If you want to watch the documentary Money Driven Medicine based on Maggie Mahar’s book, it’s now available for free download at moneydrivenmedicine.org (the DVD is also available for purchase). The free download is part of an ongoing “Watch-In! For America’s Health” — a national viewing party organized in conjunction with the Consumers Union.
Carrot or Stick? Should Patient Decision Aids Be Rewarded or Required?
- Should we incent or require providers to prescribe patient decision aids?
- Should we incent or require consumers to use patient decision aids?
Over-treatment is the most celebrated cause of runaway health care costs, but we shouldn’t blame the doctors. The fee-for-service system sets them up for over-treatment. First, they have been taught that offering all possible cures to every patient is good medicine. Second, malpractice law pushes them toward offering more testing and services, not less. And third, they generally get paid more when they do more. It’s hard to buck a triple-threat system like that without a little help from the patient. Fortunately, it’s not that hard for patients to provide that difference.Continue reading…
Can Social Media Save Healthcare Reform?
Daniel Palestrant is the Founder & CEO of Sermo, the largest online physician community, and a friend of THCB’s from the Health 2.0 world. Lately Dan has been seen on cable TV representing the 110K+ Sermo members in the health reform debate—including a very public break-up with Sermo’s former partners at the AMA, which has endorsed the House 3200 bill. I’ve been asking Dan, if his members’ don’t want the House bill, what do they want? This is the piece he sent me in reply—Matthew Holt
Speaking at Fortune’s Brainstorm Technology Conference last month, longtime healthcare reform advocate, Howard Dean pointed out that the “dirty secret” of social media is that it can put a whole lot of politicians out of business because it allows the truth to bubble up. For the sake of healthcare reform, let’s hope he is right.
True healthcare reform has no chance of occurring with the current political topography. As the general public tries to make sense of the 1,000+ page version of the bill and President Obama distances himself from Howard Dean’s raison d’etre, the public option, two things are becoming increasingly clear:
1. There is very little actual healthcare reform going on.
2 The insurance companies look like they will win, no matter what, especially if you believe the cover of the most recent Business Week “The Health Insurers Have Already Won”.
At Sermo.com we seem to be seeing Governor Dean’s prediction come true.
The Health 2.0 Accelerator is really gunning it…
The Health 2.0 Accelerator was a glimmer in the eye of Commerce.net’s Marty Tenenbaum late in 2007. But under the dedicated leadership of Julie Murchinson and Aaron Apodaca, something quite remarkable is happening. The Accelerator is an industry consortium, mostly made up of very small Health 2.0 companies who are just getting started in their own young lives. But working together they’re integrating data and services in a way that’s going to make consumers’ use of online health tools very different from the patchwork we see today.
And the effort is getting attention. Today Kaiser Permanente announced that it was joining the Accelerator, moving alongside Sage and Catholic Healthcare West as corporate members. And in the wings is a major health care data player, who’s going to be adding their seal of approval next week.
What’s happening here is the evolution of an ecosystem—an ecosystem where innovation on the web and in mobile Health 2.0 is now finding ways to present itself to consumers and healthcare organizations in new ways.
I don’t want to let the cat out of the bag completely, but I think that anyone who’s interested in seeing the evolution of Health 2.0 and the evolution of health care consumer technology will be fascinated by what around a dozen Health 2.0 Accelerator members are going to show—together—at the tools panel at the Health 2.0 Conference next week.
In the meanwhile kudos to Julie and Aaron, to Erick & Linda von Schweber from PHARMASurveyor who’ve been founding board members and have driven the technical process, to the folks from Sage who were great early supporters and to the more than 100 people and companies who’ve been supporting the Accelerator.
They’ve all made a real difference. And it’s just beginning.
I was largely in favor of Swiss-style health care…
until I found out that the people who the NY Times says are really in favor of it are Bill O’Reilly and Regina Herzlinger…
Actually I’m kidding. I knew Regi says she likes it, and Maggie Mahar ripped her position—(Herzlinger’s position being that she espouses a version of the Swiss system for the US)—to shreds a while back. But would Herzlinger really want to live in a world where there was no easy money to be made trading in the stock of health insurers who are defrauding state governments? But I’ve got to say that Herzlinger and O’Reilly make a interesting couple.…pass the falafel.
To Change Health Care, Change Diabetes.
As we work to change health care in America, we must recognize the need to dramatically change diabetes. Twenty-four million Americans have diabetes at a cost to our nation of an estimated $218 billion for diabetes and pre-diabetes, according to a series of studies recently published in Population Health Management. Imagine the effects diabetes will have on our health and economy in the future if we don’t take action now. The prevalence and economic burden of undiagnosed and pre-diabetes make the case for the importance of policies that promote early diagnosis and prevention. About 25 percent of Americans with diabetes aren’t even aware they have the disease. And, those with undiagnosed diabetes result in $18 billion in health expenses, or $2,864 per person each year, according to one of the studies mentioned above.
Another Look: Incident Reporting Systems
When the patient safety field began a decade ago with the publication of the IOM report on medical errors, one of its first thrusts was to import lessons from “safer” industries, particularly aviation. Most of these lessons – a focus on bad systems more than bad people, the importance of teamwork, the use of checklists, the value of simulation training – have served us well.But one lesson from aviation has proved to be wrong, and we are continuing to suffer from this medical error. It was an unquestioning embrace of using incident reporting (IR) systems to learn about mistakes and near misses.
The Aviation Safety Reporting System, by all accounts, has been central to commercial aviation’s remarkable safety record. Near misses and unsafe conditions are reported (unlike healthcare, aviation doesn’t need a reporting system for “hits” – they appear on CNN). The reports go to an independent agency (run by NASA, as it happens), which analyses the cases looking for trends. When it finds them, it disseminates the information through widely read newsletters and websites; when it discovers a showstopper, ASRS personnel inform the FAA, which has the power to ground a whole fleet if necessary. Each year, the ASRS receives about 40,000 reports from the entire U.S. commercial aviation system.
HIPAA’s Broken Promises
If you hate HIPAA, it’s your lucky day. Paul Ohm is handing you ammunition in his article, “Broken Promises of Privacy: Responding to the Surprising Failure of Anonymization.” His argument: our current information privacy structure is a house built on sand.
“Computer scientists…have demonstrated they can often ‘reidentify’ or ‘deanonymize’ individuals hidden in anonymized data with astonishing ease.”
Ohm’s article describes HIPAA, in particular, as a fig leaf – or worse, as kudzu choking off the free flow of information.
“[I]t is hard to imagine another privacy problem with such starkly presented benefits and costs. On the one hand, when medical researchers can freely trade information, they can develop treatments to ease human suffering and save lives. On the other hand, our medical secrets are among the most sensitive we hold.”
Catalyzing the app store for EHRs
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Recently, Steve posted about the idea, floated by Ken Mandl and Zak Kohane, that EHRs (or health IT more broadly) could move to a model of competitive, substitutable applications running off a platform that would provide secure medical record storage. In other words, the iPhone app model, but, for example, you could have an e-prescribing app that runs over an EHR instead of the Yelp restaurant review app on your iPhone. We’re thinking about the provider side of the market here, as Google Health and Microsoft HealthVault are already doing this on the consumer side.
It’s nice to ponder these “what ifs,” but we’re a bit more action-oriented here and we’ve turned our attention to asking what it would take to make this happen. It seems that there are two things that are needed. First, we need the platform. Some of the most notable platforms started out as proprietary that were then opened up. The IBM PC comes to mind as an example. Some were designed from the beginning to be open platforms with limited functionality until the market started developing applications. A recent example is the development of iGoogle and the tons of applications that are available for free. Finally, there was the purely public domain development from the beginning to end that we’ve seen in the Linux world. Or perhaps we don’t need a common platform and maybe what is needed is to stimulate the market for health IT products that have open application programming interfaces (APIs) that allow for third-party application development? Several ideas come to mind.Continue reading…
Capitol Shortage: Can the Two Democratic Parties Get It Together on Health Reform?
As an exceptionally grumpy American summer grinds to a conclusion, it is apparent that only a bipartisan solution will enable Congress and the Obama Administration to complete health reform. No, we’re not talking about co-operating with the Republicans. Other than a handful of contrarian Republican moderates on the Senate Finance Committee, at least one of whose votes might be needed for eventual passage, the Republicans are irrelevant to the final outcome.
No, the bipartisan solution we’re talking about is co-operation between the two Democratic parties represented in Congress: the “Safe-Seat” Democrats- the Pacific Heights/Beverly Hills/Berkeley Hills/Upper West Side/Harlem Democrats and the “Running Scared” Democrats from the western, southern and border states, who actually require independent and some moderate Republican support to get elected. These parties have very little in common other than the Capital D after their names.
