Peeps – sorry for the radio silence. Will make it up to you with this: http://ht.ly/4EMV8
Hew (hyū) v.
“In every block of marble I see a statue as plain as though it stood before me, shaped and perfect in attitude and action. I have only to hew away the rough walls that imprison the lovely apparition to reveal it to the other eyes as mine see it.” – Michaelangelo
An unfinished Michealangelo sculpture.
I just re-read this quote – I think it is a powerful metaphor for any innovator that is out there trying to change the world.They are the ones that can see the fully defined, fully articulated, and fully functional end product within the building blocks that others pass off as mere landscape material. I think this gift of vision – this ability to “see” what others cannot – and the doggedness to stick to the mindless chipping away until others can see it enough to give you the tools you need to finish it off.
We are privileged to be working on a HUGE project right now with a highly innovative company that sees the value of what we are doing and wants to be a part of changing health care. It has been fun to work with them to begin the process of “hewing” away and to literally see the game changing product we have always seen begin to take shape from the dust, the chipped stone, the dirty hands, and the bleeding fingers. The process of discovery and refinement is almost as fun as seeing how the end product will move people.
I am on an email list of Bill DeMarco’s, a reputable industry insider who has written and consulted extensively in the physician group and medical management space. He recently sent me a note about several physician aggregation events in New Jersey.
For some reason it struck a nerve with me . . . which led me to fire off the response below:
I thought we already saw this movie?
My question for you . . . besides banding together in some megagroup – what are these physicians doing to actual change the delivery of medicine? ACO is just the latest buzzword excuse to aggregate physicians under a new moniker and a supposed new model.
I am highly suspect that these physicians are doing anything to change the relationship with their patients, to use enabling technology to create team based care, or actually be accountable for the outcomes they produce. What systems are they using to tie themselves together? What financial alignment do they have? What measures are they using to demonstrate superior outcomes? What about the patient experience – 7 minute visits that push pills as the “treatment” won’t get it done in the future.
I think your closing statement, “Representatives from Summit and Optimus were unavailable for comment” says it all.
Am I seeing this the wrong way? Is there anything new about this model this time around? Am I getting old enough to see these things cycle through?
PS – and no, I don’t mean a wolf. The sheep get nervous and band together waiting to get pounced on by wolves.
1. Having to do with the matter at hand; to the point
I read with amusement Susanna Fox’s redux review about the relevance of Health 2.0 in general and in changing patient’s behavior specifically. Here questions reveals her bias in a very limited definition of Health 2.0 that I attempted to abolish originally in some of my bantering with Matthew Holt. I always saw Health 2.0 as a “movement” that would not be defined so much by its technology but rather enabled by it. As an “enabler”, the technology can help people do new things in new ways but I never believed technology in and of itself had the power to truly change health, health behaviors, or health care delivery in and of itself.
That is why my definition of health 2.0 was always more expansive and contemplated an entire “movement” to the next generation health care “system”. This new system must include new delivery models, new financing mechanism, and the new tools and technology that bring all of this together in a simple, efficient, and affordable way. Clearly this next generation of care would include technology, the new tools, but until we had a new delivery system that is financed in a new way we are going to continue to have the same behaviors across the patient, physician, provider, and payor continuum.
So Susanna, I don’t think your version of Health 2.0 (Tools and Technology) do much to get us to the behavior change you seek. In fact, getting to the root of behavior change requires almost a religious experience. Interestingly enough, the health care industry provides plenty of “religious” experiences including passing close to death, unbelievably poor customer experiences that invoke deep passions (ie, the birth of ePatient Dave), and promise of a far better world than we currently enjoy. So while the tools and technology show us what is possible, health care delivery and health finance are the catechismal doctrines we must reform first that actually incent the behavioral change we all seek.
So is Health 2.0 Relevant? I think it depends on your definition!
Extirpating (ĕk’stər-pāt’) v.
I recently took a great road trip with my two boys. We rented one of the new Kia Soul’s which my boys recognized from a very funny commercial developed to highlight its hipster (hamster?) vibe. The commercial reminded me of the old Hamburger A or Hamburger B commercials from Wendys back in the late 80′s wherein this ludicrous contrast is set up to demarcate the dichotomy between two distinct choices.
This modern reinvention of that age old contrast struck me because it is something that I deal with everyday in explaining Crossover Health to people. It all stems from a pervasive misconception about the term “Health Insurance”
The challenge is that “Health Insurance” is a confused term which most people equate with both Health Care (care delivery) and Health Finance (how you pay for it). Our current employer based system (wherein your employer provides and in most cases pays for your insurance) as well as a third party insurance payment system (we have the insurance pay for us) creates all kinds of weird incentives but also results in no accountability in terms of cost, quality, or outcome. It is currently imploding before our eyes.
Our reaction, both opportunistic as well as obligatory, is to do something totally different by blowing up the current Health Insurance model and separating out Health Care from how you pay for it (Health Financing). We say that there is a better way to do BOTH – pay your physician directly for the care you need and then get smart about how you pay for it with the right insurance product. In fact, you should “self insure” with the highest deductible plan you can find and then take responsibility for your health for all the small stuff or hire someone to do that for you (like Crossover Personal Health Advisory Service). There is no reason to intermediate with a parasitic organizations that are taking your premium dollars and wasting it on overhead, fancy offices, mindless phone trees, and my all time favorite “this is not a bill” disinformation pamphlets.
As people begin to take this in (they always get how the practice model is a radically improvement), they immediately revert back to the combined “Health Insurance” concept. Does Crossover Health want to replace my current “Health Insurance”? The answer is slightly nuanced, but a resounding YES! I want to replace what you call “Health Insurance” with a direct “Health Care” product (Crossover Health) and a smarter Health Finance product (highest deductible you can get).
We believe there are large and significant opportunities to roll this into a single product that can be purchased by employers, families, and other organizations seeking fresh alternatives that can demonstrate not only trend bending improvements but trend busting outcomes.
Those who fail to learn from history are doomed to repeat it, or so the saying goes.
My controversial piece on Silicon Valley missing the point of healthcare last summer doesn’t seem so controversial now, as I recently got some validation from others closer to the action than I am. First, reDesign Mobile analyst Rocky Agrawal wrote in VentureBeat that Silicon Valley might be “too smart for their own good,” building products more suited for highly educated techies than for the masses. Last week, former Apple and PepsiCo CEO John Sculley suggested at the Digital Health Summit at 2012 International CES that technology for its own sake is rather useless if you don’t understand the market you’re targeting.
“”The thing that is missing is getting the people with the domain expertise aligned with the people with technological know-how to turn ideas into branded services,” Sculley said, as I report in InformationWeek Healthcare and in tomorrow’s MobiHealthNews.
After raking Rock Health over the coals in my commentary last summer, I offered qualified praise to the San Francisco-based investor/business accelerator for healthcare start-ups last month on this blog. “I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients.” I wrote.
“I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.”
Tomorrow, I am planning on attending the kickoff event for Healthbox, a similar healthcare business accelerator that differs from Rock Health in at least one key way: it is not in Silicon Valley, but right here in down-to-earth Chicago. Does that make a difference? Well, the kickoff isn’t at a hotel ballroom or Healthbox’s office, it’s in an artsy space called the Ivy Room, in the heart of River North, an area usually populated by more tourists than locals.
I sure hope I’m not in for an over-the-top extravaganza that will highlight cool, direct-to-consumer apps with a snowball’s chance of catching on with the entities that actually pay the bills for healthcare. I want to believe there’s something real here, which is why I’m giving up at least a couple hours of my time to see the presentations. Please tell me that Chicago isn’t becoming a Silicon Valley clone, but rather the hub of health IT innovation it could be.
For what it’s worth, here is the list of companies scheduled to present tomorrow: UnitedPreference, DermLink, SwipeSense (“a comprehensive hand-hygiene solution,” whatever that means, The Coupon Doc, CareWire, Iconic Data, PaJR-Patient Journey Record (helping hospitals avoid 30-day readmissions, potentially making it a Big Deal), CareHubs, Corengi (linking diabetics to clinical trials) and PUSH Wellness. I see real potential in at least four of those, possibly more.
Other locales may get more press in this industry, but the Chicago area has a surprisingly strong community of health IT vendors.
It is well known that Allscripts is headquartered at the Merchandise Mart. GE Healthcare, while based just outside Milwaukee, maintains a large IT center in northwest suburban Barrington, Ill. CDW, based in Vernon Hills, Ill., runs its healthcare division from a downtown Chicago office. Numerous smaller vendors dot the area, too. And then there is Merge Healthcare, a medium-sized firm that historically has specialized in software for medical imaging.
Last week, I visited Merge’s home office in the Aon Center, an iconic skyscraper previously known as the Amoco Building and, before that, the Standard Oil Building. There, CEO Jeff Surges gave me a history of the company and talked about changes in the company and in the health IT field in general. Then, I turned on my video camera so Surges, sporting an orange necktie, could explain why Merge has adopted orange as its company color.
Following my interview with the CEO, Gilbert Gagné, also wearing an orange tie, gave me a demo of Merge iConnect Access, an image viewing system than works through any Web browser. I got the iPad portion of the demo on video, too.
I shot this in 720p high definition, but only uploaded it at 360p to save time. Let me know if you want HD so the iPad screen appears a little sharper.
As I first mentioned in August, John Lynn and I had the thought that it would be great if Twitter co-founder and HIMSS12 keynote speaker Biz Stone would show up at John’s 3rd annual New Media Meetup. Stone didn’t respond to our halfhearted attempt back then, but now the conference is less than two months away, and I have to imagine he will be making his plans soon, if he hasn’t done so already.
HIMSS social media guru Cari McLean also would love for Stone to meet and greet conference attendees at the HIMSS Social Media Center after his keynote on the morning of Tuesday, Feb. 21, per her tweet in response to one of mine:
That means that now is the time to put social media to work to get Stone to make a couple of appearances. Stone’s Twitter handle is @Biz. Tweet away, using the hashtag #BizatHIMSS12 and perhaps add #hcsm (for healthcare social media). Blog about this effort. Post on LinkedIn, Facebook and Google Plus. I may even make a YouTube video. Let’s impress Stone with the power of social media and get him to mingle with the masses in Las Vegas.
Have you made your reservations for HIMSS12 yet? If you’re just starting to plan, you might not have noticed some quirks with the schedule and the venue this time around.
For one thing, the mega-health IT conference in Las Vegas is not at the massive Las Vegas Convention Center, but rather at the Sands Expo Convention Center and the adjacent Venetian hotel. Remember, the 2012 HIMSS conference was supposed to be in Chicago, but the organization switched it to Sin City a couple years ago after vendors complained about high costs at Chicago’s McCormick Place for HIMSS09. (The defection of HIMSS and one other large trade show actually prompted the Illinois General Assembly to legislate changes to some of the work rules at McCormick Place, after which HIMSS agreed to hold its 2015 and 2019 conferences there.)
The last-minute nature of the relocation is changing a lot of the dynamics.
I know that HIMSS has outgrown most of the convention centers in the country, to the point that only Las Vegas, Chicago, Atlanta, New Orleans and Orlando can accommodate it, but the Sands was a surprising choice. Believe it or not, the Sands-Venetian claims to be the third largest convention facility in the nation, with 1.8 million square feet of exhibition and meeting space. However, many exhibitors will be put in Hall G, on the lower level, a 380,000-square-foot space with just a 13.5-foot ceiling height. The upper halls have 32.5-foot ceilings, so I’m guessing the downstairs space is going to seem awfully claustrophobic.
(On the other hand, the Venetian is a lot more luxurious than your typical conference hotel. Plus, I once saw Chuck Norris and his brother playing craps there. He graciously did not injure me.)
Also, HIMSS12 ends on Friday, Feb. 24, instead of the usual Thursday. When I booked my travel last week, I thought this meant HIMSS was adding an extra day to what already has become an endurance test. But I looked again today and noticed that everything has been moved back a day. The freakshow otherwise known as the vendor exhibition runs Tuesday-Thursday instead of Monday-Wednesday, and most of the preconference events, typically held on the Sunday prior to the start of the main conference, are set for Monday, Feb. 20. Alas, I’ve already booked my travel to arrive Saturday, and who knows what it will cost to change my plans? On the other hand, it gets me out of Chicago for an extra day in the winter.
Does anyone have any insight about this scheduling shift? Is it because of the venue change, or a result of the fact that Vegas hotels normally jack up the rates on Friday and Saturday nights?
Of note, though, the HIMSS travel service is a better deal in 2012 than in most years, based on my experience. Go through the official channel and you won’t pay more for staying a weekend night. You also won’t have to pay any resort fees at the many properties now adding this mandatory charge, and they’ll throw in free Internet access, too. That sealed the deal for me.
My first impression of healthcare startup incubator/accelerator Rock Health was not a favorable one. I wrote in MobiHealthNews last July that the San Francisco-based organization founded by some hotshot, young Harvard MBAs demonstrated “yet another example of Silicon Valley arrogance.” I said that Rock Health was mostly targeting the young end of the market with cool, fitness-oriented apps, not the elderly and chronically ill who account for the bulk of the nation’s $2.5 trillion annual healthcare spend. That group wants things that are easy to use rather than fun and hip.
Needless to say, I was not invited to Rock Health’s Christmas party. I did share a quick “hello” nod with Managing Director Halle Tecco when I saw her in a meeting room at the mHealth Summit last month, though.
Even then, I wondered if Rock Health had changed its attitude at all, seeing that even the executives were outfitted in company t-shirts in the buttoned-down world of (just outside) Washington, D.C. (I once had a Capitol Hill press pass early in my career. The rules require members of the media to conform to the same dress code as members of Congress. That means a coat and tie for men, while women have to have jackets if they choose to wear slacks. An unwritten rule of D.C. in general calls for women to wear stockings if they go with a skirt, even if it’s 95 degrees and humid, which it frequently is in the summer.)
Today, though, I saw a clear sign that Rock Health is starting to learn from its earlier mistakes. MobiHealthNews reported on the incubator’s class of 2012, and I was pleasantly surprised to see that the majority of the 15 companies are aimed at either healthcare providers—an important constituency largely missing from the first Rock Health class—and on treatment of truly sick patients. One startup, for example, helps people being treated for breast cancer prepare for doctor visits, while another produces an EHR for home-health agencies. Good stuff in my critical eyes, though really, enough with the social networking to get people to exercise. There are too many of these platforms and apps already.
I never thought I would say this, at least not before the end of 2011, but kudos to Rock Health for making a real effort to figure out the complex healthcare industry and to add some substance to what heretofore had been all style.
Now it makes sense.
A couple weeks ago, I got the latest update from fictional EHR vendor Extormity:
Extormity to Federal Health IT Leaders – ‘Take a chill pill, fellas.’
Brantley Whittington, fictional CEO of make-believe electronic health record vendor Extormity, is urging Aneesh Chopra, Farzad Mostashari and Todd Park to tone down their optimism and exuberance about the clinical benefits and cost savings associated with implementing health information technology.
Whittington, speaking to reporters from the offices of a K Street lobbying firm in Washington, D.C., expressed dismay at the unbridled enthusiasm exhibited by White House, ONC and HHS officials. “For years, vendors like Extormity have worked hard to cultivate a healthcare IT culture that combines complexity with closed-mindedness, creating a pervasive and stifling sense of futility.”
“Instead of the sober and staid leadership we are accustomed to, these gentlemen are inspiring new models of industry development,” added Whittington. “The Direct Project is a great example of supercharged public/private collaboration designed to simplify the flow of health information without spending a dime of taxpayer money. This may benefit patients and providers, but the lack of convoluted infrastructure does little for the Extormity bottom line.”
“While I have been known to muster up some counterfeit fervor for shareholder meetings, the consistent passion and zeal demonstrated by these officials is proving disruptive to those of us dedicated to proprietary and expensive solutions,” added Whittington. “I suggest dialing back the levels on the gusto meter to preserve the status quo, stifle meaningful innovation and ensure consistent and sizable returns to a handful of large healthcare IT vendors.”
Chopra, Mostashari and Park are exuberant, that’s for sure. The first time I saw Park and Chopra share a stage together, I labeled them the “anti-bureaucrats.” I have since added Mostashari to that category. But it was only over the weekend that I learned that Mostashari and Chopra were getting down to the “Meaningful Yoose” rap from Dr. Ross Martin at a recent ONC meeting.
Perhaps this is why Mr. Whittington wants the anti-bureaucrats to tone it down. Or perhaps (more likely) extormity feels threatened by innovation. Yeah, let’s go with the latter.
N.B. I am writing this while 33,000 feet above northeastern New Mexico, just about to cross into the Texas Panhandle, on a flight from Tucson to Chicago. I love me some Wi-Fi in the sky!