health care delivery


Wonk Alert: New Boston-Launched Journal On Health Care Changes

I strongly suspect that Boston is home to more health policy thinkers than anywhere else beyond the Beltway.

We have stand-alone institutes and foundations; we have university departments; we have hospital and health-insurance strategists; we have state employees ever more familiar with putting health reform into practice. And we have lots of Doctors Who Think. (No offense; that’s just a play on the old blog Mothers Who Think.)

So it makes copious sense that, as Chelsea Conaboy reports in the Globe’s White Coat Notes, two policy-oriented Boston doctors are launching a new journal focused on changes in health care “delivery.” She writes:

A pair of Boston physicians with experience working on national health policy are launching a new journal focused on changes in the health care system, including new payment methods. Drs. Sachin H. Jain and Amol Navathe expect the first issue of Health Care: The Journal of Delivery Science and Innovation to be published next summer.

Jain and Navathe began planning the journal, which will be published by Elsevier, while in D.C. together last year.

And: Continue reading

What The Rich U.S. Health System Can Learn From The Poor

A trio of superstar health innovators have a message for the broken U.S health care system: broaden the definition of health to include basic life necessities, bring care to where people live and study how it’s done in poor countries where you can’t always rely on expensive tests and drugs to make people better.

The persuasive new report on “re-aligning health with care” is written by Harvard doctors Paul Farmer (co-founder of the medical nonprofit Partners in Health) and Heidi Behforouz (executive director of the Prevention And Access To Care And Treatment [PACT] program) and Rebecca Onie, CEO of the nonprofit Health Leads. In it, they argue that with some rethinking, the U.S. can deliver better care at a lower price.

They lay out the central problem here:

The health care system is in crisis, driven chiefly by escalating costs, suboptimal health outcomes, scarce primary care resources, and rising poverty. At the same time…a growing number of health providers around the globe have learned to deliver high-quality health care at low cost. Now we need to align our resources in the United States to bring this knowledge fully to bear in saving dollars and lives.

Sounds great, but how to do it? The key, they write in the Summer 2012 edition of the Stanford Social Innovation Review is to change the way we view the “product” of health care, the places it’s delivered and the providers who dole out patient care. Continue reading

Xconomy: Angel Aims To Invest In Cutting Health Costs

The ever-smart Xconomy has just published this interview with an angel investor, Anna DeGheest, who says that health care delivery, long considered boring, is looking hot, hot, hot. Luke Timmerman writes:

New drugs and devices represent about 16 percent of the total $2.5 trillion U.S. healthcare market, she says, while the rest of the market is focused on the delivery side of healthcare, like the everyday transactions that happen at hospitals and clinics. Now that President Obama’s healthcare reform effort is the law, and most everyone agrees that healthcare costs need to be somehow corralled, it’s time for a wave of innovative new healthtech companies that are focused on improving care and reducing costs—not adding new costs like with all those innovative drugs and devices.

“Venture capital and entrepreneurship have been focused on drugs and devices for 20 years,” DeGheest says. “I want to look at the other 84 percent of the market. Several forces are coming together at the same time, to change the way we practice healthcare in this country, in a way more cost efficient way.”

Readers, the business side is not my strong suit. Anna is a Silicon Valley type; are we already seeing something like this happening in Massachusetts? Is our reform — the last phase, or the current one — seeming to fuel investment in delivery companies?

Dr. Paula Johnson’s Call For A New Vision Of Public Health, Care Delivery

Dr. Paula Johnson, Chief of Women

Dr. Paula Johnson delivered a 40-page speech earlier this week on how the lessons of the civil rights movement can be used to galvanize a new movement in health care — to make quality health care more accessible, and to make it more meaningful so that all people, particularly those with limited means, can achieve better health.

I excerpted some of the speech in this post, but Dr. Johnson, Chief of the Division of Women’s Health at Brigham & Women’s Hospital, and Executive Director for the Connors Center for Women’s Health and Gender Biology, had more to say.

“We have not communicated the health crisis in this country,” she told me last night, after chairing a meeting of the Boston Public Health Commission, and dealing with her own children’s health issues, which involved her running home for a change of clothes and then heading back to Children’s Hospital.

She said people don’t realize that projections show that future generations have a shorter life expectancy, and that big thinkers on health care, as well as those working in the field, need to get together and figure out ways to make clear the urgency of the problems this country faces when it comes to the health of its citizens.

“Where do we need to innovate in health care?” she asked. “We tend to work in silos — health care delivery tends to take an individual approach, and public health takes a population approach. There’s real opportunity when you start to bridge those fields. You’ve got to take a 360 degree view.”

One example, she cites is the CAVU (Ceiling and Visibility Unlimited) Foundation, which has launched a project to prevent and treat childhood obesity in underserved communities like Roxbury. This program, Dr. Johnson says, looks at childhood obesity on several levels because you can’t fix the problem without accepting its complexity.

So CAVU brings kids into community health centers (those who are already struggling with obesity as well as those just trying to maintain a healthy weight) and works with them in teams on how to motivate good behavior. The program also works with the children’s families to help them understand more about healthy food and exercise. They offer food vouchers so the families can shop at local farmers markets, while at the same time working with the farmers on making their products more accessible and affordable to lower income families. Finally the CAVU administrators are working with city and state lawmakers to make changes in food policy.

“So, it’s working on the problem on a number of levels, and not allowing health care for an individual to separate itself from public health,” Dr. Johnson says.

If all this sounds like the seeds of a larger discussion, that’s because it is. Dr. Johnson is working on a new paper that challenges her colleagues in health care to do a better job bridging the gaps.

So stay tuned.

Adding Value To Health Care

In this week’s New England Journal of Medicine, Thomas Lee, network president at Partners HealthCare, writes about “value” as a unifying principle to help revamp both the cost and the delivery of health care at hospitals across the country. Value in health care is a concept promoted by Michael Porter, the influential professor at Harvard Business School, who has thrown himself into the minutiae of health care, analyzing what works and what doesn’t, and trying to tease out strategies to make medical care better for patients (and thus better for providers, payers and everyone else involved) and also more efficient and effective — in other words, improving value.

Lee writes about Partners’ nascent efforts to change its own entrenched systems, including how doctors are paid and how care is delivered.

The “bad news,” he says about “value” as an organizing principle is this:

Making progress in the value framework requires real teamwork, which sometimes seems an unnatural act in health care. It means capturing data in different parts of the delivery system, which means that we all have to use the exact same terminology. And it means sharing accountability for performance. Who should be held responsible if a patient with heart failure is not seen within 7 days after discharge? The hospital? The primary care physician? The specialist?

But, he says, there’s some good news too:

…difficult though they may be, these changes feel like the right thing to do. To improve outcomes and efficiency for patients with specific conditions, providers must organize interdisciplinary teams around those conditions. In my organization, teams focused on stroke, colon cancer, diabetes, and other diagnoses are currently developing “value dashboards.” They are identifying “pause points” in patient care and defining what steps should happen routinely at those points. An example might be ensuring that palliative care consultations are offered to patients with newly diagnosed lung cancer, a strategy that was recently shown to improve both the quality of life and survival. Each item on these “checklists” is being chosen because of the expectation that reliable performance should lead to better outcomes, greater efficiency, or both — in other words, improvement in value.

For more on restructuring the payment and delivery system, here’s Gary Gottlieb, Partners President and CEO, giving a speech now known as the “Case For Change.”

House Calls: Caring For A Very Sick Man, And An Incurable Young Woman

Part I:

When was the last time a doctor, nurse or any other medical provider spent more than an hour taking care of you — at your own home?

Well, it happened this week in Revere.

At 10 am on Monday, nurse practitioner Therese Willette stood outside a neat brick apartment complex on Lantern Road. She and a social worker named Jen Pinto were paying a visit to Rolando Guillama, an 81-year-old Cuban-born man who takes 18 prescription medicines to treat a laundry list of complicated conditions. He’s had a heart attack and bladder cancer, undergone aortic valve replacement, coronary artery bypass surgery and abdominal aortic aneurysm repair. He suffers from hypertension, chronic obstructive pulmonary disease, hyperlipidemia, depression, diverticulosis, peripheral vascular disease, a peptic ulcer, carotid artery stenosis, diastolic heart dysfunction, chronic kidney disease, and anemia.

“I had a lousy day yesterday, and a bad night,” wheezes Mr. Guillama, above the hum of his oxygen machine. His belly and ankles are swollen, his face is puffy. He looks exhausted. “When his feet were so swollen last night,” his wife, Joanne, chimes in, his body “started jumping.”

(Video with permission from Rolando and Joanne Guillama)

I tagged along to the Guillama home trying get a feel for the medical side of Commonwealth Care Alliance, the Boston nonprofit I profiled earlier this month, as part of our series on unique health care delivery programs. Continue reading

Berwick Quietly Planning Experimental Health Sites

Donald Berwick, head of CMS, seeks novel ways to deliver affordable, high quality health care.

Donald Berwick, the new director of Medicare and Medicaid is quietly orchestrating the rollout of hundreds of model health care sites across the U.S., where novel methods of delivering care and paying providers will be tested, The Boston Globe reports.

Berwick is using a tool that Congress included in the new health care law: an innovation center with $10 billion to spend over the next decade in a quest for the best ways of improving care and reducing costs.

The launch of the test sites by the end of 2011 is just a first step in changing the fundamental ways the government pays physicians and hospitals. Over 10 years, the innovation center’s work is expected to save $1.3 billion on the $500 billion annual budget of the Centers for Medicare and Medicaid Services…

A CMS spokesperson wouldn’t comment on which sites might be funded, or any other details of the program, but it seems clear that Dr. Berwick, the former CEO of Cambridge-based Institute for Healthcare Improvement, will back the kind of innovative projects that he’s been focused on for years: those that contains costs, hone in on patient safety and deliver quality care. Indeed, in January, before he took on his current post, Dr. Berwick told a gathering of health care experts in Boston that he was working with Atul Gawande (the surgeon, New Yorker writer and big thinker on health care) and others to identify regions of the U.S. that provide high quality medical care at costs lower than the rest of the nation.