By MATTHEW HOLT
(Photo from USA Today)
It’s history
The big question for what’s next
By MATTHEW HOLT
It’s the morning after the big night. Soon all melodrama of the past 14 months will be forgotten, particularly the last 6 weeks (for which the current narrative is that Nancy Pelosi brought health care reform back from the ashes with an assist from Angela Braly and Anthem Blue Cross). In the end the current bill is probably better than the version that would have come from a 60 vote Senate win after conference as the abuses of the Cornhusker kickback and more would still be there. Given that the sticking points at the end were more about the irrelevancy of abortion than anything else, the more mainstream Democrats might be wondering whether this wasn’t a better way to do things in the first place, and therefore whether they couldn’t have got a public option through if the 51 vote reconciliation process was adopted earlier in the bill’s life.
But no matter, we’s got what we’s got. For now. And whatever happens I can’t see any way that this gets overturned—especially when people figure out what’s in the bill. More likely the subsidies get sweetened, and the holes in the coverage get filled.
So it’s almost time to turn our attention away from payment reform, to delivery reform. Now every time in the past that we’ve had reform or something approaching it, those organizations who have shaped themselves to operate in an environment that rewards cost-effective innovation have ended up losing their financial shirts. You can go back to Friendly Hills in the 1990s, or look at Intermountain and Virginia Mason more recently. (Which is why I’ve been ranting at Michael Porter & Elizabeth Teisberg for years)
Now as Maggie Mahar has trumpeted, there appear to be some serious provisions for pilots in Medicare payment and eventually changes to overall Medicare reimbursement. Ideas like accountable care organizations and more should start to become reality. But of course, these concepts will need considerable change on the provider side before they become reality.
So the big question for the health care system going forward is, if providers start making the changes that will promote more cost-effective care, will they be rewarded or will they be hung out to dry?
The Vote is 6pm EST
By MATTHEW HOLT
Just a quick note that the vote on the Health care reform bill is at 6pm EST tonight. It looks like the Stupak 6 (the anti-abortion Dems) have been persuaded that a Yes vote will be OK because Obama will issue an executive order later confirming the Hyde amendment which already bans Federal funding for abortions. So a small stupid policy stays in place so we can have a big social program pass.
But it’s certainly not confirmed that 216 is in the bag. I’m off skiing, so watch Jon Cohn on The Treatment and @jcohntnr on Twitter as I assume he’ paying attention!
Snatching victory from the jaws of defeat?
By MATTHEW HOLT
Sometime pretty soon Nancy Pelosi’s team will have figured out if they have the votes and will be moving what’s basically the Senate bill onto the House floor. Those of you who remember late 2003 may remember that the last piece of major health care legislation (Medicare Part D) didn’t have the votes when it went to the floor—but The Hammer (Tom Delay)—kept the vote open for 3 hours to make sure it got done. I don’t think Pelosi’s style is quite as brutal as Delay’s but between her and Rahm Emmanuel, plus the somewhat more measured tones of Obama, it looks like enough Dems will come around. Probably.
Now whether the things gets passed by votes, proclamation or shouting doesn’t really matter. In fact some very far reaching legislation has got passed that way and had long term implications. For example in 1937 Marijuana was made illegal with no vote; the one question asked in Congress was whether the AMA was in favor of the ban. It wasn’t but the answer came back that it was, and consequently there are the better part of a million arrests a year and most of rural northern California lives off it as a cash crop. We have our weird “democracy” and Mussolini got the trains running on time.Continue reading…
Andy Wiesenthal, Kaiser Permanente
By MATTHEW HOLT
Those of you with really long memories may remember that Kaiser had a little kerfuffle with a guy named Justen Deal. As part of that incident, I did a rather unorthodox interview with Andy Wiesenthal from The Permanente Group in 2006 which is still a hell of a read—mostly about the history of how KP got to the Epic decision and where it was in the middle of the installation process.
Fast forward the better part of 5 years. HealthConnect is done. And the pain and not inconsiderable expense is somewhat forgotten. But now it is done, what happens next? A long and somewhat philosophical interview. But a very interesting discussion.
Microsoft at HIMSS
I’m still catching up with my HIMSS interviews. This is Chris Sullivan and Mike Raymer from Microsoft who are talking about the evolution of the Amalga product—the business intelligence engine—and the current state of HealthVault.
MedApps on TV
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Kent Dicks from MedApps does a very nice job on Fox Business News. Kent explains what his company’s cell(phone)-based transmission solution does, why it’s not a privacy threat, who else is in the market, and what the upside is—cheap consistent device data from patients stored in Healthvault or other record systems.
Here’s the link
Meanwhile can anyone tell me why every business anchor these days is an incredibly hot model type?
Epocrates–reference present and EMR future
I met with Bob Quinn the CTO and Geoff Rutledge, the CMO, of Epocrates at HIMSS last week. The company has a big footprint in mobile (and web) reference content for physicians. The big news is that it’s looking to move into an EMR product. Bob and Geoff explain what they do and where they’re going.
Epocrates from Health 2.0 on Vimeo.
Glen Tullman, Allscripts
Allscirpts’ CEO Glen Tullman has had a good year. Allscripts’ stock is up four-fold, sales are going well and some people think that ARRA/HITECH’s fillup to the healthcare IT industry is mostly his doing–he was an early fundraiser for Obama. Any clouds on the horizon? You’ll have to watch the interview I did with him at HIMSS to find out.
Community Wars? WebMD launches Health Exchange
Just when we thought things were calming down in the world of Health 2.0, it’s kicking off. WebMD has been watching Everyday Health take over its spot as top Health site ranking in the ComScore rankings (cue angry diatribe from those who don’t believe Comscore, and explanations from those who think they understand what Comscore is up to). They’ve also presumably been watching as MedHelp.org went from nowhere to close to 10m visits a month (WebMD claims 60m users but Comscore says closer to 24M).
Yesterday came WebMD’s response—a serious upgrade of their community features. Over the past two weeks they’ve soft launched Health Exchange and have migrated their bulletin boards over to the new platform. On Health Exchange there’ll be lots of things familiar to Health 2.0 mavens—expert advice in the Forums from leading medical centers, the ability to tip, share resources, vote on opinions and much more.
The new launch is probably a bit of welcome change of pace for WebMD which spent the last couple of weeks getting spanked for a not-too-objective quiz on its site suggesting that everyone had depression and needed Cymbalta. Whether the new Exchange is really different to the previous bulletin boards, which weren’t as vibrant as those of its competitors, remains to be seen. But overall it shows that the world of Health 1.0 is changing and that the grandaddy of online health content sites is really going to be featuring user-generated content from now on.
