Improving Access to Care or Lowering Quality

At one time in order to get the healthcare you deserved and/or needed it was like playing darts. Your physician was the bull’s eye in the center. If it was the weekend or late at night and the need was acute enough it would be emergency room which is the next ring out from the bullseys. Finally there was the pharmacist and pharmacy where you went for poison ivy, medication side effects, diaper rash, etc. There you were likely to get advice and move along. The physician and her office was the sun and we patients were the planets revolving around. But that is changing where the patient is moving closer to the center.

The Economist has an article Medicine at the Mall which tells the story of how clinics are becoming more convenient. Walgreen is leading the change and providing patients with healthcare becoming easy. They are moving the pharmacy to the bull’s eye. Of course there have been urgent care centers and worksite clinics etc. But this move by Walgreen’s 372 pharmacy clinics and CVS Caremark’s 640 offers patient 1,012 new sites to find healthcare easier and more conveniently. Do not mistake this trend for some new healthcare disruption. These pharmacy chains are looking to partner with local hospital networks. What this is a way for patients to access healthcare on their terms matched with their needs. It is moving pharmacy to toward the center and offering patients a larger target. I would agree with Dr. Ryan this trend may be taking quality care away from the primary care physician but I would offer that these new venues and the PCP need to work together to deliver the highest quality care.

One point I want to make, no plead with the Economist shit can the stock photo or do a better job finding suitable art. 

Your Guess is As Good As Mine: Or Bayesian Logic Rocks

My favorite marketer and all around technology writer Digital Tonoto has a very interesting post titled “Bayesian Strategy”. Greg’s primary argument is that ‘…the false certainty that planning engenders is becoming an impediment to, rather than a tool for, attaining objectives.’

Technology cycles are shrinking and to plan for something that will change in a matter of months not years is a doomed exercise. We are currently using controlled variables and huge sample sizes to determine conclusions that are statistically significant and treated as true. As Greg next points out Nature recently published an article showing that the majority of cancer research could not be duplicated. Makes me stop to think if they can’t do how can we?

Greg argues that a better alternative is the Bayesian method where a guess is made and the data collected to demonstrate right or wrong in your guess. Waiting to test variables over time to prove right at a time when business cycles are moving at the speed of light may leave many good ideas behind. We could be doing more simulation testing or scenario planning.

What does this have to do with social media, medicine, patient outcomes, and improved healthcare? Everything. Today there are hundreds if not thousands of healthcare apps, everyone and most healthcare corporations are creating twitter hash tags or Facebook pages. Facebook likes and Twitter followers are driving the explosion of social media and providers. Just look at the Cincinnati Business Courier articles on social media and healthcare.  There is not a shortage of trials and errors in healthcare. Can we say what is being done is Bayesian? Needless to say it is a boom time. Healthcare is a growing sector hiring at a pace faster than the economy is growing. That lends itself to Greg’s argument that Bayesian is better. .

I am of the opinion that though many of these social media efforts are being done as part of a strategy to improve outcomes the majority is being done because social media is trending. Or it is being done to sell a product or service. Nothing wrong with that but, I fear it is supplanting the goal to improve outcomes and healthcare in America. And worse we will lose the magic of social media as it becomes a co-opted sales and marketing tool.

My guess (Bayesian) on improving healthcare is centered on two items. One is the patient physician connection. On the whole we trust our physician more and to a greater degree than any other resource. When that connection works it’s an amazing ebb and flow of information, communications, and trust. We say x to our physician and if we are lucky he/she listens. Our physician says for us to do this, we do it not because they are wearing a white coat but because we understand where that knowledge comes from and its place in our lives. We want to learn and succeed. Our physician wants us to learn and succeed. We participate in our healthcare with our physician. The sad reality of my Pollyanna outlook is that HCP don’t have the time to do this. But we need to try and find solutions not just to patient care but HCP time issues. 

This brings me to the second item knowledge/information used by patient’s drives healthcare changes. In medicine the physician is engaged in life-long learning. Similarly the patient who is seeking solutions to healthcare problems is equally involved in learning. The data is there, patients and consumers are using the Internet to search for healthcare information. They are demonstrating their desire to learn.

My hypothesis or guess is:

When knowledge and information between patients and healthcare professionals is at the center of care it improves patient health, reduces HCP time, and yields durable outcomes.

Right now we’re not maximizing the benefits of social media to patients, HCP, and healthcare in general. We are not guessing, what’s the strategy to improve healthcare knowledge among patients, and collecting data to adjust goals and strategy. It seems all we are doing in large part is throwing up feeds, links, and pages. I am not sure we are even planning as much as just executing. I realize this is medicine and it is has the baggage of evidence based knowledge as well as entrenched beliefs and attitudes. We can do this we can make it work if we set goals with a strategy and execute it all the while measuring and studying its effect and outcomes