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Getting value from medical devices

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By Jane Sarasohn-Kahn

The buyers of medical devices aren’t very good shoppers. They lack the kind of information about technologies that would help them make value-based purchasing decisions, according to James Robinson in the most recent issue of Health Affairs.

This issue is so important because medical technology is the No. 1 factor driving up health spending in the U.S., according to the Center for Studying Health System Change in their recent report, High and Rising Health Care Costs: Demystifying U.S. Health Care Spending.

What are medical devices? They’re the hardware used by surgeons and clinicians in curing, cobbling together, stabilizing, and managing patients’ medical challenges. They cover orthopedics, interventional cardiology, cardiovascular surgery, and neurosurgery. The technologies represented here are collectively known as “physician preference items.” They can account for one-third of overall hospital supply costs and are growing as a percent of total costs according to the Financial Leadership Council of the Advisory Board. They have an FDA-designed life cycle, as shown in the figure.

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Health 2.0’s impact on the digital divide

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By Gilles FrydmanGilles

For too many years, I’ve witnessed the same thing. First, it was in the ACOR system. Then it occurred in many conferences about eHealth, e-Patients, and now Health 2.0 and the Connected Health symposium
at Harvard Medical School.

Why is an entire segment of the U.S.
population almost completely absent from the fast evolving world of
Health 2.0 and Participatory Medicine?

The uneasiness has consistently grown since 2004 when we ran our first large in-house survey and discovered
that over 98% of our users are Caucasians and less than 1 percent are African
Americans. It is too easy for all of us to forget about this disturbing
fact.

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CAP’s Blueprint for reform

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By Joshua SeidmanSiedman

The Center for American Progress (CAP) released a new “Blueprint for Reform” that focuses on how to fix the delivery system. This well-constructed
document and provocative forum was spearheaded by CAP CEO John Podesta (former Clinton White House Chief of Staff) and Jeanne Lambrew.

There are a few things that really show good progress in the
national debate. First, the fact that CAP has chosen this critical time
at the precipice of the national health care reform debate to focus
attention on reforming care as well as coverage will be helpful to
facilitating that discussion in 2009 policy debates (they, of course,
support coverage initiatives as well but those aren’t addressed in this
document).

Second, the quality and thougtfulness of the work and recommendations is high. Not surprising given the exceptional collection of authors with each chapter co-authored by a physician and a policy expert. These
include: Don Berwick, Tom Lee, Judy Hibbard, David Blumenthal, Bob
Berenson, Paul Ginsberg, Steve Schroeder, Dora Hughes, Chiquita
Brooks-LaSure, Karen Davenport, and Katherine Hayes.

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Hypermimesis and Healthcare 2.0 – Guidelines for Building Contagiously Healthy Social Networks

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By Jim Walker

Socialnetwork
“Contagious” is an interesting word, especially when used outside the world of health care, carrying both positive and negative connotations, such as, “her laughter was contagious” or “a financial contagion has hit the markets.”

Of course, within health care “contagious” almost always has negative connotations – “that strain of flu is rather contagious” or “ebola hemorrhagic fever is highly contagious and kills approximately 50 to 90 percent of all people infected." There was even a recent study published by NEJM showing that obesity within social networks is contagious. The social network map that accompanied the study is literally covered with dozens of interconnected, rather plump yellow dots. The skinny dots wedged in-between were apparently feeling a lot of social pressure to eat a second or third doughnut!

Nicholas Christakis and James Fowler who conducted the obesity research noted that “we find that a person’s chances of becoming obese increase by 57% if they have a friend who becomes obese, 40% if they have a sibling who becomes obese, and 37% if a spouse becomes obese.”

Unfortunately, their related research showing healthy behaviors within social networks are also contagious has received much less media attention. In analyzing the Framingham cohort for smoking cessation, they noticed some remarkable trends:

…there appear to have been local smoking-cessation cascades, since whole connected clusters within the social network stopped smoking roughly in concert. This finding suggests that decisions to quit smoking are not made solely by isolated persons, but rather they reflect choices made by groups of people connected to each other both directly and indirectly at up to three degrees of separation. People appeared to act under collective pressures within niches in the network.

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MD Rating Sites: Current State of the Space and Future Prospects

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By Ruth Given

Ruth Given has spent the last few months doing an exhaustive study of the physician ratings business. Ruth is an independent health economist and consultant who has in the past worked for Kaiser, the California Medical Association and Deloitte Consulting. We’re very happy to make her study available on THCB and the Health 2.0 Blog. You can download the full report at the end of this introductory article — Matthew Holt

The past few years have seen an explosion in growth of websites allowing patients to review/rate (usually rant or rave about) their health care providers. Recent mainstream media attention has focused on the rating of physicians, with over 30 such sites now operating. A few sites, including RateMDs and Healthgrades, have been around for a number of years, but several high profile initiatives were recently launched. Last fall, national health plan Anthem announced that it would be partnering with restaurant rater Zagat to allow its enrollees to rate their MDs online. And in April, Angie’s List, whose subscribers rate a wide variety of local service companies, began to include all types of health care providers, including physicians.

Physician reaction to these sites has been generally unenthusiastic; but there is currently very little MDs can do legally to stop patients from posting opinions about them online. While this approach to reporting on MD performance has its shortcomings, there is also a growing recognition of the importance of accounting for patient experience in evaluating quality of care. The federal government, through the Agency for Healthcare Research and Quality (AHRQ) is moving to collect patient experience-related feedback, such as that included in their annual consumer assessment of hospitals reports. An AHRQ/Consumer Assessment of Healthcare Providers and Systems survey tool on patients’ experience with physicians has also been developed and is currently in use in a number of settings.

Given the recent ramp-up in sites and their newly legitimized role, the future for online MD rating seems fairly rosy. But is this really the case?

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Proposal for a THCB Healthcare Reform Effort

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By Deron Schriver

THCB regular reader Deron Schriver wants THCB readers to suggest plans to reform the health care system. Here’s his appeal:

I enjoy many of the discussions on THCB.  Intelligent people from all vantage points of the health care system congregate to engage in conversations about the most important issues out there. What if there was a way to translate those discussions into treatment plans for the ailments of our health care system?

Meaningful, sustainable reform can only come from a collection of people from the various stakeholder positions (physicians, patients, insurance companies, employers, etc.) who see what’s working and what isn’t on a daily basis. Politicians do not have the exposure to the system that is needed to prescribe effective solutions. However, they are in a good position to assist in the implementation of well-designed solutions.

We need to approach reform much like a physician approaches an ill patient. That involves obtaining some history, examining the system, and then prescribing a treatment plan. It would require a progress note, similar to what a physician uses, in order to document our work. After all, “if it wasn’t documented, it wasn’t done”.  All problems considered should be discussed by all stakeholders until solutions are developed that 1) are thorough, 2) treat the problem and not the symptoms, and 3) are not zero sum. We need to follow the system all the way from the time the patient enrolls in an insurance plan, to the time she is treated by her physician, to the time the claim is paid (or not paid).

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Huckabee on health & more around the Web

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By Sarah Arnquist

Trudy Lieberman at the CJR : Campaign Desk calls Mike Huckabee’s views on health care "a fresh addition to the national health care discussion." Huckabee talked about the origins of health and the need to focus on societal issues that help keep people healthy and avoid the pitfalls of obesity, smoking, alcoholism, etc. Huckabee said, “the real enemy is not the health care system; it’s poor health.”

Partners in Health improves chronic care in Rwanda with electronic medical records. The model is based on home health monitoring, a lot like Health Buddy, says Steve Brown, but without the institutional barriers and a lot less expensive.

Alex Savic, of Alensa, compares eHealth in the U.S. to the U.K. and concludes that there’s much less innovation in the U.K., which he attributes to the lack of privitization in the EMR and HIT worlds.

The Toronto Star examines how the elderly thrive in Denmark by staying in their homes as long as possible, and having the option of small, comfortable nursing homes.

At Business Week, Michael Mandel writes
that health care employment is one of the few things keeping the
economy going in a piece called "Revenge of the Health Care Economy."

Despite Democratic control, major health reform still unlikely

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Laszewski_2By Robert Laszewski

With 258 House and 57 Senate Democrats, it’s almost certain that major health
reform will be passed, right?

Actually, that was the number of Democrats Bill Clinton started off with in 1993 and we know what happened to health care reform in that Congress.

With similar Democratic majorities, I do not expect a major health care reform bill like the one President-Elect Barack Obama called for during the campaign–in 2009 or 2010.

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ON THCB This Week …

Health care information technology in an early Obama AdministrationBy JOHN HALAMKA

When Obama takes office in January, the economy will be his first
priority, followed by the war in Iraq. Health care will follow as his
next major issue to address. What will he do? I imagine
he’ll take a phased approach to ensuring all Americans have access to
health care. Given the change management needed to accomplish this, it
will take a while. FULL POST

The next president’s health agendaBy MERRILL GOOZNER

A year ago, health care held a solid lead in the polls as the number
one concern of the American people. But by the time the Iowa caucuses
closed, and Barack Obama surged to his unexpected win, it had been
supplanted by the economy … FULL POST

Social solidarity is key to meaningful health reformBy MAGGIE MAHAR

In the recent past, some progressives have warned that liberals made
a mistake when they reached out to minorities, new immigrants, and
gays, "ignoring" the mainstream middle class. But in fact,
"mainstream" America is no longer one recognizable culture. FULL POST

Is much more than we think really possible?By MATTHEW HOLT

On THCB today Maggie Mahar basically tells the health reform crowd to be patient. But two members of the unreconstructed left in other venues don’t agree. In the NY Times Paul Krugman says that deficit spending is OK, and correctly points out that Obama has a real mandate to fix the underlying problems of middle America  — and yes, that would include health care. FULL POST

"The EMR is the Foundation of Everything We Do"
Scott Shreeve interviews Anna-Lisa Silvestre, the VP of Online Services for Kaiser Permanente. TRANSCRIPT

Sermo CEO Daniel PalestrantVIDEO with BNet’s David Hamilton

Sermo has very quickly become the big Kahuna in the physician social
network space. So big in fact that its rivals trumpet how different
they are from it in their models and approach. VIDEO

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