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Science Writing Prodigy

shutterstock_51700795I’ve been teaching college for four years now, at a pretty darn good college. But I’m not sure I’ve seen student writing quite as good as this undergraduate writing sample:

There is a wide yawning black infinity. In every direction the extension is endless, the sensation of depth is overwhelming. And the darkness is immortal. Where light exists, it is pure, blazing, fierce; but light exists almost nowhere, and the blackness itself is also pure and blazing and fierce. But most of all, there is very nearly nothing in the dark; except for little bits here and there, often associated with the light, this infinite receptacle is empty.

This picture is strangely frightening. It should be familiar. It is our universe.

Even these stars, which seem so numerous, are, as sand, as dust, or less than dust, in the enormity of the space in which there is nothing. Nothing! We are not without empathetic terror when we open Pascal’s Pensées and read, “I am the great silent spaces between worlds.”

Those words, quoted from a recent Smithsonian article, were written by Carl Sagan as a Chicago undergrad in the 1950s. Pretty humbling, on many levels.

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Price Transparency Thoughts from a Thought Leader (And Former Student)

Paul MillerHere is a great piece on my former student, Jessica Harris, who now works in health care price transparency at Aetna. She visited my class this summer, and here are some of the things she taught them:

The evolution of transparency in the industry: “2013 and 2014 have been really important years for transparency and for discussion on this issue. There were many articles in the mainstream press that discussed all sides of this issue. You also saw where some states have mandated transparency and have actually created websites to show transparency. You also have some advocacy organizations — like the Catalyst for Payment Reform — that represent big companies and released a report card for state transparency laws for the first time in 2013.

And then you also saw some big events happening in federal policy. In March, the Centers for Medicare and Medicaid Services released an in-patient data set for the very first time, and then in June they released an out-patient data set for the very first time, showing payment data for individual procedures. That was a big deal. It created a lot of interest from organizations like the Robert Wood Johnson Foundation encouraging start-ups to really innovate around this data and figure out how to show it to consumers.”

Barriers to transparency: “Negotiated prices are historically considered trade secrets. Many hospitals or health systems have something called gag clauses where it forbids the payer to disclose the prices they negotiated. Actually a study came out in 2013 showing that only 16 percent of hospitals that were asked the price of a traditional hip replacement were able to give a price. And of those prices, they varied significantly.”

Trends in employer sponsored plans: “There are two trends happening for employer sponsored insurance.

First of all, you’re seeing increased cost sharing. So 38 percent of employees face an annual deductible of over $1,000 per person, in plans that the industry calls “high deductible health plans”. So in 2012, only 13 percent of employers were considering offering only high deductible options. But in 2014, 44 percent were considering offering only high deductible plans. A high deductible model means you have to pay a certain amount before the health insurance even kicks in in terms of cost sharing. So you have to pay a certain amount before you even start paying a co-pay or a percentage of the service you are using.

‘Consumerism’ and out-of-pocket spending continues to increase: despite seeing health care spending go down overall and costs start to stabilize a little bit, we saw an increase in out-of-pocket spending; it was up by 4.8 percent in 2012 to $768 per person.”

The impact of exchanges: “You are seeing a shift from a more traditional, almost like a pension model, to something more similar to a 401k model. Again when we think about health care consumerism, you see more responsibility but also more choice falling on the employee, but it also means the company isn’t defining the health care as much. They are saying go out on exchanges, we’ll give you a voucher, purchase your health care, but it is on you to decide if you’re purchasing a good plan for you and your family.

We’ve heard about the public health insurance exchanges for the uninsured, but there are actually several private health insurance exchanges that have cropped up, creating marketplaces for all those benefits you might traditionally get from your employer and having employees go out and be able to shop on the exchange to be able to get the care that they need.

It’s a really big disruptive force that we’re going to see in the next couple of years. According to one study, by 2017, nearly one in five Americans may buy benefits from an exchange. To put that in perspective, the public exchanges serve nearly 30 million uninsured. The private exchanges are going to rapidly change insurance purchasing for about 150 million people with employer sponsored insurance.”

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How Good is Healthcare in Your Country?

Here is an interesting picture of how people rate the quality of care in their countries. The US is near the top, but so too is the largely socialized British system:

healthcare in your country
One clear message here: We all have another reason not to visit Russia any time soon!

Posted in Health Policy | Tagged

Side Effect Warnings Can Increase Pharmaceutical Sales

warningI must not be the only person to wonder how pharmaceutical companies succeed with direct to consumer advertisements when, stuck in the middle of all their TV ads, are those long lists of side effects. You know what I mean. After watching a smiling and attractive person running through a field after receiving some wonder pill, the narrator tucks his voice down an octave and intones that the medication “could cause rashes, constipation, heartburn, bladder dysfunction and cardiogenic syncope.” How could anyone listening to this ad want to take this product?

Research by Yael Steinhart and colleagues suggests that such warnings may increase how much people like the product, but only after they have had the time to get over their immediate aversion to the side effects.

Steinhart presented people with product advertisements that either did or did not include product warnings. In the short run, such warnings scared consumers – they were less inclined to buy the products. No surprise here.

But for some people, the researchers didn’t ask for their immediate attitudes towards the product. Instead, they re-contacted them two weeks later… (Read more and view comments at Forbes)

Posted in Behavioral Economics and Public Policy | Tagged ,

A Picture of Scientific Publication Bias

Because so much of human thinking is dichotomous, even though so much of the real world exists on a continuum, we have strange phenomena like the one illustrated in the picture below. The picture shows the significance values of research findings, and reveals that there are many more articles published where the statistical significance of the results is just less than 0.05 than ones where the results are slightly greater than that arbitrary cutoff. The picture excludes all those values which were published at exactly 0.05 because that, somehow being the magic number where a finding shifts from false to true, would probably reveal a bar that extended beyond the top of your computer screen:

scientific bias graph

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How To Trick People Into Caring About Healthcare

a or bIn health policy circles (yes, those exist!), experts often refer to three aims for a modern healthcare system – to offer (1) universal access to (2) high quality medical care at (3) an affordable cost. Access, quality, and cost: a possibly unachievable set of goals, certainly in the U.S., where the quality of our care is decent (but uneven), while access to care and the high cost of our care compare dismally to almost every other developed country.

Suppose you were fixing the U.S. healthcare system and realized that increasing access to care would make it harder to control costs. Which of the three aims would you make your priority? I asked this question to a couple groups of people. One group came out strongly in favor of access, the other in favor of cost control. Can you guess who these two groups of people were?

I asked a group of undergrads at Duke to make the same guess. These undergraduates were taking my health policy course, and with that background were able to make some good guesses. Those prioritizing access: Some thought it might be a rural population with limited access to subspecialists. Others thought it might be a poor population with little access to health insurance. Those prioritizing costs: Some thought these might be fiscal conservatives, others thought they were large employers trying to hold down the cost of employee benefits. These were all really good guesses. Only one problem with them… (Read more and comment at Forbes)

Posted in Health Policy | Tagged , ,

How to Make People Interested in What You Have to Say

secret
In his book, To Save Everything, Click Here, Evgeny Morozov tells a story about a PR agent who was trying to create some buzz around a topic. No one seemed interested. And then the agent had an idea: “I dashed off a fake internal memo, printed it out, scanned it, and sent the file to a bunch of blogs as if I were an employee leaking a ‘memo we’d just gotten from our boss.’ The same bloggers who were uninterested in the facts when I informed them directly gladly put up EXCLUSIVE! and LEAKED! posts about it.”

Nothing makes information more interesting than being told we shouldn’t have access to it!

Posted in Behavioral Economics and Public Policy | Tagged

Financial Counseling for Cancer Patients: A Growth Industry?

A former student of mine who now works at the Advisory Board recently emailed me some figures her company put together, offering a snapshot of how many people are being hired in oncology practices to help patients with their financial concerns:

blog figure 8.12.14

I am very eager to see what these figures look like over the next couple years. I will be surprised if these numbers don’t grow significantly. Cancer-related treatment costs are a really big deal!

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Are Doctors Ready to Talk about Health Care Costs with Patients?

While I was on vacation, I spoke with reporter about a topic near and dear to my heart – importance of getting clinicians to talk about health care costs with their patients. The reporter put together a very nice piece on the topic, which I thought I would share with you:

Doctors Aren’t Grasping For Cost Transparency Tools
By Richard Mark Kirkner

In health care’s bad old days, doctors were often woefully ignorant of the costs to patients of the services they recommended. Today, with the industry striving to achieve cost transparency and physicians still the key influence on patient decision making, evidence suggests that in too many cases the bad old days are still here.

As health plans develop and refine tools to give members detailed information about how much they will pay for tests, procedures, and hospitalizations, members are taking that information to providers. Many of those providers, though well equipped to discuss the need for a test or procedure, are clueless about its cost — or where to get a more reasonably priced alternative.

That’s although physicians have a key role to play in helping payers and patients realize the savings the new cost transparency tools have been designed to yield. Despite their influence, doctors may be the last on board the cost-containment train as it prepares to leave the station…

(Continue reading here)

Posted in Ethics, Medical Decision Making | Tagged

Hello, From Michigan!

Michigan

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