Author Archives

Matthew Holt

QUALITY: A nice recommendation from the IOM

Jan 28, 2008• 5

Ironically after I spent last week sitting in with the Dartmouth crowd, on Friday the IOM (despite having a lack of Dartmouth folks on this committee!) came out with a recommendation for a New National Program To Evaluate Effectiveness of Health Care Products and Services and End Confusion About Which Work Best. In other words an American NICE. (Here’s the more digestible Retuers article).

All major Democratic proposals suggest such a thing, and it’s even something that I and Karen Ignagni can agree about.

"Patients deserve to know not only what medical treatments work, but which treatments work best," Karen Ignagni, president of America’s Health Insurance Plans, said in a statement. "With new treatments and technologies introduced each day, providers need a dependable and trusted source of information that provides useful guidance on treatment options available."

However, there might just be the teeniest bit of opposition out there even with AHIP’s enthusiasm (and the cynics would say because of it)….so don’t expect any one agency to have controls over exactly what care gets paid any time soon.

TECH: Shawn Jenkins, BenefitFocus interview

Jan 28, 2008• 1

Last year I interviewed Shawn Jenkins, the CEO of BenefitFocus. This is a really interesting company, and most of you know it — if at all — from the partnership Health 2.0 has had with icyou (headed by the wonderful Nina Sossamon-Pogue) which did all those great interviews at Health 2.0 (and made the wonderful DVD which is still available.

Sadly, the timing of the interview wasn’t great as I did it in late August 2007, got married a week later, and then dived into the conference. And as a consequence the transcript never got posted. Which is a real pity, as I just re-read it and it’s really interesting and one of the rare interviews in which the interviewer sounds like he knows what he’s talking about! Shawn, Nina and friends will be back at the next Health 2.0 conference showing various apects of their technology. But for now give this transcript a read to find out where they were 6 months ago.

Matthew Holt: This is Matthew Holt of the Heath Care Blog and I’m back with the podcast. And today, I have with me Shawn Jenkins. Shawn is the CEO of BenefitFocus.

Shawn, Good morning.

Matthew: How are you? And, where are you?

Shawn Jenkins: Good morning, Matthew. I’m fantastic today. I’m in beautiful Charleston, South Carolina, where it’s nice and warm today. And it’s great to talk with you. I really enjoyed your work and look forward to jam with you here today.

TECH: An Anonymous Bit of Cynicism, by Anonymous

Jan 28, 2008• 5

Sometimes THCB’s anonymous contributors really stick the boot in—I got this email last week after Wal-Mart Dossia progress was announced.

Twenty-odd Wal-Mart employees (including the VP of benefits / former CIO) are piloting a ten-year-old PHR system (built by Children’s Hospital Boston in 1998) and it makes the front page of iHealthbeat and InformationWeek .

The same VP of Benefits / former CIO is "pleased with the progress" of the pilot, whatever that means. I’m sure we’ll hear that same will be announced as “transforming healthcare” at HIMSS in a few weeks. It’s really sad what passes for “progress” in the world of health IT these days.

I was going to write up some thoughts on the CHCF report on NHIN progress (or lack there-of) and how the people in charge of "the plan" are now describing how it was a bad idea/approach from the start (kind of like the retired generals who are now saying that they would have invaded Iraq with more troops), but I got distracted by the Wal-Tard story…

BLOGS: Is #1 health blogger Amy Tenderich too famous?

Jan 28, 2008• 3

I don’t know, but this week she’s in Newsweek.

You’ll see more of Amy at the Health 2.0 conference…and we think she’s wonderful too!

THCB Reader Mail (from Maggie Mahar & Jeff Goldsmith)

Jan 28, 2008

Frequent THCB contributor Maggie Mahar responds to Matthew’s post last week on decision aids:

"Too often, "patient satisfaction" is based on trivial things that have little or nothing to do with the quality of care. For example, a patient may have to wait two hours to a see a doctor because the doctor was called into surgery, because earlier in the day what he thought would be a routine 20 minute visit turned into an emergency. Or maybe he just spent 10 or 15 minutes longer with each of 5 patients because they had questions.

I once spent five hours listening in while the head of cardiology at a major medical center saw patients. All of these things happened except being called into surgery. One patient showed up, without an appointment, who had begun losing his vision in one eye that morning. A very bad sign. He needed immediate attention.

Another patient’s test showed that his carotid artery was totally blocked. In other words, he shouldn’t be alive. (The doctor was completely shocked). But there he was, sitting there, 85 years old, with a flock of his octogenarian relatives. It took a while to explain to all of them what was going on and why he needed immediate surgery.

Then there was the CEO scheduled for a bypass in four weeks who wanted to put it off because he wanted to wait three months until the end of the golf season. (He had already collapsed on the golf course, which was when he was diagnosed.) He also wondered why he couldn’t have the surgery at a hospital near his home in the surburbs rather than at the medical center in NYC. "It’s so hard to park here," he explained. "And it’s expensive." I wanted to stand up and scream: "You’re having open-heart surgery! Hire a car!"

POLITICS: Whisper it quietly…

Jan 27, 2008• 6

But some on the left are begging to realize that health reform, post an assumed 2008 Democratic victory, is still a very, very big assumption. On liberal blog Daily Kos, DemfromCT uses the recent polling data from ~~Bob Blendon’s group at Harvard~~ MollyAnn Brodie’s team at KFF and an editorial from Columbia’s veteran health policy prof Larry Brown in the NEJM to help his colleagues understand why health reform is so hard. Of course you sensible folk already know.

Families USA Health Action 2008: Anthony Fauci on Global Health

Jan 26, 2008• 1

By BRIAN KLEPPER

I first met, heard and came to admire Tony Fauci several months ago at the Aspen Health Forum. Dr. Fauci heads the National Institute of Health’s National Institute of Allergy and Infectious Diseases. In addition to his spectacular medical contributions, he is, equally importantly, a passionate and wonderfully articulate explainer of the importance of infectious disease and global health to common people. Unfortunately, I was called unexpectedly out of the meeting for a call, but here are my notes on his comments. They provide a clear view of the value of his work.

Plagues and epidemics have shaped societies since the beginning of civilization. Gradually, though, and with progress in hygiene and the management of disease, the dangers from infectious diseases to ordinary people have been significantly lessened, though the idea that we’re home free is seductive and illusory. In 1967, Surgeon General William Stewart testified a little prematurely that “the war on infectious disease has been won.”

Families USA: Tom Daschle on Health Care Reform – Brian Klepper

Jan 26, 2008• 36

Former Senator and Majority/Minority Leader Daschle gave the opening address on the 2nd day of the Families USA Health Action conference. Mr. Daschle has a new book coming out in March on America’s health system and our past efforts to fix it.

I was honestly impressed with Mr. Daschle’s grasp of the sweep of health care problems and how they play out. Mostly importantly, he was clearly aware of the deep challenges associated with getting meaningful change, given the industry’s control of Congress and the policy-making process.

QUALITY: Decision aids in the real world

Jan 25, 2008• 7

Most of this morning at the FIDMD meeting has been largely technical stuff about setting up decision aids. Shannon Brownlee suggests that the name should be changed to “personalized medicine” which has been nicked by the bio-tech crowd for now.

There is progress in better patient information around systematically including patient preferences, values & desires at the point of care—particularly in prostate screening & breast cancer. (Good programs at Dartmouth, the VA local UCSF, Group Health of Puget Sound, and several other primary care programs in academic medical centers).I won’t bore you with the technicality of the decision aid methodology (because I didn’t understand much of it!)

All good stuff and all leading to the question, what happens when this starts to get mainstreamed because, (of course) better informed patients tend to desire less aggressive care? (Although interestingly there were actually several anecdotes about cancer surgeons & radiologists now pushing lumpectomy on some women who actually want the radical masectomy—so even when “do less” becomes the mantra it may not fit what patients want). But overall, this is a threat to the ability of patients to entreprenurially do what they want and get paid for it.

QUALITY: The sociology & economics of practice patterns & decision aids

Jan 25, 2008• 1

More from Matthew at the FIMDM conference

David Jones, Harvard medical historian on revascularization

Why do you need a randomized clinical trial (RCT)? From the 1960s surgeons could show that CABGs opened veins (removed plaque) so why was there a need? As it turns out, it’s not the large plaque in the vein that kills you but instead it’s the smaller “fragile” plaque which ruptures & causes heart attacks—it’s not the big blockage that causes the heart attack. Angioplasty (PCI) doesn’t get that fragile plaque out, so it shouldn’t be used as much as it is. Of course that’s not what happened. We’d already been shown that by Lee Lucas that there was lots more angioplasty when this theory became well known

However in fact the theory about these fragile plaque rupture was in the obscure cardiology pathology literature in the 1960s but didn’t break through to the mainstream cardiologist opinion until the late 1990s.