Disruptive Women in Health Care today was named one of Five Fierce Female Healthcare Bloggers to Watch.

Fierce Healthcare, “the leading source of healthcare management news for healthcare industry executives,” announced its list today and had this to say about Disruptive Women:

Why it’s required reading: This blog lives up to its name, offering challenging ideas–and a strong dose of much-needed attitude–on critical topics like medication adherence and health plan design. There’s also a lot of play given to women’s topics, such as the new breast cancer screening recommendations, which sadly don’t get as much attention in other publications. While nobody’s suggesting that women’s takes on health issues are better than men’s, these contributors are exceptionally passionate in what they have to say, and it’s a pleasure to hear women roar. There’s much to learn here.

Read more: http://www.fiercehealthcare.com/slideshows/five-fierce-female-healthcare-bloggers-watch?img=4#ixzz0YNgoUHIg

The following guest post is by Jennifer Smock, who is a Graduate Student, Masters of Public Health, at Purdue University as well as Assistant Project Manager, Purdue Homeland Security Institute, and Project Manager, Purdue Emergency Preparedness Office.

For the first time in history, we are able to listen to public’s concerns… well pretty much about everything!

Why is this important?

Major corporations such as Dell, Comcast, Pepsi, IBM, and Microsoft, care greatly about what people are saying on social media sites about their products.  You may have noticed this change in such Microsoft commercials (“Windows 7 was MY idea”), or Best Buy commercials (asking questions to a stadium full of employees).  Both implying they are listening and interacting with people to better serve their needs.  As a result, they have built trust with their consumers and are profiting because of it.

Who uses Twitter anyway?

More and more people every day.  In the fall of 2009, it was found that one in five internet users use Twitter or another service to share updates or to see updates about others, which significantly increased from one in ten in April 2009 (Pew Internet, 2009).  There has been a recent Twitter explosion growing from 2 million Twitter accounts in December of 2008 to 17 million May 2009 resulting in 83% increase, and an astonishing 3,000% increase from a year ago! (ComScore, 2009)

Ok ok… What does this have to do with healthcare?

Before putting out health messages, wouldn’t it be great to better understand what the current barriers and benefits people are already talking about using these informal channels?  This could displace rumors and fine tune messages without the time and effort of focus groups.  For instance, there is a current distrust in the H1N1 vaccine as recognized by the news media:

“Of all the big questions facing our country, there’s one in particular that touches us in an immediate and personal way. It involves the H1N1 flu vaccine … and for many perplexed Americans, the question comes down to this: is the vaccine really a healthy choice? Despite what we’ve heard from public health authorities, some Americans have their doubts.”

-CBS NEWS

In response to the recent change in way clinicians, public health practitioners, and lay-people obtain information, the Centers for Disease Control and Prevention (CDC) has recently introduced utilizing social media outlets to help communicate to the public.  These public health messages promote the seasonal and pandemic flu shots as the best weapon an individual has against contracting the flu.  This integration might have came a little too late.  Recent polls have shown a low rate of compliance with obtaining a flu shot for themselves and for their children.  Even though there has been many public health messages communicating the importance of the flu shot this season, 66% of adults surveyed said they will not receive the H1N1 flu shot, and even though children have an increased risk for complications, 45% of parents said they are not planning to get their child vaccinated (ABC News & Washington Post, 2009).

Bottom Line

The CDC is currently urging those in the healthcare field to integrate social media outlets to communicate to the populations they serve.  Listening and interacting with people will help build trust in all health messages.

In the face of acute primary care physician shortages and steady reductions in the number of physicians who are willing to accept Medicaid and Medicare, it is unclear whether our existing primary care system will be able to meet the needs of a universally-insured nation, as President Obama has expressed as a priority for his Administration.

Health care delivery is strained under tremendous pressure from the demands of chronic health issues, downward trends in third party payments, and while insurance coverage will address some of these issues, many of these problems may persist even if universal insurance coverage is achieved in the United States. So what else needs to happen to make healthcare reform a success?

In recent years, a series of “disruptive innovations” in the health care sector have capitalized on non-physician providers, such as nurse practitioners, and their ability to provide high-quality primary and preventive care in retail-based settings such as Convenient Care Clinics (also known as retail-based clinics) and in community-settings, such as Nurse-Managed Health Centers. Research in Health Affairs and other peer-reviewed journals has documented that retail based clinics and Nurse-Managed Health Centers provide safe, accessible, affordable care to millions of Americans without threatening continuity of care. Nurse practitioners practicing in these independent settings already touch millions of people annually. Thanks to regulatory reforms that have taken place over decades, including those led by governors in Pennsylvania and Massachusetts, nurse practitioners are legally authorized to prescribe medications and provide care that is a comparable in scope to that of a primary care physician in all 50 states.

Consumers gravitate to both models because they are accessible, affordable, provide quality care but most importantly, they are convenient in their locations, hours and ease of use. For healthcare reform to be successful, we need to embrace these disruptive innovations. We also need to maximize the amazing, high-quality provider workforce we educate in our finest academic institutions across the country. Nurse practitioners and other non-physician providers (such as physician assistants, pharmacists, and psychologists) are eager to partner with their physician colleagues to expand access to care for all Americans and make the Administration’s healthcare reform effort the success it needs to be!

Between October and November 2009, Disruptive Women in Health Care analyzed the issues surrounding Drug Adherence and issued a series of posts from a variety of viewpoints and perspectives. In addition to our own pool of experts, Disruptive Women invited a number of guests to post on this complex public health topic. We compiled all the posts into an e-book. We hope you will find this a useful reference.

Please feel free to share, cross post and distribute with others who would find this of interest.

As always, we welcome your feedback and comments. All the posts remain on the blog and it’s not too late to comment on specific posts.

Download a free copy of the “Drug Adherence Throwdown” e-book.

The following post represents my personal opinion and not that of any groups or organizations with which I am affiliated.

Okay, it’s enough already! Why is it that women are always the target? First it’s abortions, then mammograms, pap smears following closely, behind and now cosmetic surgery (although that’s not only women!) It looks like the Congress is desperate to find any savings anywhere. Why not tell it like it is, it’s raising taxes. Whether it is through so called elective procedures or levying taxes on devices and diagnostics, to be passed on to the patients, it’s a tax.

Instead of rewriting the rules on mammograms which will cost lives, maybe not that many, but if it is your life that’s all that matters and focusing on false positives and unnecessary screening, why not invest money in better mammograms that are more effective in identifying a lump or even distinguishing a fast growing one from a slow one. Taxing companies who make these diagnostics, while lowering reimbursement rates is not exactly a motivator for more research and innovation.

And by the way, these recommendations for mammograms are a classic example of “comparative effectiveness”, which it very well may be, but the reaction from the American public is an indication of how difficult cutting any services will be—not a great start. And no sooner does the US Preventive Services Task Force come out with recommendations then the Sec of HHS tell us to ignore them. Will private insurers ignore them?

Let’s talk about cosmetic surgery, according to the physician groups, in a survey done of people who are planning on having cosmetic surgery in the next two years, 60% reported a household income of $30K to $90K, 40% of the 60% reported incomes of $30K to $60K, this is the middle class and insurance does not pay for it. While some of the procedures may be considered elective by some, it is in the eye of the beholder and who is to make that distinction, the doctor, the patient or the government? Another bad idea.

Why are women being targeted? I thought this was all about giving women more access to health care, many of the changes in regulations are definitely positive, but what the government gives with one hand, it seems to take away with the other.

As a member of the Susan G. Komen for the Cure Advocacy Alliance Board and a breast cancer survivor, I welcome readers of Disruptive Women in Health Care to read the statement below that was released by Komen as a result of the U.S. Preventive Services Task Force “new breast cancer guidelines.” In addition, please visit the Komen website: www.komenadvocacy.org and take a stand and action by signing the petition and help ensure that all women have access to this lifesaving screening.

Susan G. Komen for the Cure® Recommends No Impediments to Breast Cancer Screening

Until Science Improves, Current Screening Recommendations Should Remain, World’s Leading Breast Cancer Organization Reports

Nov. 16, 2009 – Susan G. Komen for the Cure®, the world’s leading breast cancer advocacy organization, has carefully reviewed the data and new recommendations from the U.S. Preventive Services Task Force (USPSTF) concerning mammography screening. Komen for the Cure issued the following statement today from Eric P. Winer, M.D., chief scientific advisor and chair of Komen’s Scientific Advisory Board.

“Susan G. Komen for the Cure wants to eliminate any impediments to regular mammography screening for women age 40 and older. While there is no question that mammograms save lives for women over 50 and women 40–49, there is enough uncertainty about the age at which mammography should begin and the frequency of screening that we would not want to see a change in policy for screening mammography at this time. Komen’s current screening guidelines can be found at www.komen.org and would not be changed without serious consideration.

Our real focus, however, should be on the fact that one-third of the women who qualify for screening under today’s guidelines are not being screened due to lack of access, education or awareness. That issue needsfocus and attention: if we can make progress with screening in vulnerable populations, we could makemore progress in the fight against breast cancer.

Mammography is not perfect, but is still our best tool for early detection and successful treatment of this disease. New screening approaches and more individualized recommendations for breast cancer screening are urgently needed. Susan G. Komen for the Cure is currently funding research initiatives designed to improve screening, and we believe that it is imperative that this research move forward rapidly. Komen also provides funding for more than 1,900 education, awareness and screening programs.

We encourage women to be aware of their breast health, understand their risks, and continue to follow existing recommendations for routine screenings including mammography beginning at age 40.”

The U.S. Preventive Services Task Force unleashed a tsunami this week with new breast cancer guidelines that are suspiciously timed to current efforts to rein in burgeoning healthcare costs. Indeed, the recommendations appear to be geared towards reducing overtreatment by eliminating what the Task Force considers unnecessary follow up screenings and tests. The recommendations even suggest the breast self-examination (BSE) should be discontinued.

In essence, what the Task Force concluded was that while screening reduces deaths from breast cancer, it does not save enough lives to justify associated costs.

To exacerbate the controversy, the American Cancer Society has publicly stated that it does not endorse Task Force recommendations and in a detailed analysis suggested that in the review of the evidence, the committee got caught up in semantics (i.e. risk versus benefit) and that at the very least, computer modeling may be flawed in terms of its ability to translate statistical data into real life.

Meanwhile, the New York Times reports that many doctors are ‘staying the course,’ and in between anger and disbelief, women across the nation are crowding the phone lines trying to discern what is true and what’s not.

Have we all gone mad?

Obviously, these new recommendations will be echoing in the halls of hearings that will determine the future role of mammography in government-run health programs, private insurance programs and the current healthcare reform initiative. Already, Congress is calling for Hearings. But more importantly, is the debacle is a prime example of what ails our healthcare system and reflective some of the more important changes that must take place if we are ever going to move forward in a way that benefits all the players. Truly, who’s really in the driver’s seat?

Once again I have the privilege of introducing the newest group of Disruptive Women, all of whom are acomplished in their fields.  These women are not afraid to take chances, to cross boundaries, to look beyond what exists today and think creatively.

Please help me welcome our newest Disruptive Women:

• Debbie Myers, Founder, VirtuArte
• Estee Solomon Gray, Self-described Inveterate Boundary Straddler
• Grace Bender, President, infinisity, inc.
• Julie Murchinson, Founder, Health 2.0 Accelerator & Managing Director, Manatt Health Solutions
• Mary Grealy, President, Healthcare Leadership Council
• Rozalynn Goodwin, Director, Policy Research, South Carolina Hospital Association and Founder, the Motherhood Priority

Take a moment to read the bios of these amazing women and prepare to be dazzled.

The following guest post — part of Disruptive Women’s drug adherence series — is written by Valerie Fleishman, Executive Director, New England Healthcare Institute.

Patient adherence represents a rare “win-win” in health care, so it’s no surprise that all sectors have been busy seeking potential solutions. Technology companies have developed reminder gadgets, employers have redesigned benefit plans to remove cost barriers to chronic disease medications, pharmaceutical companies have developed combination drugs to simplify regimens, and providers have begun implementing new patient education and counseling techniques. However, efforts to date have remained largely sector specific and silo-ed. An earlier post by Janet Wright correctly pointed out that poor adherence is not the fault of patients, but rather the fault of the entire health care system. Ideally, we need to move beyond silo-ed efforts and develop a system-wide approach to the problem.

Recognizing that, the New England Healthcare Institute (NEHI) launched a multi-stakeholder initiative earlier this year to identify system-wide solutions to poor adherence. Several of these solutions have been mentioned in this series such as improved care coordination and the use of health information technology. However, I would like to highlight a fundamental system-wide change that has not yet been discussed in great detail, and was one of the critical findings from NEHI’s multi-sector expert roundtable and issue brief:  payment reform.

It is important to keep in mind that patient medication adherence is ultimately a quality issue.  As NEHI’s research shows, the link between medication adherence and improved health outcomes is clear.  Studies of chronic disease patients have shown that adherent patients have significantly lower hospitalization rates than nonadherent patients. Unfortunately, the current payment model is not designed to reward providers for patient outcomes – of which medication adherence may qualify as either a means toward that end or an endpoint itself. Either way, using payment reform to move away from rewarding volume of services and towards rewarding good health outcomes would go a long way to improving medication adherence and patient outcomes.

Performance-based reimbursements, global service payments, and Accountable Care Organizations are all being discussed as ways to reform our payment and delivery system. Performance-based reimbursements would reward providers for helping patients achieve measurable, positive health outcomes. Global service payments would give providers a lump sum to manage a group of patients as they see fit – with the expectation that the payment is used to achieve the best possible outcomes. Accountable Care Organizations are collaboratives within which a hospital, primary care physicians, specialists and other providers accept shared responsibility for the cost and quality of the care provided to a group of patients.

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A study published in last month’s issue of Obstetrics and Gynecology suggests that post-traumatic stress disorder (PTSD) is quite common in pregnant women. In fact, among the 1,581 women evaluated, more than 80% reported experiencing trauma (i.e. domestic violence, previous history of a difficult abortion or miscarriage) that could trigger PTSD. Other risk factors included socioeconomic status and a history of mental health issues (i.e. depression, anxiety, family problems). PTSD also tended to be common among women attending publicly insured clinics.

In a recent post, I wrote that that pregnancy, a prior history of C-sections and a history of domestic violence are considered preexisting conditions by insurers in several states as well as in the District of Columbia. This implies that many women of childbearing age are currently denied coverage or forced to add expensive, unaffordable riders to obtain appropriate, and in some cases, minimal maternal health care. Coupled with these disturbing data that suggest that PTSD is probably more common among pregnant women than ever, and that the factors that trigger PTSD overlap with insurer’s preexisting red flags, demonstrate that change is a reproductive right.

The Healthcare Reform bill that passed the House includes a clause that prohibits insurers from using domestic violence as a preexisting condition. This is an important first step towards ameliorating PTSD in pregnant women. However, should it fail to pass the Senate, one has to wonder if additional financial burdens imposed by lack of access will only serve to increase risk?

Pregnant, traumatized, stressed and declined: four additional reasons why reproductive health reform is essential.

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Citation: Seng JS et al. Prevalence, trauma history and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstet Gynecol 2009; 114:839-847.

Health care reform legislation isn’t just being talked about — movement is being made, and the House passed its version of health reform legislation over the weekend. There’s just one glitch — despite voting for it, House Democrats are now vowing to stop this bill from becoming a law because of the anti-abortion amendment that would prevent women from paying out of pocket for abortions. “We’re not going to let this into law,” Rep. Diana DeGette (Colo.) told the Washington Post.

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The following guest post on the subject of drug adherence is written by Janet Wright, Senior Vice President, Science & Quality, at American College of Cardiology.

If the Disruptive Women series on medication adherence has shown anything, it’s that there is a nearly endless number of potential solutions to address the nearly endless number of reasons patients and their prescribed medications do not “stick.”. Over decades of practice in cardiology, I had a first hand view of the challenges patients face in adherence – inability to afford the prescription to incomplete understanding of a med’s value or benefit to overestimating the risk to unclear directions or complex instructions on how and when to take the drugs..

Now, in a staff role at the American College of Cardiology, I join others in the search for solutions to help other cardiologists and health care professionals improve adherence to complicated medication regimens. Successful medication adherence is not a failure on the part of the patient to take their medication, but rather a failure on the part of the health system – including patients, their providers, the reimbursement structure, the insurance companies, etc. – to make it easy and worthwhile for the patient to take his or her medicines..

In July a group of key stakeholders met to brainstorm potential solutions to improve medication adherence. The sponsoring groups represented the major players in improving medication adherence – the drug stores (National Association of Chain Drug Stores), the drugs (PhRMA, GlaxoSmithKline), the patient (National Consumers League) and the ACC representing the physician joined the coalition this fall. In addition to these groups, there were about 40 leaders in the field who shared their wisdom. With the knowledge gained from the discussion in July and in the context of the proposals being considered by Congress, the group is formally recommending five solutions that will improve medication adherence:

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The following guest post on the subject of drug adherence is written by Julie Murchinson, Founder, Health 2.0 Accelerator and Managing Director with Manatt Health Solutions.

The tools are coming! The tools are coming! For a while now, tools to manage drug adherence have been developed, many designed to enable the patient to self-manage in the context of and in collaboration with the health care system from a specifically designed device or heavy application. Patient adoption, however, has been slow and the vision for self-management of drug adherence not yet reality. But recently from the budding Health 2.0 space, we are seeing tools built on more accessible web and mobile platforms that allow patients to manage when and where they want to with their mobile device (e.g. iPhone, Blackberry, cell phone). So, in much the same way many people’s lives have changed as a result of being able to use Facebook or Twitter, or read the Washington Post from their phones on the bus or out at lunch, patients who have previously required proximity to their home device or desktop to log medications taken can now not only track on their phone what they take from their pill box, but also take advantage of glow cap or smart label technologies that can technically interact with a phone-based mobile application.

It was one thing when the Brazilian government was sending text messages to remind women to take their birth control pills (which, by the way, has been highly effective), but we are in a new age of both passive and active patient engagement with mobile platforms. There are iPhone accessible apps like Polka and TheCarrot.com that enable patients to schedule and track their medications taken along with a number of other health topics including sleep, exercise and mood, among others. Medic8Manager provides an iPhone solution that goes a few steps deeper on drug adherence for managing scheduled medications with reminder functionality, refill tracking, missed dose alerts, as-needed meds and discontinued medications. A similar application in development from Informediq even uses the tagline, “enabling healthcare anywhere”. While some products are typically used solely by patients without involvement required from a physician or other caregiver, we are starting to see more user-friendly tools that originate from the physician-patient care process, while allowing for more consumer-friendly adherence tracking, a good example of which we are seeing from the new AdhereTx product. The next step in innovation can be seen from eMedMobile which facilitates a phone working with “smart labels” on prescription medication bottles that store drug data and send alerts to caregivers when a drug is missed.

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This month, Disruptive Women welcomes Patrick F. Terry, a self-proclaimed “JAD” (Just A Dad), as our Man of the Month.

Q: So, where should we start? You have been involved with founding a number of ground breaking biotechnology companies, life science research foundations, trade associations, philanthropic groups, and a whole host of public policy organizations.

A: I enjoy thinking ahead and trying to do the next new thing to advance science, biomedical research, and the business of patient-centered health care. I’m very impatient for change. I consider myself an unrepentant insurgent, renegade, and rabble rouser. I think that is the most powerful disruptive technology there is. That’s why I love the Disruptive Women in Health Care Blog.

But honestly, everything I do is in a lame attempt to keep up with my wife, Sharon F. Terry. She is one of the Disruptive Women Authors and a force of nature like the others here.

I have been burdened with the ability to visualize the dynamics of highly complex systems (like the health care enterprise) and make sense out of navigating or reorganizing aspects of the system to create new efficiencies. U.S. health care is the most inefficient and expensive system ever conceived of and implemented in the history of the planet. It is a wonderfully disturbing playground for a person like me. So, as a coping mechanism I have to create new organizations and social systems to help drive change and innovation.

I have been lucky to be associated with some really brilliant and creative people. For example, the great group who I worked with to start Genomic Health [NASDAQ: GHDX] and apply innovative clinical genomics to successfully change the standard of care for breast cancer in record time. I learned a ton from all the talented people there and from that commercial experience. It made me audacious about what was possible in the new era of optimized precision medicine, personalized medicine, technological innovation, and new approaches to health care delivery.

Q: So, why are you doing all these different things?

A: My kids made me do it! No, really they are the reason I do what I do today. A little over a decade ago, my two children were both diagnosed with a rare genetic disease a few days before Christmas. My wife and I were blown away. The diagnosis was traumatic. In hind sight, it was a seminal, life altering event. It had a profound effect on me as a man, a father, and a husband. At the time, I considered myself a failure at each. What could I do for my kids now? As a young Dad, I completely bought into the archetypal role of supporting, protecting and providing for my family. It was all I thought about. It gave me a clear purpose in life. So, after a few weeks of trying to cope with the emotional rollercoaster of my kid’s diagnosis, I decided to try to find a treatment intervention for their disease. That was the day I decided to do the improbable, potentially the impossible – tame a genetic disease. Take on the system as Just A Dad.

Q: What did you do next?
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For those of you who are visiting our blog for the first time, you will notice several blog posts on the topic of drug adherence.  From time to time Disrutpive Women tackles a particularly vexing issue and runs a series of posts that we then compile into an e-book.  

If you are interested in an overview of our current series, please read my first post.

I invite you to take a look at our adherence posts–but don’t stop there.  Explore the archives and recent posts listed on the left hand side of the blog.  Read the bios of our authors and join in the conversation.