Tuesday, June 21, 2016

Problem-Based Wisdom, The Age of Em, Reputation Economics and End of Life Care

The Population Health Blog has been busy with building on the value proposition of IT-enabled care management, helping to plan a 2017 trade show agenda, training for a race, learning about cyber-security, and staying out of the way of the PHB spouse as she plans two family weddings.
But that doesn't mean it hasn't been thinking 'bout a lot of stuff. Namely:

End-of-life care: A non-physician colleague asked the PHB why the U.S. can't seem to mitigate the skyrocketing costs of futile treatments for persons who are dying. The PHB's response was that patients and their families are less interested in value than they are in hope, and that "futility" is often discernible in hindsight, not in an ICU at 2 A.M. In addition, as "bundled payments" gain traction, patients and families may have to again wonder about the impact of local economic conflicts of interest. The PHB thinks this will get worse before it gets better.  It wonders if part of the answer may lie in Shared Decision Making, in which an independently derived calculation of the odds of survival with and without disability is provided to patients and families, along with the space to decide next steps.  Think less "defined benefit" and more healthcare financing.

An Interesting Book: Reputation Economics by Joshua Klein builds on the observation that humans ultimately prefer to trade goods with persons they genuinely trust. The invention of money as a medium of exchange may have solved a lot of inconveniences, but it also distanced the seller and the buyer. He suggests that our Information Age is ironically ushering in a return of barter, where many goods and services can be directly exchanged between parties who create a track record of their trustworthiness online. Interestingly, your personal identity doesn't need to be part of that reputation. And if barter isn't available, enter cryptocurrency like Bitcoin, which preserves anonymity but commands trust.

Another Interesting Book: The Age of Em by Robin Hanson suggests that there is less to traditional machine-based artificial intelligence than meets the eye, and that it will be simpler within the next century to image and build a replica (or "emulation") of a human brain. As a result, these super-devices will be capable of self-learning, handle all tasks and oversee a rapidly expanding economy that has little need for (real) humans. If this book is true, the PHB's current and future grandchildren can look forward to a lifetime of pure leisure.  Maybe they can spend part of that time reading PHB's past posts.....

A hot-off-the-presses PHB peer-reviewed publication: This examines how healthcare institutions' boards of directors can leverage the wisdom of crowds, problem-based learning and non-linear generative governance to create insights and unlock competitive value. Traditional governance with fiduciary and strategic oversight is unequal to the task of thriving in a complex and rapidly changing healthcare marketplace. "Problem-based wisdom" occurs when boards step back and ask more questions and seek more options. You can read the paper here.

1 comment:

Bradley Dean Stephan said...

Re: EOL care, PHB well knows that the last time and place for making such decisions is in the ICU at 02:00. Instead, bundled payments should incentivize systems to ensure that all covered members over a certain age or with with certain morbidities have generated an Advanced Directive, following discussion with their family and PCP.