Tuesday, September 26, 2017

No news is good news?

I had no idea it had been weeks since my last update.  I've kept my fly fishing blog up to date with my latest adventures, but nothing here.

September has been very, uh, busy.  I guess that would be the word.

I spent some time at a healthcare conference in Maine.  I got to see Tom Price speak (regretfully I didn't get to ask him any questions), and then had to laugh when he found himself in hot water for using charter flights to attend a private business conference.

I also got to hear Todd Park speak and I had a very nice conversation with him.  For those that don't know, Park served as the CTO of the country for President Obama.  He was also one of the founders of the company that was putting on the conference I was attending.  He focused on three things in a talk that was way too short.  Passion, diversity, and the need to make a compelling financial case in the healthcare software business.

That last point might seem obvious, but it's been a sticking point for my current company.  We sell a service that is provided through software.  We don't actually sell the software to people.  We sell them the service and then we get some data from the customer and run the software for them.  In our healthcare system, about 80% of all patients are still insured under the old standard "fee for service" model.  That is, you see a provider, you get a service, and the insurer pays for the service.

For about 20% of our patients, there are value based incentives.  That is, providers are paid not strictly for the services they provide, but rather based on patient outcomes.  It's easy to estimate what it should cost to cover a particular patient in a year.  The insurance companies have it down to a science.  If you talk to any insurance company, and you tell them you have a 56 year old male, diabetic, hypertensive, obese, but no known kidney problems, and no other diabetic complications, in a particular zip code, they can give you a quick estimate of what it would typically cost to care for that patient for a year.

Value based care is a system where we give the doctors leeway to try to improve patient outcomes.  If the outcomes improve, the doctors make more money.  If the patients get sicker, the doctor makes less.

My company's software costs money to license, obviously.  And, it increases revenue in primary practice and in the lab.  But, it also cuts revenue in the emergency department and reduces inpatient admissions.  For patients with kidney disease or diabetes, the use of our system improves the patient's health and reduces the cost of care.

In the fee for service world, this is actually seen as a negative.  With so many healthcare organizations now vertically integrated, the lab, primary care, ED, and inpatient setting are all part of the same organization.  In those organizations, when my company talks to the hospitals, we are frequently told that using our software is the right thing to do, but they can't afford to use it, even though it will make their patients healthier.  That is the absurdity of fee for service.  Hospital organizations, including places where I've gotten care, have basically told us that they would rather make more money than have healthier patients.

In the value based care world, our product is easier to sell, but it's far from an easy sale.

I got a chance to talk to Todd Park about this problem.  I've always been a dreamer, I guess, thinking that hospitals would do the right thing and use our system anyway.  But, we've been rebuffed so many times that it's shocked me.  And, Todd Park confirmed that he thinks it will stay this way.  He said that without value based care, dollars will always be more important than outcomes.  That is truly disheartening.

At the same time, he said that with 20% of the policies out there including some sort of value based care, the market for our products is huge.  And about 1/3 of those 20% are fully at risk, meaning that doctors get a fixed amount to care for a patient, and their profit is purely outcome driven.  So, that might be about 7% of the US market where our product is an ideal fit.  But, if we could get to 1% of the patients in the country, we would be wildly successful.  Our patient count is in the tens of thousands of affected patients, out of candidate pools of a couple hundred thousand patients.  One percent would be a candidate pool of 3.3M people - easily 10x what we support today.

I've been involved in this software for most of the past 15 years.  I've been with the company in some capacity or another for almost 10 years (I worked on the initial software at a prior job), and I've been here full time for 8 years.  I truly believe that we have a product that has a lot to add to the care of chronically ill patients, and I desperately want us to succeed.

I can go into our databases, and find patients whose lives are better because of our software.  Is there a better reason to get out of bed and go to work everyday than knowing you are improving people's health in the short and long term?  I honestly don't think so, which is why I love my current job so much.

And yet, we are not succeeding financially at the moment, and that bothers me.  I don't want to have to find a new job.  To be honest, the bias against people my age in IT is very real.  Finding a new job at my age gets tougher and tougher.  Plus, I love what I do now.

We just have to figure out how to get to the right people and convince them of our value proposition.

And, that was quite a tangent.

After the conference was over, I took a week of vacation.  It was my first real vacation time, one long weekend in NYC excepted, in about a year.  I spent my time, mostly alone, fishing in NH, and if you care to read about it, a link to my fishing blog is in the sidebar.  I would rather have been on vacation with my wife, but she knows how much I love fishing, and gladly supports this solo trip that I do every fall.

Now, I'm back at work and back in the gym.  Due to the time away, I won't do as many CrossFit workouts in September as I did in August, but it will still be a solid month.  I spent most of my vacation on my feet, and although fly fishing isn't exactly taxing, it can be a form of exercise.  I challenge almost anyone to walk 10,000 steps in a day in rivers, wearing big, clunky waders and boots, where half of your steps are against the current.  It's not a traditional workout, but it can be very tiring.

Right now, I'm trying to live with the heat in the gym as the month winds to a close.  I'll likely get about a dozen CF workouts this month, after 17 the month before.  I have some more vacation planned for October (a few days in NYC - my wife and sister are going to see Hamilton, I'm going to Sloan Kettering), and a weekend at a Penn State football game.  So, my October numbers for CF won't get to 17, but I should get more days than in September.

And, with October looming on the horizon, I'm starting to think about skiing.  If my scan at Sloan Kettering is clean, I will be able to ski the entire season, uninterrupted by any treatments, for the first time in three years.  That would make me extremely happy.

Friday, September 1, 2017

August Summary

I made it to CrossFit 17 times in August.  That was after one day in June and two in July.

The most I've ever done in a month is 18 days, and I came within one day of tying that record.

Since our gym opened exactly 7 years ago today, I have done 880 CrossFit workouts.  Tonight will be number 881.

Things continue to improve, but slowly.  My running is getting better, but it's far from good.  My squats this week were 20 pounds heavier than a few weeks ago, so that was good.  I did deadlifts last night at 185# - still less than half of my lifetime best, but I was happy with that number.  There was no doubt that I could have lifted heavier, and next time I do deads, I will probably shoot for 225.

But, I'm still the slowest runner at the gym, and I'm using fairly light weights for a lot of the workouts.  I feel kind of pathetic, but after the chemo and surgery I've been through this year, I need to learn to be grateful that I'm out there.  Many people I've met (online) who have liposarcoma have had treatments that make just walking a challenge.  I'm lucky that I'm still able to challenge myself this way.

Physical therapy is really exposing some imbalances and weaknesses, and I've got some work to do at home to work on that.  It's amazing how losing 2/3 of that one muscle can affect overall strength and balance.  At times, I can really feel other muscles being recruited to cover the muscle that's essentially gone.

My September totals for CF will certainly be lower than this month.  We have five weekends in the month and I rarely do CF on the weekends.  I also have a nine day trip that is a combo of business and vacation, and there will be no CF for those 9 days, most likely.

If I get 12 days in September, it will be a good month.

Right now, I'm hoping that a clean scan or two will let me stay focused in the gym, with no interruptions for treatments.  If that happens, I should do my 1000th lifetime CF workout sometime next summer.