Jim Brewer

Here is the GoogleHealth platform: http://www.google.com/intl/en-US/health/about/index.html

There are, in my humble opinion, two primary driving needs for an cloud application like Google Health:

Self-Directed/Consumer-Directed Healthcare. I remember a friend’s mother was in the hospital a couple of years ago.  She started writing down the prescription drugs that were being prescribed by the various doctors, and tracking the results that she saw in her mom’s conditions.  She was able to identify some medications that were having undesired effects. And she doing it all on a note pad…  The first potential of Google Health is using readily available access to networks via your cell phone (or soon the chip in your left little finger…) to capture health information in a system – so that you can use it, collate it, and disseminate it to needed parties.  Of course, there are restrictions on cell phones in ICU, etc.  but this is unlikely to be be a problem in the long run since the docs will be using similar devices and technology.  In addition, self-directed healthcare implies the ability to choose.  If it is drugs, doctors, institutions, payment options, or any other aspect of care, Google Health can deliver the ability to locate information on these choices and weigh the options.

The first most accessible of these choices are prescription medications.  Few practices in today’s clinical protocols can have more favorable impact on patient’s health.  The cost savings for patient’s healthcare are straightforward for many medications on a value-based formulary.  Take medication for diabetes-stay away from the emergency room, avoid blindness and limb amputation.  Take blood pressure medication and avoid expensive heart surgery.  But on the flip side, taking the wrong medications, or in the wrong combination, and it will have a disastrous impact on your health.  Industry experts contend that taking the wrong medications spends billions and costs many lives.

There are other initiatives that address a patient’s total medication regimen and capture the data from the prescribing and adjudication processes.  This is a vastly better way than depending on the consumer entering all their own medications Ala Google Health.  SureScripts is leading the solutions for ePrescibing – once it is electronic it is easier to capture as electronic. And one of the premiere vendors in pharmacy systems is working on a common database and exchange platform, the National Health Information Network.  Also, a practice common in retail pharmacy, a “brown-bag” review has for years given service-oriented pharmacists a chance to make a real difference for their patients.  Often a patient is getting prescriptions filled at multiple pharmacies, and brings to these sessions in their brown bag – “left over” medications, “borrowed” medications, herbs and supplements, and samples. It is the likely the FIRST time all the medications were discussed with the patient.  The retail pharmacist is uniquely positioned, given their personal relationship with the patient and highly-specialized training, to council that patient.  It saves money and saves lives.  In the Medicare Modernization Act of 2003 and resulting legislation, Medicare Sponsors that offered the Part D and Medicare Advantage Plans were required to offer Medication Therapy Management.  Some of these systems were just rehashed shams to save the plan’s money, but others like Mirixa, launched from National Community Pharmacy Association, offered real clinical tools and a face-to-face session between the pharmacist and patient.  The pharmacists were able to see ALL the medications that were adjudicated by a Medicare Sponsor and were able to offer consultative advice on medication interactions, brand vs generic, alternative brands on less expensive tiers in the plans, not to mention life style changes like exercise, and diet.

Best-Practices. The even more compelling argument is the value of looking at the collected data of care practices themselves and procedures, medications, and the results measured in clinical terms.  The providers have fought long and hard to avoid anyone looking over their shoulders.  But medicine is not an art; it’s a science.  Looking at the 3000 people that had similar symptoms, and understanding the statistical impact of the care choices, can have dramatic impact on the cost and health outcome of the 3000 +1 patient.  Obviously, you can eliminate needless tests that are done because the diagnostician is thrashing around trying to determine the causal factors, or doing tests because it gives the doc some covering fire in the war with liability lawyers.  But equally important, it can and will deliver new protocols that can influence outcomes or reduce the impact epidemic in getting patients well sooner and not spreading to new patients.

Why do I care? Why the rant? My interest and value to this effort is a perspective and proven ability to influence providers in this venue.  The lack of adoption and resistance of the interested parties have kept this from happening for the past 20 years.  It is an idea whose time has come. i am looking forward to contribution to the conversation and solutions.  Please share this with any visionaries in this domain.

Also of note is the pending acquisition of Perot Systems by Dell.  The stated value is healthcare and the project expertise of Perot Systems in federal initiatives, other countries initiatives, and various large hospital implementations.  I am working on getting a meeting there to understand their intentions in this area.

Welcome to Jamesabrewer.com.

I have been exceptionally busy here at my home in Dallas.  Although Dallas is, like the rest of the country, suffering through the economic downturn, it is still a vibrant climate for technology and healthcare. It is still keeping me busy with various ventures. Although thankfully, my travel has been less since my most recent trip to San Francisco. I also have a couple of offers to return to the Medicare and PBM industry in the midst of healthcare reform and perhaps large-scale changes in the system.  In my consulting efforts, leading a start up, or joining an existing organization, I hold a few core beliefs that I am willing to champion with the right organization:

• The current carrier/PBM/provider model needs to change.  We have seen the result of stakeholder wars with labor and management in the automotive sector.  Wars make casualties.  The war between retail pharmacy and PBM’s will continue to have similar results.  Deeper discounts from the retail margins can not be the entire answer for Medicare/Medicaid or commercial group or individual plans. Nor can retail pharmacy hold the position that cost control practices like PA’s, step-therapies, and QVT’s are the the tools of the devil.  Retail pharmacy providers and the physician providers hold a strong position in their direct relationship with the patient. That relationship needs to be deployed for the good of the patient and the plan. Bruce Roberts, at NCPA, has long been an advocate of the pharmacist taking an active role in plan cost control; for example, eliminating duplicate or contraindicated medications. I have seen that work.  In the early days of Community Care RX, our generic utilization was one of the highest of any sponsor in the Medicare program.  The pharmacist can make a difference with the patient.  Not only with Medication Therapy Management, but by advocating compliance and life style changes.
• Technology can make a difference.  The chain pharmacies have matched the personal touch of the independents with systems that monitor generic substitution and utilization. In the frantic pace of pharmacy, systems are the answer.  What is missing today is measuring results wtih those systems.  The lipid panel results could be monitored by the doctor and the pharmacist along with the compliance of statins or other medications.  Then we can instruct the patient to take the medications properly and add life style modifications to the drug regimen and protocols.
• We can take actions as an industry to control our destiny as an industry.  One example is negotiating better interchange rates for debit/credit and claims transactions.  The food chain of co-pays and reimbursement could be much more efficient and pass the cost savings to all the participants.

Best wishes for the remainder of the summer!

The Medicare Modernization Act of 2003 was the biggest change to the Medicare program in decades. It has done more for poverty seniors than any government program in recent memory.

Some called it an “unfunded benefit.” But that philosophy ignores that “value medications” delay, minimize, and in some cases eliminate, beneficiary’s medical costs. Therefore, it offsets billions of dollars for hospitals, operations, and doctors spent by the Medicare Fee for Service program or state Medicaid programs. Properly administered over the long run, the program should save, not cost, taxpayer dollars.  Let’s take an example to better understand.

A diabetic patient mired in financial survival skimps everywhere.  He or she skimps on insulin and other medications needed to prevent the dire consequences of the disease including blindness, limb loss, organ failure, and other debilitating and progressive symptoms.  Even if diabetic patients are served by charitable organizations or community health centers, they often are not prescribed needed medications or do not have the co pays to get the medication. No medication or skimpy compliance means that the beneficiary ends up in the doctors office or the hospital. We spend the big dollars to get them well again. A great example in the diabetic population is the use of ace inhibitors.  In many cases, these medications should be prescribed to reduce the possibility of organ failure.  But the poverty seniors use and compliance of these medications is less than it should be…  In financial survival, patients resort to extraordinary measures.  They split pills, share medications, take out-dated medication. or skimp on insulin. They simply face a choice—eat or take their meds.

The MMA 2003 provided special benefits to those below or near the federal poverty level. They pay no premiums, no co pays, no donut hole, and no catastrophic coverage limits. If they make the effort, they can get needed medications. In the over 40 million Medicare beneficiaries, there were 23 million or so that did not have credible drug coverage. A large percentage of these beneficiaries fall below 130% of the Federal poverty level.  Again, state Medicaid programs, drug manufacturer, or other programs did not serve a large percentage of these beneficiaries.

What do we do with that population? Besides being a compassionate society, ultimately we as taxpayers, cover their medical costs.  Therefore we should be proactive and keep our poverty seniors healthier.  In today’s’ medical regimes, that means using medications where they are therapeutically viable.  And we must provide the means so that beneficiaries can take the medication—and eat…

The Medicare Program has done a great deal towards that goal.  Is it perfect? No.  Like the use of prescription drugs in the wider population, drug benefits are spoiled by the manufacture and marketing of medications that have marginal therapeutic benefits and could be replaced by generic or over-the-counter alternatives. Pharmacists are the most frequently-seen, but under-utilized providers to seniors; third-party payment systems are flawed. And, the privatization of the delivery of these benefits with the Medicare Sponsors is tricky.  For example, proactive programs to encourage doctors to consider beneficiary needed medications are a cost to the drug benefit sponsor, but the benefit (cost offset) goes the Medicare Fee-for-Service medical program.  But these are small things, in the bigger picture of assisting poverty seniors, I believe the program receives high marks!

The site is under construction. My intent is not to make this about Jim Brewer, but rather to showcase the lessons learned from a career around innovation and high velocity growth. I have had the opportunity to play leadership roles in:

There are lessons learned, stories of diving saves and great successes, and a few guiding principals that are common to these experiences and may be of value to high velocity companies and skunk work teams within larger organizations. If you are poised to make leaps in concept, marketability, profit, and sales growth. That is what this site is about.