Nice post Tony. Is there an inherent conflict that will build between U.S. Preventative Medicine and those hospitals and other providers that it plans to partner with? If you are correct and U.S. Preventative Medicine are successful in creating a new focus on preventative medicine for the next generation there will be a decrease in hospital utilization. Those hospitals who recognize the shift and build a strategy around a preventative model will be successful. The other major change that has to occur for these efforts to be successful is a change in the governmental payment structure that awards providers for prevention vs. payment based on utilization.

After exploring the U.S. Preventative Medicine website a little more I found this info on payment model. Interesting:

The Center for Preventive Medicine does not accept insurance as payment. The health insurance industry currently operates primarily as a “disease-oriented” system, providing reimbursement only after diseases become symptomatic. Preventive medical care has not been valued in this model and reimbursement is variable. At The Center for Preventive Medicine we encourage our clients to take responsibility for their own health and wellness, beginning with the decision to take responsibility for the cost of preventive services. In most cases, our services qualify for reimbursement by Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs) and some preventive benefit components of insurance plans. We also offer payment plans and gift certificates to help manage the cost of your preventive services.

You have mistaken when you relegate Revolution Health to a mere web portal. Revolution Health is much more than that - Check out RediClinic (http://www.rediclinic.com), in which Revolution Health has a major investment. We are launching our preview site, but we have so much more coming and numerous partnerships underway...stay tuned! I think you will continue to be impressed.

I stand corrected - I was aware of Rediclinic but never associated it with Revolution. Don't worry, revolutionary, I am already impressed with what you've already done with the site. And I'm impressed that you read through this blog - most companies wouldn't even bother)

Bob, in terms of competition & tension with physician/hospitals, you bring up a good point. I think that'll always be there. Web 2.0 is here, and maybe it's time for Hospital 2.0.

Tony, you can be more specific about what you mean by Hospital 2.0.

As for preventative medicine, I am currently working on a new article that discusses the idea of "precaution". The Precautionary Principle, first authored by the network of people out of www.earthcharter.org with respect to the environment is a model of thought that is raising many questions in line with how we talk about Prevention.

In my history, prevention was a term describing how a well person could prevent getting sick.

Like "precaution," when you exercise prevention, you need to think of perspective.

Years ago, Jonathan Peck, a health care futurist, I read often along with Clem Bezold and Paul Starr, talked about how the hospital based system is out of date and numbers of beds would decline. I don't know if beds per 1000 have significantly designed and I know that the American population of 300M contains 100 M people who are in need of care that is not served by the acute care episodic hospital model.

The IAF reports on Diabetes authored by Peck, Bezold, et al are available at this link

http://www.altfutures.com/section.asp?sec=6&nav=6#

At this site, www.altfutures.com is a study by Peck and Yale, that investigates treatment and prevention of for Diabetes. By 2010 there will be 50M Diabetic people in the US. Within this analysis is a new thought strucuture. It won't emerge through academic analysis. It will have to emerge bringing together the voice of consumer, hospital, regulator, government and clinician as I did when I launched my first focus group examing how to build healthy communities in 1996.

Seeking to learn how to be healthy, maintain health and stay educated on treatments and opportunities is complex stuff that I have diagrammed systemically. Within this wide system are many delays, conflicts and stop gaps. It is all frozen by a system of thought from creating change. To lead for change in health care, we are going to have to do more than just mechanically go about our day. It requires innovation and unfortunately if you read Nick's blog closely, the innovator has a hard time in health care. The larger system comes along and asks them to fit what they do within a system rather than ask the innovator to teach to a wider audience and have those participants break down into local groups to apply that learning.

It is the core philosophy behind Evidential Based Medicine, the discipline of evidiential based management that is based on my community of practice theory and the way we engage
at www.workecology.com/redesign2.

Tony,

Thanks for taking the time to highlight our efforts and our recent announcement.

As you accurately point out, a key foundation of our business is partnering with hospitals and physicians. While “healthcare” has taken the heat for a long time on both efficiency and innovation, at the end of the day consumers want and expect that in time of true health need that they can turn to their community for quality care and treatment.

Regardless of what consumers may think of “healthcare”, study after study indicates that they think the world of their personal physician. All the negatives apply to some general thing called “healthcare”. Rather than create a separate track – if you get sick, take this track, if you want to stay healthy take this track – our goal is to create an integrated track that optimizes the health of the individual – in sickness and in health.

Will every hospital or physician get it? Definitely not. But from what we’re hearing and seeing – enough get it that this could well be a wave that sweeps the nation.

Brian the word "personal physician" is key. When HMO's were less than 12% of market share, that is what they promised, a "personal physician" and integrated care ---at a health center, office, hospital or at home.

Lavinia,

Hospital 2.0 could be exactly what Brian eluded to - the concept of in sickness or in health. Imagine a world where hospitals in the same city collaborate to make their city the healthiest in the world. The healthiest cities eventually draw the best companies and the best talent.

I wish that I had coined the term Hospital 2.0 because it really does capture the essence of where we are going. (I have to preface that with recognition that this is not an overnight transformation – this will occur over time and be driven by incremental early adopter successes that make the path obvious for the majority.)

As I travel the country talking with hospital leaders – the consistent theme is that they want to extend their reach in their communities – they do not just want to be the place that people turn in an emergency. Healthcare employs about 13,000,000 people nationwide – it is huge. The vast majority of these people choose healthcare because they truly want to help people. So our question – why ignore this incredible asset? What we hope to do is create a “prevention experience” one that will engage consumers, and be embraced by the healthcare community – because it is organized, packaged, efficient, i.e., Hospital 2.0. As someone earlier pointed out – some hospitals may see prevention as a threat to utilization. This is of course a very narrow view – in a perfect world, people will get sick, accidents will happen. The Hospital 2.0 – Hospital will be optimized to serve the total needs of their community – they will thrive.

(BTW – I hope you don’t mind my crashing your Health leader blog – but I very much enjoy the dialogue.)

Excellent discussion by all and a great example of the value of blogs to create electronic collaborative discussion brought to you by blogs and web 2.0. Like Tony, I'm impressed that both Revolution Health and U.S. Preventative Medicine being engaged, reading and responding to the post.

The concept of patient centered care focusing on prevention and quality is the way our health care system must head. I am hopeful that Health 2.0 companies like Revolution Health can attract and allow consumers to take more interest, control and power over their own health care destiny. Along with this I like the concept of bricks and mortar centers (proposed by U.S. Preventative Medicine) that live and breath the idea of prevention first, treatment second. If we can create a population that is healthier we stem the astronomical costs associated with health care. The explosion of diabetes largely due to obesity is a perfect example.

My state, West Virginia, has one of the poorest, sickest and oldest populations in the nation. Needless to say, health care is big business in our state -- maybe the biggest. We are seeing the train wreck of health care system right now. Economically we are poor with a low level of private business. As a result, our health care system is controlled by governmental payors (around 75%) and the burden (cost shift) that is being born by the private sector has made it even more difficult for us to attract/compete on economic development. Employers can no longer provide the level of health care coverage (if at all) to employees that they have come to expect. This in turn has resulted a larger unisured population causing severe problems for hospitals who have to bear the brunt of this group seeking care. I don't have statistics on this -- but I suspect that health benefits may now out rank salary as the most important factor someone considers when deciding on a job in West Virginia. From a business perspective (remember health care is big business – if not the biggest in West Virginia) the lowering of reimbursement probably has the unintended consequence of increasing utilization as a way for hospitals, physicians and others to maintain business status quo.

The model I would like to see adopted for reimbursement reminds me of the Maytag washer commercials where the repairman is sitting around doing nothing. We want to create a model that pays hospitals and physicians more of the reimbursement % pie for benchmarks (based on acuity level) for having a low census, high level of preventative visits, low level of symtomatic/disease intervening visits, lowering level of needed patient medications, etc.

Revolution Health's efforts play into this concept by trying to provide the health consumer with more info and control of their own health care destiny -- this might ultimately lead to the consumers choosing and then demanding that the system creates centers like U.S. Preventative Medicine that help patients with the difficult task of becoming healthier and therefore less costly to the overall health care system.

One question for the crowd? Do we need to focus first on children and the younger generation? Here in West Virginia, changing the unhealthy lifestyles of adults might be near impossible and certainly very expensive. Our population has a culture of unhealthy living that would have to be broken. I’d be interested to hear whether anyone has statistics on the percentage success of changing unhealthy lifestyles at the various age levels. I’m sure that someone at U.S. Preventative Medicine has looked at this type of information. My vision for legislative change in West Virginia is one that creates huge tax incentives to businesses to create an environment of healthy living. If you operate a business that promotes preventative care – you receive tax incentives. The vision would include increasing the tax on all unhealthy foods and products and lowering the tax for healthy foods and products. Government subsidy for healthy activities, etc.

I look forward to continued discussions on this topic here and around the blogsphere.

What Hospital 2.0 means. I'm sure Nick has visited a few car dealers and is on top of this at Windber. Another perspective on Hospital 2.0.

To - Wild and Wonderful West Virgina,

The situation you describe within your state is one that faces many areas to various degrees. Your state has tremendous assets that should make it a more appealing employment base. Moreover, with the flexibility in working arrangements today – it should be a target for the live where you want/work where you want mentality.

However, health costs are a serious gating factor that all employers look at very closely today. While I could, and would enjoy a lengthy dialogue with you, I’ll just address the point you raise relative to our children. We do believe prevention must start in schools. Our children are largely still raised in an environment where a hearty appetite is a sign of health – “finish your plate, don’t you want a second helping…”. No one ever teaches portion control, or communicates any sense of what does an appropriate “portion” look like. It is our intent to build the U.S. Prevention Network as a network of like minded proactive health organizations across the county to bring prevention to their communities. With this network in place, we plan to extend the prevention message and services from seniors to children – with services, education and programs for all.

The challenge with starting with kids – during their most critical early learning years where they are establishing lifetime behaviors, most kids aspire to be just like mom and dad. So until we break the cycle, our children will likely establish “our” health habits.

I think we all have to agree to the premise that this approach is evolutionary and not something that will connect with every person immediately. This is a generational change that we’re looking at. Early adopters and their successes will give rise to a second level of market adoption, and over time, we will begin to break the cycle. The key is – we must start somewhere, and we must make it easy for the consumer to engage. (They certainly will not struggle through to figure it out on their own.)

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