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Turning an insider beat into a feature on ‘frequent fliers’ Date: 03/28/18

Arthur Allen

By Arthur Allen

In Washington, D.C., “follow the money” drives many beat reporters, including those like myself focused on the nitty-gritty details of an Obama-era health technology-program aimed at improving health through “meaningful use” and “value-based care.”

Congress, federal agencies, lobbyists and others are all very interested in where federal dollars are going and how policy is being shaped. As the editor for Politico’s eHealth, I report for them, and sometimes my accumulated knowledge allows me to churn out a larger tale for the wider public that goes beyond the beat into other drivers of health care. Recently, that resulted in The ‘Frequent Flier’ Program That Grounded a Hospital’s Soaring Costs, a 5,000-word feature that ran in Politico’s magazine.

So how exactly did I turn a techy-beat into a major magazine piece?

To rewind a bit: I owe my job to the Obama administration which, as part of the 2009 stimulus package, created a $40 billion program to incentivize hospitals and doctors to buy information technology — investments that health care providers and companies had been slower to make than other “industries.” To collect the funds, recipients had to show they were using the computer software it helped pay for “meaningfully.” In other words, they had to buy software that could measure, monitor and report certain health traits and benchmarks as part of the federal government’s nudge toward “value-based care.”

The “meaningful use” program (and the hair-pulling, lobbying and treasury looting that surrounded it  probably to no one’s surprise) helped give rise to Politico’s eHealth vertical, and thus my job. It also succeeded in getting the vast majority of doctors to use electronic health records instead of paper.

But it also upset a large majority of those doctors, who find the software expensive, clunky and responsible for robbing them of face time with their patients. And so health IT, like many other frontiers of technology has become, for a reporter, a schizophrenic experience. On a daily basis I talk with idealistic people who believe, or act like they do, in the promise of an efficient, automated, robotics-enhanced health care future. I also spend most days reporting on the real existing present of burned-out doctors and health care services that don’t seem to be improving much.

I report about electronic health record implementations that run over budget and infuriate doctors without saving money or making care appreciably better. And I receive thousands of press releases about the exciting new IT solutions that brainy engineers in places such as California, Boston and Minnesota are developing to craft patient data into meaningful patterns that will supposedly enable hospitals to focus resources on the sickest, and doctors to spend more time with them. Some of these IT solution might even work, and if I can, I visit places using them.

So, when Bill Duryea, the editor of Politico’s What Works series, approached me last fall with the idea of writing about something health-related for a series he was working on, I started hunting around for a tech project that was affecting health care across an urban area. As the name suggests, What Works focuses on urban projects that seem to be improving the lives of citizens. It wasn’t long before I stumbled upon Dallas-based Parkland Hospital’s effort to lower its unreimbursed care – more than $870 million in 2016 – by finding food, shelter, jobs and transportation for the hundreds of people who spend up to a third of their nights at the hospital every year because they have nowhere else to go.

I spent a week traveling around Dallas, interviewing doctors and administrators at Parkland who every day take care of hundreds of people who would be better cared for if they had money or if the social net provided them with better services. I spoke with some of Parkland’s patients and with staff at homeless shelters, food banks, pantries and job training centers that cater to those same people.

A nonprofit that spun out of Parkland, and a private tech company that spun out of the nonprofit, were building an electronic case management system to allow hospital staff to communicate with the food banks and homeless shelters to find out when their patients were visiting them, what kind of services they were getting, even the varieties of food they were choosing from the pantries. An early pilot showed that by focusing on people with severe diabetes or hypertension, the system could reduce emergency room visits. The software gave people at the shelters, pharmacies and pantries a window into whether people were getting the medications they needed, whether they had housing and whether they were eating fairly well.

The system was “a little big brotherish,” in the words of one patient I spoke with – but he didn’t experience it as Orwellian. Rather, he said, he felt that someone cared enough to look out for him.

I reported out the story in painstaking detail without really knowing whether the hospital’s program will last or help improve patient’s health in the long run. Parkland isn’t the first big health care center to attack the “social determinants of health,” although this might be one of the most tech-healthy assaults on the problem. But whether the health care system can carry millions of people on its shoulders while the rest of the social system struggles remains to be seen.

Arthur Allen edits the eHealth vertical for Politico. The author of three non-fiction books on science and health, his work has appeared in The Washington Post, The New York Times, Global Health Matters and Science among other publications. He previously worked for The Associated Press for more than a dozen years with postings in several countries.