Quotable Quotes

I am a quotes person, have always been one. As a 10-year old I covered the wall of my room with quotes. Even today I maintain a diary of quotes that I refer to every now and then. Quotes inspire, guide and motivate me.

I am constantly looking for words of wisdom in the business arena as well.In this post I tried to curate a list of some healthcare quotes that resonated with me and have made me think.

Here are some of my favourites:

“Betterment is perpetual labour. The world is chaotic, disorganized, and vexing, and medicine is nowhere spared that reality. To complicate matters, we in medicine are also only human ourselves. We are distractible, weak, and given to our own concerns. Yet still, to live as a doctor is to live so that one’s life is bound up in others’ and in science and in the messy, complicated connection between the two It is to live a life of responsibility. The question then, is not whether one accepts the responsibility. Just by doing this work, one has. The question is, having accepted the responsibility, how one does such work well.”
― Atul GawandeBetter: A Surgeon’s Notes on Performance

“But now I also understand, firsthand, the meaning of what the caregivers who work in that system do every day. They do achieve amazing things, and when it’s your life or your child’s life or your mother’s life on the receiving end of those amazing things, there is no such thing as a runaway cost. You’ll pay anything, and if you don’t have the money, you’ll borrow at any mortgage rate or from any payday lender to come up with the cash. Which is why 60 percent of the nearly one million personal bankruptcies filed in the United States last year resulted from medical bills.”
— Steven Brill (America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System)

“The Universal Laws of Health Care Systems:

1. “No matter how good the health care in a particular country, people will complain about it”
2. “No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough”
3. “The last reform always failed”
— T.R. Reid (The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care)

“A recent Economist article on dialysis perfectly illustrates the inflationary impact of cost-plus pricing. Since U.S. clinics are paid on a cost-plus basis, they prefer to use expensive drugs rather than cheaper ones. In fact, many appear to order drugs in units that exceed what a standard dosage requires because they can charge the government for the wastage. Quoting a stock research firm, the article noted that many clinics preferred an injected drug with a price of $4,100 a year over the identical drug in oral form, priced at only $450 a year. Not surprisingly, the manufacturer of the oral drug responded by increasing its price above that of the injected version to make it more competitive!”
― David GoldhillCatastrophic Care: How American Health Care Killed My Father–and How We Can Fix It

“Japan has the oldest population in the world, and the Japanese go to the doctor more than anybody—about fourteen office visits per year, compared with five for the average American. And yet Japan spends about $3,400 per person on health care each year; we burn through $7,400 per person.”
— T.R. Reid (The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care)

“The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage.”
― Paul A. OffitDo You Believe in Magic?: The Sense and Nonsense of Alternative Medicine

“What is needed, however, isn’t just that people working together be nice to each other. It is discipline. Discipline is hard–harder than trustworthiness and skill and perhaps even than selflessness. We are by nature flawed and inconstant creatures. We can’t even keep from snacking between meals. We are not built for discipline. We are built for novelty and excitement, not for careful attention to detail. Discipline is something we have to work at.”
― Atul GawandeThe Checklist Manifesto: How to Get Things Right

“We’re paying a lot more for everything because we have this naive assumption that healthcare can be a marketplace when everyone of us sitting here knows that when we’re sick, we’re not a savvy consumer of healthcare.” Steven Brill, America’s Toxic Pill

“It drove home to me the reality that in addition to being a tough political issue because of all the money involved, health care is a toxic political issue because of all the fear and the emotion involved.” Steven Brill, America’s Toxic Pill

“Billions of dollars are spent on technology and IT in healthcare, but most of that is for legacy enterprise systems. Very antiquated systems and procedures are in place in healthcare. Technology can change that. This tells me that healthcare is ripe with disruptive potential.”
Aaron Levie, CEO of Box

“Today, however, anti-vaccine activists go out of their way to claim that they are not anti-vaccine; they’re pro-vaccine. They just want vaccines to be safer. This is a much softer, less radical, more tolerable message, allowing them greater access to the media. However, because anti-vaccine activists today define safe as free from side effects such as autism, learning disabilities, attention deficit disorder, multiple sclerosis, diabetes, strokes, heart attacks, and blood clots—conditions that aren’t caused by vaccines—safer vaccines, using their definition, can never be made.”
― Paul A. OffitDeadly Choices: How the Anti-Vaccine Movement Threatens Us All

“A patient in the American health care system has very little leverage, has very little knowledge, has very little power.” Steven Brill, America’s Toxic Pill

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Theranos – A Case of Disruptive Innovation in Healthcare

“My own life’s work in building Theranos is to redefine the paradigm of diagnosis away from one in which people have to present with a symptom in order to get access to information about their bodies to one in which every person, no matter how much money they have or where they live, has access to actionable health information at the time it matters.”

Elizabeth Holmes, CEO, Theranos

Disruptive innovation by definition is an innovation that helps create a new market and value network, eventually disrupts an existing market and value network, displacing an earlier technology. Generally these innovations are cheaper, faster and more convenient compared to incumbents. Medical Diagnostics is an area where a lot of such opportunities exist and one company (valued at around $9 Billion) that has made big news in 2014 in this arena is Theranos.

According to Clayton Christensen, three things characterize disruptive innovations – simplifying technology, business model innovation, and a disruptive value network. Let’s examine how this maps to Theranos’ offering:

Simplifying Technology

Until now blood was drawn out of veins, stored in vials and transported to labs for testing.  Theranos has completely transformed the process with its patented technology. The technology utilizes microfluidic chips to conduct minimally-invasive tests with a drop of blood to deliver results within a few hours. Moreover, by automating most of the processes the company claims their results are more accurate and specific than traditional tests.

Business Model Innovation

By being able to provide personalized lab test data anytime, anywhere at a fraction of cost Theranos enables patients to be more engaged and participative in their own health. While higher prices, drawing blood out of veins dissuaded patients from getting tests done, Theranos’ innovative business model allows them to overcome these pitfalls.

Comparison of Theranos with Traditional Lab Tests

  Traditional Lab Tests Theranos
Average Costs $100 <$50
Time Days – Weeks Few hours
Quantity of Blood Required 3 oz. Single Drop
 

Value Network

Traditional blood-tests require patients to visit labs. They are essentially centralized systems. To address the problem of accessibility Theranos has adopted a retail framework to decentralize blood-testing process. It has partnered with Walgreens and a few hospital groups to administer its tests. Further, the company aims at building a pathologist-centred model and is therefore focusing on establishing relationships with pathologist groups.

In most aspects, things look very promising for the healthcare start-up. But there are a few caveats. In his article A Disruptive Solution for Healthcare, Christensen points out that disruptive innovation rarely happens in a piecemeal fashion. The new value network needs to be merged with the existing reimbursement, regulatory, insurance and provider systems. It requires disruption and remodelling from these players in the market as well. From the standpoint of Theranos, integration with payers, hospitals poses a huge challenge. If it decides to go purely via patient self-ordered tests route, educating the patient community would be crucial to its success. Whatever route it chooses, it’s certain that Theranos is here to stay and as the CEO of the company puts it, it’s here to “redefine the paradigm of diagnosis”.

Mobile Healthcare Technology: A Crucial Lever for Patient Engagement

While there are many cases illustrating how an engaged patient is a great asset to the healthcare ecosystem, one of the most compelling is that of Eric Dishman’s. In his TED talk, Eric shares his personal experience with the inefficient healthcare system. Through his own example he demonstrates how mobile technological tools can help fill in the gaps of the current flawed system. More importantly, he champions the role of a more engaged patient as a way to improve healthcare outcomes.

Patient Engagement is a Focus Across all Stakeholders

Healthcare has long been a paternalistic, hierarchical, doctor-knows-it-all industry. With the advent of the internet, social networks and smartphones this is no longer so. Patients today are much more informed, connected and ready to take an active role in their fitness and well-being. Moreover, in the wake of Affordable Care Act, patients are paying higher deductibles and out-of-pocket payments that further require them to take stock of their own health and wellness. As healthcare transitions from pay-for-service to pay-for-outcomes, providers have to ensure their services are effective and efficient, which necessitates a highly engaged patient. For payers as well patient engagement is pivotal to achieve shared savings under new delivery structures such as the Affordable Care Organizations (ACO) and Patient Centred Medical Homes (PCMH). Given that poor adherence costs US healthcare nearly $290 billion a year, patient engagement has been rightly deemed as the ‘blockbuster drug of the century’.

mHealth to Drive Patient Engagement

Mobile Health (mHealth) has enormous potential (as highlighted in Eric’s example above) to revolutionize healthcare through patient engagement. And as the focus of the healthcare system moves to Meaningful Use Stage 3, the strategic importance of mHealth is all the more pronounced.

mobile-solutions-chillmark

Source: Chilmark Research

As highlighted in the figure above, mHealth started with simple data storing and sharing systems moving to sophisticated preventive engagement. The applications include SMS medication reminders, remote medical advice and remote monitoring. A few recent innovations in the patient  mHealth space are as follows:

Education and Wellness

  • Kurbo Health: Mobile subscription service focused on fighting childhood obesity
  • HealthTap: Access to doctors anytime, anywhere to get personalized answers
  • Prana: Wearable tracking breath and posture

Remote Monitoring

  • Medtep: Targeting disease prevention through monitoring life habits
  • Nephosity : Collaborative medical imaging services
  • Sano: API for bloodstream (not yet launched)
  • ViSi Mobile System: Platform for vital signs monitoring designed to keep clinicians connected to their patients

Diagnostic and Treatment Support

  • Cellscope: Smartphone enabled home otoscope
  • Lantern: Offers online and mobile coaching programs to support mental health
  • Helius: Clinicians, patients and families can use the real-time information about medication-taking, rest and activity to make informed treatment decisions

The use and popularity of above applications attests that mobile technology enables patients to be more informed, collaborative and committed. But integration of IT systems, complex healthcare environment, quantifying the benefits, measuring the ROI, patient stickiness and privacy concerns pose serious barriers to adoption. Given an opportunity to save $290 billion and a case as compelling as Eric’s, can we afford to ignore it?

Social Media in Healthcare – A Strong Value Proposition

Social Media is number one reason why people use internet today. Consumers are increasingly turning to social media to educate themselves, give feedback on products and engage with other consumers. According to a PWC consumer survey, nearly one third of the people surveyed use social media for health related discussions. Here are a few more findings from the study-

  • 45% of the participants would seek second opinion based on health information found on social media
  • 75% would want a response within a day to requests initiated via social media
  • 33% of the consumers are ready to have their social media health interactions monitored, provided they get something in return

Given above data points the influence of social is far reaching and organizations can no longer be passive participants. In fact, the biggest risk with social now is ignoring it. Until now healthcare sector has been essentially using social platforms for listening with little activity on the engagement front. With early adopters such as Aetna, Mayo Clinic, Johnson & Johnson demonstrating the benefits of social engagement, this is fast changing. Group Worldwide Chairman, Johnson & Johnson, Sandra Peterson states – “We fundamentally changed our approach to marketing to put social at the core. Yes, we still do TV advertising, but everything we do now has to be social”. Clearly, the case for social is very strong. Here are some of the ways of healthcare organizations can augment social in their current business strategy:

Monitor

One clear advantage of social media is that the data is real time. Understanding this data enables firms to get the pulse of the market. For instance pharma companies can track adverse events, physicians can monitor patient activity and payers can gauge the general sentiment of their brand. Monitoring social media also helps companies to pinpoint any particular negative publicity and therefore address it quickly.

Respond

While monitoring allows listening, it is responding that helps engage stakeholders. As social media allows real-time monitoring, it is now possible to respond quickly to queries, concerns and feedbacks generated by consumers. Patient population is very active on social portals that help them book appointments, rate services and share experiences in their social circle. Physician participation on these portals will not only help them manage their own reputation but also curb misinformation to spread.

Amplify

Social media acts like a megaphone. It has the capacity to transcend boundaries and reach millions within a short span of time. Healthcare stakeholders should take advantage of this aspect by identifying influencers and utilizing their clout to reach target audience. For example – patients are most likely to trust their physicians. Hence payers & pharma companies can get doctors to endorse their brands on social media to reach a wider consumer base.

Lead

Using social, healthcare stakeholders can lead patients to promote behavioural changes. Social healthcare mobile apps are combining gamification concepts to ensure users stick to their fitness routines.  Payers can use this data to link to insurance premiums charged to their customers. Crowdsourcing is another application of social in which firms can create platforms to encourage patients/consumers to contribute ideas to improve current offerings and get rewards in return.

Although incorporating social media in business strategy looks very promising, it is not without hurdles. There are legal, technical and regulatory roadblocks that need to be taken care of for social to work in the healthcare space. In my subsequent blog posts I will write more about how each stakeholder in the healthcare arena can benefit from social and also the challenges they may face in the process.

US Healthcare : What can it learn from the rest of the world

A few days ago I was chatting with a friend in Ohio, who happened to tell me about her colleague’s unfortunate road accident last September. My friend was having trouble with coming to terms with the financial consequences her colleague had to face due to medical bills post his treatment. The accident not only physically crippled him for the rest of his life but also left him in massive debt. His family had to eventually file for bankruptcy.

Millions of insured and uninsured Americans face medical bankruptcy each year. The issue is so serious that every 3 out of 5 bankruptcies filed in the US are due to medical bills. In addition, the US is the only developed country where cost of care can leave patients bankrupt.

Picture1

Source: The Commonwealth Fund

According to a recent survey conducted by The Commonwealth Fund, health care in the US ranks last among 11 other developed countries considered in the study. It lags behind most countries on parameters such as Quality Care, Access, Efficiency and Healthy Lives. Moreover, the expenditures in America are more than double the average of rest of the nations. This brings us to question what the US can learn from the best in the field. What are these countries doing right that enable them to achieve stellar results in quality and access while at the same time keeping the costs under control?

One of the key difference in between the US and rest of the nations included in the study is that all other countries have universal healthcare system. Intuitively, such a system might be considered wrought with long waits, delayed treatments and basic lack of compassion.  But the truth is far from it.  It has been proved time and again that universal healthcare achieves better results in quality and at lower costs compared to other systems. For instance, the NHS in the UK is one of the best examples of how universal healthcare system achieves healthcare goals of a nation within reasonable costs.

Furthermore, the hospital charges in the US are unregulated and far exceed the rest of the nations.  In countries like Switzerland, the government ranks hospitals from most to least expensive which then serve as a benchmark for hospitals and insurers on how much to charge for their services.

Data also suggests that there is a trend of over-testing and over-treating patients in the US compared to other industrialized nations. For example in UK, the Diagnostic Advisory Committee that has put in place guidelines to put in-check such practices.

Although there is no one nation that has perfected all aspects of healthcare delivery, it always makes sense to adopt certain models and features that have withstood the test of time. This is true especially when one is way off the mark from rest of the players in the field.