Hang up and dial 911

The easy button

The easy button

American consumers are used to fast access to service: Check the web to see when an Amazon package is arriving (sometimes same day now), speak to a customer service rep at Fidelity 24 x 7. If anything, convenience is increasing as pain points are being addressed. For example, I experienced frustration and poor service from the local cab company for 25 years, but now I can just press a button and summon an Uber in minutes, watching the driver’s progress on the map as the car approaches.

Healthcare sort of understands that it needs to change, but access to care is still difficult, tools are clunky, and CYA approaches reign.

One reason people go to the ED is that they know they can access care there. They don’t have to check the hours of operation and don’t need to sign up for an appointment that’s weeks or months away.

While there is a general understanding that ED visits should be reduced, in practice many providers actually encourage overuse. Call the main number of any hospital or physician office and one of the first things you’ll hear on the recording is, “If this is a medical emergency, please hang up and dial 911.” Is it any wonder that people get the message that 911 is the route to take for anything serious?

Generally, once an ambulance is summoned the patient is going to the hospital emergency department unless they convince the EMTs they are well enough to stay put. That’s why I was excited to read about a program in Reno, Nevada that preserves the convenience of 911 and the ED while avoiding some of the downside.

Paramedics are being trained to handle some primary care tasks –such as helping heart failure patients avoid complications– that often degenerate into an ED visit and hospitalization. They are also being given a broader set of destination options when they do transport, such as detox centers and urgent care.

As usual there are challenges: EMTs need different training if they are to fill the roles of primary care and visiting nurses, insurance may not pay for non-traditional approaches like this, and while this is a cheaper and better route than the ED, I doubt it’s cheaper or better than traditional primary care. Clearly Nevada doesn’t want to encourage more 911 calls.

I look forward to learning more about this experiment.

Image courtesy of Stuart Miles at FreeDigitalPhotos.net

By healthcare business consultant David E. Williams, president of Health Business Group.

Call to action: America’s Health Rankings Senior Report


Dr. Reed Tuckson

Dr. Reed Tuckson

Rankings reports are a great way to spur the public and policymakers to pay attention to important issues. The 2015 America’s Health Rankings Senior Report from the United Health Foundation, released today, is a case in point. It combines a holistic approach to the definition of health with detailed information for each state.

I had an opportunity to interview Dr. Reed Tuckson, senior medical advisor to the Foundation, about the report.

  1. (0:12) What is the purpose of this report?
  2. (1:28) What should we learn from the high-ranking states and the low-ranking ones? What are some success stories?
  3. (3:28) The report includes a “call to action” from Dr. Jewel Mullen, based on a national prevention strategy. Who is Dr. Mullen and what is the strategy?
  4. (4:55) The report mentions Alzheimer’s and dementia. There is rising prevalence, no cure, and not a lot of effective treatments. How should we be addressing Alzheimer’s?
  5. (7:52) It’s clear from your comments that this report is not meant to sit on the shelf. What impact do you think the report will have?
  6. (10:18) What else would you like to highlight?

By healthcare business consultant David E. Williams, president of Health Business Group.

Payer-provider collaboration: Podcast interview with NaviNet CEO Frank Ingari

Frank Ingari, NaviNet CEO

Frank Ingari, NaviNet CEO

Frank Ingari is CEO of NaviNet, which positions itself as a “real-time healthcare communications network leading the transformation of payer-provider collaboration…”

The payer/provider collaboration theme seems a little utopian, but I’m open minded and gave Frank a chance to explain why it’s real. Have a listen and let me know what you think.

  1.  (0:10) How will value based healthcare change the relationship between payers and providers?
  2. (2:04) Do commercial plans, Medicare Advantage and Medicaid managed care plans differ in their path toward a value based system?
  3. (7:47) You talk about payer/provider “collaboration,” which is not how I think of the typical payer/provider relationship. Help me understand the term “collaboration.” Is that real?
  4. (13:14) What are some key points of friction that NaviNet addresses? How do you do it?
  5. (15:45) Patients generally have no idea that their plan or provider has shifted to a value based arrangement. Is that something they should know about? What would you advise patients to do?
  6. (19:22) You had a big presence at #HIMSS15 in Chicago this year. What were your objectives? Did you meet them?
  7. (20:39) What should we expect from NaviNet for the rest of 2015 and into 2016?

By healthcare business consultant David E. Williams, president of Health Business Group.


Welcoming back insurance exchange expert Dave Kerrigan

David J. Kerrigan

David J. Kerrigan

Health insurance exchange expert Dave Kerrigan is back in the private sector after three years working for the Massachusetts exchange. As a result he’s reviving his A Musing Healthcare Blog. The first new post is about the potential of health exchanges in a world where healthcare costs fall on employees.

Welcome back!

Hospitals sell real estate: I’m quoted

Some urban hospitals are addressing their financial problems by leveraging their real estate assets. Healthcare Finance has a story on the topic (Hospital chains make big money in real estate by unloading properties) and I’m quoted.

By healthcare business consultant David E. Williams, president of Health Business Group.


No Tufts + BMC merger for now: I’m quoted in the Globe

Tufts and Boston Medical Center have been discussing a merger, but it seems like the deal is off at least for now. I’m quoted about it in the Boston Globe (Tufts, Boston Medical Center end merger talks).

A merger of these two entities makes a reasonable amount of sense and I expect it will be discussed again within the next few years.

By healthcare business consultant David E. Williams, president of Health Business Group.

Apple Watch: Continuous glucose monitoring

Watch this!

Watch this!

Looking for something useful to do with your Apple Watch? Dexcom, the maker of a continuous glucose monitor (CGM) for diabetics, suggests you use the watch to monitor CGM –your own or someone else’s. This functionality has been available as a smartphone app, but the watch version is designed to be more convenient and discreet.

Dexcom answered my questions below:

  1. Is the Apple Watch useful or more of a toy or gimmick?

For people with diabetes, their family members and loved ones, the Apple Watch is an extremely useful tool. It lets people access their blood glucose data right from their wrist, providing superior convenience and discretion.

  1. What opportunities does the watch provide for people with diabetes? What is the incremental improvement from a smartphone?

The Apple Watch allows greater convenience for those who want this important information in an easy-to-use and discreet form. We share Apple’s commitment to making technology more accessible, relevant and personal.

  1. How does the Dexcom CGM work on the Apple Watch? What are patients really getting?

Dexcom CGM provides patients the opportunity to track their glucose levels and trends right on their wrist with the Apple Watch. Here’s how it works: The user downloads either of the Dexcom apps, Share2 or Follow to their iPhone. The Dexcom G4 PLATINUM System with Share transmits that user’s glucose information to the Share receiver using BLE (Bluetooth Low Energy) wireless communication technology. The Share receiver then sends the information through the iPhone to the watch. The Dexcom apps on the iPhone sync with the watch to provide caregivers and people with diabetes continuously updated glucose information and trend graphs. Additionally, patients or “Sharers” can invite up to five people to view their glucose information and send an alert when the sharer’s glucose levels are outside the norm.

  1. What are the benefits to allowing other users to “follow” your glucose levels on their own devices?

The Dexcom apps will now enable users to monitor glucose on the Apple Watch so that people with diabetes can discreetly view their own information while parents and caregivers can conveniently view a child or loved one’s glucose data, giving them peace of mind and reassurance when they are apart. Examples of people who may benefit include a parent who can monitor a child’s blood glucose levels at night, while the child is at a sleepover, or away at camp or college. Or, a spouse can monitor their loved one’s glucose while they are away on a business trip. It’s useful for anyone who wants to monitor or share glucose information from a remote location.

  1. What information can a person with diabetes or caregiver get when they log into the apps?

Through the Dexcom apps, Share2 and Follow, caregivers and people with diabetes have access to glucose data in real time. They allow both users and “followers” to view glucose data directly on their phone and now on the watch.

  1. Does the Watch set off alarms for patients and followers?

Yes, with an iPhone and the Follow app installed, the watch can alert the Sharer and follower when the Sharer’s glucose levels are outside the designated range, allowing appropriate action to be taken.

  1. Can patients just use the watch and no longer wear the receiver?

Patients will need to have the Dexcom receiver in order for the glucose data to be sent to the iPhone and the watch. For the Apple Watch to work for this purpose, the receiver and the phone are both needed.

  1. What is the benefit of CGM in relation to other methods for monitoring and managing diabetes?

For someone with diabetes, monitoring blood glucose, or blood sugar, levels is a very important part of managing their diabetes. The traditional method for monitoring blood sugar levels is with a blood glucose meter where only a point in time reading is viewed a few times per day. But CGM is a dynamic tool that provides continuous glucose readings (up to 288 readings per day) along with the speed and direction that the glucose levels are headed. In addition, CGM has alerts to let the user know when they are heading too high or low so that action can be taken prior to it reaching a level of concern. Continuous glucose monitoring, or CGM, is considered the most significant breakthrough in diabetes management in the past 40 years.CGM augments the use of glucose meters for the management of diabetes. Meters are still required to calibrate CGMs and for guidance in making therapy and meal decisions.

  1. How do patients with diabetes go about getting the diabetes app? Is it included with the watch, is there an additional cost?

The Share2 and Follow apps can be downloaded for free through the App Store.

  1. Is CGM for Type 1, Type 2 or both?

A Continuous glucose monitor, or CGM, can be used by any person with type 1 or type 2 diabetes on insulin who is concerned about his or her diabetes management. People with diabetes who take insulin must monitor their blood glucose levels frequently. Uncontrolled glucose can cause health complications and can even be life-threatening.

  1. There have been concerns about the Apple Watch battery life. Is there any impact on CGM?

The Dexcom receiver houses all the CGM capabilities. In order to get CGM functionality on the Apple Watch, patients must have their receiver with them at all times.

By healthcare business consultant David E. Williams, president of Health Business Group.