Category: Health Tech

The latest on technology-enabled DM

Oct 28, 2008

By Matthew Holt

I sat in on another session at Connected Health about A Progress Report on Medicare’s CMHCB (Care Management for High Cost Beneficiaries) Pilot. This is the medical group alternative to Medicare Health Support operated via providers not health plans. Some quick notes…

Suneel Rataan from Health Hero: We know that we can make DM work using the Health Buddy and supporting nurses in the VA. But could they make it work in a community setting under Medicare Fee for Service. We know how badly Medicare Health Support has gone, what about this one (CMHCB)? “We can’t talk about the results but our program has not been terminated!” (Actually they have applied for an extension & expansion of the project).

Couple of others, one from Montefiore in the Bronx another from Partners—the Partners one has a variety of practices and the problem is that they need to have the consistent program across those.

Health Affairs makes an apPaul(y)ing choice

Sep 22, 2008• 10

By Matthew Holt

Health Affairs ran a couple of partisan analyses last week. Joseph Antos, of AEI, Gail Wilensky, former Bush 41 HCFA administrator, and Hans Kuttner labeled the Obama plan as excessive tax and spend socialized gulag regulation.

In the other analysis, four liberal academic wonks — Thomas Buchmueller, Sherry A. Glied, Anne Royalty, and Katherine Swartz — derided the McCain plan as the counter-productive ravings of a right wing nutjob. OK so they didn’t exactly say that, but you get the message. No surprises here.

The McCain plan is so far out of the mainstream that, when Bush proposed something very similar in 2006, he could not even get it introduced into a Republican-controlled Congress. Obama’s plan is a wishwashy centrist Democrat plan that doesn’t even pretend to get to real universal coverage and ignores the fact that the vast majority of Democrats prefer a straight single-payer plan (and so does he when scratched hard!).

So who does Health Affairs chooses to create a middling compromise between these two?

23andme gets unwanted publicity

Sep 19, 2008• 11

By Matthew Holt

Sergey Brin, Google co-founder and husband of 23andme co-founder Anne Wojcicki, has announced that he has the gene for Parkinson’s disease and that his mother carries it to. She already has the disease, as did her aunt. Sergey has written about this on his new blog Too and it was picked up by the NY Times. Unlike the issues around Steve Jobs and his cancer, there’ll be no impact on Google’s business. If—and it’s only an “if”—Brin develops Parkinson’s it’ll be many many years from now. However, Parkinson’s is a very serious condition which people are right to dread—the father of one of my best friends has it, and his life is extremely grim.

Coincidentally I was doing my “spit” for 23andme just a few minutes ago when this story went on the NY Times site. So I can’t tell you about my results from them yet. I have though had my genome sequenced by Navigenics. Thus far none of the results have been compelling enough to make me actually do anything.

That of course is also Brin’s problem. At the moment there’s nothing he can actually do. In Genomics diagnosis is now running far far ahead of capacity for treatment.

But the hope of services like 23andme, Navigenics, DeCodeMe, and others aimed at promoting cures and treatments like CollabRx and Cure Together, is that the body of knowledge from both genomics and overall patient experiences will advance fast enough that the current situation of “more diagnosis with less ability to change the outcome” will slowly change to one where knowing your likely health future will help you avert some of the worse consequences.

Let’s hope so for Sergey’s sake and all of ours.

UPDATE: Just to clarify the headline, I don’t mean that 23andme does not warrant or deserve this publicity, or that they have done anything at all bad here. When I say "unwanted" I mean they are getting publicity for their service because of a situation that no one would want to happen to them (or to Sergey Brin). But of course that’s true for many many great health care services of all stripes.

Tags: Genomics

Weak analysis about the “demise of Health 2.0”

Sep 17, 2008• 24

By Matthew Holt

Everyone’s favorite naysayer Dmitriy Kruglyak is getting very self-satisfied this morning about the failure of Revolution Health to change the world in three years. Normally, I leave Dmitriy’s bizarre wofflings alone, but because he’s directly "pointed the finger" at me and by extension at my partner Indu Subaiya, it’s time to respond.

While there may be a demise in Steve Case’s investment, Dmitriy proves yet again that his background as a software geek with no background in understanding the health care system — and his professional jealousy as the creator of a failed conference about blogging — gets in the way of his limited analytical skills of what he claims I’ve been saying about Health 2.0.

Yes, Indu Subaiya and I founded the Health 2.0 Conference to focus on the use of new participatory software tools in health care. Had Dmitriy paid attention when he attended the conference in 2007 he would have noticed that the audience was asked, what would be the future of the search, social networking, & consumer tools that made up Health 2.0? The response was that 70% felt that these tools would be adopted by mainstream health care companies, rather than become a standalone industry. Which was exactly what I have been saying all along.

When is the same spending more spending?

Sep 16, 2008• 2

By Matthew Holt

When it’s routed through the government because their spending is done with mythically different dollars than private spending. Or at least it is in the bizzaro world of free-marketeer policy analysts. Let me explain…

A couple of weeks back a small consulting firm working for McCain sent me an article written by University of Minnesota economist Roger Feldman about the cost of Obama’s health plan. They were complaining that I hadn’t featured their analysis. So I read the report which suggested that the Obama plan would cause $450 billion in health spending. Bear in mind, Obama suggests that it’ll cost $65 billion, so this is quite some stretch.

I was going to write a long, learned article about this, but instead I’ll just show you the email back & forth.

The problem with astroturf

Sep 15, 2008• 5

By Matthew Holt

….is that sometimes real weeds might sneak in and mess up the nice green carpeting you’re laying down.

To wit, here’s an exchange between an SEIU member and AHIP President Karen Ignagni at the AHIP astroturf meeting in Ohio. When asked why Wellpoint’s CEO is still talking about profitability (and going off message to the political world when going on message to Wall Street), Ignagni starts off about “No Margin, No Mission”.

Err … Karen, that’s the line used by non-profits that (theoretically) have a mission to do some social good. The mission of investor-owned companies like Wellpoint, Healthnet, Aetna, United, et al is to make a profit. Your opponents can show you lots of “insurance companies” that do a pretty good job (or at least as good as your members and usually better) and don’t make a profit. Hint: one’s called Medicare, another is the VA.

And at another astroturf forum a different AHIP spokesman also showed a lack of comprehension of basic economics when he apparently said that it is necessary for the insurance industry to make profits to cover costs. Err no, you have to cover your costs to cover your costs — profit is on top of that!

Has Steve Poizner gone soft?

Sep 12, 2008

By Matthew Holt

California’s de facto health insurance commissioner Lisa Girion reports on California’s actual Insurance Commissioner Steve Poizner’s agreement with Healthnet. After all that fuss, the deal is that Healthnet pays $14m in canceled medical bills, reinstates around 1,000 canceled policy-holders and pays a $3.6m fine. Poizner agreed to this despite all his tough words of not too long ago.

How is it that the punishment fine is less than the cost of the offense? So let me see. Don’t pay $14m in medical bills you’d agreed to insure, and either get away with it, or run the slight risk of not getting away with it and pay $18m several years later. That’s a deal any self-respecting egregious booty capitalist would take. And let’s face it being one of those is a requirement of the job to run a health plan these days.

Of course, the separate $9m fine Healthnet has already seen in one case alone—handed down by an arbitrator whose decisions cannot be overturned later—gives a clue to what the real damages will be in the courts should these cases get there.

So no wonder Shernoff and the trail lawyers are pissed that this settlement may undercut their case. And why has Poizner rolled over?

UPDATE: Darrel Ng, Press Secretary at the CA Department of Insurance is working late on Friday and responded to this post "One of the highlights of the settlement is that by accepting the payments and health insurance, patients do not have to forgo future litigation. So while I know critics have made the assertion that their case may be undercut, I’m not sure why they would believe that’s the case." Darrel didn’t explain why the fine for one case in arbitration was three times the fine for 1,000 cases from the DOI.

McGuire not in prison. Reyes is. Anyone understand?

Sep 12, 2008• 18

By Matthew Holt

So Bill McGuire has settled with CALPers in the scandal where he backdated the value of his United HealthGroup stock options. He’ll pay a $30m fine which sounds a lot but is a rounding error on his net worth. So it appears that his troubles are over.

Meanwhile Gregory Reyes the CEO of Brocade did exactly the same thing and he’s doing 21 months in the big house as well as paying a similarly big fine.

For that matter Steve Jobs apparently did the same thing too, and just today Apple settled with the SEC for a mere $14 million (or about 8 minutes of iPhone sales) and Jobs himself doesn’t seem to be paying anything.

Isn’t there something about equal treatment under the law in one of those fuddy-duddy 18^th century documents we Americans are so keen on? Can anyone explain the rationale behind these differences in treatment?

No such thing as Free Lunch

Sep 11, 2008• 1

By Matthew Holt

I’m over at Spot-On today writing about a great new book I’ve read, "Free Lunch." Check
out and it, and, as always, come back here to comment. Here’s a taste of what you’ll find.

Few of the books I’ve read lately have been quite as staggering as Free Lunch, from former New York Times investigative reporter David Cay Johnston who, heroically, made his career writing about – brace yourselves – the U.S. tax code. Free Lunch is a fabulous book by a veteran investigative reporter giving you his life’s work–a look at how corporations and wealthy Americans have profited, again and again, at the expense of you and me.

Johnston’s best known for his exhaustive investigations at the Times into how corporations and very very rich individuals subvert U.S. tax law so that they pay less to the government, while the rest of us pay more. But in this book – written after he’s free of the "responsibility" of being a Times reporter – he gets almost biblical in calling out the cheats, crooks and murderers.

23andMe punk rock partying, price cuts and on vid on D

Sep 9, 2008• 2

By Matthew Holt

23andme is having a gobbing party in NYC tonight—presumably at the Roxie. You didn’t know punk was back, did ya?

Indu will be there (sadly I had to stay chained to the computer). But there’s a little more 23andme news today in that they’ve dropped their core price to $399 and have inked a deal to get access to Ancestry.com’s database of users. Not quite an impulse purchase yet, but still getting down there.

And if you want to know what 23andme is up to, you can see Linda & Ann’s interview/demo at All things D last May. Of course you can see Linda at Health 2.0 next month, but I’m not sure we’ll be quite the pushovers Mossberg & Swisher are…at least we’ll keep them to 3.5 minutes!

I’m still trying to figure out whether the DTC genomic market is a gimmick or actually has some value (and I don’t mean value the way a VC does! I mean whether society should be spending health care dollars on genomics when we do such a shitty job treating diseases we do understand). But it’s good to see some real activity in at least postulating the concept.