Friday, May 3, 2013

Cajuncodefest 2.0 positions Lafayette as epicenter of health care innovation | | Acadiana-Lafayette, Louisiana

Cajuncodefest 2.0 positions Lafayette as epicenter of health care innovation | | Acadiana-Lafayette, Louisiana

Cajuncodefest 2.0 positions Lafayette as epicenter of health care innovation

Posted: May 3, 2013 11:06 AM by MELISSA CANONE 
Updated: May 3, 2013 11:06 AM

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LAFAYETTE, La. - Lafayette was the epicenter of health care technology during the second annual CajunCodeFest, a free, three-day coding competition focused on transforming data into health care solutions. The CajunCodeFest is a signature event for the Center for Business & Information Technologies (CBIT) at the University of Louisiana at Lafayette. Over 400 people from 42 cities, 12 states and 2 countries gathered at the Cajundome to create solutions and discuss the future of healthcare technology. Participants organized themselves into teams before the event, and over a 27-hour period built exciting new prototypes and tools encouraging patients to "Own your Own Health." Last year, the event spawned 6 potential startup companies through team collaborations.

The event also hosted a full day of plenary sessions with keynote guest speakers including Bryan Sivak, Chief Technology Officer, and Dr. Farzad Mostashari, National Coordinator for Health Information Technology of the U.S. Department of Health & Human Services, and Kathy Kliebert, Interim Secretary, Louisiana Department of Health & Hospitals.
The CajunCodeFest competition ended with a local team taking home $25,000 and a qualifying entry in the National Health Data Palooza in Washington DC, in June. Awards were also given for the Best Student Team, The Opportunity Machine Best "Market Ready Team", Best Use of Microsoft HealthVault Technology, and US Ignite Best Software Defined Networking Application. For more information or to view speaker presentations, visit
Recently, CBIT and the CajunCodeFest were recognized with the Innov8 Education award from the Greater Lafayette Chamber of Commerce for bringing innovation in healthcare to the Lafayette community. The CajunCodeFest is a major component of INNOV8, an annual festival of innovation and creativity showcasing talented thinkers and entrepreneurs who make the region a unique place to live and work.
CajunCodeFest Winner's Photos:
"Best in Show" Grand Prize Winner & US Ignite Best Software Defined Application: Team BreakFix
(L-R) Bryan Sivak, CTO, US Dept. of Health & Hospitals, Stacy Crochet, Bill Fentsermaker, Fenstermaker & Associates, Monica Suire, Amy Hanchey, Teri Leblanc, William Zhang, Michael Venable, Trent Poche, Clay Allen, Allen & Gooch.
Best Student Team & Best Student Team Use of Microsoft HealthVault: "Geaux KNEAS"
(L-R) Dr. Joe Savoie, UL Lafayette President, Anh Do, Cory Etheredge, Brian Richmond, Louisiana Health Care Quality Forum.
The Opportunity Machine Best "Market Ready" Team & Best Chronic Disease Application using Microsoft HealthVault: The New Old Schoolers 2.0.
(L-R) Bill Fentsermaker, Fenstermaker & Associates, Luke Ashworth-Sides, Reza Jelvah, Bob Miller, Josh Bain, Kevin Webb, Geoff Daily, Clay Allen, Allen & Gooch.
The Center for Business & Information Technologies (CBIT) supports the University's economic development agenda through research, development and technology transfer in the general area of business and information technologies. In cooperation with private sector, academic, and government partners, the Center conducts basic and applied research aimed at establishing scientific foundations and frameworks for business & information technologies. This research facilitates the development and creation of these products. The Center provides strategic and technical support to Louisiana businesses and government. Visit for more information.

The Solution to Risk Adjustment: A Coder’s Perspective

The Solution to Risk Adjustment: A Coder’s Perspective    

Kameron Gifford, CPC

Over the last twelve years, I have worked with physicians to develop efficient billing practices, implement value added processes and improve the entire experience of care for their patients. What can this knowledge contribute to developing compliant, engaging and transparent risk adjustment programs? What can health plans learn from expert practice managers?

Use a Whole System Approach

In medicine, continuity of care can mean the difference between a positive and a negative outcome. We know that fragmented systems don’t work. So why has this become the standard for Medicare Advantage plans? Initial Health Risk assessments are outsourced to midlevel providers that perform a “home based” assessment or perhaps the patient is instructed to visit a website or to call an 800 number.  Then a few months later another company is contracted to “retrieve” medical records from the PCP who then forwards those records to a coder to code any “missing diagnoses”. This does not add any value for the patient. What will?

When patients enroll in a managed Medicare plan they are assigned (or pick) a PCP. This is who should be doing the initial health assessments. CMS encourages FFS providers to perform this type of exam by reimbursing the “Welcome to Medicare” exam with no cost share to the patient. If this is the “standard of care” for some beneficiaries, why not all?

Coding comes from documentation and therefore it is impossible to improve our coding without first improving our documentation. Knowing this, retrospective audits should be used as a tool for identifying deficiencies and a foundation from which specific educational programs can be built to support individual needs and learning styles.

Educate Everyone

In 2011, I began educating medical professionals in compliant HCC Coding and Documentation.  My mission was to teach the fundamental purpose and principles behind the methodology. Doctors are trained to take an enormous amount of information and condense all of this into a progress note. This abbreviated summary of events is then interpreted into ICD-9 and CPT Codes (which may or may not risk adjust) which will determine the amount of reimbursement for that particular service.

Currently plans are trying to interject change at the end of a process. Instead, by educating physicians, nurses, coders, administrators, medical assistants, and receptionists change can be implemented at the initial point of contact. If the medical assistant and nurse understand quality measures they will be able to accurately audit the chart before the physician ever walks in. Flags can be raised for patients who have not had their mammogram or who didn’t turn in their hemmoccult cards. Physicians who understand the 10 guiding principles of HCC will document to a higher a degree of specificity and use linking words. A coder with training in HCC Coding will know that you must use a buddy code when coding manifestations. This knowledge allows the coder to query the physician immediately when the case is still fresh on their mind.  The ability to audit in “real time” expedites the process of changing one’s behavior and the physician’s ability to adapt under these circumstances are amazing. The end result is a complete an accurate medical record which does add value to the patient.

Return on Investment

Education empowers. One of the greatest dilemmas in managed care is how to get physician buy in? By providing quality educational opportunities to not only physicians but to their office staff as well you will position yourself as a blessing instead of a burden. In the current environment of greater oversight, tighter regulations and changing reimbursement patterns providing something as simple as education builds relationships.

Empirical Risk Management tested this philosophy and the return on investment was incredible. 300 to 1. But, the greatest achievement of all was seeing the hunger for knowledge and the positive impact on human life that was reflected in patient centered whole system change.

For more information please visit our website: or by email:

This is what patient engagement really is

This is what patient engagement really is

“Patient engagement.”
What is patient engagement?  It sounds like a season of The Bachelor where a doctor dates hot patients.  It wouldn’t surprise me if it was. After all, patient engagement is hot; it’s the new buzz phrase for health wonks.  There was a even an entire day at the recent HIMSS conference dedicated to patient engagement.  I think the next season of The Bachelor should feature a wonk at HIMSS looking for a wonkettes to love.
Here’s how the Internets define patient engagement:
  • The Get Well Network calls it: “A national health priority and a core strategy for performance improvement.”
  • Leonard Kish refers to it as “The Blockbuster Drug of the Century” (it narrowly beat out Viagra) – HT to Dave Chase.
  • Steve Wilkins refers to it as “The Holy Grail of Health Care” (it also narrowly beat out Viagra) – HT to KevinMD.
  • On the HIMSS Patient Engagement Day, the following topics were discussed:
    • How to make Patients Your Partners in Satisfying Meaningful Use Stage 2 Objectives; Case Studies in Patient Engagement, session #64;
    • Review Business Cases for Implementing a Patient-Centered Communication Strategy and Building Patient 2.0, session #84;: and
    • Engaging People in Health Through Consumer-Facing Devices and Tools, session #102.
So then, patient engagement is:
  • a strategy
  • a drug
  • a grail (although I already have a grail)
  • a “meaningful use” objective
  • something that requires a business case
  • something that requires “consumer-facing devices and tools” (I already have one of those too).
I hope that clears things up.
So why am I being so snarky about this?  Why make fun of a term used by many people I trust and respect?  I was recently discussing my ideas on a communication-centered medical record with a colleague.  At the end of my pontification, my friend agreed, saying: “you are right; communication is an important part of health care.”  I surprised him by disagreeing.  Communication isn’t important to health care, communication is health care. Care is not a static thing, it is the transaction of ideas. The patient tells me what is going on, I listen, I share my thoughts with the patient (and other providers), and the patient uses the result of this transaction for their own benefit.
But our fine system doesn’t embrace this definition.  We indict ourselves when we talk about “patient engagement” as if it’s a goal, as it reveals the current state of disengagement .  Patients are not the center of care.  Patients are a source of data so doctors can get “meaningful use” checks.  Patients are the proof that our organizations are accountable.  Patients live in our “patient-centered” medical homes.
Replacing patients as the object of our attention (and affection) is our dear friend, the medical record.  We faun over medical records.  Companies earn epic profits from medical records.  We hold huge conferences to celebrate medical records.  We charge patients money to get to see their own medical records.  We even build special booths (portals) where patients are allowed to peer in through a peep hole and see parts of their medical records.
This is why I’ve had such a hard time finding a record system for my new practice.  I want my IT to center on patients, but medical record systems are self-absorbed.  They are an end in themselves.  They are all about making records, not engaging patients.  They are for the storage of ideas, not the transfer of them.  Asking medical records to engage patients is like asking a dictionary to tell a story.
The problem is, documentation has taken over health care.  Just as the practice of a religion can overshadow its purpose: the search for God, documentation chokes out the heart of health care: the communication of ideas .  It did this because we are paid to document, not communicate.  Communication takes time and it is not reimbursed.  Communication prevents unnecessary care, which is a revenue stream.  Communication eliminates waste, and waste is food that feeds the system, the bricks that build the wings to hospitals, the revenue source that pads IT budgets.
So what’s a doctor to do?  I’m not sure.  I am still looking for a solution that will meet the central goals of my practice:
  • Communication – health care is a hassle,  with communication relegated to the exam room.  I want care to be easily accessible for my patients,using IT in one of its strongest areas: tools for easy communication.
  • Collaboration – the patient should be engaged, but in a two-way relationship.  This means they not only should have access to their records, they should contribute to those records.
  • Organization – I want a calendar documenting visits, symptoms, problems, medications, past and future events in each patient’s record.  I also want a task-management system I share with patients to make sure care gets done.
  • Education – I want to practice high-quality medicine, care that is informed by good information and the best evidence.  Why not do a yearly stress test?  There’s evidence for that.  Why not use antibiotics for sinus infections?  There’s evidence there.  Why use an ACE inhibitor to control the blood pressure?  I need to be able to support my recommendations with data, not just “because the doctor said so.”
The point of all of this is the moving of medicine from an industry where money is milked from disease to a communications network where diseases are prevented.  ”Patient engagement” that is done to the patient for the sake of the doctor or hospital is a sham.  Engagement is about interaction, listening, and learning in relationship to another person.  Engagement is not a strategy, it is care.
If only I could find the tools to make this happen.

4 ways to beat time constraints and guide patients to better health

4 ways to beat time constraints and guide patients to better health

As doctors, we’re typically compensated for the work we do, not the hours we spend. Our jobs are structured so that we’re taxed for time, making even the most routine office visit feel like a race against the clock. Trying to develop a long-term strategy with a patient in this context is not time-efficient. It is, in fact, incredibly frustrating.
Yet medicine is a team effort, and we understand that we’re treating people, not algorithms. We know that when patients are more informed they tend to make better choices at home (eating healthful foods), and in our offices (scheduling things like flu shots). Here, four ways to work within our existing time-constraints to help patients shift the needle toward better health.
Direct patients to good information early. Office visits can be chaotic, and one easy way to offer some focus is to start the conversation beforehand. A page of links to credible articles, a series of posts or downloadable handouts, a few minutes of video content, or even just a list of “frequently asked” questions are all easy to add to your website, for example. Early in the appointment, open the conversation up to questions on these topics. Not all patients will have time to look at or think about them before seeing you. Many won’t. However, for those who do, by introducing common reference points, you’re saving time by creating a shared language and structured dialogue from the very start.
Make intake forms available ahead of time. Another great opportunity to maximize efficiency is to make your intake form available before the appointment. Once in the waiting room, patients can feel harried, nervous, or rushed. By filling the paperwork out at home, they not only have time and additional resources to give more considered answers, but they may develop new, relevant questions to bring to the table.
Monitor. When we weigh our patients or take their blood pressure, we’re relying on single numbers from particular moments to make complex diagnoses. We’re only getting thin slices of what’s going on with their health. However, we know that one of the greatest clues in medicine is change over time, so tap that resource. Ask your patients to monitor a few simple things, such as weight, or how much they’re exercising. Nowadays, there are countless devices that make it easy to track, upload, and even share this kind of data, giving you a much richer picture of what’s going on between checkups.
Re-evaluate. As you and your patients continue your conversation over multiple visits, you’re not just getting updates on their progress, but also a deeper narrative of their long-term wellness. On every return appointment, quickly re-evaluate your own advice to your patients on diet, exercise, medication, and specific actions taken based on their medical history (like early screenings). This gives you repeated chances to ask yourself if there are better ways to deal with any of the problems you’re treating.
There is an old adage that rings true in medicine: With enough data, error goes away. The hope is that this multi-pronged strategy of data collection will enable you and your patients to have the best outcome, time after time.
David B. Agus is a professor of medicine and engineering at the University of Southern California. He is the author of The End of Illness and blogs at ZocDoc’s The Doctor Blog, where this post originally appeared.

Digital Agenda / Heart of the matter: who owns your health data? / Digital Agenda / Heart of the matter: who owns your health data?

Heart of the matter: who owns your health data?

03.05.13 @ 09:24
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BRUSSELS - The titanium metal box implanted inside Hugo Campos' chest keeps him alive.
  • Some implantable cardioverter-defibrillators (ICD) are remotely monitored by manufacturers (Photo: stuad70)
The size of a wristwatch, the €20,000 gadget houses a generator, circuitry and a battery with thin wires attached directly to the Californian's heart.
"It took me about a year to get used to the idea of having the implant and understanding how things work," he told EUobserver.
The device - or implantable cardioverter defibrillator (ICD), made by US-based firm Medtronic - is designed to treat dangerous accelerations in his heart rate.
It also collects a lot of data.
An accelerometer inside the device can tell when he sleeps, eats or walks around, when he is quiet or speaking, or if fluids are building up inside his chest cavity.
All of the information is transmitted to the manufacturer via a cloud. It does not go to the doctor, the hospital or the patient.
If something goes wrong, his cardiologist will receive an alert from the manufacturer.
If it is serious, the doctor will inform Campos.
There are many others like him in the US and in the EU. A senior director at Medtronic said her company alone remotely monitors some 750,000 ICD patients worldwide.
There are two more ICD-makers in the US - Boston Scientific and St. Jude Medical.
The only other two firms which manufacture them - Sorin and Biotronik - are based in Italy and Germany.
For Campos, there is something fundamentally wrong with the idea that a private company can own and control his most intimate of information.
There is a worry the ICD firms have too much leeway to hide potential problems.
And there is a broader worry on security.
An Australian hacker in October last year reverse-engineered transmitters to deliver killer shocks to anyone with a pacemaker or ICD within 10 metres of his laptop.
But for others, big data - US health organisations generated an estimated 150 billion gigabytes of information on patients in 2011 - is big business.
It is also an opportunity to make breakthroughs in medical research and to cut the costs of healthcare.
For their part, EU institutions are currently trying to legislate on the complex issues involved.
A new European Commission data protection bill would require ICD makers to share patient information more easily.
But there are many questions to answer.

'We are at their mercy'

Campos has for the past four years been trying to get access to the raw information stored on Medtronic's database - CareLink.
He has not got very far.
"To think that a corporation has more rights or better rights [than I have] on data that is collected from my body is actually a little bit scary," he said.
He suspects that one reason for the firms' reluctance to open up is corporate liability.
"That is the biggest threat to companies - liability - and the patient knowing that the device is not working properly and being able to sue a manufacturer," he said.
"We must rely on the manufacturer to recognise such problems and issue a recall. In a way, we are at their mercy," he added.
ICDs are prone to hardware failure.
Campos said the thin wires that attach the device to his heart are "the Achilles heel" of the system.
The wires, he noted "are very pliable and they often fail and there have been some recent problems with St. Jude Medical and Medtronic."
"The patient may be unaware that the lead has failed but the generator connected to the lead knows there is a problem," he added.
Medtronic issued a major product recall in October 2007.
The problem hardware was already in use in the bodies of over 200,000 patients.
In May 2009, the firm issued a statement that 13 patients might have died because of the defect. Related settlements were finalised in January this year.
It was the "Sprint Fidelis" lead which failed.
A fractured lead can kill a patient if it fails to tell the defibrillator to send an electrical jolt when the heart goes into arrest. It can also send repeated and potentially fatal shocks.
Medtronic had received alerts that Sprint-Fidelis-wired patients were experiencing inappropriate shocks due to lead failure and launched an internal investigation.
It looked at data from a clinical trial involving 650 patients at 17 hospitals and did a subsequent review of data collected via remote monitoring for 25,000 patients with the Sprint Fidelis lead.
The findings led it to issue a recall for all its Sprint-Fidelis-wired ICDs.
Most of the patients involved fed their data into CareLink.
But in some cases industry outsourcing - a small fraction of the patients used a generator made by a competing firm - made it more difficult to react.
"In those cases patient management was more challenging because, even when they had a remote system, data were not collected in the same way," a Medtronic spokeswoman said.

Big opportunities

The potential benefits for industry of owning the data are massive.
The size of the data pool and how it is used has implications for healthcare policy makers and healthcare businesses.
Estimates say the US health industry could save $200 billion if more advanced analytics were used on patients' health data in order to see patterns in product recalls.
"There is really a large value for hospitals, doctors, researchers and companies and individuals," Christope Wild, head of information and communication technology at Innsbruck Medical University in Austria, told this website.
He noted that every ICD manufacturer currently has its own data system, making it hard to share and compare data from one system to another, however.
"There isn't a standard to see which data needs to be stored and there isn't a standard to port this data to another manufacturer," Wild explained.
Innsbruck Medical University last year purchased software to trawl manufacturers' websites.
The software logs in with a given doctor's credentials and then pulls raw data from the ICD companies into the given hospital's electronic system.
But it did not work out.
"They had a preliminary agreement with one of the manufacturers last year, but that failed because of the proprietary system of the manufacturer and the hospital. So even if both parties agree they could work something out it still fails because of the different formats," Wild said.
A Dutch cardiologist at the Leiden University Medical Centre also said hospitals struggle to use the different data formats.
The Leiden centre has developed a common standard and is running a pilot programme to implement it at its hospital.
But only four out of the five ICD makers allowed it to run the pilot scheme for free.

Where does the EU come in?

Wild said EU policy makers need a debate on whether collection and storage of data should remain in the hands of ICD firms.
The EU commission's draft regulation would require manufacturers to export data in an easy-to-use and interoperable format.
The bill says data should, where possible, be in an open-sourced electronic format.
But industry insiders say the companies are unlikely to comply.
Meanwhile, European patients have more privacy than American ICD users.
In Europe, the clinic which performed the implant procedure has custody of "personal data" - name, address or anything else which can identify the patient.
The ICD maker has custody of "technical data" - the patient's heart rhythms, how much battery life the ICD has left - and the technical data is "anonymised."
But academic studies have shown that "anonymised" data can in many cases be used to identify people, posing the risk of "profiling."
Profiling is a practice of collecting information about individuals to make assumptions about them and their behaviour.
It is used by private firms who sell data to insurance companies, banks or employers, who can use the information to make commercial decisions which may harm the patient's interests.
The degree of mistrust in Europe is evident in so-called tele-monitoring.
Tele-monitoring allows a doctor to keep an eye on his patient from a distance, for example by checking their ICD rhythms on a website under an agreement with the manufacturer.
Martin Borggrefe - a cardiology professor at University Hospital Mannheim in Germany and vice-president of the France-based European Society of Cardiologists - noted that tele-monitoring can have big advantages.
A patient who consents to it needs to have check-ups at a heart clinic just once a year.
A patient who declines is advised to do them every three to six months.
Borggrefe said: "Medical devices are implanted by a cardiologist or a cardiac surgeon with full consent of the patient. If remote monitoring is offered, the patient signs full consent after discussing all aspects of tele-monitoring."
In the Netherlands, more than 50 percent of people opt in.
But in Germany, privacy worries mean that some 90 percent of people opt out.
Meanwhile, consent standards vary from country to country in the EU.
In some cases, they pose the question of whether a seriously ill person is in a position to make a free, rational and well-informed choice on whether to go ahead.
In Italy, a patient must sign the manufacturer's contract on paper in a doctor's office. But in the Netherlands, a patient simply checks a box on an online privacy disclaimer.
Another question for EU lawmakers is people's "right to be forgotten."
It remains unclear under EU law whether a person who signs a contract with an ICD maker can later exercise their right to have his personal data deleted.

EU law under fire

For Erik Vollebregt of Axon Lawyers, an Amsterdam-based law firm specialising in life sciences, the draft EU regulation has failed to take on board industry's concerns.
He noted that the bill's language on profiling is likely to create even more mistrust.
"If you look at the definition of profiling that is basically a functional description of tele-monitoring," he said.
He also said the EU's "right to be forgotten" conflicts with existing manufacturers' obligations to keep patient data for at least five years after the last device has been placed on the market for quality control purposes.
Vollebregt warned the law as it stands "includes a lot of measures that are not going to work for health policy."
He added: "They don't put enough depth and nuance in the statute to be able to deal with processing of personal data for health care purposes in a rational way."
Other specialists have their own take on the subject.
Annabel Seebohm, a lawyer at the German Medical Association, says people with ICD devices who enter into a contract with a manufacturer become a consumer instead of a patient.
"The patient in this regard is more of a consumer and so the 'right to be forgotten' would apply. It's not a doctor-patient relationship here since it is with the manufacturer," she told EUobserver.
There is equal confusion in the US.
An American privacy law on health information - Hippa - covers service providers who collect data on behalf of doctors or hospitals.
But when contacted by EUobserver, the US consumer protection agency - the Federal Trade Commission - was unable to say whether Medtronic falls under Hippa because it is a manufacturer, not a service provider, a doctor or a hospital.
The federal commission was also unable to say what Hippa means for patient access to health information, such as ICD data.
Amid the uncertainties, Campos' ICD battery has another three years to go.
He told this website he has nothing against tele-monitoring or other leaps forward in medical technology and practice.
But he firmly believes the US and Europe should enshrine patients' access to their data as a "civil right."
"There is nothing more intimate than an implanted electronic device," he said.

The Other Healthcare Divide: Healthcare Fluency

The Other Healthcare Divide: Healthcare Fluency

Joon Yun, M.D., Contributor
President, Palo Alto Investors (est.1989) Health, Evolution, Business
5/03/2013 @ 1:48AM
The health industry will be the largest creator of wealth in the 21st century . Yet the explosive growth in the health industry could create a new wealth divide. People often talk about the healthcare divide in terms of access to care. It’s now time to discuss the healthcare divide among workers, businesses and investors in terms of wealth generation.
For workers, healthcare education and expertise will be the major factors in achieving success in the healthcare economy.  This expertise is currently rationed out to workers through professional schools, training programs and credentialing mechanisms.  While such rationing may help to maintain appropriate standards of practice, it limits access to the knowledge to succeed in the healthcare economy.  Colleges have limited course offerings in healthcare, and virtually no healthcare instruction exists in K-12 education.
Similar to the better-publicized issue of technology illiteracy fomenting a digital divide, healthcare illiteracy will create a healthcare-knowledge divide.  The state of healthcare education promises divergent job prospects, favoring those who have healthcare expertise over those who don’t.  Job growth in the U.S. healthcare sector has consistently outpaced job growth in the rest of the economy, adding an average of 23,000 new jobs each month over the past year.
For businesses, the capacity to participate in markets for healthcare will be a major determinant of future growth.  Consumer and technology companies have established or are establishing healthcare arms of their businesses.  Examples include Johnson & Johnson, Qualcomm, 3D Systems, and Clorox, to name just a few. Other consumer companies have begun to add health as a value proposition to their products. Examples include omega-3 in food, VOC-free interior paints, minimalist shoes, healthful apps in consumer electronics, health-promoting mattresses and UV-protecting sunglasses.  Look for wellness and health offerings from many other industries including automotive, real estate, travel and leisure.  Companies ignoring the healthcare economy do so at their own peril.
For investors, exposure to the healthcare asset class could be a major differentiator of long-term returns.  Despite the strong case for growth in healthcare, many portfolios remain underexposed to healthcare investments. This is due to lack of domain expertise, fears of regulation and a bias against growth investing as opposed to value investing.  To date, fears of regulation killing the healthcare market have proven wrong.  Every major regulatory change over the last half-century has had no long-term impact on the logarithmic trend lines of increased healthcare consumptions.  While the sector is volatile, the NASDAQ Biotech Index has outperformed the S&P500 Index over the past 1, 3, 5, and 10 years.  Given the increasing average age of populations in the developed world, healthcare innovation and spreading prosperity, signs point to continued exponential growth of global healthcare consumption.
While those who are underexposed to healthcare investment risk getting left behind, there is an even worse (some would say a “nightmare”) scenario.  Many workers potentially face an unexpected double-whammy or even a triple-whammy.  First imagine lacking the training to compete for jobs in the healthcare economy, or working for a company that lacks a competitive position in the healthcare market.  Next, imagine that the worker’s company pension fund underperforms the market due to insufficient investment exposure to healthcare.  For them the healthcare wealth divide may turn into a healthcare Grand Canyon. What are the potential remedies?
For institutions, prudent exposure to healthcare investments could enable them to at least keep pace with the breakneck growth of the healthcare economy.  Indeed, for private and public pension funds including social security, investing in healthcare companies could be the ideal natural hedge to their growing liabilities. The healthcare industry is, after all, directly raising pension fund liabilities by increasing human lifespan.  For individuals, the healthcare knowledge gap needs to be closed through systematic, expanded access to healthcare education for K-12 children and adults alike, perhaps through online and other channels.  The cost of improving the public’s healthcare fluency could be high, but the cost of healthcare illiteracy is bound to be much higher.

Information and tools in untrained hands: crazy, right?

Information and tools in untrained hands: crazy, right?

Value in medicine depends on information – as I said in Let Patients Help, “People perform better when they’re informed better.” It follows that to make patients and families more effective in care, they need to know more.
But one of the most stubborn barriers to patient empowerment is the cultural assumption that since the way professionals learned was hard, you must need to be really smart, and you need to be taught in a carefully thought out, methodical sequence.
Now take 22 minutes and watch this captivating video by Sugata Mitra, winner of the 2013 TED Prize. He gave a computer to slum kids who’d never seen one, and came back a few months later:
What’s going on here?? Well, three years ago The Power of Pull made clear that life has become non-linear: you can go googling for something without knowing what it is – and find it. In a real sense, you pull what you need, rather than having it pushed to you. The whole process assumes that youknow what you’re looking for, and at every fork in the road, you decide which way to go.
Now think about it in medicine. Imagine people with no background at all, learning what they need in this fashion – not top-down, but in what Mitra calls a “self organized learning environment.”Crazy, right?
As crazy as giving slum kids a computer.
What if it worked? What if we found ways to get information – medically useful information – into the hands of people who need it, without adding burden to the people who work in clinics? So that families were better informed on their own, and more aware when they need clinicians?
What if learning what we need became a Self Organized Learning Environment?

Medicaid Expansion - Mental And Financial Health Improve, But No Improvement Shown In Physical Health

Medicaid Expansion - Mental And Financial Health Improve, But No Improvement Shown In Physical Health

03 May 2013   

New findings from the Oregon Health Insurance Experiment show that Medicaid coverage had no detectable effect on the prevalence of diabetes, high cholesterol, or high blood pressure, but substantially reduced depression, nearly eliminated catastrophic out-of-pocket expenditures, and increased the diagnosis of diabetes and the use of diabetes medication among low-income adults. The Oregon Health Insurance Experiment is the first use of a randomized controlled study design to evaluate the impact of covering the uninsured with Medicaid and provides important evidence for policy makers as the U.S. undertakes Medicaid expansion in 2014. 

The study, led by Katherine Baicker, professor of health economics at Harvard School of Public Health and Amy Finkelstein, Ford professor of economics at MIT, appears in the New England Journal of Medicine. 

"This study represents a rare opportunity to evaluate the costs and benefits of expanding public insurance using the gold standard of scientific evidence - the randomized controlled trial. Without a randomized evaluation, it's difficult to disentangle the effects of Medicaid from confounding factors like income and health needs that also affect outcomes," said Baicker, co-principal investigator of the study. 

In 2008, Oregon held a lottery to give additional low-income, uninsured residents access to its Medicaid program; about 90,000 individuals signed up for the lottery for the 10,000 available openings. Approximately two years after the lottery, the researchers conducted more than 12,000 in-person interviews and health examinations of lottery participants in the Portland, Oregon metropolitan area, and compared outcomes between those randomly selected in the lottery and those not selected in order to determine the impact of Medicaid. 

Some of the key findings:
  • Physical health

    Medicaid had no significant effect on measures of hypertension or high cholesterol, or on the rates of diagnosis or use of medication for these conditions.

    Medicaid increased the probability of being diagnosed with diabetes after the lottery by 3.8 percentage points (compared to the 1.1% of the control group who were diagnosed with diabetes) and increased the use of diabetes medication by 5.4 percentage points (compared to the 6.4% of the control group who used diabetes medication), but had no effect on glycated hemoglobin (a measure of diabetic blood sugar control).
  • Mental health

    Medicaid reduced rates of depression by 9 percentage points (compared to the 30% of the control group screening positive for depression) and increased self-reported mental health.
  • Financial hardship

    Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures (defined as out-of-pocket medical expenditures in excess of 30% of household income) and reduced other measures of financial strain.
  • Utilization and access

    Medicaid increased health care use, including use of physician services, prescription drugs, and preventive care.
"The study highlights the important financial protections that Medicaid provides, as well as the substantial improvements in mental health, but does not provide evidence that Medicaid coverage translates to measurable improvements in physical health in the first two years," said Finkelstein, co-principal investigator of the study. 

The current study is part of an ongoing research program gathering a wide array of data sources to examine many different effects of Medicaid, and represents a collaboration between non-profit and academic researchers and state policy makers. A previous study looking at data collected about a year after the lottery found that Medicaid substantially increased health care use, increased self-reported health, and reduced financial strain.
More information can be found at

Support for the study was provided by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services; the California HealthCare Foundation; the John D. and Catherine T. MacArthur Foundation; the National Institute on Aging (P30AG012810, RC2AGO36631, and R01AG0345151); the Robert Wood Johnson Foundation; the Alfred P. Sloan Foundation; the Smith Richardson Foundation; and the Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration); and by the Centers for Medicare and Medicaid Services.

"The Oregon Experiment - Effects of Medicaid on Clinical Outcomes," Katherine Baicker, Sarah L. Taubman, Heidi L. Allen, Mira Bernstein, Jonathan H. Gruber, Joseph P. Newhouse, Eric C. Schneider, Bill J. Wright, Alan M. Zaslavsky, Amy N. Finkelstein, NEJM, May 2, 2013, 368;18

Harvard School of Public Health

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