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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.

High costs cut drug use…and not in a good way

This pretty interesting study from Avalere Health confirms what several others have shown. If you add a user fee to any medical procedure people use less of it. And of course their decision to use it less is not based on whether it’s medically necessary or not; it’s based on how much it costs and what their income is. The difference with this study is that it’s about the use of expensive cancer drugs which are increasingly oral, now that oncologists aren’t being rewarded as much for delivering them via infusion. Co-pays of $500 or more saw “abandonment” rates of 25% or more. Other factors creating increased rates of abandonment included lower income (duh) and whether the patient was covered by Medicare or commercial insurance. The study was (of course) funded by a gaggle of drug companies. They didn’t fund the (non-existent) parallel study of which of these drugs actually did the cancer patients any good, but it’s not logical that cost should be the determinant of whether a drug–especially presumably a life-saving one–gets used.

Maybe there really is mobile health after all

OK, I’m kidding–but Ford Motor Co is excited enough about its new collaboration with WellDoc that it wanted to fly me to Detroit to take a look at it. (I declined–perhaps they should move their headquarters to San Tropez). Welldoc is a pretty interesting Web & iPhone based diabetes management tool (here’s a interview video I did with CSO Chris Bergstrom last February). Now Ford has put it in the car. Apparently they believe that it’ll interact with pollen counts and automatically turn on the AC (or at least this is what the “Wheels” blogger on the NYTimes took away from the meeting). But what is interesting is that they’ve integrated the speech to text version of Ford’s Sync–which is the internal bluetooth system that allows people to talk to their car. It’s experimental, but it wouldn’t surprise me to see this in many more cars–at least by the time I buy my next new one in 2024.

Sorry, been busy!

You may have noticed that I haven’t been hanging around THCB much this week so far. Well I have a great excuse. This is my wife Amanda and our new daughter Colette. She was born on Sunday at 6 am and mom and baby are doing very well!

Where is there mHealth, really?

Health 2.0 aficionados will know that I’ve been railing against the term “mobile health” or “mHealth” for about three years. Health 2.0 is simply the next thing in health technology, and will remain so (whatever that might be). Sure we have a definition, but it’s about what’s happening not how it happens. Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part of–that’s the concept we call “unplatforms.” mHealth is like talking about cooking in the kitchen and only talking about the fridge. It’s damn important but you need a stove, a sink and more to make it all work.So if you have a mHealth strategy, as Susannah Fox might quote LOLcats, “URDoin it Rong”.

However, the place where it makes sense to talk abut mHealth is where there are only cell phones, and that place is large tranches of the rural developing world. This came up for me twice yesterday. once in a long chat with DataDyne‘s Joel Selanikio who has a really cool product called EpiSurveyor that works not via SMS but via an app on simple phones and enables very cheap and easy data collection. The other was in a high profile announcement by Johnson & Johnson (a major funder of text4baby btw), which via its Babycenter subsidiary is introducing–with USAID, State Department & the mHealth Alliance– $10m program supporting the use of cell phones for maternal health in developing countries.

So for the health worker in the rural Bangladeshi village, lets have an mHealth strategy. For those of us in the developed world, we need an overall strategy to deal with data and applications–whatever devices they are using.

Big community hospital CEO pay-out. Normal, criminal, both?

Salinas is a poor-ish rural California town down Highway 101 from Silicon Valley, and the financial contrast between the two is similar to that between Beverly Hills¬† and Bell, a California city where officials’ salaries sparked national outrage and then arrests. Now it turns out that the CEO of the local Salinas community hospital got a $4m retirement pay-out and a $150,000 a year pension and managed to stay on in his job for another two years at $668,000 a year and when he retired last week he got another payment of nearly $900,000. Can we expect the same in the Salinas case as in Bell? I doubt it because that would expose to the world that there are thousands of community hospitals all over America paying their CEOs the same kind of money–ignoring the $1 million + salaries most AMCs dole out.¬† Can running a 300 bed hospital really be that difficult?

Feds on the Web: Medicare relaunches caregiver site

I’ve been impressed by the efforts of CMS and others in the Federal government to develop helpful websites. Medicare has just relaunched its Caregivers website. It’s got a nice variety of stories, links and resources–including links to multiple partners offering support communities and other help. While the Physician Compare site had problems (and is a much more complex effort), I thought that Healthcare.gov was a good start to the complex world of finding health insurance, and the Health Indicators Warehouse is another good start at releasing masses of data in a usable format (FD Health 2.0’s Technology Guide is linked to as part of the site). Everything here can and will be improved, and much of this will be built on by the private sector–and that’s the way it should be. But given the scorn poured upon government, lets recognize the strides made.

Kosmix Bought by Wal-mart

In a move I don’t quite understand, Wal-Mart has bought search & content site Kosmix for a reported $300m. Kosmix has been doing various things around presentation of search information from different sites and places on the web (including an interesting mash-up of Twitter called Tweetbeat. But it’s most of interest to us as its flagship RightHealth site has been a leader in Health 2.0. While not exactly Google-type money $300m for a company which had raised a total VC investment of about $55m is not nothing. But it appears that Wal-Mart bought it for the technology potential more than for the current revenue or the RightHealth site. So lets hope that we’ll be seeing more investment and more products from RightHealth in the coming years–rather than it being tossed as part of a larger social media strategy from the Beast of Bentonville.

To get the MU money, just a test

When ONC lunched the meaningful use program paying doctors up to $44,000 or more to adopt electronic medical records, I wondered–“how would they know?” Then I was told there would be a test. But I misheard, it’s not a test. Instead providers get to attest. For those of you like me with poor English skills, that means you get to self-report, which sounds much easier. Go to this page, follow the instructions and the money will magically arrive. Of course you have to be a qualified entity (doctor, hospital, etc) and you have to be getting funds from Medicare or Medicaid. And of course there’s never been any fraud or false reporting in those programs, so we’re completely assured that our tax-dollars (or the loan from the Chinese) are being well spent. Actually there will be audits and checks, and next year the bar for not only the use of the EMR but also the burden of proof will be raised. But for now, this looks like a way to spend that ARRA money fast and you can’t believe that this opportunity will happen for America’s providers again.

Cato’s Cannon on Medicaid–Right but Wrong, again

One of my sparring partners, Cato libertarian whizz-kid Michael Cannon, has a new column out about Medicaid and why block grants would stop a big problem. He’s right about the problem. Because states get a matching (and in some cases way more than matching) grant from the Feds, they are incented to make their Medicaid programs more expensive. Cannon echoes Ryan’s solution which is to just give them a fixed amount of money (the block grant). But that would instead incent states to spend as little as possible on Medicaid, making the program even worse for poor people than it already its–as John Goodman and others often point out. Of course none of these right-wingers, nor “sensible”centrist Dems like Tom Daschle are prepared to say the correct thing. Abolish Medicaid and fold it into the universal health insurance program that the ACA (sort of) is. Or better yet put everyone into one central pool and have them all buying into a central exchange–proposed in the House version of the ACA but skewered in the Senate.

ACOs: Unicorn breeding rules emerging

Mark Smith, the President of the California Health Care Foundation, jokes that ACOs are like unicorns–mythical beasts that no one has yet seen. Well today Politico reports that–just like the Kennel club certifying a new breed of dog–CMS is about to come out with 1,000 pages of regulations telling us what an ACO is and what it can and can’t do. Should be fun.

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