All Posts by Kanwal Sood

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Feb 05

The Strategy That Will Fix Healthcare: Part II- The Goal

By Kanwal Sood | Disruptive Innovation , Primary Spine Provider , Spine Care , Value-Based Healthcare

We continue our review of Porter & Lee’s ‘The Strategy that will fix Healthcare’.

As discussed last week in Part I, in the existing approach, patients most often receive portions of their care from a variety of types of clinicians, usually in several different locations, who function more like a spontaneously assembled “pickup team” than an integrated unit. They might undergo special testing e.g. radiology at any point- even before seeing a physician. Essentially, no one:

– measures patient outcomes
– measures how long the process takes
– measures how much the care costs

Thus, the VALUE of care never improves.

This problem has been reinforced by payment structures- however, all this is now changing. With massive pressure to contain costs, payors are aggressively reducing reimbursements and finally moving away from fee-for service and toward performance-based reimbursement. We are entering a period during which providers will work under multiple payment models with varying risk exposure. The days of charging higher fees for routine services in high-cost settings (e.g. hospitals) are quickly coming to an end.

In this environment, providers need a strategy that transcends traditional cost reduction and responds to new payment models. Providers that improve the efficiency of providing excellent care will:
– grow their market share
– be more competitive
– enter any contracting discussion from a position of strength

Let’s move away from a supply-driven health care system organized around what physicians do and towards a patient-centered system organized around what patients need. Let’s shift the focus from the volume & profitability of services provided- physician visits, hospitalizations, procedures and tests- to the patient outcomes achieved. And let’s replace today’s fragmented system, in which every local provider offers a full range of services, with a system in which services for particular medical conditions are concentrated in health delivery organizations and in the right locations to deliver high-value care

So, let us all agree on the overarching core goal of Value for health care systems – improving outcomes that matter to patients relative to the cost of achieving those outcomes- so that we can begin to make progress. How does that sound?

This ‘value agenda’ will require a restructuring of how health care delivery is organised, measured and reimbursed. The revolution is well under way- organisations such as the Cleveland clinic and Germany’s Schὅn Klinik have undertaken large-scale changes involving multiple components of the value agenda- leading to striking improvements in outcomes & efficiency, as well as growth in market share.

In Part III next week we’ll analyse the model for change that defines this ‘value agenda’, with its six interdependent components. The model for transformation of healthcare delivery.

Feb 04

Spine & Health Info Platter (4 Feb ’18)

By Kanwal Sood | Artificial Intelligence , Big Data in Healthcare , Disruptive Innovation , Spine Care , Spine Cloud Platter , Value-Based Healthcare , Videos , Wearable Tech

In this week’s platter we consider whether remote patient monitoring technologies translate into improved patient health; we look at the 3 industry tycoons who want to fix health care in the US; we study the application of artificial intelligence in big pharma; we look at Apple’s lesson for healthcare innovation; and finally, we get introduced to DNA portraits. Enjoy!
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Remote patient monitoring: From hype to reality

Enthusiasm for remote patient monitoring (RPM) is growing, and it’s no wonder. The latest wave in health data collection uses non-invasive devices (think smart watches, smart phones, and other wearables) to automatically transmit data to a web portal or mobile app for patient self-monitoring and/or health provider assessment and clinical decision-making. Could the use of these exciting technologies actually translate into improved patient health? Researchers found that RPM could be impactful—so long as it was coupled with interventions that integrated new experiences, such as personalized health coaching, into the care model. While that’s good news, we should ask ourselves: why wasn’t the technology alone enough to move the needle?

Jeff Bezos, Warren Buffett and Jamie Dimon want to fix health care

On Monday, Jeff Bezos, Warren Buffett and Jamie Dimon announced that their three companies -Amazon, Berkshire Hathaway and JPMorgan Chase- would create a new company to develop a better health care solution for their U.S. employees. Given the resources of the companies, and their history of concentrating on the long-term rather than just the near-term, they have a chance to make significant changes in the way health care is provided. Still, it won’t be an easy industry to change.

India’s Growing Healthcare Burden has a Solution at ‘Home’

As India marches ahead, the nation still struggles with substantial issues and worrying gaps in it’s healthcare system. An imminent solution which can have an immediate impact on improving India’s health status, without the additional economic burden of increased expenditure on healthcare infrastructure, is home healthcare. Increasing penetration of internet and technological improvements in healthcare will act as strong enablers in delivery of services at a patient’s home. This article posits that it is time for India to proactively consider home healthcare as a solution for the multiple challenges faced by it’s healthcare industry.

Precision medicine allows accurate disease prevention and treatment tailored to an individual by combining knowledge of a person’s environment, their genetic make-up and protein levels.

Big pharma turns to AI to speed drug discovery

The world’s leading drug companies are turning to artificial intelligence to improve the hit-and-miss business of finding new medicines. The aim is to harness modern supercomputers and machine learning systems to predict how molecules will behave and how likely they are to make a useful drug, thereby saving time and money on unnecessary tests. In fact, experts believe that AI systems could deliver drug candidates in roughly one-quarter of the time and at one-quarter of the cost of traditional approaches. Let’s hope that this contributes to a net reduction of health-care costs

Apple’s surprising lesson for healthcare innovators: it’s not about the product

In this video, Rebecca Fogg explains what the iPhone can teach us about Disruptive Innovation in healthcare to audiences at the Imperial College London Business School’s 2017 innovation conference

And finally,

Order Your DNA Portrait!

You can get your own DNA portrait!!! In the era of personalized genetics, it’s a perfect example of how industry will use these methods to explore all the financial possibilities. DNA Portraits are the world’s most unique and personalized form of art. No two prints will ever be alike (but for those who cannot read DNA, the portrait remains beautiful, even if it is not unique).

Jan 29

The Strategy That Will Fix Healthcare: Part I- The Problem

By Kanwal Sood | Clinical Pathways , Disruptive Innovation , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

This is the first article in our Harvard Business Review series. Over the next few weeks we’ll review Professor Michael Porter and Dr Thomas Lee’s publication from October 2013, ‘The Strategy that will fix healthcare- Providers must lead the way in making value the overarching goal’. The discussion relates to all health systems & delivery organisations- private practices, medical centres, physician organisations, hospitals and insurer groups.

The Problem

Healthcare systems worldwide are battling with rising costs and unsatisfactory quality. Why is this? Well, for several decades the current structure of healthcare delivery has been sustained by resting on its own set of mutually reinforcing elements:

The absence of accurate cost information: Do clinicians have any knowledge of what each component of care costs? Or any idea of how costs relate to the outcomes achieved? In most health organisations there is virtually no accurate information on the cost of the full cycle of care for a patient with a particular medical condition. Also, cost allocations are often based on charges, not actual costs.

The way clinicians are organised to deliver care: Largely siloed organization by specialty department and discrete service or independent private practice physicians. Delivery systems with duplicative service lines,  as well as minimal integration of providers & service lines.

“Quality” measurement/metrics: Most often, these don’t gauge actual quality. Rather, they are process measures that capture compliance with practice guidelines and easy-to-measure, non-controversial clinical indicators (e.g. mortality, safety) that fall well short of actual outcomes.

Fee-for-service payments by specialty: Providers are generally rewarded for increasing volume, but that does not necessarily increase value! The focus is supply driven and centered around physician visits, hospitalizations, procedures and tests.

Fragmentation of patient populations: Every provider offers a full range of services; thus, most providers don’t see enough patients with a given medical condition

Limited Geographic reach: Health care delivery remains heavily local

IT systems: Siloed by department, location, type of service, and type of data (e.g. images). Existing IT systems often complicate rather than support integrated, multidisciplinary care.

This of course means that patients most often receive portions of their care from a variety of types of clinicians, usually in several different locations. Each encounter is separate from the others, and no one coordinates the care. Naturally, this leads to duplication of efforts, delays, and more expensive care.

As this goes on, providers will face lower incomes, patients will incur higher costs, and services will be restricted. In Part II of this article next week we’ll discuss the approach that’s needed in order for us to turn this around.

Jan 28

The Choosing Wisely® Campaign- NCLC 2018

By Kanwal Sood | Clinical Pathways , Cultural Authority , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

The Choosing Wisely® campaign was developed by the American Board of Internal Medicine Foundation to facilitate informed and collaborative discussions between doctors and patients about the necessity, efficacy and risks and benefits of common tests and procedures. The Choosing Wisely initiative looks to doctors and the societies representing them to underpin these efforts by identifying a “Top Five” list of evidence-based recommendations that draw attention to potentially unnecessary tests or therapies. ACA‘s Choosing Wisely list was developed after several months of careful consideration and thorough review, using the most current evidence about management and treatment options.

The National Chiropractic Leadership Conference presents Am I Choosing Wisely? How to Implement Choosing Wisely in Your Practice on Saturday, March 3. Join us as we discuss the background of Choosing Wisely and the development of the ACA Choosing Wisely statements. Additionally, attendees will hear how the panelists are implementing the recommendations into their practices.

Register here

Jan 26

Spine & Health Info Platter 26 Jan ’18

By Kanwal Sood | Artificial Intelligence , Big Data in Healthcare , Blockchain , Disruptive Innovation , Internet of Things , Spine Care , Value-Based Healthcare , Wearable Tech

In this week’s platter, we look at a simple guide for organisations interested in utilizing blockchain technology; we look at the interesting intersection of medical training and urban design; and finally, we look at some trend predictions for 2018. Sign up for our newsletter on the left. Enjoy:

 

Blockchain Technology is Ready to Restructure the Healthcare Industry

As cryptocurrencies grow in popularity and value, there is an emerging consensus that the technology that powers them may bring long-awaited changes onto various industries. In this article, we take a look at 3 of the blockchain-based applications prepared to make a tangible impact on the healthcare industry.
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Blockchain—A new model for Health Information Exchanges

This report presents a simple guide for organisations interested in utilizing block chain technology. While the report recognizes that blockchain technology is not the panacea for all system integration challenges, the benefits of the technology are numerous.

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These Future Doctors Are Learning How to Influence Urban Design

The built environment itself can influence both physical and mental health. Researchers have even found that heart rates will go down when people simply walk past green space that have been added and blight cleaned up. The built environment is as much a public health concern as it is an infrastructure need.

Here we learn how JeffDESIGN, a hybrid university program that combines medical training with design classes, seeks to change the way doctors think and influence public health in cities by equipping them to influence the way cities are built or retrofit.

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Value-Based Purchasing Tops List of Health Benefit Trends to Watch in 2018

The pursuit of value-based purchasing arrangements tops the list of employer health benefit trends to watch in 2018, according to the National Business Group on Health. The Washington-based employer health coalition released a list of nine employer health benefit trends to watch to this year. Not surprised to see “engagement platforms” listed as number 3 – sign-up and join our network!!!!

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What To Expect From Digital Health In 2018?

2017 was a year full of marvelous advancements in healthcare. So what’s next? This article takes a sneek peek at the crystal ball (assuming one even exists) to look at what 2018 will mean for digital health

Jan 20

Spine & Health Info Platter 20 Jan ’18

By Kanwal Sood | Artificial Intelligence , Disruptive Innovation , Low Back Pain , Spine Care , Spine Related Disorders , Wearable Tech

This week, we look at chronic spine pain relief using neuromodulation technology; digital ingestibles to track medication intake; smart pills; the development of ambulance drones; and finally, we consider one of the biggest impediments to the adoption of machine learning for cancer diagnosis – trust. Sign up for our newsletter on the left. Enjoy:

Boston Scientific Announces Positive Results from WHISPER Spinal Cord Stimulation Study

Boston Scientific Corporation last week announced positive results from the WHISPER randomized controlled trial (RCT). The data demonstrated that patients who are given the choice to use both sub-perception and paresthesia-based spinal cord stimulation (SCS) therapy achieve superior outcomes in comparison to patients who have only one SCS therapeutic option.
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From digital wearables to digital ingestibles (FDA)

Hope you’re comfortable swallowing your tech, because the U.S. Food and Drug Administration has recently approved the first drug in the U.S. with a digital ingestion tracking system. The drug, called Abilify MyCite, has an ingestible sensor embedded in the pill that records that the medication was taken. We’ve gone from digital wearables, and are now at digital ingestibles – what’s the next frontier? Connect on facebook and let us know your thoughts on where this is going.
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Digital pills, digital therapeutics, smart drugs – what’s the difference? (CNBC)

See a short clip on CNBC explaining the difference
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Is it a bird? Is it a plane? Is it superman? No – it’s an ambulance! (TU Delft)

Hollywood has taught us that when you’re stuck in a critical emergency, look to the sky and hope that Superman appears. Well, in medical emergencies Superman actually comes as a drone. Recognising that accelerating emergency response can prevent deaths and dramatically accelerate recovery, engineers have developed a drone defibrillator (eh, a defibrillator on a drone). Coupled with a competent first responder, this could significantly improve survival rates of cardiac arrest casualties.
What’s next – a network of flying mini-ambulances coupled with distributed competent first-responders? Wow!
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DeepMind: can we ever trust a machine to diagnose cancer?

DeepMind, a Google subsidiary, has recently announced a fresh collaborative partnership with the UK’s health service, with plans for the artificial intelligence firm to develop machine learning technology to research breast cancer. Few details about the research project – which is in the early stages of development – have been released, but it’s likely that DeepMind will focus on applying deep neural networks for scanning mammogram images to automatically identify signatures of cancerous tissue.
The practice of medicine today relies on trust between two humans: a patient and a doctor. The doctor judges the best course of treatment for a patient based on their individual clinical history, weighing up the relative pros and cons of the different options available. The patient implicitly trusts the doctor’s expertise. But will patients or doctors trust a machine if it produced the same recommendation, based on an algorithm?

Jan 12

Spine & Health Info Platter (12 Jan ’18)

By Kanwal Sood | Artificial Intelligence , Big Data in Healthcare , Blockchain , Disruptive Innovation , Low Back Pain , Spine Care , Spine Cloud Platter , Value-Based Healthcare

In this week’s platter, we pay attention to the promises that mulberry silk has on spinal replacement therapy; what Starbucks could teach healthcare providers about “patient adherence”; the applications of blockchain technology in healthcare administration and pharmaceuticals; and, finally, we meet FLIPPY

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Powered by silk: on spinal replacement therapy (The Hindu)

Using mulberry silk, researchers from IIT-Guwahati have fabricated a spinal biodisc construct that could mimic the human intervertebral disc in form and function (successfully tested in rats so far).  Because of its abilities to accurately mimic the human disc that acts as a soft cushion between two vertebra, the artificial biodisc has the potential to replace the metallic or ceramic or collagen-based discs that neurosurgeons use at the moment to surgically cure some of the lower back pains.

Just looking at the rise in the prevalence of surgical interventions for lower back pain, perhaps it is time that we harvest silkworms… 🙂

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What could Starbucks possibly teach providers about “patient adherence”?

Patient non-adherence costs between $100 and $300 billion annually in the US alone, and is therefore an important public health consideration, affecting health outcomes and overall health care costs.   Healthcare delivery models has sold healthcare as “products” – whereas patients want “progress.”

In tune with Peter Drucker’s famous insight, “The customer rarely buys what the company thinks it is selling them.”  Starbucks has created and thrived in this space, and perhaps healthcare innovators can learn from that experience.

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Change Healthcare’s enterprise blockchain tech now available for hospitals, practices, payers

The finance domain may have been the forerunners in adopting the blockchain revolution (cryptocurrencies etc.), but healthcare is finally catching up.  Change Healthcare has launched what it’s calling the first enterprise-scale blockchain network in healthcare.  This is a positive development worth watching closely; especially as innovators continue to explore new areas where blockchain technology can leveraged to help lower costs, improve quality and make healthcare more patient-centric.

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What if blockchain could be used to save lives? (Coindesk)

In recent years, pharmaceutical companies have been put under more pressure to bring new, more personalized drugs to market faster and at more affordable prices and in a personalized fashion.  The 3 pharmaceutical heavyweights – Pfizer, Amgen and Sanofi – are now eyeing blockchain as a means of reducing the length and cost of clinical trials and improving the success rate of these trials.  Watch this space.

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Meet FLIPPY the robotic kitchen assistant (Miso Robotics)

The development of very capable and autonomous AI systems could completely transform is already transforming multiple sectors and professions.  Meet “FLIPPY” the kitchen assistant and watch him/her in action.  Watch the video and let us know what you think the implications of this development could mean in your domain.

Dec 31

Changes to LBP guidelines- avoiding medication

By Kanwal Sood | Low Back Pain , Primary Spine Provider , Spine Care , Spine Related Disorders , Value-Based Healthcare

A recent review by the University of Sydney outlines the latest revisions to major international guidelines whose recommendations were in place for decades. There is a change in stance on the use of paracetamols and anti-inflammatories and this represents a substantial shift in thinking about the primary care management of low-back pain that should see changes to practice worldwide. The new recommended approach is to avoid medication initially and discourage any invasive treatments i.e. injections and surgery.

In response to the escalating opioid crisis and unfavourable research on pain medication, family doctors are now far less likely to prescribe these medications. Their recommended treatment options for uncomplicated back pain include:

  • Acute pain: remain active, use heat and massage, arrange follow-up in two weeks to make sure the pain has settled
  • Chronic pain: yoga, exercise or mindfulness. Otherwise- spinal manipulation, acupuncture, or multi-disciplinary rehabilitation programs.

However, there will be challenges to implementing this model of care as health systems in most industrialised countries aren’t currently set up to fund the most appropriate care for low back pain e.g. a course of treatment with a physiotherapist, chiropractor or psychologist. Opioid prescription is low-admin, fast-acting, instant-relief. Thus, policy changes are needed to encourage PCPs to follow current best practice – these boil down to improving affordability of the recommended forms of care. Not only would this make the lives of GPs far easier, it could significantly impact the lives of those suffering. Ultimately, this needs the attention of the Federal government.

Image: Credit- University of Sydney

Dec 27

Spine & Health Info Platter (27 Dec ’17)

By Kanwal Sood | Artificial Intelligence , Big Data in Healthcare , Blockchain , Disruptive Innovation , Internet of Things , Spine Care , Value-Based Healthcare , Wearable Tech

In this week’s platter, we look at smart bandages, physicians who are prescribing mobile apps to their patients, the power of a humble spreadsheet, AI and 10 healthcare IT predictions for 2018. Sign up for our newsletter on the left. Enjoy:

Five major shifts in the transformation of healthcare (MaRS)

Healthcare in the developed world is undergoing a transformation. This infographic does a great job of capturing at least 5 of the major shifts.

Smart bandages for monitoring and treatment of chronic wounds

Researchers from 3 academic institutions in the USA have designed a smart bandage that could eventually heal chronic wounds or battlefield injuries with every fiber of its being. The bandage – the first of its kind that is capable of dose-dependent drug release – consists of electrically conductive fibers coated in a gel that can be individually loaded with infection-fighting antibiotics, tissue-regenerating growth factors, painkillers or other medications. A microcontroller no larger than a postage stamp, which could be triggered by a smartphone or other wireless device, sends small amounts of voltage through a chosen fiber. That voltage heats the fiber and its hydrogel, releasing whatever cargo it contains.

Elsewhere, researchers in Saudi Arabia have developed a smart bandage for real-time wirelesss monitoring of chronic wounds. This technology solves the problem of wound monitoring by offering a low-cost wearable smart bandage that detects early signs of wound infection such as bleeding and pH variations and can measure external pressure on the wound. This simple bandage strip can remotely send wound progression data and issue early warnings to patients, as well as remote medical staff, regarding the need to change the dressing. See description here

Dear Patient, please don’t forget to download your prescription (YouTube)

Someone once said that if we were told that the brain were a mobile app, we would surely us it more! That just goes to demonstrate the ubiquity of mobile computing in our age. This short clip introduces a digital medicine-centric care delivery system that enables physicians to digitally prescribe mobile health apps to patients.
But as with everything new, some of these innovations are treated with a dose of healthy skepticism as they lack evidence to suggest that they work, or more gravely, that they don’t cause harm. Another big challenge will be to ensure that the tech projects are compatible with each other (…hear the cry for Open Standards…)
Pharma and apps – never would have imagined that…

How do we heal medicine? (TEDTalk)

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawade explores how doctors can dramatically improve their practice using approaches as simple as … a checklist – or coaching
Gawande suggests we take a step back and look at new ways to do medicine — with fewer cowboys and more pit crews.

Five AI breakthroughs that could change the face of science (Imperial College)

Barely a week has gone by in 2017 without warnings in the media about how Artificial intelligence (AI) and robotics is threatening to make all human workers redundant.
AI techniques, such as machine learning, represent a complete step-change in ability.
We take a look at five stories this year where scientists used AI in completely new ways

10 Health IT predictions for 2018: Al, blockchain, robotics and a $100 million class-action suit (Healthcare IT News)

And finally, we let’s take a peek into 2018 and see which emerging technologies will start to gain some firmer footing in the year ahead.

Happy new year everybody!

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