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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.

Connecting finance to coverage

Repeating his message that Health Costs Are the Real Deficit Threat OMB Director Peter Orszag goes into the not exactly friendly territory of the WSJ Opinion pages and explains that practice variation is unnecessary and wasteful, comparative effectiveness research is a good idea. and that changing financial incentives for providers is necessary if we are ever to get health care costs under control.

The question is, how much of this gets included in the woffling coming out of Sen Max Baucus’ Senate Finance Committee? Here’s the press release on the options they’re considering. It’s a little like Stalin in 1930 saying, ‘the people are starving, we may collectivize the Kulaks, or we may rent them their farms back, or we may do nothing, or all of the above”. OK you may think I’m kidding but they give four different options for what a public plan may look like, six different approaches to small group and individual market reform (none of which deal with the smallest employers), and nothing about Orzsag’s concept of “changing financial incentives for providers”. Apparently that’s unrelated to insurance reform. (Yes yes I know they’ve floated some trial balloons about that too….)

What worries me is that because of the downturn and Orszag shining the light on the finance issue, we may have the chance to both fix coverage and finance. But I don’t see this all happening together.

So far I haven’t seen anything to change my mind about what’s going to come out of this process. So to bore all of you still reading I’m going to repeat what I said when I reviewed Tom Daschle’s (remember him?) book Critical.

So my guess is that the Federal Health Board, if it gets established, will get defanged by lobbyists immediately. The consequence of that is that the mish-mash of an “expand what we got now” system will cover a few more people at a lot more cost (as has been the Massachusetts experience). That’s OK because suddenly we’re rich (or at least suddenly the government is pretending it is!). But in a few years the stimulus will end and health care costs will have kept going up. Then we’ll realize that due to more cuts in Medicaid & subsidies for the working poor, and continued cream skimming and bad behavior by private-sector health plans, enough people have fallen through the cracks of the incremental expansion that we’ll be back where we are today again.

CODA: Click here to have some fun as to what happened when Baucus lined up 13 Democratic economists to talk about health care to his Committee and somehow couldn’t find even one who was in favor of single payer…

TV stardom (well, sorta…)

It’s just possible that you weren’t glued to the France24 cable channel (yes there is a French 24 hour news  & chat channel broadcast in English). Well yesterday they had a “debate” about healthcare hosted by the very smooth Francois Picard.

Jean-Jacques Zambrowski, a professor at Paris Descartes University got to talk about Bismarkcian and Beveridge-type systems (and why Michael Moore was wrong to call French & UK care as being the same). I was sitting in a dark studio in front of a DVD showing the Golden Gate Bridge. On the phone was Tevi Troy from the Hudson Institute (yes those right wingers) who basically spent most of his time agreeing with me—which I found pretty worrying!

Incidentally for a TV novice, I could barely hear the conversation, and couldn’t see anything, which meant that I never knew when I was on camera or not—so hopefully they don’t catch me picking my nose or something on screen!  Here’s the “debate” and here’s part 2.

Cats and dogs on film–Tullman, Leavitt, Bush

Anyone who’s been following along on THCB will realize that there’s a huge divide about whether the HITECH act should pay for and dictate a specified, certified type of EMR product use OR pay for data and outcomes and not specify how providers get there. The “cats” support certification and EMR mandating (more or less). The “dogs” think that existing EMRs are often counterproductive and that a mix of other data sources, processes, and patient outreach technologies will get us where we need to in terms of improving outcomes much quicker. And now there’s an extra $20 billion in the mix, just to add some fun.

Rather than write more about that at HIMSS this week I got detailed interviews on film with leading “cats”, Glen Tullman, CEO of Allscripts, and Mark Leavitt, Chair of CCHIT. And then a response from the always highly caffinated dog-lover Jonathan Bush, CEO of AthenaHealth. And no, they don’t agree with each other…..although there is some common ground.

If you’re at all interested in how Health IT & EMRs will play out, these three are must-sees. (I’d view them in the order I took them).

MH Interview with CCHIT head Mark Leavitt. (24:51)

MH Interview with AthenaHealth CEO Jon Bush (23:29)

A liberal is a conservative exposed to the NHS

The old adage is that a conservative is a liberal who’s been mugged. So I was much amused by this letter from a Republican to the local paper (Salt Lake Tribune) in the most conservative state in the nation (Utah). I particularly love the line I’ve bolded below because that—not all the right wing BS about effectiveness of cancer care or waiting lists—is the difference between universal health care and what America has—MH

After being laid off, I joined the 300,000 Utahns too poor to pay for health insurance. There are 47 million uninsured Americans and millions more are underinsured. Being a staunch Republican, I always resisted the notion of universal health care. But after having spent time with my son’s family in London, I’ve had an awakening.

My son’s old back injury got prompt and thorough attention. My daughter-in-law received comprehensive care for her challenging pregnancy. My new granddaughter was attended to by skilled nurses and physicians. In virtually every other civilized nation, no one fears losing everything due to some medical catastrophe. (MH emphasis added)

Americans deserve better than what we now have. Choice is an important American tradition. Let people choose between the for-profit insurance they have and a public health-care option like Medicare. A public health-care option is the only way to guarantee health care for all Americans. Any legislation without it is just more of the same broken system.

Insurance companies are afraid of a public health-care option because they will have to provide better service at lower cost to compete. But if President Barack Obama’s health-care plan gets changed to exclude a public option, then it is not health-care reform.

Ty Markham Torrey

Kaiser Permanente CEO George Halvorson on reform and life after IT

http://vimeo.com/4039344?pg=embed&sec=George Halvorson is the CEO of Kaiser Permanente, and the driving force behind both the HealthConnect EMR implementation and a national player in the health reform debate. I got to talk to him at HIMSS where he’d just finished giving the Monday keynote. We discussed KP HealthConnect, and the impact it’s having internally (good), why KP is making such a high-profile fuss about it (no, they’re not planning on expanding nationally or internationally), what AHIP and the insurers might face in the future (a choice between Canada and Switzerland), whether chronic care management can work without integration (he says yes), and whether the big guys will cast the smaller insurers adrift. You’ll have to watch for that answer.

Glen Tullman, CEO of Allscripts

Glen Tullman, Allscripts CEO is one of the more charismatic, opinionated and politically connected players in health IT. I grabbed a few minutes with him at HIMSS 09 on how he’s positioned Allscripts to be a survivor in the coming consolidation, why he likes CCHIT (he’s a happy cat!), if SaaS (and AthenaHealth) is a real threat, and whether his buddy Barrack Obama (for whom he was on the original fundraising committe) is going to whisk him off to DC any time soon…. 

It’s, err, gulp, HIMSS time

Yes, the annual cavalcade of boat-show sized booths and late night partying—interspersed with frequently mind-numbing presentations that most people skip— is on. In Chicago in a snowstorm! I touched down on Sunday midday and managed to compound the craziness in HIMSS by starting in London (thanks to American Airlines for the free upgrade this time!), but I did make it to bed before midnight. And yes, there was 3 inches of snow/slush in Chicago and I did throw snowballs.
Before I got in there appears to have been a rather odd session on Health 2.0 (at least judging by this report, it seems it was all about hospital marketing and excessive use of FaceBook which I don't think is the whole point).

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From Health 2.0 meets Ix: A Breathtaking Display of Possibilities

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(Boston) Jane Sarasohn-Kahn and I were quickly comparing notes this morning. Our impression is that, compared to past meetings, this one seems more characterized by doers than observers.

This conference brings together a dizzying array of tools and experiences, which is testament to the organizers’ encyclopedic handle on the vast diversity of activity in this sector. Josh Seidman, Indu Subaiya and Matthew Holt have done yeomans’ jobs in putting these impressive presentations together.

Mingling, I’ve spoken to person after person actively involved in mostly consumer-oriented ventures, leveraging science and user-generated information to facilitate a more favorable patient experience. There are some real steps forward, like the demo that Mayo and Microsoft showed, that takes information entered into Health Vault and applies the rules that Mayo has developed through many years of experience. Or the work that groups like Up-To-Date and HealthWise are doing, that continually, organically update descriptive information throughout medicine and health care.

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Holt accepts Beltway role, pledges new era of ‘personable responsibility’

In a dramatic reversal, THCB publisher Matthew Holt announced today that he has accepted a position with the Washington based CATO Institute, a think tank devoted to sober analysis and rigorous defense of the ideals of the modern conservative movement.

At CATO, Holt will hold the title of Distinguished Visiting British Policy Wonk.  He is expected to deliver a series of entertaining lectures designed to warn conservative audiences of the dangers of encroaching big government and the evils of internationalism.

Tentative topics in the  series, scheduled to be held at the Rottweiler Student Center at the American University are “What the Hell is Government, Anyway, Really, When You Think About it?” and “Regulation 2.0: Here We Go Again, This Guy Reminds Me of Jimmy Carter ..”

The appointment represents only the latest chapter in a personal voyage spanning three decades and six continents for Holt. In recent years the blogger and entrepreneur had become synonymous with cheeky criticism of the healthcare industry.

“It all started when I read that Ayn Rand book on a bumpy flight from San Francisco to Nashville,” Holt said. “At first, I thought I was going to be sick, then, in a moment of clarity, I became aware of my numerous internal contradictions. By the time I got off the plane I was composing a personable e-mail to Michael Cannon in my head .. ”

Officials at CATO said they were initially skeptical when Holt approached them with the idea that he join the institute, but gradually warmed to the idea, after thinking about it for a little while.  “Frankly. we thought it was a bit odd,” said Institute spokesman Chet McClellan   “Shit. I mean. Matthew Holt?  But people change. Especially in Washington around stimulus package time. ”

In recent months, Holt had been among a number of candidates rumored to have been headed to a high profile role in the White House Office of New Economic Policy.  (WHONEP).  According to highly placed sources in the administration with an intimate knowledge of events, that lifelong dream came to an premature end last month after Holt offended first lady Michelle Obama with public comments denigrating the Obama Health care reform plan.

According to several witnesses who asked not to be identified, Mrs. Obama flew into an extended rage after learning that Holt had called Mr. Obama’s bold plan to radically reshape the broken US Healthcare System in three months using a handpicked team of people from Massachusetts quote “really silly.”

“Really silly? WTF? The man has a stupid english accent and he can’t spell.” Mrs Obama is reported to have said. “And he doesn’t fact check his blog posts.”

A White House spokesperson denied the incident ever took place.

The Hawaii Health 2.0 Chapter meeting

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Indu & Matthew traveled to Hawaii (tough gig but someone’s got to do it) to take part in the Hawaii Health 2.0 chapter on Online Care, held on Thursday March 26. The chapter meeting was rather more fancy than the average Health 2.0 local meeting, with the dolphins in their own lagoon at the Kahala resort being a few steps away from the meeting.

HMSA, American Well and Kaiser Permanente hosted the meeting which focused on online care. David Kibbe kicked off the meeting with a little reprise of the Great American Health 2.0 Motorcycle Tour. Jay Sanders “father of telemedicine” gave a great presentation going back to future showing the “radio doctor” in a picture from 1924, which looked pretty much like what online care looks like now! Jay was very provocative about the potential of telemedicine and the role of physicians in the future—for example, if you have a physical and you don't check the doctor's hearing first, how do you know that they’re reporting is correct? Indu & Matthew followed with the introduction to Health 2.0 and putting online care in place within the wider technology change….but you’ve all heard way too much about that (slides to come)

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