Author Archives

Matthew Holt

Five Things Hospitals and Health Systems Have to Get Good at Fast

May 28, 2011• 38

By JOE FLOWER

There is a way to avoid a collapse of healthcare in this country.

It’s getting scary.

We are facing, before the end of this decade, a bifurcated future. The way things are going now—with the economy wheezing, doctors bailing, chronic disease rising fast, boomers sliding out of the Viagra years into the Depends years, reimbursements getting squeezed ever tighter, Medicaid sputtering on fumes, and 30 million or more new people soon swarming our doors with insurance cards—if we don’t pull a rabbit out of a hat real soon now, we’re in serious trouble.

If we just muddle along, the best we can hope that “trouble” will look like is horrifying gridlock, no options, no exit. That would be the good outcome. The bad outcome would be the destruction by strangulation of all these great institutions, the utter collapse of our ability to serve this society with real medicine, real healing, real help.

The good news? There is a hat, and it has a rabbit in it.

Medicare should pay less & differently

May 25, 2011• 1

Easy to say. Rita Redberg from UCSF points out in the NY Times that Medicare pays for loads of procedures that we know are a waste of money. After all the COURAGE trial a while back showed that stents were a waste of money, and we put in more stents now than when the data were released. This shouldn’t be much of a surprise–we ignore the evidence all the time in making health care decisions. Brian Klepper in his wonderful but probably ineffective crusade to abolish the RUC shows that CMS (and therefore Medicare’s) payment methodologies are fundamentally flawed–yet we can’t fix them either. So it’s easy to say Medicare should pay less and pay differently but the political will is just not there yet. It’s lucky the Chinese are so generous.

Health 2.0 Pavilion @ Maker Faire Bay Area THIS WEEKEND

May 21, 2011

By MATTHEW HOLT

Maker Faire Bay Area is the worlds biggest DIY and tinkerers festival–at the San Mateo County Fairgrounds (about 20 mins south of San Francisco). I’ve heard it called a cross between the Home Depot & Burning Man. And this year for the first time, Health 2.0 is there with its own pavilion and lots of great speakers–and lots more hands on activity. Below is one photo and there are more on Health 2.0 News.

Here’s the Health 2.0 Stage schedule, with our own Lizzie Dunklee taking the stage at 11 am this morning to kick it all off.

High costs cut drug use…and not in a good way

May 20, 2011• 3

This pretty interesting study from Avalere Health confirms what several others have shown. If you add a user fee to any medical procedure people use less of it. And of course their decision to use it less is not based on whether it’s medically necessary or not; it’s based on how much it costs and what their income is. The difference with this study is that it’s about the use of expensive cancer drugs which are increasingly oral, now that oncologists aren’t being rewarded as much for delivering them via infusion. Co-pays of $500 or more saw “abandonment” rates of 25% or more. Other factors creating increased rates of abandonment included lower income (duh) and whether the patient was covered by Medicare or commercial insurance. The study was (of course) funded by a gaggle of drug companies. They didn’t fund the (non-existent) parallel study of which of these drugs actually did the cancer patients any good, but it’s not logical that cost should be the determinant of whether a drug–especially presumably a life-saving one–gets used.

Talking Uninsurance with Phil Lebherz

May 19, 2011• 2

By MATTHEW HOLT

Phil Lebherz is the Executive Director of the Foundation for Health Coverage Education, which has as its mission the goals of educating uninsured people about their options to get insurance. Phil is also the Founder and Chairman of LISI, a company that provides sales support services for employee benefits insurance brokers. With colleagues at the Foundation (including Alain Enthoven, Len Schaeffer and David Helwig) Phil just released a report that was featured in Health Affairs that basically said that most uninsured people showing up in Emergency Rooms in San Diego should have been covered by Medicaid, and that the set-up of Medicaid in California makes it impossible for them to enroll themselves. This is preciously close to the conservative argument that there are no uninsured because they all “could be” covered by Medicaid. But given that under the ACA Medicaid is going to massively expand, you may surmise that I’m not altogether won over by this argument.

So a fun conversation with Phil ensued. You can listen to it here (and look at for the bit where he claims that Len Schaeffer–the man who built Wellpoint into the force it is today–is really a supporter of universal health care because he ran HCFA under Carter for a few minutes in the 1970s!). And no, it wasn’t all violent disagreement–but enough was to make it interesting.

Maybe there really is mobile health after all

May 18, 2011• 1

OK, I’m kidding–but Ford Motor Co is excited enough about its new collaboration with WellDoc that it wanted to fly me to Detroit to take a look at it. (I declined–perhaps they should move their headquarters to San Tropez). Welldoc is a pretty interesting Web & iPhone based diabetes management tool (here’s a interview video I did with CSO Chris Bergstrom last February). Now Ford has put it in the car. Apparently they believe that it’ll interact with pollen counts and automatically turn on the AC (or at least this is what the “Wheels” blogger on the NYTimes took away from the meeting). But what is interesting is that they’ve integrated the speech to text version of Ford’s Sync–which is the internal bluetooth system that allows people to talk to their car. It’s experimental, but it wouldn’t surprise me to see this in many more cars–at least by the time I buy my next new one in 2024.

Wellpoint gets aggressive on inpatient payment changes

May 16, 2011• 3

We’ve heard a lot of whining over the years from private insurers about how they have to pay more because Medicare pays less. But now Wellpoint is going to essentially use the ACA as cover to put all of its hospitals on a pay for performance plan–obviously related to the ACO ideas we’re hearing from CMS. The WSJ reports that all hospitals in Wellpoint’s networks are going to be paid future increases based on a formula for outcomes, patient safety and patient satisfaction. Thus far private insurers have been laggards in that they haven’t really mixed up payment schemes to incent better behavior by providers–even though nothing was stopping them. They always claimed they would eventually. Maybe eventually is now.

Sorry, been busy!

May 12, 2011• 8

You may have noticed that I haven’t been hanging around THCB much this week so far. Well I have a great excuse. This is my wife Amanda and our new daughter Colette. She was born on Sunday at 6 am and mom and baby are doing very well!

Silicon Valley roars back…in healthcare too?

May 12, 2011

By Marco Smit

Recently, the Wall Street Journal has been writing article after article about how Silicon Valley is suddenly as hot again as in 1995. And anyone driving into San Francisco these days will have views of the city obscured with big “we’re hiring” billboards from the Groupons, Zyngas, Rockyous, and whathaveyous of the world.

In the past healthcare innovation and startups/new value creation has proceeded independent of that tech-scene and it has been much slower, dominated by buying behavior from giant incumbents who thought NIH stood for Not In Healthcare. But as my colleague and Health 2.0 co-founder Matthew Holt likes to put it: change starts at the edges. And we have seen Health 2.0 start small at the edges with the growth of patient communities, followed by other models connecting patients, payers, and providers in new ways (e.g. American Well, athenahealth, Castlight).

On May 18 SDForum is organizing a one-day event highlighting the change that is afoot in mainstream healthcare as a result of the innovation from the edges reaching the shores (and more) of mainstream health and wellness industries.

I am introducing the first keynote speaker (Holly Potter from Kaiser Permanente) and moderating a panel on one of my favorite topics: how data and innovation in analytics can make treatment and wellness decisions better, and hence create value, for all involved. While 80% of presenting companies are young (from only a few months in existence to 5 years from initial funding), there are also some pioneering established companies (Kaiser Permanente, Safeway, PAMF) who will touch upon topics like:

how ONC’s push for ‘data Liberacion’ is one of several forces helping to make health decisions more data-driven
how mobile/unplatforms, cloud-computing, and innovative use of analytics create new opportunities to understand patient behavior and introduce new, smart interventions
how chronic disease treatment is starting a transformation (funky billboards in LAX not withstanding, Lisa)
how new entrepreneurial energy is being backed by more and more funding (Healthtap is one of the companies who recently received funding and who will be on the panel that I moderate, Doximity is another company that fits that bill)

Finally, while some companies in general tech or consumer markets seem to pursue growth without a business model, this event shows how companies in healthcare who get it right (e.g. Limeade), can grow fast, do good, and become financially viable businesses. Maybe one day the WSJ will report on the exciting IPO window of healthcare technology innovation companies for a change. In the meantime, come and see what the future will look like by hearing from those who are building it now.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.

Health 2.0 Advisors at Tiecon 11

May 9, 2011• 2

By Marco Smit

At Health 2.0 Advisors we not only scan and analyze the healthcare innovation landscape incessantly, we also share our thoughts and insights with clients and at conferences at times. On that note, on May 13 at 10am I will be moderating a panel on cloud-computing in healthcare at Tiecon 2011. It is the first panel right after the ‘interesting’ Steve Case speaks – Marissa Meyer from Google closes on Saturday evening.

Cloud-computing is one of the topics that Health 2.0 Advisors will start sharing more perspective on in public this year, in addition to unplatforms/mobile, analytics, and care delivery innovation. What these topics all have in common is that they are forces rapidly changing the healthcare landscape (competitive landscape, business models, patient-provider dynamics, other) and companies are grappling where they all fit in with their strategies and business realities.

This Tiecon 2011 panel is a good reflection of that: cloud-based EMR-systems where a novelty 18 months ago, but the number of companies offering them (stand-alone or embedded in e.g. a practice management suite), has exploded since. But cloud-computing goes far beyond EMRs of course. That is why the panel will cover a range of experiences, struggles, and expectations for the future of the cloud from large (IBM, Kaiser Pemanente) and small – but rapidly growing (Practice Fusion, CareCloud) – companies that have cloud-computing in their DNA.

Marco Smit is President of Health 2.0 Advisors, the market intelligence arm of the Health 2.0 family.