I always say that I have the best job: I get to talk to smart people doing really interesting work. I have met dozens of entrepreneurs this year. There is amazing work going on around the country with payment reform, price transparency, nanorobots, incredibly early detection of cancer and sensors that can measure any biometric data you want to track.
Three people stand out in my mind, though: Kathy Richard, Larry Galluzzo, and Dan Hogan. These people are taking on the problem that no one wants to face: dying. So many people are excited about Calico – Google’s live forever project. These “cheat death” projects are misguided and arrogant. Why spend money and time and smarts on living forever when there are so many people we can help right now?
This year – the last 18 months really – has been rough for my family. My grandmother died in July 2013, my brother-in-law’s father died in August, my father died in January of this year, and my father-in-law died this August.
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My aunt said, “It’s not death that is so hard, it’s the process of getting there.”
This Thanksgiving, I want to recognize to these three people who are focused on helping people make this final part of life less painful and less frightening. They are each using clinical data to make emotional and wrenching conversations and decisions about death and dying easier.
Making the hospice decision
I didn’t meet Dan Hogan, the founder of Medalogix until this summer, but I wished with all my heart that my dad’s doctor could have used his company’s software to analyze my dad’s condition and help our family talk about hospice care. The original purpose for the analytics software was to spot people who were at high risk for readmission. But then clients asked for help understanding when to recommend hospice care. Hogan used to run a home health care agency, so he knows how end-of-life care works.
Once the software has identified a person who may be ready for hospice care, the conversation starts with a nurse, and a doctor has to sign off on this option as well. Then the conversation starts with the family.
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Health systems have spent billions on portals while investments in modernizing the voice channel — the dominant preference of healthcare consumers — have taken a backseat.
“This is never going to be the end point in the evaluation process, it is designed to begin the discussion,” Hogan said. “The will to live, the human spirit is the greatest factor in longevity, and we can’t calculate that.”
What a risky move it was to launch this tool. I could hear yelling about death panels when I spoke with Dan in June. I could hear how hesitant he was to make this tool publicly available.
“We did some soul searching, it’s not a big leap mathematically, but it’s an enormous leap cognitively and ethically,” Hogan said. “If we are wrong on readmissions, it only means an extra nursing visit, but if we are wrong about death, we have caused the patient to have a very difficult conversation.”
Hogan said he struggled with how to present this new tool in an ethical way. The software is only part of a bigger product.
“We worked with a medical ethicist at Vanderbilt University and took three and a half months to build a very comprehensive training program,” he said.
It was really hard to understand how my dad talked about his health. He had pulmonary fibrosis, which is fatal (although a new treatment was just approved this year). He was a chemist and built nuclear power sources for satellites. He was capable of understanding his diagnosis. But he couldn’t accept his mortality or talk about it at all. When his lung doctor approved hospice care for him, he felt like he was getting a good deal because the provider would bring in a hospital bed and give him free Ensure.
“Hospice doesn’t mean what you think it does,” he said.
If my Dad’s doctor had had access to Medalogix’s analytical tool, it could have made the last few months of his life easier. It would have it easier for he and my mom to make decisions about in-home care or nursing home care. It would have made it easier for me and my sister to talk with him about his health and his mortality.
The reality is that doctors are as uncomfortable about death as the rest of us are. It makes them uneasy and uncomfortable and they certainly don’t want to talk about it. My mom had to learn to decipher the coded messages my dad’s doctor was sending about his faltering health, because the pulmonologist couldn’t speak plainly.
Getting meds right with pharmacogenetic testing
Deciding to accept hospice care is a big step. Getting pain management right is the next big challenge for people at the end of their lives. Two companies in Ohio are using pharmacogenetic testing to make sure dying people can rest as easily as possible.
I didn’t know anything about this testing until earlier this year when I met, Kathy Richard, the chief clinical officer at ViaQuest. The company provides this specialized service to all hospice patients who agree to the test. The goal is to make sure pain medications are working.
“The current prescription method is guess work and often we are with patients who can’t communicate pain level,” Richard said. “The genetic piece narrows it down for us to get the best dose.”
I also spoke with Larry Galluzzo, the CEO of Skilled Care Pharmacy. His company provides drugs to nursing homes and other care facilities as well as medication reviews for residents. This year he started working with Assurex Health to provide pharmacogenetic testing to nursing home patients. His goal is to make sure patients are on as few medications as possible.
“I’ve had people tell me, ‘You’re losing revenue by taking people off drugs,” he said. “But this is about respect for the older generation. You do what you have to do to make sure the resident is taking only the meds they absolutely need to take.”
When doing medication reviews, Galluzzo’s consultants look at physician orders, talk with nurses, check lab results and interview the resident if possible. The consultants recommend pharmacogenetic testing if appropriate to determine whether anti-depressants and anti-psychotics are appropriate for a patient.
“We’ve been very successful in reducing the amount of meds and reducing cost,” he said. “We haven’t done any studies on it but we’re pretty sure we’re reducing readmissions for the elderly living in institutions.”
[Thankful image from flickr user Nakeva Corothers]