Archive for September, 2009

What We Can Learn About Health Reform from GE’s Robert Galvin MD

September 30th, 2009

As members of Congress continue the arduous work of cobbling together healthcare reform legislation patients and consumers should hope that they are listening to the likes of Dr. Robert Galvin, Chief Medical Officer at General Electric.  I have to admit that after speaking with Dr. Galvin for some time last week about his career in clinical practice and his 15 years in the corporate setting researching, piloting, and sharing best practices in healthcare delivery and financing, I am now a huge fan.

I am a fan of:

Large employers, like GE, have served as a testing ground for many of the major elements of health reform.  Let’s use their lessons as a platform to accelerate meaningful changes in the healthcare system that  benefit us all.

Patient-Owned Health Delivery System in Alaska

September 16th, 2009

Before you think I’ve reverted to writing fiction with the title “Patient-Owned Health Delivery System in Alaska” let me share with you things I learned at a presentation last night at the National Library of Medicine, the originators of Medline Plus and PubMed among other activities.

Katherine Gottlieb, MBA, Native Alaskan, and CEO of the Southcentral Foundation described the creation and operation of the Alaskan Native and American Indian owned $160 million corporation which runs healthcare in Anchorage and its surrounds.  This is no casino-fueled initiative, but the result of a decision by the native peoples to take control of the monies previously spent on their behalf by the Indian Health Service and other government entities.  Under  their self-trained and determined native leadership the SouthCentral Foundation reports 50% reductions in urgent care use and hospital admissions than under IHS, 66% fewer C-sections than the national average, 95% childhood immunization rates and 91% customer satisfaction.

Their operating principles are based on considerations for the whole person and the whole community. Their vision is for A Native Community that enjoys physical, mental, emotional and spiritual wellness and they underscore key points of shared responsibility, commitment to quality, and family wellness.

When will patients in the Lower 48 decide that we can direct and drive healthcare here too?

September 12th, 2009


A Patient’s Perspective on Medication Compliance (Part 2)

September 9th, 2009

Part 1 of this entry on medication compliance explored the disconnect between physicians and patients and the costs in both health outcomes and health economics on non-compliance.

So what are an army of pharmaceutical, medical and communication professionals to do when faced with a non-compliant patient?

1.  Think of the patient as a person not a condition

A patient had a life before entering the doctor’s office and will have a life afterwards that includes but may not be defined by the particular condition that led them to seek care.  As much as patient communications can honor and encompass a patient’s values, cultures, and life circumstances the more successful they will be.

¨      Will the patient’s family need to be involved in the decision to begin or continue a therapy?

¨      Does the method of administration embarrass the patient?

¨      Is there an alternative medication when taking another would, if taken as prescribed (with food for example), violate a patient’s religious beliefs (during a period of fasting)?

2.  Educate the patient to make their own decision

If patient fully comprehends the implications of the disease or condition for their lives, including the risks and benefits of various options for treatment and nontreatment they can perform the personal calculus necessary to choose and value treatment.

¨      What is the timeframe for making a decision?  Are there consequences for waiting?

¨      Would medication now avert surgery or other complications later?

¨      Did the medical research include patients just like me?

3. Provide tools/approaches for success

Even a patient fully convinced and committed to a treatment plan can fail if they cannot overcome an obstacle course of barriers such as cost, health literacy, and the vicissitudes of life.

¨      Does the patient’s insurance cover the medication prescribed? Can they afford the co-pay?  Do they have a ride to the pharmacy?

¨      Is the complicated treatment regimen written in plain language?  Once is one time to an English speaker, 11 times to a Spanish speaker.

¨      Would a multi-compartment pill box or alarm watch help the patient remember?

¨      Would a call from a member of the medical team a week after the visit make the patient feel both more supported and more accountable?

Considering patients not as passive recipients of medications but as full partners in developing, describing, and delivering health solutions can result in healthier companies and medical practices as well as patients.

A Patient’s Principles for Healthcare Reform

September 7th, 2009

If we truly wanted to create a patient-centric healthcare system – not insurer-centric, employer-centric, or even physician-centric – I believe that we need to do the following:
1. Redefine healthcare to include a holistic, 360 degree view of health from wellness, to prevention, diagnosis, treatment, rehabilitation, and hopefully back to wellness.
2. Align a payment system, not necessarily, but possibly an insurance system, to support those elements along this 360 degree paradigm that provide actual value, i.e. improve patient outcomes.
3. Provide transparency in pricing. Costs, potential cost-savings, and how those costs were calculated should all be included. Cost and price can be two different things. The government declaring that they need to cut physician payments in Medicare, for example, does not lower the costs of physicians delivering care.
4. Widely disseminate consumer education and patient decision support tools to facilitate informed evaluation of health and medical options.
5. Universal mandatory participation in some type of health insurance or financing mechanism coupled with guaranteed issue. The system should put individual coverage on an even playing field with employer coverage and drop barriers to multi-state or other groupings.
I believe in a system that is consumer-directed, where patients are able to accurately estimate the amount of financial risk they can tolerate for health expenses and can buy reasonably priced coverage for services above that personal level of risk. I believe that patients should have their choice of physicians and be supported and empowered to engage in appropriate self-management by members of their healthcare team. I believe that the most important decisions we make in healthcare involve what we eat, how much we move, choosing not to smoke, and other lifestyle choices, but when our genes, fate, or attempt to stay forever young fail us, the availability of quality medical care that does not bankrupt us in the best interest of all.


September 7th, 2009


A Patient’s Perspective on Medication Compliance (Part 1)

September 7th, 2009

As the costs to the pharmaceutical industry and to the economy from patients not taking their medications as prescribed escalate into the billions and physician reimbursement is increasingly shifted to a “pay for performance” model where they are judged by outcomes as well as interventions, interest in understanding why patients do and do not comply with medication or other therapy recommendations increases.

Surveys of physicians consistently report a top complaint that patients refuse to take their medications as directed. Surveys of patients just as consistently state patients’ views that they are fully compliant with their medication therapeutic regimen. Somewhere in between lies the truth.

First, there’s the term compliance. Compliance, as defined by the Random House Unabridged Dictionary, is the act of conforming, acquiescing, or yielding. A person does not trade her free will for blind obedience when she trades her clothes for a paper gown. In this age of personalized medicine patients demand and deserve a personalized plan on taking that medication to which they are empowered and inspired to adhere.

Second, when a physician asks if a patient has taken her medicine that seems like a yes or no question. In fact, the patient is being asked, “Did you fill the prescription in a timely manner? Did you take the right dose at the right time in the right way every time (with food without food with a full glass of water on an empty stomach without lying back down for 30 minutes)? Did you take all the medicine (even after you felt better)? And did you refill the prescription as soon as you finished the first?” A patient may answer yes if they have fulfilled even one of these criteria.

What would drive a patient, even if diagnosed with diabetes, heart disease, or another serious, life-compromising condition, to not follow “doctor’s orders”?

  • Didn’t like being ordered around by the doctor
  • Medication tastes bad Side effects too much to bear
  • Method of administration painful or unpleasant
  • Taking the medication reminds the patient of her mortality
  • Doesn’t believe the condition is that serious
  • Treatment interferes with lifestyle
  • Forgot

(To be continued in Part II)

Welcome to the DCPatient Blog!

September 7th, 2009

Welcome to the DCPatient Blog.  A special hello to those who have followed me over from Twitter.  My intention is to inform, shape, and participate in the conversation about what type of healthcare we can have in this country.  I am influenced both by my experiences as a patient — inflammatory bowel disease, liver transplant, fertility challenges — and my 17 years and counting here in the Nation’s Capital involved in health care policy, advocacy, and communications.