Author Archives: Mitesh Patel

Connected Health Approaches to Improve the Health of Veterans

Nov 12, 2014, 1:00 PM, Posted by Mitesh Patel

Mitesh S. Patel, MD, MBA, MS, is an assistant professor of medicine and health care management at the Perelman School of Medicine and the Wharton School at the University of Pennsylvania. He is a staff physician and core investigator at the Center for Health Equity Research and Promotion at the Philadelphia Veterans Administration (VA) Medical Center. Patel is an alumnus of the VA/Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at the University of Pennsylvania (2012-2014).

Cardiovascular disease is the number one cause of hospitalizations, morbidity and mortality among the veteran population. Building a Culture of Health could address this issue by focusing on individual health behaviors that contribute to risk factors associated with cardiovascular disease such as physical inactivity, diet, obesity, smoking, hyperlipidemia and hypertension.

The current health system is reactive and visit-based. However, veterans spend most of their lives outside of the doctor’s office. They make everyday choices that affect their health such as how often to exercise, what types of food to eat, and whether or not to take their medications.

Connected health is a model for using technology to coordinate care and monitor outcomes remotely. By leveraging connected health approaches, care providers have the opportunity to improve the health of veterans at broader scale and within the setting in which veterans spend most of their time (outside of the health care system). The Veteran’s Health Administration (VHA) is a leader in launching connected health technologies. VHA efforts began in 2003 and included technologies such as My HealtheVet (serving approximately 2 million veterans) and telemedicine (serving about 600,000 veterans).

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Creating a System that Encourages Healthy Behaviors

Dec 27, 2012, 3:00 PM, Posted by Mitesh Patel

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While most people spend a few hours a year visiting the doctor, they spend another 5,000 waking hours without any direct contact from the U.S. health care system.  There has been an increasing amount of attention on how to design systems that encourage healthy behaviors among the population during their everyday activities.  Insights from behavioral economics provide opportunities to design systems that monitor, incentivize and provide feedback to encourage these changes. 

One proposal to change behavior is to increase price transparency in the U.S, with initiatives at the state and federal levels.  Lessons from other industries and concepts from behavioral economics demonstrate that this must be designed carefully to increase the likelihood that price transparency changes behavior. 

One example is the use of calorie-labeling in fast food restaurants.  While its intended outcome is to reduce consumer consumption, there are several reasons why it has thus far not been very successful. Consumers may not understand the caloric information or the problem may be self-control and not related to information at all. 

Using concepts from behavioral economics such as framing the information or making it more salient could improve its impact on reducing calorie consumption.

As the New Year approaches, millions of Americans will make resolutions to improve their diet, increase their exercise, or to quit smoking.  Let’s do our part to design systems that help our population meet their goals and increase healthy behavior. 

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

Improving Medical Education to Focus on Delivering Value to Patients

Oct 8, 2012, 9:00 AM, Posted by Mitesh Patel

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation Clinical Scholar and senior fellow at the Leonard Davis Institute for Health Economics at the University of Pennsylvania, a member of the AAIM-ACP High-Value, Cost-Conscious Care Curriculum Development Committee, and a practicing physician at the Philadelphia Veteran Affairs Medical Center.  He is also the author of Clinical Wards Secrets, a guide for medical students transitioning from the classroom to hospital wards.

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Health care costs continue to escalate.  Concurrently, the amount of published medical research has increased 10-fold over the last decade.  Each of these changes combined with recent health care reform has led to a rapidly evolving health care system.  Unfortunately, medical education has been unable to keep pace with these changes. 

Health care professionals find themselves searching for ways to deliver better value for their patients.  They are looking for an opportunity to become a part of the solution to stemming the rising costs while still providing high-quality, evidence-based care.

The American College of Physicians (ACP), the Accreditation Council for Graduate Medical Education (ACGME), and the Medicare Payment Advisory Commission (MedPAC) have each recognized these deficits among the health care workforce.  They’ve called for a restructuring of medical education to address these issues.  However, teaching hospitals and medical educators lack a common strategy to accomplish this daunting task.  To address these issues, my research team and I studied approaches to transforming medical education to help prepare providers to assess and deliver value-based care for their patients.

To better prepare a high-functioning health and health care workforce, we must start by gaining a better understanding of the problem.  In 2009, we published the first study that shed light on this issue on a national scale.  We found that among U.S. medical students, less than half felt they were appropriately trained in topics relating to the practice of medicine such as medical economics.  In addition, we found that a higher intensity curriculum in health care systems resulted in a payoff, not a tradeoff.

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