Archive for the ‘Wellness’ category

Beyond the ACO – Creating the Well-Being Society

September 8th, 2011

 

I have spent the past two rainy days with senior executives from the Adventist Healthcare System and a range of integrative medicine and community leaders as part of an effort called Next Century Health. Next Century Health is a visionary initiative of the Adventist Healthcare System, a  large integrated  network of hospitals, rehab facilities, home health, and other health services, to respond to the key trends and drivers transforming healthcare today in something more than a pro forma fashion.  I, along with such notables as former HHS Secretary Dr. Louis Sullivan, former FDA Commissioner Dr. David Kessler, and former Senator Dr. Bill Frist, are committed members of the Next Century Health Leadership Council.  Below are 5 reasons I think that Next Century Health may actually achieve its ambitious goal of advancing whole-person health and healing across the greater community.

  1. It’s in their culture.  The Adventist HealthCare System has its roots in the Battlecreek, Michigan  health resort of Kellogg’s corn flakes fame.  It flourished with a focus on connected mind, body, and spirit for healing purposes.  Discussions of whole-person health and well-being are authentically part of their DNA as an organization.
  2. They have a track record.  The five-year and counting Center for Health Disparities established by Adventist is a create model of addressing tough issues, working with community leaders, and keeping long-term commitments.
  3. Vision before bricks and mortar. The system has several large-scale building projects in the works, including a massive White Oak Campus adjacent to the FDA.  Integrating elements into every building and campus expansion plan that actively promote fitness, restoration, and connection from the start rather than as an afterthought greatly increases their chances of adoption and execution.
  4. Partnership, Structure, and Sustainability.  The two days of discussion included very tactical and tangible planning for the best partnerships, structures, communication loops, and policies to sustain the effort for decades.  This could have been so easily just a PR opportunity, but the time commitment of the hospital and system presidents to a multi-hour roll-up-your-sleeves  brainstorming and options weighing lent a great deal of credibility.
  5. Stewardship.  The second day of the Next Century Health meeting was a forum on Whole Person Health, Scientific Advancements & Ending Obesity with panelists including former AARP CEO Bill Novelli and Partnership for a Healthier America CEO Larry Soler.  A robust conversation on the root causes and potential solutions  (active, passive, and sanction-based) for the obesity crisis was held for several hours, but what impacted me most was the last comment of the morning, made by Dr. Alan Handysides, Director of the Department of Health Ministries, and a member of the Next Century Health Leadership Council, that core to the Adventist approach is the belief that stewardship of health has value.  From roots that strong a mighty tree can grow.

Learn more about Next Century Health at http://www.nextcenturyhealth.org/

 

What I Learned About Health at the Sting Concert

July 12th, 2010

I spend almost every waking hour fixated on health and healthcare – my own, my family’s, the nation’s. I do research, discuss, or meet with innovative thinkers and practitioners on economic theories and cutting edge technology. Yet I think the best lessons I’ve had in a while on the true meaning of health came Saturday night at the fantastic concert with Sting and the Royal Philharmonic Concert Orchestra.
1. I have had a skip in my step for 2 months since my husband told me he had bought the tickets. Many studies have shown that having a happy marriage can lower blood pressure, inflammation, and levels of stress hormones.
2. Likewise, having something to look forward to all week, seemed to lighten the load of every task I undertook.
3. The music at the concert somehow allowed me to both transcend and fully inhabit myself in a way that my poor but earnest attempts at daily meditation never reach.
4. I danced for much of the 3 hour set and certainly never thought of it as exercise.
5. Watching, being in the presence of people creatively and passionately expressing themselves inspired me to do the same.
6. Finally, experiencing the music live in the company of hundreds of others similarly enjoying themselves gave a sense of universal harmonization and wellbeing, a comfort in alignment.

So what did I learn about health at the Sting concert?
Health is a manifestation of a positive emotional and mental state much more than simply lack of physical disease.

The Real Death Panel: USPSTF and Breast Cancer

November 17th, 2009

In today’s Annals of Internal Medicine and splashed across the front pages of many major newspapers are the shocking new recommendations of the U.S. Preventive Services Task Force (USPSTF) that:

  1. Women should not begin routine mammograms until age 50 (instead of the current age 40)
  2. Women should not be taught to do monthly self-examinations
  3. Physician/clinical breast exams have insufficient evidence of benefit.

Was there a new study that changed their minds? No, just some computer modeling.

Did this modeling show that lives would be saved?  No, annual mammography for all women beginning at age 40 reduced the death rate from breast cancer by 15%, yes, fifteen percent.  According the American Cancer Society in 2009, among women younger than 45 – 6, 460 were diagnosed with in situ ( confined to the breast) cancer; 18,640 had invasive breast cancer; and 2,820 died.  These women and their families don’t matter? Apparently mammography saving lives is not a persuasive argument for these folks.

The justification of the USPSTF and its supporters – false positive readings of earlier screening may cause anxiety and 33/1000 women may have an unnecessary biopsy.

Now I don’t take this lightly.  I was diagnosed with high grades of dysplasia (cellular changes on their way to becoming cancerous) and have had multiple biopsies of various body parts in my 20s and the “anxiety” of a false positive (the false parts later leads to relief) does not even come close to the joy of being alive.

What is the U.S. Preventative Services Task Force for if they’re not for prevention?  They’ve recently torpedoed prostate cancer and Peripheral Arterial Disease (PAD) screening.  Economists may say that they are for evidence-based public health policy, I see rationed care and justification for reduced insurance reimbursement.  Talk about a death panel.

Resources:

Annals of Internal Medicine – USPSTF recommendations   on breast cancer screening http://www.annals.org/content/151/10/716.full

American Cancer Society response to USPSTF recommendation http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp

USPSTF Information including Membership http://www.ahrq.gov/clinic/uspstfab.htm

National Breast Cancer Coalition supports new recommendations http://www.stopbreastcancer.org/

From Health Insurance to Health Plan – A Patient’s View

October 13th, 2009

It has been interesting for me to watch the transformation of the term health insurer to health plan.  Having been insured since in my mother’s womb, I have never been notified that any of my health insurance companies has a plan for my health.  For a health insurance company to be termed a PLAN, in my mind, I would like to see:

1. Prompting and  reimbursing me and my physicians to establish my baseline health metrics and specific health goal(s)

Enrolling in a plan as a new subscriber, a milestone birthday, or just the turn of the calendar could provide the incentive to create a personal plan for my health.  Am I hypertensive? Am I diabetic?  Do I want to lose weight this year, train for a marathon or have a baby?

2. Providing quality and cost assessment information so that I could select the best physicians for my circumstances

See post  A Patient’s Quest for Quality in Healthcare.

3. Facilitating information exchange between my team of physicians

I have a primary care physician, gastroenterologist, transplant hepatologist, gynecologist, reproductive endocrinologist, dermatologist, and from time to time an oncologist, across 4 different practices and medical centers. I would pay anything to have them talk to each other.  Even to have them reliably and regularly share data and view one unified chart and come to a common assessment and plan for my treatment would relieve me of the huge burden of coordination, and no doubt reduce cost, waste, and error.

4. Suggesting, creating networks and reimbursing or providing discounts to complementary services to augment my health such as acupuncture, nutrition counseling, gym membership

90% of what I do to maintain and improve my health happens outside of a doctor’s office.  Health insurer’s buying power and breadth can support my access and use of complementary wellness services to optimize medical treatments and prevent others.

5. Proactively sending me lab results, medication refill and appointment scheduling reminders

Health insurers could add real value by leveraging technology to facilitate my adherence to my treatment plan in the midst of a busy life.

6. Helping me track my progress against an integrated care plan that I create with my team of physicians and complementary providers

Whether building on success or highlighting areas for early intervention, an integrated health plan dashboard with alerts could encourage my focus and active pursuit of health.

Under increased scrutiny in this era of healthcare reform, health insurance companies need to decide and describe how they add value to the healthcare system.   Their access to aggregate data on their members can fuel the integration of care across physicians, hospitals, and pharmacies for patients and support empowered consumer behavior.

Further reading:

The Patient-Centered Care Collaborative

Optum Health, subsidiary of United Health Group

Mayo Clinic Health Policy Center

Google Health

Microsoft HealthVault

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. http://www.nlm.nih.gov/

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.

http://www.southcentralfoundation.com/

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