The Health Care Blog

UnitedHealth trying to regroup for an uncertain future

By Matthew Holt

In an attempt to put that messy options back-dating business behind it, yesterday UnitedHealth Group settled with CalPERS (the ever vigilant pension fund of California state employees) and other class action suit members. And they settled for a bunch — $985 million. That’s even more than ex-CEO Bill McGuire gave back in his long running attempt to apologize without admitting criminal liability. Although, of course, United’s stock is down so much from the halcyon days of 2006 that it would require me to take my socks of both feet to work out if McGuire’s remaining options are worth anything these days!

Meanwhile, the CEO of Brocade is in jail (or may be out on appeal, I’m not sure) for back-dating options that helped his employees — and hurt his shareholders. Yet, McGuire (and for that matter Steve Jobs) seem to my untrained eye to have done the same thing without severe consequences. I’m still baffled.

United’s business seems to be heading into more trouble. Profits are down, lay-offs are up, and overall membership is down. More people and employers can’t afford health insurance in a weakening economy. And don’t forget total enrollment in commercial employment-based insurance plans fell during the most recent economic expansion!

The only logical rescue comes from an expansion of government plans. But there’s of course the little issue of how much they get paid for those government plans! The long-term question is whether they will lose more on the Medicare Advantage roundabout under the next Administration than they make up on any universal health care swings.

UPDATE: Wall Street didn't like it too much. UNH is down 9% today

Healthcare Unbound, and HHS Genomics Workshop

By Matthew Holt

There's lots of activity coming up next week. Matthew Holt will be at a star-studded workshop about personal genomics put on by HHS in Washington DC Monday afternoon. Details are here and if you can't get there you can see the webcast.

Meanwhile, the Healthcare Unbound Conference is having a session on Monday afternoon in San Francisco about Health 2.0. David Kibbe is the moderator, and our very own Indu Subaiya is on the panel with Adam Bosworth (ex-Google, now with Keas) and Cris Ross from CVS MinuteClinic.

THCB is proudly sponsored by

THCB UPDATE

If you haven't had a chance to sign up for THCB UPDATE yet, you really should. You'll get a helpful reminder email from us a few times a week when important posts go up on the site. In the two and a half six months since the service launched more than 700 1,000 1,200 1,300, 2,000  people have signed up, thoroughly surprising me. I've pledged not to divulge any details about the people who sign up, but I can tell you that list reads a bit like a health care who's who. Go on: It's free. It's useful. And people seem to like it. Go visit the sign up page.

MARKETPLACE: Patient safety barbecue

LeapforPatientSafety.org is hosting a patient safety barbecue in Aiken South Carolina July 4 to commemorate Patient Safety Day. The organization also has an online petition requesting increased protection for physicians who complain to hospital administrators regarding poor quality patient care.

Mitigating interference between electronic medical devices

By John Halamka

Last week, JAMA published an article about the risks of active and passive radio frequency identification  to other hospital equipment.

The Associated Press and ABC News issued major stories about it.

Although the study focused on RFID tags, the issue is more generic. Electronic Magnetic Interference (EMI) is generated by many devices including cell phones, laptops, and microwave ovens. Such devices emit RF energy which may interfere with the operation of sensitive electronic components used in medical equipment. The interference may be frequency related (signal jamming) or cause the device to fail because a chip or wire is exposed to too much energy from an emitting device. The very best defense is to have adequate shielding for medical equipment. It's inconceivable that hospitals can keep patient care areas free of RF emitters. Thus, it is important for hospital clinical engineering departments to be  vigilant in identifying potentially unsafe devices.

Continue reading "Mitigating interference between electronic medical devices"

AMA and AHIP go head to head with TV ads

By Sarah Arnquist

The American Medical Association this week began a television ad campaign, lambasting Republican Senators who failed to prevent the July 1 automatic 10.6 percent Medicare physician fee cut.

In the one-minute ad, AMA President Nancy Nielsen says, "A group of Senators decided it was more important to protect the health insurers than seniors."

Just as Robert Laszewski predicted here last week, the doctors are coming out in full lobbying force.

But wait. The Association of Health Insurance Plans is also running ads filled with nice looking seniors saying that to protect seniors Congress must protect the Medicare Advantage program.

Who is a senior taking 10 prescription medications for six chronic diseases with a calendar full of doctor's appointments to believe?

Here are the ads.

Continue reading "AMA and AHIP go head to head with TV ads"

Health 2.0 San Francisco

October 22 - 23 | The Marriott, San Francisco

Pricing - Full Agenda - Register Me!

Building on the excitement generated by the first two Health 2.0 conferences, Health 2.0 User-Generated Healthcare promises to take the conversation to a new level across an even more dynamic and panoramic landscape. Come see how at Health 2.0 User-Generated Healthcare on October 22-23rd 2008 in San Francisco.

Confirmed speakers include leaders from Google, Microsoft, Yahoo!, WebMD, AthenaHealth, A.D.A.M, Healthgrades, Healthline, Sermo, Daily Strength, Patients Like Me, DestinationRx, HealthCentral, Organized Wisdom, 23andMe, and many more. You'll meet insiders in the field and learn how these new technologies are transforming - and in some cases not yet transforming - the way the healthcare industry does business.

You'll see action-packed demos of new services and tools on the horizon and have a chance to network with more than a thousand other healthcare and tech industry professionals at the Marriott San Francisco.

Register Me!!

To register and for more details on rates and the conference agenda, click here.

Conference highlights include...

The Future of Health 2.0

Indu Subaiya, MD/Matthew Holt

Three Health 2.0 CEOs

3 CEOs from businesses transforming, and being transformed by, Health 2.0, talk about the future. Conversations with AthenaHealth's Jonathan Bush, Kerry Hicks of HealthGrades and Sermo's Daniel Palestrant.

The Consumer Aggregators — One Year On

Jane Sarasohn-Kahn reviews a major year of product introductions and controversy. Conversations with, and demonstrations from, some of the big consumer aggregators including Google, Microsoft & WebMD. Look for special guests and some interesting partnerships.

Keynote: "Health" Comes Everybody

New media pioneer(ing) pundit Clay Shirky gives a new health-related talk.

The Business Case for Health 2.0

How will today's obvious social value and consumer enthusiasm be turned into revenue for sustainable businesses? Scott Shreeve will head a panel talking to payers, employers, pharma, and government. He'll ask who will be writing the checks, and for what?    

Search in the Long Tail & Intelligence in Communities

Much of the promise of Health 2.0 is in searching for and finding exact personalized health information content, especially for rare or hard to categorize conditions. Much of that information is in social networks. Matthew Holt and Indu Subaiya will introduce a new framework looking at the evolution of search into the long tail. There'll be demonstrations of search and social networks, and reaction.    

Health 2.0 Across America

David Kibbe (with a cast of thousands) reflects on his Great American Health 2.0 Motorcycle Tour where he found new developments in Health 2.0 across the country.    

Getting Past the Privacy Conundrum

The Markle Foundation's Josh Lemieux leads a discussion about how the issues of privacy, confidential and security will impact consumer confidence in Health 2.0. But more importantly, we'll be demonstrating several solutions designed to get us past the privacy conundrum.    

Breakout Demos

There's so much happening in Health 2.0 that we're taking a deeper look at specific technology and business segments in a series of demo-based break-out panels.  

• Patient Social Networks
• Online Identity and Privacy
• Content, Navigation & Advocacy
• Provider Directories, Search & Rating
• Vertical Search
• Clinician Social Networks
• Wellness 2.0
• Genomics Online
• Identity, Security & Confidentiality for Health Online
• Pharmacy & Pharma
• Managing Money in Health 2.0
• Health 2.0 for ElderCare
• Gaming in Health care
• Disease Management 2.0
• Telepresence, Virtual Visits and Provider Communications    

Health 2.0 Unconference

An unconference is a meeting where the participants drive the activity. There's no set agenda, no set presentations, but rather a series of discussions that people leave and join as they see fit. Topics at last year's conference included Social Media and the pharmaceutical Industry, Legal Issues Facing Health 2.0 and more.    

Sign up now

To register for a pass and to learn more about the conference agenda click here.    

Sponsorships

For details on exhibiting and opportunities for sponsors, please contact John Pluenneke of the Health 2.0 business development team. He can be reached at 415.315.9568 or by email at john@health2con.com.    

Staying at the Marriott

We've worked out a special deal with the Marriott to make rooms available at the special low rate of $239. To reserve your room, visit Marriott.com or call 1-888-575-8934. Be sure to mention the reservation code HEA or the Health 2.0 conference when you call.

THCB welcomes our latest sponsor ...

We need to take some changes to change health care

By Charlie Baker

Charlie Baker is the president and CEO of Harvard Pilgrim Health Care, Inc., a nonprofit health plan that covers more than 1 million New Englanders. Baker blogs regularly at Let's Talk Health Care.

One of the reasons the operating model in health care doesn’t change much over time is pretty simple: most of the people who think about it, write about it, work in it and study it have trouble seeing the model any differently than they see it today. I was struck, therefore, by Hebrew Senior Life’s Len Fishman the other day when he and I served on a panel at the 30th annual meeting of the Massachusetts Health Data Consortium. We were told to discuss health care 30 years from now — me from the plan perspective, and Len from the long term care perspective. I went pretty far out there in my remarks, imagining, among other things, a world in which there were no health plans at all(!). Len did too. His presentation on the future of long term care could not have looked more different than what we have today. He literally re-imagined the whole thing. It was startling — and refreshing.

This question — is the future just like the past, or something different — was raised again for me earlier this week when Brian Rosman — a good guy with whom I almost never agree — posted a blog on the Health Care for All Web site that basically said that more publicly available information on health care cost and quality could/might/will lead to higher costs and higher prices, because no one really cares about costs, and if they do, they’ll flock to higher cost options, because they’ll think they’re better than lower cost ones.

Continue reading "We need to take some changes to change health care"

Consumer genetic movement: Cease and desist? How about understand and resist!

By Scott Shreeve

I have been following health care consumerism for several years now. Particularly, the “Direct Access” or “Direct To Consumer” laboratory testing market. While analytic lab testing has led out in this area, genetic testing has received all the regulatory attention, national press, and policy efforts (GINA).

So it is no surprise that consumer genetic movement would be the first legal test of the Health 2.0 movement. As reported by Matthew Holt here on THCB, and a host of national outlets (Wired has had extensive coverage here, here, and here), there seems to be quite a hornets nest unleashed by our friends at the California and New York Departments of Health who are attempting to prevent consumers from accessing their own genetic information.

Thanks to some transparency efforts of the blogosphere, you can read the actual cease and desist letter written by Karen Nickels, the California Department of Pubic Health Chief of Laboratory Field Services. I actually know Karen Nickels personally. She has been a long time steward of ensuring regulatory exactness of all things laboratory within the State of California for 30+ years. She has a well deserved reputation as one tough cookie for the “precision” with which she carries out her duties

Ultimate Genetic Fighting - Which Genetic Variation Wins?

Continue reading "Consumer genetic movement: Cease and desist? How about understand and resist!"

THCB is underwritten by Overlake Medical Center

Overlake Medical Center is a 337-bed, nonprofit, state-of-the-art medical facility equipped to deliver the highest standards of medical care to the Puget Sound Region.  Overlake is seeking primary care and specialty physicians to join our growing network of clinics located in the prosperous Eastside area across Lake Washington from Seattle.Click here to learn more. THCB thanks Overlake for it's support!!

Docs get mad, 2.0 style, at Sermo

By Matthew Holt

Of course, it's not just cornering a Senator at July 4th picnic that changes policy. These days there are online communities doing it too. And with increased grumpiness among many doctors, and now the almost-here-rather-than-looming-on-the-horizon cuts in Medicare, you can expect a response online. And here it is: Fed up Sermo docs draft manifesto. Yup, those docs hanging out on Sermo are not just discussing clinical cases, they’re on the verge of getting politically active. As you might expect, they’re pissed off with insurers, the government and lawyers. And who could disagree? (I know, I know it’s more complex than that….)

Never one to miss a trick, Sermo has allowed itself to be used as a vehicle for the open letter that’s going to get much more publicity (and yup, as a doc you have to sign up for Sermo to sign the letter, to verify that you are a doc!). Here’s the site called Doctors Unite.

Every other form of political activism has moved online, so don’t be surprised to see more like this. Of course, if the details get specific, it’s tricky to know whether the coalition of pissed off docs will hang together, and also whether Sermo will become type-cast as representing a particular flavor of doctor (see: Medical Association, American) which may somewhere down the road limit its business initiatives. But for now, it’s fun to see online organization get serious in health care.

Matthew's top podcasts this year

By THCB STAFF

The Health Care Blog is working hard to bring readers more excellent content, but the downside of that is great posts and podcasts quickly get buried. Here's a quick list of Matthew's top podcasts this year.

Interview with Kerry Hicks, HealthGrades CEO By Matthew Holt

HealthGrades has been busy. The publicly traded, pure-play provider ratings company is changing the way it offers ratings, it's publishing a book, and it's starting to rate drugs. It's not alone. Last week, Consumer Reports announced it also is getting into the business of rating hospitals and using a model developed in conjunction with the Dartmouth crowd. Plus, there's the CMS effort. Given the way that ratings are evolving and HealthGrades' partnership with Google, (more to come on Google from me separately soon) last week was a great time to talk with HealthGrades Chairman & CEO Kerry Hicks. (Sadly it was before the Consumer Reports announcement but fascinating nonetheless). Listen to the interview.

Kaiser tiptoes into HealthVault & tells THCB about it By Matthew Holt

Kaiser Permanente signed an extensive pilot with Microsoft, allowing its 159,000 employees to copy their online health records into HealthVault. This is a big coup for Microsoft and a fairly ambitious move for KP which to this point hasn't said much publicly about the data transferability it was going to provide for its members. This is a clear signal. Assuming that the pilot is a success, presumably all Kaiser members using My Health Manager (over 2 million now and heading to 3 million at years end) will soon be able to move their data to HealthVault. We are potentially seeing the first real example of mass scale data interoperability onto a platform not connected to a health care organization. And obviously, Google is playing in this same space too. Kaiser gave me a pre-release interview with with Peter Neupert, Corporate VP of Microsoft Health Solutions Group and Anne-Lisa Silvestre, VP of Online Services at KP. Listen to the Podcast.

The Long Baby Boom By Matthew Holt

I had a great chat with health care futurist Jeff Goldsmith about his new book, the Long Baby Boom. We discussed the policy and cultural issues of retirement, Medicare, Social Security, immigration, end-of-life care and meaning... Listen to the podcast.

Caring.com & Trusera -- two Health 2.0 newbies talk By Matthew Holt

Two of the more interesting newcomers in the Health 2.0 scene gathered around the electronic water cooler, which is THCB's podcast series, to talk about what they're up to and why they are worth looking at. Andy Cohen is CEO of Caring.com and Keith Schorsch is CEO of Trusera. Some of you may have seen Keith at the March 2008 Health 2.0 Conference. Andy is providing content checklists and much more for those who have sick or frail parents, which will be most of us. Keith is providing a sophisticated place for story telling and information exchange for those facing serious health conditions. Both have serious ambitions. Interesting stuff -- listen to the podcast.

Continue reading "Matthew's top podcasts this year"

Google Health and the PHR: Do Consumers Care?

By Keith Schorsch

Google Health’s unveiling last week and Microsoft’s HealthVault launch last October are important milestones in the evolution of Health 2.0. Both of these heavyweights have the resources and potential to improve the health consumer’s customer experience. I have followed the active (and important) conversations about privacy concerns, HIPAA, and Google Health’s terms of service, which are well represented by Erik Schonfeld’s post on Techcrunch and Larry Dignan’s post on ZDnet. And I read with interest Google’s rapid response offered by Google Senior Product Counsel Mark Yang.

What’s missing from all of these conversations is the elephant in the room: Do consumers really care about having online personal health records?

Continue reading "Google Health and the PHR: Do Consumers Care?"

Dispatch from India: Private sector responding to new health care consumers

By Jay Srinivasan

Editor's note: The current issue of Health Affairs released next week focuses on health care in India and China.

As with most parameters within the Indian economy these days, the health care industry is huge but that doesn't tell you much.

The fact is that health care in India is a broken system whose fault lines are fast being papered over by the rapidity of change, influx of big capital, drive of entrepreneurship and the relative ease of staking positions and targeting opportunity in an economy on fire. Combine that with the government's involuntary relinquishing of idealistic heights due to resource constraints and its abysmal record and you get an industry that is overwhelmingly in the hands of the private sector. Maybe the private sector can redeem the industry after six decades with little to show by the government.

Continue reading "Dispatch from India: Private sector responding to new health care consumers"

The Feds' strange love-hate relationship with health IT policy

By David Kibbe

With less than loud fanfare -- barely a peep, really -- the Office of the National Coordinator for Health IT (ONC) finally last week released its ONC-Coordinated Federal Health Information Technology Strategic Plan.

The plan is more than two years overdue and came only after scolding from a Government Accountability Office report in 2006 and an internal, semi-secret review of ONC's doings by the Institute of Medicine late in 2007. The IOM criticized ONC for the lack of a viable strategic road map almost four years after President Bush's call for interoperable health information technology and personal health records. A lot has happened since 2004 in this area, though you'd hardly know it reading the ONC Plan.

ONC is a top-down, heavily bureaucratic, large-medical-enterprise-centric, and large-IT-vendor-led juggernaut that has always been out of touch with what goes on down on the ground where consumers, patients, nurses, and primary care doctors live and work.

Continue reading "The Feds' strange love-hate relationship with health IT policy"

Using virtual reasoning to redefine health care

By Marlene Beggelman

Dr. Marlene Beggelman is the CEO of Enhanced Medical Decisions, which is the company behind DoubleCheckMD.com.

The Internet is redefining the health care industry. Major transformations can be expected because Internet-based technology will deliver certain health care services more effectively and at lower costs. In the near future, much of the information that is currently imparted to consumers by clinicians will be delivered through and by web-based technology. If the web-based tools that deliver this information mature to the point of becoming reimbursable, beyond their current usefulness as value add-ons, the health care industry could experience a dramatic shift.

Continue reading "Using virtual reasoning to redefine health care"

Recent deals in Health 2.0

By THCB Staff

MedHelp and HealthCare.com, Inc., a provider search service, recently got together and announced a new version of HealthCare.com's private-label provider search. To learn more go here.

Meanwhile, talking of Health 2.0 standouts, Organized Wisdom which seems to have been around forever but is in fact only about two years old, recently raised a series of about $2m from ETF Venture Funds and some angels, including Esther Dyson.

Today's news today, doctors, Peel, and individual insurance

By Matthew Holt

I just noticed that THCB today is all about last week and Sunday’s news—including Merrill Goozner and me jumping separately on the same magic quote in the NY Times CT piece. So how about three little pieces of news about stuff reported today.

First off, in a desperate attempt to keep the Republicans from losing all 33 Senate seats in November, CMS is freezing the cuts in Medicare fees which were due to go automatically into effect this week. Bob Laszewski has a just excellent explanation of how the Dems finally seem to have figured out how to play hardball with the Republicans and AHIP. Perhaps they’ve taken on Tom Delay as an advisor, now he’s not so busy. Meanwhile Bob thinks that the 7 missing Republican votes will return from July 4 and the Medicare Advantage and PFFS plans will get their comeuppance. Wall Street isn’t so sure, and those health plan stocks are trading higher today.

Continue reading "Today's news today, doctors, Peel, and individual insurance"

A classic from a cardiologist

By Matthew Holt

The NY Times has a long piece on the fast spread of 64 slice CT scans and their using in cardiac imaging. This is all pretty much taken straight from Shannon Brownlee's fabulous book Overtreated which has a whole chapter on the topic. But it's good to get the debate out there.

It appears that essentially there’s no real reason to use these scanners for the vast majority of patients. And in fact they’re use probably leads to more unnecessary angioplasties and stenting (which in itself doesn’t seem to reduce the number of heart attacks). But of course once a practice buys a 64 slice CT it’s an ATM machine sitting in the corner—not much good if you don’t use it, but very profitable if you do. Of course, the more conservative approach gets short shrift and those waiting for evidence to justify all this spending get ignored in the rush by both doctors, hospitals and manufacturers to get at the taxpayer’s coffers.

I was though vastly amused by this quote from an Manhattan cardiologist which will bring joy to the ears of those fuddy-duddies in the pay for performance movement:

Cardiologists like Dr. Brindis hurt their patients by being overly conservative and setting unrealistic standards for the use of new technology, Dr. Hecht said. “It’s incumbent on the community to dispense with the need for evidence-based medicine,” he said. “Thousands of people are dying unnecessarily.”

Of course he just knows that thousands are dying due to lack of these scans, so why do we need any evidence!

Run for the hills: the doctors are coming

By Robert Laszewski

What is the one thing no human being should want to be next week?

A Republican Senator at a Fourth of July Picnic.

In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare cuts to pay for nixing it. Also at stake is another 5% physician fee cut set for January 1, 2009.

Continue reading "Run for the hills: the doctors are coming"

Doctor fee stalemate exemplifies problems of universal health care

By Donald Johnson

The thousands of physicians and millions of Medicare beneficiaries who think the government should provide “universal health care” insurance to all Americans are getting a good look at how ugly such a politically-driven scheme would be. Doctors would see their incomes fall, and patients would suffer big time.

Because Congress cannot agree on how to prevent a 10.6 percent cut in Medicare payments, doctors are threatening to drop their Medicare patients. And because the Democrats want to prevent the cut in Medicare payments to doctors by cutting payments to private insurers that cover millions of Medicare beneficiaries, insurers are threatening to drop out of that program and make those Medicare beneficiaries very unhappy.

The Washington Post's report on the politically-driven stalemate is here. Clearly, the Democrats are intent on winning political points regardless of what happens to patients. And the Republicans are intent on preserving Medicare Advantage, which they created when they controlled Congress.

Under a “universal health insurance system,” which is advocated by the Democrats, political fights like this would happen every year. Doctors and insurers, if they were still in business, would face payment cuts. Patients would face uncertainty about who their doctors and insurers would be. And relationships between doctors, insurers and patients would become more strained than some of them already are.

NY Times examines CT scans and evidenced-based medicine

By Merrill Goozner

The front page of the New York Times Sunday morning had a don't miss article on the financial incentives behind using CT scans to look for heart disease. Medicare's decided in March to begin paying for the test despite no evidence that it saves lives (see this GoozNews post). The lobbying campaign by a newly created physicians guild that invests in CT scanning clinics is discussed in the last few paragraphs of the story. That campaign was aided by "entrepreneurial guidelines" touting the procedure, discussed in this GoozNews post.

Here are the two key quotes from the story:

"It's incumbent on the community to dispense with the need for evidence-based medicine." --Dr. Harvey Hecht, Manhattan cardiologist and CT scan advocate

"There are a lot of technologies, services and treatments that have not been unequivocally shown to improve health outcomes in a definitive manner."
--Dr. Barry Straube, chief medical officer, Medicare

Continue reading "NY Times examines CT scans and evidenced-based medicine"

Drug advertisements annoying and possibly misleading

By Sean Neill

Sean Neill is a South African-born, British-trained anesthesiologist, who recently relocated to Midwestern USA. He blogs regularly at OnMedica about his cross-cultural experience, frequently pointing out oddities of American health care. 

Watching television in America takes some getting used to. Apart from the accent, it is strange to hear companies marketing drugs directly to the consumer. Not only do they sell their own brand, but they actively name and shame their competitors' products. During a commercial break there may be two different brands of antihistamine telling you how bad the other is.

Direct-to-consumer advertising (DTCA) is the promotion of prescription drugs through newspaper, magazine, television and internet marketing. Although the drug industry is mounting major campaigns to have DTCA allowed in Europe and Canada, the only two developed countries where it is currently legal are the U.S. and New Zealand.

Studies have shown that increases in DTCA have contributed to overall increases in spending on both the advertised drug itself and on other drugs that treat the same conditions. For example, one study of 64 drugs found a median increase in sales of $2.20 for every $1 spent on DTCA. It has been reported that 10 of the leading 12 brand-name drugs with DTCA campaigns have sales in excess of $1 billion annually.

Continue reading "Drug advertisements annoying and possibly misleading"

Should progressive reformers talk about reining in the cost of care?

By Maggie Mahar

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron's and Institutional Investor. She is the author of Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much, an examination of the economic forces driving the healthcare system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite healthcare reads, where this piece first appeared.

“It seems that John McCain may have stolen some of the fire that Democrats traditionally wield on health issues by making cost control his top priority, rather than universal coverage.” -Rob Cunningham, “Health Affairs” May/June 2008

Last week, the bold proposal for health care reform that Dr. Ezekiel Emanuel outlines in Healthcare, Guaranteed drew high praise from the American Prospect’s Ezra Klein. As Klein described it:

Emanuel’s Guaranteed Health Care Access Plan maps out “a total transformation of the system.  It does not build on the inefficiencies of the current structure, preserving them in amber for the next generation.”

Rather than expanding on the dysfunctional system that we have today, Emanuel, who is the director of bioethics at NIH (and brother to politician Rahm Emanuel), is calling for structural reform. This is what makes his proposal both brave and fresh.

Continue reading " Should progressive reformers talk about reining in the cost of care?"

The mutli-factorial equation of individual insurance

By Matthew Holt

I'm up at Spot-on talking about the perils of being in the individual insurance market and wondering whether I should get out. As ever, come back here to comment if you please.

I want to ask your help. I have to make a financial decision regarding my health insurance and given the confusion of the system - one I'm supposedly expert in - I need advice.

Now realistically you're not likely to be much good to me. Why do I say this? Well, the data says you're dummies.

Last week Trizetto, a private tech company, put out a survey that said as much. While 80% of consumers surveyed were concerned about health care costs, less than a third knew how much their family spent.

It gets worse. Around 60% of Americans, including the vast majority of those under 65, get their insurance from their employer. How much are employers paying each year? Well according to Joe Public, not that much. Most don't know, or they think it's less than $5,000 per family. In reality it's around $9,000.

But I'm not one of the blissfully ignorant who gets his insurance at the company trough. Well, not quite. And hence my cry for help. Read the rest

Markle promotes a privacy standard

By Matthew Holt

The Markle Foundation put together a group creating a road map over the last few years and today they announced their new policy framework for privacy in PHRs and personal health information. In general this is a great framework, and hopefully will help gain more consumer confidence in PHRs and other uses of personal health information online by consumers and doctors. (The AMA was on the call and was a “supporter” if not an “endorser”).

Overall I’m not sure that privacy is that big a deal (as I’ve written elsewhere). Given the choice between being private and being useful, most people pick useful. (You’ll give out your Social Security Number to just about anyone to make a credit check). So I think that PHR and consumer online services need to be useful first. It was a little telling that when someone asked if this would change any of the PHR vendors actual activity, they all said that they’d been adhering to these processes all along! But there is something to being publicly and loudly transparent about it.

Continue reading "Markle promotes a privacy standard"

Universal access to high speed Internet

By Sarah Arnquist

Achieving universal Internet access may happen well before we see universal access to health care -- at least if the advocacy group Internet for Everyone has its way.

The Mercury News reports that a "broad coalition of Internet business leaders, online gurus, community organizers and advocates across the political spectrum launched a campaign Tuesday with the lofty goal of universal high-speed Internet service."

The group is driven by the ideals that "Everyone must be connected to a fast, affordable and open Internet connection to prosper in today's economy and participate in our democracy. The Internet is no longer a luxury. It's a lifeline."

Increasing access to broadband Internet is obviously important to expand the use of personal health records and other health 2.0 technologies, but on a more basic level it's key to eliminating health disparities.

Communicating and informing people about their health and major health care issues are integral parts of eliminating health disparities. And that communication increasingly occurs electronically on the Web. So expanding access to affordable Internet and improving public health go hand in hand.

The coalition will hold forums around the nation and try to build support for plans that improve access, choice and innovation. To learn more about the movement or participate in upcoming hearings, you can email the organizers at contact@internetforeveryone.org.

Internet expert fields questions on participatory medicine

By Susannah Fox

I always suspect that audience members have as much to share as I have to say. So when Mary Madden and I received an invitation to speak at the National Institutes of Health we created a participatory talk about participatory medicine: 35 minutes of our findings; 45 minutes of discussion.

It was a blisteringly hot day, so we ended up having 50 people in the room and about 50 more watching the videocast from the cool of their offices on the NIH campus. The video is a little blurry, so I recommend treating it like a podcast and downloading the slides separately, but you might enjoy hearing how we wove together our research on digital footprints, Web 2.0, and health.

Here is a sample of the excellent questions we were asked and our attempts to answer them:

Continue reading "Internet expert fields questions on participatory medicine"

Check the WSJ opinion section for more BS on Medicare Advantage

By Matthew Holt

Scott Gottlieb, who passes for what the right call a health economist these days, has an opinion piece in the WSJ singing the praises of Medicare Advantage plans.

Anyone reading the article would think that Medicare Advantage plans provide better and cheaper care than the FFS program, showing the triumph of private enterprise over government welfare. And that’s why evil Democrats hate them so much.

Unbelievably, Gottlieb ignores the extra payments Medicare Advantage have received over the standard Medicare program since 2004. Even Karen Ignagni doesn’t do that any more. The AHIP crew has long changed its argument from “we do it better and cheaper” to “we help poor black and Hispanic seniors get better benefits, and the fact that we rake a ton off the top and the taxpayer gets screwed is just the cost of doing business, sorry!” But Gottleib is back in the dark ages. Is this really the best the right can do?

Continue reading "Check the WSJ opinion section for more BS on Medicare Advantage"

Online bullying care management works

By Matthew Holt

So says a study out in JAMA today from Group Health of Puget Sound. They randomly divided high blood pressure patients into three groups. Being Group Health members they all had online access to the MyGroupHealth site and services, but the second group got blood pressure cuffs and training on the site. That made no difference. But the third group got all that and online counseling from pharmacists about every two weeks.

After 12 months, about one-third of the patients in the first two groups achieved normal blood pressure. However, with the Internet-based pharmacist care, more than half the patients got their blood pressure down to normal.

Which is both good and bad news. Good news because it’s somewhat scalable to have online counseling from clinicians, in that it’s more convenient for patients and clinicians. Bad news because it’s much, much more scalable to have computers do all the work. But currently computers alone, even when the patients are given more training and services don’t do much better than general medical treatment.

Much of what needs to be done to make care management effective is to figure out how to replace and augment the most precious resource (skilled humans) with a cheaper one (less skilled humans, possibly a long way away, and computers). But at least this combination has been shown to be effective.

Can Connected Health survive the political economy of health care?

By Matthew Holt

Jennifer Priester & Joe Kvedar over at Partners' Center for Connected Health asked me to step in and be the guest host of their discussion group for the month. I wrote a piece called, Can Connected Health survive the political economy of health care?

Please go take and look and of course feel free to join in the discussion there.

Congress votes for higher Medicare costs when voting down competition

By Sarah Arnquist

Congress is bowing to pressure (read: financial contributions) from medical equipment makers that stand to lose money if Medicare expands its competitive bidding program.

The NY Times reports today that the House approved legislation Tuesday that would delay the launch of the competitive bidding program for 18 months -- all to appease a few companies that are scared of staying viable in, gasp, a competitive market.

The results of the pilot bidding program show this is good policy that will save Medicare and individuals money. The Times reports:

"When Medicare awarded competitively bid contracts to some 325 companies to serve the 10 metropolitan areas, it reduced equipment prices by 26 percent on what it would have paid for the same equipment under the current fee schedule. That means that if the contracts were allowed to proceed, beneficiaries would save 26 percent on their co-payments. Medicare would save $125 million the first year and as much as $1 billion a year if the program went nationwide."

Yet, good policy may lose this battle.

As NY Times columnist David Leonhardt and an accompanying editorial aptly point out, this small battle is ominously prophetic of the impending battles over health care reform.

"By standing in the way of this competition, Congress is really standing up for higher health care costs," Leonhardt wrote.

It will be interesting to see which Congressmen and women vote against competitive bidding now and then assail the rising costs of health care from the podium this fall.

For the cynical out there, this is a reminder of what you already know.

As industry veteran Brian Klepper told me yesterday, "Only innocents and little children think health care reform is going to happen through policy. It’s not going to happen because half of all the money is unnecessary and because Congress is on the take."

Lots of Health 2.0 articles indicates that it's heating up

By Matthew Holt

I don't know if it's just me, but there appears to be a quick vogue in round-ups of the Health 2.0 world at the moment.

UCLA doc John Luo wrote about The People and Companies Driving Health 2.0 on MNDG. He gives a good overview, and mentions some familiar and not too familiar names

In the slightly more rarefied atmosphere of the  American Academy of Neurology, Barbara Scherokman of Kaiser Permanente, and Michael Segal, from SimulConsult, give a great overview of the components in Health 2.0 for Neurologists. They focus alot of course on BrainTalk and PatientsLikeMe.

Talking of PatientsLikeMe, I missed this due to being in the Jordanian desert at the time, but in March Wired's Tom Goetz (who was on a panel in the March 2007 Health 2.0 conference) wrote a fantastic and long article about PatientsLikeMe called Practicing Patients for the New York Times in March. I learned alot and I've been giving  PLM demos in public for the last year (and no, I'm not a shareholder!)

The people at at nursing online education database bombard me with their posts, but this one about Taking Control of Your Health Records throws in everything including the kitchen sink, but has some interesting links.

At ReadWriteWeb, Richard MacManus has been looking at DiabetesMine and DiabeticConnect. Not surprising as he's a geek who recently discovered that he had diabetes.

Meanwhile Indu Subaiya and I have been diving into the latest rash of companies wanting to present at Health 2.0. Just 12 months ago we were scratching around to come up with enough candidates to fill four demo panels. Now we have 20 panels and we don't have enough room to show half of the people who want