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The Enormous Potential for Digital Health Care Services in Germany

Oct 31, 2012• 2

By Martin Schmucker

Throughout Europe, digital innovations with substantial benefits for the patients are spreading quickly. However, stakeholders in Germany are still reserved about these new technologies. Alexander Schachinger, founder and CEO of healthcare42.com and speaker at Health 2.0 Europe, talks about the chances of digital healthcare services in Germany.

Mr. Schachinger, healthcare42 and Publicis Healthware/ razorfish are currently preparing a survey about the utilization of health information by chronic patients in the Internet. What exactly is the objective of your investigations?

Alexander Schachinger: Up to now, there haven‘t been any representative scientific studies about the usage of health information by chronic patients. We still don‘t know how this influences their knowledge, their attitudes or their behavior in regard to the healthcare market, in particular towards doctors and pharmacists. We are attempting to close a gap here since research on e-patients has been unfortunately neglected in Germany. In a survey in cooperation with KWHC and others, we interviewed 3,500 e-patients online. We were able to show that the Internet, exchange in forums and suchlike do have an effect on the patients, especially in regard to medical consultations and the decision for or against a certain therapy.

How do you define “e-patients?”

With this term we refer to people suffering from chronic diseases, but also to acutely ill patients, who use the Internet to find out and share information about health issues. This term also comprises all sorts of caregivers, including parents, children or spouses who inform themselves about the medical conditions of their loved ones via the Internet.

Four New Tools for Brain Workouts

Oct 31, 2012

By H. James Wilson

How do you sharpen your thinking?

I’ve written already about how you can use auto-analytics to measure and improve the tasks you take on every day at work, but there’s another class of auto-analytics that help you improve at a more fundamental level. These tools strengthen the underlying brain and behavioral structures that support smarter thinking, decisions, and routines in any professional field.

Here are four new tools that I’ve spotted in my research. I use the term “DIY” because each option can be tested, and learning outcomes quantified, without the need for an outside instructor or expert.

Quantified Mind is a personal online cognitive testing platform based on psychometrics, the measurement of cognitive performance in areas like reaction time, executive function, and verbal learning. You take a battery of tests to see your current cognitive performance; then you introduce an intervention to understand whether it helps or hurts thinking. Interventions can include changes to daily routine or diet.

Why Obamacare Is Good for White People

Oct 30, 2012• 27

By Michael L. Millenson

With some pundits predicting that President Obama’s re-election could be sabotaged by a slim level of white voter support, I decided to dig through the small print on Obamacare to see how this right-wing lightning rod actually affects my fellow Caucasians.

It turns out that the high-profile legislative highlight of Obama’s first term is very good for white people. When the Affordable Care Act is fully implemented, 12.3 million more white people will have health insurance than have it today, according to an analysis in Health Affairs.

Obamacare looks even more positive for the pale skinned when put next to the Romney-Ryancare alternative. If Obamacare is repealed and replaced by the health reform plan Presidential-candidate Romney now proposes – not to be confused with the plan Massachusetts then-Gov. Romney enacted into law — an extra 24.8 million white people will not have health insurance. (That’s if you apply current demographics to a recent Commonwealth Fund analysis.)

By way of perspective, that’s nearly equivalent to the entire population of Texas (but all white people) having to cope with serious problems accessing medical care and paying for it. Or to use a more politically compelling comparison, 24.8 million white people would be more than twice the size of the whole population of Ohio.

Irresistible Forces

Oct 30, 2012• 16

By Brian Klepper

At our first meeting years ago, Tom Emerick, Walmart’s then VP of Global Benefits, told me,

“No industry can grow indefinitely at a multiple of general inflation. It will eventually become so expensive that purchasers will simply abandon it.”

He said it casually, as though it was obvious and indisputable.

Health care is playing out this way. From 1999 to 2011, health care premium inflation grew steadily at 4 times the general inflation rate. During that same period, the percentage of non-elderly Americans with employer-sponsored health coverage fell from 69.2 to 58.6 percent, a 15.3 percent erosion rate.

Health care’s boosters like to argue that it has buttressed the economy, and that it means more jobs and economic prosperity within a community. A February 2011 Altarum Institute report estimated that private sector health care jobs now account for nearly 11 percent of total employment. Since the recession began in December 2007, health care employment has risen by 6.3 percent while employment in other industry sectors fell by 6.8 percent.

But there’s a darker side. Health care’s ever-increasing revenue growth has come at the expense of individuals and firms that pay its bills, directly through health plan premiums, and through taxes, often instead of buying other goods and services. It transfers wealth to health care from everyone else. Like the finance services industry, health care has become a disproportionate “taker” industry, sapping economic vitality from America’s communities.

A Sign of the Times

Oct 29, 2012• 10

By David Dranove

Coming Soon, North Shore University Health Systems Medical Office Building.

For me, this is sad news. I am not saddened that North Shore University Health is opening yet another medical office building. It is where they are opening that gets me. They are taking over a two story building that used to house a Border’s Bookstore. My Border’s Bookstore. Sure, Border’s may have been a bit corporate, but this was still a great bookstore. They sold best sellers there, of course, but they also carried all the classics and lots of eccentric titles. Heck, they even briefly carried one of my own books! They had a vast selection of books about military history and an amazing travel section. My wife lost herself for hours in gardening and my sons ogled the aisles of mystery and fantasy novels. Border’s also had vast CD and DVD departments (with classical CDs and Criterion Collection movies) and the café sold a chocolate bundt cake that was out of this world. Maybe best of all, the building had an odd layout with lots of nooks and crannies and surprises around the corner. For a corporate bookstore, it oozed charm. Medical office buildings never ooze charm.

Man versus Pizza

Oct 29, 2012• 4

By Peter Ubel, MD

As a fan of free markets, I recognize that sometimes intelligent government regulations (not always an oxymoron!) can improve markets by requiring companies to provide consumers with information that will help them make better choices. Informed consumers, after all, are a central ingredient of a successful free market. That’s why even most libertarians support regulations that ban fraudulent advertising.

That’s also why, at first glance, the federal government seemed to be promoting better markets when it passed rules requiring chain restaurants to post calorie counts next to their menu items. Research has shown that many consumers are horribly uninformed about the number of calories in most menu options, often significantly underestimating the amount in their favorite meals. Calorie count information should help these consumers make more informed, and therefore better, decisions.

But recent push-back from groups like pizza companies raises important questions about the proper size and scope of such regulations. More importantly, this controversy should remind all of us that, when debating government regulations, we should be humble, because it is often difficult to set a proper balance between helping consumers while at the same time allowing businesses to prosper.

To understand the push-back, it helps to take a guess – your best shot – at estimating the number of calories in a large Little Caesars pizza.

Stumped? You should be. There is no right answer to this question, because there is no such thing as a generic large Little Caesars pizza. Instead, there are hundreds of possible large pizzas one could buy from this company – cheese pizzas, pepperoni and sausage pizzas, mushroom green pepper and extra sauce pizzas . . . you get the idea. The number of calories in a large Little Caesars pizza depends on how many toppings consumers choose to put on top of their pies. This variability makes it hard for Little Caesars to post calorie counts on its menu.

How to Stop a Future Cancer Epidemic

Oct 29, 2012• 5

By Paul Levy

The theory of preventative care, including inoculations, is that we spend a little money now to offset big expenses later in life. But sometimes behavioral friction keeps this from happening, even when the technologies and approaches are proven. We are witnessing such a failure right now with regard to Human Papilloma Virus (HPV).

Here’s the story, from MGH’s James Michaelson, PH.D., arguably one of the most thoughtful, trustworthy, and sensible researchers in the field of analysis of cancer survival. Jim and his team develop sophisticated mathematical methods for predicting the risk of local, regional, and distant recurrence. He says:

There are a couple of good papers about Human Papilloma Virus (HPV), and the coming epidemic (yes, an overused term, but truly applicable here) of head and neck cancer. As Chaturvedi et al say in a recent paper: “If recent incidence trends continue, the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020.”

I get to see this problem from two angles: From my work as the the manager of the MGH/MEEI Head and Neck Cancer Database, and from my experiments in using computer telephone messages to get patients in for preventive health services, such as the fabulous HPV Vaccines: Cervarix (from GlaxoSmithKline) and Gardasil (from Merck). The vaccines are incredibly underutilized. Only about 1% of eligible boys and only 50% of eligible girls get one shot. Only about 25% of girls get all three shots.

Continue reading…

The Good Doctor Learns to Fly

Oct 26, 2012• 37

By Rob Lamberts, MD

This is my new office. I signed the lease for this property yesterday – another big step in the process of getting my new practice off the ground. I should feel good about this, shouldn’t I? I’ve had people comment that I’ve gotten a whole lot accomplished in the 4 weeks since I’ve been off, but the whole thing is still quite daunting. Yes, there are days I feel good about my productivity, and there are moments when I feel an evangelical zeal toward what I am doing, but there are plenty more moments where I stare this whole thing in the face and wonder what I am doing.

I walked through the office today with a builder to discuss what I want done with the inside; it quickly became obvious that there was a problem: I don’t know what I want done, and nobody can tell me what I should do. Yes, I need a waiting area, at least one exam room, an office for me, a lab area, bathrooms, and place for my nurse, but since I don’t really know which of my ideas about the practice will work, I don’t know what my needs will truly be. How much of my day will be spent with patients, how much will be doing online communication, and how much will be spent with my nurse? I want a space for group education, but how many resources should I put toward that? I also want a place to record patient education videos, but some of my “good ideas” just end up being wasted time, and I don’t know if this is one of them.

I come across the same problem when I am trying to choose computer systems. I know that I want to do that differently: I want the central record to be the patient record, not what I record in the EMR. I want patients to communicate with me via secure messaging and video chat, and I want to be able to put any information I think would be useful into their PHR. So do I build a “lite” EMR product centered around the PHR, or do I use a standard EMR to feed the PHR product? Do I use an EMR company’s “patient portal” product, or do I have a stand-alone PHR which is fed by the EMR? I have lots of thoughts and ideas on this, but I don’t really know what will work until I start using it.

How Bundled Payments Just Might Save Health Care From Itself

Oct 26, 2012• 5

By Wes Champion

In the 1960s, Texas Instruments developed the first handheld calculator. It could display up to 12 digits while performing addition, subtraction, multiplication and division. And it cost $2,200.

Since then, the calculator has come a long way. Competition forced continuous innovations, and today’s models are more lightweight, have longer battery life, are capable of performing more complex computations –all at a dramatically reduced price point.

That’s the typical cycle in virtually every sector of the American economy. Innovations are introduced, competition forces design improvements and cost reductions and products are continually improved until the next big thing comes along to start the process over again.

But that’s not the way things work in healthcare.

Like the calculator, Medicare was first created in the 1960s.

But even though the practice of medicine has changed dramatically over the last 40 years, the Medicare program has stayed largely the same. And, since most commercial insurers tend to follow the government’s lead in terms of payments and benefit design, even private markets have played a role in limiting innovations in the way we pay for healthcare.

Patient Satisfaction: The New Rules of Engagement

Oct 26, 2012• 11

By Holly Korda, Ph.D.

Patient satisfaction has garnered new attention as an indicator of provider performance and an important dimension of value-based health care under the Affordable Care Act (ACA). Defined in any number of ways, it is often publicly reported to help patients choose among health care providers.

This month, patient satisfaction takes on even greater importance as ACA provisions set to begin October 1, 2012, tie patient satisfaction to Medicare reimbursement, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. HCAHPS scores reflect patients’ perspectives on several aspects of care: communication with doctors and nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, and quietness of the hospital environment—and are estimated to place at risk an average of $500,000 to $850,000 annually per hospital.(1)There’s a lot riding on patients’ perceptions of the health care experience, our satisfaction with the care we receive. But what do we really know about patient satisfaction, its relationship to patient outcomes and cost—and just what is it we are rewarding?Continue reading…