Tag: Commentology

Commentology: The Real Professor Baicker

flying cadeuciiInfluential RAND researcher Soren Mattke had this to say in support of Al Lewis and Vik Khanna’s latest post on the Wellness story “Would the Real Professor Katherine Baicker Please Stand Up?

“Gentlemen. Great post. Like you, I am disappointed that researchers of the caliber of Kate Baicker and David Cutler do not respond to the mounting debate about their paper. They should defend or disown their work rather than hope that the debate goes away.

In my mind, their paper is a product typical of high-end academic research. Two brilliant professors spot a gap in the evidence on a hot policy topic and decide to go after it. But the actual work gets done by a graduate student in his cubicle without windows or guidance, and then hastily published.

Then the problem arises that the paper becomes hugely influential and people start having a closer look. For our paper on the PepsiCo program, we reviewed in detail the seven publications that Baicker and colleagues called “high quality evidence”. We found that five of those analyzed programs that operated over 20 years ago and most of them had severe methodologic flaws. (John P. Caloyeras, Hangsheng Liu, Ellen Exum, Megan Broderick and Soeren Mattke. Managing Manifest Diseases, But Not Health Risks, Saved PepsiCo Money Over Seven Years. Health Affairs, 33, no.1 (2014):124-131)

Unfortunately, many defenders of the industry continue to take the Baicker paper at face value, while closely scrutinizing or ignoring more nuanced and scientifically sound findings.

So I herewith support your motion!

Why Isn’t There a App?

A THCB reader who asked that we not identify him because his company does unrelated contracting work with the government writes in to ask:

“Why isn’t there a app? If the problem is that the system is failing because the poorly designed web site is being crashed by monster waves of traffic, wouldn’t putting out an app help?

I mean, ‘cmon guys. It’s 2013. Millions of Americans have iPhones, iPads, Androids and god knows what other mobile devices. In theory a freestanding app — even a simple one — that allowed browsing and “print my application” capabilities would help the traffic problem by giving people an alternative way to access the features available at the government web site.

If the problem is in fact the web site and not the data hub, wouldn’t that go a long way to solving the problem? How hard could it possibly be to put something together quickly and get it out there? Why isn’t this being done?

Knowing how this game works, I’m pretty sure the plan was to originally include something like this. Then the vendors and contractors involved quoted an astronomically high price tag that nobody was willing to go for. Then somebody else said something ominous about privacy and an awkward silence broke out at the table. The app was put in the “nice to have” – “we’ll get around to it when we can” – “bells and whistles” camp.”

Have a brilliant idea that could help save Somebody has got to do something.  Drop us a note. We’ll publish the good ideas.

Commentology: Where Do Apps Go When They Die?

The developers of  the app Pain Care, the winner of the Robert Wood Johnson Foundation’s Project Health Design challenge two years ago,  have this to say about THCB contributing writer Dr. Leslie Kernisan’s recent post wondering why the winning entries of development challenges have a habit of  disappearing and never being heard from again:

We are the app developer. We are also disappointed with the outcome of the app. But I think we also learned valuable lessons here.

One of the challenges small business facing is the need to rapid prototype and test the market, and then move on to another idea when the previous idea fails to gain traction. That is especially true with grant funded projects — they need to “make money” after the grant ends in order to justify continued development effort.

Pain Care was developed in the early days of mHealth, and it was indeed very physician focused — the reason is that we believe we must engage physicians to look at the data. We still hold that belief. It is a learning process for us. We put in our own money to develop the app, and fortunately, won the developer challenge.

We made the app public after the challenge to “test the market” — so to speak. But, as you know, essentially *none* of the pure app-based “patient journal” has turned out to be a success (let alone a financial success). Our app is no exception. It is enormously costly keep the app updated for all those iPhone, iPad, iOS released every year, as well as thousands of Android devices released since then.

So, the app becomes one of those “outdated” apps in the app store, and I think it is quite obvious to users as well. However, I think the app did contribute significantly to the “science” of mHealth. We now understand much more what works and what not in “patient engagement”. Many other “pain management” apps have since emerged, and many have done a better job than ours. I think that was what RWJF wanted when they challenged developers back then. :)

Today, we do things a lot differently. We no longer release research grant-funded apps to the public. Instead, we run clinical studies to test them in much smaller / controlled groups. We do not attempt to tackle vague “big problems” like general pain management any more — instead, we are much more focused on managing specific diseases that include pain. We are also moving beyond “pure software” and “simple reminders” to engage people in multiple modalities.

All of these would not be possible without the generous award RWJF gave us in picking Pain Care as the winner of one of the first developer challenges.

How Reform Law Funds Itself, Strengthens Medicare, and Cuts the Deficit: Part 1

The Mainstream Media Rarely Tries to Explain the Congressional Budget Office’s nearly unbelievable claims that the Patient Protect and Affordable Care Act can:

1)  Pay for itself

2)  Provide coverage for 32 million uninsured Americans

3) Trim this nation’s deficit by some $143 billion over the next ten years

And, that’s not all. Medicare’s Trustees say that the reform legislation puts Medicare on the road to financial solvency–while limiting co-pays and beefing up benefits.

You might well ask: How can this be? How can we provide insurance for an additional 32 million people, improve Medicare, and simultaneously save money?

The media has not been a great help in answering these questions. This is, in large part, because the good news lies in the details—dozens and dozens of details. Fleshing out the myriad ways that the ACA generates new revenues while reining in health care spending would take up far too much time on a cable television show—and way too much space in most newspapers.

Continue reading…

AMA and Congress: Playing “Chicken” Again

Nine times in the past eight years, Congress has, at the last second, delayed the automatic cuts in doctors’ Medicare fees that it decreed some 13 years ago to prevent Medicare spending from outpacing other consumer expenditures.

The AMA threatens that doctors, especially primary care doctors, will stop accepting Medicare patients if the cuts go through. Congress hurtles toward the head-on collision, citing runaway budget problems. Doctors are kept in suspense, their claims held in abeyance while carriers wait for Congress to fix the problem retroactively if it has missed its deadline. The AMA claims credit when the wreck is averted, and urges doctors to continue paying their dues while it feverishly works for a permanent “fix.” Only the AMA, it implies, stands between Congress and certain disaster.

Every time cuts are postponed, the next scheduled cut gets deeper. It’s like a balloon mortgage payment in reverse.

And the controversy gives columnists another occasion to rail against those greedy overpaid doctors, unwilling to assume a bit of shared sacrifice despite the economic downturn.

Continue reading…

Monsters Inside of Me

Picture 24 Why do they lock gas station bathrooms? Are they afraid someone will clean them?” Anonymous

Growing up in the era of “Walk It Off” parenting, I was never
allowed to get too in touch with my hypochondria. Occasionally, I might
get my hands on a National Geographic magazine that would feature
Amazon explorers, tribes that had never been touched by the outside
world or an expedition into the heart of darkest Africa.  To properly
frame the perilous nature of uncharted corners of the world, the
articles would relate the hazards associated with indigenous people,
nasty flora, unpredictable fauna and myriad microscopic predators that
could all kill a man – often in bizarre and horrific ways.

I did not just want to know about the 1000 ways in which I could die
– – I wanted to witness them.  The fact that most of these diseases,
parasites and insidious bacteria were transmitted through unclean
drinking water, monkey bites, and unnatural encounters in dark,
forbidden places did not matter to me.  I was certain these germs were
lingering everywhere.

Continue reading…

Commentology: A mother’s plea for help

Picture 4 Desperate and stuck in the middle

I am the mother of an 11-month-old baby girl, Cassidy, who has CCHS (Congenital Central Hypoventilation Syndrome), a very
rare genetic mutation. Our union health care company recently changed
"paperwork" companies,at which time we were told that we were getting special pediatric respiratory services that we were not entitled to
and it [coverage] would end!

We scrambled to make other arrangements since Cassidy is ventilator-dependent and suffers from frequent "blue
spells" that require oxygen to be administered asap. We were finally able to get the pediatric respiratory coverage
in a state-sponsored policy for a fee. We were starting to breathe a little easier about the situation until we called my
husband's employer. We were told that we could not remove Cassidy from the original health policy because it was a self-funded
insurance plan and federal regulations prohibit switching to a different plan.

Continue reading…

COMMENTOLOGY: Only Two of Millions Who Need Health care

089232-3d-transparent-glass-icon-signs-z-roadsign90 The purpose of this letter is to
produce another example of the health care crisis facing millions of
hardworking Americans.  Both my wife and I are facing medical and
financial hardship due to the pending lack of health insurance coupled
with being diagnosed with two serious illnesses.

My wife and I are 57 and 58 years old
respectively. Throughout our adult lives, we have carried and paid for
health insurance through our jobs for both ourselves as well as our
minor children. We have never gone a single day without health
insurance. In 2003, my wife accepted a promotion resulting in a move
out of state from Minnesota. Five months after moving I was diagnosed
with throat cancer; fortunately I am doing well. In December of 2008,
my wife’s position was eliminated leaving her unemployed. She worked
continuously for this company for 28 1/2 years at the time of her

Continue reading…

Dear Mr. President

I am writing this as a representative of the examination room – one who sits facing patients, dealing with   our healthcare delivery “system” on a daily basis. I am writing this as one who will bear the brunt of what you accomplish or fail to accomplish in your attempts to reform our “system.” I write this as a primary care doctor who makes a living (or not) by what I earn from that “system.” I write as someone who has seen people not take medicine they need, not get the help they should, and not care for themselves as they should because of our “system.”

I talk to patients every day about what you folks are doing, and let me tell you what they are saying: nobody has any confidence in you whatsoever. Whether conservative or liberal, insured or not, black or white, elderly or young, all of my patients express frustration, disillusionment, and pessimism over your chances at getting it right. Nobody is confident, nobody is all that passionate anymore, and nobody is holding their breath.

Continue reading…

Stressed Out System

I saw a patient today and looked back at a previous note, which said the following: “stressed out due to insurance.” It didn’t surprise me, and I didn’t find it funny; I see a lot of this. Too much. This kind of thing could be written on a lot of patients’ charts. I suspect the percentage of patients who are “stressed out due to insurance” is fairly high.

My very next patient started was a gentleman who has fairly good insurance who I had not seen for a long time. He was not taking his medications as directed, and when asked why he had not come in recently he replied, “I can’t afford to see you, doc. You’re expensive.”

Expensive? A $20 copay is expensive? Yes, to people who are on multiple medications, seeing multiple doctors, struggling with work, and perhaps not managing their money well, $20 can be a barrier to care. I may complain that the patients have cable TV, smoke, or eat at Taco Bell, but adding a regular $20 charge to an already large medical bill of $100, $200/month, or more is more than some people can stomach. I see a lot of this too.Continue reading…