better tomorrow.

The Begging

Since 2000 my passion has been to understand the workings of the U.S. systems. From formal education to walking the halls of hospitals my journey has taught me much about humanity and the systems that make up our world. Join me as I make reflections on what I’ve learned and my daily discoveries.