Satyanarayan H.

I’ve been given advice that the fastest way to monetize HER Heard without charging the end user (woman) is trackers and selling data. Instead, I’d like to build something more trustworthy. I don’t want to be in a headline like this. If you are not paying, then you are the product (you/your data are being sold). There are newer ways to deindentify data or even to aggregate things women search for that can be of interest to various stakeholders. In theory that could be okay to sell, but in a post-Roe world with laws encouraging bounty hunting, I am vetting the choices ahead. I am all for moving fast, without breaking things.

6

Like an unfazed young quarterback who keeps firing it downfield despite a spate of interceptions, CMMI keeps tossing around VBC models hoping something will connect. Contrary to its intent, CMMI's programs increased spending by $5.4 billion from 2011-2020 with another increase in net spending of $1.3 billion by 2030. Of the more than 50 models the Center has implemented, only 6 have generated "statistically significant" savings. Only 4 (Home Health Value-Based Purchasing, Prior Auth Model for Non-Emergent Ambulance Transport, Diabetes Prevention Program, and Pioneer ACO) were certified for expansion. CMMI points to the voluntary nature of the programs as a challenge to achieving cost savings. However, CMS hasn't done itself any favors here by aggressively ratcheting down payments and making downside risk >>> upside risk. (Notably, two upcoming programs -- TEAM and Inpatient THA/TKA PROMs are mandatory). Finding the VBC sweet spot was always going to require some trial and error. Perhaps CMMI has learned from the programs that failed or weren't chosen for expansion. TEAM doesn't seem to be all that different from CJR. Making Care Primary aims to closely integrate primary and specialty care (or, more likely, incentivize PCPs to take on more of this work). Not surprisingly, one of the criticisms is lack of provider input. The programs are too complex, too expensive to administer, and aren't transparent. CMMI should take note of several studies demonstrating the success of physician-led VBC efforts. Here are some other thoughts: - Offer financial grants in 5- or 10-year terms for any organization that designs its own VBC program and presents a reasonable and viable clinical/business model. CMMI would do itself a favor by partnering with or at least listening to innovators. - Medicare Advantage complexity and risk adjustment handwaving shouldn't be the only mechanisms by which advanced providers can profitably care for beneficiaries. That program isn't saving money either, but it's the only way many of these approaches can generate meaningful revenue (and most still aren't profitable). - Have regular meetings with those building VBC models, particularly those with strong physician leadership. Those meetings should be transparent and productive of action plans and iterative changes that increase model viability. - Be more open about what your goals and targets are. No one should be a victim of their own success, and if you keep moving the goalposts, you shouldn't be surprised when people get frustrated and drop out. I'm certain that, given fair incentives, a meaningful voice, and an equal seat at the table, healthcare innovators can design sustainable VBC programs. But there needs to be more collaboration and a willingness to listen and engage. Otherwise, you're just slowly adding to the alphabet soup of also-ran programs. #medicine #healthcare #health #vbc #healthcareinnovation #valuebasedcare

50

17 Comments

Many thoughts as Medicare Advantage continues to come under scrutiny. - MA has features of a value-based program, but most of the current "value" is being delivered through diagnosis capture and complexity payments. Ironically, much like FFS, it pays more to keep people sick (or make them look sick). Don't think that's anyone's definition of value. - To be fair, most doctors (especially specialists) don't do a great job of capturing diagnosis and patient complexity beyond their immediate area of expertise. (We're especially bad at this in MSK). We should have accurate representation of a patient's health in the medical record. Complexity and co-morbidities affect treatments and outcomes. We don't yet have a good way to account for this complexity -- and it's becoming clear the MA system isn't it. - EMRs make all of this worse. It's both too easy and too hard to record, change, or resolve diagnoses. EMRs should facilitate accurate complexity capture and treatment personalization. The goal shouldn't be to increase billing, it should be to increase sophistication and precision. - As MA scrutiny grows, the business model of many alternative care models (especially in primary care) will be challenged (potentially dealing another blow to retail healthcare). - CVS' purchase of Signify health is put into full context by this article. - It boggles the mind that CMS can develop and administer a program that nets billions for inscos (at the expense of taxpayers) while reducing physician reimbursement yearly and rolling out ineffective VBC programs for providers. CMMI should have an open-door policy for anyone delivering care and working on true value-based models. Ears, eyes, and minds should be wide open. h/t Mahek Shah MD, MBA Moby Parsons, MD #medicine #healthcare #vbc #valuebasedcare #health

26

11 Comments

Moral injury in medicine: Why doctors are burning out Today's practicing physicians find themselves grappling with burnout. Witnessing how our cherished medical community has succumbed to moral injury and compromised its values is disheartening and confounding. This troubling phenomenon appears intrinsically tied to the shifting landscape of employment within our profession, where the erosion of autonomy has become increasingly evident. This issue transcends mere statistics, speaking to a deeper systemic imbalance. At its core lies a troubling power dynamic, with employers assuming disproportionate control over the practice of medicine. This encroachment on our autonomy undermines the very essence of our profession, leaving us grappling with diminished agency and a sense of disempowerment. Tod Stillson is a family physician and entrepreneur. Link in bio or visit https://lnkd.in/eEgKJj_6 #PhysicianBurnout #DoctorWellbeing #HealthcareCrisis #MedicalAutonomy #SaveOurDoctors #FixMedicine #EndMoralInjury #EmpowerMDs #WeNeedDoctors #HealthcareHeroes

17

1 Comment

MATERNAL DEATH and SUICIDE: AI SUCCESS? In todays world, the American public health system produces increased fetal and maternal deaths and increased homicide and suicide rates in young adults 16-40. In todays world, the fortune500 for "health" includes corporations that sell insurance, pharmaceutical drugs, and hospitals that will incarcerate your family not heal them. LinkedIn is a peephole to what is wrong with ALL of us: MISINFORMATION. Anyone who says they are an expert, guru, or data scientist because you know how to Google is a DANGEROUS FRAUD. Yesterday, a young man from Florida lit himself on fire in front of a New York court room. Not as a political statement for or against the man seated before a judge because he is charged with 91 felonies. The young man lit himself on fire because the terrorists in his mind are a greater threat to him than the terrorists who will not treat him. AI IS THE GREATEST THREAT TO SOCIETY. Those of us who are LICENSED human physicians, nurses, and therapists who are trained to SAVE lives watch as corporations and our public servants use AI to replace us and we watch as our young Americans suffer and die. This first responder with the fire extinguisher is too late. #ai #aihealth #maternalhealth #womenshealth #mentalhealth

1

The Wall Street Journal recently published an article, "Insurers Pocketed $50 Billion From Medicare for Diseases No Doctor Treated", shedding light on the systemic issues within the Medicare Advantage (MA) program. Here are the key points: 1. Financially Driven Diagnoses: Insurers are incentivized to diagnose more severe conditions to receive higher payments. This leads to questionable and often false diagnoses, as seen in cases like Gloria Lee's misdiagnosis of diabetic cataracts by UnitedHealth. 2. Impact on Patient Care: These false diagnoses often don't result in additional care. For example, less than 17% of patients diagnosed with HIV by insurers received necessary treatments, highlighting a severe gap in patient care. 3. Rising Costs: Instead of saving taxpayer money, MA has added billions in costs due to inflated diagnoses. This misalignment with healthcare objectives diverts funds from genuine patient care. 4. Manipulative Tactics: Insurers use home visits and AI-driven chart reviews to add false conditions, undermining the integrity of medical records and inflating costs. 5. Regulatory Challenges: Despite efforts by CMS, regulatory frameworks fall short in curbing these abuses. Stronger measures are needed to align financial incentives with genuine health outcomes. This investigation calls for stricter oversight and policy changes to ensure Medicare Advantage fulfills its goal of providing cost-effective, high-quality care. https://lnkd.in/d_9N3zRD

3

1 Comment

“To protect insurers from the risk of winding up with sicker-than-average patients, the government allowed bigger payments for certain serious health conditions.” News flash, it’s not “risk” if you’re being paid to take it! It’s like giving the gambler an extra $10k just in case because he decided to play the high stakes table. The The Wall Street Journal article goes on… “Partly because of [the bigger payments intended to protect insurers from risk] Medicare Advantage has cost the government an extra $591 billion over the past 18 years, compared with what Medicare would have cost without the help of the private plans, according to a March report by the Medicare Payment Advisory Commission, or MedPAC, a nonpartisan agency that advises Congress. Adjusted for inflation, that amounts to $4,300 per U.S. tax filer.” For the folks in the back: When carriers (MA or otherwise) are being paid massive amounts of money to compensate them for taking on additional “risk” intended to offset the cost of said risk, they ARE NOT value based or at risk! Indeed, they are profiting from a system designed to reward them for risks they aren’t actually bearing. This isn’t risk management—it’s a manipulation of the system for financial gain.

41

8 Comments

#Enforcement activities against #telehealth companies got a lot of headlines last week. First (https://lnkd.in/e5Ni2fen) was the announcement of an amended complaint against Cerebral and some of its former executives. The second (https://lnkd.in/euMAgWua) was against Done Health and its #CEO over alleged #fraud schemes that included driving Adderal prescriptions for profit. The issues raised in both instances are not unique to #virtualcare, but arguably represent long term problems in #healthcare. Don't let the venue of the issue sway understanding of the root issue.

5

What is the state of #competition in #healthcare? One report doesn't paint such a rosy picture. The study suggests that insufficient #antitrust enforcement and scrutiny has allowed prices to rise and competition to reduce. Those sorts of findings align with anecdotal feelings and assumptions about what is happening across the industry. That is arguably the result of smaller #mergers and acquisitions occurring that can presumptively slip under the radar or avoid scrutiny. The question now is what will happen going forward. The #FTC and others are showing an increased willingness to review proposed #transactions and challenge what is happening. https://lnkd.in/ef35-yAD

1

Moratorium = a temporary suspension or delay of an activity or a law. A moratorium is effected and enacted in: -economic crises -public health emergencies -environmental protection -social unrest -technological changes In healthcare, every point above is checked off. We've noticed a decline in lifespan, severe substance abuse, homelessness, massive impact on the environment from healthcare waste, lack of access to timely care in medicine, and technology that can drastically improve healthcare. I propose the following moratorium until the above issues drop below 5% impact: 1. No physician lawsuit except for gross, known negligence 2. No patient suing for unpaid medical bills 3. Basic medical access to a primary care doctor anywhere in the US 4. Multi-state licensure for any physician already licensed 5. No business entity may override a physician's clinical decision-making 6. No new technology may be rolled out or funded without proving patient health outcomes 7. No public research funding for any research that measures surrogate endpoints instead of clinical endpoints 8.... please add yours below

2

We have to be realistic about American culture, values, and political landscape. While I do see positive examples of government run #healthcare in other countries, the U.S. is its own country. At no point in the last 50 years of U.S. history has the American public agreed on becoming more like Commonwealth countries (Canada, U.K.) or like Scandinavian countries (Sweden, Denmark, etc) in terms of healthcare. Even if one streamlined system could drive greater coordination and efficiency (in theory), that is not what the last 10 years since the ACA shows. I’ve worked in government and I see how much lobbyists influence the elected politicians and the unelected bureaucrats to extract money from the “value chain” while patients have less and less choice, autonomy, control. Clinicians of various types also have little to no control. Large systems that gobbled up independent practices have driven consolidation. Instead of “economies of scale”, we’ve seen predatory higher pricing from lack of competitive threats. While I started off my career with high belief in collaboration, I have not seen that validated in how the stakeholders behave. Right now, patients are not decision makers and become pawns on a chessboard. We need to empower patients with real choices in American healthcare. Ge Bai‘s publications and posts identify many of the underlying mechanisms that get between patients and good, accessible, affordable, quality healthcare.

6

1 Comment

"Peer to peer". What a wonderful phrase. If you are not involved in the US healthcare system then it is probably meaningless. If you are in the US healthcare system then it is a dreaded phrase, a time and money waster that can cause real harm to your patients. A peer to peer is supposed to be when the health insurance company doesn't think a treatment is necessary for your patient, you can call and talk to a doctor and make your case to get it approved. What it actually is, is a method of attrition, meant to make it so the health insurance company doesn't have to pay out when a MEDICAL EXPERT IN THEIR NETWORK HAS RECOMMENDED A MEDICALLY NECESSARY TREATMENT! The peer to peer has to be scheduled. Basically taking time out of a busy physicians schedule to make a phone call. And it's not a short process. If you've ever called a health insurance company you know what I'm talking about. Multiple phone trees and waiting, until you finally get to the fabled health insurance doctor. About these health insurance doctors, they are board certified, but might not be board certified in your specialty. They are also not practicing clinical medicine. They have also sold their soul to the devil himself. Could you imagine if these medical school deans knew that one of their future medical students would end up working for a health insurance company? If they could go back in time and revoke their acceptance letter then I bet they would. But I digress... Here is an example of a "peer to peer" that I once did for a questionable ankle syndesmosis injury: Cardiologist: "I don't even know what an ankle syndesmosis is so I'm going to approve the CT scan" The whole process is a joke, a scam, and only meant at making health insurance companies more money. #healthinsurance #scam #medicine #peertopeer

85

42 Comments

"A 17-year-old Black male is brought in by the police to the emergency room restrained and agitated...." This statement is a classic example of how (mental) healthcare providers frequently use racial identifiers as a standard clinical practice that few question. What is less standard, however, is examining how using racial identifiers in the chart is a non-consenting practice that opens the door to racist clinical practices that harm the person's well-being in ways their providers never recognize much less explain. I take this practice to task and break down this risk in Lecture 5 of the Antiracism in Mental Health Fellowship, "Racism, not Race"--an excerpt from which is featured below. Here are some of the main takeaways from this lecture, which details why healthcare's very typical practice of invoking race as a part of clinical care must be supplanted by a deeper understanding of how racism impacts clinical care--and how this distinction is foundational to an antiracist clinical practice: 💡 To paraphrase Ta-Nehisi Coates, "race is the child of racism not the father"--meaning the social construction of race is itself a racist practice, and race-based mental healthcare (including using racial demographics in notes) can perpetuate biases and stereotypes. 💡 Using a racial identifier in a chart can perpetuate racist tropes about criminalization and deficiency which can feed into mental healthcare’s interfacing with policing/juvenile detention and child welfare, which are known to target Black and Brown people. It can lead to drug testing, restraints, and accusations of malingering. 💡 The need to cultivate a reflective practice whereby anytime a racial identifier is used, this immediately triggers a critical conscious response of why and what impact. 💡 The imperative for healthcare providers to talk to people about using racial identifiers in the chart as part of a thorough informed consent process, noting the risks involved. As part of this process, healthcare providers MUST ask people what--if any--identifier THEY want listed. To randomly assign one based on phenotype is careless. 💡 That discussing race/”racial differences”/racial disparities (as opposed to racism) can advance scientific racism by suggesting that race confers biological qualities. It can lead to the sloppy reliance on race as a proxy for genetics, ancestry, and geography. Some of the most egregious examples of racist documentation practices I've witnessed include referring to someone as "clowning" or "a crack baby." Sometimes they are blatant, sometimes they are more subtle; but now whatter what form they take, they are always damaging to care. Sign up for my youtube channel (https://lnkd.in/gQ7tEuy2), which will continue to feature free excerpts from the Antiracism in Mental Health Fellowship. Consider signing up for the fellowship itself at edu.rupileghamd.com. Huge Ty to Luis Enrique Chochón for producing this clip! #antiracism #mentalhealth #psychiatry #meded

14

4 Comments

Dr. Ted Kyle at ConscienHealth reports on ‘Two updated analyses from the Global Burden of Disease (GBD) Study…’ in The Lancet encompassing data across 204 countries and territories, from 1990 to 2021, for 88 risk factors. The authors state ‘…Troubling increases in high fasting glucose, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions.’ BMI and dietary behavior are framed as both the problem and the solution, influenced by lifestyle factors and an ageing population, focused upon dietary behaviors. https://lnkd.in/ein7XnBB

3

1 Comment

The Federation of State Medical Boards has weighed in recently on liability, risk, and responsibility for AI: it's all on the doctor. I don't entirely disagree with their rationale, but their decision support recommendations bother me. 🟣Purple: If the doctor ultimately has to explain why they are or AREN'T following an AI model recommendation, then models will have to have some degree of explainability. I'm okay with that stance. 🟡 But (Yellow): if the doctor should be disagreeing with a model because it doesn't support the standard of care, how the hell does the standard of care ever change? If the standard of care is to use some outdated tool — then what's the point of using AI in the first place? 🟢 And (Green): How exactly is a doctor supposed to explain a black box tool recommendation — and support or go against it — when it's by definition a black box? The whole point of some of these models is that the data is hidden in plain sight and human eyes cannot see it. Or: how can I even make any argument about a model with 500 variables that predicts 15 year mortality? At that point the only argument is about the math and the config, as it's too complex for any human to agree or disagree with. Link to the full document: https://lnkd.in/g6xpyEQZ Tagging a few colleagues to weigh in. David Ouyang, MD Andrew Lundquist Matthew Sakumoto Morgan Cheatham Morgan Jeffries Resa E Lewiss MD David Wang, MD Spencer Dorn Maxime Griot, MD Cyril Zakka, MD Craig Joseph MD, FAAP, FAMIA Tina Shah MD MPH Karl Cole Scott J. Campbell MD, MPH Paulius Mui, MD Mario Amaro, MD Kenneth Qiu, MD Shoreh Irani, MD Ainsley MacLean, MD Dr. Zhong Wei Khor Keith Kwan Keith Grimes

170

69 Comments