Category: Uncategorized

Patients still choose docs based on word of mouth

Dec 4, 2008• 3

By Sarah Arnquist

Patients still choose where they receive care based on good old word of mouth and referrals from their doctors, despite numerous Web sites and initiatives aimed at giving them information to compare the cost and quality of doctors and hospitals.

That’s the finding of a new national study released today by the Center for Studying Health System Change (HSC) and funded by the California HealthCare Foundation.

The key findings were:

In 2007, only 11 percent of American adults looked for a new primary care physician. In doing so, half relied on recommendations from friends and relatives, 38 percent relied on physician recommendations, and another 35 percent used health plan information.
When choosing specialists, nearly all consumers relied exclusively on physician referrals.
Use of online provider information ranged from 3 percent for consumers undergoing procedures to 7 percent for consumers choosing new specialists to 11 percent for consumers choosing new primary care physicians.
Very few of the 35 million adults who underwent a medical procedure used information other than the doctor’s referral in deciding where to seek care.

The bottom line: All the hoopla about consumer shopping and seeking out the bargains and best value for themselves, may be just that – hoopla.

How do all the Health 2.0 platforms launching into this area plan to change this ingrained consumer behavior?

There’s waste in the medical system–Duh!

Dec 3, 2008• 6

By Robert Laszewski

As we begin the health care reform discussion in earnest, many are pointing out all of
the waste in the system and the need to research what works best, provide the incentives to do it, manage the big spenders’ chronic care better, make better use of heath information technology, and encourage wellness and prevention.

One of the disadvantages of being at this for more than 20 years is that I feel like I’ve seen this movie a few times before. You may recall the picture "Groundhog Day" where the guy kept living through the same thing time after time.

I am particularly taken by those that cite the statistics regarding health care waste and efficiency as if this was a new discovery they made in the last few days.

For example, the excellent groundbreaking research from Dartmouth is often cited pointing to the conclusion that as much as 30% of all medical spending does nothing to improve care.

I can’t disagree with many of these conclusions having argued much the same myself.

Addressing an epidemic of overtreatment

Dec 3, 2008• 6

By John Halamka & Rich Parker

Health care costs in the U.S. are approaching 17 percent of the GDP and may be as high as 20 percent in the next few years.

What is causing the US to have the highest cost and lowest value for the healthcare dollar? Simple – it’s overtreatment.

Overtreatment
takes many forms – from over ordering expensive diagnostic tests to the
prescribing of expensive and sometimes unneeded therapeutics.

After 12 months of recession, whither health reform?

Dec 3, 2008• 1

By Jane Sarasohn-Kahn

We’re in a recession; actually, we’ve been in one for the past year, but no official agency decided to tell us. Perhaps "they" wanted to wait until after the November ’08 Presidential election?

The declaration of recession is the official news from The National Bureau of Economic Research (NBER), whose mind-numbingly-titled press release, Determination of the December 2007 Peak in Economic Activity, provides the following important details:

* The Business Cycle Dating Committee of NBER met by conference call on 11/28 to discuss whether the U.S. economy was in recession.

* The group figured out that the U.S. economy "peaked" in December 2007.

* They calculated that the 12/07 peak ended the economic expansion that started in November 2001, lasting 73 months.

* The previous expansion in the 1990s lasted 120 months (that would include, but not be limited to, The Clinton Era).

* Other measures of a declining economy — including personal income less transfer payments, real manufacturing and wholesale-retail trade sales, industrial production, and employment estimates based on the U.S. household survey — also peaked some time in the past 13 months.

Presidential Rx for Health

Dec 2, 2008• 4

By Susan Blumenthal and Yi-An Ko

Capital_2
Past U.S. presidents have provided innovative leadership that shaped the landscape for our national health and science institutions.

President Lincoln established the National Academy of Sciences. President Truman’s foreign policies inspired the creation of the United States Agency for International Development (USAID). President Lyndon Johnson signed legislation that established Medicaid and Medicare. And President Clinton signed legislation that created the State Children’s Health Insurance Program (SCHIP).

Currently, our country faces significant health challenges including skyrocketing health-care costs, declining funding for medical and scientific research, and a lack of effective coordination and innovation in the government’s response to emerging health threats such as obesity and pandemic flu. Addressing these issues must be a top national and foreign policy priority for the next administration. With transformational leadership, President-elect Barack Obama has the opportunity to build upon his predecessors’ legacies and write a new national prescription for improving the health of Americans.

Extracting more value from the health care dollar

Dec 2, 2008• 1

By Sarah Arnquist

Americans spend more money on health care than any other nation, but get far less in return, say multiple health care executives in Sunday’s Washington Post.

That’s not news to readers of this blog, but probably is not yet common knowledge among the general American taxpayer. That might change. The news media seems to be writing about this "value gap" more frequently, particularly in citing the growing momentum behind creating a center for comparative effectiveness research to evaluate drugs, devices and treatments to find out what works best.

Defining and measuring value is not easy, but increasingly public and
private health care purchasers are using their market power to demand higher quality care. Whether the science is
ready to support this "value-based purchasing" is the topic at the ECRI Institute’s annual conference today and tomorrow. (I’m attending the conference and will report on it tomorrow.)

More on the 5 myths of U.S. health care

Dec 2, 2008• 1

By Charlie Baker Charlie_baker

A good friend sent me a recent op-ed from the Washington Post that discussed the 5 myths of health care reform by Shannon Brownlee and Ezekiel Emanuel.

I’ve written about both of them before (here & here). Brownlee is a visiting scholar at the NIH’s Clinical
Center, and Emanuel is the chair of the Center’s Bioethics Department.
Ezekiel also happens to be the brother of incoming White House Chief of Staff Rahm
Emanuel’s. Hmmm…

Anyway, I really like most of what they have to say – which will
probably come as a surprise to them – and maybe to some of my
colleagues as well. Their five myths are, in no particular order…

1) America has the best health care in the world.

2) Somebody else is paying for your health insurance.

3) We would save a lot if we could cut the administrative waste of private insurance.

4) Health care reform is going to cost a bundle.

5) Americans aren’t ready for an overhaul of the health care system.

e-patient Dave & his e-doctor describe their journey in participatory medicine

Dec 2, 2008

By Sarah Arnquist

Over at the e-patients blog, blogger e-patient Dave has posted video clips from his presentation with Dr. Danny Sands at the Connected Health Forum last month at Harvard Medical School.

Dave describes the presentation called "Illness in the Age of ‘e’ " as a "full-length case study in participatory medicine." Here’s the first video clip. To see the rest go to the e-patients blog, where presentation slides are also uploaded.

Fact or Fiction: Electronic health records save money

Dec 1, 2008• 24

Note by Brian Klepper: Today the actuarial consulting firm Milliman is convening a town hall meeting in Seattle focused generally on health care reform, but specifically on Electronic Health Records (EHRs). The larger Seattle metropolitan area is a hotbed of health care innovation, with Virginia Mason Health System, Costco, Starbucks, Boeing, Premera and other forward-thinking firms. The conference will have representatives from CMS, Microsoft, the VA, Group Health Cooperative, and Milliman, and is open to the public. Should be an interesting session.

To kick it off, here’s a little piece on EHRs by Jeremy Engdahl-Johnson, Managing Editor at Milliman.

By JEREMY ENGDAHL-JOHNSON

Of all the initiatives endorsed by outgoing Secretary of Health Mike
Leavitt, few are likely to be met with as much agreement by his likely
successor, Tom Daschle, as the need for wider adoption of electronic
health records (EHR). While there is general agreement on the need for
this technology investment—both presidential campaigns included EHR in
their health platforms—the cost ramifications are still up for debate.
Will electronic health records reduce costs? There are compelling
reasons to answer both “yes” and “no.”

Fighting AIDS for decades

Dec 1, 2008

By Sarah Arnquist

Every 9.5 minutes, someone in the United States is infected with HIV. Every 33 minutes, someone in the U.S. dies from AIDS.

While great gains have been made in the fight against HIV, still more than 53,000 new HIV infections occurred in 2006 and it predominately burdens minority communities. Young, black men and women are at the highest risk of new infection. The HIV incidence rate for black females is nearly 15 times the rate for white females, according to the CDC.

Today is the 20th anniversary of World AIDS Day. Here are some links to excellent summaries of the progress in fighting HIV in the U.S. and around the world.

Message from World Health Organization Director-General Margaret Chan.
Updated estimated U.S. incidence of HIV from the Centers for Disease Control and Prevention.
World Aids Day Blog.
Aids.gov HIV & AIDS quick facts.