Lake Wobegon was a place where “all the women are strong, all the men are good looking, and all the children are above average.”  We all recognize that Lake Wobegon is a quaint fiction; so why then do we act as if our doctors and hospitals come from a place where all are superhuman and there are no below-average doctors or hospitals?

A recent article in the WSJ highlights the benefits of using top-rated hospitals…that by making transparent the success rate of various procedures in Pennsylvania, companies that work with the best performing hospitals find significantly better outcomes for their employees…and save lots of money.

Although at times premium care can be exorbitant, there’s evidence some in Pennsylvania saved money using top-rated hospitals. Hershey Co. offered workers medical coverage based on the state agency’s reported outcomes, and cut the company’s expenses by 50% over several years. The Philadelphia police union’s benefits-management company says it uses the state reports to steer officers to the best hospitals; as a result, it say its costs fall about 17% below those of comparable plans.

Tom Lamb, administrator of Philadelphia police health benefits, says he frequently explains to members why they should go to hospitals with better outcomes. “If an officer’s 7-year-old daughter has to go in for surgery,” he says, “I’ll sit down with the father and say, ‘Are you just going to shake your head yes when your pediatrician wants to send her to his golfing buddy?’ ”

So what is keeping us from seeing the tremendous shift of patients from sub-par to above-average performers?  In a word…its a coverup.  Data allowing consumers to objectively understand performance have been kept from them…so that there is no objective way to compare performance.  Payment via claims is locked into a group discount model…better performers see no rewards financially or through transparency.  Reputation tends to be based on institution rather than individual performance…and so varies tremendously between physicians.

It is differentiation…and the celebration of better performance that pushes the rest of our economy to offer better, more segmented value propositions to sophisticated consumers.  Why, when it comes to our health, are we left to hope that we get lucky and get someone above average?

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Check us out at http://blog.consumerfocusedhealth.com

Can you handle the stream?

HealthStreaming is something that I’ve been thinking a lot about lately. We have all kinds of streams of data that help us make decisions these days: blogs, reviews, recommendations, financial data, etc. When I look at the data we’re gathering on the health side, I see a real disconnect: its primarily billing and clinical data built for doctors, hospitals, and insurance companies rather than the information that would help me to understand and improve my health.

Its not a surprising state of affairs: the consumer is not the customer of health care today, and information is gathered to meet the needs of health insurers, employers, providers, vendors (incl. pharma) and researchers. I would assert that most of this stuff in its current form is useless to consumers.

Yet, if we want to capture the experience and personalization we see in other places in our lives, we need to create the HealthStreaming infrastructure that captures and aggregates the data that actually matters for consumers as we all make our own health choices. As we’ve seen with EMR and PHR adoption rates, platforms like Google Health or Microsoft HealthVault are unlikely to take off until the data we want to use follows us with little effort, and killer apps allow us to use them in ways that transform our lives.

So what are the pieces of data that will matter as we start HealthStreaming?

• Social activity: What are our friends eating? Where are they exercising? What treatments have alleviated their problems or made them feel better? Everyday health decisions have a huge impact…and our everyday health decisions are shaped by our social networks. Nike’s done some interesting things with Nike+ and fitness across teams starts with school sporting programs and events from marathon training to run-walks.
  
• Desired health experience: What are our preferences in a health experience? How do we make trade-offs between convenience, quick solutions, and in-depth 1 on 1 time? Do we want the world’s expert or a simple solution? Do we want the best or good enough (at a discount)? If my wife loves the gym and I’d rather play sports outside, then for the same goal, there are two very different ways we should be engaged…and companies approaching us should know this and message accordingly. My company, HealthShoppr, is focused on creating a much more targeted health experience with every appointment. Zagat’s partnership with WellPoint and BCBS MN’s The Healthcare Scoop are other entities in the space. There are, of course, a number of companies laying out the infrastructure to deliver a better experience from MinuteClinic to Myca/ Hello Health to American Well.
• Personalized health risks and solutions: Where does my health stand today? I want to know what my risks are based on my genes and my health history and activities and conditions. I also want to know what interventions or programs will make the most difference for me or solve an issue in my everyday life. Michael Roizen’s RealAge is an example of making overall risk easy to understand. Phreesia is tracking our medical history and distributing it to the point of care. On the solution side, PatientsLikeMe, DiabetesMine, Disaboom capture the wisdom of crowds from those living with a disease. Leslie Michelson (Private Health Management) is allowing individuals to buy personalized research from the world’s experts (Best Doctors has a similar service).
• Activity tracking: How many calories did I burn? How long was my training in desired zones? How many calories did I eat? Did I remember medications? When did I feel pain? What made me feel bad/ good? What’s happening as I look at specific biometrics? All of these things need to be tracked easily and recalled in a way that allows us to learn what makes a difference. People like Neal Spruce (BodyBugg/DotFit), Adam Bosworth (Keas), Nike+, FitBit, are measuring what we do. Electronics manufacturers and tech companies are helping us to record what is happening with our bodies

As we begin to utilize data coming from HealthStreaming to truly make health care consumer-centered, I believe we’ll find that most of the existing data will be supplanted by new sources more relevant to individuals and the way they live their lives (much of today’s information is heavily clinical and focused on 3rd party billing).

Where do you think the HealthStreaming opportunities will be? How will those companies look different than those in today’s Health IT community?

We believe there is a better way.

This belief is founded in the idea that aligned incentives can be a powerful way to spur innovation and seek breakthrough ideas from the most unlikely sources. Many of the reform ideas being put forward may not include some of the best thinking, the collective experience, and the most meaningful ways to truly implement change. To address this issue, the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize for health care innovators to implement a new model of health. The focus of the prize is to increase health care value by 50% in a 10,000 person community over a three year period.

The Healthcare X PRIZE team has released an Initial Prize Design and is actively seeking public comment. We are hoping, and encouraging everyone at every opportunity, to engage in this effort to help design a system of care that can produce dramatic breakthroughs at both an individual vitality and community health level.

Here is your opportunity to contribute:

1. Download the Initial Prize Design
2. Share you comments regarding the prize concept, the measurement framework, and the likelihood of this prize to impact health and health care reform.
3. Share the Initial Prize Design document with as many of your health, innovation, design, technology, academic, business, political, and patient friends as you can to provide an opportunity for their participation

We hope this blog rally amplifyies our efforts to solicit feedback from every source possible as we understand that innovation does not always have a corporate address. We hope your engagement starts a viral movement of interest driven by individual people who realize their voice can and must be included. Let’s ensure that all of us – and the people we love – can have a health system that aligns health finance, care delivery, and individual incentives in a way that optimizes individual vitality and community health. Together, we can ensure the best ideas are able to come forward in a transparent competition designed to accelerate health innovation. We look forward to your participation.

This post was written by Scott Shreeve, MD in behalf of the X PRIZE Foundation. Special thanks to Paul Levy for both demonstrating the value of collaborative effort and suggesting we utilize a blog rally for this crowdsourcing effort.

You must reward the innovators in order to see those changes scale and continue to improve.

In the debates on health reform, you can’t just look from the macro perspective and say waste exists and should be eliminated. No one will voluntarily take a pay cut, and all of that waste is someone’s pay.

Instead, we must reward those that do a better job; the companies that we want to grow because they offer us higher quality, better prices, or both. Those companies need to benefit by being able to grow market share, selling products at an attractive margin, or both.

As we evaluate the various health reform proposals out there, the question that should be asked is: how are we setting this up so the person who’s solution best meets the described goals can increase their profits and scale their solution?

Unfortunately, most of the reform proposals out there focus on unilaterally cutting reimbursement (without giving increased profits to those that deliver better results) and distorting the market through mandates. Neither will put in place the sustainable incentives needed to drive increased efficiency over time.

We must find a way to reward Virginia Mason for cutting imaging by 30%, Ascension Health in Texas for eliminating Neonatal Birth trauma, ICP The Hospitalist Company for following up with early post-discharge concerns in 20% of those 24 hours post-discharge, Geisinger for taking the risk on complications with its “warranty” program.

How do we ensure that we reward and help to scale the programs that these innovators have started instead of watching the “death to innovators” cycle:

1. Implement program to eliminate clinical events
2. Succeed in eliminating clinical events
3. Watch revenue decline from lost volume from the eliminated clinical events
4. Get angry calls from CFO
5. Contain and/or eliminate the innovation to prevent further damage to the bottom line OR watch company fail

Until we stop systematically killing off the innovators who eliminate the need for care, we will never see the proactive system we all want for our families.

The view that a single entity is required to execute a given task is no longer a given in a world where smaller companies can use outsourced services to appear much larger and large companies outsource everything to smaller companies.

Take for example, Dell. Dell has become primarily an aggregator which allows customers to customize their computer primarily by giving them access to all the options in the supply chain through an easy-to-understand user interface and through the experience of running all communications through that one company’s brand.

Who are the aggregators in health care that help us similarly understand our choices and make appropriate selections? That entity does not exist today in the consumer world…it has been filled by payors in the employer world.

As we move to a world that increasingly must organize around the individual, who will be the aggregators that make health easy to understand for the consumer and allow them to make the best decisions for themselves?

Anyone else in town?

If we are what we measure, what should we be measuring to determine what return we’re achieving for our healthcare dollar?

What metric would you use to highlight the improved outcomes of a better-performing health system?

Some thoughts I’ve heard:

• Death
• Major morbidity
• Hospitalizations
• Sick days
• QALY
• % “passing” President’s Fitness test

What do we want our health dollar to buy? Appreciate your thoughts!

As some of you know, I’ve taken a new role with the X PRIZE Foundation…they offered me an amazing role in designing a X PRIZE for healthcare– finding the market failure in the health sector that can best be solved by a competition for a $10M+ prize.

The mission is amazing…define a competition to showcase competitors that will definitively improve quality while reducing costs. The execution will be challenging– defining the appropriate scope of this particular prize where teams can clearly understand the start and finish lines and a clear winner can emerge.

At present, we’re looking to define the best space to start, so please let me know if you would like to share your insights on addressable issues that would make for a good competition.

HealthShoppr.com continues to grow…we’ve seen an amazing growth in massage therapists posting profiles over the past 6 weeks and look forward to continuing to push the boundaries of transparency and personalization in finding a best fit health professional.

Here’s to healthy innovation in healthcare as we kick off 2009!

Happy New Years to all!

We’ll get back to policy issues shortly…