By Matthew Holt

It’s Thursday morning. Fresh off the digital presses. It’s finally here. THCB (after a long absence) is back hosting Health Wonk Review….

Health IT Dept

We start close to home with huge news for THCB’s sister organization Health 2.0. (FD-Matthew Holt THCB’s Founder is also Co-Chairman at Health 2.0). And the news is that the world has gone crazy for Challenges, and that HHS and ONC (they of the billions for EMRs) are joining in, and funding a huge series of challenges for tech innovation in health care. Over at Health 2.0 News Matthew and Health 2.0 CEO Indu Subaiya explain Heath 2.0’s role in Investing In Innovation or i2.

And if that wasn’t enough, the entire health data wonk world is descending physically or virtually on Rockville, MD this morning for the Data-Palooza inspired by HHS’ CTO Todd Park. If you don’t know about Todd you should read this great profile by Simon Owens in The Atlantic. But THCB published Todd’s piece about the Data-Palooza (or more formally the Health Data Initiative Forum) a fraction ahead of the HHS blog, so we’re linking to it here. It includes information about what, who and how you can see it live–and if you care about health and tech and data, how can you miss it?

Of course, i2 and HDI is not all that’s been announced in tech this week. Inspired by Steve Jobs’ iCloud keynote this week in San Francisco, Dr. Jaan Sidorov at the Disease Management Care Blog ponders the healthcare potential of Apple’s ballyhooed mobile operating system.

Despite the boom over the past few years in new technologies and services targeting healthcare, many new services are not doing as well as the experts have predicted. (Note LOTS more HWR below the jump)

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Paul Krugman spends time today ripping Paul Ryan once more. Ryan’s plan is to limit government spending way off into the future (starting with people who are now 55) by giving them a flat Medicare voucher and then telling them to try it on for size in the individual insurance market. The joke is that there is a rational way to try to introduce some consumer-choice competition into Medicare. Essentially there are two alternatives to dealing with the mess that is Medicare. One–try to manage Medicare spending both with a global budget (the IPAB) and with specific restrictions on care that’s delivered that’s wasteful or unnecessary (via changes in FFS payment). That’s essentially the route the ACA goes. Two, give recipients a voucher that lets them choose between competing entities that can’t charge more than the value of the voucher and actually are mandated to compete on the correct things (outcomes, service, etc) like they do in Holland and in Alain Enthoven’s theories. That’s rational managed competition under a global budget, and the winners in that would look more like Kaiser and Group Cooperative than today’s insurers. Ryan’s idea is just to subsidize the dysfunctional private marketplace and to repeal the minor restrictions the ACA puts on health insurers while he does it–a sure-fire recipe for disaster.

There is of course another alternative. Just to let Medicare continue to spiral out of control on both costs and the quality of services it provides, and Ryan’s plan basically does that without a safety net

Easy to say. Rita Redberg from UCSF points out in the NY Times that Medicare pays for loads of procedures that we know are a waste of money. After all the COURAGE trial a while back showed that stents were a waste of money, and we put in more stents now than when the data were released. This shouldn’t be much of a surprise–we ignore the evidence all the time in making health care decisions. Brian Klepper in his wonderful but probably ineffective crusade to abolish the RUC shows that CMS (and therefore Medicare’s) payment methodologies are fundamentally flawed–yet we can’t fix them either. So it’s easy to say Medicare should pay less and pay differently but the political will is just not there yet. It’s lucky the Chinese are so generous.

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.

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.

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!

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?

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.