Healthcare Beans

Episode 6 of Healthcare Beans podcast

Cityblock Health is a unicorn startup serving high quality healthcare to low-income communities.

Episode takeaways:

(1) There are several high profile companies supporting the nation’s transition to value-based healthcare. Cityblock Health is at the forefront. Here’s a short list: Oak Street Health, Iora Health, Lumeris, and UniteUs.

(2) Managing healthcare spending for complex, low-income patients is not an easy task – many smart, dedicated people have tried and failed.

(3) Addressing the social determinants of health may be the determining factor for long-term success – not just for Cityblock Health, but for the entire sector.

~ James

Transcript

Hello and welcome to Healthcare Beans, I’m your host James Haven. In this episode, I’m going to focus on a rather interesting startup in value-based healthcare. On Healthcare Beans, I often talk and write about the many federal and state programs which address some really big challenges in healthcare (mostly around lowering healthcare spending or expanding access to good healthcare) and to be fair, the results of these government programs are kind of mixed.

Many of these programs fall under some sort of accountable care model and these models try to connect physician (or hospital) payment to patient health outcomes; to put it simply, this means good doctors are rewarded for delivering good care, and bad doctors are financially penalized.

But again, the results of these programs are mixed; many of them have not actually reduced the cost of healthcare (at least not in any significant way), and only a few programs show some promise in doing that in the near future.

Outside of government programs, there are many interesting and valuable developments in the private sector, and in the end, it wouldn’t be surprising if healthcare companies make some real lasting changes in terms of lowering the cost of healthcare and improving our health outcomes.

And the companies I’m currently thinking about use different types of data along with specialized care teams in order to manage (or drive down) healthcare spending. These companies (that I think are worth keeping an eye on) are Oak Street Health, Iora Health, Lumeris, Unite Us, and Cityblock Health. And I include these company names with links in the show notes, if you’re interested in learning more about them.

So with that, I’d like to dive more deeply into Cityblock Health. Cityblock is headquartered in Brooklyn NY, and operates across NYC, Connecticut, Chicago and Washington DC. The company specializes in delivering quality healthcare to low-income patients. Now, when you hear “low-income” a few key points come to mind.

Low-income patients often have more health problems than people with average incomes, and this is a well-known pattern coming out of numerous studies in Medicare and Medicaid. And because low-income patients have more health problems, they’re much more expensive to care for; they’re more likely to end up in the emergency room, and more likely to be hospitalized.

And perhaps most importantly, low-income patients have social service needs that are often unmet. And that could be a lack of transportation, or unstable housing, not having enough nutritious food, being socially isolated... so not having nearby friends or family – and studies have shown these types of social problems play a huge role in poor health outcomes.

Going back to Cityblock Health, the company just completed Series C fundraising and is currently valued at over $1 billion, so perhaps there’s an IPO in the near future. And early reporting suggests the company’s healthcare delivery model can reduce unnecessary health spending among complex patients. All in all, I’d love to invest in Cityblock Health if given the chance (it’s a very exciting company), but at the same time, it’s really important to understand just how difficult it is to truly reduce healthcare spending (emergency use or hospitalizations) for complex, low-income patients.

So here’s the backstory for managing complex patients in the United States. About 10 years ago, a new healthcare group called the Camden Coalition of Healthcare Providers began some innovative programs to address the social determinants of health in complex, low-income patients, and they demonstrated some very positive results in reducing the health costs for this population (at that time).

The broader healthcare community took notice of this and began similar programs across the country, with mixed results. Fast forward several years later, health researchers...

Episode #4 of the Healthcare Beans podcast In the United States, privacy protections for health data are not as restrictive as most people think. Your doctor is not the only person who can access your data. In this episode I talk about: (1) how health data is used, (2) who has access to our health data, and (3) who benefits from sharing health data. Check out these links for background content on health data privacy laws and value-based healthcare. ~ James Transcript Hello friends and welcome to the Healthcare Beans podcast, I’m your host James Haven. Today I want to talk about issues involving your health data; so questions like how’s your data being used; who exactly is benefiting from your data; the types of people and entities who can access your data, and of course – why you should care about how your data is being used. When it comes to health data sharing, the first thing you should understand is that you actually do not have much control over your data (when you have a medical event, be it a basic checkup or emergency care or something else, there’s a host of entities that have legal access to your data, for the purpose of providing good care to you) – and I know (from a privacy perspective) that’s not a very comforting thought, but for the most part, your data is being handled in a way that is aligned with your overall health interests. Now, there are folks out there who might disagree and think your health data is being used to expose you or harm you in some way, but I want to share my experiences working in healthcare data operations, including my work with health data under federal and state programs – and after hearing that I hope to (alleviate some of your concerns on data privacy) persuade you about the benefits of sharing your health data, because there are benefits. Once you receive any type of medical care – your diagnoses, the procedures and tests you went through, and your demographic data, that can all be accessed by several types of entities. And these entities include your doctor (of course), your doctor’s health network (which could be a small group of providers, or could be thousands of providers in your state or region), your insurance company (we refer to these groups as payors) so thinking about Medicare, Medicare Advantage, Medicaid, and also technology companies that contract with your healthcare provider – so companies providing data management services (like EMRs) or some number-crunching analytics or whatnot. And to be clear, that means a lot of different people have access to your data. When I was working as a data analyst, I had access to tons of data, and that includes people’s names, addresses and health conditions. Now, did I personally know any of these people – absolutely not. Do I recall these data? – to be perfectly honest, no, I do not. The reason is that when analyzing the data, I almost always used some sort of alpha-numeric IDs, not patient names. So if my job was to find people with diabetes, who visited the ER in the past 6 months, and have not had a wellness checkup this year – I’d dig through the data, pull that list together, and it would be filled with IDs like “patient: NZ8211560” and I would send that info off to folks on the care management team (nurses, social workers, and doctors). By and large, the people who actually witness your personal data (like your name, gender, address) & your medical data are the clinical folks you interact with. Now, that doesn’t mean other people cannot access personal information and medical conditions, but there’s really no reason (incentive) for people outside your care team to do this. Again, I’m not quoting hard-n-fast rules here; I’m just sharing my experience in healthcare data operations – nobody digs through personal-level data because you probably have to jump through some hoops to do that (which means getting actual names behind these obscure IDs) and there’s just no reason to do it,

Episode #2 of the Healthcare Beans podcast Keeping your annual wellness visit is a great way to safeguard your future health! In this episode, I talk about the importance of the annual wellness visit, and how health systems use data to prioritize patient outreach. Check out my earlier post on this topic (if you prefer to read instead of listening to a podcast). ~ James Transcript Hello everyone and welcome to the Healthcare Beans podcast, I’m your host James Haven, and today I want to talk about annual wellness visits, and in particular, should we (and by “we” I mean patients) care about these types of medical appointments. At the outset, talking about annual wellness visits may seem a bit unimportant or even a little boring, but it’s actually kind of surprising what’s goes on behind the scenes with annual wellness visits and by the end of this episode I hope I can convince you to take them seriously. And for additional context, the annual wellness visit is a pretty important element for implementing value-based healthcare, which I talk about in episode #1 of this podcast. And I will circle back to this topic later in the episode... As always, the best way to think and talk about healthcare is through the patient experience. So I’m going to share a patient story that I came across a few years back. Several years ago, while interviewing for an analytics job in healthcare, someone showed me a graph of a single patient’s movement across 10 different hospitals and rehab sites, across a span of 8 months. Now, there’s a particular name for this type of patient, sometimes referred to as a ‘super-utilizer’, but some folks find this term a bit offensive, not really sure why though it might remind people of the term ‘super-predator’ from the 90s which coincided with tough crime laws and really high incarceration rates among black men. Anyway, the new term is “high-cost, high-need” patients, and this term describes people who end up costing health insurance companies a small fortune in a short time span (3 to 6 months, or 1 year). So going back to that interview, a health system VP shared some graphs with me and asked me what I thought of the data? So as I studied the patterns of movement between facilities, the key thing that jumped out at me was that this patient (we’ll just call him Harry) never went home! He bounced around the healthcare system for 8 months, wound up costing Medicare half a million dollars, and then he died. Harry’s entire problem began with a poorly managed chronic disease. He went to the emergency department one day, and that was it, he never escaped the health system. And this is where good preventative care comes in, this where annual wellness visits become important – we want our doctors to spot our health problems long before we spot them ourselves, and certainly before we require emergency care. To be clear, the wellness visit is an annual touch base with your doctor, that includes a routine check-up, blood test, a vitals check, and a LOT of information gathering. A key thing about annual wellness visits are that these visits are often initiated by your doctor. Someone from your doctor’s office calls you, and wants to set up an appointment. So this is not the usual type of dr visit, where I feel like something is wrong in my body, and I reach out to my doctor to schedule an appointment (this is the other way around). Now I was talking to a health policy colleague a while back and he did not really understand the significance of wellness visits (or much of primary care in general) and whether these visits were actually effective at keeping people healthy. He didn’t have much faith in a doctors’ ability to spot problems early on, but I would argue otherwise. It’s not just the doctor’s training, or skill or intuition, that’s involved in “problem-spotting”; it’s the data that’s gradually collected on patients over time. And the annual wellness visit is a great data col...

Episode 9 of the Healthcare Beans podcast

Without realizing it, I played an important role in my wife’s health journey. But first, a bit of context..

I often find that healthcare professionals pay little regard to individuals’ capacity for willpower or grit. The prevailing viewpoint is that poor health outcomes are caused by systemic problems like waste, greed, and failed policy. Period. There is no doubt that healthcare delivery in the United States is poorly designed, and must be corrected through policy changes. But without holding patients accountable for their own health outcomes, we cannot help people live the best version of themselves. And until we do that, I fear a great deal of time and money will be spent on healthcare solutions that barely work.

Episode takeaways:

(1) I share a story about my wife’s health journey, as an example of how family and friends can be excellent constructive critics who propel us toward better living.

(2) There are countless success stories about people who dropped unhealthy habits and started living a better life. These stories should form the foundation of how health systems engage patients.

(3) Resilience research can serve as a framework for healthcare professionals to better support patient accountability and help people live the best version of themselves through a combination of (1) grit and (2) a practical method of self-improvement.

Godspeed!

~ James

Episode #3 of the Healthcare Beans podcast In this episode, I argue against putting too much faith in good doctors. I know that sounds strange but a well organized care team is what really counts, and this is what people should expect from their local health system. I stress the importance of organized care delivery by sharing a story about my 73 year-old uncle who suffers from multiple chronic diseases. He recovered from a COVID-19 infection back in September 2020, after being treated with Dexamethasone. He had a great doctor but his care team dropped the ball. And when it comes to finding a new doctor, I think healthgrades is a good site to explore. But make sure you read the full profile - the bad stuff is often tucked away at the bottom of a profile. Subscribe to my podcast or check out my site's episode list if you’d like to learn more about US health systems and value-based healthcare. ~ James Transcript Hello healthcare enthusiasts and thanks for tuning into the Healthcare Beans podcast, I’m your host James Haven. This is the 3rd episode in the podcast, and we’re still laying out the fundamental knowledge on healthcare and health systems, and what people should be aware of in order to understand and navigate this complex system. So onto the big question for today – “what exactly is good healthcare?”. And I pose this question for a reason, it is to help people put down a very common, simplistic and ultimately wrong idea of what good healthcare is. Many, many people think good healthcare is all about having a good doctor, and this is NOT true. And I’m going to share a brief story that I think will convince you not to put your full trust in a good doctor. I’d like to share a story about my uncle. He’s 73 years old with chronic liver disease; he underwent a triple bypass heart surgery about 2 years ago, and struggles to maintain a healthy blood pressure. He’s certainly not in good shape, but my aunt takes great care of him, staying on top of all his medications and his diet – so he’s pretty lucky in that respect. And to be fair he lived much of his life on his own terms, eating and drinking whatever he wanted; and ignoring exercise. Back in August, my uncle contracted COVID-19. We were surprised to hear this because he and my aunt were social distancing in a small apartment in CT, but social distancing is not a guarantee that you won’t get sick. And as expected, my uncle developed the usual symptoms: high fever, aches, and difficulty breathing. Now it’s common knowledge that COVID-19 is very serious for the elderly, especially older people with chronic disease. So we had zero faith that he would ever leave the hospital; our concern was making sure my aunt felt supported and getting ready to help make funeral preparations. He spent about 8 days in the hospital, and during that time the doctor would keep in contact with my family every day, letting us know how he’s doing, because (of course) we could not visit him ourselves; answering our questions, and making sure he’s getting the care he needs. She (the doctor) treated him with a steroid, Dexamethasone, and he started feeling better pretty quickly where each day was better than the previous day. If you haven’t heard of this drug, definitely look it up, the findings are very positive (doctors are using this drug in combination with other drugs) – all the major news outlets are reporting on it; again, it’s called dexamethasone and I have a link in the show notes so you could click on that and learn more about it. I can’t say enough good stuff about this doctor, she was super-responsive, compassionate and brought my uncle back from the brink of death. There was even an incident where the hospital (someone from nursing administration) tried to discharge him early, at around 5 days, and we were concerned about that timing, we thought it was too short, so we discussed that with his doctor, and she decided to keep him inpatient for 3 more days.