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Pioneering a health care innovation ecosystem to better serve patients

The MIT Center for Biomedical Innovation on Dec. 12 announced its New Drug Development Paradigms (NEWDIGS) initiative to pilot a next-generation health care innovation ecosystem. This pilot is designed to deliver more value from new medicines to patients at a faster pace, in ways best suited for all parties. Current NEWDIGS collaborative members GlaxoSmithKline, Merck, and Sanofi are providing the $500,000 startup funding, with other corporate and nonprofit members contributing in-kind resources.

One component of the NEWDIGS approach is the Learning Ecosystems for Accelerating Patient-Centered and Sustainable Innovation (LEAPS) Project, which focuses on connecting knowledge generation across the silos of drug development and patient care through platform clinical trials linked with a real-world, evidence learning engine — a system for managing and sharing knowledge across stakeholders. The first pilot in LEAPS will leverage Massachusetts as a statewide test bed.

“While pharmaceutical research and development is a global enterprise, the value of new medicines is assessed and driven locally. This has always been true in other countries, but is increasingly the case in the U.S.,” says Gigi Hirsch, executive director of the MIT Center for Biomedical Innovation and of the NEWDIGS initiative. “Our goal is to integrate emerging but fragmented innovations in policy, process, and technology into a system that works better for everyone, and especially for patients.”

LEAPS will leverage NEWDIGS methods and tools for collaborative systems engineering involving patients, providers, payers, biotechnology and pharmaceutical companies, information technology firms, regulators, payers, public health officials, and academic researchers.

“It is critically important that we align priorities in pharmaceutical drug development with unmet public health needs,” says Massachusetts Health and Human Services Secretary Marylou Sudders. “By engaging the entire health care system and its key stakeholders, this pilot project has the potential to serve as a model for person-centered health care and break down barriers that currently exist when linking patients with timely, essential treatments.”

The LEAPS project will launch in January 2018. Target diseases under consideration for the pilot are rheumatoid arthritis, Type 2 diabetes, Alzheimer’s disease, and opioid addiction. Objectives, beyond improving patient outcomes, include the following:

  • Enhancing the value of the growing array of disparate data and evidence from electronic medical records and insurance claims to mobile apps and longitudinal patient and disease registries;
  • Accelerating health care insights from data analytics tools such as artificial intelligence, machine learning, and blockchain technologies; and
  • Establishing community hospitals and clinics as key elements of the broader innovation ecosystem.

“Massachusetts is uniquely suited to serve as the test bed for this pilot project, which offers an exciting opportunity to better serve patients by connecting the unparalleled strengths of the state’s biocluster, world renowned provider systems, and payers, who play an increasingly important role in access to new products,” says Robert K. Coughlin, president and CEO of the Massachusetts Biotechnology Council.

“We look forward to building on the work we have done with the NEWDIGS collaborative to design and pilot a next-generation biomedical innovation system in Massachusetts. Done well, we believe this effort can help transform the way new therapies are developed and delivered, and serve as a model to replicate in other states, and for other diseases,” says Susan Shiff, senior vice president and head of the Center for Observational and Real-World Evidence at Merck.

Elements of the strategic vision for LEAPS were explored in the Next Wave Forum, hosted by NEWDIGS on Dec. 12-13, in Cambridge, Massachusetts. The event included keynote speakers Janet Woodcock (Food and Drug Administration), Hans-Georg Eichler (European Medicines Agency), Trent Haywood (Blue Cross Blue Shield), Donald Berwick (formerly Centers for Medicare and Medicaid, and Institute for Healthcare Improvement), and MIT’s Alex “Sandy” Pentland, Jonathan Gruber, and Michael Cusumano.

Further details on MIT NEWDIGS LEAPS are available at newdigs.mit.edu.

Alarm over restraint of NHS mental health patients

Patients in mental health units were physically restrained by staff more than 80,000 times last year in Britain, including 10,000 who were held face down or given injections to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years.

Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint, he warned, “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used on fewer women than men, but is used on the former more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards with low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems.

A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6 million patients ended up in hospital receiving treatment.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Alarm over restraint of NHS mental health patients

Patients in mental health units were physically restrained by staff more than 80,000 times last year in Britain, including 10,000 who were held face down or given injections to subdue them, new NHS figures show.

Girls and young women under the age of 20 were the most likely to be restrained, each being subjected 30 times a year on average to techniques that can involve a group of staff combining to tackle a patient who is being aggressive or violent.

Black people were three times more likely to be restrained than white people, according to the first comprehensive NHS data on the use in England of such techniques, which have provoked controversy for many years.

Mental health campaigners fear that the use of such force can cause patients physical harm or revive painful memories of the trauma that many have suffered in childhood.

The figures, published by the NHS Digital statistical agency, show that the 80,000 uses of restraint in 2016-17 included patients being subjected to “prone” restraint – being held face down – 10,000 times, and patients being controlled by “non-prone” physical force 43,000 times. Chemical restraint was used on another 8,600 occasions.

The findings have prompted fresh concern among mental health experts that too many patients are still being restrained, despite moves by the government and NHS in recent years to reduce the incidence.

“It is troubling to see how prevalent the most severe, and dangerous, kinds of restraint are in the mental health system,” said Brian Dow, director of external affairs at the charity Rethink Mental Illness. Prone restraint, he warned, “can be terrifying and badly damage someone’s recovery”.

NHS Digital’s figures were published in the recent annual mental health bulletin detailing activity and treatment in NHS mental health units in England. They show that:

■ Black people were more than three times more likely to be restrained than white people.

■ Prone restraint, which guidance says should be used only in life-threatening situations, is used on fewer women than men, but is used on the former more often; women are physically subdued multiple times.

■ Mechanical means of restraint were used 1,200 times, seclusion on 7,700 occasions and segregation 700 times.

Katharine Sacks-Jones, the director of Agenda, an alliance of 70 organisations working with women and girls who are at risk, said: “It’s completely unacceptable that so many women and girls are being restrained over and over again.

“The picture for girls and young women is particularly alarming, with those under 20 subjected to restrictive practices nearly 30 times each on average, the majority of these being incidents of physical and face-down restraint.

“More than half of women who have mental health problems have experienced abuse, so not only is restraint frightening and humiliating, it also risks retraumatising them.”

In its annual report in July, the Care Quality Commission, which regulates NHS care in England, said its inspectors had found unwarranted and wide-ranging variation between units in terms of how often staff used restraint. Wards with low rates had staff who had been trained to handle difficult behaviour and de-escalate challenging situations.

But, the CQC added, mental health wards dealing with acutely unwell patients are high-risk environments where patients can regularly be violent towards staff or fellow patients. The number of times restraint techniques are used has risen from 781 per 100,000 bed days in 2013-14 to 954 per 100,000 bed days last year. However, use of face-down restraint has fallen, from 231 incidents per 100,000 bed days in 2014-15 to 199 incidents per 100,000 bed days in 2015-16.

The Department of Health said that its guidance, issued in 2014, stressed that restraint should be used only if other means of dealing with difficult situations were unlikely to succeed.

“Physical restraint should only be used as a last resort and our guidance to the NHS is clear on this – anything less is unacceptable,” a spokeswoman said. “Every patient with mental health issues deserves to be treated and cared for in a safe environment. We are working actively with the CQC to ensure the use of restraint is minimised.”

The bulletin also reveals that almost one in 20 people in England received NHS help last year for mental health problems.

A total of 2,637,916 people – 4.8% of the population – were in contact with secondary mental health, learning disabilities and autism services at some point. Of these, 556,790 were under 18.

In addition, 101,589 (3.9%) of those 2.6 million patients ended up in hospital receiving treatment.

In the UK the Samaritans can be contacted on 116 123. In the US, the National Suicide Prevention Lifeline is 1-800-273-8255. In Australia, the crisis support service Lifeline is 13 11 14. Other international suicide helplines can be found at www.befrienders.org.

Computer with patients’ info stolen from Burlington practice – News …

Thousands of patients might have lost their medical privacy two months ago when a Burlington dematology practice’s computer was stolen, UNC Dermatology said Friday.

The UNC Dermatology Skin Cancer Center, 1522 Vaughn Road, had a break-in Oct. 8, and taken was a computer with information on patients of the former Burlington Dermatology Center or Burlington Dermatology, UNC Dermatology said.

The information, in a password-protected database, is patients’ names, addresses and phone numbers, employment status, employer names, birthdates and Social Security numbers. No diagnosis, treatment or prescription information was kept on the computer, though the information includes diagnosis codes for billing purposes.

UNC Dermatology was notifying 24,000 patients, it said.

Patients can place fraud alerts on their credit reports by contacting any of the three major credit bureaus, UNC Dermatology said. UNC Dermatology also is offering patients free credit monitoring for a year.

UNC Health Care acquired Burlington Dermatology in 2015, and a computer containing patient information remained there, until it was stolen two months ago. UNC Health Care believes it has information on patients seen at the practice through September 2015.

“We have ensured that all remaining computers acquired from or kept for use by Burlington Dermatology have been properly secured,” said David Behinfar, UNC Health Care’s chief privacy officer. “UNC Health Care has also implemented process improvements to ensure that future acquisitions of physician practices include a process to properly secure legacy computers and electronic patient information.”

For more information, patients may call 888-356-0275 from 9 a.m. to 6 p.m. weekdays.

 

Computer with patients’ info stolen from Burlington practice

Thousands of patients might have lost their medical privacy two months ago when a Burlington dematology practice’s computer was stolen, UNC Dermatology said Friday.

The UNC Dermatology Skin Cancer Center, 1522 Vaughn Road, had a break-in Oct. 8, and taken was a computer with information on patients of the former Burlington Dermatology Center or Burlington Dermatology, UNC Dermatology said.

The information, in a password-protected database, is patients’ names, addresses and phone numbers, employment status, employer names, birthdates and Social Security numbers. No diagnosis, treatment or prescription information was kept on the computer, though the information includes diagnosis codes for billing purposes.

UNC Dermatology was notifying 24,000 patients, it said.

Patients can place fraud alerts on their credit reports by contacting any of the three major credit bureaus, UNC Dermatology said. UNC Dermatology also is offering patients free credit monitoring for a year.

UNC Health Care acquired Burlington Dermatology in 2015, and a computer containing patient information remained there, until it was stolen two months ago. UNC Health Care believes it has information on patients seen at the practice through September 2015.

“We have ensured that all remaining computers acquired from or kept for use by Burlington Dermatology have been properly secured,” said David Behinfar, UNC Health Care’s chief privacy officer. “UNC Health Care has also implemented process improvements to ensure that future acquisitions of physician practices include a process to properly secure legacy computers and electronic patient information.”

For more information, patients may call 888-356-0275 from 9 a.m. to 6 p.m. weekdays.

 

24000 UNC Health Care patients affected by potential security breach

UNC Health Care is notifying 24,000 patients about a potential security breach at a UNC dermatology practice in Burlington.

UNC said Friday that personal patient information was contained on a hard drive of a laptop computer that was stolen from UNC Dermatology Skin Cancer Center in October. The absence of the computer was discovered only recently, prompting alerts to patients as required by federal law governing patient privacy protections, as well as by the N.C. Identity Theft Act.

The computer’s hard drive is password-protected and contains information pertaining to patients seen by the practice through September 2015, when it was acquired by UNC Health Care. The laptop’s patient database contains patient names, addresses, phone numbers, employment status, employer names, birth dates and Social Security numbers.

The affected patients are being offered free credit monitoring services for one year.

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According to the police report filed by the Burlington Police Department, the Oct. 8 theft resulted in the disappearance of a safe, cash, Dell computer and a computer tower. The theft is under investigation.

24000 UNC Health Care patients affected by potential security breach

UNC Health Care is notifying 24,000 patients about a potential security breach at a UNC dermatology practice in Burlington.

UNC said Friday that personal patient information was contained on a hard drive of a laptop computer that was stolen from UNC Dermatology Skin Cancer Center in October. The absence of the computer was discovered only recently, prompting alerts to patients as required by federal law governing patient privacy protections, as well as by the N.C. Identity Theft Act.

The computer’s hard drive is password-protected and contains information pertaining to patients seen by the practice through September 2015, when it was acquired by UNC Health Care. The laptop’s patient database contains patient names, addresses, phone numbers, employment status, employer names, birth dates and Social Security numbers.

The affected patients are being offered free credit monitoring services for one year.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

According to the police report filed by the Burlington Police Department, the Oct. 8 theft resulted in the disappearance of a safe, cash, Dell computer and a computer tower. The theft is under investigation.

24000 UNC Health Care patients affected by potential security breach

UNC Health Care is notifying 24,000 patients about a potential security breach at a UNC dermatology practice in Burlington.

UNC said Friday that personal patient information was contained on a hard drive of a laptop computer that was stolen from UNC Dermatology Skin Cancer Center in October. The absence of the computer was discovered only recently, prompting alerts to patients as required by federal law governing patient privacy protections, as well as by the N.C. Identity Theft Act.

The computer’s hard drive is password-protected and contains information pertaining to patients seen by the practice through September 2015, when it was acquired by UNC Health Care. The laptop’s patient database contains patient names, addresses, phone numbers, employment status, employer names, birth dates and Social Security numbers.

The affected patients are being offered free credit monitoring services for one year.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

According to the police report filed by the Burlington Police Department, the Oct. 8 theft resulted in the disappearance of a safe, cash, Dell computer and a computer tower. The theft is under investigation.

24000 UNC Health Care patients affected by potential security breach

UNC Health Care is notifying 24,000 patients about a potential security breach at a UNC dermatology practice in Burlington.

UNC said Friday that personal patient information was contained on a hard drive of a laptop computer that was stolen from UNC Dermatology Skin Cancer Center in October. The absence of the computer was discovered only recently, prompting alerts to patients as required by federal law governing patient privacy protections, as well as by the N.C. Identity Theft Act.

The computer’s hard drive is password-protected and contains information pertaining to patients seen by the practice through September 2015, when it was acquired by UNC Health Care. The laptop’s patient database contains patient names, addresses, phone numbers, employment status, employer names, birth dates and Social Security numbers.

The affected patients are being offered free credit monitoring services for one year.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

According to the police report filed by the Burlington Police Department, the Oct. 8 theft resulted in the disappearance of a safe, cash, Dell computer and a computer tower. The theft is under investigation.

24000 UNC Health Care patients affected by potential security breach

UNC Health Care is notifying 24,000 patients about a potential security breach at a UNC dermatology practice in Burlington.

UNC said Friday that personal patient information was contained on a hard drive of a laptop computer that was stolen from UNC Dermatology Skin Cancer Center in October. The absence of the computer was discovered only recently, prompting alerts to patients as required by federal law governing patient privacy protections, as well as by the N.C. Identity Theft Act.

The computer’s hard drive is password-protected and contains information pertaining to patients seen by the practice through September 2015, when it was acquired by UNC Health Care. The laptop’s patient database contains patient names, addresses, phone numbers, employment status, employer names, birth dates and Social Security numbers.

The affected patients are being offered free credit monitoring services for one year.

Never miss a local story.

Sign up today for a free 30 day free trial of unlimited digital access.

According to the police report filed by the Burlington Police Department, the Oct. 8 theft resulted in the disappearance of a safe, cash, Dell computer and a computer tower. The theft is under investigation.

Computer Stolen From UNC Facility in Burlington; 24K Patients Info At Risk

Health insurance options dwindle for neediest US patients

WASHINGTON • Josh Brookhart has four health insurers to choose from in Seattle’s King County for 2018, more than many Americans like him who buy coverage on the Obamacare individual market.

Yet none of the plans cover all the complex medical care needed for his seven-year-old son, Gabriel.

Born with an extreme form of Chiari malformation, Gabriel required surgery to reinsert a part of his brain into his skull. He lives with hydrocephalus, or extra fluid in his brain, and spina bifida, which causes abnormal development of the spinal cord.

The Brookharts’ insurer, Regence BlueShield of Washington, said in June it would exit the Obamacare markets in 2018, citing unsettled marketplaces across the country, a move common to many insurers uncertain about the program’s future under President Donald Trump.

All of Gabriel’s specialists, who span multiple medical centers and practices and have been coordinating his care for five years, were covered under Regence.

Based on the limited options for 2018 enrollment, the Brookharts plan to pick an insurer that will cover some of Gabriel’s care and expect to pay tens of thousands of dollars for the rest of his needs.

“I would pay a high price for a good policy. It’s just mind-boggling to me that it doesn’t exist no matter how much I would want to pay,” Brookhart said.

Gabriel’s case shows how difficult it can still be to find adequate health care for very complex conditions four years after Obamacare took full effect. In many cases, an insurer will cover medical care but not certain prescription drugs. In other cases, an insurer may cover one specialist doctor but not others, or cut expensive academic medical centers out of their networks to lower costs.

Patients with complex medical cases often take high-cost prescription drugs, rely on specialists who sometimes coordinate their care and may require sophisticated surgeries, among other needs.

The challenge of finding adequate health care on the Obamacare market is expected to intensify as the Trump administration strips away aspects of the law, health care experts say.

“Instability is just a very stressful thing for people dependent on a stable connection to the healthcare system,” said Daniel Polsky, professor at the University of Pennsylvania and executive director of the Leonard Davis Institute of Health Economics. “Even just a change of doctors could result in some difficult health consequences.”

Restricted choice

U.S. consumers have often complained that subsidized health insurance under former President Barack Obama’s Affordable Care Act restricted their choice of doctors, or forced them to change providers. In some cases, that may mean switching primary care providers. But for patients with serious medical needs it can prevent them from seeing their specialists.

The Obama administration attempted a fix, directing more federal oversight of the plans, requiring transparency from insurers on what they did, and did not, cover and setting guidelines for insurers to cover enough health care providers.

Trump has promised to repeal Obamacare and is using executive powers to undermine it, including a rule finalized in April that allows individual states to determine whether insurers provide enough access to doctors.

The administration has also proposed giving states more authority over their insurance markets and allowing them to water down some Obamacare benefits in 2019. That could create wide discrepancies in access to doctors among states, said Sabrina Corlette, an expert on health insurance markets at Georgetown University.

There is no national estimate of how many people with complex medical cases may struggle to find a plan that covers their particular doctors. About 2.2 million people on the individual market have some form of a pre-existing chronic condition, according to Avalere Health, a research and consulting firm.

Seventy-three percent of the Obamacare 2018 individual market is comprised of restrictive plans, or those that cover fewer providers, according to Avalere, up from 68 percent in 2017 and 54 percent in 2015.

Research has shown that insurers are more likely to offer limited access to doctor practices in markets where they compete against one or more rivals. This helps keep insurer costs down, and therefore allows them to offer lower prices.

Matt Slaby of Denver, Colo., can choose between six Obamacare insurers, but none cover all the care for his genetic blood clotting disorder, called Factor V Leiden. He relies on the bloodthinner Xarelto, which costs about $400 per month without insurance, to prevent life-threatening clots.

His insurer from last year, Cigna Corp., dropped his plan from the Denver market for 2018.

“There are no plans that cover everything I need,” Slaby said. “Finding two or three, the intersection of things that keep me alive, that’s the challenge.”

In U.S. counties with a single insurer, there is less incentive to whittle down the provider list because there is no competition. The departure of major insurers including Aetna Inc. and Humana Inc. from Obamacare markets has left about half of U.S. counties with only one insurer selling plans, up from one-third in 2017.

But that does not guarantee that a sole insurer in a market will cover medical care at any specific hospital or physician practice.

In Virginia’s Chesterfield County, a single insurer, Cigna, is offering Obamacare coverage, presenting a tough choice for Jodi Smith Lemacks, whose son was born with a heart defect. The plan does not cover her son’s specialists at Children’s Hospital of Philadelphia (CHOP) five hours away, where Joshua Lemacks, 14, has been treated since he was in utero for hypoplastic left heart syndrome.

There is no cure for his condition. In three major surgeries, doctors at CHOP have rerouted Joshua’s anatomy so that his blood can pump through one heart chamber instead of two. They have also provided medication, some through a clinical trial, to help prolong his heart’s ability to function in this way.

Lemacks spends $6,000 to $7,000 a year out-of-pocket for Joshua’s medical expenses, and once had medical debt close to $100,000 due to the surgeries. She decided to put him on her employer’s plan for 2018, but says if anything were to happen to her job at a nonprofit or she chooses to change jobs, she would need to return to the Obamacare market.

“You do everything you can to protect your kids but at the end of the day if you can’t get coverage, you can’t get coverage,” she said.

18470 Henry Ford Health System patients’ data hacked

 

  • Personal health records breached in early October
  • Not clear if information used for inappropriate purposes
  • Investigation of how it happened continues

 18470 Henry Ford Health System patients' data hacked

 18470 Henry Ford Health System patients' data hacked

More than 18,000 Henry Ford Health System patients’ personal health information was viewed or stolen in early October by an unknown person or entity who hacked the Detroit-based health system’s electronic health records.

 

HFHS officials said it is not clear whether the 18,470 patient files have been used for inappropriate purposes.

“We are very sorry this happened. We take very seriously any misuse of patient information, and we are continuing our own internal investigation to determine how this happened and to ensure no other patients are impacted,” Henry Ford said in a statement.

Henry Ford said it first learned of the incident Oct. 3 after someone gained access to or stole the email credentials of a group of employees. The employee credentials are name- and password-protected by encryption. The email accounts had patient health information.

Like other health organizations, Henry Ford providers share encrypted email messages to ensure patient care is seamless, the statement said.

Over the past several years, hospitals and health insurers in Michigan and other states have been subject to loss of patient data through hacking or stolen laptops. For example, Detroit Medical Center in July warned 1,529 patients of a systemwide breach of protected health information.

In 2010, Henry Ford experienced a patient data breach when a laptop containing personal health information was stolen from an unlocked office.

Federal law requires health care organizations to notify patients within 60 days of a data breach.

Henry Ford said patient information viewed or taken may have included their name, date of birth, medical record number, provider’s name, date of service, department’s name, location, medical condition and health insurer. Social Security numbers or credit card information were not compromised, HFHS said.

“To reduce future risk of this happening again, we are strengthening our security protections for employees, all of whom will be educated about this measure in the coming weeks,” the statement said.

“In addition, we are expediting our initiatives around email retention and multi-factor authentication, which will decrease future risks to our patients and employees.”

Henry Ford said patients can request new medical record numbers.

Henry Ford Health data breach affecting 18K patients

The Henry Ford Health System announced this week that some 18,470 of its patients, had their health information either viewed or stolen. 

“It is not clear,” the statement on the data breach said, “whether this information was used for any inappropriate purposes.”

There is no criminal investigation into the breach, said David Olejarz, a spokesman for the Henry Ford Health System.

Henry Ford Health first learned of the breach two months ago, on Oct. 3, “after someone gained access to or stole the email credentials of a group of employees,” which are name and password protected. Someone who was able to access those email accounts would be gaining access to information on patients. 

In the full statement, Henry Ford Health System said:

“Henry Ford Health System is notifying 18,470 patients whose personal health information was viewed or stolen by someone who gained access to it illegally. It is not clear whether this information was used for any inappropriate purposes.

“We are very sorry this happened. We take very seriously any misuse of patient information, and we are continuing our own internal investigation to determine how this happened and to ensure no other patients are impacted.

“We first learned of the incident on Oct. 3, 2017 after someone gained access to or stole the email credentials of a group of employees. The email credentials are name and password protected by encryption. Using the email credentials, the person(s) would have had access to the email accounts of the employees. Contained in the email accounts were patient health information.

“Like other health organizations, our providers share encrypted email messages to ensure patient care is seamless.

“The patient information viewed or taken may have included their name, date of birth, medical record number, provider’s name, date of service, department’s name, location, medical condition and health insurer. Neither their Social Security number nor credit card information was revealed.

“To reduce future risk of this happening again, we are strengthening our security protections for employees, all of whom will be educated about this measure in the coming weeks. In addition, we are expediting our initiatives around email retention and multi-factor authentication, which will decrease future risks to our patients and employees. To provide protection to our patients, new medical record numbers will be issued upon request.

“Patients who received a notification letter are asked to call 844-327-2396.”

 

 

Doctor out sick? A substitute physician is no worse for patients’ health

I

t’s long been thought that hospitalized patients are better off getting treatment from full-time doctors instead of temp physicians. Those temps are called in to cover for doctors’ sick days, vacation, or staff vacancies. But new research finds that a doctor’s employment status may have little to do with quality of care.

Doctors who are employed under short-term contracts — called locum tenens (Latin for “to hold a place”) — provided a similar level of care as staff doctors, a study published Tuesday in the Journal of the American Medical Association found. Researchers came to that conclusion after analyzing 1.8 million Medicare patients hospitalized between 2009 and 2014 who were treated by general internists. No significant difference in 30-day mortality rates was seen between patients treated by temp physicians compared to those treated by staff physicians.

That finding could help dispel the stigma that temp doctors have long faced, researchers said.

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“Years ago, locum tenens doctors might’ve had worse outcomes than non-locum tenens docs, but that’s changing,” said Dr. Anupam Jena, an associate professor at Harvard Medical School and one of the study’s authors. “There appears to be very little difference, if there’s any difference at all.”

Dr. Daniel Blumenthal, an internist affiliated with Massachusetts General Hospital who was the paper’s lead author, said little to no research had previously been conducted on the difference between full-time and temp doctors before this study.

For years, a common bias was that locum tenens doctors simply lacked the credentials to land permanent gigs. “Early on, locums [tenens] physicians were looked upon as ‘less than,’” said Jeff Decker, president of Staff Care, a national recruiting firm that connects locum tenens doctors with hospitals. “They were seen as a necessary evil.”

But growing numbers of hospitals have turned to temp doctors in the face of a national doctor shortage — one that could grow to more than 100,000 unfilled positions by 2030. Staff Care has found that the number of U.S. doctors employed as temps — now at 48,000 — has nearly doubled since 2002.

As part of that shift, Decker believes more physicians are choosing to freelance for a variety of reasons. Young doctors can test out different kinds of medicine to see which ones they like. Mid-career doctors can take on more shift work to pay off medical school debt faster. And older doctors can partially retire but still see patients.

“The paradigm is shifted,” Decker said. “They’re a fill-in … but they’re no less of a physician.”


But on one measure researchers did see a difference. Locum tenens doctors were associated with a higher spending on patient care than full-time doctors, the study found. Some of those costs can be attributed to longer lengths of stay, researchers said.

“It makes sense because [locum tenens] doctors providing care don’t know the system as well,” Jena said. “That might mean inefficient spending in ordering tests or procedures. They may keep patients in hospital longer. The care is more inefficient.”

As physician demand continues to grow, Blumenthal believes hospitals should find ways to better onboard and educate locum tenens doctors in order to lower costs and boost patient outcomes. “Any doctor who is new will go through a period on how to best deliver care, access the right resources, and what kind of acute-care facilities exist for patients,” he said.

Blumenthal would like to see further research conducted on locum tenens doctors in other specialties, including emergency medicine, psychiatry, and anesthesiology.

Doctor out sick? A substitute physician is no worse for patients’ health

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t’s long been thought that hospitalized patients are better off getting treatment from full-time doctors instead of temp physicians. Those temps are called in to cover for doctors’ sick days, vacation, or staff vacancies. But new research finds that a doctor’s employment status may have little to do with quality of care.

Doctors who are employed under short-term contracts — called locum tenens (Latin for “to hold a place”) — provided a similar level of care as staff doctors, a study published Tuesday in the Journal of the American Medical Association found. Researchers came to that conclusion after analyzing 1.8 million Medicare patients hospitalized between 2009 and 2014 who were treated by general internists. No significant difference in 30-day mortality rates was seen between patients treated by temp physicians compared to those treated by staff physicians.

That finding could help dispel the stigma that temp doctors have long faced, researchers said.

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“Years ago, locum tenens doctors might’ve had worse outcomes than non-locum tenens docs, but that’s changing,” said Dr. Anupam Jena, an associate professor at Harvard Medical School and one of the study’s authors. “There appears to be very little difference, if there’s any difference at all.”

Dr. Daniel Blumenthal, an internist affiliated with Massachusetts General Hospital who was the paper’s lead author, said little to no research had previously been conducted on the difference between full-time and temp doctors before this study.

For years, a common bias was that locum tenens doctors simply lacked the credentials to land permanent gigs. “Early on, locums [tenens] physicians were looked upon as ‘less than,’” said Jeff Decker, president of Staff Care, a national recruiting firm that connects locum tenens doctors with hospitals. “They were seen as a necessary evil.”

But growing numbers of hospitals have turned to temp doctors in the face of a national doctor shortage — one that could grow to more than 100,000 unfilled positions by 2030. Staff Care has found that the number of U.S. doctors employed as temps — now at 48,000 — has nearly doubled since 2002.

As part of that shift, Decker believes more physicians are choosing to freelance for a variety of reasons. Young doctors can test out different kinds of medicine to see which ones they like. Mid-career doctors can take on more shift work to pay off medical school debt faster. And older doctors can partially retire but still see patients.

“The paradigm is shifted,” Decker said. “They’re a fill-in … but they’re no less of a physician.”


But on one measure researchers did see a difference. Locum tenens doctors were associated with a higher spending on patient care than full-time doctors, the study found. Some of those costs can be attributed to longer lengths of stay, researchers said.

“It makes sense because [locum tenens] doctors providing care don’t know the system as well,” Jena said. “That might mean inefficient spending in ordering tests or procedures. They may keep patients in hospital longer. The care is more inefficient.”

As physician demand continues to grow, Blumenthal believes hospitals should find ways to better onboard and educate locum tenens doctors in order to lower costs and boost patient outcomes. “Any doctor who is new will go through a period on how to best deliver care, access the right resources, and what kind of acute-care facilities exist for patients,” he said.

Blumenthal would like to see further research conducted on locum tenens doctors in other specialties, including emergency medicine, psychiatry, and anesthesiology.

Dangling A Carrot For Patients To Take Healthy Steps: Does It Work?

Patricia Alexander knew she needed a mammogram but just couldn’t find the time.

“Every time I made an appointment, something would come up,” said Alexander, 53, who lives in Moreno Valley, Calif.

Over the summer, her doctor’s office, part of Vantage Medical Group, promised her a $25 Target gift card if she got the exam. Alexander, who’s insured through Medi-Cal, California’s version of the Medicaid program for lower-income people, said that helped motivate her to make a new appointment — and keep it.

Health plans, medical practices and some Medicaid programs are increasingly offering financial incentives to motivate Medicaid patients to engage in more preventive care and make healthier lifestyle choices.

They are following the lead of private insurers and employers that have long rewarded people for healthy behavior such as quitting smoking or maintaining weight loss. Such changes in health-related behavior can lower the cost of care in the long run.

“We’ve seen incentive programs be quite popular in the insurance market, and now we are seeing those ramp up in the Medicaid space as well,” said Robert Saunders, research director at the Margolis Center for Health Policy at Duke University.

Medicaid patients who agree to be screened for cancer, attend health-related classes or complete health risk surveys can get gift cards, cash, gym memberships, pedometers or other rewards. They may also get discounts on their out-of-pocket health care costs or bonus benefits such as dental care.

Under the Affordable Care Act, 10 states received grants totaling $85 million to test the use of financial rewards as a way to reduce the risk of chronic disease among their Medicaid populations. During the five-year demonstration, states used the incentives to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs. The states participating were California, Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin.

Medi-Cal, for example, offered gift cards and nicotine replacement therapy to people who called the state’s smoking cessation line. Minnesota’s Medicaid program handed out cash to people who attended a diabetes prevention class and completed bloodwork.

An evaluation of these programs, released in April, showed that incentives help persuade Medicaid beneficiaries to take part in such preventive activities. Participants said gift cards and other rewards also helped them achieve their health goals. But the evaluators weren’t able to show that the programs prevented chronic disease or saved Medicaid money. That’s in part because those benefits could take years to manifest, according to the evaluation.

Overall, research on the effectiveness of financial incentives for the Medicaid population has been mixed. A report this year by the Center on Budget and Policy Priorities found that they can induce people to keep an appointment or attend a class but are less likely to yield long-term behavior changes, such as weight loss. And in some cases, the report said, incentives are given to people to get exams they would have gotten anyway.

The center’s report also found that penalties, including ones that limit coverage for people who don’t engage in healthful behaviors, were not effective. Instead, they can result in increased use of emergency rooms by restricting access to other forms of care, the report said.

Some of the biggest factors preventing Medicaid patients from adopting healthful behaviors are related not to medical care but to their circumstances, said Charlene Wong, a pediatrician and health policy researcher at Duke University.

That makes administering incentive programs more complicated. Even recruiting and enrolling participants has been a challenge for some states that received grants through the Affordable Care Act.

“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” said Hannah Katch, one of the authors of the report by the Center on Budget and Policy Priorities. Another barrier is being able to take time off work to go to the doctor.

But health plans are eager to offer patients financial incentives because it can bring their quality scores up and attract more enrollees. And medical groups, which may receive fixed payments per patient, know they can reduce their costs — and increase their profits — if their patients are healthier.

Providing incentives to plans and medical groups has created a business opportunity for some companies. Gift Card Partners has been selling gift cards to Medicaid health plans for about five years, said CEO Deb Merkin. She said health insurers that serve Medicaid patients want to improve their quality metrics, and they can do that by giving incentives and getting patients to the doctor.

“It is things like that that are so important to get them to do the right thing so that it saves money in the long run,” she said.

Agilon Health, based in Long Beach, Calif., runs incentive programs and other services for several California medical groups that care for Medi-Cal patients. The medical groups contract with the company, which provides gift cards to patients who get mammograms, cervical cancer exams or childhood immunizations. People with diabetes also receive gift cards if they get their eyes examined or blood sugar checked. And the company offers bonuses to doctors if their Medicaid patients embrace healthier behaviors.

The incentives for patients are “massively important for the Medicaid population, because the gaps in care are historically so prevalent,” said Ron Kuerbitz, CEO of Agilon. Those gaps are a big factor pushing up costs for Medicaid patients, because if they don’t get preventive services, they may be more likely to need costlier specialty care later, Kuerbitz said.

Emma Alcanter, who lives in Temecula, Calif., received a gift card from her doctor’s office after getting a mammogram late this summer. Alcanter, 56, had noticed a lump in her breast but waited about two years before getting it checked, despite reminders from her doctor’s office. “I was scared they were going to find cancer,” she said.

Alcanter finally decided to get screened after her first grandchild was born. The gift card was an added bonus, and Alcanter said it showed her doctors cared about her. Her mammogram revealed that the lump wasn’t cancer, and she plans to use the gift card to buy a present for her grandson.

KHN’s coverage in California is supported in part by Blue Shield of California Foundation.

Related Topics

Cost and Quality Medicaid


Priority Health’s money-saving move will be hard on some Medicaid patients

GRAND RAPIDS, MI — Rebecca Joehlin is a frequent face at her neighborhood pharmacy, Maple Valley.

Her husband, Aaron, 26, has a host of serious health issues including seizures and fibromyalgia. He is on disability and Joehlin, also 26, cares for him full time.

Money is tight for this Barry County couple. She plots out trips to the pharmacy, grocery store and other necessities to make sure she has enough gas in the tank. Maple Valley Pharmacy is close enough to her Nashville home that she can walk in a pinch.

“We are on a fixed income,” Joehlin said. “Every appointment is budgeted. If there is an emergency with his medicine, that can be hard.”

Beginning this month, she drives 40 minutes round trip to pick up some of his prescriptions at a pharmacy in Hastings. She’ll still be able to pick up some medications that are covered directly by Medicaid from Maple Valley.

A change by her family’s health insurance carrier resulted in the need for the couple to find a pharmacy outside the small village in Barry County.

Joehlin worries that bouncing between two pharmacies will complicate managing her husband’s 10 medications, which can change if doctors determine a medication is losing its effectiveness in treating Aaron’s symptoms.

Maple Valley is one of at least 15 pharmacies that have been cut out of Priority Health’s new pharmacy network for Medicaid patients.

Escalating Costs

The new pharmacy rules are part of the Grand Rapids-based healthcare insurer’s efforts to respond to limited Medicaid funding. Pharmacy costs are a major contributor to the overall cost of health care, said Amy Miller, Priority Health spokeswoman.

Drug costs went up just over 11 percent last year, and are on pace to climb even higher in 2017.

Miller said she couldn’t say how much Priority Health is saving with its new network.

“We are challenged as a Medicaid provider to be good stewards of those funds and with pharmacy costs continuing to escalate at significant rates, this is one area we can proactively address health care costs,” Miller said.

To lower its costs, Priority Health has contracted with an outside entity, Express Scripts, one of the two largest pharmacy benefit managers in the country, which processes prescriptions claims for patients.

Medicaid patients account for about 10 percent of Priority Health’s membership — or about 12,500 people.

Only 5 percent of the Priority Health’s Medicaid patients — about 325 people  — won’t have access to a pharmacy within 5 miles of their home, Miller says. She adds that the network still includes locally owned pharmacies but declined to share the list of pharmacists.

Priority Health has a contract with the state to provide insurance to nearly 125,000 Medicaid patients across 20 counties in west and southwest Michigan.  

Owned by the Grand Rapids-based Spectrum Health System, Priority Health is the state’s second largest health insurance company. The nonprofit is one of Michigan’s biggest providers of Medicaid coverage, according to Dominick Pallone, executive director of the Michigan Association of Health Plans.

With medication accounting for 20 percent of premiums, more insurers are looking for ways to reduce pharmacy costs.

“The growth has been dramatic over the last decade,” said Pallone. “Some of that increase is because of the development of new life-saving drugs. Unfortunately, those drugs come at a high cost.”

Insurers, especially those providing Medicaid coverage, can’t restrict enrollees access to these expensive new drugs, he said. So they have to look for other ways to reduce costs.

The Lansing organization represents 13 health-care insurers that provide Medicaid, Medicare and professional coverage in the Michigan. Together, those members have more than an 80 percent market share for the state’s Medicaid patients.

‘Bizarre deal’

Medicaid patients who want to stay with their current pharmacy have to drop Priority Health and pick up a different HMO. There are six health-care options in Barry County and the other 12 counties that make up Region 4.

Shane McNeil’s Maple Valley Pharmacy, at 219 Main St., is the only pharmacist in the rural community of less 2,000 people. McNeil, a pharmacist and a former assistant Barry County prosecutor, says he is outraged with Priority Health’s treatment of his poorest customers.

In a letter to about 100 Medicaid patients, he urged them to stand up to the bureaucracy that is going to turn their lives upside down by changing HMOs.

“Make yourself heard. This coverage is paid by taxpayer dollars, for your welfare and care — not their bank accounts,” read part of his letter.

As of Dec. 1, his pharmacy no longer had access to fill many prescriptions for his Priority Health Medicaid patients.

“If they have new scripts or valid refills still remaining at our store, we can fill and comp enough meds so they avoid some health crisis, but we cannot feasibly do this on the meds that cost $5-$10+/tablet,” he said in an email. 

Cherry Health, which operates a clinic near Hastings for low-income residents, says some of its patients are impacted by Priority Health’s pharmacy network change.

The organization is stepping in to help patients with the transition, said Dr. Leslie Pelkey, Cherry Health’s sssociate chief medical officer.

Don Eichholz, pharmacist and owner of Hasting Pharmacy, says some of his patients were in tears when they received letters announcing they could no longer fill prescriptions at his pharmacy.

“We do extra things that other places aren’t going to do,” said Eichholz, referring to packaging of medicines, extra time explaining and free delivery.

He estimates he’ll lose about 100 patients, which is less than 5 percent of his customer base.

The change was made without giving pharmacists a chance to bid on a contract.

“It’s a bizarre deal and we are all truly confused,” said Eichholz. “They are telling our patients that we didn’t sign a contract. We weren’t offered one.”

His pharmacy, at 400 W. State St., is right across the street from Walgreens, which is one of Priority Health’s designated pharmacies.

Biggest impact on rural communities

Usually, pharmacists are paid the cost of medication and a dispensing fee. But in some cases, the prices set by the benefit manager are less than the cost of the medicine. A retailer like Walgreens has deeper pockets for loss leaders.

Walgreens is a good fit for the Priority Health pharmacy program because of the chain’s nationwide locations which means customers can refill prescriptions anywhere they travel in Michigan and across the country, said Jim W. Graham, a spokesman for the Illinois-based pharmacy chain. 

“We offer many locations that are open 24 hours a day and our pharmacies offer benefits such as drive-through service and private consultation rooms,” Graham said in email. “Increasingly our customers find it invaluable to access our services through an excellent personalized online experience and through an our easy to use mobile app.”

The change comes as Priority Health is switching to a pharmacy manager with a “very closed network,” according to Larry Wagenknecht, chief executive officer of the Michigan Pharmacists Association.

The Lansing organization counts locally owned, chain and hospital pharmacies among its members. So far, the MPA has heard from about 15 pharmacies with Priority Health patients who aren’t in Priority Health’s new Medicaid pharmacy network. Many are rural.

The new rules don’t affect Medicare, coverage provided to those 65 years or older. But they restrict Medicaid patients, who qualify for the coverage because their income is below the federal poverty line.

“The issue that we are most concerned about is the disruption to patients in their care,” said Wagenknecht. “Today, many Medicaid patients frequently have transportation issues. They picked their pharmacy because they can walk to it.”

Michigan requires Medicaid contractors to consider distance, travel time and access to transportation when selecting providers for enrollees, but doesn’t have any specific requirements.

“This is the first time we’ve seen this,” Wagenknecht said of the Priority Health change. “There is a fear that this may spread out.”

Retail health care lacks the personal connections that patients want and need

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etail thinking is spreading quickly in health care. It promises greater convenience and speed for delivering basic health care services — but it isn’t what patients really want.

Retail thinking views patients as consumers: faceless targets for buying services and products that aren’t always health-related. It’s the thinking behind technology-assisted health care services, like ZocDoc, Amwell, and One Medical, which quickly triage symptoms or serve up medical advice. It’s the thinking that makes it possible for me to walk in, no appointment needed, to my local CVS or Target to have a cough or sore throat examined.

At the same time, it gives web-based apps opportunities to sell some of your information to advertisers, who want to sell you other things. It gives brick-and-mortar organizations cross-selling opportunities for everything from allergy medications to Halloween candy as I walk down the store aisle to get my flu shot from the pharmacist or have the nurse practitioner apply guideline-driven diagnosis and treatment. The providers I see during these interactions know nothing about me, offer little tailored advice, and the services they provide will be both limited and standardized in how they are delivered.

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Being viewed through the retail lens also means that I am asked to consume other offerings pitched to me by whoever provides me with health care, be it my insurance company or my employer. They try to get me interested in legal and babysitting services, gym memberships, pedometers, mail-order pharmacies, round-the-clock nurse help lines, life insurance, and more. They do this to help them earn more of my loyalty, generate more revenue for themselves, or reduce their costs.

The hospitals and medical offices I visit seek to keep me within their system of care delivery, make me a long-term customer, and refer me only to their providers and services, both of which they control. By using retail tactics like offering one-stop shopping — where I can get primary, specialty, and other types of care all without leaving the same building — and marketing their brand to me with simplified rating systems that show their high quality, they want me to trust that they have my interests at heart and can deliver any type of health care transaction I require.

Retail thinking has its place in health care today because there are some services and products that people need quickly and which do not require a personal touch or someone who understands them as unique individuals. Such services might be low-level acute care (think strep throat), flu shots and immunizations, and some forms of simple chronic disease management, such as blood sugar checks or foot and eye exams for people with diabetes, especially if they are guideline driven. There’s no question that retail thinking can also create purchasing opportunities for things patients find useful, if not always essential, and perhaps do so in ways that are cost-effective or convenient for us.

But retail health care is impersonal, lacks relational warmth, and isn’t what patients really want.

I interviewed 80 patients and doctors for a new book on the doctor-patient relationship in the era of efficiency-driven innovation, corporate care, and retail medicine. What I heard from patients is that the impersonal nature of retail thinking is frustrating them and lowering their expectations about the levels of emotional support and customized help they can get from any doctor, or from others in the health care system.


No patient with whom I spoke wanted transactional care at the expense of relational care. No one prioritized Fitbits, web-based assessments of symptoms, or seeing a stranger about a sore throat in a big-box store over a long-term personal connection with a doctor. What these individuals wanted most in health care was something human and more intimate, maintained through regular one-on-one interactions with experts they knew and trusted who were compassionate, empathetic, friendly, and respectful.

The physicians with whom I spoke wanted the same things.

This type of sustained personal experience between two people who know something about each other, and who are motivated to really talk and listen as care partners, is something retail thinking does not do well. It is not concerned with the emotional aspects of care, building interpersonal trust between doctor and patient, or getting to know people as individuals with their own relevant life stories.

Yet existing research demonstrates that these are the very features that are good for patients. For example, care continuity through a stable doctor-patient relationship improves health care quality and patient satisfaction. Doctor-patient trust, established through extended interpersonal contact, helps patients become more engaged in their care; creates a positive patient experience; and increases perceived effectiveness of care. Extended dialogue between patient and doctor positively affects health outcomes ranging from high blood pressure to mental health problems. Physician empathy is linked to more accurate diagnoses, better health outcomes, and an enhanced patient experience.

If you don’t believe the literature, just ask the patients I interviewed. Teddy, a healthy man in his 30s, believed that without feeling trust towards a specific doctor — which for him was forged over time through regular face time and conversations with that doctor — little could be uncovered of the more intimate, life story information that he felt was most important for keeping him healthy. He said he had never been completely honest with clinicians he didn’t know.

Hallie, a 50-year-old woman with several chronic diseases, talked confidently about better understanding how to manage her many conditions, and how they affected her everyday life — the result of having a doctor who knew something about her personally, who spent time not reading off a care guideline but instead asking her real-time questions about how she felt, and then showing genuine compassion with her daily struggles. Hallie felt better able to self-manage her care, which kept her from using the system unnecessarily.

Cliff, a stressed-out dad in his 50s, talked excitedly about finally having the same physician he could see on a consistent basis; a doctor who in their first visit had spent time just listening to him, nothing more; then taking that information and asking him questions about his own life; and finally tailoring therapeutic advice based on the entire dialogue. Janell, a career-minded mom in her 40s, recalled with joy the memory of a past primary care physician who remembered conversations they had during previous visits and who used that knowledge to give Janell tailored guidance about how to manage her life stressors more effectively.

Can an industry that wants to use retail tactics also deliver on the relational excellence that patients and research say is important? It’s not easy, given retail thinking’s focus on speed and efficiency. Here are four ways that might meld these two approaches.

First, put more thought into where not to use retail thinking in health care. It may make sense for care delivery that is routine, care that can be standardized in a straightforward way, and in situations where the patient wants convenience above all else. But that actually amounts to a limited menu of services, and even routine care can often reveal deeper problems in patients, requiring the kinds of relational features I’ve described.

Second, better measure and monetize the components of relational excellence, making it matter to health care organizations and third-party payers. That means carefully assessing dynamics like interpersonal trust between doctor and patient; analyzing those data to see how they positively affect health outcomes; and then giving this metric the same relative importance in high-quality care delivery compared to other things like prescribing a particular drug for a particular condition.

Third, look for innovative ways to strengthen the doctor-patient relationship, not undermine it. For example, the industry should experiment with using technology as a tool to give doctors more face time and direct contact with their patients. Right now, both doctors and patients perceive technology, primarily the electronic health record, as interfering with their relationship.

Fourth, and most important, the patient voice must be heard. This could include adopting greater transparency with respect to assessing patient satisfaction with retail tactics, say through Yelp-type accountability mechanisms, and conducting market research that goes beyond simple binary questions of “would you use this” or “would you like greater convenience in accessing your care” and instead delves deeper into discovering what patients really value.

In thinking about my discussions with patients, there is one other important thing they want. They want to decide when their health care should work like the drive-through at McDonald’s or buying with one click at Amazon and when it should be more personal than that, involving extended human-to-human interaction, highly trained experts who know their patients, and an abundance of the time, trust, and soft skills required to make us healthier long-term and see health care as the important part of our lives that it really is.

Timothy J. Hoff, Ph.D., is professor of management, health care systems, and health policy at the D’Amore-McKim School of Business and the School of Public Affairs and Policy at Northeastern University in Boston; a visiting associate fellow at Green-Templeton College and visiting scholar at Said Business School, both at the University of Oxford; and the author of “Next in Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health” (Oxford University Press, September 2017).

After 20 years, Health Van stops transporting cancer patients – Casper Star

Jan Rayburn, driver, poses by a van in February purchased by Blue Envelope for Rocky Mountain Oncology to transport patients to and from treatment appointments. Many patients would have no other way to get to regular treatments without the van. The Health Van program in Riverton, which offered a similar service, was forced to shut down due to lack of funding.




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