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.
Among its many less-noticed accomplishments, this Administration has strangled funding for comprehensive sex education. Instead, it has thrown the immense weight of the US government behind abstinence-based education, an impractical ideological approach rooted in religious zealotry and a romantic notion of social mores that no longer exists for most young Americans. In 2005 and 2006, the Bush Administration spent $170 and $178 million, respectively, more than double the 2004 expenditure, much of it allocated to mostly conservative Christian organizations, to encourage children to refrain from sex without explaining the fundamentals of contraception and sexually-transmitted disease (STD). In 2004, a Minority Staff Special Investigations report prepared at the request of Rep. Henry Waxman (D-CA) found that more than 80 percent of federally funded abstinence programs contain false
or misleading information about sex and reproductive health.
Last weekend I heard several great presentations at a meeting convened by Jeff Goldsmith, but one contained a point I hadn’t heard nailed down before. Kaveh Safavi MD JD, from Thomson Healthcare’s Center for Healthcare Improvement, detailed the results of several large sample surveys on consumers’ attitudes toward web-based health care information.
One of Dr. Safavi’s opening slides came from Solucient’s HealthView Plus 2006 data, and was focused on "Quality-Driven Consumers," people who are "likely to research ratings information on hospitals or doctors," and likely to change providers if the one they originally preferred received a low rating. Strikingly contrary to the conventional wisdom, this group makes up only 19%, or one-fifth, of American adults.
Here are two very interesting and frightening charts that my good friend Warren Brennan, the CEO of SMA Informatics in Richmond, passed along this AM, with this question, aimed at the CFOs of hospitals and other health care organizations:
What do these mean for bad debt and for the health care sector’s future financial performance?
Regular readers will know that, last Sunday, I posted a column that pointed to HHS’ schizophrenic behavior when it comes to the release of Medicare physician data. First they fight the consumer advocacy group Checkbook.org’s lawsuit demanding the release of data in 4 states and DC. (The AMA’s Board Chair has admitted that they lobbied HHS to appeal the court’s finding that they should make the data public.) Then, a week ago last Friday, HHS announced a new program that would identify Chartered Value Exchanges (CVEs) in 14 communities – these are coalitions of employers, payers, providers and consumers – and then hand over the same physician data they’ve been fighting the courts to keep secret so these groups can combine them with data available from the private sector and create physician quality/cost report cards.
Here’s a classical example of a federal regulatory agency holding fast to two opposing ideas at the same time. I wonder what it means?
Last week the Department of Health and Human Services posted an interesting notice announcing a new program that recognizes 14 (presumably) forward-thinking health care coalitions of providers, employers, insurers and consumers, which it refers to Chartered Value Exchanges, or CVEs. (Who comes up with these names?!) HHS promises that, by summer of 2008, it will provide "access
to information from Medicare that gauges the quality of care
physicians provide to patients." This "physician-group level
performance information…can be combined with similar private-sector
data to produce a comprehensive consumer guide on the quality of care
available" in each community. Cool! Sign me up!
The NY Times ran an important op-ed yesterday by Susan Shepherd, a pediatrician and medical advisor to Doctors Without Borders.
The core of her message is that as the farm bill progresses through
Congress, we should focus not only on the quantity of food that is
produced and that we export for relief to underdeveloped nations, but
on its quality as well.
Dr. Shepherd describes the difficulties
in treating children who are victims of severe malnutrition,
particularly in areas like Africa and South Asia where milk and clean
water can be scarce.
A wonderful meeting (Full disclosure: They brought me in to blog my impressions.), The Families USA conference that ended Saturday brought together some impressive Congressional politicians – Nancy Pelosi, Tom Daschle, Ken Salazar, Blanche Lincoln – and true health care experts – Don Berwick, Tony Fauci – with "consumer advocates" from around the country.
I thoroughly enjoyed the people at the conference. They were, for the most part, knowledgeable about health care and committed to driving a better system. (My favorites were a group of California Gray Panthers, all of whom were VERY up on the issues). There were also bright young people relatively early in their careers, and representatives from community health advocacy organizations around the country, all fervently dedicated to a better, more equitable health system.
One of the pleasures of the Families USA Health Action conference was that the speakers represented a nice blend of top politicians and genuine health care experts. Tony Fauci MD, the wonderful head of NIH’s National Institutes for Allergies and Infectious Diseases, who talked about Global Health, was followed by the equally impressive Don Berwick MD, the Founder and leader of the Institute for Healthcare Improvement. I’ve heard Dr. Berwick speak several times and am always delighted by his cogent, comfortable, sensible presentations.
I can think of several people who, if they gave one, deserve a health care Nobel Prize for the positive impact they’ve had on millions of people through their work to change the industry. Dr. Berwick is one. (Others include Jack Wennberg MD, the founder of the Dartmouth Atlas, and David Eddy MD, who leads the Archimedes Project and who coined the term "Evidence-Based Medicine.")
I first met, heard and came to admire Tony Fauci several months ago at the Aspen Health Forum. Dr. Fauci heads the National Institute of Health’s National Institute of Allergy and Infectious Diseases. In addition to his spectacular medical contributions, he is, equally importantly, a passionate and wonderfully articulate explainer of the importance of infectious disease and global health to common people. Unfortunately, I was called unexpectedly out of the meeting for a call, but here are my notes on his comments. They provide a clear view of the value of his work.
Plagues and epidemics have shaped societies since the beginning of civilization. Gradually, though, and with progress in hygiene and the management of disease, the dangers from infectious diseases to ordinary people have been significantly lessened, though the idea that we’re home free is seductive and illusory. In 1967, Surgeon General William Stewart testified a little prematurely that "the war on infectious disease has been won."