The KHIT Blog: Health 2.0 #WinterTech 2017

Monday, January 16, 2017

Health 2.0 #WinterTech 2017

Following up on my prior post. Above, Julia Morgan Ballroom, 465 California Street, downtown San Francisco, 7 a.m., the calm before the storm.

Above, the emblematic WinterTech 2017 slide of the day. The recurrent major topic was that of speculations as to the future of "Obama Care" (and specifically what it portends for #SiliconValley and venture capital investments in Health IT) under the incoming Trump administration. Below, the signature of Tea Party Republican Dr. Tom Price (orthopedic surgeon) of Georgia, Trump's nominee for the next Secretary of HHS." The Price is Right?"

Above, an audience phone-text poll on the likely alternative futures of Obama Care under Trump. "Obama Care Lite with Slowed Value" was the winner with about 2/3rds of the vote. ("Obama Care Lite" meaning that "repeal" measures will be in large measure "cosmetic" -- meant to be political pacifiers, while core coverage elements of the ACA will remain quietly in place, with some decrements in "value" QI initiatives).

Anybody's guess at this point. As I write, it's Monday Jan. 16th. This headline blares forth online at HuffPo:

President-elect Donald Trump says he’s putting the finishing touches on his plan to replace Obamacare.

It sounds absolutely terrific, like the best health plan ever!

It also sounds wildly out of step with what Republicans in Congress, or even some of Trump’s own advisers, have said they would like to do.

Trump’s comments, which he made in an interview with The Washington Post that appeared Sunday, could mean he’s gone rogue and decided that, at least on health care policy, he has more in common with Sen. Bernie Sanders (I-Vt.) than House Speaker Paul Ryan (R-Wis.).

Or they could mean that, in reaction to public anxiety and recent protests over the possibility of more than 20 million people losing insurance, Trump is already misleading people about what he and his Republicans are planning to do.

Or Trump’s statements could mean that he has no idea what he’s talking about...

You're gonna get cognitive whiplash trying to stay abreast of this stuff.

Succinct summary update of the day's highlights in my inbox:

Co-host Indu laid out the day's WinterTech themes at the outset, based on emergent trends stemming from 2016:

New care delivery models;
New insurance models;
Technology advances;
Analytics;
Emerging (non-U.S.) markets.

If there was any consensus coming off the stage as to where things are headed, it was a prediction of inexorably increasing patient "OoP" (Out of Pocket) participation in health care expenditures, and whatever that may imply for "innovative care delivery" and other "consumer-facing apps" models.

BTW: The policy debate has been fairly raging over at THCB these days. I mostly stay out of the comments of late. Let these (mostly untraceable screen name) know-it-alls have their respective contending says.

To me, health care policy arguments ignore a couple of fundamental things. First, there's the "Ich/Du/Sie" PoV problem:

I deserve full, affordable first-dollar indemnity coverage for my medical misfortunes;

You need to have significant "skin the the game" to inhibit you from overutilization, which drives up my costs;

He is a mooching parasite, a free-rider driving up my costs.

Then there's the ideologically glossed-over actuarial reality:

Health care UTIL risk is roughly, speaking of only adults in E-Z round numbers, a 60-year proposition tightly coupled in the aggregate with age (in sort of "hockey stick" fashion). We have long known this. Yet we continue to insist on selling "coverage" (much of which is 3rd party-intermediated "pre-payment," not "insurance") in one-year chunks (wherein everyone thinks they're getting screwed on both the insuree and insuror sides). None of the ensuing administrative paper-shuffling going to deductibles, co-pays, coinsurance, and other fine-print policy babble adds any value to actual care delivery (notwithstanding its profitability to the intermediaries).

Of course, the alternative would be the "social insurance" model now decidely out of favor with the GOP.

Agggh...
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Some random photos from WinterTech...

All told, an interesting day, notwithstanding the intractable equivocality of the myriad learned opinions set forth.

Met some cool people.

Aristotle Mannon, Founder and CEO of bosWell. "Client data collection, made simple.
bosWell provides free web-based record keeping and reporting tools for community based organizations."
Ursula Hessenflow, CEO and Co-Founder, myLAB Box. "myLAB Box is a first-of-its-kind service that delivers STD screening solutions to your doorstep allowing you to keep private things private."

I spoke with a young woman with the company DesignMap, one of the WinterTech booth vendors.

"User experience design to improve the workplace."
"DesignMap brings years of experience from internal teams, startups and enterprise tech firms to deliver smart  solutions to make enterprise software great."

I asked her a number of questions going to EHR "usability" (UX). I don't think she understood the drift. I got nothing but generalities. I expect to have better luck when I do a follow-up with ElationHealth.

BTW, in the context of "Venture Capital," it's worth revisiting my recent citing of Steve Tobak's fine book. I still think Steve would be a great WinterTech panelist.

ERRATUM

My latest book.

From the Conclusion:

Public ignorance means power for institutions, because it lowers the probability of accountability. Institutions are built on delegation of decision-making, which allows a division of labor and the development of expertise. Yet delegating choice also creates the opportunity for abuse, for an agent to take hidden actions against the principles interest or to use limited knowledge about options to pursue an agenda the principal would not favor if fully informed. Information costs involving uncertainty about quality or trust often drive choices away from markets and into the hierarchical structure of firms. Information costs contribute to him perfectly functioning markets when there are negative spillovers like pollution, anti-competitive acts and cartels, or asymmetries in knowledge about goods and services such as with credit, insurance, and healthcare industries...

Theranos, anyone? apropos, see my recent post "2017: Disruption ahead on all fronts, for good and ill."
____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
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"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Monday, January 16, 2017

Health 2.0 #WinterTech 2017

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