Tuesday, February 20, 2018

the South Dakota Way: Understanding How One State is Fighting the Flu

    I recently had the opportunity to ask a few questions of Tim Heath, Program Manager for Immunizations with the South Dakota Department of Health. South Dakota may not necessarily be top of mind when it comes to fighting the flu: but it ought to. According to the numbers I pulled from the CDC’s FluView program, South Dakota is amongst the Top 5 states in terms of pediatric vaccination rates over the past five years of available data(65.72%).

    Interestingly enough, South Dakota stands alone geographically amongst leading states. In fact, neighboring states Montana and Wyoming have some of the lowest rates in the country. That disparity piqued my interest -- and, thankfully, Tim helped shed some light on what makes his state different.

    First and foremost, South Dakota has long made fighting flu a priority. While the state no longer has the universal vaccination program for kids it used to, the state continues to advocate strongly through concerted media outreach to keep vaccination top of mind. This speaks volumes: patient education starts before people even become patients.

    One way South Dakota succeeds despite its size and rural nature is through a strongly centralized state department of health. Nearly all the state’s 66 counties maintain local health offices operating under the same flu prevention strategy in tandem with clinics, Indian Health Service facilities, community health centers and hospital centers.

    In short, the Department of Health acts on well-established partnerships at every state of the patient care chain.

    While vaccination rate alone can never be a proxy alone for future influenza hospitalization rates(due to vaccine efficacy, the nature of that year’s strain(s) and a host of other issues), Tim firmly believes that the best first step many can take to stop the flu is by getting the shot.

    Despite South Dakota’s strong successes in combating the virus, Tim is reluctant to think it can serve necessarily as a model. The state is blessed with tight-knit, centralized Department of Health, proactive partners and strong relationships.

    With that said, I certainly believe that other states could look at ways their own systems could improve by trying to achieve similar characteristics. While some states, say New York or Illinois, face a different reality on the ground, they can still work hard to make the most of their healthcare partners and build relationships that deliver long-term results.

    In a perfect world, Tim would love to have the budget and resources to not just return to a universal vaccine for kids -- but for all South Dakota’s citizens. In lieu of perfection, Tim is focused on leveraging the skills of the people around him to do the most for the people of his state.

    I want to thank Tim Heath for taking a little bit of time in a very busy flu season to give his perspective on the ways states can combat the flu. Though every state faces its own challenges, there is much each state can learn from the others about their experiences -- and their successes -- when it comes to keeping people healthy. Until we have a perfect vaccine, that might be the best we can do.

Tuesday, February 13, 2018

What doesn't kill us will make us bankrupt

    Two recent articles about two very different diseases, rabies and the flu, underscore one uncomfortable truth about our healthcare system: it’s killing us.

    Vox detailed how lifesaving rabies shots in America are often priced ten times higher than the same medication in other countries -- usually over $10,000. And while insurance companies often negotiate the price down, the reality of facilities fees, co-payments and follow-up visits leave patients burdened with bills well after they leave the emergency room.

    Meanwhile, a Texas teacher opted against paying the $116 copay for Tamiflu -- and later died from the virus. To be clear: she had health insurance. However, the high cost of one single shot on top of her regular monthly premiums was too much to stomach. In the end, the decision to forego preventive care cost her her life.

    The fact is that the high cost of care is forcing us to make difficult decisions with serious repercussions.

Do we get the treatment we need and risk bankruptcy for it?
Can we afford not to?

    The Kaiser Family Foundation has a sobering report detailing how even those with insurance continue to struggle to pay their medical bills. Women, those living in the South, and those with greater medical need appear to suffer disproportionately --  but the reality is that the burden is borne by Americans of every class, race and gender.

    And, isn’t just the flu or a bat bite that’s crippling people’s finances: MRSA, miscarriages, dental care and even a pair of glasses are all expenses that add up. These are the kind of bills that many people fail to ever fully recover from.

    As we continue to debate the merits of healthcare reform, we need to be aware of the reality of not improving our current system -- or of making it worse. People will continue to be forced to choose between the care they need and the care they can afford.Medical debt will continue to be a leading driver of bankruptcies: a hole few Americans have the means to ever pull themselves out of.

    It’s time our healthcare equip us with the tools to make ourselves better off -- not worse.

Thursday, February 8, 2018

Look, flu's talking

  On the off-chance that in the last few weeks you’ve become a Bitcoin billionaire, you might have missed the news: this flu season has been bad.

  Real bad. And, while doctors had originally thought the already deadly virus had reached its peak a few weeks ago, it’s actually keeps getting worse. In fact, according to the New York Times, this season is set to at least equal the especially voracious 2014-2015 flu -- responsible for at least 56,000 deaths. Worse yet,  CDC statistics blame the flu that year for 127 pediatric deaths.  This year, by comparison,  53 children have already fallen victim to the flu- compared to an average of 76 over the past eighteen years.
Considering that some seasons stretch through May, we’ve still got a ways to go. 

Of course, nothing quite compares to the 1918 flu when as many as 100 million people died worldwide, including a staggering 675,000+ Americans.

Still, hospitals have set up parking lot triage tents to handle the hordes of sickened patients, whole school districts are taking sick days and our national anthem singers have been forced to take their lozenges onto the field.

So, what can we do?

First off -- wash your hands. Really. Just do it. It’s very easy and it’s a perfect frontline defense against infected mucus, saliva, and all of those others nasty places where flu bugs thrive.

  Second, get vaccinated. Studies have shown that getting kids vaccinated reduces their likelihood of dying from the flu. Yeah, yeah yeah -- the flu shot doesn’t always work. But, statistically speaking, it’s a lot better than some other options.

    I took a (not so) quick and (pretty) dirty look at state-by-state pediatric influenza rates. The results were a mixed bag.

  Looking at the five states with the lowest immunization rates averaged over the past five years of available data, we’ve made little progress getting more kids vaccinated. A brief uptick in 2014 did little to change overall habits -- numbers dipped back down and have nearly returned to where they were in 2012. In sum, we saw just a 1.04% rise -- and just 0.2% averaged across all five states.

  The news, thankfully, in the top five immunization states is much better. Rates climbed nearly 23% in sum and over 4.5% on average. Still, Connecticut, I’m looking at you: what happened between 2015 and 2016?
  What’s the key takeaway? At a time of government impasse and fiscal turpitude, we need to redouble our public health efforts to get a better handle on the flu -- and get more kids vaccinated.

Saturday, February 3, 2018

Who's waiting on Jeff and Warren?

            Earlier this week, Amazon, Warren Buffet and JPMorgan Chase & Co. made waves by announcing plans to disrupt the health industry by creating their own insurance company and lowering healthcare costs in the process. The ramifications were immediate. Many of the industry's traditional big players(UnitedHealth, CVS, Cigna) saw their stock sink.

            All told, news of the new effort alone cost healthcare stalwarts nearly $70 billion in stock value. And, while it wouldn't be surprising to see share prices in these traditional players rise again over time, the 'Amazon effect' on the industry is undeniable. Amazon has transformed industry after industry -- and by combining forces with the Guru of Omaha and one of the world's leading financial services firms, Jeff Bezos is certainly to be reckoned with.

            But-- don't hold your breath. Not only have we not learned quite when the new healthcare outfit is set to launch, we also don't know many more details other than its coming existence. What shape the company takes remains to be seen.

            Will Amazon & friends be content leveraging their size to negotiate lower rates on prescriptions? Are we talking about a new payer, akin to traditional insurers like Humana?

            Or is this a new paradigm altogether? Nobody knows!

            In the meantime, while we wait for news to trickle out in its usual fashion, a few start-ups are already addressing the questions of access and availability head-on. Of course, they lack the scale of the soon-to-be Amazon company. Instead, they are focusing on particular aspects of the system that have caused costs to rise, putting care out of reach for many American consumers.

            For instance, Blink Health is tackling the absurd cost of prescription drugs for the insured and uninsured with an easy-to-use app and online interface, bringing prices lower and increasing transparency across the board. Aledade is using AI to help PCPs get back to what they do best -- practicing -- by helping them tackle regulatory issues, patient data and more. Flatiron Health has developed a platform that connects doctors, payers, patients and more to make treating cancer more effective, better and cheaper.

            So, should we be excited about Amazon and their entrance into healthcare? Of course! But there's no one pill that will cure our healthcare ills. The start-up scene is full of exciting, innovative new companies intelligently fighting back against the high costs making us sick.

Friday, February 2, 2018

Get Smart

              Whether it’s a readout from a research firm or gleamed from interviews with physicians themselves, one thing medical professionals often cite as high on their wish lists is better educated patients. And no wonder: from lumbar fusion to breast-cancer related lymphedema; COPD to diabetes, patients who are better educated adhere to their medication more often,  meet target clinical goals and lower utilization rates.    

              Lower costs. Healthier patients. Better outcomes. 

              And yet, I’ve heard more than once something along the lines of, ‘Well, of course, every physician wants a better education patient’.

              Let’s cut the cynicism. 

              Better educated, more engaged patients are good for doctors, nurses, payers and, of course, patients.  Patients who know more about their disease or condition become active participants in their care – instead of standing on the sidelines. With an active role, patients can make appropriate lifestyle changes, stick to drug regimens, and communicate more effectively with their care providers.  

              We want patient partners, not patient spectators. 

              So, how do we get there?

              Thankfully, the era of a brochure and a goodbye is long past us. While printed material is certainly valuable and we shouldn’t overlook the importance of printed collateral in certain populations like the elderly, new digital platforms offer the opportunity for patients to interactively learn more about their health and their role in improving it. 

              BeeWell allows physicians to connect directly with their patients, delivering individualized, actionable care plans. With clear guidance on their mobile devices on what to do and what not to do before an operation, for instance, physicians can reduce complications – and costs – while improving the overall patient experience. BeeWell recognizes that much of a patient’s care happens outside the office; by keeping clear, simple and effective direction in the palm of their hands, patients can help take ownership of their treatment. 

              Mytonomy delivers clinical information without feeling clinical. Unique video content and intuitive pre-procedure lists all underscore an immersive atmosphere that is comprehensive yet simple. Patients feel better prepared and better informed. Physicians reduce wasted time and resources. With a focus on improving the experience, Mytonomy has also improved outcomes.

              Through point of care digital tablets, anatomy boards and a wide library of waiting room digital videos, Outcome Health in many ways helps patients and their providers speak the same language. Complex conditions are made easier to understand. Treatment options are more thoroughly communicated. Targeted information helps all parties stay on the same page. 

              Look: a pilot flies no better if his or her passengers know what a safe altitude is. A chef is no better off his or her patrons know the difference between a crudité and a croquette. 

              But medicine is different. Educated patients equal improved outcomes.

Mental Health's Moment