The sessions (and meals) – positioned around the exhibit floor were meaty – and welcomely unscripted, offering plenty of time for real-world reflections on the state of health delivery.  Afterward, speakers would mingle on the exhibit floor to answer questions and continue the conversation.  Whether an intended benefit for attendees or not, the meeting structure was a great hit and strengthened ViVE as a go-to community where people can interact and discuss challenges and possibilities. 

The number of attendees was right-sized, where meeting and exchanging thoughts is a priority and at a time when the economy and health system are under a magnifying glass.  The system is broken. That’s a collective given. However, where we go next remains a mystery.

Some 6,000 people were in Nashville for this four-day CHIME intensive, and the schedule of events – official and unofficial – offered plenty of opportunity – need – to catch up.  There were specialty Start-Up, Interop Now, and Cybersecurity Pavilions for the ever-curious and Speed-Connection Forum for deal makers and plenty of action on the exhibit floor.

Some of the add-on gatherings included: the Start-Up Health Transformers Session, UC Davis and FINN Partners Summit on Innovation and the timed release of the Galen Growth Digital Health Report on US Health Provider Systems, the Nashville Entrepreneur Center Evening Meet-Up, and the always fun and welcome Pinksocks Get-Together at the famed Springwater.

MAGIC AROUND THE EXHIBIT HALL

The everyday magic centered around the exhibit hall – home to the mainstage presentations, provided meals, pop-up post-5 PM receptions, and varied entrepreneurial hubs.  That offered plenty of opportunities to connect with innovators who reserved exhibitor space. 

The themed location of exhibits also supported a deep dive for conversation with people looking to improve the flow of information within health systems, better utilize information for preventive care or harness the power of smart tech and wearables.  Most importantly, there was a general acknowledgment from the speakers and vibe that our health system doesn’t lack innovation – it is sorely in need of structural healing. 

ADDRESSING HEALTH ECOSYSTEM PAIN POINTS

In this way, the range of companies appearing on and wandering the exhibit floor made the meeting well worth the time investment.  Many of the companies present at ViVE are worth following (those here are in alphabetical order).  These are among the enterprises that are addressing pain points of the health ecosystem and rallying to pressing patient needs:

• AssureCare, a population-health company connecting payers, providers, pharmacies, and government-sponsored healthcare programs across the US, is taking the long-awaited patient-centric approach using technology to generate better insight through health information. This company is working to converge pharmacists’ and pharmacy data into a bigger population health picture. AssureCare hopes to break down silos in healthcare data sharing from specialty pharmacies to national chains.

• Babson Diagnostics is doing what over-promoted Theranos failed to deliver. Babson is reimagining the diagnostic blood testing experience making routine blood testing less invasive, more convenient, affordable, and empowering people to take charge of their health. The holy grail of patient testing has been to bring it into the retail pharmacy setting using technologies that require one-tenth the sample blood volume of traditional venipuncture methods without sacrificing quality, accuracy, or menu breadth and pushing these diagnostic tests into a well-known setting where convenience corresponds to patients’ upcoming physician visit is in itself a big step in the right direction.

• CereCore® is elevating hospital operational effectiveness.  Its systems are already based in top-performing US hospitals, enabling this health IT enterprise to improve processes, data security and clinical applications. Hospitals remain the most expensive points of care within the US health ecosystem.  Generating insights and learning to mine and apply data earlier in the patient engagement process is key to improving care and reducing costs.  Hospitals cannot go it alone; tapping into a well-proven system is a smart starting point.

• CPSI has combined several companies under its corporate umbrella focusing on health solutions and services for community hospitals, clinics, and post-acute care facilities. These are the health systems that are known to struggle as more and more systems look to align with other, larger entities. The path to system-wide health has been to ensure a better patient care experience, improve financial operations and offer community hospitals and affiliated clinics EHR solutions that can accurately code assignments for reimbursement. While many companies in the field are looking to “innovate,” sometimes the greatest care advances are in strengthening the care system’s capacity to be economically viable.

• eVideon uses smart-room technology to streamline clinical workflow and transform the patient room into an immersive environment. This company enables hospitals and long-term care clinics to integrate EMR and other installed technologies to display real-time information through the in-room Smart TV, digital whiteboard, digital door sign and bedside tablet. The platform is streamlining clinical workflow and reducing the technology burden on clinicians. This system even features in-room surveys and video chat so the patient has a greater real-time voice.

• Harmony Healthcare IT is the data management firm that moves and stores health organizations’ patient, employee and business records. Among the category of veteran players, it continues to pioneer health IT tech in many ways.  Founded in 2006, this company works with more than 550 clinical, financial, and administrative software in the US and Canada.

• HCTec provides services to more than 1,500 academic medical centers, health systems, community hospitals, critical access hospitals, and healthcare provider organizations. While patients are supposedly the health system’s priority, it’s vital to remember that if the care locations are poorly staffed and lack infrastructure, their mission will be severely hampered.  At a time when hospital systems are integrating, getting their staff and EMR systems connected is a mega – even life-saving priority. 

• Interwell Health is a kidney-care management platform in a field that has become one of the most pressing health sector needs.  The Centers for Disease Control and Prevention (CDC) estimates that 37 million Americans are affected by kidney disease, and most are unaware of their progressive condition.  With kidney disease reaching near-epidemic levels, how physicians care for patients and help them navigate a fragmented reimbursement environment is a monumental task. The cascade of care – from diagnosis to dialysis – requires access to practice knowledge and reimbursement.  Learning about an illness is the start of a process and getting the care essential to keeping people on track to prevent additional medical risks is where medical outcomes are judged.

• ixlayer is partnering with payors, retail pharmacies, direct-to-consumer brands, biopharma, health systems, and telehealth providers to create quick and easy diagnostics for common conditions where reducing cost is possible – before an illness is much more severe. This platform “white labels” its tests for major customers with direct patient access and enables numerous testing options and seamless integration with its customers and lab partners. Like many innovation leaders, its goal is to shift engagement to earlier stages when a disease presents and its management has far more cost-effective treatment options.

• Juli was front-and-center at the American Telemedicine Association meeting in San Antonio earlier this year. The consumer-direct platform – available through a convenient app – supports people with chronic health conditions such as asthma, migraine, depression, bipolar disorder, hypertension or chronic pain through several evidence-based approaches. This consumer health empowerment tool integrates information that impacts health and awareness by tracking health responses to environmental data (e.g., weather, air pollution, pollen) through smartphones or popular wearables and aligning health.  The information can help shift the sick-care reactive system to a self-care preventive care approach.

• Lifepoint Health, the Nashville-headquartered provider, has, since its founding, become a national health system serving patients, clinicians, communities and partner organizations across the healthcare continuum.  A spin-out of the pioneering HCA, this system now includes more than 50,000 employees, 62 community hospital campuses, 50 rehabilitation and behavioral health hospitals – plus 200 additional care sites, including managed acute rehabilitation units, outpatient centers, and post-acute care facilities.  It was no surprise that Lifepoint Health was present at ViVE.

• Loyal is among the first companies to offer end-to-end digital and AI-powered solutions tracking the patient journey; its software solutions for improved care utilization can be found within the nation’s top health systems and hospitals. From selecting a provider best suited for treating a specific condition to closing a feedback loop on patient experience, they have demonstrated that feedback is desired and that people who engage their health networks tend to show greater loyalty.

• Sheba Medical Center was part of the expert conversation at ViVE – a surprise for some as Newsweek World’s Best Hospitals five years straight – this medical system sent representatives from more than 6,000 miles away to share insights on how it maximizes technology across its care systems.  Its acute-care hospital, rehabilitation center, research and training programs, medical simulation center, center for disaster response, and the ARC Innovation Center for redesigning global healthcare all tap into the full range of digital and health technologies. At ViVE, its head of innovation spoke about the importance of looking for innovation from within its walls and the benefits of sharing best practices around the globe.  

• Teladoc Health appears to be about accessing care from many locations, but the pandemic demonstrated that the platform could provide much more to improve people’s well-being.  Now, telemedicine has become a given and has shown its value in patient adherence, management of chronic conditions such as diabetes, checking in with people enrolled in clinical trials and dealing with senior care needs.  In post-acute hospital care, telemedicine can support the outpatient process and keep people healing at home.  This global leader in delivering whole-person virtual care – including primary care, mental health, chronic condition management, and more – is the category must-watch innovator.

WHAT’S UP NEXT FOR HEALTH INNOVATORS?

The success of ViVE had many looking forward to April and HIMSS in Chicago, and CNS Summit in Boston this November.  For health innovators planning for 2024, mark your calendars for ViVE February 25 – 28, 2024, in Los Angeles.  If you have already marked your calendar for those dates, it’s a sure sign that #ViVE2023 was a hit!

The post ViVE Was an Out-of-the-Box Hit Among the Digital Health and Health Innovation Tribe appeared first on Medika Life.

On the one hand, we have incredible science, technologies, drugs, devices and providers. On the other hand, we have a truly dysfunctional healthcare delivery system.

America has exceptionally well-educated and well-trained providers committed to your care.

America is the envy of the world for its biomedical research prowess uncovering the basic science of human biology, funded largely by the government via the National Institutes of Health and conducted across the county in universities and medical schools.

The pharmaceutical and biotechnology industries continuously bring forth lifesaving and disease-altering medications.

The medical device industry is incredibly innovative and entrepreneurial. The makers of diagnostic equipment such as CT scans and handheld ultrasounds are equally productive. 

Consider these examples: The science of genomics is revolutionizing medical care in profound ways, such as producing targeted cancer drugs, predicting later onset of cardiac disease, offering prognostic data to guide cancer treatment, rapidly identifying bacteria and its antibiotic susceptibility, indicating whether a drug will work in a specific person and determining if a drug will cause a side effect in that person. 

The pharmaceutical industry has brought us statins to reduce cholesterol, drugs to prevent blood clotting and effective means to control high blood pressure. The rapid development of multiple vaccines and treatments against Covid-19 has been an incredible tour de force.

The device industry has created a potpourri of new approaches that have transformed, for example, cardiac care, including angioplasty, stents, pacemakers and intra-cardiac defibrillators. We even have the ability to replace the aortic valve without major heart surgery. 

Organs can be imaged noninvasively in incredible anatomic detail while also showing their inner cellular workings. The operating room is equipped with devices that make surgery less invasive, more effective and much safer.

Simulation technology has completely changed how trainees learn the basics of procedures from the simple, such as drawing blood, to the complex, such as laparoscopic surgery and cardiac catheterization. Robots are assisting surgeons in open heart and prostate surgery and are integral to today’s large hospital pharmacies and central sterile supply systems.

We may be on the verge of using genetically modified animal organs transplanted to humans for heart, lungs and kidneys.

The electronic medical record allows rapid access to information at any time and place, helps the physician to select the correct medication and dose and speeds up prescription transfer to the patient’s local pharmacy.

Radiology and pathology images can be sent via the Internet to a distant site for interpretation by a specific expert. A video of an ongoing surgical procedure can be evaluated by a distant authority in real time to give advice to the operating surgeon, such as in a battlefield situation far from home. And some surgery can even be done distantly via robotic controls.

We can be appropriately awed, proud and pleased about what is available for our care but to a large degree, we don’t fully benefit because —

We have a very dysfunctional health care delivery system. It is highly flawed and just does not work well.

Image from Peterson KFF Health System Tracker

America spends nearly 20 percent of its Gross Domestic Product on medical care, which is double that of the average of 9.9% for the other 34 economically-developed countries (such as Canada, Britain, France, Germany and Japan) in the Organization for Economic Cooperation and Development. On a per capita basis, America spent ~$12,000 on health as of 2020, which is more than twice the average of the other countries and well above Switzerland, the second highest country in expenditures, at ~$7000.

Despite these expenditures, our lifespans are somewhat shorter with Japan and Hong Kong at the top of the charts averaging 85 years and the United States ranked at number 46 with an average of 79 years and falling somewhat in the past few years. This decline is not for lack of medical advances but is rooted in the social determinants of despair and disease and the linked epidemics of obesity and type 2 diabetes.

There are thousands of preventable hospital deaths each year, and there are ~100,000 deaths due to hospital-acquired infections.

On a direct personal basis, you experience the dysfunction personally in many venues. You pay a high price for your health insurance yet you get only 15 minutes with the doctor. You are frustrated, perhaps angry and the doctor is equally frustrated and increasingly burned out. Tests and procedures are way overutilized. Trips to the ER and admissions to the hospital are much greater than necessary. Plus, these incredible technologies and lifesaving drugs are often used in ways or settings in which the marginal benefit barely, if at all, exceeds the marginal cost.

This is not an enviable record.

A report from the National Research Council and Institute of Medicine, summarized in the Journal of the American Medical Association, found “the health outcomes [of the United States] are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent.”

Although there is better control of high blood pressure and cholesterol and there are lower cancer and stroke mortality rates, U.S. citizens have a lower life expectancy, higher infant mortality, higher rates of premature birth and thus lower birth weights, a higher incidence of HIV-AIDS, the highest prevalence of obesity and diabetes and the second highest rate of death from coronary artery disease, among other ills. To repeat, this is not an enviable record, especially given the level of expenditures. 

In sum, the paradox is that America has the providers, the science, the drugs, the diagnostics and the devices needed for outstanding patient care. But the delivery of care is dysfunctional at best and far too expensive. You are not getting the full potential of care that could and should be available and you are paying too much for what you do get.

In the articles to follow, I will delve into the what’s and why’s of this predicament along with practical approaches to improvement. Please join me.

The post The Paradox of America’s Healthcare System appeared first on Medika Life.

In a comment related to the patient’s story, it was suggested that the American medical delivery system is truly dysfunctional. I agree. This has prompted me to write this series of articles to define, address and offer opportunities for improvement – improvements that will make medical care better, will reduce patient frustration and anxiety, and greatly improve physician well-being, the latter now being at rock bottom.

To begin, consider this true story. The patient’s name and some characteristics have been altered to protect anonymity. It is adapted from my book Fixing The Primary Care Crisis which was a sequel to The Future of Healthcare Delivery.

Susan is 56, married, insured, a successful professional and is in generally good health. She began to have a strange sensation in her right chest, which she described as a shooting sensation almost electrical or vibrational in nature which stretches from high up in her right chest down as a narrow line over her rib cage and onto her abdomen. It seems to be immediately under the skin, starts intermittently and ends at no set time. She visited her primary care physician (PCP) and gave this description, adding that she was concerned that it might be her heart. The doctor asked additional questions and did an exam and electrocardiogram. All were normal except for the description of the sensation Susan was feeling.

Her PCP was now running out of time for this fifteen-minute visit. Here was a fork in the road with two paths. One path was to say that it was a real sensation but nevertheless he could reassure her that there was no evidence of disease.  But given that Susan indicated a concern about her heart, the PCP chose the path to send her to a cardiologist for further evaluation. The cardiologist did a history and exam related to her heart and found nothing abnormal but suggested a stress test and an echocardiogram. Both were normal. The cardiologist said it was not Susan’s heart causing the problem, but since the sensation crossed over to the upper abdomen, maybe it would be a good idea to see a gastroenterologist.

The GI doctor also did a history and exam and found nothing. Nevertheless, among many other tests, he ordered a CT scan of the abdomen. All was normal except for a small cyst in her uterus. The radiologist read it as a benign cyst but – feeling the need to be cautious – recommended Susan visit a gynecologist, “just to be sure.”

The gynecologist also said it looked benign, but “ just to be on the safe side,” she could remove it laproscopically. Susan would be “out of the hospital the same day and feeling fine in a day or so.” The cyst was just that, a benign cyst.

Susan still had the strange sensation in her chest and no one had found an answer for her. But given that it seemed to have an electrical feeling, the gynecologist suggested that it could be a nerve issue. So, she visited a neurologist who found nothing, commenting that nerves run around the chest, not up and down. She still had the strange sensation,

Susan’s story illustrates the problem so common today in primary care. The primary care physician should be the backbone of the American healthcare system. But primary care is in crisis – a very serious crisis. In this story, the PCP did not truly listen to his patient. He did not stop and think the issue out carefully. The fundamental problem was not his disinterest. It was that he had no time to delve into what might actually cause Susan’s pain since there was a waiting room full of patients and he needed to see about 25 that day. So instead, he took the easier path and referred the patient to a cardiologist since this seemed like a logical choice.

Had he followed the other side of the fork in the road, listened long enough and then thought about it, he would have concluded that Susan was hypersensitive to minor – albeit real – sensations. He would have offered reassurance that it did not represent a life-threatening ailment. He would have said that it was real but of no concern. He might have offered a few weeks of a low-dose anti-anxiety medication such as alprazolam (Xanax), offered further reassurance and told her to return in two weeks for a follow-up. At the follow-up, he might have explored the issues producing anxiety or stress in her life – finances, marital relationship, a disruptive child, or an overbearing in-law.

After hearing about this patient’s saga, I asked a highly-regarded PCP to comment on how he would have cared for this patient. I told him only about the initial visit. He smiled and said, “I bet she got sent for a big workup.” He first said that if she were his patient then he would know her well, her family situation, and would be aware of her health status including blood pressure over the years, cholesterol levels and other factors that might predispose to heart disease.  From there he offered his approach to her visit, which I have reiterated above.

Unknown to the original PCP, Susan had some very stressful events occurring in her family, a situation that was having a major impact on her and her husband’s lives. What Susan really needed was assistance to overcome her stress, not months of specialist hopping, which was unnecessary, very expensive and only increased her stress.

Anxiety and stress are often components associated with a physical symptom, and these can only be addressed with more time to carefully listen and respond with suggestions. But Susan was shipped from doctor to doctor, test to test, and even had an operation with no one really listening enough to figure out her problem. All each specialist could do was say it was not in his or her “organ system” and leave her without a sense of closure. Each said it was not the heart, the stomach or the nerves. And the surgery “went fine,” but she still had the unpleasant sensation. All of this resulted in far less than adequate medical care and cost a king’s ransom. That is what happens today. All that was needed was for the PCP to spend some more time – time to listen, then to think and then to counsel. That’s not expensive at all.

These events point to at least three significant issues that help to define why American medical car is dysfunctional. The first was the PCP not spending the time to truly understand Susan’s issues. If he had done so, there would have been no needed to refer her to the cardiologist. That referral was essentially a copout. But perhaps, we should blame the PCP but at the same time understand his circumstances. He was stressed for time as a result of the perversity of the insurance system. No excuse but perhaps understandable. Unfortunately, this lapse resulted in the patient undergoing months of useless strain and lots of anxiety.

The specialists continued the referral process, one to the other, again without much attention to what the underlying causes of her problem might be. It was simply easier to send her to another specialist than to spend any time thinking more broadly, silo based rather than holistically based care.

Finally, the specialists were totally disconnected. If indeed specialty care was indicated, it should be the PCP that is in the driver’s seat, coordinating the referrals, personally contacting the specialist and explaining why the referral was pertinent and requesting an early appointment. As best Susan knew, none of the specialists even consulted with the PCP as to next steps before referring her on to the next specialist. None called ahead and all left it to her to arrange for an appointment, meaning that it often took weeks or more to see the next specialist on this ever-lengthening list. Another copout for sure but in some ways explainable since it is easier to refer than it is to connect back in a useful manner – telephone discussion with joint planning on next steps.

Susan’s story and her travails with the medical system illustrate how deep the problem goes. Her journey highlights many of the issues I will address in the coming articles. Multiple other patient vignettes will underscore the reality of the crisis – and its impact on all of us. In the process, I will explain how you, as a patient, can receive excellent care at limited expense.

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