Is Healthcare Exploitative And Extractive?

I've had this post sitting around in draft form for far too long and it's time to get it off my chest.

Several years ago, MSNBC commentator Dylan Ratigan interviewed Umair Haque, author of The New Capitalist Manifesto: Building a Disruptively Better Business, founder of Bubblegeneration, Director of the Havas Media Lab and blogger at the Harvard Business Review. Though the topic wasn't healthcare, there was much for healthcare leaders to ponder.

Haque draws a clear contrast between productive wealth and destructive wealth.  Both count toward Gross Domestic Product (GDP) but only the former really contributes.

Says Umair,

"It’s easier to make money in the short-term through exploitation and the extraction and much more labor intensive with a higher failure rate and a much greater degree of challenge to actually advance and create something that is new and different and differentiates in its creation of value. “So to me, this is a crisis that is about failing to create real value, but it is a crisis of our institutions. And it’s a crisis that is of things like GDP and corporate profits, and the ways in which we measure and conceive of income. And so to really get to grips with this crisis, I think we have to begin by taking a cold hard look at those things,”

A 'cold hard look' at income and value-creation in health care is likely to be all of that AND a little bit uncomfortable. The short-term thinking. The fee for service-driven decision making.  The inward-looking, edifice-focused ways we define terms like 'health' and 'success.'

Maybe you don't think of health care as "exploitative" or "extractive?"  What else would you call a willingness to amputate a diabetic's foot while letting the underlying disease process continue apace?

Yeah I know, we're really, finally, truly getting serious about fixing stuff like that.  And though it's been part of every community needs assessment and strategic plan and QI/QA/PI target since, oh, 1965, things have changed. No more business as usual. This time it's different. We mean it. Really.

Or at least we mean it so long as Medicare guarantees us extra payment for meaning it.  Or the payers give us part of their risk pools for doing it. Ahhh, the sweet smell of success.

12:13 PM

What Tech Trends Do CIOs See As Overrated?

From Chris Murphy, Editor at InformationWeek.com: "7 Tech Trends CIOs Call Overrated."

Trend #4: "Big data over small data."

(Says) Ken Harris, Shaklee CIO: "I'm not convinced that big data for most companies is a promising investment right now. We haven't learned how to handle small data well, let alone throw big data on there. That isn't to say there aren't some companies for whom big data could be a game changer, but most companies don't even effectively handle small data."

Harris is entirely correct, especially regarding healthcare's provider organizations - hospitals and physician groups - who, despite much talk about evidence-based practice, remain too often stuck in patterns of deliberate, consensus-to-a-fault decision-making. 

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Shared on Google+. creativecommons.org.au

Think that's harsh?  One AHRQ study found that "...(t)ranslation of research findings into sustainable improvements in clinical outcomes and patient outcomes remains a substantial obstacle to improving the quality of care. Up to two decades may pass before the findings of original research becomes part of routine clinical practice."

It's not for lack of data, big or otherwise, that this pattern remains.  No, it's culture trumping data. 

What happens when your Chief of Cardiology says "Nah.  I disagree with those research findings.  That's not what I learned in medical school and I'm not gonna do it."  Who wins?  Her or the data?  I think we've all been around hospitals (and cardiologists) long enough to know the answer.

So work on that culture thing first.  In fact, get the culture right and the rest follows.  Otherwise you're just writing big checks to big IT companies, expecting big things and setting youself up for big disappointments.

1:07 PM

Questions For A Sunday Morning

Weight loss:  Commercial weight-loss schemes outperform physician recommendations.  Does your heart follow where your pocketbook leads?  (Chicago Tribune)

Prostate surgery: Risks associated with prostate surgery are lower at academic medical centers.  Does practice make, if not ‘perfect,’ at least ‘better?’  (Chicago Tribune)

Quality measures:  Will your physician ‘fire’ you to meet standards for incentive-based compensation?  Are you a parent who refuses to vaccinate your kids?  “You’re fired!” (Advisory Board)

Disease management:  Programs for Medicare patients do not improve quality, reduce costs or decrease hospital and ED visits.  It’s only one study, but disappointing nevertheless. (NEJM)

 (Image from http://www.steinski.com/blog/a_question_for_you/ via a Creative Commons search)

12:07 PM

David Leonhardt writing in the NY Times: "Health care is far larger, with the United States spending at least 50 percent more per person on medical care than any other country, without getting vastly better results. (Some aspects of our care, like certain cancer treatments, are better, while others, like medical error rates, are worse.) The contrast suggests that a significant portion of medical spending is wasted, be it on approaches that do not make people healthier or on insurance-company bureaucracy."

8:21 AM