Econometric Techniques Applied to Orthopaedic Datasets

It’s fun when interests collide. In a recent podcast interview with Davida Dinerman[1], we reviewed how my academic and career experience have led me to where I am today, with an emphasis on developing and disseminating information for decision support in healthcare. We covered a lot of ground in my non-linear career path, but Davida perked up when she heard me mention the term econometrics, which was new to her.

Then, this past weekend, I listened to the Orthopod podcast[2] on the topic of using real-world evidence (RWE), in this case, a Dutch registry that includes over 400,000 orthopaedic patients. Dr. Mohit Bhandari (@orthoevidence), the host, talks with Dr. Rudolf Poolman (@rudolfpoolman), who describes how he was able to question a guideline that calls for an age cut-off for cemented vs. non-cemented hip hemi-arthroplasty, using a research technique borrowed from econometrics.

Both podcasts cover other topics, including empowering patients by including them in research design (Orthopod) and providing access to medical information and data (my interview with Davida), as well as shared decision-making and clinical decision support/guidelines. I encourage you to add both episodes— and series—to your podcast list.

And, I thank Davida for asking me to describe my background, so that I can now point people to the LookLeftforGrowth podcast episode if they want to know how I ended up with my unusual mix of technical, analytic, behavioral economics and market research skills.

I haven’t made direct use of econometrics in my work since I left business school—a long time ago. Nonetheless, my training in econometrics, economics, statistics, mathematics and French(?) have given me a foundation in and perspective on big data and analytic methods that I rely on frequently for envisioning and assessing new research methods in medical and life science research. When listening to the referenced episode of the Orthopod podcast, I felt a sense of satisfaction that my stack of skills[3] has value in today’s big data-enabled, evidence-based medical research environment.

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[1] https://www.lookleftforgrowth.com/podcast/episode/487d00f0/janice-mccallum-on-the-promise-and-challenges-of-healthcare-data. Relevant discussion occurs between 3 min 15 seconds and 5 min 40 seconds.

[2] https://myorthoevidence.com/Podcast/Show/84? Relevant discussion starts at 14 min 9 seconds.

^[3] https://www.theladders.com/career-advice/skill-stacking-instead-of-mastering-one-skill-build-a-skill-set

Should We Expect Healthcare Providers to Plot Their Own Demise?

The Triple Aim of improving quality, improving patient care and reducing costs is a noble mission, but can we expect the current vendors of medical services to take the lead in reducing costs?

There is so much to debate in healthcare regarding where to focus reform efforts. Many will look at the high costs of caring for chronically ill patients and conclude that that the segment that accounts for the greatest share of expenditures must surely be the target for cost savings and disruption.  It’s difficult to argue against the need to continually improve how we care for the acutely and chronically ill. However, to use one analogy, we can’t continue to get better at putting out fires once they are in full burn without equal or greater efforts devoted to preventing fires. For the population as a whole, the benefits of prevention far outweigh the benefits of incremental improvements in managing chaos.

Given that hospitals and physician practices exist to perform medical interventions, how can we expect these organizations to lead the efforts in reducing demand for their services by promoting wellness and patient education programs?  We can’t. The same logic applies to patient engagement. How can we expect provider organizations to lead efforts that ultimately will reduce the demand for medical services? We can’t. Instead, we have patient engagement programs that predominantly target medication adherence.

Granted, there are attempts at creating patient-centered medical homes and accountable care organizations (ACOs) that have incentives to better coordinate care and attempt to reduce duplication of tests, overtreatment and medical errors, all things that should help reduce overall costs. But, it would take some pretty massive incentives to ask physician practices to become public health promotion centers. In fact, the pendulum is moving away from primary care physicians’ offering even basic preventive health services. One data point to support my statement: vaccinations are moving from primary care facilities to pharmacies. One anecdote: my mother’s primary care physician effectively refused to give her a shingles vaccine on two occasions, saying she’d be better off getting it at CVS. My mother interpreted the doctor’s comment and attitude to mean that the vaccine isn’t medically important, even though the doctor more likely was trying to save my mother some money (CVS charges less than $100;  the doctor’s administrative staff could only say that depending on her insurance, the cost to her could be as high as $300).

So, if we want to make a serious dent in the level of health care expenditures in the US, we’re going to have to bolster our public health efforts and educate and engage the greater population on how to adopt behaviors that help maintain health and avoid disease. Harvard School of Public Health received a gift of $350 million this week. That’s an encouraging sign. To quote the benefactor, Hong Kong billionaire Gerald Chan, “While medical doctors give health benefits to individual patients, public health is a field that helps to give benefit to the whole population”. [1]

While we still need better one-on-one communication between physicians and patients, we can’t expect a meaningful reduction in healthcare expenditures until we reduce the demand for medical services. And, we shouldn’t expect the providers of those services to lead the efforts to reduce demand.

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[1] Source: http://www.bostonglobe.com/metro/2014/09/07/harvard-school-public-health-gets-largest-gift-university-history/YixNC3xkBfMtg3mrSmE6zJ/story.html See also: http://www.thecrimson.com/article/2014/9/8/chan-gift-public-health/

Healthcare IT Predictions for 2014: Patient Engagement, Interoperability and the Value of Price Transparency

As 2013 comes to a close, we are excited to welcome the insights of top healthcare IT leaders in our Healthcare IT Predictions for 2014 blog series. So far we’ve heard from David Harlow, renowned healthcare lawyer, and John Lynn, prolific blogger on healthcare IT, EMR and HIPAA. Today, we welcome Janice McCallum, managing director of Health Content Advisors. Janice is a top authority on commercial applications across stakeholder groups and relevant sectors, including providers, clinicians, payers, life sciences, government and patients. At Health Content Advisors, Janice helps publishers and suppliers of healthcare information services develop effective marketing and business development strategies for reaching today’s clinicians and consumers.

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1)    What healthcare IT buzzwords will move to the center of conversation in 2014?

Patient engagement will continue to be a hot topic in 2014 because of the increased role that patients are playing in nearly every aspect of their healthcare. However, there’s not much clarity on the definition of “patient engagement”. Since the Meaningful Use program is a key driver of patient engagement initiatives; and since IT infrastructure is critical to Meaningful Use implementation, patient engagement is still very much a health IT issue. I’ve said many times that providing patients with access to their data is the most important element for providers that want to engage patients. But, patient engagement is just a first step in a process to rebalance the current information asymmetry between physicians and patients.

Leonard Kish coined the phrase: “Patient Engagement is the Blockbuster Drug of the Century” last year.  I agree, but due to the range of interpretations of what it encompasses, I expect “patient engagement” to be the most overused and least understood buzzword in 2014.

2)    Jacob Reider has taken over for Farzad Mostashari as Interim National Coordinator post at the ONC; what does the industry need most from the next leader?

Given the political environment, our next National Coordinator for Health IT will need have a rare mix of health IT knowledge, political savvy and management skills. To respond to concerns from provider organizations, I would recommend that the next ONC leader have some experience within a provider organization; ideally, someone who has dealt with implementing reporting systems for early stage Meaningful Use. Better yet, I’d like to see a new ONC leader who wants to put him or herself out of a job by helping to consolidate the various quality-reporting programs within HHS and encouraging industry associations to take over the leadership function for health IT standards.

3)    What is your top prediction for Healthcare IT in 2014?

My top prediction is that the topic of price transparency will be paramount. Even though price is a business rather than an IT issue, provider IT systems need to be capable of providing reliable price estimates to patients, since an increasing number of providers require patients to pre-pay their copay portion of medical bills at check-in. We can’t expect patients to approve an unknown charge to their credit card or their bank account without some reasonable estimates of costs, although I have heard of plans by some providers to do just that! Price transparency also helps inform consumer choices about where to seek care and what care plans to choose.

4)    What initiatives do healthcare stakeholders need to prioritize in order to reach true interoperability in 2014?

I’m not even sure how to define true interoperability. Common data standards are a huge part of facilitating data interoperability. But, different stakeholder groups will continue to have different data standards, especially when the different parties include research data, clinical data, patient-reported data and sensor data. Furthermore, a big part of the health information exchange problem stems from the incomplete nature of patient records in any single institution or network, errors in patient records, and the lack of unique IDs. The solution has to involve patient review and control of his/her own records.

This post was originally published at the Orion Health Blog on December 3, 2013.