By Matthew Holt

JD Kleinke has been one of my favorite people in health care for at least a decade (or probably more!) notwithstanding his barrages at all and sundry (sometimes including me) on this very blog. He’s been a little quiet of late, but that silence is over. He’s out with a new novel called Catching Babies. It’s a topic I’m thinking about a lot! As you may know I’m less than 2 months from being a first time dad, and Indu (my Health 2.0 partner) is similarly close to being a first-time mom. Both me and my wife read Catching Babies in pre-publication and it’s a tour de force of health policy and medical soap opera–Health Affairs meets Grey’s Anatomy–wrapped up in the complex world of childbirth. Now the book is out and we’ll be having JD at the  Health 2.0 Spring Fling in San Diego in a fireside chat about the book with Amy Romano (@midwifeamy). but I thought I’d take the chance to interview JD about the book and his previous and next steps. Here’s a (heavily edited) version of our IM chat–Matthew Holt

Matthew: You’re well known to THCB readers as a medical economist, policy wonk, and health IT entrepreneur geek from way back.  The obvious first question – why a novel of all things?  Does your shift to fiction imply that you’ve lost touch with reality?

JD: Lost touch? That would imply that I was ever in touch with reality in the first place!  You may recall that my very first book tried to argue that managed care was a necessary evil for the good of us all, including providers.  That the harshness of commercial managed care was the change agent we needed to get hospitals and physicians to modernize. I suppose that turned out to be fiction as well!

Matthew: OK so you’ve always been a bit of a dreamer, I might say the same thing about the health care IT ventures you’ve been involved with. But some of them, like Solucient and HealthGrades, are now pretty successful!  And Catching Babies is not just a novel – it’s a great story – but it also has more powerful things to say about a dozen health policy problems than as many treatises on the exact same subjects.

JD: Thanks for the kind words about the story, and if that’s true, it’s powerful as a policy document precisely because it is a novel.  For better or worse, this is how all of us, as human beings, relate to even the most abstract health care policy, or new technology, or business idea.  Every health policy is ultimately a patient, and every patient is ultimately a story.  Medicare coverage is extended for a new treatment because a Congressman’s mother once needed it. The crazy quilt of health benefits mandates at the state level exist because someone in each of those states got sick, was stuck with the bills for treatment, and took his case to the state senate either directly, or via the front page of the largest Sunday paper in his state. If you look back at the news building up to the passage of health reform, you’ll see that public opinion probably crested in support, when President Obama took the stage with the sweet lady from Ohio with cancer who couldn’t get health insurance.Continue reading…

By Matthew Holt

A year on from Wellpoint’s ju-jistu move of announcing a 39% rate increase in California, therefore re-invigorating the health care bill and guaranteeing themselves billions in government subsidies, Blue Shield of California, the non-profit rival to Wellpoint’s Anthem Blue Cross, announced a 59% increase! In the annals of THCB, Blue Shield has a mixed record. CEO Bruce Bodaken was a big supporter of the ACA and consistently called for universal coverage, but at the same time the behavior of Blue Shield after the revelations about the insurance recissions was worse than any other insurer. It actually fought much harder for the right to continue them than Wellpoint, Healthnet and the rest. The most recent rate increases also concern the individual market—you know, that segment of the insurance market that Mark Pauly thinks works pretty well.

Blue Shield is saying that the rates really are only a 15% average increase, and that for some individuals they’re getting a delayed increase—in other words they should have been charged more last year—which is where that 59% number comes from. Why are rates going up? Blue Shield put out a handy press release giving its side of the story. Blue Shield is pretty explicit that the extra costs of the abolition of life-time maximums and the addition of kids up to 26 on family policies was only around 4% over 2 years. The big factor was that utilization went up 7%, unit costs (prices) went up 5% and the rest of the increase (3%) is due to lower overall out of pocket costs relative to what the insurer was covering (because of overall cost increases).

Translated into “where the money went,” hospital payments went up 15%, drugs up 12% and doctor payments went up 9%. In addition, although Blue Shield doesn’t state it, the pooled risk profile of everyone in a particular individual market product gets worse as while they all get charged the same at “entry”, and then more healthy people drop out as prices go up than sick ones. This is the insurance death spiral we used to hear so much about.

However, it’s not just Blue Shield and it’s not just the individual market.

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By Matthew Holt

There’s lots going on in the world of online tools for health improvement and prevention. Yesterday I saw a new demo of the latest version of Keas (can’t tell you much but think Zynga!). Just this Fall we had a whole host of wellness tools including Limeade which is working with REI and other employers. Another of our buds in the world of Health 2.0 is Fred Goldstein, who runs The Prevention Plan. Like the others, Fred’s mostly been going after employers as his main client base. But is there room for a consumer-direct online wellness plan?

Fred obviously thinks so and today is announcing that a major retailer, Sam’s Club (the warehouse store owned by the beast of Bentonville) will be selling The Prevention Plan at $99 to its members. Sam’s Club has had a couple of false starts in health care before (remember them trying to sell eClinicalWorks to doctors?) but it’s likely that they think that their members (many of whom are small businesses) might be interested in buying wellness as a consumer product. By the way, Whole Foods CEO John Mackey also said at a conference in October that they’re getting into that business too.

So we’ll see. But maybe this is the way that (at least some of) middle America gets into the world of wellness.

And if you want to get a freebie intro, tomorrow (Saturday) Sam’s Club will be offering free health screenings.

By Matthew Holt

This is my personal end of year letter. I used to send it to my personal email list but in the Facebook/Twitter era, it doesn't make much sense. I hope THCB readers will indulge me by taking a look and maybe even thinking about some of the charities and causes I support–feel free to add your own in the comments. I'll be back with a more health care featured forecast next week–Matthew

I'm determined to make this the end of 2010 letter, not "well into 2011" letter. But as I've also got tons to do of an unfortunate work nature on NYE even though it's a holiday, so I am going to be quick–or at least a little quicker than in years past.

I do these letters about charity and politics every year and moved them onto a blog a while ago (here's 2010 2009s, 2008s and you can search back), and now it's all I use my personal blog for, given that my Twitter account @boltyboy & Facebook page contain most of my very limited rantings. Of course I started these partly because I didn't have the wife & kids that most people send out their end of year missives about. Then in 2007 I added the wife part, and this year's big news is that next year Amanda and I are expecting a daughter. Little Colette should be here around the end of April, and I'm sure she'll have her own Facebook page and 529 account very soon if I know Amanda! The other family news this year is that my sister Dordy had a baby boy called Alex in February. Sister-in-law Lyn has a baby girl called Talia in 2009 but as it was Dec 26 you can count her in the most recent crop!

But enough about babies (for now!). I'm still running the Health 2.0 Conference with my partner Indu Subaiya and now (gulp) four other full time staff (Hillary, Lizzie, Bianca & new recruit Emily). It's still growing (4 conferences last year including one in Europe) and much more besides. Somehow none of this has translated into more time off for me and Indu! I still own The Health Care Blog but basically now that's a group blog I contribute to very occasionally! Other than getting a little plumper around the middle, Amanda is still being a big time star running HR at her company PRN.

This letter is, though, about stuff I care about on a slightly more altruistic level. This annual missive usually breaks down into my views and suggestions for donations about health care, poverty in developing world, poverty at home, torture, and drug prohibition. Feel free to comment, ignore, delete or whatever. But hopefully at least some of you may pay attention to some of it or even write a check.

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By David Williams

David is a long time friend and occassional contributor to THCB. And he politely asked if the THCB audience would be interested in helping contribute to the charity he works with–please read and give what you can–Matthew Holt

The Hearts & Noses Hospital Clown Troupe provides professionally trained volunteer clowns to hospitalized children in Greater Boston and training for other clown troupes worldwide. I’m chairman of the board of directors and hope you will join me in supporting the work of the clowns by making a donation.

Hospitalized children often experience stress, fear, and anxiety, which can become a barrier to healing. Hearts & Noses clowns are specially trained to provide relief for ill children and respite for their families. Our clowns strive to uncover the hidden spirit of joy and the creative energy that lives in the heart and soul of children− a spirit that is often dampened by the sterile and sometimes frightening clinical environment. Our clowns’ central goal is to engage, empower and give choices to hospitalized children.

After a life-changing trip to Russia with famous clown and physician Patch Adams, troupe founder Jeannie Lindheim began offering a series of seminars on hospital clowning in the 1990s. Lindheim, an actor, began training clowns to visit ill and disabled children at Boston area hospitals. She formed the Clown Troupe and worked diligently to build a strong, professionally-trained group of volunteers. More than a decade later, our clowns are still all volunteers and we have helped build clown troupes throughout the world.

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Since 2008 THCB has featured Engage with Grace at Thanksgving. We invite everyone to post this to their blog or Facebook page, and to link here with their status update. You can download a “blog ready” html version of this piece in .txt format to drop into your blog software by right-clicking and choosing”save link as” here. This post was written by Alexandra Drane and the Engage With Grace team.

For three years running now bloggers have participated in what we’ve called a “blog rally” to promote Engage With Grace – a movement aimed at making sure all of us understand, communicate, and have honored our end-of-life wishes.

The rally is timed to coincide with a weekend when most of us are with the very people with whom we should be having these unbelievably important conversations – our closest friends and family.

At the heart of Engage with Grace are five questions designed to get the conversation about end-of-life started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

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By Matthew Holt

Eric Dishman has been working with a big team at Intel on the use of technology to help seniors and patients age in place. It’s been a long-ish road for Eric but in the last few years his extensive work on the anthropology of aging is starting to bear fruit in terms of products from the chip giant, including a new-ish joint-venture with GE. I talked with Eric and got some brief overviews of some of the products at last week’s TEDMED conference.