This quarter I am taking a phenomenal course titled "Health Care Management," taught by one of the leading experts in the field, Elizabeth Teisberg. Professor Teisberg wrote the book on value based health care. Literally, she authored a more than 700 page book on the faults and solutions for the health care system with Michael Porter, arguably the greatest strategic mind in the history of business. The course examines why competition in the health care industry does not add value and simply spreads costs instead of developing more profitable, innovative ways to treat diseases. Last week our case was on The Joslin Diabetes Center!
Some of the interesting business aspects of The Joslin are that the Joslin operates at a loss per patient while their affiliate programs operate at a positive cash flow. Additionally I found out from some of my classmates who are MDs that for non-compliant patients it's a lot better to get them to take care of all their appointments in one day rather than have them schedule several different appointments. That was a bit counter to my experience, when I was a patient at a diabetic center I hated having to spend hours there to meet with several different doctors and also didn't like that I was forced to use who they had on staff. I've been a lot happier putting my own team of experts together who fit my personality and goals but the class all agreed that I'm kind of "weird."
As the conversation progressed we discussed what was optimally needed to treat both type 1 and type 2 diabetics; although the conversation mainly focused on type 2 which requires a different type of management. I believe that since type 1s basically face immediate death if their disease is not kept somewhat in check forces us to be more compliant than type 2s whose symptoms progress at a slower more prolonged pace. While advances in medical technology and blood sugar management ideology have now allowed juvenile diabetics to do everything from playing professional football to competing in the Olympics more can be done to help educate all diabetics alike.
Most of my classmates had the idea that for better integrated health care diabetes centers should include more doctors, cardiologists, podiatrists and any other person that can treat symptoms. My take was in a business symptoms are treated as errors and our goal should be to reduce the number of errors that we have. If a diabetic maintains their A1c below 7 the chance that they will ever need to see a specialist for complications is dramatically reduced. My goal is to never have to see a cardiologist or other doctor to treat me for a complication, my goal is to only see my endo for when I need my A1c tested and to get prescriptions for my own management. So I suggested that diabetes centers should have a mock grocery store, a test kitchen and a gym – that the centers should be focused on preventing the symptoms, not screening for the symptoms. My question was, what if diabetic centers taught patients how to live healthy lifestyles through hands on experience and classes, rather than a ½ hour meeting with a CDE; focus on simple recipes, smart decisions in the grocery store and work outs that aren't intimidating – that is what health care needs to prevent the consequences of chronic disease, not better screening techniques. At that Professor Teisberg was pretty excited and said, that's health care from the patient perspective; I personally would be pretty psyched to find a diabetic center set up like a marriage between the Food Network and ESPN.
That conversation got me pretty motivated and as I went to the grocery store in Charlottesville snow storm last weekend I really focused on healthy choices. I had originally planned to make pork or chicken fajitas for dinner that night, but Kroger only had grass fed beef, not chicken or pork. So I quickly changed the protein and switched to steak fajitas; everything else I purchased was organic and I remained on the outside aisles; the only time I entered the middle of the store was to pick up some diet pepsi, my coffee grinds and 2 cans of tomato soup. Granted, I pursue my blood sugar management a lot more neurotically and aggressively than most would ever want to but the principles are the same, learning how to make smart choices prevents complications, screening for them is when it's too late.