Category: Matthew Holt

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.

(Limited) Sympathy for the Blue Devil(s)

Jan 10, 2011• 5

By Matthew Holt

A year on from Wellpoint’s ju-jistu move of announcing a 39% rate increase in California, therefore re-invigorating the health care bill and guaranteeing themselves billions in government subsidies, Blue Shield of California, the non-profit rival to Wellpoint’s Anthem Blue Cross, announced a 59% increase! In the annals of THCB, Blue Shield has a mixed record. CEO Bruce Bodaken was a big supporter of the ACA and consistently called for universal coverage, but at the same time the behavior of Blue Shield after the revelations about the insurance recissions was worse than any other insurer. It actually fought much harder for the right to continue them than Wellpoint, Healthnet and the rest. The most recent rate increases also concern the individual market—you know, that segment of the insurance market that Mark Pauly thinks works pretty well.

Blue Shield is saying that the rates really are only a 15% average increase, and that for some individuals they’re getting a delayed increase—in other words they should have been charged more last year—which is where that 59% number comes from. Why are rates going up? Blue Shield put out a handy press release giving its side of the story. Blue Shield is pretty explicit that the extra costs of the abolition of life-time maximums and the addition of kids up to 26 on family policies was only around 4% over 2 years. The big factor was that utilization went up 7%, unit costs (prices) went up 5% and the rest of the increase (3%) is due to lower overall out of pocket costs relative to what the insurer was covering (because of overall cost increases).

Translated into “where the money went,” hospital payments went up 15%, drugs up 12% and doctor payments went up 9%. In addition, although Blue Shield doesn’t state it, the pooled risk profile of everyone in a particular individual market product gets worse as while they all get charged the same at “entry”, and then more healthy people drop out as prices go up than sick ones. This is the insurance death spiral we used to hear so much about.

However, it’s not just Blue Shield and it’s not just the individual market.

Sam’s Club as a locus for (The) Prevention (Plan)?

Jan 7, 2011• 1

By Matthew Holt

There’s lots going on in the world of online tools for health improvement and prevention. Yesterday I saw a new demo of the latest version of Keas (can’t tell you much but think Zynga!). Just this Fall we had a whole host of wellness tools including Limeade which is working with REI and other employers. Another of our buds in the world of Health 2.0 is Fred Goldstein, who runs The Prevention Plan. Like the others, Fred’s mostly been going after employers as his main client base. But is there room for a consumer-direct online wellness plan?

Fred obviously thinks so and today is announcing that a major retailer, Sam’s Club (the warehouse store owned by the beast of Bentonville) will be selling The Prevention Plan at $99 to its members. Sam’s Club has had a couple of false starts in health care before (remember them trying to sell eClinicalWorks to doctors?) but it’s likely that they think that their members (many of whom are small businesses) might be interested in buying wellness as a consumer product. By the way, Whole Foods CEO John Mackey also said at a conference in October that they’re getting into that business too.

So we’ll see. But maybe this is the way that (at least some of) middle America gets into the world of wellness.

And if you want to get a freebie intro, tomorrow (Saturday) Sam’s Club will be offering free health screenings.

2011 beckons; Matthew’s personal end of year letter

Dec 31, 2010• 4

By Matthew Holt

This is my personal end of year letter. I used to send it to my personal email list but in the Facebook/Twitter era, it doesn't make much sense. I hope THCB readers will indulge me by taking a look and maybe even thinking about some of the charities and causes I support–feel free to add your own in the comments. I'll be back with a more health care featured forecast next week–Matthew

I'm determined to make this the end of 2010 letter, not "well into 2011" letter. But as I've also got tons to do of an unfortunate work nature on NYE even though it's a holiday, so I am going to be quick–or at least a little quicker than in years past.

I do these letters about charity and politics every year and moved them onto a blog a while ago (here's 2010 2009s, 2008s and you can search back), and now it's all I use my personal blog for, given that my Twitter account @boltyboy & Facebook page contain most of my very limited rantings. Of course I started these partly because I didn't have the wife & kids that most people send out their end of year missives about. Then in 2007 I added the wife part, and this year's big news is that next year Amanda and I are expecting a daughter. Little Colette should be here around the end of April, and I'm sure she'll have her own Facebook page and 529 account very soon if I know Amanda! The other family news this year is that my sister Dordy had a baby boy called Alex in February. Sister-in-law Lyn has a baby girl called Talia in 2009 but as it was Dec 26 you can count her in the most recent crop!

But enough about babies (for now!). I'm still running the Health 2.0 Conference with my partner Indu Subaiya and now (gulp) four other full time staff (Hillary, Lizzie, Bianca & new recruit Emily). It's still growing (4 conferences last year including one in Europe) and much more besides. Somehow none of this has translated into more time off for me and Indu! I still own The Health Care Blog but basically now that's a group blog I contribute to very occasionally! Other than getting a little plumper around the middle, Amanda is still being a big time star running HR at her company PRN.

This letter is, though, about stuff I care about on a slightly more altruistic level. This annual missive usually breaks down into my views and suggestions for donations about health care, poverty in developing world, poverty at home, torture, and drug prohibition. Feel free to comment, ignore, delete or whatever. But hopefully at least some of you may pay attention to some of it or even write a check.

Send in the Clowns!

Dec 23, 2010• 1

By David Williams

David is a long time friend and occassional contributor to THCB. And he politely asked if the THCB audience would be interested in helping contribute to the charity he works with–please read and give what you can–Matthew Holt

The Hearts & Noses Hospital Clown Troupe provides professionally trained volunteer clowns to hospitalized children in Greater Boston and training for other clown troupes worldwide. I’m chairman of the board of directors and hope you will join me in supporting the work of the clowns by making a donation.

Hospitalized children often experience stress, fear, and anxiety, which can become a barrier to healing. Hearts & Noses clowns are specially trained to provide relief for ill children and respite for their families. Our clowns strive to uncover the hidden spirit of joy and the creative energy that lives in the heart and soul of children− a spirit that is often dampened by the sterile and sometimes frightening clinical environment. Our clowns’ central goal is to engage, empower and give choices to hospitalized children.

After a life-changing trip to Russia with famous clown and physician Patch Adams, troupe founder Jeannie Lindheim began offering a series of seminars on hospital clowning in the 1990s. Lindheim, an actor, began training clowns to visit ill and disabled children at Boston area hospitals. She formed the Clown Troupe and worked diligently to build a strong, professionally-trained group of volunteers. More than a decade later, our clowns are still all volunteers and we have helped build clown troupes throughout the world.

Engage with Grace at Thanksgiving

Nov 26, 2010

Since 2008 THCB has featured Engage with Grace at Thanksgving. We invite everyone to post this to their blog or Facebook page, and to link here with their status update. You can download a “blog ready” html version of this piece in .txt format to drop into your blog software by right-clicking and choosing”save link as” here. This post was written by Alexandra Drane and the Engage With Grace team.

For three years running now bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage with Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

Suzanne Delbanco on the new Catalyst for Payment Reform

Nov 12, 2010• 3

By MATTHEW HOLT

Catalyst for Payment Reform is a new organization set up by several large employers. The organization’s goal is to pay for health care differently, and make sure that those employers run ahead of any Medicare payment reform coming down the track. Suzanne Delbanco, formerly of Leapfrrog, is now the first Executive Director and Founder of the new organization. Last week I interviewed her about what the organization is going to do, what employers care about, and (despite decades of employers being simple price takers in health care) why this time it’s going to be different.

Keep watching to the very end to see the great view from Suzanne’s office!

Eric Dishman talks about Intel in health

Nov 4, 2010• 2

By Matthew Holt

Eric Dishman has been working with a big team at Intel on the use of technology to help seniors and patients age in place. It’s been a long-ish road for Eric but in the last few years his extensive work on the anthropology of aging is starting to bear fruit in terms of products from the chip giant, including a new-ish joint-venture with GE. I talked with Eric and got some brief overviews of some of the products at last week’s TEDMED conference.

Alexandra Drane doing Engage With Grace at TEDMED

Oct 28, 2010• 2

By Matthew Holt

Just one photo from TEDMED, a really fascinating conference where I’ve been this week (courtsey of RWJ). This is Alex Drane telling Za’s story and presenting Engage with Grace. She was remarkable.

Vic Fuchs Speaks!

Sep 19, 2010• 14

By Matthew Holt

I was absolutely delighted that after several polite “maybe later” responses I was able to recently interview Victor Fuchs, the Henry J. Kaiser Professor Emeritus at Stanford University. Vic is best known as the “Father of Health Economics” and perhaps less well known (but more importantly to me!) the professor who taught the first health economics class that I ever took.

Matthew Holt: Victor, thanks so much for agreeing to come on THCB. I must admit Vic when I joined your class I had no idea about your background and reputation in health economics. So, I was just delighted to figure out that I blundered in right at the top. It’s a real pleasure to have you on the line

Victor Fuchs: I think you’re doing a great job and therefore I’m glad to spend some time with you.

Matthew Holt: Fantastic! You’ve, obviously, been observing and commenting on– and more recently sort of promoting ideas around –health reform for quite a while now, so let’s jump into a couple of things that you’ve published very recently, in fact just these past few weeks.

The first is a paper in The New England Journal of Medicine about a conceptual future for new biomedical innovation and I’d be grateful if you could just explain just a little bit what your general concepts are here. You’ve been working on this for quite a while. In fact, back when I was in your class, you were publishing some stuff with Alan Garber about technology assessment and this is sort of a continuation to that in some ways. So, I’d love to hear your thoughts.

Victor Fuchs: Well, I think there were two key elements here, one of them better understood by a larger audience and one of them I think rather new. Let me do the new one first. The new one is that we are going through what I call the second demographic transition.

The first transition was when every country had high mortality and high fertility and then the mortality especially of young people started to drop, but fertility did not drop right away, so you had a divergence there and in some cases it lasted for a couple of decades and during that time the population soared because there was this discrepancy between mortality and fertility.

You see the high fertility made sense when mortality was high because you wanted to have at least a couple of children survive to adulthood, but when mortality dropped it didn’t sink into people’s consciousness right away, so it took quite a bit of period which the historians and the demographers referred to as the demographic transition, okay. I don’t know if you’re familiar with it or not, but —

Matthew Holt: Yeah, I get the concept and there’s been some stuff written about that in terms of the impact on social security and healthcare.

Victor Fuchs: And some of the third world countries are going through it now, but now the second demographic transition is the one that I talk about in the NEJM piece a little bit. It has the following elements.

First is that a very large and increasingly large percentage of the population cohort lives until age 65, whereas at the beginning of the 20th century only a small percentage lived until 65. Now we’re going to 80% and we’ll eventually approach close to a 100% living till 65.

The second element is that life expectancy at 65 is increasing and it’s increasing at a quite brisk pace in recent decades. You put those two things together and you find out a very large and growing percentage of all the additional years that are lived if you have increasing life expectancy will be lived after 65.