Category: Health Tech

Health IT policy: the fur is flying

Some fur is flying in the rarefied world of health IT policy geeks this morning. Health Affairs has three articles. The first from Markle’s Carol Diamond, writing with Here Comes Everybody author and Internet guru Clay Shirky, more or less says that obsessive attention to rigid standards is not helping and actually may be hindering the IT adoption process. And yes, in case you were wondering they do mean CCHIT and ONCHIT’s current policies and agenda which has been going for four years and which they’re accusing of “magical thinking.” Instead, we need new policies which target desired outcomes measured in improved patient care, instead of assuming that creating new technology standards will get us there. And by policies I think they mean money, and its redirection by current payers. After all, if putting in a RHIO costs hospitals operating revenue in reducing admissions and tests, why would they do it?

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Flacks peddle false “reality”

Such a pity that the NY Times has been so beaten up by the commies amongst us that it actually now feels that it has to point out where Peter Pitts and Janet Trautwein get their money. Although, as per the last time it let Pitts write an op-ed, it didn’t mention his day job as a PR man for pharmaceutical companies. After all, who could be opposed to “Medicine in the Public Interest” — after all it is in the interest of the public to pay for all and any medicine at any price that PhRMA chooses, right?

And let’s not get started on underwriters (for whom Trautwein is the main flack). After all Grace-Marie Turner thinks that they’re the health care heroes! Perhaps they’re heroes because they drive sick people into the uninsured population so that the under-paid clinical staff working in America’s public and community health system get to show their worth by caring for them —even if they’re less heroic than underwriters.

But that’s OK, Pitts & Trautwein can be printed in the NY Times cherry-picking problems with other countries health care systems. Because as we all know there’s absolutely nothing wrong with ours, eh?

And why should Pitts quote the peer-reviewed 2007 Commonwealth Fund study that showed that waiting times for surgery were longer in the US than in the communist hell-hole of Germany, when instead he was able to cite an 11 year old study about longer waiting lists for one specific type of surgery in the Netherlands, which has completely revamped its health care system since then. Something he and Trautwein have helped stop us doing — preserving a dismal status quo they obviously want to maintain.

Those two wouldn’t last 92 seconds in a debate with Uwe Reinhardt or Hillary Clinton.

On the other hand, there’s no letter from Karen Ignagni to make up the trifecta. Did she negotiate some summer vacation time along with her $1.3m salary?

Omnimedix still fighting Dossia owners

KleinkeJD Kleinke and Omnimedix are still in business and still fighting a pretty serious lawsuit
about the Dossia breakup. I talked with JD yesterday. The team is working on several super secret client projects, but it’s tough to run a small consulting shop and keep a protracted lawsuit open, so they’re passing the hat! Why keep the lawsuit going?

Well, there’s obviously stuff that JD couldn’t tell me, so this is speculation but it’s clear that this is much more than an a “vendor didn’t deliver/client didn’t pay” dispute. JD was always very vocal about an open nonprofit being the protector of the Dossia members’ employees’ data, so I surmise that contractual disputes about who got access to what data are at the root of this. It would be interesting (if practicably impossible) to compare Dossia’s contact with Omnimedix in their contract with Indivo.

More generally, JD and I talked about whether there’s a need for a Dossia-type entity when there’s Google Health and HealthVault. Here’s what JD said about Microsoft and Google’s privacy stance.

“In both cases they’ve violated their own operating principles as businesses to do the right thing.”

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Interview with Sandeep Agate, REACH Call

We don’t talk much about traditional telemedicine at THCB, but remote care is not just for consumers. There’s also huge possibilities for clinicians to use these technologies to tap into expertise that can make specialty care more available and improve care in dramatic ways.

REACH call, which is a 2-year-old company from Georgia has an interesting and relatively cheap technology that gets vital expert specialty opinion to emergency rooms and enables stroke care to be significantly improved. I spoke to Sandeep Agate, REACH’s CEO last week and it’s a pretty interesting interview.

Matthew’s top podcasts this year


The Health Care Blog is working hard to bring readers more excellent content, but
the downside of that is great posts and podcasts quickly get buried. Here’s a quick list of Matthew’s top podcasts this year.

Adam Bosworth speaks about Google Health, Keas and everything By Matthew Holt


After a long period of time I’ve finally wrestled Adam Bosworth to
the floor and forced the microphone to his mouth. Adam of course is the
software guru (he’s one of the originators of XML) who went to Google
to start Google Health,
and spent much of 2007 talking about how he hoped Google Health would
change health care. He then left Google Health (several months before
it launched in March 2008) and at the very end of 2007 founded Keas. Adam has very strong views on health technology, data, PHRs.
HealthVault & Google Health, and much much more. Listen to the podcast.

Cisco’s Frances Dare talks about Congressional action on health IT By Matthew Holt

Frances_dare_2Frances Dare has seen the painfully
slow developments in many aspects of health IT since the 1990s, and has
an experienced view of what’s coming along at what pace. These days
Frances is a Director at Cisco focusing on health care, and more
recently she’s taken an active role in Cisco’s health care lobbying
efforts on Capitol Hill. Here’s the podcast.

Interview with Trizetto & Eliza By Matthew Holt

I spoke this morning with Gene Drabinksi, who runs the CareAdvance unit of Trizetto, and Alexandra Drane, President of Eliza. They recently announced a partnership that integrates the care
management aspects of Trizetto’s services with the automated phone
outreach provided by Eliza. It’s another step in the evolution of
phone-based contact and personalization in health care — which, the
careful THCB reader will have noted, I think is an important channel
for delivering and capturing health information. Of particular importance, is making useful that vast glob of data
stored within a health plan by communicating about it with the members.
It’s also always good to hear from some experienced and passionate
players, and Alex and Gene certainly fit that bill. Here’s the podcast.

Interview with Kerry Hicks, HealthGrades CEO By Matthew Holt

HealthGrades has been busy. The publicly traded, pure-play provider
ratings company is changing the way it offers ratings, it’s publishing
a book, and it’s starting to rate drugs. It’s not alone. Last week,
Consumer Reports announced it also is getting into the business of
rating hospitals and using a model developed in conjunction with the
Dartmouth crowd. Plus, there’s the CMS effort. Given the way that
ratings are evolving and HealthGrades’ partnership with Google, (more
to come on Google from me separately soon) last week was a great time
to talk with HealthGrades Chairman & CEO Kerry Hicks. (Sadly it was before the Consumer Reports announcement but fascinating nonetheless). Listen to the podcast.

Kaiser tiptoes into HealthVault & tells THCB about it By Matthew Holt

Kaiser Permanente signed an extensive pilot with Microsoft, allowing
its 159,000 employees to copy their online health records into
HealthVault. This is a big coup for Microsoft and a fairly ambitious
move for KP which to this point hasn’t said much publicly about the
data transferability it was going to provide for its members. This is a
clear signal. Assuming that the pilot is a success, presumably all
Kaiser members using My Health Manager (over 2 million now and heading
to 3 million at years end) will soon be able to move their data to
HealthVault. We are potentially seeing the first real example of mass
scale data interoperability onto a platform not connected to a health
care organization. And obviously, Google is playing in this same space
too. Kaiser gave me a pre-release interview with with Peter Neupert, Corporate VP of Microsoft Health Solutions Group and Anne-Lisa Silvestre, VP of Online Services at KP. Listen to the Podcast.

The Long Baby Boom By Matthew Holt

I had a great chat with health care futurist Jeff Goldsmith
about his new book, the Long Baby Boom. We discussed the policy and
cultural issues of retirement, Medicare, Social Security, immigration,
end-of-life care and meaning… Listen to the podcast. & Trusera — two Health 2.0 newbies talk By Matthew Holt

Two of the more interesting newcomers in the Health 2.0 scene
gathered around the electronic water cooler, which is THCB’s podcast
series, to talk about what they’re up to and why they are worth looking
at. Andy Cohen is CEO of and Keith Schorsch
is CEO of Trusera. Some of you may have seen Keith at the March 2008
Health 2.0 Conference. Andy is providing content checklists and much
more for those who have sick or frail parents, which will be most of
us. Keith is providing a sophisticated place for story telling and
information exchange for those facing serious health conditions. Both
have serious ambitions. Interesting stuff — listen to the podcast.

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State regulators challenge the rights to your DNA

It is something of a surprise that it popped up this way, but the establishment
challenge to Health 2.0 was going to start somewhere. And it appears to have started with two big states, New York & California ordering 13 companies to stop Gene Testing.

Karen Nickel, from the California Department of Public Health, argues that these companies are operating without a clinical laboratory license in California. The genetic tests have not been validated for clinical utility and accuracy.”

But as those companies are outsourcing the testing anyway, that argument barely holds water. Here’s what Navigenics CEO Mari Baker said Navigenics uses a doctor to transit orders and review results, and it relies on a state-certified lab testing company to do the gene tests.”

So what this really is about, of course, is who has the right to order a test? Is it you or do you have to go through a doctor? Or put another way, is it your DNA or is it the state’s?

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Kaiser tiptoes into HealthVault & tells THCB about it, with UPDATE

Kaiser Permanente signed on this morning for a pretty extensive pilot with Microsoft,
allowing its 159,000 employees to copy their online health records into HealthVault. This is a big coup for Microsoft and a fairly ambitious move for KP which to this point hasn’t said much publicly about the data transferability it was going to provide for its members. This is a clear signal.Kp

Assuming that the pilot is a success, presumably all Kaiser members using My Health Manager (over 2 million now and heading to 3 million at years end) will soon be able to move their data to HealthVault. We are potentially seeing the first real example of mass scale data interoperability onto a platform not connected to a health care organization. And obviously, Google is playing in this same space too.

Once the data is collected in HealthVault, there are lots of possibilities for what can be done with that data, and what services can be offered.

Back in the days when Justen Deal was causing havoc with HealthConnect, I had a somewhat unorthodox interview with Permanente’s Andy Wiesenthal — in which (without KP’s PR folks knowing) I called him in a taxi on a cell phone late on a Friday night. Perhaps it’s a mark of how far THCB has come (you decide if it’s good or bad) that in regular business hours on Friday, KP’s publicity machine lined me up for a pre-release interview with Peter Neupert, Corporate VP of Microsoft Health Solutions Group and Anne-Lisa Silvestre, VP of Online Services at KP.

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Google Health — A serious test drive

After all the fuss, I thought that I should take Google Health for a real test drive. So I did. Given that it contains a gazillion screenshots, I did it in the form of a slide show and uploaded it to the website. To view it, you’re best off using the full screen mode (which you can get to by opening “view” (the middle of the three links below the slides, and then clicking the “full button” on the bottom right in the slide on slideshare).

I’d of course love your comments about my conclusions.


POLICY: While we’re on the subject of Medicaid

Modern Physician reports that HHS is getting serious about cutting off those "accounting games" that enable states like New York (but by no means only New York) to get so much extra cash out of Medicaid. While this might be a great idea in theory, you can expect that Congressional delegations from several states, not to mention the Governors, will go ballistic when they figure out what that might mean for their budgets. It’s tantamount to going to the block grant proposal that we’ve heard before, and that was discussed on THCB on Inauguration day, which now seems quite a while back.

POLICY: Medicaid as the route to universal insurance?

During the Dolphin Group webinar I was presenting on today, I was asked if Medicaid would become a communal buying pool that would solve the unisurance problem. I rather fliply dismissed the idea, and Scott Tiazkun, healthcare analyst, IDC Research mentioned that something like that was going on in Massachusetts. Now there have been local changes in how many people Medicaid covers — for instance Tennessee put almost all its uninsured into Medicaid in the mid 1990s and more recently threw most out, and Utah changed the way it paid for Medicaid and enrolled more people — but we’re nowhere near the Clinton plan of putting all of Medicaid, all the uninsured and most small business employees in big buying pools. So I felt fairly safe saying what I said, but I also wasn’t exactly working from the latest data in my head. (Remember this was a webinar about health plan web strategies!)

To be honest I knew that Medicaid had picked up its enrollment relative to private payers in recent years — particularly in the recent recession, and as I really hadn’t looked much at this recently, I spent a bit of time today digging. What I did know is that the restrictions on Medicaid eligibility were greatly slackened at the end of the first Bush Administration and (from memory) the numbers on Medicaid went from the mid-20 millions in 1989 to nearer 35 million in the mid 1990s (with most of the rise during to the 1990-2 recession). Then under the SCHIP (health insurance for children) program in the mid-to late 1990s, another several million kids were put into Medicaid. Now some 5 million of that 35 million were dual eligibles (poor seniors on Medicaid and Medicare) and were double counted, but nevertheless the number of Medicaid recipients has gone up quite a bit. USA today reported last week (chart lifted from their site) that the number went from 34 million in 1999 to 47 million this year.

Us_mcaid The reason they gave in a companion article was that because welfare had essentially been abolished back in 1996, states no longer gave Medicaid only to AFDC recipients, but now have the freedom to base eligibility on income. And although eligibility has toughened up and rolls have been cut somewhat in most places during the most recent recession, in general states are getting more relaxed about eligibility requirements and some states such as Minnesota and Massachusetts are actually trying to add to their rolls.

I went to look at my estimates for the IFTF/RWJ 1997 Ten Year Forecast and I then estimated mostly just on population growth that by 2006 some 35m would be on Medicaid (which equates to 40-42m if you count in the dual eligibles). So things have progressed faster than I thought. The Center for Health System Change reported that despite a rise in the number of Americans getting employment based-insurance in the boom times, that number fell from 67% of the under-65 population in 2001 to 63% in 2003, and that most of that decline was replaced by people moving into Medicaid, although the number of uninsured did rise slightly too. Clearly at the margin Medicaid is replacing employer-based insurance. But have the numbers within Medicaid really gone up quite so much?

Using some data from 1993 that CMS has available, it looks as though some 5 million children got into Medicaid (or separate but equal SCHIP programs) between 1998 and 2003, and this seems equivalent to the data that HSC used in its study. Kaiser Family Foundation (which is a wealth of information about Medicaid) in a January 2005 fact sheet said that in 2003 Medicaid covered 25 million children, 14 million adults (primarily low-income working parents), 5 million seniors and 8 million persons with disabilities. That gets us to a total of 53 million, or 48 million not counting the seniors (who are dual eligible). CMS said in 2004 using FY 2001 data that 46 million people received Medicaid services. But CMS says in another data sheet that in 2004 there are 42 million enrollees and 52 million beneficiaries. A beneficiary is someone who receives a (payment for a) service from Medicaid. Now we are getting somewhere near the nub of the issue, in that people go in and out of Medicaid often on a monthly basis.

My assumption is that the "snapshot" is the 42 million, which seems much lower than the 47 million that USA Today reports citing CMS data that I cannot find on their web site. So I suspect (but please if you know I’m wrong email me) that the USA Today number is the 42 million plus some 5 million dual eligibles (although KFF says that the number of dual eligibles is now 7 million in this recent factsheet). So overall counting Medicaid enrollement is very hard to do, as you are counting several moving targets, and it’s a question of definition.

But what Scott said this morning was that Massachusetts was looking at Medicaid as becoming a way to provide universal health insurance.1121593676_3333jpg And judging by this article in the Boston Globe, that’s what Mitt Romney, (who is the guy who made me wait 2 hours to get into the Ski Jumping at the 2002 Winter Olympics, and incidentally) the Governor of Massachusetts, is saying he’s aiming for. Enrollement went from under 700,000 in 1997 to nearly 1,000,000 in 2002, back down to nearer 900,000 in 2003 and is now moving back up near to 1,000,000.

However, this is all a long way from saying that Medicaid is going to be the cure for uninsurance. There are two main reasons why.

First, most of the people going into Medicaid are effectively leaving employer-based insurance rather than moving from being uninsured to having Medicaid. Of course there may be people moving from being uninsured into Medicaid as featured in the USA Today story, but overall their places in the ranks of the uninsured (which is itself an extremely fluid population) are being taken by an equivalent amount of people losing employer-based insurance. So the overall number of uninsured is not being changed by this increase in Medicaid enrollment, other than the uninsured number would be much higher than the current 45 million (snapshot), had it not happened.

The second reason is the relative makeup of Medicaid and the uninsured. KFF also has a great fact sheet on the unisured.  Only 20% or 9 million of the 45 million uninsured are children, leaving 36 million adults, of whom 80% are in some type of work, or have a family member working. Medicaid now only covers 14 million adults. That means that Medicaid would have to double enrollment overall and nearly quadruple it amongst low-income adults to get rid of the uninsured, and given that half of those uninsured adults are over 35 and thus somewhat expensive, that would cost plenty.

This is just not going to happen in the current fiscal and political environment. So even though getting some of the working poor onto Medicaid is a good thing, it’s disingenous to say that Medicaid is going to be the solution to the uninsurance problem.

What we should so with the Medicaid population is move it en masse into some type of universal insurance pool, with the uninsured, and a bunch of other people.  But no one in Congress with any clout is going to be touching that with a ten-foot pole, and while Bush has noticed that health care is an issue, we all know this his "solutions" aren’t.