The Collaborative Forum

I’ve been in the healthcare field for over 20 years now, and I still believe that the vast majority of those involved—whether on the payer or provider side—truly want what’s best for their patients or members.  After all, healthcare quality and cost affects everyone.

In an editorial published earlier this week in the New York Times entitled “The Gaming Begins,” the editors point out the difficult struggle over how to calculate medical loss ratio under the new healthcare law and discussed concerns that insurers could “game” medical loss ratio by spending money on administrative costs, rather than on meaningful measures to improve quality.

Beginning in 2011, the new law requires health insurers to spend 80-85 percent of the premiums they collect on medical services or activities that improve the quality of care (the medical loss ratio).  Insurers can then use the remainder of the premiums for things such as marketing, overhead, salaries, and profit. Read the rest of this entry →

Just a few weeks ago, the American Heart Association (AHA) released a scientific statement, State of the Science: Promoting Self-Care in Persons with Heart Failure: A Scientific Statement from the American Heart Association, that discusses the importance of patient self-care (PSC) and provides evidence-based recommendations to clinicians to promote self-care in their heart failure (HF) patients. The AHA placed significant emphasis on teaching patients how to recognize condition symptoms and what to do with that information, how to make appropriate behavior changes and the importance of transitions of care and depression screening.  In addition, the statement acknowledged that systems of care, such as care coordination and telehealth, hold promise for improving the self-care abilities of persons with HF.

Clearly, this set of recommendations resonates with us at Pharos Innovations. These recommendations are directly aligned with the paradigm of physician- and patient-centric care coordination that we created with Tel-Assurance^®.  The AHA recommendations are all about accountability: the patient’s as well as the physician’s. Accountability brings better results with healthier patients and reduced hospital readmission rates—both which on the face of it, are great things.

Unfortunately, our healthcare delivery system, as currently designed, is not set up to maximize patient and physician accountability. Specifically, in the way healthcare providers are currently incented for the quantity of care, not the quality. The good news is that this is changing. Read the rest of this entry →

I read an interesting article on Sunday, in The New York Times Magazine, Making Healthcare Better. The article discusses Dr. Brent James of Utah’s Intermountain Healthcare and the results that he and his team are producing with their patients. The Intermountain team has been improving healthcare and reducing costs by following treatment protocols and estimates indicate that the data-driven changes they’ve made at Intermountain have saved thousands of lives a year. In total, Intermountain has developed protocols for 50 clinical conditions, which accounts for more than half of their patients.
 
There are plenty in the medical field who are skeptical of Dr. James and his approach—and the balanced article includes them—but the results speak for themselves. In the end, what Dr. James and his team at Intermountain have done, is take a different approach to practicing medicine. They’ve looked at the way things were done, and effectively disrupted the intuitive approach to medicine. By providing protocols as a guideline, their doctors have saved thousands of lives.
 
Disruptive innovation—a theory of Clayton Christensen—discusses that the way to affect real change, is to disrupt the way things have been done. Disruptive innovation can have characteristics that traditional segments may not want (protocols vs. intuitive medicine). In fact, I founded Pharos Innovations and developed Tel-Assurance® based on Christensen’s notion of disruptive innovation. Read the rest of this entry →