Last week, The Health Care Blog ran two articles about new wiki sites
that will develop
and continuously update medical information. A wiki
is a “content collaborative” that allows anyone (or anyone authorized
by the site) to contribute or modify content; Wikipedia is the best
In Medicine Meets Wiki, Jane Sarasohn-Kahn brought our attention to MedPedia, a
collaboration between major academic institutions and governmental
agencies to clearly describe the entirety of current medical knowledge.
Then Bob Wachter described Google’s new Wikipedia competitor, Knol, and
suggested sites like this could threaten the stranglehold that
traditional medical journals have had on emerging information.
Lately, I’ve had interesting discussions with a thoughtful exec. at a
major Western health system about the ferocious challenges facing
hospitals and health systems. Her organization’s internal conversations
at the moment are centered, in part, on what they should do to become
"reform ready," not only for policy changes that could be in the wings,
but more importantly, for emerging market dynamics that will change the
ways hospitals work. She asked me to catalog some of the trends I think
health system managers will have to deal with, along with five
recommendations for action. Here’s some of what I told her.
Hospitals face dramatic financial stresses on a range of fronts.
Over the last 25 years, health systems’ average total margins have
remained reasonably stable at around 5 percent. As you’d expect, some
organizations have performed better, and others worse. About
one-quarter of all US hospitals, many of them safety nets, have
reported negative margins, and continually teeter toward failure.
Now the pressures are ramping up considerably. Perhaps most
profoundly, the balance has eroded between more profitable
privately-covered patients, and patients with public coverage –-
Medicare, Medicaid and other governmental sources –- that may not cover
Those who wait, ever hopefully, for real health reform might want to take a deep breath and take stock of a few realities.First, think about the fact that when the Democrats retook Congress, they tweaked but did not fundamentally change the lobbying rules that trade money for influence over policy. In fact, most contributors have now adjusted their contributions to favor the current, rather than the past, majority party. As it turns out, Democrats, like Republicans, are only too eager to allow special interests to trump the common interest, so long as the transactions fetch a good price.
by BRIAN KLEPPER
Today, Matthew, Michael Millenson and I are converging at a Robert Wood Johnson Foundation conference on public reporting of health care pricing/performance information in Amelia Island, FL, three short barrier islands north of my home in Atlantic Beach. (Always helpful, Michael suggested to the conference organizers that I should be required to walk or take public transportation, to compensate for the fact that everyone else has to come in by airplane.)
In any case, we decided that we might as well seize the opportunity and hold a short symposium on market-based transformation for the Northeast Florida health care and business communities. Dean Chally of the University of North Florida’s College of Health graciously arranged the space on their beautiful campus, and so we’re set for a 7:30AM, 2 hour conference on Friday May 16th–that’s tomorrow.Michael will talk about public reporting, Matthew will present on the consumer side of H20, and I’ll hit H2O business-to-business analytics, the emerging medical home movement, and some wellness/prevention approaches that are gaining traction. Should be a fun morning. If you’re in the neighborhood, be sure to drop by and join us.
Here’s one of today’s entries in The Writers’ Almanac, the wonderful daily newsletter sent out by Garrison Keillor on NPR. Parents of boomers like me were big fans of Dr. Spock, treating him with an almost cult-like reverence for his sensible wisdom about child care. He later parted ways with some of his more conservative followers, when he became an iconic protester against America’s war in Viet Nam. I wonder whether regular THCB readers will read this and, like me, note that this is the same message Jane Sarasohn-Kahn relates in The Wisdom of Patients. We stand on the shoulders of giants.
It’s the birthday of Dr. Benjamin Spock, (books by this author) born in New Haven, Connecticut (1903). His Common Sense Book of Baby and Child Care (1946) was a best seller during the period after World War II, when parents across America were raising the Baby Boom generation. Spock opened his first pediatric practice in 1933. After 10 years of observing children and their health, Spock decided to write a book about taking care of them. Instead of writing it out himself, he dictated the book to his wife, to give it a conversational tone. Previous parenting guidebooks had encouraged parents to be stern with their children, and they were written as a list of commands. Dr. John B. Watson had written in his guidebook, "Never, never kiss your child. Never hold it in your lap. Never rock its carriage." Dr. Spock encouraged parents to be affectionate, and he also encouraged them to follow their own instincts. The first sentence of his book was, "You know more than you think you do."
A detailed new study from the Economics Policy Institute confirms what many of us suspect but haven’t had the data to easily nail down. This weightily-titled report by Jared Bernstein and Heidi Shierholz – A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006 – provides more granular information about the enrollment dynamics over time in employer-sponsored health coverage than we’ve seen in a while. Based on an analysis of the March 2007 Current Population Survey, the numbers reported here are mostly in sync with (but deeper than) similar studies that have attempted to size the enrollment and erosion characteristics of the employer-sponsored coverage market. Strap yourself in; this isn’t pretty.There are two important points here. The first is that, in the six years between 2000-2006, the percentage of American workers with employer-sponsored coverage fell from 51.1 to 48.8 percent, a 2.3 percent absolute or 4.5 percent relative drop. 6.4 million workers (and presumably, another 7.6 million of their family members) lost their health coverage in the process. These losses exceeded gains made between 1995-2000, when the percentage of workers with coverage rose from 49.6 to 51.1 percent.
A few months ago, the two of us – both long-time advocates for
transparency and accountability – posted separate comments on Secretary
Mike Leavitt’s blog. Brian asked Secretary Leavitt to square his
support of "Chartered Value Exchanges” with the attempt to block
release of physician-specific Medicare claims data to Consumers’
Checkbook, which wants to rate doctors. After a court ruled that the
data should be provided to the group, HHS appealed. Michael urged the
secretary to go beyond supporting Consumers’ Checkbook and use his
“bully pulpit” to promote sophisticated data analysis that could be
used to create national quality comparisons.
Secretary Leavitt graciously asked us to consider and comment on the
department’s proposed "Medicare trigger legislation" calling for the
release of physician performance measures. We are delighted to continue
First, let’s give credit where credit is due. We agree that the proposed legislation is a major step in the right direction.
Over the last year or so, I’ve written a lot about how health care
information will become increasingly available to consumers and health care
business, and how this access will drive new decision-support
capabilities that will profoundly change how health care works,
eliminating many of the problems that have placed health care in
crisis. So imagine my delight when a colleague forwarded this quote.
Sir Muir Gray is Chief Knowledge Office of Britain’s National Health Service. His wonderfully clear explanation of how health care knowledge will become guidance – that is, decision-support – makes a compelling case for the transformative power of Health 2.0.Check it out.
The future is something we make, not something we discover. And the
future is easy to make because as William Gibson has said, the future
is here, it’s just not evenly distributed.
The second revolution took place in the latter part of the 20th
Century. It was driven by science, making plastics, airplanes,
televisions and innovation in chemical and mechanical technology in
We’re in the middle of the third Healthcare revolution. The first was
based on common sense, an empirical revolution; the health of nations
was transformed by making observations and deductions from data and
improving conditions based on those deductions. So now, for example, we
take clean clear water for granted.
HWR has clearly arrived, at least in the sense that all KINDS of
columnists are clamoring to be read here. More than thirty submissions
arrived in my inbox, a collection of the utilitarian, the thoughtful
and sometimes the downright ridiculous. Given only so much space for an anthology, I set aside more
than a few. Some were simply plugs, or not directly relevant to a blog focused on
health policy and market dynamics. Others were merely good.
But the twenty remaining posts were, I thought, exceptional
contributions from writers who continually plug away, asking themselves, “What
really matters and how can I talk about it?” As ever, you’ll find a
potpourri here of expert observation, analysis and commentary from
every part of health care. It’ll take a little effort wading through
it, but I promise you an illuminating and entertaining time.
Ah, a warning. One of these posts is for April Fools. Keep your eye out!
On to The Review! Enjoy!
Though it probably went mostly unnoticed in the cacophony of health care stories, last week’s news that Walgreen’s had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger of very big changes in health care. Walgreens, the ubiquitous drugstore company that, with Wal-Mart and CVS, has already leveraged its pharmacy platform to establish a strong footprint in retail clinics, undoubtedly startled many health care observers with its announcement. After all, isn’t the company doctor a relic?
Actually, no. The worksite clinic – and by way of disclosure for the better part of the last year I have
worked closely with a small, very innovative, Orlando-based startup worksite clinic
firm, WeCare TLC – has been
reinvented and refitted with 21st century tools, and offers the promise
of nothing less than a paradigm shift toward dramatically better care
at significantly lower cost. Understanding how these structures work and how they differ from both old-fashioned medical practices and retail clinics provides clues into what Walgreens likely sees and why that matters to American health care.