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POLICY/INTERNATIONAL: The best health care system in the world!

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God Bless America.

Zeke Emmanuel is a pretty prominent ethicist and with my former economics teacher/prof Vic Fuchs author of a not bad proposal for universal health care. He’s more famous as the least famous Emmanuel brother—the one who’s not in The West Wing or Entourage. And he thinks that the health care system is a mess. Now you’d assume that if he was fired one of his two very, very rich brothers could step in to keep his family out of the workhouse. But apparently not.

President Bush frequently has said Americans have the world’s best health care system, but Emanuel stopped short of calling Bush clueless in his essay (behind JAMA firewall)and during an interview with The Associated Press. “I work for the federal government. You can’t possibly get me to make that statement,” Emanuel said in the interview.

But don’t worry, the AP found a rent-a-quote to make the article fair and balanced:

David Hogberg, senior policy analyst at the National Center for Public Policy Research, said a strong case can be made that the U.S. health care system is the best. “It depends on what measures you use,” Hogberg said. Life expectancy is influenced by many factors other than health care, he said, and nations measure infant death rates inconsistently. Other measures show the United States performing well, he said.

Just in case you wondered the National Center for Public Policy Research may sound like its some official well respected non-partisan body  but its header title describes it as a  “A Conservative Think Tank” (an oxymoron perhaps). Yeah, those guys know all about health care, I’m sure.

However the reason for this fuss is the latest edition of the Commonwealth Fund’s six-nations report. What does it say? Same thing it’s said for ages. (Shorter version here) The US system costs more and is no better—nay, it’s worse. But Karen Davis and pals have this little zinger in the tail

Findings in this report confirm many of the findings from the earlier two editions of “Mirror, Mirror”. The U.S. ranks last of six nations overall. As in the earlier editions, the U.S. ranks last on indicators of patient safety, efficiency, and equity. New Zealand, Australia, and the U.K. continue to demonstrate superior performance, with Germany joining their ranks of top performers. The U.S. is first on preventive care, and second only to Germany on waiting times for specialist care and non-emergency surgical care, but weak on access to needed services and ability to obtain prompt attention from physicians.

Did you notice that? We’re not even Number One in shortest waiting times for elective surgery. Want to get your hip replaced most quickly? Move to FrankFurt!! I assume that David Gratzer and Sally Pipes are brushing up on their Deutsch right now.

And in other news…apparently Michael Moore isn’t a thorough fact checking reporter and according to his supporters(!) leaves behind a “trail of broken promises to colleagues, exaggerations of facts, and footage used out of context.  Hmm, I’d never have guessed that (actually I’ve read one of his books and yup his “research” is incredibly sloppy. In fact so sloppy that apparently PhRMA and AHIP are on to him:

The Pharmaceutical Research and Manufacturers of America issued a statement attacking Moore’s record. "A review of America’s health care system should be balanced, thoughtful and well-researched," the statement said. "You won’t get that from Michael Moore.

And given the quality of “research” from those two organizations, do I have to add the next sentence for you?

TECH: A top 10 list from Quadramed

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Health tech vendor Quadramed sent me this Top 10 list about Consumers and Health Information Technology

10. Health Information Technology Improves the Quality of Care Received

9. Health Information Technology is Critical in the Event of a Nation-Wide Emergency

8. Health Information Technology Increases Accountability from Providers

7. Health Information Technology Prevents Medical Errors and Saves Consumers’ Lives

6. Health Information Technology Can Empower Consumers to Make Smarter Healthcare Decisions

5. Health Information Technology Saves Consumers Money

4. Health Information Technology Allows Nurses to Spend More Time with Patients

3. Health Information Technology Increases the Health of the Entire American Population

2. Health Information Technology Keeps Hospitals Profitable

1. Health Information Technology Decreases Billing Errors

You may not agree with all of these! Fire at will!

TECH: David Pogue inadvertently pimps Whoissick

Pogue’s techy columns are usually great. This one is too, but he had missed WhoIsSick  in his quest to Ask the Crowd to Spread the News about health care online. Of course we’re all over the Health2.0 phenom at THCB because, well, we’re hosting a conference on it.

 More details on said conference such as the agenda and location will be out later this week (hopefully tomorrow). I know I’m boasting but the agenda and quality of speakers rocks.

HEALTH PLANS: Blue Cross makes about-face on cancellations, with late afternoon UPDATE

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Lisa Girion in the LA Times reports that one of the uglier pieces of health plan activities in recent years may be drawing to a close. Wellpoint’s Blue Cross of California unit has agreed that it will only rescind policies in the future if there is obvious fraud, rather than an explainable oversight or error.

Blue Cross of California agreed Thursday to stop canceling individual health coverage unless it can show policyholder deception — a major shift by the state’s largest health insurer that could lead to sweeping industrywide changes. The move is part of an effort to settle a class-action lawsuit on behalf of as many as 6,000 people canceled since late 2001. It is an about-face for Blue Cross in what had become known as "use-it-and-lose-it" health coverage because the cancellations were often triggered by patients’ claims for treatment.

This is something of an improvement, although of course in a decent world there’d be guaranteed issue and community rating so the whole practice would be moot—and Wellpoint is fighting that in California. However, they need to cut the crap about “only 1,000 policies got rescinded and it’s less than 1%” which comes up in the article again. That’s of course lying with data. The vast majority of people in the individual market who get past the underwriting in the first place are healthy. That’s why the medical loss ratio for BC of California’s individual business is below 60%—yes apparently that’s the number. So there’s likely to be less than 10% of the enrollees and probably close to 5%, who are running up large bills in the first place. Which means that Blue Cross was scouring every one of those applications and canceling some 5–10% of them. They weren’t looking at the applications of the vast majority who didn’t have any major claims.

I still want to see how they settle the individual claimants who busted them for cancellations when BC clearly in error. Or are they in the class action too?

UPDATE: I’m adding this comment from the always sensible Barry Carol: "I wonder how much the new CEO (and former General Counsel), Angela
Braly, had to do with this settlement and whether former CEO, Larry
Glasscock, would have agreed to it. At any rate, it looks like common
sense has prevailed, and it’s about time."

This reminds me that recently Wellpoint changed its bonus structure to relate it to the overall health of their members. I was at a meeting with some Wellpoint employees (in their IT stack) last week, and they highly concerned about what that meant. But perhaps it means that the medical types (presumably led byCMO  Sam Nussbaum) are gaining the upper hand over the financial underwriting types–who’s leader as Barry points out, just got off the ship.

Meanwhile if you want some amusement looks at these comments about what some Wellpoint employees think about the new bonus policy!

POLICY: Podcast with Jon Kingsdale, Massachusetts Connector

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Crossposted from the  Worldhealthcareblog, this is the interview I did at WHCC with Jon Kingsdale, who created and is running the  Massachusetts Connector–the organization at the center of that reform effort. Many of you have many opinions about what’s going on in that state, so now you’ve heard it from the horses mouth, feel free to comment.

Matthew Holt:  This is Matthew Holt, again on the floor at the World Healthcare Blog this afternoon. Coming towards the end of the session, I have Jon Kingsdale with me. Jon is the executive director of the Commonwealth Insurance Health Connector Authority, better known as the Massachusetts Connector. This is the central body in the middle of the new Massachusetts Health Plan arrangement. And Jon gave a very interesting talk about how that is playing out in a session early this morning. So I thought I would grab him and grab a few minutes of his time. So Jon, thanks a lot for doing the conversation.

Jon Kingsdale:  My pleasure.

Matthew:  Let’s start in with the basics. Most people know that Massachusetts has gone in with some kind of individual combined with an employer mandate. And know that there’s some arrangement in the middle of that so people can actually buy into an affordable health plan. There’s been come controversy about what affordable means. But what’s the Connector doing in the middle of all that? What does the Connector do?

Jon:  Well, we have a number of functions, Matt. One is a whole set of regulatory functions to decide some of the tough policy issues, frankly, that the legislature grappled with and decided they wanted to let the next generation of decision makers handle.

Matthew:  Pass-off.

Jon:  You might well say that. I wouldn’t. So those include, what is the affordability schedule? So adults in Massachusetts, starting later in 2007, need to have health insurance if they can find something affordable. Well, given your income, what is determined to be affordable? And what is the minimum amount of insurance that you would have to have? So regulatory policy decisions like that, on the one hand.

And on the other hand, we’re actually running a couple of insurance programs, one that’s subsidized for low-income uninsured. And we set the benefits and the enrollee contribution and actually enroll people, and serve as a market for them. And the other is, private unsubsidized health insurance, particularly for uninsured individuals above 300% of the federal poverty level, who are going to be buying out of their own pocket. And a big piece of what we do there is organize the market for them and try to do almost like some group buying for them. And create sort of a shopping mall for health insurance.

Continue reading…

PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru

This is the transcript of the podcast interview I did with Joseph Kvedar, from Partners Center for Connected Health. Coincidentally this past Tuesday in NYC, the Center, along with Continue Health Alliance and others, sponsored a meeting about the use of monitoring devices as part of a general strategy by leading edge employers to try to do something about the management of the chronically ill. There’ll be more from me about that later.

Matthew Holt:  Hi, this is Matthew Holt with The Health Care Blog, and I am doing another podcast. If you are one of those people who thinks that we have too much medical technology and too many medical facilities in America–I am deep in the belly of the beast. Sitting in the middle of the academic medical center triangle of Boston speaking with Joseph Kvedar. Joseph is the director of The Center for Connected Health. He also, for those of you who are paying careful attention, wrote an article in The Health Care Blog about Connected Health, just, I think, a week-and-a-half ago. Joseph, first off thank you very much for hosting me in your office.

 

Joseph Kvedar:  Delighted to be with you, Matthew.

 

Matthew:  You are also the Vice-chair and the Associate Professor of the Residency Program in the Department of Dermatology, so obviously you have a medical background. You know, that it’s not unusual in the AMC for somebody who is an academic physician to be also prodding around in another area. This center was, until recently, called The Center for Telemedicine.

 

Joseph:  Yes.

 

Matthew:  Also it is an integral part of Partners, what you are doing in terms of outreach into the community with technology. Why the change to Connected Health?

 

Joseph:  Well, we felt that most of what we are doing these days is not captured by what people traditionally think of when they use the word "telemedicine." I have spent a lot of in time in meetings over the last few years explaining that. So it just made sense for us to adopt a moniker that was a bit more fresh, a bit more 21st century, and could really allow us to have people engage with us and our vision in a more effective way.

 

Matthew:  That makes a lot of sense. My friends at Cisco think that they invented the term and that the NHS and everyone else is copying them. But the concept around connection and health seems to be really taking off. You can guess if that is a good thing or a bad thing, but I think it underscores a lot of what we are talking about. Now some of the things you brought up in the brief piece you wrote for The Health Care Blog I think are very interesting. Just capture, for those people who haven’t read it, the flavor of what you think the possibility of change that this kind of technology can bring.

 

Joseph:  Let’s use the example of diabetes. So today your average diabetic often views their condition as somewhat of puzzlement, somewhat of an accident. They may or may not understand the relationship between diet, exercise, and glucose. They may or may not understand how changing their activity level can help their condition. They are really left with occasional, brief, hurried visits to their doctor, and a lot of instructions, and often very little in the way of a true relationship or connection with healthcare.Now picture the same individual with a lot of physiologic feedback. Let’s say an accurate step count, once or twice daily a log of their glucose readings that is contextualized with their diet and their activity, and a medication reminder system. And I think that is, for us, all of that is what we mean by "connected health."

Continue reading…

INDUSTRY: You can’t buy publicity like this

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The kids at AHIP and PhRMA must be holding their heads in their hands this morning. Everyone in health care knows that Michael Moore’s Sicko is coming out soon. But in case you thought there wasn’t going to be enough publicity, the US Government has launched an investigation to see whether Moore’s trip to Cuba—where he followed some American patients seeking free care in a publicity stunt—violated US law. Apparently you have to be a journalist to go to Cuba…and by the Treasury department’s definition Moore might not be one.

This is so stupid that you have to believe that whoever launched this in the government is a mole for single payer interests or owns stock in the movie. Moore must be laughing his ass off with delight! 

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