Author Archives

Matthew Holt

POLICY: Vic Fuchs speak–You listen

Oct 31, 2007• 1

Just one article in a wonderful 25th Anniversary perspective for Health Affairs.

From the greatest health economist of them all, What Are The Prospects For Enduring Comprehensive Health Care Reform?.

POLICY: David Gratzer, source of Rudy misinformation

Oct 31, 2007• 10

My, my. We can’t exactly be surprised that Rudy Giuliani is on the one hand telling yet more porky pies and on the other hand not contributing to the debate in health care—other than shouting “socialized medicine” as loudly as he can.

It’s interesting to note that Giuliani who’s playing a moderate has surrounded himself with some of the most extreme wingnuts in health care, including Sally Pipes and David Gratzer. (Full disclosure, I think David is a very nice guy, but I think he massively misrepresents the facts in his book—as we discussed when I interviewed him. Also Rudy does have Mark McClellan on the list, who’s not an extremist.)

But I can’t understand how Giuliani can possibly believe that surrounding himself with people who think that Medicare is evil socialized medicine (after all it’s single payer for seniors) is going to help him. After all Rudy will need all the moderate votes he can get if he’s around come November 2008.

But according to the Giuliani campaign Gratzer is “an expert at a highly respected think tank”. And Gratzer has the chutzpah to say that Commonwealth is biased! As if Manhattan has no views, and no opinions.

And of course the tosh about cancer survival rates has long been revealed to be crap by John Cohn & Ezra Klein based on Gerald Anderson’s work—differences in survival rats are all based on early screening and doesn’t show up in overall death rates. In other words there’s have a different denominator.

It is amusing that the Brits are now saying that their prostate survival rate is 74% not what Commonwealth reported a while back. But as I’ve explained at nauseum it’s all about picking your disease. If you want to pick a bunch of others, we do much much worse. And of course we’re paying way, way more.

But the real point is not that Giuliani is misrepresenting the cancer rates.

Why Consumers’ Checkbook v CMS is a Sideshow – Brian Klepper

Oct 30, 2007• 7

There are people who call for market solutions as the answer to every societal problem, but who then work to restrict the information that markets (and societies) must have to function effectively. Often, the truth is that these supposed market advocates need secrecy and opacity to protect their current advantages. If markets were to work as they claim they want, their actual behaviors (or pricing, or performance) would become known, and their positions compromised.

BLOGS: Grand Rounds is up at Running A Hospital

Oct 30, 2007

Everyone’s favorite blogging hospital CEO Paul Levy hosts Grand Rounds at Running a hospital

HEALTH PLANS: Trading health plan stock rumors for fun & profit

Oct 30, 2007• 3

Just when you thought stock action in health plans was all dull, along comes a little fun. Wellcare’s chart of course looks about as good as the average stock chart when the Feds raid. Whatever the company says, Wall Street believes it’s bad news. $120 to $25 in 5 days is Enron-type numbers, and one rumor is that some directors were selling not a couple of months back, but a couple of weeks.

Wellcare

But the fun continues. Humana is the “big” health plan that’s made the greatest push into Medicare Private FFS where most of the abuses have occurred and it’s also huge in Florida. (I don’t have to explain that statement I hope). That was enough for one analyst to say on Friday that they heard the sound of FBI sirens too, and the stock fell about 5% in a few minutes, before recovering when it was confirmed that the sirens were in his head. (OK, maybe the FBI doesn’t use sirens!)

Humana

But then Humana released some great financial results on Monday and the stock rallied on the opening up 5% from where it had been, but then ended up falling more than 10% on the day. Why? Well perhaps its because when some smart types look at the numbers they notice that the MLR fell from 84% to 81% in a year. So first, what happened that there was such a big fall? And second, if most of this increased profit comes from the Medicare business, why would the end-payer (you and me represented by Pete Stark et al) put up with it?

This of course makes Humana a fun stock for the swing traders on the message boards. But I’m not so sure it makes for great public policy.

Patients: Coordinated Physician Care Pilots – Paul Grundy MD, IBM

Oct 30, 2007• 5

Dr. Paul Grundy helped organize
the Patient-Centered Primary Care
Collaborative at IBM and serves at its Chair. IBM spends about $1.7 billion a year on
healthcare for its employees and families, providing coverage for half a million people. The company is working to improve their
healthcare quality, while lowering costs through wellness programs, but believes that more could be accomplished if a critical mass of key
healthcare participants work together to drive even more significant change. Executives believe the Patient-Centered Primary Care Collaborative is a major step towards that goal.

Health 2.0 FAQ with UPDATE on Health 2.0 San Diego

Oct 29, 2007

Q. What is Health2.0 and why are we running conferences about it?

The term Web2.0 has been around since 2003. The O’Reilly organization both coined the term and created a definition that year, and then they went on to create the Web 2.0 Conference. Meanwhile over at The Health Care Blog and in his by now relatively long consulting career, Matthew Holt has been following technology in health care since the early 1990s. Some of his eHealth era reminisences were relatively poignant…Indu Subaiya, a healthcare consultant and entrepreneur was similarly starting to follow Web 2.0 trends and their impact on health as she embarked on designing a prototype for a medical record-sharing website.

Towards the middle of 2006 several start-ups began targeting health care using Web 2.0 technologies such as wikis, mash-ups, video, blogs communities, and user-generated data. And to be fair Wondir which has since been sucked into the Revolution Health vortex started a now seemingly defunct blog called Health 2.0 in late 2005. In early November 2006 Matthew did a podcast with 3 Health 2.0 companies on THCB, and the community was beginning to emerge. (From now on Matthew is switching to “I” & “me”)

Two events crystallized this. First an article in Business 2.0 (part of CNNMoney these days) which was the first "mainstream" mention of Health 2.0 outside the blogs, and the December 2006 Healthcamp "unconference” in which several of us got talking about the topic. (Here’s a photo with Enoch Choi standing & talking and me apparently falling asleep on my hand at the far end of the table! And here’s Health2.0 co-founder Indu Subaiya eating health food!).

Continue at the Health 2.0 site

HEALTH2.0: Some new players, some very interesting technology

Oct 29, 2007• 5

There’s lots of activity in Health 2.0. So I thought I’d showcase a couple of new sites today…

1. A company that I’ve been closely involved with and (FD!) am
an adviser to, Enhanced Medical Decisions, has now officially launched
the beta of DoubleCheckMD.
You can go to the site, put in your symptoms and the drugs that you’re
on and effectively (without knowing it) in seconds search the entire
literature on which symptoms might be caused by the drugs you’re on,
what possible interactions there might be, what your next steps should
be, and what else you should be aware of. I know I’m biased but I think
that this is one of the most innovative technologies developed so far
in Health 2.0.

2. CEO Chiara Bell has been working hard to develop Enurgi, which allows people to locate, hire, manage and pay nursing staff for families that need support for elderly relatives at home. A nice integration of directory, social networking and functionality. And of course nurses and other caregiver professionals can use this site to look for business.

3. Health World Web launched
this year with a healthcare provider directory that allows members to
search for providers and add their own reviews and rankings to that
knowledge base. In September, HWW relaunched its patient community with
social network functionality. Dan Kogan the CEO says to think of this
site as a cross between Facebook and Citysearch.com that’s devoted to
health and healthcare. Like the former site you can create your own
communities, like the latter you can search for the Healthcare
providers in your area or country-wide as well as research their
education and experience and share that information with others. Stay
tuned for other HWW innovative functionalities based on social network
and decision making platform. To learn more about Health World Web go
to here.

All of these are very, very early stage companies. And all of them have really interesting promise. Feel free to go take a look. And of course give the companies feedback as to what you thing about their tools.

HEALTH PLANS: WellCare killing healthcare? With help?

Oct 29, 2007• 5

There’s been enough bad behavior in Medicare private health plans to go around, but some of the worst behavior has come from private FFS plans, and some of the worst behavior of all has come from WellCare, a Medicaid and Medicare plan in Florida. Last Wednesday the FBI raided Wellcare, with allegations of fraud and presumably a qui tam suit in the works. And since then the stock is down some 70%.

Just another story of another private organization pushed by Wall Street to over plunder Medicare? After all I’ve been writing about why Wall Street Hates Healthcare Services But Doesn’t Know It for years. (Apparently George Soros, who, despite his liberal foreign policy leanings, isn’t above making the odd buck or two, made out like a bandit from Wellcare).

Well almost, but then there’s one little wrinkle.

Because there are also others apart from the single-payer advocates who don’t like health plans. In fact one prominent consumer advocate from her lofty ivory tower has proclaimed health insurers as one of those who’ve been “killing” healthcare.

Who killed healthcare?

Regina E. HerzlingerPosted 09/07/2007 (Medscape)

We turn over $2.2 trillion of our money each year to those who manage our healthcare, without holding them accountable for efficiency or quality. Not surprisingly, these folks — hospitals, insurers, governments — they use the money to benefit themselves. Jack Morgan, the insured, middle-class protagonist in Who Killed Health Care? was killed by this system.

Insurers, hospitals, and governments have gotten fat on our bloated healthcare costs, which kill the competitiveness of US firms.

<SNIP>

That’s my opinion. I’m Professor Regina Herzlinger of the Harvard Business School.

But funnily enough, there must have been something different between WellCare and those other “insurers” that were “getting fat on our bloated healthcare costs”. Different enough that Regina Herzlinger allowed herself to be appointed to the WellCare board in 2003.