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>View discussions about this entry Country: United States
Organization: Vitis Healthcare
Focus of activity - Service/process
Year the initiative began (yyyy) - 2006
Positioning in the Mosaic of solutions
Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? The majority of traditional health is focused on symptoms. At the center of traditional care one finds medicines and therapies while the patient is pushed to the periphery. Traditional care is very adept in the specialty treatments of disease, but neglects the core of preventive care and the individual ownership of health. Inside Out functions as the disruptive intervention that centralizes the consumer in healthcare. Rather than a complex reactive model to symptoms, Inside Out is interactive, where the consumer interacts with the science of medicine. Treatments are not dictated to the consumer, rather the individual takes an active role in determnining the prescription for his health care.
As healthcare continues to become more consumer-driven, centers of excellence will emerge. The Inside Out initiative is the catylyst that will transform family medicine from mere gatekeeping for the specialty world into centers of excellence that specialize in the foundations of health care. Central to this process is the involvement of patients and preventive measures rather than contracted members and specialty procedures. The consumer may actually become a corporation who wants to promote health in individual employees, or a school that wishes to increase academic success by promoting healthier students. The long term future of efficient health care is found in individual consumer education, access and choice. Initially these choices will allow consumers to shop for the best service but true disruption of the traditional model will occur when the consumer is able to choose his testing and initiate his individual care. We cannot expect a patient to take responsibility for his health if he has not been given the tools to do so. It is not unlike the home repair market that now allows consumer access to the knowledge and the tools to fix and maintain their homes. Inside Out provides the tools necessary for the maintenance of an individual's health. Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. The Inside Out initiative focuses on accessible consumer driven medical testing and education. The emphasis is on restoring and maintaining health rather than simply reducing the symptoms of disease. The program is based on two premises. First, the consumer is the most important health care provider in their life; and secondly, the patient with access to technology and education becomes the most important lab test available. The three initial diagnostics offered are bone density, body composition and insulin resistance screening. Other testing includes advanced nutritional, thyroid, adrenal, gastro-intestinal and SNP (genetic) evaluations. Web based educational resources as well as educational DVD's accompany each report of findings.
BONE DENSITY: The majority of bone formation occurs from 15 to 25 years of age. It is imperative to assess bone density in the formative years of adolescent bone development as well as the latter years of bone loss. The Inside Out initiative provides affordibility and accessibility. The report of findings incorporate education and simplify interpretation for the consumer. The program will be offered through mobile test centers that can meet consumers at their neighborhood, school, place of employment or community outreach. Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? Inside Out is structured so that the program may be offered through mobile clinics. Rather than having individuals leave work or miss school in order to travel to a clinic, the clinic comes to them. This develops economies of scale as well as time efficiencies as whole sub-groups can be onsite and evaluated at the same time. Currently Inside Out operates as a stand alone clinic in a suburb of a large metropolitan area. The clinic and the principles have been well received. The model calls for a centralized regional clinic from where the mobile clinics are based out of.
Further marketing and communication efforts are underway. These include the design of an interactive web site with reference library, blog, newsletter and weekly podcast. Patient seminars are also being conducted and other resources are being filmed and written at this time. As the Inside Out initiative is truly a new paradigm in health care, there are very few benchmarks currently available. As such, it is hard to determine market penetration as we see Inside Out as a new market in health care. Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. Inside Out is provided through Vitis Healthcare. Vitis is currently in negotiations with a national provider of consumer-driven health care products that markets to individuals looking for alternatives to the traditional medical plans. Vitis has acquired a marketing consultant firm to aid in branding and promoting the initiative. Vitis is also developing relationships with various corporations interested in pursuing the model. While these relationships are welcomed, the central success of the initiative lies in the continued development of the offering and promotion.
Internationally, relationships have been developed in Bangledesh, Bolivia, Haiti, India, and Puerto Rico. Many of these were developed through medical mission trips and could serve as future international sites for the initiative. Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? Vitis Healthcare operates under a fee for service structure and we assist patients to file for insurance reimbursement. Currently all income is generated through product sales and patient consultations. As we are not bound to insurance stipulations and associated fee schedules, we are able to offer our testing at significant discounts to the consumer.
As the portable clinic becomes available, these economies of scale will increase resulting in further cost savings to consumers upwards of 2/3 off of what they would pay otherwise.
Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? Many of the patients that we saw had either given up hope on receiving effective care or had already been treated by a multitude of other health care professionals. The best way to summarize the impact of Inside Out is to quote what the majority of our patients say after their first visit, " I have hope again." Many patients suffering from chronic fatigue, fibromyalgia and obesity are getting their lives back and this success has crossed multiple age groups. Several elementary children have renewed confidence as they are able to do their school work and remain on task. Several type II diabetics and patients with hypertension have been able to reduce their medications. One patient, after loosing 40% of his trunk body fat was able to discontinue all of his diabetic and hypertensive medications. (See attached figure)
Personally, I feel I am now able to accomplish the role of a family physician. I am educating and assisting my patients in their responsibility to be good stewards of their health. In a time when the New England Journal of Medicine reports that 87% of doctors are disgruntled with medicine, the Inside Out approach is a breath of fresh air. This initiative has the potential to revive and turn the practice of medicine Inside Out.
Scaling up Strategy - What is your priority for the next 3 years and please describe why. We are currently in the start up mode and have used are standing clinic to beta test many of the diagnostics offered in the Inside Out initiative. The rest of 2007, the focus will remain on completing this process, establishing the web services and developing the portable Inside Out Clinic. In 2008, the portable model will become operational and corporate, school, and neighborhood programs will be the focus. This year will also be used to develop the master program for duplication in other cities. This will be initiated with several cities in Florida during the last half of 2008. In 2009, a state wide program will be implemented throughout the United States. Partners in other countries will be sought for replication of the program abroad as well.
Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. I originally entered medicine because of my love of applied science and my desire to help people. On entering medcal school, I felt like the boy described by Issaac Newton that was "playing on the seashore and diverting myself in now and then finding a smoother pebble or a prettier shell than ordinary, whilst the great ocean of truth lay all undiscovered before me."
On entering practice, I quickly became disenamored with traditional medicine. Patients were replaced by contracts, and protocols and quotas soon replaced the need for medical problem solving. After sixteen years I decided a change was needed. I returned to the roots of health care rather than symptom management. I listened to my patients tell their stories and they became my best lab test. I became a partner in my patients individual health. Inside Out is my initiative and call to try medicine again, for the first time. Contact Information:
Scott VanLue
Medical Director Vitis Healthcare (Medical Practice) drv@vitishealthcare.com 940 Centre Circle Suite 1010 Altamonte Spgs. Florida 32714 United States Tel: 407.862.5637 Fax: 407.862.8243 Website: vitishealthcare.com Discussions about this entry |
Inside Out: Patient Empowered Health Care
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It is not easy to motivate oneself and others to take the behavioral steps necessary to decrease risk of future serious disease. There is some evidence that motivational interviewing/counseling with an accounting for stages of change, decisional balance and self-efficacy can make a difference in activating longer lasting behavioral change. Problem is this takes time, is under-reimbursed and there are not a lot of folks in primary care who have the training to do it, even if time permits.
It is important to train primary care folks in particular in these skills and assess outcome when they are applied.
It is interesting that these skills are now starting to show up in OSCE type of evaluations of medical students. But, try and convince a medical student of the importance of the above when it is likely to show on on exams as one of many questions/evaluations. There needs to be a reimbursement model that reinforces the practice monetary value of these kind of approaches. There is not, even though the literature on motivational interviewing and its variant gets more and more support for more and more conditions.
Scott VanLue, M.D. : You are correct that it is not easy to motivate much less establish lasting change. Moreover the traditional approach quite frankly is a waste of money. Take weight loss for example. 35 billion dollars a year is spent by the public on weight loss. 90% of those individuals gain back all the weight they loss within one year. Thus 31.5 billion dollars is wasted on ineffective weight loss yearly.
I am convinced that the majority of health initiatives fail because they are directed and dictated at the patient from without, rather than supporting and generating an individual desire for health from within.
The solution lies in defining the right goal and motivation in the first place. The goal is to maintain or restore proper physiologic function. The reason that primary care is floundering is two fold. It is easy to blame the current insurance delivery system but that is not the cause, it merely is an opportunistic response to 1) Physicians giving up their role as scientific detectives that focus on wellness rather than cookbook protocols for lessening disease, 2) and patients neglecting their primary role in maintaining their individual health.
The truth of the matter is there is significant reimbursement for doing primary care correctly... however to do this a provider must not contract 'work' for insurances. In my practice, I no longer accept insurance. As a result my overhead is significantly lower and I make 100% of what I charge. As a result I have more time with each patient 30 minute and 60 minute appointments rather than 10 minutes. The other reimbursements are that patients actually get better and stay healthier rather than simply having a reduction in symptoms. I love my job as opposed to the recent NEJM article that reported 87% of doctors are disgruntled with their jobs.
ULTIMATELY the innovative disruption is to educate the patient and empower them to be the most imortant lab test and provider in their own health care. Hopefully initiatives such as Dr. Beauchamps and ours will gain support to literally turn medicine back to its PRIMARY support of health rather than the SPECIALTY treatment of dis-ease.
This project represents one of many mobile screening van projects that seem to offer a lot of expensive tests in an attempt to increase access to preventive care. Many of these tests (such as those for insulin resistance) don’t have track records of encouraging the provision of known interventions that can reduce later disease complications. In the case of insulin resistance, we know that diet change and exercise improve outcomes, but not any current medications (beyond a reasonable doubt). Therefore, it is not clear how it would change our recommendations or treatment/prevention strategies.
Thank you,
Changemakers Team
Scott VanLue, M.D.- Ms. Ahn I appreciate your input and wish to clarify the Inside Out Initiative for you. I agree with you that there is nothing new in a mobile preventive or screening initiative. You correctly point out that a preventive screen, in and of itself, has a poor track record in producing life style changes that ultimately reduce future morbidity. Similarly, scare tactics of future disease rarely help in smoking cessation and 95% of all dieters gain back the weight they lost within a year. Yet smoking and obesity remain the number one and two causes of preventable death in America. Most preventive programs in healthcare fail because they do not empower individuals, and they are fueled from forces outside the patient. For example, if a patient has no real internal desire, motivation, or dis-ease, an external test that they have little knowledge about will produce minimal if any change..
In contrast, Inside Out recognizes and affirms individuals as the most important factor in their health. They are given information about tests that they can ultimately use and interpret. They are given the chance to actively participate in their testing. This breeds internal motivations and forces that bring about lasting change.
There is common ground in the actual tests and delivery systems between the traditional approaches and The Inside Out Initiative. The tests are accurate measures and mobile clinics do offer conveneince and accessability; but, these are merely tools that are used in the program and simply add more efficiency. The initiaive itself is to deliver health in such a manner that educates and actively involves the primary health force in any individuals life-themselves. The Initiative focuses on ways to restore and maintain an individuals function from within.
I will use the insulin resistance example to illustrate the subtle but significant difference between a traditional external approach and the Inside Out Approach. The goal in the treatment of insulin resistance is not diet and exercise. It is fat loss and muscle preservation. Granted for many and those without significant insulin resistance or obesity, diet and exercise are the most effective ways to reduce fat mass and preserve muscle mass. However, the individual with insulin resistance experiences a physiologic shift that transfers 60% of the fuel away from being burned in the muscle to the liver where it is converted into fat. There are few things more disheartening for an individual with insulin resistance who does diet and exercise and looses very little weight. On the other hand, an initiative that educates this individual on why it is so difficult for them to succeed if they have insulin resitance and then is able to offer the testing to show them, breed immense hope and encouragement. Inside Out breeds medicine and motivation that brings about lasting change from the Inside Out.
Donna Daniel, EdD - Here is a great example of a corporate response to the problems that many can speak to but few will adjust to, as this project has done, and apparently rather successfully. The verbiage of the proposal is still rife with medical-model language, and the listing of diagnoses rather than clusters of patient problems speaks to this perspective, but the vision is sound and the efforts laudable. Your community patients are quite fortunate to have you there for their improved health interventions!
Scott VanLue, M.D.- Donna, I would first like to thank you for your kind words regarding our efforts and I will try to clarify how traditional-model language is still necessary in describing a new paradigm. I whole heartedly agree with you that the inherent danger is that the diagnosis becomes the focus and the patient becomes labeled as the disease, ie. Mr. Smith the hypertensive. In reality, symptoms are where traditional medicine intersects with the new paradigm we promote. The difference between the two approaches is what we define the symptoms to actually represent and what we do about them. The traditional approach groups the symptoms into diseases with the treatment goal being to ease the dis-ease. Typically these treatments are generated through therapies outside the patient's knowledge base, responsibility and control. It leads to patient dependence and medo-babble. Our approach looks at symptoms as indicators of altered function within the individual. The treatment goal involves restoration of the altered function rather than simply lessening the red flag. Typically our approach involves patient education and originates from within the individual. The same diagnosis generates a radically different approach which leads to patient empowered independence.
An Extreme Example of Medo-Babble:
Traditional- Unfortunately you have Borborygmi and I am prescribing medication to ease you pain and decrease the hyper-peristaltic activity that you are suffering from...
Functional- Yes you have Borborygmi otherwise known as excessive stomach growling...Your body is telling you that it needs nourishment and you can prevent this in the future by not skipping breakfast
I hope this helps to bring some clarification and I ask for your thoughts as well as others...