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…
Usual, customary and made up
It’s been a while since THCB discussed usual customary and reasonable charges, and it’s been longer since health plans did much about them–other than cover them at a low rate and let providers charge what they like. That’s mostly because Ingenix (now Optum Insight) got itself and United beaten up about the topic a while back. But I noticed today (via a company selling expensive webinars about the topic) that Aetna is starting to go after providers that are gilding the Lilly on out of network charges again. In this case a couple of surgeons who were self-referring to a surgery center they owned, not charging the patients their official share, and meanwhile somehow managed to charge nearly $100K for ear wax removal. Aetna, don’t forget, was the “nice” insurer that started the trend of settling with doctors and being nice to them over pricing back in Jack Rowe’s time as CEO. If Aetna’s now starting to get aggressive about out of network charges to its members, then perhaps we really are entering a new era of health insurer activity.
Matthew’s end of year letter
OK, the new year has started, but those of you who are interested in my personal “End of 2011” letter about charities & causes can find it on my barely-used personal blog here—Matthew Holt
Uwe on premium support and vouchers
There’s a great post on the NY Time Economix blog from Uwe Reinhardt explaining the theoretical difference between premium support and voucher systems (and you thought they were the same thing!). Unfortunately it skirts the real problem that those of us playing along at home know too well. Either a well constructed premium support (Ryan done right), or a well constructed voucher/managed competition (Enthoven) system, a mixed public/private system (Germany, Starr, Reinhardt) or even a decent Medicare for all /Single payer system (PNHP, McCanne) needs to be designed holistically to have a chance of working–especially to ensure that all people are in plans that treat them all equally.Continue reading…
Obama-cares (if you’re under 26)
CDC data just in, reported by Jonathan Cohn at THR, suggests that the impact of allowing young people to stay on their parent’s insurance (or as Michael Cannon would say, forcing employers to cover dependents up to the age of 26) is having a big impact. Up to 2.5 million adults under the age of 26 have moved into coverage. Frankly I’m not surprised. There’s always been a huge group of uninsured young adults moving between high school and college and the workforce. And if you hadn’t noticed, there’s a recession on and good jobs with insurance are hard to find. I know at least three young adults working in the semi-contingent labor force who are on their parents’ insurance. Of course they’d better hope they don’t turn 26 before 2014. But even this little gain is something the Democrats need to punch home about the Republicans: Those bastards want to take your kid’s insurance away! And they do.
Karen Ignagni tells (some of) the truth
Long time THCB readers will remember how several times I’ve called out AHIP president Karen Ignagni for being economical with the truth. Today in a letter to the NY Times she actually tells it how it is. Medicare Advantage plans provide more and better benefits than the FFS program. Ignagni also says that FFS program is outdated and that Medicare Advantage plans also emphasize prevention, wellness, care coordination and management of chronic conditions, do better than the FFS program in reducing hospitalizations and even are fostering the innovations needed to reduce health care cost growth. So given that there is so much waste and poor care in the FFS program (over 35% by most estimates) why do the so superbly managed Medicare Advantage plans require and spend more money per capita than the FFS program? Imagine my surprise when I was unsuccessful in my search to find the explanation for this in Ms Ignagni’s letter.
Bespoke Limbs and Real Mass Customization
There’s a new world emerging of customizable materials and it’s being led in health care by designers like my old friend Scott Summit. Scott designed products like an early prototype of the Palm V (yes, there was a life before the iPhone!) and servers for Apple and Silicon Graphics, but in the last five or so years he’s got very interested in the human body—particularly artificial limbs.
Artificial limbs are an interesting challenge for an industrial designer both because mass production doesn’t do a good job at addressing it and because most of them are interested in form as well as function. Scott started doing his first prototypes on real people three years ago when it became possible to use 3D printing relatively affordably to create bespoke parts customized for individual human needs.
End of life “care” redux
There ‘s an excellent article by physician Ken Murray at Zocalo Public Square suggesting that few (or no) doctors would put themselves through routinely practiced end of life care. Let’s face it. The system is on automatic for reasons that are lost in professional medical culture and propagated by the Jerome Groopman meme that we must keep practicing new stuff to find out what works, and if lots of people suffer on the way….well that’s the cost of progress. The result is a medical system that does massively excessive care of everyone–especially the nearly dead. As the old joke goes, they really do put nails in coffins to keep the oncologists out. Yes there are cases when intensive treatment does work, but I suggest everyone looks at the engagewithgrace.org site in order to start the conversation with their own families and providers. At least take the system off automatic for you and your loved ones.
EMR’s hockey stick up!
Every VC loves and hates the hockey stick–that growth curve that potters along and then suddenly shoots up. But if you check out the new numbers from CDC the use of a basic EMR is on that hockey stick curve. Adoption of a “basic system” has gone from under 17% in 2008 to 33% this year, with another 40% of doctors saying they’re going for the Meaningful Use gold–which means essentially a more than “basic” system. So maybe this is a hockey stick curve that we can all love. (Well all other than the curmudgeons over at Health Care Renewal!). On a somewhat related personal note, I too was awaiting the hockey stick of EMR adoption. I abandoned my attempt to catch the start of the hockey curve in 2000 when I quit my EMR survey job at Harris Interactive. All I had to do was hang on for another eight years and I’d have been proved right!
Starting Solids: An Exciting Reason to Be Thankful
I’ve been helping Alan Greene and his all volunteer team on the Whiteout campaign. And today Alan has exciting news about the progress so far! Talking about starting solids you can see how my daughter Coco did in this video that we made with Alan!-Matthew Holt
Last Thanksgiving I announced a bold campaign, spearheaded by an amazing band of volunteers, to upgrade babies’ first foods to real foods – and babies’ first grains to whole grains – and to do this in 2011.
It’s November, and we still have a ways to go, but we also have an exciting reason to celebrate!
Over 10,000 physicians, mostly pediatricians, took part in a July/August 2011 survey by Medscape.com that demonstrated an historic shift in their feeding recommendations this year. The first question in the survey was “What do you recommend for baby’s first food (check all that apply)?” The options were white rice cereal, whole grain cereal, a vegetable, a fruit, egg yolk, meat, or other. Of those who answered as of August 31, the number one choice was white rice cereal – garnering nearly twice as many votes as the next most common.
But after reading an article about WhiteOut Now, our public service campaign the survey results were strikingly different. Responding to,” What will you recommend for baby’s first food (check all that apply)” only 3% even included white rice cereal among their recommended choices. Physicians were also asked, “Do you think white rice cereal is the best choice for baby’s first food?” About 3% of those who responded had “No opinion” and an overwhelming 93% responded, “No.”
As of now over 12,000 physicians have taken part in the survey, and the change continues to spread. To me this major reversal suggests that the old white rice cereal recommendations were based on well-meaning habit rather than on science or even on careful consideration. When asked to reconsider, an overwhelming majority of physicians were quickly able to see advantages of abandoning the old recommendation.
Evidence is mounting that changing early feeding habits is critical to reversing the childhood obesity epidemic. This stunning survey suggests that first feedings are poised to change. A reason to be thankful indeed!
