Have any of you heard of the term P4 Medicine? The term was coined several years ago by biotech pioneer Leroy Hood. Following a complex recipe of the integration of biomedicine, information technology, wireless and mobile, a new phase of digital medicine is being born. The shorthand for P4 Medicine – Predictive, Preventative, Personalized and Participatory – is already in play. Right here, right now, we are witnessing the transformation of how we will receive and experience health care, and it is amazing. How is that happening, and how will it affect us?
The vision of P4 Medicine is that instead of waiting for clinical symptoms to appear, like a growth spotted on an ultrasound after it has spread, physicians will be able to see early warning signs of malignancies from a tiny bit of blood analyzed by genomic instruments and software. If the genes and proteins are really predictive, then physicians could take early action, or patients can focus on prevention via lifestyle. All of a sudden, the focus of medicine goes from reaction to an investment in wellness.
And then there is the technology portion. There are currently over 20,000 different mobile apps available which merge your phone and diagnostics. For example, you can now measure your blood glucose on your and send it to your physician, which, in turn, can help you better understand your blood sugars as a diabetic. (Already, this has covered Personalized and Participatory.) Once this information is predictive, it can also be preventative as well. And that’s just for starters.
The booming field of mobile-health technology is only one part of an equation that is playing into this transformation. For example, GE Healthcare manufacturers a portable ultrasound device about the same size of a cellphone. It’s called the Vscan, and it allows a physician to look directly into the heart of a patient. Here, both the patient and the physician can see the muscle, the valves, the rhythm, and the blood flow. Already, we are touching on the Participatory and Personalized element of P4 Medicine. When we have the experience of witnessing what is happening inside our own body, we can start approaching medicine differently. No longer is your physician simply informing you about news which you may feel slightly removed from. (The language is medical. You may feel a disconnect.)
For those of you who, like me, have had the overwhelming experience of seeing your developing fetus via ultrasound, you can remember what that experience was like. For the first time, you are drawn that much closer in, witnessing life inside you. Similarly, physicians expect that patients who witness their own health in real time will be propelled to take charge of their own health care. It stands to reason that patients are more willing to make lifestyle changes that keep them healthy when they can monitor the consequences of their actions in real time.
Here at oomphtv, we aim to be a great communicator of new age 21st medicine, so stay tuned. Dr. Hood, in particular, believes that this transformative new idea in healthcare is near the tipping point. Timing is everything – we are blessed to be a witness.
If your curiosity is piqued, check out theP4 Medicine Institute for more information.
Tomorrow marks another birthday. As I age, I recognize that good health is more and more important than anything. It’s everything.
We’ve all heard the “be proactive” call to action. In a sense, this is assessment from a bird’s eye view. We can assess our lifestyle by repeating the mantras we’ve all heard before: Follow a healthful diet. Get plenty of exercise. Channel our stress. Don’t smoke. Moderation is key. Be engaged, be mindful. Okay, okay….let’s say that we do all that. Are we where we should be in the preventative health maze?
When I conduct an on-line search for “How to Assess Your Health”, my computer screen urges me to take a health report card quiz so that I can determine what my risk factors might be and use my overall score to evaluate my health. Been there, done that. I’m healthy, according to my on-line test results. Is there anything else included in proposed self-diagnostic test kit? Yes. One more thing: I need to trace my family history, which will give me clues about what diseases I might be susceptible to. According to my on-line guides, I am now complete. I can feel assured that I can head off problems before they ever come to the surface.
I’m not a medical professional and sincerely don’t profess to be, but through a devastating illness which my husband is currently combating, I’ve learned that assessment is key to everything. The assessment that my husband’s doctors and nurses speak of is that of learning about your own norms by following a road map and listening to your body. So this year, I’m challenging myself to actually learn something about my own norms, to “look under the hood of my engine” so to speak. I’m making my first attempt to understand how I run.
Last week, I had my annual physical. Although I get blood work done every year or so, this was the first time I requested a hard copy of my lab results. I also requested that my physician walk me through the results. He consented, and was happy to empower me to learn about the person whom I think I’ve known all too well for many-a year now. This was a valuable lesson. Having seen the same physician for years, he told me how my norms have been running for everything from blood sugar to iron, from blood pressure to cholesterol, both good and bad. I asked about hemoglobin, thyroid, and Vitamin D. And the list didn’t stop there.
I feel as though for the very first time, I’ve practiced the best prevention method: understanding. Not only did my physician take the time to teach, I became an inquisitive student. I followed up his assessment by utilizing a primer I found on the New York Times which allows the user to look at blood counts and understand what they mean. This served as a great follow up to help me interpret my test results.
As we continue to drown in this information age, it’s easy to get lost between multiple health blogs, hundreds of internet sites, and countless medical apps. The daily bombardment of drug advertisements and the conflicting (but well intentioned) studies about medical tests can be confusing at best. Ironically, the very best person to advise us, our doctor, is now more likely to spend less time with each and every patient. This is especially why we all need to get acquainted with ourselves, know our baselines and understand what they mean. How else will we recognize a change of status if and when a change happens?
Of course, when you’re sick, knowledge is power. But I’ve just learned that knowledge is power when you’re healthy as well.
Many agree that the recent historic overhaul of the nation’s health care system does a lot of things, but it may be more challenging to understand how the legislation will make an impact on us as individuals. While some will not see much change in their coverage, others will be greatly affected, depending on if insurance is provided through work, or if one has pre-existing conditions. As the mother of two girls in college, the benefit that allows them to stay on my insurance past the age of twenty three was one element that I could deftly recall.
Most agree that the bill can be divided into two major categories: It tightens regulation of the insurance industry, and it expands access to care for the poor and for low-income working people. But what does this reform actually do for you, as a consumer, taxpayer, and a patient?
Like many of you, I tend to make annual appointments towards the end of a calendar year, hoping my deductible has been met. Thus, with the last few months of 2010 upon us, I had scheduled a few preventative screenings, even though my insurer’s coverage would be minimal at best as preventative services are minimally covered. Regardless, some of these exams are important. As a newly minted fifty year old, the annual ob/gyn appointment is a must for me. I added a trip to my opthymologist (it’s been way too long), along with a mammogram. The colonoscopy exam is one more thing that I’ve thought about, but haven’t scheduled. Three appointments is plenty for December, right?
But wait. Perhaps the newly passed insurance legislation affects me in some small way. And thus began a phone call to my health insurer to ask that very question. After enduring sixteen minutes on hold, I was politely greeted by a young sounding voice who was all too eager to answer my question of how the new law impacts my specific insurance plan.
Turns out that if I push off all of my appointments to January of 2011, my insurer will pick up a minimum of forty percent of preventative services, including a diabetes test, vision test, mammogram, pap smear, bone density test and colonoscopy. This came as a great surprise. The representative even offered me a prostate screening test. (Yes, I am female.) Sadly, I explained to her why I’d have to decline this one.
While forty percent of adult preventative services is no windfall, it is possibly enough motivation to get myself and others into a screening mode. This small flirtation with coverage inspired me to find out more about the bill. This is where it gets more complicated. If you’re curious about the particulars, I offer this useful breakdown of the major pieces of the legislation, provided by a website I highly recommend healthycal.org.
The following legislation is categorized by the dates on which they take effect:
Taking effect in 2010:
–Increase in Medicare prescription drug benefits. A one-time rebate of $250 for seniors who have exhausted the first part of their drug benefit and are paying 100 percent of the cost of their medication. The following year, low-income and middle-income seniors would begin getting a 50 percent discount on brand-name drugs.
–A high-risk insurance pool for people with pre-existing conditions who have been turned down for regular coverage. This pool would be available until 2014, when new regional insurance exchanges will be created and take over this function.
–Insurers prohibited from imposing lifetime limits on a person’s benefits.
–Insurers prohibited from rescinding coverage when a person becomes sick or disabled, except in cases of fraud.
–Insurers required to cover dependent children on a family policy until the age of 26.
–Subsidies for small business. Tax credits covering up to 35 percent of premiums for employers with 10 or fewer workers and average wages of $25,000 or less. This subsidy would climb to 50 percent of premium costs in 2014 but would phase out as a firm’s number of employees and average wages grows. The credit would end once a company had more than 25 workers or average wages of $50,000 or more.
–Tanning tax. A 10 percent tax on the purchase of indoor tanning services.
Taking effect in 2011:
–Insurers required to spend at least 80 percent of their revenue on medical claims.
Taking effect in 2013:
–Higher payments for doctors who treat the poor. The federal government would reimburse states that increase payments to primary care doctors in the Medicaid program to match what is paid under Medicare. These federal subsidies are intended to entice more doctors into the Medicaid program in advance of major expansions in enrollment in 2014. But the new subsidies to the states expire in 2015.
–A higher Medicare payroll tax rate, adjusted for the first time according to income. The rate would increase from the current flat 1.45 percent to 2.35 percent on income above $200,000 for individuals and $250,000 for couples. These groups would pay an additional 3.8 percent tax on capital gains, dividends, interest and other investment income.
–A new cap of $2,500 on the amount of money people can set aside tax-free to pay for medical expenses.
Taking effect in 2014:
–Individual mandate, requiring most people to buy insurance. People who did not comply would face penalties beginning at $95 a year or 1 percent of their income, whichever was higher. These penalties would rise over time.
–Insurance exchange. States or regions would organize new insurance marketplaces for people who could not find coverage in the private market. There would also be two national plans, including one non-profit. Insurers competing to win customers through the exchanges would have to justify rate increases and could be barred from the exchange if they raise rates excessively.
–Insurers prohibited from charging older people more than three times what they charge younger people.
–Insurers required to offer minimum benefits, to be determined later by the federal government. The minimum plan would cover 60 percent of the costs and limit out-of-pocket costs to consumers to about $6,000 annually for individuals and $12,000 for families.
–Subsidies for individuals. Tax credits would be available for low and moderate income people who buy through the exchange. People with incomes below about $33,000 for a family of four would pay 2 percent to 4 percent of their income in premiums, and health plans would be required to pay 94 percent of the cost of their benefits. These subsidies would continue at a lower level for families with incomes up to four times the poverty level, or about $88,000 for a family of four.
–Employer penalties. Employers would not be required to offer coverage to their employees, but if they did not and their workers used the exchange, employers with more than 50 employees would have to pay a fee of $2,000 for every worker who used the exchange, after the first 30 employees. Employers that do offer coverage would also have to pay a fee if their workers opted for insurance sold through the exchange.
–Expansion of Medicaid (Medi-Cal in California). This government-subsidized insurance would expand to cover everyone with incomes up to 133 percent of the poverty level, or about $29,000 for a family of four. Currently, families with children, the aged and disabled qualify for this system, and at lower income levels. The federal government would pay the full cost of this expansion until 2016, then phase down its contribution to 90 percent by 2020. The state would be responsible for the remainder of the cost.
–Higher reimbursement rates for states that cover children through the program for the working poor, known as Healthy Families in California. The federal government currently pays an average of 70 percent of the cost. This would increase to 93 percent.
Taking effect in 2018:
–A new tax on so-called “Cadillac” or expensive health insurance plans. This 40 percent tax would take effect on individual plans costing more than $10,200 a year and on family plans costing more than $27,500.
You may want to pick up the phone and call your insurer, and ask what, if any, changes will be implemented to your plan.
After all, it’s not like they’re going to tell us. We have to do the asking.
The Journal of Consumer Research recently released a study concluding that people who become focused on how to achieve a goal may have a harder time achieving their aims than people who think abstractly about why they want to do something.
The authors of the study found that when people focus on concrete aspects of how a goal will be achieved, the person who is trying to achieve the goal becomes more close minded and less likely to take advantage of an opportunity that may fall outside of their plan. On the other hand, people who focus on the “why” are more likely to consider a new opportunity which could help them attain their goal.
This is not to say that forming a way to implement a goal is not valuable. It is. The study reveals that when people form “implementation intentions” they become overly focused on the specific details of the implemental plan and less focused on the overarching goal.
The mere knowledge of the outcome of this study may be helpful as you try to achieve your goal. Let’s say you recently discovered that you are pre-diabetic. Your doctor recommends an overhaul of your diet. Immediately, you shelve any and all white, refined flour. Day after day, you stick to your guns: no white, refined flour. What you don’t know is what your doctor may have failed to tell you: daily, moderate exercise may be an even more effective way to stave off diabetes. In comparison to someone who has not yet formed a plan for lowering their diabetes, are you more or less likely to add an exercise regimen?
While the authors may not have conclusive evidence to answer this specific question, they are likely to tell you that you may not value an ‘out of plan’ opportunity the same as you would your original plan. “Planning is more effective when people think abstractly, keep an open mind, and remind themselves of why they want to achieve a goal,” they write. In a sense, this seems counter-intuitive, as so much of goal-setting seems to be all about the ‘how’. Asking “why” may help you to stick to your intentions, especially as you face unexpected challenges. This helps all of us be our own life coach, answering the “why” as we move forward. The lesson learned here is to keep examining the role of your own mind-set as you pursue your goal. Otherwise, you may just be letting a good opportunity simply pass you by.
If any of you want to share your insights, let us know!
If you’re over forty, you’ve no doubt experienced a medical appointment which was rushed by your physician. Or perhaps you’ve had the misfortune of misdiagnosis or a medical error. Nothing new these days, right?
What may be a new chapter in healthcare is an era of patient advocacy, a term more and more of us will come to know in the coming years. With doctors pressured to see a higher volume of patients, the time you spend with your physician will no doubt be more limited. And with the 32 million people getting health insurance by 2014, there will be more patients for doctors to see. With an aging population and medical schools producing the same amount (or fewer!) physicians, a warning shot has been fired: all of us must be poised to be effective advocates for our own health.
What does that mean, exactly? We, as both patients and caregivers, need to understand our treatment options. We also need to learn how to proactively work with insurance companies, how to talk about and prepare for end of life decisions, how to advocate for our safety, and learn how to question and ultimately advocate for our own health.
Author Trisha Torrey of Every Patient’s Advocate is a woman who has spearheaded the patient advocacy movement. Sadly, she knows the American healthcare’s dysfunctional system all too well. When she was diagnosed with aggressive, terminal cancer and told she had only a few months to live, it didn’t sit right. She searched further and further. Ultimately, Trisha had indeed been misdiagnosed with cancer. Once a mild-mannered marketing consultant who knew almost nothing about healthcare, she delved into the American healthcare system that was tasked with treating her.
Initially Trisha made every mistake a patient could make. But she got smart, fast. She learned that the possibility of excellent care was too easily and frequently eclipsed by miscommunication and mistakes. She also learned that if she didn’t stick up for herself, and insist on the help she needed, she would not get it.
As a staunch advocate of the Patient Advocacy movement, here are some of her suggestions:
• Get invested in the process. Think about how you would advocate for your child. Now do it for yourself.
• Know your family history. This can help with both diagnosis and treatment phase.
• If you ever get a devastating diagnosis, don’t make quick decisions. Explore resources to get the comfort and information you may need.
• Realize the pull and power of the pharmaceutical industry. It is a business. Don’t be naïve.
• Research all prescribed drugs, and recognize that drugs affect each individual differently. One must take into account their age, ethnicity, and sex. Recognize that no drug hold all the answers, so research complimentary alternatives.
All in all, have a voice. Support those who cannot support themselves, and recognize that we have to make ourselves accountable for our own health as we make healthcare providers more accountable.
If you are trying to navigate the healthcare maze, you may want to check out the following Patient Advocacy Resources:
• About.com Patient Empowerment: http://patients.about.com
• AdvoConnection: www.AdvoConnection.com Helps ﬁnd an advocate when you or a loved one needs assistance for medical/ navigation issues, billing or insurance claims, getting permission for insurance payment rejections, birthing, geriatric home health and more. Itʼs a free service that lets you search by zip code and service needed.
• Association of Cancer Online Resources (ACOR): http://www.acor.org/ offers access to 159 mailing lists that provide support,
information, and community to everyone affected by cancer and related disorders.
• Center for Advancing Health (CFAH): http://www.cfah.org. CFAH conducts research, communicates ﬁndings and advocates for policies that support everyoneʼs ability to beneﬁt from advances in health science.
• Center for Medical Consumers: http://medicalconsumers.org/. Is committed to broadening public awareness about the safety and quality problems that pervade Americaʼs medical care. The Center is active in both nationwide and statewide efforts to reduce medical errors, report disclosure of physician conﬂicts of interest, improve the quality of medical care, and encourage public access to information about the comparative performance of doctors and hospitals.
• CNNʼs Empowered Patient: http://www.cnn.com/SPECIALS/empowered.patient/. Elizabeth Cohen presents her weekly stories about patients who stepped up in unusual ways to get the medical help they needed.
• Coalition for Patients Rights: http://www.patientsrightscoalition.org/. The Coalition for Patientsʼ Rights consists of more than 35 organizations representing a variety of licensed health care professionals who provide a diverse array of safe, effective, and
affordable health care services to millions of patients each year.
• Consumers Advancing Patient Safety (CAPS): http://www.patientsafety.org/. Is a consumer-led nonproﬁt organization formed to be a collective voice for individuals, families and healers who wish to prevent harm in healthcare encounters through partnership and collaboration.
• The Empowered Patient Coalition: http://www.empoweredpatientcoalition.org/. The Empowered Patient Coalition is dedicated to providing an unprecedented level of information, resources and educational support to the public. The Coalition is committed to promoting a culture of transparency, meaningful interaction and active participation that will allow patients and their advocates to assume a greater role in improving the safety and the quality of their health care.