Category Archives: Culture

Ready for the eyeSelfie for diagnosing health problems?

Ok Google, am I healthy?

Ok Google, am I healthy?

I spoke last night to a friend who lamented that his teenage daughter seemed fixated on taking selfies of her eyeball with his phone. He found these when he went to review his stored photos. I thought it was a little odd but suggested that maybe she was looking for just the right shot to send off to an ophthalmology lab for diagnosis.

I may not be far from the truth. Today’s Boston Globe included MIT Camera Culture Group develops the ‘eyeSelfie’ to help monitor eye health. Sure enough, my suspicions were confirmed:

Researchers at the Camera Culture Group, headed by Ramesh Raskar at the MIT Media Lab, have designed the eyeSelfie, an inexpensive hand-held device for taking a photograph of the retina, the optic nerve, and the vasculature, which is located all the way at the back of one’s eye.

Digital snapshots of the interior of the eye can help physicians detect and treat vision-threatening diseases such as glaucoma, macular degeneration, and diabetic retinopathy early. New research indicates that the snapshots can also be used to identify risks factors for hypertension, heart disease, multiple sclerosis, and Alzheimer’s disease.

Taking this back into the realm of speculation, let’s imagine that Google decides to use its new image recognition initiative to automatically analyze eyeball photos, like those of my friend’s daughter. If the technology improves enough it could give Google vastly more insight into users’ health status. It goes way beyond my speculation from eight years ago (What if Google finds out you have cancer before you do?) about Google’s ability to guess a person’s illness from search logs, even if the user hasn’t been diagnosed yet.

I could take this further. Right now the MIT camera is a specialized unit and it still takes a bit of jiggering to get a clear shot that can be analyzed. But as camera technology improves perhaps we’ll get to the point where we can analyze even regular smartphone snapshots, zooming in on the eyeballs of everyone in the frame and assessing their health status.

That will take a while but we should be prepared for when we get there.

Image courtesy of Serge Bertasius Photography at FreeDigitalPhotos.net

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

 

Fast progress on transgender benefits

Bruce Jenner’s transition to Caitlyn Jenner has brought transgender issues quickly to the fore. What I had not realized is that major employers and the federal government are well on their way toward providing coverage for transition-related health care. I’m not in a position to comment on the adequacy of the coverage, but just want to make the point that it’s advanced faster than I thought.

According to Business Insurance (Transgender benefits gain attention of employers), the Office of Personnel Management recently required Federal Employee Benefit Plan providers to cover transition-related care, citing an emerging consensus that such treatment is medically necessary.

About half of large employers offer transgender-related surgical coverage compared with 5 percent in 2007, according to a National Business Group on Health survey.

Transgender-related benefits are varied, and include “mental health counseling, hormone replacement therapy and gender reassignment surgery. Some employers… include coverage for facial feminization or reducing the Adam’s apple…” Not every employer offers all categories of benefits.

Private employers aren’t required by law to offer such benefits, but they have various motivations. They include:

  • An increasing belief that such coverage is medically necessary, and therefore in keeping with the overall philosophy of health insurance
  • A desire to increase competitive positioning in recruiting –including for employees that do not themselves expect to use such coverage but are looking for employers that are progressive
  • A realization that the overall costs are likely to be small, typically less than 0.5% of total health care costs
  • A defensive view that not offering such benefits could lead to discrimination claims

I don’t typically think about insurance benefits being in the social and cultural vanguard, but at least based on this example that may not be a fair assessment.

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

An inspiring product development tale

Just do it

Just do it

The times they are a changing, and in some ways for the better. Nike is releasing a new sneaker designed for people with disabilities who have trouble putting regular shoes on by themselves. The idea for the shoe came from a teen with cerebral palsy who wrote a letter to Nike that ended up with the CEO. A related request came from a Nike employee who had suffered a stroke.

The company then spent three years to design a sneaker with what USA Today calls “an elongated wraparound zipper system to allow a wearer to open close the show with one hand.” They collaborated with the teen to perfect the design.

This isn’t some clunky looking, medicalized shoe. Instead, the Zoom Soldier 8 Flyease is a variation on a Lebron James basketball shoe. It’s cool and stylish.

Advocates for the disabled are pleased, because Nike can make a significant impact on quality of life with this product, and because it represents a new phase of acceptance for people who are a little different. I won’t be surprised if the shoe is a big hit –there are lots of people who have physical challenges of various types who might really like it.

If Nike can make money on the concept, that’s good news for everyone because it will demonstrate that this is a profitable opportunity, which will encourage others to compete.

The situation reminds me somewhat of the highway safety movement a generation ago. Although the problem of avoidable automobile deaths was there if you looked for it, the auto industry –with the exception of Volvo– wanted nothing to do with it. But once the public started to express an interest in safety, the world changed, and car companies started to compete on safety as well as styling and power.

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

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

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.

Chronically ill man walking

Can I leave now?

Can I leave now?

(Aging inmate population takes toll on prisons; Harsh sentencing of 1980s, 1990s didn’t foresee health care) announces the Boston Globe headline. I’ve been reading a story like this every year or two for the past 10 years. It’s kind of pathetic: cold blooded killers now incontinent, motor cycle gang members with “special medical boots” for a foot condition, etc.

Some prisons have needed to set up geriatric wards, while others have effectively been turned into convalescent homes.

The aging of the prison population is driving health care costs being borne by American taxpayers. The Bureau of Prisons saw health care expenses for inmates increase 55 percent from 2006 to 2013, when it spent more than $1 billion…

‘‘Our federal prisons are starting to resemble nursing homes surrounded with razor wire,’’ said Julie Stewart, president and founder of Families Against Mandatory Minimums. ‘‘It makes no sense fiscally, or from the perspective of human compassion, to incarcerate men and women who pose no threat to public safety and have long since paid for their crime. We need to repeal the absurd mandatory minimum sentences that keep them there.’’

I agree that the “War on Drugs” has put far too many people in prison for far too long. That sentiment seems to be getting more popular. If revulsion at high medical spending for prisoners helps some people come around to a less draconian view of sentencing, so much the better.

Image courtesy of tiverylucky at FreeDigitalPhotos.net


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

What’s the difference between New York and Boston?

A million here, a billion there

A million here, a billion there

We are modest and moralistic in Boston. The lead story in the May 1 Boston Globe criticized Vertex Pharmaceuticals for approving a plan to pay a dozen executives a total of about $54 million if the company becomes profitable, something that has taken 25 years to achieve. If the company becomes profitable it will be because it successfully launches a new drug that will improve the lives of people with cystic fibrosis. Sounds pretty good to me.

The bonuses represent an insignificant percentage of the $15 billion increase in Vertex’s market value in the past 12 months. Critics can complain all they want, juxtaposing the high prices insurers pay for medication with the bonuses awarded. I just don’t see this as a headline issue.

Meanwhile the New York Times yesterday led off with an article about the top paid hedge fund managers (For Top 25 Hedge Fund Managers, a Difficult 2014 Still Paid Well). The top 3 managers each made about $1 billion. That’s right, each one made 20x what the dozen Vertex managers might be due for collectively. To make it to #25 on the list required earning $175 million, still far, far above the Vertex dozen. Oh, and by the way most of the hedge funds had mediocre performance in 2014, in the low single digits, and their operations didn’t contribute much, if anything to improving society.

Some of the funds employ scientists (physicists and astronomers are two examples provided) to help with their trading, yet they earned returns far lower than the non-geniuses who bought and held the S&P 500. Vertex critics are up in arms about taxpayers indirectly paying executive bonuses, but maybe they should instead scrutinize public entities such as pension funds that are paying large fees to hedge funds.

Image courtesy of samandale at FreeDigitalPhotos.net

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

Do it yourself death panel

How are you feelin' today, mom?

How you feelin’ today, mom?

Federal law allows states to recover Medicaid costs from heirs. This little known provision is getting more attention as part of the debate over Medicaid expansion. The Wall Street Journal (New Wrinkle for Health Law) wrote a balanced article about it, highlighting consumer fears about having to sell assets while also sharing the government perspective that “estate recovery helps shore up the program for others who need it.”

The online comments and letter to the editor generally support the view that recipients’ estates should have to pay back the government. The letter (First, Estates Should Repay the Taxpayersis characteristic of the righteous indignation provided by the commenters.

Where is it written that a person is entitled at death to leave assets to children, particularly after someone else, in this case the taxpayers who fund Medicaid, has paid the health-care bills? Where is it written that children are entitled to inherit assets from a parent who has unpaid bills for services received during his or her lifetime?

Maybe if the issue were framed differently the commenters would rethink. Two points in particular:

  • If we seek to reclaim Medicaid payments we need to reclaim Medicare payments as well. Although recipients pay into the system, Medicare is far from self-sustaining. More than 40 percent of Medicare spending is financed from general revenues.
  • If the government starts going after estates for medical expenses more broadly, dying patients will worry that heirs will ration care to preserve their own inheritances. And with so much at stake, it’s not a paranoid thought

So here’s my question for the commenters and letter writers: Are you willing to expand this logic to Medicare and provide your own heirs with an incentive to form a death panel for you?

Image courtesy of artur84 at FreeDigitalPhotos.net

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