Category: Uncategorized

And the Health 2.0 Design Award Goes to … by Indu Subaiya

Nov 23, 2007

I’d
like to dedicate my Thanksgiving post to the people who are working on,
have worked on and most importantly, ought to be working on issues of
design and usability in healthcare.

I seem to be joined by Sohrab Vossoughi, Founder of Ziba Design who wrote a viewpoint article in this week’s Business Week, Designing the ‘Care’ into Healthcare.

What do I mean by design? To quote Joan Osburn, who runs Osburn Design,
a well-known architecture and design firm in San Francisco, with her
husband Steve, "design is not decoration." Design to me is a philosophy
and an intentionality behind creating things, be they physical
structures, gadgets, websites or services, that translate into an
optimal user-experience. Optimal, in turn, has elements of both
functionality and beauty i.e., (1) were you able to do what you needed
to do and, (2) did you enjoy doing it?

> Continue reading this post on the Health 2.0 Blog

HEALTH 2.0: In mourning, meanwhile over at Health 2.0 Blog

Nov 23, 2007

Like every proud American I’m spending the day paralyzed by the effect of way too much excellent food and wine yesterday. And like every other Englishman (ex-pat or Blighty-based) I’m also mourning the national team’s appalling performance in losing at home to the mighty Croatia and hence missing out on going to the European Championships finals next summer.

So while THCB sleeps forlornly over the weekend, Health 2.0 Blog is up and humming with Indu Subaiya’s superb thanksgiving for excellent design in health care.

POLICY: Someone else beats up on Herzlinger

Nov 21, 2007

Here’s Maggie’s takedown of Herzlinger’s WSJ column, with a heavy dose of Uwe included. And as far as I can see the most important thing about any regulated individual insurance system is consistency of benefits across plans—which means the plans then have to concentrate on improving care rather than gaming risk selection. And then there’s risk adjustment between them. (At least that’s the original Enthoven model).

I haven’t felt the need to torture myself enough to read the latest Herzlinger book—given that I suffered through the previous two, I awarded myself time off for good behavior. However, she appears to want to allow plans to offer personalized benefits “for consumer choice” and then somehow do back end-risk adjustment between them later. Funnily enough that’s roughly what Wellpoint’s California lobbyist said when I asked how they justified selling Tonik et al. At the least it sounds very complex (after all, risk-adjustment between plans with identical benefits is hard enough), and in reality it’s probably just more destruction of the risk pool.

So in other words the part of Switzerland that does work (the uniform benefits) is the part that Reggie wants to destroy. No doubt Maggie will be looking forward to lots of incoherent comments and accusations of plagiarism and poor research skills on her blog.

The Massachusetts Plan: What did they know, and when did they know it? by Eric Novack

Nov 20, 2007• 6

Dateline, Boston…

According to an article in the Sunday,November 18th, 2007, Boston Globe, “(Massachusetts) the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection.”

2009 looks worse: … “Since insurers who participate in the subsidized program are expected to ask for significantly higher payments from the state”.But, government regulators are keeping up appearances: "It’s too early to make any departure from the health reform plan," said Leslie Kirwan, secretary of administration and finance and chairwoman of theCommonwealth Health Insurance Connector.”

“"It’s a good problem to have – people are getting insured and hopefully getting care," state Senator Richard T. Moore told the newspaper.

When the Patient is a pain the doctor blames Google, by Matthew Holt

Nov 20, 2007• 2

This article in Time written by an New York-based orthopedic surgeon is called When the Patient Is a Googler. But the problem is not Google, or online health information searching. Most doctors like a better informed patient. The problem is that this patient didn’t respect the doctor and that the doctor in turn didn’t respect the patient.

Trot over to Tara Parker-Pope’s Well blog on the NY Times to see a lot of comments about the surgeon’s attitude. (And no cracks from those of you who know a few orthopedic surgeons!)

Matthew Holt

POLICY: Low prices ain’t cheap enough

Nov 20, 2007• 23

Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans.

Fewer small employers offered health insurance this year, despite
the widespread availability of new, lower-cost high-deductible
insurance plans, a survey released today by benefit firm Mercer shows.
Advocates of the high-deductible plans touted them as one solution to
the growing number of uninsured, expecting the plans to appeal to small
employers, who would continue to offer health insurance as a result.
"That’s not happening," says Blaine Bos, a Mercer partner and one of
the study authors. "In fact, the reverse is happening."The
study of nearly 3,000 employers found that the percentage of employers
with 200 workers or fewer offering any kind of health insurance fell to
61% this year from 63% in 2006.That drop came even as the cost
of high-deductible plans with tax-free savings accounts averaged $5,970
per worker per year. That was $700 less than a comparable plan without
a savings account and far lower than the $7,120 for the average HMO,
the study says.

HSA/HRA type plans are growing in the market, but not as fast as employers are dropping coverage.

POLICY: The NY Times Remembers the War on Drugs, but has learned none of its lessons

Nov 20, 2007• 1

No one bothers to care much about the war on (some) drugs these days. Sure it’s an $80 billion a year boondoggle for law enforcement and criminals, paid for by the taxpayer at an untold cost in lost civil liberties. But that pales in comparison to the $200 billion a year boondoggle otherwise known as the War in Iraq—a trough in which there are even more snouts. And of course one which has created even more problems than the war on drugs, which may even have a larger effect and last as long. But out of nowhere, the NY Times Editorial page has remembered.

Sadly remembering and understanding are two very different things.

Mexican criminals make money off the criminilization of personal behavior in the US. That money, in the form of cash and guns, flows south. And there’s a terrible inevitability about it, as the Times says, Yet so long as there is demand, the narcotics will always find a route, through Mexico or some other way.

So what, after 90 years of failed prohibition, is the NY Times’ radical answer? Send more money to the Mexicans from the US taxpayer so that the police there can buy more guns.

Did Judy Miller get moved to the editorial department? The NY Times editorial is drinking the kool-aid straight from the futile but endless fundable idiocies of the drug warriors at the DEA. Can it not do better?

HEALTH2.0: Personal Genome Management–The Next Big Thing?

Nov 19, 2007• 3

There are 160m Americans looking for health information online and
somewhere in the realm of 10–30% of those are viewing and creating
their own content. But that has made moderate impact on the mainstream
press (with Laura Landro being an honorable exception). So it was a
little surprising to see both the WSJ and the NY Times feature a related issue in the last week—online genetic screening.

Suddenly the concept of getting your genome tested and laid out online is really hot. 23andme (with its Google connection and Esther Dyson on the board) and Navigenics
(with Kleiner Perkins and MDV as blue chip VCs in a $25m round) are the
two best known west coast players. 23andme has already found out that Warren and Jimmy Buffet are not related and you can go to their site and sign up for their service for under $1,000. (And learn lots more about it in this Wired article) But they’re not alone. In Boston, Knome is
gearing up for something similar and Icelandic company DeCODE genetics,
which already has a database with the island’s entire population in it,
has also introduced a similar service called DeCodeMe.

And of course there’s The Personal Genome Project. It’s an effort led by George Church and includes 10 people who are putting all their genetic information online. (One is Esther Dyson of course)

Meanwhile, plenty of other companies are doing genetic testing mostly on genealogy grounds. The Genetic Genealogist Blog estimates that some 600,000 tests have been done and they are worth about $300 each. but for an annual market, that’s only $25m. The Genetic Genealogist Blog also has a long list of those genetic companies.

Finally, while there’s all this excitement about doing comprehensive DNA testing, DNADirect has been offering a direct to consumer service for a couple of years which offers the most common tests. You can see their price list here. One estimate which seems in the ball park is that the total market for that testing is $200m.

But let’s hang on a minute. (Read the rest on Health 2.0 Blog)

When is a Medical Error a Crime? by Bob Wachter

Nov 16, 2007• 17

Bob Wachter is one of the nation’s leading experts on medical safety and one of the pioneers of the hospitalist movement. And now he’s descending into the mire of blogging! So we’re pleased to cross post one of the more recent pieces from his (relatively) new blog Wachter’s World.

Robert_wachter The first commandment of the modern patient safety movement was “Thou Shalt Not Blame.”
Old-Think:
errors are screw-ups by “bad apples,” and can only be prevented by some
combination of shaming and suing the doctor or nurse holding the
smoking gun. New-Think: errors represent “system problems;” any
attempt to assess blame will drive providers underground, inhibiting
the free-flow of information so crucial to error prevention. Like
most complicated issues in life, the truth lives somewhere between
these polar views. In the main, the “no blame” view is right – most
errors are committed by good, hardworking docs and nurses, and
finger-pointing simply distracts us from the systems fixes that can
prevent the next fallible human being from killing someone.Yet,
taken to extremes, the no blame argument has always struck me as both
naive and more than a little PC. Anyone who has practiced for more than
a month can name docs and nurses who they would never want caring for
their loved ones. And what about the substance-abusing nurse, the
internist who doesn’t keep up with the literature, the
retractor-throwing surgeon, or the provider who refuses to follow
reasonable safety rules. If nobody is ever to blame, who is
accountable?

Think Again: Payments to doctors By Eric Novack

Nov 16, 2007• 9

I am frankly a bit surprised at the lack of comment at THCB on the recent orthopedic device
manufacturers’ settlement with the government for concerns about illegal payments to physicians. I would have expected Matthew or Maggie, at least, to be sounding the alarm over the dangers of the private sector in healthcare. The most interesting byproduct of the settlement is the development of a public database where you can search by company to see who is getting the ‘big bucks’.

But like many simple statistics, the data can be misleading.

Let me be clear—paying a surgeon for ‘work’ with the real expectation that he or she will use a specific product is unethical, not to mention illegal (but a problem inherent in our 3rd party paymentsystem in medicine, but that is another issue entirely…).

One Phoenix area surgeon has been paid $3 million this year by Stryker.

‘Outrageous’, you say. “Ah- ha—see, all doctors are corrupt and need to be controlled”, others exclaim. But what are the facts? In this case, the surgeon helped develop some of the early hip and knee replacement designs… These designs have served as the basis for literally millions of replaced joints over the last 20 years. He owns a piece of the patent.Is it immoral to get paid for people using a product you work hard to develop? Should Google’s founders still benefit? How about those who own patents on everything vacuum cleaners to hair care products?

Of course they should– because our society encourages innovation by protecting the value of innovation.