Countering the Cruel Tutelage of Healthcare Access, Quality and Cost: How mHealth Can Do It Faster, Better and Cheaper

While there many maxims about the delivery of healthcare, the MedSolis Chief Medical Officer PHB has discovered that three in particular stand out:

1) Many healthcare outcomes are more a function of social, economic and cultural determinants than medical quality. Zip code trumps diagnosis code.

2) Say's Law warns us that healthcare utilization may be a function of  sevice availability rather than need. As a result, compelling innovations like this or this can be "additive" to healthcare, not "substitutive." Demand trumps discovery.

3) Healthcare access, quality and cost are interdependent, and improvements in one has downsides in the other two.  For example, price controls can lead to lower access in the form of queues. Increasing quality can drive up prices.  And, Obama's healthcare reform emphasizing better access arguably led to higher prices.  

 

Trump's rhetoric trumps brainy Obamacare.

Naturally, there are exceptions to every rule.  And the PHB wonders if healthcare technology's mHealth may offer an important exception to rule number three.

If so, there are important implications for U.S. healthcare delivery.

An important mHealth mantra for MedSolis is "faster, better, cheaper."  mHealth is defined as as any medical practice supported by devices such as mobile phones, patient monitoring devices, personal digital assistants (PDAs) and other wireless technology. A considerable body of literature on the topic shows that patients using mHealth can access the information they need to make informed choices, that those informed choices serve greater engagement, and that this leads to fewer avoidable complications.

Examples from the MedSolis #mHealth archives:

Mary Jones* has diabetes, and uses her smart phone paired bluetooth-enabled blood sugar monitor to assess her diabetes control versus diet, exercise levels and medications. Her A1c improves, which correlates with her future health care costs.  She not only sees her outpatient physicians less often, but the A1c data inform public measures of quality and decreases the likelihood of depression.  Ms. Jones has hit the trifecta: lower cost, higher quality and better access to more care.

William Smith* has heart failure and has just been discharged from a hospital. He uses a telemonitoring-linked home scale to detect the subtle increases in weight from fluid retention that can herald an exacerbation of his condution.  William knows how to increase the dose of some of his medicines leading to return of his weight to normal. William has avoided an unnecessary night in the emergency room.  What's more, the avoided readmission is an important measure of quality. Mr. Smith has also hit the trifecta of lower cost, higher quality and better access to more care.

Bottom line: as healthcare consumes a greater fraction of the U.S. gross domestic product, the cruel tutelage** of healthcare acess-cost-quality can be mitigated by faster-better-cheaper.  Whether it's Obamacare, Repeal, Replace or Trumpcare, the the value proposition of mHealth will endure.

*Names and scenarios are realistic, but ultimately fictional

** With apologies to Pai Mei and his fans

Three Health App Lessons from the James Bond Movie "Spectre" - Shaking and Stirring Health Care

The Population Health Blog took time out of its busy schedule to check out the latest James Bond movie. While posting anything that refers to a months-old movie is inconsistent with standards of modern social media, Spectre has some important lessons. 

 

The PHB begs its readers' forgiveness as it is filters out the improbable car chases, dubious gadgetry and staged fisticuffs and examines the underlying health app technology insights. 

 

Without revealing too much of the plot, Mr. Bond continues to recklessly expose himself and others to STDs while battling a global conspiracy that is led by a cryptic master criminal.  The bad guys want to exploit the weaknesses that come with combining the intelligence data of the world's democracies. 

 

And what are three cinematic health app teaching moments?

 

Health Information Technology vs. People is a Classic False Choice: In Spectre, British Intelligence seems ready to invest in a global big-data initiative and jettison the "Double O" programme; Whitehall apparently fails to realize combining both would be greater than either alone.  Think Deep Blue "versus" Kasparov, or Dr. Watson "versus" Dr. House. Yet, Bond prevails precisely because Ms. Moneypenny is his 24-7 data muse.  Smart health app designers understand that the best apps are the ones that synergistically enhance, not replace, what doctors and patients bring to their care planning.

 

For example: Asynchronous two-way HIPAA-compliant communication that allows consumer concerns to be mutually addressed in partnership with a nurse-provider before the emergency room becomes the best option.

 

Health Information Technology Needs Good People: No Bond movie is complete without legions of pistol-wielding bad guys who can't hit the side of data warehouse, which is why Bond prevails. Think putting an Acela locomotive on decades-old train tracks under AMTRAK's ossified management. The health technology insight here is that any health app that perpetuates health workers' can't-shoot-straight business-as-usual will enable incremental, not transformative change.

 

For example: During a recent health plan launch involving the medSolis app, the PHB had the pleasure of working with expert professionals who knew the purpose of the program (er, programme) initiative was to enable informed patient decision-making.  In response, we also began to alter long-standing health plan policy and procedure.  

 

All Things Equals No Outcomes: Other than pooling the intelligence data, none of spy-administrators seem to be able to articulate the purpose of their joint data initiative. While cleverly branded and all-purpose apps strive to "be" the intended outcome, truly successful health apps will be those that can be purposed for a defined population and prospectively aimed at a limited set of clinical, financial and patient-centered outcomes.

 

For example: Once the generic coding/architecture is set, a winning app's content, channel and outcomes can be tailored for, say, a precisely defined group of high risk persons with diabetes.  And, to borrow from the concept of "parallel processing," the app should also be able to be altered to simultaneously serve a parallel population that is prone to rehospitalization (outcome: reduce avoidable readmits), or who would benefit from weight loss (outcome: reduce BMI).

 

Conclusion: Health concerns aside, perhaps nothing signals Bond's adaptability better than his willingness to forego his long-standing "shaken, not stirred" workflow in favor of quaffing a "dirty" martini with the sultry Dr. Madeleine Swann.  Even the Bond franchise is not immune from the adage that "change happens."

 

The same should be true for traditional health care as it continues to import an emerging ecosystem of health apps.  Delivery systems, hospitals, clinics, ACOs and networks that understand that will win.

 

And "Cheers!" to that, Dr. Swann.

 

Image from Wikipedia

The PHB is Back

The Population Health Blog received a gratifying number of "Where'd ya go?" reader posts, emails.  Thank you......



It didn't need a handgun to know it wasn't going anywhere.

Rather, the PHB recharged over the holidays, continued to build its Twitter followership and, best of all, was busy with medSolis.

It's paid off. We've closed 2014 with a solid product, two customers, one investor and more than a dozen employees. Looking ahead to 2015, it's gonna need shades.

Speaking of a bright future, it recently got to surf the JP Morgan Health Care Conference ecosystem, described by CNBC as the "biggest health care investing event of the year." In addition to some promising additional investor leads, the PHB came away with two memories:

1) San Francisco's Union Square is usually populated by a pleasant mix of tourists, shoppers and natives. During the conference, however, it was thick with (mostly white male) suits, most of whom were staring off into space while pressing the latest handheld technology against the side of their heads. They moved very little.  The PHB knows this because it watched them very closely.

2) Overcome by the bursts of electromagnetism, the PHB retreated and sought out quiet time in those oases formally known as "hotel lobbies." They too were packed with suits, but they were excitedly clustered around open lap tops or lustfully stroking some piece of monitoring gadgetry. Open seats and cheap coffee were nowhere to be found.

And what has it learned in the last two months? In addition to discovering that the PHB spouse doesn't believe $400 San Francisco hotel rooms are a "biggest health care investing week" bargain, the PHB also confirmed that the most promising population health technology solutions are simple and scalable.

More on that in a future post.