Tag: Policy

Health costs are small businesses’ No. 1 problem

The cost of health insurance is the No. 1 problem cited by small business owners. Health costs beat gas prices — the No. 2 most severe problem cited by small business, in a March 2008 survey.Smallbusiness

This week, small business leaders convened at the annual National Small Business Summit conference of the National Federation of Independent Business (NFIB).

The report notes the downturn in the economy during the second half of 2007 when the NFIB Small Business Optimism Index dropped to 94.6 in December, the lowest since 2001.

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The Long Baby Boom

Last Friday I had a great chat with healthcare futurist Jeff Goldsmith about his new book, the Long Baby Boom. We discussed the policy and cultural issues of retirement, Medicare, Social Security, immigration, end-of-life care and meaning in work.  With 76 million baby boomers heading towards age 65, these issues or of  great importance.

Here’s the interview.

CBO assesses return on investment of HIT

The return on investment of health care information technology isn’t uniformly positive, according to a recent analysis from the Congressional Budget Office titled, Evidence on the Costs and Benefits of Health Information Technology.

The underlying rationale for the report, which was requested by the Senate Budget Committee, is to sort out the federal government’s role in health IT. The report asks, "Whether — and if the answer is yes, how — the federal government should stimulate and guide the adoption of health IT."

The federal government is already in the health care IT fray. President Bush set the goal in 2004 that every American have an electronic health record by 2014. This was a vision, however, without a funding source. There are also several proposals in Congress that would expand the federal government’s role in health IT by mandating the use of electronic prescribing, provide financial incentives to providers who use health IT, and offer grants to purchase systems for providers.

The CBO report points out a major benefit of health IT that has been largely overlooked: IT’s role in research on the comparative effectiveness of medical treatments and practices. When individuals’ health data is in electronic format, it can be depersonalized, aggregated, and analyzed for a range of uses, such as medical effectiveness, quality, and system efficiency, among other research questions.

One sentence in the 48-page report encapsulates the Mother of All Barriers to Health IT Adoption: "How well health IT lives up to its potential depends in part on how effectively financial incentives can be realigned to encourage the optimal use of the technology’s capabilities."

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AHIP & Health 2.0 — caveat whatever the Latin is for movement

Last month, the trade group America’s Health Insurance Plans sponsored a seminar on Health 2.0 with Lynne Dunbrack at IDC Health Industry Insights and Roy Schoenberg from American Well. Any resemblance in Lynn’s presentation to the talk I’ve been giving since mid-2007 is I’m sure completely coincidental. (To be less snide, it’s all pretty obvious stuff, and many others are doing it, too). Meanwhile, next month at the big AHIP meeting in San Francisco, another analyst from a Massachusetts research outfit (Carlton Doty of Forrester) will be presenting on this “new” trend.

Now, I’m not exactly blaming these guys for getting into a good thing. Both American Well and David Sobel (who’s appearing with Doty) have been featured at Health 2.0 Conferences already, and Indu and I certainly didn’t discover them, the term Health 2.0, or the Internet. And given the “praise” I’ve heaped on AHIP and its President on THCB over the years, I wasn’t exactly sitting by the phone waiting for their call. Certainly slightly more, ahem, compliant pundits can do a great job instead — even if flying a guy from Boston to talk in San Francisco, when I could walk three blocks may not be the best use of their members’ money.

While it’s good that AHIP is introducing its member health plans to the potential of the Health 2.0 world, let’s not forget that the motivations of the organization don’t exactly square with where many of us think health care, including Health 2.0, should be going — and nor that matter do the Association’s  President’s public pronouncements fit with  the long-term interests of those of its members who do have something to offer society (e.g not Mega Life/HealthMarkets). Meanwhile, over the years, the quality of AHIP’s research and the veracity of its public statements about the value its members deliver to society have been laughable. So let’s be a little careful about AHIP’s role in Health 2.0

OK, rant over. You can all go back to Friday dog blogging


American Cancer gets hip on uninsurance

The American Cancer Society is focusing all its marketing budget this year on the issue of uninsurance and is trying to get the message out in new ways to new audiences. Here’s one using rap/poet MIKE-E.


Humana’s competition for change

Health benefits heavyweight Humana Inc. (HUM – 11.5M members) recently launched ChangeNow4Health, an ambitious, optimistic coalition inviting anyone to submit ideas to fix America’s ailing health care system.

The top three entries receive a $10k prize, and the top 20 get publication exposure galore, including a spot in Humana’s forthcoming e-book, “Tomorrow’s Health Care.” The big winning concepts have a chance to secure further funding and incubation support from Humana.

Full Disclosure: Shortly after this interview was conducted, ChangeNow4Health became a sponsor of The Health care Blog. However, if you think that in any way influenced the content of this article, you don’t know the Health 2.0 folks very well…


On the second day of World Health care Congress 2008 in Washington D.C., I interviewed Elizabeth Bierbower, Humana’s Vice President of Product Innovation.

Bierbower, who has spent her career working with consumers, told me that ChangeNow4Health is looking for doable ideas that can quickly be put into play in the game as it is now, not how we wish it were.

They’re also harnessing the power of the semantic Web by partnering with, an online community that posts projects from groups like the Rockefeller Foundation.

The contest has 4 categories:

  • Helping Consumers Make Smarter Health Care Decisions
  • Simplifying the Business of Health Care
  • Preventing Sickness and Maintaining Health
  • General Innovations in Health Care

The contest runs through July, and winners will be announced in August. Judges include industry experts, who are looking for “both an idea’s potential to bring about true change in a tangible way” and “feasibility for implementation now.”

Here’s a transcript of my conversation with Bierbower.

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Malpractice premiums fall in Massachusetts

Bay State doctors paid lower malpractice insurance premiums on average in 2005 than 1990, according to a new Health Affairs study. The study clashes with popular beliefs frequently touted by sponsors of legislative efforts to cap damage awards.

“If you don’t find a crisis here, you’re probably not going to find one nationally,” lead author and Suffolk University Law School scholar Marc Rodwin told The Boston Globe. “Clearly there are some increases in premiums and high premiums for a small percentage of doctors in three specialty groups, but that’s entirely different for the rest of doctors.”

Malpractice settlements in Massachusetts are the fourth highest in the nation, and the American Medical Association lists it as one of 21 states being in a crisis due to high medical malpractice payments and lack of laws to cap settlements, the Globe reports.

The Suffolk study found that most Massachusetts physicians paid an average of $17,810 in premiums in 2005, slightly less than the $17,907 paid in 1990, after adjusting for inflation.

The researchers analyzed data from 1975 to 2005 provided by ProMutual Group, the insurer for about half of the state’s doctors.

Rates for specialists in obstetrics/gynecology, neurological surgery, and orthopedics involving spinal surgery increased on average from $66,220 in 1990 to $95,045 in 2005.

So is malpractice reform a distraction from real health reform debate? Probably, but it is one that must be dealt with to get docs on the side of real health care reform.

Bitter doc wants more respect for primary care

A primary doctor ranted anonymously this weekend on Kevin MD’s blog about the lack of appreciation for primary care in his small Midwestern town and predicted its future demise.

The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:

"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."

His rant has struck a chord in the medical blogosphere.

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Health 2.0 Consciousness Dawns – Even In Jacksonville, FL!


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.

POST-MORTEM: California health reform

The debate over why health reform failed in California sparked up again following the release of a Field Poll in late April that found that nearly three-quarters of California respondents supported Gov. Arnold Schwarzenegger’s plan.

Following the poll’s release, Schwarzenegger told
the Associated Press he’s not giving up and will push his $14-billion plan forward. Despite his optimism, most
wonks in Sacramento have called it dead at least though 2009.

In a recent column, Sen. Sheila Kuehl, D-Santa Monica, diverts any blame for the reform’s failure from the vehemently opposed single-payer coalition, which she leads from her perch as chair of the all-powerful Senate Health Committee and author of the single-payer bill SB 840. Kuehl blames reform’s failure the governor’s unwillingness to challenge the insurance companies."In fact, the Governor’s plan appropriately fell," Kuehl writes, "because of the Governor’s own reluctance to make the difficult policy decisions necessary for the plan to be in any way affordable to the state as well as to businesses and individuals, but which would have stirred up strong opposition from insurance companies."

Well, not everyone agrees.

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