Coordinated Health Care & Evidence Based Medicine, Aided by Social Media

Slate Magazine's recent analysis of the Obama administration's forecasted $2 trillion in health care savings questioned which initiatives would provide true savings.  The highest ranked was "encouraging coordinated care..." and "...adherence to evidence-based best practices and therapies..."  Coordinated care seems to suggest clinical integration and savings derived from better information about what works and what doesn't, would create efficiencies.  

Increased information could increase the benefits of innovation and the ability for federated groups of health plans to use the best ideas for the best results.  Secure Social Media, i.e. the idea of aiding discovery within the enterprise can help.   No World Borders has been advising health care firms on ways to use social media techniques to provide openness, while still providing security and privileges regarding who can access the information within the enterprise.

From Slate:

"3.) Encouraging coordinated care, both in the public and private sectors, and adherence to evidence-based best practices and therapies that reduce hospitalization, manage chronic disease more efficiently and effectively, and implement proven clinical prevention strategies.

"Coordinated care" seems to suggest integration of clinical care by hospitals and doctors. If bundling requires doctors and hospitals to knock heads over submitting a single bill, integration requires doctors and hospitals to knock heads over how the patient will be cared for. "You have to grow both organically side by side," Reinhardt says. A good start, he added, would be getting the pediatrician, obstetrician, and gynecologist to develop a common plan for an individual childbirth; medical procedures don't come much more straightforward than the delivery of babies. "Evidence-based best practices and therapies" refers to compiling national statistics about which clinical approaches work best and then putting some pressure on physicians and hospitals to follow them. It's very difficult to know in advance what the budgetary impact of this information would be. In a recent article in the Annals of Internal Medicine, Theodore Marmor, Jonathan Oberlander, and Joseph White wrote, "Although comparative effectiveness research may provide useful information about the clinical effectiveness and costs of medical treatment options, that information is not guaranteed to lead to significant cost savings." The Congressional Budget Office calculates that between the new money spent on research and the savings derived from better information about what works and what doesn't, the net five-year cost to the federal government would be $490 million over five years. Total health care spending—public and private—the CBO says, would be reduced by $8 billion over 10 years. The CBO doesn't have a five-year number, so we'll slice that one in half."

Healthcare Business Models: Mayo Model Losing to McAllen?

An article in the New Yorker asks: Why does the border town of McAllen, Texas, spend more er person—an average Medicare enrollee there costs $15,000 per year—on health care than any U.S. city besides Miami? The author blames "across-the-board overuse of medicine," which stems from the fact that our health care system "pay[s] doctors for quantity, not quality." This overuse isn't just expensive—it's less effective. "In an odd way, this news is reassuring," the author notes: Providing better health care will also save money. 

This is a disturbing and perhaps surprising diagnosis. Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Do Schools Kill Creativity? How do we apply creative thought in business and process improvement?

How will education play out in the future given the use of technology and information sharing?  Children starting school in 2006 will be retiring in 2065.  We aren't sure what the world will be like in five years, so how do we educate students to innovate as the world changes?

Creativity is as important in education as literacy, according to this talk at a TED conference.  This creativity, we would like to add, does not stop in the class room.  Regulatory compliance projects such as HIPAA compliance will require re-thinking process.  This is an absolute opportunity to re-design process.  By questioning how things are done we can innovate to make them better, as this video explains.