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	<title>Comments for "Your Healthcare. Your Choice."</title>
	<link>http://nyashgroup.com/blog</link>
	<description>Working To Better Understand Our Healthcare Community's Needs</description>
	<pubDate>Thu, 20 Nov 2008 22:03:17 +0000</pubDate>
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		<title>Comment on Health Clinics: Risk or Health Revolution by Larry Stiffman, Ph.D., MPH</title>
		<link>http://nyashgroup.com/blog/2008/01/05/health-clinics-risk-or-health-revolution/#comment-94</link>
		<author>Larry Stiffman, Ph.D., MPH</author>
		<pubDate>Wed, 23 Jan 2008 18:00:14 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2008/01/05/health-clinics-risk-or-health-revolution/#comment-94</guid>
		<description>The retail/in-store clinic movement is more than a highly beneficial strain of “disruption” to the primary healthcare delivery system. Looking forward, it should also be a significant catalyst and test-bed to improve community health status. 

This strategy entails e-collaboration with a robust referral care network harmonizing enabling tools related to consumer-directed wellness, early disease detection and disease management services. Add a hefty dash of one-on-one customer rewarding based on health risk appraisal completion. Follow up with sequential adherence-based economic incentives fulfilled through behavioral target marketing with customized couponing triggered by the HRA findings, seasonal drivers, and respondent demographics. Similar reward triggering could be based on benchmark attainment within disease management protocols. 
Win-wins arise building loyal families in touch with new teams of wellness providers. It’s opt-in and HIPAA immune, and is freed from the babble generated by a zillion committees, taskforces, and “working” groups intent on cyber transacting everything. To the extent progressive local and regional health systems are included, the smoother the political sailing. For example, a Blue Cross plan could co-venture production of selected services. Local VNA and health departments would continue to make excellent staffing partners for short-lived campaigns such as back-to-school vaccinations. With insurance coverage arising and rising, the customer is the beneficiary regardless of the chosen production function. 

Service demand can be continuously driven by demographic (gender and age) thresholds per U.S Public Health Service guidelines. Such info is captured within the HRA completion process to trigger sentinel announcements (for example, 50th birthday) and invites along with customized coupons to promote visiting the clinic and the store. Intervention opportunities also arise seasonally. Examples include the promotion of back-to-school and vacation-prompting vaccinations, flu season shots with pneumonia piggy-backed on, spring and fall seasonal allergies, and national body part (i.e., Breast Cancer) of the month campaigns. 
Why Retail Clinics as the Locus for Change? 

Incumbents in the retail clinic space grow because their business case is compelling, enterprises are sufficiently capitalized and customer experiences are highly scored by all relevant satisfaction metrics. These operations are still in early growth facing normal start-up woes: 

1.	Uncertain ROIs and break-even points, staffing, information capture and work-flow patterns
2.	“Without the doc” risk-averse service menus, voluntary script dispensing/selling firewalls, constrained spatial layouts and low-ball pricing. 

Thus, there is plenty of wiggle room to now plan additional functionality as the kinks get worked out and consumer acceptance grows. As competition increases, investment drivers include the need for continuous product improvement and differentiation as well as for satisfying large customer cohorts shifting from latent to expressed demand for diagnostic, immunization and screening services. In-store worker-focused risk assessments add icing to the convenience cake, especially by filling in off-peak appointment slots, smoothing work flow and reducing queues and wait times. (Workers’ rewards must be nondiscriminatory per U.S. Department of Labor regs compared with customers’ rewards.) 

Like Lipitor, the “daughter products” released after its ingestion are more beneficial than the original dose. Sensible protocol-based and decision-supported adult primary care is the core retail clinic output platform now in place. Providing appropriate consumer-assisting programs with health systems co-venturers builds upon sunk investments at low marginal cost. 

In many urban and rural communities, the default locus for free “medical advice” has traditionally been the neighborhood pharmacist. The retail clinic can expand this tradition with one-on-one assistive and practical care in terms of fuller primary prevention services that are disease- or body-part specific. 
Many screening and testing services have been battle-tested in drug stores, at health fairs and convention lobbies and within assorted clinics of all stripes. More recently, based on strong empirical evidence from workplace wellness settings, providing customized incentives and rewards is essential to “get people to the last mile” to initiate behavioral change. This might become an especially compelling strategy with the deployment of emerging home-based disease management products incorporating remote monitoring. Incentives could take many forms from reward programs to price discounts on in-store goods and services. 

Convenient Primary Prevention Would Gain Equal Footing with Convenient Care 

Given pervasive techno-chaos within the overall healthcare industry, it takes business discipline and standardization to harmonize appropriate processes and technology. Just consider the hundreds of options flowing from web-based and traditional programming in risk assessment and personal auditing and tracking programming including health risk appraisals, HSAs and derivative financial products, mini personal health records, electronic medical records, chronic disease management with remote monitoring, behavioral targeting and one-on-one relationship marketing and loyalty card systems. 

Each of these now operate under different parentage – from health departments, governments, self-insured large employers, progressive unions, managed care organizations, classic insurers, marketing services firms and, increasingly, by customers themselves. Many have or will become zero-priced commodities. The good news is that all are adjunctive to enhancing the retail clinics’ care and caring missions. 

The retail clinic could assume employers’ traditional role in health risk appraisal to get incentive packages, monitoring and benchmarking locked and loaded. Then, many follow-through tests and procedures are done in store with out-referral when appropriate. Record keeping would be online and really simple. It’s like installing training wheels for the emerging PHR and EMR systems. These convergent systems are typified by early developer groups such as WebMD while 
Google is constructing a PHR system. 

Caring Processes are Inseparable from Care Processes 

Retail Clinic 2.0 positioning is not glitzy PR to deflect the opening blows by organized physician groups that wrongly perceive negative competition from nurse practitioners and others. The reality is all PCPs (and, more importantly, their patients) will be universally better off if they begin to mimic some of the critical convenience, staffing, IT and pricing success factors put in place by the retailers. 

The docs are far from being disintermediated; they can be emancipated from the routine sniffles and scratches while remaining wired in, utilizing their time and skills more appropriately and productively. Ditto for our under-funded public health clinics that will face huge work flow and staffing problems as prevention and wellness eventually obtain public and private core financing. Latent demand for the 55-year-olds and kids is likely to explode if Medicare expands down and SCHIP widens. 

Recent AMA opening moves challenging the emerging retail clinic industry’s usurpation of physician roles and functions were inevitable. It’s fuming again but will lose the battle because: 

1.	Their economic self-interest becomes more visible than their patients’,
2.	The inherent cost-effectiveness of the current approaches is readily apparent to customers (especially where services are insured), and
3.	Business groups, governments, employers, public health associations and insurers all welcome price and quality competition wherever and whenever they find it.</description>
		<content:encoded><![CDATA[<p>The retail/in-store clinic movement is more than a highly beneficial strain of “disruption” to the primary healthcare delivery system. Looking forward, it should also be a significant catalyst and test-bed to improve community health status. </p>
<p>This strategy entails e-collaboration with a robust referral care network harmonizing enabling tools related to consumer-directed wellness, early disease detection and disease management services. Add a hefty dash of one-on-one customer rewarding based on health risk appraisal completion. Follow up with sequential adherence-based economic incentives fulfilled through behavioral target marketing with customized couponing triggered by the HRA findings, seasonal drivers, and respondent demographics. Similar reward triggering could be based on benchmark attainment within disease management protocols.<br />
Win-wins arise building loyal families in touch with new teams of wellness providers. It’s opt-in and HIPAA immune, and is freed from the babble generated by a zillion committees, taskforces, and “working” groups intent on cyber transacting everything. To the extent progressive local and regional health systems are included, the smoother the political sailing. For example, a Blue Cross plan could co-venture production of selected services. Local VNA and health departments would continue to make excellent staffing partners for short-lived campaigns such as back-to-school vaccinations. With insurance coverage arising and rising, the customer is the beneficiary regardless of the chosen production function. </p>
<p>Service demand can be continuously driven by demographic (gender and age) thresholds per U.S Public Health Service guidelines. Such info is captured within the HRA completion process to trigger sentinel announcements (for example, 50th birthday) and invites along with customized coupons to promote visiting the clinic and the store. Intervention opportunities also arise seasonally. Examples include the promotion of back-to-school and vacation-prompting vaccinations, flu season shots with pneumonia piggy-backed on, spring and fall seasonal allergies, and national body part (i.e., Breast Cancer) of the month campaigns.<br />
Why Retail Clinics as the Locus for Change? </p>
<p>Incumbents in the retail clinic space grow because their business case is compelling, enterprises are sufficiently capitalized and customer experiences are highly scored by all relevant satisfaction metrics. These operations are still in early growth facing normal start-up woes: </p>
<p>1.	Uncertain ROIs and break-even points, staffing, information capture and work-flow patterns<br />
2.	“Without the doc” risk-averse service menus, voluntary script dispensing/selling firewalls, constrained spatial layouts and low-ball pricing. </p>
<p>Thus, there is plenty of wiggle room to now plan additional functionality as the kinks get worked out and consumer acceptance grows. As competition increases, investment drivers include the need for continuous product improvement and differentiation as well as for satisfying large customer cohorts shifting from latent to expressed demand for diagnostic, immunization and screening services. In-store worker-focused risk assessments add icing to the convenience cake, especially by filling in off-peak appointment slots, smoothing work flow and reducing queues and wait times. (Workers’ rewards must be nondiscriminatory per U.S. Department of Labor regs compared with customers’ rewards.) </p>
<p>Like Lipitor, the “daughter products” released after its ingestion are more beneficial than the original dose. Sensible protocol-based and decision-supported adult primary care is the core retail clinic output platform now in place. Providing appropriate consumer-assisting programs with health systems co-venturers builds upon sunk investments at low marginal cost. </p>
<p>In many urban and rural communities, the default locus for free “medical advice” has traditionally been the neighborhood pharmacist. The retail clinic can expand this tradition with one-on-one assistive and practical care in terms of fuller primary prevention services that are disease- or body-part specific.<br />
Many screening and testing services have been battle-tested in drug stores, at health fairs and convention lobbies and within assorted clinics of all stripes. More recently, based on strong empirical evidence from workplace wellness settings, providing customized incentives and rewards is essential to “get people to the last mile” to initiate behavioral change. This might become an especially compelling strategy with the deployment of emerging home-based disease management products incorporating remote monitoring. Incentives could take many forms from reward programs to price discounts on in-store goods and services. </p>
<p>Convenient Primary Prevention Would Gain Equal Footing with Convenient Care </p>
<p>Given pervasive techno-chaos within the overall healthcare industry, it takes business discipline and standardization to harmonize appropriate processes and technology. Just consider the hundreds of options flowing from web-based and traditional programming in risk assessment and personal auditing and tracking programming including health risk appraisals, HSAs and derivative financial products, mini personal health records, electronic medical records, chronic disease management with remote monitoring, behavioral targeting and one-on-one relationship marketing and loyalty card systems. </p>
<p>Each of these now operate under different parentage – from health departments, governments, self-insured large employers, progressive unions, managed care organizations, classic insurers, marketing services firms and, increasingly, by customers themselves. Many have or will become zero-priced commodities. The good news is that all are adjunctive to enhancing the retail clinics’ care and caring missions. </p>
<p>The retail clinic could assume employers’ traditional role in health risk appraisal to get incentive packages, monitoring and benchmarking locked and loaded. Then, many follow-through tests and procedures are done in store with out-referral when appropriate. Record keeping would be online and really simple. It’s like installing training wheels for the emerging PHR and EMR systems. These convergent systems are typified by early developer groups such as WebMD while<br />
Google is constructing a PHR system. </p>
<p>Caring Processes are Inseparable from Care Processes </p>
<p>Retail Clinic 2.0 positioning is not glitzy PR to deflect the opening blows by organized physician groups that wrongly perceive negative competition from nurse practitioners and others. The reality is all PCPs (and, more importantly, their patients) will be universally better off if they begin to mimic some of the critical convenience, staffing, IT and pricing success factors put in place by the retailers. </p>
<p>The docs are far from being disintermediated; they can be emancipated from the routine sniffles and scratches while remaining wired in, utilizing their time and skills more appropriately and productively. Ditto for our under-funded public health clinics that will face huge work flow and staffing problems as prevention and wellness eventually obtain public and private core financing. Latent demand for the 55-year-olds and kids is likely to explode if Medicare expands down and SCHIP widens. </p>
<p>Recent AMA opening moves challenging the emerging retail clinic industry’s usurpation of physician roles and functions were inevitable. It’s fuming again but will lose the battle because: </p>
<p>1.	Their economic self-interest becomes more visible than their patients’,<br />
2.	The inherent cost-effectiveness of the current approaches is readily apparent to customers (especially where services are insured), and<br />
3.	Business groups, governments, employers, public health associations and insurers all welcome price and quality competition wherever and whenever they find it.</p>
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		<title>Comment on How Do You Choose the Right Medical Doctor? by Shain Waugh</title>
		<link>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-11</link>
		<author>Shain Waugh</author>
		<pubDate>Fri, 04 Jan 2008 06:37:40 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-11</guid>
		<description>The comments above are of a similar pattern among many within the community concerned about finding the right medical physician, hospital, clinic, or practice. The quality of health care is improved significantly by the informed consumer, but challenges still present themselves. As D. Gardner states in the above post, when looking for a physician in North Florida her research was some what informative, thorough, and well thought out, but medical errors and problems still took place.

In evaluating these physician practices and medical facilities, we as a community must demand more from the facilities in being more open about their medical practices. Its not significant enough to just illustrate a facility or physician online, but more so to detail those practice, illustrate procedures, and discuss many of the improvements within the facility designed to improve medical error, nursing shortage, medcial personnel evaluations after hire, and so forth. 

These processes once in place enables use as a community to make better informed decision about a particular facility for ourselves, parent, children, and friends. Its critical that in America we as a people get valid information, given that we cannot have universal health care. It interesting how the government can give $550 Billion for the Iraq war, but cannot give 10% of this total to improve U.S. health care system and start universal healthcare.</description>
		<content:encoded><![CDATA[<p>The comments above are of a similar pattern among many within the community concerned about finding the right medical physician, hospital, clinic, or practice. The quality of health care is improved significantly by the informed consumer, but challenges still present themselves. As D. Gardner states in the above post, when looking for a physician in North Florida her research was some what informative, thorough, and well thought out, but medical errors and problems still took place.</p>
<p>In evaluating these physician practices and medical facilities, we as a community must demand more from the facilities in being more open about their medical practices. Its not significant enough to just illustrate a facility or physician online, but more so to detail those practice, illustrate procedures, and discuss many of the improvements within the facility designed to improve medical error, nursing shortage, medcial personnel evaluations after hire, and so forth. </p>
<p>These processes once in place enables use as a community to make better informed decision about a particular facility for ourselves, parent, children, and friends. Its critical that in America we as a people get valid information, given that we cannot have universal health care. It interesting how the government can give $550 Billion for the Iraq war, but cannot give 10% of this total to improve U.S. health care system and start universal healthcare.</p>
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		<title>Comment on How Do You Choose the Right Medical Doctor? by D. Gardner</title>
		<link>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-6</link>
		<author>D. Gardner</author>
		<pubDate>Wed, 19 Dec 2007 04:04:27 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-6</guid>
		<description>Even though you may not beleive it, try the North Broward Hospital District in particular Broward General.  The have Drs. of all specialties tied into the hospital.

BG is a teaching hospital and what they see in a month, many Drs. and hospitals never get to see.

My experience was great.  Give them a try!</description>
		<content:encoded><![CDATA[<p>Even though you may not beleive it, try the North Broward Hospital District in particular Broward General.  The have Drs. of all specialties tied into the hospital.</p>
<p>BG is a teaching hospital and what they see in a month, many Drs. and hospitals never get to see.</p>
<p>My experience was great.  Give them a try!</p>
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		<title>Comment on Universal Health Care in U.S.A. is Our Right! Right? by D. Gardner</title>
		<link>http://nyashgroup.com/blog/2007/12/10/is-universal-health-care-a-right-or-a-privilege/#comment-5</link>
		<author>D. Gardner</author>
		<pubDate>Wed, 19 Dec 2007 04:00:58 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2007/12/10/is-universal-health-care-a-right-or-a-privilege/#comment-5</guid>
		<description>Shain you are definately on point!

Those of us with a history of Cancer are virtually uninsurable.  I am sure that even the government want this for their citizens.

Winning the election is the least of mine concerns, I will definately support the candidate having the best plan for the uninsured in this country.</description>
		<content:encoded><![CDATA[<p>Shain you are definately on point!</p>
<p>Those of us with a history of Cancer are virtually uninsurable.  I am sure that even the government want this for their citizens.</p>
<p>Winning the election is the least of mine concerns, I will definately support the candidate having the best plan for the uninsured in this country.</p>
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		<title>Comment on How Do You Choose the Right Medical Doctor? by R. Garvey</title>
		<link>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-3</link>
		<author>R. Garvey</author>
		<pubDate>Wed, 12 Dec 2007 06:00:01 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-3</guid>
		<description>I am currently looking for another primary physician, and I totally agree that we need a better way of finding a great doctor. Sadly enough, my only method is to print a list of doctors within 5 miles of my job, and call to carefully listen to how the receptionist answers the phone. If he/she sounds really busy more than a few times or the answering service keeps picking up, it's not the place I'd like to frequent. 

Someone advised me once to visit the doctor's office a few times to observe. It's sad that although we're in a technologically advanced society, we must resort to such antiquated tactics. Where can I find a good doctor in Broward County, who is concerned about the patients' total well being!!??</description>
		<content:encoded><![CDATA[<p>I am currently looking for another primary physician, and I totally agree that we need a better way of finding a great doctor. Sadly enough, my only method is to print a list of doctors within 5 miles of my job, and call to carefully listen to how the receptionist answers the phone. If he/she sounds really busy more than a few times or the answering service keeps picking up, it&#8217;s not the place I&#8217;d like to frequent. </p>
<p>Someone advised me once to visit the doctor&#8217;s office a few times to observe. It&#8217;s sad that although we&#8217;re in a technologically advanced society, we must resort to such antiquated tactics. Where can I find a good doctor in Broward County, who is concerned about the patients&#8217; total well being!!??</p>
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		<title>Comment on How Do You Choose the Right Medical Doctor? by D. Gardner</title>
		<link>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-2</link>
		<author>D. Gardner</author>
		<pubDate>Sun, 25 Nov 2007 08:03:28 +0000</pubDate>
		<guid>http://nyashgroup.com/blog/2007/11/24/how-do-you-choose-right-medical-doctor/#comment-2</guid>
		<description>Choosing the right Dr. can somtimes be out of your hands especially when you move to a new city.  Often were are forced to go on the reccomendatioons of friends or medical aquaintances.  The unfortunate part is that even though you are happy with the referrals and feel that the Drs. must be safe, this is often not the case.
I moved to north Florida and had completed most of my txs. for breast cancer completed in South florida.  The care I rec'd was in my opinion very substand to the care recd. in N. Florida.  I am right now sufferring greatly from the side effects of radiation.  The side effects have gone from worst to unbelevable.  I am also caught in between the proverbial rock and a hard place as when one Dr. messes up, almost no one wants to touch ya.  Please wish me well in this struggle!</description>
		<content:encoded><![CDATA[<p>Choosing the right Dr. can somtimes be out of your hands especially when you move to a new city.  Often were are forced to go on the reccomendatioons of friends or medical aquaintances.  The unfortunate part is that even though you are happy with the referrals and feel that the Drs. must be safe, this is often not the case.<br />
I moved to north Florida and had completed most of my txs. for breast cancer completed in South florida.  The care I rec&#8217;d was in my opinion very substand to the care recd. in N. Florida.  I am right now sufferring greatly from the side effects of radiation.  The side effects have gone from worst to unbelevable.  I am also caught in between the proverbial rock and a hard place as when one Dr. messes up, almost no one wants to touch ya.  Please wish me well in this struggle!</p>
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