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Retail healthcare. At Walmart. The pluses and minuses.
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Image credit: Walmart
Walmart is going into the healthcare business.
This is notable for a number of reasons:
- 8¢ of every dollar spent in retail in the US is spent at Walmart
- It’s the largest employer in the US
- It’s the largest retailer in the US
Those stats add up to a behemoth. If Walmart enters an industry vertical as a competitor, it says they’ve run the numbers, and it makes revenue sense.
While listening to Morning Edition on NPR this morning, I hung on every word of the piece that revealed that Walmart was planning on putting clinics in their stores. Even Walmart has been hit by the downturn in the economy, so they likely see healthcare as an additional draw – get someone in the store for a doctor’s appointment, and sell them some groceries and housewares while they’re there.
Here’s why this could be a great idea:
- Access. You don’t have to make an appointment, you can just walk in. And you’re getting care in a place that you’re likely visiting anyway, given Walmart’s ubiquity.
- Cost. We all see what Walmartization has done to retail pricing in most of the retail sector. Walmart entering the healthcare vertical will put downward pressure on primary care pricing.
- Quality. Walmart is known for cheap and plentiful. Those are not the key words for good outcomes in healthcare.
- Doctor-patient relationship(s). This effort could turn in to a trip in the way-back machine to the bad old days of the early HMOs, when “doctor, doctor, who’s my doctor?” felt like a bad game of musical chairs.
I’m going to watch closely to see how this story plays out. It’s already getting interesting – Walmart’s Senior VP & President of US Health & Wellness John Agwunobi M.D. issued a statement at 2:52pm Eastern today (11-9-11) saying that “The RFI statement of intent is overwritten and incorrect. We are not building a national, integrated, low-cost primary care health care platform.”
Well, John, then what the H-E-double-hockey-stix ARE you building? And who will come?
Will you? I really would like to know.
Comments open. WIDE open. Please share!
November: forget pink, go clear! #lungcancer
Posted by: | CommentsOK. The Month of Pink is over. Now it’s time to get serious.
November is Lung Cancer Awareness Month, the support ribbon is clear.
Get one thing perfectly clear: lung cancer is a killer.
Lung cancer kills more women than breast cancer does (see some CDC stats on that here), but we don’t see the NFL gearing up with lung cancer awareness gear.
Lung cancer has no brand. It also has no early detection protocols, so it’s usually discovered at the “if you survive, it’ll be a miracle” stage.
Where’s the funding for lung cancer?
That’s a question asked daily by my friend Jennifer Stauss Windrum via her awareness campaign, WTFLungCancer.com.
Her mom became one of the people fighting the lung cancer troll, which opened her eyes to the total lack of awareness of the risks and consequences of getting lung cancer.
- Her mother never smoked. Most diagnoses are now people who don’t smoke: either never-smokers or former smokers. So stop thinking it’s the lung cancer patient’s fault. Even if they do smoke.
- Lung cancer kills more people than the #2 through #5 most deadly cancers … combined. Lung cancer is #1-with-a-bullet on the deadliest list.
- Lung cancer kills three times more men than prostate cancer.
- Lung cancer kills more than twice as many women as breast cancer.
- Lung cancer kills 437 people every day.
Worried yet? You should be.
What I suggest you do is get involved with the Lung Cancer Alliance. Support them, and support the Canary Foundation, too – they’re actively working on early detection research for lung cancer, and they’re my primary focus for TeamPlaid.
Have your home tested for radon – that’s the #2 identifiable risk factor for lung cancer after smoking. If someone in your family does smoke, encourage them if they want to quit. If they don’t want to quit, make the inside of your house a smoke-free zone.
Make a difference in your own life by cutting down the risks. Make a difference in the community, and the world, by being 100% clear that lung cancer is a killer stalking each and every one of us: men, women, white, black, brown, rich, poor, smoker, non-smoker.
Everybody is at risk.
Let’s get to work.
It’s the month of “pink” + I’m seeing red
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The month of October is awash in pink. Everyone from the NFL to Panera Bread is on the pink bandwagon in support of breast cancer “awareness” – is awareness an end in itself?
Gayle Sulik, who I’ve mentioned before here, does a masterful job of ripping the lid off the damage that pinkwashing has done. Her book, Pink Ribbon Blues, is linked in the image on the right.
I think awareness alone falls very short of the goal if ending the disease is the goal. Unfortunately, I think that Susan G. Komen – and I’m talking the Houston mothership here, not the local chapters – is now much more about the brand than it is about the cure.
When it comes to “pink”, I see red. And I’m not alone.
- In 2005, the estimated mortality rate for breast cancer was 15% of those diagnosed with the disease
- In 2007 (the year I was diagnosed), the estimated mortality rate was 17%
- In 2009, the estimated mortality rate was 16%
Where’s the win here? If mortality rates are essentially holding steady, where’s the progress on “the cure”?
In the pink avalanche that is now the month of October, where is the discussion of the fact that the very products being pink-washed carry toxic substances with a link to cancer?
That includes the Avon Army of Women campaign (most Avon cosmetics contain paraben preservatives, which are estrogen mimickers that have been linked to breast cancer).
It also includes the Promise Me fragrance – also an Avon product – that has toluene and galaxolide in it, both of which are toxins. Read about them here.
There are a host of other regrettable “pink” products flacked in October, including Kentucky Fried Chicken (really?) and dairy products with rBGH, the growth hormone pumped into dairy cows that has in turn driven the rise in breast cancer diagnoses. Which hormone is, BTW, made by Eli Lilly, who also produces a number of breast cancer drugs. Talk about milking cancer!
And don’t get me started on the pinkwashing of the NFL. The pink gloves/cleats/dancing-ribbons-at-halftime do NOT mean that the NFL is giving one thin dime to Komen. It’s “awareness” – where’s the ****ing money, dudes? Don’t tell me it’s coming from the pink products being flacked on NFL team sites. The league keeps the lion’s share of that money.
Komen is a brand, it’s no longer a cause. They’ve started “lawsuits for the cure” – you can read my buddy Alicia Staley’s take on that here, which includes a good drill-down into the numbers. There is also a follow-up here, and you’ve really got to read the comments on both, which include a “harrumph” from the Director of Communications at Komen, Andrea Rader.
If you want to support action to stop breast cancer – and other cancers – join the movement to cut down on environmental toxins, to end plastic food, to stop ingesting endless amounts of crap through our skin, our lungs, our mouths. It’s not just about cancer, it’s about the health of our entire community – the human community. On the whole dang planet.
I recommend Breast Cancer Action and the Breast Cancer Research Foundation if you’re passionate about ending breast cancer.
Stop buying makeup and skin care products with parabens and other toxins in them. You can get information on most products via SkinDeep, the Environmental Working Group‘s searchable cosmetics/skin care products database.
Stop eating food out of boxes, and introduce yourself to your stove. Cooking is easy, it’s fun, and it puts you more in touch with your family. Make time to cook together, you’ll be amazed at the conversations and communication that develop in the kitchen. Make trips to your local farmer’s markets a weekend excursion for the family.
And stop buying “pink”.
Is #occupyhealthcare a healthcare #arabspring?
Posted by: | CommentsI’ve been thinking about the top-down, inverted-pyramid nature of healthcare for a long time now. That inverted pyramid is poised atop the industry’s customers – us, people, patients – crushing us, and collapsing under its own weight.
All of us could benefit from a little revolution, don’t you think?
The quote at the right is Buckminster Fuller at his best – simple and revolutionary.
I think that trying to fight our current reality – the current healthcare delivery system – is a waste of time.
What’s needed is for people – the aforementioned patients – to act as if healthcare was there to serve us. Currently, the system is set up to serve no one, unless maybe the insurers at the top of that food pyramid are getting something out of this insanity.
Somehow, though, I think they’re as broken as the rest of the system.
I’ll repeat what I posted over on the MightyCasey.com blog on Monday:
Don’t settle for less-than-full disclosure from any of your healthcare providers – in other words, ask why your doctor is prescribing a name drug, if a generic is available.
Act as if your health is YOUR responsibility. Get off the couch, call a halt to drive-through nutrition, examine your habits and ditch what doesn’t serve you, and your health.
Engage with pharma companies who provide you or your family with drugs that work, and tell them so.
Rabble-rouse the FDA to stop standing on innovation, and to start freeing up both farm AND pharm to help us eat better, and help researchers bring new drugs that actually help to market.
Take to the the streets by visiting your local farmer’s market and buying/cooking local. Boycott processed cr*p disguised as food.
Firing that rocket drew the attention of my new friends over at OccupyHealthCare.net.
Recommended reading over there:
The Line Between Radicalism and Realism in Healthcare - speaks clearly about the need for a Bucky Fuller version of reinvention from the ground up
Fragmentation as a Never Event (“never events” are 28 healthcare outcomes listed as total failures by the US National Quality Forum) – the post focuses most on the importance of making mental health part of primary healthcare and the establishment of patient-centered medical homes.
Join me in an #arabspring for healthcare.
Our lives are in OUR hands.
Digital Patient Bill of Rights: check!
Posted by: | CommentsA group of about 20 passionate e-patients, including e-Patient Dave his own self and yours truly, gathered around a biiiiig table on Monday in Philadelphia to talk about what an e-patient Bill of Rights might look like. I have to give a shout-out to my buddies at WEGO Health, particularly Jack Barrette, Bob Brooks, and Natalia Forsyth
One conclusion: don’t call it the e-patient Bill of Rights. Since we’re talking digital healthcare, let’s call it the Digital Patients Bill of Rights. That conclusion was reached hours into the discussion, which ranged over topics from chronic conditions like diabetes, HIV/AIDS, multiple sclerosis, rheumatoid arthritis, lupus, multiple sclerosis, and fibromyalgia to acute illness like cancer.
We had about four hours to hammer out a first-principles statement, and Mark Bard of the Digital Health Coalition deserves the Cat-Herding Nobel Prize for keeping a group of vocal, passionate, diverse e-patients on task.
To lift directly from the Klick Pharma blog (Klick was one of the sponsors of the event, along with Pixels & Pills, Health Central, Care Coach, Kru Research, Radian 6, Red Nucleus, Think Brownstone, Verilogue, and a who’s who of health media sponsors):
“After an intense four hours, we were able to reach consensus on the following key messages as a foundation to a Digital Patient Bill of Rights:
- Shared access to my data
- Attitude of collaboration and overall respect
- The patient is the largest stakeholder
- Transparency and authenticity across all areas
- Voice of the patient is a legitimate (clinical) source
- The right to efficient communication with providers who utilize the technology that we need”
It’s a start. A damn good one. The Klick Pharma blog post also has a full list of all the e-patients who participated in the conversation. It was quitea day.
- Those dealing with chronic conditions have an even deeper need to be activist e-patients. They also have a greater level of knowledge, and can be true leaders in this on-going discussion.
- Each healthcare consumer – formerly known as “patient” – must take action and responsibility on his/her own behalf. And not shut up until they get what they need to achieve the best health possible.
- Having town-hall meetings across the country, inviting community members – healthy, chronic, whatever – to attend, to share, and to learn how to both be consumers of healthcare and advocates for the family members who depend on them, would be a great way to keep the ball rolling and drive wide awareness/support for empowered, engaged e-health.
- Those of us who’ve taken a trip through the medical care car wash have a duty to share our stories, to lead, to educate, to shake up the status quo, to effect change. We get the elected representatives, and the healthcare, we deserve.
Have any thoughts on what you’d like on your Digital Patient Bill of Rights? Tell me.
It’s your health, your healthcare, your life, your choice. Exercise it.
It’s National Health IT week … does that actually MEAN anything?
Posted by: | CommentsData, data – who’s got your data?
Do you have access to your health data? It’s National Health IT (Information Technology) Week, so if you don’t have access, this is the week to start demanding it. Really.
My biggest frustration with the healthcare system, and its use of IT, is that patients are always being told that the only way to secure their data is to restrict access to it. That restricted access include restricting PATIENT access to our own data. It’s Alice in Wonderland for the 21st century. Doubt me? Go ahead, ask a hospital for all your admission records. If that hospital has a patient portal, you might get lucky. If, however, they don’t have a portal? It will be like asking a bureaucrat in the old Soviet Union for paperwork.
HealthIT.gov draws an inspiring, sunny picture about how patients can access their health records. Their vision may come to pass, but it ain’t here yet. Particularly if your cardiologist has his/her own stand-alone practice, then sends you for testing at a hospital, followed by a consult with a vascular surgeon in another independent practice. Getting CCD (Continuity of Care Documentation) data from all three will be a long slog through “please?? PLEASE??” Lather, rinse, repeat.
There is a big light of hope on the horizon, though, and part of that light is shining from actions like the National Health IT Week proclamation. Another big searchlight is a round-table discussion I’ve been invited to participate in on Monday, Sept. 19 in Philadelphia.
One of my very favorite people will be there, e-Patient Dave deBronkart. There will be a number of very passionate advocates for patient access to electronic health records also in attendance. I am literally doing handsprings about this opportunity to engage with other health activist e-patients in a way that will move 100% patient-accessible data protocols forward.
Watch this space for updates 
If you want to be really proactive on your own behalf, and on behalf of your family, join me as an early-adopter at iPersonalHealthCenters.com. Create your own Patient Health Record (PHR) on a secure, portable chip card that can double as your HSA debit card, if you have a Health Savings Account. iPHC membership will also give you access to Health Advocate, which has one of the best patient education platforms this e-patient has ever seen.
Let’s start a patient-centered-medicine revolution, and storm the healthcare Bastille. Who’s with me?
Here’s a link to a slice of my most recent rallying cry on YouTube.
WHO’S WITH ME???
Dear Health IT geeks: LET PATIENTS IN. Please.
Posted by: | CommentsI read, with a combination of amusement and rage, a conversation-via-post about healthcare information technology (HIT) between John Halamka, the CIO of Beth Israel Deaconess Hospital in Boston, and Ken Terry, the editor of FierceHealthIT. Halamka thinks that the rise of electronic medical records is the key to empowering both patients and healthcare providers toward more effective, efficiently-delivered care. He also thinks that the cloud – delivering software services via the web, and hosting system data on servers at scattered sites across a city, region, country, or the globe – will be the biggest driver of health IT innovation and use.
Terry thinks that Halamka’s overly optimistic.
I was moved to make a comment on Terry’s post – that was driven not by amusement, but by a touch of rage – regarding the fact that nowhere in his post did he address the patient. Who is the entire purpose of the exercise in healthcare, even if many people involved in medicine have forgotten that fact.
Halamka actually talks about patients as more than data points. Both Halamka and Kelly are HIT thought leaders, but I give Halamka the win here because he sees patients as both the purpose of the exercise (healthcare) and as the central driver of HIT development and adoption.
As patients, we have to add our voices to the chorus. We must storm the HIT Bastille, demanding secure access to our data, control over who sees it, a say in who are providers are.
Only when patients are truly empowered – and we’ve got to take that power, not wait for someone to give us permission – will healthcare really be transformed into an industry that serves all the players involved in its process. Engaged, empowered patients are more likely to do what their healthcare providers recommend, because they’re truly communicating with each other.
Safety and cost controls will be meaningful because the patient and provider are directly connected as a team working toward the best possible outcome.
Where we are now? To this patient, it feels like the 7th, 8th, and 9th circles of Dante’s hell, all at once.
Please click this link for a bit of humor – infused with just the right touch of irony and rage – that illustrates my point (embedding isn’t working right now … GoDaddy got up and went?)
LET US IN, otherwise the system will remain broken.
