Author Archives

Matthew Holt

Hospital Bills, Insurers and Pricing

May 24, 2010

By MICHAEL RICCIARDELLI

A few weeks ago I wrote here about my
unhappy experience of inadvertently mixing two different types of drain
cleaners together. I learned then, and thought it useful to relate,
a painful in-home science lesson: the combination of hydrochloric acid
and hypochlorite (bleach) apparently forms chlorine gas, which was used
as an agent of chemical warfare early in World War I. Serious lung
damage and death are real possibilities. After a trip to the emergency
room, a follow-up visit to my doctor and the passage of time– I’m ok.

But the other day I got the bill, or thankfully, as I am insured
through my employer, the explanation of benefits. My present insurance
company, CIGNA, detailed the claim in an easy to read and understandable
manner. It is telling.

med-bill-breakdown2

I was in the
Emergency Room for about 4 hours (they had wanted to keep me overnight
for observation but released me under the condition (and my pleading)
that I return immediately if any number of things happened). I received
oxygen and breathing treatments, x-rays, lab work, an electrocardiogram,
and the care of a physician. The total billed was $2,270. But perhaps
more importantly, the amount “discounted,” or the amount my insurance
company did not pay through its negotiated pricing contract with the
hospital, was $2007. Which is to say that my insurance company paid a
total of only $263 of this bill. Thankfully, I owe nothing except a
small co-pay.

It Slices, It Dices, It Fleeces

May 24, 2010• 9

By MICHAEL TURPIN

Infomercials annoy me. They are social polyps that have grown to outlandish proportions on the intestines
of a bloated and sick American media. The portmanteau term “ infomercial” is clearly an oxymoron describing the contradiction of programs that are both hosted and devoured by morons. The fact that infomercials are even allowed by the FCC is a sign of the advanced dry rot in our American entertainment, economic and regulatory systems.

The FCC, according to one gadfly, now stands for “Forget Catching Criminals.” It appears that after decades of exporting our innovation, manufacturing and customer service, the dregs of commerce have reached new lows where 30 minute advertisements fill vacant morning programming time – feeding bread crumb promises to an inactive and unemployed America gulping down like boat marina carp visions of cleaner colons, miraculous weight loss without exercise and abs as chiseled as parking lot speed bumps.

I can recall the first time I was ripped off by a false advertisement via a DC Marvel comic book. The “Live Sea Horses” actually turned out to be ionized pieces of tire rubber. As they floated and swirled in my “seahorse garden”, I felt my first sensations of buyer’s remorse. I had been had. Weeks later, I was tempted to send away for X-Ray glasses. The idea of being able to watch the older eighth grade girls PE class run laps with my three dimensional goggles was intoxicating. Yet, the cynical memory of pathetic black floating bits of rubber had already eroded the tint from my rose colored glasses. My father, the advertising man, later explained to me the simple Latin maxim that would echo in my brain for decades: “Caveat Emptor – Buyer Beware.”

National Healthcare Insurance Isn’t Enough: Six Crucial Steps To Improve Healthcare

May 21, 2010• 19

By ALBERT S. WAXMAN, PhD

Healthcare reform has finally made its way through the U.S. political machinery, emerging with a $1 trillion reform plan extending health insurance to 32 million additional Americans and eliminating other barriers to healthcare insurance.

To be sure, it’s a good start: America has finally joined the world’s other developed nations and made healthcare a national requirement for most citizens. However, there is a real risk that we have traded one problem for another.

The healthcare reform law – formally, the Patient Protection and Affordable Care Act (PPACA) – does very little to address the underlying costs and structural issues that have driven healthcare costs to rise at about 2 ½ times the annual rate of inflation. Adding 32 million people to these bad economics will place additional stress on a system that continues to swell. Failure will lead an existing $2.5 trillion industry to inflate to more than $4.5 trillion in 2019, according to The Centers for Medicare and Medicaid Services, and further weaken the U.S. economy.

Health 2.0 Goes to Washington conference – DC, June 7th!

May 21, 2010

With less than 3 weeks to go until this groundbreaking event, we are happy to announce 2 NEW special sessions!

Patients 2.0: Join Gilles Frydman, ACOR, as he hosts a panel of 7 vocal ePatients who will share their personal journeys and experiences navigating the healthcare system and the world of Health 2.0.

Moving the Needle on Innovation Together – A Workshop for Federal Agencies and Health 2.0 Companies: With your hosts Wil Yu, ONC and Julie Murchinson, Health 2.0 Accelerator and Manatt Health Solutions, roll up your sleeves for a hands-on session highlighting federal initiatives for care improvement where the government is funding programs and seeking solutions from the Health2.0 innovation community to “move the needle” forward on national healthcare priorities.

Also check out the updated agenda, don’t wait till it’s too late – REGISTER TODAY – and be there for this amazing line-up of speakers and presenters!

Dislodging the anchor

May 21, 2010• 3

By PAUL LEVY

A well-established technique in negotiation is to “set an anchor.” The
idea is to be the first person to put out an offer in a negotiation in
which price is the main issue. Many people think, incorrectly, that you
are better off if you let the other party make the first offer. But,
no. An anchor, once set, has a powerful impact on the negotiation,
causing the final price to settle in its vicinity — even if the anchor
has no substantive basis.

I fear that we are seeing this phenomenon happening in Massachusetts. Many of you have followed our
current controversy regarding insurance rates for individuals and small
businesses. Lots of people with these kind of insurance policies found
themselves with large premium increases this year.

How to Build a Culture of Innovation From the Inside Out

May 21, 2010• 11

By Jennifer Ruzek Liebermann

“How do you inspire and enable innovation in a large organization?”

That’s the question I grapple with daily as director of Kaiser Permanente’s health care innovation center. I’ve observed that it isn’t sufficient to have a dedicated Innovation Center, an Innovation & Advanced Technology Group, or in-house Innovation Consultancy design group – all of which Kaiser Permanente has. The real question to solve is: “How do you create a culture that enables innovation throughout an organization?”

To explore answers to that, this week I am joining with physicians, nurses and design thinking, quality and innovation experts from the United Kingdom’s National Health Service and Kaiser Permanente for three days in South Devon, England, at the NHS Horizon Centre for Innovation, Education & Research in Healthcare, to share successful failures and best practices in innovation.

One contribution the NHS already has shared with the extended health care innovation community is a guide that helps leaders enhance the conditions for innovation: “Creating a Culture of Innovation.” Given that organizational leaders’ behaviors have a disproportionate influence on creating a culture that either hinders or aids innovation, Lynn Maher and Helen Bevan of the NHS Institute for Innovation and Improvement and Paul Plsek distilled the organizational research on innovation into a helpful “how to” guide outlining the seven dimensions of culture that support innovation. These principles, summarized below, can be applied to any organization.

So how can you begin building your own innovative culture — and how have we used these principles at Kaiser Permanente?

Risk-taking: Establish a climate in which people feel OK trying out new ideas by not shutting down ideas before they’ve been vetted. Leaders should demonstrate they are more interested in learning from failure than punishing people for it.

To foster innovative thinking at Kaiser Permanente, our Information Technology leadership created an Innovation Fund, an internal program that provides seed funding and support to teams of doctors and employees to facilitate the rapid prototyping of novel IT ideas and diffusion of successful innovations. Leadership also created iLabs, an innovation lab that serves as a technology research, advisory and software prototyping group that works with Kaiser Permanente innovators to help develop technology solutions for health care.

Resources: Resources are meant in the broadest sense of the term here. The traditional definition signifies an organizational commitment to innovation, but resources need not always be concrete. Time, permission and autonomy to innovate may be what is needed. For example, Kaiser Permanente’s Innovation Fund not only provides seed funding, but access to mentors and tools to jumpstart innovation.

Are New Yorkers Sicker Than Patients in Atlanta–or Are They Just More Likely To Be Diagnosed?

May 21, 2010• 48

By MAGGIE MAHAR

At a dinner party in Manhattan, someone mentions the problems he has been having with his sinuses, and his doctor’s diagnosis. Since everyone at the table is over 40, his comment quickly leads to a lively discussion of back pain, rotator cuffs, high blood pressure, skin cancer, and diverticulitis. It seems that everyone in the room has been diagnosed with something. Finally, someone asks “Are we really that old? Can’t we talk about something else?” Everyone laughs and the conversation turns to politics.

I couldn’t help but recall that evening while reading an article in the May 12 New England Journal of Medicine (NEJM) titled “Regional Variations in Diagnostic Practices” written by a team of investigators at Dartmouth.

Earlier work done by researchers at Dartmouth has shown that patients in some regions receive moretreatment than others. This newest study, written by Yunje Song, senior author Elliott Fisher, and colleagues, goes further, to suggest that patients in places such as Miami, New York or McAllen, Texas are more likely to be diagnosed in the first place. “Their doctors order more tests and refer more patients to sub-specialists than doctors in Atlanta, Phoenix or Jackson, Mississippi,” explains Jonathan Skinner, one of the co-authors, “and so they discover more disease.”Continue reading…

Symantec tiptoes into health care

May 20, 2010• 4

By Matthew Holt

It’s always interesting to see examples of how mainstream tech companies move into health care. Symantec is following the path of taking its capabilities for storage management and cloud-based hosting and tweaking them so that they’re selling a storage system for images. Given that this means hospitals and image centers don’t have to buy and manage in house storage, that’s pretty attractive. But the interesting thing they’ve done is to create an easy way that any physician can share images with any other—either uploading images themselves to Symantec’s cloud storage or having them come from PACS systems or direct from imaging machines. And (assuming it takes off) that in turn will create viral pressure on image producers (like hospitals and imaging centers) to get them into the system and therefore buy more storage. Clever, huh.

I talked with Lori Wright, VP of SymantecHealth about this new image sharing service and she gave me a quick demo—all well captured on the trusty Flip cam. You’ll see why this is intriguing for doctors and, perhaps in the future, patients. (I can certainly imagine OBGYNs sharing ultrasounds with patients one day soon)

Design for America–I declare the winner

May 19, 2010• 1

By Matthew Holt

I met with Clay Johnson from Sunlight Labs yesterday and we talked about hackathons for health (much more to come on that) and the current Sunlight Foundation prize contest called Design for America. There are six individual prizes with one focused on visualizing health data, using data provided from the Community Health Data Initiative started by Todd Park, CTO of HHS, as part of his “data liberacion” campaign.

The contest closed yesterday, but I’m pretty sure I know who the crowd favorite is going to be! (Hat-tip to Regina Holliday's partner in crime Ted Eytan from whom I pinched this video).

HCAHPS Visualization from Eidolon Films on Vimeo.

You can meet Regina as she'll be on a couple of panels at Health 2.0 Goes to Washington.

DrChrono shows their iPad chops

May 19, 2010• 19

By Matthew Holt

The guys from DrChrono have come a long way since we saw them first just last summer. They have a SaaS based practice management system, but at Health 2.0 at the Doctor’s Office they introduced an iPad-based tool for physicians. Here’s a quick video I took of them last month, with a live fake demo of what it might look like in a real encounter between a real doctor, and a fake patient.