My thinky head and idiot brain...

My thinky head hurts. I love The Economist and their new imprint, Wake Up Thinky Head--an espresso size shot of what's new in the world. Traveling from policy meeting to medical conference and back again challenges my evolutionarily primitive brain--and often disrupts my thinky head.

Brain stories are interesting. Especially when there is much we don't know about the inner workings of our command center.

Do you ever wonder why we get car sick? Our brains haven't had the opportunity to adapt to our advancements in travel. The brain is happy to come along for the ride when we are self-powered but throw in an automobile or an airplane and things can get complicated. Terry Gross interviewed Dean Burnett on Fresh Air, A Neuroscientist Explores The Illogical Behaviors Of The Mind In 'Idiot Brain' where he confirms the problematic neurology of a moving body that lacks the typical vestibular and motor feedback.

I thought it germain to lead with discussion of our faulty brain before my segue into the ongoing healthcare debate. I certainly don't pretend to have the answers but I will admit to having a lot of questions. And at times a queasy stomach when considering the answers...

If you have been reading and observing healthcare debates the perspectives keep piling up. Even with the best of intentions it isn't possible to fix the US healthcare system and retain the status quo market driven cost and profit foundation.

Somewhat naively I envisioned the value paradigm as one way out--until I listened to debates in Washington of how Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) would incentivize high-value care allowing ridiculously generous payouts to hospitals and physicians alike. It seems like "first do nothing" never made the cut.

The Lown Institute, Choosing Wisely, National Physician Alliance (The Unbranded Doctor), and Preventing Overdiagnosis are all organizations acknowledging the risks of too much medicine/intervention. Unfortunately many of the value algorithms and frameworks for high-value care are intervention heavy. I don't see a big difference between fee for service and fee for this service instead of this one (value).

It is important to enter the debate and step out from the sidelines. I recently read about Continuing Medical Education wanting to be included as a Clinical Practice Improvement Activity.CMS Receives Hundreds of Comments to include CME in MACRA.

As a recovering CME professional aware of the heterogeneity of continuing education offerings from a relevance and quality perspective it makes me curious as to who will be guarding the hen house?

I haven't seen any of the high-ranking CME executives at the ISPOR Framework sessions, National Health Statistics conferences, Brookings Institution panel discussions, or meetings of the aforementioned physician led groups committed to improving the quality of patient care outside of the influence of strong industry marketing and funding.

Healthcare providers are going to need the support of an informed educational framework to help navigate the shifting landscape of market driven healthcare, single payer schemes, or public utility models (my vote)--wherever we end up.

Next post--the opportunity of the public utility model of healthcare.

Thoughtful discussions about content development and outcomes analytics that apply the principles and frameworks of health policy and economics to persistent and perplexing health and health care problems...