A group of 20 doctors specializing in brain, spine, and orthopedic surgeries announced that it will shutter its hospital on Chicago's North Side and join suburban hospital operator NorthShore University Health System. The major shareholder in the hospital from which the doctors operate, Neurosource Inc., needed to find a larger, more capitalized partner amid the push for healthcare reform that threatens to squeeze how much medical-care providers are paid, its spokesman said.
With the debate over President Barack Obama's healthcare reform bill raging on Capitol Hill, some physicians are carving out their own path to reform that involves eliminating barriers to care and improving the doctor-patient relationship through the use of technology.
"The health system has been moving in the wrong direction," says Sean Khozin, MD, MPH. "People talk about healthcare reform, but no one is talking about what happens between a doctor and a patient. We have to pay much closer attention to the way that doctors and patients interact and transact and enhance that process because that's where care is delivered."
Khozin's futuristic Brooklyn, NY-based practice is unlike any other. It is powered by Hello Health, a secure, Web-based platform that includes a practice management system, an electronic medical records system, and a social networking tool that allows physicians to communicate with patients both online and face-to-face. Another Hello Health practice is scheduled to open in the West Village. Both practices serve as the beta testing grounds for the product, which was developed in collaboration with a Quebec-based technology company called Myca.
Creating improved access to care
According to Khozin, ER overcrowding doesn't happen because of the uninsured. It happens because patients can't access their primary care doctors when they need medical attention.
"Despite the fact that you have to wait at the emergency room for five hours, at least you get seen the same day," he says. "In my practice, you get an appointment the same day or within 48 hours."
After a patient establishes a relationship with a Hello Health doctor, he or she can use e-mail, video chat, instant messaging, or phone to reach their physician to ask questions, obtain test results, and to conduct other matters which would typically require an appointment in the office.
"We establish a relationship with a patient and we do a lot of the follow ups and care coordination online," says Khozin. "We cut down on the number of unnecessary visits while giving patients different channels of communication with their doctor."
Patients still have the option of scheduling an appointment if they have a problem that requires attention, but he has found that most of the time he can conduct patient follow up visits remotely.
While not all patients feel comfortable using technology to communicate with their physicians, Khozin says they learn over time and with his encouragement. He expects that more and more people will begin relying on technology to communicate with healthcare professionals.
While video-chatting with your physician may sound out of the ordinary now, Khozin predicts that it a few years it will be commonplace for a large segment of the population. In fact, today's young generation will more than likely expect this type of communication in the future because of the way that they have embraced technology and integrated it into their lives.
For example, the company is conscious of how popular smart phones have become. According to an April report by Manhattan Research, the number of physicians using smart phones more than doubled to 64% over the past year. In response to this growing trend, the company is in the process of developing applications for use on the Apple iPhone to address the needs of patients and physicians who want to communicate using smart phones.
"A smart, health IT company builds products for devices that people already have."
Khozin currently uses his iPhone to e-prescribe, review test results, e-mail, and graph and trend disease information for patients while they are in the office.
He says that with diabetes and heart disease on the rise, physicians need to engage patients and pull them into the process of care by allowing them to use online tools to better track their health and communicate information remotely.
For example, patients with diabetes would be able to submit their glucose levels online to Hello Health and have their physician monitor their results and respond to them if necessary—all without an office appointment.
"We can't rely on office visits alone anymore," he says. "Even if you have a chronic disease and you see your doctor four times a year, the rest of the time you're on your own. By connecting a doctor virtually with a patient, you can ensure continuity of care."
Building a Hello Health "ecosystem"
When physicians conduct an in-office or remote transaction with a patient, it automatically becomes part of that patient's electronic medical record in the Hello Health platform. The patient can view their medical record at any time. In addition, other physicians in the practice who see the patient and have access to the system can also view the same information.
The company plans to develop regional "ecosystems" on the Hello Health platform that will consist of a group of primary care doctors and specialists who can communicate with the patient and with one another in a patient-centered environment. Khozin says that specialists are beginning to participate in the Hello Health platform in New York and he expects similar ecosystems to be launched throughout the country.
"There's a lot of ways this technology can be implemented in terms of coordinating the care of complex patients, such as cancer patients," he says. "It's so difficult to really take care of these patients because of lack of access to the right information when you need it."
An elegant platform to replace Frankenstein systems
L. Gordon Moore, MD, a family medicine physician, has been waiting for a product like Hello Health to come along for quite some time. He is credited with pioneering the Ideal Medical Practice (IMP) philosophy. Physicians who subscribe to IMP concepts operate low-overhead, high-technology practices that provide patient-centered care that is efficient, effective, and accessible.
To run these types of practices, physicians often piece together many different pieces of technology to build a grassroots version of what Hello Health now offers. They pull together billing systems, appointment schedulers, and bare bones EMR applications to come up with a complete, albeit imperfect, package.
"Other docs have picked up this Frankenstein system, and it's hard," he says. "They're pouring money into IT to finesse this Holy Grail of interoperability, which is almost an illusion."
By comparison, Moore describes Hello Health as an "elegant platform." "It manages relationships like nothing I've ever seen," he says. "It's really the best IT solution that I've seen out there so far."
Moore is in the process of developing Hello Health University for the company. It will educate physicians who are about to launch their own practices using the platform. The tool will provide the physicians with assistance on everything creating a business, deciding whether to hire staff, and purchasing office space.
Cash-based practices
The company will offer the platform to physicians free of charge and collect a fee for each transaction.
"If physicians aren't seeing patients on the platform, they're not paying for anything," says Khozin. "If they see a patient and a transaction occurs, then a percentage of that goes to Myca/Hello Health."
The Brooklyn Hello Health office is operating a cash-based, concierge practice, since most insurers do not pay physicians for the phone, e-mail, video chat, or instant messaging services that they offer. A concierge practice allows patients to pay for this service themselves, and many patients are more than happy to do so for the added convenience of being able to access their healthcare provider. The Brooklyn practice does not accept insurance, but they will provide paperwork for patients who want to submit claims for reimbursement.
Moore says that Hello Health is one of the few venues where practices are able to completely cut loose of all the rules and impediments, allowing them to perform e-care when it makes sense because they don't need to worry about receiving reimbursement from an insurer.
Initially, Moore expressed concern that some patients may skimp on vaccines, tests, and the like if they participated in a cash-only practice. "There are a lot of people who think that if you care about healthcare, then you'll get out your wallet and pay for it," he says. "I don't think that applies to everyone."
His concern was assuaged when he learned that the platform allows physicians to determine their own price structure and payment policies. Even physicians who cater to vulnerable populations such as the uninsured, unemployed, or underserved can opt to charge as little as $25 per transaction.
"There are wonderful programs that are cash-based and accessible to a huge slot of the population," says Moore. "What I was initially interpreting as concierge, breaks open to a pretty full practice model. Those who can afford it can be a very large slot of the population depending on how you set up the pricing."
According to Moore, the company has plans to incorporate back-end billing into the platform in the future so that practices can use the platform to bill insurance companies.
A practice platform for physician "entrepreneurs"
According to Khozin, many physicians from across the country have contacted Hello Health to express an interest in using the platform for their practices. It has selected approximately 20 physicians to become part of their beta test.
"We're starting a process to educate and empower other doctors to start using the platform so they can lower their overhead and start practicing medicine in a more meaningful way," he says. "Right now, not only are patients unhappy, but a lot of doctors are unhappy. Their overhead is so high, they have to see 30 to 40 patients a day to stay afloat."
Khozin says if physicians can lower their overhead, cut down on the number of unnecessary visits, and conduct virtual visits instead, then they can have more meaningful interactions with patients and, as a result, operate a sustainable medical practice.
"They can lower their overhead, better communicate with patients, and generate more revenue," he says.
Physicians interested in the platform generally have an entrepreneurial spirit, says Khozin. The platform appeals to physicians who want to build stronger relationships with their patients to deliver effective care—something most physicians want but find difficult to achieve due to the administrative work they must complete to receive reimbursement from third parties.
"This allows a viable way of actually running a practice and making a living," says Khozin. "The traditional way has become very abrasive."
Cynthia Johnson is the editor ofMedicine On The 'Net, a monthly newsletter from HealthLeaders Media.
The number of people using social networks around the globe continues to climb, as Internet users are starting to focus their digital life around single networks, rather than many specialized tools with social features. Universal McCann's "Power to the People: Social Media Tracker" study found a major increase in the percentage of US Internet users with a social network profile between 2008 and 2009.
Internet users have been going to the Web to find health information for years and have been perpetually growing in number—until now. New data from Harris Interactive's annual survey on the popularity of online health searches shows that the amount of people searching the Internet for health information may be leveling off. The percentage of Internet users who have researched health issues online peaked at 84% in 2007, then dropped to 81% and 78% in 2008 and 2009, respectively.
Finger painting is generally an activity done by kindergarteners in a classroom with scaled-down furniture, not by physicians, employees, and volunteers in a hospital. But for Miller-Dwan Medical Center's foundation this childish activity was the perfect kick-off to its "You touch lives" campaign.
The Duluth, MN, foundation embarked on the internal communications campaign in an attempt to increase the number of employee donors. Working with Duluth ad agency H. T. Klatzky & Associates, the foundation created a brochure and poster promoting donations and featuring hand prints from the finger-painting event.
"We then took some of their handprints and incorporated them into our design," said H.T. Klatzky's Assistant Creative Director Diane Tobin in a case study. "This brochure detailed some of the year's highlights, as any annual report piece might do, but there was a twist—when unfolded, the piece turned into a beautiful, inspirational poster."
Since the campaign launched the Miller-Dwan Foundation has seen a 20% rise in donations and an increase in the number of donors.
"The posters are often seen hanging in offices and around the facility; and activities like the finger painting attracted dozens of participants," Tobin said. "Normally, only about 25% of nonprofit foundation employees give to their employer; at the Miller-Dwan Foundation, it's 48%."
On both sides of the political isle, there is agreement that our healthcare system needs meaningful reform to lower costs and expand coverage to the uninsured, and it needs to be done now. The key question is how to lower costs.
For the past four decades, a host of "managed" strategies have been deployed that include price controls (Medicare), controlling the doctor's pen (managed care), denying care (benefit design), and other restrictions, as well as wellness initiatives—all failing to reduce healthcare cost increases, which have risen at three times the consumer price index.
Democratic leadership released legislation that builds on these failed practices. Why have they failed? It's because they have not addressed the underlying reason for our escalating utilization of healthcare services—consumer behavior.
A significant disconnect exists in our current framework that disenfranchises the individual from the financial ramifications of their day-to-day lifestyle and health-related decisions. One hundred fifty million people get their health insurance from their employer, their rates set on a group basis. Eighty million get their coverage from the federal government through Medicare and Medicaid, again community rated. Where is the financial incentive for individuals to embrace personal responsibility for their health status and reward the right behavior when third-party payers are paying the tab, and pricing is set on an aggregate basis?
Add to this the rich benefits offered by employers fueled by its tax advantages—i.e., employer-provided health insurance is not taxed, so every $1 offered in benefits is worth $1.50 to the employer—and you have a formula that has caused the employee to be removed and disengaged from the actual cost of providing their care.
These perverse mechanics have driven the alarming acceleration of risk factors well documented to be behind our cost problems: Obesity, chronic conditions (diabetes, congestive heart failure, cancer, COPD, and asthma), poor diet, and sedentary lifestyles.
This setup is analogous to charging all drivers the same auto insurance premium regardless of whether they had a perfect driving record, or had a history of accidents and speeding. What effect would it have on driver's habits if they knew their driving record had no impact on their premium? Yes, a collective shudder at the thought.
The same holds true in financial services, where one's credit score, their track record of paying debts, is relied on to make decisions on one's creditworthiness. What happens? Many monitor their scores to ensure the most favorable financing rates.
In other businesses, consumers consistently demonstrate that financial rewards are the most effective at influencing their behavior. As examples, we now pump our own gas to save 3 or 4 cents a gallon, shop at big box home improvement stores to do it ourselves, and push a cart around warehouses to buy mutant sizes of goods with the goal of savings. In healthcare now, the consumer's pocketbook is not part of the equation, and that must change. Fundamental reform must start with six corrections in order to lower costs by creating a truly retail healthcare marketplace that brings transparency, choice, and portability:
1. Taxing of Employer Health Insurance. Right now, employers are burdened with selecting a health plan or plans that fit all of their employees—an impossible task the larger the number of employees covered. More importantly, the employer health insurance tax deduction is the largest tax entitlement, worth $1.5 trillion over 10 years, and would not only pay for the expansion of coverage to the 46 million uninsured, but also produces a $500 billion surplus to pay for needed subsidies outlined below. Consumer coverage would then not be affected by job change or loss, bringing much needed portability peace of mind.
2. Mandate All Have Health Insurance. Everyone must have car insurance to protect against catastrophic injury and cost on our roads, and carry homeowners insurance to protect their home in order to obtain a mortgage—the same protective safeguards apply to themselves. Onerous existing regulations on benefit design need to be replaced with flexible approaches that allow consumers to choose the right coverage for their needs. Insurers must accept all applicants—no pre-existing condition exclusions.
3. Price and Quality Transparency. In what other industry do customers (and their surrogates, providers) order service without knowing the price or quality record other than healthcare? Legislation should ensure prices, and outcomes/quality results for all healthcare services and products are clearly communicated to consumers before or at the time of service enabling a cost benefit decision aligned with other efficient markets. Comparable transparency principles now being applied to protect consumers in financial services have relevance in healthcare.
4. Subsidies for Low-income Consumers. Direct the $500 billion surplus generated by taxing employer health benefits toward extending coverage to all qualifying individuals and families, with the goal of having all 300 million U.S. citizens covered.
5. Choice. Drive efficiency by giving consumers the ability to choose their preference—in health plans, providers (both physicians and hospitals), ancillary providers, retail clinics, and other healthcare menu items. The existing 1,300 health plans provide ample competition and options, there is no need for a federal sponsored public plan to "keep them honest." Empower consumers with information, and they have a demonstrated track record of "finding the cheese."
6. Standardize Health Information. Aren't we all tired of filling out those exhaustive health questionnaires when we see a doctor or apply for insurance? The technology has existed for years to make immediately available electronic medical records and the transference of data that would significantly enhance decision making by all healthcare constituencies (providers, consumers, health plans, etc.) and lead to better outcomes. This is an area that the federal government can and should facilitate—now.
Eighty-five is an important healthcare number. It is both the percent of Americans now covered by insurance (255 million), and the percent of each dollar, or more than $2 trillion annually, spent on care for patients. It's imperative we get reform right, to protect and ensure both these percentages move in the right direction.
Now is the time to enact legislation that creates a robust retail marketplace that properly aligns economics to facilitate the behavioral change critical to reducing healthcare costs.
Rob Tazioli is a 25-year veteran of healthcare and has served as an executive and entrepreneur. He cofounded two business process outsourcing healthcare companies: Connextions and VIHMS, and was chief marketing officer at HealthNet and Matria Healthcare. He also led the mountain region for Prudential Healthcare.For information on how you can contribute to HealthLeaders Media online, please read ourEditorial Guidelines.