Big Changes Coming to Healthcare


Last week, the new Health and Human Services (HHS) Secretary, Alex Azar, said, “Change is possible, change is necessary, and change is coming.” I hope so. Change is desperately needed. It remains to be seen if the federal government can make the changes needed and make them fast enough. The biggest barrier is Congress. HHS tried to simplify drug insurance last year, and Congress blocked the simplification because it would have been negative for the health insurance industry, one of the powerful lobbies that fuels Congress with donations. 

Azar had other encouraging comments. He said one of the key commitments of the administration is to see the private sector as partners, not just entities to be regulated or overseen. He said HHS sees stakeholders as part of the solution to our country’s many healthcare challenges. The most important thing he said as part of the recent address was, “We’re unafraid of disrupting existing arrangements just because they are [controlled by] powerful special interests.”

Medical science has advanced rapidly, but innovation in payment and delivery systems has been slow. While Blockbuster put local video shops out of business and then Netflix put Blockbuster out of business, the healthcare system of care delivery and administration changed very little. The cost of Medicare healthcare has grown from $400 billion in 2001 to $1.2 trillion, but quality has not grown at the same rate.

Azar outlined four priorities for HHS:

  • Giving consumers greater control of their healthcare records through health information technology
  • Making healthcare pricing more transparent
  • Using experimental models in Medicare and Medicaid
  • Removing government burdens which impede the transformation to value-based healthcare

Electronic Health Records (EHRs) have the potential to lower cost and improve quality, but so far they have mostly frustrated patients and providers. They have outdated and awkward interfaces for doctors and are nearly unusable by patients. I am fortunate to live in two states. I am currently in Florida. I saw a doctor who ordered a routine test. The test was performed at a different hospital than the one who employs the doctor. The only way he can get the results is by fax. Paper. I asked for a copy of the results. I waited while a nurse took the time to make a copy of the pages. I don’t even have to ask about getting the results into my EHR in Connecticut. Fax is the only way. This despite $35 billion spent by the government for incentives for providers to implement EHRs, which were supposed to be interoperable. Contrast this with searching Amazon’s selection of 100+ million items, clicking once, and having the item on your doorstep in a day or two. I am hopeful Apple and Amazon will shake up the EHR industry.

I’ll have more to say about pricing transparency and value-based healthcare in later posts. See full article about Mr. Azar’s comments here. Read more about healthcare in Health Attitude: Unraveling and Solving the Complexities of Healthcare.

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Home Attitude with Skip Prichard

Skip Prichard with Home Attitude

Skip Prichard is President and CEO of OCLC, a global nonprofit computer library service and research organization. He is also the author of newly published The Book of Mistakes: 9 Secrets to Creating a Successful Future. Skip was giving a speech in Edinburgh, Scotland recently and, as shown above, he made some remarks about my new book, Home Attitude: Everything You Need To Know To Make Your Home Smart. Skip loves books and is passionate when talking about them. I just read his new book, and you can see the passion in his writing.

The YouTube video below is #6 of a seven-part series. I hope you enjoy it. There are now 12 5-star reviews of Home Attitude. Feel free to add yours here. Once you get a vision from Home Attitude, you will be ready to make your home a smart one. The benefits will include energy efficiency, enhanced security, and an abundance of convenience.

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Health Attitude Book CoverOne of the topics in Health Attitude is obesity, a chronic condition which has become a pandemic. In 2013 at the annual meeting of the American Medical Association, physicians voted overwhelmingly to categorize obesity as “a disease that requires a range of interventions to advance treatment and prevention”. In the United States, 36.5% of adults are obese. Morbid obesity is a condition of weighing double or more a person’s ideal weight. It is called morbidly obese because it correlates with numerous serious and life-threatening conditions. Obesity is a significant inhibitor to America’s positive growth and development. Three percent of the population are considered morbidly obese, but the treatment of the condition and related healthcare costs represent 21% of healthcare spending. Obesity is a serious problem beyond the condition itself.

Obesity causes serious related diseases including diabetes, cancer, sleep apnea, osteoarthritis, and cardiovascular disease, including myocardial infarction (heart attack). The quality of life for an obese person is reduced significantly. Unfortunately, there is no simple procedure or medication to eliminate the negative conditions. There are three main approaches to managing obesity; lifestyle modification, pharmacological treatment, and bariatric surgery. Each has significant economic and ethical implications. The most effective treatment for obesity is a combination of behavior modification and bariatric surgery. However, a new study suggests that the surgical route is often better.

The causes of obesity are complex and include socioeconomic factors such as household income, median earned income, employment, poverty status, and welfare participation. These factors influence lifestyle changes through clinics, counseling, and home healthcare. A bariatric surgeon told me the surgery is just one small encounter with a lifelong obese patient. She said patients understand they have to change their lifestyle or surgery won’t solve the problem, but often they do not make the required changes. She went on to tell me bariatric surgery could help people achieve an improved level of health.

The impact of obesity is extraordinary and growing. Fortunately, research is advancing on multiple fronts. Diabetes has traditionally been classified as Type 1 or 2. New research is showing it is not so simple. There are at least four types. The World Community Grid is busy sequencing the genes of the microbiome (our gut). This could be quite revealing and may show some people gain weight not just because they eat too much but because of how their gut handles the digestion. New research in Singapore has shown promise in laboratory trials. A new type of skin patch contains hundreds of micro-needles, each thinner than a human hair. The needles are coated with the drugs which are known to turn energy-storing white fat into energy-burning brown fat. The trials on mice show  reduced weight gain on a high fat diet and reduced fat mass by more than 30 per cent over four weeks.


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Eradicating Polio

Rotart Club of Palm Coast

It was a pleasure to speak to the Rotary Club of Flagler CountyPalm Coast, Florida at their monthly luncheon meeting. As is their custom, the club made a donation on behalf of their guest speaker to the Polio Plus Program of The Rotary Foundation. The donation will enable immunization of 25 children against polio. Polio is a crippling and potentially fatal infectious disease. There is no cure, but there are safe and effective vaccines. The strategy to eradicate polio is based on preventing infection by immunizing every child. When transmission stops, the world can become polio-free.

Rotary, along with the Bill & Melinda Gates Foundation, have reduced polio cases by 99.9 percent worldwide since their first project to vaccinate children in the Philippines in 1979. This is big news not often reported. They are close to eradicating polio, but there is more to do. Three countries are still considered endemic to polio: Afghanistan, Nigeria and Pakistan. However, until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio. Through the work of Rotary and its partners, strong population immunity levels are being maintained through high vaccination coverage. The addition of strong disease surveillance to detect and respond rapidly can lead to the complete elimination of polio from the world.



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Clinical Trials for Stem Cell-based Cartilage Underway

3D Printed Knee Implants

One subject among my weekly e-briefs which consistently generates a lot of feedback is related to knees. One thing baby boomers have in common is the need for joint replacements. The number of hip and knee replacements in the U.S. is roughly one million per year, 2/3 of which are knees. Over the years ahead, projections indicate there may not be enough surgeons to handle the rapidly growing demand. In many cases, the need for the replacement comes from overuse, injury, or osteoarthritis that led to destruction of cartilage, the flexible connective tissue in hip, shoulder, and knee joints. The common phrase uttered by those facing the joint replacement is “I am down to bone on bone”. All this will change with the development of artificial cartilage and 3D Printing. The 3D printers are quite advanced and able to print body parts using specialized cells as the “ink”. Every week, I see something new in the development of artificial cartilage.The ultimate solution will likely come from cells in our own bodies.

Determining the number of cells in the human body is not easy. If you base the number on volume, you get an estimate of 15 trillion cells. If you estimate based on weight, you end up with 70 trillion. The consensus is 37 trillion. The cells of increasingly intense interest are stem calls. Stem cells are capable of giving rise to indefinitely more cells of the same type. Even more interesting are pluripotent stem cells, often called master cells. Pluripotent stem cells can be induced to produce any cell or tissue the body needs to repair itself. 

Even more specific are mesenchymal stem cells (MSCs), which are cells which can morph into a variety of cell types, including osteoblasts (bone cells), chondrocytes (cartilage cells), myocytes (muscle cells) and adipocytes (fat cells which give rise to marrow adipose tissue). The MSCs are adult stem cells traditionally found in the bone marrow.

Eighteen stories here on have discussed or referred to artificial cartilage, but all have seemed distant. That perception is changing fast. A group of researchers at Osaka University in Japan has developed a synthetic tissue using MSCs for treatment of damaged cartilage. The Medical Center for Translational Research (MTR) has performed surgery on the first patient in a Phase III clinical study to confirm efficacy and safety of the therapy. This is the first clinical trial of regenerative therapy in Japan using stem cells.

The number of patients with potential osteoarthritis (OA) is estimated to be about 30 million. The potential for a safe and cost effective treatment option is now in sight. I will be following the results of this exciting clinical trial. Read more about the Osaka University clinical trial here. Read more about regenerative medicine in Health Attitude: Unraveling and Solving the Complexities of Healthcare.

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