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Category: Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site and hosts the #THCBGang and #HealthInTwoPoint00 video shows/podcasts. He was co-founder of the Health 2.0 Conference and now also does advisory work mostly for health tech startups at his consulting firm SMACK.health.

ProPublica’s Pulitzer piss-take

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By Matthew Holt

In a decade when there are countless really, really important issues to investigate in health care, ProPublica took more than $400,000 and spent it on a rehash of a well known story. The story was about a completely exceptional circumstance that will likely never happen again. The original criminal investigation against the alleged perpetrator of the “crime” was abandoned. And the big important result that this new investigation caused in our health care system? Nothing.

This was a complete waste of resources in an era when very few are available to investigate the major issues in our health care system which cause so many problems for so many people. Could ProPublica really not think of any other major investigative health care story to pursue? Like one that impacts millions of people? They could have asked me for a few suggestions. Instead they went looking for something that was purely sensationalist, akin to the National Enquirer chasing down Tiger Woods.

And now whoever awards Pulitzer prizes has decided that this is the best investigative reporting of any kind done last year. Pathetic.

I repeat–where the hell is Lisa Girion‘s Pulitzer?

Lisa Girion is a hero

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By Matthew Holt

One reporter changed the behavior of every health plan in California all by herself.

Even before Tuesday’s announcements, however, health insurers in California had all but stopped the number of policy cancellations, state records show. Last year, only four such cancellations were reported to the managed healthcare department, down from 1,552 in 2005.

Where the hell is her Pulitzer prize?

Reg strikes back! Apparently Wellcare were a bunch of crooks after all. Maybe

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By Matthew Holt

Everyone’s favorite Harvard Business School professor is back in the news. Those of you with long memories may remember that at THCB I’ve been a tad critical of Regina Herzlinger’s ideas, her presentation of said ideas and—resulting in a letter from her lawyer whose previous gig was writing the Patriot Act—her stewardship of the shareholders and other stakeholders of Wellcare. Wellcare is a pretty scummy Medicare and Medicaid HMO in Florida. The scuttlebut I heard about Wellcare a few years back was that it was hiding money offshore in some weird re-insurance arrangement with a fully owned subsidiary, and was essentially faking profits a la Enron.

While that may or may not have been exactly accurate, Wellcare was certainly overcharging its client, the taxpayer in Florida. It was raided by the FBI and eventually settled with the state.

What did one of its best known directors says when she joined the board in 2003?

Dr. Herzlinger said, “WellCare is a case study of a successful public-private partnership, and a model for delivering quality affordable healthcare. Over the years to come, companies like WellCare that reach out to members with information, wellness planning and screenings will be agents of change in the delivery of managed care under government programs.

So by late 2007 Herzlinger had been on the board for four years. What had been her major achievement given the the close-to-criminal activity that was going on the company? Oh yes, it was selling nearly $2.3m worth of stock—completely coincidentally—three months before the FBI raid when the stock was worth 5 times what it fell to shortly afterwards.

And then early last year (2009) Wellcare was suspended from Medicare sales for more bad behavior. Did Regi resign at that stage? Uh….no.

But on Friday she actually did quit!

Continue reading…

Well, point-less?

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By Matthew Holt

OK, so it’s a terrible and stolen pun but Wellpoint’s recent history is getting more and more bizarre. First they become the poster child for the recissions scandal (even if not the worst offender)—which eventually helped push the “evil insurer meme” which helped health care reform along its way.

Then they helped kill Arniecare, and tried hard to kill Obamacare, all the while being a fringe member of the AHIP coalition which actually wanted health reform. And they managed to both showcase a bizzaro interview with CEO Angela Braly and then ended up pouring gasoline on the fire dying embers of health reform in late February, early March by their crass mismanagement of their individual market business —which apparently required increases of 39% despite their alleged excellence at accurate market pricing.

Now we have a new article from Reuters who are zeroing in on the actual way that Wellpoint went after cancer patients with the aim of figuring out if there was any reason to cancel their coverage. It’s pretty unsavory stuff, but everyone knows from Lisa Girion’s reporting that this stuff was going on with all California insurers and most everyone else who could get away with it.

Continue reading…

THCB relaunch to change focus to renewable energy, fly fishing, sailing

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By Matthew Holt

The Patient Reassurance and Consumer Total Insurance Confirmation Access legislation was signed into law last week, and the powers that be at THCB have had a radical rethink about what we should do next.

I myself have led this effort. Given that all the major problems in the health care system in the US have more or less been solved by the recent law, it’s apparent that a blog focusing on only health care is going to be pretty superfluous. Some of the more frequent and most important THCB contributors are have also subtly told us that they’re ready to move onto other things.

Brian Klepper told me that with a combination of both leadership from Congress and employers “85% of everything I think we need in health care is done.” Brian plans to spend even more time sailing his catamaran off the coast of Florida and down to the Caribbean where he’ll be focusing on his new business with David Kibbe of importing cheap Cuban rum to Florida—at least until the embargo is lifted. Bob Wachter has decided that with a combination of the new health care bill and with Don Berwick taking over all his work on patient safety, hospital care is about as good as it’s going to get. Bob is going to stay in health care, but he’s taking a crack at the issue of the rural physician shortage by moving to Idaho to start a solo primary care practice. He’ll be opening his new practice just as soon as the bunker is built and stocked with sufficient supplies.

Continue reading…

The big question for what’s next

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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

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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?

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By MATTHEW HOLTMatthewlive

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

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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.