Category: Uncategorized

QUALITY: Does DM save money? The old chestnut rears its ugly head

Oct 30, 2006• 5

Poor Chris Selecky of Lifemasters. I had a brief chat with her at a DM conference in August and she was heading to the beach (happily) after selling the company to Healthways. Or so she thought. But then that merger fell apart, mainly because LifeMasters was making less money on a contract than it thought it would.

Now things have gotten much worse. As reported by Vince Kuratis at Better Health Technologies. Selecky announced that Lifemasters has pulled out of its Medicare Health Support project in Oklahoma.

A central factor in their decision was the unexpected medical needs of the Oklahoma project population. These are "really, really sick patients. It takes a lot more to get them under control." She explained that the Oklahoma population included many patients with five or more comorbidities. She pointed out that the rural nature of the population led to unexpected results. Lifemasters found that the population was significantly medically underserved — people had not been receiving appropriate medical care in the past. Arranging for needed care would lead to higher medical costs for Medicare and would prevent Lifemasters from achieving required cost savings.

The entire DM industry is hanging on Medicare Health Support and has really been talking it up. More importantly an even bigger industry is sitting behind MHS expecting that Medicare will start paying for in home monitoring as a consequence. Remember that Forrester thinks that’s going to be a $35bn market in less than 10 years, with Medicare paying most of the freight.

But several studies over the years have suggested that DM improves quality but has found it hard to prove that it saves much money. The response of the DM industry has been, to quote Al Lewis, “let’s go surfing”. in other words, do it anyway and let the academics worry about the savings. And they’ve convinced some health plans that this works.

But to get Medicare, the big kahuna to pay for DM , they’re going to have to persuade the taxpayers’ agent that spending money on DM will reduce the amount spent elsewhere in the system. If the answer is that we’re not spending enough on health care, and we should spend more, and DM will help us do that, then it’s hard to imagine that DM will get the positive response it’s looking for in a world in which everyone’s budget in Medicare is under pressure.

(Hat tip to the ever wonderful Jane Sarasohn Kahn for pointing this one out to me!)

TECH: Bizzare data theft headline

Oct 30, 2006

If you read this headline, what would you think was going on?

Perot Systems Walks Off With Indiana Hospital’s Patient Data

The story is that an employee of Perot which runs the IT systems for Sisters of St. Francis (a hospital chain in Indiana and Illinois) took patient data on CDs home (or somewhere) and left them in the bag when s/he changed their stuff into another bag. It’s unclear as to where or for how long the CDs sat in the employee’s original bag, but it was later returned to the hospital.

It looks like just another “IT guy goes home with data, mislays it” story. So why the headline that suggests that one of the nations biggest outsourcers is stealing its clients’ data — which it’s already got on its servers anyway? Sloppy reporting or not, the guys at Perot will want to clarify this ASAP!

QUALITY/TECH/PODCAST: Interview with Don Kemper, CEO of Healthwise

Oct 30, 2006

Don Kemper from HealthWise essentially invented the concept of information therapy–the idea that every contact between patients and the medical system should come with an actual prescription for information. I think it’s an incredibly important concept, so I talked with Don in this podcast
about how it got started and where we are, as more and more technology becomes available. (Trascript available in a few days)

TECH: The best treatments for heart disease?

Oct 30, 2006• 4

I’d never heard of EECP as a treatment for heart disease. Apparently it works, according to this UCSF analysis. But Debra Braverman’s letter to the NY Times says it all (other than mistaking the drug industry for the medical device business):

A full course of EECP costs Medicare a fraction of one stenting procedure and offers physicians and hospitals very little and the pharmaceutical industry nothing. EECP does, however, offer patients substantial relief and improvement in quality of life without risk of heart attacks or death, unlike the drug-coated stents in widespread use, despite the little scientific evidence of long-term benefits.

Meanwhile does anyone know if Dean Ornish’s program is routinely reimbursed by Medicare? Because if the tax payer is buying stents that dont really work as advertised, perhaps we should also be funding alternatives.

Meanwhile, apparently the latest wisdom is that angioplasty is essential within a few hours of a heart attack. And where did this inspired piece of medical wisdom come from? It was developed in the socialized health care havens of Denmark and Sweden. But we’re told that patients there are left to die; apparently not necessarily so!

THCB: It’s a big month here!

Oct 27, 2006• 4

Judging by my sitemeter October will blow any other month out of the water for traffic here on THCB with more than 25,000 visits and on the way to 50,000 page views. Part of the reason is the exposure we got on ABCNews and EzraKlein’s site, but hopefully some of it is more people realizing that there’s good stuff about the intricacies of health care on this blog! I’d like to thank John, who keeps the buses running on time, my contributors, my commenters, and my advertisers.

Next week we’re going to start with another podcast from Don Kemper, CEO of Healthwise and doyen of the information therapy movement, and later I’ll be doing a podcast with three leaders of “Health2.0” companies.

Talking of podcasts you’ll see a new ads this week from Vimo, and some new sponsored links from GSK and Health1to1. Please go check them out. I’m nowhere close to making any money off this blog, but at lease these folks are putting in enough to ensure that we can keep the lights on, and enough to afford that the podcasts can be transcribed! (Speaking of Vimo, their study on the costs of setting up an HSA account is very interesting indeed!)

And of course I want to thank my readers for coming! Please keep coming back!

POLICY/POITICS: A Grim Anniversary

Oct 27, 2006• 2

A Grim Anniversary: 20 years ago today possibly the worst single bill ever passed by the US Congress went into law. In the the hysteria over crack cocaine and the death of basketball star Len Bias (not from crack by the way), Tip O’Neill decided to get tough on drugs. In 3 days law left committees and was voted on with no one stopping to think.

The result is long long mandatory minimums for low level drug users and dealers—which far exceed those for murders and rapists— and massive costs for the taxpayer. The consequence has been the general corruption of our entire criminal justice system and civil liberties.

POLICY/THE INDUSTRY/HEALTH PLANS: Employers trying to be not so dumb

Oct 27, 2006• 2

This is definitely one to watch. With help from THCB buddy Brian Klepper, the employers in Reno are interested in becoming smarter purchasers, and they held a forum without letting any plans or providers in the room. The results suggest that they’re pretty serious about pooling their data instituting P4P & transparency, and basically doing what their health plans should but don’t do. The employers account for about 25% of the population in northern Nevada.

All employer groups have had this clout potentially. None of them have ever used it. And usually they’ve been too chummy with the delivery system or have been bamboozeld by their “agents” the health plans and PBMs. It’s possible that in some places the worm is turning.

PHARMA/POLICY/POLITICS: More rational behavior from big Pharma

Oct 26, 2006• 16

Exactly as happened in 2000, and 2002 a late surge of money is coming to help Republicans from the PACs of New Jersey’s finest.

According to a report published Wednesday in the Wall Street Journal, drug-industry dollars are helping to fuel the campaigns of Republican candidates like embattled incumbent Sen. Rick Santorum, R-Pa., who faces a tight race against Democratic challenger Bob Casey Jr., who calls the Part D program a “giveaway to Big Pharma.” The Santorum re-election bid has drawn $454,500 in contributions from pharmaceutical companies, WSJ said.Part D has drawn fire from Democrats in congressional races in part because it doesn’t permit the federal government to negotiate with drug companies on drug prices, and Democratic challengers have vowed to change that if elected, the report said.

While the concept of science-based companies backing Rick Santorum (the one who took his stillborn child home to meet his kids, and thinks that the earth is 6,000 years old) may be odd, it’s completely rational. Essentially now that there is a Medicare drug benefit, eventually price controls will be introduced. It’s in Pharma’s interest to delay that day as long as possible. Anyone can see that including big Pharma, who as Joe Paduda reminds us have seen profits rise with their volume now that Part D has cut in

However, it therefore exposes the whole McClellan/Ignagni line about how the private market in Medicare Part D has lowered drug costs more than direct negotiations would have done for the lie it is. After all, if Part D as written is so much worse for big Pharma than government negotiations/price controls, why would they be fighting so hard to protect it?

POLICY/POLITICS: Uwe gets a job

Oct 26, 2006• 4

Apparently New Jersey is going to rationalize its health care system. Well at least they put the best guy in charge.

New Jersey Governor Jon Corzine has announced that Uwe Reinhardt, the Woodrow Wilson School’s James Madison Professor of Political Economy and an authority on health care economics, will head the New Jersey Commission on Rationalizing Health Care Resources. According to an official announcement from the governor’s office, the Commission is charged with ensuring that New Jersey’s supply of hospital and other health care services is best configured to appropriately respond to community needs for high-quality, affordable and accessible care. In addition, the Commission will ensure that there is proper oversight and accountability of limited public funds.

This is of course the state of which the biggest AMC was run by a bunch of crooks and is now having another big academic name, Bruce Vladeck, oversee its rehabilitation. I’m not sure how much Uwe will like it out there in the real world, but I’m sure that the Commission won’t have much power,and I look forward to what it’s going to say!

PODCAST/POLICY: A frank exchange of views with David Gratzer

Oct 25, 2006• 20

So I tried really hard to be nasty to David Gratzer. I’ve complained bitterly on THCB about his op-ed posts which I think just misrepresent Canadian and American health care, and I still think that his book The Cure misrepresents both the prospects of his solutions fixing the US mess, and the desire of foreigners to implement US-style solutions. But as I was interviewing him, he was just so nice and reasonable!