Brown2020

Anyone who has read headlines about skyrocketing healthcare costs or has been to the doctor or hospital knows we need some fresh thinking in how we organize and deliver healthcare.

Have you ever had an experience where you go to the doctor and find yourself filling out the same three-page form asking for the same information that you have filled out many times before?

Or an experience where the one medication that really seems to work for your child is not covered by your insurance without an appeal, and each time you need a refill, they seem to have lost the results of your appeal and need to start over?

I remember one visit to a local medical center that I won’t name other than to say that it is in the heart of Silicon Valley. Without an electronic medical record, I remember the doctor asking me in earnest, “Think, Steve, think! When did you have your last tetanus shot?”

We all have stories and personal experiences of the inefficiencies of our healthcare system.

Some of us may have started to see some new ideas based on the Internet making their way into the mainstream, ideas that open our eyes to new possibilities for a better and more efficient healthcare system. We can go to the Internet to research treatment options, schedule doctor visits, get personalized advice and feedback, and look up our own personal medical records. Maybe Silicon Valley ideas can help transform healthcare, as they have in other major fields.

Yet healthcare costs continue to explode, and it is bankrupting our government. Let me tell you why.

In San Jose, California, just south of Silicon Valley, a farm worker will show up at the Valley Medical Center emergency department with a foot ulcer that has become unbearable and has gangrene, a complication of diabetes. He has been to the hospital many times before, but no one will have any records, or know his history. He will spend 10 days in the hospital, where his foot will be amputated. He doesn’t have insurance, and now he won’t be able to work, either.

Then he will be sent home, where no one will be helping him manage his diabetes until the next crisis, when the cycle will repeat.

Any doctor will tell you that this is the most expensive and most painful way to treat diabetes. The tab will be picked up by Valley Medical Center and passed on to taxpayers, one way or another.

Just across Highway 101 from wealthy Palo Alto, a child lives with asthma in East Palo Alto. She will go to the Stanford Hospital emergency department for the 10th time this year, unable to breathe, parents in a panic. This time the child will be admitted to the hospital for three days.

Then she will be sent home with no support in monitoring and managing her asthma to prevent the next crisis. The cycle will repeat.

Med-Cal will be charged tens of thousands of dollars, not to mention the missed school days, the missed work for the parents, and the mental trauma of constantly living from crisis to crisis.

Within a few miles of the headquarters of Google, Yahoo, Cisco Systems, Intel, Sun, Hewlett Packard, and eBay, an 85-year-old woman lives alone in Mountain View with congestive heart failure. She will have a doctor’s appointment tomorrow. Everything will appear to be fine.

Tomorrow evening she will have difficulty breathing. By Friday she will be retaining fluids. No one will know. But she won’t call her doctor because she just had a visit and everything was fine.

Saturday she will feel worse and her legs will be swelling, but it is the weekend and she doesn’t want to bother her doctor. On Sunday, she will dial 911, and will be admitted to El Camino Hospital, where she will stay for 10 days to get stabilized.

Then she will be sent home again, alone, with no one monitoring or managing how she is doing, and the cycle will repeat.

Medicare will be billed tens of thousands of dollars.

Do any of these cases sound familiar? How many of you know someone with diabetes? Asthma? Congestive heart failure? How about emphysema or COPD? Hypertension? Coronary artery disease? Depression, or another mental health issue?

Do you know what these conditions have in common? They are all chronic conditions that need to be monitored and managed every day. If they aren’t, they get worse until you end up in the hospital.

Just how big is this issue? Chronic disease accounts for a vast majority of the $1.7 trillion that will be spent on healthcare in the United States this year. In the State of California, chronic disease accounts for most of the $200 billion we will spend on healthcare.

This year, there will be over 450,000 hospital admissions in California for the 7 chronic conditions I mentioned. That’s right, 450,000 acute care hospitalizations, costing $15 billion, for chronic conditions that can and should be monitored and managed before they become an acute crisis.

In public health these are called “ambulatory care sensitive hospital admissions”, which means, hospital admissions that you might have been able to prevent, if you had better care before you ended up in the hospital.

Here is the interesting part: If you look at who is paying the bills for hospitalizations that result from our failure to properly care for patients with chronic disease, over 70% is paid for by government: Medicare, Medi-Cal, cities and counties.

So how can we do it better? Let me share a few stories from my experience as CEO and founder of Health Hero Network, a Silicon Valley technology company focused on improving chronic care.

Our product is the Health Buddy® system, a home health monitoring system that links patients at home with care providers on a daily basis. A simple countertop messaging device connected to the phone line educates patients about their disease, guides them in daily self-care, and monitors symptoms. The data is transmitted to nurses and doctors, who use web-based tools to quickly see which patients are having problems before the condition becomes a crisis.

Working together, we have shown that public health nurses can monitor and educate uninsured farm workers with diabetes, heart failure, and hypertension. By improving self-care at home, and by identifying problems early when they still could be treated in a community health center, these program have cut hospitalizations in half, and saved millions of dollars per year.

We have shown that hospital case managers can monitor, educate, and support children with asthma covered by Medicaid. Kids learn about medications and symptoms, and begin to recognize and prevent impending asthma attacks. These kids gain confidence that they can live normal lives, while cutting their need to go to the emergency department to a fraction of what would have been expected.

We have helped nurses and doctors at the Department of Veterans Affairs to reduce hospital admissions for chronic diseases like heart failure, diabetes, COPD, hypertension, and depression by an unbelievable 63%, while improving quality of care and support for aging veterans. As a result, the VA is rolling out home health monitoring programs through its medical centers around the country as part of a national chronic care improvement program.

Home health monitoring programs at the VA are an important part of a technology-enabled transformation that has improved quality and access while reducing overall costs by 24%, according to the Undersecretary of Health at the VA who initiated the programs, and this transformation is just getting started.

If Med-Cal could achieve results like the VA, the savings would be $8 billion per year, one billion more than the structural budget deficit that is forcing Californians to compromise on education, roads, and lots of other important things we all care about.

Our experience at Health Hero Network is just one small example of a transformation in healthcare that is starting to take hold around the country. At our last count, 46 states have recognized the opportunity to improve the way they handle chronic care in their Medicaid programs, and have initiated Medicaid transformation projects and chronic care improvement programs.

Sadly, though, California’s response so far has been that “things are so bad right now that we can’t even think about fixing it.” The only ideas to be discussed come down to either cutting services or raising taxes.

That is why we urgently need fresh thinking in our government. We need leaders with the vision to see that it is possible to transform services in ways that improve quality and health care access, and lower costs at the same time. We need leaders with the guts to take on healthcare transformation precisely because our health system is in crisis.

Silicon Valley innovations in technology and the Internet have enabled transformation in just about every other industry to improve services and lower costs.

If the State of California can partner with Silicon Valley to transform healthcare across this state, not only will we improve quality of life for those who suffer from chronic disease, we will also remove a drag on our State budget, and on the economy.

One day we will have a smarter healthcare system in California that can serve those who need it most – without breaking the budget.

One day we will have a new model of care in California that empowers and supports citizens proactively rather than in reaction to a crisis after crisis.

The tools for transforming healthcare are made right here in Silicon Valley. This will be a new growth industry for California, creating jobs and serving a growing need around the world.

This can happen and will happen when we choose leaders who have the vision and courage to step forward and make a difference.