Notes & Links: November 15, 2013

Stefan Larsson: What doctors can learn from each other
An important TED talk about creating patient value in healthcare through outcomes that matter. At the center of this talk is the very simple idea of when physicians share with each other their clinical work (i.e.say hip replacement) and through that sharing create a list of outcomes that patients value those physicians improve outcomes and lower costs. Larsson identifies this as continuous improvement since this process of meeting, sharing, and ranking physicians work happens annually. What occurs is that those physician who may be at the bottom half change behavior and move up. New techniques are introduced and those who may have moved down on measured outcomes can now move up.

What strikes me hearing this talk is that it mimics constructivism which simply stated is the process of integrating new knowledge with existing knowledge to create new. That is what is occurring here is discovery, it is linking new information to prior knowledge and helping physicians improve care.

Most TED videos are brilliant but this one touches on so much we are doing and talking about regarding healthcare.

Obamacare And The End Of Employer-Based Health Insurance
Peter Ubel contributing to Forbes does and excellent job of clearing the underbrush in our current employee based healthcare system. Next he tackles Analysis & Commentary from Health Affairs “Will Emplyers Drop Health Insurance Coverage Because of the Affordable Care Act? written by Thomas Buchmueller et. al. out of University of Michigan. What is interesting in this analysis by Ubel is that he demonstrates why large companies can afford to keep giving health insurance and small ones don’t.

Because of their large size, these companies are able to negotiate lower premiums with insurance companies, because they have enough employees to reduce their actuarial risks. If a company employing 10 people is unlucky enough for one of their employees to experience a serious cancer diagnosis, for example, the insurance company offering coverage for this company will lose money on that company’s business. By contrast, there is not much chance that a company with 5000 employees will have 500 of their employees develop cancer over the next year. Big numbers reduce risk. And reduced risk means lower insurance premiums.

So on my reading large companies are behaving in classic free market economics. They can afford to offer insurance since there is a pooled risk. Small companies can’t. Therefore small companies can’t compete.

Offering healthcare to all and trying to make it affordable we are improving competition. Though the cost, which Ubel presents in the next few paragraphs works against the small company due to wages paid. On some level we need to consider ACA as a tool to help not just people live longer and better, we need to think of it as a way for small companies to compete for talent with the large companies.

Performance measurement and the new cholesterol guidelines
Rcentor at db’s Medical Rants takes a moment of clarify the new cholesterol guidelines and put them into perspective.

The new cholesterol guidelines have responded to a series of studies and analyses that have made clear that lowering the cholesterol is not the magic goal, rather statins (which clearly lower cholesterol) are “magic” but probably because of their pleiotropic effects.

The primary consideration here is that doing performance measurements based on guidelines may miss the point and it takes time to correct course. Once you’ve read the new guidelines take a look at this for its measured thoughts on why these new guidelines are important.

What Closed Circuit TV Can Tell Retailers About Customers
Streetfight interviews Steve Russell the founder of Prism Skylabs that is a startup in Sand Francisco who offers retailers software to analyzes video streams looking at traffic, heat maps, etc. It is interesting that those CC videos used to catch shoplifters at Barney’s, Wrongly. Can not be used to analyze customers behavior.

It’s a shame that we can’t use this to measure the behavior of patients on learning about their health and what they do with data. It can be done but not as easily as watching a video tape.

The Myth of Patient-Centered Care
Steve Wilkins posting at Healthworks Collective makes a cogent and important argument and solution to

Findings from BJM Quality and Safety article, and other like it, suggest that health care providers today are no more patient-centered in the way they communicate with patients than they were 30 years ago when research into the dynamics of physician-patient communication first began.

Even though physicians failure to inquire about patients expectation is not about understanding how important it is. It was lack of communications skills and know how. They do what they did 30 years ago which is not much.

But Wilkins jumps into the fray with a solution

Helping raise awareness of the state of physician-patient communications in the U.S. is why I have taken the lead in bringing together some of the leading authorities in the physician-patient communication filed to organize the Adopt One! Challenge. Adopt One! challenges physicians across the country to take the first step by committing to adopt one new patient-centered communication skill in 2014.

It is nice to see people looking at strategic solutions based on data.

America’s cancer care crisis-is Europe any better?
Lawler, Duffy, La Vecchia, et. al. writing in The Lancet points out that America’s cancer care crisis and how optimum health care and raising costs are driving inequalities in treatments and outcomes. The authors examining the International Cancer Benchmarking Partnership (ICBP)  that those issues demonstrated in America exist in Australia, Canada, and Sweden. And cancer mortality remains higher in central and eastern Europe than the rest of the continent, largely due to delayed diagnosis or access to treatment.

Another issue common to the IOM and ICBP reports is inequality in treatment of elderly people with cancer. Ageism in intention to treat could have profound negative effects on cancer outcomes, particularly in view of recent projections of population ageing. Unless our philosophy for treating older patients changes fundamentally, the welcome increase in cancer survivors that we are currently experiencing will be reversed.

Hard to consider that any gains we’ve made in cancer diagnosis and treatment may reverse. Well I guess we can say here is one statistic where we on par with other developed countries.

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