9 min reading time

I called best-selling author Terry Grossman, M.D. (Baby Boomer’s Guide to Living Forever) last week because we’re both speaking at BRINK 2015 on June 5.

See http://medgroup.biz/BRINK2015 to join us in Palm Springs, California. (It’s very reasonably priced.)

Terry told me about his health and wellness evaluations, emphasis on carotid artery ultrasounds, and his Program for Optimal Wellness. From his site:

The US is 45th for average life expectancy. Cardiovascular disease and cancer are our two leading causes of death and together are responsible for more than half of all deaths. If we could significantly reduce the impact of just these two conditions, it is very likely that a dramatic increase in life expectancy would result.

I asked if his programs were covered. He said no, they aren’t, and continued:

“No, insurance companies pay for drugs, surgeries, and procedures instead of the appropriate preventative measures in the first place.”

What do you think of his statement?

If you agree with it, how would a practical alternative work?

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I’m excited about BRINK 2015.

It was conceived only two months ago and already they expect 200-300 guests due to the caliber of the faculty assembled. Terry will discuss stem-cell use in clinical medicine.

Give a click. Join us at http://medgroup.biz/BRINK2015 and I’ll see you in two weeks.

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Our first overbooked webinar?

Robert Packard’s June 4 webinar about FDA submissions attracted 903 registrations since last week. If you want to participate, register now at http://medgroup.biz/510k-tips because there are only 1,000 seats.

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Make it a great week.

Joe Hage
Medical Devices Group Leader

P.S. I discovered a technical glitch at http://medgroup.biz/510k-tips so if you were unable to register, give it another try, thanks.

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KHALID PASSIA
OWNER at OSSE ENT
0195200008

Michael Weiner
Chairman
Joe, your forum is a great follow-up to the excellent discussion you led in Palm Springs. it is much appreciated.

Merrilee Zigarelli
Medical Marketing Consultant
Wouldn’t if be great if health insurer’s could initiate a ‘vanishing deductible’ program similar to some auto insurers, rewarding healthy lifestyle and preventive health maintenance. If they would pay for more preventive technologies (i.e. advanced imaging for mammogram, etc.), the cost savings would be more than realized on the back end in the trickle down effect of less treatment of active symptoms.

Ian Nemerov
Providing legal services to growing businesses
Atul Gawande had a good article in the New Yorker a few weeks ago regarding progress in changing the medical system from being test and treatment based, with its attendant costs and perceived insufficient impact on outcomes, to being focused more on prevention and care, with the goal of improving health and lowering costs. He discusses the issues much better than I can, so, other than saying that the system will likely reflect incentives and regulations much more than it will reflect visions and speeches, I will just provide the link.
http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

Narayanachar Murali
MD, FACP, FACG at WWW.DRMURALI.COM
Tim Welch.. Why do you think taking profit out of healthcare would make it better? Peole like me have put in tremendous effort, invested time and money and love to work fo rprofit. When did profit become an obsscene word?? Even in liberal California, profit drives innovation! Who do you think financed Google, Apple, microsoft? Why do you think venture capitalists would venture near people who do not think like them? The trick to making things better and competetive is to not allow lobbied regulations. In that, US has failed the markets..

Stephen Glassic
Available: Biomedical Equipment Technician, Field Service Engineer, Electronic/Electromechanical Technician
The Affordable Care Act Is trying to make it the physician’s and the hospital’s responsibility to improve patient outcomes but if the insurance companies can deny coverage for something the doctor recommends, doesn’t that create a roadblock against achieving better outcomes? Isn’t it effectively like tying the physician’s hands behind his back?

Elizabeth Blake
20 years experience in Medical Devices, holding senior global positions for startups and large corporate organisations
Interesting comments, as patients lives change and a lot of the reasons for illness change their treatment or more importantly prevention will have to change. The payment for healthcare is also going to have to change.

Juan Pedro Herranz Sanmartín
Secretario general en Consejo Mexicano de la Industria del Turismo Médico
The first level of ateención, first contact is not properly designed to perform the required prevention and even less the concept of self-care, the system d medical intention in Mexico is far from satisfactory, not ls user requirements are addressed to not aware of their environment and medical establishments act without social contact and a regionalized tiered system of health care, disruption is evident, this jeopardizes any serious effort …

Caroline Winslow
President at Winslow & Associates
Our whole system disincentivizes preventative care. First, the emphasis on paying for procedures rather than health maintenance. Second, I understand the average time a particular person is covered by any particular insurance company is something like 11.6 months – due to changes in employment, changes of employers in who their carrier will be, changes in life status (married vs not, etc.). In this scenario there is no incentive to pay for preventative care since the savings are not realized by the carrier who would pay for it. Wouldn’t it be nice if the whole system operated to prevent disease so all carriers benefitted?

I have worked for many years (decades) with new, and admittedly expensive, technologies that clearly improved health AND saved medical $$. From the outside it is easy to say “do the hard work to prove the efficacy of a product/service to convince the insurer to pay”. Unfortunately, the system doesn’t work that way. It may take 10 years for an insurer to “give in” and cover any given technology – even if there are 20 clinical studies, and 95% of the nation’s insurers pay. It is not uncommon to get the determination that a technology is “experimental”, even after efficacy is clearly proven. Sadly, one technology I worked with had an exorbitant price above $15,000 because of the cost of getting it paid for. OVER 60% of the cost of the device was for reimbursement expense. This is crazy.

Narayanachar Murali
MD, FACP, FACG at WWW.DRMURALI.COM
Why is tiered insurance not acceptable? Why not offer everyone a taxpayer funded, taxed, catastrophic care ONLY type of lowest common denominator? This should also apply to the politicians and lobbyists…NO exceptions. Then people can buy whatever they want as added benefit.

Dani Gavson
Connecting Talent with Opportunity in Pharma & Biotech
Discovery ( a health insurance company) in South Africa is leading the charge. They reward people for “healthy behavior”. I’m not sure of the specifics of the program but I believe that members can link their gym memberships to their insurance card. Each time they go to the gym and swipe their card to gain entry, they clock up wellness points. They also have a program with leading retail supermarkets – discounts on healthy purchases (fresh fruit & veg, dairy products etc) and they offer rewards similar to the credit card mileage points we have here in the US. These are just a few of the program notes that I am aware of. Kudos to their CEO Adrian Gore.
See article below

1. May 2015 – Adrian Gore, CEO of Discovery, will tomorrow night receive the Geneva Forum for Health Award at a ceremony during the Forum for Health in Geneva, Switzerland.

Commenting on the achievement, Gore said, “I am truly humbled by this recognition of Discovery’s effort, as a business, to bring about positive change in the health and wellbeing of people. I view it also as a manifestation of the success of Discovery’s shared-value business model in being globally relevant, and I am hugely honoured to have been chosen.”

Gore will be one of four recipients this year, and the first recipient of the award from the private sector since it was established in 2009. He will be presented the Geneva Forum for Health Award together with Aravind Eye Hospital in India; Dame Sally Davies, Chief Medical Office for the UK; and Professor Therese N’Dri Yoman, former Minister of Health for the Ivory Coast.

The Health Practice of McKinsey and Company arranges the Geneva Forum for Health each year during the World Health Assembly. The Forum is now in its 8th year, and is aimed at advancing the global dialogue on best practices in health systems by providing global leaders an opportunity to share their experiences and learn from successes.

Tim Welch
Sr. Technical Recruiter at Tenable
It’s very simple. Take the profit out of healthcare (aka sick care). Drug companies, hospitals and even some device

Bruce Dobsch
Independent Medical Devices Professional
A compromise I would suggest would be one at 35 followed by a 5 year lag unless issues are detected. However it should be part of a discussion on life style changes needed to help maintain a clear artery or correct existing conditions. It’s a question of pay me now or later. Insurance entities need to be more proactive in keeping all costs down. A more complete view of health care should be a piece of their perspective.
I do agree with others on personal responsibility. I know it is not necessarily acceptable to offer tiers of insurance but I think the time has come to push it out and reward those with healthy lifestyles.

Bruce

Narayanachar Murali
MD, FACP, FACG at WWW.DRMURALI.COM
Prevention is NOT insurance company’s job! They have been mandated to cover a lot of stuff due to political activism from focus groups. This has jacked up costs for everyone with no tangible benefits.
More medical tests and “drugs” do not equate with better health.
A lot of what they cover as “preventive Services” do not better health or even population outcomes.

John Abbott
Consultant, Medical Devices & Regulatory Affairs
I agree with the first comment in that the statement “No, insurance companies pay for drugs, surgeries, and procedures instead of the appropriate preventative measures in the first place.” is not really an accurate statement. Most insurance companies these days, including the one I use, DO pay for specific preventative measures without either deductible or co-pay. Now, this HAS changed from 20+ years ago when insurance companies existed simply to pay bills. But they eventually figured out that if they covered preventative measures – like an annual physical – that many conditions were captured before they needed really expensive treatments saving both them and their customers money – and extending lives in the process. It happened with me. Maybe it is true that some insurance companies don’t consider Dr. Grossman’s ideas “preventative” in nature but if these measures really do reduce long term costs and improve life expectancy then do the hard legwork of proving it and convincing the companies to add those procedures to their “preventative” list.

Merrilee Zigarelli
Medical Marketing Consultant
I’ve had two personal encounters with this ‘penny wise, pound foolish’ approach used by insurers and in both cases, the logic behind them escapes me. A few years ago, after suffering for many years with back pain and shoulder issues, I approached my physician about undergoing a breast reduction procedure. At 4’11” and bearing DDD breasts, this seemed like a no-brainer. He recommended it, as did the surgeon he referred me to…when the surgeon’s office submitted for authorization to my insurer, along with clinical notes and photos, they were patently denied!! The insurer suggested that they needed evidence of at least 6 months of failed conservative treatment with non-steroidal nsaids to address the back pain and then we should resubmit. Seriously??? So they were willing to incur the unnecessary expense of monthly doctor visits, imaging tests and prescriptions for six months to know that this physiological anomaly was not going to disappear on its own??? This, thankfully was not a life-threatening condition and though frustrating, wasn’t going to kill me. Recently my friend underwent total knee replacement and during in-patient rehab, contracted C-diff, a devastating infection that wreaked havoc with her and endangered her life. She is on Medicare, and when the initial course of treatment failed, her doctor wanted to prescribe a better medication that is proven to work better and quicker, since time is of the essence in stopping the infection. Medicare denied the submission and demanded that another course of the failed medication be tried. This extended her bout with this for another two weeks, during which time she developed severe anemia from rapid weight loss, and required two blood transfusions — all expenses that could have been avoided had the better drug been initially approved. However, Medicare seemed to have no problem paying out for all of the additional treatment costs associated with the protracted course of the C-diff which would have been avoided… Eventually, since the conservative drug again failed, they were forced to cover the better drug and after another two weeks of treatment, she began to respond. In this case, the denial could have cost her her life. I’m afraid that most insurers leave these life/death decisions in the hands of lay people who are not really qualified to make the determination of whether a specific treatment is necessary — isn’t that why we have doctors?? Where are the Medical Directors at these insurance companies? Why aren’t they more actively involved in case review and coverage decisions? The only way to get a Medical Director involved is to appeal and threaten legal action — then suddenly the case file is handed over to an actual physician for review. Again, it’s impossible to think that this protracted bureaucracy comes without a cost.

Anil Bhalani
Consultant – Regulatory Affairs/Quality Assurance
“No, insurance companies pay for drugs, surgeries, and procedures instead of the appropriate preventative measures in the first place.”

Insurance companies pay for preventive measures just not the one’s that Dr. Grossman wants. And then there are preventive measures such as exercise and health eating, which the corporate world has taken over and redefined making them financially stressful. Try walking around the neighborhood parks instead of the “running machines” and try buying raw ingredients and cooking rather than frozen foods. The resulting drop in blood pressure will push back cardiovascular disease death by a few years; ultimately it will take its toll but will raise the life expectancy.

As for ultrasound exams. Ultrasounds are very cheap these days, that is if Dr. Grossman bought one from outside the USA and took 15 minutes from his allocated 30 mins. with a patient.