Neupert On Health

Neupert on Health has moved!

Sean Nolan — Mon, 06 Feb 2012 16:32:20 GMT

The leadership for the new Microsoft/GE joint venture is getting firmly in place and as noted in my last post, I have now transitioned to be a consultant/contractor.

I remain focused on the intersection of information technology and health to improve health around the world; if you want to follow my ramblings going forward – you can find me here:

http://neupertonhealth.wordpress.com

A New Chapter

pnblog — Sat, 10 Dec 2011 00:51:00 GMT

Yesterday we announced an exciting new chapter in the Microsoft in Health story. Microsoft and GE Healthcare (GEHC) are forming a joint venture – with equal investment from each ‘parent’ – that will offer advanced IT solutions to healthcare organizations.

Microsoft’s vision for health has always been ambitious – ‘Improve health around the world, through software innovation.’ This joint venture represents a doubling down on our commitment to healthcare.

The complementary strengths of Microsoft – platform and ecosystem development – and GE Healthcare – clinical applications and workflow expertise, global sales force and domain knowledge in healthcare – will help us get there faster. Of course, Microsoft will also continue to offer our core technologies to healthcare organizations, working with partners to deliver innovative solutions for health and health management. And we’ll keep investing in HealthVault to support patient engagement and personal health management.

The new company we’re planning to create will combine real-time data analysis with knowledge management tools to build a platform and set of applications that will improve patient care and reduce costs. The healthcare industry is the largest sector of almost every economy. It touches every citizen – and it consistently under-invests in IT.

But healthcare information is getting more and more digital. For better patient care to happen, data needs to move with the patient. Unfortunately, almost all systems are built around an institution rather than a patient, so it's hard to separate the data from the application and make it available within and across organizations.

The new company’s collection of assets, Microsoft Amalga, GEHC Qualibria and the future apps we want to build on those platforms, will give people access to digital data and make it reusable. It's a hard problem that nobody has really solved. So we’re going to work together to build a robust, data-driven platform that enables us and third parties to create the next generation of clinical applications. GEHC is bringing a level of knowledge and capability around building apps – and determining which apps are the right ones to get started with – so that we can make the platform more compelling in the early stages.

Other HSG leaders and I had the opportunity to talk with many of our customers about the announcement. It was great to hear their enthusiasm for the deal -- after we assured them that we’re committed to delivering on our product roadmaps. They totally get the need for differentiated apps to help showcase the value of the platform and understand that healthcare needs to move toward population health management.

So, pending regulatory approval, the new company will launch in 2012 and will be headquartered near the Microsoft campus in Redmond, Wash., with a big presence in Salt Lake City. Our goal is to get the venture off to a fast start with a great set of products, employees, customers and partners.

As the leadership team for this new venture takes its place, I'll move to a role where I advise and make recommendations based on my learnings and experience. I'm committed to making this new company a success, and I’m committed to making the transition as smooth as possible for all involved.

My wife and I recently became “empty nesters” so this is a great moment and a wonderful confluence of events that will let me take a step back – and think about what my next chapter will be.

Making Sound Decisions in Health

pnblog — Wed, 30 Nov 2011 03:26:00 GMT

In past blogs, I have frequently discussed the need for the consumer to be a more active participant in the health ecosystem. I passionately believe the citizen/consumer has to be accountable for their many personal health decisions – such as lifestyle, smoking, nutrition, activity levels and the like. It is simply not right or fair that the additional health costs of others’ lifestyle choices be a financial burden on all of us. The most recent government forecast for Medicare expenditures says on page 44:

"Total Medicare expenditures were $523 billion in 2010 and are expected to increase in most future years at a somewhat faster pace than either workers’ earnings or the economy overall. Based on the intermediate set of assumptions and current law, expenditures as a percentage of GDP are projected to increase from the current 3.6 percent to 6.2 percent by 2085."

And then the report goes on to say Part B expenditures are substantially understated in the forecast!

Let me be clear – I am NOT saying that all health costs or even that the rise in health costs are all the result of consumer lifestyle choices – they are not. But they do play a part – and if we are ever going to solve our financial crisis in the US – we need to get more value (better health outcomes at the same or lower cost) out of our huge and growing health expenditures. This will require reform across many fronts – payment reform, physician culture and importantly, consumer engagement and accountability.

So with the above context in mind, I read with interest this Forbes article by Leslie Michelson, What Steve Jobs’ Death Can Teach Us about our Own Health Care. I encourage you to read it. Michelson’s basic premise is that the approach Jobs took to making a critical health decision was flawed, and because he took nine months to try alternative options prior to surgery, surgery ended up not being enough. More importantly, Michelson’s point is that making medical treatment decisions is ‘different’ than everyday business or life decisions and that you need a framework (and support) for making them. They are different for two key reasons – one, the overwhelming emotional stress associated with them (in the case of life-threatening issues) and two, the specialized knowledge and collaboration required.

Despite the fact that I believe many other business or life decisions are high stress – I completely agree with him. Making decisions about health is different and requires a different decision framework. Personally, I have been dealing with health decisions related to a parent-in-law. The decisions (where to go, who to see, what to do next) are just hard, and the health delivery system is neither helpful – nor designed to be – in guiding patients through the decision-making process.

Michelson’s first step in the framework is to get an ‘accurate and complete diagnosis.’ Sounds right to me – but in my experience, even after many doctors, specialists, innumerable diagnostic tests and biopsies, plus a few hospital stays – we still don’t have even that. We have met many caring and thoughtful people along the journey, but we haven’t really had much help in how to think about and approach the key decisions – and nothing about how to deal with inability to diagnose.

I believe one of the big areas for innovation in health is in consumer decision making and behavioral insight. Dartmouth has long been a proponent of ‘shared decision making’ and has set up a Center for it. There clearly is a lot to learn just in the basics. However, I think the knowledge and possibilities for innovation are going to explode as the infrastructure is put in place now for an explosion of data and more closed loop feedback systems. With EMR data flowing into patient-centric data platforms like HealthVault – which are increasingly being connected to mobile devices or home health devices with masses of data points around activity, diet, pill taking, lifestyle preferences – we will be able to use ‘big data’ tools and machine learning to identify what works for which groups. It will be very exciting. As Glenn Reynolds over at Instapundit frequently says about innovations – faster, please.

Data Liberation is Great – Let’s Talk About What’s Next

pnblog — Mon, 12 Sep 2011 18:00:00 GMT

Today, I had the honor of participating in a Consumer Health IT Summit at the Department of Health and Human Services in Washington, DC. It was great to see health IT stakeholders coming together to help drive the industry toward a more patient-centric health system, and I applaud the leadership at HHS and ONC – particularly folks like Aneesh Chopra, Todd Park and Farzad Mostashari – for drawing attention to the need for patient engagement and ‘data liberation.’ And, as always, the showmanship of Farzad, Todd and Aneesh made for an entertaining event!

At the event, HHS announced that they are releasing a PHR Model Privacy Notice for PHR vendors – or personal health platforms like HealthVault – to use to communicate to consumers their data sharing and security policies. We intend to post our PHR Notice on HealthVault.com as soon as the HHS web tool goes live later this week. We have been very focused on transparency and making it easy to understand how we approach privacy and security since we started working on HealthVault – because we know that transparency is required to enable trust. This notice offers another way to communicate our privacy and security practices, so we will use it and encourage our partners who build HealthVault apps to use it also.

I was excited to participate in today’s event, however – as readers of this blog know – I have been talking about data liberation and patient-centric healthcare for a long time. The free flow of health data is the necessary foundation for a healthcare system based on value – high-quality, cost-effective, personalized medicine. But enabling access to data is a necessary – but insufficient – condition for getting patients engaged. Data liquidity is important because it brings patients and their healthcare providers the information they need to improve health and healthcare, but patients must be inspired to use the data – not just store it on their PCs.

That’s why, although I was glad to be part of today’s event, I want to challenge ONC and the private sector to do more. Engaging patients is critical to driving value – better outcomes at lower costs – in our healthcare system. We need to move from expecting clinicians to do everything to a world where patients are empowered – and expected – to share decision-making and to be responsible for managing their health.

Two examples of connected data enabling better outcomes and higher satisfaction are studies we conducted using HealthVault – one with the Cleveland Clinic and one with Kaiser Permanente Colorado and the American Heart Association. The studies were designed to see if the use of at-home medical devices (such as blood pressure cuffs, scales, glucometers, etc.) help patients and their physicians work together more efficiently to manage chronic conditions. The results suggest that at-home medical devices – connected to cloud-based services for storage and sharing – can help patients and doctors work together to better track chronic conditions, coordinate treatment schedules, manage medication regimens and schedule timely interventions. Ultimately, these improvements could help create a more efficient healthcare system and healthier, more satisfied patients.

In order to move consumers to participate in managing their health, we need to motivate them with a call to action that is relevant, meaningful and actionable. My recommendation is that the CDC and HHS work with the private sector to create a campaign like “Know Your Numbers” (building on Dr. Oz’s work) or “Know your Meds” to begin educating consumers on the importance of understanding and managing their health.

Imagine if the government organized a group of great consumer companies – Nike, Apple, Starbucks, Microsoft – and got us to work together to create a campaign with a clear call to action around managing your health. If we could do this in a sustained way over a period of time, I’d bet there’d be some impact.

The idea behind today’s Consumer Health IT Summit was a good one – but let’s not stop here. The real value – for consumers and for the health system – will come when we create compelling ways for consumers to engage in managing their own health.

Better Care at Reduced Costs? A Real-Life Example!

pnblog — Thu, 01 Sep 2011 11:50:00 GMT

The results of a recent peer-reviewed study conducted by Humana Inc. and Wisconsin Health Information Exchange (WHIE), a long-time Amalga customer, are both exciting and important.

They’re exciting because the results begin to prove what many people involved with health information exchanges have long theorized – that providing a more complete view of a patient’s medical history at the point of care helps doctors make more informed decisions that can improve the quality of care while reducing waste. Humana and WHIE achieved an average cost savings of $29 per emergency department (ED) visit when doctors queried the WHIE for information about the patient’s medical history upon registration. Redundant testing represents a huge strain on the healthcare system, and as the study demonstrates, can be reduced when ED clinicians have the right information at their fingertips. This degree of savings, if extrapolated across all of the emergency encounters in the country (120 million per year), could potentially yield $3.5 billion in savings annually. You can learn more about how these savings were achieved by reading a blog from Ed Barthell, MD, director, Microsoft Health Solutions Group.

The study results are important because they demonstrate the power of the public and private sector working together to drive greater efficiency and value in the healthcare system – by enabling an open, secure exchange of data. From the beginning, WHIE leaders recognized that the exchange needed to focus on the ends – rather than the means – of health information exchange: improved care of individual patients and data to support initiatives to provide better care across populations. WHIE implemented Amalga to support a regional data aggregation strategy as a core component of the solution – in contrast to many other HIEs that concentrate only on point-to-point messaging.

In addition, aligning innovation across health IT and business, WHIE and Humana were able to establish a symbiotic relationship that can serve as a model for state and community HIEs across the country – a model that benefits the payer, the provider, the patient, and the public. Specifically, WHIE and Humana have shown:

Health plans can reduce their costs by partnering with emergency departments to use health information exchange to access patient information at the point of care.
Providers can reduce the cost of caring for uninsured patients – and might also share some of the savings. In addition, providers can benefit from unlocking data, aggregating it, sharing it and learning from it – to provide care based on more complete information.
Patients and their families can gain peace of mind knowing caregivers are coordinating care and making informed decisions – and not worry about piecing together their medical history in an emergency situation.

And, although it wasn’t covered in this study, the WHIE also demonstrates how a community-based HIE can help protect populations by allowing the near real-time analysis of cohorts and the ability to identify trends and epidemics as they emerge.

Perhaps most important, the Humana and WHIE study presents a model of sustainability for HIEs. If payers can realize a greater than 2:1 return incenting hospitals to use health information exchange, as Humana has, there’s reason to believe similar payer-provider partnerships can create sustainable HIEs across the country. And, imagine how much progress we could make on ‘bending the cost curve’ if we liberated the data across the entire system?

HealthVault -- We’re Still Driving Forward

pnblog — Mon, 18 Jul 2011 17:45:00 GMT

This blog was also posted on the Microsoft News Center.

Following the Google Health announcement, a number of people have questioned whether Microsoft will continue to develop HealthVault without another vendor like Google to ‘compete’ against. The reality is that we’ve always viewed the status quo as our biggest competitor and Google as an ally in the movement to transform health care around the world – so we’re sorry to lose their voice in the discussion.

Since Google’s announcement, the two companies have worked together to create ways for Google Health users to transfer their data into Microsoft HealthVault. Today, we announced an option that leverages the Direct Project protocol for encrypted messaging to enable the data transfer with just a few clicks.

And what about HealthVault? Will Microsoft continue to invest? HealthVault is not peripheral to Microsoft’s health IT business – it’s core to our strategy and to what we believe is required to truly make a difference in health and health care.

In order to transform health care, I’ve said for a long time that data must flow across the system – from the hospital to the physician to the home. Health care should be a data-driven industry, and software is designed to manage data in efficient and effective ways – creating new insights that often lead to new ways of delivering care. Whether it’s a clinical pharmacist who needs access to a patient’s complete history or a patient who is tracking her diet, exercise and blood pressure readings to better manage her hypertension – having the right information at the right time is critical to decision-making about health and health care – and it’s the key to delivering better value.

To accomplish this, health care stakeholders need better systems in provider organizations and better systems for connecting caregivers with patients. Microsoft’s strategy and investments continue to be focused on delivering these systems – Microsoft Amalga, which is designed to help health systems streamline operations and connect care teams, and HealthVault, which enables engagement with patients. We believe these two platforms combined – Amalga and HealthVault – can transform care and create a patient-centric health system.

Getting there has been – and continues to be – hard work – and it’s not happening as fast as we’d like.

Because of how HUGE the health ecosystem is – trillions of dollars, hundreds of millions of consumers/patients, hundreds of thousands of physicians, thousands of hospitals, hundreds of insurance plans and so on – progress is hard.

But we are seeing changes. In the US, incentives are being realigned to foster engagement with patients and management of care beyond the walls of an organization. And the government is driving projects to support the flow of data across the health care system. The UK is also focused on some exciting ideas around transforming health care delivery. And we’re in conversations with a number of governments and large health care providers around the world about how technology can enable the flow of data across the health care ecosystem to better manage the health of a population – at lower cost.

So, for people wondering about the future of HealthVault and Microsoft’s ongoing commitment to health care, let me be clear. We continue to be focused on driving change in health and health care around the world through data liberation. This is the position we staked out 5+ years ago – and the ongoing focus of our investments.

The "Economic Imperative" – Healthcare Delivery Must Be Transformed

pnblog — Mon, 02 May 2011 23:18:00 GMT

Last week I participated in our fourth annual Connected Health Conference, held in Chicago. At this event we get together with hundreds of customers, partners, policy makers, and thought leaders from across the industry to talk about what’s going on in healthcare today – and what’s next.

A highlight of the conference for me was the opportunity to moderate a lively panel that included Phil Bredesen, Bill Hazel and Mike Leavitt . Given all the talk in Washington, DC and the states about how to rein in rising U.S. healthcare costs, it was great to hear from current and former officials from HHS and state governments on the forces driving evolving payment models and delivery system reform. They all agreed on this point – regardless of what happens with U.S. healthcare laws and regulations, the healthcare delivery system will change dramatically in the next 5-8 years because the current model is unsustainable. Mike Leavitt said it best – there is an “economic imperative” to change the healthcare system and “health reform is now economic reform.”

We need to drive additional value – better care for the same or lower costs – into our healthcare system. All the panelists agreed that to get to value, we must throw away the fee-for-service model, support greater transparency within the system, and enable innovation. The fee-for-service rules have stifled innovation by reinforcing volume over value -- reimbursing on a per-procedure basis rather than on the number of patients who remain healthy year over year.

Phil Bredesen emphasized the need to re-introduce “economic tension” into the system. When businesses and consumers purchase goods and services, they typically have the opportunity to balance what they want to spend with the value they perceive. Without transparency around cost and quality, healthcare purchasers can’t make informed choices. Bredesen’s view is that transparency will generate the required tension – improving healthcare dramatically.

I asked the panelists where innovation will come from. The consensus was that states and employers will drive change because they are desperate to figure out how to balance their budgets. Bill Hazel told a story about a manufacturing company with a significant population of diabetics. They’re working with local healthcare providers to drive change in the system – to address high costs, high absenteeism and ineffective care. The employer was clear – if the U.S. can’t figure out how to provide better value in the healthcare system, the company will be forced to move elsewhere.

A focus of our Connected Health Conference is innovation in technology. Craig Mundie, Microsoft’s Chief Research and Strategy Officer, gave a great presentation on the future of technology and its potential impact on healthcare, and a number of our customers and partners demonstrated significant progress in using technology to drive change in care delivery.

But, technology is only part of the story. As Leavitt explained, until recently “medical innovation” has been a new gadget, chemical or procedure. Now it’s about:

Innovating around defining and demonstrating a value proposition for stakeholders – Pay $1 today and get $1.50 tomorrow.
Innovating around collaboration – Networks of care teams are emerging, but successful collaboration requires the ability to split up a series of activities and a set of money in an orderly way.

It’s clear that change is coming. I’m excited about the potential to drive real value in the healthcare system – with innovative technology and innovative business models.

HIMSS 2011: We’re Not So Crazy After All

pnblog — Fri, 25 Feb 2011 00:47:00 GMT

I spent most of this week at HIMSS in Orlando – a conference I’ve attended every year since 2006 – which gave me an opportunity to reflect on the significant changes I’ve seen in the healthcare industry over the last few years.

Four years ago at the HIMSS in New Orleans, Microsoft’s CEO, Steve Ballmer, gave one of the keynotes. Steve spoke about the proliferation of clinical data, the need to engage patients in managing their own health, the required move to a more collaborative approach to life sciences research, and Microsoft’s focus on helping to harness technology to drive improvements in health and healthcare around the world. One of the things Steve discussed is the need for “a different kind of working relationship between public and private people, between providers, insurance, and government to really develop and deploy the kind of interoperable systems that will let this vision happen.”

In 2007, when we started talking about different relationships among stakeholders in healthcare and highlighting the important role of consumers as well as interoperability – data liberation and liquidity – in transforming care, everybody thought we were crazy. And now – in the US, at least – it’s the law.

Meaningful use was once again a big topic at this year’s HIMSS since many organizations are focusing their IT investments in order to qualify for federal incentive payments. But, we need to recognize the vision behind the meaningful use of EHRs: an interoperable system of care that increases quality, safety and efficiency, improves care coordination, engages patients and their families in managing their health, enhances population and public health, and ensures adequate privacy and security. Meaningful use of EHRs requires moving beyond the traditional electronic medical record to enable the secure flow of data across the health ecosystem in ways that enable new delivery and payment models to flourish. This is the position we staked out four years ago – and the ongoing focus of our investments.

Earlier this week we announced an alliance with athenahealth designed to drive better care coordination across outpatient and inpatient physicians and settings, a priority for health systems looking to form ACOs and qualify for pay-for-performance funds. We’re connecting Microsoft Amalga with athenahealth’s hosted web-based services (athenaClinicals and athenaCollector) to enable physicians to see inpatient and ambulatory information in a single view. Microsoft and athenahealth decided to make these investments because they meet a need our joint customers – specifically, Steward Health Care System in MA (formerly Caritas Christi) and Cook Children’s in TX – have expressed.

Steward is focused on executing on programs like their Alternative Quality Contract (AQC) with Blue Cross Blue Shield of Massachusetts, which is a contract model designed to give providers meaningful incentives to improve the quality of care while conserving healthcare resources. To meet these objectives, Steward is looking to drive efficiencies and deliver truly coordinated care. At Cook Children’s, the goal is to improve the health of every child in their region by providing patients and physicians with access to an information platform that transcends physical location and has the capacity to evolve to meet changing rules and requirements. athenahealth and Microsoft are bridging the information gap – giving clinicians the ability to access patient information from anywhere, regardless of its origination, and enabling a new level of patient engagement.

In 2007, we knew it would take time for our vision to come to fruition – and we’re clearly still at the beginning stages of data liquidity and health information exchange and the innovation these changes will enable. And, the government and private insurance companies need to ensure that the right incentives are in place to drive this move toward greater interoperability and to avoid stifling innovation before it has a chance to take root. But, as these customers and others are demonstrating, the healthcare system can achieve our shared goals of better value – better outcomes for the spend – today by enabling the flow of data and collaborating across the healthcare system in new ways.

Connected Health: Bringing Patients and Physicians One Click Closer

pnblog — Wed, 02 Feb 2011 16:47:00 GMT

Almost two years ago on this blog, I issued a call for ‘data liberation’ – emphasizing that the free flow of health data should be the foundation for realizing a future of secure, personalized, data driven medicine. A year later, I discussed the concept again as we began to see the idea of ‘meaningful use’ take shape – with its focus on data exchange for the benefit of physicians and patients. I see an increasing amount of activity that keeps me optimistic about us realizing this vision for ‘connected’ health. Of particular note are the folks at the Federal level (HHS and ONC) who are increasingly grounding their initiatives in the same concept of data liquidity. See the re-post below of a blog I wrote for “Microsoft on the Issues” on this topic.

Health has been a huge focus for the federal government over the past year – specifically, how to expand access and drive value: improving care for the same or lower cost.

The Office of the National Coordinator within Health and Human Services (HHS) successfully spurred the industry to action last year with its Blue Button Initiative and worked with private sector organizations to drive the Direct Project. The Direct Project is focused on using e-mail as a secure way to share health information. Microsoft was an early participant in this project along with other companies such as Allscripts, MedPlus and VisionShare.

Today in Washington D.C. at an HHS press event, we announced that next week we will be launching new functionality that wires every Microsoft HealthVault account to use online encrypted patient e-mail based on Direct Project security protocols. To start with, we will enable physicians to transmit a copy of a patient’s clinical information to a new email address created within HealthVault. This information can be read or saved to a patient’s HealthVault account to build their personal health record – a holistic view of an individual’s health history. In the future, we expect to make this functionality available to providers and to enable secure messaging for physician-to-physician consults and for transfer of patient records.

At this point, most people recognize that software technology can be a catalyst for connecting the health ecosystem and transforming the ways we manage and deliver healthcare. Healthcare should be a data-driven industry, and software is designed to manage data in efficient, effective – and new – ways. Whether it’s a surgeon who needs access to a patient’s complete history, or a patient who is tracking her health and diet information to better manage a chronic condition – having the right information at the right time is critical to decision-making about health and healthcare – and it’s the key to delivering better value.

Historically, the data has been hard to get. Within the hospital, it is trapped in siloed systems that support different departments but aren’t connected. Within the physician’s office, it is trapped on paper, in hundreds upon hundreds of file folders. For the patient, their personal health data is often inaccessible – since the data is typically collected and stored at the point of care.

At Microsoft, we talk about the need for “data liquidity,” which translates into liberating data from across the health system so that individuals can start engaging with the information and using it in meaningful ways.

The Direct Project is designed to address part of the issue as an easy, secure way to exchange health information. The Direct Project specifies a simple, secure, scalable, standards-based way for participants to send encrypted health information directly to known, trusted recipients over the Internet. This can be physician-to-physician; physician- to-public health authority; physician-to-patient; and on and on.

With the Direct protocols in place, patients can more actively engage with their providers in the ongoing management of their health. And these protocols enable improved care coordination across the health system. Physicians can more easily communicate with each other about patients, and patients can share their personal health information as they move across encounters with different healthcare providers. Putting patients at the center is the vision behind Microsoft HealthVault – so it has made sense for us to be an early participant in the Direct Project.

Step by step, we are liberating the data and bringing patients and their healthcare providers one click closer to the information they need to improve health and healthcare.

“Partnering for Cures” to Advance Personalized Medicine

pnblog — Fri, 17 Dec 2010 04:36:00 GMT

I think we all would agree that finding cures and improved treatments options for cancer are a moral imperative. They will have a dramatic impact not only for those fighting the disease, but also for the families, friends, healthcare providers, and other caretakers that support them in their battle. Personalized molecular medicine provides a promising path forward in cancer care, but accelerating this research requires the brightest minds, great laboratories, cross-disciplinary collaboration, rich software tools and LOTS of relevant, annotated, real-time data. Today we are missing the “LOTS of data” piece, because our health information technology (HIT) and consent systems are not effectively connected for either the improvement of care or the acceleration of research.

Estimates in the U.S. indicate that more than 1.5 million will be diagnosed with – and more than a half million people will die of – cancer in 2010. And, as of 2007, 11.7 million Americans were living with the disease. Of those 11.7 million cancer survivors, it’s estimated that only 5% are enrolled in clinical trials, and only 15% are being treated at major research centers – which means more than 9 million people with cancer are not part of formalized research. This is a highly motivated community, many of whom would welcome the chance to participate in research that could help their children, or their children’s children, receive more effective treatments if they suffer from the disease.

In partnership with the National Cancer Institute (NCI) and SAIC we have built a prototype to demonstrate that we can solve this problem now. Earlier this week at the Partnering for Cures conference in NYC, Ken Buetow, Ph.D., Director at the Center for Biomedical Informatics and Information Technology at NCI and Dr. Jon Handler, from Microsoft’s Health Solutions Group, presented a jointly developed prototype that showcases the potential for information technology to accelerate personalized healthcare research and improve clinical care. Dr. Buetow talks here about the information challenges faced by researchers, providers and patients, and looks at the potential for technology to drive meaningful transformation in support of these stakeholders’ needs.

The prototype uses Microsoft HealthVault and the Patient Outcomes Data Service (PODS) created by NCI to collect provider and patient-generated data on cancer diagnoses, treatments and outcomes. Since PODS and HealthVault are easily accessible outside research centers, the prototype highlights ways to engage a broader set of clinicians and patients in research – making it easier to reach those 9 million people who are not currently represented in research studies. In addition, gathering regular reports from patients on their experience with cancer treatments – for example, tracking daily pain levels, sleep patterns and mood – can provide researchers and clinicians with a richer set of data for understanding the impact of cancer treatments, particularly among certain patient sub-types and populations.

Using Microsoft Amalga, this data can be made anonymous and aggregated with data available in other research databases to create a disease registry that enables more complete analyses of the efficacy of cancer treatments. Providers and patients have the opportunity to not only contribute their own information to benefit others; they can also view trended data from across similar patient populations, enabling shared decision-making around diagnoses and treatment plans.

While the prototype we built focused on cancer research, there is potential to use HIT to further the personalization of treatments for other diseases – Parkinson’s, Multiple Sclerosis, and Alzheimer’s – and begin to see how we can use the power of technology to create closer connections and valuable feedback loops across providers, patients and researchers. Ultimately we hope this will translate to people arriving at critical insights more quickly and partnering with each other to not only improve the care of the individual patient, but also to find cures for cancer and other devastating diseases.

Transforming Healthcare Delivery

pnblog — Mon, 15 Nov 2010 03:57:00 GMT

So…life’s been really busy – which has meant a hiatus from the blog. Moving forward, I’m committed to making this more of a priority and looking forward to writing about a range of health-related topics – not just US healthcare reform.

A couple weeks ago, I had the opportunity to spend some time in the UK meeting with folks from several hospitals, including University Hospital of South Manchester, Milton Keynes Hospital and Great Ormond Street Hospital Charity. Fun story about Great Ormond Street Hospital – JM Barrie gave them the rights to Peter Pan, so they get royalties every time the play is performed.

The UK is focused on some exciting ideas around transforming healthcare delivery. They think about health from end-to-end – including everything from subsidized child care for poor families to social services to elder care to General Practitioners (GPs) to specialists to hospitals – and are working to align incentives and reimbursements with integrated care models. As they look to reform the system, the government is focused on two core principles: creating a marketplace for healthcare services – so market signals determine who gets paid what for healthcare and how capital is invested – and a patient-centric approach that includes a personally controlled health record.

The changes will be dramatic. The government has already announced a plan to give GPs responsibility – and funds – for commissioning care for patients in their area by buying treatment from hospitals, charities and other doctors. Folks are taking a collaborative approach to building out these integrated systems – at South Manchester, they’re pulling together officials from public health, the hospital and community GPs to figure out how to get started.

It’s going to be really interesting to watch this over the next two to three years. There’s every chance the UK will move much faster than the US to a health system that’s more focused on value.

Last week, I was in Washington, DC. It’s a trip I haven’t made in a while, and it was fun to be back. A highlight of the week was a meeting at the Pentagon – my first time there. It was great to see and honor those that serve – especially a couple days before Veterans Day.

I was in DC – along with about 2400 others – for the mHealth Summit. The event was filled with lots of buzz and excitement around the transformative possibilities of cheap mobile devices and connected services for healthcare around the world. Health is inherently mobile – it’s about decisions you make and actions you take as you live your life, so I’m optimistic that ‘mobile health’ will become an integrated part of our healthcare system. What I don’t know is whether it’s going to take three years or thirty years for us to get there. In the US, we need to transform the incentive system – so doctors don’t just get paid when patients come to their office – before broad adoption of mHealth will happen.

In DC, there was of course lots of conversation about the election and its impact on healthcare reform. It’s unclear how the politics will play out, but payment reform to create value and drive out waste is a bipartisan issue – Democrats and Republicans both see the need, though they disagree on the means.

I applaud the attention on new delivery and payment models for healthcare – in the US, through the creation of accountable care organizations (ACOs) and in the UK through GP-based commissioning. Both models support a holistic, integrated, patient-centric view of health and recognize the need to get the incentives right. It seems like healthcare reform will enable and may potentially accelerate experimentation.

As we talk to customers around the world, it’s clear that they aren’t waiting for results from all these reform experiments. There’s a distinct focus on finding information technology tools now that help them understand how to manage the care of populations in a very different way – not just when patients visit their facilities.

Our Connected Health Conference - a View of the Future Grounded in Some Really Exciting Reality

pnblog — Thu, 20 May 2010 22:35:00 GMT

We’re just wrapping up our third annual Connected Health Conference, held in downtown Bellevue, WA. It’s where we get together with a few hundred customers, partners, thought leaders from the industry, policy makers -- and talk about the healthcare industry and the kind of positive change and innovation that’s happening. I like to think of it as a “Community of Innovators.”

We’re seeing real progress. At last year’s conference, much of what we talked about was still at the 'implementation' stages -- customers were deploying, beginning to use and see value from our products. I won’t go so far as to echo what our conference moderator, Ian Morrison, said -- that the only place where a new vision for the industry seems to be alive is in PowerPoint -- but 2009 was an earlier stage of the business . Today, our vision about ‘liberating data’ and creating a ‘connected’ health system with patients at the center is becoming a reality, as demonstrated by the work our customers are doing with Amalga and HealthVault.

During the conference, we heard about the work taking place at Seattle Children’s Hospital, Golden Living, Medstar Health, Virtua and elsewhere. They are re-engineering workflows, engaging with patients differently, empowering healthcare workers to be more effective, using and re-using data to drive better decision-making. These folks are building ‘learning organizations’ – able to react and adapt – which will help them get more value out of their orgs and more value out of the system as a whole.

My Wednesday keynote focused on just that – driving a health system based on VALUE versus the system of today, which focuses on VOLUME. You can see some of the highlights of my talk in the video below. I shared some perspectives on the system as a whole, on organizations and their path forward to becoming more flexible, empowering, and adaptive and on consumers – and of course included some thoughts on how technology can be a tool at all three levels to help drive positive change and enable innovation.

My favorite part of the conference was a panel we had on the topic of driving innovation in health. The panelists included Todd Park, CTO of the U.S. Department of Health and Human Services , David Brailer, Chairman of Health Evolution Partners, and Rod Hochman, CEO of Swedish Medical Center. These folks are all innovators in different ways, and we had a very insightful and lively discussion.

Some of the more interesting thoughts:

Actions to improve the system – Drive variability out of healthcare delivery, Get back to ‘community rating', Have the government create incentives and remove dis-incentives, Separate employment from insurance
How to remove the barriers to innovation: focus on incentives (paying for VALUE not VOLUME) and information (data liberation).
Driving demand-side ‘consolidation’ – Folks talked about how supply-side innovation and change are clearly happening, but what’s really needed to drive systemic change, including motivating and catalyzing politicians, is a different kind of aggregation on the demand side. Historically, patient populations have coalesced around diseases and disease states, but there’s a need to aggregate differently – by age, sex, etc. – to really understand and communicate patient needs and wants.

You can see more panel highlights in the video below:

We also had the opportunity to ‘zoom out’ and take a broader look at how the field of computer science is advancing. Microsoft’s Chief Research and Strategy Officer, Craig Mundie, shared some perspectives on how powerful client machines and the cloud, combined with a revolution in the ways people interact with computers, will define a new era of computing. He demonstrated the kind of future that’s possible – you can see it in the video below.

I left the conference feeling very energized, excited and inspired! While sometimes it feels like we are pushing a rock uphill, I believe we’re on the right path. This ‘Community of Innovators’ will be catalysts for change.

Stop Demanding Too Little of the Health Care Industry

pnblog — Tue, 13 Apr 2010 23:03:00 GMT

For my latest thoughts on the business of health care, particularly the existing health care delivery system and payment framework, please see my contribution to the Harvard Business Review Conversation Starter blog.

The First Mile on the Marathon of Reform

pnblog — Wed, 31 Mar 2010 19:31:00 GMT

Last June, I became a regular contributor to The Washington Post’s “Health Care Rx” blog, which provided space for me and other experts from across the industry to comment on the current state of the health system and offer real-world insights into how to improve health care. Now, given the recent passage of health reform legislation, the blog will come to a close. The final question came on Monday:

This week, President Obama plans to sign into law a budget "reconciliation" bill that includes the final changes to the new health-care overhaul. What is your assessment of the now-complete health law and its implications for the future?

My response, The First Mile on the Marathon of Reform, is below:

The mainstream reform debate has been primarily focused on access -- the millions of Americans who don't have insurance. We heard heartbreaking story after heartbreaking story day after day for nearly a year. And this bill tackles that enormous problem!

But there are the other big problems -- skyrocketing costs, misaligned incentives, inferior and inconsistent care, and so on -- all stemming from the fact that our health delivery model has remained what is essentially an acute, episodic care business model from the 19th century; a traditional fee-for-service model based on patients visiting hospitals and physicians' offices when they're sick. We have a system that hasn't evolved to keep up with the way our nation's health has changed -- toward chronic care. Nor has it progressed to use health data in an effective way to drive better decision-making and improved methods. It's not set up to enable the kind of broad-scale innovation and consumer-focus that has transformed nearly every other industry that touches our lives. Nor is it poised to keep up with and take advantage of advances in medicine, especially to deliver on the promise of personalized medicine.

In the context of these massive structural problems, while the bill is a positive step forward, it seems like it's just the first mile on the marathon of reform.

There are other good "ideas" from "experts" in the bill besides access to address some of these problems -- an Innovation Center within CMS to pilot payment reform, a Patient-Centered Outcomes Research Institute to identify and carry out national research priorities to drive "evidence-based" medicine, a Medicare shared savings program to pilot cost-savings for accountable care organizations, and so on. But these will require doing a fundamentally better job of running pilot and demonstration programs in Medicare. Right now, we evaluate the reforms over 8 to 10 years. We need to lower that dramatically to accelerate the path for these ideas to 'scale' and become common practice -- driving the kind of wholesale transformation needed.

Most people recognize that it will take several years to get reform "right"-- we have an opportunity to do even more to drive innovation and shift the system to drive real value for every dollar spent. I hope that we will continue to work at driving the right combination of structural change, innovation, and use of technology to create a better system for our generation and those to come.

The Ups and Downs of Managing my Own Health

pnblog — Mon, 22 Mar 2010 21:57:00 GMT

I learned about the importance of diet and health very early in life as my Dad had his first heart attack when I was 12, and subsequently, my Mom made dramatic changes to our 1960’s diet at home. Since my college years, I’ve always been a bit of a health nut -- careful with my diet and disciplined about working out. During my 30’s and 40’s, I relied on my supposedly high degree of exercise/fitness to manage my cholesterol levels…while my older brothers started on statins in their late 30’s. One of my brothers warned me that everything gets harder after 50, so I focused on continuing to make a combination of subtle shifts in diet, stress and exercise, which have led to my chart below -- from the Mayo Clinic Health Manager.

Just about Christmas time last year, the trend wasn’t looking good, so my doctor strongly suggested starting on statins (he’d been suggesting it regularly in the past but had left it up to me). I’d heard a lot about taking them versus not -- but I thought the pros and cons were especially well summarized at a panel on which I spoke at the Partners’ Connected Health Conference in Boston. John Halamka, John Glaser, and I were on the panel, and an audience member posed a question about tools to do research and manage one’s health -- I can’t quite remember it specifically -- but I do remember the specifics of the answers from the two John’s -- two distinctly different answers. John Halamka talked about how his doc had suggested statins, but after doing some research, he decided to pursue a difficult personal course of action -- to shift his behaviors, change his eating habits, lose weight, and exercise more. He actually became a vegan -- quite a dramatic shift! John Glaser, on the other hand, didn’t want to give up his burger, so he chose the med route. And BOTH are doing well!

For me, I decided to try the Halamka route. For the past three months, I’ve aggressively modified my diet -- cutting out eggs and red meat, eating oatmeal every morning, eating lots of green vegetables, salads and chicken for dinner. My doctor and I had agreed on a three month retest, and I just got my results back, which are reflected in the chart below. While I have reversed the trend and have bent the curves in the right direction, I still need to work on improving my LDL levels, which are not yet where they need to be to lower my risk levels. However, I am still not yet prepared to start a statin regimen. It seems clear that my DNA and biology create higher than ‘recommended’ cholesterol levels -- the question though -- is this fact creating a potential health problem or not? I wish the genetic understanding and testing had reached a point where it could definitively answer this question!

Going Beyond Insurance Reform

pnblog — Fri, 12 Mar 2010 23:58:00 GMT

This week's question for the Washington Post Health Care Rx blog was:

Last week, President Obama admonished insurance company executives for excessive rate increases. He is taking aim at them again in his speech in Philadelphia right now. How much of our problem rests with insurance companies and how much is the result of other facets of the health-care system?

My response, Going Beyond Insurance Reform, is posted below.

In 2009, the United States spent an estimated $2.5 trillion on health care. That same year, the profits for the top five for-profit health insurance companies totaled around $10 billion, generally 3-4 percent of their revenues -- a fraction of total health-care costs. So, while insurance reform is important, fixing our health care system will clearly require more.

We need to think more broadly about redesigning today's health-care system to drive innovation, better value and improved outcomes to be able to increase access. Our current system is based on a fee-for-service model that primarily addresses acute care issues versus today's health concerns, which are dominated by chronic conditions. The CDC estimates that more than 75 percent of America's health-care costs stem from six chronic disease states. And the number of people with chronic diseases continues to rise. Today, about 133 million Americans (nearly half of all adults) live with at least one chronic illness - and most chronic diseases require a lifetime of ongoing care. As the population ages, we must evolve our health-care system to more effectively address the needs of chronic disease patients -- improving care and managing costs. Further, we have to engage consumers in managing their own health - providing tools and information to support informed choices and holding consumers more accountable.

To support a redesigned health delivery system, we need the right types of insurance. Let's remember that insurance companies are designed to spread risk, but health insurance is unique because it's used for routine as well as catastrophic needs. People expect their health insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care and only tap into health insurance when they need to cover major, unpredictable issues.

Key to reforming health insurance is separating it from employment, which would guarantee that individuals would not lose their insurance even if they were to change or lose their jobs. Most importantly, it would encourage new innovation in the health insurance industry.

If people were responsible for paying for routine visits and procedures, they would demand greater transparency around the costs and effectiveness of their care, be more engaged in their health and consider more fully how their choices impact themselves and others. This would enable more innovation in insurance and health delivery and make health care more affordable for all.

Liberate the Data Part II – Perspectives from Eclipsys and Microsoft

pnblog — Mon, 01 Mar 2010 16:34:00 GMT

It was just about a year ago at last year’s HIMSS that I posted about the need to “liberate the data” within health IT systems – separating data from applications and making it available for reuse in different contexts. What I said then holds true now. For health enterprises and consumers, health data is a vital asset that can move us toward a more efficient, higher quality, evidence-based future for medicine.

While we still have a long way to go, a year later I’m encouraged by a couple of developments that indicate we’re moving in the right direction – and actually making some real progress!

First, the draft regulations on “meaningful use” include a focus on the exchange of data – acknowledging that physicians need real-time access to comprehensive patient data to improve quality, safety and efficiency, and to coordinate care effectively. The draft legislation also recognizes that engaging patients and families in managing their own health is paramount – requiring that providers make patient data accessible soon after those visits happen. For the first time, the proposed rule-making puts a stake in the ground with real ‘sticks’ and ‘carrots’ – a significant milestone in putting the foundational drivers for change in place.

Second, I’m very excited about the strategic alliance with Eclipsys that we announced last week. This is a key milestone for two leaders in the health IT space to be a driving force in enabling data to become liquid. Both companies share a common vision – of an open architecture for future-flexible IT – which is critical for our customers and their customers to improve the care they provide. As part of the partnership, a richer set of data from Eclipsys systems will be available within Amalga UIS. Using their expertise in developing healthcare applications, Eclipsys will offer modules that run on top of Amalga. The combination of these Eclipsys products and Amalga UIS will give customers access to data across the enterprise and support workflows that leverage this liberated data.

I’ve invited Phil Pead, CEO, Eclipsys to share his thoughts on the partnership.

The alliance we have created with Microsoft is part of an overall strategy by Eclipsys to break away from the tradition of closed, proprietary systems in healthcare. This notion that in order to have one patient one record everything must be purchased from a single vendor burdens healthcare with making unnecessary investments and limits the pace of innovation. Eclipsys has used the Microsoft .NET Platform technology to deliver its software applications since 2003. This agreement between our two companies marks a second, staged reversal from closed, proprietary monolithic systems. By opening our platform to third-party companies, such as Microsoft, we can deliver the choice and flexibility that hospitals need and want to improve health information technology in a demanding and dynamic healthcare environment.

The new federal regulations surrounding the American Recovery and Reinvestment Act of 2009 and achieving “meaningful use” are a tipping point that is causing rapid change in how healthcare information is accessed. In addition, clinicians have been frustrated by not having critical information available to them at the point of care because either the information was spread across disparate systems, or they were unaware the patient data was available. These factors, among others, are creating higher costs and less time for patient care.

Our new agreement with Peter and his team brings Eclipsys one step closer to delivering on a vision of healthcare data set free. We plan to integrate key components of Eclipsys’ award winning Sunrise Enterprise suite of integrated software applications with Microsoft Amalga Unified Intelligence System (UIS). The integration will further enhance the analytic capabilities we provide to our clients and allow clinicians within any hospital to have access to patient data regardless of the system in which it resides. No other industry relies upon a single vendor to do it all. We think it is time to stop this fundamentally flawed approach in healthcare.

We also are inviting other healthcare industry leaders, as well as small, entrepreneurial companies to build on our platform. So hospitals have the opportunity to use our suite of applications, keep their best of breed solutions, while benefiting from newer, innovative systems— all on one platform. We think this is the future of health technology.

Health Care Reform is About Improving System Performance

pnblog — Sun, 28 Feb 2010 21:16:00 GMT

I was asked to contribute to the sequel to the award-winning book, Paper Kills. The New Edition (released just last week) is called Paper Kills 2.0, How Health IT Can Help Save Your Life And Your Money. In the Book, Newt Gingrich, Tom Daschle, and other national industry leaders explore the leading information technologies that can and will transform our health system. I was pleased with how our chapter turned out -- it's the first chapter of the book and is called 'Re-charting Healthcare: Innovations to Drive a New Delivery Model for Tomorrow's Health System'.

As part of the launch of the book, I was asked to comment on last's week Health Summit with other folks who spend just as much -- if not more time -- thinking about health reform. My post -- Health Care Reform is About Improving System Performance is below.

Health Care Reform is About Improving System Performance

I commend the Administration for continuing to try to keep healthcare reform in the spotlight -- it affects all of us in so many ways, and we all have to keep trying. The President kicked off today’s summit with a great summary of what’s happened with reform over the past year -- lots of people on both sides of the aisle have worked hard with good intentions, but somehow the whole effort/discussion/debate turned into an ideological and partisan battle in which politics seem to have trumped common sense.

What we need now is to take the opportunity to get back to a ‘common sense’ approach and get to the ‘basics’ of what we want reform to do and then figure out the best way to achieve those desired outcomes.

Everyone (citizens and politicians) wants more and better 'health' -- a better health delivery system, more prevention, more therapies to cure complex diseases, more and better doctors. In addition, there seems to be a large focus on ensuring that everyone has access to health insurance. But more 'health' is not free, and more health insurance does not necessarily equal more 'health’. Our challenge is to reduce the waste in our current system to get more 'health' for the same amount of money. This is clearly very hard, from both a legislative and practical implementation perspective, but it needs to be done.

If we look at today’s system performance, in our best case scenario (Breast Cancer), we’re only ‘getting it right’ approximately 85% of the time, and at a cost that will bankrupt our nation. We have massive variation in practices, costs and outcomes – at the root of which is a fee-for-service payment model that has locked us into the past inhibiting the kind of broad-scale innovation that has transformed nearly every other industry that touches our lives. If any other business were to run this way, common sense would tell us that it would fail -- people would lose their jobs and consumers wouldn’t get their products.

With healthcare, it’s more serious. When the system fails, people die. We can and need to do better. We need to create a new system -- transitioning healthcare from unmanaged care (show up when you are sick, fee for service) to informed, coordinated care (population focus and pay for outcome), and from unmanaged processes (treat in office/hospital, based on physician) to managed processes (assuring that patients follow a care pathway; drug and test regimen across time and location). To do this, we must:

· Take the Variation Out of Care By Creating Feedback Loops. If we do a task differently every time, we won’t be able to improve the result. In health, this is about using data to see what works or not, and then educating medical professionals and consumers pervasively to put the best methods into practice.

· Encourage and Stimulate Supply-Side Innovation. Our current fee-for-service payment model does not reinforce and reward provider innovation nor does it facilitate new industry entrants to drive better, more efficient, convenient, and cost-effective delivery methods. The current model rewards ‘doing more’ versus ‘doing better’.

· Shift the Value Chain. We need to let consumers and other health professionals like nurse practitioners or even software do some of the work that the most educated (and therefore, most costly) physicians should not and cannot be doing anymore. Physicians should be focused on using their unique expertise and skills on the things that require very specialized knowledge and skills like treating top priority, chronic diseases

Just making the system bigger -- adding more people -- doesn’t solve the problem. We have to change the health delivery system -- real reform is about ‘doing health’ differently. Once we figure out how to reform the health delivery system -- to get the most out of it, then we can turn our sights on how to design the right insurance programs and regulations to expand access. Regardless of how we do that, one point is clear –we need to decouple health insurance from employment so that it’s portable and open to all.

Today’s discussion focused on four main areas -- controlling costs, reforming insurance, expanding coverage, and reducing the federal deficit. At the end of the day though, we won’t be able to tackle these issues until we fundamentally change the system -- how care is delivered and individuals manage their own health.

A Milestone on Many Levels: Publishing a Joint Op-Ed with Google

pnblog — Thu, 25 Feb 2010 00:02:00 GMT

Over a year ago, a dialogue started about the rules surrounding ‘meaningful use’ – and with anything like this, there are always lots of voices, lots of opinions. Given our history, we were in the ‘faction’ of folks focusing on ensuring that consumers were at the center of this discussion – and along with us was Google. This was surprising to some given that we compete in so many areas. But in this case, we all recognize that reforming healthcare is so important that it will take a lot more than just one or two companies rallying around the cause. And so, we worked together with Google to respond to the Meaningful Use definition through an Op-Ed for The Hill, which can be read below.

Adopting electronic health records will cut costs

By Peter Neupert and Alfred Spector

http://thehill.com/opinion/op-ed/83267-adopting-electronic-health-records-will-cut-costs

As described in a report from the Robert Wood Johnson’s Commission to Build a Healthier America, “For the first time in our history, the United States is raising a generation of children who may live sicker, shorter lives than their parents. We must act now to reverse this trend.”

The good news is that the Congress and the Obama administration have taken significant actions that could help. In February 2009, Congress included in the American Recovery and Reinvestment Act $36 billion in funding that will provide incentive payments to healthcare providers and organizations to encourage them to adopt health information technology. This technology aims to transform healthcare by improving quality and reducing costs, most significantly through the adoption of electronic health records.

In late December, the Obama administration issued proposed regulations governing the distribution of this funding. The administration and Congress wisely perceive the tremendous opportunity to transform the health system through widespread adoption of electronic health records, while also recognizing that the adoption of technology by itself is not a silver bullet.

A recent study conducted by Harvard Medical School and published by the American Journal of Medicine stated, “As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.” To address this issue, the government is working to finalize a formal standard of “meaningful use” of electronic health records that will require things like the electronic exchange of data and reporting of clinical quality measures to ensure effective use of technology in healthcare.

But if we are to successfully bend the cost curve on healthcare — and improve our health at the same time — the government needs to focus on two core principles as it finalizes the meaningful-use standard: putting consumers at the center of the solution, and focusing rules about the use of health technology on the outcomes we want to achieve, rather than on the technology itself. How do we do this?

First, it is essential that the definition for “meaningful use” of health information technology includes enabling consumers to have convenient, electronic access to their own medical data. This would guarantee that stimulus dollars are spent on health IT that would engage consumers in managing their own health and their family’s health. Our current system has been built around providers, insurers, the government and employers — not around consumers. But the majority of health decisions are made at home, and the daily choices individuals make can affect what everyone in the system pays for healthcare. By empowering consumers with the right information, they can make more informed decisions and work with healthcare providers to more effectively manage their health.

Second, the rules around the use of health technology should set objective goals and criteria — focused on better outcomes, chronic care management and hospital effectiveness — without mandating the use of specific technologies or development models. This approach is similar to the government’s involvement in other industries. For example, automobile safety is regulated, but the shape of the car and its features and functions are generally not regulated — which spurs ongoing industry innovation.

The power of technology lies in its potential to transform industries, enabling new ways of working and communicating, new economics and new business models. As consumers, we’ve experienced how technology impacts nearly every area of our lives — how we manage our finances, travel, communicate, shop and so on — with more self-service, more control, more convenience and ultimately better value for what we spend.

No one said this road would be easy. We are trying to change a system that is deeply ingrained in our country’s way of life, and it will take all of us — patients, physicians, hospitals, health insurers and technology companies — working together to achieve real reform. The current focus on healthcare gives us an opportunity to do what America does best — innovate to improve productivity and efficiency. As we continue our debate on healthcare reform, we commend the Obama administration for supporting consumer engagement and a focus on health outcomes in the proposed regulation, and we encourage continued commitment to these core principles.

Neupert is the corporate vice president of the Health Solutions Group at Microsoft. Spector is the vice president of Research and Special Initiatives at Google

Change Agents at Work; Catalysts to Improve Our Health System

pnblog — Sun, 21 Feb 2010 02:32:00 GMT

There are days that I love my job (not every day yet), and last week I had one of those special days. I participated in the Forum for Sustainable Health, an event hosted by Arizona State University’s Biodesign Insitute with a bunch of incredibly smart people -- all change agents in their respective areas -- talking about the policy, scientific, clinical and consumer changes needed to transform the health delivery system and leverage the knowledge coming from scientific discoveries to predict and prevent disease. I was there because many of the stakeholders recognize that scale software is a critical component to enabling discovery and transformation and because consumer engagement is critical.

At the center of the event was the launch of an effort called the Global Biosignatures Network, a global network/confederation of public and private sector groups -- clinical care sites, clinical research investigators, academic research laboratories and medical technology and biotechnology companies in the US and elsewhere -- all collaborating to drive better diagnostics and accelerate applied research. Imagine the world’s best and brightest working together to share knowledge about the science and how to apply it to solve real world problems quickly…that is the goal of the GBN.

The forum was basically a brainstorming session (with a lot of big brains -- Lee Hartwell, Denis Cortese, David Lawrence, Alan Nelson, Spyro Mousses to mention a few) around how this network could help drive the use of information more effectively to enable earlier detection, intervention and ultimately the prevention of disease.

We talked about a lot of the issues… When you think about healthcare today, most systems -- whether in the U.S. or elsewhere -- dedicate most of their resources to what David Lawrence calls “sick care” and the late stage treatment of disease. And in those areas -- we apply pretty generic “treatments,” which produce a wide variation in terms of outcomes. We don’t have very good feedback loops and therefore can’t drive “continuous improvement.” So, we end up with poor health outcomes and skyrocketing costs. Not to mention that we’re totally not set up to handle or deliver on the promise of personalized medicine.

And we talked about solutions…. We have to develop better diagnostic capabilities to transform our ability to prevent and respond to disease -- being able to identify diseases at their earliest and most curable stage, and for those who develop disease, be able to have tests that predict who will respond to which therapies before they are given. As part of this, we have to be able to connect and engage with consumers in new ways -- to accelerate research, to educate on how lifestyle actions affect health and disease and on their role in engaging with the medical community around “shared decision making.” As is pointed out in The Innovator’s Prescription, with greater precision and predictability, we create the opportunity to develop innovative and disruptive ways to deliver less expensive and more reliable care using non-physician health professionals, consumer “self-serve” models and other types of technology services and solutions.

And for an old philosophy major, it was interesting to me that the discussion also traversed into the areas of Epistemology and Philosophy -- really fascinating to think about the intersection of bio-medical science and philosophy. I even added a few books to my list of upcoming ‘reads’: On Intelligence and The Origin of Consciousness in the Breakdown of the Bicameral Mind

The science is really exciting (at least what I could understand from it) -- there is a ton of exciting work advancing our understanding of how the body works and the efforts are really spread out around various centers in the world -- which is a good thing. The conversation amongst the stakeholders was powerful, and there were frank discussions about the challenges in implementing the kind of changes necessary to accelerate real world solutions -- changes in the regulatory environment, in the incentives of stakeholders, funding, business models, aggregating/sharing this data, and other policy issues. Often I feel that the most significant barriers are those around policy, and ironically, I had the opportunity to spend some of the day talking to Aneesh Chopra and Todd Park on the phone -- they are true change agents, trying to push the envelope inside our government in so many ways. While I’m often a skeptic, I couldn’t help but leave this meeting hopeful -- with all these incredibly smart people working to find practical solutions to make improvements to our systems, I can’t help but feel that we can make a better health future for our kids.

The Way Forward

pnblog — Tue, 09 Feb 2010 17:42:00 GMT

This week's question for the Washington Post Health Care Rx blog was:

In a Feb. 2 conference call, House Speaker Nancy Pelosi talked about starting small. She indicated she wants the House to vote on elements of health-care reform, such as repeal of McCarran-Ferguson Act, which exempts insurance companies from antitrust laws. Is this a smart strategy or just political show?

My response, The Way Forward, below:

It seems like this is more of a move to revive the momentum for larger health reform. The Senate can't pass a repeal of McCarran-Ferguson and in the grand scheme of things, it's hard to see what the practical implication of this would be on improving health outcomes, increasing access, or slowing skyrocketing costs.

While some may think that the Massachusetts election has caused health-care reform to grind to a halt, I think we need to treat this as an opportunity to take stock of what we've learned and what we want reform to achieve. At the end of the day, citizens are the ones responsible for their health - they make decisions every day that affect their own health and can increase costs to the entire health system. Reform has to be about empowering consumers to understand and take charge of their health and we need a system that will allow that to happen.

A thoughtful commentary on a path forward is the Wyden-Bennett Healthy Americans Act. It is, by definition, bipartisan and takes a big step forward by separating health insurance from employment, which will guarantee that individuals will not lose their insurance even if they change or lose their jobs. Most importantly, it will encourage new innovation in the health insurance industry. The bill provides some solid thinking and solutions to improve outcomes by focusing on prevention, wellness and disease management, and tying accountability and incentives appropriately.

By creating a system driven by innovation with consumers at the center (versus providers) we can move forward with meaningful change.

Health Reform -- Fixing the Core Problem or Just Symptoms?

pnblog — Tue, 29 Dec 2009 05:02:00 GMT

The health reform debate has passed another milestone, but the question I keep getting asked by friends and family is whether the proposed legislation will actually improve our health delivery system. I want to be optimistic, but I’m skeptical that the kind of comprehensive change we need to truly reform the system will happen.

As I talk to so many folks across the country (and around the world), I find that most agree on one thing -- our current system is ‘broken’, and it can and should get better. But when it comes to getting to a deeper understanding and discussion of the details -- the core problems, the choices for change, the costs and impact of these changes, and so on, folks just aren’t getting a very clear picture from the MSM. Often what’s highlighted is the political drama versus the real issues, the real story.

I don’t claim to fully understand the actual legislation or even to comprehend the hysterical politics that seem to surround the conversation. But I do know that the central question people want and need answered is HOW to make the system better. As a business guy, when I try to solve a problem, I focus on understanding the ‘root cause’ to make sure I’m fixing the core problem and not just a symptom or secondary effect. And I think we’ve got to do the same when it comes to solving ‘health’.

Everyone (citizens and politicians) wants more and better ‘health’ -- a better health delivery system, more prevention, more therapies to cure complex diseases like cancer, more and better doctors and the like. And we all recognize that more ‘health’ is not free. The current system has lots of waste and inefficiencies. If we could figure out how to remove these from the system, we would get more ‘health’ for the same amount of money. This is clearly very hard, from both a legislative perspective (why neither bill really tackles it) and from a practical implementation perspective. But it needs to be done, and after we get it done, we then have to figure out how to invest the dollars to provide more ‘health’. Alas, more health insurance does not necessarily turn into more ‘health’.

Practially, there are several fundamental questions we need to answer. First and foremost, what framework or system of rules, incentives, relationships, markets etc. will lead to more ‘health’ for Americans over time? Should we as a society, provide healthcare (unlimited?) to all citizens? And then, how should we finance this new economic liability? What role do individuals play in being responsible for their own health -- in terms of paying for it, being accountable for healthy or risky behaviors and consuming health delivery resources?

It is hard to be a market oriented capitalist today, particularly in the health debate. Everyone loves to hate the insurance profiteers, the bad drug companies and the greedy medical device companies. The public seems to easily forget that economic growth and the principles that support economic growth are the reasons that we can even have a conversation about providing subsidies for the less fortunate.

Ten years from today, we could have a society with a GDP of $16 trillion or one of say $17 trillion (the actual numbers don’t matter). In the scenario of higher economic growth, where society has created $1 trillion more dollars of GDP, we could make a choice to consume/finance more ‘health’ than if we were to have a smaller GDP. Given the inevitable pressures on the health care system -- an increasing proportion of the population over 50 and people living longer -- as a society we know we would like to be able to afford more ‘health’ not less. Just raising taxes alone without creating more wealth might patch things in the short run but not in the long run. One illustrative example is the Medicare system -- which is projected to go bankrupt in a few years, even after increasing taxes to support it. There are really only three approaches to preventing it from going bankrupt; cut benefits, grow GDP faster, and improve value (more ‘health’ for the same dollars).

To have a meaningful debate about ‘health reform’, we’ve got to consider the overall context of the principles leading to economic growth and the core questions raised about rules, roles and incentives in the health delivery system. Creating substantive legislation in a democracy is messy. But for a democracy to thrive, it needs an informed and engaged public, a transparent legislative process and stakeholders who are willing and able to advocate without fear of being penalized.

From what I can read and learn -- in this critical debate and time – it seems like we may be failing in all three areas.

The Top Ten Medical Advances of the Decade. What’s Wrong with the Picture?

pnblog — Fri, 18 Dec 2009 19:55:00 GMT

Sometimes it’s fun to peruse year-end lists—best shows, best moments, best songs, best presidential gaffes, best viral videos, and the list goes on…. which gets even longer with the end of decade or the century.

In this spirit, ABC News just ran a story about the ‘top ten’ medical advances of the decade, which I found very interesting. They reached out to more than 800 specialists for their suggestions, and those suggestions were sent to the American Association for the History of Medicine, which narrowed down the list to the medical advances this decade that have had the MOST IMPACT.

Here they are:

1. Human Genome Discoveries Reach the Bedside

2. Doctors and Patients Harness Information Technology (moving away from pad and paper)

3. Anti-Smoking Laws and Campaigns Reduce Public Smoking

4. Heart Disease Deaths Drop by 40 Percent

5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances

6. Targeted Therapies for Cancer Expand with New Drugs

7. Combination Drug Therapy Extends HIV Survival

8. Minimally Invasive Techniques Revolutionize Surgery

9. Study Finds Heart, Cancer Risk with Hormone Replacement Therapy

10. Scientists Peer Into Mind with Functional MRI

The list is a great reminder about how big an impact knowledge can have in improving life – sometimes through science, sometimes through changes in policy and sometimes through applications of technology. From the perspective of other industries or aspects of life, it’s hard to believe that doctors and patients harnessing the power of Information Technology—moving away from pad and paper—makes the top ten list. It’s pretty ironic with all the amazing medical advances that our health delivery system is so far behind….but it really highlights just how much opportunity there is for us to improve it.

It’s my first wish for the new year that #2 isn’t on the list in the next decade – that we see something about the impact of information technology on the whole system—in the form of improved health outcomes and efficiency gains. My second wish is that we continue to see dramatic innovation in knowledge (science, technology, policy) improving life here and in the rest of the world.

The right solution for the ‘population’ may be the wrong solution for the ‘individual’

pnblog — Fri, 11 Dec 2009 21:04:00 GMT

This week's question for the Washington Post Health Care Rx blog was:

What does the debate over mammography screening teach us about the challenges in moving to evidence-based medicine in a revamped health system?

The debate truly highlights how much work is yet to be done to build a health-delivery system that generates enough accurate data so that we can truly 'know' the evidence! More importantly, however, it underscores two fundamental issues impacting broader health care reform:

1. The USPSTF made a recommendation for an 'overall population' vs. an 'individual' choice for a doctor and patient. The funny thing about statistics is that they're about percentage risks for a population, but individuals have different genetic profiles/risks, and attitudes and priorities around health. There is no one right answer for everyone. If the health sector were more market-oriented like other industries (people have different 401k investment plans, different savings rates and the like) and not driven by health insurance companies or the government making determinations about what is 'right', consumers would explore the information available and make their own choices with their physicians.

2. Insurance should address catastrophic events, not every day expenses. Yet people expect insurance to cover every doctor's visit, test and treatment, which is economically inefficient and establishes the wrong incentives for providers and consumers. People should pay for routine care -- doctor's visits, mammograms, routine medicines -- and only tap into health insurance when they need to cover major, unpredictable issues. If people were in charge of paying themselves, they would be more engaged in their health and understand how their choices impact themselves and others. Differentiating major medical coverage from full health coverage would reduce the incentive for some to over-consume health resources. This would enable more innovation in insurance and health delivery and make health care more affordable for all.

Evidence-based medicine is the 'brass ring' for health-care reform. Medicine is going to continue to evolve and improve, and we need the right system in place to ensure that individuals have the information they need to make informed choices about their care to drive the best outcomes for their health.

Reform Health Care by Re-empowering Consumers

pnblog — Tue, 24 Nov 2009 14:20:00 GMT

For my latest thoughts on consumer engagement and its relation to health care reform, please see my contribution to the Harvard Business Review Conversation Starter blog.