Michael Millenson | Northwestern University (original) (raw)

Papers by Michael Millenson

UNSTRUCTURED For those of us who believe deeply in a collaborative relationship between patients ... more UNSTRUCTURED For those of us who believe deeply in a collaborative relationship between patients and doctors, the chaos created by the COVID-19 pandemic has brought an uncomfortable question to the fore: Is participatory medicine still relevant during a pandemic? Drawing liberally upon the Jewish tradition of Talmudic reasoning, I would like to offer 3 considered replies: “Yes,” “no,” and “it depends.” Sometimes, patients may have no choice but to cede control to medical professionals, even though patients are still the experts on their own lives. Other times, the shared control of participatory medicine is both an ethical and clinical imperative. However, as the worldwide toll exacted by COVID-19 has made us grimly aware, no one is really in control. That is why, in these uncertain times, the path forward requires maintaining mutual trust between health care providers and patients, whatever the circumstances. After all, it is our bodies and our selves at stake.

This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jef... more This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been

There are three, and only three, ways to reduce the total cost of any good or service: pay less p... more There are three, and only three, ways to reduce the total cost of any good or service: pay less per unit; use fewer units; or improve efficiency and effectiveness so that less money and/or fewer units are needed to achieve the desired result. With trembling hands, the U.S. health care system is preparing to give the third method a serious try. Government-controlled systems excel at the first two options. They set global budgets, prescribe prices and proscribe pricy new technologies until there's tangible proof of need. The decisions about each individual's care may ultimately lie with clinicians, but government or government-funded intermediaries can place a heavy thumb on the scale. In this country, Medicare and Medicaid offer less-comprehensive versions of price and utilization controls through a kind of single-payer "light." The effectiveness of these strategies, however, is now facing unprecedented challenge. Were the draconian 24.4 percent cut to physician pay mandated by the Medicare Sustainable Growth Rate (SGR) formula for 2014 to go into effect, the program would be thrown into chaos. On the demand side, meanwhile, as many as 32 million Americans could enter the health-care system because of the Patient Protection and Affordable Care Act (ACA), upping national use of medical services at the same time aging Baby Boomers are doing the same.

Israel Journal of Health Policy Research, 2020

The scope of health information and health care services available online is rapidly expanding. A... more The scope of health information and health care services available online is rapidly expanding. At the same time, COVID-19 is causing vulnerable elders to reconsider in-person provider visits. In that context, recently published research by Y. Mizrachi et al. examining obstacles to the use of online health services (OHS) among adults age 50 and up takes on new importance. An iconic Israeli song begins, “Will you hear my voice?” (Hebrew Songs. Zemer Nugeh (Hatishmah Koli), 2020). What makes Mizrachi et al.’s findings particularly intriguing, despite several caveats, is the manner in which they demonstrated a commitment to genuinely listen to individual voices. The researchers spoke “openly and bluntly” with interviewees as peers and were rewarded with “specific, well-defined and applicable answers with the potential to be used.” The most striking findings came in candid answers that went beyond the factors intrinsic to the online offerings and addressed important factors in what regu...

Quality and Safety in Health Care, 2002

Effective public accountability in health care demands effective communication to the public. The... more Effective public accountability in health care demands effective communication to the public. The public release of healthcare performance information can easily turn into a media circus focusing on boondoggles and body counts. Michael Millenson, a former reporter with the Chicago Tribune who went on to become a health services researcher and author, reflects on the minor media storm that accompanied release of a study by the UK's National Patient Safety Agency (NPSA). Releasing public information on medical errors is a delicate task. Context—or, more cynically, what modern public relations practitioners would call “spin”—is critical. At one extreme there is the “bad is good” approach of The Doctor's Dream , in which the 19th century British physician William Snowden Battles gave this tongue-in-cheek confession of his shortcomings: And thus I dreamt that round me stood The victims of disease The patients I had failed to cure Though some had paid my fees. One said, “It is a h...

Healthcare

Although there is a widespread belief that ACOs must be patient-centered to be successful, eviden... more Although there is a widespread belief that ACOs must be patient-centered to be successful, evidence to guide them in achieving that goal has been lacking. This case report examines four ACO innovators in patient-centered care that together represent urban, suburban and rural populations with a broad range of economic, racial, ethnic and geographic diversity. Seven patient-centeredness strategies emerged: transform primary care practices into patient-centered medical homes; move upstream to address social and economic issues; use both high-tech and high-touch to identify and engage high-risk patients; practice a whole-person orientation; optimize patient-reported measures; treat patients like valued customers; and incorporate patient voices into governance and operations. Exemplars prioritized direct care interventions perceived as central to financial and clinical success, and organizational maturity played a role. Activities that decreased the traditional system's authority, such as incorporating patient voices, were less popular. Local practice factors were important, and a mixture of mission and margin energized front-line staff in implementing patient-centered care as "the right thing to do." Unresolved questions remain that are related to the impact of individual and multiple interventions and how successful interventions can be disseminated widely. In order for patient-centeredness innovations to enable transformation, providers, payers and policymakers alike must consciously adopt strategies that nurture it.

BMJ (Clinical research ed.), Jul 5, 2017

Genetic Engineering & Biotechnology News, 2012

Journal of Medical Marketing, 2001

Journal of General Internal Medicine, 2014

P atient-centered care" was anointed one of six aims for US health care in a 2001 Institute of Me... more P atient-centered care" was anointed one of six aims for US health care in a 2001 Institute of Medicine report that simultaneously unfurled a long list of its defining traits. The term encompassed "qualities of compassion, empathy and responsiveness to the needs, values and expressed preferences of the individual patient" while addressing "technical care and interpersonal interactions" within "a healing relationship." 1 A dozen years later, a 2013 IOM workshop sounded a strikingly different note. It recommended "strategies and policies at multiple levels to advance patients, in partnership with providers, as leaders and drivers of care delivery improvement through the protected use of clinical data, informed, shared decisions and value improvement." 2 Despite the leaden language, this shift signals significant progress. Behaviors formerly presented as ideals are being reframed to include measurable benchmarks such as one might see in a financial plan. The analogy is apt, since patientcenteredness is now deemed essential to transforming the $2.7 trillion health care system. As the IOM workshop put it: "Prepared, engaged patients are a fundamental precursor to high-quality care, lower costs and better health." The ongoing change from aspirational goals to operational ones in patient-centeredness can be seen in the "meaningful use" regulations affecting doctors and hospitals using health information technology obtained with federal grants. Even more significant, the Patient Protection and Affordable Care Act uses "patient-centered" 43 times and includes nine separate provisions requiring "patientcentered" quality measures. There are also references to patient satisfaction, patient experience of care, patient engagement and shared decision-making. This burst of activity and enthusiasm, while welcome, carries its own dangers. Distinct ethical, economic and clinical concepts have been cobbled together under the "patient-centeredness" banner. These separate ideas are sometimes complementary, but they can also clash. The central importance of a new kind of collaborative relationship between doctor and patient risks being lost in a blizzard of buzzwords.

Health Affairs, 1997

Sitting on my desk are two clues about the very differ-ent ways in which the American Medical Ass... more Sitting on my desk are two clues about the very differ-ent ways in which the American Medical Association (AMA) approaches the topic of quality of care. The first piece of evi-dence is a glossy, silver-colored cardboard folder with the AMA's name and logo tastefully ...

AMA journal of ethics, 2016

In October 1997 the book Demanding Medical Excellence: Doctors and Accountability in the Informat... more In October 1997 the book Demanding Medical Excellence: Doctors and Accountability in the Information Age provided a pathbreaking examination of the quality of American health care. In it I documented rampant medical error and the absence of evidence-based practice, highlighted the potential of electronic health records (EHRs), endorsed what is now called value purchasing, and showed how patients could exert more control over their care. Although the book suggested that transformational change was imminent, sixteen years later little has changed in some areas (medical error), while in others (evidence-based medicine and population health) change is only now gaining momentum. The exception is technology, where incentives boosted EHR use, and the Internet has made a vast array of information available to patients. Paradigm shifts are traumatic, and only recently has intense financial pressure made greater clinical accountability seem less painful than retaining the tradition of untrammeled autonomy. In hearing rooms and hospital hallways, the policy conversation is changing. This shift, though an unavoidable source of anxiety, nonetheless promises a genuine renewal of American medicine.