Author: Brian Klepper

William Bestermann, MD

No matter how far up the food chain you are, the failure to reform US healthcare puts you and those you care about squarely in the crosshairs of physical and financial catastrophe. Almost everything that you love about life depends on your health. You may have the wherewithal to have a vacation home and a yacht. You may have access to the best interventional cardiologist, but almost no one has access to optimal medical therapy to treat and prevent chronic conditions.  

No one has access to the best new science and systems because of an abject failure of leadership at multiple levels. If you don’t get best practice medical treatment and develop a heart attack with congestive heart failure, your endurance and enjoyment of life will be diminished. The failure to improve health and lower costs creates a medical financial bubble that puts every segment of our economy at risk. Men will frequently ignore their own health for a dollar, but are you really ready to throw your spouses, parents, and best friends under the bus? Are you ready to put national security at risk? Really?

Moneyball tells the story of a team manager who turned baseball on it’s ear by using data, evidence, and systems to do more with less. Money medicine isn’t like that. Money medicine defends old expensive treatments that are proven ineffective, while failing to apply new data, evidence, and systems.

We know how to do this. We know how to develop a system that serves patients and voters. The way forward has been spelled out in detail years ago. The Institute of Medicine (IOM) brings together the best and brightest in American healthcare to provide advice on health policy. In 2001, the IOM called for drastic change and provided a roadmap for reform that has been entirely ignored. Nothing has changed 18 years later.Read More

Al Lewis

The wellness withhold provision in the Affordable Care Act codifies the CDC’s  2009 “Call to Action” about chronic disease: The Power to Prevent, the Call to Control. On the summary page, we learn some of what the CDC calls “arresting facts”:

  1.  “Chronic diseases cause seven in 10 deaths each year in the U.S.”
  2.   “About 133 million Americans — nearly one in two adults — live with at least one chronic illness.”
  3.   “75% of our healthcare spending is on people with chronic conditions.”

More recently, they decided that 75% was not a high enough statistic to get people’s attention, so they changed it to 86%. Most recently, they’ve upped the third statistic to 90%. More on that later.

The most “arresting fact” is how head-scratching these CDC claims are…and of how they created the wellness legend.

Take the first statement — “chronic diseases cause seven in 10 deaths.” We have to die of something. Would it be better to die of suicides and homicides? Mercury poisoning? Barbecuing rattlesnakes?

The CDC’s second statistic is also a head-scratcher. Only 223 million Americans were old enough to drink in 2009; divide 133 million into that number, and you see that a whopping 60% of adults, not “nearly one in two,” live with at least one chronic illness. So they got that part wrong but…Read More

Brian Klepper It seems inevitable that, in the near future, an innovative health care organization is going to seize the market opportunity, gradually cobble all the pieces together, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than has...

Brian Klepper In this issue’s guest essay, VIVIO Health’s CEO Pramod John guides us through four sensible drug policy changes and supporting rationales that could make drug pricing much fairer. Reading through it, one is struck by the magnitude of the drug manufacturing industry’s influence over...

Ron Donelson No area of clinical over-treatment is as egregious as musculoskeletal (MSk) care. Mis-diagnoses resulting in mis- and over-treatment and wildly excessive spending are especially blatant within low back pain (LBP) care. The conventional LBP clinical exam and imaging diagnostics are unable to identify an...

Brian Klepper

All growing health care organizations struggle for visibility. Within the vast health care universe, thousands of companies strive to be noticed as better and different than others competing in the same spaces. Organizational health care buyers face an overwhelming signal-to-noise challenge, trying to discern whether programs improve quality and cost and, if so, by how much. It’s a market beleaguered by untrustworthy information, and it’s an arrangement that favors vendors’ interests, at purchasers’ expense. Those delivering higher value – consistently better health outcomes and/or reduced costs – may be surprised to find lukewarm reception from the health plans they thought would be eager to learn of new ways to deliver better results. The cold reality is that most health plans make more if health care costs more. Only organizations that are at financial risk for management of quality and cost – e.g., fully insured health plans, managed Medicaid plans, Medicare Advantage plans – are likely to be eager for approaches that can streamline processes and improve outcomes.Read More