Category: Uncategorized

Cal Blue Shield wins recision case, but it’s very, very strange

May 29, 2009• 7

By Matthew Holt

So Blue Shield of California wins the first case it’s fighting over the recission issue. But it’s in very strange circumstances. The plaintiffs (a couple trying to get coverage for a doctor they like that wasn't in their employer’s plan) changed their story and said that they had lied on their application.

Blue Shield’s lawyer even went after St. Lisa herself!

Blue Shield's lawyer, Jacobs, also complained about "unrelenting negative coverage in the Los Angeles Times." Despite that, he said, "we fought this lawsuit because we knew we had behaved properly and we were confident that the evidence would speak for itself. It has."

So four burning questions remain.

1. Why did the couple who’ve been fighting this all the way, suddenly capitulate when not significantly different circumstances in the only other case to go to arbitration (the Healthnet case) led to a $9m verdict? Something happened here and in the interests of transparency Blue Shield had better tell, or suspicions will be raised.

2. If it’s so sure that it’s legally in the right, why did Blue Shield settle with the state insurance commissioner earlier this year (albeit on pretty favorable terms) and pay the out of pocket expenses and offer insurance to the 678 people with claims against it? If you’re in the right (and legally I think they may be in many of those cases), why be expedient?

Calendar: Tufts Summer Institute on Web Strategies for Health Communication

May 29, 2009• 2

What do millions of people do online and why does this matter to
healthcare? That question, and many related ones about how to take
advantage of the Web for health communication, will be answered in a
new course offered by Tufts University School of Medicine on Web
Strategy for Health Communication, http://webstrategiesforhealth.com.
This one-week intensive course will be offered July 19-24 to help heath
communication professionals develop, justify, and implement a coherent
Web strategy for their organization.

Students will learn from Tufts faculty and industry experts, including:

Bill Tancer, author of "Click: What Millions of People Do Online and Why It Matters" and general manager of global research at Hitwise
Tara Montgomery, Publishing Director at Consumer Reports Health
Gilles Frydman, founder of Association of Cancer Online Resources (ACOR)and blogger at e-patients.net
Dan Childs, Health Page producer for ABCNews.com
Diane Aronson, Past-President of the Road Back Foundation
Aviva Must, Dean of Public Health and Professional Degree Programs, Tufts University School of Medicine
Lisa Gualtieri, Adjunct Clinical Professor, Health Communication Program, Tufts University School of Medicine

Students
will learn best practices through case studies from leading healthcare
organizations. For some organizations, including Consumer Reports
Health, they will conduct Web strategy "makeovers". "Our challenge is
how to leverage our trusted brand to engage consumers online, explain
the scientific evidence behind their healthcare options, and ultimately
empower them to change their behavior so that they can live healthier
lives," said Tara Montgomery, who will be presented with the results
from student teams.

Another case study is Families for Depression Awareness.
“We started a Facebook page hoping it would bring more people to our
Web site but we don’t think it’s working,” Ritu Gill, Staff Member.
They also use twitter
but have one person they are following (moi), two tweets, and three
followers. Given limited staff and budget, how can they best use their
resources to help patients?

Other case studies are from the Road
Back Foundation, Memorial Sloan-Kettering Cancer Center, CureTogether,
Weight Watchers, and TuDiabetes.com. While the organizations differ in
many respects, they share the goal of how to best leverage Web
technologies today and in the future.

For more information go to: http://webstrategiesforhealth.com

Helping Each Other Take Care of Each Other

May 29, 2009• 2

By STEVE ADAMS

How many billions of dollars in volunteer health care services are donated in this country?
How can HIT stimulus dollars help to provide development of businesses or business models that provide an economic multiplier effect to the value of volunteer health services work?
How can volunteer health care services be attached to the coordinated care team? (Clinicians, family, friends, volunteers)

I attended a “Health Fair” today. I confess that it is the first one I have experienced. While I have been working in health care information technology longer than I will admit, I have been aware of “health fairs” but never actually participated. I have always been able to afford health insurance throughout my adult life and in my childhood my parents had access to employer sponsored health coverage. When I am due for a check up or need other attention to my aging body, I have been quite fortunate to have very talented and dedicated physicians and other providers who accommodate me and take care of me.

Workers Ungrateful for Empowerment to Pay More

May 28, 2009• 24

By MICHAEL MILLENSON

American workers sure are ungrateful.A new report by the National Business Group on Health (NBGH) says that 27 percent of insured workers are skipping health care treatments to avoid co-payments, 20 percent of employees are not taking their prescriptions as advised by their doctors, and 17 percent of employees are cutting their pills in half to make them last longer.Yet rather than expressing gratitude for the opportunity to express their consumer-driven preferences, and rather than praising the benefits consultants and conservative think-tank talkers who have given them the chance to have “skin in the game,” 58 percent of those surveyed said they “continue to be surprised” at their out-of-pocket costs. Obviously, they haven’t been attending conferences of HR execs, or they’d know that one man’s “cost shifting” is another man’s “empowerment of my employees.”It turns out that shopping for health care is not like shopping for a refrigerator and that changing co-pays and deductibles has to be undertaken with a great deal of care. Workers, hard-pressed financially by a deep recession, workers are not craftily eliminating unnecessary and non-evidence-based care. Instead, they’re pill splitting or skipping the pills entirely. This is precisely what the landmark RAND Health Insurance Experiment research on copayments and deductibles predicted more than two decades ago, which would be no surprise had the study consistently been quoted honestly by all proponents of the so-called consumer-driven health plans.

Of course, what goes around, comes around. Since 68 percent of employees say that having access to health benefits is a key reason for staying with their employer, it will be that same employer who picks up the tab for the consumer-driven diabetic who has to drive her consumer self to the emergency room because she couldn’t afford her medication. However, the good news is that a majority of workers polled said financial incentives from their employers have motivated them to try to lead a healthier lifestyle.In fact, about half of workers now agree that fat people and smokers ought to pay higher premiums. That’s only fair. And I think guys who have personal trainers and executive physicals should pay less, too, don’t you? Oh, wait. That wasn’t on the questionnaire.Why not just eliminate health insurance altogether and instead give every worker a shiny apple a day? (To keep the doctor away, of course.) If any HR execs, benefits consultants or conservative policy wonks out there would like to adopt this proposal, you can call it One More Fruity Idea for Health Care.

Certifying Health IT: Let’s Set the (Electronic Health) Record Straight

May 26, 2009• 90

By MARK LEAVITT

The Stimulus bill catapulted health IT – previously the domain of clinicians with a passion for applying technology to improve healthcare – onto the national stage. When you inject billions of taxpayer dollars, politics inevitably comes with it. There have been valid observations that CCHIT’s approach needs to change in this new world, and I wholeheartedly agree. But I’m stunned by the level of dishonesty a few have stooped to in a desperate attempt to toss aside years of work by hundreds of public-spirited contributors. Perhaps they want to bypass the challenge of supplying robust electronic health records and re-educating clinicians to use them meaningfully in transforming care, and just get unfettered access to some stimulus dough.

For months, I’ve been “turning the other cheek” to Dr. David Kibbe because I believe in devoting my energy to solving problems rather than to criticizing other people or worrying about what others think of me. But his repeated use of falsehoods and innuendo to attack CCHIT have found an audience in the national media, reaching a level that can no longer be ignored. By implication, he demeans the integrity of everyone who has contributed to that work – and I must rise to their defense.

David, in your most recent quote for the Washington Post, you called CCHIT a “vendor-founded, -funded and -driven organization.” So let’s take a look at the Commissioners, in chronologic order of service, who have served since our founding in 2004 — people who have been at the core of an organization you claim to be tainted:

X PRIZE Blog Rally: $10M for Health Care Innovators

May 25, 2009• 5

By THCB STAFF

Scott Shreeve, MD, Senior Health Advisor at The X Prize Foundation and frequent THCB contributor, has asked the health care blogosphere to take part in this blog rally in order to raise awareness about the Healthcare X Prize Foundation competition and encourage public participation in the prize design. Pass the word around and feel free to post this to your own blog if possible.

We are
entering an unprecedented season of change for the United States health
care system. Americans are united by their desire to fundamentally
reform our current system into one that delivers on the promise of
freedom, equity, and best outcomes for best value. In this season of
reform, we will see all kinds of ideas presented from all across the
political spectrum. Many of these ideas will be prescriptive, and don’t
harness the power of innovation to create the dramatic breakthroughs
required to create a next generation health system.

We believe there is a better way.

This
belief is founded in the idea that aligned incentives can be a powerful
way to spur innovation and seek breakthrough ideas from the most
unlikely sources. Many of the reform ideas being put forward may not
include some of the best thinking, the collective experience, and the
most meaningful ways to truly implement change. To address this issue,
the X PRIZE Foundation, along with WellPoint Inc and WellPoint Foundation as sponsor, has introduced a $10MM prize
for health care innovators to implement a new model of health. The
focus of the prize is to increase health care value by 50% in a 10,000
person community over a three year period.

Money-Driven Medicine—N.Y. Premiere of Film, June 11

May 25, 2009• 16

By MAGGIE MAHAR

At last, Money-Driven Medicine is finished. This 90-minute documentary was produced by Alex Gibney, best known for his 2005 film, Enron: The Smartest Guys in the Room and his 2007 Academy Award Winning documentary, Taxi to the Dark Side.The film was directed by Andy Fredericks, and is based on my book, Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper Collins).The Century Foundation and the New York Society for Ethical Culture are co-hosting the New York premiere on June11, 7p.m. at the New York Society for Ethical Culture, 2 West 64th Street at Central Park West. Doors open at 6:30. Admission is free. If you’re planning to attend, please RSVP Loretta Ahlrich, ********@*cf.org“>ah*****@*cf.org or (212) 452-7722 so that we can have a rough idea of how many people will be coming.

Alex Gibney will be there to talk about the film, and following the screening, I’ll take questions from the audience about healthcare and healthcare reform.

About the Film: Money-Driven Medicine explores how a profit-driven health care system squanders billions of health care dollars, while exposing millions of patients to unnecessary or redundant tests, unproven, sometimes unwanted procedures, and over-priced drugs and devices that, too often, are no better than the less expensive products they have replaced. As I have said on this blog, this isn’t just a waste of money. It’s ‘hazardous waste’—waste that is hazardous to our health.In remarkably candid interviews both doctors and patients tell the riveting, sometimes funny, and often wrenching stories of a system where medicine has become a business. “We are paid to do things to patients,” says one doctor. “We are not paid to talk to them.”Patients,and physicians star in the film. They include Dr. Don Berwick, author of Escape Fire and founder of the Institute for Health Care Improvement , and Dr. Jim Weinstein, Director of Dartmouth’s Institute for Health Policy and Clinical Practice. ( Dr. Jack Wennberg, the founder of what I often refer to as “the Dartmouth Research” passed the torch to Weinstein in 2007.)Lisa Lindell, a HealthBeat reader, patient advocate and author of 108 Days, also appears in the documentary, talking about her husband’s experience in a Texas hospital after he was seriously burned in a freak industrial accident.

How Physicians Inspired Money-Driven Medicine: I narrate the film, and in the course of the narration, recall how the story began:“When I started writing the book, I began phoning doctors, explaining the project, and asking for interviews. To my great surprise the majority of them returned my calls. In most cases, I didn’t know them. I expected responses from perhaps 20 percent. Instead, four out of five called back.“‘We want someone to know what is going on,’ explained one prominent physician in Manhattan. ‘But please don’t use my name. You have to promise me that. In this business, the politics are so rough—it would be the end of my career.’”They were right. Everyone needs to know.

Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of “Money-Driven Medicine: The Real Reason Why Healthcare Costs So Much,” an examination of the economic forces driving the health care system. A fellow at the Century Foundation, Maggie is also the author the increasingly influential HealthBeat blog, one of our favorite health care reads, where this piece first appeared.

Sword-swallowing and health care?

May 23, 2009• 3

By Matthew Holt

I have no idea why this was at HealthcampNashville today, but here’s sword swallower Dan Meyer swallowing a huge sword with change:healthcare’s Chris Parks removing it!

More tweets from HealthcampNashville here

Beyond Wikipedia

May 23, 2009• 23

By NAOMI FREUNDLICH

No surprise, these days more and more doctors are searching online for medical information. What is surprising, however, is that in a recent study, nearly 50% of physicians indicated that they use Wikipedia—the open-access encyclopedia that allows anyone to edit articles—as their source for medical information.

The study, conducted by Manhattan Research, and reported on here found that although physicians were visiting Wikipedia for medical conditions and other health information, only about 10% of the 1,900 physicians surveyed created new posts or edited existing posts on the encyclopedia.

“The number of physicians turning to Wikipedia for medical information has doubled in the past year alone,’ said Meredith Abreu Ressi, vice president of research at Manhattan Research. ‘Physicians, just like consumers, are heavily search engine reliant, and often Wikipedia results are what come up in the top of the organic results.’

Abreu Ressi noted the concern about accuracy regarding Wikipedia, which allows its users to create content for the site essentially without restriction. Articles are subject to perpetual editing by Wikipedia’s readers. Inevitably, false information sometimes slips through the cracks.”

Wikipedia is not a reliable source of medical information for doctors.

How to Waste a Boatload of ARRA Money

May 22, 2009• 70

By CINDY THROOP

Cindy on Bus I want to take a moment to make sure we are all on the same page here with the business of health care reform. This is inanely simple. When it comes to health care, keep doing things the same way. It’s a proven business model. Here are a few specific pointers.1) Don’t Involve ConsumersThis is really critical. Do *not* ask consumers what they want. Whatever you do, don’t ask consumers to define “meaningful use.” These kinds of rhetorical debates are best left to academics and bureaucrats inside the beltway. Every time a consumer mentions anything resembling meaningful use or a “personal” health record, change the subject immediately.2) Act Like Privacy Issues are InsurmountableThe possibilities here are endless. The more you can distract consumers with potential privacy issues, the less they will pay attention to the ways in which they would benefit from having true ownership of their health care data.

3) Don’t Learn from Other IndustriesDon’t bother reading that book by Clay Christenson. He has spent a decade studying the inefficiencies of the health care system. Inefficient by whose standards? Let the academics put their two cents in when it comes to meaningful use, but don’t listen to any of that Harvard B-school innovation nonsense.4) Act Like Open Source Doesn’t ExistFortunately, most people have long forgotten that once upon a time, software was free and/or inexpensive. They continue to blindly support proprietary software, even during a prolonged recession. They even purchase new computers to run this bulky, expensive software!This ties into the next point. 5) Think Short TermThe time to think through any major conceptual problems is not now. Come up with brilliant, yet strangely expensive health care solutions (remember, they must be proprietary). Don’t worry about long term sustainability or stupid things like sharing your source code. Having proprietary solutions is exactly the leverage you need to maintain your involvement in perpetuating, I mean solving, the problem. This is advice you can (both literally and figuratively) take to the bank.Oh, yeah, speaking of the bank, by the time tax payers realize what you’ve done, you will have already deposited your bonus check and had a fabulous spa treatment.

Cindy Throop is a University of Michigan-trained social science researcher specializing in social policy and evaluation. She is one of the few social workers who can program in SAS, SPSS, SQL, VBA, and Perl. She provides research, data, and project management expertise to projects on various topics, including social welfare, education, and health. www.cindythroop.com