Category: Uncategorised

Great meeting with Amy Costello and Jo Porter.

This team have led the charge on freeing data to improve trasparency and accountability in the US health system.

Academic but with a strong, pragmatic approach.

Main obstacle to progress has been clinician objection and payer ambivalence/resistance despite mandates to release data.

From: Porter, Josephine [mailto:jo.porter@unh.edu]
Sent: Saturday, 18 April 2015 8:31 PM
To: Paul Nicolarakis; Costello, Amy
Subject: RE: thank you

Hi Paul,

It was great to meet you, and spend time discussing all of the ways we all can make a difference with data…around the globe!

Here is the link to the accountable care site: www.nhaccountablecare.org. Click “Access Public Reports”. It’s all descriptive stuff, but it’s really where the health systems are right now.

The APCD Development Manual can be found here: http://apcdcouncil.org/all-payer-claims-database-development-manual.

And here is the article that describes the impact of the NH HealthCost (www.nhhealthcost.org) site and how the transparency impacted the Exeter Hospital-Anthem negotiations: http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/M/PDF%20MovingMarketsNewHampshire.pdf

Also – do you know the work of Dr. Neal Shah (http://www.costsofcare.org/)? He has a vision to include costs into the clinical decision-making at the point of care. He is in Boston, and I would be happy to provide an introduction, if you think it would be helpful.

Thanks for making the trip to NH. Let’s chat again soon!

Jo

From: Paul Nicolarakis [mailto:paul.nicolarakis@loricahealth.com]
Sent: Friday, April 17, 2015 10:08 PM
To: Costello, Amy; Porter, Josephine
Subject: thank you

Dear Amy and Jo,

Thanks so much for your time, hospitality and apparel today. It was terrific to hear about your pioneering and hard fought journey to make a real difference with health data…. truly inspiring stuff, albeit with plenty more fights to come. Am looking forward to staying in touch and comparing notes as we seek to bring on the global healthcare reckoning.

Cheers, Paul

 

P.S. Jo – can you send through that accountablecare.org link, and the state development manual? The NPR story on cost of care impacts was excellent.

P.P.S .You can find out more about Australia’s Classification of Hospital Acquired Diagnoses system here.

P.P.P.S. I listened to the NPR story Jo mentioned, and also heard these two terrific Freankonomics episodes also about general healthcare mayhem on the drive back to Boston – suspect you may also enjoy them too

— How Do We Know What Really Works in Healthcare?

— How Many Doctors Does It Take to Start a Healthcare Revolution?

Churrusco. Oh dear.

Porridge, sultanas, blackberries and pineapple

 

There are two aspects of Presidency Eisenhower’s life and presidency that resonate with the key themes of my Eisenhower Fellowship: Chronic Disease and the consequences of ungoverned Institutional Power.

As a consequence of a life of smoking, President Eisenhower later suffered terribly from heart disease, culminating in the first of a number of heart attacks (see this NEJM book review) that inevitably led to a deterioration in his health.

The second aspect is highlighted in a warning he gave during his televised farewell address in 1961 where he airs his concern for the power granted to, and then held by the military-industrial complex in the wake of the World War II and then later the Cold War.

“A vital element in keeping the peace is our military establishment. Our arms must be might, ready for instant action, so that no potential aggressor may be tempted to risk his own destruction. . . . American makers of plowshares could, with time and as required, make swords as well. But now we can no longer risk emergency improvisation of national defense; we have been compelled to create a permanent armaments industry of vast proportions. . . . This conjunction of an immense military establishment and a large arms industry is new in the American experience. . . .Yet we must not fail to comprehend its grave implications. . . . In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military-industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.”

More analysis on this here.

 

Had a good conversation with Constantijn about our Fellowship foci. In describing the new financing model, he asked an excellent question:

In what circumstances would an institution be able to get people to trust them to do the right thing with their data?

In other words, how much, and what kind of value does a company need to provide to the population to allow them to entrust them with their most personal and sensitive information?

Surely extending their vital, healthy life would qualify?

So the day is finally here and I’m about to embark on my 2015 Eisenhower Fellowship. I’m typing this on the plane from Sydney to Philadelphia via San Francisco.

I’m trying not to succumb to the American food environment, so hope to be more conscious about what I put in my mouth. Part of this will involve me taking photos of what I eat, to wit, my first meal of the trip (I didn’t eat the bread roll):

Transit Details: 

• UA870: SYD > SFO 13hr 40mins
• UA267: SFO > PHL 5hrs 23 mins
• SYD>PHL door to door: 24hrs
• Meal: Omelet, smear of spinach, chicken sausage (photo).
• Movies: Gone Girl. Trading Places.
• Paid US$250 after boarding for an upgrade to premium economy.

I’m coming around to the view that with a few exceptions, there are generally no people, just bad incentives. However, I also contend that these bad incentives have resulted in the world’s healthcare systems letting down the populations they are bound to serve. Fixing doctors’ incentives, as the US is seeking to do, will only be just part of the fix, with hospitals, pharmaceutical companies, prosthesis manufacturers etc. also in time having to participate in value-based payment models.

In this context, my Fellowship will focus on two themes:

1. A contemporary exploration of how data science can improve healthcare systems
   • Measurement/Detection/Prediction of Fraud, Abuse, Waste and Errors
   • Measurement/Detection/Prediction of Cost
   • Measurement/Detection/Prediction of Quality of Care
   • Measurement/Detection/Prediction of Value of Care
   • Delivery of Transparency (Cost, Quality, Value Indicators) Metrics to legitimate health market stakeholders
   • Data-driven, Behavioural Economic Health System Interventions focused on improved outcomes

2. A blue sky thought experiment on how a novel financing model might support an enterprise market for population health
   • Beneficiaries of Healthy Life Extension
   • Data sets/statistical treatments/in vivo measures/predictors of wellness e.g. social determinants/health data
   • Financial Models for Pooling Population Health Risk e.g. Life Insurance
   • Potential Efficacy of Population Health Intervention
   • Attribution of Interventions to Health Outcomes
   • Priming the Wellness Market

After discussing the Fellowship with Australian Eisenhower Alumni, I’m persuaded that the experience will be transformative, but not for the reasons I had assumed. Despite the privilege, honour and compelling subject matter associated with the Fellowship, I’m reliably informed that I’ll get at least as much (if not more) from my fellow Eisenhower Fellows (who I’ll be meeting face to face in just a few hours) and the people and places I visit, as I will from the ideas we exchange and discuss. As such, I’m going to use this blog to support a discipline around the contemporaneous capture of the various experiences during and beyond the Fellowship.

I’ll be accompanied on the last three weeks of the Fellowship by my wife Yan Li, who has been in Singapore awaiting the arrival of her partner visa after our marriage last year. She’ll be returning to Sydney with me at the conclusion of the Fellowship which is very exciting.

Many people have provided inspiration and encouragement at various stages leading up to and including the fellowship – family, friends, soon to be fellow EF alumni, and my colleagues at work who are covering for me in my absence.