Health minister “denies she is crazy”. OK she’s Australian, so take that with a grain of salt.
What’s the fuss about? Using more allied professionals to replace primary care docs. Apparently that’s not certifiable, even in Australia.
Managing obesity, Japanese style
So after making cracks about Strength through Joy last week, it appears that plans to change the health of the nation are happening. Not here of course, but the NY Times tells us about Japan:
Under a national law that came into effect two months ago, companies and local governments must now measure the waistlines of Japanese people between the ages of 40 and 74 as part of their annual checkups. That represents more than 56 million waistlines, or about 44 percent of the entire population.
Those exceeding government limits — 33.5 inches for men and 35.4 inches for women, which are identical to thresholds established in 2005 for Japan by the International Diabetes Federation as an easy guideline for identifying health risks — and having a weight-related ailment will be given dieting guidance if after three months they do not lose weight. If necessary, those people will be steered toward further re-education after six more months.
To reach its goals of shrinking the overweight population by 10 percent over the next four years and 25 percent over the next seven years, the government will impose financial penalties on companies and local governments that fail to meet specific targets. The country’s Ministry of Health argues that the campaign will keep the spread of diseases like diabetes and strokes in check.
SNIP
Companies like Matsushita must measure the waistlines of at least 80 percent of their employees. Furthermore, they must get 10 percent of those deemed metabolic to lose weight by 2012, and 25 percent of them to lose weight by 2015.
NEC, Japan’s largest maker of personal computers, said that if it failed to meet its targets, it could incur as much as $19 million in penalties. The company has decided to nip metabo in the bud by starting to measure the waistlines of all its employees over 30 years old and by sponsoring metabo education days for the employees’ families.
Sounds like fairly vicious pay for performance to me!
Do worker wellness programs violate employee privacy?
Employees are split on whether employer wellness programs intrude on privacy, according to an Issue Brief from the Center for Studying Health System Change (CSHC).
The report details the results of interviews conducted in 2007 in 12 metropolitan American communities: Boston, Cleveland, Greenville, Indianapolis, Lansing, Little Rock, Miami, northern New Jersey, Orange County, Phoenix, Seattle, and Syracuse.
Employee wellness programs are growing in the marketplace as employers try to stem ever-increasing costs, both direct and indirect. This is real money: a report from the American Hospital Association estimated that three chronic diseases — asthma, diabetes and hypertension — accounted for 164 million days of absenteeism each year which cost cost employers $30 billion.
Health wonk review
Jane Hiebert-White compiled it over at Health Affairs blog.
Paul Wallace–Get the patients brain in the game
Paul Wallace, who is both Senior Medical Director at Kaiser Permanente and Chair of the Center for Information Therapy, has some sensible things to say about the transition from Health 0.0 to 1.0 and then includes some of the lessons of Health 2.0. He also wanted us to think about the links to the big building behind him in this picture.
Kaiser now has the EMR up everywhere — that’s 1.0 in his terms—information flow. The workflow change is a big deal and we have to think about it. Paul used to wait a few days before dictating notes. No more. That information is needed immediately, and his colleagues let him know about it!
Wallace on the deal with HealthVault—we now have the opportunity to “understand the operational implications of such an endeavor”. Ho, Ho. What does portability really mean? He can see his medical record in Berlin. How does that change care?
The Advisory Board’s David Bradley had earlier told a story earlier of tapping into early wisdom of the crowd to discover that he had shingles. An instructive story of 2.0–-sharing health information and discovering more than is known by the system.
What about engaging the employer. You spend 2000 hours at work each year and probably 1/100th of that with a doctor. Where can we have a bigger impact?
The 2.0 issue is to get the patients brain in the game….
He likes Susannah Fox’s phrase—"let’s design for what could be."
Lucas Merrow demos Eliza
Lucas is demoing today’s flashiest presentation at The Center for Information Therapy’s Wired.
Thank goodness; it’s 4:30 and there’s been no audience bleed out the door since Merrow took to the podium.
I missed Eliza’s presentation at the Health 2.0 Spring Fling, so this
is the first time I’ve viewed the platform. Eliza has my interest when
Merrow describes "how we converse with people with diabetes" rather
than "diabetics."
Sometimes it is all about semantics; in this case, Eliza shows respect
for each person’s health/wellness goals via the details, right down to
terminology, not limiting our identity to powerless ‘patienthood’.
And it works. People respond to requests with respect. Lucas shares a
case study. When Eliza took over for a client – 23 percent prescription
refill rate. They saw an increase right off the bat – 10% early –
"primarily due to the conversational nature of the service."
Eliza has it right here – Healthcare is a conversation. Let’s keep talking.
PCHIT and patients online…
Josh Seidman & Ted Eytan (he of the latest, latest Health 2.0 definition) have written a piece for CHCF called Helping Patients Plug In: Lessons in the Adoption of Online Consumer Tools.
Susannah Fox (all hail!) from Pew is talking about patients online. She gave some neat data Broadband is about 20 points below basic Internet access….at about 54% overall (up from 5% in 2000). It’s only pockets (those over 70s, Spanish speaking Hispanics). Health care is stuck in broadcast, not interactive. Susannah thinks that the option is to go mobile—especially for low income young minority males. I asked her about broadband….it’s growing but slowing she says, but there’s lots of potential to copy what’s happening elsewhere. Susannah’s quote of the day “Online banking may be softening people up for PHRs…”
My Group Health and “Killer Apps”
Here at the Center for Information Therapy’s Ix Conference,
transparency is the name of the game. Transparency in information transfer, information therapy, also literal transparency – we’re surrounded by tons of
glass and steel here, late-morning light is streaming in, and attendees zone out to a sweet view of the Washington Monument.
James Hereford, executive VP of Strategic Services
and Quality for Group Health Cooperative (Seattle), has the smooth
charm that tells you he has a sales background. He’s taking us on a tour of Group Health’s portal – My Group Health.
His pitch – "My Group Health" is a combo of killer apps, including:
1. EMRs
2.
Secure messaging (between doc and patient)…Group Health has
received/sent these from all over the world, every continent, including
Antarctica
3.
Automated results sharing (lab results)
4. After visit summary
5. Integrated health profile
Hereford’s thesis on the main difficulty of HIT adoption – it’s "completely
psychological." Providers (1k in the Group Health network) didn’t believe the patient should
have ANY information before they did. There’s a shocker.
But as James points out – "You don’t have to be a brain
surgeon to look at your lab results and figure out if they’re outside the
normal range."
The Health IT politics overview (more from Ix)
Up next at Information Therapy was Claudia Williams from Markle introducing Kavita Patel, Ted Kennedy’s staffer from the Health (et al) Senate sub-committee, and Joel White, a former Republican staffer now running the Health IT Now coalition. There was far too much agreement between Kavita and Joel for my liking!
Essentially they both agreed that the Federal government should pay something for Health IT, and Joel said that actually HHS is piloting spending up to $56,000 per physician to buy medical records.
Joel seemed OK with this—and like Newt Gingrich—seems to be OK with socialist mandates as the way to provide IT (that is, the government paying). On the other hand, Kavita wasn’t sure that the Feds should pay for everything and maybe the states and even consumers should be paying something. So I for one now don’t understand where ideology has gone in health politics!
But they were both confident that bipartisan legislation will pass encouraging Health IT (such as ePrescribing) via Medicare and other programs in the next Congress (but not this one) but both were a little concerned about the incentives problem. As Claudia said, Health IT leads to better quality, but Health IT won’t be widespread without a change in incentives.
CODA: Meanwhile and somewhat off topic, at the end Joel, (who’s now a fellow at Galen with Grace Marie Turner to give you a hint), went off on a rant about what was wrong with comparative effectiveness research. He recited PhRMA’s lines pretty well, but ran away before the mass ranks of Kaiser attendees surrounded him and pecked him to death. If you want to see some of the controversy about who has what to say about comparative effectiveness, look at what Merrill Goozner said about it last year.
The Massachusetts Question
Two years ago lawmakers in Massachusetts made the state the first in the nation to mandate that residents purchase health insurance. The proposal quickly caught on, inspiring similar efforts on the state level and eventually becoming the blueprint for the national health reform efforts of Democratic presidential candidates Sen. Barack Obama and New York Sen. Hillary Rodham Clinton.
More than a year into the experiment the first returns are in. And reviews are mixed. Not surprisingly, the program is costing far more than backers had initially predicted. On the other hand, the ranks of the uninsured in the state have dropped sharply. (See Matthew’s podcast with Jon Kingsdale, executive director of the Massachusetts Connector, the agency created to administer the program, for more on the back story.) The Massachusetts experiment is clearly not something to be dismissed — nor is it something to
defend for the sake of argument.
In brief, the Massachusetts health care reform law appears on its way to:
- Covering two-thirds of those who did not have health insurance on the day it was enacted — about 400,000 people by the end of 2009.
- Covering most of those who were uninsured in households with incomes below 300 percent of the federal poverty level–below which the plan pays all or most health insurance premiums.
- Offering health insurance plans to middle-income people that are still largely unaffordable for those families making less than $110,000 a year –– people for whom the state has generally canceled the individual mandate that they must buy coverage.
- Racking up costs well above what was first estimated. The plan looks to be coming in 38 percent higher than originally estimated for its first year and the Governor is now estimating second year costs 50 percent higher than the original estimate –– from $725 million to $1.1 billion for the 2008-2009 fiscal year.
- Developing an annual cost trend for the program’s insurance programs, Commonwealth Care and Commonwealth Choice, in the 10 percent to 15 percent range.
So, lots more people, particularly lower-income residents, are covered but the program’s costs are unsustainable.
