It seems that I just got back from Vegas and CES although I had 3 weeks in India & Hong Kong in between. But in a few minutes I’ll be off there again as this time HIMSS brings its modest 40,000 attendees to Vegas. (When I say modest, CES had 200K!) THCB and Health 2.0 News will be there in force with me, Laura Montini & Jennifer Lee looking dangerous with our flip cams, while Health 2.0ers Marco Smit, JL Neptune & Pat Ryan will be working with AT&T, ONC, Novartis and other clients. And to those of you following on Twitter, the red satin jacket was the winner in the poll for what I’ll be wearing as fashion judge at HISTalkpalooza (and afterwards Regina Holliday will paint it!). So expect lots of video interviews on THCB and Health 2.0 News in the next days and weeks, and wish us luck as we descend into miles of walking all fueled by too much alcohol and too little sleep!
Matthew Holt
CareZone –1999 PHR Redux?
In 1999 PersonalMD & HealthCompass were some of the new personal health records (PHRs) where you could store health data and share it with others who needed to see it. They were basically vaults, they rarely even had data linked to a drug or condition database–just plain text, and they couldn’t get data out of larger systems. And they were not successful.
Later PHRs tried to overcome these problems by making it easier to import data from other systems (think geting your drug data from Walgreens) and linking to other reference databases (so that when you enter a drug name the right spelling comes up and it can tell you about interactions, etc.).
There was (and still is) the problem of how to get paper documents into the record. MyMedicalRecords.com allows you to fax in paper records to make PDFs, and has burned through some $30m in 5 years (and I was pretty cynical about them from the start). Of course even getting much of this right didn’t help many early PHRs like WellMed which went through some $40m before being sold to WebMD for $20m and iMetrikus (now Numera) which spent some $75m (est) of Chiron Founder William Rutter’s money before completely changing models.
CareZone is the product of ex-Sun CEO Jonathan Schwartz’s last two years since the fire-sale to Oracle. It was introduced to an adoring bunch of journalists yesterday including Techcrunch’s Eric Eldon, Robert Scoble, and Xconomy’s Wade Roush. All of them continue to confirm to me that they don’t much understand this market and they fawn over former techies who think that they’ve discovered health care nirvana. I really cannot see what the fuss is about. They’re all fascinated by the fact that this doesn’t link to Facebook and somehow keeping instructions to take Johnny to the doctor off the Twitter feed is a huge advance. But none of them see the really basic flaws in CareZone or seem to have any history of what’s happened in this market before.
Another nail in the DM coffin?
Just when you thought it was safe to go back to the water, the CBO is out with the bad news that in its analysis of over 30 disease management programs, and none of the independently run ones saved Medicare any money. Even the ones that succeeded, which put the medical groups at risk and generally lodged the DM nurses with them (rather than have them call in on the phone), didn’t save enough to justify the costs of the program.
Now the first group isn’t a surprise to those of us who followed the fate of Medicare Health Support. The second group includes a series of demonstrations paying physician groups to save money. They did better, but not well enough to save once the extra costs of the program are included. (Details here). We can only hope that using more lightweight technologies with better understanding of patient behavior does in fact end up saving money–as has been shown in some commercial medical home settings. But we must also be prepared to admit that we don’t yet know how to save money in the care of the chronically ill under Medicare. Which means that the only obvious way to do it is to cut payments to providers!
CES Mania Over at Health 2.0 News
If you’re not seeing all the news and views coming out of the Digital Health Summit at the huge CES show in Vegas–a big segment of the Health 2.0 team is there so you dont have to join the hour long cablines. There’s a series of fabulous articles on new products, a great newsbites roundup and an interview with the new Blueprint Health incubator launching in NYC this week. All a click away here—Matthew Holt
What Missy Did Next
While I was blundering around the excellent Venrock/athenahealth party last night I ran into Missy Krasner. Missy ran David Brailer at ONC and then ran Adam Bosworth at Google Health and is as good as anyone in spotting and being around the trends in health IT. So what’s she doing now? Well she’s joined Rebecca Lynn’s crew at Morgenthaler Ventures. Is this cause for the boys of health IT VC to get afraid? Probably yes.
So what is Missy actually going to do? I had the good sense to ask her and she had perhaps less sense in telling me in quite some detail:
During my 5 years at Google on Google Health, we met with alot of innovative healthcare startups who came in and pitched their solutions as possible integration partners or acquisition targets. There is still so much out there that has not be adequately addressed: end-of-life documentation, personalized health and provider search, big data and analytics, patient/provider communications via ACO trends, transparency solutions for benefit design and EBOs, patient UGC and the social web, cheaper and better reimbursable telemedicine, and on and on. With all the innovation coming out of the various health IT accelerators and government app challenges, it’s a great time to align with a seasoned venture firm and take a deeper look at what is really ripe to become a market disrupter.
Progress made by ONC (Really!)
ONC Director Farzad Mostashari is out with his review of 2011 on a month by month basis. Good to see that Farzad & colleagues took December 2011 off (just kidding!). He calls it a year of “momentous” progress. I’m doubly biased because I’m a proponent of newer and better health technology for clinicians AND citizens. Also, (FD) Health 2.0 is the main subcontractor on the i2 Investing in Innovation challenges which were–as noted by Farzad–launched in June, have had several close already, and will continue to roll off the production line for another 18 months. But as a general and occasionally cynical observer I’m very impressed with what ONC has done. Continue reading…
The slow integration of community into health care
For a long time now patients have been meeting in online (and offline) communities, sharing experience, advice and more recently data and measurements. And the health care system–which knows that communities improve health–has done virtually nothing–other than some doctors having doctors answer questions on MedHelp. That is just starting to change. Last year Geisinger did a small trial with dLife that showed improvement in diabetics outcomes. More recently Aetna inked partnerships with MindBloom and OneRecovery, two communities focused on spirituality and addiction, and today Diabetic Connect (part of Alliance Health) announced a deeper integration with the Joslin Diabetes Center. It’s been a while, but the heart of Health 2.0 (communities) are starting to move towards the mainstream.
Usual, customary and made up
It’s been a while since THCB discussed usual customary and reasonable charges, and it’s been longer since health plans did much about them–other than cover them at a low rate and let providers charge what they like. That’s mostly because Ingenix (now Optum Insight) got itself and United beaten up about the topic a while back. But I noticed today (via a company selling expensive webinars about the topic) that Aetna is starting to go after providers that are gilding the Lilly on out of network charges again. In this case a couple of surgeons who were self-referring to a surgery center they owned, not charging the patients their official share, and meanwhile somehow managed to charge nearly $100K for ear wax removal. Aetna, don’t forget, was the “nice” insurer that started the trend of settling with doctors and being nice to them over pricing back in Jack Rowe’s time as CEO. If Aetna’s now starting to get aggressive about out of network charges to its members, then perhaps we really are entering a new era of health insurer activity.
Matthew’s end of year letter
OK, the new year has started, but those of you who are interested in my personal “End of 2011” letter about charities & causes can find it on my barely-used personal blog here—Matthew Holt
Uwe on premium support and vouchers
There’s a great post on the NY Time Economix blog from Uwe Reinhardt explaining the theoretical difference between premium support and voucher systems (and you thought they were the same thing!). Unfortunately it skirts the real problem that those of us playing along at home know too well. Either a well constructed premium support (Ryan done right), or a well constructed voucher/managed competition (Enthoven) system, a mixed public/private system (Germany, Starr, Reinhardt) or even a decent Medicare for all /Single payer system (PNHP, McCanne) needs to be designed holistically to have a chance of working–especially to ensure that all people are in plans that treat them all equally.Continue reading…
