Thursday 4:30-6:30 pm Book Signing at B&N at the Inner Harbor PowerPlant

I will be at the Barnes and Nobel bookstore in the Inner Harbor Power Plant this Thursday from 4:30 to 6:30pm. Please do stop by and say Hello.

I will be happy to sign your copy of "The Future of Health Care Delivery - Why It Must Change and How It Will Affect You."

http://store-locator.barnesandnoble.com/store/2881

Will Eating Chocolate Increase Your Chances For A Nobel Prize?

We all want to not only improve or cognitive function but to preserve it as we age. Certain dietary flavonoids improve cognition and these can be found in foods like cocoa, green tea and red wine.

Franz Messerli, MD, a self-described lover of dark chocolate published an article in the New England Journal of Medicine October 10, 2012 on the implied potential of chocolate in improving cognitive function. He hypothesized that one might use the awarding of Nobel prizes as a surrogate for superior cognition. He thus rank ordered countries by the per capita number of Nobel laureates through October, 2011. He then obtained chocolate consumption per capita for 22 countries. He found a close linear correlation which was highly statistically significant between chocolate consumption and the awarding of Nobel prizes.

 

 

 

 

 

 

 

 

 

Messerli points out that the chocolate consumption of individual Nobel laureates is not known and that “the cumulative dose of chocolate that is needed to sufficiently increase the odds of being asked to travel to Stockholm is uncertain.”  And of course he notes that this correlation is in no way proof of cause and effect. But it does offer one more satisfying rationale for chocolate cravers to persist in their love affair.

 

 

Paying Primary Care Physicians Directly is Advantageous

I wrote an Op Ed for the Washington Times that ran today suggesting it is advantageous to us as patients when we pay our primary care doctors directly rather than depend on insurance. This returns us to the position of being in a direct professional financial contractural relationship with our PCP. It leads to better care, greater satisfaction and ultimately a major reduction in total health care expenses.

Here is the link
http://bit.ly/T0gxN4

Transformational and Disruptive Changes Are Coming to the Delivery System

More chronic illnesses, more diseases of old age, consumers demanding more quality and safety, physicians no longer in typical private practice, and high deductible health care polices are each about to cause major changes in the practice of medicine and how it is delivered to patients. Will this come about smoothly or, more likely, with some serious hand wringing? 

Health care delivery will change substantially in the coming years. This is not because of reform but rather due to a set of drivers that are exerting a great push and pull to the delivery system. Some of these changes will be quite transformational and some will be very disruptive of the status quo. What are these drivers?

 

One of the most important is that there will be many more individuals with chronic illness. The Milliken Institute offered a white paper a few years ago on chronic illnesses and noted that nearly one half of Americans had one or more chronic illnesses, most of them preventable and  which were costing the economy over $1 trillion per year and rapidly rising.  

These are diseases like diabetes with complications, heart failure, cancer, or chronic lung disease. What is apparent is that they are mostly due to adverse lifestyles. Eating a non-nutritious diet -- and too much of it combined with a sedentary existence leads to obesity. One third of Americans are overweight and another one third are frankly obese. Add to this chronic stress and that 20% still smoke and there is an effective recipe to produce chronic illnesses. Chronic illnesses will make up a greater and greater proportion of all medical ailments as time goes on. And of course they are more difficult to manage, generally last a lifetime and are inherently expensive to treat (although there is much that can be done to reduce the costs of care.) 

A second driver of change is the aging of the population. The American society is growing older and just like a car:  “Old parts wear out.” Aging brings on visual and hearing impairments, mobility difficulties and diseases like osteoarthritis, Alzheimer’s and other chronic illnesses that, as best we know today, are not due to adverse lifestyles but are tied into the aging process. 

Another driver is the increasing demand for medical services. Perhaps this is saying the same thing another way. More aging and adverse lifestyles create more disease and the need for care. 

Consumerism is becoming – finally – more and more of a driver of change. Patients are coming to want and expect to be treated like a valued customer. Like the movie where he shouted “I can’t take it any more,” now “the patient is no longer willing to be patient any more.” What do the patients want? They want service, good service. They increasingly understand that quality and safety are not ideal so they are looking for and expecting high levels of quality & safety. Perhaps the most important one of all is respect, respect for their person, confidentially, and the quality of their care. But also patients want convenience & responsiveness. They don’t want to have to travel long distances, wait long times in the “waiting room,” nor be put on indefinite telephone hold. They want interaction by email and other electronic methods.   And finally, patients increasingly expect to have a closing of the information gap – they expect the playing field between patient and doctor to be much more level in the future. 

Professional shortages are also definite drivers of change in the delivery system. There have been shortages of nurse and pharmacists noted for more than a decade. More and more there is a shortage of primary care physicians (PCPs) and also general surgeons. These shortages are more acute in rural areas and urban poor areas.

Combined with shortages are changes in professional aspirations and lifestyles. More and more physicians want and expect to have more time for family and recreation. And they no longer want to run their own private practices. They prefer to be employed with little if any administrative burdens. Indeed the number of PCPs in a typical private practice arrangement has declined precipitously in recent years. And since so many patients coming to the ER today are uninsured, many physicians are no longer willing to take call unless on a contract with the hospital. Most physicians are willing to accept that some patients will be of limited means but they are not wiling to be overwhelmed with non paying patients.  

And among many other drivers of change is that patients will have greater requirements toward a direct share of costs. Today we have mostly “prepaid” health care, meaning that our insurance covers most everything, minus a low deductible or co-pay, from routine exams and well baby care all the way to a heart transplant. Among employer sponsored plans, there is an increasing push toward high deductible plans, with deductibles in the $1000-2000 range. Even some Medigap plans have high deductibles corresponding with much lower premiums.  

These are but a few of the drivers that will change the delivery of health care in dramatic ways in the years ahead. I discuss them in much more detail in The Future of Health Care Delivery – Why It Must Change and How It Will Affect You with data obtained through over 150 in-depth interviews of medical leaders from across the country. It is fair to expect that physicians, patients, hospitals, insurers and employer/government sponsors will be challenged to adapt.

My next post will examine what these drivers of change will actually cause to happen to the delivery system.

 

 

You Are Not Your Doctor’s Customer - But You Can Do Something About It

Our care is generally good in the United States but not as good as it could be nor as good as it should be. There are multiple problems to consider.  

First, ours is a medical care system not a health care system. We focus on disease once it has occurred but give relatively little attention to maintaining health and developing wellness.  

Clearly there is a need for greater attention to disease prevention and health promotion.  Second, our sytem developed over many decades to care for acute illness but today we are faced with more and more chronic diseases. Sure there are still patients with an ear infection or a broken leg. But more and more individuals are developing diabetes, heart failure (both of these now becoming epidemics), cancer, chronic lung disease and others. These are illnesses that generally last a lifetime (some cancers can be cured, of course), are complex to manage and inherently expensive to treat. They are best handled by a multi-disciplinary team coordinated by a primary care physician. But such is seldom the case today.  

Third, of course, many do not have health insurance with some 47 million uninsured and many more underinsured. And as they obtain insurance or join the Medicaid ranks as the result of healthcare reform, there will be way too few primary care physicians to care for them. They will therefore continue to use the emergency room as their principle place for care.

Fourth, our system of care is not customer-focused. We wait long weeks and months for an appointment, spend long times in the waiting room and are frustrated that we get just 12-15 minutes with our doctor. Our doctor suggests that we go to a specialist but does not personally call the specialist to explain the issue nor to smooth the path for a speedy appointment. 

And then there are the insurers. We are not their customer – our employer is their customer or our government is their customer but not us. And it shows – by our long waits on the phone, by the complex often hard to understand paperwork and by the frustration when the insurance we thought we had does not cover our latest tests, x-rays or specialist visit.

Indeed we are not the insurer’s customer nor are we the doctor’s customer. The physician is the customer – sort of – of the insurance company. We are mere bystanders. This is hardly the type of contractual relationship we have with our lawyer, architect or accountant. 

So a new vision for our system must make it a healthcare not just a medical care system. It must recognize the importance of intensive preventive care to maintain wellness. It must address the needs of those with chronic illnesses (who consume 70-85% of all healthcare claims paid) to both improve quality of care while dramatically reducing the costs of care. And it must be redesigned so that the patient is the customer that he or she should be – of both the physician and the insurer. It’s doable but it means a rethinking of how our delivery system is structured. 

One thing individuals can do now is to obtain a high deductible insurance policy. This means your premiums will come down and you will be paying for primary care out of pocket. But primary care is generally not expensive and now you will be in a position to expect more from your doctor – after all, it is you who is paying the bill and doing so directly. Alternatively, look for a PCP that has a retainer based practice or simply does not accept insurance. In each of these scenarios, you now have a direct professional contractual relationship with your doctor. You will be treated as such and now you are more likely to challenge suggestions and ask questions. You will also get better preventive care because the doctor has more time to spend with you. The result will be far fewer referrals to specialists, fewer tests and procedures and an ultimate savings in health care costs.