As you may know, our cofounder was one of five women in her medical school class.

She’s a tremendous doctor, bringing compassion, strong instincts, and impeccable skill to the challenging field of pediatrics.

But she didn't have it easy along the way. She certainly experienced gender bias (to put it lightly) over the span of years. She thrived despite challenging conditions around her, and became a leader in medicine.

So as I flipped through the New England Journal of Medicine recently, a chart caught my eye. It showed women as a percentage of matriculants in US medical schools -- from 10% in 1955 to about 50% in 2017. Which had me wondering -- is gender bias a thing of the past for women in medicine? And what does it mean for our teams that the percentages of male and female doctors are changing so dramatically?

In "Recognizing Blind Spots - A Remedy for Gender Bias in Medicine?" Loren Rabinowitz, MD looks at the question of how gender bias functions in medicine. She cites data, both personal and quantitative, demonstrating that despite the changing numbers, gender bias and even sexual harassment are common in the medical workplace for women. And, women are underrepresented in leadership positions in medical schools and hospitals.

That said, she also points to data showing the richness that women bring to the medical field. One study, for instance, shows that patients treated by female doctors have better outcomes than those treated by male doctors. 

In some ways, I notice that this changing landscape starts to make it feel like a competition for scarce resources among male providers and female providers. Does the growth of women in medicine -- past, present, and future -- come at a cost for men in medicine? It's a divisive question to ask, but I believe that it underlies many people's actions and is worth bringing to the surface.

My take? It’s in our interest to make sure that we don’t have a “zero sum” mindset. Women having a safe and respectful workplace for their practice of medicine doesn’t detract from men’s experience. In fact, strong medical teams depend on a diversity of opinions, experiences, and skill sets. And the truth is that our personal background (including race, gender, nationality, etc.) is big part of the experience and opinions that we bring to the table. When we create an environment that values these differences, rather than seeking to minimize them, our practice of medicine becomes richer and more nuanced.

Beyond just ensuring gender equity in medicine, I believe that it's important to look at the issue more broadly. Effective healthcare collaboration demands that we are respectful of all of the voices on our medical team. But this requires more than good intentions -- it requires that we have the appropriate tools to enable teams to truly collaborate, not just fit in with the hierarchy. If you don't use telemedicine for healthcare collaboration, I encourage you to think about what tools you do have to encourage the team to collaborate in all its diversity -- and in all its strength.

Population health initiatives are nothing new -- but I'll be the first to admit that I was floored by the results that some projects are getting, and this may aid our efforts toward coordinated care. 

As you likely know, population health initiatives are projects that look at the health of a group -- for instance the health of everyone in a state -- including the distribution of those outcomes.

CareOregon is one example -- a nonprofit that increases access to healthcare services for patients on Oregon’s Medicaid programs. As their CEO tells it, their goal is to make hospitals all but unnecessary by limiting the need for that kind of care.

The surprising results? Since it launched in 2011, CareOregon has seen a statewide 23% drop in unnecessary emergency department visits and admissions have decreased as well.

As providers, we may not be population health practitioners in name, but it's our responsibility to look at these determinants of health as well. And we've identified three crucial takeaways from population health that any provider can use.

CareOregon is a great example to look at when it comes to population health. It's broad-based enough to carry takeaways for all kinds of health initiatives. Its results have been substantial in a short period of time. And they've generously shared their initiatives and results so others can learn. 

4 Takeaways from Population Health That Every Provider Can Use:

• Focus on health, not just healthcare.
  For instance, with CareOregon, a child with severe asthma might be cared for with air conditioners or air filters -- not just medication or even emergency care. This full picture of the "social determinants of health" is something we're passionate about at ClickCare -- and a big reason that the case method of iClickCare is flexible, holistic, multimedia, and includes providers across the continuum of care.
  
  
• Value people -- including the patient and the family -- across the continuum of care.
  CareOregon focus on teams, not events. So whether that means a specialist, an aide, or even a professional outside of medicine, if it will help the patient's overall healthcare, it's part of the picture. As they say, "Sometimes protecting your health means we’ll help you find other agencies that can help you access non-medical support." They also prioritize improving teamwork and communication over advancing specific tactics to improve care. If the team is working well, the results will be good. Finally, they use a “bottom up, top-enabled” approach -- so that the folks who are in most contact with the patient are driving the care (the day-to-day providers), in ways that are enabled at the top (administrators). Valuing people strongly supports our belief that healthcare collaboration and coordinated care are also crucial initiatives -- and telemedicine is one way to make them practical, efficient, and easy.
  
  
• Use simple, inexpensive solutions. 
  This approach is about using technology to work smarter, not harder. Sure, videoconferencing telemedicine systems are fancy (and expensive) -- but we believe that the best medical camera is the one in your pocket already and that the technology should be deeply intuitive. Sophisticated technology doesn't need to be expensive -- and that usually means investing in software, not hardware that is rapidly outdated. 
  
  
• Look at holistic data.
  Fierce Healthcare quotes Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health of Human Services, as saying that we need to break down data "silos that prevent providers from seeing the full picture of a patient's, or community’s, health. Having the full picture allows for a 'system that wraps around people and supports them."  Electronic health records (EMRs and EHRs) are just one piece of the puzzle. All of the other parts of patient data -- that anecdote from a nurse, the self-reported weight changes, etc -- need to be taken into account in systematic ways. Sure, the data in EMRs and EHRs can be codified, but we think that a big reason that CareOregon has seen such dramatic results is because they use the data that helps, even if it's not able to be put into a spreadsheet.

We applaud the pioneers of CareOregon, and the work of every provider who has been courageous enough to try something new as part of it. 

Maybe your medical context is not one where these principles are being used -- but that doesn't mean that you can't apply them, even in small ways, today. 

And if you want a medical collaboration tool like iClickCare as part of that effort, try it for free:

There is a poll that came out recently, done by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. The poll looks at Americans' perceptions of their healthcare, doctors, insurance, and health. And the findings are surprising.

Two things, in particular, struck us about patient perceptions -- and they may indicate an important reframing of where the problems and opportunities in medicine lie.

1. Doctors are great, but the medical system is not working because of the gaps between doctors.

About 80 percent of Americans say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor. 

How to reconcile those dramatically different numbers? Our take is that patients recognize that the doctor that is caring for them is doing a great job. It is the system itself that people are struggling to navigate -- and the ways doctors collaborate and communicate with each other. NPR comments that difficulty in navigating the system, repeat visits, and the process of getting help is what patients dislike. 

2. Patients probably don't have a single provider who coordinates all their care.

Nationally, a quarter of adults say they do not have a regular doctor or health care professional who provides most of their health care when they are sick or have a health concern. 

When people do not have a medical home, providers have to be sharing that they know about patients with each other. Healthcare collaboration and active coordination of care becomes crucial in providing even basic levels of care.


To us, these findings point more than ever to care coordination as a huge part of what it will mean to improve medicine. Each provider may be caring for his or her patient in excellent ways -- but if we're not talking to each other, then patients can get lost in the cracks. 

Get our take on using telemedicine for care coordination and healthcare collaboration:

Last weekend, I visited Philadelphia to see my daughter. As I walked along one cobblestone street, I noticed a metal plaque with four interlinking hands on some of the oldest homes. It was familiar to me, and in reminding myself of the history of these placards, I realized something fundamental about the changes in medicine.

But let me back up. In fact, let me back up to Benjamin Franklin in 1752. In response to the horrific fires in the young city of Philadelphia, Benjamin Franklin put together a “contibutionship” to take care of rebuilding after the fires. Modeled after a London firm, policyholders of this contributionship formed a mutual insurance company to share burdens in the case of fire. A contributionship member placed a medallion or plaque on the house. When a fire occurred, the paid firemen raced to the scene and put the fire out. If there was no medallion, they watched the property burn. Of course, risk was managed: there could be no trees on the property of the houses with medallions.

Capitated care, managed care, accountable care are all built on the same principle. Benefits (care) are given, but risk is shared by everyone involved. The only difference is that there are a lot more middlemen and statisticians in the healthcare system. And rather than each member paying directly, the member pays taxes or a premium to the government or insurance company.

Management of that care involves finding a better way to decrease costs. Instead of requiring no trees on the property, healthcare management focuses on efficiencies and expensive outcomes. iClickCare focuses on both the quality and savings of coordinated and collaborative care. Everyone “at risk” -- institutions, providers and patients themselves -- can contribute to the outcome by safe handoffs, time saved, and decreasing waste.

The nearly unspoken caveat is that everyone must behave differently. Not only the providers need to change, the patients need to do so as well. An excellent commentary on that piece by Christensen, Flier and Vijayaraghavan is here.

So as these concepts become even more crucial for us all to move towards sharing the burden of disease, managing risk, decreasing costs, and providing good care, these are the definitions that will be crucial:

• Capitated care:  By the head. The payment for insurance to care for a member for a fixed fee per year.
• Managed Care:  Adding tools such as approvals for procedures, a panel of physicians, and occasionally rationing of services. Remember the rule about trees in the contributionship? HMOs have those kinds of provisions.
• Accountable Care Organization:  An organization which pays by capitation or fee for service, but adds penalties and rewards based on quality measures from the Centers for Medicare and Medicaid Services.
• Managed Medicaid:  A healthcare payment system by states which enrolls the poverty stricken in a capitated plan. Payments to providers can be fee for service or capitated.
• Prepaid Health Plans:  Same as above. Prepaid group practices developed from 1930 through 1960.
• HMO (Health Maintenance Organization):  A prepaid health plan but based on the Health Maintenance Organization Act of 1973. Payment for services is only made within the network of the plan after referral from a primary care provider.
• PPO (Preferred Provider Organization):  A prepaid heath plan in which the patient is able to make self referral within and without of the network of the plan.
• EPO (Exclusive Provider Organization):  A hybrid of HMO and PPO. The patient selects the provider without a primary care referral, but the care must be exclusively within the network of the plan.
• BPCI (Bundled Payments for Care Improvement):  Not prepaid, but retroactively paid services to groups of providers to force alignment of incentives. A managed care program with retroactive payments instead of prospective payments. 

When all is said and done, though, medicine should come down to a partnership with the provider and the patient. The doctor, the nurse, the aide and the therapist are a team with the patient and for the patient. Any system will only work when it is also really bought into by the patient. For as Benjamin Franklin said when referencing fighting fires: “an ounce of prevention is worth a pound of cure."

Tools like iClickCare can support a Managed Care system by improving the way that coordination and collaboration happen. See how iClickCare can work for your organization with a free 2-week trial:

There have been a lot of exciting articles recently about the advantages of replacing some in-person visits with telehealth visits.  

For instance, these stories on using telehealth services to cut costs and improve care have stood out to us as models: 

• Veterans have been getting telehealth appointments for services like therapy, enabling the VA to leverage capacity and allow some vets increased privacy and ease.
• Prisons are finding telehealth crucial in decreasing risks and cutting costs.
• This study found that telehealth visits costs $40-$50 per visit, as compared to $136-$176 for a conventional visit.

Because "telehealth services" are often defined as video conferencing, there is a gaping hole in the process. When the initial visit fails to get the expected results, it can actually end up less efficient for all parties.