- The pandemic accelerated one of the largest trends in healthcare today: the movement of high-quality healthcare from the hospital and into homes and the community.
My wife is launching her own private practice in the midst of all of this. They are starting with telemedicine and home visits.
This is all well and good until you need a blood draw, a BP, a swab, a sample, a palpitation or any physical examination. We're at about 50% telemedicine for visits (100% for non-contact) but you can't do treatments or vaccines or physical diagnosis remotely. Subsidize Medicaid to the point where more clinics will take it. We're at 28% Medicaid and they're one of our top three best payers. This shit's easy. Everyone keeps trying to make it hard but fundamentally, states that pay for Medicaid have a robust Medicaid system and states that don't, don't. Guess which ones are doing better under COVID. Fuck off with that shit. AI fucking sucks at medicine. Point-of-care diagnostics was the hype that launched Theranos (hey TNG! TheranosTheranosTheranos!) because VC idiots figured a machine the size of a garage could be miniaturized to the size of a toaster if they wanted it hard enough. And wearable biometric monitoring that isn't a joke is pretty much limited to the diabetes industry which has pushed into it hard. Not until you start paying them. Seriously. Rather than make Medicaid something doctors and nurses are willing to do, you're going to throw it at the church. Because the people who are trained enough to take Medicaid are going to work out of a church basement for some reason. Mutherfucker has never participated in a clinical trial. My daughter makes about $300 a year to go sit in a doctor's office and eat pudding four times. I like how we got a real estate squeeze in here. We had one of these in Seattle. it was a pyramid scheme. ...dunno if he's noticed all the urgent cares closing... Right. Rather than simplify the patient side of things we'll just give them golf caddies so that they don't feel so completely brushed off by their eight minute patient visit in which six minutes are the doctor typing into the EHR. So this "care quarterback" is now my home chemo nurse? But we're going to fob Medicaid off on churches? Hey I know. Give medicare for all and then let the rich people pay for "care quarterbacks."Uncoupling healthcare assets from healthcare services:
Patients as the organizing principle for healthcare delivery:
Artificial intelligence, point-of-care diagnostics, and wearable biometric monitoring:
Next-generation paramedics: To bring care to patients when and where they need it, paramedics, tethered to physicians in centralized medical command centers, will receive increased training to deliver rapid care to patients wherever they are.
Houses of worship and religion: With growing pressures on the economy and the increase in unemployment and homelessness, the number of Americans on Medicaid roles will grow, and with that growth, there will be a need to provide lower cost creative sites of medical care in the community. Churches, mosques and synagogues will become community-based sites of care delivery for under-served patients.
Clinical trials at home: With a decentralized healthcare delivery chassis in place, clinical trials will be conducted in patients’ homes, enabling a democratization of access to advanced experimental therapies.
Health Campuses: Large hospitals will give way to health campuses, carrying the hospitals’ brands, that provide an integrated community experience of complex care, assisted living, employee housing, health clubs, restaurants, and retail.
Complex Care: Hospitals that do not become health campuses will become complex care sites, with a smaller footprint, limited to intensive care and complex surgery. All other surgery will be provided in outpatient surgery centers, already conducting more than half of surgeries in the U.S. today.
Care quarterbacks: There will be very limited patient hand-offs and transfers, as is the case today with our current industrialized healthcare delivery model. Care quarterbacks will be patient advocates who steer patients through the care-delivery system.
Cancer will become a chronic disease: People with cancer will be diagnosed earlier and have targeted therapies that will be delivered at home, supported by a care quarterback and supportive tools for them and their families.
Single payer with a twist: With a price tag of more than $4 trillion for healthcare, reimbursement will likely be consolidated under government payment. Patients will have choice in providers, plans and service offerings, as private health plans will offload the financial medical cost risk from the government and compete on cost, quality and patient experience.
I haven't read the article, but clearly this statement is true. Drug companies have a hard time getting academic physicians to follow protocols exactly as written. What's gonna happen when people who literally don't know what medicine they're taking or why (and I'm being serious...I reviewed a study once of a surgery group who was surveying patients to determine how many women who were undergoing a hysterectomy could actually name which organ(s) were being removed or why...the numbers, if I recall correctly, were about 40%) are charged with following a precise instruction, while keeping accurate and auditable records? It will not, I'm afraid, be the utopia envisioned by the author. (This is ignoring the other obvious point, which is why in the hell does anyone want clinical trials "democratized" to begin with? What possible benefit to medicine or society could that bring?)Mutherfucker has never participated in a clinical trial. My daughter makes about $300 a year to go sit in a doctor's office and eat pudding four times.
Aimmune thought things would be awesome if they came up with an app that you could record when your kid took their dose. Then it threw a couple errors. Then the FDA said people had to enter their shit into the app, because it was protocol, and also write it in a journal. And the clinicians had to compare the two. Then a year later they managed to get it so they could drop the app, but not fix the app, because it had been erroneous. Then two years later they finally got to the point where you didn't have to write down exactly what time you'd dosed, just whether or not you hadn't. That's for a dose of characterized peanut protein that your test subject has already demonstrated tolerance to in a clinical setting. That clinical setting? BP before, during and after. 3 hours of monitoring. Can't leave without an epipen. Epipen in your car? Show it to me. Expired epipen? have a new epipen.
And every. single. one. of those changes required a protocol amendment, which probably required a data review, which probably necessitated at least a phone meeting with FDA. Now multiply that by as many studies as there are registered on clinicaltrials.gov. FDA has a hard job, and putting the controls in the hands of laymen will not make it easier.