Tag: Scott Shreeve

Moving forward on genetic testing

Scott_shreeveThree months ago,
there was a huge hubbub about genetic testing in California. In a
dramatic effort, albeit totally misguided, the California Department of
Health sent “cease and desist
letters to multiple vendors who were offering genetic testing services
directly to the consumers. They were concerned by the cost, the
accuracy, the ability for medical professionals to interpret the
results, and the potential for harm to the consumers. However, with
many technology advances that outpace the regulatory apparatus, this
one was well ahead of its time and when the dusts settles, this type of
testing will become a normal part of your health portfolio.

Need proof?

This week Microsoft, Scripps Health (based in San Diego), Affymetrix and Navigenics
announced they are launching a research study to evaluate the impact of
personal genetic testing. The study will offer genetic scans to up to
10,000 employees, family and friends of Scripps Health system and will
measure changes in participants’ behaviors over a 20-year period.
Participants will be able to save a copy of their genetic information
and analysis in HealthVault, enabling them to retain it for future use
as they continue to manage their health and wellness, whether it is for
preventative or treatment purposes.

From Cease and Desist, to a public announcement from all California
based companies on a landmark longitudinal study with 10,000 people
validating the use of personal genetic information in just over three

Stylin’ and profilin’ Cali Style.

The invisible hand and capitalistic sustainability

I, along with everyone else, have been walking around hollow-eyed given the speed of the recent financial meltdown. One-hundred-year old firms disappearing in a weekend, markets roiling with every bit of news, experts clamoring about the greatest calamity ever in the recorded history of finance, and politicians actually working weekends to attempt to rescue the largest and most important financial system in the world.

This is serious business.

I have also been amazed at the Governments response to nationalize “key” companies – AIG, Fanny/Freddie, and probably a few others before it is all through. Several people have made the connection between the nationalization of financial companies with the potential nationalization of the health care systems. Actually the wealth-health connection is probably stronger than you think. Just as the current financial mess is related to the “toxic” subprime debt on the books of the eviscerated companies, hospitals are also being laden with “toxic” debt from consumers who are also leaving them holding the bag on their bad debt.

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Exploring and conquering new health care frontiers

The September/October issue of Health Affairs is dedicated to reviewing concepts of the medical home. It is most likely the most current, authoritative, and impressive review of this emerging idea. Health Affairs is an excellent resource for health policy wonks to gather, but in recent years has become more accessible to the general health care audience. I would recommend it as required reading for anyone interested in learning about this trend.

Simultaneously, there have been some recently updated “state of the industry” reports coming out of the retail health clinic world. As noted by Jane Sarasohn-Kahn, the fact that more and more retail clinics are being created has increased access, improved quality through an evidence based approach to a limited set of clinical conditions, but has not done nothing to address the cost issue. In fact, increasing the supply of retail clinics, has simultaneously increased the demand for these services. This is a common phenomenon within healthcare, and the supply driven demand has been well described particularly in the hospital setting.

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Do membership practices offer privileges or just reserved for the privileged?

Scott_shreeveI have watched the meteoric rise of popular term “Medical Home.” While I personally dislike this phrase, it has caught on in the popular vernacular and looks like it is here to stay. In conjunction with the rise of the term is the growing popularity of a practice model that includes a higher level of service on a membership basis. It is essentially, next-generation concierge medicine, but now being promoted under the more politically correct banner of “direct practice.” Multiple variations of the model exist, from an all-inclusive single fee to a membership structure that retains a fee for service financial arrangement.

So discerning patients evaluating these practices are forced to determine the relative value of this new direct practice concept, and having passed that test, determine which type of practice model actually makes sense to them (All inclusive or Fee-for-Service). Lets look at these questions using a traditional four-person family with an annual all-in health care spending of $15,000 (consistent with Milliman’s 2008 numbers).

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Balloon Mania: Happy Birthday Health 2.0

Having been around for the beginning of the Health 2.0 movement, it is good to see the conference continuing into its sophomore year. A lot has and continues to happen regarding the ongoing health care innovations that collectively make up Health 2.0.Balloon

An ongoing criticism and source of frustration for me has been the banter of those who continue to regard the entire space as a “farce.” People who demand the “proof”, demand unwarranted standards of outcome/impact prior to experimental implementation, and dismiss the space because current business models have yet to produce multiple exits (although there have been a few notables, including AthenaHealth, Medstory, HealthCentral, etc).

So at the infancy of this movement, all I can share with those doubters is an anecdote from the life of one the most famous tinkerers of all time — Benjamin Franklin (just finishing up his biography). In describing the distinctively French invention and subsequent “hype” associated with hot air balloons:

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The call for government EHR unification

While on my VistA kick (here and here), I need to respond to several important errors of understanding in the recent press release hailed with a “Bravo!” from Fred Trotter. I also wanted to take the opportunity to mention a significantly broader and more meaningful opportunity that the open source community should be rallying around.

First, so people are clear – the Department of Defense does NOT currently use VistA. They haven’t since their 1988 decision to have SAIC fork the code. The only reason that VistA is mentioned as part of the DoD’s selection process is that their own physicians are clamoring to throw away the current system in favor of VistA. While the DoD is correct in identifying some of the weakness of VistA, they also appear to recognize many of its outstanding clinical attributes.

Comments from a July 21 letter from Principal Deputy Assistant Secretary of Defense for Health Affairs Stephen Jones seem to indicate a ray of hope for a VistA compromise: “There is a strong feeling here and at the VA that the best approach is a convergent evolution of the two systems. This approach optimizes the strengths of both systems while creating interoperability that will drive more universal information exchange.“

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Dude! The $100m VistA Open Source Opportunity


6a00d8341c909d53ef010536f31133970c-pi I am known for throwing an occasional “Dude” into my jocular speech. Ok, maybe more than a couple when excited. OK, maybe more than a couple when I am not so excited as well. OK, maybe I use it indiscriminately at random times. But hey, I am just following Merriam-Webster definition of the appropriate usage of the term “practically anywhere” within a sentence.

But dude! Have you actually read the recent GAO reports regarding the status of the current VistA modernization project? I was literally shocked – let me save you the trauma by pulling in the highlights (where is WorldVistA, VistA Software Alliance, Roger Maduro, or any of the VistA luminaries in terms of reporting on this?)

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State telemedicine networks: a modern anachronism

I continue to read with interest articles describing new telemedicine projects. I just don’t get it.

What are these guys doing? You don’t need a telemedicine network fraught with complicated hookups, poor screen quality, and difficult communication interfaces. The new telemedicine network is called the I-N-T-E-R-N-E-T (invented by Al Gore in 1994) which in case you didn’t know obviates your “telemedicine initiatives”. I mean seriously, who is sponsoring all these things anyway? Oh, it must be the really efficient guys who you want to sponsor your health care.

There are hundreds of services popping up that do this stuff all day long – American Well, TeleDoc, Consult-A-Doc, Myca, etc. The only thing encouraging I saw in this article is that they actually believe they can have a 100 clinics up the first year. That will be great so that the millions of people who have been doing eConferencing via the internet for the last five years can have some medical people to talk to. Cool.

Oh, and by the way, congratulations on the concept of a broadband connection. Maybe you can download some Seinfeld re-runs to celebrate the glory days of 1998.

Consumer genetic movement: Cease and desist? How about understand and resist!

I have been following health care consumerism for several years now. Particularly, the “Direct Access” or “Direct To Consumer” laboratory testing market. While analytic lab testing has led out in this area, genetic testing has received all the regulatory attention, national press, and policy efforts (GINA).So it is no surprise that consumer genetic movement would be the first legal test of the Health 2.0 movement. As reported by Matthew Holt here on THCB, and a host of national outlets (Wired has had extensive coverage here, here, and here), there seems to be quite a hornets nest unleashed by our friends at the California and New York Departments of Health who are attempting to prevent consumers from accessing their own genetic information.

Thanks to some transparency efforts of the blogosphere, you can read the actual cease and desist letter written by Karen Nickels, the California Department of Pubic Health Chief of Laboratory Field Services. I actually know Karen Nickels personally. She has been a long time steward of ensuring regulatory exactness of all things laboratory within the State of California for 30+ years. She has a well deserved reputation as one tough cookie for the “precision” with which she carries out her dutiesUltimate Genetic Fighting – Which Genetic Variation Wins?

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Mckinsey smells opportunity in explaining health care

McKinsey Quarterly released an interesting study this week under the moniker, “What Consumers Want in Health Care." The central theme of the publication was the large and growing opportunity for a new type of health care “infomediaries” (who traffic in the flow, enhancement, and interconnectivity of information) to have a large and sustained impact in the transformation of our current system to a next-generation system required to meet the health needs of the future.

A few relevant quotes:

  • Retail health consumers constitute a market worth hundreds of billions of dollars annually.
  • Currently 116 million consumers have a choice of health insurance (expected to be 151M by 2011).
  • Most consumers still do not “shop” for insurance — 74 percent will like purchase from current health insurer.
  • People who do “shop” do so during moments of considerable change — and a full 41 percent either considered or changed insurance.
  • Most people need additional guidance, education, and advice to make decisions.
  • Innovative, cross-industry products that assist with the complex decision making will be highly valued by an influx of consumers eager for options but unsure where to turn.

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