Category Archives: Advisory Services

Day 47: Succinct Health Care – Is there an app for that?

Succinct (sək-sĭngkt’) adj.

  1. Characterized by clear, precise expression in few words; concise and terse.
  2. Marked by or consisting of few words that are carefully chosen

The other day I was having a conversation with our Director of Membership Experience Stephen Gaines regarding how ineffective and inadequate the current health care experience is for patients.  As our conversation wound around we ended up discussing some principles from Stephen R. Covey’s book, “The Seven Habits of Highly Effective People“. I suggested that Stephen should purchase the book as it is a great read on alot of levels. Before I could even finish the conversation, Stephen had pulled out his iPhone, typed a few things into his Amazon app, and before I had finished my conversational paragraph he announced, “Cool, I just ordered it.”

It gave me pause.

I had thought he was just texting someone or taking notes but rather he was acting in real time on my suggestions right then. Since we were talking about the type of experience we want our members to have, I was struck by how seamless, how effortless, and how painless it was for Stephen to complete a transaction. I thought about the app itself how it had already obtained all of Stephen’s demographic information, his credit card, authentication; I thought about Amazon how they are organized to store, ship, and deliver the book; and I thought about the consumer experience being able to get what they want when they wanted it literally a touch of a button.

The next day Stephen sent a slight smug text that “the book just arrived” – less than 24 hours, to the right place, with the right merchandise, at the right agreed upon price, and all done in an effortless way.

Wow.

Contrast that with your typical health care experience – every turn, every step, every interaction another major roadblock or transactional barrier to get through. Think about how you make an appointment, how you pay for care, how you stand in line for medications, how you wait on hold for answers, how you can’t get what you need, when you need, for a price you can understand, and a manner that is satisfying.

Where is the health care App that could make my interactions with the health system this smooth? What organization or entity is removing these barriers, smoothing out the rough transactional edges, and helping people achieve a seamless, effortless, satisfying conclusion to their health care need? For a long time I have thought about how this could actually work, how you could create a “health care app” that would allow this type of experience to be possible.

Obviously health care is complex; it is confusing, it is a conundrum of the highest magnitude. While reducing this complexity to a “health care app” might not be possible, I think you can approximate this with a health care advisory service designed specifically to abstract all the complexities of health care into a single, succinct experience for individuals.

Crossover Health is attempting to replicate the transactional effortlessness of the above example through our membership programs which include a health care advisory service. Essentially, using our the HelloHealth software platform as the enabling technology, we build membership programs include member concierge services to begin to approach the smoothness and effortless of a health care app. If you want the opportunity to experience this type of care, we look forward to having you join us for impending launch of our Crossover Health flagship store in Aliso Viejo.

Simple. Succinct. Coming soon!

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Day 80: My take on “meaningful use”

Meaningful (mē’nĭng-fəl)adj.

  1. Having meaning, function, or purpose.
  2. Fraught with meaning; significant:

I grow exceptionally tired of the entire “meaningful use” conversation. I see multiple definitions, serious scholarly work, conferences, and an entire industry built up around or attempting to knock down this obnoxious term. Its wearisome . . .particularly when I think the term is meaningless in terms of attempting to get people paid for using specific types of technology. My contention is that the government bureaucrats will never be able to run fast enough to keep up with technology which will outstrip not only their ability to classify it, let alone dictate the terms of its use.

As an example of that, I am using HelloHealth’s EHR platform. It is not EHR certified, it is unclear if it will meet any quality or feature/function litmus test, or some of the other criteria being dreamed up. When I think of “meaningful use” I don’t have to turn any farther than the patients that we serve. Here is an unsolicited email that demonstrates the true and only relevant definition I will ever use:

Thanks for the quick response. Your team took great care of me!!!

The A1c was 5.8 and trending the right way – I’m not sure what it was before. I was 1 point away from being on the good side of the Pre-diabetic equation at 100. I’m not taking any Avandia and have not been for a while now. Based on what I know and what you guys were telling me…I’m going the right way and am right now —ON TOP OF THE WORLD!!!

This goes to show you that everyone at the practice are doing the right thing by providing this program [HelloHealth]. This program shows that if a person like me wants to get better we can control our own destiny – we are in the drivers seat (to a degree). I would have been carrying the BIG Burden that I had to be on meds with this had I not met you!!! My hats off to everyone there. You all did great – thanks for guiding me along the way. I cannot thank you all enough.

And if it was not for YOU – I’d be another prescribed drug statistic.

All the best.

Technology is an enabler that allows me as a physician to be more effective in “laying on of hands” (which has been and will always be the essence of being a physician healer). My ability to impact patients lives for the better is exactly the type of impact that we can and should have with technology. This should be the only meaning of the term “meaningful use”.

I really want everyone to experience health in this way – for everyone to have the privilege of being apart of the next generation of care. That is what we are attempting to build at Crossover Health.

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Health Care Moonshot: The Health Care X PRIZE Development Project

Moonshot (mūn shŏt) n.

  1. Description of the audacious attempt and the subsequent race to place a man on the moon
  2. Used as an analogy to describe similarly gigantic challenges under competitive influence

The best health care book I have ever read, is ironically the first one I was fortunate to pick up. “Redefining Health: Creating Value Based Competition on Results” literally became a life altering experience for me as I read it at a time when I was seeking to redefine my career path. The notions of health care value (outcomes/price), the organizational principles engendered by this approach (focus on the medical condition across the full cycle of care), the competitive forces that this framework unleashes (virtuous cycles of innovation), and the overall promise for improving our deliver system (increased access, lower costs, and high quality) absolutely resonated with me and framed where I wanted to take my professional career.

After reading the book, I immediately set about to capture the key concepts and ideas visually, and to weave the story of value based health care. This effort launched me into the emerging Health 2.0 movement, and illuminated for me a clear path to move toward next generation health care (this is why I always argue for an expanded definition). As the tools and technologies of Health 2.0 began to be introduced into the health care conversation, I also observed that a more systematic approach was being taken to quality, cost containment, health care disparities, payment reform ideas, and the design of a high performance, connected health systems with built in pricing, incentive, and quality transparency.

Subsequent consulting projects in management of health/wealth, direct to consumer laboratory services, new payment models, and ultimately new models of health care delivery, led me to create a new concept of care called “personal health advisory services”. These concepts are now being introduced to a small group of private clients, but more importantly, the notion of new types of health care organizations (Accountable Care Organizations) being created within the construct of a new type of health system (based on value and focused on health vitality as the metric that matters) are infinitely more promising. As part of these developments, I have become convinced that we aren’t going to get there incrementally, with modest improvements, with limited vision, or paralyzed by the “inevitability” of our current staggering national and health sector problems.

I have always dreamed big, and sought impossible challenges, and for this reason I am excited to announce my association with the X PRIZE Foundation as a Senior Health Advisor. This very discrete project (through June 2009) is solely focused on defining a Health Care X PRIZE that can leverage a well described competition as the catalyst for transformative change. Over the coming months, I will be meeting with corporate executives, policy experts, government officials, thought leaders, patient advocates, and others interested in engaging in this work to to define the “health care moonshot”.  The X PRIZE framework has specific competition constraints, a unique investment multiplier effect, and holds the promise of organizing many of the best and brightest reform efforts currently underway in our country. I look forward to working with Dr. Peter Diamandis and Robert Weiss on this very exciting project.

I will also look forward to speaking with many of you, sharing our findings and research as we proceed, and engaging the broad health community and ultimately our entire country to join in the inspirational effort to transform our health care system.  Please feel free to contact me directly with your interest, your X PRIZE ideas, or to discuss how you can help be a part of the “Health Care Moonshot”.

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Personal Health Advisor: The Perfect Care Coordinator

Coordinator (kō-ôrdn-ā’shən) n.

  1. The act of coordinating
  2. The state of being coordinated; harmonious adjustment or interaction.

I am finishing up some more of my postings related to the Innovators Prescription, but prior to do so I wanted to highlight a key insight mentioned when evaluating the disruptions required to help the Primary Care system to become more effective:

“We have concluded that a personal adviser of some sort truly needs to be available to direct patients who may not know where to go, so they can find the care they need, and receive that care through the appropriate business models. Many of those who write and speak about reforming health care have called this adviser an Accountable Care Organizationone whose perspective enables it to orchestrate the health care that individuals consume.

Dr. Elliott Fisher and his colleagues at Dartmouth College have played a leading role in promoting the concept of the Accountable Care Organization. It is an entity that can guide each patient to the right provider at the right time, given the job he or he needs to get done, linking the more focused and specialized care providers together with the personal electronic health records.  Some have likened this adviser as a medical “On Star” button, referring to the button in General Motors cars that motorist can press whenever they get lost or need help.

Still others have encouraged the notion of a patient-centered medical home, a model of care in which a single individual, – most often a physican – serves as the first point of contact for the patient, coordinates the entire team of providers, and integrates care across all institutions to ensure quality and safety.

We have concluded, however, that assigning this role to an independent primary care physician’s practice is a bad choice. It forces those practices into comingling business models, with the result that they are integrated inadequately for the jobs pateints need to do, and imposes accountability for areas of care that are often beyond the coordinator’s control. Furthermore, the information, skills, and perspective required to play the role of an effective advisor are not uniquely instilled in physicians.  With this burden placed on others, primary care doctors can practice medicine, which for most is the career they thought they had chosen in the first place.

I find this so insightful because this line of thinking was the exact job that  Crossover Health was designed to perform for individual consumers. The service concept behind Crossover (aggregate, analyze, and advise) appeals to individuals and sponsoring organizations  who value their health as an asset and want a trusted advisor to help personalize and assist in managing it as such. The technology that Crossover is developing/evaluating will also help make this mass personalization scalable to address what I perceive will be a large and growing need among consumers as the health care system continues to fragment in the coming years.

Stay tuned for some announcements from Crossover in the coming weeks.

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Filed under Advisory Services, Consumerism, Crossover, Entrepreneurship, Innovation, Transparency, Uncategorized, Value

Launch: Personal Health Advisory Services

Crossover (krôs’ōvər) n.

  1. The adaptation of a musical style, as by blending elements of two or more styles or categories, to appeal to a wider audience.
  2. A recording designed to appeal to wide or diverse audience

    I have been blogging for just over two years at Crossover Health while also working as a strategic consultant in the area of health care innovation.  I have had the privilege to work with some promising companies, some great people, and some excellent ideas during that time. However, I have also been working on some of my own concepts based on the things that I have been observing.

    Crossover Health recently launched its beta version of personal health advisory service to South Orange County residents and employers. Crossover Health provides a new category of health offering, called personal health advisory services, which are designed to provide members with a personal medical advisor to oversee and coordinate all aspects of their health and wellness. The new service appeals to individuals and families with high deductible health plans, those wishing to establish a medical home, and physician groups wanting to augment their concierge medicine offering.

    Given that consumers remain bewildered by the opaqueness of the health care industry, Crossover was modeled after the financial services sector (unfortunately a tough analog right now) where wealth advisors provide a single point of accountability, a source of professional analysis, and a trusted advisor actively involved in the long term management of assets. I believe an individual’s health is the most valuable asset they possess and would benefit from the oversight of a health advisor devoted to helping members achieve optimal health care value. The service is being phased in regionally beginning in the south Orange County, California area with the first clients coming on board in February.

    Several innovative concepts have been tied together in the new service offering. Each members is invited to create their “Health Portfolio” which serves as in depth review of their health status and objectives. In addition, a Personal Medical Office is created whereby all health related statements, bills, and benefit statements are routed. Crossover care coordinators ensure this information integrates into the members electronic health record. A care team led by a Personal Medical Director oversees the individuals care, and coordinates between providers, proactively alerts to health improvement opportunities, and is available for consultation as needed by members who are advise on how to obtain maximal health care value.

    The service is provisioned through the unique Crossover “XHR“, a ubiquitous health record platform utilized by Crossover members, their physicians, and partner organizations. The XHR integrates a comprehensive electronic medical record, with multi-media communication technologies, and all the administrative and financial transaction capabilities required to administer the Personal Medical Office. The XHR will continuously learn from the experience of the members , including the pricing (and hopefully the outcomes) information, that will enable a deep knowledge of the local health care market to be shared across the Crossover Network. Three service levels are available, including the management of a members Health Finance Portfolio which actually functions as a bill pay service for all health care related expenses with a single monthly fee.

    I believe we are entering a new era of personalized medicine where millennial patients will expect a high-service, low-hassle, integrated method to manage their health assets. Inspiration sources for the Crossover Health personal health advisory concept included the information integration avaiable through Mint.com, the service enabled network of athenahealth, and the robust change:healthcare transparency platform as the foundational price transparency tool. This new Crossover Health service, while still somewhat experimental and limited in geographic scope, will continue to complement my strategic consulting by providing a working model of the type of disruptive innovation that should help members cross over into next generation health care.

    Do Good. Be Well. Enjoy Life.

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    Filed under Advisory Services, Change Agents, Consumerism, Crossover, Entrepreneurship, Health 2.0, Innovation, Quality, Transparency, Value

    Twittering Scott Shreeve, MD: What are you doing?

    Tweet (twēt) n.

    1. A weak chirping sound, as of a young or small bird.
    2. A “Tweet” is an individual message (or “update”) posted from Twitter.

    Twitter is an interesting application with a very simple premise – your friends and associates are actually interested in knowing “What are you doing”. These “tweets” are constrained to 140 characters and for a wide variety of reasons people are actually interested to follow these micro-updates. As with most technologies, the original somewhat superfluous reason for which it was created has begun to find new uses, in new settings, and to be adopted by an ever expanding base. Interesting to watch and follow.

    The premise of Twitter – What Are You Doing – has stuck with me during the last several months that I have been using this new tool. The reason for the reverie is the unsettled feeling I have had for the last two and half years since an acrimonious departure from my former cause. When you pour your heart and soul into something, only to have the dream denied for completely preposterous reasons, it takes some “gathering time” to reinvent yourself, or more appropriately realign yourself with a cause worthy of passion to which you can devote.

    There is a recent precedent for this. While I do not support his politics, you cannot help but acknowledge former presidential candidate Al Gore for creating the template for this type of career recharging. After losing the highly contested election in 2000, in the most bitter way possible (won the popular vote, miscounting hanging chad’s, and judges determining the outcome), he had to gather himself. As the bitterness began to eat away at him, he realized that he needed a new cause, to redeploy his focus, and redirect his passion. The election had caused him to “fall out of love with politics”, and so he took up his other passion, the environment. His prodigious effort was captured in the award winning film an Inconvenient Truth which ultimately led to his winning of a Nobel prize. Impressive.

    This past October, Steve and I quietly celebrated the one year anniversary of our own career freedom. After being handcuffed for 18 months in litigation, I have taken the last 12 months to re-engage in the broad and emerging Health Consumer space (is Health 2.0 a better term?). I started blogging about two years ago, and was immediately awakened to the possibilities of this new communication medium. I started connected with fellow sojourners, interested in reforming health care to create a true health care system based on the principles of quality, access, and value. I had wonderful opportunities to engage as a consultant with MyMedLab, HealthEquity, Lemhi Ventures, and most recently San Francisco On Call. My efforts have been focused on health care information technology, finance and delivery innovations, and open collaboration.

    So what am I doing now?

    Essentially, I have been focused on bringing in a new era of health care, enabled by technology, enhanced by open collaboration and shared learning, and tailored to each person who is accountable for their own health care decisions. Essentially, I want to “tear down the walls” that have prevented the free flow of information, failed to deliver outcomes consistent with the price we pay, and hindered the creation of true health care “system” that we as Americans demand. One patient, one process, and one system at a time.

    I am still currently working as a consultant to innovative organizations seeking business acceleration in the consumer health space. I am currently engaged in an awesome project that will be unveiled before the year is out – great concept, great team, and great opportunity. I have also been contacted by Ingenix, Walmart, and other larger players about potential collaboration opportunities. Even while consulting, I have continued to evaluate, design, and test out some new concepts which tie all my interests and consulting work together back into a new concept that Crossover Health will be introducing. It will serve as an extension of my consulting services, but may very well evolve into something much more.

    Just in case you were wondering. Stay tuned.

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    Filed under Advisory Services, Consumerism, Crossover, Direct Practice, Entrepreneurship, Health 2.0, Innovation, Value

    Cease and Desist? How about Understand and Resist!

    Desist (dĭ-sĭst‘) v.

    1. To cease doing something; forbear.
    2. To abandon, break off, discontinue, give up, leave off, quit, relinquish, remit, or stop.

    I have been following health care consumerism for several years now. Particularly, the “Direct Access” or “Direct To Consumer” laboratory testing market. While analytic lab testing has led out in this area, genetic testing has received all the regulatory attention, national press, and policy efforts (GINA).

    So it is no surprise that consumer genetic movement would be the first legal test of the Health 2.0 movement. As reported by Matthew Holt, and a host of national outlets (Wired has had extensive coverage here, here, and here), there seems to be quite a hornets nest unleashed by our friends at the California and New York Departments of Health who are attempting to prevent consumers from accessing their own genetic information.

    Thanks to some transparency efforts of the blogosphere, you can read the actual cease and desist letter written by Karen Nickels, the California Department of Pubic Health Chief of Laboratory Field Services. I actually know Karen Nickels personally. She has been a long time steward of ensuring regulatory exactness of all things laboratory within the State of California for 30+ years. She has a well deserved reputation as one tough cookie for the “precision” with which she carries out her duties

    Ultimate Genetic Fighting - Which Genetic Variation Wins?

    In my interactions with her, she was succinct, well versed, and uncompromising on her interpretation of the letter of the law. With great effort, and mutual patience, I was able to convince her that the letter of the law has fallen way behind the speed of technology and that adaptions would need to be made to the consumer laws to account for the new direct to consumer analytic testing market. To her credit, she was able to recognize my points and make accommodations that acknowledged some technical advances yet remained consistent within her interpretation of the current regulatory framework.

    Unfortunately, the letter which has been made public seems to once again misjudges the product offerings, misunderstands how the solution is offered, and misinterprets the situation while regressing back to a very narrow interpretation of the law and myopic view of consumer testing.

    Here are the nuts and bolts of the letter:

    1. All clinical labs receiving CA specimens or processing specimens originating in CA must possess a valid CA clinical laboratory license or registration (CA Business and Professional Code Section 1241)
    2. Consumers are prohibited from ordering tests (with a few FDA approved exceptions) without a physician order (CA Business and Professional Code Section 1288).
    3. Finally, in order to obtain a CA clinical laboratory license, organizations need to provide satisfactory documentation to verify that laboratory tests being offered meet performance specifications

    These are all well and good and reasonable requests from the regulatory agency. Unfortunately, the CA Department of health immediately leaps to the conclusion that these companies don’t possess a license or a physicians order and therefore must not be meeting the requirement. Furthermore, in the most egregious abuse of personal liberty, the letter goes on to say that GENETIC TESTING IS PROHIBITED FOR CALIFORNIA RESIDENTS.

    Say what?

    I salute Navigenics and 23andMe as they give their own form of salute to the CA Department of Health. These companies are absolutely RIGHT and the CA Department of Health is absolutely WRONG in this case.

    Navigenics and 23andMe use third party labs that ARE licensed by CA regulatory bodies to process the genetic samples and perform genetic testing. I am certain that these labs absolutely meet every criteria and CLIA performance specification accepted by the CA Department of Health. Furthermore, I am positive that both Navigenics and 23andMe have CA licensed physicians who approve consumer orders and release results to consumers all within compliance of every CA law governing physician fudiciary duty. And finally, as a consumer, I want to let the CA Department of Health know that I have every constitutional right to order any test I want (particularly when I am paying for it) that does not cause me direct harm, inure harm to others, or misdirect scarce public resources.

    Having met the criteria above, on what basis does the CA Department of Health have to issue “Cease and Desist” letters to these companies? They are concerned that the tests costs too much? They are concerned about false marketing? They are concerned about accuracy of labs THEY have already certified? It’s actually quite embarrassing given that the Department has completely misunderstood how the process works and how technology is enabling people to learn more about their health than ever before.

    The appropriate solution is for CA Department of Health to create a forum where their regulatory concerns can be aired out, and the companies can explain to the department how their technology, the business models, their testing and compliance framework, and their overall objectives are consistent with the laws. Navigenics CEO Mari Baker has just requested such an opportunity.

    Conversation or Cat Fight? Two fiercely independent woman. One intractable issue. Millions of dollars at stake. Tens of millions of people watching. Vegas odds, anyone?

    Lets get ready to Rummmmmbbbble!

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    Filed under Advisory Services, Consumerism, Health 2.0, Innovation