The Century Foundation has a discussion from a bunch of health care policy experts/pundits about the latest developments in the health reform “debate”. Given the large cast of characters (inc Aaron, Hacker, Relman and younger punks Cohn, Klein et al), it’s interesting stuff, but not exactly as diverse as say Cato’s recent back and forth! Yup, it’s a bunch of DimmyCrats talking to each other, but smart ones. Here’s the document. (rather annoyingly it’s a PDF).
PHARMA: The Future of Non-Profit Drug Development By Merrill Goozner
Merrill Goozner has been writing about economics and health care for many years. The former chief economics correspondent for the Chicago Tribune, Merrill has written for a long list of publications including the New York Times, The American Prospect and The Washington Post. His most recent book, "The $800 Million Dollar Pill – The Truth Behind the Cost of New Drugs " (University of California Press, 2004) has won acclaim from critics for its treatment of the issues facing the health care system and the pharmaceutical industry in particular. Today he has something to say about a familiar topic : the relationship between public sector R&D investment and innovation in the pharmaceutical and biotech industries. You can read more pieces by Merrill at Gooznews.com
The United States is the world leader in investing in biomedical
research and development. In the public sector, the National Institutes
of Health spent $28.6 billion in 2005, largely for basic science
research. The pharmaceutical industry spent an estimated $39 billion in
2004. This includes investment in the U.S. by U.S.-based firms,
investment overseas by U.S. firms, and foreign companies’ R&D
expenditures in the U.S. Indeed, over the past quarter century, the
private sector’s investment in the search for new medicines has grown
eight percent per year on average, faster than the industry’s growth in
sales and profits.
Despite this massive public and private effort, output, as measured
by the number of new drugs, biologics, vaccines and devices approved
for use by regulatory bodies like the U.S. Food and Drug
Administration, has slowed in recent years. Last year, the FDA approved
just 21 new drugs and biologics, the second lowest total since 1993.
Moreover, about half of these new drugs were not given priority status
by the FDA, which meant they were not considered a significant new
advance in medicine. This significance ratio has held steady for over a
decade. Clearly, the steady increase in private and public R&D
spending is generating diminishing returns, whether measured by return
on investment or public health.
PODCAST/TECH/QUALITY: MedEncentive–can a simply “elegant” solution really change health care delivery?
Jeff Greene believes that his "elegant" solution can change health care delivery in one of the toughest places in America to do it–the wild medical mid-west. Jeff claims that the only two places on earth where life expectancy is falling are sub-Saharan Africa and Oklahoma City. (I assume Iraq is soon joining that list!) His company MedEncentive offers a simple way of physicians to follow guidelines, patients to get informed about their care, and apparently payers to save lots of money. Before you dismiss it, listen to this podcast.
(Technical note–For some bizarre reason Jeff’s channel was recorded a few seconds ahead of mine. So he’s answering my questions a little before I’ve finished asking them. Or alternatively, he’s psychic. At any rate it sounds a little odd. But I know you lot never listen to me on these podcasts anyway!)
INTERNATIONAL: Gaming Choose & Book?
The Daily Mail, a British tabloid that is not exactly known for its rational, pro-Blairite analysis says that UK Hospitals are cheating over patient choice and gaming the Choose and Book system.
POLICY: Vic Fuchs still bringing it!
Vic Fuchs and Zeke Emmanuel body slam reform efforts that leave employment-based health care in the system.
TECH: HIMSS blogger meet-up
HIMSS blogger meet-up is on.
Sunday, February 25, 2007Time: 08:00 PM (right after the HIMSS Reception)Location: Mulate’s (Cajun restaurant and bar located right across from the convention center) — thanks to Tim Gee for this arrangement
Come meet Shahid Shah, Tim Gee, John Sharp, and guess whic one of the lurkers at the bar is really MrHISTalk….
This is so important that I’m flying in especially from London for it. Hope to see you there!
INTERNATIONAL: Having run ahead on primary care PCP, Brits copying Medicare on hospital P4P
The Brits have decided that in at least some regions their hospitals are going to try American style P4P
Health bosses have announced a plan to reward hospitals for low death and infection rates and few readmissions. NHS North West said it was piloting a scheme where cash bonuses are paid to hospitals following the success of a similar programme in the US. Trusts will compete for a total pot of £1.5 million, with any ranking in the top 10 per cent or 20 per cent getting a share. Initially, payments will be made for treatments for heart failure, pneumonia, heart bypass grafts, and hip and knee replacements. But critics said people would expect hospitals to be prioritising safe care anyway.
Don’t forget that on the primary care side they’ve been well ahead of anyone else. Although that’s had it’s issues too. The first year the GPs beat their targets so easily, they’ve made lots more money then the government thought they would.
TECH: WorldDoc CEO Rahul Singal transcript
This is the transcript from my recent podcast with WorldDoc CEO Rahul Singal transcript.
Matthew Holt: Hi. It’s Matthew Holt, at The Health Care Blog, and we’re back with another podcast. This time, I’m talking with the C.E.O. of a very interesting company, which has its fingers in multiple pieces of the health-care system. I’m talking today to Rahul Singal, M.D., who is the president and C.E.O. of WorldDoc. Rahul, how are you today?Rahul Singal: Doing fine. Thanks, Matt. Good afternoon.
Matthew: WorldDoc is based in Las Vegas, just to let the people listening know. I saw Rahul there at a conference a week or so ago. I’d kept tabs on WorldDoc a little bit in the last couple of years, but I wanted to find out a bit more about what was going on. But a number of interesting health care stories are coming out of Las Vegas. I suspect that both those stories and the roles of WorldDoc are not so well known. Anybody going to your website would see that you’re involved in a bunch of different things: strategy analysis, software, personal health records, pharmacy benefits management. To tell the people listening, what does WorldDoc do and what are your main lines of business?
Rahul: WorldDoc is in its seventh year of operations. We started with 14 board certified specialists. We now have 20. We have the single vision of trying to educate and empower consumer end users about their health before seeing a doctor. So we created a web based software system that helps people understand their acute care problems, things like a cough or red eye or stomach pain, "What’s wrong with me? What can I do to make myself better?" Acute care is one of the things. Preventive health. "Hey, I just turned 40 years old. What tests do I need? How can I maintain a healthy lifestyle? Am I at risk for a heart attack?" Then chronic conditions, things like when you know you have high blood pressure or diabetes or high cholesterol. We teach people about their goals, how to talk to their doctors, how to get to their goal.
We do this all in a software based system, created by the 20 board certified specialists.
Matthew: That’s one part of your business. As you know, there have been plenty of companies over the last decade or so who have created software programs to do some parts of some of that, but you guys seem to have made a real business of it. So what have you been selling, who are your customers, and what kind of services are you selling?
Rahul: Our core customers are self insured employers and their payers. The self insured employers are the true purchasers of health care. Their payers are independent third party administrators or regional health plans, which market to these entities, and then their consumers and end users use them.
Our core web based system comes with a 24 hour nurse line. One of the things that we’ve been able to do is import pharmacy and medical claims into our care engine, so that the pharmacy claims can be done within 24 hours of a claim fill. That means that, if I have diabetes and you have high blood pressure, and we each fill a prescription, then, the next day, the WorldDoc system might message you and say "Hey, for your high blood pressure, do you know what your goals are? Here’s the medication. You may want to talk to your doctor about this alternative, which will save you $1,000 a year."
Matthew: Let’s get down to a more granular example. Let’s say I’m one of your customers who is an employer, and I’m working with a TPA to administer a regional health plan or a TPA to administer my employee benefits. Maybe you want to pick a real example, of one of your employer customers. How does it actually work? What are the pieces that you’re supplying to them? What are the pieces that they’re really looking for?
I understand that a smaller TPA may not have done what some of the larger health plans have done and created their own online consumer health experience, as it were. Perhaps they’re looking to you to provide that. What is the value proposition? What are the reasons for which they will engage WorldDoc?
Rahul: On the health risk assessment side, where organizations profile a population’s risk, there’s a lot of examples in the industry in which an employer or a health plan will incentivize a population to fill out a health risk assessment. We do that as well, it works great.
However, we go a few steps further, so that, if, on the basis of pharmacy claims, we know that 500 people may have diabetes, and we’ve done this with Coast Resorts, a casino here in Las Vegas. These 500 people that were on a diabetes claim file, out of a total population of about 7,000, were sent one letter, which invited them to come to the WorldDoc website and fill out a diabetes report card. About 150 people did that.
What’s fascinating is that these 150 people, whom we taught to know their numbers, put in their cholesterol levels, their hemoglobin A1c, and blood pressures, and we created a profile of "Hey, am I at goal?" Simultaneously, we sent this to the employees’ doctors, and we had that in our database. What we showed, within six months, was that these people that participated, that their blood sugars improved to the same degree as they would have if a nurse had phoned them at home. So, we believe, for working age people, commercial people, "Get on the same page with your doctor, reach your goal." This study was published in the Journal of Managed Care about a year ago, and really empowered end users to take better care of themselves.
HOSPITALS: More patient dumping in Los Angeles?
This time apparently Hollywood Presbyterian is at it.
BLOGS/OFF-TOPIC: A Brief History Of Football Violence
Over at Spot-on I’m writing about a not very health care topic A brief history of football violence.
Only a few months after winning the World Cup,
Italian football is in crisis – again. Last year a referee-tampering
scandal sent Series A champions and Italy’s most famous club Juventus
to the barren wastelands of Serie B. Last weekend Italian football was
shut down after a policeman was killed by a crowd in a Series A game in
Sicily.
Currently a 17-year-old is the main suspect. And the government has reacted strongly. Apparently only six stadiums are going to be allowed to reopen
any time soon. The others lack the suddenly required safety features
(including close circuit TV) which they’ve supposed to have had for
several years. This includes Italy’s most famous arena, the San Siro in
Milan which is shared between the two giant Milan clubs, AC and Inter.
Anyone who’s ever seen the briefest scenes of Italian football
on TV will probably have been astonished by the huge fluorescent
purpley-red flares set off by the fans standing behind the goals . They
usually are lit when their team scores, but in some cases they’ve been
used to disrupt games. The most notable case was in the semi-final of
the European Champions League played in San Siro Stadium between the
two Milan clubs. Inter were losing, then had a goal disallowed, and their fans threw flares onto the field. One hit the AC Milan goalkeeper.
The game was halted, then abandoned, and later awarded to AC Milan (who
went on to lose the final to Liverpool). Inter’s penalty was the
proverbial slap on the wrist – they were forced to play their next 4
home games in an empty stadium. Go on, continue …
