Author Archives

Matthew Holt

A Second Life on Second Life

Mar 15, 2008• 6

In real life Alice Kreuger has severe multiple sclerosis and is unable to walk without the use of crutches. She rarely leaves her home except for trips to see her doctor. In the virtual world of Second Life she leads a radically different existence. Here, she is the avatar Gentle Heron, the co-founder of the Heron Sanctuary – a self-described “support community” for others facing similar situations. In this clip she takes us on an eye opening and moving tour of her world. The clip was among the most popular at Health 2.0.

Produced by our friends at Scribe

Loving Our Children

Mar 14, 2008• 3

By Brian Klepper

Among its many less-noticed accomplishments, this Administration has strangled funding for comprehensive sex education. Instead, it has thrown the immense weight of the US government behind abstinence-based education, an impractical ideological approach rooted in religious zealotry and a romantic notion of social mores that no longer exists for most young Americans. In 2005 and 2006, the Bush Administration spent $170 and $178 million, respectively, more than double the 2004 expenditure, much of it allocated to mostly conservative Christian organizations, to encourage children to refrain from sex without explaining the fundamentals of contraception and sexually-transmitted disease (STD). In 2004, a Minority Staff Special Investigations report prepared at the request of Rep. Henry Waxman (D-CA) found that more than 80 percent of federally funded abstinence programs contain false
or misleading information about sex and reproductive health.

An overdue change….THCB goes group

Mar 14, 2008

I’ve been writing THCB since 2003 and those first few years were great fun, if a little lonely. Back then I was a dotcom refugee getting to grips with the American health care experience after a year or so away. Those (few!) of you reading back then have noticed quite some changes over the years. Now we’re reaching over 40,000 visits a month and I don’t have to explain what a blog is every time I meet with a health care group.

One major change has been the growing visibility of THCB to advertisers/sponsors and also other authors. All credit for that goes to THCB’s web guru and editor, John Pluenneke who has nurtured THCB as if it was his own–which in a way it is. Thanks John.

Another change has been the growth of the Health 2.0 Conference that I co-founded with Indu Subaiya last year. And of course on a personal note, I’ve gone from being the fun loving swinging single guy to happily married man.

This has all meant that there’s been less of me and much more of many great authors on the site especially over the last year or so. I’d like to thank everyone who’s written specially for THCB or asked us to co-post their work here. It’s been an honor and a privilege.

So as I break to take an extended vacation (on honeymoon at long last!), even though I’m going away for a few weeks, THCB is most definitely not. So it seems like now is a good time to formalize what’s already been a fait accompli for the last several months.

From now on THCB is officially a group blog.

I’ll start using my byline, and we’ll be adding bios and information about our regular contributors. And we’ll continue to welcome other contributors from across health care so long as their writing is opinionated, punchy and fun.

And also we’re going to be announcing plans soon to really turbo-charge our content and push the envelope further. I won’t spoil the surprise, other than to say that we hope soon to be giving Lisa Girion, Barbara Martinez, Shannon Brownlee, Maggie Mahar and my other favorites a run for their money!

It’s been a great ride and it’s going to get even better! Thanks for being with us and we’re looking forward to the next adventure.

The Myth of Health Care Consumerism

Mar 13, 2008• 24

By Brian Klepper

Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn’t heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers’ attitudes toward web-based health care information.

One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.

HEALTH 2.0: Getting the PHR, Privacy and Deborah Peel issue off my chest

Mar 13, 2008• 14

By Matthew Holt

I’m a card carrying member of the ACLU. I oppose the Patriot Act. And I absolutely oppose the current Administration’s decision to ignore the FISA law that already bends over backwards to help the government spy on Americans whom it suspects of criminal activity. I’m also appalled when I read stories like this one—in which the FBI has been illegally abusing its power by issuing “National Security letters” willy nilly.

I say all this because it’s now a couple of weeks since Google announced it’s health initiative and during that time we held the second Health 2.0 conference. And all the mainstream press can write about is the potential for privacy violations in online health sites, and PHRs, whether it’s been in the San Diego Union Tribune, ZDNET, USA Today or Modern Healthcare.

So even this balanced article in the Washington Post leads with Deborah Peel from Patient Privacy Rights and you have to wade through her incendiary rhetoric before you get to some sense from John Rother, while David Kibbe’s rational applauding of electronic health records only appears towards the end. Here’s what Peel says:

Many online PHR firms share information with data-mining companies, which then sell it to insurers and other interested parties, Peel said.

Well I’m still waiting to see the proof about this. Essentially she’s saying that consumers’ identifiable data is being sold and used against them, and so PHRs are bad.

Much data is of course sold in health care, but as far as I’m aware it’s all de-idenitifed. Whether PHR companies are systematically selling data is unclear. Whether they are selling identifiable data (the thing HIPAA bans and everyone agrees is a bad idea) I severely doubt.

And the problem is that this type of allegation gets the conversation completely off track. The biggest problem with the US health care system and its use of technology is not privacy violations. It’s inefficient use of data causing harm (and costs and poor quality care).

I am getting more than a little annoyed with this focus on the wrong thing. As my commenter JD paraphrased in my earlier piece on the topic (5^th comment down here), do the Deborah Peels of the world not use bank accounts or credit cards? Do they not buy houses or have credit scores? Do they not know about what is already known about them in the real world? People understand this data flow and they accept it because it brings them a return that they value. And the same will be true for health information—if health information technology produces valuable results

So what are the nay-sayers going on about? Well I actually suffered and read the World Privacy Forum report on PHRs by Robert Gellman. It’s a hash of conjecture with its main complaint being that HIPAA doesn’t explicitly cover PHRs. Well, no shit Sherlock. HIPAA passed in 1996. It was actually was prepared years earlier and it’s about the automated transactions that existed then. No one had heard of a PHR in 1995, so why should the law cover them? What will happen is that PHRs will start being provided by covered entities and will be under the aegis of HIPAA (in this country at least—it’s called the “World” privacy forum but in reading the report Gellman only has heard of one country apparently).

But even if PHRs are not covered by HIPAA, what are the terrible consequences? Well let’s see. I’ve taken a few excerpts from the report. In the first Gellman says:

Regardless of the PHR’s policy on marketing disclosures, advertising can provide a method for a consumer’s health information to escape into marketing files. Marketers already have millions of names of consumers categorized by specific diseases and diagnoses. Most of the information comes from consumers who provided it in response to “consumer surveys” or through other stealthy methods for collecting health information for marketing use. Health records maintained by health care providers have been unavailable to marketers directly, but commercial PHRs operated outside of HIPAA offer marketers the promise of more and better health information from consumers.

So the problem is not PHRs. It’s consumer surveys taken over the years by marketers. But let’s blame PHRs because they might potentially be used for the same thing.

But hang on, if I’m a transparent PHR vendor won’t I drive out the scummy guys who are secretly selling data which will be used to harm their customers? And aren’t Microsoft and Google and many others being transparent about that? Yes they are, and why won’t consumers vote with their data?

HEALTH 2.0: Healthline personalizes Aetna (and more)

Mar 12, 2008• 14

By Matthew Holt

Healthline Networks is pursuing a really interesting strategy as it attempts to "dance with the elephants" in vertical search in health care. Today, it’s announcing a number of new partnerships and perhaps most interestingly a deal with Aetna, where the information in the members’ PHR will personalize their online experience. I sat down with Chairman and CEO West Shell yesterday to talk about what it means for the industry, for health plans and where he sees Healthline going.

Listen to the podcast

HEALTH PLANS: Time to cut a deal?

Mar 11, 2008• 26

By Matthew Holt

There’s carnage amongst health insurer stocks on Wall Street this morning. For a long while I’ve been saying that the health insurer party was too good to last and in the past year things have certainly cooled down. Hanging over the industry has been an inability to extend itself further into the commercial market (commercial enrollment has been flat over the course of the boom—and now we’re going into a recession) and of course the lingering concern that payments for Medicare enrollment will be cut at some point.

Last night Wellpoint had at least the first shoe drop when it announced that a combination of higher medical costs and lower than expected enrollment would mean that it was going to miss its profit numbers. The stock is off more than 25% and most of the rest of the sector is well off too. Now this wasn’t a huge cut in the numbers—the reduction in forecast profits is under 10%. But Wall Street as you know hates the concept that earnings will diminish, and Wall Street doesn’t understand health care anyway.

Wall Street likes earnings machines that continually increase profits. To be such an earnings machine that you need to be able to sell an increasing number of widgets to the same people, or widgets to new people, or raise the price of the widgets you’re selling to the same people. Health plans can’t really do the first. They have done the second only because of massive subsidies in the Medicare market since 2004 and they look like they’re running out of steam in doing the third—although it’s been a darn good run! (Medical loss ratios are higher on on a base of greater overall revenue than they were 5 & 10 years ago, but that can’t go on for ever and that appears to be where the problem this morning lies).

And of course the political pressure on all the ways health plans make money continues to grow. Those games in the individual market are being found out, the games with opaque pricing are being investigated as consumer fraud, and although they’ve staved off Medicare private payment cuts for now, that issue isn’t going away.

So perhaps it’s time for health plans to consider their potential future as a regulated industry—one that will be forced to compete on issues that actually matter for the good of the health care system and the nation. And perhaps it’s time to prepare to really cut a deal on that, rather than propose a fake plan that takes but doesn’t give.

Now, there’s no way that under such an approach insurers will be allowed to make the kind of profits they’ve seen over the last five years, and of course Wall Street will freak out. But then again, perhaps there’s no time like the present to tell Wall Street the really bad news.

Health 2.0: The Long Tail of Healthcare

Mar 10, 2008• 3

By Scott Shreeve

Long Tail: New business phenomenon in which low distribution and storage cost enable significant profits to be realized by selling small volumes of niche items instead of large numbers of popular items.

The potential for online retailers to make more money than their bricks and mortar counterparts because there is virtually unlimited “shelf space” to offer products.

Chris Anderson of Wired magazine editorial fame, coined the term and described the phenomenon in a 2004 article called The Long Tail. For the unfamiliar, the Long Tail is best described as the ongoing niche interest in something once the large pulse of public interest has died off. Essentially, so the theory goes, when distribution and storage costs of a business are very low, they can realize significant profit by selling small volumes of hard to find items to many customers instead of selling large volumes of a few popular items. Given the length, or the area of the curve under the “tail”, it turns out there is actually a greater opportunity for profits pursuing this niche strategy if the right distribution and cost elements exists.

The Long Tail Explained. As demonstrated by the above example, while Walmart sells the bulk of popular music at their stores, the distribution and storage costs elements of online retailers like Rhapsody are such that they can actually mine a very large, underserved niche market that proves to be just as, if not more, profitable.

In my closing remarks yesterday on the final reactor panel at the Health 2.0 conference (totally off the cuff by the way as I was unaware I was going to have an opportunity to make a statement), I had mentioned this concept. However, given my uncharacteristic lack of preparation and desire to offer a coherent closing statement. I have including the following:

Monday Freedom Watch

Mar 10, 2008• 3

By Eric Novack

From Canada:

“Liberty – hostage to medicare”

“The Ontario Superior Court on Thursday rejected a Sikh man’s claim to a
religious-freedom exemption from the province’s law on mandatory
motorcycle helmets. Supporters of safety as the holiest of political
principles upheld the ruling as a triumph of reason; Sikh organizations
denounced it as an act of naked discrimination against their faith. Few
stepped forward to defend the idea that an adult in a free society
should be able to wear what he wants and take the risks he wants where
only his own body is concerned…”

Read the whole thing… and comment here…

As we consider health care reform—shouldn’t we protect freedom first?

Or: do we prefer this? Or, this?

Perhaps we’ll just end up with this.

HEALTH PLANS: Three Inconvenient Truths: The Future of Health Plans in a Connected World

Mar 7, 2008• 25

By Matthew Holt

In the same vein as Wyden’s speech to AHIP yesterday, this is the talk I gave to the Western Regional Conference (a group of Blues plans) on October 14, 2007.

Hello my name is Matthew Holt and I’m here to tell you the truth. Now I know that you are a bunch of senior executives at health insurance companies, so you may not be very used to that….

I also understand that the person I’m replacing as a speaker here is Governor Arnold Schwarzenegger, who starred in some famous movies involving the end of the world and invasions by aliens, predators and terminators–something which might seem metaphorical to you after you’ve heard my talk.

I’m here today to tell you three potentially inconvenient truths.

First, you’ve done very, very well for the past several years. But the chances that you will be able to keep running your businesses in the same manner in a decade or so are very low. In fact if you keep running your businesses the same way the chances are good that you won’t be in business. That may not matter to those of you close to retirement, but it probably does matter to everybody else.