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Matthew Holt

Todd Park speaks: Free the data!

Feb 4, 2010• 2

By Matthew Holt

Todd Park is definitely one of health care IT’s good guys. Todd was the brains (though not the mouth!) behind athenahealth. After he left athenahealth, he spent a year back in California doing angel investing (Ventana among others) and being a dad. But despite his desire to stay on the west coast, he was dragged into the vortex known as Washington DC, and for the last 5 months he’s been the (first) CTO of HHS. (By the way, he cashed out his investments, and politely turned down my proposal to “care for” his cash while he was being a public servant!)

Todd gave the keynote yesterday at the Health IT Summit for Government Leaders. He describes his job as unlocking HHS’ “inner mojo” in terms of data use and technology innovation. So what are the big deals he sees? These are my notes on his fast talking!

1) HITECH/ARRA is not about for paying for software. Its purpose is to incentivize “meaningful use”. He wants to make sure that people understand that the NHIN (National Health Information Network) is not a thing. It’s a set of policies and services that people can use to make health data work over the Internet. It is NOT a parallel network. And at the end of the day, what’s going to make this work is the private sector — including vendors modifying their products to match these policies.

2) Leveraging the power of HHS data for public good. The amount of data HHS has is “ridiculous”. It has a set of sets of data. Todd is a paid up member of Tim Berners-Lee “free the data” club. They’re adding all kinds of data sets to data.gov including every grant, patent et al licensed/paid for by HHS. Todd calls this “data liberation”. They’re also creating community health maps where data on community health performance can be mashed up with other types of maps (real estate, job listings, et al). In addition, they’re doing “smart targeting” — an attempt to combine findings from different/disparate data sets without waiting to do the big database integration. He’s hoping to use techniques that the intelligence community uses to link, say, emails and bank wires, to similarly track, say, disease outbreaks, drug interactions, etc.

Simple Steps to Meaningful Health Reform

Feb 3, 2010• 5

By KIM BELLARD

Now that health reform at the federal level seems to have hit an impasse, Congress and the Administration are scrambling to see if anything can be salvaged this year. Although both the House and Senate bills are severely flawed, each falling short both on true health reform and on fiscal responsibility, it would be a shame if we walked away from these efforts with nothing to show for it.

Doing something about those “evil” insurance companies remains a primary target, with brave talk still coming out about removing the ability of health insurers to consider pre-existing conditions in accepting new applicants.

This singular focus ignores two important facts – first, that this problem is primarily in the individual market, since such use of medical underwriting/preexisting conditions exclusions is largely absent from the predominant group health insurance market, and second, that such restrictions will inevitably lead to higher costs. The latter statement is not fear-mongering; it is Economics 101.Continue reading…

10 Insights on the iPad

Feb 3, 2010• 18

By DOUGLAS GOLDSTEIN

The iPad got it right and will set the standard for a new and improved way to enjoy our connected lifestyle. The iPhone blazed the way as it shifted mobile phones from something to talk on…to powerful multi-app platforms that solve many problems and just happen to make phone calls, too.

The iPad and soon many similar devices will revolutionize the way we experience life and work from newspapers, t.v. and movies to fitness, personalized health and medical services. Here are 10 insights for delivering person- centered fitness, health and health care inspired by the iPad, iPhone and iPod Touch from Apple, the world’s leading MD (Mobile Device) company.Continue reading…

Collecting Patient Info in Haiti Using the iPhone

Feb 2, 2010• 3

Dr. Elizabeth Cote, from Harvard Humane Initiative collects patient data at Fond Parisien, Haiti using iPhone and iCharts from www.CareTools.com. The developers were kind enough to customize the form in less than a week to support fields and info required to comply with international disaster data collection standards. HT / Dr. Enoch Choi

Medical Experts Say Haitians Will Need Health Care Help for Years to Come

Feb 2, 2010

By POOJA AWATRAMANI

The BBC recently reported that medical organizations with members serving the Haitian communities affected by the earthquake on January 12^th warn that one of the larger issues for Haitians will likely be the need for increased medical supplies, such as prosthetic devices and rehabilitation services.

Concerned about infection, doctors in Haiti have had to amputate the limbs of a great many injured patients. In addition to the need for such resources as medical devices and prosthetic equipment, doctors are also still in need of simple medications. Antibiotics are needed to prevent the spread of infections and painkillers to help damaged patients simply make it through the day.

Because many of the country’s hospitals were also destroyed by the earthquake, doctors in Haiti are performing most care in makeshift open areas. And in such environments, infection spreads fast. Though the few hospitals that are running are reported to be in relatively well-organized condition, many of the patients in those hospitals are not leaving as they have nowhere else to go, except perhaps the streets– where infections await their open wounds. So they stay, Doctors are left with fewer and fewer areas to treat, and the number of patients increases. To remedy the situation, there are plans at present to quickly build a convalescent center.

Job Post: THCB Editorial

Feb 2, 2010

THCB is looking for talented interns to assist with editorial, research and web production tasks as our web site undergoes a major expansion. Perfect for a grad or med student with an interest in journalism, public policy, and/or the business of health care. Work out of a great home office location in the Princeton area, convenient to both Princeton University and UMDNJ. Reasonable train ride from midtown Manhattan. Production and research opportunities may also be available in our San Francisco offices for qualified candidates.

Editorial candidates should have an in depth familiarity with at least one area of the healthcare or tech industries and strong writing and editing skills. Web production candidates should know their way around content management systems like Typepad (our current platform) and
WordPress, our CMS in the not-too-distant-future. Basic photoshop /fireworks / gimp or comparable image editing software required.

Send us an email telling us a little bit about yourself and detailing the reasons you’re interested in the position. If you’re a candidate for the editorial role send us a few clips to give us a feel for your writing style.

Responses to THCB Editor in chief John Irvine jo**@***************og.com. No calls please!

Check Lists and Decision Trees versus Spontaneity and Imagination

Feb 1, 2010• 5

By KENT BOTTLES

The task of health care reform in 21^st century America is to decrease per-capita cost of care and to increase the quality of care delivered to patients. It’s complicated. A famous Rand study concluded that Americans only receive 55% of the care that science dictates. Patients intuitively believe that more health care is always beneficial. Medicare reformers would like to do comparative effectiveness research so that CMS and private insurers could wind up paying only for therapy that actually works. Some estimate that 30% of all care delivered in the United States is waste. What some call waste, others label revenue, and Atul Gawande becomes famous for identifying waste/revenue in McAllen, Texas (http://bit.ly/ENlli).

Neuroscience tells us that the smartest human can only keep track of seven variables at one time, and physicians tell us that diagnosis and treatment of a complicated patient can involve as many as 100 such variables. Computers are good at cataloging, organizing, and retrieving information, but physicians are not yet routinely utilizing them at the point of care. Computers are also good at allowing us to analyze large data sets and learn from experience. Patients yearn for the warmth and caring of a doctor who really knows and cares about them. Behavioral economics pioneered by Amos Tversky and Daniel Kahneman taught us that human brains are designed with inherent biases that make us less than rational decision-makers. We now know that human physicians and patients suffer from biases such as Pygmalion complex, confirmation bias, focusing illusion, incorrectly weighing initial numbers, and being more impressed with single cases than conclusions based on large data sets (http://bit.ly/49q4Uy).Continue reading…

An Unhealthy Debate Around Wellness

Feb 1, 2010• 36

By JAAN SIDOROV

Sidorov There’s an adage that, except for their tax revenue, American business is something the left loves to hate. And who can blame them, what with executive compensation, minimum wage and overseas job outsourcing powering the left wing’s ascent faster than corporate gunships in a greedy search of Avatar movie unobtainium? Being the principal source of health insurance for their employees hasn’t helped the liberals’ view of American business either, not only because it gets in the way of their cherished public option, but because their constituents’ benefits have been squeezed by the specter of an unholy alliance with managed care over caps, deductibles, co-insurance and co-pays.

So when it came out that the Senate’s proposed health reform legislation would increase employers’ and insurers’ ability to incentivize employees’ participation in worksite-based health promotion activities, progressives zeroed on it like Air Force One on a Massachusetts political rescue mission. Believing that any use of any financial rewards is just plain wrong, opponents have cast incentives as penalties on those who don’t participate in workplace wellness programs – a sneaky, indirect and backdoor way of making the sicker pay more for their health insurance.

Uwe and Heritage agree: we need a tax-funded universal pool

Feb 1, 2010• 46

By Matthew Holt

When you’re at a party and someone explains to you that they just read a great article in the NY Times explaining why Peggy Noonan doesn’t understand basic math, and you know that they’re referring to Uwe Reinhardt, then you’re over-wonked. That’s surely my condition

Here’s what Uwe said—you can’t just ban medical underwriting as Noonan suggested, because the individual insurance market will collapse. Both the history of New Jersey (and Washington state) in the 1990s, and in current Massachusetts where people can buy insurance or pay a lesser fine, show that healthy people won’t buy insurance until they need it.

The answer is to force everyone into a universal insurance pool

But of course, that means younger and healthier people will likely pay more. For the good folks from Heritage writing on the WSJ Opinion page this is an outrage. Using their complex model they came up with the amazing analysis that if you give uninsured younger people with no health condition the choice of paying a smaller fine or a higher premium—surprise surprise—most will pay the fine. And of course that’s exactly what’s happened in Massachusetts.

The problem is of course that most younger people who have no insurance are in low wage jobs, They therefore place a much higher value on receiving money now than forgoing it to later stave of a potential risk of catastrophe from having no insurance

So we deal with this in a very sensible way in the rest of society’s transactions.

Regional Variation Revisited: Price Differences Not A Significant Factor

Jan 29, 2010• 20

By MERRILL GOOZNER

Dartmouth scholars have revisited their analysis of regional variation in health care spending and found contrary to the assertions of some critics that cost-of-living differentials do not account for much of the difference. However, they confirmed that some big cities with high poverty concentrations that also serve as training grounds for future physicians may have been unfairly lumped in with areas that overuse health care services.

The new study in Health Affairs showed after adjusting for price differences that Miami, Florida and McAllen, Texas still led the pack in terms of how much Medicare spent on each beneficiary. Both areas still spent nearly three times more than the lowest spending regions of the country, which remained Honolulu, Hawaii and LaCrosse, Wisconsin.

There were a few areas of the country where the adjustments made a big difference, and they were mostly big cities. The Bronx and Manhattan in New York City fell 39 and 33 percent, respectively, from the adjustments. But price was only a minor factor, according to the researchers, who were led by Daniel Gottlieb of the Dartmouth Institute for Health Policy and Clinical Practice.

Much of the reason why the New York metropolitan area is so costly is not because of the wage index per se (what we usually think of as “cost-of-living” adjustments), but because the CMS pays hospitals in the New York area so much to reimburse them for graduate medical education and caring for disproportionate shares of low-income patients.

Other high-spending areas frequently targeted by critics did not do so well under the adjustments. Los Angeles, for instance, dropped just 14 percent after adjusting for cost-of-living, graduate education and disproportionate share payments for low-income residents.

The Medicare Payment Advisory Commission issued a report late last year that suggested regional variation in use patterns were less than the Dartmouth Atlas of Health scholars had previously estimated. This latest study says regional variation still matter — a lot. The debate clearly isn’t over.

Here’s the list of the ten highest and ten lowest spending areas in the country both before and after adjustments for price, graduate medical education and disproportionate share payments:

10 high-spending hospital regions:

BEFORE AFTER % CHG.

FL-Miami               $15,909     $14,966      6%
TX-McAllen              13,633       13,881      -2
NY-Bronx                12,004         8,653    39
NY-Manhattan          11,744         8,861    33
TX-Harlingen            11,489       11,324      1
CA-Los Angeles        10,674         9,325      14
NY-Long Island        10,608         8,740      21
MI-Dearborn            10,460         9,791        7
LA-Monroe               10,226       11,385     -10
MI-Detroit                 9,954         9,541       4

10 low-spending hospital regions:
ND-Minot                   6,033         6,711     -10
VA-Lynchburg           6,022         6,524      -8
CO-Grand Junction      5,983       6,075      -2
OR-Eugene                5,968         5,798       3
IA-Iowa City               5,902         6,254      -6
SD-Rapid City             5,854         6,176      -5
OR-Salem                  5,810         5,642       3
IA-Dubuque               5,799         6,219      -7
WI-La Crosse             5,715         5,757      -1
HI-Honolulu               5,293         5,212       2

5 hospital regions with biggest drop due to price and other factors:

NY-Bronx                 12,004         8,653   39
NY-Manhattan            11,744         8,861    33
CA-Alameda County   9,251     7,094 30
CA-San Francisco         8,140        6,278    30
CA-San Mateo County 7,878        6,104     29