Tag Archives: blood pressure

Rapid Diagnostics for Life Policies

For years, insurance companies have taken steps to improve the life insurance underwriting experience in the hope of removing obstacles and decreasing not-taken ratios. To that end, some have forgone the traditional exam altogether in favor of simplified issue. But the truth is, consumers still aren’t flocking to life insurers, and the results of these efforts have been incremental.

Force Diagnostics has taken a different approach. We’ve developed a consumer-centric process featuring rapid testing that delivers results in 25 minutes. Tests are performed outside of the home in retail clinics and pharmacies, and results are immediately transmitted directly to the carrier’s underwriting engine for immediate processing. Because of the speed to results, innovative insurers and reinsurers could offer an accurate quote for life insurance to their consumers within 24 hours. And with the benefit of testing with fluids (HbA1C for diabetes, cotinine for nicotine, lipids for cardiovascular risk and the presence of the HIV virus, as well as body mass index and blood pressure), insurers may offer the majority of their products quickly and with assurance.

See also: Next Generation of Underwriting Is Here  

The potential results of using this new process can be seen in this underwriting performance calculator.

Once the calculator is downloaded, you may select a typical life insurance policy from a dropdown menu and enter assumptions that reflect an existing underwriting process. The calculator then shows a comparison on underwriting costs, internal rate of return (or IRR) increases, issued policy increases and the potential effects on persistency. At the end, total costs per app are calculated, as are total profits.

There is tremendous value in improving the customer experience throughout the underwriting process.

free clinic

What New Delhi’s Free Clinics Can Teach U.S.

Rupandeep Kaur, 20 weeks pregnant, arrived at a medical clinic looking fatigued and ready to collapse. After being asked her name and address, she was taken to see a physician who reviewed her medical history, asked several questions and ordered a series of tests, including blood and urine. These tests revealed that her fetus was healthy but that Kaur had dangerously low hemoglobin and blood pressure levels. The physician, Alka Choudhry, ordered an ambulance to take her to a nearby hospital.

All of this, including the medical tests, happened in 15 minutes at the Peeragarhi Relief Camp in New Delhi, India. The entire process was automated — from check-in, to retrieval of medical records, to testing and analysis and ambulance dispatch. The hospital also received Kaur’s medical records electronically. There was no paperwork filled out, no bills sent to the patient or insurance company, no delay of any kind. Yes, it was all free.

The hospital treated Kaur for mineral and protein deficiencies and released her the same day. Had she not received timely treatment, she may have had a miscarriage or lost her life.

This process was more efficient and advanced than any clinic I have seen in the West. And Kaur wasn’t the only patient; there were at least a dozen other people who received free medical care and prescriptions in the one hour that I spent at Peeragrahi in early March.

The facility, called the “mohalla” (or people’s) clinic, was opened in July 2015 by Delhi’s chief minister, Arvind Kejriwal.  This is the first of 1,000 clinics that he announced would be opened in India’s capital for the millions of people in need. Delhi’s health minister, Satyendar Jain, who came up with the idea for the clinics, told me he believes that not only will they reduce suffering but also overall costs — because people will get timely care and not be a burden on hospital emergency rooms.

The technology that made the instant diagnosis possible at Peeragarhi was a medical device called the Swasthya Slate. This $600 device, the size of a cake tin, performs 33 common medical tests including blood pressure, blood sugar, heart rate, blood haemoglobin, urine protein and glucose. And it tests for diseases such as malaria, dengue, hepatitis, HIV and typhoid. Each test only takes a minute or two, and the device uploads its data to a cloud-based medical-record management system that can be accessed by the patient.

The Swasthya Slate was developed by Kanav Kahol, who was a biomedical engineer and researcher at Arizona State University’s department of biomedical informatics until he became frustrated at the lack of interest by the medical establishment in reducing the cost of diagnostic testing. He worried that billions of people were getting no medical care or substandard care because of the medical industry’s motivation in keeping prices high. In 2011, he returned home to New Delhi to develop a solution.

Swasthya Slate is a mobile kit that empowers front-line health workers with usable technology for prevention diagnosis care and referral of diseases. The Swasthya Slate kit was launched in the state of Jammu and Kashmir by the Ministry of Health in 2014. (Swasthya Slate)

 

Kahol had noted that, despite the similarities between medical devices in their computer displays and circuits, their packaging made them unduly complex and difficult for anyone but highly skilled practitioners to use. They were also incredibly expensive — usually costing tens of thousands of dollars each. He believed he could take the same sensors and microfluidics technologies that the expensive medical devices used and integrate them into an open medical platform. And with off-the-shelf computer tablets, cloud computing and artificial intelligence software, he could simplify the data analysis in a way that minimally trained front-line workers could understand.

By January 2013, Kahol had built the Swasthya Slate and persuaded the state of Jammu and Kashmir, in Northern India, to allow its use in six underserved districts with a population of 2.1 million people. The device is now in use at 498 clinics there. Focusing on reproductive maternal and child health, the system has been used to provide prenatal care to more than 22,000 mothers. Of these, 277 mothers were diagnosed as high-risk and provided timely care. Mothers are getting care in their villages now instead of having to travel to clinics in cities.

A newer version of the Slate, called HealthCube, was tested last month by nine teams of physicians and technology, operations and marketing experts at Peru’s leading hospital, Clinica Internacional. They tested its accuracy against the Western equipment that they use, its durability in emergency room and clinical settings, the ability of minimally trained clinicians to use it in rural settings and its acceptability to patients. Clinica’s general manager, Alvaro Chavez Tori, told me in an email that the tests were highly successful, and “acceptance of the technology was amazingly high.” He sees this technology as a way of helping the millions of people in Peru and the rest of Latin America who lack access to quality diagnostics.

The opportunity is bigger than Latin America, however. When it comes to healthcare, the U.S. has many of the same problems as the developing world. Despite the Affordable Care Act, 33 million Americans ,or 10% of the U.S. population, still lacks health insurance. These people are disproportionately poor, black or Hispanic, and 4.5 million are children. They receive less preventive care and suffer from more serious illness — which are extremely costly to treat. Emergency rooms of hospitals are overwhelmed by uninsured patients seeking basic medical care. And even when they have insurance, families are often bankrupted by medical costs.

It may well be time for America to build mohalla clinics in its cities.

What Loneliness Does to Your Health

One of the myriad reasons workplace wellness is not performing well is that all humans have about 100 risk factors, of which obesity, high blood sugar, high blood pressure and high cholesterol are only four. If those four are in pretty good shape but the other 96 are out of whack, don’t expect good health results.

Further, putting bandages on symptoms of metabolic disease has limitations. Such bandages do not address the root causes of metabolic syndrome. According to Wiki, “Root cause analysis (RCA) is a method of problem solving used for identifying the root causes of faults or problems. A factor is considered a root cause if removal thereof from the problem-fault sequence prevents the final undesirable event from recurring; whereas a causal factor is one that affects an event’s outcome but is not a root cause. Though removing a causal factor can benefit an outcome, it does not prevent its recurrence within certainty.” [Emphasis mine.]

One thing sorely missing from most modern wellness methods is RCA. Unless one deals with RCA in metabolic syndrome, it will continue to recur.

Some other huge health risks factors are job misery, terrible marriages, very poor money-handling skills, envy, general lack of contentment in life and loneliness. Another health risk is how far you live from a “dial-911 first responder.” Yet another is how safe your neighborhood is. I could go on and on. Worksite wellness does nothing to address the vast majority of personal health risks. My book, An Illustrated Guide to Personal Health, elaborates on such health risks.

This article will cover just one of those risks, loneliness, which among other things is a root cause of metabolic syndrome. (Let’s hope this information does not inspire true believers in wellness penalties to look for ways to charge lonely employees higher payroll deductions.)

Loneliness harms your immune system, makes you depressed, diminishes cognitive skills and can lead to heart disease, vascular disease, cancer and more. Loneliness is roughly the health risk equivalent of being a diabetic who smokes and drinks too much. Read on.

An article from the National Science Foundation explores the health hazards of loneliness. According to this article, “Research at Rush University has shown that older adults are more likely to develop dementia if they feel chronic loneliness.”

Moreover, John Cacioppo, neuroscience researcher of the University of Chicago, says of loneliness, “One of the things that surprised me was how important loneliness proved to be. It predicted morbidity. It predicted mortality. And that shocked me.”

Dr. Sanjay Gupta recently wrote, “The combination of toxic effects [of loneliness] can impair cognitive performance, compromise the immune system and increase the risk for vascular, inflammatory and heart disease.”

According to studies in Europe, loneliness has about the same health risk as obesity.

An article in Caring.com says, “A 2010 Brigham Young University review of studies involving more than 300,000 people concluded that loneliness is as unhealthy as smoking 15 cigarettes a day or being an alcoholic.

This is a headline in the U.K.’s Express: “Loneliness is as big a KILLER as diabetes.” The article describes how loneliness is like a deadly disease that decreases life expectancy and makes you more susceptible to cancer, heart disease and stroke. The study behind that conclusion was published in the Proceedings of the National Academy of Science.

Here are some personal observations:

Why do many people have so few friends as they age?

  • Maintaining long-term friendships takes a lot of work and investment of time.
  • Don’t let your career stand in the way. Don’t wait for someone to befriend you; reach out.
  • Some people have invested their time and energy solely in a spouse, who may predecease them by 25 years, or in children, who fly the nest in time.
  • Many people have invested much in work-related friendships, which, while genuine at the time, can wilt almost immediately when they retire or move on.
  • In friendships, one has to give more than he takes. Make yourself likable. Who wants to spend time with someone who complains all the time? People like that are often avoided by people around them.
  • Be a good listener.
  • If you’re lonely, try joining something…a place of worship, a book club, a hiking club, anything. In every community are places where everyone is welcome.

In the end, a true measure of your wealth is the number of lifelong friends you have. Having lifelong friends is a joy and a perfect cure for loneliness.

1 Myth, 2 Truths, 5 Hot Trends in Health IT

There is a myth out there that healthcare providers are unwilling to adopt new technology. It’s just not true. In the last few months, I have spoken to dozens of healthcare leaders at hospitals both small and large, and I am amazed at their willingness to understand and adopt technology.

Pretty much every hospital CEO, COO, CMIO or CIO I talk to believes two things:

With growing demand, rising costs and constrained supply, healthcare is facing a crisis unless providers figure out how to “do more with less.”

Technology is a key enabler. There is technology out there to help save more lives, deliver better care, reduce costs and achieve a healthier America. If a technology solution solves a real problem and has a clearly articulated return on investment (ROI), healthcare isn’t that different from any other industry, and the healthcare industry is willing to adopt that technology.

Given my conversations, here are the five biggest IT trends I see in healthcare:

1. Consumerization of the electronic health record (EHR). Love it or hate it, the EHR sits at the center of innovation. Since the passage of the HITECH Act in 2009—a $30 billion effort to transform healthcare delivery through the widespread use of EHRs—the “next generation” EHR is becoming a reality driven by three factors:

  • Providers feeling the pressure to find innovative ways to cut costs and bring more efficiency to healthcare delivery
  • The explosion of “machine-generated” healthcare data from mobile apps, wearables and sensors
  • The “operating terminal” shifting from a desktop to a smartphone/tablet, forcing providers to reimagine how patient care data is produced and consumed

The “next generation” EHR will be built around physicians’ workflows and will make it easier for them to produce and consume data. It will, of course, need to have proper controls in place to make sure data can only be accessed by the right people to ensure privacy and safety. I expect more organizations will adopt the “app store” model Kaiser pioneered so that developers can innovate on their open platform.

2. Interoperability— Lack of system interoperability has made it very hard for providers to adopt new technologies such as data mining, machine learning, image recognition, the Internet of Things and mobile. This is changing fast because:

  • HHS’s mandate for interoperability in all EHRs by 2024 means patient data can be shared across systems to enable better care at lower cost.
  • HITECH incentives and the mandate to move 50% of Medicare payments from fee-for-service to value-based alternatives by 2018 imply care coordination. Interoperability will become imperative.
  • Project Argonaut, an industry-wide effort to create a modern API and data/services sharing between the EHR and other systems using HL7 FHIR, has already made impressive progress.
  • More than 60% of the proposed Stage 3 meaningful use rules require interoperability, up from 33% in Stage 2.

3. Mobile— With more than 50% of patients using their smartphone to monitor health and more than 50% of physicians using (or wanting to use) their smartphone to monitor patient health, and with seamless data sharing on its way, the way care is delivered will truly change.

Telemedicine is showing significant gains in delivering primary care. We will continue to see more adoption of mobile-enabled services for ambulatory and specialty care in 2016 and beyond for three reasons:

  • Mobile provides “situational awareness” to all stakeholders so they can know what’s going on with a patient in an instant and can move the right resources quickly with the push of a button.
  • Mobile-enabled services radically reduce communication overhead, especially when you’re dealing with multiple situations at the same time with urgency and communication is key.
  • The services can significantly improve the patient experience and reduce operating costs. Studies have shown that remote monitoring and mobile post-discharge care can significantly reduce readmissions and unnecessary admissions.

The key hurdle here is regulatory compliance. For example, auto-dialing 9-1-1 if a phone detects a heart attack can be dangerous if not properly done. As with the EHR, mobile services have to be designed around physician workflows and must comply with regulations.

4. Big data— Healthcare has been slower than verticals such as retail to adopt big data technologies, mainly because the ROI has not been very clear to date. With more wins on both the clinical and operational sides, that’s clearly changing. Of all the technology capabilities, big data can have the greatest near-term impact on the clinical and operational sides for providers, and it will be one of the biggest trends in 2016 and beyond. Successful companies providing big data solutions will do three things right:

  • Clean up data as needed: There’s lots of data, but it’s not easy to access it, and isn’t not quite primed “or clean” for analysis. There’s only so much you can see, and you spend a lot of time cleansing before you can do any meaningful analysis.
  • Meaningful results: It’s not always hard to build predictive analytic models, but they have to translate to results that enable evidence-based decision-making.
  • Deliver ROI: There are a lot of products out there that produce 1% to 2% gains; that doesn’t necessarily justify the investment.

5. Internet of Things— While hospitals have been a bit slow in adopting IoT, three key trends will shape faster adoption:

  • Innovation in hardware components (smaller, faster CPUs at lower cost) will create cheaper, more advanced medical devices, such as a WiFi-enabled blood pressure monitor connected to the EHR for smoother patient care coordination.
  • General-purpose sensors are maturing and becoming more reliable for enterprise use.
  • Devices are becoming smart, but making them all work together is painful. It’s good to have bed sensors that talk to the nursing station, and they will become part of a top level “platform” within the hospital. More sensors also mean more data, and providers will create a “back-end platform” to collect, process and route it to the right place at the right time to can create “holistic” value propositions.

With increased regulatory and financial support, we’re on our way to making healthcare what it should be: smarter, cheaper and more effective. Providers want to do whatever it takes to cut costs and improve patient access and experience, so there are no real barriers.

Innovate and prosper!

2 Studies of Why Wellness Fails

Henry David Thoreau famously said, “Most men lead lives of quiet desperation…”

People who lead desperate lives don’t make good subjects for wellness programs, nor, for that matter, lifestyle advice from doctors. Below are two real life examples of ordinary people I’ve chatted with about matters of personal health. After both of these conversations, I was quite humbled.

Case 1

I had a chance conversation with a pleasant but overweight woman I’ll call Donna, a cashier in a big city grocery store, who was about 50 years old. We were having a nice chat, and I asked her if she had opportunities to exercise after work. Donna said that, after being on her feet all day, she had to go home and put her feet up. That prevented her from having much of a social life, too. Donna said she would never have a better job, that she’d never buy a new car, nor afford vacations or holiday trips. Her rent was so high, it was all she could do to makes ends meet. Donna said her only fun in life was buying a take-home pizza and a six pack of beer once or twice a week. Take that away, and Donna said she had nothing. Truthfully, and sadly, in my heart I could not blame her.

Case 2

A few years ago I had a lengthy cab ride in Baltimore and struck up a good conversation with the cab driver, a friendly, middle-aged man I’ll call George. He asked what I did for living, which resulted in a good chat about personal health. George smoked, had high blood pressure and diabetes and was overweight. He said he’d tried to get those things under control but just couldn’t. The interesting part of the story is why he couldn’t control his health risks. George said he’d lived in Baltimore all his life and had the same set of friends since grade school. One night a week, they’d go bowling, eat huge meals and drink way too much beer. Also, once a week or so they’d go to a sports bar and do the same thing. George truly believed he’d have to give up his lifelong friends if he were to cut out that lifestyle. He knew it was slowly killing him, but he just wasn’t willing give up. It was hard to blame him either.

Those are two true stories of people trapped in a lifestyle they can’t or won’t willingly forfeit. Huge numbers of people are in the same boat.

Some people are going to comply with doctor suggestions on lifestyle without any help at work. But, if Thoreau is right, there are many people out there like Donna and George.

Bad lifestyle choices can be terribly complex. They virtually never arise from the lack of the kind of information that wellness vendors push as the solution.