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Category: Health Tech

JSK (national treasure) on data liquidity, and how it fits into Health 2.0

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By Matthew Holt

Given that she taught me most of what I know about health IT I don’t know why I ever need reminding about how great Jane Sarasohn-Kahn is at keeping her finger on the pulse of health care, and how consistently good is her one daily post on Health Populi.

Yesterday was no different. She gave a great overview of a new PWC study on data liquidity. You’re going to hear lots from me and others in the coming days about data liquidity, substitutability, intermingling of applications, and unplatforms. But what’s happening on the edges of health care IT in the Health 2.0 movement is a combination of tools, content and transaction data beginning to flow between applications. More and more this is both enabling better management of the consumer (and clinicians) workflow experience and better ways to aggregate these new data sources for clinical decisions and research.

On day Two of the Health 2.0 Conference next week we’ll be showing this both in our panel on Data Drives Decisions, but also on the Tools panel which will feature a series of inter-operable applications sharing data. And we’ll also be showing the big players (Google, Microsoft & WebMD) as they move their offerings to a world where other service providers can use their platform.

Truly exciting times, but Jane points out that there are lots of barriers. She calls the PWC report

a sober analysis of what stands between transactions and raw data, and the ultimate goal of using that information: clinical transformation that benefits people.

And those barriers all center around the workflow, payment structure and institutional inertia of our current health care establishment.

 the health industry en masse needs to shift the focus of data from transactions to quality and outcomes. This will require – surprise, surprise – incentives to, as PwC puts it, “induce all stakeholders to collect, report and use the data.”

Swine flu, uninsurance and not-so fondly remembering the teenage years

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By Matthew Holt

We get sent lots of rants to our tips line, most of which we ignore in an amused jaundiced way. But this one I found very amusing. I’m not sure it’s 100% accurate, but it is very funny and essentially details something that we know happens every day. So to have some fun with how to buy individual insurance in California, head over to this post on a blog usually concerned with selling you credit cards.

By the way, a close colleague of mine trying to buy a short-term stop-gap policy while her husband changed jobs got a very similar “we’re not selling you insurance and we’re not telling you why” just last week.

Don’t forget that virtually any form of the bills in Congress outlaws these shenanigans.

Morons like us

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By Matthew Holt

I still read the articles every day that Google and the rest of my searches spit into my inbox. But as the sausage gets made I despair for the country. Not so long ago the NY Times met the Rush Limbaugh fan who decries the government takeover of health care, even though his wife ran up $68,000 in care while she had breast cancer and no insurance. Somehow because his local hospital let him off the charges, he thinks that the system was OK, and drove for an hour to shout at a Democrat who wanted to change it! (Of course the taxpayer absorbed the costs).

Yesterday NPR reported about the Sacramento man who loves his current health insurance. He’s had six or seven surgeries in the past five years—in other words he would be completely uninsurable if he lost his job (post-COBRA). He even sort of understands that.

“I mean you hear horror stories about people who have insurance and then all the sudden get denied coverage down the line because they may have had a pre-existing condition,” Koenig says. He, too, worries that he’s one step away from being dropped from his plan or losing his job and not being able to afford coverage…..And that’s why Koenig is on board with parts of the big push to change the health care system.

And like about half of other Americans, he’s actually been uninsured.

In the early nineties he was laid off and went without insurance for several months. He says it was an uncertain time and he sympathizes with the millions of Americans who don’t have coverage — or could be dropped at any time

So what does he think?

he says the focus should be on regulating the insurance industry and not a government take-over, which he believes President Obama is pushing for.

Let’s quickly review here.

Obama/Baucus/HR3200 all basically keep employer-based insurance as is with a bit of expansion, keep Medicaid as is with some expansion to suck up a few of the uninsured poor, and change the regulations in the insurance market to prevent (some of) the problems the Sacramento man understands. Oh, and they sort of put in place a backstop public plan (well HR 3200 does anyway) which people could buy into if there wasn’t a private plan they liked.

So does this sound like “regulating the insurance industry” or is it “a government take-over”.

I hesitate to remind the Sacramento man that a government takeover means the communists collectivizing your farm and stealing your pigs, and shipping you off to Siberia. What Obama/Baucus/HR3200 is proposing is minor reform of the insurance market.

And yet, somehow that message cannot get itself into the thick skulls of people who those reforms would actually help.

Yet another reason to abolish the Senate

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By Matthew Holt

Ezra Klein, feeling a little soft, interviews Kent Conrad—he of the co-op feed stores for health care idea.

My take on the interview is that I seriously believe Conrad's entire knowledge of health care comes from his time being lectured on the vagaries of Medicare reimbursement by a local rural hospital lobbyist, his one visit to a co-op seed store where he found the farmers chatting happily, and his reading the cliff notes (prepared by his staff) of TR Reid's good but not too sophisticated book focusing on the Beveridge v Bismarck distinction—which is high school civics lesson stuff.

Yet he gets to meet 61 times with the Gang of six that was really going to get it all right before time ran out, and he gets to make policy!

And you wonder why the Senate should be abolished.

Interview: John White, Director IT, AHRQ

By Matthew Holt

Last week I got to spend some quality time in Washington DC including moderating a panel looking at new research behind physician-patient communication at the annual AHRQ conference. AHRQ will play a significant role in comparative effectiveness research, as it basically is channeling the $1 billion or so in the stimulus package for that. But AHRQ is also pretty active in trying to figure out what works and what doesn’t in health care IT, and has an online resource center about that too.

The man running AHRQ’s initiatives in IT is John White, who’s affable, amusing and has an interesting point of view or two. So to let you know a little more about the mysteries of government, here’s my interview with John.

Regina Holliday: Fred’s life & death at 73 cents a page

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By MATTHEW HOLT

If you ever wonder why the efforts to make it easier for patients and families to get information and be treated as equals in their care by the medical care system matter….

If you need convincing that the concept of participatory medicine is important enough for its own society, advocates & journal….

If you wonder whether it’s OK to wait to phase in the possibility of patients actually having rights to their own data….

Read Regina Holliday’s story about Fred’s illness and the way she and he were treated.

A little ain’t enough, or is it?

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By Matthew Holt

I've been so buried in the run up to Health 2.0 that I haven’t had a chance to add to the deluge of electrons about the bills in Congress, Obama’s speech, the several hundred amendments to Baucus’ bill in mark-up, etc, etc. And my colleagues on THCB and elsewhere are taking good care of you in the details.

But I thought that I’d quickly respond to today’s WaPo article in which Erza Klein connects two themes that matter, while leaving out two that matter more. The first of the two he identifies is that most Americans don’t see the cost of health care. If we made them all write a check for $13,000 a year, and they’d seen that number go from $8,000 a decade ago and realized that it will be $25,000 in another decade, then the cost problem would be much more real. It would also get associated with the access problem as people realize that as the cost goes up, they (and their employer) can afford less. At the moment those problems are disconnected.

The ignorance here remains palpable. An HR exec I know did an exit
interview last week with an employee who was astonished to find out
that now he was on his own he could buy family health insurance in
California for under $500 a month which was less than his contribution
to the company plan. The concepts of risk pooling, risk selection,
varying benefit levels et al were clearly foreign to him. And of course
had his family had a pre-existing condition that policy might have cost $3,000 a month or more.

Continue reading…

Washington DC conference and party!

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By MATTHEW HOLT

Wednesday morning I’ll be at the AHRQ annual conference in Rockville, Maryland. I’m moderating a panel looking at “Experiences in Patient-Centered Care: Improving Coordination and Communication among Patients and Providers”. Given this is an AHRQ meeting there’ll be actual research presented from:

    • Gail Brottman, Director of Pediatric Pulmonary Medicine at Hennepin County Medical Center in Minneapolis;
    • Jennifer Uhrig, Senior Health Communication Scientist at RTI;
    • Jim Tufano, Assistant Professor, University of Washington’s program in Biomedical & Health Informatics

Of course I’ll be dragging them down to my non-academic level pretty soon!

If you can’t join the academics in the morning, you may want to come by a drinks party hosted by my friend Maggi Cary in the evening. For that one you’ll have to email me to find out a few more details!