Category: Uncategorized

Is HITECH Working? #7: Where’s Plan B? Congress and ONC need to address major flaws in HITECH

May 26, 2010• 4

By VINCE KURAITIS JD, MBA and DAVID C. KIBBE MD, MBA

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue. He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

Defending Plan A to your dying breath?
Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping CertificationContinue reading…

Commentology: Is This the Future of Insurance Negotiations?

May 25, 2010• 1

Names withheld to protect the innocent.

Dear Patient:

You may have read
recent media
coverage concerning contract negotiations between XXXX Insurance
Company and XXXX Healthcare Group. First, on behalf
of XXXX
Healthcare Group, our hospitals and our physicians, I would like
to
apologize that you heard this information via the media and not from us.
We
were very surprised XXXX Insurance
Company contacted the press about the negotiations because when XXXX
released its media communications,
we hadn’t even had a face to face discussion about the contract
proposals. Most
contract negotiations include actual “negotiating” to arrive at
reasonable
terms, but it appears XXXX Insurance
Company preferred to start things off by pressuring patients to end
their
existing relationships with family physicians and local hospitals.

We believe XXXX Insurance
Company’s approach of distorting the facts and
misleading the public instead of negotiating a reasonable contract is an
attempt to deflect attention from XXXX Insurance
Company’s overall plan to increase their profits. It’s a negotiating
tactic we
feel is designed more to frighten patients than resolve differences.

We want to give our
patients as
much information as we can to help them navigate this situation. First,
you
should be aware that XXXX Insurance
Company is required by law to notify you by June 1, 2010 that the
contract may
terminate on July 1, 2010 and XXXX Insurance
Company may even advise you to select a new in-network physician. Your
letter
should arrive any day but your coverage with XXXX Insurance
Company remains unchanged today.

However, that
letter does
not mean you must change your physician. We understand how important it is for you to maintain a relationship
with a
physician you trust and knows about your health. That is why our
existing contract
allows patients and employers to request XXXX
Insurance Company to keep the doctors and facilities in-network for one
year or
until the employee’s subscriber contract anniversary date, whichever
date is
earlier should we not have a new contract in place by July 1.

We encourage patients
and their
employers to write to XXXX Insurance
Company today and request they keep XXXX Healthcare
Group doctors and facilities
in-network and to continue to negotiate a fair contract.

XXXX Insurance Company has
alleged XXXX Healthcare Group’s costs are higher
than
state and national averages. We disagree with this statement and
challenge
their data. We monitor the cost of care very closely through independent
actuaries used by many of the largest payors in the country and know
that our
commercial reimbursement is comparable to other healthcare providers
across the
state. We asked XXXX Insurance
Company to substantiate its data, which is based on its own company
information, but they have ignored our request.

In the last two years XXXX
Insurance Company earned $2.6
billion in profits. In contrast, XXXX Healthcare
Group has made $10 million in net
income in the last two years while also providing $222 million in
charity care
for patients who were uninsured. While XXXX
Insurance Company wants to argue they are fighting for their members,
it’s
clear they are looking for ways to prepare for healthcare insurance
reform
while still maintaining their profits for shareholders. One of those
ways is to
squeeze hospitals and physician clinics that are already operating on
very slim
margins.

Even though the
negotiations
have started rather unpleasantly, we will work in good faith to come to
terms
with XXXX Insurance Company so you
can continue to have XXXX Healthcare Group
physicians and hospitals as
an option for your care.

If you have any
questions
concerning this situation you can call us at xxx-xxx-xxxx.

Sincerely,

Introducing San Francisco Health Innovation Week

May 25, 2010

Health 2.0, LLC and Health Care Conference Administrators, LLC (HCCA) are excited to bring you Health Innovation Week, October 3 – 10, 2010 in San Francisco.

Together with the REC/HIE, EHR and HIPAA Summits, the popular HealthCampSFBay and the 4th Annual Health 2.0 conference, Health Innovation Week will be a fantastic opportunity to get immersed in the world of health and technology innovation in the beautiful city by the Bay.

To find out more about the events of Health Innovation Week, or to add your own to the calendar, check out: http://healthinnovationweek.com/.

ReachMD: 2.0 Tools and Healthcare

May 24, 2010

Web 2.0 tools have made the Web more
interactive for everybody. But what is Health 2.0?

Find out, with Matthew Holt, healthcare futurist, co-founder of the
Health 2.0 conference and founder of The Health Care
Blog, tells you why you should.

Listen to the ReachMD
broadcast or podcast
— Then it’s your turn. Vote in the ReachMD Poll.

You can also:

Add your comments at Tweet us
Post on Facebook
Or call the ReachMD Listener Line at 888-639-6157
to record your comments (portions of which may air).

Hospital Bills, Insurers and Pricing

May 24, 2010

By MICHAEL RICCIARDELLI

A few weeks ago I wrote here about my
unhappy experience of inadvertently mixing two different types of drain
cleaners together. I learned then, and thought it useful to relate,
a painful in-home science lesson: the combination of hydrochloric acid
and hypochlorite (bleach) apparently forms chlorine gas, which was used
as an agent of chemical warfare early in World War I. Serious lung
damage and death are real possibilities. After a trip to the emergency
room, a follow-up visit to my doctor and the passage of time– I’m ok.

But the other day I got the bill, or thankfully, as I am insured
through my employer, the explanation of benefits. My present insurance
company, CIGNA, detailed the claim in an easy to read and understandable
manner. It is telling.

med-bill-breakdown2

I was in the
Emergency Room for about 4 hours (they had wanted to keep me overnight
for observation but released me under the condition (and my pleading)
that I return immediately if any number of things happened). I received
oxygen and breathing treatments, x-rays, lab work, an electrocardiogram,
and the care of a physician. The total billed was $2,270. But perhaps
more importantly, the amount “discounted,” or the amount my insurance
company did not pay through its negotiated pricing contract with the
hospital, was $2007. Which is to say that my insurance company paid a
total of only $263 of this bill. Thankfully, I owe nothing except a
small co-pay.

It Slices, It Dices, It Fleeces

May 24, 2010• 9

By MICHAEL TURPIN

Infomercials annoy me. They are social polyps that have grown to outlandish proportions on the intestines
of a bloated and sick American media. The portmanteau term “ infomercial” is clearly an oxymoron describing the contradiction of programs that are both hosted and devoured by morons. The fact that infomercials are even allowed by the FCC is a sign of the advanced dry rot in our American entertainment, economic and regulatory systems.

The FCC, according to one gadfly, now stands for “Forget Catching Criminals.” It appears that after decades of exporting our innovation, manufacturing and customer service, the dregs of commerce have reached new lows where 30 minute advertisements fill vacant morning programming time – feeding bread crumb promises to an inactive and unemployed America gulping down like boat marina carp visions of cleaner colons, miraculous weight loss without exercise and abs as chiseled as parking lot speed bumps.

I can recall the first time I was ripped off by a false advertisement via a DC Marvel comic book. The “Live Sea Horses” actually turned out to be ionized pieces of tire rubber. As they floated and swirled in my “seahorse garden”, I felt my first sensations of buyer’s remorse. I had been had. Weeks later, I was tempted to send away for X-Ray glasses. The idea of being able to watch the older eighth grade girls PE class run laps with my three dimensional goggles was intoxicating. Yet, the cynical memory of pathetic black floating bits of rubber had already eroded the tint from my rose colored glasses. My father, the advertising man, later explained to me the simple Latin maxim that would echo in my brain for decades: “Caveat Emptor – Buyer Beware.”

National Healthcare Insurance Isn’t Enough: Six Crucial Steps To Improve Healthcare

May 21, 2010• 19

By ALBERT S. WAXMAN, PhD

Healthcare reform has finally made its way through the U.S. political machinery, emerging with a $1 trillion reform plan extending health insurance to 32 million additional Americans and eliminating other barriers to healthcare insurance.

To be sure, it’s a good start: America has finally joined the world’s other developed nations and made healthcare a national requirement for most citizens. However, there is a real risk that we have traded one problem for another.

The healthcare reform law – formally, the Patient Protection and Affordable Care Act (PPACA) – does very little to address the underlying costs and structural issues that have driven healthcare costs to rise at about 2 ½ times the annual rate of inflation. Adding 32 million people to these bad economics will place additional stress on a system that continues to swell. Failure will lead an existing $2.5 trillion industry to inflate to more than $4.5 trillion in 2019, according to The Centers for Medicare and Medicaid Services, and further weaken the U.S. economy.

Health 2.0 Goes to Washington conference – DC, June 7th!

May 21, 2010

With less than 3 weeks to go until this groundbreaking event, we are happy to announce 2 NEW special sessions!

Patients 2.0: Join Gilles Frydman, ACOR, as he hosts a panel of 7 vocal ePatients who will share their personal journeys and experiences navigating the healthcare system and the world of Health 2.0.

Moving the Needle on Innovation Together – A Workshop for Federal Agencies and Health 2.0 Companies: With your hosts Wil Yu, ONC and Julie Murchinson, Health 2.0 Accelerator and Manatt Health Solutions, roll up your sleeves for a hands-on session highlighting federal initiatives for care improvement where the government is funding programs and seeking solutions from the Health2.0 innovation community to “move the needle” forward on national healthcare priorities.

Also check out the updated agenda, don’t wait till it’s too late – REGISTER TODAY – and be there for this amazing line-up of speakers and presenters!

Dislodging the anchor

May 21, 2010• 3

By PAUL LEVY

A well-established technique in negotiation is to “set an anchor.” The
idea is to be the first person to put out an offer in a negotiation in
which price is the main issue. Many people think, incorrectly, that you
are better off if you let the other party make the first offer. But,
no. An anchor, once set, has a powerful impact on the negotiation,
causing the final price to settle in its vicinity — even if the anchor
has no substantive basis.

I fear that we are seeing this phenomenon happening in Massachusetts. Many of you have followed our
current controversy regarding insurance rates for individuals and small
businesses. Lots of people with these kind of insurance policies found
themselves with large premium increases this year.

How to Build a Culture of Innovation From the Inside Out

May 21, 2010• 11

By Jennifer Ruzek Liebermann

“How do you inspire and enable innovation in a large organization?”

That’s the question I grapple with daily as director of Kaiser Permanente’s health care innovation center. I’ve observed that it isn’t sufficient to have a dedicated Innovation Center, an Innovation & Advanced Technology Group, or in-house Innovation Consultancy design group – all of which Kaiser Permanente has. The real question to solve is: “How do you create a culture that enables innovation throughout an organization?”

To explore answers to that, this week I am joining with physicians, nurses and design thinking, quality and innovation experts from the United Kingdom’s National Health Service and Kaiser Permanente for three days in South Devon, England, at the NHS Horizon Centre for Innovation, Education & Research in Healthcare, to share successful failures and best practices in innovation.

One contribution the NHS already has shared with the extended health care innovation community is a guide that helps leaders enhance the conditions for innovation: “Creating a Culture of Innovation.” Given that organizational leaders’ behaviors have a disproportionate influence on creating a culture that either hinders or aids innovation, Lynn Maher and Helen Bevan of the NHS Institute for Innovation and Improvement and Paul Plsek distilled the organizational research on innovation into a helpful “how to” guide outlining the seven dimensions of culture that support innovation. These principles, summarized below, can be applied to any organization.

So how can you begin building your own innovative culture — and how have we used these principles at Kaiser Permanente?

Risk-taking: Establish a climate in which people feel OK trying out new ideas by not shutting down ideas before they’ve been vetted. Leaders should demonstrate they are more interested in learning from failure than punishing people for it.

To foster innovative thinking at Kaiser Permanente, our Information Technology leadership created an Innovation Fund, an internal program that provides seed funding and support to teams of doctors and employees to facilitate the rapid prototyping of novel IT ideas and diffusion of successful innovations. Leadership also created iLabs, an innovation lab that serves as a technology research, advisory and software prototyping group that works with Kaiser Permanente innovators to help develop technology solutions for health care.

Resources: Resources are meant in the broadest sense of the term here. The traditional definition signifies an organizational commitment to innovation, but resources need not always be concrete. Time, permission and autonomy to innovate may be what is needed. For example, Kaiser Permanente’s Innovation Fund not only provides seed funding, but access to mentors and tools to jumpstart innovation.