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Matthew Holt

High Stakes Health Reform ‚Äì Employers: In or Out?

Dec 15, 2010

By MICHAEL TURPIN

It‚Äôs high noon for private healthcare. Over the last decade, large, medium and small employers that procure and manage over $1T of private healthcare spend for an estimated 180M Americans have been engaged in an expensive game of Texas Hold ‚ÄòEm ‚Äì – wagering with and against a continuum of stakeholders that all seem to possess more powerful hands. As providers consolidate, insurers retrench and the government wrestles with obligations of an uncontrolled fee for service Medicare, the costs of staying at the final table are taking its toll.

To many veteran observers, it appears that employers may be on the brink of folding their cards. As finance and HR professionals consider the table stakes and costs to remain in the game, the Affordable Care Act (ACA) has suddenly provided a potential golden opportunity to step away from a fifty year obligation without incurring onerous near term financial consequences.

As individuals and small business have continued to lapse into the ranks of the uninsured, those small and mid-sized businesses choosing to continue to offer health insurance are coming to the realization that the Affordable Care Act will not result in the moderating of double digit medical trends. In the near term, some contend costs will continue to rise by much as 25-40% before the launch of 2014‚Äôs guarantee issue health exchanges.

Larger employers are already cynical to whether reform will actually work for them or against them. Bigger firms and collectively bargained plans are beginning to understand that if small and mid-sized employers drop out of offering private healthcare, the decline of employer plans will leave them as the sole remaining source for private insurance cost shifting. As the cards are turned, the outcomes are far from certain ‚Äì – and as we have come to discover, business hates uncertainty.

High Stakes Health Reform – Employers: In or Out?

Dec 15, 2010• 18

By MICHAEL TURPIN

It’s high noon for private healthcare. Over the last decade, large, medium and small employers that procure and manage over $1T of private healthcare spend for an estimated 180M Americans have been engaged in an expensive game of Texas Hold ‘Em – – wagering with and against a continuum of stakeholders that all seem to possess more powerful hands. As providers consolidate, insurers retrench and the government wrestles with obligations of an uncontrolled fee for service Medicare, the costs of staying at the final table are taking its toll.

Larger employers are already cynical to whether reform will actually work for them or against them. Bigger firms and collectively bargained plans are beginning to understand that if small and mid-sized employers drop out of offering private healthcare, the decline of employer plans will leave them as the sole remaining source for private insurance cost shifting. As the cards are turned, the outcomes are far from certain – – and as we have come to discover, business hates uncertainty.

Health 2.0 Announces its Starting Five for the 2011 Developer Challenge

Dec 15, 2010

Following the success of the 2010 Health 2.0 Developer Challenge, we are excited to get the ball rolling again for 2011. Within the short time the Developer Challenge has been live, we have had six winners, who were able to present their solutions at the Health 2.0 Fall Conference in San Francisco, October 7-8, 2010, and two challenges that came to an end in late November. We are incredibly proud of the achievements of the participants in the 2010 Developer Challenge and we are delighted to announce the starting line-up for the 2011 Health 2.0 Developer Challenge.

Now here are the starting five:

The myHealthyPeople Challenge, sponsored by Healthy People 2020 Splash, asks to develop a “myHealthyPeople” application for the thousands of Healthy People stakeholders using national health objectives and related health indicator data as part of Healthy People 2020, the national agenda for health promotion and disease prevention that outlines a set of health objectives for the US to achieve over a 10-year period.
Analyze This!, sponsored by Practice Fusion and Microsoft, invites teams to use medical research data to answer pressing public health questions. Access the free Windows Azure Marketplace DataMarket dataset from Practice Fusion to visualize healthcare trends, find adverse drug reactions, chart chronic disease, mash up the results with other sources or build applications.
Engage with Grace Challenge, sponsored by Engage with Grace, asks the question: Can you make an application that uses the power of today’s software and data to incorporate a much broader range of options, and a process for communicating information around those options, regarding end of life preferences?
WWHI / VAi2 Veterans Health Wireless Innovation Challenge, sponsored by West Wireless Health Institute and VAi2, challenges teams to design an award-winning wireless device or application targeting a problem specific to the Department of Veterans Affairs regarding care for our Veteran population, through apps that wirelessly connect hardware with cell phones (or some type of wireless technology), and target identified Veterans health problems.
Food Find: Putting Healthy Food Choices in the Path of Everyday Life, sponsored by the American Heart Association, is a challenge to developers to help consumers/communities put healthy food choices in the path of everyday life. Create a tool to look at food desert issues, triggers that drive people to healthier food choices and/or analysis that drive communities to identify and activate on food access issues in new ways.

The Grinch that Stole Obamacare

Dec 15, 2010• 10

By DAVID DRANOVE, PhD

Article 1, Section 8, Clause 3 of the Constitution, better known as the Commerce Clause, states that Congress has the power to “regulate Commerce…among the several States.” To supporters of health reform, the Commerce Clause is the Grinch that stole Obamacare. To opponents, the Commerce Clause might seem like a Sanity Clause (apologies to the Marx Brothers.) One thing now seems certain. Obamacare is on the fast track to the Supreme Court, where a ruling on the Commerce Clause could have far reaching implications for health reform and, frankly, for many other federal interventions into economic activity.

Virginia officials cited the Commerce Clause in arguing that the individual mandate was beyond the power of Congress. U.S. District Judge Henry Hudson agreed with the centrality of the Commerce Clause:

While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate and tax a citizen’s decision to participate in interstate commerce.

Judge Hudson sided with Virginia, stating that “no specifically articulated constitutional authority exists to mandate the purchase of health insurance.”

Judge Hudson does not reject health reform in its entirety. Although he speculates as to whether the bill would have been enacted without the exchange, he notes that the record in the case is insufficient for a final determination and thus he “severs (the individual mandate) with circumspection,” leaving the rest of the bill intact. In doing so he provides a road map to others attempting to strike down the entire legislation, provided they can find some evidence that votes hinged on the inclusion of the exchange.

To Die Well

Dec 15, 2010• 2

By ROB LAMBERTS, MD

Everyone liked him. Though his later years (the only ones in which I knew him) took away his ability to do most things, and though he was in great pain every day, it was easy to see the mischief in his eyes. The subtle humor was still there, coming out of a man who was weak, in pain, dying.

She lived for him. She was always telling me of his pain, frustrated with the fact that he didn’t tell me enough. She was anxious about each complaint of his, wondering if this was the one that would take him away from her. Many of her problems were driven by this anxiety and fears, and she spent many hours in my office giving witness to them through her tears.

As his health failed, I wondered at her future. He was the center of her life, the source of her energy, joy, purpose. How could she manage life without him? How could she, who had so much lived off of the care of this wonderful man, find meaning and purpose in a life without his calming presence?

Then he died.

I saw her in the office recently, and was amazed at the look in her eyes. It wasn’t the empty, lonely look I was expecting. It wasn’t the worried, helpless look that I had seen so many times. It was peaceful, content.

Selecting an EHR for the Patient-Centered Medical Home

Dec 15, 2010• 2

By MARGALIT GUR-ARIE

The conceptual definition of a Patient Centered Medical Home (PCMH) speaks of a physician directed medical practice, oriented to the whole person, where patients have enhanced access to a personal physician and care is coordinated and integrated focusing on quality and safety, nothing more and nothing less, other than appropriate payment to physicians for all activities.

Since concepts are rarely enough, the National Committee for Quality Assurance (NCQA) took it upon itself to provide concrete requirements and formal certification for medical practices desirous of being recognized as Patient Centered Medical Homes. The NCQA PCMH definition consists of nine Standards used to score the practice. This is NCQA’s attempt at translating the original PCMH concept into measurable activities and here is where Health Information Technologies (HIT) and EHR in particular, are formally associated with the PCMH concept. Conspicuously absent from the NCQA standard are the “personal physician” and unless you consider the assessment of language barriers sufficient, so is the “whole person orientation”. Most NCQA PCMH elements are geared towards data collection, data analysis, tracking and reporting. Theoretically, you could earn NCQA PCMH designation without an EHR, but the amount of typing, writing, filing and calculating would easily consume your entire day. If you are serious about PCMH designation, you will need an EHR. But which one should you get? Are some technologies better than others for PCMH purposes?Continue reading…

Great Ideas: Improving Healthcare Infrastructure

Dec 13, 2010• 12

By GEORGE HALVORSON

Sepsis is the number one cause of death in American hospitals–higher than cancer or stroke. Your chance of dying from a sepsis infection can triple if you choose a hospital that doesn’t have a good sepsis response team.

Care outcomes always vary from site to site and from caregiver to caregiver. For instance, if you have cystic fibrosis, your life expectancy can be diminished by a decade if you choose one of the lower success care programs for that disease.

But people don’t know where to go for best care for almost any level or category of care. That is the missing link in our healthcare delivery infrastructure. The least successful cancer centers will not get better if neither they nor the world knows how relatively low their success levels are. The world needs a scorecard for care performance that is mathematically sound and scientifically valid. It should only measure and report outcomes where outcomes vary and matter.

Enough of those areas exist now, but others still need to be created. The survival rates for each stage of each major cancer should be in a publicly accessible database, and patients with cancer should be able to consult that database to see where to go for best care. The database should also show clearly what the survival rates are for each major type of treatment for each stage of cancer. For example, surgery survival rates, hospital infection rates and cancer treatment survival rates would be a nice starter set for improving patient choices about care.

Such a database is entirely feasible, but we need people with authority and purchasing power to demand it. Employers, care purchasers, governmental care buyers and the new health insurance exchanges created under the new American health care reform act should all be insisting on these data sets.

Sticker Shock

Dec 13, 2010• 18

By GRAYSON WHEATLEY, MD

It was supposed to be a routine office visit for my patient. Unexpectedly, it turned into a real-world health economics lesson for me, the treating physician. The old adage “listen to your patients; they will always give you the answer” became exceedingly true in this case, even when it dealt with an issue beyond a medical diagnosis, such as lack of transparency regarding insurance coverage for medical procedures.

My patient had recently undergone an interventional procedure to treat severe peripheral vascular disease in order to improve his leg circulation. Usually, patients like him don’t seek treatment for vascular insufficiency until the discomfort associated with activity, or claudication, is severe enough to interfere with their regular rounds of golf. That is the real motivator for these patients. The procedure was a success and a few days following the procedure he was back to his normal activities and was pleased that his leg no longer bothered him as he motored around the golf course.

My patient calmly waited until after I checked his pulses, reviewed his medications and gave him a plan for follow-up before he expressed his real concern, and it certainly wasn’t about whether he could now get an extra 20 yards on his tee shot as a result of the new strength in his leg. Despite my office obtaining all the necessary private insurance pre-authorizations for the interventional procedure, he still had received a bill for approximately $10,000 related to out-of-network charges. I was baffled and my patient was disgruntled about this mix-up. After reviewing with him in the examination room the numerous sheets of paper he had received from his insurance company, it became clear what had happened.

Letter From London

Dec 13, 2010• 5

By BOB WACHTER, MD

I’ve just returned from a few days in London, scoping things out for a planned sabbatical next fall. In what may be a pale echo of the late Alistair Cooke’s always fascinating “Letters From America,” here are a few of my initial observations:

The dominant issue, of course, is the Cameron government’s new austerity program, with its planned deep cuts to government services and benefits. While the program (or programme, I guess I should say) has created some upheaval – witness the recent semi-violent demonstrations by university students, whose tuitions may treble – it has not torn apart the society, the way belt tightening of this magnitude undoubtedly would in America. My sense is that the relative acceptance (yes, I know Charles and Camilla had a frightfully awful limo ride to the West End the other night, but this was, er, theater rather than a defining moment) can be explained the Brits’ stronger trust in their government. It is this same trust that leads to near-universal support for the National Health Service, the UK’s tax-funded healthcare system. This wellspring of support gives the government a little leeway when it says, “We can’t afford to do all this anymore, folks, and we can’t just print money. We must cut programs and benefits.”

In the US, of course, there is no such trust today, nor harbingers of its return any time soon. In a recent issue of Time that outlined this past decade’s mega-trends, Nancy Gibbs observed that the cumulative effect of 9/11, Katrina, BP and the subprime crisis was to markedly shrink Americans’ already scanty faith that their government can do anything competently. So our response to the recent announcement that Chinese kids are shellacking us in educational achievement is hand wringing and statistical nitpicking, not the call for vigorous government action that characterized our nation in the Sputnik era.