Healthcare Beans: Recent Episodes
James Haven, PhD
Shining a light on American health systems (and other cool stuff). This podcast dives into the mechanics of how policy, financing, and technology shape the patient experience.
In this episode, I talk with Lindsey Kratzer about the self-insured employer market. This is a fast-growing market and employers are facing significant challenges with rising healthcare costs, countless healthcare vendors vying for their attention, fuzzy ROI assessments, and ultimately deciding how to best manage the health needs of the employee population and their families.
Lindsey is the Founder of Spark Health Advisors, a healthcare consulting firm specializing in growth advisory and hands-on sales and marketing support for healthcare companies targeting the employer market. Lindsey has over a decade of experience working with HR leaders at top, Fortune 1000 employers such as Google, Tesla, Intel, Microsoft, Genentech and Rocket Mortgage as well as top payers, PBMs and benefits consultants. Over the years, she’s developed and implemented GTM strategies for over 15 products targeting employers and scaled products from $0 to $50M+ in annual revenue. Lindsey lives in Denver and loves working with health tech Founders and teams driving meaningful change in the industry.
Throughout our discussion, Lindsey shared a ton of valuable insights for healthcare companies that are targeting this space.
We hope you enjoy the show!
Godspeed.
~ James
In episode #16, I speak with Luká Yancopoulos, CEO and co-founder of Grapevine Technologies.
Luka is an entrepreneur with a track record of innovation and consistent delivery in the healthcare industry.
As CEO and one of the faces of the company, Luká is involved at every level of Grapevine’s operations: securing funding, innovating on the platform, and looking for ways to take the company’s offering to an even wider market.
In this episode, we talk about:
- Crazy inefficiencies in the current healthcare supplies market
- Grapevine’s marketplace solution and cost savings
- Price transparency for healthcare supplies
- Grapevine’s growing popularity among specialist providers
- How Grapevine enables cost savings for struggling rural hospitals
- The importance of efficient supply chains for value-based care
- Experiences from early adopters of Grapevine’s services
Sign up for free at Grapevine today and save on your medical supplies.
We hope you enjoy the show!
Godspeed
~ James
In episode 15, I speak with Leon Wisniewski about his company Health Cost Labs and their new product Billy – a consumer app that shows hospital prices by service and geographic area, and lets users shop around for the best price.
Leo is passionate about bringing fair and transparent prices to healthcare. We talk about…
- Billy: a healthcare price app
- Recent healthcare price transparency laws
- The no surprises act
- The importance of a “good faith” estimate
- Hospital compliance with price transparency
- The Managed care “beast”
- Payment “no” integrity
- A superior cash-first system for healthcare payments
- Prospect of Medicare-4-all
- Leo’s Home Brew recipe -> How to buy low cost healthcare
We hope you enjoy the show!
Godspeed
~ James
In this episode, I speak with Dr. Yazan Abdullah, an internist who specializes in hormone replacement therapy and founder of Newport Health & Vitality.
One interesting quote from Yazan: “Fee-for-service is the most ethical way to pay for healthcare”.
Our conversation spans:
- Testosterone therapy and stigma
- Pursuing vitality in addition to longevity should be the goal for health-conscious Americans.
- Obesity and its connection to observed, low testosterone levels in American men
- Pros and cons of managed care (mostly cons!)
- The rise of psychedelics as a treatment for mental health disorders
- The potential for Bitcoin payments for healthcare services
We hope you enjoy the show.
Godspeed!
~ James
In this episode, I speak to Claudia Armani, a health coach and founder of Claudia Armani Wellness and The Healthy Gourmet blog dedicated to simple and healthy Mediterranean recipes and lifestyle tips.
She works with clients both in UK and around the world to help them let go of yo-yo dieting and improve their metabolic health.
Our conversation spans:
Claudia’s background and entry into health and wellness
The fundamentals of health coaching and how to empower patients
Functional and holistic medicine
The use and limitations of willpower for behavior change
Intermittent fasting
The state of health coaching in the UK
The rise of subscription-based payments in health coaching
Risks and benefits of new weight loss medications
Emotional eating and maladaptive coping mechanisms
The pursuit of the dopamine kick
The value of social prescriptions in healthcare
And the Claudia Armani Wellness brand and services
We hope you enjoy the show..
Godspeed!
~ James
In this episode, I speak with Bryan Guadagno - CEO and cofounder of It's Skinny. We discuss the 9-calorie noodle, the health benefits of Konjac, the future of food technology, and the founder's story. Our chat dives into consumer behavior modification and how that relates to healthcare spending in the United States.
Godspeed!
~ James
In this episode, I talk with Michael Boerner (CEO of Engage Technologies) about his company's transformative mobile intelligence and patient education technology - connecting patients to a digital health platform with no app or user logins (e.g., NO FRICTION).
We discuss the value and power of video storytelling, the importance of behavior change for disease prevention, new opportunities in gamified learning, and how this company is optimizing the patient journey while reducing practice burden on providers.
"Engage Technologies believes that timely knowledge from a trusted relationship empowers. It empowers patients, providers and their staff, and all healthcare stakeholders. Engage transforms lives with breakthrough mobile intelligent storytelling at patient height of interest and time of need. The right message at the right moment motivates behavioral change for optimal patient outcomes and improves practice performance with proven six-figure and above return on investment" - Steve Inch, Chief Marketing Officer, Engage Technologies
Here's a list of Engage demos & links that showcase different products:
Engage Aesthetics Demo (featuring breast augmentation, mastopexy, breast revision, and neuromodulators & dermal fillers, and patient pre-consultation journeys): In the United States, anyone with a mobile smartphone can text to 418418 and enter the typed message: TVPS CONSULT
Engage Aesthetics Demo (featuring pre-operative and post-operative breast surgery patient journey): In the United States, anyone with a mobile smartphone can text to 418418 and enter the typed message: TVPS JOURNEY
Engage Ocular Demo (featuring multiple ocular patient journeys): In the United States, anyone with a mobile smartphone can text to 214214 and enter the typed message: BRIGHT EYES M
Engage Ocular (ROI results) video (6:30 min): Hero Video for Engage Website
Engage Aesthetics (behind the scenes) video (5:20 minutes): https://engagetg.wistia.com/medias/8ubwbabbry
Godspeed!
~ James
In this episode, I talk with Jonas Goldstein (Vice President of Strategy at VIM) about value-based healthcare, risk-sharing arrangements, Medicare Advantage, direct-to-consumer healthcare, and point-of-care digital solutions.
Here is a great article by Jonas in Physicians Practice that lays out the imperative to "lower the risk" in value-based healthcare in order to quickly expand accountable care delivery across the US.
Godspeed!
~ James
Episode 9 of the Healthcare Beans podcast
Without realizing it, I played an important role in my wife's health journey. But first, a bit of context..
I often find that healthcare professionals pay little regard to individuals' capacity for willpower or grit. The prevailing viewpoint is that poor health outcomes are caused by systemic problems like waste, greed, and failed policy. Period. There is no doubt that healthcare delivery in the United States is poorly designed, and must be corrected through policy changes. But without holding patients accountable for their own health outcomes, we cannot help people live the best version of themselves. And until we do that, I fear a great deal of time and money will be spent on healthcare solutions that barely work.
Episode takeaways:
(1) I share a story about my wife's health journey, as an example of how family and friends can be excellent constructive critics who propel us toward better living.
(2) There are countless success stories about people who dropped unhealthy habits and started living a better life. These stories should form the foundation of how health systems engage patients.
(3) Resilience research can serve as a framework for healthcare professionals to better support patient accountability and help people live the best version of themselves through a combination of (1) grit and (2) a practical method of self-improvement.
Godspeed!
~ James
Episode 8 of the Healthcare Beans podcast
Mental health took a nosedive during the pandemic. We need to expand access to mental healthcare in our communities, ASAP. To meet this need, telehealth companies that provide virtual psychotherapy are growing very fast. In particular, I'm rooting for Talkspace therapy.
Episode Takeaways:
(1) Have you ever seen a strong, confident, clear-headed person break down in front of you? No one is guaranteed good mental health across time. One thing I learned from the pandemic is to never assume your friends and family are OK based on past appearances.
(2) A mental telehealth app called Talkspace recently signed a deal with the city of Reno Nevada to provide psychotherapy for its residents. Here's a good, comprehensive review of Talkspace.
(3) The Reno Talkspace therapy deal can set the stage for other cities to make similar deals with telehealth providers. I'm betting it will!
~ James
Transcript
Hello and thanks for catching episode #8 of Healthcare Beans, I’m your host James Haven. I want to share a strange experience I had during the pandemic, that really hit me in terms of the poor state of mental health in our communities. Now, we’re all hyper aware of how bad depression and anxiety has gotten during the pandemic – it’s common knowledge and supported by public health data (no surprises here).
But what did surprise me is that it’s not only people with existing mental conditions who are suffering – people who (in the past) typically enjoyed good mental health are also struggling. And that means we really can’t make assumptions around people who look fine or appear to be happy, thinking to ourselves, “oh that person’s okay”.
So, a friend of mine (she’s a psychotherapist) lives in a nice home, in a nice upscale neighborhood with her husband (great guy by the way), her 2 small children and a family dog. And like pretty much everyone in the first half of 2020, they were self-isolating in their home, and my wife and I were isolating in our home, and we didn’t see them for about 5 months. And we come to find out that she and the husband are having a major disagreement about how to stay safe during the pandemic. Essentially, she felt an absolute need to get outside, get some fresh air, mingle with a small group of close friends & family, and provide some sense of normalcy to her kids. On the other hand, her husband took COVID very very seriously. He felt that any contact with other people should be avoided, and that even taking walks outside, by yourself & breathing in the air, was a bad idea. So for about 5 months, they did it his way, living totally isolated from other people, and in that time his wife’s mental state was deteriorating.
By the time I finally saw her, she was sitting on the floor of her home, with her head buried in her skirt, just crying uncontrollably. I could not believe my eyes. Up until that point, I’ve always seen her as calm and in control. But the thing I’ll never forget was what she said to us – she said we abandoned her, that we never checked to see how she was doing. And she was right, we did not check on her, we just assumed she’s okay because she lives in a nice home, in a nice neighborhood, with her beautiful family.
We were totally wrong – mental illness can strike anyone, at any time, and especially during the pandemic. And from a data standpoint, I know this, but it’s something else to see it happen (up close) to someone you know. So one of the big takeaways from 2020 is access to mental health services – this has got to be a priority going forward - fundamentally improving access to mental health services throughout our communities.
So, for the past few months, I’ve been keeping a close eye on mental health apps – in particular, there’s two companies I’ve been reading up on – one is Talkspace and the other is BetterHelp (I found a really good user review of these services, there’s a link in the show notes if anyone is inte...
Episode 7 of the Healthcare Beans podcast
Virtual reality (VR) therapy can be very effective for treating pain. The key issues are the types of pain that can be treated with VR, and how we can pay for it. In early 2020, Medicare approved payments for acupuncture to help treat pain without prescribing opioids, which clearly signals the demand for different ways to treat pain.
Episode takeaways:
(1) Due to the opioid crisis, it's very difficult to (legally) get your hands on prescription pain medication. Clinicians are reluctant to prescribe opioids for anything except severe pain. For people with substance use disorder, this is a good thing. But that also means we need other, non-addictive ways to treat or eliminate pain.
(2) Virtual reality companies like AppliedVR and XR Health are providing VR therapy to better manage acute pain, chronic pain and anxiety. VR therapy can be self-administered in your home, after receiving minimal instruction.
(3) The next step for VR therapy is getting health insurance companies to pay for it. Certain Medicare Advantage plans and commercial insurers have started covering VR therapy, but it still has a long way to go.
The benefits of virtual reality for patients are becoming clear, but what's not clear is whether the technology will be widely adopted, or will it actually help lower the rates of opioid addiction in the United States. I'm betting it will do both.
~ James
Transcript
Hello and thanks for tuning into episode #7 of Healthcare Beans, I’m your host James Haven. This episode is inspired by a recent experience I had with my dentist (and please bear with me – this will certainly connect with the broader theme of healthcare in the United States).. So I showed up for an emergency visit on a Saturday; and I was in a lot of pain and it turned out that I needed my wisdom tooth pulled… I’m one of those types that wait till the last minute for dental care because I just hate going to the dentist.
Now, I’ve had this sort of dental work before, where after a tooth extraction, I start to experience a lot of pain, maybe around 4 hours after the surgery, when the pain medication wears off. As a matter of fact, I once ended up in the ER after dental surgery, the pain was so bad. So I describe my past experience with the dentist and I ask her for prescription pain medication (real pain medication); not high dose tylenol/ibuproferin. And she said to me (these are her exact words) – it’s not in my philosophy to prescribe opioids for a tooth extraction.
I got to say, I wasn’t expecting that, and I was a little upset. Nobody wants to hear about someone’s clinical philosophy when you’re having pain.
So I left the dentist office with a useless prescription of high-dose Tylenol and crossed my fingers for good luck. About 6 hours later, I was in serious pain. The Tylenol didn’t work, the dental office was closed, and I was pacing back-n-forth in my living room because that’s what I do when I’m not feeling well.
And then it hit me – the last time this happened (and I ended up in the ER), the emergency room physician gave me a prescription codeine; and I filled that prescription. So the codeine was somewhere in my home, I just had to find it. And that’s what I did; I frantically searched for the codeine, found it, and popped one pill. And about 20 min later, the pain was much reduced and after another 10 min, the pain was pretty much gone. Presto!
Now, the moral of the story is not that codeine is the best thing since sliced bread; I mean, it worked well, but that’s not the point. The point is that pain management is a very real problem in healthcare. Dentists and doctors are very reluctant to prescribe opioids, and there’s a very good reason for that; the opioid epidemic is killing thousands every year, and the best way to save lives, at least in the near term, is to stop prescribing opioids for anything less than 3rd degree burns (unfortunately).
Episode 6 of Healthcare Beans podcast
Cityblock Health is a unicorn startup serving high quality healthcare to low-income communities.
Episode takeaways:
(1) There are several high profile companies supporting the nation's transition to value-based healthcare. Cityblock Health is at the forefront. Here's a short list: Oak Street Health, Iora Health, Lumeris, and UniteUs.
(2) Managing healthcare spending for complex, low-income patients is not an easy task - many smart, dedicated people have tried and failed.
(3) Addressing the social determinants of health may be the determining factor for long-term success - not just for Cityblock Health, but for the entire sector.
~ James
Transcript
Hello and welcome to Healthcare Beans, I’m your host James Haven. In this episode, I’m going to focus on a rather interesting startup in value-based healthcare. On Healthcare Beans, I often talk and write about the many federal and state programs which address some really big challenges in healthcare (mostly around lowering healthcare spending or expanding access to good healthcare) and to be fair, the results of these government programs are kind of mixed.
Many of these programs fall under some sort of accountable care model and these models try to connect physician (or hospital) payment to patient health outcomes; to put it simply, this means good doctors are rewarded for delivering good care, and bad doctors are financially penalized.
But again, the results of these programs are mixed; many of them have not actually reduced the cost of healthcare (at least not in any significant way), and only a few programs show some promise in doing that in the near future.
Outside of government programs, there are many interesting and valuable developments in the private sector, and in the end, it wouldn’t be surprising if healthcare companies make some real lasting changes in terms of lowering the cost of healthcare and improving our health outcomes.
And the companies I’m currently thinking about use different types of data along with specialized care teams in order to manage (or drive down) healthcare spending. These companies (that I think are worth keeping an eye on) are Oak Street Health, Iora Health, Lumeris, Unite Us, and Cityblock Health. And I include these company names with links in the show notes, if you’re interested in learning more about them.
So with that, I’d like to dive more deeply into Cityblock Health. Cityblock is headquartered in Brooklyn NY, and operates across NYC, Connecticut, Chicago and Washington DC. The company specializes in delivering quality healthcare to low-income patients. Now, when you hear “low-income” a few key points come to mind.
Low-income patients often have more health problems than people with average incomes, and this is a well-known pattern coming out of numerous studies in Medicare and Medicaid. And because low-income patients have more health problems, they’re much more expensive to care for; they’re more likely to end up in the emergency room, and more likely to be hospitalized.
And perhaps most importantly, low-income patients have social service needs that are often unmet. And that could be a lack of transportation, or unstable housing, not having enough nutritious food, being socially isolated... so not having nearby friends or family – and studies have shown these types of social problems play a huge role in poor health outcomes.
Going back to Cityblock Health, the company just completed Series C fundraising and is currently valued at over $1 billion, so perhaps there’s an IPO in the near future. And early reporting suggests the company’s healthcare delivery model can reduce unnecessary health spending among complex patients. All in all, I’d love to invest in Cityblock Health if given the chance (it’s a very exciting company), but at the same time, it’s really important to understand just how difficult it is to truly reduce healthcare spending (emergenc...
Episode #5 of the Healthcare Beans podcast
In the United States, caregiver burden is a really big problem.
Episode takeaways:
(1) Care-giving is very stressful work and roughly 48 million people in the US are spending about 28 hours per week caring for loved ones.
(2) Patient health outcomes depend on your home environment. When you get sick, your future will depend on a caregiver.
(3) A startup called Carallel (www.carallel.com) has demonstrated success in helping caregivers do their jobs well, and with less stress. Listen to the episode to learn more.
Transcript
Hello and welcome to Healthcare Beans, I’m your host James Haven. Today I want to talk about a major problem in healthcare (and really, across society) that has, historically, received very little attention. And to be fair, there’s really no shortage of problems facing health systems in the United States; some of the big ones are, of course, how we pay for healthcare (which is way too much), the quality of healthcare (our health outcomes are not awesome, especially considering the price tag), and access to healthcare (too many people don’t have insurance or they’re worried about losing their health insurance) – but the problem I want to highlight is the invisible healthcare workforce.
As I’ve discussed in episode #3 of Healthcare Beans, there are a lot of people involved in delivering good care to you and your loved ones, and when we think about these folks, we’re usually thinking about doctors, nurses, care managers, social workers, data analysts, transporters, and several layers of administrators, and the list goes on and on. But the invisible healthcare workforce is you. It’s the unpaid caregivers at home; every patients’ family and friends who sacrifice their time and their energy to care for loved ones. And these caregivers are absolutely critical to ensuring good health outcomes for patients. And here’s why…
Health outcomes are greatly affected by our home environments. Things like preparing healthy meals, making sure the oven is turned off, making sure there’s adequate heat in the home, moving safely from the bed to the bathroom and back again (recovering patients and chronically ill people have a high risk of falling in their homes), keeping track of their medications, getting fresh air and sunlight, touching base with the patient’s care team, and simply having healthy social interactions to ward off depression and anxiety.
Altogether, this is a ton of work, and if you’ve ever dealt with sick friends or family members, you can understand the stress that comes with being a caregiver. In health policy circles, we call this “caregiver burden” and it’s no joke. Here are some stats that help paint a picture of how massive caregiver burden is in the United States – a new study from AARP & the National Alliance for Caregiving (this study came out in May of 2020) estimates that roughly 48 mil people are serving as unpaid caregivers in the United States, averaging about 24 hours per week performing caregiving activities.
That is an enormous amount of unpaid, stressful work – and Gallup research estimates the direct economic cost of caregivers being absent from their paid jobs (to care for loved ones), is in the neighborhood of 28 billion dollars, annually. Suffice it to say, we need to start looking at solutions to the huge caregiving problem in the United States.
And that’s why I’m pretty excited about this new company called Carallel – which is a digital platform designed to help caregivers reduce the stress that comes with caregiving, and actually help caregivers do a better job at managing the needs of their loved ones.
So first, I’ll talk about how Carallel came to be. This company sprang out of the Guidewell innovation challenge which was called “Caring for Caregivers” – this challenge was launched in 2019. If you haven’t heard of Guidewell, it’s a rather interesting outfit - it’s essentially a holding company that owns...
Episode #4 of the Healthcare Beans podcast
In the United States, privacy protections for health data are not as restrictive as most people think. Your doctor is not the only person who can access your data.
In this episode I talk about: (1) how health data is used, (2) who has access to our health data, and (3) who benefits from sharing health data.
Check out these links for background content on health data privacy laws and value-based healthcare.
~ James
Transcript
Hello friends and welcome to the Healthcare Beans podcast, I’m your host James Haven. Today I want to talk about issues involving your health data; so questions like how’s your data being used; who exactly is benefiting from your data; the types of people and entities who can access your data, and of course – why you should care about how your data is being used.
When it comes to health data sharing, the first thing you should understand is that you actually do not have much control over your data (when you have a medical event, be it a basic checkup or emergency care or something else, there’s a host of entities that have legal access to your data, for the purpose of providing good care to you) – and I know (from a privacy perspective) that’s not a very comforting thought, but for the most part, your data is being handled in a way that is aligned with your overall health interests.
Now, there are folks out there who might disagree and think your health data is being used to expose you or harm you in some way, but I want to share my experiences working in healthcare data operations, including my work with health data under federal and state programs – and after hearing that I hope to (alleviate some of your concerns on data privacy) persuade you about the benefits of sharing your health data, because there are benefits.
Once you receive any type of medical care – your diagnoses, the procedures and tests you went through, and your demographic data, that can all be accessed by several types of entities. And these entities include your doctor (of course), your doctor’s health network (which could be a small group of providers, or could be thousands of providers in your state or region), your insurance company (we refer to these groups as payors) so thinking about Medicare, Medicare Advantage, Medicaid, and also technology companies that contract with your healthcare provider – so companies providing data management services (like EMRs) or some number-crunching analytics or whatnot. And to be clear, that means a lot of different people have access to your data.
When I was working as a data analyst, I had access to tons of data, and that includes people’s names, addresses and health conditions. Now, did I personally know any of these people – absolutely not. Do I recall these data? – to be perfectly honest, no, I do not. The reason is that when analyzing the data, I almost always used some sort of alpha-numeric IDs, not patient names. So if my job was to find people with diabetes, who visited the ER in the past 6 months, and have not had a wellness checkup this year – I’d dig through the data, pull that list together, and it would be filled with IDs like “patient: NZ8211560” and I would send that info off to folks on the care management team (nurses, social workers, and doctors).
By and large, the people who actually witness your personal data (like your name, gender, address) & your medical data are the clinical folks you interact with. Now, that doesn’t mean other people cannot access personal information and medical conditions, but there’s really no reason (incentive) for people outside your care team to do this. Again, I’m not quoting hard-n-fast rules here; I’m just sharing my experience in healthcare data operations – nobody digs through personal-level data because you probably have to jump through some hoops to do that (which means getting actual names behind these obscure IDs) and there’s just no reason to do it,
Episode #3 of the Healthcare Beans podcast
In this episode, I argue against putting too much faith in good doctors. I know that sounds strange but a well organized care team is what really counts, and this is what people should expect from their local health system.
I stress the importance of organized care delivery by sharing a story about my 73 year-old uncle who suffers from multiple chronic diseases. He recovered from a COVID-19 infection back in September 2020, after being treated with Dexamethasone. He had a great doctor but his care team dropped the ball.
And when it comes to finding a new doctor, I think healthgrades is a good site to explore. But make sure you read the full profile - the bad stuff is often tucked away at the bottom of a profile.
Subscribe to my podcast or check out my site's episode list if you’d like to learn more about US health systems and value-based healthcare.
~ James
Transcript
Hello healthcare enthusiasts and thanks for tuning into the Healthcare Beans podcast, I’m your host James Haven. This is the 3rd episode in the podcast, and we’re still laying out the fundamental knowledge on healthcare and health systems, and what people should be aware of in order to understand and navigate this complex system.
So onto the big question for today – “what exactly is good healthcare?”. And I pose this question for a reason, it is to help people put down a very common, simplistic and ultimately wrong idea of what good healthcare is. Many, many people think good healthcare is all about having a good doctor, and this is NOT true. And I’m going to share a brief story that I think will convince you not to put your full trust in a good doctor.
I’d like to share a story about my uncle. He’s 73 years old with chronic liver disease; he underwent a triple bypass heart surgery about 2 years ago, and struggles to maintain a healthy blood pressure. He’s certainly not in good shape, but my aunt takes great care of him, staying on top of all his medications and his diet – so he’s pretty lucky in that respect. And to be fair he lived much of his life on his own terms, eating and drinking whatever he wanted; and ignoring exercise. Back in August, my uncle contracted COVID-19. We were surprised to hear this because he and my aunt were social distancing in a small apartment in CT, but social distancing is not a guarantee that you won’t get sick. And as expected, my uncle developed the usual symptoms: high fever, aches, and difficulty breathing.
Now it’s common knowledge that COVID-19 is very serious for the elderly, especially older people with chronic disease. So we had zero faith that he would ever leave the hospital; our concern was making sure my aunt felt supported and getting ready to help make funeral preparations. He spent about 8 days in the hospital, and during that time the doctor would keep in contact with my family every day, letting us know how he’s doing, because (of course) we could not visit him ourselves; answering our questions, and making sure he’s getting the care he needs. She (the doctor) treated him with a steroid, Dexamethasone, and he started feeling better pretty quickly where each day was better than the previous day. If you haven’t heard of this drug, definitely look it up, the findings are very positive (doctors are using this drug in combination with other drugs) – all the major news outlets are reporting on it; again, it’s called dexamethasone and I have a link in the show notes so you could click on that and learn more about it.
I can’t say enough good stuff about this doctor, she was super-responsive, compassionate and brought my uncle back from the brink of death. There was even an incident where the hospital (someone from nursing administration) tried to discharge him early, at around 5 days, and we were concerned about that timing, we thought it was too short, so we discussed that with his doctor, and she decided to keep him inpatient for 3 more days.
Episode #2 of the Healthcare Beans podcast
Keeping your annual wellness visit is a great way to safeguard your future health!
In this episode, I talk about the importance of the annual wellness visit, and how health systems use data to prioritize patient outreach.
Check out my earlier post on this topic (if you prefer to read instead of listening to a podcast).
~ James
Transcript
Hello everyone and welcome to the Healthcare Beans podcast, I’m your host James Haven, and today I want to talk about annual wellness visits, and in particular, should we (and by “we” I mean patients) care about these types of medical appointments.
At the outset, talking about annual wellness visits may seem a bit unimportant or even a little boring, but it’s actually kind of surprising what’s goes on behind the scenes with annual wellness visits and by the end of this episode I hope I can convince you to take them seriously.
And for additional context, the annual wellness visit is a pretty important element for implementing value-based healthcare, which I talk about in episode #1 of this podcast. And I will circle back to this topic later in the episode…
As always, the best way to think and talk about healthcare is through the patient experience. So I’m going to share a patient story that I came across a few years back.
Several years ago, while interviewing for an analytics job in healthcare, someone showed me a graph of a single patient’s movement across 10 different hospitals and rehab sites, across a span of 8 months. Now, there’s a particular name for this type of patient, sometimes referred to as a ‘super-utilizer’, but some folks find this term a bit offensive, not really sure why though it might remind people of the term ‘super-predator’ from the 90s which coincided with tough crime laws and really high incarceration rates among black men.
Anyway, the new term is “high-cost, high-need” patients, and this term describes people who end up costing health insurance companies a small fortune in a short time span (3 to 6 months, or 1 year). So going back to that interview, a health system VP shared some graphs with me and asked me what I thought of the data? So as I studied the patterns of movement between facilities, the key thing that jumped out at me was that this patient (we’ll just call him Harry) never went home!
He bounced around the healthcare system for 8 months, wound up costing Medicare half a million dollars, and then he died. Harry’s entire problem began with a poorly managed chronic disease. He went to the emergency department one day, and that was it, he never escaped the health system.
And this is where good preventative care comes in, this where annual wellness visits become important – we want our doctors to spot our health problems long before we spot them ourselves, and certainly before we require emergency care.
To be clear, the wellness visit is an annual touch base with your doctor, that includes a routine check-up, blood test, a vitals check, and a LOT of information gathering. A key thing about annual wellness visits are that these visits are often initiated by your doctor. Someone from your doctor’s office calls you, and wants to set up an appointment. So this is not the usual type of dr visit, where I feel like something is wrong in my body, and I reach out to my doctor to schedule an appointment (this is the other way around).
Now I was talking to a health policy colleague a while back and he did not really understand the significance of wellness visits (or much of primary care in general) and whether these visits were actually effective at keeping people healthy. He didn’t have much faith in a doctors’ ability to spot problems early on, but I would argue otherwise. It’s not just the doctor’s training, or skill or intuition, that’s involved in “problem-spotting”; it’s the data that’s gradually collected on patients over time. And the annual wellness visit is a great data col...
Welcome to the first episode of the Healthcare Beans podcast!
Many health systems and doctors get paid regardless of your health outcomes, and that needs to change.
In this episode, I touch on the basics of how our healthcare is delivered, and how that's changing into something better (we hope!).
See these links for accountable care organizations and bundled payment models, which are two primary ways value based healthcare is being implemented in the United States.
~ James
Transcript
Hello everyone and welcome to the Healthcare Beans Podcast, where we discuss all things healthcare. I’m your host James Haven. And today, I want to pose a question about our experiences as a patient, or as a consumer, of our health systems. At some point in our lives, we all run into health problems, and at that time we realize how we always pay for healthcare regardless of the outcome. There are no refunds if we don’t get better; we simply stay sick and end up with less money in our pocket. Do we ever stop to think of whether that’s right, and if that is the only way to operate our health systems in the United States?
So, I want to talk about a different way to operate our health systems, and it’s called value-based healthcare. In the United States, it is painfully obvious that healthcare is way too expensive, it is not well distributed across different people and zip codes, and our health outcomes are simply not good enough to justify the price tag. But there are a lot of people working hard to fix our nation’s health systems, and this is where value-based healthcare comes into play. Our entire healthcare system is undergoing a gradual deconstruction, from a system built around service fees, to a system that prioritizes value. Now, a good starting point for explaining anything about our complex health systems, is to talk about the patient experience, so I’m going to start by sharing a personal healthcare story with you.
About 2 years ago, my stomach started giving me trouble, I could not eat anything comfortably. I went to my primary care doctor – he could not figure out what was wrong with me. I then went to a GI doctor, he performed a lots of tests, and still could not figure out what was wrong. So I had an endoscopy and there was this weird encounter with some greedy anesthesiologist, who demanded to know about his payment while I was in a medical gown, lying on a gurney, moments before the procedure.
And that’s the key problem with healthcare – the health system gets paid regardless of my health outcomes.
Now fee-for-service means a healthcare provider, someone like a doctor or a group of doctors or a hospital or a clinic, some type of provider, gets paid after performing a particular type of service for you. Maybe it’s a diagnostic exam, or administering a vaccine, or heart surgery or delivering your newborn – the point is that every service, big or small, has a fee associated with it. And many experts in health policy believe that this is the core reason, or at least one of the core reasons, why healthcare spending is skyrocketing. Over time, doctors are doing more and more services, they’re getting paid more, regardless of whether you get healthy.
Under value-based care, the healthcare providers are financially incentivized to keep us healthy.
And this is achieved through risk-sharing contracts. There are lots of technical details around risk-sharing, but here’s the main takeaway; if my local health system does not appropriately manage my illness, then I’m going to see other doctors, maybe end up in the emergency room, or even hospitalized if unlucky. And under value-based healthcare, my health system will incur a financial penalty for that. So when you think about it, it’s really a fantastic, sort of natural concept that makes us wonder why we haven’t been using value-based care all this time.
So what does this mean for you, your family, your loved one.