Thursday, December 14, 2023

Opining on the "Top."

In the past few days there have been multiple posts in my LinkedIn time line by health care systems celebrating their inclusion in the "Gartner Healthcare Supply Chain Top 25 for 2023."

About five months previously Gartner had a post related to their changing their measurement methodology for this recognition by adding an ESG (environmental, social, and governance) component. At the time I took a quick look at their methodology, and was surprised to find that it did not seem to include any supply chain related KPIs. I commented on the entry, but it did not receive any response at that time and I forgot all about it.

Seeing all the recent entries on this topic reminded me of this, so I went back to view the methodology that was used to come up with the "Top 25" list:

The various components included:
  • Alignment to Quality of Patient Care (20%): This is listed as being based on IBM Watson Health Top 15 Health Systems Study. Further search on Merative (Watson Health had been divested by IBM in 2022 and spun-off to a private equity firm, Francisco Partners, that renamed the company Merative) indicated that the measures used here included: risk-adjusted inpatient mortality, risk-adjusted complications, healthcare associated infections, 30-day mortality, 30-day readmissions, severity-adjusted length of stay, Medicare spending per beneficiary, adjusted inpatient expense per discharge, and overall HCAHPS patient rating.
  • Financial Performance (15%): Here they used S&P bond rating as a proxy.
  • Alignment to Environmental, Social, and Governance (5%): This was measured by the organization belonging to the Healthcare Anchor Network ("a growing nation collaboration of 70+ leading healthcare systems building more inclusive and sustainable local economies"), providing supplier diversity data to the HAN, and signing the HAN Purchasing Impact Commitment. A set of laudable goals no doubt, but not really any measurable results to demonstrate leadership in any ESG areas of focus!
  • Community Opinion (60%): 30% each from a 'Gartner analyst panel' and a 'Peer panel.'

Now while supply chain will have some impact on most of the actual measures used that are listed above and account for 35% of the ranking ratings, these are rather indirect measures of supply chain effectiveness, efficiency, and impact to the organization. Using this logic these measures could as well be used to rank the healthcare systems by their revenue cycle, by clinical staffing, or by a whole host of other inputs!

Additionally, odd for a supply chain ranking, no supply chain-specific measures or KPIs are included. For example none of the twenty-nine 'Health Care Supply Chain Metrics and KPI's' listed by AHRMM are used.

What is left? 60% Opinion. Even if this opinion is all qualified as "expert" (which would seem to be a stretch), it it still opinion! And this is not the strongest foundation to build on; for example it would seem to me to have an inherent bias in favor of much larger systems!

OK, so there are numerous ratings systems in health care, for example the U.S. New and World Report annual ranking, the Leapfrog Group ranking, etc., etc. And, almost always, their methodologies usually start off on the rudimentary side before being 'beefed up' and further developed. Not the case here as this is Gartner's 15th annual listing!

So, who is hurt by this ranking? No one really, so it's not like this is the end of the world. And, truth be told, the organizations listed are all great organizations and they may well be doing amazing things in their supply chains! However, Gartner may be overlooking other (perhaps smaller) supply network exemplars that may be doing great work and should be lauded and emulated. And this ranking provides no benchmarks that others can use to improve themselves, unless of course they sign up as Gartner clients!

P.S. I hope I'm not being petty by pointing out that Gartner actually believes strongly in metrics and KPIs itself, apparently just not in this specific case.

P.P.S. Also odd given the inputs, the Composite Score runs to two decimals!

Tuesday, December 12, 2023

Biological Age Testing II

One's chronological age is how long one has been alive, while one's biological age is the age of your cells and systems based on physiological information. The two ages may be the same or they may also differ, sometimes significantly.  Your biological age is effected by your genetics and by environmental factors such as stress, exercise, diet, sleep, and other factors. Biological age is a better predictor of  possible disease and death than chronological age. 

Biological age determination is now readily available, so I decided to give it a try when I first read about it almost four year ago.  Here are some good introductory articles on biological testing, focused on Elysium Health's process:

Aging clocks aim to predict how long you'll live

I found out my biological age - and was annoyed by the result

A test told me my brain and liver are older than they should be. Should I be worried?

Elysium Health's Index ($299): (link)

When you place an order online they send you a kit that you can use to return a saliva sample. Elysium then extracts your DNA and analyzes DNA methylation across your genome to calculate your overall biological age. They now also determine the biological age of various systems in the body (brain, liver, metabolic, immune, hormone, kidney, heart, inflammation, and blood), and also provide science-based lifestyle recommendations. 

I first did Elysium's Index Jan 2020, followed by repeating testing in July 2022 and September 2023. As you can see the results were internally consistent over the years, with my biological age running at approximately 90% of my chronological age. Initially Elysium only provided the overall biological age; however, they subsequently refined their process and began to also provide the biological age at a system level. Previously I had felt pretty satisfied with my results since I appeared "younger" than my chronological age; however, when I received the additional detail I was taken aback that the picture wasn't that positive, especially the 'brain' result!

My state of mind wasn't helped by running across this article, 'Higher Biological Age May increase Stroke and Dementia Risk' which found:

I posted the Biological Age Testing entry, and resolved to follow some of the (somewhat general) recommendations. I purchased a Whoop 4.0 to track and improve my sleep, as well as to significantly increase my activity and exercise levels. To 'exercise' my brain I now conscientiously do brain puzzles (including the NYT's Wordle, Connections, and Spelling Bee ) every day, and have signed up with Babbel to learn a new language while also brushing up my French, Spanish and German (all very rusty with disuse!).

Biological age testing appears to have come into its own, and there are a multitude of companies offering this service, each touting their methodology (DNA methylation, telomere length, etc.) and scientific expertise. I decided to try two other companies to see if they would validate my Elysium Health estimates. 

Thorne ($99): (link)

Once you purchase the test you first complete an online questionnaire. Then then provide you a lab order that you will have to download and take to a local Quest Diagnostics branch to provide a blood sample. Quest provides you a full blood work-up in a day or two, and a few weeks later you get your results from Thorne. They use "multi-omic testing, artificial intelligence and machine learning to create an in-depth and accurate picture of your biological age." You will receive your overall biological age; your blood, kidney, lipid, liver, and metabolic ages; and information/recommendations related to diet, exercise, lifestyle, and supplements.

MyDNAge ($299): (link)

When you buy the test they send you a kit that you use to send them a (very small) blood sample. Their analysis methodology is based on Dr. Horvath's epigenetic clock - they analyze "DNA methylation patterns of over 2,000 loci on the human genome" and provide your overall biological age,  your epimetabolic index, information on your APOE and MTHFR genes, as well as information that can be used to improve your health and wellness. 



So, how do the results stack up? I have to say that when you compare results for common items (each test yields results for different sets of items!) they're not very consistent at all!  For example, the estimates of my overall biological age range from 58 to 71!  When you consider the granular system numbers, of  systems reported by Elysium and Thorne, they show significant differences for three of four systems. 

OK, these significant variances would seem to undermine the validity of all of these results, so I am unsure how to take this. Unfortunately there seemed to be some concordance related to the brain results -  Elysium's brain age estimate along with the 'Higher Biological Age May Increase Stroke and Dementia Risk' article created some concern about potential dementia and Alzheimer's. This was accentuated by the APOE gene results from MyDNAge  ("Having one APOE e4 gene increases your risk of developing Alzheimer's disease two- to three-fold."

Hmm, I guess time will tell!