NEW @ THCB PRESS: Surviving Workplace Wellness. Spring 2014. Al Lewis and Vik Khanna. e-book edition. # LIGHTHOUSE Healthcare. Illuminated.

Matthew Holt

The Administration has snatched victory from the jaws of defeat and enrolled 7 million people (give or take a million who may not have paid their premiums) into health plans under the ACA, and more into Medicaid. The Affordable Care Act (ACA) isn’t as big a change as some of us would have liked, But in this moment of modest celebration let’s remember what some of the sensible old men said all along.

Sensible old men said reform couldn’t pass without bring in the Republicans. Sen. Baucus tried hard to do that, and it’s beyond clear that no Republican would have ever supported it–even a moderate like Snowe who was quitting. It passed anyway.

They said that we’d see massive rate shock. Instead plans tightened networks and rates were in general lower than they had been before.

They said that the web site debacle meant no-one would sign up and we’d go into an insurance death spiral. The web site launch was a cock up, but Medicaid expansion (where allowed) has more or less been OK, and the exchange web site(s) now more or less work(s)–outside Oregon & Maryland. By the way this backs my argument for having one Federal exchange, which you may remember was in the House bill before we ended up being forced to take the Senate version due to Ted Kennedy’s death.

One wise old man (Robert Laszewski) was still saying that the exchanges would be financial disaster for insurers the very week Wellpoint raised earnings expectations because they had more enrollees than expected.

Let’s also remember that because of the politics of the nation, the ACA is a ridiculous hodge-podge of a law requiring–you’ll recall:

a) an opt-in to what’s basically a social insurance program (hey, let’s opt-in to fire protection while we’re at it!)

b) arbitrary tax (and now subsidy) distinctions between those who get insurance via an employer and those who don’t, and

c) arbitrary access to insurance (well, Medicaid) for the poor depending on their income and which side of a randomly drawn line they live.

Continue reading “The ACA– As Much As We Could Have Hoped For, Despite Sensible Old Men”

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After years of speculation about a possible name change, Health 2.0 has become mHealth & Associates. My partner Co-Chairman and CEO Indu Subaiya and I didn’t take this move lightly. We were though concerned that the tired “2.0″ moniker is now thoroughly discredited by the emergence of the fully interoperable semantic Web, particularly as it’s been demonstrated in the healthcare sector in the US in recent years. In addition leading luminaries such as Chris Schroeder have finally realized the importance of the brand new smart phone devices that we’ve been ignoring for most of the last decade. And after some prompting, we were convinced by the intellectual rigor of the wider mHealth movement with its clear definition of mobile health, including the incorporation of highly portable technologies such as televisions bolted to the walls of hospital rooms.

Admittedly, while mHealth Intelligence and the mHealth Challenge roll off the tongue, we were a little stuck by what to call our main Fall conference–our organization’s best known event. But while mHealth Summit, mHealth Conference and most other variants are already use, we think that clear market visibility will surround out new name. So instead of the 8th Annual Health 2.0 Fall Conference, this September we’ll welcome you to the First mHealth Confabulation.

Finally we wanted to acknowledge the role of  our wider movement, our team and our 75 chapters across the globe, so we have added the “*& Associates” moniker to the name. In recognition of their contributions all mHealth colleagues will now be known as Mobile Health Associates or in its shortened version, as an “mHealth Ass.” Indu has suggested that I adopt the title of “Biggest mHealth Ass.”

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Matthew Holt sat down with CareCloud President and CEO Albert Santalo to discuss the latest news from the Miami-based cloud practice management and EHR services provider. CareCloud got started in 2009 and since then has raised $55 million in angel and private venture funding and grown to 270 employees.

Currently, about 5,000 doctors use CareCloud for their practice management services with about a quarter of those doctors also using the CareCloud EHR. Santalo expects that number to grow to about 12,000 by the end of the year, explaining in three points why he thinks the market is primed for CareCloud’s cloud-based, integrated practice management and EHR system.

While Santalo’s grin says more than his answer when asked about a potential IPO, he shares some interesting thoughts on practice consolidation, meaningful use requirements, and the cloud in in-patient settings in this interview recorded at HIMSS last month.

 

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Today venerable health content creator Healthwise merged with the Informed Medical Decisions Foundation which was previously funded by (and had an exclusive relationship up until last month with) Health Dialog. I asked Healthwise CEO–and old friend of Health 2.0–Don Kemper what was happening and what it meant. I also snuck in a smidgen of snark about a conference we worked on together five years ago.–Matthew Holt

Matthew: Don, you’re merging Healthwise with the Informed Medical Decisions Foundation. So I know the two organizations are both non-profits but as a poorly informed outsider I always thought of you as rival content creators, with Healthwise selling your content and services to insurers and providers and Informed Medical Decisions being funded by Health Dialog which then got to use and sell the content and decision support aids it created to its customers. Am I wrong?

Don: You aren’t completely wrong—but then not overly well informed either. We have always thought of ourselves as sister organizations rather than rivals. We have collaborated well in advocacy efforts to promote the role of the patient. Health Dialog has had a near exclusive relationship with the Foundation until recently. Health Dialog has been a long-term client of Healthwise, too—just not an exclusive one. When the restructured Health Dialog-Foundation relationship dropped the exclusivity requirement it allowed us to proceed with the merger discussions.

Matthew: Now that change occurred for Informed Medical Decisions and you two can merge, what do they have that Healthwise hasn’t got, and vice versa?

Don: The Foundation has three things that will add greatly to the Healthwise mission:

1. Medical Evidence—Their assessment of medical evidence in key areas goes deeper than we have been able to go. Whereas we have often waited for treatment guidelines to change before reflecting the changes in our content, their medical editors are often involved in making the guideline changes. Getting that information into the patient’s hands six months earlier could make a life or death difference.

2. Value Demonstration—The Foundation has developed research relationships with many health services researchers around the country. By setting up and evaluating demonstration sites for shared decision making (SDM) they have proven how SDM improves decision quality and reduces the use of expensive but preference-sensitive treatments.

3. Practice Change Management—The Foundation has gained a great deal of experience in helping clinicians build SDM into their workflow. Those learnings will help as we integrate patient engagement into the mainstream of care.

What they get from us is “reach.” People now turn to our information, tools and solutions over 340 times a minute. (180 million times a year). Fifteen percent of US physicians can now prescribe Healthwise patient instructions through their EMRs.

Healthwise has invested heavily in the technology needed to integrate into EMRs and has excelled at building broad-based solutions that fit within a health plan’s or health system’s workflow. It would have been hard for the Foundation to have matched that without us.

Matthew: So how will this actually work. How many people do you have, how many do they? Who gets to keep their jobs? Is this a real merger or a takeover?

Don: This is a merger made in heaven. No one will be out of work. Continue reading “Healthwise Adds Informed Medical Decisions: Don Kemper Interview”

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I’ve been a busy world traveler lately. The focus of the health care tech and policy crowd in the US has been on the fix to one high visibility website. Before I talk about the rest of the world it’s worth noting that the Administration painted itself into a corner here.

When healthcare.gov failed on take-off they didn’t make the obvious choice of letting other brokers and plans enroll people directly–and worry about correcting subsidies on the back end. I spoke with one big online broker this week who told me that his company still couldn’t get reliable access to the subsidy calculator API, and so can’t enroll people. I suggested the solution to that back in October but apparently no one is listening at HHS–although Sen Mary Landrieu was. The White House was however listening to the Fox news crowd ranting about cancelled insurance policies and made the bad policy (if necessary political) call to allow current individual market policies to continue–even if they are rightly now illegal under the ACA.

But elsewhere the impetus that the US has been seeing on the health technology side–with over $2 billion in venture funding this year–is spreading. The UK just confirmed that it’s releasing the equivalent of $800 million for new health technology, and we just returned from a very successful Health 2.0 Europe conference. All kinds of activity is going on over there–did you know there were over 100 digital health start-ups in Finland & the Baltics alone? Well, you do now.

Today the Health 2.0 international roadshow is in Sao Paulo, Brazil–a city that has the size and energy of New York–albeit before Guliani cleaned up the graffiti. And yes, even in Latin America, there’s lots of activity in using technology to change health care. I’ll tell you more next time, but it’s clear that there’s way more than one website in healthcare.
Hope to see you in Brazil or at at our Health 2.0 at the mhealth Summit Session in DC on Monday.
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-Matthew Holt
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Most of us find ourselves pretty fascinating… flipping through photos and slowing down for the ones where we’re included, tweeting our favorite tidbits of information, facebook-ing progress on this or that…

We find other people captivating as well. In fact, there’s a meme going around on facebook where people share a handful of things that most people don’t know about them – and there’s a great joy in learning these tidbits about the friends and family we think we know so well.

This Thanksgiving, we’re asking our friends and family to try this exercise, but with a twist – we want to know how they’d answer just five questions on their end-of-life preferences.

What? Are you CRAZY? Talk about how you’d want to die over Thanksgiving? Yup – that’s exactly what we’re suggesting. You know why? Because this is a conversation you absolutely want to have exactly when you DON’T need to have it… and it’s a conversation you need to have with your loved ones. Our hope for you this Thanksgiving is that you’ll have the luxury of checking both those boxes.

Continue reading “We Love to Talk About Our Lives. What About Our Deaths?”

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By now even those of us who originally thought that we were seeing minor teething troubles are no longer deluding ourselves. Healthcare.gov, the federal health insurance exchanges (HIXs), and many of the state HIXs are in deep trouble.

One summary of many articles about this is up at ProPublica. But now that the House Republicans have stopped trying to destroy the country and themselves, attention will turn quickly to this problem, and–much worse–beyond the politics, there is now only eight or so weeks to get ready for actual enrollments for Jan 1, once you take out Thanksgiving and the Christmas holiday. Getting ten or twenty million new customers on board, not to mention the small businesses who want to move from their current insurance onto the exchanges, seems like an impossible task.

But, if we can muster the will, there may be a solution. (And yes, I want it to work, faut de mieux). Quietly last summer two private online insurance brokers, eHealth which runs the eHealthInsurance.com site, and GetInsured, struck deals with HHS which allowed them to enroll individuals in plans that qualify for the mandate under the ACA, and more importantly, connect with the “Health Exchange Data Hub” that figures out whether the enrollee qualifies for a subsidy (theoretically by connecting to the IRS).

That part of the transaction, though, could be done by attestation and dealt with later. In other words, someone buying health insurance could state what their income will be in 2014 (or was in 2013) and if it ends up varying dramatically on their 1040 then in 2015 they will pay or receive the difference. Essentially this is something all Americans recognize–the IRS asks you for more or gives you a tax refund well after the fact, and H&R Block and their competitors make a business of giving you the refund right away (and of course charge you for the privilege).

That is important because what seems to be crippling the HIXs right now is not the back end, it’s the front end. (Go to this Reddit thread for lots more deeply technical conversation about that). Showing people options, comparing plans, setting up accounts–that’s all standard web stuff and most of the HIXs can’t do it. Those private brokers have both smoothly done this for years and at least the two I mentioned have built comparative tools for the new insurance plans. (Both were demoed at Health 2.0 on October 1).

So why can’t we put prominent links to eHealthInsurance.com and GetInsured on the Healthcare.gov site and move people over there? Continue reading “A Pragmatic Fix for Healthcare.gov & the HIXs”

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How does a corporate behemoth heavily invested in the transaction-based health care system of today make the shift to engaging with its 20 million+ customers about their health in new and deeper ways? Humana’s new CEO Bruce Broussard sees technology as key to successfully meeting this challenge.

The company does a good part of its $39 million annual business in one of the health system’s status quo areas: providing medical benefit plans to employer groups.

In his October 1st keynote at the Seventh Annual Health 2.0 2013 Fall Conference, Broussard will share some thoughts from the executive suite about the role Humana envisions for itself as part of health care’s future. Health 2.0 co-founder Matthew Holt recently chatted with Broussard about Humana’s plans.

Matthew Holt: Humana has been looking to get involved in the new changes in health care as a whole. I know you’ve been surveying the role of new information technologies and tools in recent months.

What kinds of things are you seeing? What has most surprised you about the possibilities?

Bruce Broussard: The informational tools that are coming out are pretty powerful. I’d categorize them as allowing individuals and companies like Humana to educate and motivate individuals, and to gain easier access to providers and to more timely treatments.

When we look at the new tools coming out, I think these are going to greatly improve health care in multiple ways.

Continue reading “Moving Beyond the Sick Care Model”

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And now, for your crassly commercial consideration, I am emerging from my bunker/email queue and relentless rehearsing of 150+ demos to tell you the Top Twelve reasons why you need to join over 1,600 others at the 7th Annual Health 2.0 Fall Conference which starts with pre-conferences on Sunday 29th and kicks off officially on Monday 30th September:

Twelve Teams creating new on-body laboratory grade sensors competing for $2.25 million in prizes in the Nokia Sensing XCHALLENGE

Eleven Pre-conference sessions including International Health 2.0, a design workshop from Mad*Pow on behavior change, Patients 2.0, Doctors 2.0, Employers 2.0 and more!

Ten New Companies introducing their brand new products to the market in Launch!

Nine Developer Challenge Competitions with winners & new challenge announcements on stage!

Eight Start-Ups Competing in the DC to VC start-up showcase from Morgenthaler Ventures with 8 VCs as team captains

Seven Sponsored Deep Dive Sessions from leaders Janssen,  United Healthcare, Cigna, Airstrip, Health Dialog, NaviNet &  The Iron Yard (featuring 10 startups from the South)!

Six Demos showing the latest tools for and about health consumers on our panel called Big Data: Tools & Applications for Individuals

Five Networking Parties for attendees, sponsors, and exhibitors!

Four Cutting-Edge Revolutionary Demos on the Frontier of Health 2.0 panel including SyapseBrainControl and from the labs of Adam Gazzaley at UCSF and Louis-Philippe Morency at USC.

Three Female Health 2.0 Rising Stars: Akhila Satish, CyberDoctor; Hind Hobeika, InstaBeat; Julia Winn, BetterFit Technologies.

Two Engaging Keynotes by movers and shakers –Bruce Broussard, CEO of Humana, and Gavin Newsom, Lt. Governor of California.

One Revolutionary Health Technology Conference you don’t want to miss!

And honestly we could have done a top 100! You can find out more and sign up here! And, to quote a recently late Silicon Valley legend, it will be insanely great.

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Please enable Javascript and Flash to view this Viddler video.

Allscripts is one of the biggest companies in Health IT. Glen Tullman built it from almost nowhere and then last year after one bad quarter and a power struggle in the boardroom (which he initially won), he left–and he stresses it was his decision. Along the way there were lots of interesting choices made, and he and Allscripts ended up with a sweep of all the negative awards at this years HISSIES (including his first time as “Industry figure in who’s face you’d most like to throw a pie”).

But despite all the abuse, what Glen did over the past 15 years is pretty remarkable given the stagnant state of the enterprise HIT market. I’ve interviewed him almost every year since THCB started and he was never shy in giving his opinions. Last month I got him for a long retrospective. THCB will be running that in parts over the next week or so, and he dishes on the Allscripts’ record, on Epic, on the future of health IT and more.

But here’s a teaser…

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MASTHEAD


Matthew Holt
Founder & Publisher

John Irvine
Executive Editor

Jonathan Halvorson
Editor

Alex Epstein
Director of Digital Media

Munia Mitra, MD
Chief Medical Officer

Vikram Khanna
Editor-At-Large, Wellness

Maithri Vangala
Associate Editor

Michael Millenson
Contributing Editor










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