This is very, very unpleasant. A staph infection outbreak in Los Angeles that’s got its own name— the Scourge of Skid Row. And it’s one reason why public health, including the real basics like housing, clean water and access to medical care affects everyone—not just those without it.
First the merger was delayed for some vague reason. Now it’s off. LifeMasters and Healthways nix $307M merger basically because of over-reported value of a certain contract — presumably one of the larger ones, and my guess would be a Medicaid one (But that is just a guess). And the difference was important enough that they couldn’t get to a new price
The termination followed a data and reporting error made by the unidentified actuarial firm regarding a LifeMasters’ contract, the companies said. That error “was unknown to LifeMasters at the time the parties entered into the Merger Agreement.” But the correction of the error “materially impacted period revenues” and financial projections that Healthways relied upon when it entered into the agreement.
“We are also disappointed that the merger could not be completed,” said David Strand, LifeMasters’ president and CEO.
Disappointed? I suspect that’s putting it mildly!
Clem Bezold from Institute for Alternative Futures (kind of the alternative IFTF) gave an overview of the conference and an optimistic 2016 forecast for the availability of broadband to the home, better knowledge and personalized tools that will work on that information. Then he gets a little more controversial, including personal values, need for universal coverage, end of life care in context, etc — all as part of care in 2016
His main talk is about accelerating Disparity Reducing Advances project—wants to accelerate the technologies and process that reduce the social disparities in health care. They are not looking at the bigger picture of employment, education, etc, (consciously) and its impact on health, but they think that they can make a difference in the health care provision and tech part. They’re trying to pick their targets. And the first one is:
—Prevent obesity in poor populations. That leads to different levels of action in diff government and social programs. but we need to change the social environment, including getting the right foods into the right neighborhoods, as well as doing the health care screening and pre-diabetes initiatives. So there are a whole variety of factors you;d get to for any diseases, and information therapy is a big part.
Some things they’re trying—working with cell phones (LG has launched a diabetes phone this month which has a built in test strip reader. Also looking at biomonitoring activity, all connected to cell phones infrastructure. But needs to be connected to services. There are proposals to say that spectrum should not be auctioned off, but instead should be free (internet telephony over free wiMax?). That will be all added to patient and care giver “navigation”.
His forecast for monitoring. By 2008 standards for biomonitoring; by 2012 reimbursement has changed so it gets pay for; by 2016 common in us for monitoring the chronically ill and elderly. My feelings that this is about right, but it’ll require a whole hell of a lot of changes in the system…and of course there are huge infrastructure issues for the lower income providers (tech access, language, etc) which Clem spelled out clearly (and far too quickly to note down easily!)
Clem is an “aspirational” futurist who’s trying to change the future as much as explain it. At IFTF we were “analytical” futurists, and we derided the aspirational guys as the “personal helicopters by the year 2000” school of futurist — but his talk was really interesting, and frankly alot of analytical futurism is by definition wrong. So hopefully Clem provoked some big goals that we should all be going after.
I asked him about the norms of advertising for food and obesity—he thinks policy things can be done. And also about the system change required for home monitoring? How can the system change? He thinks that health care will be redesigned the hard way, otherwise it’s a perfect storm. It’ll get worse before it gets better. How do you get the patients and care-givers in the right place within the system. We will re-torque our use of health care providers to make that change.
Josh Seidman put up the Ghandi mantra “First they ignore you, then they laugh at you, then they fight you, then you win.” I think Ix is still being ignored, but soon it’ll be heading to the “fighting” part—and that is when it’ll get brutal.
Meanwhile in a moment of Ghandi zen, here’s a photo of a balloon over the canyons this morning
Deborah Bell—Runs ovarian cancer listserv and became an in-depth patient
Alan Greene, the pediatrician who runs DrGreene.com, and gets 50 million hits a month from 2 million unique users—Money quote for doctors online and off – “You have to get to the spot where you are OK that you patient knows more than you do.” He rewrote the Hippocratic oath because it said that physicians should NOT share information with patients! But doctors should still take a stand and tell patients what they really think.
Don Kemper, Healthwise—Infrastructure change saves lives for average people. Water quality; seatbelts in carsthey worked for the 20th century. What about the new century? How about message systems to tell you about immunization for kids? Information to cut out unnecessary surgery? Medication adherence protocols and information for everyone? Personalized wellness, prevention and screening for everyone? An appreciative approach to the end of life? We need to change the infrastructure so that the average person cannot avoid the Ix infrastructure!
Next up at the Ix conference, Medicare Health Support got three cheerleaders telling us that they’re doing very, very well (Sandy Foote ex CMS, George Bennet from Health Dialog, Michael Montijo from American Healthways. There;s lots and lots of details about how to do this, and there are lots of problems to be overcome. But it works. I wont go into the details as I’ve written plenty about it a while back. And my sense is that the lack of DM is so apparent in the wider health system that basically any intervention which concentrates on educating and informing people about their health works.
I want to know whether it will work when we look to crank down beyond the 5% savings that Medicare Health Support committed to making today. Usually the rule is that Medicare overpays the private sector for what it does. But perhaps we’ll never find out.
Meanwhile, Ted Eytan, who’s the MD who runs Group Health Cooperative in Seattle’s Informatics group just won the first annual award for really making a big difference in information therapy (not sure what the award really is called but that’s what it’s about). No question that GHC is a leader, and kudos to Ted for making it so! (Ted is also the sponsor of a secret blog which will appeal to you process types)
Information Therapy center chair Paul Wallace is from Kaiser Permanente, who quite logically would be interested in Ix.
He notes that the medical care cost, and the costs of poor health to employers far exceed the medical cost. (Absenteeism. etc)
He also notes that no consumer is involved in designing consumer directed health care. How do we get “skin in the game” not to be a blunt tool like managed care? And he explains that the revenue that would pay for the care of the 20% has left the system. let’s not use blunt tools to solve complex problems. That means using co-pays to access selective care, but not for pharmacy, well baby care, etc. And are there incentives to use information therapy in those decisions?
He has a vision of putting the patient centered care integrating this around patients not their diseases.
Then it’s on to two patient advocates. Sue Sheridan (who gave a harrowing speech last year that’s well worth re-reviewing) and Jesse Gruman from the Center from Advancement of Health. Sue has got the CDC to engage consumers in telling mothers about the risk that jaundice can cause brain damage. So eventually this fall they are putting out information that are right for new mothers—not about the disease but “how can my baby get hurt and how can I do something about it. Sue thinks fear is a gift that will motivate. Jesse is not so sure, but know that we need to arouse the anxiety just enough to give them something productive to do. Last year Jesse told us about “blunters and monitors.” In other words some people want the second opinion, want to know everything, but others want the doctor to tell them what to do. But there is no neutral health information. So the people trying to engage patients in health information have a major challenge. But Sue thinks that we should create the demand for patients to be engaged because if they’re more involved they’ll have better outcomes.
Jesse thinks that using marketing methodologies that retail et al use to make people buy stuff they don’t really want/need (e.g. data mining connections) needs to be used to deliver information therapy and make people integrate it in their life. We also need to tell people what we expect them to do.
One of the most interesting questions is from a Canadian who is telling about how consumer health information in his hospital (McMaster, in Hamilton Ontario) is worked out in conjunction with marketing academics. In the US he says that this stuff seems to be part of the marketing department, and be kept as proprietary information.
So as I warned you, I’m at the Information Therapy conference in Park City, Utah.
Andrew Webber from National Business Coalition on Health. Tries to come at Information Therapy from the point of view of an employer—but an employer who was brought up as the son of a Minister living in Spanish Harlem.
Employers are figuring it out….he thinks they can improve quality while controlling costs, and do it by making the health care system more functional. Andrew thinks that employers really want a more productive healthier workforce. He thinks that there should be metrics for how Wall Street looks at individual companies on the health/productivity issue. So we need better stories to get employers to realize that they need to get on board with improving this.
But overall employers want to point at providers and call it their fault! (for a bunch of reasons). But he thinks that employers can do better and they’ve been a big part of the problem. Employers have created a toxic payment system, that pays for poor quality of care.
Andrew wants employers to take responsibility for it! Their vision is health purchasing reform via value-based purchasing community by community.
His 4 pillars (of wisdom) are
1. Performance measurements2. Transparency and reporting3. Payment reform (he wants population-based not a fragmented FFS-based payment)4. Informed consumer choice
But you all know that, so let me show you a photo I took in a slot canyon in Arizona yesterday (taken on my Treo no less!)
Meanwhile, Andrew thinks that this is all wrapped up in the change of Federal incentives (and the recent directive) to do more transparency and get consumer purchasing on the national radar.
Personally I get very nervous when Information Therapy gets wrapped up in the ideology of consumer-directed health care. Somehow he manages to think that what HHS and Leavitt is up to and what RWJ is supporting are consistent with each other! But he does make the reasonable point that Ix needs to somehow connect with the wider movements. I just hope it gets done as a neutral issue without getting into a real war over the ideology. If Ix gets wrapped up in that it will be shot in the crossfire.
The 2006 Information Therapy Conference starts later today in lovely Park City, Utah. I may post a photo or two from my weekend in the lovely southern part of the state, and I’ll be giving more information about what’s going on at the conference right here on THCB later
Pretty interesting article from the Freakonomics guys about the large efforts it took to get docs at Cedars Sinai to change a relatively simple behavior with a big impact on patient safety— washing their hands. One gets the impression the same hospital didn’t work quite that hard on understanding how to effect a different behavior change, also concerning doctors and patient safety.
In a vox populi column the SF Chronicle asked readers, How would you rate your last hospital stay? Funnily enough in every case when they had a good experience they mentioned the name of the hospital. If they had a bad experience, they didn’t call out its name.
Do people with bad experiences really tend to keep quiet about who did the dirty on them? Or is the Chronicle scared of pissing off advertisers? We report, you decide!
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