On The Horizon

Photo credit:  INOVA

Photo credit: INOVA

Dr. Stephen Clement was my first endocrinologist out of college. He has been an Army doctor, a fellow at the Joslin Clinic, the head of diabetes program at Georgetown University, and is the architect of the (fairly) new inpatient diabetes program for Inova Fairfax Hospital in Virginia. I’m sure there’s more. Almost 20 years ago, he started teaching me how to be my own advocate. I recently sat down with him to explore how he came to be a patient-first doctor in a generation where such providers were few and far between.

These are turbulent times for healthcare. We are paying too much on all fronts. There have been some phenomenal breakthroughs, like personalized medicine, but for every step forward, it feels like we take a step back. Measles, once thought eradicated, have returned. And recently, the British Medical Journal released a study that found a lot of people who had knee surgery, a common and longtime treatment for certain issues, saw no improvement.

But the future is now. What is on the near horizon that could change healthcare for the better?

Treatment – Bringing it home

According to Dr. Clement, technology has dramatically transformed the home medical environment in the last decade, and it will continue to have an impact. In my world – diabetes world – devices have put more and more of our care in our (the patient’s) hands. We can arrange for our providers to have access to accounts with downloaded information from continuous glucose monitors, and no matter how it does or does not work for me personally, the fact that there is a closed loop external pancreas is pretty life changing.

Dr. Clement also pointed to breakthroughs in the treatment of heart failure patients. Even something as simple as a digital bathroom scale that can feed into a medical record and be monitored by a provider can make an enormous difference. (Too much weight gain by fluid retention can indicate that all is not well.) Seeing daily increases in weight could allow a provider to intervene with an adjustment to medication before the issue gets severe enough to require a hospital visit.

Another aspect that we are leaning toward is telemedicine. Now, I am not generally a fan, but Dr. Clement points out that for some of our periodic check-ins, where we go over lab results and other general updates, those could be accomplished perfectly well over a computer screen. The problem, he said, is that a lot of these remote advancements that allow patients more control, are not covered by insurance. Yet. 😊

Care

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I asked Dr. Clement, as someone who has seen many changes over his career, how we fix the healthcare system. He said that, regardless of who is paying, there is more healthcare to be done than there is money to go around, and pointed out that insurance companies have a good day when they avoid paying for something.

When asked how we change that mindset, where payer has a better day when they don’t do their job (paying health insurance claims) than when they do, he reminded me that parts of Blue Cross Blue Shield (BCBS) are not-for-profit. In fact, there are several health insurance companies that are nonprofits. As a nonprofits, those companies do not have financial obligations to shareholders that often drive changes in coverage (link to open letter to Express Scripts) and higher premiums. Companies whose sole interest is healthcare, and not making money for shareholders, sounds like a solid step for the future of healthcare.

Dr. Clement acknowledges that change required to get to patient-centric care will not come any time soon, maybe not in our lifetimes. But however long it takes to get there, patients need to be involved every step of the way. We need to advocate for what we want with real, tangible action (e.g. the AIDS quilt). It’s the only way we get it right the first (next) time around.

Couldn’t agree more.