TECH/CONSUMERS: Holstein on Information Therapy

So it’s Fall in Park City, so here are some pictures of the view I’m getting.



Yes that is a weather balloon rising over the valley.

Meanwhile back to the conference. Roger Holstein just left WebMd after it was spun off from the newly titled Emdeon. His talk is making think we’re back in 1998, by the way he’s reading his talk, which is a little off from a major keynoter.  However, he’s a powerful guy with a strong track record and what he’s saying is right, although it’s preaching to the converted here.

Imgp4559 As for the content. He started off saying that the Internet has changed the world. I think I heard the same thing back in the day 10 years ago about how amazing the Internet was and how it changed the world from Esther Dyson or Paul Saffo. Holstein is giving the "how great the Internet is now" (rather than the 1998 model of how great it was about to be) and how that the net will change healthcare, all put around the patient using technology.

This chart looks disturbingly like the original Healtheon chart from Jim Clark.


However, he thinks that benefit information as provided by payers is woefully inadequate. No shit, Sherlock.  He thinks that payers need to expose understandable payment data, and benefit data, as that will help payers get HRAs (health risk assessments, he means not health reimbursement accounts) plus claims to personalize a person’s health record. The reduction in FICA taxes alone on the money diverted to FSAs (flexible spending accounts) should justify the cost of creating that information on a portal (I’m not sure that I agree with him that it’s that cheap!)  But today’s tools are far from where the market needs to be.  He’s right; although I was selling a "good enough" tool in 2001!

Providers: we should be able to do comparisons the way we do car shopping online — including information about outcomes and costs. And hospitals should have costs and outcomes (and cost per outcome) information up on the web…he used an example from New York where he had colon surgery. NYU med center had a 5% mortality rate while Sloan Kettering’s was 2% and Sloan-Kettering was $20,000 cheaper (although Alain Enthoven points out that it hasn’t changed patient or physician behavior in NYC or in Pennsylvania). He believes that combining that information with information therapy (right information to patients in right manner at right time) will really change behaviors in the system.

He thinks that it’s "funny" that payers have trouble connecting with consumers despite the fact that they have their health information and their financial information about their health. They should put them together for members.

Provider information–Medicare should release public data about hospitals and providers. And it should really show quality at a useful level that consumers want –to make sure this doesn’t fall under the control of big health plans. In addition consumers want much better information about providers(including physician specific severity-adjusted outcomes), who have a terrible information distribution track record. We should also allow consumers and physicians the ability to compare their care to national standards.

If the health care organizations spent more time sharing their data, then we’d get much better information about what works and what doesn’t, for example in off-label use of chemotherapy. But in oncology the information about staging, diagnosis, and drug use is already submitted on the medical claim if only payers would share that data de-identified, we could really advance this science very quickly.

I asked Holstein why it took so long for this information to get to where it is today. He says that it’s employers who are driving this and now finally health plans are following along. If you build it can you make them come? Maybe not, but if they do come change is tremendous. He says it’s happening now.

What about getting the data right for doctors, who say that the data’s always wrong?  He suggests that if you give the consumers access to the data they will self correct it, so then the data reported back to the docs from the health plan will be more accurate.

Interesting stuff, but I need to hear more about incentives and/or regulation….