Thursday, August 6, 2015

Medicine Is Going Through A Revolution -- With Doctors' Help - Forbes

from Forbes Magazine, as written by David Chase
"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete. Buckminster Fuller"
"It is only after a revolution concludes that one can clearly look back and fully understand what triggered the revolution. External factors such as technology shifts can create the conditions for a revolution where it may not have been possible before. A generation that has a different worldview than their elders may not accept that status quo. From what I’m observing, I believe we are seeing a revolution’s first phase happen before our eyes. (ZdoggMD)

As you can see in the picture accompanying this article after the post-Velvet Revolution celebration, it’s all ages who celebrate. It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.

I’m convinced that the only way there will be a true revolution in healthcare is if there is a partnership between clinicians and individual citizens (aka patients/consumers/people). One without the other isn’t sufficient to unseat deeply entrenched systems. However, I feel doctors will play a unique role in catalyzing the revolution (not to say that clinicians of all types won’t play important roles as well). As I’ve been a Johnny Appleseed of sorts chronicling the far-reaching and transformational work of doc-entrepreneurs, it feeds my optimism that it’s possible to overcome the “Preservatives” who have 3 trillion reasons to protect the status quo. " 

One might interchange the word Conservative for Preservative, since conservatives usually like the status quo.

For those of us who have seen how much better the system can work when goals are properly aligned, it’s “good news” that doctor burnout and dissatisfaction is at an all-time high (see The Quadruple Aim: A Square Deal for Clinicians for more). Why? Dissatisfaction is the seed corn for change and revolution. Make no mistake. There is extremely high level of dissatisfaction amongst a large chunk of doctors who yearn for change. The contrast between those inside of flawed versus optimized care delivery and payment models is stark. One the one hand, I have heard and seen docs who are seeing 30-50 patients a day, dealing with unwieldy/outdated EHRs optimized for billing (vs. care) and getting more bureaucracy thrown on top of an already-flawed model. On the other hand, it’s breathtaking when I visit clinics like CareMore, ChenMed, Iora Health, Qliance, Vera Whole Health and others where the clinicians and patients are both extremely satisfied.
In the video below, Dr. Zubin Damania powerfully captures the sorts of internal dialogue doctors have had one by one with themselves.

I suspect all the doctor entrepreneurs/leaders I’ve highlighted below had some similar internal discussions. This is how revolutions begin. By no means is it limited to young doctors but typically it’s the young who foment revolutions and they are then joined by those older than them.
It’s worth noting that the Velvet Revolution was triggered by a crackdown on students.  This is what we see in medical school and in young physicians in training, or in the early years of practice. More likely it will occur when they enter the practice world. For most MDs it has been a shock to adjust how they practice.
In their own way, each of the doctors listed below is contributing to building the new ecosystem and ignoring the Preservatives who are wedded to the status quo. As mentioned above, there are non-physician clinicians and individual citizens having a big impact but I focus on doc-entrepreneurs and intrapreneurs here.
  • Dr. Rajaie Batniji co-founded Collective Health in the belief they could help employees receive better care and coverage than what many experience with incumbent health plans
  • Dr. Steven Eisenberg for adding love & music to #oncology and humanity to medicine (h/t Bunny Ellerin)
  • The late Dr. Tom Ferguson coined the term e-patient many years before others were focused on equipped, enabled, empowered and engaged patients. This is a whitepaper (PDF) finished by his colleagues after his untimely passing.
  • Dr. Rushika Fernandopulle founded Iora Health to restore humanity to healthcare. They have proven to take on the most challenging patient populations and achieve outstanding outcomes and even take on individuals not addressed by the new health law with the support of a Nobel Prize winner.
  • Dr. Paul Grundy has led IBM’s transformation in healthcare shifting their thinking from healthcare as a soft benefits item left to HR to something that is a critical supply chain cost and source of competitive advantage.
  • Dr. Rob Lamberts showed how an independent family physician can strike out on their own and provide better care and be more professionally satisfied
  • Dr. Risa Lavizzo-Mourey is leading the Robert Wood Johnson Foundation spearheading their major re-focus on creating a Culture of Health that is impacting communities throughout the country.
  • Dr. Harry Leider is leading Walgreens retail clinic and telehealth expansion that promises to reach half of the country by the end of the year.
  • Dr. Geraldine McGinty for her work creating innovative radiology payment models & spearheading payment reform (h/t Bunny Ellerin)
  • Dr. Farzad Mostashari described Aledade’s goals as follows: ”It’s to help independent primary care doctors re-design their practices, and re-magine their future. It’s to put primary care back in control of health care, with 21st century data analytics and technology tools. It’s to support them with people who will stand beside them, with no interests other than theirs in mind.”
  • Dr. Stan Schwartz saw what Dr. Keith Smith was doing and has been creating a true transparent medical network and making that available to employers  — both doctors and patients are saved from excruciating amounts of bureaucracy in a very appealing economic model to both parties. It’s also the first Health Rosetta item to be delineated.
  • Dr. Danny Sands co-founded the Society for Participatory Medicine while practicing and famously taking care of ePatient Dave.
  • Four years ago, I observed how doctors such as Wendy Sue Swanson, Natasha Burgert & Howard Luks were doing something similar to how Sal Khan had “flipped the classroom”. This led to the Robert Wood Johnson Foundation initiating a major program called Flip the Clinic to improve outcomes and participation by patients.
  • Dr. Mike Sevilla for using  to educate, elucidate and save family medicine  (h/t Bunny Ellerin)
  • Dr. Eric Topol has written and spoken extensively about how central the patient will be as a participant in their care compared to traditional practices. He highlights how the smartphone is the equivalent of the Gutenberg Press for medicine
  • Dr. Bryan Vartabedian is showing other doctors how to be a “public” physician & the impact that can have on outcomes
  • Dr. Sheldon Zinberg founded CareMore creating a national leader in treating the frail elderly.
By no means is the list above complete. Add your comment below on a revolutionary doctor that has inspired you. Let us know what they are doing. Whether it is private practice, venture-backed startups, public health or health benefits, each doctor is contributing to the revolution. In their own way, they are fostering a Velvet Medical Revolution.


Medicine Is Going Through A Revolution -- With Doctors' Help - Forbes
Post a Comment