While it is seems that these denials are random in nature – and many times they really are – and there does not seem to be any way to completely avoid them, there is one strong defense against these denials: our documentation in the medical record.

The only thing that we can do to strengthen our cases against denial is proper documentation. This is especially true when the acuity of the patient may be borderline or – most especially – when the length of stay is relatively short. I interviewed an insurance company medical director, and he told me, “Oh we love those one day stays…” He said that because it is fodder for a denial in payment, and it sets off a lengthy process to get these denials overturned.

We need to document accurately and properly. We need to take the time to document our thinking process, and explain why we are doing what we are doing in the record. At the time we see the patient, it may be self-evident to us. But, when looking at the record months or even years later, it is not self-evident to the person reviewing the chart.

This cannot be overstated. This cannot be overemphasized. Documentation in the record is everything. It establishes the proper diagnoses for the Diagnostic Related Groups (DRGs); it establishes the severity of illness for a specific patient case and hospitalization; it sets the reimbursement for services rendered to care for a patient; and if documentation is poor, it gives powerful ammunition for insurance companies to deny payment. This is not even mentioning the fact that good documentation protects you in medicolegal cases…(that’s another newsletter at some point).

Does this mean that insurers will not deny payment for cases with good documentation? Of course not. At the same time, with good, detailed documentation, it becomes that much easier to defend the care during a Peer-to-Peer discussion; it becomes that much easier to defend the care in an appeal letter; with good documentation, it becomes that much easier to defend the care to an Administrative Law Judge. Good documentation is everything, and poor documentation just makes everything that much more difficult.

Documentation. Documentation. Documentation. It is so so important that we document properly. Yes, we are all busy. And with today’s technology, it is so much easier to document well. In a few seconds, I can document an entire paragraph in the record. It is time very well spent, and in today’s healthcare environment, there really is no excuse for poor documentation.

The post Your Best Defense Against Denials: DOCUMENTATION appeared first on Medika Life.

• Inspire and influence leaders (leadership does not equate to a title) to prioritize the practical build of pathways and platforms that measurably move us from our current sick care model to a future model of actual healthcare.
• Invite an increasing engagement of talents, resources, technology, ideas, and influential networks to shift our focus from perpetuating our sick care model to stepping into a concrete vision of true healthcare.
• To spark conversation and amplify the message: we can do better.

Step into the following words – lift them from the page. Debate, share, and put them into action. Discuss them in a board meeting, during a podcast, as a class assignment, in a team meeting, or while sharing a meal with friends. Lift them from the page and bring them to life.

Many will resonate with these concepts. Others will not understand them or perhaps choose to disagree. There will also be those with no interest, being too stressed by waves of daily disruptive change. Some walk that tricky line of being rewarded financially yet are experiencing burnout from the sick care system they serve. I respect each position and each individual.

As you can, I ask that you participate in envisioning a better way. Today, that’s the invitation offered by our children and our future.

Singularity

The term singularity is defined as the state, fact, quality, or condition of being singular. Similar terms are “unique”, “distinctive”, and “particular”. In physics or mathematics, the term singularity reflects a point at which a function takes an infinite value. In the study of unstable systems, James Clerk Maxwell in 1873 was the first to use the term singularity in its most general sense: it refers to contexts where arbitrarily small changes, commonly unpredictably, may lead to arbitrarily large effects.

It refers to contexts where arbitrarily small changes, commonly unpredictably, may lead to arbitrarily large effects.

The term singularity offers a glimpse into an unfolding journey of true healthcare transformation. I believe it will not be what most envision or expect. It will start small (quite possibly already underway in corners of the world) and capture the vision and passion of the greatest minds and hearts. Those excelling in technology, design, social theory, behavioral science, cognitive computing, ethics, and economics will be drawn into the vision and will eventually steward a future of infinite value and exponentially large effects. Before we go there, however, we must first visit the ground on which we currently stand.

Our Present Reality

According to Silicon Valley Bank, for the full year 2021, a record $86B of venture funding was invested in health sector companies in the U.S. and Europe. In just Q1 of 2022, that number was $19.6B. That’s $105,600,000,000 in fifteen months. These investments in venture-funded health sector startups are happening while many large health systems are hemorrhaging. For example, according to Beckers Hospital Review, nationally recognized Cleveland Clinic reported a net loss of $786.9M for the second quarter of 2022 and a $1.07B loss for the year’s first half. They are not alone. In an article published one week ago, Beckers highlighted the need for health systems to shrink executive teams as costs rise.  

In a recent briefing, Fitch Ratings warned it could take years for provider margins to recover to pre-pandemic levels. Those moves include steeper rate increases (read rapidly rising prices) and “relentless, ongoing cost-cutting and productivity improvements” over the medium term. Further out, “improvement in operating margins from reduced levels will require hospitals to make transformational changes to the business model,” Fitch emphasized.

Our sick-care system is killing us and killing our economy. Transformational changes are required. In the recent blog post titled “Prime Health,” Professor Scott Galloway stated it this way.

“The U.S. Healthcare industry is a wounded 7-ton seal, drifting aimlessly, bleeding into the sea. Predators are circling. The blood in the water is an unearned margin: price increases, relative to inflation, without a concomitant improvement in quality. Amazon is the lurking megalodon, its 11-foot jaws and 7-inch teeth the largest in history. With the acquisition of One Medical, Amazon is no longer circling…but attacking.”

Professor Galloway allows facts to speak for themselves (I strongly suggest you read his full blog here):  

• Per capita, U.S. healthcare spending went from $2,968 in 1980 to $12,531 in 2020 (both in 2020 dollars), resulting in an industry with 13% of the nation’s workers and total spending accounting for a fifth of U.S. GDP.  
• Two-thirds of personal bankruptcies in the U.S. result from sick-care issues (medical expenses and time off work).  
• Forty percent of adults in the U.S. have delayed or gone without needed sick care because it’s too expensive.  
• The U.S. has one of the highest infant mortality rates among developed nations.  

Professor Galloway provides an additional summary opinion; “No industry has better demonstrated the dis-economies of scale. If we received the same return on our healthcare spending as other countries, we’d all live to 100 without getting sick … U.S. healthcare is the worst value in modern history.”

U.S. healthcare is the worst value in modern history precisely because it is not healthcare – it is overburdened sick care.

A Growing Discontent

Improving the future in no way diminishes the past or disparages the present. For the last few decades of my career, I have served within the same industry reflected in the data above. Most recently, as market COO in a national health system with a portfolio of provider services exceeding $1.2B in gross revenue, facilitated and supported by a team of thousands. I’ve worked with exceptional physicians, extended care team members, non-clinical leaders, and a host of others that are passionate about their mission, skilled in their craft, and seeking a better tomorrow.

Over a decade of consulting nationally, I’ve also been privileged to support founders in startups, early-stage launches into healthcare, middle market provider organizations, physician-owned national practices, and the household names of multi-billion dollar health systems. All these experiences have taught me this truth: serving the sick with grace and compassion is a worthy calling. It is a vital necessity in our nation’s infrastructure and required for a flourishing society.

It has also taught me another essential truth.  Though our current sick care industry is necessary, it is not sufficient. I’m thankful for access to world-class sick care, but we can do better. We must do better. Physicians and nurses are burnt out and quitting in mass. Executives and leaders at all levels are also under extreme pressure and joining the “great resignation.” Our talented and caring front office team members are quitting and going to work at Costco or Chick-Fil-A for “better pay and less stress.” There is an ongoing flurry of mergers, acquisitions, bankruptcies, restructuring, and closures. 

There is no easy answer to transforming what we are now experiencing. No vested “unicorn” will pull us out of our current challenges. No siloed approach in chronic disease management, remote patient monitoring, hospital at home, or digital innovation will bring us where we need to go. Yes, Amazon buying One Medical is bold. CVS buying Signify Health is bold. Walmart and UnitedHealthcare signing a 10-year collaborative is bold. We all sense it and see it; accelerated and purposeful movement. Things “as is” are changing and must continue to change.

In observing these bold movements, I (and many others) are left with growing discontent. These moves are necessary, but they are not sufficient. Data trends still reflect an unraveling and unsustainable system. These trends we observe both in the headlines and in our bank accounts. Most poignantly, in our and our loved one’s health journeys, we know it. I suggest we need a longer view. We need the courage to amplify the growing voice of “we can and must do better.” We need to move radically and decisively upstream from sick care. We must continue building and making changes of different sorts and in different directions. We must dramatically reduce the need for sick care. Our vision must be bold. Very bold. Fortunately, there are models we can use to inform our approach.

The Model of Megaprojects & Cathedrals  

According to The Prepared, in an article titled Building a Cathedral by Nicolas Kemper, “across 217 church and abbey projects in England, construction took an average of 250–300 years.” Cathedrals were megaprojects rooted in community and spanning generations. The emphasis here is not on the cathedral but on the representation of a megaproject model rooted in community, spanning generations, and having an expansive scope. In this fascinating study of building cathedrals, Kemper goes on to highlight the practical work of Virginia Greiman and her survey of megaprojects.

“In her book on the Boston Big Dig, Megaproject Management, Virginia Greiman offers a list of 25 different characteristics, including long duration, multiple stakeholders, ethical dilemmas and challenges, and discontinuous management (the Big Dig, for instance, spanned the terms of five governors). Yet the single most salient feature of what makes a megaproject a megaproject is the scope.”

Unlike other megaprojects, an essential and unique (singular) component of building cathedrals is the realization that all effort is accretive. Cathedrals are distinct from typical megaprojects in a significant way: an unfinished cathedral, even if over decades or centuries, is by no means a failure. Most large megaprojects are binary; they are done or not. For example, a 90% complete bridge is practically useless.

“Cathedrals, on the other hand, are not binary. The aspiration may be much larger, but in essence, a single room could act as a cathedral. Salisbury cathedral took a full century to build, but services commenced almost immediately in a temporary wooden chapel. Cathedrals, Ansar posits, are accretive – they gain value as built, “like a beehive.”

This posture of evolving accretive value (expanding as ongoing components come to life) is one of purpose and patience. It is a model of a broader arc pointing to a future state and more significant benefit. Applied to themes within healthcare, the supposition behind population health is radically different than pursuing short-term profit by launching a digital tool to manage a specific disease state. Seeking accretive value by offering and impacting healthcare is a different journey than harvesting outsized economic return by building the next sick care unicorn.  

The resourcing of today’s sick care system is necessary. It is up for debate how it is resourced, at what levels, and to produce what benefits and outcomes. However, what is not up for debate is the importance of one of the most critical and clarifying questions in healthcare: what is the definition of winning, and how do we do it? I believe, quite simply, that we win when individuals are flourishing, and we do it by keeping them healthy. If we’re not lowering cost, improving quality, enhancing access, and measurably moving from “sick care” to improved health of populations, we’re all still losing.

If we’re not lowering cost, improving quality, enhancing access, and measurably moving from “sick care” to improved health of populations, we’re all still losing.

This perspective presents a different view and an expansive definition of success. A model of megaprojects can inform the effort of building a healthcare singularity. Like building a cathedral, the actions and efforts produce accretive value as they develop. Even if judged unfinished five, ten, or twenty years from now, it should not keep us from starting and is by no means a failure.

Even in the most minor initial and incremental steps to keeping people healthy, there is value and worth.  The process of building is accretive; the effort will gain value as it develops and evolves, “like a beehive.” Over the coming years and decades, more individuals will become and stay healthy. As a generation learns and then passes on, choices in health flourishing, the future beneficial impact will be incalculable.

The Beehive – Endless Accretive Value

The following components of building this healthcare singularity are worthy of further study, debate, and economic investment. In decades ahead, a few degrees of change beginning today will create an entirely different trajectory and outcome for future populations (resulting in planned and arbitrarily large effects). As the “beehive” evolves, it will also produce lasting accretive economic value. As we step toward building a true healthcare singularity, let’s remind ourselves that all the raw materials we need exist today. All the talent is currently present. We lack nothing to get started. With the hopes of creating a meaningful nudge in turn of our collective health flywheel, these proposed components reflect an aspirational, high-level, and directional view. Over time they can (and will) be proofed, adjusted, and implemented in a foundational and tangible way. Here is what I see coming to life:

• Successive generations begin to learn improved health literacy, improved health behavior, and increased transparency (at scale) in how their personal choices impact the economics of individual and societal health rewards and sick-care expense burden.
• Creation of a meaningful and personal indicator of health (personal health score) that is clinically accurate, always current, accessible in real-time, insightful, and actionable.
• Building of a 24/7 “opt-in” A.I. enabled, digitally designed, and personally influenced healthcare ecosystem (spanning and reconfiguring typical industry boundaries). The health ecosystem will offer an integrated and elegant service bundle to influence and guide individuals on a journey to sustained health, overall wellbeing, and improved health scores. For example, see the recent article Prevention-as-a-Service by Dr. Ramin Rafiei and Dr. Jacob LaPorte.
• An evolving “beehive” of cross-industry and local community connections on the one hand and access to health products, goods, and services on the other, with the intended purpose of reinforcing health literacy and healthy choices at decision points related to food, fashion, exercise/sport, finance, mental wellness, art, entertainment, and connection. As compelling examples, review how Iceland reduced alcohol and tobacco consumption among youth here and how a West Virginia town uses a similar model.
• An offering of an “opt-in” community (locally in-person, virtually connected, and globally networked) that allows community members to encourage, support, and invest in the health scores of one another.
• This “opt-in” community brings a heightened invitation to purposely connect with causes and efforts that preferentially pursue the marginalized, underserved, and those who will most value from deeper connection, practical resources, and new possibilities on their journey to health and wellbeing. As encouraging evolving models, see ChenMed and CityBlock.
• Curated gateways developed within the “beehive” ecosystem that allows for seamless access to growing national and global platforms of health-focused providers and health prevention services (primary care, optical care, dental care, dermatology/skin care, mental health/behavioral health, labs/testing, and discretionary health spend)
• A radically increased investment in developing a strong sense of individual and personal health “agency” at scale (to the strongest degree, I am the one who impacts my health)
• A radically increased investment in building an expanded base of primary care physicians who are digitally enabled and upskilled, health-coach supported, team connected, and fully resourced and rewarded to keep individuals healthy.
• The launch, soon, of a megaproject that will shift, over longer rhythms of time, a legacy sick care system to an integrated and aggregated healthcare ecosystem producing a sustained quality of life (and substantial economic value) for future generations.  
• Joining this megaproject will be an increasing number of proven and influential leaders inviting us into a journey of actually walking away from sick-care-centric national models to a healthcare-centric future. Healthcare singularity.

The Long View

While improving how we care for the sick today, we must also strive to make the need for ongoing sick care obsolete. 

While improving how we care for the sick today, we must also strive to make the need for ongoing sick care obsolete. 

In a parallel path to enhancing current models, we must gather meaningful investment and exceptional talent to create a future foundation of sustained healthcare. This dual process is possible and yet will not be easy. Increasing numbers of individuals and organizations are willing to see and join the long game. It is also a reality that there are constructs of power, control, and profitability deeply rooted in ensuring sick care’s expansion and economic engine continues. To a few, sick care has become the bullseye of profitable investments. There is a better way. For our benefit and the benefit of future generations, we must cast a vision beyond unicorns fueled by individual and societal ills.  

I am proposing the long view; a meaningful megaproject per se to move us away from a burdened and unsustainable sick-care model to actual healthcare.  

Characteristic of a megaproject, the effort will take a long duration, have multiple stakeholders, present ethical dilemmas and challenges, be stewarded with discontinuous management, and require a massive scope. The building will not be easy. We most likely will not see it complete in our generation. It is for those who possess vision and hope.

Characteristic of a megaproject, the effort will take a long duration, have multiple stakeholders, present ethical dilemmas and challenges, be stewarded with discontinuous management, and require a massive scope. The building will not be easy. We most likely will not see it complete in our generation. It is for those who possess vision and hope.

In casting a vision worthy of both personal and collective investment, an image of increasing health and flourishing for successive future generations, that sounds about just right.

Coda

Each of us can lift the concepts presented from the page. Find others who resonate with this journey. Discuss and debate the bullet points offered and influence how we might bring them to life. Ponder the long view and begin to take small steps. Build prototypes and launch experiments. Co-create with grade school and high school students. If Roblox can be built and grow to engage 202 million monthly active users spanning 180 countries, we can create a healthcare singularity for this (and a future) generation.

Talk with college students about the future they desire regarding health and wellbeing. Think through and discuss the unique profiles and needs of those in their 30’s, 40′, and 50’s. Find a few sages, share the vision, and listen. Really listen. Take the learning and begin to build. Yes, there will be questions we (today) cannot answer. There will be ethical dilemmas and challenges. As we collaborate and move forward, however, we will eventually find answers to all of today’s unanswered questions. The accretive value will bear fruit.

I still support many efforts related to sick care. It is worthy of passion and resources to improve the necessary sick care systems we all need. It is not sufficient. Let’s also spend as much (or more) time, intellect, and resources ensuring coming generations inherit a better future. A future where the vast majority of sick care needed today, with associated economic and societal pain, can be significantly reduced.  True healthcare singularity.

The post Toward a Healthcare Singularity appeared first on Medika Life.

The blood counts never came back to normal, even though they were supposed to. The toxic effects of the chemotherapy never went away, even though they were supposed to. The hospital stay was not short, even though it was supposed to be. Everything that could go wrong went so terribly wrong.

Then, on Saturday morning, something changed. Her breathing got worse. She was less responsive. She was immediately transferred to the ICU to get closer monitoring. All throughout the day and night, her organ systems began to fail – one by one. By the end of the night, she was on a ventilator and had to be transferred to another hospital to get dialysis.

Everything continued to deteriorate, and by the following morning, my daughter was dead. She succumbed to gram negative septic shock that caused multiorgan failure. All I could do was watch in horror and grieve over the death of my firstborn, a death I could do nothing to prevent.

This is the ruthless monster that is sepsis. This is the horror that I witnessed firsthand as a father and witness countless times as a physician in the ICU caring for sepsis patients.

Sepsis is defined as organ failure as a result of an abnormal response of the body to an infection. It can be devastating. In a matter of hours, it can take someone from awake, alert, and talking to fighting for his or her very life in shock on a ventilator and dialysis machine. It is the number one diagnosis we see in the ICU, and it has exacted a terrible toll on so many people and their family and loved ones.

We try to always be vigilant against this disease, because it can sneak up on our patients with very little warning. Decades of research have been conducted to try and fight this disease, and there have been many drugs and therapies that have been tried and tried without success. I “grew up” in the era of those drugs and therapies, and I have seen one after the other fail to prevent death and destruction from this disease.

At the same time, it is not hopeless: I have been blessed to help heal countless patients from certain death from sepsis, and seeing them survive this terrible illness brings a feeling of joy that is beyond words to describe. Sepsis can be treated successfully, as long as one is always thinking about it, is aggressive with resuscitation early on, and administers appropriate antibiotic therapy as soon as it is suspected.

September is Sepsis Awareness Month. It is of the utmost importance that we, as ICU clinicians, are ever vigilant against this ruthless monster that ravaged my poor daughter and sent her back to our Precious Beloved. And we should also take some time to remember and pray for all those who have lost their battles with sepsis, as well as their families and loved ones having to move on with the grief of horrible loss. May our Lord ever comfort them in this life and the next. Amen.

The post The Ruthless Monster That Is Sepsis appeared first on Medika Life.

Full disclosure: back when Covid was rampant, and our hospital was busting at the seams with Covid patients, I was in full support of everyone having to wear a mask. I believe it definitely helped reduce transmission of the virus, and this saved lives, especially when we did not have a vaccine, and most of our population was still susceptible to the virus.

We are in a different situation now. Vaccines are widely available, and many people have already been vaccinated and boosted (myself included). Most of the adult population has either been vaccinated or have had Covid or both. While cases are rising – and hence my donning a mask every time I go inside – hospitalizations are not rising to the same degree. Things are different now.

What I like most about our current situation is the “live and let live” approach. I recently went shopping, and I was probably one of a small minority who wore a mask. Yet, no one gave me a hard time. No one yelled at me for wearing a mask. No one gave me a dirty look. Those who had masks went on their merry ways, and those without masks did the same.

The same went with me: I did not take anyone who did not wear a mask to task. I didn’t look at them with disdain or think they were “ignorant.” Every person can gauge their own personal risk tolerance, and every person was tolerant of another’s choice with respect to masking in public.

For me, with cases rising in the community, I wear a mask because I don’t want to get sick – with Covid or anything else. If I get sick and can’t work, it puts strain on my colleagues who have to cover my shifts while I’m out. It causes a huge disruption to many people’s lives, and so to protect myself and others, I endure the inconvenience – especially in the hot weather – of wearing a mask.

Others do not have the same worries and constraints as I do, and that’s fine. We are all living and let living, and this is very refreshing. Perhaps the lack of contention over masks is a result of the fact that indoor mask mandates are now a thing of the past. Perhaps the mask mandate – of which I was indeed very supportive – did more harm than good from an overall societal perspective.

I am willing to concede that I may have been wrong about the importance of mask mandates, not from a viral transmission perspective, but from a social cohesion perspective. As we study the aftermath of this pandemic, hopefully we will learn important lessons on how we can do better the next time a global pandemic reaches our shores.

It is sad that our country has been so divided over the issue of whether to wear a mask in public. Indeed, back in 2018 when I was in Paris on vacation, I would look at people wearing a mask in large crowds with derision. Fast forward to today, if I ever go back to Paris on vacation, I will be one of those people wearing a mask, too. My how times have changed.

The most important thing is that we tolerate each other’s decisions. Whether it is on a plane (where I also still wear a mask), in the mall, in the park, or anywhere else, we should respect each other’s choice to mask or not wear a mask. The “peace of the mask” has been most refreshing.

The post ‘The Peace Of The Mask’ Has Been Most Refreshing appeared first on Medika Life.

Our biggest challenges aren’t lack of ability to source ideas and innovate. We demonstrate daily the power of collaboration over competition to accelerate new medical possibilities. There is a different problem we must resolve in order to move beyond the status quo — lack of confidence in authority.

But, for decades we have been sowing fields of scientific doubt and global health disparities. The 24/7 news cycle gives equal voice to naysayers of “possibilities” and hypotheses to keep many wondering. Social media feeds on placing clinical experts on an even par with skeptics and anti-vaxxers. We are stuck — a paralysis that contributed to some 800,000 COVID-related deaths in the United States alone.

I’m republishing the original article from March 2020 — with little change. These words still have power. In the past 21 months, ideas and innovation — science — demonstrated we can navigate this incredible public health labyrinth. Now, communication skill must rise to exceptional levels in support of policymakers, public health scientists and health professionals if we are to see any meaningful progress in rallying consumers to move with confidence toward thefinish line.

Consider this hypothesis: Lack of a widely embraced information clearinghouse on COVID prevention and mitigation, using consumer-friendly language and championed by a widely respected voice and global bodies sustains confusion instead of collective and collaborative, swift action.

On February 7, 2020, PR Week ran a story about the coronavirus that examined the disease’s progress from a communications standpoint. The piece noted that governments and businesses were struggling to give their stakeholders accurate, current information on the spread of the virus — because they lacked a strong, centralized source of information to consult in determining the next steps. Two year ago, I said:

“… governments and multinational businesses, especially tourism companies and organizations with supply chains in China, are lacking a primary information source about the virus, notes Gil Bashe, managing partner of global health at Finn Partners.

“It’s evident that comms is not yet aligned [among major organizations],” he says. “What we don’t have is a central clearinghouse of expertise and accuracy that all partners can draw from.”In the absence of an authoritative source, a void is created, and people fill the void with what they think.”

What has changed in two years? Unfortunately, when it comes to communicating about the outbreak and what people in the United States might do, very little.

When people hunger for direction, they seek authoritative voices. Right now, writing eyeball-popping headlines and generating viewership seems to be the news media’s focus. Reporters even pressed noted soccer coach Jurgen Klopp for his opinion on how coronavirus would impact championship games. Klopp, with more sense than many, snapped back that his opinion was unimportant — ask a real expert.

As the Wall Street Journal points out, fighting this virus varies from place to place, state to state and, no surprise, country to country. When facing pandemics, Americans have traditionally relied on good, solid public health information from Federal and state governments upon which local authorities can base their response and which the public can use to protect themselves and their families. This time, information is lacking and inconsistent. In Newton, Massachusetts, a school group returning from a trip to Italy is quarantined, and yet, in New York City, a group that visited the same towns in Italy is not. Both municipalities are working from communications that are weeks old and which leave discretion to local authorities and individuals to “self-monitor,” without clear direction.

It turns out that, at least as far as COVID-19 is concerned, communicating about the disease is more difficult than overcoming its contagion.

In fact, poor communications are clearly making it more difficult to fight the disease. Public-education campaigns have been critical to fighting pandemics and scourges like polio ever since public health authorities began their work in the 20th Century. Communicating is key to the success or failure of public health efforts around infectious diseases — and our inability, so far, to do it well with COVID-19 is as dangerous as the virus itself.

When authorities fail to communicate facts and “what you can do” next steps, people fill the void with what they (and others) think — not what they know. When those people are the heads of businesses or local public officials, messages about the disease are not just mixed — they’re completely jumbled and often in conflict. [2022: Company leaders may need to apply the same thought and rigor to communicating to their employees about vaccination and mitigation strategies as was expected by government. Employees may have more confidence in corporate leaders and local elected officials than Federal policymakers. Still coordination and collaboration is essential.]

Not even the news media are immune to the effects of poor disease communication. The competition among news sources to be “your address for updates” is fierce — and in some cases, doing a disservice to public information.

One local New York news broadcast led last week with a frenzied report on panic in the city’s stores as customers made runs on hand sanitizer, protective masks, canned goods and bottled water. Buried several stories later was the information that people actually needed: a balanced report with the head of infectious diseases at a city hospital explaining that viewers shouldn’t panic, should take basic precautions and that COVID-19 would impact most people less than a mild case of flu. At one point, a New York Times headline grabbed readers with the information that coronavirus’s death rate hovered at around 3.4 percent. Buried in the body copy were the reassuring facts: “…this figure does not include mild cases that do not require medical attention and is skewed by Wuhan, where death rate is higher than elsewhere in China. It is also quite possible that there are many undetected cases that would push the mortality rate lower.” The headline was updated that same day to reflect balance.

What can we as communications professionals do to make the situation better?

1. In successful issues management, it’s vital to start with “what we know.” Here, it’s hard. We don’t know everything. Some facts change daily. Public health experts learn more every hour. But, it is more vital than ever that we in the US and worldwide get a handle on communicating clearly what we know and what we don’t. Those of us communicating on this issue, even peripherally, need to base our language on facts from authoritative public officials dealing with the disease.
2. Separate fact from opinion. As communicators, we must always recognize that self-appointed experts may not have the clinical expertise or insight to comment authoritatively. We must then clearly offer their comments as an opinion to ensure that reporters — hungry for a new angle on this attention-getting subject — are able to recognize speculation from fact. [2022: consumers are finding that the CNN, MSNBC, FOX news formats designed to retain viewership require constant hypotheses. This swirl keeps eyeballs tuned to screens — but it also creates public health mobilization push back.]
3. Build authoritative voice. While epidemiologists, virologists, infectious disease experts and others plumb the data for insights, no leader has stepped forward and secured the public’s ear, eye and heart on this issue. For that reason, those tasked with communicating — whether to the public or to their companies and communities — should look to these sources of reliable information to build an authoritative voice:

• World Health Organization recommendations and guidelines
• Centers for Disease Control advisories and guidelines
• National Health Service coronavirus information
• WebMD Coronavirus Updates

Also, on Twitter, there are several knowledgeable influencers worth tracking. These include former Food and Drug Administration Commissioner Scott Gottlieb, MD (@ScottGottliebMD), WebMD Chief Medical Officer John Whyte, MD (@drjohnwhyte) and UK-based Junaid Bajwa, MD (@jrjbajwa), NHS England advisor and global digital/health biopharma leader. These two public health physicians double- and triple-check their data sources and have access to both public health officials and scientists on the frontline. My last go-to source is one of the world’s leading virologists and champions in confronting infectious and viral disease, Dr. Peter Piot. [2022: Dr. Piot has since stepped into the shadows. WHO has been pushed aside. I have now added George Washington University Professor Leana Wen, MD, @DrLeanaWen, and James E.K. Hildreth, MD, @JamesEKHildreth president and CEO, Meharry Medical College to my trusted info source list.]

Are we facing a World-War-Z-zombie-apocalypse situation? The answer is no. But, we are anxious and uncertain, vacillating between bravado and self-imposed isolation. Now is the perfect time for us to support — and rely on — our public-health leaders and infrastructure and use common sense when communicating. We live under a partially unknown threat, and our access to constant information — pushed via phone alerts and constant social and traditional media updates — transforms what we hear into what we fear. Perhaps, when considering how we communicate, we can heed the words of one of our greatest communicators, who steered the world forward during a period of much greater uncertainty that included a depression and looming world war — the 32nd US President Franklin D. Roosevelt, when he said:

“We have nothing to fear but fear itself.”

The post The Pandemic of Poor Communications appeared first on Medika Life.

Even those not dealing with illness or the loss of loved ones have often faced financial pressures, isolation, and the impossible task of juggling caregiving and professional responsibilities. Remote work, while bringing a welcome increase in flexibility, has also allowed our jobs to intrude even further on our personal lives, leading to rising stress, languishing and burnout.

According to the Kaiser Family Foundation, the share of U.S. adults reporting symptoms of anxiety disorder and/or depressive disorder rose from 11% in the first half of 2019 to more than 40% in January 2021.

Employers living through this Great Resign period recognize the growing issue, and many are looking for support systems — beyond employee assistance programs and mental health care coverage designed to address more severe situations — that can preemptively help their workers before serious problems emerge. In most cases, fortunately, it’s not necessary to reinvent the wheel. With a few tweaks, a robust corporate well-being program can enable employees to improve their physical and mental health.

Following are three tips for incorporating a greater mental health focus into your employee well-being program.

1. Solicit employee input

Regular anonymous pulse surveys can give you a big-picture view of your organization’s overall mental health climate and help you identify any workplace culture issues that may be affecting employee morale and mental health. (It goes without saying that appropriate reporting structures are required for any type of harassment, discrimination, or other toxic behavior, but you’ll also want to know about potential lower-level stressors that don’t rise to the seriousness of requiring a formal complaint.)

In addition to executing periodic surveys, you should seek out input from individuals to make sure their specific concerns are being addressed. One way to do this is to incorporate well-being into the standard employee review process. Broadening the discussion beyond individual job performance to include questions about whether the employee feels valued and heard, and whether the organization’s well-being benefits are meeting their needs, can both demonstrate that the company cares about its people and help improve future benefit offerings.

2. Address lifestyle health issues that diminish well-being

Mental and physical health are inextricably linked, and sustainable improvements can’t be achieved with a siloed approach. For example, stress and anxiety can lead to lost sleep, emotional eating, substance use, and other unhealthy behaviors that ultimately lead to physical ailments, and conversely, addressing the unhealthy lifestyle choices that lead to chronic conditions such as obesity, hypertension, and diabetes can have a considerable impact on mental health and well-being.

So to fully support mental health, a well-being program must help employees develop long-term positive lifestyle habits that will lead to significant improvements in physical health.

A good mental health measurement component to use in your well-being program is the National Institutes of Health’s PROMIS (Patient-Reported Outcomes Measurement Information System). Newtopia, for example, uses PROMIS measures for resilience, mood, anxiety, sleep, and energy in its personalized habit change programs alongside the tracking of more traditional factors such as exercise and nutrition.

3. Take advantage of virtual tools

Most of us have grown accustomed to turning to our smartphones for solutions, so it’s not surprising that many people are embracing apps — for meditation, mindfulness and relaxation, for example — to improve their mental health as well. When a human connection (or a trained mental health professional) is needed, many companies are offering their employees virtual therapy and counseling sessions, either from emerging digital-only providers or from traditional providers who have embraced telehealth during the pandemic.

These types of virtual tools are convenient and accessible, but it’s important to remember that they are most effective when they’re incorporated into a holistic whole-person care support program that comprehensively addresses physical, emotional, and mental well-being, rather than simply offering employees a grab bag of individual solutions that they can pick and choose from.

A win-win

The mental and emotional scars of the pandemic will likely get worse before they get better, and last long after employees return to the office. Incorporating mental health into your company’s well-being program can help your employees thrive and achieve their potential. It’s a win-win investment that leads not only to enhanced individual health and happiness but to greater organizational effectiveness thanks to reduced burnout, higher productivity, and improved retention.

The post 3 Tips for Incorporating Mental Health Into Your Corporate Well-Being Program appeared first on Medika Life.

Health information plays a vital role in guiding care priorities, diagnoses, reimbursement, research and drug development. However, information anxiety — an overabundance of information — is also causing healthcare professionals to tune out to the constant background buzz. Information can lead to provider burnout and suddenly become a nuisance.

In this Medika Life exclusive, we speak with Dr. Stein about his efforts to harness the power of AI and clinical data to identify patient-specific medication risks throughout the patient journey.

Physician Desire to Heal Can Be Augmented by Tech

Gil Bashe: As a physician, scientist, and innovator, you’ve dedicated your career to using your knowledge of healthcare, technology, and data to help solve the challenges healthcare professionals are facing today. As more medications come to market, one of those challenges is surrounding the safety of medication prescribing and monitoring, specifically for drug-drug interactions. Can you tell us a little about the current landscape of medication prescribing and how physicians and patients are impacted?

Dr. Gidi Stein: The impact is of a totally different magnitude than when I started to practice medicine. There was an adage then that every physician had to know 50 medications really well. There were only a few hundred medications available, and patients received perhaps two to three medications regularly, so the probability of drug-drug interaction was relatively low. But today, when hundreds of new drugs enter the market annually, there is no way that any physician can know even 10–15% of them, and definitely not all the possible interactions and contraindications.

Bashe: Can you tell us more about how current systems used for drug-drug interactions are designed and managed?

Stein: Currently, the state-of-the-art systems used in most medical institutions are clinical databases that are manually curated and updated by clinicians and pharmacists tapping the latest clinical evidence and guidelines. These systems contain hundreds of thousands of potential drug-drug interactions and other rules such as dosages. Most databases generate alerts in the electronic medical record (EMR) when medications that shouldn’t be taken together are prescribed to a patient. In concept, this approach should be sufficient to eliminate most drug-drug interaction errors. In reality, it doesn’t happen.

Bashe: With all these databases and knowing the essential mandate to protect patient health, how do medication errors still occur? How can artificial intelligence improve the provider and patient experience?

Stein: Many good people have put in the time and effort to create state-of-the-art clinical knowledge bases, but these data do not necessarily translate into real-world clinical value. In reality, these systems generate a very high alert volume. Most of these alerts are seen by clinicians as false alarms, which drives “alert fatigue,” and often results in clinicians ignoring the alerts altogether. Ultimately, this puts patient safety at risk and actually reduces clinicians’ confidence in the alerts that were designed to help them.

Unfortunately, there is a discrepancy between the knowledge stored in clinical databases and the limited clinical value these systems provide. One of the main reasons for this is that while knowledgebase rules are accurate, they aren’t necessarily relevant for a specific patient in a specific clinical situation at a specific time. Personalizing rules for each patient by using AI establishes alerts for specific, relevant clinical situations. This can reduce the overall alert burden and increase clinical accuracy — thus improving clinician compliance and, most importantly, patient safety.

Bashe: Recognizing these gaps and opportunities, you founded MedAware to create a physician- and patient-sensitive, intelligent system that could leverage thousands of data points to provide both a panoramic view of prescribed medications and potential errors and personalize outputs for specific patient needs. How does this technology all come together and how has it been received by the healthcare community?

Stein: We recently showed the results of one of our implementations to leaders of a leading hospital. The chief medical officer stood up and said “We’ve been slaves to the EMR for years — we’ve been entering data relentlessly and now, for the first time, our data works for us.”

This is the magic of speaking to people’s needs rather them having them adapt to what’s available. We use data hidden within the EMR to understand how physicians practice and how they treat patients in varied clinical scenarios. By combining that intel with the knowledge from the drug interaction databases, we are able to personalize alerts to reflect the clinical needs of that specific person, and ensure the alert is medically relevant for the individual patient.

Bashe: Does this system provide direction to the physician on what steps should be taken after receiving an alert?

Stein: Artificial intelligence (AI) is geared to support physicians. It’s not a replacement. It would be presumptuous for AI or a computerized system to suggest something to a physician and the medical team. What we can do is identify potential adverse drug events very early on and perhaps prevent them. We’re not simply assessing the medication at the moment of prescribing — we’re also monitoring the patient, post-dispensing, looking at any changes in their clinical status or datasets that this patient may present. If we identify that this patient suddenly has another side effect, it is possible to capture this early on, and associate it with the potentially offending medication.

The system notifies the care team that there may be a suspected interaction, and that the clinician and patient should consider taking a lab test to confirm. We’re not telling clinicians what they should do; we’re just providing a safety net of continuous monitoring to ensure that patients remain safe. This is another one of the unique features and main benefits of this system.

Bashe: You are synthesizing vast amounts of data behind the scenes. How does it work? How does it relate to the institution’s own IT network?

Stein: On the technical level, we have our own server that resides either onsite at a health system or in the cloud, and it communicates directly in real-time with the institution’s EMR system. In order for the algorithms to work, we take the data from the EMRs and process so that system compares patient records across different geographies and technologies. We then apply AI on top of that, which is agnostic to the specific location or the technology being used onsite. At that point, we are able to get a clear picture of the patient’s clinical situation, understand the mechanisms by which clinicians make mistakes, and create models that would specifically address these situations. We can compare practices and behaviors among institutions, and this creates great value that is immediately translated into benefit to users and their patients.

Bashe: As the adage goes: “Data in-data out.” There is information and application of these databases. How does this look on the physician side? How will they know there is a possible medication risk or drug-drug interaction for one of their patients?

Stein: It’s split into two scenarios. The first is having an alert generated at the moment of prescribing. That’s a very straightforward, synchronous warning. The second scenario is an asynchronous alert generated after the patient has been receiving the medication. That could be when a new lab test or vital sign ties together information and recognizes that one of the medications the patient is taking is a danger.

Different institutions have different workflows — operational cultures — to ensure the clinician receives the alert in a timely manner. The way the alert information is shared aligns to the infrastructure of the hospital. The insights MedAware generates become part of the set workflow for the clinician and care team.

Bashe: It sounds like artificial intelligence can have a big impact on identifying drug-drug interactions or contraindications at any point in the physician’s workflow and patient journey. With impressive data from implementations already in place, what’s the next big development you’re working on?

Stein: The next level is expanding beyond indications, looking at issues that may have slipped through the diagnostic and primary care cracks.

Bashe: This is interesting. So, you’re looking to expand upon current AI-driven medication insights to identify other areas of risk that physicians may not yet be aware of?

Stein: Yes. For many years, physicians tried to be both memorizers and philosophers. That doesn’t work anymore. We have to let the computerized system be the memory and the physicians be the philosophers. At the end of the day, the value of the clinician is measured in that intimate encounter with the patient in the office, during that dialogue, in that physical checkup — really comprehending the problem and translating the patient’s words into a clinical understanding. What we are trying to provide are critical accessories that free clinicians to devote more time to really take care of their patients.

How Tech Supports the Hippocratic Oath

Bashe: Providers too often see the burden of managing health information falling on their shoulders. They ultimately shoulder the responsibility for patient wellbeing. EMR input, keeping track of the growing list of condition codes and navigating the challenges of interoperability become obstacles to their care mission. Machine learning, combined with the operational culture of an institution, the personal-care needs of each patient and the passion of the healer to do their best work, can bring about a long-needed change. Machine learning and physician expertise combined can do even better in fulfilling the Hippocratic pledge to “Do no harm.”

The post Using Artificial Intelligence to Deliver on the “Do No Harm” Pledge appeared first on Medika Life.

Our world is at a watershed moment. Fractures in the public health system that have been present for decades have recently become apparent to us with the impact of the COVID-19 pandemic. We have seen public health statistics associated with fear of vaccination, health disparities, and racial inequities. What’s been revealed to a broad audience ranging from people and families trying to stay healthy to business and government leaders is that our health system extends into every aspect of our lives in ways that we never considered before — and that we can no longer delay the fixes that it requires us to make.

Clinical leader, cardiologist, voice for public health and chief medical officer at the well-known global consulting and advisory firm EY — Yele Aluko, MD, MBA — shares thoughts on these pressing health urgencies in this exclusive Q&A with Medika Life contributing author Gil Bashe.

Gil Bashe: Dr. Aluko, you’ve been in clinical practice as a leader in cardiology for many years and you have served as a leader in several important health industry organizations, including the American Red Cross, American Heart Association, American College of Cardiology and Association of Black Cardiologists, and we are both members of the International WELL Building Institute. One key question: What led you to make the transition from clinical practice to industry and join EY as chief medical officer?

Yele Aluko, MD: I left the patient’s bedside with the deliberate intent to develop a broader platform and louder megaphone for messaging on the imperatives for the health industry to re-engineer its business models in a manner that places patients at the center of its focus. I don’t make this assertion lightly. It is time for the health industry to be able to define and deliver high quality outcomes, be held accountable for those outcomes, understand the cost of care to deliver those outcomes, eliminate unnecessary care variation and by so doing, deliver the best outcomes at the best cost across the value chain consistently and reliably. By so doing we shall be successful in delivering value-based care to all.

Bashe: The whole experience of COVID-19 has brought to light some of the greatest struggles we’re dealing with in public health, particularly with health inequities. You’re the coauthor of an article that lays out three pillars with which people have to engage: testing, vaccination and education. That’s broad territory. Why did you decide to choose those three pillars?

Aluko: The intent really was to sensitize the reader to understand that COVID-19 is likely here to stay at some level (even when the pandemic is over), and to do this with three very targeted messages. The first is the awareness of the need to be able to diagnose COVID-19 not just efficiently, but more cost-effectively through testing going forward. Second, the importance to continue to educate people about the merits of vaccination, about its science and its safety. The third is to emphasize the imperative of vaccinating as many people as possible, with the goal to achieve herd immunity to prevent widespread transmission. That’s the rationale behind those three pillars.

Bashe: Three very necessary pillars, and yet, we are dealing with a sudden slowdown in the rate of vaccination. When the first two mRNA vaccines became available people rushed to get an appointment as if we were giving away free movie tickets. What are the challenges that we need to define right now and what might we do about them?

Aluko: We do know that there is a percentage of people that aren’t sure about the vaccine, about safety, about the science. Those are the people now that need to be further educated about the merits of vaccination. This is likely to require more nuanced, targeted and customized communication strategies to provide credible information about the safety and the science of the vaccine, so that people can then make informed decisions.

There’s also the logistics issue around vaccination, where certain rural communities are harder to penetrate with infrastructure and where the lack of needed logistics have also compounded the delay in getting more people vaccinated. Then there’s the historical issue of vaccine hesitancy within vulnerable populations; even though this is an established and age-old problem, public health systems and the health industry itself have not invested resources to truly understand the complexity of the vaccine hesitancy problem, let alone develop strategies to solve for it, and as such it still remains poorly understood and minimally impacted.

Employers must realize they’re in the health business

Bashe: Two questions about the role business leaders can play in health. What role do employers have in encouraging their employees to get vaccinated? Wouldn’t it be a better investment for employers, instead of paying out for sick care, to get into the well care initiative? To start to work with their employees to reduce their weight, to monitor their cardiovascular health, to exercise and build muscle mass as a way of preventing the need for hip replacement or knee replacement?

Aluko: Employers need to be aligned on the imperative and the role they can play around the test-vaccinate-educate pillars. They can facilitate testing and vaccinating, as well as provide education so that people make informed decisions. While there’s a whole lot of swirling conversation around the pros and cons of mandating or not mandating vaccines and all that, fundamentally employers can facilitate the processes of engaging the people within the context of those three pillars.

This pandemic has paralyzed several businesses and has adversely impacted most. All companies as such are now realizing that they are indirectly in the business of healthcare, and to develop workforce resiliency, businesses need to do a better job around understanding the health risks and vulnerabilities within their workforce and develop proactive resiliency processes.

Most large businesses now have employee assistance networks to provide support resources, but questions are now arising: What percentage of people are actually using these resources? How do we track that and should we? And if then we find that 25% or 30% of people have never had a physical examination in the past five years, what should we do?

There’s now a shifting conversation about what is the responsibility of a business in understanding the vulnerability of the workforce and incentivizing their employees to be more proactive about engaging in healthy lifestyles and diminishing their risk for disease.

Bashe: For leaders in executive positions at a global enterprise who need to have informed choice and to share wise counsel with their organizations, would you mind sharing some of the authoritative voices that are important to you?

Aluko: I would hesitate to do that without informing them ahead of time, but let me just say that we draw from our internal competencies as a leading global health consulting firm, but we also have access to global insights and best-in-class practices depending on what questions or problems are posed. When needed we leverage our access to health industry and public health leaders. We tap into an entire national network and, when necessary, a global network of health industry intelligence. We seek information, evaluate it, distill it and apply it with a reference source as needed. I don’t have a static portfolio of specific people; what I do have is the ability to customize insight that is relevant to problems that are important to us and to our clients done in a manner that we can provide actionable solutions.

Variants of interest, concern and high consequence

Bashe: There’s a lot of conversation about COVID-19 variants right now. What are your thoughts on the variants and vaccines? Do you feel that we have a good safety net at this point? From your perspective, do the current vaccines work against emerging variants?

Aluko: The CDC follows variants’ activity very closely. Variants are generally considered in three categories as defined by the CDC: the first is a variant of interest, where the viral structure has changed through mutations but infectiveness of the virus or its response to available antiviral treatment has not changed in a meaningful manner. The second is a variant of concern, where the mutated virus is identified to be less responsive to standard anti-virus treatments or other types of interventions, but in addition this variant may be more transmissible from one person to another. The third and the most worrying category is the variant of high consequence, when the mutated virus variant is now seen to be more infectious, may be more deadly, and may not be responsive to vaccines.

The current evidence suggests our vaccines do work well against variants of interest and variants of concern. Thus far, using genetic sequencing of the viruses, no variants of high consequence are being identified in the United States. This is important to know because it does have impact on the need for potential booster shots going forward. If we do present with a circumstance where the virus mutations are so overwhelming that it’s a new virus over time intervals — such as one year, 18 months, or two years — then a different architecture of vaccines will need to be reengineered within those determined intervals.

Differences between health disparities and health equity

Bashe: Switching to questions that we’ve talked about before: health disparities and health equity, and if there’s a difference between the two. Could you define the difference, but also why it’s important that we differentiate?

Aluko: This is a very important question because it should not be presumed that audiences understand what health equity is, and indeed we shouldn’t presume that our audience at large is aware about the impact of health disparities.

Health disparities speak to different outcomes from a medical condition that different groups of people experience. We saw that in COVID-19, more Latinx and African Americans died from COVID-19. This is an example of disparity in outcomes (death) in different populations (black and brown people) with the same disease (COVID-19).

It’s important to understand that there is a myth that health disparities as just described are driven by genetic differences in black and brown people. Indeed, these disparities are, more often than not, not genetic. More commonly they’re driven by what we refer to as the social determinants of health: where people live, the type of work they have access to, what community, societal and environmental exposure they experience that impacts their financial or health literacy, or exposes them more to disease risk and vulnerability, etc.

Health equity is an aspirational yet achievable goal, where we are able to eliminate health disparities so that each person — irrespective of their background, socio-economic status, gender, race, station in life — has an equal opportunity to achieve their best health outcomes in their lifetime. Achieving health equity requires eliminating health disparities.

Bashe: What’s your level of optimism around health equity in the United States?

Aluko: My optimism, on a scale of one to 10 is about a 7.5. But that’s a good place to start. The needle moving towards health equity is predicated on society being willing to dismantle the systemic drivers and resultant behavioral issues that have led to the current structures we have that perpetuate health disparities and keep us far away from achieving health equity.

The current conversation going on nationally about societal justice, about health equity, drives a moral imperative. This conversation is going on across health systems, big business, government, and in philanthropic organizations. Everybody’s talking about how we need to fix this wrong, so the time is now. We have a convergence of goodwill that drives my optimism. But we must seize the moment and translate it into actionable solutions.

Bashe: One last question: In addition to test, vaccinate and educate, what other things would you state to America that we need to start on right now to achieve health equity?

Aluko: I will speak to three action items that address your question. The first would be for business, community and political leaders to acknowledge the health disparities problem to be real, and that ignoring it (as has been done) has consequences for all of us. This problem has existed for centuries: it is serious, and it is dangerous, it is impacting the health of our society. Recognize the problem, understand it and empathize around it, and commit to being a part of solutioning for it — that’s number one.

Secondly, what needs to happen is that all businesses, not just those in the health industry, need to develop strategies to address this. We spoke about moral imperative: businesses now have an imperative in seeing, having a lens and a better understanding into the resiliency of their workforce. All businesses should consider developing health equity strategies and this needs to be driven from the C-suite.

The third would be to hold society at large — government, advocacy, corporate and philanthropic organizations — and of course the health industry itself that dispenses healthcare, accountable for the execution of strategies developed and programs implemented to reduce and ultimately eliminate health disparities.

People must be held accountable, and by doing so on these three imperatives, we will move the needle over time towards health equity. I am optimistic that if we have these three imperatives in place, we will be successful over time.

Bashe: I think that you have mapped out a strategic roadmap for corporate America to not only get past the pandemic, but the waves of public health pandemics that we’re facing: the pandemic of obesity, the pandemic of heart disease, the pandemic of noncommunicable diseases, the pandemic of health inequities. I think you’ve given us a grand plan, much like when the President goes before Congress and gives the State of the Union address.

Dr. Aluko, thank you for your words and direction and inspiration.

The post Time for Health Industry to Deliver Value-Based Equitable Care appeared first on Medika Life.

This isn’t the first time Baptist Health System has offered a sign-on incentive. A staff hiring event was held last month for both their North Central Baptist Hospital and St. Luke’s Baptist Hospital, both San Antonio based, at a similar event. This month’s event was scheduled for the 11th of May, but if you’re San Antonio based and you missed it, you can still reach out to the hospital via social media or connect with Sherwin Guevarra at Sherwin.Guevarra@tenethealth.com

Baptist Health System is facing a common problem that’s emerged post-pandemic and isn’t restricted to areas like San Antonio. Across America, the demand to fill medical posts have that have been lost to the pandemic, either through poor wages, illness, death, or simple weariness, is growing.

It’s a problem that’s become increasingly challenging. We spoke to the CEO of MacArthur Medical Center in Irving, Texas, Obgyn Dr. Jeff Livingston. During the course of the pandemic, their practice lost doctors, nurses, and related professional and administrative staff. They are still struggling to replace these and being short-staffed has knock-on effects for the doctors and nurses left to carry the load. Still recovering from the drain of a pandemic that’s yet to pass, exhausted providers are having to pull longer shifts, covering for the gaps they’ve been unable to fill. 

“We lost 3 doctors who did not want to take the temporary pay cut caused by the cash flow crisis during the pandemic. We lost another doctor and a midwife who decided they wanted to change careers. We lost about 10% of our medical assistants and office staff who needed to go home to take care of kids who were not in school during the pandemic,” said Dr Livingston

Trying to replace these staff members has been challenging and while they’ve managed to replace most of their administrative staff, they still have gaps, most noticeably, doctors. To resolve the problem, like many medical facilities, they turned to agencies. But that hasn’t always worked and they have been forced to look to new avenues, in particular social media and professional networking platforms like Linkedin, where they run paid advertising campaigns in an attempt to recruit.

Dr. Livingston offers the following.

“We are using recruiters for doctors. Networking works better. For medical assistants and office staff, we use Facebook ads and Linkedin ads. Networking works more effectively on these platforms too, but if you don’t have a well-established social media presence, this isn’t an option.”

This problem isn’t localized to Texas either. Beyond its borders, hospitals and practices across America are facing a skills shortage. In the Chicago area, there are also significant staffing shortages in many hospitals, according to Dr. Hesham A. Hassaballa, a practicing critical care specialist in the greater Chicago region. 

“Many nurses, respiratory therapists, and patient care technicians have left,” says Dr Hassaballa. “Some have left because they can earn much higher salaries working contract jobs across the country. Others are wanting to pause and start families. And a substantial number have left the bedside for good.“

This mass exodus has caused a palpable strain on the remaining staff, and it can definitely affect the care a hospital can deliver. 

“It doesn’t matter if there is an empty bed,” says Dr. Hassaballa. “If there is no nurse to staff said bed, the patient has to wait in the hospital emergency department, sometimes for hours or even days. This is never a good thing.” 

Recruiting their replacements takes time, and it may be very hard to find good, experienced staff. And right now, there are not many in the market to look for a job. Dr. Hassaballa is very concerned about what this portends for the future. 

How will healthcare address these issues?

These are vastly different practices that have been affected similarly, but their ability to respond to staffing shortages varies dramatically. Baptist Health is in a unique position, not enjoyed by many other hospitals on the heels of the pandemic. Most are still struggling to recover financially and offering cash sign-on bonuses just isn’t an option for them.

Dr. Hassaballa’s example is a perfect one. Cash strapped and limited in their avenues of recruitment to more traditional systems, their hospitals face an uphill battle recruiting and replacing staff. Salaries can not be incentivized or raised if budgets don’t allow for it. The consequences are felt by patients, as staff shortages affect the quality and speed of care delivery. 

On the heels of a pandemic which many argue is far from over, now more than ever, staffing levels in healthcare facilities across America really matter. The profits enjoyed by pharmaceutical companies stand in stark contrast to those made by the providers and institutions who ensure our health and administer and prescribe these drugs. The time for reassessing healthcare’s financial models is upon us.

This American Association of College of Nurses highlights the problem of staff shortages, which existed prior to the pandemic, and points to the impacts of nursing shortages in an insightful article you can access here.

The post Staff Shortages. Baptist Health Highlights a Growing Issue in Healthcare appeared first on Medika Life.

Each year about one in five hospital patients in the U.S. require follow-up care after hospital stays for major surgery or illness. What does the “free market” look like in post-acute care?

Patients and their families usually ask a doctor or nurse at the hospital for a recommendation because they have never considered post-acute care until they need it. Or a hospital staff member whose job it is to process your discharge provides some options close to patients’ homes. Or a representative from a rehab facility pays a visit to the hospital to market their services.

Too often, patients do not have the critical information they need to carefully assess their options and make informed choices when they are at their most vulnerable. They rely on faith, instead of facts.

Decisions on where to go for post-hospital care usually have to be made quickly, and patients are just relieved to find a bed. The result is that people end up choosing lower-quality providers. One study found that only 16% of Medicare recipients using services at a skilled nursing facility chose the best provider that’s available to them. 

And unfortunately, poor care transitions end up having negative consequences for patients, including additional hospital stays, longer recovery times, and long-term complications.

The coronavirus pandemic exposed how fragile and disconnected care transitions are. Hospitals didn’t allow family members, let alone representatives of post-acute providers, also known as community liaisons, to make bedside visits. As skilled nursing facilities closed their doors to control outbreaks in their facilities, patients had fewer choices. Post-acute care companies had staffing shortages and struggled to find personal protection equipment. Patients stopped health aides from entering their homes because of COVID-19 fears.

Where does that leave us? How does the post-acute environment evolve to improve the quality of care while lowering costs and empowering the consumer?

Aidin recently hosted a webinar featuring our partners at health systems and post-acute care providers. The pandemic forced them to quickly come up with ideas to address capacity constraints in the hospital while also providing appropriate follow-up care. Their insights provide a roadmap to better align hospital incentives to reduce unnecessary discharge delays and readmissions with providers’ goals to earn more referrals and patients’ desires to find the best possible care.

Upgrade care through telemedicine and remote monitoring 

Vanderbilt University Medical Center created a “Covid to home,” program, which is an enhanced home health strategy for Covid patients. The medical center was able to put the program in place within a few days and has taken care of more than 500 patients to date. Nurses and physicians used the hospital’s telemedicine platform to connect with patients. To make these virtual visits more productive, patients were given simple medical devices like pulse oximeters and blood pressure upon discharge to allow the hospital to better monitor their respiratory status.

“The use of these simple technologies has caused us to ask, ‘How can we do even more,’” said Dr. Tara Horr, outpatient clinical service chief at Vanderbilt. “We can start to look at remote patient monitoring devices to enhance the care we provide in the home.” 

She said Vanderbilt can apply this experience to improve chronic disease management and keep people at home and out of the hospital.

More collaboration between hospitals and post-acute care providers

Providers rely on community liaisons to generate referrals and evaluate complex cases to determine the appropriate level of care. When Loma Linda University Medical Center barred liaisons, the health system gave providers access to patient electronic medical records. Access to the records satisfied a lot of the providers’ information needs that would have normally come through a liaison, said Paul Arias, assistant vice president of care coordination at Loma Linda.

Improving the flow of information between the hospital, provider, and insurer can shorten the time between referral and admission. Eliminating unnecessary delays during the discharge process was critical in the past year as hospitals looked for ways to increase bed capacity as well as protect patient safety.

Leveraging advanced digital tools to modernize the referral process

Without liaisons, hospitals had to lean on digital communication and workflow tools to match their patients to the services and providers that best suit the patients’ needs as well as meet their expectations.

The industry now has software technology that gives case managers visibility into the entire market of clinically appropriate post-acute options and insight into the quality of care offered at each provider. Patients also can review detailed outcomes and partnership data about their available options to find the best possible care, not just the care closest to their homes.

“We teach patients how to interact with us by making it easy for them to do the right thing,” said Stephen Blau, senior director of care management and transitional care shared services at Luminis Health. “So as we design the care of the future, we have to think about how we create a frictionless environment, so that it makes sense for patients and reduces barriers for the system.”

Reimagining the role of the liaison 

If providers have more tools to capture and share their reputation and skills with patients and case managers alike, then they don’t need liaisons to be their marketing reps. If hospitals commit to an open marketplace dedicated to transparency and data instead of old habits and familiar patterns of referrals, then all stakeholders can benefit.

Liaisons can transition from marketers into full-time patient advocates. They can add value by identifying gaps in care transitions so patients don’t have unexpected returns to the hospital. They have more time to evaluate the more complex patients and make sure they meet the criteria for admission. There are good clinical reasons to see patients in person before they move home or to a nursing facility. And stronger bedside connections can go a long way toward comforting patients and their families, forging trust, and building reputations as caring providers.

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