by Dave Chase
Even worse from a public health perspective is the status quo’s limited ability to facilitate two-way communication in crisis situations. We’ve seen this recently with Zika. Modern, clouded-based electronic health record and other communication systems can rapidly identify and respond to public health threats, identifying regions and individuals at greatest risk.170 Yet most organizations use outdated systems that require manual updates. This unnecessarily imperils the most vulnerable in society.
4. Get out of the way!
Sadly, many well-intentioned government efforts have damaging unintended consequences. Government officials should adopt a Hippocratic Oath of sorts. Too often, recognizing the damage caused by policy mistakes and the subsequent confessions come too late.171 Government should avoid defining technology innovation and what connectedness looks like, instead focusing on rewarding adopting it. Stop dictating how technology companies share data and information. Demand that the private sector deliver the right outcomes — information flowing from all clinical data sources — then let the private sector complete that work.
Technology Startups
Innovate with the Like-Minded – Where’s that Puck Going?
Avoid the hazard of selling to large health care organizations too early, which is often terrible advice investors and others give (e.g., land a big account).172 Innovation takes time to incubate in smaller organizations before expanding to larger organizations. Typically, traditional large health care organizations aren’t far enough ahead of the curve on Health 3.0 to be the most valuable early customers.
Further, there are entirely new digital health opportunities that span beyond traditional health care systems. In the population health era, a true population health manager could be a city health commissioner that looks beyond the sick care system. Don’t focus on where the world is, think where health-related services might and should go. That is likely more fertile ground for a startup in their early years. A good rule of thumb is don’t pursue a provider that is bigger than your current install base.
Health 3.0 is an exciting world where hospital CEOs aren’t in the conflicted position of being rewarded to fill beds like a hotel manager. It puts health in the community. Health systems should rejoice that their new financial incentives are aligned with their missions, unlike the status quo that incentivizes the opposite.
The great news is that many hospital CEOs are just as excited about Health 3.0 as the hundreds of thousands of clinicians activating to drive towards a health ecosystem that works for everyone.
Author Bio
Dave Chase conceived of the Health Rosetta. Its application has two main pillars.
1. Impact – Chase is a cofounder of the Health Rosetta Institute (HRI). HRI is an education/certification entity that is a LEED-like organization for health care. It advances the Health Rosetta blueprint for purchasing health care wisely. HRI’s primary initial focus is on the U.S. employer health care market, although the Health Rosetta isn’t inherently employer or U.S. specific.
2. Investment and company building – Chase is a cofounder of the Health Rosetta Group, a holding company and investment group that backs the transformation of health care. It includes the Quad Aim Fund, a seed stage venture fund, and an innovative acquisition and transformation model for building next-gen services companies.
Chase’s TEDx talk entitled “Health Care Stole the American Dream - Here’s How We Take It Back” sums up health care’s devastation of the middle class and the redemption coming via a grassroots movement. It can be viewed at healthrosetta.org/tedx. Chase was named one of the most influential people in Digital Health because of his entrepreneurial success, speaking, and writing. He delights in sharing how high-performing organizations have solved health care’s toughest challenges. Chase coauthored the 2014 health care Book of the Year awarded by HIMSS entitled Engage! Transforming Healthcare Through Digital Patient Engagement.
Chase was the CEO and Cofounder of Avado, acquired by & integrated into WebMD & Medscape (the most widely used health care professional site). Before Avado, Chase spent several years outside of health care in startups as a founder or in consulting roles with LiveRez.com, MarketLeader, and WhatCounts. He was also on the founding & leadership teams in two $1B+ businesses within Microsoft including their $2 billion health care platform business.
Chase is a father of two great kids/athletes, husband, and oxygen-fueled mountain athlete. His team placed 3rd in their division and 24th overall (of 500 teams) in the oldest adventure race in the U.S. where Dave tackled the Nordic ski leg. Dave is also a former PAC-12 800 Meter competitor.
Bibliography & Endnotes
1Joe Eaton and M.B. Pell, “Lobbyists Swarm Capitol to Influence Health Reform,” The Center for Public Integrity (May 19, 2014), accessed July 4, 2016 https://www.publicintegrity.org/2010/02/24/2725/lobbyists-swarm-capitol-influence-health-reform.
2Arnold S. Relman, M.D., “The New Medical-Industrial Complex,” The New England Journal of Medicine (1980): 303, accessed July 4, 2016, DOI: 10.1056/NEJM198010233031703
3David I Auerbach and Arthur L. Kellermann, How Does Growth in Health Care Costs Affect the American Family? (Santa Monica, CA: RAND Corporation, 2011), https://www.rand.org/pubs/research_briefs/RB9605.html.
4“The Big Picture: The Burden of Musculoskeletal Disease in the United States,” United States Bone and Joint Initiative, accessed July 4, 2016, http://www.boneandjointburden.org/2014-report/i0/big-picture
5Organization for Economic Cooperation and Development, OECD Health Data 2011 (Nov, 2011).
6Kim Chul M.D., M.P.H. and Vinay Prasad, M.D., M.P.H., “Cancer Drugs Approved on the Basis of a Surrogate End Point and Subsequent Overall Survival: An Analysis of 5 Years of US Food and Drug Administration Approvals,” JAMA Intern Med. 175 (2010): 12, accessed July 4, 2016, doi:10.1001/jamainternmed.2015.5868
7A.L. Kellermann and D.I. Auerbach, The Rand Blog, (January, 3, 2013), http://www.rand.org/blog/2013/01/health-care-cost-growth-is-hurting-middle-class-families.html.
8“Health Care Costs: A Primer,” The Henry J. Kaiser Family Foundation, accessed July 4, 2016, http://www.kff.org/report-section/health-care-costs-a-primer-2012-report/
9Anna Louie Sussman, “Burden of Health-Care Costs Moves to the Middle Class,” The Wall Street Journal, access December 12, 2016, https://www.wsj.com/articles/burden-of-health-care-costs-moves-to-the-middle-class-1472166246
10“US Health Care Spending: Who Pays?,” California Health Care Foundation, accessed July 4, 2016, http://www.chcf.org/publications/2015/12/data-viz-hcc-national
11Angela Mueller, “Supreme Court rules for Schlichter Client in 401(k) case,” St. Louis Business Journal, accessed July 4, 2016, http://www.bizjournals.com/stlouis/news/2015/05/18/supreme-court-rules-for-schlichter-client-in-401-k.html
12The core issue is that ERISA health plan dollars are viewed under case law as the employer’s, not the employee’s. However, the Department of Labor even says these fiduciary duties apply on their website. “Health Plans & Benefits: Fiduciary Responsibilities,” United States Department of Labor, accessed January 10, 2017, https://www.dol.gov/general/topic/health-plans/fiduciaryresp. In fairness to the DoL, prior to high-deductible plans it was once easier to argue that health benefits spending was the “employer’s money.” But today 51 percent of the workforce has a deductible of more than $1,000. “Section Eight: High-Deductible Health Plans with Savings Option,” The Henry J. Kaiser Family Foundation, accessed December 5, 2016, http://www.kff.org/report-section/ehbs-2016-section-eight-high-deductible-health-plans-with-savings-option/. With cost-sharing and high-deductibles, employees are typically paying approximately 30 percent of health benefits costs. “2016 Employer Health Benefits Survey,” The Henry J. Kaiser Family Foundation, accessed December 5, 2016, http://www.kff.org/health-costs/report/2016-employer-health-benefits-survey/
13David I. Auerbach and Arthur L. Kellermann, “How Does Growth in Health Care Costs Affect the American Family?” accessed July 4, 2016, http
s://www.rand.org/pubs/research_briefs/RB9605.html
14Modupe Idowu, “Premium Hikes Eat Up Teacher Pay Raise,” accessed October 14, 2016, http://local15tv.com/news/local/premium-hikes-eat-up-teacher-pay-raise
15“Make America Make Again: Manufacturing in the U.S.A.,” WAMU/NPR., accessed February 1, 2017, http://the1a.org/shows/2017-01-25/made-in-america
16Barry Ritholtz, “Health-Care Costs Ate Your Pay Raises,” accessed November 5, 2016, https://www.bloomberg.com/view/articles/2016-09-28/health-care-costs-ate-your-pay-raises
17Richard A. Young, M.D., “Who Will Have Health Insurance in the Future? An Updated Projection,” Annals Family Medicine 10 (2010): 2 accessed July 4, 2016, doi: 10.13americans with less than 1,000 in sss70/afm.1348
18Cameron Huddleston, “69% of Americans Have Less Than $1,000 in Savings,” accessed November 4, 2016, https://www.gobankingrates.com/personal-finance/data-americans-savings/.
19David U. Himmelstein, M.D. et al., “Medical Bankruptcy in the United States, 2007: Results of a National Study,” accessed July 4, 2016 http://www.pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf
20Christina Lamontagne, “NerdWallet Health finds Medical Bankruptcy accounts for majority of personal bankruptcies,” accessed July 4, 2016, https://www.nerdwallet.com/blog/health/managing-medical-bills/nerdwallet-health-study-estimates-56-million-americans-65-struggle-medical-bills-2013-2/
21“American Health Care Tragedies Are Taking Over Crowdfunding,” accessed July 4, 2017 https://www.bloomberg.com/news/articles/2017-06-12/america-s-health-care-crisis-is-a-gold-mine-for-crowdfunding
22Health Policy Commission, “List of Figures in 2013 Cost Trends Report by the Health Policy Commission,” accessed July 4 2016, http://www.mass.gov/anf/docs/hpc/2013-ctr-chartbook.pdf
23Susan Brink, “How Health Care Costs Affect Small Town Living,” accessed July 4, 2016, http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2014/02/05/how-health-care-costs-affect-small-town-living
24JJohn T. James, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care” Journal of Patient Safety 9 (2013): 3, accessed July 4, 2016, doi:10.1097/PTS.0b013e3182948a69;” Medical Errors Are No. 3 Cause Of U.S Deaths, Researchers Say,” NPR: Boise State Public Radio, accessed July 4, 2016, http://www.npr.org/sections/health-shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-errors; “Study Suggests Medical Errors Now Third Leading Cause of Death in the U.S.,” John Hopkins Medicine, accessed July 4, 2017, http://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us
25Ariana Eunjung Cha, “Researchers: Medical Errors Now Third Leading Cause of Death in United States,” The Washington Post, May 3, 2016, accessed July 4, 2016, https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-united-states/?utm_term=.0e773eff4155
26Jon Krakauer, Where Men Win Glory: The Odyssey of Pat Tillman. (New York: Doubleday, 2010), 343; “United States Military Casualties of War,” Wikipedia, accessed July 4, 2017, https://en.wikipedia.org/wiki/United_States_military_casualties_of_warr
27Sarah Kliff, “Do no harm,” Vox, accessed July 4, 2016, http://www.vox.com/2015/7/9/8905959/medical-harm-infection-prevention
28Marty Makary, Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care. (London: Bloomsbury, 2012)
29For this calculation, I compared actual health care premium growth rates with historical rates of inflation, then assumed the difference would have been invested in an S&P index fund and that dividends would have been reinvested.
30The Pew Charitable Trusts, “Retirement Plan Access and Participation Across Generations,” accessed March 2, 2017, http://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2017/02/retirement-plan-access-and-participation-across-generations; Sean Williams, “Nearly 7 in 10 Americans Have Less Than $1,000 in Savings,” USA Today, accessed March 2, 2017, https://www.usatoday.com/story/money/personalfinance/2016/10/09/savings-study/91083712/
31Samer W. Cabbabe, M.D., “The Medical Profession Has a Bad Reputation. Here’s Why,” Kevin MD, March 1, 2017, http://www.kevinmd.com/blog/2017/03/medical-profession-bad-reputation-heres.html
32Christine Sinsky, M.D. et al., “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties,” Annals of Internal Medicine 165 (2016): 11, accessed January 4, 2016, DOI: 10.7326/M16-0961
33Sandra G. Boodman, “Patients Lose When Doctors Can’t Do Good Physical Exams,” Kaiser Health News, accessed July 4, 2016, http://khn.org/news/patients-lose-when-doctors-do-not-perform-physical-exams-correctly/
34Christine Sinsky, M.D. et al., “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties.”
35Ken Murray, M.D., “How Doctors Die” Saturday Evening Post March/April 2013, accessed July 4, 2016, http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html
36Craig Hatkoff, Rabbi Irwin Kula, and Zach Levine, “How to Die in America: Welcome to La Crosse, Wisconsin” Forbes (September 23, 2014), accessed July 4, 2016, https://www.forbes.com/sites/offwhitepapers/2014/09/23/how-to-die-in-america-welcome-to-la-crosse/#17df59bbe8c6
37 David Epstein & Propublica, “When Evidence Says No, but Doctors Say Yes,” The Atlantic. (February 22, 2017), https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/
38Gina Kolata, “Why ‘Useless’ Surgery Is Still Popular,” The New York Times (August 3, 2016), accessed July 4, 2016, https://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html
39“Infographic: Health Care Waste,” PBS News Hour (July 4, 20126), http://www.pbs.org/newshour/multimedia/health-750b/
40This chart is adapted from one provided to me by an industry insider.
41“How Many Doctors Does It Take to Start a Healthcare Revolution? Full Transcript,” Freakonomics (April 9, 2015), http://freakonomics.com/2015/04/09/how-many-doctors-does-it-take-to-start-a-healthcare-revolution-full-transcript/
42Atul Gawande,” The Hot Spotters,” The New Yorker (January 24, 2011), accessed July 4 2016, http://www.newyorker.com/magazine/2011/01/24/the-hot-spotters
43This data comes from ClearHealthCosts internal datasets that they’ve given us permission to use.
44“2016 Employer Health Benefits Survey,” The Henry J. Kaiser Family Foundation.
45This data comes from ClearHealthCosts internal datasets that they’ve given us permission to use.
46Private discussions with other industry executives and experts not for attribution.
47“FRAUD, WASTE AND ABUSE IN SOCIAL SERVICES: Identifying and Overcoming this Modern-Day Epidemic,” Accenture Consulting, accessed March 2, 2017, https://www.accenture.com/us-en/insight-fraud-waste-abuse-social-services-summary
48Private discussions with other industry executives and experts not for attribution.
49“HRI Benefits Advisor Compensation Disclosure Form,” Health Rosetta, accessed May 25, 2017, https://healthrosetta.org/learn/benefits-advisor-disclosure/
50Richard Fry, “Millennials Surpass Gen Xers as the Largest Generation in U.S. Labor Force,” Pew Research Center, (July 4th, 2016), http://www.pewresearch.org/fact-tank/2015/05/11/millennials-surpass-gen-x ers-as-the-largest-generation-in-u-s-labor-force/
51David Goldhill, Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong (New York: Knopf Doubleday Publishing Group, 2013)
52Ibid., 59.
53Cascadia Capital, “The Future Health Ecosystem Today” (January 15, 2016). Datapoints from Robert Wood Johnson Foundation, https://www.forbes.com/sites/davechase/2016/02/03/report-the-future-health-ecosystem-today-provides-look-into-healthcares-future/#1f9cc7065171
54Danny Crichton, “Millennials Are Destroying Banks, and It’s the Banks’ Fault,” TechCrunch (May 30, 201
5), https://techcrunch.com/2015/05/30/millennial-banks/
55Adam Hanft,“The Stunning Evolution of Millennials: They’ve Become the Ben Franklin Generation,” THE BLOG Huffington Post (August 11, 2015), http://www.huffingtonpost.com/adam-hanft/the-stunning-evolution-of_b_6108412.html
56Danny Crichton, “Millennials Are Destroying Banks, and It’s the Banks’ Fault.”
57Christina Farr, “Are Millennials Ready to Ditch their Regular Doctor?” KQED Science Future of You, (August 12, 2015), http://ww2.kqed.org/futureofyou/2015/08/12/convenience-or-loyalty-what-do-millennials-value-more-when-it-comes-to-their-health
58Robert Wood Johnson Foundation, “Growing Retail Clinic Industry Employs, Empowers Nurse Practitioners,” accessed July 4, 2016, http://www.rwjf.org/en/library/articles-and-news/2015/02/growing-retail-clinic-industry-employs--empowers-nurse-practitio.html; Craig E Pollack et al., “The Growth Of Retail Clinics And The Medical Home: Two Trends In Concert Or In Conflict?,” Health Affairs (29); 5, accessed July 4 2016, doi: 10.1377/hlthaff.2010.0089; Bruce Jaspen, “Retail Clinics Hit 10 Million Annual Visits But Just 2% Of Primary Care Market,” Forbes, accessed July 4, 2016, https://www.forbes.com/sites/brucejapsen/2015/04/23/retail-clinics-hit-10-million-annual-visits-but-just-2-of-primary-care-market
59Jason Hidalgo, “Here’s How Millennials Could Change Health Care” USA Today (February 7, 2016), http://www.usatoday.com/story/news/politics/elections/2016/02/07/heres-how-millennials-could-change-health-care/79818756/