How will MedOn (p.p.) operate?

In a nutshell -- with most of the goals outlined in Porter & Olmstead-Teisberg's 2006 book on health care --

http://harvardbusinessonline.hbsp.harvard.edu/b02/en/common/item_detail.jhtml;jsessionid=WMYRKFHW0JUE2AKRGWDR5VQBKE0YIISW?id=7782&_requestid=128898

The U.S. health care system is in crisis. At stake are the quality of care for millions of Americans and the financial well-being of individuals and employers squeezed by skyrocketing premiums--not to mention the stability of state and federal government budgets. In Redefining Health Care, internationally renowned strategy expert Michael E. Porter and innovation expert Elizabeth Olmsted Teisberg reveal the underlying--and largely overlooked--causes of the problem and provide a powerful prescription for change. The authors argue that participants in the health care system have competed to shift costs, accumulate bargaining power, and restrict services rather than create value for patients. This zero-sum competition takes place at the wrong level--among health plans, networks, and hospitals--rather than where it matters most: in the diagnosis, treatment, and prevention of specific health conditions. Redefining Health Care lays out a breakthrough framework for redefining health care competition based on patient value. With specific recommendations for hospitals, doctors, health plans, employers, and policy makers, this book shows how to move to a positive-sum competition that will unleash stunning improvements in quality and efficiency.

To paraphrase Warren Buffett -- our goals are value, value, value.

Not buck-passing. Not bureaucracy. Not work-avoidance. Not herky-jerky treatment systems.

If it don't get the patient better -- if it does not create value -- dump it.

MedOn (p.p.) began as a logical response to medical tourism -- why burn all that CO2-producing jet fuel?

The short-coming of medical tourism -- still mired in buck-passing. Who's responsible for what?

MedOn's goal is to create 'caring circles of community." To operationalize systematically, and not with the awful, wasteful, and soul-crushing SNAFUs that plague health care today.

To those who say that the Porter/Olmstead approach is unrealistic and unworkable -- we have read your comments.

Our reply: the beauty of MedOn (pat. pend.) is that, at this point, it is a "clean sheet."

No embedded culture of SNAFUs and FUBARs. And a clear, strong vision -- affordable medical treatment for the working-class, to provide authentic patient value.

So .. to those AMA-types who call MedOn "provocative" --

If providing affordable quality medical-care options for the working-class is "provocative" to you, we wish you well.

We're trying to work with others to make things better for patients.

My "MedOn" professionals

What kind of professionals are needed for Medical Onshoring (patent-pending)?

Oh .. like these guys .. from the HBO movie "Taking Chance" .. professionals for whom "responsibility" and "honor" are more than legal theories.

Working with Mother Teresa

An important step towards Medical Onshoring (pat. pend.) ..

Once upon a time, someone whom I befriended volunteered for a year with Mother Teresa in Calcutta. My friend's letters were very gripping -- how, at the moment of death, the very great and mutual gratitude between patient and caregiver that fairly glowed. Pretty intense stuff. (And yes, Calcutta was like the Mumbi of "Slumdog Millionaire").

When my friend, age 34, returned to the U.S., many questions arose about what to do next. After long -- and sometimes pointed -- discussions, my friend decided to apply to medical school. Fifty of them. I suggested 10 was probably enough. At least 15 applications went out.

As a "Public Ivy" master's graduate, I explained what was required. I edited the admissions essay.

Accepted at Northwestern. Accepted at Harvard. Dang.

This was just another step in the process of developing Medical Onshoring (pat.-pend.). And doing what you can, with what you have.

Not politics. Not power and turf-wars. Not just money.

Just doing what has to be done, 110%.

The Indian Health Service of the USA & us

As the inventor of Medical Onshoring (patent-pending), one of the first questions I get is, "what about the Indian Health Service (IHS)?"

My response: "I welcome them as a partner in trying to make health care worldwide better. We're national -- IHS is local. We should work together, not at cross-purposes."

Plus -- I've already improved conditions for IHS (see following).

MedOn (pat. pend.) began as a logical alternative to "medical tourism" -- why burn all that jet fuel?

Knowing our logical, caring beginnings -- to think MedOn (p.p.) would want to directly compete with IHS is "illogical," as Star Trek's Mr. Spock would say. And wasteful and financially-crippling for everyone involved.

MedOn (p.p.) wants to work with IHS -- not get into a zero-sum game with no winners.

MedOn (p.p.) is national -- IHS is local.

We're different. Really different.

Now .. back to caring for patients ..

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Did MedOn spur federal action for a new IHS facility?

Well ..

First this on 5/15/08, in the "Minot Daily News" --

CHAPEL HILL, N.C. – An engineer in North Carolina has filed a patent for a new medical-care system that he says would be a good business fit with the Minot area.

C. Alex Chien said Wednesday that Minot has the technology, transportation and environment to host a prototype “medical onshoring” clinic.

Chien, a self-employed engineer, is a former rural economic developer with RochesterTel, former owners of Minot Telephone Co. SRT purchased Minot Telephone Co. in 1994.

Then this on 11/11/08 in the "Minot Daily News"

NEW TOWN, N.D. -- The design plans for a $20 million health-care facility for the Three Affiliated Tribes on the Fort Berthold Reservation are moving forward.

"We're looking at a groundbreaking next spring or early summer, with a completion of 2010," said Jim Foote, project manager for the Three Affiliated Tribes' Elbowoods Memorial Health Facility.

In September, Sen. Byron Dorgan, D-N.D., announced that the U.S. Army Corps of Engineers had awarded a $1.48 million contract to launch the design phase to build the health-care facility on Fort Berthold.

Nice coincidence that a long-delayed IHS project accelerates -- or separate matters? You decide.

USA health care -- how much pain?

Why Medical Onshoring (patent-pending)?

Consider the existing alternative -- the $2.4T (trillion) U.S. health care system.

• High costs, putting tremendous financial strain on patients, families, employers, health plans/payors, providers, and taxpayers.
• Uneven coverage and quality -- even with single-payer groups like VA.
• Ruinous medical-malpractice costs, driving up (1) costs and (2) resulting in mostly-wasteful "defensive medicine" to deter malpractice lawsuits -- between $250B (billion) and $500B in wasted costs.
• High administrative costs due to poor management and billing practices -- between $750B (billion) and $1T (trillion) in wasted costs.

This is on top of the USA's self-inflicted medical problems -- smoking, poor diet, alcoholism, drug abuse, and dangerous lifestyles -- as much as $750B (billion) in wasted costs.

Fixing half those issues would free up hundreds of billions of dollars spent on health care now -- wouldn't it?

Editorial note: as a new company, Medical Onshoring (patent-pending) is not shackled to the past. By requiring top performance and med-mal reforms, we will provide the maximal surgical service possible.

Better medicine via medical-malpractice controls?

What makes Medical Onshoring (patent-pending) so promising is the goal of restraining runaway medical-malpractice costs and defensive medicine, via special rules and regulations that call for prompt and reasonable compensation for the very rare medical error and mandatory arbitration. The alternative? Read the following ..

Xiao Xu, a research investigator in the University of Michigan Health System's Department of Obstetrics and Gynecology, won the 2008 BCBSM Foundation McDevitt Excellence in Research award in the area of policy research.

Xu received the award for a paper that was published in the American Journal of Obstetrics and Gynecology, examining the effects of medical liability risk on the availability of obstetric care in the state. The study by Xu and her co-authors found that many obstetricians, family physicians and nurse midwives in Michigan planned to discontinue delivering babies or reduce their provision of high-risk obstetric care in the next five years.

The award comes with a $10,000 grant from the Blue Cross Blue Shield of Michigan Foundation.

Xu discussed her findings with reporter Gary Gosselin.

Business Review: Hasn't tort reform helped mitigate malpractice liability some?

Xu: A variety of tort reforms have been adopted by states, such as caps on damages, abolition of joint-and-several liability, elimination of prejudgment interest, amendments of the period of limitation of actions (statutes of limitations), caps on attorney contingency-fees ... Overall, the literature finds limited impact of state tort reforms on the size and number of paid medical malpractice claims. Only certain tort reforms, such as caps on damages, collateral-source rule reforms, and reduction of the statutes of limitations, have generally been shown to increase physician supply and reduce malpractice premium rates and severity of medical malpractice payments.

BR: Since malpractice insurance rates dropped this year, wasn't Michigan's reform enough to help obstetrics?

Xu: Obstetrical providers are one of the groups most affected by the increasing medical liability insurance premiums and malpractice litigation risk.

Despite the various efforts made to constrain malpractice insurance premiums and claims costs, concern among obstetric providers remains widespread.

For example, data from the 2006 American College of Obstetricians and Gynecologists survey on professional liability found that nationwide, 65 percent of obstetrician-gynecologist respondents had made some changes to their practice over the previous three years for fear of professional liability claims or litigation.

This ACOG survey showed that, for District V - in which Michigan is situated - almost 9 percent of obstetrician-gynecologists had ceased practicing obstetrics and 34 percent of obstetrician-gynecologists had reduced the number of high-risk obstetric patients since 2003 because of risks for medical malpractice claims or litigation.

'Universal Healthcare' -- panacea or pipe-dream?

Will "universal health care" solve the USA's medical-care crisis?

Hmm .. consider these case studies ..

Case 1: Bill Clinton. An MD on duty, 24x7 between 1992-2000. In 2004, has to be rushed to heart surgery. Hecka' job, universal healthcare.

Case 2: David Letterman. Medical/health insurance for a multi-millionaire. In 2000, emergency heart surgery required.

Case 3: Tim Russert. Medical/health insurance for a network VP. Died suddenly of a heart attack.

There's a myth that 'universal healthcare' will solve everything.

It won't. It never will. Get used to it.

All we can hope for, is for people to their best. People treat patients -- not bureaucrats.

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More details ..

What will health reform do for the unhealthiest Americans?

.. Consider the shoppers at the Save-A-Lot supermarket in Hamlin, West Virginia. At the beginning of the month, when the food stamps arrive, they snap up buckets of lard so big that the label says: “Warning—Children can fall into bucket and drown.” The manager, Key-Ray Adkins, shrugs: “People now say lard isn’t good for you. But it’s what we grew up with.”

Thinking and "developing policy" are not the same as knowing, engaging, and authentically teaching.

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The Cost of Smoking

What does a pack of cigarettes cost a smoker, the smoker's family, and society?

This longitudinal study on the private and social costs of smoking calculates that the cost of smoking to a 24-year-old woman smoker is $86,000 over a lifetime; for a 24-year-old male smoker the cost is $183,000.

The total social cost of smoking over a lifetime—including both private costs to the smoker and costs imposed on others (including second-hand smoke and costs of Medicare, Medicaid, and Social Security)—comes to $106,000 for a woman and $220,00 for a man. The cost per pack over a lifetime of smoking: almost $40.00.

The first study to quantify the cost of smoking in this way, or in such depth, this accessible book not only adds a weapon to the arsenal of anti-smoking messages but also provides a framework for assessment that can be applied to other health behaviors.

The findings on the effects of smoking on Medicare and Medicaid will be surprising and perhaps controversial, for the authors estimate the costs to be much lower than the damage awards being paid to 46 states as a result of the 1998 Master Settlement Agreement.

Does "universal healthcare" make smoking a moral hazard?

Yes. By attaching no direct penalty for smoking (sin taxes do not always count), in effect non-smokers subsidize the medical cost of smokers. Logical, clear and simple.

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Cost of obesity

Six in ten people in the United States are overweight, with a third crossing the boundary into obesity. The extra weight leads to at least 100,000 deaths annually. Obese people are at a much higher risk for heart attacks, strokes, diabetes, arthritis and some cancers.

Doctors call people obese if their weight in kilograms is more than 30 times bigger than their height in meters squared. This is known as a high body mass index, or BMI.

Even kids are getting fatter. Nineteen percent of children between the ages of 6 and 11 are overweight, up from 4% in the 1970s. Doctors are turning to intensive behavioral therapy to try to keep these children from gaining more weight.

The economic cost of all this extra fat is immense. Direct medical costs are easiest to calculate, coming in at $93 billion, or 9%, of our national medical bill.

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Cost of Alcohol Abuse

Your boss might want to forget about making you wear that BlackBerry and take away your bourbon instead.

Businesses spend big bucks on both the little, addictive wireless e-mail gadgets and programs that screen for and treat problem drinkers. Both make back the cost of investment.

But searching for alcohol abusers brings in $2.15 for every dollar spent, compared to a mere $1.62 for keeping workers connected with Blackberrys.

In fact, just by surveying employees and offering counseling sessions of 30 minutes or less, employers might be able to put a big dent in the $35 billion that excessive drinking adds to health care coverage annually, according to the George Washington University researchers who came up with the comparison.

What is striking is that the GWU researchers don't recommend counseling only alcoholics, who require years of treatment, but also people who aren't addicts but simply drink too much.

"Since there are so many more people who drink in hazardous or harmful amounts, about 60% of the costs of alcohol to society are from people who are not dependent," says Eric Goplerud, who heads an alcohol abuse program at GWU called Ensuring Solutions.

"There are people who drink even though they have sore stomachs, or drink and get into a fight and get hurt or engage in unprotected sex."

Each year, alcohol abuse costs the United States an estimated $185 billion, according to the National Institute on Alcohol Abuse and Alcoholism. But only $26 billion, 14% of the total, comes from direct medical costs or treating alcoholics.

Almost half, a whopping $88 billion, comes from lost productivity--a combination of all those hangovers that keep us out of work on Monday mornings, as well as other alcohol-related diseases. People who drink too much and too often are at greater risk for diabetes and several kinds of cancer, according to some studies.

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Cost of Drug Abuse

The economic cost to U.S. society of drug abuse was an estimated $97.7 billion in 1992, according to recent calculations. The new cost estimate continues a pattern of strong and steady increase since 1975, when the first of five previous cost estimates was made.

The current estimate is 50 percent higher than the most recent previous estimate - which was made for 1985 - even after adjustment for population growth and inflation.

The parallel cost to society for alcohol abuse was estimated at $148 billion, bringing the total cost for substance abuse in 1992 to $246 billion. This total represents a cost of $965 for every person in the United States in 1992. The per-person cost for drug abuse alone was $383.