Just passing along that I’ll be speaking at Wharton on Feb 13th about healthcare, entrepreneurship, and a plethora of other things that come to mind (anyone who has seen me speak knows can be both comical and unnerving to a facilitator).  Please feel free to join us and participate!

The Healthcare Panel for the Wharton Entrepreneurship Conference on February 13th, 2009 in Philadelphia, PA – www.wec2009.com

Flickr @ jimfrazier

The “Last Mile“

It’s an expression that has been running through my mind for quite some time over the past year.  I think that I first heard it used to describe the frustrating gap of getting everyday consumers/households connected to high-speed internet svc with the belief that if only our Parents and the guy that works at the bowling alley could surf the internet at high-speed for a reasonable price, then people would flock to (nay… DEMAND) rich media experiences such as music, videos, pictures, etc.

There existed an ever growing fat pipe of rich content just sitting… waiting… to entertain and engage people on the internet backbone and trunk-lines that ran into the cities and across the country – If only people had faster internet than their old 56k dial-up modem via home telephone lines in order to connect at blindingly faster speeds across that figurative last mile gap of connectivity from a person’s home to the internet-backbone connection point in the community . Of course, much more expensive internet access was available but only eager techies and early adopters were willing to pay the much higher costs to access this pipe of richer information. I’m sure that i’ve botched the exact specifics, but hopefully I’ve jogged your memory enough to understand the issue of the time – that palatable yet intangible Last Mile of connectivity, of rich and engaging User experience.

Healthcare Consumerism

So what the heck does that Last Mile stuff have to do with American healthcare?  Well, i’ve begun to feel a growing sense of Deva Vu.  There has been an ever increasing explosion of healthcare technology and web-based services that was first aimed at payors, then TPAs, then employers, and now the burgeoning and highly befuddled individual consumer. And as more emphasis and focus has been placed on individuals becoming both financially and personally accountable for their health and all related costs – I am left with a seriously nagging question: As the arsenal of tools and information available to consumers grows…what is the Last Mile of healthcare consumerism?

Unfortunately, I don’t have a clear ‘answer’. I’m just not that smart. But as I think about it, I thought that I’d lob some characteristics of the Last Mile of Healthcare Consumerism out to the blog-o-sphere to ponder and see what you guys throw back:

The 6 Things Needed to Shorten the Last Mile of Healthcare Consumerism

(e.g. the ingredients needed to cause Joe Average to actually care about and desire to get the best value for the his dollar spent on healthcare services received)

In no particular order, make ‘it’…

1. Relevant – People just don’t care about information or services unless it relates to them directly and to the specific issues that they face NOW.  A 30yr old male doesn’t care about and becomes miffed when he gets a flurry of emails reminding people of the importance of mammograms. Actually, I think that Relevance AND Specificity go hand-in-hand.  One big challenge of keeping communication and tools relevant to individuals is that something that IS relevant now, may not be relevant 3 months from now. Just as something that isn’t relevant now, may be relevant 2 months from now.  Yep, us healthcare consumers are a fickle lot.
2. Timely – It seems like people have a loosely defined horizon of what conversations and information are ‘timely’.  Any communication beyond two weeks of when I needed it just seems worthless. And printed materials that are more than a month old, seem out-dated and irrelevant.  Timeliness, fortunately, is a dimension of communication that falls into the ‘perception is reality’.  It’s not that the information or communication has to be newly created but rather that it is presented within close proximity to when the person needed it.
3. Simple – Yep, often the hardest thing to do is make complex things simpler and less confusing. I like the adage of ‘Keep It Simple Stupid’  and yet healthcare consumers are overwhelmed by the complexity of rules, plans, choices, communications and multitude of various entities involved in a basic healthcare service transactions. It’s sad when an insurance company has to create for its members an Explanation of its Explanation of Benefits.
4. Easy – Just because something is Simple… doesn’t mean that it is Easy (as in nearly effortless or without much thought).  Just as people can use Mint.com to gain insight into their finances and GoodRec.com to review/find what people say about local restaurants – the tools available and services accessed should require minimal effort to get started with. As a general rule of thumb, the more effort or interest that is exerted, then the derived insight and resulting value should dramatically increase. Honestly, this is one aspect that we (change:healthcare) continued to struggle with but are making some significant strides (and announcements) in the coming months to overcome this barrier. Healthcare data has been historically locked up in separate or proprietary silos but soon, we’ll be breaking it free!  Viva Consumers!
5. Trustworthy – Without trust, consumerism will stall and wither.  I know that many of you have thoughts about where, when and how a trusting relationship is established and perpetuated… but i’ll summarize it as my Dad did once for me, “Trust is earned, often fragile, and hard as hell to earn back once lost.”  What are the qualities of sites/Brands that you trust with your healthcare information, transactions, and tools?
6. Controllable – I’d argue that when it comes to healthcare data and information, that people are actually LESS concerned about being secretative or isolated BUT RATHER care more about controlling who or what other parties has access to or sees their healthcare issues and related data. In fact, my guess is that the more control individuals are given over their own data, the likely people will begin to share and exchange personal information that can help others… aka healthcare transparency of choices made, perceived quality and experiences, and the costs thereof.

Final Questions

Went for the third of the four surgeries for varicose veins in my legs. Tweeted the whole procedure again (see below). And since this procedure was soooo much more graphic, I got the pix and video to go with it. To bring everyone up to speed, the first two surgeries were laser ablation from the front and back of the legs. That sealed off the problem veins. The last two are the actual removal of visible veins which have proven to be painful. The pain was the result of phlebitis. As Dr. Bonau removed the veins, he asked if I had ever had phlebitis. The veins showed signs of it and the pain that I have had would be consistent with that diagnosis.

Fair warning: the pix and vids are pretty graphic. Not for the squeamish. All pix and vids were shot by me personally while they did the work on my legs. The areas were deadened so I felt nothing, but it was still a bit unnerving to watch the doc tugging on my body like he was.

Thanks agin to all of you following along and thanks for the supportive messages before, during and after surgery. A special shout out to @MindofAndre twitter and blogger trailblazer.

We are sooooooooo excited!  Chris McIntyre (of Podcast Alley, PodShow.. aka Mevio fame) is joining the change:healthcare team as Director of Product Management and Making Stuff Useful.

If any of you listen to podcasts or work in San Francisco, then you know Chris’ work and understand why we are so freak’n thrilled to add his integrity, experience, focus, insight, and personality to the team — He’s an A+ rock-star who understands development, community engagement, and building products and services that are intuitive, collaborative, support millions of Users and scales to meet demand. Most importantly, Chris knows how to listen to Users, respond, and get stuff done!

Please welcome Chris (sometimes referred to as ferf, theFerf or cmac), his wife Amy (who has a fitness book and video podcast), and their 100lb. golden retriever ‘Cason’ to the change:healthcare family and Nashville.

The change:healthcare team is growing and preparing for some more significant announcements that will DRAMATICALLY shift and improve how everyday people try to deal with the healthcare system as consumers.

More to come, but we thought you might want to know about Chris.

The tweets (messages on twitter) was so popular last time, I did it again for the follow up laser ablation surgery done on the back of my legs for varicose veins. You can catch the first installment here if you missed it.  And once again, I went through the trouble of reverse flowing the tweets so they go in order as you read down. For the record, I saw Dr. Roger Bonau at The Surgical Clinic in Nashville.

The discomfort this time may be a little bit more apparent from the posts. But the post op has been better. Luck of the draw, I guess.

The award for best tweet to me during the surgery comes from good friend and health care law blogger, Bob Coffield (catch his tweets @bobcoffield on twitter):

@robert_hendrick another twitter use. Monitor real time malpractice. Going to start including tweet requests in discovery

@bobcoffield doc found no humor in tweets in discovery. I did though.

@Robert_Hendrick did you tell him that I am on the defense side?

Enjoy!

Live from surgery part 2. Tweeting my surgery starting around 9am

Sooo. Valium $2.63 last time. $2.29 this time at same kroger. Must be on sale. Purely for research. Going drug free.

Uh oh. The staff at the doc’s office is following me on twitter now.

Getting quick ultrasound on previous surgery spot. Healing nicely.

Smearing betadine on my legs now. COLD.

Waiting for the rock star doc to show for surg. Country music playing in operating room. I love Nashville.

Doc walked in “what the hell are we listening to?”

First stick. No big deal. Still feel the flush and warmth in my body. Nerves.

Man I’m sweating. Stress of recent days ha heightened my apprehension over this. Doc in canulating (trying to get needle in vein)

Dr. Bonau says of the canulating “This is a bit tortuous.” Mmmmhmmmm.

Doc jinxed us when he said “this will be easier than first one.” Getting more lydocaine right now.

Wondering where the health content 08 tweets are. Not seeing any.

@dian_luffman the adrenaline rush has abated. Still on leg #1. Searching…searching…searching

Left leg canulated. FINALLY! Going for other leg and planning to laser both at one time.

@bobcoffield thanks for the distraction.

Doc is giving me his entire educational background. Been at tulane, NY, sloan kettering, st thomas, vandy…

No more pain than the first time. Far more tedious. “Worst is over.”

Firing up the laser…

Lydocaine going in around laser site. Flattens the vein a bit by putting pressure protectsthe vein from the heat.

Ooooooooow. Bad stick. Bad bad stick. Ow ow ow ow ow

Taste of burnt blood in the back of my throat from laser

Right leg hurt like shit up in the hammy. Left leg done and no pain at all.

Oh so glad to be done. Cleanup to ensue. More COLD stuff on my legs to clean.

So doc goes in at calf. Runs catheter up leg about 12″ and then lasers 12″ of vein shut.

Only getting compression wrap on calves. w00t! No behind the knee wrap.

@bobcoffield doc found no humor in tweets in discovery. I did though.

And done. Thanks to everyone!

8 hours after the surgery, the lydocaine has worn off.

Ah. Now I’m getting the feeling of little bee stings up the back of my left leg. This is fun (sarcasm noted).

Christopher celebrated his birthday last week!  Well kind of… he attempted to fly under the radar and avoid any cake, gifts, and party hats by traveling and keeping his  b-day on the down-low.

So yesterday the crew at change:healthcare took him to lunch to celebrate the right way… by making him wear a BIG sombrero!  How fun…

First off, thanks for all of the concern and support from so many people over the past few days WRT my surgery. It seems I’m telling people things and repeating myself and I hate to bore anyone, so I’m putting this together to give folks the details and use my own experience as a personal example of why change:healthcare does what it does.

Why change:healthcare Does What It Does:

The business end of things…My doc will bill my insurer somewhere around $6,124. However, the allowed amount with my insurer is $2,904. Per the FANTASTIC staff at Dr. Bonau’s office, “double check with [insurer] to be sure and I don’t even know if they will tell you an exact number but you can try… The procedure codes are 36478/36479″

They also pointed me to the insurer’s financial counselor complete with the phone number.

Had I been uninsured, the amount would have been $6,124. On a different insurance, the cost would most assuredly been something OTHER THAN $2,904. And had my surgery not been Medically Necessary, and I had simply done self-pay without submitting a claim, I may have been expected to pay $6,124. Keep your eye on the peanut, now which shell is it under?

change:healthcare helps people sort through all of that.

My Status:

I’m doing well. 48 hours out of surgery the wrap is off, I have to wear a support sleeve on the leg, but I got on my bicycle on the stand in my home office. Rode for an hour at a moderate pace on an easy gear. Felt great to move again. Doing well.

So well in fact that I failed to take the prescribed ibuprofen today (day 2 post surgery). Should have taken some on waking up at 6 AM. After lunch, I started to feel it a bit, and finally got the anti-inflammatory into my system at around 2PM (Kids, do NOT try this at home).

The Procedure:

The procedure I had is called laser ablation or a phlebectomy. It beats the living crap out of the other option which is the traditional vein stripping I had done 25 years ago (I describe the traditional method below).

With laser ablation, they do a local anesthesia and then they insert a catheter into the leg near the vein. they run a fiber optic cable into the vein and use a laser to cauterize the vein closed. I literally stood up from the procedure and walked out the door. The other method would have left me bed ridden for several days and as much as 6 weeks from any significant physical activity (Boooooooooo).

The degree of discomfort during the procedure was less than that of getting some ink. Post-op, the discomfort is minimal and far less than the discomfort that I used to live with on a day to day basis. I did not realize how much pain I was living with day in and day out.

History:

I have a long-running history of varicose veins. My first surgery was at age 16 on both legs. Had a second surgery at 18 on the right leg. That would have been 1983-85 time frame. There was no ultrasound in those days to see what was going on inside, so they did what they thought was best, but in fact it turned out to create future problems. So here I am today some 25 years later dealing with it again.

I went to Doctor N., Head of Vascular Surgery at a large academic hospital which shall remain nameless. I told him the procedure I wanted – laser ablation. He told me the veins were not big enough and that the method would be the traditional vein stripping.

In vein stripping, they put you under general anesthesia and make numerous small (1-2 inch) incisions all down your legs, tie off the veins at those spots, cut them and pull them out. Bad news. Long recovery times (6 weeks) and severe bruising of the legs all along the path of the veins. That’s what Doc N. wanted to do to me. I declined.

A good friend of mine I ride bikes with had the same condition and recommended Dr. Bonau instead. My buddy told me that he did not realize how much pain he was living with until after surgery. Pre and post, the relief is hard to believe. I am ever so grateful to my fellow cyclist.

Had a bit of outpatient surgery done on my legs today. Laser ablation on my legs to eliminate varicose veins. Basically they numb the site, locate the vein using ultrasound, insert a fiber optic cable and cauterize the veins closed at the faulty junction. I was awake and on no drugs for the whole procedure. Opted out of the Valium to calm my nerves. And I “tweeted” (used twitter) the entire experience in real-time. Some of those who follow me suggested I post the tweets. So here they are. For the twitter-savvy, the order is in chron order – went thru the trouble so it would read from top to bottom.

Alrighty now. Get ready for live tweets from surgery. Getting laser ablation on my legs this am.

Got some great paper shorts. Then they french cut them up the side. Gr8!

Pre-op ultrasound.

I’ve got 10mg valium just in case I get nervous. So far no drugs.

Betadine on the legs. Damn this room is cold.

Ah, the joys of medicine. All dignity is sacrificed

Enter the rockstar…erm…doc

Oh crap. The ultrasound is running thru a laptop running windows platform.

To clarify. Having laser ablation to remove varicose veins.

First stick. Little bit o lidocaine. No biggee. Laser in.

2 lasers in top part of left leg. Little bit of sting not bad. Getting a tattoo is worse.

Doc explaining procedure and pointing out what’s going on on the screen.

Looking at ultrasound, doc says,”That’s the sheath and this is the laser” blown up to several times actual size this looks painful. But its not.

Lydocain and sodium bi-carb going in around site for laser. Provides better contact and numbs. Extreme laser heat next.

Head down to make vein smaller. First shot of laser stings a bit. Getting more numbing med.

Getting a bit of a burning taste in the back of my throat. Normal perdoc. No pain now from laser.

2 veins down. 2 to go. 1 lower left leg. 1 lower right leg. Top left leg done.

FYI there will not be pix of this one. Will bring cam next time. Back of the legs in a couple of weeks.

“Lower leg harder to anethesize” yeah thanks doc. Noticing that.

And lasering the lower left. Much quicker set up.

Dr. Bonau rocks! Gr8 sense of humor about all of this. He’s not sure what twitter is but he’s indulging me.

Feels like a bad windows program – searching…searching…searching. Looking for something on left leg. Left is all in back so will get it in 2 weeks. Done.

Now its time for cleanup. Wiping down the betadine from my freshly shaved legs. Maybe I’ll b faster on the bike now.

@bobcoffield @matt_mueller @georgesibble and others. Thanks for all of the support. @caparks. Thanks for the ride.

Leg wrapped tight. Stays bandaged for 48 hrs. No bath. Hmmmm.

Kroger pharmacy – healthcare consumer shout of the day! They have $4 generics but 3x 10mg valium generic only $2.63.

@jenmccabegorman I’m sure its even cheaper in the netherlands.

@bobcoffield had this done at ages 16 and 18. Now at 41. Have watched options evolve. Laser ablation is best imho.

@georgesibble Yep. Normal routine. Movement is good for circulation in lower leg. No heavy lifting. Ibuprofen o’ plenty.

Transparency: Dr. Bonau has performed this surgery 2500 times. 2 cases w complications. Both successfully resolved.

Monday (10/6) at SHOUTAmerica’s first leadership conference I had the pleasure of hearing Senator Corker brief the audience on his recent accomplishments in bi-partisan healthcare activities.

Here are his four opening points:
1.    Congress does little communicating across party lines – this needs to change
2.    30% of healthcare delivered is wasted, i.e. it does not actually help people get well/healthy
a.)  That directly translates to 5% of our GDP wasted
3.    800,000 Tennesseans and more than 45 million across the country do not have health insurance coverage
4.    Healthcare is not a right, rather a moral obligation
a.)  Everyone deserves access to affordable private healthcare

He was cautious to make the distinction between what Republicans are striving for (preservation of choice) and what Democrats are striving for (universal coverage).  Corker wants the best of both worlds.  He wants  to preserve choice while finding a way to cover everyone.

Throughout the hour and a half speech/discussion I had several points of contention/questions.

1. Is choice our number one priority when we have 45 million uninsured Americans, 9 million of which are children?
2. Should we be providing tax credits as an incentive to purchase health insurance coverage?
3. Should the federal government mandate health insurance coverage?
4. Should all health insurance be community rated?
5. Should we separate health insurance benefits from the employer?

Choice should never be our number one priority (should I never say never?).  We need to focus on increasing access, coverage, and quality, while simultaneously reducing costs.  Choice isn’t even in my top 3 priorities for healthcare reform.

The American government has used the tax-credit concept for years with respect to financial saving.  Despite the tax incentives, Americans still fail to reasonably save the money they earn.  Why would the concept be any different applied to healthcare?  Just because a $5000 per family tax-credit is issued does not mean people will purchase a policy costing $14,000.  That’s still $9000 left for a family to cover.

I still haven’t figured out all the reasons why health insurance coverage has not been mandated by the government. Obviously cost is one (look at the difference between auto insurance and health insurance, we are talking thousands of dollars).  But what are some other reasons, and possibly coverage should be mandated and subsidized by the government up to a certain % of the poverty level.

Community rating all health insurance would mean that risk would be spread equally over large groups of people.  If you have high blood pressure and high cholesterol you would pay the same as the same price as a healthy individual your age.  This could be a good thing if the price groups change/account for age, smoking, family size and location.  It certainly provides a way to increase coverage and reduce costs for high-risk groups.

Health insurance benefits have been linked to our employers for years.  Is this practice too entrenched in our culture to separate it?  No.  However, I think the idea has its pros and cons.

Pros:

1. Makes healthcare portable.  Individuals will no longer feel tied to their dreaded job due to health benefits.  Their coverage and chosen plan could be taken with them to any place of employment.
2. Leads to more individual responsibility.  An individual will have to better understand what they are purchasing.

Cons:

1. Less guidance on aggregating large numbers of people to spread insurance risk.
2. Decoupled benefits will reduce competitive advantages between employers. Not that this directly is a bad thing – but will we see employers giving employees the money in their pockets that they used to see by way of health benefits?

All and all I still haven’t figured out the details of my proposal for healthcare reform.  Fortunately Senator Corker seemed to have a solid “moderate” stance on the issue!

The SHOUTAmerica Conference was a huge success!  About 100 student n leader, presenting almost a million students across the country, attended the conference to hear CEOs, Senators, House Reps and health care educators speak about the current healthcare crisis.  By the end of the conference once puzzled students emerged engaged and ready to make a difference!

The new LiveBlog on the SHOUTAmerica documents the conference, student sentiments, and speakers.

Check out Christoper in Part 3.