Cartoon – No One Jumps off a Winning Horse
Monthly Archives: March 2017
Cartoon – Redirecting Our Shared Passion
Artificial Intelligence In Healthcare Will Make Decisions For Doctors
Artificial intelligence could soon make tough medical choices
Patients are often willing to put themselves in the hands of healthcare professionals when they need to see a doctor, and this includes accepting the technological devices that help physicians. But, artificial intelligence making vital decisions for doctors is another story.
AI is already playing a significant role in healthcare. The healthcare organization, MedyMatch says it is, “creating a new category of AI-driven diagnostic tools” and “leveraging the richness of 3D imaging, the breadth of patient-specific data, and other relevant data… to deliver precise clinical decision support directly to the physician.”
MedyMatch recently announced a major collaboration with IBM Watson Health. The aim is for artificial intelligence applications to work alongside doctors in emergency rooms and other acute care settings.
AI can use deep learning to help physicians by highlighting regions of interest that could “indicate the potential presence of cerebral bleeds in suspected head trauma and strokes.”
Better decisions from better information
So what would AI decision making in a hospital setting look like?
“Clinical Decision Support (CDS) is where the greatest opportunity exists to make an impact,” MedyMatch CFO Michael Rosenberg told TechDigg.
While it’s well known that better decision making comes from having better information, it’s also well known that healthcare professionals are constantly short of time, making it difficult to process a lot of information.
“CDS in its classical sense has been about decision trees, if this then do that… when it comes to AI, we take it to a whole other level,” Rosenberg said.
“When looking at decision support, we aren’t looking at a set of rules, but a set of considerations highlighted for the physician, whether they be statistical data looking at similar patients across a population or highlighting regions of interest.”
This also has a positive financial impact, because: “better decisions lead to better outcomes, and better outcomes mean the reduction of costly errors, which means cost savings for the healthcare system from the Provider, Patient, and Payer.”
Speaking on the relationship between artificial intelligence and doctors, and the stage that relationship is now at, Rosenberg said:
“I think we are seeing the very early stages of an evolution where the definition of a doctor changes. AI will never replace the physician, at least not in our lifetime. The physician will always be the ultimate decision maker, however that decision will be influenced by recommendations that an AI platform recommends.”
“We think of AI as a capability that can be used to enhance the work of a physician… the final diagnosis will always be the responsibility of the doctor, but it will rapidly increase the number of physicians that can perform at an expert level.”
Can we be sure artificial intelligence decisions are safe?
There are many areas of life where people are both excited and cautious about the role that AI can play. Healthcare is perhaps the number one area where the public needs to know it can trust the technology.
“The great thing in healthcare is the regulator,” Rosenberg said. “The FDA is looking out for the patient, and close collaboration between the healthcare industry and the AI provider will result in the best quality for the marketplace.”
Even the best doctors get tired and short of time, and artificial intelligence could be on hand to do the work they simply can’t do themselves.
The Devil is in the Culture: It is all about Will!
As lawmakers on Capitol Hill wrangle over the fate of the Affordable Care Act and its would-be replacement, the American Health Care Act, the National Academy of Medicine said its four main priorities for fixing the country’s healthcare industry include continuing the shift from fee-for-service to value based payment models; empowering people to be fully engaged in their healthcare decisions; tapping communities for local health solutions; and implementing integrated services and seamless digital interfaces.
Writing a blog for the Journal of the American Medical Association, Donald M. Berwick, MD, acknowledged that these solutions don’t exactly reinvent the wheel.
“The strength of the Vital Directions report is not in its innovativeness; it contains no surprises,” said Berwick. “This report offers a template for change broad and inclusive enough for it to be a charter for coherent and effective system redesign.”
The first step in that redesign, the shift from volume to value, is already underway, and the academy contends that its continuation is vital in terms of reducing waste and improving value.
Berwick agreed that this shift is needed, but wrote that fee-for-service behaviors “and top line-driven revenue growth strategies continue to dominate healthcare economies, and recent political pushback has been strong against expanding effective bundled payment models and value-based pharmaceutical purchasing.”
The report also cites evidence that underinvestment in social services relative to healthcare services may be contributing to the country’s poor health performance. To reduce inequality and increase cost savings, the report recommends integrating clinical care services and non-medical services, such as housing, food, transportation and income assistance.
That solution leads into another of the report’s action plans, activating communities. A person’s health is very much a product of the available social supports within their community, their physical environment and their behavior. The U.S. continues to invest far less in community-based social services, which the report said is vital to combating health threats such as chronic disease and substance abuse. The report recommends investing in local leadership and infrastructure capacity for public health initiatives, and calls for collaboration from leaders in different sectors, such as business, education, housing and transportation. For this approach to be successful, close coordination is needed between medical and social services.
When it comes to empowering and engaging people, the report claims that patients are often insufficiently involved in their own care decisions, sometimes resulting in care that doesn’t take their specific life situations into account. Health regimens and treatments should work within that context, and policymakers should focus on increasing the amount of information that’s available, the authors wrote. Telehealth was identified as an important component of that, as it helps patients in underserved or remote areas and essentially gives them greater ownership of their health information.
Revamping digital interfaces, the fourth action plan, is particularly vital, the authors said, because the extent to which systems can share and make use of data remains severely limited. That causes breaks in care continuity, which not only predisposes the patient to harm but increases stress for the clinician. Creating principals for end-to-end interoperability, strengthening the overall data infrastructure, building public trust around privacy and security, and smoothing over inconsistent state and local policies on data use and sharing are possible solutions.
Berwick wrote that if the country adopted these policy frameworks, healthcare quality and costs would likely improve dramatically within a decade.
“The devil is not in the details here,” wrote Berwick. “Everything the authors recommend can, in principle, be done with remarkably few cycles of trial and learning. The devil is in the culture. It is all about will.”
“Leaders must recruit the courage to make the case and put their own political and organizational futures on the line,” wrote Berwick.
California Employer Health Benefits: Prices Up, Coverage Down
Since 2000, the percentage of employers offering health benefits has declined in California and nationwide, although coverage rates among offering firms have remained stable. Only 55% of firms reported providing health insurance to employees in 2016, down from 69% in 2000. These findings underscore the important role that Medi-Cal and Covered California play in providing insurance to working Californians — coverage that could be negatively impacted if the Republicans repeal and replace the Affordable Care Act.
Nineteen percent of California firms reported that they increased cost sharing in the past year, and 27% of firms reported that they were very or somewhat likely to increase employees’ premium contribution in the next year. The prevalence of plans with large deductibles also continues to increase.
California Employer Health Benefits: Prices Up, Coverage Down presents data compiled from the 2016 California Employer Health Benefits Survey.
Other key findings include:
- Health insurance premiums for family coverage grew by 5.6%. Family coverage premiums have seen a cumulative 234% increase since 2002, compared to a 40% increase in the overall inflation rate.
- The average monthly health insurance premium, including the employer contribution, was $597 for single coverage and $1,634 for family coverage in California, and was significantly higher than the national average.
- 41% of workers in small firms faced an annual deductible of at least $1,000 for single coverage, compared to 17% of workers in larger firms. The prevalence of these higher deductibles in small firms has increased substantially in the past five years.
- Only one in four firms with many low-wage workers (those earning $23,000 or less) offered health coverage to employees in 2016.
- In the past year, 24% of large firms extended eligibility for health benefits to workers not previously eligible.
The complete Almanac report, as well as past editions, is available under Document Downloads.
True Sign of a Great Leader > How Well They Protect PTO
To me there is one way to know if a leader is worth their salt. It is something I don’t recall seeing in leadership books, white papers, or in training sessions. To me the simplest way to see if a leader is doing their job is to ask team members one question:
“Did you use all your PTO last year?”
When a team member tells me they did not, my antennae go up. My follow up, of course, is “well, why not?”. Answers I get:
- I didn’t have time to take it
- I didn’t want to leave my team short-handed during that data conversion
- I forgot I even had PTO
- I have so much PTO I could never use it all
- I’d rather use our great benefit that allows me to “cash in” my PTO
Here is the deal. If you are a leader and you are OK with any of these reasons, you are not doing your job. I’ll take it a step further and say you should not be a leader. Quit. Be an incredible individual contributor. But you need to let go of your dreams of being a leader. Let that go. It’s over.
I’m emphatic about this.
Transforming Care: Reporting on Health System Improvement
In Focus: Reimagining Rural Health Care
News of growing health disparities between rural and urban Americans prompted Transforming Care to focus on what’s happening in rural health care today. What we found was surprising: While there is much to worry about—including a greater risk of dying from preventable causes and worse access to care—there are also many signs of innovation, including bold experiments in organizing and financing care delivery, making services more accessible, and addressing the social determinants of poor health. This issue focuses on these bright spots—places where policymakers, providers, and community organizers are seeking to transform their health care systems to better serve residents.
Forty-six million Americans—some 15 percent of the U.S. population—live in rural areas of the country.1 Data from the Centers for Disease Control and Prevention show they are more likely to die from the five leading causes of death—heart disease, cancer, unintentional injuries, chronic lower respiratory disease, and stroke—than residents in urban regions and that a greater percentage of rural deaths may be preventable.2 Gains in life expectancy among urban and rural Americans, which once tracked fairly closely, began to diverge in the 1990s. By 2009, the life span of residents of large cities was 2.4 years longer; for poor and black rural residents, life expectancy was what urban rich and urban whites enjoyed four decades earlier.
“Rural America is a unique health care delivery environment,” says Alan Morgan, CEO of the National Rural Health Association, a nonpartisan organization with more than 21,000 members. “You have an elderly population, you have a sicker population, and you have a low-income population. Yet you have the fewest options available when it comes to seeking care. It’s a perfect storm.”
But for all these challenges, Morgan and other experts say some rural communities have begun to innovate, adopting new care delivery and payment models to address long-standing workforce shortages and population health needs.
Fitch: Uncompensated care could increase next year under ACA
Without modifications to the ACA, exchange enrollment could suffer and hospitals are likely to see uncompensated care rise next year, according to Fitch Ratings.
Last Friday, the GOP’s proposal to repeal and replace the ACA was pulled from the House floor, leaving the ACA in effect for the time being.
Hospitals are not expected to see a rise in uninsured patients this year since those enrolled in an ACA plan for 2017 will keep it, Fitch said in a news release. However, with premiums rising and insurers leaving the exchanges, ACA enrollment is likely to decrease, the agency noted. Total signups for open enrollment fell 4 percent from 2016 to 2017.
“The failure of the AHCA [American Health Care Act] to move forward means that the ACA exchanges will be ostensibly functioning in 2018, but hospital companies will likely face higher levels of uncompensated care as fewer individuals enroll in exchange products,” Fitch said.
Still, Fitch said it is the ACA’s Medicaid expansion — not the exchanges — that have primarily driven a decrease in uncompensated care for hospitals.
“The AHCA’s changes to the ACA related Medicaid expansion were relatively more benign than the expected dislocation in the exchange covered lives with respect to the ultimate influence on hospital companies’ patient payer mix and the financial burden of treating uninsured patients,” Fitch said. “However, while current Medicaid enrollment is likely to be stable, more states will not likely expand eligibility given the uncertainty of future funding.”
Cartoon – Will the data be accurate?
Cartoon – We’re just better at it
HENRY KOTULA 