Met with Jeff Brenner, Medical Director at Camden Coalition of Healthcare Providers.
Learned about him after listening to these freakonomics podcasts:
An eloquent, thoughtful keen student of the history of epidemiology, public health’s political success and a tireless advocate for the underserved communities of Camden, NJ.
Holds a strong, long-term, systems view of change in public health and healthcare.
Currently engaged in a loss-avoidance play as an ACO demonstration site – geographically defined, shared savings project, which has protection from federal anti-trust laws to allow providers to collaborate.
Doubts the claims of most preventive health organisations, on basis of the Medicare Chronic Care Demonstration Project in the 80s where only 3 of 15 corporate participants survived a randomised control trial of preventive interventions after a year.
The game changer in many examples of public health shift are the troubling personal experiences of decision makers.
Emotional, visceral, aesthetic impact.
Tapped into Grenny’s observation about Don Berwick needing to get hospital CEOs to run the analysis of patient harm personally rather than to delegate in order to experience first hand the damage their institutions were doing to their patients.
Examples of AU Health Minister’s personal experience of the harms of tobacco driving the change to plain packaging.
Complex systems are kept in place by:
- goodwill
- money
- tax dollars
- positive media
- These foundations need to be eroded one by one to effect change.
For a venture capitalist, they’ll need a pitch that appeals to their outrage at the lack of evidence or transparency around the way that healthcare works.
For someone on the left, the conversation will need to be nuanced around the human tragedy of chronic disease, and the need for humanity to do better.
Don’t get wedded to the strategy, just the outcome.
There is a 100 year gulf between the way corporations collect and use data, and the way that government uses the same resource.
Analytics allow us to surveil, segment, target and measure interventions, then tell a good story of why things happen.
Dual System Utilizers – healthcare and law enforcement
On the way to the meeting, came up with a name for the concept – the QALYBOND – will grab the domain name.
References
http://www.macfound.org/fellows/886/
- “Bury the Chains” – end of slavery
- “The Children” – civils rights movement
- The fight to roll out covered sewers, welfare reform (fixed by the right)
- Adverse Childhood Event Study – Vince Felitti, KP
