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Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

Matthew Holt’s EOY 2017 letter (charities/issues/gossip)

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Right at the end of every year I write a letter summarizing my issues and charities. And as I own the joint here, I post it on THCB! Please take a look–Matthew Holt

Well 2017 has been quite a year, and last year 2016 I failed to get my end-of-year letter out at all. This I would like to think was due to extreme business but it probably came down to me being totally lazy. On the other hand like many of you I may have just been depressed about the election–2016 was summed up by our cat vomiting on our bed at 11.55 on New Years Eve.

Having said that even though most of you will never comment on this letter and I mostly write it to myself, I have had a few people ask me whether it is coming out this year–so here it goes.

2017 was a big year especially for my business Health 2.0. After 10 years my partner Indu Subaiya and I sold it to HIMSS–the biggest Health IT trade association and conference. And although I used to make fun of HIMSS for being a little bit staid and mainstream, when it came to finding the right partner to take over Health 2.0’s mantel for driving innovation in health technology, they were the ones who stepped up most seriously. From now on the Health 2.0 conferences are part of the HIMSS organization, and Indu is now an Executive Vice President at HIMSS. I’ll still be very involved as chair of the conferences and going to all of them but will (hooray!) be doing a lot less back office & operational work. (Those of you in the weeds might want to know that we are keeping the Health 2.0 Catalyst division for now at least)

That does mean that next year I will have a bit more time to do some new things. I haven’t quite figured out what they are yet but they will include a reboot of (my role at least) on The Health Care Blog and possibly finally getting that book out of the archives into print. But if you have any ideas for me (and I do mean constructive ideas, not just the usual insults!) then please get in touch. You can of course follow me on Twitter (@boltyboy) to see what I’m thinking with only modest filtering!Continue reading…

Let’s Have APIs for Those Provider Directories!

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This was a comment I submitted submitted to this proposed set of regulations on health plans participating in the ACA. (Use ctrl-F to search “provider directory” within the page). HHS is proposing forcing insurers to make their provider directories more accurate and machine readable, and it would be great for consumers if that was made the case–especially if APIs (which means basically giving access for other computers to read them) were mandated–here’s why:

By MATTHEW HOLT

Subject–Immediately updated  provider directories machine readable via APIs should be mandated for health insurers.

Finding accurate information about providers is one of the hardest things for consumers to do while interacting with the health care system. While regulation cannot fix all of these issues, these proposed regulations in section  156.230 can greatly help, But they should be strengthened by requiring (under subsection 2) that health insurers immediately add new information about providers in their networks to a publicly available machine readable database accessible via a freely available API.

Currently companies trying to aid consumers in provider search and selection tell us that the information pertaining to which providers are in a particular network is the least accurate of all data they can receive. For consumers the biggest question for plan selection is trying to find out which provider is in their plan, and at the least this requires searching multiple websites. Worse, particular insurer’s plans can even have the same name but can have different networks (in one instance in our personal experience Aetna in New York state had two different plans with effectively the same name but different networks). This is essentially impenetrable for consumers and that is assuming that the information on the websites is accurate or timely–which it is often not.

Continue reading…

Halbig corpus interruptus

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By MATTHEW HOLT

In more stunning proof that America’s 18th century style governing process just doesn’t work, a subset of a regional Federal court ruled against part of Obamacare. The Halbig ruling is certain to be overturned by the full DC court and then probably will stay that way after it makes it’s way through the Supremes–at least Jonathan Cohn thinks so.

But think about what the Halbig ruling is about. Its proponents say that when Congress (well, just the Senate actually as it was their version of the bill that passed) designed the ACA, they wanted states only to run exchanges and only people buying via states to get subsidies. But that they also wanted a Federal exchange for those states that couldn’t or (as it turned out) wouldn’t create their own. But apparently they meant that subsidies wouldn’t be available on the Federal exchange. That would just sail through Logic 101 at any high school. Well only if the teacher was asleep, as apparently most Senators were.

Now two judges interpret what was written down to imply that subsidies should only be available on state exchanges–even though logic, basic common sense and fairness would dictate that if we’re going to subsidize health insurance we should do it for everyone regardless of geography.

Don’t forget that in the House version of the bill there was only a Federal exchange. Continue reading…

Samsung Throws Kitchen Sink onto the Wrist

BY MATTHEW HOLT

Yesterday phone and electronics giant Samsung rushed out its next step in health related hardware. Samsung was clearly trying to get this out the door and in the press before Apple’s forthcoming announcement of something health-related –or I assume that’s what their industrial espionage told them Apple was about to reveal (just kidding guys!). And some people (well, Techcrunch) were clearly unimpressed.

The most compelling moment which I captured (poorly) in the video above was the demo of the new SIMBAND–albeit a concept rather than an available product. (In fact a couple of their partners told me that no-one outside the company has one). In the SIMBAND are a stack of new sensors which attempt to use the wrist to monitor not only heart rate, but blood pressure, temperature, EKG and do it all continuously. You can see a rather better video of the demo from Gizmodo, which I cued up to start at the right place.

They also announced a fully open platform (what at Health 2.0 we dub the Data Utility Layer) called Samsung Architecture Multimodal Interactions (SAMI) to accept and spit out all types of health related data.

This is all potentially very impressive. Samsung’s first two attempts at Smart Watches have fizzled, but they tend to keep coming back, and now are pretty much the best at Smart Phones. (You fan bois can keep your teeny iPhone screens!) But can they make the health related smartwatch work? I’ve three quick assessments/questions.

Continue reading…

A Pragmatic Fix for Healthcare.gov & the HIXs

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By MATTHEW HOLT

By now even those of us who originally thought that we were seeing minor teething troubles are no longer deluding ourselves. Healthcare.gov, the federal health insurance exchanges (HIXs), and many of the state HIXs are in deep trouble.

One summary of many articles about this is up at ProPublica. But now that the House Republicans have stopped trying to destroy the country and themselves, attention will turn quickly to this problem, and–much worse–beyond the politics, there is now only eight or so weeks to get ready for actual enrollments for Jan 1, once you take out Thanksgiving and the Christmas holiday. Getting ten or twenty million new customers on board, not to mention the small businesses who want to move from their current insurance onto the exchanges, seems like an impossible task.

But, if we can muster the will, there may be a solution. (And yes, I want it to work, faut de mieux). Quietly last summer two private online insurance brokers, eHealth which runs the eHealthInsurance.com site, and GetInsured, struck deals with HHS which allowed them to enroll individuals in plans that qualify for the mandate under the ACA, and more importantly, connect with the “Health Exchange Data Hub” that figures out whether the enrollee qualifies for a subsidy (theoretically by connecting to the IRS).

That part of the transaction, though, could be done by attestation and dealt with later. In other words, someone buying health insurance could state what their income will be in 2014 (or was in 2013) and if it ends up varying dramatically on their 1040 then in 2015 they will pay or receive the difference. Essentially this is something all Americans recognize–the IRS asks you for more or gives you a tax refund well after the fact, and H&R Block and their competitors make a business of giving you the refund right away (and of course charge you for the privilege).

That is important because what seems to be crippling the HIXs right now is not the back end, it’s the front end. (Go to this Reddit thread for lots more deeply technical conversation about that). Showing people options, comparing plans, setting up accounts–that’s all standard web stuff and most of the HIXs can’t do it. Those private brokers have both smoothly done this for years and at least the two I mentioned have built comparative tools for the new insurance plans. (Both were demoed at Health 2.0 on October 1).

So why can’t we put prominent links to eHealthInsurance.com and GetInsured on the Healthcare.gov site and move people over there? Continue reading…

Welcome to Healthcare IT Live!

[youtube width=”475″ height=”300″]http://www.youtube.com/watch?v=9-2EkxSHPIg[/youtube]

This time the camera was turned on THCB’s Matthew Holt. Tim Cook of Healthcare IT Live! interviewed Matthew for the web show, which takes place weekly on Google+ Hangouts. Click for a list of the show’s upcoming guests.

Vegas, Baby, Vegas

It seems that I just got back from Vegas and CES although I had 3 weeks in India & Hong Kong in between. But in a few minutes I’ll be off there again as this time HIMSS brings its modest 40,000 attendees to Vegas. (When I say modest, CES had 200K!) THCB and Health 2.0 News will be there in force with me, Laura Montini & Jennifer Lee looking dangerous with our flip cams, while Health 2.0ers Marco Smit, JL Neptune & Pat Ryan will be working with AT&T, ONC, Novartis and other clients. And to those of you following on Twitter, the red satin jacket was the winner in the poll for what I’ll be wearing as fashion judge at HISTalkpalooza (and afterwards Regina Holliday will paint it!). So expect lots of video interviews on THCB and Health 2.0 News in the next days and weeks, and wish us luck as we descend into miles of walking all fueled by too much alcohol and too little sleep!

Another nail in the DM coffin?

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Just when you thought it was safe to go back to the water, the CBO is out with the bad news that in its analysis of over 30 disease management programs, and none of the independently run ones saved Medicare any money. Even the ones that succeeded, which put the medical groups at risk and generally lodged the DM nurses with them (rather than have them call in on the phone), didn’t save enough to justify the costs of the program.

Now the first group isn’t a surprise to those of us who followed the fate of Medicare Health Support. The second group includes a series of demonstrations paying physician groups to save money. They did better, but not well enough to save once the extra costs of the program are included. (Details here). We can only hope that using more lightweight technologies with better understanding of patient behavior does in fact end up saving money–as has been shown in some commercial medical home settings. But we must also be prepared to admit that we don’t yet know how to save money in the care of the chronically ill under Medicare. Which means that the only obvious way to do it is to cut payments to providers!

Progress made by ONC (Really!)

By Matthew Holt

ONC Director Farzad Mostashari is out with his review of 2011 on a month by month basis. Good to see that Farzad & colleagues took December 2011 off (just kidding!). He calls it a year of “momentous” progress. I’m doubly biased because I’m a proponent of newer and better health technology for clinicians AND citizens. Also, (FD) Health 2.0 is the main subcontractor on the i2 Investing in Innovation challenges which were–as noted by Farzad–launched in June, have had several close already, and will continue to roll off the production line for another 18 months. But as a general and occasionally cynical observer I’m very impressed with what ONC has done. Continue reading…

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