AI Talk: Book review and pigeon drones

January 24th, 2020 / By V. “Juggy” Jagannathan, PhD

This week’s AI Talk…

The Price We Pay – Book Review

I recently heard about the pioneering work being done by Dr. Marty Makary on healthcare prices. He is speaking at an upcoming 3M health summit, so I learned about his book, The Price We Pay: What Broke American Health Care–And, How to Fix It. I bought an ebook version of it last week and boy, was it a page turner! In my opinion, it should be mandated reading for every tax-paying American. There are no sacred cows in his exposition of the underbelly of healthcare pricing—all with meticulous data to back it up. To be clear, he is not castigating everyone, he is just focusing on the bad apples and the real impact they have on the runaway healthcare costs we all face.

The book starts off describing a physician practice that “prospected for gold” at church outreaches. They screened for leg pain and foisted unneeded treatment on Medicaid recipients. Dr. Makery’s team conducted research that unearthed 1,100 U.S. churches, synagogues and mosques used for vascular screening to promote totally unnecessary and perhaps harmful treatments. The chapter that completely shocked me was about a town called Carlsbad. The local hospital has a wonderful practice of suing thousands of low-income people who are slapped with outrageous, inflated bills they can’t pay. Not only does the hospital successfully sue them, they manage to garnish up to 70 percent of their wages (which is illegal) to pay for it. And, it turns out they are not the only hospital with this practice!

I have long felt that a good majority of current quality measurement practices are counterproductive. I believe outcome measures are the answer. This good doctor has an additional solution: practice patterns. Measure how often a particular treatment is done, be it a c-section procedure or opioid prescription and identify outliers. Outlier physicians are perhaps doing something that is not supported by the majority. Dr. Makary defines consensus-driven approaches to appropriateness of care in their Improving Wisely effort.

But that’s not all: Dr. Makery exposes price manipulation tactics of some Pharmacy Benefit Managers (PBMs), who influence medications. Group Purchasing Organization (GPOs) – that deal with all hospital supplies—are another source of price inflation in health care. And then there are unethical brokers, who take kickbacks from insurance companies and steer employers to sign up for insurance policies which only serve the brokers and insurers. I was also surprised that Dr. Makery took on most of the wellness programs offered by employers in the belief that they lower overall costs. His caustic comment: The vapid advice shelled out by such outfits do not deserve the expense. Study after study has shown no difference in real healthcare outcomes by these wellness programs designed to steer employees to better health!

Along the way, he highlights numerous healthcare initiatives and organizations that are trying to do the right thing. This book is indeed a call to action for everyone, not just employers. Each and every one of us can be a force for sorely needed change!

Pigeon Drones?

On a lighter note, I saw this article in MIT Technology Review last week about a drone being designed by Stanford engineers, along with the Smithsonian Institute and others, that mimics a pigeon. Pigeons, apparently, can fly extremely well in turbulent weather. The drones even use real pigeon feathers! An early version of this PigeonBot has taken flight.

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V. “Juggy” Jagannathan, PhD, is Director of Research for 3M M*Modal and is an AI Evangelist with four decades of experience in AI and Computer Science research.