Archive for: January 2008

Health 2.0's Spring Fling: Connecting Consumers & Providers

Jan 31, 2008, 7:58 AM, Posted by Susan Promislo

Emily Culbertson attended and blogged about last fall's inaugural Health 2.0 conference, led by Matthew Holt of The Health Care Blog and Indu Subaiya of Etude Scientific.  Their next meeting is coming up March 3-4 in San Diego, and they'll keep this dynamic conversation going with sessions featuring:

  • Doug Solomon of IDEO talking about the optimal user experience for Health 2.0 destinations
  • M.D.s outlining ways patients should consider communicating with their doctors
  • CEOs of firms that are out in front when it comes to using the web and automated mobile and voice solutions to keep consumers healthy and engaged

To find out more and register, check out the Health 2.0 conference site.

Knowing What Works in Health Care

Jan 29, 2008, 9:10 AM, Posted by RWJF Blog Team

The IOM last week released a new report calling for an independent entity to assess clinical effectiveness and provide credible, unbiased information about what really works in health care. The report was commissioned by RWJF and Risa Lavizzo-Mourey, our president and CEO, issued a statement calling the IOM right to emphasize that the future of health care quality and safety rests on the strength of the evidence we collect, and on our ability to channel that evidence to providers, policy-makers, payers and consumers to help them make better decisions.”

Despite our tremendous medical advances, in reality we too often don’t know which treatment, policy or mix of approaches really works to improve people’s health in this country. As Lynn Etheredge, with the Rapid Learning Project at George Washington University, says, we are developing technologies faster than we know how to use them. We cannot say whether we are getting value for the high costs we pay. Ultimately, these pervasive evidence gaps contribute to the wide variation we see in the quality, costs and outcomes of care experienced by patients, and this makes a huge difference in people’s health.

The report’s call to action, if heeded by policy-makers and other stakeholders, would drive forward the field of comparative effectiveness research, which requires rigorous evaluation of the costs, risks and benefits of different treatment options for different medical conditions in different sets of patients.

Such studies, we think, can be done quickly and inexpensively using existing data. To support this vision, the Foundation is promoting the concept of a rapid-learning health care system – one that draws on large electronic health record databases (think Kaiser Permanente and the VA) that represent the experience of millions of patients. Harnessing the cumulative data power within a rapid-learning system would dramatically speed clinical research, supply needed knowledge about the value of existing and new medical technologies, and provide better safety surveillance.

At the same time, we’ve funded David Eddy, founder of Archimedes, Inc. to build the ARCHeS interface, which will enable far more decision-makers to use the predictive mathematical modeling power of the Archimedes model to answer a potentially limitless number of key health care questions.

We hope the IOM report helps the nation rally attention and resources toward strengthening the research and evidence base in health care. If reliable, unbiased and transparent evidence can be put in the hands of providers, policy leaders, patients, insurers and other key actors, it will go far toward creating a higher quality, safer and more cost-effective system for all.

Michelle Mello podcasts on health courts

Jan 22, 2008, 2:00 AM, Posted by RWJF Blog Team

Pioneer grantee Michelle Mello of the Harvard School of Public Health discusses health courts as an alternative to the current tort system for medical malpractice issues.

Opportunities, from Alice Gosfield

Jan 15, 2008, 12:00 AM, Posted by RWJF Blog Team

Alice Gosfield, Esq.’s entire 34-year legal career has focused on health law. Ms. Gosfield served as Chairman of the Board of Directors of the National Committee for Quality Assurance and was President of the American Health Lawyers Association. She is currently Chairman of the Board of PROMETHEUS Payment, Inc., a not-for-profit national multi-stakeholder project to develop a new provider payment model. (In the spirit of transparency, RWJF’s Quality/Equality team has made a planning grant to test the PROMETHEUS model.) Gosfield told Pioneer:

It occurs to me that there are five types of issues, some of which are quite different from the types of things you have funded and which may fall into the breakthrough category:

  1. Getting Guns off the Streets. If heroin, crack and meth addiction are a public health problem so is getting guns of the street. Using entertainment, video and completely different forms of communication to get guns out of communities and gunshot wounds out of the nation’s ERs seems an important issue that health care foundations are not addressing. There has to be a way of thwarting the desire to have the guns in the first place rather than controlling the selling of the guns...We are spending scarce resources in our health care delivery system on something that shouldn’t even exist as a problem.
  2. Community Created Health Resources.For many years, the view of the emergency department as a source for care for non-emergencies has been decried as a waste of money and resources. Urgi-centers, whether owned by hospitals to lower the pressure on ERs, or as feeders for their physicians and services, have never generated much in solution. The advent of Redi-clinics and Minute Clinics speaks to the need to get convenient care to where people are. Why isn’t there a Habitat for Humanity for health care resources so that people in a community who work to design and build their local health care resource could develop a real stake in the ongoing process of receiving care much the way building a home creates a connection with maintaining it?
  3. Resolving the Tension between Standardization and Innovation. How can we increase quality and expand access—where economies of scale actually arise in a capitalist structure—if we are focused on standardized medicine and centers of excellence? The tension between increased standardization to science for quality, and both innovation in clinical delivery processes as well as diffusion of resources to meet access and convenience issues, has not yet been addressed with breakthrough solutions.
  4. A Fresh At Look Health Care Payment Systems. Today the poles in the health care payment world are defined as a government- sponsored universal health system or consumer driven health care, which often is code for high deductible, tiered health care network employee based insurance. There has got to be more creativity available on this. Everything I read is from the same guys from the same orthodoxies writing in the same journals complaining about the same stuff but not creating or proposing anything really new. More focus on payment mechanisms that engage customers of health care in their own care delivery without merely requiring them to be responsible for co-pays would give them a stake in the game. It would also advance us well beyond what the last 50 years of employer sponsored health insurance has created.
  5. Regulatory Systems That Protect People and Foster Innovation.Patient safety is not adequately addressed in current regulatory mechanisms. The many ways in which licensure regulation impedes real quality is insufficiently known and some real breakthrough thinking would be interesting and would have impact on other issues including access, payment and consumer-engagement.

Opportunities, from Wylie Burke

Jan 14, 2008, 12:00 AM, Posted by RWJF Blog Team

Wylie Burke, MD, is an expert in the implications and appropriate use of genetic information in clinical and public health practice. Her research addresses the bioethical and health policy implications of genetic technology. She is currently Chair, Department of Medical History and Ethics, and Professor of Medical History and Ethics, University of Washington School of Medicine, has served on the NIH National Advisory Council for Human Genome Research and the Secretary's Advisory Committee on Genetic Testing, and is formerly the President of the American Society of Human Genetics.

Burke suggested several areas in which Pioneer could, she felt, play a stronger role:

Genomics

Given the claims currently being made for the transformation of health are by genomic technologies, it is striking that no project – at least by the descriptions given—seems to be addressing this area. The claims for genomics seem badly in need of critical and pragmatic assessment, so this might be an area for future investment.

Evidence-Based Medicine

This seems to be an area of under investment. There do not appear to be any projects in your portfolio that are looking critically at how evidence is used to craft practice guidelines, or what constitutes relevant evidence for health care practice. These questions represent important corollaries to investigations of patient-centered care, patient measures of health care quality and efforts to decrease the cost of health care.

Boundaries of Health Care

I think there is a need to explore the concepts of health and health care and their relationship to the obligations of health care providers and delivery systems; and to consider these issues from the perspective of emerging technologies. If we assume that decisions about the delivery of health care service should be based on evidence of outcome benefit and wise use of resources within the health care commons, how do we decide when an activity is part of healthcare or a covered service? How do different stakeholders approach the issue? What are the implications for innovative funding? e.g. of workplace prevention, residentially based health care, or delivery of screening in a consumer service model.

Social Networks and Structures at Older Ages

Recognizing that end of life care is an area of active research, there still seems ample opportunity for considering innovations informed by interdisciplinary thinking, in particular about how ideas in diverse areas like architecture, bioethics, public health, and preventative medicine might work together to promote high quality of life for low-income elders.

Needed Research

Many health care services are provided without a robust evidence base.  This problem speaks to several needs:

  • Policy Analysis to identify the barriers and incentives for different types of research
  • Rigorous assessment of the evidence need to justify different kinds of medical innovation. How can we make best use of less expensive methods of gathering evidence? When is a Randomized Clinical Trial necessary?
  • Consideration of some problematic issues in research ethics: e.g. performing research without consent to address important health care problems (such as optimal management of patients in cardiac arrest or precipitous pre-term labor) building data repositories in clinical settings; public health interventions among disadvantage populations.