By Alexandra Drane, Leigh Calabrese-Eck & Matthew Holt
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.
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).
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.
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 Conferencewhich 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!
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.
At Health 2.0 we have a natural bias toward the innovator, the entrepreneur, and the developer. Health care is largely broken, and those upstarts have the potential to fix it. But it’s by no means easy. Part of what we’re doing at our upcoming Health:Refactored conference is helping developers get access to APIs and other technical entrees into health care data (such as the SHIN-NY or HealthVault).
But as Paul Levy pointed out in a recent post about Epic’s domination of the large hospital system EMR market, and as Jonathan Bush hilariously detailed in a talk at last week’s TEDMED, health care’s money and data and power are still locked up in huge institutions that don’t have it in their business plans to give up that position — whatever their mission statements might say.
Francois de Brantes’ book The Incentive Cure details in a fun way how hard it is for providers to do the right thing, and how in the absence of changing incentives, most of the things that seem to make sense for better health (like holistic patient management, care variation reduction, better informed patients and providers) actually make worse sense for health care institutions. Which means that the dam is still holding back the torrent of ideas and solutions from innovators, entrepreneurs and developers. We know (broadly) what to do but we can’t do it. It’s the worst of times.
But two things are changing. One is that we at least recognize the problem. The system may be an addict, but it knows it’s one, and so does the taxpayer and the patient. So that first step has been taken. The second change is the flood of new technologies outside of, and now inside of health care, that can help us get through the next 11 steps. Todd Park says this is the best time ever to be a tech entrepreneur in health care. So is this the best of times? Eventually it’s up to all of us to make it so.
While my politics are well known to THCB readers, I rarely encourage people to do anything about it–especially in a state where I don’t get to vote, but today is different. Aneesh Chopra is running for Lt Gov in Virgina. He’s the former CTO of the US and a really good guy–who is running based on improving science and technology in a vital state, where the Republicans are literally into trans-vaginal ultrasounds & creationism. To my SF and LA-based friends, you can meet Aneesh at Cigar Bar & Grill on Mon 18th 5.30-7 in downtown SF and in in 1240 Shadow Hill Way, Beverly Hills on Tuesday 19th 7-9pm. This is a chance for the tech community to support one of its own, so I encourage you to go along and write a check. For more information or to RSVP please contact Caitlin Blair at Caitlin@chopraforva.com or (703) 468-1456, or I’m sure if you show up Aneesh will be happy to see you!–Matthew Holt
THCB founder Matthew Holt is reporting live from HIMSS 2013 in New Orleans. Matthew’s first guest is Ben Chodor of Happtique. We’ll then hear from Matthew on his walking tour of the floor as he drops in on a few companies, including Kareo, CareCloud, Wellness Layers, and more…
Founded in 1947, the United Kingdom private health insurance provider, Bupa, predates the National Health Service. Today Bupa is a global health care company, which includes subsidiary Health Dialog in the United Sates. CEO Stuart Fletcher explains Bupa’s decision to buy the health care management company.
Early this week Greg Masters and Pat Salber chatted with me for a fun convo about EMRs, NOLA, HIMSS, and alot more. It’s part of their overall series for the HIBCtv (Health Innovation Broadcast Network Consortium). And be warned they are giving me keys to the car for 90 minutes at HIMSS next Weds! You should be able to click on the player above to hear. If not click to this.