THCB

Categories

Month: June 2006

BLOGS/QUALITY: Big themes and signing off from FierceHealthcare

Here’s my last ever FierceHealthcare editorial. The FierceMarkets team is taking the editorializing of FierceHealthcare back in-house and I wish them luck. It’s been fun for me (and John Irvine who’s supported me all the way) to work on this over the past couple of years, but I’m happy to get away from the deadline grind and concentrate on THCB and my consulting work. And hopefully I’ll find the time to start working on that book I’ve been threatening you all with. Anyway my last editorial is about the two biggest themes in health care—fixing process and fixing insurance.

Perhaps the dominant theme of the decade in healthcare has been patient safety. Since the 1999 IOM report, hospitals and doctors have focused on improving the medical error situation. Last week, Don Berwick’s IHI announced that a precise number of lives (123,000 and change) had been saved since the voluntary 100,000 Lives Campaign started. This week, the carping started with The Wall Street Journal suggesting that the IHI numbers were inaccurate. Commenters also started down the path of whether saving the "life" of a severely ill patient who was going to likely die soon anyway was all that important–or at least as important of saving the life of an otherwise young healthy patient.

But beyond questions about the data, there are two crucial related points we must hold onto. First, medical errors are symptoms of poorly designed medical processes, and we know that reducing "muda"–waste in medical care–is an achievable goal. Second, patients are not just vulnerable to physical harm from interacting with the healthcare system, they’re also extremely vulnerable to financial harm caused by that "muda" and facilitated by our dog’s breakfast of an insurance and financing system. These are two sides of the same coin, and efforts like the 100,000 Lives Campaign should be applauded for focusing on at least part of the problem. It would be nice if there was a similar system-wide commitment to concentrate on the whole of the cost and care crisis rather than just one part.

DISEASE MANAGEMENT BOSTON JULY 30 – AUG 2At a three day conference in Boston MA, scheduled between July 31 and Aug 2, industry leaders from managed care companies, employer groups purchasing healthcare services, providers, third party administrators, physicians, healthcare technology players, nursing and pharmacy practitioners, disease management experts will meet at the 4th Annual Disease Management Conference. The event is posted online at www.srinstitute.com/ch142

HOSPITALS: Scrushy guilty of something at last

• 3

Those of  you despairing of rich people being able to buy their way out of trouble may be encouraged by this headline—Scrushy, Siegelman found guilty on federal conspiracy, bribery charges . Well at least he’s going down for something. Perhaps this jury wasn’t quite a susceptible to the bought and paid for black Ministers that are Scrushy’s new best buddies, or maybe he didn’t bother hiring them this time around. At any event hopefully he gets what’s coming to him this time.

PHARMA/PHYSICIANS: Yet more on Rx data sales

• 3

The NEJM has a perspective about the sale of Rx data of physicians prescribing patterns, which caused a lot of fuss on THCB a while back. In my view this is problem about number 728 on the docket of what’s wrong in American health care, and those physicians complaining about it should look to solve the first several hundred before they set their sites on changing the law, or just kick the drug reps out of their offices. There’s nothing particularly good about the current situation but it’s just not that big a problem and banning the sale of data won’t change it too much. the perspective from Robert Steinbrook largely agrees.

Prohibiting the release of prescribing data to sales representatives will not put an end to another practice to which some physicians object: the use of such data by managed care or pharmacy benefit managers. These entities have sources of information that are independent of the AMA Masterfile. It also will not stop visits from sales agents, which doctors have always had the right to refuse, nor will it curtail the marketing of drugs. According to the AMA, the potential effects of restricted release may include a reduction in the number of “offers physicians currently receive from the pharmaceutical industry, such as drug samples, CME programs and speaking engagements.”

BLOGS: Health Wonk Review is up

I knew I should have hired an unpaid summer intern. At IBM they have them by the dozen and one of them, Emily Goodson, has done a nice round up of health care blogging in Health Wonk Review over at HealthNex.

Any unpaid interns looking to boost their resumes know where to apply…

PHARMA: The Macular Degeneration Rip Off, By PAT AWASH

• 7

Occassionally I get actual patients writing into me at THCB and sometimes it’s worth letting their experience with the system tell a story about how the opaque world of drug and health services pricing comes home to ground level. This is a verbatim email from a 70 year old patient Pat Awash:

Friday, June 9, 2006 I was facing imminent blindness in  one eye and poor vision in the other. Beginning Saturday a miracle began to unfold after an initial injection in my eye of Avastin. Avastin is used to treat mestasticized colon cancer and someone deduced that it might, just might be effective for Age-Related Macular Degeneration, the leading cause of blindness and vision impairment among the elderly.

Due to an undetermined cause, leaking fluid had formed a large blister behind my retina causing four changes in my eye-glass
  prescription between February 24, 1906 and late May, 2006, the last of which
  did not hold for four days. I was frightened to say the least. Only one day after the injection I  experienced a 70% vision improvement. This improvement continues each day and I am using a three-year-old prescription.
 

I am writing in objection to the current policy of the FDA in regard to Avastin. It is an off-label use but the cost is minimal, only $60.00 when provided at cost as my physician does. The same drug company that
  makes Avastin has developed Lucentis which has a slightly different molecular
  structure than Avastin but is basically an analog. Only thing is, Lucentis will cost an expected $1,500.00 per dose. They claim a reported $400 million research cost but I’m wondering what is included in that amount. 

I hope you get the picture. The manufacturer of Lucentis has changed the drug to the degree that it can be classified as a new drug. Whereas Avastin is expensive when used as a cancer drug it is very  inexpensive for eye treatments because the dose is so small, and some would say Lucentis is not as effective. Once approved, Lucentis will be covered by
  Medicare, a windfall for the manufacturer and huge cost to the public considering a rapidly aging population. Gentech could have done the trial on Avastin.
 
  Everything would be ok except Genentech will no longer make Avastin available except to those who exclusively treat cancer patients.
  No off-label applications and no choice for patients. Thankfully, my physician bought a substantial (several month’s) supply prior to the June 1, 2006 cut-off date.
  I find this insane and I think you will too. I am sick and tired of experts saying how much trouble Medicare is in when this kind of shenanigan is going on.

Respectfully, 

Pat Ahwash (a 70-year-old senior citizen)

TECH/CONSUMERS: Anytime, Anywhere Healthcare

• 1

This panel will focus on in-store clinics, and mobile devices in health care

On the panel is Michael Howe, CEO MinuteClinic, Delmer Dukjhart from Technology Center, Cisco & Don Jones, VP Healthcare, Qualcom

Intro from Richard Adler, IFTF—about 100 clinics around the country, small companies but big partners. Most NP run, no doc on site, but some experimenting with that problem. Lots of encouraging data presented about why these clinics are good in terms of cost and convenience. Of course one question is how much $$ per sq. ft can these clinics generate.

Next steps for these clinics? Video visit booth, with only pharmacy tech or EMT tech, remote contact to clinicians. CHCF has funded Mercer to create this.

Mobile health applications….several applications all built on growth in use of cell phones. Now 75% of adults have a cell phone (more than 60% of those in their cellphones) 8% of cell phones in US are smart phone. NOT just a US phenomenon 25% of worlds pop use them, and several other companies use them Italy’s cell phone penetration is 108%. China has 335m cell phones (25%). Lots of progress in medical devices, sensor arm bands, life shirt, etc, etc (Check out medgadget for more of all this). Two new ones are 3G doctor (apparently coming in the UK) and the VeriChip (My note—it is not far out….it already exists and John Hamalka has already got one).

Michael Howe, CEO MinuteClinic. Started because the founder was pissed off at having to wait 3 hours for an urgent care clinic visit for his kid’s ear infection, brought in retail experience (Michael). Have gone from 19 clinics to 84 clinics. Will have 250 clinics by end of years and going to 1000 clinics by end of 2008. It’s meant for binary decisions on confirmations of diagnosis and simple treatment. Cornerstone of the system is an EMR that functions like a pre-flight check list for a pilot. Can also change the algorithm/care for all clinics. Can provide summary of visit back to PCP if they can accept it.

Don Jones; “it’s very slow to drag that health care mule through the water”….but the fun part of his job is remote glucose monitoring, etc.

Del Dukjhart: So much synergy between wireless devices, clinics and the network. Lots of places where telepresence can get access to good quality health care. He thinks technology can solve many of the problems. Telepresence needs to get to be easier to use, that’s the big rock.

Michael—What’s the impact on PCPs? (my question)….there hasn’t been an impact on primary care docs. There’s resistance at first, but then they work as a complement, and then within a year or so they start giving referrals to their clinics. This is about making access and convenience for patients….it also means that patients will get access to maintenance care more easily. He thinks that the primary care doc is a coach who’ll uses resources like MinuteClinic

 

CONSUMERS/TECH: Technology in health in the next decade

Tech trends….

EMR is now banal, aparently its happening, and there’s congestion in hospitals on traffic over WiFi networks.

Personal products Nike has systems that track your health conditions as you run—your new buzz word is the “Body Area network”. Now we have the development of wearable and implantable biosensors. These sensors will be intergrated with sensors in the environment (Matthew’s Note—Intel has several prototype houses where there are sensors checking in on the occupants all the time). He showed us a list of a huge number of sensors announced in the consumer market place in both persona and ambient information over the last 6 months. Plus there’s also gathering more adn more data from “lifesensing”—capturing images and data from every moment of daily life.

Sensemaking is the process of putting all this data together and synthesizing it into results that can be used.

Abundant computing is going to provide the power to put this all together…so one of the most interesting applications is to take all of life data and synthesise it for new resutlts. Accenture labs has designed a persuasive mirror that is designed to change your behavior (eat too much food, get fat, etc—and show you a picture)

Medical telepresence—at “arms length future” we’ll have a critical care facilty at home—doctors can operate robotically on patients at home. He says this is a reach, (My note: actually I dont think so. We already have robotic surgey and we’re slowly seeing the separation of diagnoses and treatment, and the separation of the hands on/therapeutic process).

 

POLICY/TECH: Foodscapes ( cool word, huh!)

More from the IFTF meeting on Global Health….

Food production is a 200 year old paradigm dominated by producers. Food producers are going to have to deal with increasingly active bio-citizens. More than 70% of Americans identify themselves as environmentalists, while only 5% actually act on that in their shopping choice. And even being an environmentalist consumer is difficult, even if there is transparency about where the food came from, how it was grown and what resources were devoted to it. One site (experimental) is iBuyRight which will allow people to scan products with their cell phone and know all about what that food came from.

If health gets to the center of how we treat food, then this bio-citizenship trend may impact everyone  That make make the boundaries of the corporation more porous. That will make things like socially responsible investment mainstream, we may see more impact on trust and branding of products, which may provoke more regulation. Food is no longer social, it’s more and more political, and changing behavior is going to be a major struggle. So can we improve the way individuals behave, but we also need a wider system change (or at least need to develop one). Lots about individual responsibility versus system change.

My comment: All these theories and information are getting lots of attention, but all the indicators (eating, obesity, fat/sugar consumption, etc, increased pollution, etc, etc) are all getting worse….and all the advertising/marketing is mostly going the wrong way.

assetto corsa mods