Atlantic Monthly: Electro-Shock Therapy

This quote caught my eye about General Motor’s approach to planning their next generation electric car:

Perhaps most audacious of all was a decision to allow unusual public access to the Volt program. The industry’s standard procedure is to develop new products, especially risky ones, out of sight, unveiling them only when proven. GM decided to do exactly the opposite. The PR department flung open the doors. GM executives discuss the program’s progress as publicly as if it were a bill in Congress. They show off photos of batteries under development. They promise to let reporters ride in test cars. They lead them through the labs and design centers and even into the wind tunnel. They run ads, for instance in this magazine, touting the Volt in the present tense, as if it already existed. By earlier this year, expectations were so high that President Bush was commending the car, and it had developed a national grassroots following. This article is itself a product of the fishbowl strategy.

GM is using the publicity to excite the public, of course. It is also using the publicity to push itself. “We thought it would be a motivating thing to do,” Wagoner says. “Certainly it gets everybody aligned”—not always easy in a giant corporation. And GM wants credit for trying, which it never received for the EV1. “If it fails,” Harris says of the Volt, “we want people to know exactly why it failed. It wasn’t lack of commitment or passion on our part; we hit a hard point we couldn’t get around.”

On the other hand, I don’t see a newer update than March, 2008 on the official Volt Web site. There are blogs about it though, and it’s possible that those publishers have good access to how things are going.

Click on the image to see a much larger version…just 1 page.

Issue & Focus

1. The California Healthcare Foundation is dedicated to the improvement of the lives of Californians managing chronic illnesses.
2. There are many community stakeholders involved in supporting this goal; their work could be improved by making connections to each other that are meaningful for patients.
3. This is part of a broader strategic plan to support the objective of involving patients and families in all aspects of their care. This is the identified gap to be closed through this work.
4. California Healthcare Foundation is seen as catalyst and partner for patient engagement in California. It’s scope is 36,000,000 Californians

Current Condition

1. All chronic conditions can benefit from better patient engagement
2. Hypertension is a good example of one - recently published studies demonstrate both the gap and the opportunity with non-office-based approaches

Problem Analysis

1. Divided into three areas : Clinical Gap, Technology Gap, Partnership Gap, that California Healthcare Foundation can connect partners to assist with
2. Clinical Gap: Patient role in recognizing blood pressure out of control; currently this rests with the physician, in an office-based setting
3. Technological Gap: Chronic disease assessment is typically performed in the office or medical setting
4. Partnership Gap: Stakeholders (patients, payers, providers, connectivity providers) are not connected to patients and one another at the same time
5. The societal costs of inadequate management are spread diffusely; few organizations are able to to see the total harm from this perspective

Target Condition

This pilot seeks to create a functioning ecosystem that supports chronic disease management across the lifecycle, with the best candidate being hypertension

Action Plan

We began by interviewing example employers, health care providers, and technology providers to understand which approaches and components appeared most promising. At this time, it seems most reasonable to approach this first from the employer perspective.

Next step will be to convene a group of potential partners in July, 2008, at California Healthcare Foundation, to discuss how pieces would fit together.

A presentation would be made to the CHCF Board in the fall, with funding and activity to begin in 2009.

Cost / Cost-Benefit / Waste Recognition

There are recognized wastes, which include unnecessary visits for blood pressure monitoring, inadequate medication therapy, and inadequate use of the health system, for patients who have not been seen in the past 12 months.

There are costs including, technology costs (although the goal is not to build anything new), and realignment of incentives to support non-visit-based care.

Followup / Unresolved Issues

Points of concern and planned countermeasures

1. What is the metric for patient access? (Pacific Business Group on Health is working on an employee engagement survey; metrics for patient access to their health data may need to be developed)
2. How can this complement the launch of both a P4P measure for blood pressure management, and a HEDIS “Relative Resource Use for Uncomplicated Hypertension” measure for 2008?
3. Data for presenteeism and productivity loss does not seem intuitive (I have reviewed this in depth and we can bring in clinical champions to verify)
4. Partners and aligned interests (will do due diligence to support cooperative business models of partners)
5. How to engage patients in things like biometric monitoring and blood pressure control (there is data supporting patient interest in this monitoring, but most importantly will go to the factory floor, and will bring an employee/patient advisor on to the team)

That’s the latest script that goes with the story, more or less. Comment away, and keep in mind that each comment will change the A3 a little every time.

Health care found to be better with online help - Nice localization of the landmark Group Health study on managing hypertension using Web services, from the Seattle PI.

So…if the study and the community agree that this kind of care is better, and there is data to show that diagnosing “white coat” hypertension is cost-effective, and payers already have reimbursement policies for ambulatory blood pressure monitoring (and older type of technology to figure this out), why not create more modern policies for home blood pressure monitoring?