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Friday, September 1, 2017

Coming up in one month, THE Health IT event of the year

As I've previously noted recently in some detail here. Will it commence amid the turmoil of a FY September 30th Trump federal shutdown? Or, will the exigent upshot of Hurricane Harvey force the hands of the Executive and Legislative branches to deal with far more pressing matters -- like actual responsible adults?

(Or, will Kim Dim Sun successfully jerk the POTUS chain?)


I got onto this book via one of my LinkedIn group email updates.

I signed up to get the frisbee pre-pub free pdf download copy. Just started digging into it.



Ran across this in back of the book (I'm jumping around in it):

“Healthy citizens are the greatest asset any country can have.” ― Winston S. Churchill 

As health benefits get a major overhaul in the employer arena and policymakers determine where publicly paid health care programs will go, we believe it’s imperative to take a fresh look at how we’ve organized our health care “system.” One area of near-universal agreement is that we should expect far more from our health care system, given the smarts, money, and passion poured into health care. Simply shifting who pays for care does little to address the underlying dysfunction of what we pay for and how we pay. 

A group of forward-looking individuals have developed a vision for Health 3.0 to address the future of care. It is a common framework to guide the work of everyone from clinical leaders to benefits professionals to technologists to policymakers. Each should ask whether their strategies, technologies, and policies accelerate or hinder the journey to Health 3.0. If Health 3.0 is the North Star, the Health Rosetta is the roadmap and travel tips on how to get there. 

To fix health care, we need a common vision for the future― Health 3.0 We believe this vision encompasses four key dimensions. 

1. Health Services (e.g. health care delivery and self-care)
What is the optimal way to organize health services so they build on the strengths of each piece of the health puzzle, rather than operating as an unmatched set of pieces (today’s world)? Innovative new care delivery models create a bright future (that some are already experiencing) where every member of the care team is operating at the top of his or her license and is highly satisfied with his or her role—a stark contrast to Health 2.0, where only 27 percent of a doctor’s day is spent on clinical facetime with patients. Put simply, they didn’t go to med school to become glorified billing clerks. 

2. Health Care Purchasing
Underlying virtually every dysfunction in health care is perverse economic incentives. Various industry players are acting perfectly rationally when they do things that are counterproductive to achieving Health 3.0. The Health Rosetta and Health 3.0 outline the high-level blueprint for how to purchase health and wellness services wisely. We’ve seen how a workforce can achieve what one health care innovator has described as “Twice the health care at half the cost and ten times the delight.” 

3. Enabling Technology
Technology only turbocharges a highly functional organizational process when the proper organization structure, economic incentives, and processes are in place. Unfortunately, health care breaks the first rules I learned as a new consultant fresh out of school— don’t automate a broken process and don’t throw technology on top of a broken process. Sadly, health care is riddled with these two common mistakes, stemming from the flawed assumption that technology alone can be a positive force for change.

4. Enabling government
At the local, state, and federal level, government can play a tremendously beneficial (or detrimental) role in ensuring healthcare reaches its full potential. There are four main ways that government entities contribute. 

  1. As an enabler of health (e.g., public health and social determinants of health) 
  2. As a benefits purchaser, since government entities are large employers who can accelerate acceptance of new, higher-per- forming Health 3.0 care models 
  3. As a payer of taxpayer-funded health plans 
  4. As a lawmaking or regulating entity
The first item, in particular, is frequently overlooked as a powerful tool for testing and refinement of new models of care payment and delivery. 

Failings of Health Care 1.0 and 2.0
Before defining Health 3.0 further, it’s important to outline the failings of Health care 1.0 and 2.0. Dr. Zubin Damania (aka ZDoggMD) describes the positive facets of Health care 1.0 and Health care 2.0 but also gives the two earlier eras of health care a stinging rebuke. 

Behind us lies a long-lost, nostalgia-tinged world of unfettered physician autonomy, sacred doctor-patient relationships, and a laser-like focus on the art and humanity of medicine. 

This was the world of my father, an immigrant and primary care physician in rural California. The world of Health care 1.0. While many still pine for these “good old days” of medicine, we shouldn’t forget that those days weren’t really all that good. With unfettered autonomy came high costs and spotty quality.
Evidence-based medicine didn’t exist; it was consensus and intuition. Volume-based fee-for-service payments incentivized doing things to people, instead of for people. And although the relationship was sacred, the doctor often played the role of captain of the ship, with the rest of the health care team and the patients subordinate.

So, in response to these shortcomings we now have Health care 2.0. The era of Big Medicine. Large corporate groups buying practices and hospitals, managed care and Obamacare, randomized controlled trials and evidence-based guidelines, EMRs, PQRS, HCAHPS, MACRA, Press Ganey, Lean, Six- Sigma. It is the era of Medicine As Machine...of Medicine As Assembly Line. And we—clinicians and patients—are the cogs in the machinery. Instead of ceding authority to physicians, we cede authority to government, administrators, and faceless algorithms. We more often treat a computer screen than a patient. And the doc isn’t the boss, but neither is the rest of the health care team—nor the patient. We are ALL treated as commodities...raw materials in the factory. 

Health 3.0 Vision
Dr. Damania goes on to describe Health 3.0 as follows: Taking the best aspects of 1.0 (deep sacred relationships, physician autonomy) and the key pieces of 2.0 (technology, evidence, teams, systems thinking), Health 3.0 restores the human relationship at the heart of healing while bolstering it with a team that revolves around the patient while supporting each other as fellow caregivers. What emerges is vastly greater than the sum of the parts. 

Caregivers and patients have the time and space and support to develop deep relationships. Providers hold patients accountable for their health, while empowered patients hold us accountable to be their guides and to know them—and treat them—as unique human beings. Our EHRs bind us and support us, rather than obstruct us. The promise of Big Data is translated to the unique patient in front of us. Our team provides the lift so everything doesn’t fall on one set of shoulders anymore (health coaches, nurses, social workers, lab techs, EVERYONE together). We are evidence-empowered but not evidence-enslaved. We are paid to keep people healthy, not to click boxes while trying to chase an ever-shrinking piece of the health care pie. Our administrators seek to grow the entire pie instead, for the benefit of ALL stakeholders…
Well, I don't see any use of "Health 3.0" referent trademark symbols (maybe we can put Robert Budzinski's lawyers on it). But, I can see the Health 2.0 folks not digging the the use of the phrase. And, I rather doubt that Indu and Matthew would agree with the characterization of "Health 2.0" above.

BTW: The Dave Chase book continues with an "Appendix F" further characterizing "Health 3.0." -- "Health 3.0 Vision: Implications for Providers, Government, and Startups."
Health care is frequently a jumble of uncoordinated silos organized around medical technology, rather than people. This has led to a suboptimal experience for both patients and clinicians. This is often made worse by incentives that run counter to optimizing health outcomes. [ibid, pg 257]
Can't really argue with that.

Mr. Chase's book will be released for sale on Amazon on September 5th.Stay tuned, I've much more to read and assimilate in my copy.

BTW, given the thrust of this book, you might want to triangulate with "An American Sickness."


Even my own professional society has gotta get in on the "version enumeration" act. From my inbox recently:

Lordy. Whatever. Maybe we should just ditch the long-passe word "quality" anyway. How about "Disruptive, Innovative, Lean, Agile, Excellence 2.0?"


I seem to have precipitated a bit of a Twitter kerfuffle.

All of it matters, acutely. Data, InfoTech, Med/BioTech more broadly, pharma, process QI, basic and applied science, clinical training, empathy, organizational culture, just market economics, rational policy... All of it.



More to come...

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