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PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru

This is the transcript of the podcast interview I did with Joseph Kvedar, from Partners Center for Connected Health. Coincidentally this past Tuesday in NYC, the Center, along with Continue Health Alliance and others, sponsored a meeting about the use of monitoring devices as part of a general strategy by leading edge employers to try to do something about the management of the chronically ill. There’ll be more from me about that later.

Matthew Holt:  Hi, this is Matthew Holt with The Health Care Blog, and I am doing another podcast. If you are one of those people who thinks that we have too much medical technology and too many medical facilities in America–I am deep in the belly of the beast. Sitting in the middle of the academic medical center triangle of Boston speaking with Joseph Kvedar. Joseph is the director of The Center for Connected Health. He also, for those of you who are paying careful attention, wrote an article in The Health Care Blog about Connected Health, just, I think, a week-and-a-half ago. Joseph, first off thank you very much for hosting me in your office.

 

Joseph Kvedar:  Delighted to be with you, Matthew.

 

Matthew:  You are also the Vice-chair and the Associate Professor of the Residency Program in the Department of Dermatology, so obviously you have a medical background. You know, that it’s not unusual in the AMC for somebody who is an academic physician to be also prodding around in another area. This center was, until recently, called The Center for Telemedicine.

 

Joseph:  Yes.

 

Matthew:  Also it is an integral part of Partners, what you are doing in terms of outreach into the community with technology. Why the change to Connected Health?

 

Joseph:  Well, we felt that most of what we are doing these days is not captured by what people traditionally think of when they use the word "telemedicine." I have spent a lot of in time in meetings over the last few years explaining that. So it just made sense for us to adopt a moniker that was a bit more fresh, a bit more 21st century, and could really allow us to have people engage with us and our vision in a more effective way.

 

Matthew:  That makes a lot of sense. My friends at Cisco think that they invented the term and that the NHS and everyone else is copying them. But the concept around connection and health seems to be really taking off. You can guess if that is a good thing or a bad thing, but I think it underscores a lot of what we are talking about. Now some of the things you brought up in the brief piece you wrote for The Health Care Blog I think are very interesting. Just capture, for those people who haven’t read it, the flavor of what you think the possibility of change that this kind of technology can bring.

 

Joseph:  Let’s use the example of diabetes. So today your average diabetic often views their condition as somewhat of puzzlement, somewhat of an accident. They may or may not understand the relationship between diet, exercise, and glucose. They may or may not understand how changing their activity level can help their condition. They are really left with occasional, brief, hurried visits to their doctor, and a lot of instructions, and often very little in the way of a true relationship or connection with healthcare.Now picture the same individual with a lot of physiologic feedback. Let’s say an accurate step count, once or twice daily a log of their glucose readings that is contextualized with their diet and their activity, and a medication reminder system. And I think that is, for us, all of that is what we mean by "connected health."

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TECH/HEALTH PLANS: AthenaHealth causing trouble again

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AthenaHealth caused a ruckus last year when it put out  a ranking of how fast health plans were paying doctors. Now they’re at it again. Cigna ranked No. 1 and United didn’t do so well. Of course if just speed of payment were the problem in American health care, it would have been fixed long ago.

But surely there’s much else in their data that would be interesting to know about. For example, I’m looking forward to AthenaHealth telling us from its data what activities of its physician customers were appropriate given their patients’ conditions. I’m interviewing AthenaHealth CEO Jonathan Bush in a few days, and I’ll ask him about that.

Any other suggested questions?

UPDATE: Here’s the chart of AthenaHealth’s 2007 Payerview rankings. They’ve also put up a rather flashy website explaining it all.

PAYERVIEW NATIONAL PAYER RESULTS:

National Payer 2007 Rank 2006 Rank
CIGNA Healthcare 1 5
Aetna 2 4
Medicare – B 3 2
Humana 4 1
UnitedHealth Group 5 3
Wellpoint 6 7
Coventry Health Care 7 Not ranked
Champus/Tricare 8 6

TECH: Quadramed surveys consumers on EMRs et al

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Just to show that you don’t have to be Kaiser to survey the public on EMRs, mid-tier vendor Quadramed has done so too. The basic findings are that few consumers were aware that national quality ratings exist. And frankly I think that the few who are aware are wrong! But if they did exist they say they would use them (which is now what actually happens now BTW according to Harris data). Even fewer had heard of P4P, but in general they liked the idea once it was explained to them. And while roughly half had heard of EMRs, they like that concept too. Finally 42% said they’d experienced an insurance related error. I assume the remaining 52% have never filed a claim!

PODCAST/TECH: Interview with Chris Hobson, Orion Health

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Since John Irvine’s taken over as the business lead for THCB, we now have a raft of new sponsors including CDW, Silverlink and now Orion Health. Apparently the marketing folks at Orion thought that it would be a good idea for me to interview their Chief Medical Officer Chris Hobson. What I didn’t realize is that Chris is a wealth of knowledge about health care systems around the world, and in particular how EMR use became prevalent–yup that essentially 100% adopted–in New Zealand We had a very interesting conversation about that, and if you’re as interested in that conundrum as you ought to be (which is very!) you need to read this. And hopefully the marketing people wont be too upset that their CMO barely got close to the topic of what OrionHealth actually does!

Matthew Holt:  This is Matthew Holt at The Health Care Blog and today I’m doing another podcast. And with me I have Chris Hobson. Chris is the Chief Medical Officer at Orion Health. I’m very happy to be talking to anyone at Orion Health because unbeknownst to me last week they have decided to become a sponsor of The Health Care Blog. As part of that arrangement, I’m very delighted to interview Chris because I interview a lot of people who do not sponsor me. [laughter] Anyway, Chris, good morning. Thank you very much for joining me. Thanks to Orion. I don’t know who was it who your organization who decided to do this as I am no longer the business rep of the Health Care Blog but delighted to talk to you.

Chris Hobson:  Good morning. It’s nice to be here.

Matthew:  I sense by your accent you are one of these American immigrants. Well, you’re in Canada, right?

Chris:  Yes, actually I’m native from New Zealand. Orion Health, actually, we started in New Zealand. As we’ve grown from New Zealand across UK, Canada, Australia, and other parts in the US, I’ve sort of tagged along with the company.

Matthew:  That’s great. Well, it’s always good for people to come from the rest of the English speaking world to tell the North Americans how to do it. I’ve been doing it for years, not that anyone is listening.

Chris:  [laughter]

Matthew:  Let’s talk a bit about that. There are a couple of things that Orion does. For those people who don’t know about Orion, and you’ll explain it better than I do, loosely you’re in the business of improving data communications and data integrations and that ends up being a lot around messaging and interoperability issue–currently a big picture problem in the US. But also elsewhere. Let me ask you to start with a couple of things. First off let’s talk a bit about what you perceive to be the big problem in the US in that sector. Because you guys are also in a lot of other countries, you mentioned New Zealand, UK, Canada and also some other European countries, give me a sense of. Is this the same problem everywhere in health systems or is the US unique?

Chris:  Sure. Well, we have our own perspective on what’s wrong with the health care system, but I guess, there would be fairly few people who would disagree a major problem with health care is the fragmented nature of it. There are a lot of different people, all well intentioned, doing a lot of good things across that the patients may interact with. The problems that we see arise as the result of all this—Going on from fragmented system to provider-to-provider-to-provider. In particular the information does not move along with the patient and it is very easy for the provider to focus on a narrow area and miss the big picture for what is going on with the patient.In the US, health care is more fragmented probably than anywhere else. In the sense that there are six thousand hospitals and just a huge range of both providers and payers. And if you look outside of the US, health care is not as fragmented; however, it is still quite fragmented and the same problems do arise.So if look for instance, the classic kind of story comes where down to and I’m taking this case from Don Berwick, and so I hope that’s OK but–

Matthew:  [laughter] We steal from Don Berwick all the time.

Chris:  [laughter] You steal from Don Berwick all the time. That’s great. He’s a Harvard professor of pediatrics, and his wife developed an obscure neurological complaint. It took some nearly six to twelve months before she got better more or less as a result, or not as a result, of the health care system. Along the way, she saw a huge range of different professionals who were all trying, well intentionedly trying, to help. The problem from his perspective was that each time they went to see a new professional he had to remember the case history. Each time they would see another professional, they would ask, "Tell me about what’s been going on." sort of thing. Of course, he had told the story so many times and been questioned about it so often that by the time he got to about 10 days or 10 weeks of this it was very hard to be strictly correct or accurate even with the best intentions.Another case in a sense that may be described as another sort of sense from when I was working at South Auckland in New Zealand, we went out and visited a home visiting nurse. And the first thing she said as she went in to visit a patient, she said, "Everything you tell me will be kept completely confidential, and I won’t share it with anyone." She then proceeded to take the whole history about what had been going on, and the patient had diabetes and had been to see a primary care practitioner who had said, "You have diabetes." But of course, the patient didn’t like that message particularly. So, he did nothing and a few months later he still wasn’t feeling very well, and went to see another practitioner who said ‘You’ve got diabetes’, and he didn’t like that story either. But eventually he managed to end up in the emergency room in the hospital and they looked up the history and said ‘You’ve got diabetes’. And they operated on the patient and then sent him out into the community. So when the community visiting nurse went to see the patient to look at the ulcer on the leg and dressings she knew nothing of all of this. Even though she worked for the same hospital and the same surgeons had done the surgery they hadn’t communicated onto the next provider what needed to be done.Now let’s rewrite that script and go back and say. The patient goes to see the first GP and he says you’ve got diabetes and the patient doesn’t like hearing that news so he goes to see the second practitioner. When he goes to the second practitioner, this time the stories different because he says ‘hey you’ve got diabetes, and by the way that first doctor that you didn’t like for telling you that you’ve got diabetes. He was right. You’ve got diabetes and now two of us have told you and you need to take this seriously.’ Let’s imagine the patient still did nothing and ended up in the hospital. The hospital specialist will say ‘You’ve got diabetes, and by the way, all these other people who’ve been telling you the same thing, it’s about time you started to take note of it.’So that’s a short vignette on what we see as the biggest problem in health care from our perspective. I mean health care is full of problems, but the information continuity and sharing of information, and sharing it in a way that improves the quality of care and re-enforces messages to the patient and it’s consistent. We see the lack of that as a huge barrier to improving the quality of care.

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TECH: Andy Grove ‘s Prescription By John Irvine

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Former Intel Chairman and CEO Andy Grove is in the latest issue of WIRED talking about the paradoxical relationship between healthcare and technology. “We have the Human Genome Project, personalized medicine, war on
cancer, CyberKnife, stem cell research on one hand — no doctor to be
found or to take care of your sore throat on the other," Grove says. "That’s a pretty
ugly picture. It’s pretty ugly today but it’s going to get uglier."

WIRED’s Kristen Philipkoski interviewed Grove after a recent talk he gave at Berkeley. (Watch the webcast here.) The Silicon Valley legend, who Harvard Business School biographer Richard Tedlow thinks "could [probably] hold his own against Benjamin Franklin," argues that part of the answer lies in less complicated solutions than the industry is currently pursuing. "Altogether," Grove tells the magazine, "I am obsessed with doability as opposed to desirability."

Like other tech executives who have been drawn to healthcare as both a business and social issue, Grove has been thinking and talking publicly about the problem for years. Philipkoski writes that Grove’s current thinking focuses on three general areas where he thinks quick improvements might be possible:


First: Keep elderly people at home as long as possible (an idea he
calls "shift left"). Use high-tech gadgets to help them remember to
take their medicine and monitor their health. In one year, if a quarter
of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.


Second, Grove advocates addressing the uninsured by building more
"retail clinics" — basic health care centers in drugstores and other
outlets that can take care of problems that are presently, and
expensively, addressed in emergency rooms.


Lastly, unify medical records using the internet. In his vision, every
patient carries a USB drive containing his or her medical records,
which any doctor can download.

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TECH: KP promoting EHRs

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Kaiser Permanente is trying to shift the focus on its EHR programs back to the good things about it (and we’ve heard plenty about the controversy). They are having a conference today in DC with big guns like Carolyn Clancy and have put out a survey. Their spin on the survey is that Americans Want to Go Digital When it Comes to Their Health Care.

And while approximately one in ten (12%) of Americans currently review their personal medical records on their health insurance company’s Web site, over half say they would like to be able to check claims and coverage (56%) or access personal records (51%) electronically in the future.

It’s not all sweetness and light, but there clearly is more interest in accessing information that’s pertinent and personalized about health care from health plans, and of course KP is not the only one making steps in that direction. So they’re roughly right. As for HealthConnect, as I’ve been saying for a while, the proof of the pudding will be in the actual use when fully rolled out in California. And for that you’re going to have to wait.

PODCAST/CONSUMERS/TECH: Interview with Joseph Kvedar, Partners’ Connected Health guru

Joseph Kvedar wrote a piece for THCB a couple of weeks back on Connected Health and its potential. As I’m in Boston I dropped in on him in his office at the center of the world’s greatest collection of medical ivory towers in downtown Boston, just near Mass General. What he’s doing is preparing for a world in which doing more of the same may not be an option, and his employer is at least thinking about what it’s role might look like in that future.

But Joseph isn’t some other start-up whiz-kid with a few ideas. He’s the Director of the Center for Connected Health at Partners, and he has some very interesting things to say in depth about the promise of using technology to improve health and reduce costs of the very sickest patients–and the roadblocks and incentives along the way. And he’s, just perhaps, threatening to radically disrupt his own organization from the inside.

Here’s the interview.

TECH/HEALTH PLANS: Interview/Podcast with Mark Ganz, CEO Regence and Luis Machuca, CEO Kryptiq

This is the transcript from an interview I did at WHCC last week with Mark Ganz, the CEO of Regence, the Oregon based Blues plan that operates in the Pacfic Northwest, and Luis Machuca, the CEO of Portland-based health IT messaging company Kryptiq. Machuca is innovative as both and employer and a technology guy, and Ganz is, shall we say, not your typical insurance company executive!

Matthew Holt:  This is Matthew Holt with the World Healthcare Blog, reporting from the World Healthcare Congress, doing a podcast. It’s kind of funky back here because we are in this glass-enclosed blogger’s corner which they put together at the back of the exhibit hall, but they are still setting up the exhibit hall, so you can hear the vacuum cleaners in the background. But no matter, we are on with the first podcast of the day.Today we have got some very interesting folks: Mark Ganz, who is the president and CEO of the Regence Group, which is the big Blue’s plan in Oregon and the Pacific Northwest; and Luis Machuca, whose name I just got wrong again. [laughs]

Luis Machuca:  Machuca!

Matthew:  Machuca! Sorry, my pronunciation is–they never taught you that about proper Spanish accent in the English school I went to. He is the CEO of Kryptiq, which is an IT messaging company. Well, I should let Luis tell you about that. Mark has already been on the podium twice today in two different areas; Luis has just been talking about an initiative that is being run for his employees with Regence. So let’s start there; Luis, give us the quick find out about what are you doing with your employees and how you work with Regence and what innovative things you are doing around employee healthcare at Kryptiq.Luis:  Hi Matthew. So, really what Kryptiq is all about is building tools that enable healthcare transformation. We’ve really, from day one, always felt that transformation starts from the inside out. So before we try to transform the world of healthcare outside, and build tools for them, we wanted to make sure that we were sensitized to the notion of delivering the very best possible healthcare in the most efficient of ways. So we’ve done many things along those lines, starting with reimbursing for email and patient portal enable clinics for employees.More recently, and why Mark is here really, is to align with health plans who also embrace the notion of transformation and the notion of getting more decision in the hands of the employees, and more tools and information for employees to make the right decisions about their healthcare dollars.

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TECH/POLICY: Boston Friday dog blogging

This week I’ve been in Washington DC at the World Health Care Congress and I’ve talked to a lot of people–some on and some off the record. Much of that of course has been available at WorldHealthCareBlog, and some smattering of that has been seen over here at THCB from time to time. But all engrossing stuff—especially getting up close and personal with Jack Wennberg a couple of times.

I then moved up to Boston where I’ve been listening to some smart people and talking with various technology companies. You’ll hear much more about that in the coming days, including a very interesting interview with Joseph Kvedar at the Center for Connected Health at Partners. That’ll be a podcast when the upload cooperates.

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