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Matthew Holt

The Other Medicare Report

Aug 17, 2010• 22

By JOHN GOODMAN, PhD

The release of this year’s Medicare Trustees report was unprecedented. As noted in previous posts here and at my blog here and here, Medicare’s chief actuary not only refused to sign off on it, he disowned it — encouraging readers to ignore it and focus instead on an alternative report, prepared by the office of the Medicare actuaries.

So what’s the difference in the two reports? It all relates to the health reform bill that passed last spring. The formal trustees report shows health reform dramatically reducing future Medicare spending. In fact, it is so dramatic that even the White House seems reluctant to talk about it — perhaps because it’s prima facie unbelievable.

Consider this: In 2009, the trustees reported that (looking indefinitely into the future) Medicare had an unfunded liability of $89 trillion. This year, the trustees report that number has fallen by more than half to $36.6 trillion. If the numbers are to be believed, health reform has already saved us $53 trillion — a sum more than three times greater than our entire gross domestic product!

RWJF’s Stephen Downs on a New Model for the Foundation – and the Health 2.0 Developer Challenge

Aug 17, 2010

Last week, we sat down with Steve Downs, Assistant Vice President, Health Group, Robert Wood Johnson Foundation to discuss the 3 New Challenges they’ve announced for the Health 2.0 Developer Challenge. Steve explains RWJF’s current areas of focus in health and how they are testing the Developer Challenge as a novel process to source and spur innovation.

Interview with Steve Downs, RWJF

From building real apps based on the Project Health Design PHR prototypes (in partnership with CHCF) to using County Health Rankings to build interactive tools for decision-making (in partnership with U. of Wisconsin) to working with the Markle Foundation and VA/CMS on the Blue Button initiative, RWJF has given the Health 2.0 innovator community lots of raw material and inspiration to work with.

And within just a couple of days, 5 Teams have already signed up to compete. For more on RWJF’sChallenges and to get involved with the Health 2.0 Developer Challenge, go to www.health2challenge.org.

Diversinet: a backbone for unplatforms?

Aug 17, 2010• 3

By Matthew Holt

Unplatforms is the term I’ve been using to describe the multitude of devices that people are using to collect and receive information. And also to cover the different channels they are using often on the same device (e.g. text, voice and web on one smart phone). Application developers are having to come up with strategies for connecting with people and moving and integrating their data in a world of multiple unplatforms, Diversinet has been focusing on creating a turnkey system for moving health data securely to patients–here’s a demo you can play around with to see how it works. It might be one solution for health care organizations to deal with all those unplatforms over which they need to reach consumers.

The company has recently changed its business strategy–it was working with a subsidiary of a Penn Blues plan to distribute its services, but following a protracted legal dispute, it’s now going direct to health care plans and providers who want to move data between multiple devices, and has hired McKesson veteran Mark Trigsted to run its new health care group. First customer is Minnesota integrated systems HealthPartners, with a pilot for pregnant women underway already. I spoke with Diversinet’s SVP of sales Jay Couse to find out more about the technology and the business strategy.

Interview with Jay Couse, Diversinet

Privacy and Security of Patient Records: The Lesson of the Weakest Link

Aug 16, 2010• 1

By DAID HARLOW

The Queen of Soul famously wailed about being a link in a chain of fools. Today’s lead story in the Boston Globe tells us about another sort of link in the chain — the weakest link in the chain of custody of patient records. In brief, a pathology billing service bought out by another service apparently dumped all records more that a year old in a town dump; a Globe photographer taking out his own trash noticed that the paper records (which he was looking at because he thought they ought to be recycled rather than dumped) had identifiable patient data and represented at least four hospitals from across Eastern Massachusetts. Clearly, these records ought to have been shredded or otherwise destroyed before disposal. Assuming they had some airtight contracts in place, the hospitals involved may well be looking to the seller of the billing service in this case to reimburse them for costs of:

identifying the patients involved in this data breach
notifying affected patients of the breach
providing credit monitoring services to affected patients
any damages incurred by patients
any fines incurred by the hospitals

Under the HITECH Act’s “Son of HIPAA” rules, the hospitals could be on the hook to the federales for up to $1.5 million in fines each as a result of this incident, and the state AG could get in on the action as well, filing suit on behalf of the affected Massachusetts residents and seeking to ensue that proper procedures are in place. There may also be a violation of the state data security law here as well. Massachusetts has a particularly stringent data security law on the books that took effect within the past year, and not all affected businesses have come into compliance. The AG may be on the prowl for a few high-profile cases, like this one, in which to levy substantial fines and convince the laggards that compliance would be more than worth their while.

The natural question to ask, given the facts of this case, is: What Would a Meaningful User Do?

Can Health 2.0 Fix Clinical Trials?

Aug 16, 2010• 6

By MATTHEW HOLT

Saturday’s New York Times portends more trouble for big Pharma. The headline is wrapped up in an examination of foreign corrupt practices, but the bigger issue is that clinical trials have hidden serious adverse events. The recent allegations that GSK hid data about heart attacks from an Avandia trial conducted abroad highlight the reality that over the last 20 years or so it’s been very hard to recruit patients for clinical trials in the US. It’s expensive to find patients, and the numbers of patients available near centers has not proved enough. The answer has been to go to places with lots of people and lower costs, like India.

One obvious consequence is that few of the significant advantages of Internet connectivity and patient community which have been developing in recent years have been adopted as part of these pre- or post market trials. Several online communities–notably PatientsLikeMe–have been running their own studies but they have typically been observational studies and haven’t had much acceptance from Pharma or regulators.

Ingenix buys Axolotl (with minor Update)

Aug 16, 2010• 4

By Matthew Holt

Ingenix, the arms dealer that’s been supplying all sides in the health care information war for the past decade or so, built itself up by buying lots of little companies in the data analytics space. Now it’s repeating the effort in the Health Information tools space. First it bought Caretracker (actually the company may have had a different name when it bought it, but that’s the name now). It’s a Web-based EMR for smaller practices (a sector with lots of Federal dollars attached). Then it bought Picis, a company that offers software that runs ORs, EDs and other high acuity inpatient sites (another recipient of lots of Medicare dollars).

Today it bought Axolotl, one of the vendors that’s biggest in the emerging (and constantly confusing) Health Information Exchange marketplace. Yet another place that lots of Federal dollars via ONC are going.

You’re probably noticing a pattern by now…

Ingenix itself of course is owned by United Health Group, although its CEO Andy Slavitt will be at pains to tell you that United also just happens to own a health insurer or two, and that Ingenix is not the subsidiary of a health insurer. Of course, Congress doesn’t always agree…

Normally I’d do lots of in-depth analysis about this story, but I’m for now just rushing to for once beat HIStalk to the punch!

UPDATE: Inga at HISTalk won’t truck with my “I beat her” comment and notes that she posted the following tweet before me (even if I got my post up on THCB before her or MrHISTalk posted on HISTalk!)

ngaHIStalk 1:09pm via Facebook

Rumor from two good sources: Ingenix/UnitedHealth Group will announce its acquisition of Axolotl after the market…http://fb.me/ECtaUXRc

boltyboy 2:56pm via TweetDeck

Ingenix (UHG) getting even more expansive in HIT, buys HIE vendor Axolotl

The Federal Reserve Wants to Rebuild Main Street

Aug 16, 2010• 9

By DAVID ERICKSON, Federal Reserve Bank of San Francisco and JAMES S. MARKS, Robert Wood Johnson Foundation

We all have a vision of the “Main Street” we would like to live near – tree-lined, friendly and safe. But our “Main Streets” are in disrepair. Across the country, they lack sidewalks, parks, well-stocked grocery stores with fresh food, healthy homes and apartments, and convenient public transportation. And it turns out, these things add up to a lot more than just an unpleasant place to live – they can have a major impact on our health.

There has been much in the news about the costs of medical care and our current and future economic competitiveness because of those costs. But little has been done as a nation to see if we can reduce the amount of disease we have to treat.

On Main Street in America, a woman with diabetes – perhaps one who is newly insured under health reform – will see her doctor, who after telling her what medications and tests she needs, will tell her to improve her diet and be more physically active. But what if she returns home, to a neighborhood that makes following the doctor’s advice nearly impossible because there is no supermarket with fresh food like in Detroit, where there are only 5 grocery stores for a city of 139 sq. miles?

That’s Dr. Geek Squad to you

Aug 16, 2010

By JANE SARASOHN-KAHN

Best Buy is teaming up with Cardiac Science, targeting potential purchasers of electronic health records (EHRs) and noninvasive cardiac devices. The venture
looks to take advantage of economic stimulus funding available through
the HITECH Act aimed at motivating physicians to adopt EHRs.

Cardiac Science is a medical device company focused on the
noninvasive management of heart disease. Their products include
defibrillators, ECG/EKG devices, stress testing equipment, Holter and
vital sign monitors. These heart-hardware products are designed to
connect with electronic health records systems in hospitals and
physician offices. and are used in many settings outside of health
institutions including schools, emergency medical response centers, fire
and law enforcement, airports, and the hospital industry.

Interview with Mary Hiller, MedExpert International

Aug 16, 2010

By Matthew Holt

Mary Hiller is Executive Director at MedExpert International — one of the companies behind Safeway’s remarkable results in reducing health care costs. The company manages a system that aligns best practices from intensive literature searches (although Mary is a little quiet about how they do that) with patient’s decision at the moment of diagnosis. The company is coming out of a relatively stealthy period, and when they contacted THCB I thought it would be a good opportunity to find out more. Plus Mary’s role in the Bond movie Diamonds are Forever makes her a little unique among health IT executives! Here’s the interview:

Mary Hiller, MedExpert International

Atul Gawande and the Art of Medical Writing

Aug 15, 2010• 13

By BOB WACHTER, MD

Don’t read this.

That is, if you have a limited amount of time for reading today, I’d rather you read Atul Gawande’s essay on end-of-life care in this month’s New Yorker than this blog.

But if you can spare a little time, I’ll be focusing on some of the techniques Gawande uses to make his writing so lyrical and memorable. Whether you write yourself or limit your storytelling to cocktail parties and presenting H&P’s on morning rounds, lessons abound. Here are a few, gleaned from this month’s piece, “Letting Go: What Should Medicine Do When It Can’t Save Your Life?”:Continue reading…