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Patient Well-Being Foundation – April 23, 2018

The mission to transform the United States health care system from volume to value, makes sense to most of us. As with any complex mission, it is challenging to determine how to measure performance of the mission.  How do we measure value-based care (VBC)? How do we measure VBC performance in a cost-effective way? With thousands of possible elements that could be measured, it will take many years and iterations to get this right.

A recent study demonstrated major flaws in how Centers for Medicare and Medicaid Services (CMS) measures value in primary care. The study published in the New England Journal of Medicine found that 63% of the performance measures were either not valid or lack evidence to support their validity. See more.


Managing Complexity – April 21, 2018

When people break into banks, they don’t tend to deposit money. Which explains why JPMorgan Chase and Wells Fargo spend billions of dollars each year on artificial intelligence, physical security and cybersecurity to prevent financial and identity theft.

When Cambridge Analytica compromised 87 million Facebook users’ data, they deposited millions of dollars into Facebook’s bank account. Which may explain why Facebooks’ massive, world-class team of Artificial Intelligence professionals in Building 20 were not working to prevent bad actors from purchasing ads and stimulating users emotions with sensational material (a.k.a. click-bait).

Cambridge Analytica claims they have 5,000 data points on American voters. They leveraged Facebook’s artificial intelligence powered capability that predicts how each of their two billion users will behave, think and purchase. Yes, if you are a Facebook user, they may be able to predict your future behavior better than you. See more.


Health3-0.com – April 6, 2018

If you have predictable patterns of chest pain, you may be diagnosed with stable angina. When deciding on a treatment, your decision may involve people outside your exam room. Treatment options include lifestyle changes, medical therapy (drugs) and a procedure that inserts a catheter into your coronary arteries to place a stent to improve blood flow to the heart. The procedure is called Percutaneous Coronary Intervention (PCI). 

The lifestyle changes and medical therapy options could be selected by you (the patient) and your physician. PCI may require prior authorization by your insurance company that may determine the potential benefit is not worth the cost or that they want you to try lifestyle changes and medical therapy first. While PCI has produced great outcomes for many people with stable angina, a 2007 study found that overall, PCI is no better than optimal medical therapy at alleviating symptoms. Physicians, insurance companies and device makers (stent) may each have different opinions as to whether the costs and risk outweigh your potential benefit from PCI.

See more about the complexity of medical decison making and why health outcomes is often not part of the decision.


PatientWell-Being.org – March 22, 2018

Don Speranza is in his late 60s and lives on a farm along the Columbia River in Washington state, where he runs a bed and breakfast with his wife. Last year he received an email from his doctor with some test results. “It was like a gut punch, ” Speranza says. 

Based on his weight, which crept up to 210 pounds, and his blood glucose levels, he was diagnosed with prediabetes. 

Don’s story, recently shared by Allison Aubrey on NPR, is an all too familiar one with one third of the adults in the United States being obese. A recent study predicted that we will have more of these stories with 57% of today’s American children forecasted to be obese by the time they reach the age of 35.

See more …


ManagingComplexity.net – March 5, 2018

The simple answer is, complex challenges are complex.

While that’s a correct answer, it’s not helpful in improving our abilities to manage complexity.  With complexity, we know simple solutions usually fail miserably. That’s unless the solution to a complex challenge fits on a bumper sticker and you are a politician. See more …


Patient Well-Being Foundation – January 20, 2018

Obesity is one of the most complex challenges of our time. Today, over one third of the adults in the United States are obese. Our future may not be any better based on a recent study predicting over 57% of today’s American children will be obese by the time they reach the age of 35. To address complex challenges, we must understand the impacting elements (determinats of health) that may need to be addressed to achieve the mission. Our National Institute of Health Director, Dr. Francis Collins, writes that we may have discovered new determinants of obesity: neuronal projections on brain cells. See more …


Managing Complexity – January 9, 2018

For the first time since 1962 and 1963, the United States life expectancy at birth has declined two years in a row.  This has been mostly attributed to higher death rates among young and middle-aged Americans with a 21 percent increase in fatal drug overdoses and the death rate doubling from synthetic opioids like fentanyl. See more …


Managing Complexity – October 18, 2017

A mother of three young children is ten minutes into her thirty-minute drive home after a challenging day at work. She will not remember anything about her commute. The prefrontal cortex of her brain that controls executive functions is consumed with thoughts of her kids, husband, parents, boss, clients, friends and other commitments. The basal ganglia of her brain that coordinates automatic behaviors is managing the driving on this ordinary trip home. See more …


Managing Complexity – October 10, 2017

Economist Richard Thaler won the Nobel Prize in economics yesterday for his work in Behavioral Economics. This is a field of study of the complexity of human decision making. He is second person to win a Noble Prize in economics for Behavioral Economics. Psychologist Daniel Kahneman won the same award in 2002.  The field is a bridge between economics and psychology in decison making. See more …


Managing Complexity – October 9, 2017

There are few things more complex to manage in life than choosing a path or journey after graduation. A high school teenager, with little experience with life altering decisions, must choose an education or vocational path, maybe a new place to live, and a complex journey. A college senior must choose a path of uncertainty that they hope leads to what they think they want. See more …