December 15th, 2008 by Dr. Val Jones in Expert Interviews
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Skip Brickley
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Skip Brickley is the master mind behind the popular Consumer Health World conference series. He is a natural communicator, and a bundle of positive energy. I was pleased to have the chance to interview him last week about his provocative views on healthcare reform. Enjoy the conversation:
Dr. Val: Tell me about the importance of “community” in healthcare reform.
Brickley: I’ve been thinking about the healthcare problem in this country for many years. First of all, I believe that the wellness of a community is related to the economic health of that community. Therefore, improving healthcare is about improving the economic health of this country at the community level. Successful communities like Silicon Valley, Raleigh-Durham, and Cambridge, Massachusetts have similar underlying reasons for their success: they figured out what they’re good at, learned out how to monetize it, and then found the necessary support for a global reach. They involved all the key stakeholders (at the community level) in their singular purpose: educational institutions, government, consumers, businesses, and non-profit partners.
Although I don’t agree with Hillary Clinton on her approach to healthcare reform, I think she’s right about starting at the community level. Our education system must teach people to value their health as their #1 asset, to provide them with the tools and training necessary to manage their personal finance, and to create ongoing programs to keep the community focus in the forefront. People need to feel that their health choices don’t just affect them, but it impact their entire community.
For example, when we realized that second-hand smoke could be deadly to others, we were able to enact legislation to ban smoking from common areas, and dramatically reduce the population’s overall exposure to cigarette smoke. We need to make that leap in healthcare too – for example, eating two Big Macs at a time is like second-hand smoking for those around you. Because that kind of lifestyle choice is going to cost your community a lot in the future when they have to pay for the inevitable health consequences of such behavior.
When the individual consumer has no contract in the health relationship, any health initiative is doomed to fail. Community leaders must rise up to help us change the culture of health in America. We must align healthcare with community economics – providing incentives for behavior change, and effective education to make people aware that bad choices affect us all. Cowtowing to the whims of consumers is what caused our current financial crisis – we need leaders who will do what’s best for communities, rather than follow faddish trends.
Dr. Val: What is “Health 3.0?”
Brickley: Health 3.0 is where the consumer and the provider engage online together. If providers don’t connect with consumers online, there will be no trust developed and the two groups will continue to exist in parallel universes.
Dr. Val: What inspired you to create the Consumer Health World conference?
Brickley: I wanted the conference to be a catalyst for change. I’m a conversation facilitator – and the event brings together key healthcare stakeholders so they can plan a multi-faceted, community-based approach to healthcare reform. If we can inspire communities to organize themselves around personal responsibility, teamwork between providers and patients online, and legislated incentives for behavior modification – all the while using the “Silicon Valley model” to encourage entrepreneurial, local economic development – we can reform healthcare and improve the health of this country, one community at a time. Consumer Health World stimulates discussion amongst the people who have the power to make these changes a reality. I can’t wait to witness the fruit of these discussions.
December 15th, 2008 by Dr. Val Jones in Opinion
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The “Health 2.0” movement is about “consumer directed healthcare” and proposes to empower patients with online tools and technologies to help them manage their care and take control of their health. Some Health 2.0 initiatives have been quite popular – though many suffer from lack of participation on the part of consumers. Having your own personal health record sounds great – but when you’re the one who has to manually enter the majority of the data into it, only the most motivated patients will participate. Access to online physician ratings is appealing – but when everyone wants to read the ratings, but no one takes the time to complete the ratings questionnaire, the value of the tool is lost.
Over the past few years there have been a number of regularly repeating conferences created to unify key stakeholders around healthcare’s digital agenda – Health 2.0, Health Care Consumerism, The Healthcare Globalization Summit, Health 3.0, New Media Expo, Blog World Expo, Health 4.0, the AMA’s Medical Communications Conference, and more. Thankfully, these disparate groups with overlapping agendas are beginning to consolidate – offering new mega conferences that simplify the learning and relationship-building process.
My observation as an attendee of several of these conferences is that providers and patients are still not coming together as they should. Online healthcare solutions tend to be created in a lopsided manner – either by consumer/patient groups without much provider input, or by providers/health plans/governmental agencies without much patient/consumer input. The result tends to produce two types of products 1) active online groups and tools that facilitate both helpful information and misinformation or 2) products that advance good concepts, but have low participation due to lack of user-friendliness.
The current conference version “arms race” (to attract the most powerful vendors and largest audience possible) is not terribly helpful. Whether you associate with Health 2.0, 3.0 or 4.0 – the bottom line is that the Internet is a powerful force in healthcare. It can provide many different kinds of tools that make valuable contributions to health education, care management, behavior modification, emotional support, and improved quality outcomes. In the wrong hands it can also mislead patients, promote snake oil, sensationalize health news, confound research efforts, misinform, and mislead.
There is no more critical time than this for providers and patients to join forces to guide the development of new online health initiatives. The successful execution of digital health platforms requires a patient-provider partnership – I can only hope that upcoming conferences will embrace this view more fully.
In my next few blog posts, I’ll provide you with some fascinating interviews with key opinion leaders from the recent Consumer Health World mega-conference in Arlington, Virginia. The interviews are as follows, so stay tuned:
1. Skip Brickley, founder of Consumer Health World
2. Joseph Heyman, M.D., Chair, Board of Trustees, the American Medical Association
3. Emme Levin Deland, Senior Vice president, Strategy, New York Presbyterian Hospital
4. Joseph Kvedar, M.D., Director, Center For Connected Health, Partners Healthcare
December 15th, 2008 by Dr. Val Jones in Medblogger Shout Outs
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I hope you enjoy this week’s round up of quotable quotes from the medical blogosphere…
Scalpel or Sword quotes Taiwanese hospital administrator who chose “Hello Kitty” as a new design theme for their maternity ward: “I wish that everyone who comes here, mothers who suffer while giving birth and children who suffer from an illness, can get medical care while seeing these kitties and bring a smile to their faces, helping forget about discomfort and recover faster.”
Charlie Baker on hospital financing: Calculating hospital operating margins actually draws a starker picture. Hospitals collectively lose $30 billion on Medicare and Medicaid and earn $66 billion on commercial business, thereby generating a $36 billion gain overall on their insured patients. They lose another $13 billion on their uninsured patients, netting out to a $24 billion – or 3.6% – operating margin.
This means private sector employers and their employees and families are paying as much as 10-11% more than they would otherwise pay for health insurance – to fund the provider operating deficit created by Medicare and Medicaid.
Paul Levy: There are two types of hospitals, the kind that have had a wrong-side surgery and the kind that will have one.
Edwin Leap: Over the past few years, I’ve observed some curious phenomena. For instance, the raging debate over pharmaceutical companies. Sure, bad data is bad data. And of course, we shouldn’t have our prescribing practices ‘purchased’ by gifts, trips or cute reps.
But, what I find fascinating is the collective anger against those companies for trying to ‘profit.’ Ghastly! Companies, publicly traded ones, in America,trying to make a profit? What are they thinking? I mean, considering doctors and nurses work for free, with no thought to financial benefit…right?
Let’s face it, like it or not, those huge companies make life better. They create and market substances that keep us healthier; and of course, in some instances they offer very vanity driven products that keep us having sex longer or getting fewer wrinkles. But on the balance, we wouldn’t want them to go away, any more than we really want oil companies to disappear.
Respectful Insolence: given the utter lack of scientific support for the vast majority of CAM modalities and the weak support for the remainder, what’s left if you’re a CAM advocate trying to prosletyize about how great CAM is?
Argumentum ad populum, of course. Otherwise known as the bandwagon fallacy or appeal to popularity, it is one of the most favorite logical fallacies of all.
Terra Sigilata: Readers often ask me and other sci/med bloggers why revered academic medical centers are increasingly offering these questionable approaches. The truth is that there is a market for them. A good market. And one that will gladly pay out-of-pocket for such things.
Never mind if the approaches are effective. Or safe. Or can delay treatment with science-based approaches known to be effective.
Smoking, abusing alcohol, using CAM: Just because a lot of kids do it, does that mean it is right for yours to do so as well?
DB’s Medical Rants: Because prices are increasing, Medicare has tried classic bureaucratic techniques to minimize expenses. Our billing system requires extensive documentation. If we do not document well, then we are not paid appropriately.
In an effort to pay physicians more appropriately, Medicare adopted RBRVS. But then they made a huge mistake. They let the AMA develop the RUC – The primary care reimbursement mess. The members of that secret society include very few primary care physicians and many proceduralists.
Movin’ Meat: Wondering why it is that my placing a stethoscope on a patient’s chest is universally interpreted as a signal for the patient (or a family member) to begin talking.
PixelRN: The other day I was talking to a veteran CCU nurse. She told me that she worked at the hospital where the first defibrillations were studied and performed. Like many health care studies, the testing was done on animals – dogs in this case.
She then went on to tell me that one of the requirements for working in her CCU (back in the 1970’s) was that you actually had to defibrillate a dog to show that you were competent in that skill! Yes, the dogs were sedated before hand, but still.
Nurses see (and do) the craziest things.
December 12th, 2008 by Dr. Val Jones in Celebrity Interviews
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Dr. Richard Carmona
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I’ve interviewed Dr. Richard Carmona (the 17th Surgeon General of the United States, and former EMT, nurse, and surgeon) several times on this blog and have been intrigued by his insights and approaches to health. In our most recent interview, he discussed obesity from a provocative new angle: national security.
Dr. Val: What do you mean that obesity is a national security issue?
Dr. Carmona: There are many competing interests on Capitol Hill – the war, the economy, etc. and obesity is something that just doesn’t get enough traction. When I was serving as Surgeon General, I realized that obesity was acting as an accelerator of chronic disease and was the number one health threat to our country. But after several failed attempts to get attention focused on this issue, I realized that I had to present the message in a unique way in order to get it to resonate. It occurred to me that if I used different language to describe the threat, people would allow me to connect the dots and explain the problem fully.
Retaining EMS, police, firemen, soldiers, sailors, and airmen has been challenging because many of them can’t pass their physical fitness tests due to obesity and sedentary lifestyles. Health is therefore inextricably tied to national security. Describing the health threat in these terms helped legislators to understand the complex ramifications of the condition.
Dr. Val: How rigorous are these fitness tests? Are we talking about soldiers not being able to run a 5-minute mile, or is it less challenging than that?
Dr. Carmona: The fitness tests are based on research from the Cooper Clinic in Texas and include a measure of aerobic capacity, strength, and flexibility. There are standardized minimums based on gender and decade of age, and although I don’t have the exact minimums memorized for each age group, they’re very reasonable. We’re not talking about having to run a 5 minute mile. More like having to run a mile and a half in 15 minutes or having the flexibility to touch your toes in a seated position. As far as push-ups are concerned, the qualifying range is about 20-45.
Dr. Val: One of my blogger friends relayed a story recently about a surgeon who asked his hospital cafeteria to serve healthy options instead of fried food. They responded that no one would buy the healthy food and they’d go out of business – so economic necessity required that they continue to serve unhealthy food. What would you say to that surgeon?
Dr. Carmona: I’d invite that surgeon to come out to Canyon Ranch where we serve healthy gourmet meals every single day. Our chefs are very innovative and entrepreneurial – they make healthy food taste delicious, and at a cost-effective price. Americans need to learn how to make healthy food delicious. My friend Toby Cosgrove is a surgeon at the Cleveland Clinic, and he was able to spearhead a healthy food initiative there that has been very successful. We strive to find new and creative ways to prepare healthy food at Canyon Ranch – and are always coming out with new recipes and cookbooks to keep people interested in healthy eating.
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I caught up with Dr. Carmona at the STOP Obesity Alliance briefing about the new GPS (Guide for Policy and Program Solutions) initiative. Please click here to learn more about the STOP Obesity Alliance.
