Category: Uncategorized

The Connected Medical Home: Health 2.0 Says “Hello” to the Medical Home Model

Dec 22, 2008• 21

By David Kibbe & Joe Kvedar

The concept of participatory medicine is taking hold, fueled, at least in part, by what we see as two complementary forces, these being the patient-centered medical home (PCMH) and Health 2.0. Health 2.0 is very much a grass roots phenomenon, dominated by a small but significant group of patients who are testing the hypothesis that the wisdom of the crowd can rival the wisdom of physicians. The PCMH is a concept, not new, but gaining tremendous traction in the provider sector now as a best-try effort by some providers to be truly patient centric in their approach. The two should be complementary and mutually self-supporting. One might even suggest their respective champions should be collaborating right now, when the scent of health reform is in the air in our nation’s capital. But they are not. Lets examine why and explore ways in which to create a natural bridge between these two concepts and their champions.

The medical home concept was first introduced by the American Academy of Pediatrics in the 1960s. But several factors are now converging to update this original concept for today’s health care environment. The growth in chronic illness, the emergence of new reimbursement models designed to improve quality and control costs (e.g. pay for performance), and the greater availability of monitoring and messaging technologies have providers, payers and patients taking a fresh look. This is a good thing, in that it is an effort by organized medicine and large corporations to get into the reform conversation.

But the aspects of the medical home that are getting the most airtime are largely focused on rounding out office staff, adding new roles that take work away from the physician so that the physician can tend to more patients, and taking a population view of the patient panel. This vision is idyllic, but several challenges suggest that as conceived it will be tough to get it out of the womb.

Prop 8 still reverberates, and bigotry is still with us

Dec 21, 2008• 20

By Matthew Holt

There’s a pretense from the ~~anti~~ (whoops!) pro-Prop 8 diehards that somehow this is not about them hating gay people. Rick Warren says that, as did Mike Huckerbee said when he ended his (clearly losing) conversation with John Stewart on The Daily Show. Frankly I’d be happier if they just came out and admitted it.

In a portrayal of one of the most unpleasant sounding families I’ve heard about in some time, the LA Times has a couple of juicy quotes. And the unpleasant family and their equally unpleasant pastors essentially come out and say it.

The Bible is very, very clear . . . that that kind of perversion will not get people into heaven," Abel said. "They’re fallen people, broken people, hurting people."

SNIP

Brooklyn and her family believe that gay activists have unfairly painted Proposition 8 supporters as "hate-mongers and bigots."

Hmm…who’s painting who?

But I’m always amazed that while caring so much about what happens in the afterlife, the fundamentalists among us are so determined to ruin other people’s lives in this space-time continuum.

CODA: The ridiculousness of the “resting on what the Bible says” position is of course best revealed in this classic, which ended up being used in a memorable scene in The West Wing.

Weighing in on the New FDA Commissioner

Dec 21, 2008• 1

By MERRILL GOOZNER

Patient
advocacy groups, most of them drug industry-funded, have asked
President-elect Barack Obama to appoint a Food and Drug Administration
commissioner who won’t cave in to pressure from lawmakers or the news
media, according to the Wall Street Journal.

It is news to me that the news media has much say about decisions at
FDA. There are reporters who highlight problems, especially safety
problems, in the nation’s food and drug supply. And there are reporters
who highlight every study suggesting the next miracle cure is just
around the corner. Large news organizations like the New York Times
have both. For every Gardiner Harris, there is a Gina Kolata. The news
media are megaphones. They are not, to use someone else’s phrase, the
decider.

Vioxx and Avandia didn’t come to light because of the press or angry
legislators on Capitol Hill. What consumers and patients, legislators
and the press learned about the lethal side effects of those drugs was
due to diligent researchers like Steve Nissen and Eric Topol and
courageous whistleblowers inside the FDA like David Graham. Ditto for
most of the other safety scandals that have plagued the agency in this
decade.

That said, patient advocates who are worried that the agency under a
more safety-conscious commissioner will somehow abandon the search for
faster cures should know that their views are well represented inside
the transition team. Josh Sharfstein, the Baltimore health
commissioner, formerly on Rep. Henry Waxman’s staff, who took up cause
of making pediatric cold medicines safer, may be leading the effort.
But his co-conveners include Greg Simon, who heads a group called . . .
da da . . . Faster Cures (not industry-funded, according to Simon). The
other team leader is attorney Alta Charo from the University of
Wisconsin, whose expertise is primarily in bioethics, not drug safety.

Cool Technology of the Week

Dec 20, 2008• 5

By John Halamka

In my experience, social networking applications gain marketshare by being first to innovate and then spreading virally.

I
was an early adopter of Facebook but delayed joining Twitter, a
microblog that enables me to post instant blog entries via SMS from my
Blackberry.

Over the past 60 days, I have seen an incredible
rise in Twitter use among my colleagues and have now joined the ranks
of folks who "Tweet" their blogs. You’ll find me at http://twitter.com/jhalamka

Here’s what I do to use Twitter :

Conservatives Need to be Part of Health Care Reform

Dec 20, 2008• 3

By Robert Laszewski

Stuart Butler, Vice President of Domestic Policy at the conservative Heritage Foundation has an op-ed in Thursday’s Washington Times, “Four Steps Can Heal Health Care.”He makes some very valuable points and proposes four steps toward reforming the health care system most people—liberals and conservatives —could agree on:

Making sure every working family has access to an affordable private health plan
that could include state-based default plans with agreed upon minimum
benefits and premiums subsidized through reinsurance pools that spread
any adverse risk over the broad private market.
Encouraging insurance exchanges not unlike those envisioned by Democrats but at the state level where Stuart sees these exchanges avoiding “endless Congressional micromanagement.”
Reforming the existing federal tax preferences for health insurance by capping the value of these tax breaks as a means to encourage more efficient plans and raise revenue to help pay for premium subsidies
Redesigning the Medicaid and SCHIP programs
by giving states the ability to streamline these programs and free-up
funds to expand the help the low-income people get for health
insurance—including vouchers to purchase private coverage.

California transplant surgeon acquitted

Dec 19, 2008• 1

By Sarah Arnquist Roozrokh

A jury acquitted a San Francisco transplant surgeon Thursday of criminal charges
related to his alleged actions during an attempted organ harvest nearly three years ago in a small town on California’s central coast.

In what’s thought to be the first case of its kind in the United States, prosecutors accused surgeon Hootan Roozrokh of ordering excessive amounts of painkillers to hasten the death of a potential organ donor.

The not-guilty verdict relieved the
transplant community, which feared the case would have chilling effects
on the public’s willingness to donate organs and surgeons’ willingness
to participate in the rarer type of donation done in this case, called
donation after cardiac death or DCD.

The Medicare Ponzi Scheme

Dec 19, 2008• 21

By Eric Novack

Just today, our next President spoke out against the largest investment swindle in US history. The alleged behavior of Bernard Madoff may have cost investors up to $50 billion.

“In the last few days, the alleged scandal at Madoff Investment Securities has reminded us yet again of how badly reform is needed when it comes to the rules and regulations that govern our markets. … And if the financial crisis has taught us anything, it’s that this failure of oversight and accountability doesn’t just harm the individuals involved, it has the potential to devastate our entire economy. That’s a failure we cannot afford.” — Barack Obama Dec. 18, 2008

What did Madoff do? He lured investors with big returns, and used the “profits” as a means to encourage additional investment by investors, while luring new ones.

Washington, Please Don’t Bail Out the Health Care Industry

Dec 19, 2008• 61

By RICK PETERS Capital

A health care Marshall Plan — $50 Billion stimulus to get electronic health records (EHRs) in every doctor’s hands or $50,000 to each physician -– what an incredible marketing job.

Detroit, are you listening? Stop whining to Congress that you need a bailout. Tell them you want to be the new alternative energy Manhattan Project, get the money, and then keep building SUVs and flying around in corporate jets.

To Congress, Daschle, and Obama, please don’t do this. Our industry, health care, combines the worst of the Big Three automakers with the worst of the hubris, dishonesty, and failure of the public trust of Wall Street. Please do not bail us out.

An Open Letter to the Obama Health Team

Dec 19, 2008• 48

By David C. Kibbe & Brian Klepper

It seems likely that the Obama administration and Congress will spend a significant amount on health IT by attaching it as a first-order priority to the fiscal stimulus package. We take the President-elect at his word when he recently said:

“…we must also ensure that our hospitals are connected to each other through the Internet. That is why the economic recovery plan I’m proposing will help modernize our health care system – and that won’t just save jobs, it will save lives. We will make sure that every doctor’s office and hospital in this country is using cutting edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes, and help save billions of dollars each year.” (December, 6, 2008)

Whether the health IT money is well spent will depend on how it is distributed and what it buys. Most observers suppose that federal health IT investment dollars will be used to help doctors’ offices and hospitals acquire and implement electronic health record systems (EHRs or EMRs). These are commercial software suites for entering, storing and managing patient health data within a practice or health organization.

Jack says cover the uninsured & spend less!

Dec 18, 2008• 5

By Matthew Holt

It’s no secret what the Dartmouth group’s solution for the health care system has been — reduce practice variation, get surgery and physician resource use rates similar to the Mayo Clinics’ of the world, and take the huge savings that would be generated to cover the uninsured. In fact Wennberg, Skinner, Fisher & Weinstein, now joined by “gone native” journalist Shannon Brownlee, have a new White Paper out—their own open letter to Obama’s mob.

Along the way that requires demand-side reductions (achieved by shared decision making) and supply side changes.