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HEALTH PLANS/QUALITY: Setting up high performance networks leads to lots of trouble

Hmm…mistakes in health care data? Who’d have imagined that. Which leads to lots of politics in the setting up and creation of these “high-performing networks” and of course the ability for the baby of improvement to be thrown out with the bathwater of data incompetence, if poorly introduced.

What am I talking about? Well you’ll have to read Jeremy Smerd at Workforce.com on what went wrong when Regence tried to introduce a high-performance network for Boeing. And then too about how Group Health of Puget Sound Puget Sound Health Alliance did it in a rather kindler, gentler and less lawsuit attracting way.

It’s in the end the employers’ fault. There the ones who told their plans to back off from doing this when costs were (apparently) under control in the 1990s. So the plans gave up on limiting their networks, and as a partial consequence, costs went up, and then the cycle starts again. Of course, the same thing will be true for the whole P4P movement.

POLICY: Lord save us–Reggie is back at it again!

America’s most famous business school health care maven is back it again. Reggie has a new book coming out called Who Killed HealthCare?  I for one can’t wait to see if she’s managed to sit in on Logic 101 somewhere on the other side of those hallowed Harvard halls and bring that content back to her new tome. She certainly didn’t bother to include any of that in the last two go arounds, as I suggested in my review of her last book.  I’d like to tell you what I really think, but Jamie Robinson got there first in Health Affairs letter exchange back in 1998 responding to her letter lambasting his criticism of her book:


To the Editor:
If you liked Regina Herzlinger’s letter, you will love her book. In the larger work you will find the same measured tone, the same intellectual profundity, and the same judicious use of analogy and statistics.
Caveat emptor.

James C. RobinsonUniversity of California, BerkeleyBerkeley, California

While I have quoted Jamie’s letter before it’s been a while since I took a look at Reggie’s letter in the same issue. It’s just too good not to share this wonderful assessment of what was happening in health care in 1998.

As my book describes, the market forces that revolutionized the once-bloated U.S. economy are now reshaping health care. Activist consumers’ demands for accountability, convenience, and control are making the system more informative and accessible. The focused-factory concepts that revived the nation’s manufacturing sector and fashioned its world-class service sector are now shaping high-quality, cost-controlled health care delivery systems. And the sort of technological innovations that have increased productivity since the Industrial Revolution are improving the quality of health care while controlling costs. Brilliant entrepreneurs are using the managerial lessons learned from successes such as SamWalton to create a better, cheaper,more accessible health care system.

I for one am reveling in the fact that we now have a better, cheaper, (Cheaper?!!) more accessible health care system than we had in 1998! I guess Reggie, who learned the first rule of forecasting–never put a number or a date in your forecast–has only just learned the second. Never actually write your forecast down or let it be recorded.

But don’t worry she has learned that one now. A couple of years back she debated Alain Enthoven, she was apparently so distressed at what he did to her that she forced the conveners of the conference to remove her words from the transcript!!

The other good news is that she’s not the only Harvard Business School professor getting thoroughly confused by the simple laws of economics. More on Clayton Christensen and Michael Porter later.

POLITICS: Survey–wanna take it?

The nice people at SUNY Stony Brook want you to take a survey about political advertising on the Internet. The survey is anonymous. You will not be required to give your name. It should take 10 to 15 minutes to complete. This survey is designed to help us understand what Americans like you think about Internet advertising, modern campaigns, and politics. Here’s the survey

POLICY: Susan Blumenthal–wanting to change the world by studying it?

Susan Blumenthal, M.D (who I’ve met and like a lot) thinks that we can change the world (or at least the health care system) by studying it  a little more. Then the incoming President in 2008 will have all the answers and we just have to pass the legislation. (OK she doesn’t quite say that).
I’m all for more better information on what we should do and on what’s wrong now. But I’m torn. Don’t we know the problems already? Don’t we know the solutions? And don’t we know that the health care system actors will do virtually anything to keep the status quo going?

JOB BOARD UPDATE

Last week THCB launched its latest experiment — the THCB health care job board.
Many of you went over to look at our inaugural job postings, which were
offered courtesy of Humana. There are more jobs up today with more on
the way. If you’re an employer tired of being buried in resumes from
the wrong people, you’ll find this may just be one of the best deals on
the web. Yesterday we officially partnered with Kevin MD,
meaning that your post will be exposed to a monthly audience of thousands of healthcare professionals. If you’re hunting for a job, we’re
also collecting resumes (in confidence of course), which we’ll pass on
if we think we might know of a match. Those *******@*********lt.net“>go to Matthew.
THCB’s crack technical staff is hard at work building the board itself.
For now, posts live in their own thread. Go take a look …

JOB POST: Release Engineer

Sermo.com Cambridge, Ma. CNN called Sermo “A MySpace
for Physicians.” The Motley Fool said “Add Sermo to the IPO watch
list.” We say … Sermo aims to revolutionize health
care in the US. We’ve already built the largest on-line community
for physicians, by physicians. And that’s just the start. Sermo’s
unique technology and business model is at the cutting edge of information
markets and arbitrage, and vertical social networks. Learn more about
us at www.sermo.com. > THCB JOB BOARD

Continue reading…

HEALTH PLANS: Guess who said this?

"Health insurers are committed to improving health care choices for small businesses and bringing costs under control for all Americans,"

A woman who’ll say anything in absolute opposition to the facts, so long as it makes her patrons look better. Don’t you think she’d make a good next attorney-general?

TECH: Interesting employment agreement

There’s a certain fast growing practice management company with a very outspoken CEO, who has a very famous last name. I poked fun about their sorority-crowd employees at HIMSS. But I didn’t know the type of scrutiny that they’d have had to come through. Look at this as part of their employment application agreement:

I understand that the Company reserves the right to require me to submit to a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by applicable law. I authorize the Company to investigate my driving record, my criminal record (Federal, state and local, as well as any record of health care fraud and abuse or other offenses retained by the OIG or other regulatory agencies), and my credit history, and I understand that an investigative consumer report may be prepared whereby information is obtained through personal interviews with neighbors, friends, and others with whom I am acquainted. This inquiry would include information as to my character, general reputation, personal characteristics, and mode of living. (THCB emphasis added) I understand I have the right to make written request within a reasonable period of time to receive additional information about the nature and scope of this investigation.

Well they wouldn’t give me a job! Nor basically anyone else in San Francisco. Then it hit me; what a tradition said company is joining. There’s Henry Ford who sent his minions out to investigate his employees behavior, and then more recently someone else equally outspoken and equally paranoid also started a pretty big health care IT firm and put lots of conditions on his employees behavior too. So I suspect this pretty much guarantees AthenaHealth’s success…..

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