Jaan Sidirov at Disease Management Care Blog did a great job combining the best of the health blogs for this issue of Health Wonk Review.
Controlling costs is the central problem in U.S. health care
By
The central problem in the U.S. health care system isn’t cost or insurance, per se, it’s the challenge of increasing health care value to the patient/consumer.
That means we must improve the poor quality and inefficiency of care, so that we all receive only the care we need, delivered in a timely and effective manner, without waste and over-treatment, and with a focus on integrating “well-care” (prevention and self-management) with sick-care.
It also means dealing with the knowledge void, an ironic situation in which our health care community is drowning in oceans of information, yet no one knows the best ways to prevent health problems and treat them cost-effectively, especially when you take individual differences into account. To address this problem, we need better health information technologies, as well as a collaborated effort to develop, disseminate, and deliver cost-effective evidence-based care.
If consumers were to receive high value health care in this manner, costs would be lower since poor care costs more and delivering only the minimal necessary care typically results in better outcomes! More appropriate care, delivered competently and cost-effectively through cost-conscious, patient-centered “medical homes,” for example, is the only way to control costs long-term.
Weak analysis about the “demise of Health 2.0”
Everyone’s favorite naysayer Dmitriy Kruglyak is getting very self-satisfied this morning about the failure of Revolution Health to change the world in three years. Normally, I leave Dmitriy’s bizarre wofflings alone, but because he’s directly "pointed the finger" at me and by extension at my partner Indu Subaiya, it’s time to respond.
While there may be a demise in Steve Case’s investment, Dmitriy proves yet again that his background as a software geek with no background in understanding the health care system — and his professional jealousy as the creator of a failed conference about blogging — gets in the way of his limited analytical skills of what he claims I’ve been saying about Health 2.0.
Yes, Indu Subaiya and I founded the Health 2.0 Conference to focus on the use of new participatory software tools in health care. Had Dmitriy paid attention when he attended the conference in 2007 he would have noticed that the audience was asked, what would be the future of the search, social networking, & consumer tools that made up Health 2.0? The response was that 70% felt that these tools would be adopted by mainstream health care companies, rather than become a standalone industry. Which was exactly what I have been saying all along.
On the Road Again: Health 2.0 Motorcycle Tour
In "Zen and the Art of Motorcycle Maintenance," Robert Pirsig writes about the different reactions to our experiences living with modern technology, which he describes as romantic, classic, and a third and completely separate element and perspective, which he calls Quality.
I’m finding that there is a bit of all three in my Health 2.0 motorcycle tour and the interviews along the way. It’s a curious revelation, and I’m somewhat awestruck by the relevance of his musings about how we lived during the 1970’s to our situation here in the new century with health, wellness, and the Internet.
Exploring and conquering new health care frontiers
The September/October issue of Health Affairs is dedicated to reviewing concepts of the medical home. It is most likely the most current, authoritative, and impressive review of this emerging idea. Health Affairs is an excellent resource for health policy wonks to gather, but in recent years has become more accessible to the general health care audience. I would recommend it as required reading for anyone interested in learning about this trend.
Simultaneously, there have been some recently updated “state of the industry” reports coming out of the retail health clinic world. As noted by Jane Sarasohn-Kahn, the fact that more and more retail clinics are being created has increased access, improved quality through an evidence based approach to a limited set of clinical conditions, but has not done nothing to address the cost issue. In fact, increasing the supply of retail clinics, has simultaneously increased the demand for these services. This is a common phenomenon within healthcare, and the supply driven demand has been well described particularly in the hospital setting.
Forcing the candidates to get real on health care change
By Robert Laszewski
Let’s pretend that either Senator Obama or Senator McCain will be able to implement their respective health care reform plans if elected. This exercise should be easy. We’ve been doing it for months now.
Or, we can get real and expect them to do the same.
For all the arguments both candidates are making that they are change agents, including over their competing health care reform proposals, this dirty little secret remains –– neither Senator’s health care plan has a chance of being implemented.
Adding layers to Health 2.0
By 
Jen McCabe Gorman drew a picture at HealthCampDC last that I really liked. Luckily, I found this image of her Medicine 2.0 presentation, so nobody has to decipher my sketch.
The one difference is that, on Friday, Jen pointed out that the outer square ("content") is Health 1.0 and Health 2.0 begins with the "community" square. After reading her research paper, I now understand that the next inner square is Health 3.0, or content + community + commerce and the final, innermost square is Health 4.0, which would add coherence to the equation. Health 4.0 in this model is the "evolutionary stage connect[ing] the real world of brick-and-mortar systems with the virtual world of online services."
The paper is well worth a read, whether you agree with this model or not. I’m going to have to think about the following points, for example:
Another weakness of current Health 2.0 initiatives is the tendency of communities to attract similar people. Many focus on connecting "like-minds," relatively homogeneous groups such as patients with the same diagnosis or physicians in the same subspecialty. Similar groups then generate very similar content. Users become settled and ‘comfortable’ and thus less inclined to venture out and advocate for other consumer groups and sytemic change.
When is the same spending more spending?
When it’s routed through the government because their spending is done with mythically different dollars than private spending. Or at least it is in the bizzaro world of free-marketeer policy analysts. Let me explain…
A couple of weeks back a small consulting firm working for McCain sent me an article written by University of Minnesota economist Roger Feldman about the cost of Obama’s health plan. They were complaining that I hadn’t featured their analysis. So I read the report which suggested that the Obama plan would cause $450 billion in health spending. Bear in mind, Obama suggests that it’ll cost $65 billion, so this is quite some stretch.
I was going to write a long, learned article about this, but instead I’ll just show you the email back & forth.
Around the Web in 60 Seconds (Or Less)
The majority of ER patients leave confused and with unanswered questions, which can contribute to medication errors and return visits, the New York Times reports. And the study published in the Annals of Emergency Medicine was among English speakers! Imagine the confusion among those with limited or no English.
Illinois is debating its certificate of need laws, following a decision by the US Department of Justice and Federal Trade Commission that it hampers competition and weakens the market’s ability to contain costs, the Chicago Tribune reports. The Illinois Hospital Association president defended the law: "The state has a legitimate interest … in preventing the proliferation
of profit-seeking enterprises that seek to cherry-pick well-paying
patients or those who have good insurance coverage, leaving
full-service community hospitals to provide vitally needed but
money-losing services, such as emergency and trauma care and care for
the uninsured, that are poorly reimbursed or not reimbursed at all."
Pennsylvania politics over medical malpractice insurance subsidies threaten the existence of the state agency that monitors hospital finances, occupancy, procedures and infection rates, the Pittsburgh Tribune-Review reports.
Health Affairs has critiques of McCain and Obama’s health plans, along with a proposed comprimise by Wharton professor Mark Pauly.
Golden Rule Founder dies
It is not seemly to speak ill of the dead so this is all you’ll hear from me about the passing of Patrick Rooney, founder of Golden Rule. An obituary is here.
