How Can We Fund Principled-Centered MedicineTM?
Hard to believe that we are halfway into Summer 2018! I hope that you have found time with family/friends to relax. Recently, we have introduced Principle-Centered Medicine™ as a brand of patient care that focuses on the doctor-patient relationship that osteopathic internal medicine can lead. Patient care that enables a physician’s energies and healing skills with “principles” of individual medicine is extremely valuable and often underfunded. The spectrum of quality-based “low hanging fruit” payments have not been very fulfilling outside of huge corporate health delivery groups. We can be as “Principle-Centered” as we want, but if it isn’t properly capitalized then it remains an uphill battle. The following paragraphs will highlight some ideas as a start on how to properly link our focus on the patient to appropriate capitalization.
Data Grabs Out of Control
The middle world (Tolkien) money grab going on in the American healthcare system is a real and disturbing problem that continues to victimize patients and physicians. The patients pay and insurance companies do not. This is just scratching the surface. Large corporate systems using Electronic Medical Record (EMR) systems are selling the patient interaction data that you slog entering day and night for millions of dollars (while haranguing you to do more). This is often raw data that is un-adjudicated and at best poor, though incredibly valuable. Insurance companies have funded sub-corporations such as Optum (United Healthcare) to buy patient data, or use their patient data collected (ironically) to prove service that we have created, then sell the data for huge profits. They withhold payment to physicians and hospitals in order to fund these data repository companies. It will only end if we change it. Would we settle for clinical data culled from EMRs to direct patient care and call it peer reviewed research (rhetorical)?
Control Your Data
As far back as ancient Greece, data was God. The Oracle of Delphi and the Temple of Apollo became the oracle using data that was meticulously collected thereby becoming the epicenter of predictions, prevention and geopolitical control. Data needs to drive quality, better patient outcome and computational learning from those contributing on the Front Lines. Controlling data, adjudicating it precisely and accurately is the future of medicine. It will not be accurate enough from insurance companies, big pharma or device companies. In fact, it is best found, created, adjudicated and re-adjudicated in the patient encounter by expert physicians in the field. Principle-Centered Medicine™ physicians provide their best data and outcomes. We need to cultivate the data and prove it.
Longitudinal Outcomes Research
A starting point is strong prospective registries that are well-adjudicated by experts or “principled” investigators/physicians such as ACOI members. Data Science such as sold by Optum can only organize their data retrospectively. Retrospective groups of atrial fibrillation or cardiac arrest patients are much more skewed and weak than well-organized prospective registries examining the same. In fact, longitudinal prospective real data is more valuable for clinical appropriate use than most randomized clinical trials (RCTs) today because of the computational strength available today and the highly exclusive RCTs. Non-profit organizations such as the ACOI are perfectly positioned to link your practices to easy to use registries where you own the data and the organization leverages the overhead for your practices to demonstrate true outcomes (more on this in coming perspectives). Creating strong group-based quality metrics that are real rather than contrived and then translating this to quality versus poor outcomes and eventually artificial intelligence towards management is only as good as your input and expertise, which the ACOI is committed to preserving.
Bilbo Baggins scrapped into middle world, we should too. The wellness of our profession and our physician colleagues demands it.
Martin C. Burke, DO, FACOI