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HEALTH PLANS: Trading health plan stock rumors for fun & profit

• 3

Just when you thought stock action in health plans was all dull, along comes a little fun. Wellcare’s chart of course looks about as good as the average stock chart when the Feds raid. Whatever the company says, Wall Street believes it’s bad news. $120 to $25 in 5 days is Enron-type numbers, and one rumor is that some directors were selling not a couple of months back, but a couple of weeks.

Wellcare

But the fun continues. Humana is the “big” health plan that’s made the greatest push into Medicare Private FFS where most of the abuses have occurred and it’s also huge in Florida. (I don’t have to explain that statement I hope). That was enough for one analyst to say on Friday that they heard the sound of FBI sirens too, and the stock fell about 5% in a few minutes, before recovering when it was confirmed that the sirens were in his head. (OK, maybe the FBI doesn’t use sirens!)

Humana

But then Humana released some great financial results on Monday and the stock rallied on the opening up 5% from where it had been, but then ended up falling more than 10% on the day. Why? Well perhaps its because when some smart types look at the numbers they notice that the MLR fell from 84% to 81% in a year. So first, what happened that there was such a big fall? And second, if most of this increased profit comes from the Medicare business, why would the end-payer (you and me represented by Pete Stark et al) put up with it?

This of course makes Humana a fun stock for the swing traders on the message boards. But I’m not so sure it makes for great public policy.

Patients: Coordinated Physician Care Pilots – Paul Grundy MD, IBM

• 5

Dr. Paul Grundy helped organize
the Patient-Centered Primary Care
Collaborative at IBM and serves at its Chair. IBM spends about $1.7 billion a year on
healthcare for its employees and families, providing coverage for half a million people. The company is working to improve their
healthcare quality, while lowering costs through wellness programs, but believes that more could be accomplished if a critical mass of key
healthcare participants work together to drive even more significant change. Executives believe the Patient-Centered Primary Care Collaborative is a major step towards that goal.   

Many studies have shown that patients with a personal
physician who coordinates their comprehensive care have better outcomes
with lower costs.  We want to make this a reality for patients in the
US. So we joined with the four major primary care physicians’
professional societies, national employers and their associations, quality
advocacy groups, academic centers and consumer advocacy  groups to create the
Patient-Centered Primary Care
Collaborative. The Collaborative is
advancing a new primary-care-based healthcare model called the \u003cu\>Patient-Centered Medical Home \n(PCMH)\u003c/u\>\u003c/font\>\u003c/a\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>. We're also \nworking to \u003cbr\>restructure traditional reimbursement practices, which currently \nincent physician \u003cbr\>specialization. We want to support and reward the \ncomprehensive delivery of \u003cbr\>primary care and expand the role of primary care \nphysicians as patient care \u003cbr\>coordinators. \u003c/font\>\u003cfont size\u003d\”3\”\> \n\u003cbr\>\u003c/font\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>\u003cbr\>Last week, we added to our \nmomentum. Aetna, BCBS Association, CIGNA, \u003cbr\>Humana, MVP Health Care, \nUnitedHealthcare, and WellPoint \u003c/font\>\u003ca href\u003d\”http://newsroom.cigna.com/article_display.cfm?article_id\u003d791\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>\u003cfont face\u003d\”Times New Roman\” color\u003d\”blue\” size\u003d\”3\”\>\u003cu\>announced\u003c/u\>\u003c/font\>\u003c/a\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\> they \u003cbr\>will support Medical Home pilot \ndemonstrations. \u003c/font\>\u003cfont size\u003d\”3\”\>\u003cbr\>\u003c/font\>\u003cfont face\u003d\”Times New Roman\” size\u003d\”3\”\>\u003cbr\>Together, we want to start one or more pilots \nnext year. Stay tuned! \u003c/font\>\u003cfont size\u003d\”3\”\> \n\u003cbr\>\u003c/font\>\u003cfont face\u003d\”sans-serif\” size\u003d\”2\”\>\u003cbr\>\u003cbr\>Steve\u003cbr\>\u003cbr\>IBM Analyst & \nInfluencer Relations\u003cbr\>Phone 845-677-1017 t/l 320-8929\u003c/font\>\u003cfont size\u003d\”3\”\>\u003cbr\>\u003cbr\>\u003cbr\>\u003c/font\>\n\u003ctable width\u003d\”100%\”\>\n \u003ctbody\>\n \u003ctr valign\u003d\”top\”\>\n \u003ctd width\u003d\”45%\”\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>\u003cb\>"Matthew Holt" \n <\u003ca href\u003d\”mailto:ma*****@*********lt.net” data-original-string=”D3FI2qmf/az26stSU+muXw==57dQII36Jdfq0M6s1L55w9BFXC4EpRUObGzunaJeWknIXg=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>ma*****@*********lt.net\u003c/a\>>\u003c/b\> \u003c/font\>\n \u003cp\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>10/19/2007 07:48 PM\u003c/font\>\u003cfont size\u003d\”3\”\> \n \u003c/font\>\u003cbr\>\n \u003ctable width\u003d\”100%\” border\u003d\”4\”\>\n \u003ctbody\>\n \u003ctr valign\u003d\”top\”\>\n \u003ctd width\u003d\”100%\” bgcolor\u003d\”white\”\>\n \u003cdiv align\u003d\”center\”\>\u003cfont face\u003d\”sans-serif\” size\u003d\”1\”\>Please respond \n to\u003cbr\><\u003ca href\u003d\”mailto:ma*****@*********lt.net” data-original-string=”rvvTB1dtlgerm7dElKh9Vw==57dZD/N1J61lZcWwrghmQ3J2rA+9U7iXfPmXrlxlj44zBM=” title=”This contact has been encoded by Anti-Spam by CleanTalk. Click to decode. To finish the decoding make sure that JavaScript is enabled in your browser.\” target\u003d\”_blank\” onclick\u003d\”return top.js.OpenExtLink(window,event,this)\”\>”,1]
);
//–><span face="Times New Roman" Patient-Centered Medical Home
(PCMH)  We’re also
working to restructure traditional reimbursement practices, which currently
incent physician specialization.  We want to support and reward the
comprehensive delivery of primary care and expand the role of primary care
physicians as patient care  coordinators.   
Last week, we added to our
momentum.  Aetna, BCBS Association, CIGNA, Humana, MVP Health Care,
UnitedHealthcare, and WellPoint announced they will support Medical Home pilot
demonstrations.   Together, we want to start one or more pilots
next year.  Stay tuned!  

Health 2.0 FAQ with UPDATE on Health 2.0 San Diego

Q. What is Health2.0 and why are we running conferences about it?

The term Web2.0 has been around since 2003. The O’Reilly organization both coined the term and created a definition that year, and then they went on to create the Web 2.0 Conference. Meanwhile over at The Health Care Blog and in his by now relatively long consulting career, Matthew Holt has been following technology in health care since the early 1990s. Some of his eHealth era reminisences were relatively poignant…Indu Subaiya, a healthcare consultant and entrepreneur was similarly starting to follow Web 2.0 trends and their impact on health as she embarked on designing a prototype for a medical record-sharing website.

Towards the middle of 2006 several start-ups began targeting health care using Web 2.0 technologies such as wikis, mash-ups, video, blogs communities, and user-generated data. And to be fair Wondir which has since been sucked into the Revolution Health vortex started a now seemingly defunct blog called Health 2.0 in late 2005. In early November 2006 Matthew did a podcast with 3 Health 2.0 companies on THCB, and the community was beginning to emerge.  (From now on Matthew is switching to “I” & “me”)

Two events crystallized this. First an article in Business 2.0 (part of CNNMoney these days) which was the first "mainstream" mention of Health 2.0 outside the blogs, and the December 2006 Healthcamp "unconference” in which several of us got talking about the topic. (Here’s a photo with Enoch Choi standing & talking and me apparently falling asleep on my hand at the far end of the table! And here’s Health2.0 co-founder Indu Subaiya eating health food!).

Continue at the Health 2.0 site

HEALTH2.0: Some new players, some very interesting technology

• 5

There’s lots of activity in Health 2.0. So I thought I’d showcase a couple of new sites today…

1. A company that I’ve been closely involved with and  (FD!) am
an adviser to, Enhanced Medical Decisions, has now officially launched
the beta of DoubleCheckMD.
You can go to the site, put in your symptoms and the drugs that you’re
on and effectively (without knowing it) in seconds search the entire
literature on which symptoms might be caused by the drugs you’re on,
what possible interactions there might be, what your next steps should
be, and what else you should be aware of. I know I’m biased but I think
that this is one of the most innovative technologies developed so far
in Health 2.0. 

2. CEO Chiara Bell has been working hard to develop Enurgi, which allows people to locate, hire, manage and pay nursing staff for families that need support for elderly relatives at home. A nice integration of directory, social networking and functionality. And of course nurses and other caregiver professionals can use this site to look for business.

3. Health World Web launched
this year with a healthcare provider directory that allows members to
search for providers and add their own reviews and rankings to that
knowledge base. In September, HWW relaunched its patient community with
social network functionality. Dan Kogan the CEO says to think of this
site as a cross between Facebook and Citysearch.com that’s devoted to
health and healthcare. Like the former site you can create your own
communities, like the latter you can search for the Healthcare
providers in your area or country-wide as well as research their
education and experience and share that information with others. Stay
tuned for other HWW innovative functionalities based on social network
and decision making platform. To learn more about Health World Web go
to here.

All of these are very, very early stage companies. And all of them have really interesting promise.  Feel free to go take a look. And of course give the companies feedback as to what you thing about their tools.

HEALTH PLANS: WellCare killing healthcare? With help?

• 5

There’s been enough bad behavior in Medicare private health plans to go around, but some of the worst behavior has come from private FFS plans, and some of the worst behavior of all has come from WellCare, a Medicaid and Medicare plan in Florida. Last Wednesday the FBI raided Wellcare, with allegations of fraud and presumably a qui tam suit in the works. And since then the stock is down some 70%.

Just another story of another private organization pushed by Wall Street to over plunder Medicare? After all I’ve been writing about why Wall Street Hates Healthcare Services But Doesn’t Know It for years. (Apparently George Soros, who, despite his liberal foreign policy leanings, isn’t above making the odd buck or two, made out like a bandit from Wellcare).

Well almost, but then there’s one little wrinkle.

Because there are also others apart from the single-payer advocates who don’t like health plans. In fact one prominent consumer advocate from her lofty ivory tower has proclaimed health insurers as one of those who’ve been “killing” healthcare.

Who killed healthcare?

Regina E. HerzlingerPosted 09/07/2007 (Medscape)

We turn over $2.2 trillion of our money each year to those who manage our healthcare, without holding them accountable for efficiency or quality. Not surprisingly, these folks — hospitals, insurers, governments — they use the money to benefit themselves. Jack Morgan, the insured, middle-class protagonist in Who Killed Health Care? was killed by this system.

Insurers, hospitals, and governments have gotten fat on our bloated healthcare costs, which kill the competitiveness of US firms.

<SNIP>

That’s my opinion. I’m Professor Regina Herzlinger of the Harvard Business School.

But funnily enough, there must have been something different between WellCare and those other “insurers” that were “getting fat on our bloated healthcare costs”. Different enough that Regina Herzlinger allowed herself to be appointed to the WellCare board in 2003.

Continue reading…

HEALTH 2.0 Connecting Consumers and Providers

Health20logoIt’s official! The waiting is over. The follow-up to the first Health 2.0 conference has been scheduled.
"Health 2.0  Connecting Consumers and Providers" will be held on March 4th, 2008 at the Westin San Diego. For details, visit the Health 2.0 site. If you’re thinking of attending, you may want to act now and pre-register.  You’ll get a friendly email from us alerting you when passes go on sale. Doing this is probably a good idea as Health 2.0 User Generated Content sold out a month before before the conference. For email updates sign up for the THCB email list.

Meanwhile, the Health 2.0 media room is now open. If you’re interested in browsing recent articles on the Health 2.0 movement, this is a good starting point. If you know of a piece that we haven’t included, drop us a note. We’ll be adding more material soon, including links to blog commentary. Also coming soon: an updated Health 2.0 FAQ, pics from the September conference, user-generated content and more. 

POLICY: Socialized fire departments & trading up

• 8

Michael Millenson’s excellent and biting piece on the willingness of Orange Country Republicans to accept socialized fire departments has provoked great response. But of course this being America, even the concept of us “all being in this together” for a devastating disaster isn’t quite true.

Friday’s LA Times has an article about private home insurers running a “concierge-level” fire protection service for those in very expensive homes, and it appears that in some cases the intervention of the private firemen was the difference between saving a $3-5m home and it burning down like the one across the street.

There are obvious comparisons to the privatization of police forces—both the growth in special security companies and the over-staffing of police in tony towns compared to the under-staffing in poorer towns where there’s way more crime. And it does seem unfair that in the midst of the crisis some people got better treatment.

But I don’t think the private firemen completely defeat the concept of social insurance for health care. If you think about it, this is exactly what happens in the UK. Everyone pays into the pool according to their ability to do so. No one is sent a bill for fire protection or health care from the socialized provider, whatever their need. But in the UK and in many universal insurance companies countries, you can trade up to buy supplementary insurance that allows you to jump the queue in certain cases—a little like having the private fire guy come and spray extra retardant on your roof. But the main fire department will still be the ones coming to try to save your house when the fire actually gets into your backyard.

Of course the danger here is that everyone of any means gets the private fire insurance, and then decides that they don’t need to pay for the socialized fire department. Then, if you can’t afford private fire insurance, your house will be left to burn down—while what’s left of the underfunded socialized fire department does its best while overwhelmed by demands from the rest of the poor saps who couldn’t afford private coverage.

And that’s essentially what we have in health care now.

QUALITY: Stents cannot be killed, well perhaps not

• 3

So in the latest of the stent wars a new study suggests that Medicare has been saving money as drug-eluting stents have replaced by-passes. This of course is music to the ears of J’n’J & Boston Scientific — not to mention the odd invasive cardiologist. And they’ve been getting, shall we say, a touch aggressive about marketing their product–here’s JSK’s great entry on DTC stent marketing  at Health Populi. (By the way, Jane’s blog is really good. and is keeping those old veterans of the HC blogging world amongst us on our toes!)

However, it’s not clear to me whether the interpretation of this study hasn’t ignored two things in the context of the stent world.

The first is that earlier this year COURAGE essentially showed that medical management is better than stenting (or at least no worse). The other issues is the timing. What we really need to know is the value over the long-term. The data in this study is not old enough to know what happens in the long term–and of course in Medicare we’re all paying over the long term.

But of course four years ago in what is still one of my favorite posts on THCB, a Stanford study showed that in the long-run stents ended up costing considerably more than CABG’s — which is why I said then that we should dump the stent and have a by-pass!

X2HN, Women’s Executive Networking Conference

Want to go to a conference where there’s no chance that you have to meet Matthew? Gale Wilson-Steele (founder of MedSeek & CareSeek and one of my favorite people in healthcare) wrote to THCB about the conference that she co-founded last year. Apparently because men haven’t got X2 but a spare Y instead, they can’t come! Here’s why you should go if you don’t have a dangling Y!

X2HN was founded to accelerate the pace of healthcare improvement by providing the top-level women in all sectors of healthcare a venue for exchanging ideas, knowledge, and resources. Each year we host a space-limited 2-day Xscape where our members are recharged and inspired by learning from each other and experiencing the nation’s best programs and products.

This year we will convene January 30 – February 1, 2008 at the legendary La Valencia Hotel in the heart of La Jolla, California—a village known for its beauty, beaches, and boutiques.

The rejuvenating agenda for this remarkable event includes:

  • An Inspiring Evening with Darlene Price – Darlene, is one of America’s finest executive communications trainers. No wonder she is retained by many of the world’s top corporations. Darlene is President of WellSaid! and has received numerous honors including nine Telly Awards for outstanding corporate communications. Listen to the life-altering tale of her own healthcare experience, as Darlene sets the tone for the 2008 Xscape and focuses our hearts and minds on leading a much needed healthcare revolution—one communication at a time.
  • Pearl Sessions—X2HN-member presentations provide illumination on the numerous, interconnected facets of our healthcare system. In a few moments you will learn how your executive peers use their competencies and connections to drive important healthcare objectives.
  • Life Lesson —"Constructing a Business Plan for Life”—a female executive’s guide to applying business mindedness to the personal pursuit of meaning and happiness.
  • Workshop—Darlene Price will share the secrets to effective executive communication in an interactive training workshop.
  • Trends for 2008—A panel discussion of the top trends in healthcare improvement.
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