link Awesome story about Dr. Sean Khozin...

Creating improved access to care
According to Khozin, ER overcrowding doesn’t happen because of the uninsured. It happens because patients can’t access their primary care doctors when they need medical attention.

"Despite the fact that you have to wait at the emergency room for five hours, at least you get seen the same day," he says. "In my practice, you get an appointment the same day or within 48 hours."

After a patient establishes a relationship with a Hello Health doctor, he or she can use e-mail, video chat, instant messaging, or phone to reach their physician to ask questions, obtain test results, and to conduct other matters which would typically require an appointment in the office.

"We establish a relationship with a patient and we do a lot of the follow ups and care coordination online," says Khozin. "We cut down on the number of unnecessary visits while giving patients different channels of communication with their doctor."

Patients still have the option of scheduling an appointment if they have a problem that requires attention, but he has found that most of the time he can conduct patient follow up visits remotely.

4 years ago

21/8/09

link Now Reading: The Story of Dr. Sidney Garfield: The Visionary Who Turned Sick Care into Health Care

I’m always inspired by doctors who think that there’s got to be a better way to both deliver and pay for healthcare. This book is a great find:

via Ted Eytan, MD:

Part of my eagerness is the fact that I didn’t enter medicine with the intention of being a Permanente physician; I didn’t even know what that meant, until the end of my residency, when the Group Health medical group in Seattle became the Group Health Permanente Medical Group.

All I knew at that time was that I enjoyed an approach to medicine that provided patients exactly what was needed – no more, no less, to maximize benefit and minimize side effects. This was and is a simple enough formula in my head – where did it come from? Is it better? If it is how should it be spread?

Sidney Garfield’s “a ha” is described in the book as a simple change to his payment scheme as a physician – when he could not afford to keep a 12-bed hospital in the Mojave Desert open on worker injuries alone, he accepted an arrangement with the insurer of the Colorado River Aqueduct project. The arrangement was a nickel a day per worker prepayment for injury treatment (to abate high costs from transporting injured workers to Los Angeles for care), followed by the addition of a nickel a day per worker for comprehensive care. The rest is history. An innovative physician discovered that he could increase his revenue stream by discovering the causes of injury in the workplace and preventing them before the patient was injured.

In short, Garfield reversed the traditional economics of medicine, in which physicians are paid only when a patient is ill. Instead, Garfield would benefit by keeping his patients healthy and accident-free. It was a lesson he would remind himself of in later years with a newspaper clipping he kept in his desk drawer describing the tradition in ancient China, where a physician was paid only while his patient was healthy, not while his patient was ill.

Garfield also recognized an acute change in the transition from training in academic medical center – from collaboration across specialties to the solo practice model, and sought to replicate this in private practice:

“It has always seemed a paradox,” said Dr. Garfield in later life, “that in universities, which teach us medicine, we learn medicine under the highest type of group practice, but when we go out into practice, we revert to the old type of individual private practice.” Dr. Garfield’s great contribution to the evolution of group practice was to layer onto it the additional power of two other elements: prepayment and integration of the medical group with what he termed “adequate facilities” — “bringing the doctors’ offices, laboratory, X-ray, and hospital … all together under one roof.”

4 years ago

7/8/09

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A bit of an update…

We launched a complete overhaul of our site and app on Monday. The launch went well and we’re off and running with only a few inevitable hiccups. In just a few weeks, we’re signing up our first group of beta docs on Hello Health. And the interest from other docs all around the country continues to come in. That’s super exciting for us and we honestly can’t wait to sign all of you up who have expressed an interest in simplifying your lives and your practice. Hello Health for Professionals is all about freedeom — the freedom to do your jobs well.

As a matter of fact, that’s one of the main reasons why I started my initial practice. As a pediatric resident, I became so frustrated just trying to find the information I needed to do my job well. And I’m the kind of person who can’t do anything unless its done as best as possible. We live in the age of almost instant findability. If we don’t know something, we Google it. It drove me crazy as a clinician to not simply be able to Google a patient’s chart. I’d have to log in to a green and black DOS-based lab system, copy it into my handwritten notes, and then depend on one of the hospital’s billers to do all the interpretation. As a professional living in today’s world, that is simply unacceptable.

So we set out to change that with one login from anywhere you are…whether it’s your laptop in your office or on your iPhone, you should simply have findability at all times when working with your patients and managing your practice.

The development team is working around the clock and doing a rock solid job at building this for you. Stay tuned…it’s coming!

4 years ago

24/7/09

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Collaboration

Politicians and policy wonks love the Mayo Clinic model because of its quality and outcomes.

This model works well because of collaboration amongst doctors within its walls.

Solo/small medical practices powered by the HelloHealth web-based technology allows collaboration amongst doctors locally, regionally, nationally, and globally.

The web really can make the healthcare world flat.

4 years ago

19/7/09

link Medicine meets social networking

Dr. Sean Khozin chatting it up with Crain’s about docs using social media…

4 years ago

16/6/09

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Moving forward

There is much chaos and uncertainty in our nation these days.  It’s refreshing to band together with docs who truly want to do the right thing and simplify medicine the way it should be.

Let’s step up our efforts through online collaboration at how we transition from our current situation to a Hello Health-powered practice.  For example, how do we create peripheral revenue streams while ramping up our patient panel?

It’s time to move…

4 years ago

15/6/09

link Top 10 Most Creative People in Health Care | Fast Company

I’m honored to be included in a list of such great thinkers. Like Rocky Balboa said last week, revolutionizing healthcare will only come from the ground up as a coordinated effort to change how healthcare is delivered in America. If there are only a finite amount of doctor visits in America per year, how do we maximize those visits and make efficient use of them? This is the topic that Washington is ignoring in their discussions around healthcare reform. It’s tragic…but at the same time, you can’t expect one titanic to change the course of three others. The only solution is a coordinated, integrated, bottom-up fundamental change to what it means to receive healthcare in America…all organized by the internet and a core group of doctors creating an alternative, high-tech, more efficient healthcare system at the fringe of this big, bloated fiasco.

4 years ago

15/6/09

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To all those who came to the first Hello Health University…

Thank you.

I started my practice on September 24, 2007. Like every doc out there trying to use technology and the internet to go at it by themselves, I too was practicing in a silo of one-to-one communication with frankenstein-like, cobbled together technology. Little did I know that less than two years later, I’d be a part of a phenomenal team and in a position to now start offering doctors all over the US a platform that connects us, as ethical practitioners of modern medicine, with all of the tools that other industries have enjoyed for years. The only way we were able to do this, was to step back and ask ourselves, “how should we deliver healthcare today?” It wasn’t about how to create technology that integrates into a broken payment and delivery system to wedge our piece of a messy, sinking pie.

It was about doing the right thing and being a good doctor.

That’s the heart of Hello Health. We’re gathering together a group of leaders of change to take back our hijacked profession and turn it into one that makes us feel good every single day of our lives.

Thank you for coming. Thank you for being a part of this change. Thank you for thinking differently. And, most importantly, thank you for your courage.

We’re going to succeed. And the world will be a better place when we leave it.

4 years ago

15/6/09

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Breakthrough

rbalboajr:

Modern medical breakthroughs in the last 100 years include antibiotics, vaccines, chemotherapy, surgical techniques, etc.

By far, in the next decade, the most important life-saving public health breakthrough will not be found by pharmaceutical companies or medical device manufacturers.

It will be HOW we DELIVER healthcare

4 years ago

9/6/09

reblogged via rbalboajr
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Before You Get Started

Are You Hello Health Material?
We recognize that Hello Health isn’t for everyone. But you are Hello Health Material if you:

  • still believe that health care can be changed for the better, and doctors can be that change
  • want to simplify your practice
  • have even a spark of the entrepreneurial spirit
  • aren’t afraid to be different
  • want to spend more time with your patients
  • are tired of paperwork
  • would like to focus on your patients— not the insurance companies
  • love the freedom and simplicity of technology and the Internet


Slow Down and Think
This is your life and your practice, so first consider what you want it to look like. Talk it over with family and friends. Write it all down. From the “just a doctor and a laptop” style to a bigger office with multiple partners, Hello Health practices can take many forms.

Here are a few questions to start you off:

• Where would you like to work?
• How much time would you work?
• What would you do?
• If your practice were truly ideal for you, what would it look like and what would it accomplish for you and the patients you serve?

And here are a few things to consider about Hello Health:

  • You don’t need much staff, if at all, as our web app takes care of most of the “paperwork,” such as billing, scheduling, and refilling.
  • Hello Health generally doesn’t take insurance. If your patient has a plan that allows for out-of-network docs, you’ll send them along confident that they have the right forms in hand.
  • It’s free to create a profile, but we do charge 7% of every transaction you make on Hello Health.
  • You charge what you want to charge. Charge more to less patients? Go for it. Want to give free prescription meds as a perk? Go for it.
  • Although you should (of course) take only local patients, Hello Health helps you communicate with patients and colleagues whether they’re next door or across the country on vacation. Freedom!
  • Hello Health is here to help however we can. But this is your practice, and it’s up to you to do the legwork— such as finding office space (if you desire), making sure you’re compliant to your state’s standards, and building up your patient base.
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Getting Started

Space Case
If you’ve decided you want to work out of an office, here are a few recommendations for what to look for in a space, and how to set it up to feel like Hello Health.

  • Either live near your office, or work near your home. This obviously saves time and cuts back on the stress of commuting.
  • Go as centrally located and urban as you possibly can, in the most high-traffic area. We’ve learned that a great deal of our signed-up patients learn of Hello Health by just walking or driving past the office.
  • Hello Health is meant to be a completely different experience for our patients. Think “retail boutique.” We’re clean, modern, open, and airy. Check out Highbrow Furniture for ideas of what a Hello Health practice looks like. It may be slightly more expensive up front, but it makes a world of difference for your patients.
  • Keep it small. You actually only need one exam room (which can double for an office), a waiting area, and a handicapped accessible bathroom.


The Money, Honey
You don’t have to be a serious business person to start a Hello Health practice. But you do need a bit of savvy, which we can help with.

No matter what the business, whether coffee shop or medical practice, the simple equation is this: Gross Income – Expenses = Net Income.

The traditional approach has been to increase gross income by seeing more patients and working harder. However, by minimizing expenses (such as staff, equipment, and office space), you can spend more time with less patients and still take home more at the end of the day. Remember: at Hello Health the simplest route is best.

Working Smart: Business Model
The model that Hello Health recommends is a “low overhead practice.” This is one that delivers care at lower expense. In doing so, the revenue left over after your expenses will increase. That’s a good thing. Another benefit of this practice style is the ability to get off the productivity hamster wheel and see fewer patients per hour.

Check out these tips on how to build a “low overhead practice.”

  • A little goes a long way. Smaller offices, supply reservoirs, and staff mean less expense to you.
  • When in start-up mode: pare down, pare down, pare down. If casting is your thing, you don’t need a whole casting room. Just the equipment and materials.
  • Don’t buy the toys. If you do not need an EKG machine, don’t buy it. However, and this is a big “however,” your patients should not suffer for frugality.
  • You love your staff. We know. This is a touchy one. But see, your patients would really rather to talk to you than to explain to three or four separate people why they’re there. In addition, the more staff you keep on, the more patients you have to see, and the less time you get to spend with them.


Legal Eagle
Laws for medical practices differ from state to state, so you’ll definitely have to get in touch with a great lawyer and a great accountant.

Show Me Your Credentials
Do you have your state medical license? Your DEA license? You’re good to go.

Insurance
For malpractice insurance, rates vary by region, the services you offer, and how well the malpractice insurance company is doing with its stock portfolio. Shop around! Some small practices have successfully negotiated lower rates by demonstrating high quality documentation and care or only practicing half time or less.

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Growing Your Baby

Get Paid
We at Hello Health don’t deal with insurance, and all of the payment you receive for using our web app is straight from your patients. Their credit card is on file with us, just like iTunes, so you don’t have to deal with billing.

Charge It
How you charge, and what you charge for, is up to you— all of the fee settings are within your profile and are automated by Hello Health. And do not be afraid to charge what you’re worth. Take these tips into account:

  • Charge by the hour. We’re currently charging $200 an hour in Williamsburg, but this will vary by area.
  • Charge hourly for emails from the get-go. Small barriers up front is best to prevent frivolous communications. Six minutes spent on an email? That will be 1/10th of an hour, thank you.
  • No monthly fee for the first six months. Once you’re on more solid ground, after about 6 months, then start charging a fee (if you want). Depending on your clientele, $20 a month is probably the magic number.
  • Your incidental fees are up to you. Just remember, keep things simple.


Supply Side
Yes, you’ll need supplies. Not everyone needs everything on this list, and some will need more. But here’s a good place to start:

  • Laptop. It doesn’t have to be to any specifications— just Internet accessible. If you’re the “house call type,” you might want to think about an “Aircard” so you can get wireless Internet wherever you are. Of course, we recommend a Mac.
  • Exam Table. We recommend, especially at the beginning, to get a plain old non-power table. If you don’t plan on having an office at all, you might look into a folding massage table.
  • ‘Fridge for vaccines. Maintaining temperature is crucial to storing vaccines. Your fridge needs to have a thermometer that not only tells the temperature, but also tracks temperature over time.
  • Two garbage cans: one for office waste, and one for bio-hazards.
  • Sharps box.
  • Medical and non-medical office supplies. That encompasses everything from printer paper to prescription pads, and cotton swabs to needles.
  • Don’t believe the hype. There are many companies and consultants whose job is just to get to you buy stuff you don’t need. That goes for everything from insurance contracts to Band-aids.


Marketing
We have found, through experience, that word-of-mouth and a prominent office presence are what gets the word out best. If you would like to do a bit more, try these on for size:

  • Community events. Think creatively and differently— after all, Hello Health is different. Throw a party. Do a blood drive. Give free flu shots. Sponsor a “Field Day.”
  • Get in the media. Write an advice column in a local paper, or ideally, a blog. If you do a community event, write up a little press release and send it around.
  • Take out a small ad in a media outlet that you presume your prospective patients read. Don’t go overboard, though, as word-of-mouth really is the biggest driving factor.
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Basics

All the hoopla currently about Obama’s plan to slow down increased healthcare costs is smoke and mirrors.  Unfortunately, patients are the only ones who will suffer in the end.

He essentially is asking some of the most aggressive executive management types in industry to cut back on their ability to make money…  ain’t gonna happen.  Then, government will step in to ration care. 

I like the prior quotation post because it gets to the heart of a major issue.  Each individual must do what he/she can to PREVENT becoming a patient in the US healthcare system.  There are too many forces within our healthcare industrial complex that suck patients in and morph them into profit centers.

4 years ago

2/6/09

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I believe everyone should pay something–something should come out of pocket, not to discourage going for care, but because paying this and that over time makes you think twice about smoking, about over eating, about bike riding without a helmet, about unhealthy habits in general that end up costing a lot later in life.

If we all had the view that we are responsible for at least some of the cost of maintaining our own health, we’d be more responsible about maintaining our own health.

-hannah  

Commentator on Tara Parker-Pope’s Well column on NYT Health blog article, “When Insurance is Bad for Your Health”

4 years ago

2/6/09