Showing posts with label chronic disease management. Show all posts
Showing posts with label chronic disease management. Show all posts

Wednesday, May 13, 2020

IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis


CEO and founder Tim Fitzpatrick is leveraging the latest in neuroscience research and VR filmmaking to radically improve health education and patient confidence. 

Kidney disease is a large and growing health challenge, in the United States and globally, thanks in part to rising rates of diabetes and high blood pressure. A full 37 million Americans (15% of the adult population) suffer from kidney disease, according to the National Kidney Foundation, and in 2016, more than half a million people had to be put on dialysis at least 3 times a week just to survive. 

This represents a huge cost to Medicare ($114B in 2016) and efforts are now underway to transition dialysis patients to in-home care, a cheaper and more comfortable alternative. This need for this transition to home became even more acute during the COVID-19 pandemic, but how can resource-strapped dialysis clinics — which currently only spend a few minutes on patient education through paper pamphlets — safely and efficiently transition hundreds of thousands of patients to home care?

Levin is a former CEO of Time Warner

It has been said that necessity is the mother of invention. Jerry Levin, ex CEO of Time-Warner shares his own personal experience with dialysis. Following a severe injury from a fall, with multiple injuries he eventually was placed on hemodialysis while rehabilitating in a skilled nursing facility.  The experience was an eye-opener and less than optimal for his condition and many others.

The Centers for Disease Control and Prevention has also provided specific guidelines to address a similar deathtrap: dialysis centers, due to their comparable high volume of older patients (50% of all dialysis patients are over 65) and their history of infections are a very high risk for heightening the spread. More than 725,000 Americans suffer from kidney failure, otherwise known as end-stage renal disease (ESRD). Of these, at least 500,000 individuals are on dialysis.

Receiving home dialysis treatments in a nursing home is not something that is only available to people like me (former CEOs). It could be provided to any patient who needs it. Unfortunately, right now it’s not available to many, which is mainly a function of the red tape and bureaucracy in healthcare. Our current system is characterized by slow decision making, limited willingness to try new and innovative therapies, and stubborn adherence to the status quo of where and how healthcare should be delivered.

But there is a safer way to administer this lifesaving care, and we must urgently make plans to deliver dialysis within nursing home and long-term care facilities, and further to accelerate the provision of dialysis for those able to do it in their home. We must save our elderly and our broader population from this deadly blind spot.















Say Hello to IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

Thursday, January 30, 2020

Chronic Disease Management, A better Way

The management of chronic health conditions such as prevention, obesity, diabetes, and hypertension creates a burden upon health care providers. There are now the means to have better monitoring by non-physicians. Access to monitoring and decision-makers are augmented by several offerings.


One example follows:

Integrated Chronic Care Platforms have transformed disease management and prevention, replacing episodic care with combination therapy of smart connected devices, AI learning, and expert coaching. This digital care model helps payors and large employers lower costs and improve member and employee health.

  • Health data monitoring from smart, connected health devices.
  • Translation of health readings into insights to make healthy habits and behaviors last.
  • A digital health company with outcomes in all of diabetes, hypertension, and prediabetes.
  • Scalable care with seamless deployment and enrollment that integrates and doesn't silo.
Chronic disease management takes place in the home, and workplace, requiring a mobile platform (smartphone). Employer-based systems enable employees to access their management programs.  The employer may choose to offer this support to employees as a benefit added to the value of health insurance.

An ideal platform would integrate the employee, employer, and health care provider(s) for chronic disease management.

Help Health Plans and Employers

Prevent and Better Manage Chronic Conditions.




The change from FFS (fee for service) to APM (alternative payment model) requires demonstrated improved outcomes and the use of preventive measures for chronic illness to be proactive rather than waiting for bad outcomes. These new AI-driven programs offer that ability without direct healthcare provider involvement, leading to considerable time and cost-savings

These programs for prevention can be integrated with genetic programs, such as 

23andME

Rather, by integrating information from 23andMe into Lark’s proven and peer-reviewed AI coaching programs for diabetes prevention and weight loss, there is simply an added layer of personalization for customers. The integration uses information from a number of reports already available to 23andMe customers. Those include 23andMe’s reports on Genetic Weight, Saturated Fat and Weight, Lactose Intolerance, Caffeine Consumption, Deep Sleep, Sleep Movement, Bitter Taste and Sweet v. Salty Preference.

Cautionary Note

Here’s the breakdown on the Lark Apps:

  • The Wellness Program will tap into data from the 23andMe genetic reports, and the A.I. coach will focus on suggestions around nutrition, sleep, and exercise. The program can also seamlessly merge data from more than 70 other types of monitors or apps to incorporate that information that in turn can improve the personalization of the A.I. recommendations. To integrate Lark’s Wellness Program and use it with your 23andMe results, it will cost $19.99 a month. There is now a special introductory offer of just $14.99 per month.
  • The CDC-recognized Diabetes Prevention Program is a yearlong program meant to lower the risk of developing type 2 diabetes. This program includes specialized coaching, a digital scale, and a Fitbit, and some insurance providers cover it. You can find out if you are eligible by downloading  Lark and taking a survey. For those who do not qualify for insurance coverage, they can still self-pay for the Diabetes Prevention Program. The price for this self-pay option includes a digital scale but not a Fitbit.



The above illustration is but one example of what will be developed in the next several years.  Given the relative shortage of   primary care physicians treating both acute illness and chronic management the development of similar digital AI aids will be cost effective, especially in the era of APM

Friday, June 24, 2016

The Affordable Care Act, Accountable Care Organization and the Election

Better Together Health 2016 Event - Better Together     Are we really

The Affordable Care Act has stimulated many changes in health care. What is  considered good or bad depends upon the viewpoint of the provider and/or patient.

We have not yet seen the details of the Republican plan so Health Train Express will not offer our evaluation. Decisions based upon political rhetoric are at the least foolish, and at the worst dangerous.

It is doubtful if the ACA will be repealed entirely. Significant amendments ill be made. Other than some displeasure in the provider and health insurance industry patients who are able to access care are at less risk of not getting urgent care.  Even that presents problems in terms of provider accesss and the high deductible and premium expence for most receiving a partial subsidy. For those who are indigent, they have not expenses.

The progress of the organization being promoted by Medicare and some private insurers is the Accountable Care Organization (ACO).  The progress of developing this organization is fraught with many barriers. The ACO is an HMO on steroids.

Perhaps the closest organization to an ACO is the Kaiser Permanente model. The Counsel of Associated Physicians Group recently held a symposium, Better Together Health 2016 Event - Better Together.

The speakers represent a broad spectrum of the view on Accountable Care Organizations.

ROBERT PEARL, MD   CHAIR, COUNCIL OF ACCOUNTABLE PHYSICIAN PRACTICES
Robert Pearl, MD, is Executive Director and CEO of The Permanente Medical Group and President and CEO of the Mid-Atlantic Permanente Medical Group. Dr. Pearl serves on the faculties of the Stanford University School of Medicine and Graduate School of Business. Dr. Pearl is a frequent lecturer on the opportunities to use 21st century tools and technology to improve both the quality and cost of health care, while simultaneously making care more convenient and personalized.

SENATOR JOHNNY ISAKSON    (R-GA), CO-CHAIR, SENATE FINANCE COMMITTEE CHRONIC CARE WORKING GROUP

Senator John Hardy Isakson (R-GA) is serving his second term in the U.S. Senate, and was recently tapped to lead the Senate Finance Committee’s Chronic Care Solutions working group with Senator Mark Warner (D-VA). The work of the bipartisan committee is to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care. Isakson is the first Georgian since the 1800s to have served in the state House, state Senate, U.S. House of Representatives and U.S. Senate. He also serves on the Senate HELP Committee, Senate Finance Committee, the Senate Foreign Relations Committee, the Senate Ethics Committee, and the Senate Veterans’ Affairs Committee.

TIM GRONNIGEr    DEPUTY CHIEF OF STAFF, DIRECTOR OF DELIVERY SYSTEM REFORM AT CMS
Tim Gronniger is the deputy chief of staff and director of delivery system reform at CMS. He was formerly a senior adviser for healthcare policy at the White House Domestic Policy Council (DPC), where he was responsible for coordinating administration activities in healthcare delivery system reform. Before joining DPC he was a senior professional staff member for Ranking Member Henry Waxman at the House Committee on Energy and Commerce, responsible for drafting and collaborating to develop elements of the Affordable Care Act. Before joining the Committee staff, Tim spent over four years at the Congressional Budget Office.

CECI CONNOLLY    PRESIDENT AND CEO, ALLIANCE OF COMMUNITY HEALTH PLANS

Ceci Connolly became president and CEO of the Alliance of Community Health Plans in January 2016. In her role, she works with some of the most innovative executives in the health sector to provide high-quality, evidence-based, affordable care. Connolly has spent more than a decade in health care, first as a national correspondent for The Washington Post and then in thought leadership roles at two international consulting firms. She is a leading thinker in the disruptive forces shaping the health industry and has been a trusted adviser to C-suite executives who share her commitment to equitable, patient-centered care.

KAREN CABELL, DO    CHIEF OF QUALITY AND PATIENT SAFETY, BILLINGS CLINIC

Dr. Karen Cabell is the chief of quality and patient safety and a practicing internal medicine physician at Billings Clinic, an integrated medical foundation healthcare organization, located in Billings, Montana. Dr. Cabell has implemented diabetes, heart failure and HTN disease management registries along with point-of-care tools for patients and clinicians to better manage chronic disease. She was involved with Billings’ rollout and adoption of an electronic health record implementation since 2004 including all clinic sites and regional partners to include 15 other hospitals with clinics across a 500-mile radius. Dr. Cabell has been instrumental in gaining alignment between the EHR, quality and patient safety as well as strategic planning to support Billings Clinic’s organizational goals of clinical excellence, operational efficiency, market growth and development, and financial strength.

REGINA HOLLIDAY    PATIENT RIGHTS ACTIVIST, ARTIST, AUTHOR

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

MARC KLAU, MD

ASSISTANT REGIONAL MEDICAL DIRECTOR, SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Dr. Marc Klau has been with the Southern California Permanente Medical Group for 31 years. He is currently the regional chief of Head and Neck Surgery, providing leadership for 100 surgeons.  He is also the Assistant Regional Medical Director for Education, Learning and Leadership. He now oversees the new KP School of Medicine and all of the Southern California Kaiser Permanente residencies, as well as continuing medical education and leadership.

JANET MARCHIBRODA

Artist Regina Holliday is a patient advocate known for her series of murals depicting the need for clarity and transparency in medical records, and for founding the Walking Gallery movement. The Walking Gallery consists of more than 350 volunteer members who make statements about the lapses in health care at public meetings by wearing business suits or blazers painted with patient stories. Holliday’s experiences during her husband’s illness and subsequent death inspired her to use painting as a catalyst for change. Backed by her own patient and caregiving experiences, she travels the globe heralding her message of patient empowerment and inclusion in healthcare decision making. Holliday’s mission is to demand a thoughtful dialog with officials and practitioners on the role patients play in their own healthcare.

DIRECTOR, HEALTH INNOVATION INITIATIVE, BIPARTISAN POLICY CENTER
Janet Marchibroda is the director of the Bipartisan Policy Center’s Health Innovation Initiative in Washington, DC. She has been recognized as one of the Top 25 Women in Healthcare by Modern Healthcare and is a nationally recognized expert on the use of health IT to improve healthcare quality.

LEANA WEN, MD  HEALTH COMMISSIONER, BALTIMORE CITY

Since taking the reins of America’s oldest health department in Baltimore, Dr. Leana Wen has been reimagining the role of public health including in violence prevention, addiction treatment, and urban revitalization. Under Dr. Wen’s leadership, the Baltimore City Health Department has launched an ambitious overdose prevention program that is training every resident to save lives, as well as a citywide youth health and wellness plan. She is the author of the book, When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests, and is regularly featured on National Public Radio, CNN, New York Times, and Washington Post. Her talk on TED.com on transparency in medicine has been viewed nearly 1.5 million times.




Better Together Health 2016 Event - Better Together

Wednesday, January 8, 2014

Will the Affordable Care Act overwhelm the Health System?


In the midst of the fury, anger, and frustration with the Affordable Care Act we have been focused on chronic care, outcomes, meaningful use, accountable care organizations, HIT, and coming changes in reimbursement paradigms.



The increasing rates of obesity, hypertension, diabetes mellitus, breast cancer. colon cancer sits in stark opposition to acute illnesses, such as flu, otitis media, pharyngitis, bronchitis, pneumonia, infectious gastroenteritis,  and the tsunami of routine care, skin rashes, exanthems, pregnancy and it's secondary consequences as well.




Raising the bar for excellence in chronic disease management as measured by somewhat subjective criteria does not occur in isolation. This will have an effect on the system's ability to deal with the 'walking ill".   The overwhelming majority of health care takes place in an outpatient environment.  Monitoring this segment will require extensive monitoring and a means to encourage clinicians to use evidence based medicine. EBM at
it's best can be questionable and subject to clinical judgment and years of experience. Given the recent experience with screening for prostate cancer and breast cancer imaging standards were reversed after controversy erupted, and the USPHS did a quick reversal of it's stand on prevention of breast cancer and prostate cancer.

While the majority of health costs occur in the population above 55 years of age, this portion of the population is not as active in the economy.  Younger patients illnesses effect their attendance and ability to participate in the workforce, at times.  This is a  'hidden expense; to the system which is difficult to measure.

The initial phases of the Affordable Care Act have caused employers to look carefully at their full-time work force, and will shift to more part-time employment.  This will in turn stimulate the Individual Family  Plans not tied to an employer group plan.  History reveals these IFPs are more expensive to administrate than GHPs.

It has been a more than decade long crusade to develop a plan such as the ACA. Some are ecstatic and even euphoric about the ACA to the point of an unrealistic assessment of what the ACA can accomplish.  The very worthwhile plan  has caused a deep divide between fiscal conservatives, and liberals. What we need is more 'reaching across the aisle and open minds.  Both sides must lower the volume.