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POLICY: It’s not just me saying that the individual market sucks

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You’ve heard me saying it often enough.  And later this week I will start to tell you my new personal horror show in navigating yet another twist in the individual insurance market.  But given the lack of a rational government regulated system that anyone can access, the NY Times is right to say that Employer-Backed Health Care Is Here to Stay, for Lack of a Better Choice.

What is also clear, though, is that there are no clear alternatives. Corporate executives and many others are leery of a government solution, but no one has come up with a private-sector option that has gained significant support. Because individuals who buy private insurance on their own pay much higher prices than the group rates employers get, many people could probably not afford health insurance if their employers were not buying it for them.

And I love what Helen Darling, the voice of big employers on health care, says in this juicy quote.

"There’s no functioning individual market" for insurance, Ms. Darling said.

Too bloody true, no matter how much free-market fantasists who haven’t read their Adam Smith might wish it weren’t so.

PHARMA: Cox-2s–Really putting the boot in

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So the latest study about the Cox-2s shows not only that they give heart trouble, they’re used for people who shouldn’t need them, etc, etc, etc. No this study shows that they don’t even do what they’re supposed to do—they are no better than NSAIDS in preventing stomach bleeding

British scientists said on Friday they had found no evidence that prescription painkillers designed to protect against stomach bleeding were safer than older drugs.Julia Hippisley-Cox, of the University of Nottingham in England, said she had found no proof the painkillers, known as COX-2 inhibitors, were less likely to cause gastrointestinal bleeding than aspirin or other treatments called non-steroidal anti-inflammatory drugs (NSAIDS).

A benighted class of drugs, forsooth, as the 7,000 soon to be laid-off Merck employees must be thinking.

TECH: Mark Gaynor on sensor network

Mark from Boston is building a sensor based application that talks HL7 (open standards) to all systems so that an air ambulance company (Boston MedFlight) can gather data in advance of hospital admission.  Thus they need to build a sensor gateway. All the filtering (how many times you get information per minute from the sensor) can happen in the gateway or even in the application (so doesnt need to be in the sensor). Data mining can be done later. They’ve also built some of their own monitors and have allowed Welch-Allen and others to connect.

On top of the sensors they need an application, and they are building a GUI  which shows the body etc, and will probably be run on a tablet PC to be used in the helicopter. But of course this data requires context (e.g. depending on the patient state…what if the patient is pregnant, a child, on certain meds?) and so they are building a rule processing system that prompts for the rules (that Med Flight mostly already has). Eventually they want this data to be mined and so they want to be able to collect it….again all open source standards. So their sensors are running TinyOS (sensors open source operating system). There’s a GPS in it too, so they can track location. They also want applications to exchange data — SOAP (better but incorrectly known as “web”services) in order to get these distributed pieces to exchange data. Here’s a chart of their infrastructure.

 

Figure 1: iRevive interface between field, 10-blade server

Data


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TECH: Cindy LeRouge on using claims data in PHRs

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Cindy LeRouge is from Washington Univ in St Louis, and has been working with Wellpoint on a study of integrating claims and chart data….there is some chart-type data (i.e. lab tests) around so some chart elements (electronic) can be put together.

Insurers are not yet seeing costs savings or consumer push for this, but there might be a competitive first mover advantage (if you can delay first mover as much). Insurers would like to see some chart data (e.g. getting lab data or blood pressure for DM). So there are reasons at the margin for plans to do this (although I might have to pick a fight with her later about this!). So out of claims they can start to generate reports that patients can view, and emergency rooms.

Running a test in Missouri, which will integrate data from certain hospitals in Missouri, and will eventually allow Wellpoint claim data to post back into some hospital forms and reports.

Oh, but of course the internal data at Wellpoint is a mess, so that data scrubbing issue remains a problem…and legal is getting in the way.

And then what about moving records between plans (UPIN and all that)? Do we go to a credit bureau-type reporting structure?

And why would providers want to share their chart data? (Good question!). Why are they going to the brain damage of working with providers to get that part of the chart in? Apparently there’s something in the chart that they need for UM that they can’t get out of the claims (but it’s not in the attachment either). And it’s all been driven by the marketing department.  Strikes me that the Blues yet again need more consulting help!


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TECH: Mary Jo Deering

Mary Jo Deering is  the director for Informatics Dissemination, National Cancer Institute’s Center for Bioinformatics; she has (self-professed) been around health informatics in DC for quite a while!

The big problem they face is that there is a divide between health care practice and clinical trials. Only 3–4% of cancer patients are in clinical trials, and all trials are delayed because of enrollment. But there is no general EHR which people can be matched with.  Right now neither the eligibility critieria nor the patient information are standardized. Can this be done thru a PHR instead? Maybe. They are putting together cancer centers to try to match all types of data form the big NCIs to make the loop of all information, on a standards based information infrastructure. (The caBIG initiative)

She tracks this all back to NCVHS talking about PHRs in 1996, with their report in 2001 being a catalyst for the NHIN movement. It distinguishes person, 050909l3

provider and populations so she has provider and personal centric views.

Then there are syntactic interoperability (can the machines talk) and semantic interoperability (does the language mean the same). NCVHS has recommendations for standards on semantics in a Sept 2005 report. AHIC is trying to get people to concentrate on a “clipboard”.  But the capacity for interoperability is not the same as actually having information exchanged. Reluctance to share data is a continuing problem, not least for incentive and business reasons. But nonetheless data standards and getting them worked out is the

Mary Jo says instead of building from where we are, why not build the working model of the vision? And then see if that motivates people.

She’s fabulous BTW, and I hope to engage her some more.

 


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TECH: Motorola’s view of seamless health

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Jose Lacal is from Florida, and they have lots of hurricanes there (and there’s a reason for that!). Motorola has built a seamless health record (basically a CRM system that has all the information, built on the mobile device). You can use a cellphone to download iTunes, to pay parking meters, etc, etc. So if the phone is trustworthy enough for those guys, than it’s more secure than the PC. OK, but he thinks it should live on the phone…(I assume that it’s backed up somewhere?)

Then he wants the “iPod of personal health”—bring it all in including meidcal guidelines via RSS feeds, information from hospital information systems, etc, etc. All in one place.  Wants to focus on chronic improvement. Wants to empower mom as the chief medical officer.

Thinks that some big org will host it. (Banks, Quicken, Google, USPS). This is a prototype


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TECH/POLICY: Steeve Kay on integrating disability via PHRs

More from the conference. Steeve Kay is the founder of QTC, a disability company which provides outsourced evaluations. Given the problems in figuring out who’s disabled and who’s not, you can see why they care about getting these records electronic. Meanwhile, a private equity firm just bought his company, so he’s obviously convinced someone else that it’s a good business! Yet another little niche in the health care world where plenty (plenty!) of money is flowing around.

Steeve says that medical treatment is provider centric, medical disability is payer centric — and there are lots of payers. It’s about $350 bn total on the health care side (public and private) for medical care for disability, plus another $200 bn for cash payments to the disabled. There’s about 10,000 claim centers in the US who are involved in allocating money, and that includes about 250,000 people working as claims administrators (of various types) with some 10 m claims a year. (I may have that number wrong—Mapping this system is damn confusing!)

These all need evidence to process and judge a disability claim. Most of that needs to come from a medical record, and the legal custodian of the medical record for disability is the payer, while in the medical world it’s a provider. And the disability payer needs to do a bit more to make that complete.

And of course not much has been thought about how these different parties access medical records in an electronic world. His 2 key questions are can we standardize billing codes for disability? And is evaluating disability a practice of medicine.


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TECH/POLICY: Disability and PHRs

David Stapleton (from Cornell Univ Inst for Policy Research) is here to talk about disability. He says that we spend over $200bn on disability (via Medicare, SSI, and Medicaid) and the process of getting people onto disability is totally broken (Determination takes forever, and appeals take even longer). Much of that problem is due to the fact that there is no easy access to the medical record, and then if they actually get the record, figuring out what’s in it is hard, and the information may be biased because the provider is somehow colluding with the applicant (Imagine that in health care!), or applicants may withhold information early, and then produce it later. (If you let the consumer have control of the PHR, then they’ll fix the record to make it favorable to them to qualify for SSI!)

So if there was national PHR then the applicants could give these records out and they’d theoretically be available, accurate and complete! But funnily enough he thinks that disability is not the right place to target EHR development…and given the complications in that part of the world….yup! So why is he here? This conference (and in fact the sponsor of the center) are from a disability management company, hence the role of disability is coming up more than you might suspect! Still it’s a pretty interesting part of the system that we don’t hear about much, and it takes a lot of dollars. And if there was a national, reliable PHR with adaquate rules to get into it — and people trusted the government which Helga Rippen just told us they don’t — then management of the disabled population across programs could dramatically benefit in many ways, but we’re not holding our breath!


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TECH: Personal Health Records–a conference

I’m at a conference with a bunch of academics at Claremont graduate school, all about the Personal Health Record. Helga Rippen, who’s been hanging out in health care IT for a while, and is now buried somewhere in HHS is up and talking now. She’s telling us that people are very concerned about privacy. (I think I’ve heard this before somewhere…and you know that I don’t think that it’s the main problem)

IMGP5585 Allegedly this will all be up on video/podcast/multi-media sometime soon. 

PHARMA: Pfizer fires Rost

Pfizer fired its troublesome VP Peter Rost, the one who’s been criticizing them for opposing drug re-importation.  It looks like they suckered him — he tried to start a whistleblower suit for the way that Pharmacia had been marketing a drug. “Pharmacia offered doctors illegal inducements to use genotropin, its growth hormone, as an anti-aging drug for adults”. He obviously thought that Pfizer (which bought Pharmacia in the middle of all this) was covering it up, but they’ve convinced the DOJ that they had brought it to the FDA’s attention before Rost did. So now that the government has pulled out of supporting his suit, Pfizer can call him a wrecker. So they’ve booted him.

Which leaves one issue behind. Given that his position involved being paid $600,000 a year to basically do nothing, how do I apply for the job?


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