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POLICY/INDUSTRY: HSC on 10 years of change

Whe I was first figuring out the private sector in health care about 10-12 years ago while Hillary was trying and failing to get reform done, I heard a gazillion people, usually in the strategy or policy dividions of big plans and drug companies tell me that we didn’t need government reform because the market was going to sort it all out itself. And ten years after we got the market reform that meant we didn’t need governmnet reform. What happened?

"In a decade that saw the rapid rise and hard fall of tightly managed care, there was plenty of change but little progress in solving the cost, access and quality problems in the health care system," says Paul Ginsburg in the release about HSC’s 10 year retrospective.

 

You can read the full report here. It’s taken me ten years to figure out what went wrong. Let’s not have that happen again next time, eh.

TECH: Of geeks and grandiose misunderstandings

Writing in his blog from PC Forum, Esther Dyson’s technology conference that Dave Winer says is apparently is back “in” these days, here are some parts of what Michael Miller had to say.

Esther Dyson talking about how the health care industry showed extreme versions of many of the issues discussed earlier in the day: more information than ever, with users having to make more decisions themselves.

Scott Cook talked about the difficulty of tracking medical expenses and figuring out how much an individual owes.    He talked about Intuit’s Quicken Medical Expense Manager, and how institutions are wanting to get more data into it.  There are lots of issues about understanding the information, who owns the information etc. 

Jeffrey Rideout of Cisco talked about the problem of trying to get his employees information about their medical plans, expenses and other information.  We have a lot of problems to solve with the health care system, he said.  He said Cisco is looking on how to use its influence as major employer to help its employees navigate the system and get better care.

J.D. Kleinke of Omnimedix Institute talked about how looking at data is improving health care, and how it was important to gather more information about the health care process.  His company wants to give people personal health care records.  They want information that is private and portable.  He also operates Healthgrades – a site for getting the grades of your doctor and hospital. (Matthew’s note—not sure how JD ended up Vice Chairman there but he has been since the dark days of 2002!)

Gina Glantz from Service Employees International Union talked about how many of their members don’t have good health coverage; and how health care costs are an increasingly large issue in negotiations with employers.

The discussion talked about the need to deliver the technology in lots of places, perhaps by mobile phone.  But all seem to agree that technology has a way to help the system.

Scott Cook said “we don’t have time to wait” for a complex solution.  More people die because of medical errors caused by bad systems than from Diabetes or car accidents. We need to go after the root causes of the complex work systems and use best practices to improve this. We can’t wait for an all-encompassing technology solution, he said.

Rideout thought the personal health record was the first and easiest way to make an improvement; by getting a core set of information to people.We don’t spend enough money on IT for health care, he said. (Matthew’s retort—Well at least they’ve taught him something about marketing IT since he went to Cisco!)

People in the audience seemed particularly interested in the concept of a personal health record that you could carry around with you electronically. Both Intuit and Omnimedix said they were working on the problem.  Rideout said many doctors don’t trust this information though. Kleinke said the problem was not primarily technological, but instead was getting political agreement

I’ve remarked before how it’s incredible that really bright people from outside the industry just have no comprehension of how this business works. I can forgive Esther (and I was relatively nice about her before). Cook is selling a software program, and so if he can create a consumer market for PHRs, good luck to him — although I hope it’s a whole lot more transparent that the baffling TurboTax.But if this is reported accurately JD and Jeff Rideout, who both know plenty more about health care than the rest of the people in that room, need a good paddling if they seriously believe that portable PHRs are the best we can do as a solution for anyone apart from Quicken’s shareholders.

The only person who even appeared to be in the ball-park of defining what was wrong is the rep from the SEIU who’s noticed that health care costs are going up too fast and have been for years. No one (unless JD was transcribed wrongly about what was political) seems to have mentioned the overall access/cost/quality/practice variation problem.  Couldn’t they have got tech guru Len Schaeffer in there? At least he understands that part of the problem.

Of course as has been discussed many times by the crowd over here on THCB who do know something about this business, the broad problems with health care are a) the insurance market, b) the structure of the delivery system, c) the quality of the care delivered by that system and very lastly d) customer service. Well the portable PHR might solve some of the last issue, but that’s eventually being dealt with by the plans and providers starting to use decent CRM. So by glomming onto the portable PHR as a solution because it looks like a piece of technology that they vaguely understand, the PC Forum crowd is imitating the drunk looking for his keys under the street lamp because it was dark where he dropped them.

And unless the major issues of the health system are changed by some type of reform, all the technology and information in the world won’t make much difference.

 

 

THCB: Jobs, Jobs, Jobs

OK. I have two requests for people in slightly different parts of health care IT. Both are based on the west coast.

One is for a senior level marketing Director at a large technology company to build a health care marketing group. Needs 10+ years experience knowing health care, technology and marketing.

The other is a 9 month full-time contract as an IDX implementation consultant/manager for their enterprise wide scheduling system. If you don’t know what that means, it’s not for you!

Please email me with your details (resume/bio/experience) if you think that it might be you. And as I’ve said before feel free to write if you’re just looking but not for these in particular as I get asked a lot. Obviously everything is treated in total confidence,

 

HEALTH PLANS: Hey, wasn’t UHC supposed be nice now?

Having been the first health plan to say that it was going to stop hassling physicians back in 1999, I thought United was supposed to be behaving itself and promoting love, flowers and puppy-dogs all around with its providers. (Well apart from that quality ranking stuff in St Louis). Well apparently the answer is not exactly not exactly:

The Arizona Department of Insurance on Friday ordered United Healthcare to pay civil penalties totaling $364,750 — the largest fine in the department’s history — for violations of state insurance laws. State regulators said United Healthcare illegally denied more than 63,000 claims by doctors without receiving all of the information needed to accept or deny a claim. The company also failed to follow state laws for promptly notifying doctors and patients about about decisions and appeals, the state said. United also violated a 2002 agreement to correct previous violations, the state said.
Just a word of warning to the payers that the providers are ready to step it up, just in case you’ve got any ideas — like say insisting on proper documentation, or rewarding for quality (and punishing for the lack of it). And that if you’re going to throw stones, better make sure that you don’t live in a glasshouse yourself.
 

PHARMA/POLICY: In this game of monopoly drugs the market is working, oh yes

So the new maker old off-patent drug that is needed badly but only by a few people, and for some reason isn’t in the Part D or most other private formularies “notices” that it has a monopoly. So what does it do?  It puts the price up nearly ten fold . (The drug is called Mustargen and the company is called Ovation Pharmaceuticals). And of course this behavior is matched by other companies that have monopolies bestowed by patents.

Presumably if the market price is that high on the non-patented drug some smart Indian generic will start making it and bring the price down, but that’ll take a little while. And in the meantime 5,000 patients are getting screwed to the wall.

We should have a rational debate about whether there ought to be coverage for certain drugs (and in the UK for instance there is such a debate).  But if there’s an egregious monopoly or market-distortion like this, then we know the solution, and it’s called monopsony — or, if you like, price-fixing. Of course this nation’s government doesn’t like to intervene in these types of cases even when it means a bunch of crooks steal blindly from a whole state and help push its economy (and by consequence that of the whole nation) into recession. And I suspect the people who need this drug view Ovation Pharma as Enron wearing lab coats.

But eventually if Pharma (both big and small) continues to abuse its monopoly power, there will be a predictable response. You can argue that making hay while the sun shines is Pharma’s best financial course (if not exactly its best ethical one), but I suspect that whoever sits in the C suites in New Jersey (and South San Francisco) and has to pick up the pieces under the next Democratic Administration may wish that a little restraint had been shown while that sun was shining.

PHYSICIANS/HOPSITALS/INDUSTRY: Customer service: are new market entrants showing the way?

Interesting piece from a marketing consultant called Chris Bevolo from boutique firm GeigerBevolo Inc., in Minneapolis. The report looks at new entrants into health care services and responses to improve the patient experience at Mayo and Park Nicollet.

The new entrants profiled are Steve Case’s Revolution Health, Best Buy’s eq Life ( a pharmacy with manicures while you wait), and MinuteClinics (nurse practitioners in shopping malls). The choice of Revolution Health is a little off, and its attempts (as well as the track record of its advisory board)  has been well slagged off on TCHB and by Joe Paduda before. But the other two are well worthy of a look.

And the message seems to be a) provide shopping while people are waiting to see the doctor as Americans like shopping, and b) do it in Minnesota, because those Minnesotans like innovation. I actually think that Chris has missed a third option which is edutainment while patients are waiting.  But I’ll have more to say about that when I finally get around to discussing Phreesia’s in-office tablet entertainment/patient history service again.

But while I’m more than half-joking, I am full serious. The level of customer service in health care remains abysmal, and whether or not the market forces plans and providers to do something about it sooner rather than later, it surely can’t hurt for them to get out ahead of this trend.

PHARMA/QUALITY: New York Times discovers compliance

Says here, compliance with drug regimens is a big problem. (Adopt Harry Shearer voice with hard “en” sound in “knew”)”

Who knew? Who knew?

And McKesson, plus a boat load of other DM, PBM and pharma-related companies (like Pfizer Health Solutions) are bugging patients to take their pills, and increasing pharma company profits into the bargain. And even after digging up David Sobel, John Abramson & Jerry Avorn, the NYT can’t find too much bad to be said about these programs — even though pharma companies are paying for them. Everyone agrees compliance is good, and getting patients to take their pills is hard work.

But I didn’t notice them referring to any compliance programs for generics. Funny that.

White House Letter; An Outspoken Conservative Loses His Place at the Table – The Archive – The New York Times

White House Letter; An Outspoken Conservative Loses His Place at the Table – The Archive – The New York Times

Mr. Bartlett, 54, the author of a syndicated newspaper column and articles in academic journals, was dismissed in October as a senior fellow at the National Center for Policy Analysis, a research group based in Dallas. In the interview, Mr. Bartlett said he had been fired because his increasingly critical comments about Mr. Bush, in his column, in his book and in other publications, had hampered the ability of the research institution to raise money among Republican donors.He also provided a copy of an e-mail message that he said was sent to him in August 2004 by Jeanette Goodman, the vice president of the research institution. ”100K is off the table if you do another ‘dump Cheney’ column and 65K donor is having a rebuttal done, in a national magazine, to your attack on the fair tax people so that 65K may be gone also,” Ms. Goodman wrote about one of Mr. Bartlett’s columns about the vice president. ”Do you have any ideas on where I could raise that amount quickly?”John C. Goodman, the president of the organization and Ms. Goodman’s husband, said in a telephone interview over the weekend that he did not know what his wife had said to Mr. Bartlett and that he did not want to say whether Mr. Bartlett ”did or didn’t hurt fund-raising.” But Mr. Goodman added, ”That’s not why he was fired.”

PHARMA/PHYSICIANS: Reimbursements Sway Oncologists’ Drug Choices, by Greg Pawelski

Greg Pawelski is not exactly surprised about the latest revelations about oncologists and their use of chemotherapy.

A joint Michigan/Harvard study confirms that medical oncologists choose cancer chemotherapy based on how much money the chemotherapy earns the medical oncologist. Just published in the journal Health Affairs is a joint Harvard/Michigan study entitled “Does reimbursement influence chemotherapy treatment for cancer patients?” In a study of 9,357 patients, the authors documented a clear association between reimbursement to the oncologists for the chemotherapy of breast, lung, and colorectal cancer and the regimens which the oncologists selected for the patients. In other words, oncologists tended to base their treatment decisions on which regimen provided the greatest financial remuneration to the oncologist  This study adds to the ‘smoking gun’ study of Dr. Neil Love on the subject. The results of his survey show that for first line chemotherapy of metastatic breast cancer, 84-88% of the academic center-based oncologists prescribed an oral dose drug (capecitabine), while only 13% prescribed infusion drugs, and none of them prescribed the expensive, highly remunerative drug docetaxel. In contrast, among the community-based oncologists, only 18% prescribed the oral dose drug (capecitabine), while 75% prescribed infusion drugs, and 29% prescribed the expensive, highly remunerative drug docetaxel. The existence of this profit motive in drug selection has been one of the major factors working against the individualization of cancer chemotherapy based on testing the cancer biology. Once a decision to give chemo is taken, physicians receiving more-generous Medicare reimbursements used more-costly treatment regimens.

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