Wednesday, 25 May 2016

Pricing, Product and Audience: Theranos and DTC Blood Testing

Is the Population Health Blog due for a meal of humble pie?



In this well-written Viewpoint published in JAMA, Stanford's John Ionnidis composes a Theranos requiem that ultimately questions the virtues of the company's low-cost and direct-to-consumer blood testing. He argues that while the solution of self-diagnosis and early treatment only sounds revolutionary. That pales in comparison to the far larger problem of misdiagnosis that leads to the reality of overtreatment.

Good point.  But, while Theranos' prospects are clouded, the PHB is still long on the underlying three point business model.  Theranos got one right, and the other two are within reach.

To wit,

1) The pricing is uncoupled from opaque insurer-based fee schedules and based on rational consumer-driven price points.

2) The product is health insights, not blood testing data.

3) The audience needs to understand the value-based outcomes  
 
The PHB explains:

1) Theranos stumbles over internal quality control and regulatory compliance issues will play out, and after a sufficient number of heads roll, will be addressed.  Once that's settled, consumer interest in being able to circumvent insurance and "buy" transparently-priced and OTC blood tests should remain considerable. Medicare's fee schedules are ultimately "cost-plus" which includes the costs of a highly inefficient care system. Think about that $500 stitch and it's little wonder why consumers are so willing to beat a retail path to Walgreen's door.

2) Consumer insights about screening blood tests come from combining the data with pre-test odds, sensitivity and specificity.  While a smart physician can certainly help patients navigate an abnormal liver test or a high cholesterol, distance technology combined with consumer-friendly machine intelligence (here's a simple example) can also. It's simply a matter of industrializing and democratizing what we've known for decades. And once consumers can understand tests' imperfections, things will equilibrate between under and overtreatment

3) For many reasons, healthcare is a different business. Among the many reasons for that is that "success" is particularly dependent on the need to understand the short and long term outcomes and costs (i.e. value) of any new care model. That means committing considerable resources to study, document, internalize and publicly report what was achieved at what price. An audience of scientists, regulators, providers, insurers, buyers, politicians, physicians and bloggers want to know: does open-range testing for Hepatitis C paired with education on false positive test results reduce the incidence and costs of cirrhosis or liver cancer?  Does consumer self-ordering blood glucose levels combined with post-test odds reporting increase awareness of otherwise undiagnosed diabetes and increase claims expense? Does DTC pregnancy testing.... oh, wait, we know that one. You get the picture.
 
If not Theranos, then some other company will profit from putting patients in at the center of lab testing.  The genie is out of the bottle.

Monday, 23 May 2016

Today is Your Monday to Make Fit Happen

How many Mondays have gone by without starting your fitness program? The day is here again and what are you doing to get closer to your goals? We have good intentions, want to get in shape but follow through is lacking.

It's time to put a stop to the excuses always getting in the way of our health. Health is our wealth and we couldn't be so busy without it. Think about that. Declining health equals no work, no social life, and no money. Not that money is or should be the most important thing in life.

Our priorities are skewed and our reasons to not get fit make no sense in the big scheme of life. We shouldn't wait to feel sick and tired of being sick and tired. Our lives require a priority overhaul. Living a life without health is not a quality life at all. When waking is greeted to popping pills to run our body there is something wrong. This shouldn't be an acceptable norm for society. This should piss you off and motivate change in your life.

Today is your Monday to make fit happen. Someday is no longer an acceptable excuse and doesn't qualify as a day of the week. Do you want to lose fat, look good naked, feel great, move better, and be more confident? Do you want to toss those pills prescribed from self-induced illness?

Change takes a choice and you're responsible for your health and fitness. Your busy lifestyle should include workouts and healthy food. Fitness is good time management. Make going to the gym one of your social hours and don't cancel. Take time to pack your healthy food instead of dashing to nearby restaurants.

You can achieve your goals by applying simple changes. It will be a progressive life-long journey. Life is meant to be enjoyed with a healthy, fit body. The choice is yours to make it happen. All in fitness love. Stay Healthy!

Are you living Verywell? Don't miss out on helpful articles to achieve your best healthy body. Start with this great read on "Are You Eating for Muscle".

Read: Are You Eating for Muscle? 

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Be well and Stay Healthy ~ Darla :)





Tuesday, 17 May 2016

19th Hedda Gabler's Lessons for 21st Century Health Information Technology

It's the 17th of May, which means it's Norway's Constitution Day.  Sort of like July 4th.  Which reminds the Population Health Blog.....

If you are in D.C. in the coming weeks and have an interest in health information technology (HIT), you may want to check out the Studio Theatre production of Norwegian playwright Henrik Ibsen's Hedda Gabler. 
 
The Population Health Blog explains.

In the two and a half hour production, Hedda struggles to reconcile her human dysfunctions with the rigid etiquette of an aristocratic age. As her dilemmas unfold, her academic husband George delights in analyzing societal trends while being unable to see the disaster unfolding in his own home. George ironically delights in knowing more, but is aware of less and less. 
 
There's far more to the play, but what can this 19th century masterpiece teach about HIT?

While Hedda has her issues, she's still being victimized by a complex set of external social determinants.  The PHB suspects playwright Ibsen was intrigued by the impact of rigid social norms in late 19th century Europe.  His play examines their implications for otherwise smart people who can't and/or refuse to adapt. 

Is Hedda's resistance to be reviled, or admired?

Sound familiar?  Instead of a mansion decorated with dying bouquets, we have hospitals filled with the fading economics of piecemeal work. Physicians are working harder than ever to help their patients, but a new technocracy is advancing a new set of expectations.  And the mainstream HIT Georges are so fascinated by making meaningful use meaningful, they are likewise unable to see the forest past all the trees. 


Tuesday, 10 May 2016

Why some dogs (and humans) are born hungry

The brain is the central regulator of appetite and body fatness, and genetic variation that affects body fatness tends to act in the brain.  One important site of variation is the POMC gene, which codes for a signaling molecule that suppresses food intake.  A new study shows that Labrador retrievers often carry an inactive version of the POMC gene, causing them to be highly food motivated, obesity-prone-- and perhaps more easily trainable. 

Read more »

Monday, 9 May 2016

Achieve Fitness One Day at a Time

Believing anything happens quickly is not realistic. Fitness is a process of small changes creating large results over time.  No magic wand to instantly provide a chiseled physique or bikini body.  We may want that, but not how it works.  Quick fix thoughts only set us up for frustration and failure.



Achieve fitness one day at a time.  Biceps don't suddenly appear after your first day in the gym.  What does occur when you apply fitness daily is progress.  The muscle will show up but let it work, grow and build.  It's like a fine wine or great simmering stew.  The journey will be rewarding but patience is required.

One of the worst things you could do is to jump into a fad diet or take unregulated fat burning supplements thinking this is the answer.  Read the small print on any of these psuedo fitness deals.  "Best results when accompanied with a healthy diet and exercise program" is what you'll find.  All that needs to happen is to follow the small print which is the best advice on those bottles. In fact, any results achieved comes from implementing a healthy nutrition plan and exercise.  You're the one doing the work, not what's in those bottles.

Fitness done daily will take time and effort but the lifelong results are the reward. It's also a journey and not a destination.  There's no need to feel rushed or stressed about getting fit.  It's really a simple process often over-complicated. Find healthy foods and exercise you enjoy and this is what keeps you coming back for more.

Avoid jumping ahead in your mind to what you want now and focus on today. What are you doing today to reach your fitness goals?  Did you workout, eat healthy and get plenty of rest?  Awesome!  Celebrate your daily achievements.  Write them down if it helps.  Stay positive even when things aren't showing up as fast as you think they should.




We're all different in how our bodies respond to change.  Comparing to friends or people we see at the gym is the thief of joy.  We're not here to be or look like someone else.  Our job is to become our best healthy self through daily choices. Who cares if your friend lost 5lbs and you didn't reach that mark. Fitness is not about who is faster at achieving results.

The goal is getting fit and loving ourselves through the process.  The days are going to pass anyway so focus on adopting a healthy lifestyle the right way. Today is what we have, tomorrow isn't promised and yesterday is gone.  Be in the now with your fitness and you'll get there one day at a time. Be well and Stay Healthy!

Are you living well or Verywell?  Read my articles and others to help you achieve your fitness goals the right way!
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Darla Leal, Fit-over-50




Thursday, 5 May 2016

The Latest Health Wonk Review Is Up

"If elected, I'll....."
Wright on Health pivots to an excellent "general election edition" of the Health Wonk Review.  After reading it, you'll be better informed than either Hillary or The Donald about health policy. 

Too bad you can't do anything about it, but enjoy, eh?


Wednesday, 4 May 2016

My Recent Paper on Linoleic Acid in Adipose Tissue

Linoleic acid (LA) is the predominant polyunsaturated fat in the human diet, and it's most concentrated in seed oils such as corn oil.  LA accumulates in fat tissue, and as with many of the nutrients we eat, it is biologically active.  In a new paper, we systematically review the studies that have measured the LA concentration of fat tissue in US adults over time.  We show that the LA concentration of fat tissue has increased by approximately 136 percent over the last half century.

Susan Carlson, PhD
In 2011, I posted a graph on my blog in which I summarized some of the studies that have measured the LA content of fat tissue in US adults over time (1).  It showed a remarkably consistent upward trend.  Last year, a University of Kansas nutrition researcher named Susan Carlson contacted me and asked if I had published my findings in a scientific journal, because she wanted to cite the trend in one of her papers.  I said I hadn't published them, but that I would love to do so together.

Read more »

Governance Advice for Hospital Boards: Population Health

"For 60 or 90 days of post-discharge care?"

As income shifts from fee-for-service to global payments, the insurance risk transfers that underlie much of "population health" are an important threat to these enterprises' viability.

After a compact and well-written summary of the growth of population health, he offers six suggestions for these boards:

1. Plan on having "forthright discussions" about the difficult tradeoffs between still-remunerative fee-for-service activities (such as high-dollar imaging, lucrative surgical services) and having to invest in the Triple Aim (care coordination personnel, improving quality measures for persons with chronic illness).

The Population Health Blog suspects most boards will ask why they can't have both the FFS cake and the global payment icing. If that's the case, these boards need to plan on having forthright and very lengthy discussions. It's organizationally difficult to have one mission on the 4th floor of the hospital and another in the emergency room.

2. If the organization's employees are enrolled in a "self-insured" health plan, bring them into a population health program sooner rather than later.

Not only is this an important opportunity for a board to understand the revenue versus savings versus expenses involved in driving the clinical and care experience outcomes of population health, its only right to take this for a personal test drive before subjecting your patients to it.

3. Look for common ground between old fee for service and new global payment arrangements.  The author suggests reducing readmissions is a good start.

The PHB suggests boards ask their management teams to also pursue the care coordination "chronic care management" payments offered by CMS.

4. Start demanding population health metrics from your management team, "such as details of total medical expenditures."

More details on the work of measurement can be found here.  The PHB has also humbly suggests here that health organizations should be prepared to invest significant resources - and discipline - into the process.

5. Invest in primary care, care coordination teamwork and pursue "population health pilot programs."

Since the PHB believes well-intentioned CMS' programs are star-crossed (see here and here), it suggests working with local commercial insurers for starters.  As it reviews resources like this, they seem to have a better track record. 

6.  Ask your management team to be open population health contracting.

Hear hear, says the PHB.  But it also cautions that the board needs to have individuals with the kind of industry knowledge necessary to provide oversight of these contracts.