Category: Uncategorized

Overestimating Consumer Demand for Health Care Technology

Nov 1, 2011• 3

By Jane Sarasohn-Kahn

More people with higher levels of concern about their health feel they are in good health, see their doctors regularly for check-ups, take prescription meds “exactly” as instructed, feel they eat right, and prefer lifestyle changes over using medicines.

And 40% of these highly-health-concerned people have also used a health technology in the past year.

At the other end of the spectrum are people with low levels of health concern: few see the doctor regularly for check-ups, less than one-half take their meds as prescribed by their doctors, only 31% feel they eat right, and only 36% feel they’re in good health.

While roughly one-fourth to one-third of U.S. adults have been early adopters of consumer technologies in general across low-moderate-and-high health concern segments, more of those with greater health concerns tended to use health tech products in the past twelve months: 40% of the highest concerned people vs. 25% of those with moderate health concerns and 14% of those at the lowest-concern level.

These insights are discussed in a report, The New Role of Technology in Consumer Health and Wellness from the Consumer Electronics Association (CEA), published in October 2011.

Apps Against Abuse–the Winners

Nov 1, 2011• 1

By Matthew Holt

The Federal government has been getting behind the Challenges craze in a big way but this one from the Vice President’s Office and HHS is a doozy. Called Apps Against Abuse it asked developers to create an application that would help young people deal with abuse and violence, primarily in the world of dating and relationships. (FD my company Health 2.0 has a contract with HHS to run challenges, and Apps Against Abuse was featured in the Health 2.0 Developer Challenge and we worked on publicizing the project).

Today two winners were announced on the White House Blog by HHS Secretary Kathleen Sebelius and in a conference call hosted by Aneesh Chopra (Federal CTO) and Todd Park (CTO, HHS) and some fellow called Joe Biden was there too!

OnWatch is a phone based app that has a series of alarms and prompts built in. For example, it can be set with a message sent to friends saying “I went to a party at XYZ dorm, if I don’t come back by midnight come find me” or it has a panic button that calls 911 or the campus police.

The other winner is called Circle of 6 and it comes from the team at ISIS. (FD I’m on the board of ISIS but I didn’t even know they’d entered the contest!). Circle of 6 puts you in touch with 6 of your closest friends and asks them to come help you if you’re in trouble. It even plugs in the coordinates for them. The ISIS team intends to build out Circle of 6 which is currently an iPhone only prototype.

There were more than 33 entries for Apps Against Abuse, even though there was no prize money at stake. It’s good to see that such commonsense use of these new technologies is finding so many spirited innovators willing to help.

Is Southern Europe’s Debt Crisis an Omen for US Health Care?

Oct 31, 2011• 2

By David E. Williams

The Wall Street Journal (Pain for Europe’s Smaller Drug Firms) notes that Spain, Greece, and Italy are putting the squeeze on drugmakers as part of national austerity programs designed to ease the debt crisis. Companies like Almirall and Alapis that depend heavily on those markets are suffering mightily as national health systems cut reimbursements. There’s less appetite for cuts to hospitals and physicians, and none for taking away coverage.

The US fiscal situation isn’t as pressing as Southern Europe’s. Still if present trends continue, we’ll get there. In fact, uncontrolled health care spending –mainly Medicare– is the culprit. So what can we expect in a 10 year time frame, assuming the US’s finances aren’t straightened out by then?

Hospitals and physicians are likely to get hit harder in the US than Europe. That’s partly because physicians get paid more here than Europe and also because Medicare sets rates and pays providers directly

Pharmaceutical companies won’t escape the axe, but they’re a bit less vulnerable politically in the US because they are a major source of R&D spending, are seen as innovative and a more attuned to the political system

Failure as a Path to Success

Oct 31, 2011• 2

By Jennifer Ruzek Liebermann

In a world that celebrates success, the idea of rewarding failure may seem counterintuitive. Failure and the learning that comes from it from it are essential ingredients of success, something that innovative organizations understand. They create environments where failure is expected and the only “true failure” is a failure to learn when things don’t go as planned.

Throughout history, innovators and enlightened leaders have observed that failure begets success. “The fastest way to succeed is to double your error rate,” said Thomas J. Watson, founder of IBM, a company Fortune recently ranked one of the most innovative. “Success is 99 percent failure,” legendary car builder Soichiro Honda said.

I write and speak often about how organizations can create a culture of innovation. Encouraging appropriate risk-taking is an important dimension of an innovative culture and organizations struggle with how to create environments where employees can learn from failure. How can they take small, safe risks or even big and bold ones, but in controlled ways?

To an innovator, “Oh, that will never work” may be the five worst words in the English language. Few things chill innovation more than people who reject new ideas in their infancy. Innovative organizations understand the dynamics of failure – not only why people fear failure, but also why it’s important. They value failure because of what they can learn from it. Employees are expected to take intelligent risks and are given the “air cover” from leadership to risk failure.

What Keeps Me Up at Night

Oct 31, 2011• 3

By John Halamka, MD

Every year I write about the projects and trends which keep me up at night. Here’s my list for FY12:

1. Workforce recruitment/retention – $27 billion in stimulus funds from HITECH have increased demand for experienced IT staff to implement and support electronic health records. In many ways, it’s a mini “dot com” boom for healthcare IT experts. This makes recruiting and retaining qualified staff even harder. Tomorrow, I’m meeting with a consulting team to formulate an FY12 workforce strategy.

2. 5010/ICD10 – 5010 describes a set of X12 standards used for administrative transactions (benefits/authorization. referral authorization, claims). Payers and providers must support 5010 by January 1, 2012 or risk disruption of the revenue cycle. BIDMC completed all its 5010 work and is now in final testing with every payer. Most payer and provider stakeholders will meet the deadline, but significant resources have been pulled from other projects. ICD-10 implementation is required by October 1, 2013 and I’ve written about those challenges. Billions will be spent, many healthcare IT projects will be deferred for the next 2 years, and the end result will be no cost savings (coding costs are likely to increase 50%), no quality improvement, no increased safety, and no efficiency gains. If we complete the ICD-10 project on time, no one will notice, but customers will all be angry at the IT department (and the CIO) for the work on other projects that was deferred.

3. Vendor Product Quality – over the past year, I’ve had several bad experiences with infrastructure and application vendors which delivered products that did not have the reliability, security, or performance promised. Why?

* the pace of innovation is so fast, that time for quality assurance is diminished

* the economy has stressed companies and they are focused on making as many sales as fast as they can while controlling development and support costs

* the end result is less satisfied customers

Romney vs Romney

Oct 29, 2011• 9

By ROBERT LASZEWSKI

Republican presidential frontrunner Mitt Romney has pledged to end “Obamacare.” Upon taking office, he would immediately begin the process by granting the states waivers from having to implement it:

“I’ll grant a waiver on Day One to get repeal started. On Day One, granting a waiver for all 50 states doesn’t stop it in its tracks entirely. That’s why I also say we have to repeal Obamacare, and I will do that on Day Two, with a reconciliation bill [requiring only 51 votes in the Senate] because as you know, it was passed by reconciliation with 51 votes.”

Romney appears to be on thin ground in making his waiver promise and his promise to use reconciliation to stop “Obamacare” could lead to chaos in the market and among consumers.

The waiver promised is based on a provision in the law authored by Senator Ron Wyden (D-OR). Wyden’s provision was designed to allow states to petition the feds to opt out of the new health care law by taking the federal money that was going to be spent in their state under the Affordable Care Act and draft a comprehensive plan of their own that covered at least as many people as well as the Affordable Care Act would have.Continue reading…

How Much Is a Life Worth?

Oct 28, 2011• 105

By DAVID DRANOVE

This blog continues my ongoing series of “mysteries of health economics.”

The mystery this week is “what is a life worth?” We cannot ignore this question because it seems unthinkable. As will discuss, coverage decisions by public and private insurers depend on the answer. Some payers are rather explicit about they think a life is worth.

Before I try to solve this mystery, let me acknowledge that we should not spend money on health services that are of zero value (or worse.) But what about expensive health services that might prove to be of some value? How much should we spend on these?

Let us accept the reality of insurance. When we “purchase” health care, someone else foots the bill. Perhaps insurance should contain big deductibles, but even big deductibles are quickly exhausted if we need surgery or have a chronic health problem. If we are pooling our resources to pay for medical care, then we will probably want to reach some sort of collective decision about what drugs and treatments we will pay for. The alternatives would be to invite massive moral hazard. (Let me repeat for those who bang the drum loudly for big deductibles – deductibles are quickly exhausted when serious illness strikes and moral hazard again rears its ugly head.)

Now imagine a new cancer drug that offers a small prospect of survival to patients who have no other choices. Suppose that on average, patients who receive this drug can expect to live about another three months and that there are no downsides to this drug. If the drug company offered to give the drug away for free we would surely want patients to have access to it. If the drug company asked $100 million a dose, we would probably agree to spend the money elsewhere.

The Massachusetts Disconnect

Oct 28, 2011• 4

By Trudy Lieberman

Much of the national press took a pass last week on another important “study says” story out of Massachusetts. This is the second time in the last month where the national media missed a story with implications for the success of health reform. The latest report, which came from the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, showed that Massachusetts residents have different views about what’s causing the high prices of medical care than do the state and national policy wonks who are framing the solutions. What a surprise! We have repeatedly reported that the public is disconnected from what the pols are saying. Why should we be astonished they are not in step with the policy community?

The study, says lead researcher Dr. Robert Blendon, found that the public generally believes the cost problem stems from excessive charges by drug companies, insurers, and hospitals. Why not doctors? “Doctors have managed to present a picture in the state that they are not the reason why costs are rising. It speaks to the efficacy of the physicians’ campaign that their fees are not high enough,” Blendon told me. Indeed, doctors around the country have mounted local media campaigns to build their case that Medicare’s fee cuts will result in patients not getting care. Furthermore, the state media have focused mostly on the duel between hospitals and insurers, and that’s the message the public has received.

Health 2.0 Europe–the view from hip Berlin

Oct 28, 2011

By Matthew Holt

It’s morning on Day 2 of Health 2.0 Europe. We’re at the on the campus of Charité Hospital and University of Medecine (in the old East Berlin) in the Langenbeck-Virchow Building which is now a conference center for medical societies but apparently was used as a part of the old GDR parliament before 1989.

Yesterday, we had a series of intense panel discussions, not least between the German members of the panel who were discussing (and disagreeing) on whether Health 2.0 tools could come “bottom up” or would have to fit in the rather slow creation of national electronic infrastructure for clinical care.Continue reading…

Constitutional Serendipity

Oct 27, 2011

By David Boyle

Serendipity is not a word one usually associates with the present raucous debate over the “individual mandate” of the Patient Protection and Affordable Care Act. Democrats tend to support both the mandate and the PPACA, while Republicans tend to oppose both. However, this “between the devil and the deep blue sea” approach, whereby one makes a Hobson’s choice between being tyrannized by a government command to buy health insurance, or seeing no comprehensive health reform enacted in a country that needs it, is a false dichotomy, serendipitously enough.

The PPACA offers comprehensive reform, including welcoming features such as guaranteed issue of insurance regardless of preexisting medical conditions. However, the fact that the PPACA has valuable features doesn’t automatically legalize any possible measure designed to fund the Act, including coerced health insurance purchase. As former Vermont governor Howard Dean noted in August 2010 on MSNBC’s The Daily Rundown, Vermont enacted a successful state health care program without an individual mandate; Dean emphasized, “And people don’t like to be told what to do.” This latter factor is not negligible in a country with a statue in New York Harbor dedicated to liberty. (Perhaps this is why a June 9, 2011 CNN poll shows 54% of Americans opposed to the mandate, and other polls report similarly.)

Our American liberty has various constitutional and legal underpinnings which can defend people from the federal individual mandate, and maybe even from state individual mandates. As for Congress’ power to tax for the general welfare: taxes and penalties, such as the “Shared Responsibility Payment”, the PPACA financial penalty for refusal to buy health insurance, are not just interchangeable “economic incentives”.