Category: Uncategorized

Another Look at Health Insurance Exchanges

Apr 11, 2012• 23

By JONATHAN HALVORSON

Of all the provisions of the ACA, probably none has received greater attention from health insurers than the exchanges. Though the exchanges are expected to be the conduit for just a small fraction of all the insured at their start in 2014, they will be where most of the growth in health insurance lies. Given the rule that the individual exchanges must be integrated with Medicaid, their role will be critical for any insurer that wants to compete and grow in the individual or Medicaid markets. The dominance of the exchanges for growth in the small group and even the Medicare markets may not be not far behind. It should be no surprise if, eventually, all fully-insured business goes through the exchanges, leaving only self-insured plans outside.

So getting it right matters. Now is the time to think hard about getting it right, before the exchanges are created and inertia sets in. And, as some have argued, getting it right means that we think about the exchanges as places for people to choose their health care, not just their health insurance. So how should we do that?

Here is what we should not do: make it easy to choose care without considering both the quality and the cost of care delivered by the care system. It would be an enormous lost opportunity to improve consumer attitudes towards health care if we built the exchanges to make it easy for people to reason: “I like doctor A. Doctor A accepts insurance products X, Y and Z. Of these three, insurance product X seems to have the lowest cost, so I’ll choose product X.”

TEDMED 2012: HBO Documentary Films “Weight of the Nation”

Apr 11, 2012

[youtube width=”560″ height=”270″]http://www.youtube.com/watch?v=zYrOW_WGJj0[/youtube]

HBO Documentary Films premiered clips from its upcoming feature “The Weight of the Nation” at TEDMED 2012. The film debuts May 14.

What Keeps Me Up at Night 2012

Apr 11, 2012• 1

By John Halamka, MD

I’ve written several posts about the issues that keep me up at night. Here’s what I wrote in 2011.

Today, my team presented a list of risks to the Compliance, Audit and Risk Committee at BIDMC. Here’s my list of top risks for 2012:

1. Old Internet browsers – many vended clinical applications require specific versions of older browsers such as Internet Explorer 6, which are known to have security flaws. We’ve worked diligently to eliminate, upgrade or replace applications with browser specificity. At this point we are 96% Internet Explorer 8/Firefox 7/Safari 5 minimizing our risks to the extent possible.

2. Local Administrative rights – Of our 18,000 devices on the network, a few thousand are devices that require the user to have local administrative rights to run their niche applications (often the research community doing cutting edge research with open source or self developed software). We have done everything possible to eliminate Local Administrative rights on our managed devices.

3. Outbound transmissions – Security has historically focused on blocking evil actors from the internet. Given the current challenges of malware and infections brought in from the outside, it’s equally critical to block unexpected outbound activity.

4. Public facing websites – any machine that touches the internet has the potential to be targeted for attack. We’ve implemented proxy servers/web application firewalls on most public websites.

5. Identity and Access management – Managing the ever changing roles and rights of individuals in a large complex organization with many partners/affiliates is challenging. If an affiliate asks for access to an application, how do you automatically deactivate accounts when users leave an affiliate, given the lack of direct employment relationships?

If the Supreme Court Kills ObamaCare, Should We Thank Mitt Romney?

Apr 11, 2012• 5

By John R. Graham

There is no doubt that the campaign to “repeal and replace” ObamaCare will have its weakest standard bearer if Mitt Romney becomes the Republican candidate for President. His embrace of an “individual mandate” to buy health insurance or pay a penalty, as legislated in his 2006 Massachusetts health reform, is anathema to those faithful to the ideal of limited government. When Mr. Romney declares that he will issue a universal waiver from ObamaCare’s regulations as his first executive order, the people who should be voting for him fear that such action would be a substitute for repeal, instead of a preparation for it. (Do these folks really think a clean repeal bill, like the one passed by the House of Representatives in January 2010, will be on the president’s desk on inauguration day?)

But maybe we should look at it another way: If Mitt Romney had never signed his 2006 law (which was motivated, as the president’s men are so fond of telling us, but an idea generated at The Heritage Foundation), those of us committed to defeating ObamaCare would never be in the fortunate position we are today – the whole, ungodly mess hanging by a thin thread after a brutal hazing in the Supreme Court last week.

Without Massachusetts’ 2006 law, there is almost no likelihood that the Democrats would have written an individual mandate into the bill. Instead, they would have just hiked taxes. The only reason they painted a thin varnish of so-called “individual responsibility” onto the bill was so that they could pin some of the blame on Mitt Romney and certain conservatives who had embraced it. As noted by Avik Roy, the individual mandate was traditionally anathema to liberals, who prefer straight-forward tax hikes.

Does Anybody Want to Pay for Depression Treatment?

Apr 11, 2012• 10

By Peter Ubel

Imagine for a moment you are suffering from an illness that makes you feel like your soul has been run over by an angry defensive lineman, a disease that interferes with your desire to sleep, eat and make love. Oh, and this illness will continue to make you feel this way for the rest of your life. How much would you be willing to pay for a treatment makes you feel normal again?

My colleagues and I posed that question to a nationally representative sample of more than 700 Americans and we discovered something troubling—people’s willingness to pay for medical interventions depends in large part on whether the illness in question is “physical” or “mental.” People are much less willing to part with money to treat mental illnesses, even after accounting for the perceived severity of those same illnesses. Our article—“What’s It Worth?”—is available online at the Journal of Psychiatric Services.

Let me tell you a bit more about our study. We described a handful of illnesses to people and asked them to tell us, in effect, how bad each one would be to experience. For instance, we describe type 2 diabetes to people, and told them that it was uncomplicated by any other medical problems. People thought that would be pretty hard on their quality of life. We also described below-the-knee amputation, and they thought that would be even worse than diabetes. We described severe blindness, which only leaves one able to distinguish shadows. People thought that one was worse than either of the first two problems.

We also described a case of moderately severe depression to people, a level bad enough to cause the victims to “feel sad and downhearted a lot of the time.” The description went on to explain that it would make people “feel like a failure” and lose interest in food and sex. Trust me, it was a thorough and devastating picture of how depression can affect people’s lives. Indeed, people thought it was horrendous, at least as bad as any of the physical illnesses we described.

Health 2.0’s Spring Fling: Matchpoint Boston – Final Agenda Announced

Apr 10, 2012

In case you haven’t heard, Health 2.0’s Spring Fling is returning to Boston on May 14-15. The panels and sessions will focus on commercializing Health 2.0, and feature Matchpoint, the industry’s preeminent deal-making and partnership forum.

Highlights include:

Matchpoint Boston. Face-to-face meetings between entrepreneurs and decision makers from the nation’s leading health care organizations and investors including: Aetna Inc., Angie’s List, athenahealth Inc., AT&T, Bristol-Myers Squibb, California HealthCare Foundation, Healthline Networks Inc., Kaiser Permanente, Virgin Healthmiles Inc., and Ziegler. The deadline for entrepreneurs to apply to meet with the leading companies is April 17th.

Featured speakers. Farzad Mostashari, M.D., National Coordinator for Health Information Technology, will announce the latest winners of the ONC’s i2 Developer Challenges. The competitions, run by Health 2.0, were created to accelerate the development and adoption of health technology solutions. Jonathan Bush, CEO of athenahealth, will be the keynote speaker, detailing his company’s rise from start-up to $2.5 billion market cap segment leader.

What Can We Do to Simplify Healthcare?

Apr 10, 2012• 6

By Markus Fromherz

Information is power, but sometimes it can be too much of a good thing. Information overload affects workers in every industry – this is particularly true for data-reliant and intensive industries like healthcare. And, it’s not getting any better – by 2020 the healthcare industry alone is estimated to have 25,000 petabytes of data – that’s equivalent to 500 billion four-drawer filing cabinets. With its complexity and breadth, and not least with its impact on our lives, healthcare has to be the poster child for how efficient management of data can improve productivity and help providers make better, more informed decisions.

A first trick, however, is getting at the relevant pieces of information. Today, a lot of manual work goes into accessing and cleaning up data that is siloed and unstructured. Too much information is still on paper, but even where it has been migrated to electronic medical records (EMR), practice management systems, or lab diagnostic systems, much of it is still unstructured. The majority of hospitals are finally implementing EMRs, and many of us are working to provide advanced analytics based on the information going online, but, at a recent Xerox healthcare client council meeting, several CIOs emphasized that there still remains a huge challenge in cleaning, standardizing, and integrating data before it can be used for decision making.

Fortunately, powerful methods are becoming available that can extract relevant events from physician narratives, intelligently aggregate data, customize information for clinicians based on context, and visualize information. For instance, in France, a number of hospitals are testing an emerging application based on Natural Language Processing technology developed at the Xerox Research Centre Europe in Grenoble, France. Researchers designed the solution to help prevent the spread of hospital-acquired infections by finding, extracting, and combining key information in physician narratives distributed in medical records. As another example, our Midas+ Live product accesses and integrates information from diverse hospital systems and puts them on a single dashboard, multiple patients at a time, hugely simplifying a physician’s task to monitor all of his or her patients.

Infographic: The Future of Healthcare

Apr 10, 2012• 3

Click to open infographic

Health Care for 1% of the Cost

Apr 9, 2012

By Vijay Govindarajan

This blog post is written with Pepijn Veling, Utrecht University, Netherlands.

There is a general consensus that U.S. healthcare needs major reform. Can reverse innovation — innovations originating from poor countries — provide one important answer? Most definitely.

In the U.S., the approach is to spend more money on major technological advances and come up with innovative products and solutions. In poor countries, the innovation paradigm is just the opposite: spend less and innovate new business models. Poor countries face severe resource constraints. They just cannot afford to spend a lot. Constraints need not be limiting, they can actually be liberating.

The ultra low-cost, high-quality prostheses innovation of Dr. Therdchai Jivacate and the Prostheses Foundation of Thailand is an inspiring example of this. Over the years, they have developed and delivered over 25,000 affordable and appropriate artificial legs to amputees in remote areas of Thailand and surrounding countries. In the U.S., an artificial leg costs about $10,000 and the delivery time is 7-10 days. The Prostheses Foundation of Thailand is able to do it for less than $100, about 1% of the U.S. cost, and their delivery time is 1-3 days.

Though Dr. Jivacate spent four years as a resident of physical medicine and rehabilitation in Northwestern University, he understood that conventional artificial legs were unaffordable and inappropriate for the majority of Thai amputees. There are several reasons. First, customers in rural Thailand simply cannot afford to pay a high price. For the poor making $2 a day, a $10,000 product would require 5,000 days of income. (With 200 working days a year, that amounts to an incredible 50 years). Second, the context and functional requirements for amputees in Thailand are vastly different from those in the U.S. Thai people do many of their daily activities with bare feet, sitting squat on the floor or cross-legged, and many work in wet paddy fields. Furthermore, while many roads in the U.S. are paved, Thai people walk on uneven roads. Finally, the expensive artificial legs are only available in Bangkok, thus making it virtually inaccessible to the rest of the population.