JAY PARKINSON + MD + MPH

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Here is my new project, healthetica. I don’t know what the actual concept of the site will be, but I think it’s going to be a repository of interesting ways to visualize health, wellness, and disease.

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Here is the cover story from the just-released Hospitals and Health Networks magazine entitled, Your Future Chief of Staff?

“A lot of my friends are artists and freelancers, and if you make $40,000 a year and health insurance costs $950 a month like it does in New York you are kind of screwed,” Parkinson says. “To succeed, I had to create something that these people would want enough to pay for it. So I asked myself, ‘What would I want?’ ”

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Yesterday, we at Myca, announced hello health at the Health 2.0 conference in San Diego. hello health is the consumer brand of healthcare delivery powered by the Myca platform. It’s Geek Squad with doctors and a Netflix-priced monthly membership subscription fee — it is a branded healthcare “experience” that mixes “concierge service for all,” with house/office calls and web visits via email, IM, video chat, and text messaging. It’s Fed Ex, Apple, Whole Foods, Amazon, Toyota, Fresh Direct, and Geek Squad all applied to healthcare delivery. We’re opening our first node in Williamsburg, Brooklyn on May 1st. We are a group of physicians specializing in pediatrics, internal medicine, emergency medicine, and preventive medicine and we will see people of all ages.

Our focus is on you — a human being; a person paying hard-earned money for a service that should rival the value of your money; a person concerned with their health who understands that western medicine cannot provide absolutely everything; a person who wants a knowledgeable, personable doctor who will treat you with respect and dignity; a person who wants to simply feel their best and wants to embrace the most reliable health information on the internet and wants a doctor to interpret it and personalize it specifically for you. We are your doctors. We are your resource for health information. We are your healthcare financial consultants.

Depending upon the nature of your symptoms, you will be able to make an appointment for a house/office call, a video chat, an IM, or simply send us an email. A hello health doctor will then show up at your apartment/office or meet you virtually on the web. We’ll also have an exam room in our office for problems that require a doctor’s office visit. The appointment process will nearly exactly mimic making an appointment at the Apple Store Genius Bar.

Our market is the 47 million people in America without health insurance; the other millions of Americans who are underinsured; and the 40 million Americans over the next four years who will have high deductible health insurance plans. In essence, there will be nearly 100 million people in America in 4 years who have to pay cash for their healthcare. Our other market — considering half of my current patients have insurance and simply pay for accessibility and convenience — are people who value relationships and communication with their own personal doctor.

hello health is concierge service for all.

We will add significant value to the cost of the subscription fee by taking advantage of the weaknesses and insufficiencies of the traditional healthcare system that has left behind the healthcare consumer:

1. The healthcare system is disorganized, confusing, and not consumer friendly. hello health serves as your guide and your doctor to deliver a pleasurable consumer experience found nowhere else in the healthcare industry. We are your first line of defense and administer your primary care transparently, cost-effectively, and with the highest quality. You, as a patient, have complete readable access to your EMR so you can view all of your medical information when you’d like. Since patients only remember about 10 to 15% of all information told to them by their physician, all email, IM, and video visits will be archived in your records (including audio recordings of your in-person doctor visits) so you can simply press play to hear again what your doctor told you. Should you need anything beyond what we provide, we have secured relationships with specialists, radiologists, and labs to get you what you need, from exactly who you need, at the best price (often just 10% over what providers are typically reimbursed by insurance companies). Instead of being price gouged by providers who see that you have no insurance and have to pay cash, we have done the leg work for you as representatives of thousands of cash-paying consumers who offer significant revenue to those specialists who agree to see our patients for a reasonable cost. Those providers we have relationships with are personable, high quality, private practice specialists. They are also simply savvy business people — they understand that hello health members will pay them cash that day for services rendered without having to pay the overhead of dealing with insurance companies. Since we have established this network for you, when you need services we can’t provide for you, the money we save you will pay for your annual subscription fees many times over. We won’t let you go to a radiologist who will charge you $700 for a mammogram we have secured for you for $125. We understand how the healthcare system works. We understand reimbursement and the difference between what doctors will accept from cash paying consumers and what they charge insurance companies. We help you spend your money wisely and protect you from subsidizing the costs of decreasing physician insurance reimbursement. We are your primary care doctors, your guides, and your healthcare financial consultants. We save you money.

2. The pharmacy industry takes advantage of consumers. We provide free generic medications so you don’t have to worry about filling your prescriptions. We get these medications in pre-packaged, typical dose packages for nearly nothing because generic medications cost mere pennies per pill. Typical pharmacies mark up generic medications sometimes thousands of percent and take advantage of the fact that most people do not realize that prices vary widely between pharmacies. We think this is wrong and unfair because, unlike every other industry, prices in healthcare are not posted and searchable on the internet. When hello health physicians order you a prescription, we will automatically send you a text message with the most convenient pharmacy to get your medication at the lowest price. Since medication prices vary so markedly (for example, a Z-pack ranges from $25 to $80 at different pharmacies in a 5 block radius), we make sure you get the best deal. We we save you money on medications.

3. We provide free or highly subsidized healthcare to neighborhood business owners in exchange for discounts or other perks at their businesses for hello health members. We are “inventing” creative new perks for our members every day to add significant value to the subscription fees. Since many of you will not use healthcare services more than a few times a year, we’re working with neighborhood business partners to help you lead a healthier lifestyle every day of your life.

4. Insurance and healthcare is ridiculously too expensive because (of course I’m missing a lot) of high overhead, inefficient processes, lack of coherent communication, lack of centralized repositories of information, practice of defensive medicine because of the breakdown of the doctor-patient relationship, and oligopolization of local healthcare delivery systems and health insurance companies. If you cannot afford the ridiculously expensive insurance premiums in your local area, we provide the next best thing — your own personal accessible doctor who you can communicate with however you’d like who treats your medical conditions at a reasonable price, and who helps you spend your money wisely. We are not a replacement for insurance. We, at hello health, are simply your best healthcare resource for the vast majority of people who do not get hit by a bus in a given year. We save you money.

The US Healthcare system has let you, the healthcare consumer, down. On May 1st, in Williamsburg, Brooklyn, you will have your own personal “concierge for all” doctor from a streamlined, high-quality, cost-conscious, trustable brand of convenient, accessible healthcare delivery called hello health. Say hello to a new brand and a new concept — hello health — healthcare delivery as it should be in 2008, just patients and doctors communicating effectively both armed with the best tools to optimize the patient’s health and the doctor’s practice, dignity, income, lifestyle, freedom, and professional satisfaction.

We at Myca are developing a robust web platform that allows patients to tell us what’s wrong with them and schedule their own appointment. It is an online scheduling system, a practice management system, and an electronic medical record. The interface looks much more like this than this.

We understand there are two consumers in healthcare — patients and doctors. hello health offers physicians freedom, more money, efficiency, and opportunities to deliver quality care and develop personal relationships with your patients.

1. Freedom. Insurance companies can no longer enslave physicians. Physician salary has been decreasing relative to inflation for years. Doctors are tired of working harder to help others more profitable. We are highly educated professionals with a vital responsibility in society. Our services will not be cheapened and diminished to a $5 copay. hello health physicians can make as much money as they want because there are millions of Americans who either have to pay cash or want to pay cash for healthcare. Our personalized, reasonably priced, accessible service; word of mouth; reputation; and direct to consumer ads and marketing supply the patients. hello health physicians fill that demand. A house visit actually costs less than the average office visit in NYC. Physicians do not have to join an established practice as the junior attending working to subsidize the senior attendings’ golf memberships. We provide the patients, you, as a physician, provide the skills. You have no restrictions from insurance companies, large healthcare institutions, etc. You simply see patients and get paid for your hard work and work as much as you’d like.

2. More money. The average general physician in NYC makes about $165,000 working over 55 hours a week. The average overhead for a general physician is nearly 50%. Since we are a “virtual” company without costly staff and office space, we have damn near no overhead and physicians can make significantly higher salaries seeing much fewer patients in person but handling about the same amount of patients due to proper communication over the internet. We’ve used technology to eliminate costly staff and facilities. The hello health business model benefits physicians, patients, and Myca. Myca and hello health physicians share the revenue from both doctor visits and the subscription fees. Patients will rate the visit (because it is tied to the transaction much like eBay with their very simple one question survey) and Myca will take a certain percentage of the revenue depending on that physician’s average monthly satisfaction score. Myca will take less from that physician’s revenue, the better the physician’s score. Of course, this builds the hello health brand and ensures doctors focus on the consumer experience rather than volume. Even while traveling to and from patients, we enable you with mobile applications to get paid by answering emails, IMs, and giving your professional opinions.

3. More efficiency. We at Myca are developing a platform that streamlines documentation significantly with heavy doses of artificial intelligence built in to the backend. My goal is to design a system that enables physicians to document 90% of patient interactions with less than 10 clicks of a mouse. Our interface is revolutionary as evidenced by the reaction of the crowd at the Health 2.0 conference. I will have a guided tour of the demo up online as soon as possible. For now, forget about all the other EMRs you’ve seen that look like they were designed by the military with tabs, lists, and drop-down menus showing unnecessary amounts of useless information. No matter how much “Web 2.0” style sheets you apply to your EMR, it’s still an unintuitive way to organize voluminous, complex data. Our interface looks and functions like no other application you’ve ever seen.

4. More quality. The Myca platform ensures prevention and best practices based on evidence, expert guidelines, and consensus opinion. We also encourage that you spend as much time with the patient as you see fit. We do not pay for volume, we pay for consumer satisfaction scores. You, as the physician, at the point of ordering prescriptions, tests, and services will be armed with cost information. Every order you type will have an associated price tag so you can help your patients spend their money wisely. Information will also be given to you that will enable you to make a more informed decision about lab tests. You will be able to know if the combination of two $50 tests will have a higher positive predictive value than the $600 lab test you are about to order.

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I’ve been quite busy for the past week or so at this conference in DC and seeing patients.

I’ve joined a ridiculously talented company as their Chief Medical Officer. We’re going to turn the Industry upside down and inside out. Those bureaucratic monoliths aren’t going to know what hit them.

Stay tuned for more details and announcements. And if you want to see me in person to hear me discuss this new venture, visit San Diego March 3-4 for the Health 2.0 conference. Please, stay tuned.

And if you thought I was going to join Microsoft or RevolutionHealth or “one of those” you were wrong. I’m not interested in yapping…I’m interested in doing.

Heads will spin.

“When great changes occur in history, when great principles are involved, as a rule the majority are wrong.”
-Eugene V. Debs

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I’m in DC at a conference that focuses on information technology and innovation in the healthcare industry. The first speaker was Kevin Kelly, the founder and senior editor of Wired Magazine. He gave a very Larry Lessig kind of presentation that was actually quite a kick in the ass for all of the “industry leaders.” I looked around the audience and wondered the average age of the attendees. I think I was the youngest out of the 200 or so attendees. After Kevin spoke, the passion, innovation, and profundity took quite a nose dive.

All the technological innovators are in another field trying to change the world rather than patch a severely broken system with “innovative” technology. Integration into a broken system just unbreaks the system a tad bit less. Maybe.

The problem is…there’s a lot of money to be had in the “innovation” because it’s in the healthcare industry. All kinds of people are trying to get their share of the fluff. Good luck to these people.

While they wander around looking to sell that innovative technology to any company threatened by it who will purchase it and kill it, I will be doing my own thing. That’s vague isn’t it?

After Kevin spoke, three people were invited to form a public roundtable interview/discussion in front of the audience. David Brailer led the panel. Dr. Brailer was the first National Coordinator for Health Information Technology appointed by Bush. He subsequently left probably due to getting sick of being a figurehead. The panel was three men: Jonathin Perlin (CMO of Hospital Corporation of America), Jeffrey Gruen (CMO of Revolution Health), and Bill Crounse (Director of Health at Microsoft). It was quite a discussion led mainly by the only innovator on the panel, Bill Crounse. Bill sent me a very long and personal email a few weeks back thanking me “for doing what I’m doing to disrupt the industry.” I talked with him afterwards and he told me he damn near mentioned my name up on stage as an example because he’s been “telling everyone” about me. We talked for about 45 minutes about his background and how HealthVault is doing…he says “very well.” He also interviewed me and I will appear on his blog in the near future. Stay tuned.

I’m tired…I’ll write something profound tomorrow.

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After medical school, I spent three years in a Pediatric residency where I focused on treating individuals. After that, I spent two years in a Preventive Medicine residency where I focused on treating populations and discovering interventions that improve the health of a population.

What medical interventions improve the health of a population? This is the question all scientific studies ask and hope to answer with a specific number.

I posted a possibly inflammatory question a few days ago: “Does access to online health information improve the health of a population?” I got plenty of personal anecdote comments about individuals whose lives were changed by online health information. That actually makes me extremely happy.

But I’m suggesting treating online health information as a therapeutic intervention. We should compare two groups: a population of people who do not have access to the internet and a population who does. Then we should assess the long term effects of health information. My guess is that the intervention will work for a sizable minority of savvy patients and fail for the sizable majority.

I can provide strong evidence suggesting that knowing what is good and bad for you doesn’t change behavior that leads to improved health. I can also provide strong evidence that the only beneficial aspect of regular prenatal care visits is having access to routine blood pressure checks and urinalyses. That doesn’t stop the insane amount of New Mommy sites from creating an entire industry around telling pregnant women that it’s much more complicated.

Does this mean that we should not publish health information on the internet available to all? Hell no. But it does mean that the vast majority of health-related websites are worthless excuses to host advertisements and do nothing for the majority of people who aren’t savvy enough to sift out the good and bad. It also means that the push toward creating websites that organize health information in new ways (such as Revolution Health) is barking up the wrong tree and are simply excuses to make money in the lucrative healthcare advertising business. Look at Sermo. The drug companies are already salivating. It’s 43,000 physicians all in one place! Revolutionary! It’s revolutionary advertising…that’s about it.

The internet has enabled everyone to essentially have access to the information from the first two years of medical school. However, having information does very little when synthesizing that information and doing something about it…that’s why doctors train for years after learning all these facts.

Folks, it’s not about health information. It’s about personalized, accessible communication between patients and doctors mixed with the other magic question…how do we change a culture’s behavior?

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Yesterday’s post about health information was a bit purposefully misleading. I’m not saying we should burn the internet in a bonfire. But that’s only because the pretty colors arising from the smoke would probably be bad for us.

There is an old saying in the public health world that goes a little something like this…”The greatest predictor of health is wealth.” Therefore, since the US is by far the wealthiest nation in the world, we should also be the healthiest. Doesn’t hold true on a population level.

The saying was recently amended to something less poetic…”The greatest predictor of health is health literacy.” Sounds true but definitely less catchy. The more you know about your body, health, and disease, the healthier you will be as an individual.

Therefore, Americans should also be the healthiest because we have the most access to health information than any other country in the world (I don’t have the data to back that up, I’m just assuming considering high quality American health-related web sites and internet accessibility). Why, then, do we trail behind many other countries in population-level health indicators? We are bombarded with health information and yet 25% of adults continue to smoke and 25% continue to be obese. I guess 25% of people have no idea it’s bad for them to smoke and to eat themselves silly.

Health literacy, when it comes to the top two killers in America, fails miserably.

I’m going to amend the statement once again…”The greatest predictor of health is giving a crap about yourself.”

Finally, I’m happy to announce it’s poetic once again.

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Health information on the internet is overrated. Social networking is overrated except for the support patients with certain chronic diseases can get from others with similar situations.

It’s a bit perplexing to step back and realize something. The explosion of the internet — and specifically the explosion of health information on the internet — has done absolutely nothing for healthcare in America. Has it empowered patients as consumers? Not even close. Has it saved us money? Again, a very loud nope. Has it improved outcomes? Nope…it might even worsen outcomes. Has it caused undue anxiety in millions of people? Yep. Has information (some true, some not) clouded patient understanding of health problems? Again…yep.

How many doctor visits has the vaccine and autism “debate” consumed? How many children have suffered or died from preventable diseases because any paranoid schizophrenic with a computer can write that autism is caused by a vaccine that prevents fatal illnesses?

Does it do anything besides provide a home for health ads to generate money for Google and the companies that sell health products?

But thousands of doctors and health companies all over the country are investing an insane amount of time and energy into creating sites that, when boiled down, simply provide health information to the average Joe/Jane.

Patients without a formal health education who read health information on the internet often don’t do themselves a favor. As a matter of fact, all of this information is likely doing a disservice. I know it’s doing a disservice to our country’s bottom line. I’m sure there is a nice correlation between the dramatic rise of health related internet sites and skyrocketing healthcare costs in America.

I’m sort of kidding. But the real question is “Does the average person’s health benefit from having access to a seemingly endless supply of internet health information?”

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I think I have an idea that could literally save our country billions by encouraging cost-conscious spending amongst doctors. It’s a bit like $aved…but on lots of steroids.

Please contact me if you are interested.

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