June 16th, 2007 by Dr. Val Jones in Announcements
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Because Washington DC is the national headquarters for many heathcare professional organizations and advocacy groups, we host more than our fair share of medical conferences. Just a few weeks ago I attended Digestive Disease Week, where 16 thousand gastroenterologists descended upon our fair city from all over the globe. Sporting purple gift totes and oversized name tags, these docs moved like a great school of fish through the reefs of our convention center. At one point I was standing in the wrong place at the wrong time – a lecture let out just before lunch, and I was almost flattened by the wave of hungry purple people on a frantic quest to be first in line at the refreshment counters (the song, “one eyed, one horned flying purple people eater” kept dancing in my head as I ran for cover).
And I started thinking – gee wouldn’t it be easier to have a virtual conference where you could attend from the comfort of your own home? You could navigate to the information booths that interest you, you could attend lectures via telecast, and you could even opt in for goodie bags that could be mailed to you. No need to be stressed out and jostled by well meaning, but frantic colleagues. You could sit in your PJs with kitty or puppy nearby and click your way through a much calmer version of the educational experience.
And so the Revolution Health team discussed this idea and came up with the Online Health Fair. We invited a small group of advocacy groups to set up booths on our website to show others all the exciting programs they have going, and to spark interest in getting involved. The fair just opened and I think it’s a pretty neat idea – Revolution Health is donating money to the groups, based on page clicks. So the more people who go to learn about their favorite advocacy groups, the more they benefit.
So I would encourage you to check this out and let us know what you think – do you like this online health fair concept, or are you more of a “flying purple people eater” kind of person?
Here are the advocacy group “booths” at the fair:
Autism Speaks
American Kidney Fund
National Alliance on Mental Illness
IBS Self Help and Support Group
National Family Caregivers Association
The Wellness Community
National Foundation for Celiac Awareness
Asthma and Allergy Foundation of America
National Sleep Foundation
Society for Women’s Health Research
If this online fair is popular, we can create many more of them in the future. I think it’s great to support these noble groups, and the Wall Street Journal agrees. Tell a friend. 🙂This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
June 15th, 2007 by Dr. Val Jones in Announcements, Expert Interviews
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I was recently interviewed about my blog (and this week’s edition of Grand Rounds) by Dr. Nick Genes at Medscape. For the curious among you – here is the full Medscape interview with Nick Genes (prior to editing). It gives you a little more information about Revolution Health…
1. You’ve
been involved in writing since medical school, for various audiences. Who are
you trying to reach with your new blog, and how have you found blogging to be
different than the other media you’ve worked in?
The best part about
blogging is that it’s a dialogue rather than a monologue. I find the interactive discussions and
heartfelt responses to be touching and engaging. My previous writing was more academic because
of the medium (medical journals) but now I’ve found that blogging is where I
can really be myself – there is no team of reviewers to scrub my words. So what you read is what you get!
2. I’m
very curious about Revolution Health, your role as Senior Medical Director, and
where you think this is all going. But all revolutions have their origins
somewhere, and yours seems to start… on a yogurt farm. Please share a little
of what that was like, and maybe what early influences have given you such an
interesting background. From small towns to New York City, from theology to medicine, it
seems like you’re living a very rich life.
Yes, I guess you could
say that my origins as a revolutionary are firmly rooted in dairy farming. Although it may not be immediately apparent
how the two are related, Internet startups and cattle herding have their similarities. First, you have to wear many hats – there is
no job too small or too large. If the
cows need milking, and the electric machines are broken, you do it by hand. If a cow breaks through the fence and wanders
off into town, you lure her back with short feed. If a large batch of yogurt curdles, you’ve
got yourself a gourmet meal for your pigs… you get the drift. In a large start up, all manner of unexpected
events happen – but the trick is to handle them quickly and efficiently, and
make sure the outcome is a win-win.
As far as my other
life detours… I guess you can say that I’ve been a victim of my own
curiosity. There are so many interesting
things going on, I just can’t help but want to try them out. In the past I’ve held jobs in the following
capacities:
A protestant minister,
NYC bartender, bank spy, food critic, doctor, cartoonist, computer sales
associate, yogurt mogul, nanny, motivational speaker, biophysics researcher,
graphic designer and revolutionary medical director.
So my life has
certainly been an adventure!
3. How did you get involved with this company? Did Steve
Case find you, or know you from before — or was there an application process?
Is the mingling of medical and computer technology folks going smoothly? Is it a
mix of hospital culture vs. laid-back internet start-up culture? (Foosball and
mountain bikes, or suits and meetings?) Can you make comparisons to your time
with MedGenMed?
A friend of mine had
interviewed at Revolution Health for an executive position and thought that the
company would be a great fit for me.
When I heard who was involved (including Colin Powell, Steve Case, Carly
Fiorina) and that the goal was to create a website to help patients navigate the health care
system, I thought – gee, this sounds serious, challenging and worthwhile. So I sent in my resume, got offered an
interview, put on a bright red suit and announced that I’d heard that there was
a revolution afoot and wondered where I could sign up. They hired me that same day (May 8, 2006) and
it’s been the most exciting job I’ve had to date!
About the “mingling”-
a very interesting question. There is a
hint of Foosball/mountain bike in the mix, but I think we’re a little more hard
driving than that. Since Revolution
Health is in its start up phase, there is simply too much work to do for people
to be playing Foosball. When I started,
there were 30 employees, now there are closer to 300. We are all working long hours on cutting edge
projects that I believe will make a big difference in supporting the
physician-patient relationship, streamlining the process of healthcare delivery
and improving accessibility to the uninsured and underinsured. Revolution has attracted some of the
brightest minds in the tech industry – and they are building products I could
never have dreamed of on my own. Since I have such an unusual background,
I’m bilingual in both techie speak and
physician speak, and this helps a great deal.
Because I understand what physicians and patients need, and can translate
that for the “creatives” we can build some really meaningful tools and products
together.
My time at MedGenMed
was wonderful, primarily because Dr. George Lundberg is a dear friend and
mentor. He has done fantastic work
creating a pure platform (no pharma influence or fees for readers or authors)
for open-access publishing. He taught me
to speak my mind, follow my gut and never compromise my ethics. His book, “Severed Trust” galvanized me into
action – to do my part to improve the damaged physician-patient relationship
that is at the core of our broken system (caused by middle men, volume
pressures and decreased time with patients).
After reading his book, I wanted to do something big – so I joined a
revolution.
3. Revolution
Health has some bold ideas about improving care for its members — getting
appointments with specialists, patient advocacy in dealing with insurance, and
of course, sharing information. What’s your job entail, as medical
director? Do you think you’ll find yourself making policy decisions that
could affect, directly or indirectly, chunks of the population? Could
you find yourself in a position where some specialists are not recommended
based on their insurance? Will Revolution Health have a formulary, will it
be evidence-based — or could could care be rationed ?
My job is incredibly
challenging and fun, and I rely on both halves of my brain for much of what I
do. We have 146 medical experts most of
whom I’ve personally recruited, I’m responsible for coordinating the medical
review of all the content on our portal (so that it conforms with
evidence-based standards), I facilitate relationships with major hospital
systems (such as Columbia University Medical Center), spearhead new product
initiatives (such as Health Pages for physicians), monitor and promote our 30+
expert bloggers, participate in writing press releases, creating podcasts, radio interviews,
identifying new partnership opportunities and much more.
I do think that
Revolution Health will greatly influence vast “chunks” of the population. And this is what’s particularly exciting
about working here. We really are
building a brand new navigational system for healthcare – and this will empower
patients to take control of their health and provide them with better
information and guidance in living their best.
I believe that Revolution Health will become the new virtual medical
home for physicians and patients, just the way that AOL grew to be America’s
Internet home. You log on first to AOL
to get your email, check your news, and get plugged in before surfing the
net. You’ll log in to Revolution Health
to track your health, connect with your lifestyle coach or physician guide, get
involved with a community of others like you, or track your loved ones’ health
issues through Care Pages. This is a 20
year project, so all of our plans and programming may not be apparent yet, but
the trajectory is amazing and I wouldn’t want to be anywhere else as a
physician today.
5. What are some of your favorite posts — something that
struck a nerve with readers, or captured something you wanted to express?
Please provide links!
My absolute favorite
post is the story of how my mom, a strong patient advocate, saved my life as a
baby. She refused to accept the
misdiagnosis I was given, and continued to nag the medical team until they
realized what was wrong and took me to the O.R.
If it hadn’t been for her persistence (or the incredible skill of the
surgeon who ultimately took care of me), I wouldn’t be here today. And maybe that’s why I’m passionate about
both good medical care AND patient empowerment!
Other posts that have
been well received are true stories from my medical training days. Some are controversial (like this one about
end of life issues and my first day as a doctor),
and others are warmer reflections. But ultimately, I just share what’s on my
heart and let the audience take away what they can from it.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 18th, 2007 by Dr. Val Jones in Opinion
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Ask any American if they think
their current healthcare system is operating smoothly and efficiently, and
you’ll hear a resounding “NO!” Adjectives such as
“confusing, complicated, and disorganized” are often used to describe
our current state, and for good reason. The science of medicine has
advanced enormously over the past 50 years, but somehow this rapid growth in
knowledge has been plagued by chaos. With every new therapy, there’s a
new therapist – and the result is a fragmented assortment of tests, providers,
procedures, and administrative headaches. So what does a patient in this
system really need? She needs a coordinator of care – a compassionate
team leader who can help her navigate her way through the system.
She needs a central location for all her health information, and an easy way to
interact with her care coordinator so she can follow the path she has chosen
for optimum health. She needs a medical home.
Primary care physicians (especially family physicians, pediatricians, and
internal medicine specialists), are ideally suited for the role of medical team
leader in the lives of their patients. It is their job to follow the
health of their patients over time, and this enables them to make intelligent,
fully informed recommendations that are relevant to the individual. Their
aim is to provide compassionate guidance based on a full understanding of the
individual’s life context. The best patient care occurs when
evidence-based medicine is applied in a personalized, contextually relevant,
and sensitive manner by a physician who knows the patient well.
Revolution Health believes that establishing a medical home with a primary care
physician is the best way to reduce the difficulty of navigating the health
care system. We believe that our role is to empower both physician and
patient with the tools, information, and technology to strengthen and
facilitate their relationship. Revolution Health, in essence, provides
the virtual landscape for the real medical home that revolves around the
physician-patient relationship.
What’s the advantage of having a medical home? Jeff Gruen, MD, Chief
Medical Officer of Revolution Health:
1. Care is less
fragmented: how many times have you heard of friends with multiple medical
problems who are visiting several physicians, each of whom has little idea
of what the other is doing or prescribing, and none of which are focusing
on the big picture? When a single physician is also
helping to “quarterback” the care, there is less chance that
issues will fall between the cracks, and less chance that consumers will be
put through unnecessary and costly tests or procedures
2. Care is better:
studies have shown that excellent primary care can reduce unnecessary
hospitalizations and assure that preventive tests are performed on
time. One study for example showed that the more likely
it is that a person has a primary care family physician, the less likely
it is that they will have an avoidable trip to the hospital. This
makes intuitive sense: a physician who knows you is critical to have if
you were to get very sick and need alot of medical
attention.
3. Care is more holistic:
medical care is part art and part science and good care requires the
clinician to understand something about the whole person they are caring
for. Many complaints that are seen in primary care practices are
physical manifestations of underlying emotional, family or adjustment
issues. A good primary care clinician who knows the individual and
family is more likely to strike the right balance between appropriately investigating
physical causes for complaints, and addressing more subtle underlying
causes
So to physicians and patients alike, we say, “Welcome home to Revolution Health.”
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 31st, 2007 by Dr. Val Jones in Health Policy
1 Comment »
We all agree that improving healthcare quality is a critical goal, but there is no real consensus on how to achieve that goal. In recent years, a “Pay for Performance” or P4P strategy has been put forth by the US government’s Center for Medicare and Medicaid Services (CMS). The gist of the strategy is to pay physicians more or less based on certain disease outcome measures of the patients they treat. So if a physician treats a large group of patients with diabetes, that physician would be paid more/office visits if, on average, those patients demonstrated lower blood sugar levels, lower cholesterol levels, and less evidence of end-organ damage on various tests.
P4P assumes that a patient’s chronic disease outcomes are completely dependent upon the physician. To me, this underlying assumption (that the patient is not involved in his/her own health) is offensive. It is offensive because it assumes that patients are not in control of their lifestyle choices, that their circumstances can be summed up by lab tests, and that their doctor takes all the credit for their hard work to control their disease. It also assumes that patients and families need not be partners in the quest for optimum health – no, that is solely the responsibility of the physician. Ultimately, P4P is disrespectful to patients – it takes them out of the health equation, it presumes that they’re passive participants, and it depersonalizes medicine.
And it gets worse. If physicians are paid more for patients who do well, they will be tempted to “cherry pick” the most motivated and privileged patients. How does this help the patients who need the most help? It will further earmark them for lower quality care.
One of my favorite bloggers, Dr. Richard Reece, echoes my sentiments, further explaining how ludicrous it is to assume that doctors are in full control of patient health outcomes:
People spend 99.9 percent of their time outside of doctors’ offices and hospitals. This time gap is particularly important in patients with chronic disease. Your outcomes depend on how and where you live and work…
Many patients don’t follow doctors’ orders. Many never fill prescriptions, fail to get refills and avoid exercise.
Half-way technologies–stents, coronary bypasses, joint replacements, statins, etc.–don’t eliminate underlying diseases or change their basic pathophysiology. The problem here, of course, is many patients have overblown expectations at what these technologies will accomplish and often return to the behavior that led to the problem in the first place.
Even CMS recognizes the limitations of P4P:
Pay-for-performance is in its early stages of development and a great deal of work still must be done to determine the best method of approaching a comprehensive program.
But that doesn’t stop them from promoting the program to states that are in desperate need of federal funds:
CMS will provide technical assistance to those states that voluntarily elect to implement pay-for-performance programs. We also plan to work with states to encourage that evolving pay-for-performance programs include an evaluation component to provide evidence of the effectiveness of this methodology.
For some further examples of how P4P doesn’t work, check out the following blogs: 1) disaster in the nursing home setting and 2) a summary of recent research studies on the ineffectiveness of P4P by Dr. Poses (via KevinMD).
Then what is the real issue that we’re trying to get at?
Quality care is dependent upon the regular application of evidence-based medicine (EBM) to clinical situations. What is EBM? Every medical decision that physicians make should have a good reason behind it – and that reason, whenever possible, should be based upon scientific evidence that the decision has worked in the past. What I mean is that we spend billions of dollars on medical research to learn the difference between truth and error, and doctors should do their level best to apply the research findings to the care decisions they make each day. Now, keep in mind that there are about 6000 research articles published each day in the medical journals world-wide… so it may come as no surprise that (as Dr. Reece explains):
It’s well-documented doctors only follow preventive and treatment guidelines 50 percent to 55 percent of the time. Moreover, doctors could do a much better job communicating with and educating patients, deploying the Internet (for example) to reach patients when they are outside of the immediate care setting.
So what we really need to do, is support physician education efforts to incorporate the very best research findings into their clinical practice of medicine. How can a physician keep up with all the latest research? I maintain that the government’s efforts would be better spent on hiring physician task forces (to summarize the very latest evidence for the treatment of every disease and condition – and then supply simplified guidelines to docs across the country) than on scheming up ways to penalize physicians for treating patients who are sicker and less willing or able to take control of their health. It would be great if physicians were incentivized to use the latest clinical guidelines in their care of patients – but basing the incentives on outcomes (rather than on applying the guidelines) cuts out the patient’s responsibility as a partner in the treatment. As Dr. Feld rightly points out, quality care based on EBM could be vastly improved through a central EMR.
And what can patients do?
In this new era of consumer directed healthcare, patients need to understand that they really are co-partners with their doctors. A doctor can give you all the best possible advice, but if you don’t take the advice, then that doctor’s work on your behalf may be in vain. I believe that patients should be aware of the care guidelines that doctors use to treat them – and have access to a simple check list to track their own progress. I am personally helping to translate clinical guidelines into consumer-friendly lists for patients so that they can actively participate in, and follow along with, their care plan (so stay tuned for that). Revolution Health is committed to empowering consumers – and helping them to be a full partner on the road to wellness. In fact, we are developing a full suite of su
pportive services (including health coaches, chronic disease management programs, insurance advocates, nurse call lines, physicians available via email, and more) that will make it much easier for them to stay on track. In addition, we are enabling physicians to customize educational information for their patients, and participate (via IT) in a broader relationship with them.
There are many exciting improvements in healthcare currently under development. The Internet will play a central role in connecting patients and physicians to the scientific information that will help them get the best care no matter where they are or which doctor they see. I don’t believe that P4P is anything more than another misguided attempt to “improve healthcare quality” by creating more of the red tape that keeps doctors and patients from meaningful personal interactions.
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 3rd, 2007 by Dr. Val Jones in Health Policy
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Improving quality in healthcare is an important fundamental goal. New “pay for performance” measures initiated by the Center for Medicare and Medicaid services is a well meaning attempt to provide financial incentives to physicians who demonstrate improved patient outcomes. Unfortunately, this incentive program could backfire.
A recent article in Medical Economics (via Kevin MD) raised the question of “cherry picking and lemon dropping” your way to higher pay. In this frightening scenario, physicians would be tempted to select healthier, more compliant patients for regular treatment in their practices. In this manner, they can demonstrate better outcomes, since the sicker, poorer, or less compliant patients no longer factor into their performance measures. And with the upcoming physician shortage, it really is a seller’s market.
It is critically important for the government programs to allow physicians to accurately risk stratify their patients so that they are not financially penalized for taking care of sicker patients bound to have below average outcomes. The same goes for surgeons, who should not be discouraged from undertaking potentially lifesaving surgeries for patients who are critically ill.
Dr. Kellerman, the president of the American Academy of Family Physicians, reminds us that quality of care is vastly improved by having a central medical home (i.e. one physician who can coordinate care for patients, so they’re not left with a group of disconnected specialists ordering duplicate tests and prescriptions). I personally think that a centralized EMR/PHR controlled by the patient (and located at an Internet based “medical home” complete with disease management tools and the ability to email a physician as needed) would go a long way to improving quality.
What do you think?
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
