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Tag: Startups

TECH: In which Dmitriy challenges Health2.0, but reveals that he’s challenged, and not just by the calendar

Over at Trusted MD Dmitriy “jumps on Health 2.0 Bandwagon”.  Well actually he’s taking the piss, as we English say. The only problem is that today is April 2, not April 1. And Dmitriy doesn’t understand technology diffusion as opposed to stock market bubbles (which Health2.0 and Web2.0 are quite evidently not, unlike the companies in the DotCom boom which obviously were….)

Never mind. It’s fun to have a contrarian point of view. And don;t worry Dmitriy some people who are if not wiser at least a lot richer than you and me are already using the Health3.0 moniker.

As for Health2.0. You’ll be hearing much more about that on THCB. But don’t worry, it’s just a label, and labels don’t mean a whole hell of a lot. But the technology and the trends embodied in it are too powerful to be ignored—just as they were in the DotCom boom. Or is Dmitriy still buying paper tickets from his travel agent?

TECH: Top Health IT innovators 2007

FierceHealthcare (which I have NOTHING to do with any more!!) is out with a list of Top Health IT innovators for 2007 . Funnily enough several companies I’ve featured here or in my talks are on the list, and #1 is Enhanced Medical Decisions—which I liked so much when I saw it that I started working with it! (So if you’re interested in them, you can email me!) Here’s the full list:

FierceHealthIT Top Health IT Innovators 2007

10.   NaviMedix
9.   PatientsLikeMe
8.   MDVIP
7.   Get Well Networks
6.   MedApps
5.   athenahealth
4.   Devon IT
3.   QlikTech
2.   Practice Fusion
1.   Enhanced Medical Decisions (EMD)

PODCASTS/HEALTH PLANS/TECH: Interview with Stan Nowak, CEO of Silverlink

Stan Nowak is President and CEO of Silverlink which does automated phone calls on behalf of health plans. It’s a lot more complex and much more interesting than you might think, and it really is closing the loop for those health care consumers who don’t use the web. Plus Stan is an interesting and fun guy, even though he had to suffer through that awful Cambridge, Mass based business school!

Listen to the podcast. The transcript will be up in a few days.

TECH/QUALITY: Stents–it’s even worse than we thought, WITH UPDATE from The Industry Veteran

Note: I put this up late last night–but it’s such a huge story (and as one emailer says, can you think of a recent study that so blatantly points out all the flaws in the health care industry better than this?) that I’ve moved it to the top today

Man. This is no fun for Boston Scientific and the rest. Most angioplasties unneeded, study finds. This is even worse than was thought. Non-emergency angioplasties with stents are not even any good at reducing chest pain (angina) compared to drugs over 5 years:

The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients. An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done. "By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

<SNIP>

About 1.2 million angioplasties are done in the United States each year. Through a blood vessel in the groin, doctors snake a tube to a blocked heart artery. A tiny balloon is inflated to flatten the clog and a mesh scaffold stent is usually placed. The procedure already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later. The new study shifts the argument from which type of stent to use to whether to do the procedure at all. It involved 2,287 patients throughout the U.S. and Canada who had substantial blockages, typically in two arteries, but were medically stable. They had an average of 10 chest pain episodes a week — moderately severe. About 40 percent had a prior heart attack.

Live by the stent and potentially die by it. BSX was down around 6% at the close. And it would be un-THCB like to say “I told you so”, but I told you so.

UPDATE: Meanwhile, all the analysts MarketWatch polled don’t think that this study will make any difference, even though BSX barely got a dead-cat bounce today after its mauling yesterday. And then, well you knew this was coming….here’s what The Industry Veteran thinks about my pussyfooting around the issue:

The NEJM study on stents versus medical therapy, publicized this week in connection with the American College of Cardiology meeting, is not really “worse than what we thought” in terms of what it reveals about the larger health care system. It demonstrates exactly what we thought and what I’ve made explicit on this site several times. Ed Silverman over at Pharmalot nails it squarely when he writes that a large segment of cardiologists feel threatened by the study’s results because there are financial incentives for them to insert stents. In other words, the big problems facing health care will not be adequately addressed by digitalizing medical records, adopting treatment algorithms or any other technical tweaks. As long as the public remains hostage to obsessively greedy manufacturers, equally greedy physicians and third-party payers that are capital aggregators, we will continue to pay more than the rest of the world for our health care and, for the population as a whole, derive fewer benefits. Too many middlemen are allowed to extract too much economic rent from the health care system.

As the ACC meeting in New Orleans winds down, I’m reminded of a conversation I had at a previous meeting with a cardiologist from Westchester County, New York. American society, in his considered opinion, must guarantee practitioners who choose to start in his field a minimum yearly salary of $250,000 in return for their willingness to “give up the decade of their twenties.” Until then I still held the naive notion that while nationally acclaimed investigators working in academic medicine are exalted whores and crooks, the garden variety specialists in solo offices maintain genuine concerns for their patients as they work to obtain a secure but not unconscionable livelihood. In a pig’s eye!! Specialty practice in the United States today attracts people with the souls of Tony Soprano or “Chainsaw” Al Dunlop and it refines their predatory instincts through an arduous indoctrination process. Debating whether they or the pharma and stent companies do more to corrupt the system remains pointless, similar to arguing whether local politicians or the road contractors who bribe them are worse crooks.

POLICY/TECH: Harvard business school prof #3 doesn’t understand economics

And following up on Reggie Herzlinger and Michael Porter in my continued series beating up on Harvard Business School professors who don’t understand health care, I move onto a relative newcomer.

CHCF’s President Mark Smith interviews  Mr Disruptive Innovator himself Clayton Christensen in Health Affairs. Mark asks his a bunch of sensible questions about how disruption can work in health care (as compared to computers and high tech) with our different payment structure, concentration of diseases/costs amongst a few people and (implicitly) the long term non-episodic nature of the care required for chronic disease. And what does Christensen do? He ignores the parts that don’t make sense to him. The best example is this extract.

HSAs And The Individual MarketSmith: <snip> After all, if you’re choosing between a $150 doctor visit and a $39 MinuteClinic visit, this choice might drive your behavior and help develop a market for MinuteClinic. But the 20 percent of people who are responsible for 80 percent of the costs are often choosing between a $47,000 hospital bill and a $45,000 hospital bill–neither of which is something they can pay out of pocket. Can you think of anything that will result in similar pressure being applied to the high-cost segments of the markets, where we pay though an insurance mechanism and are likely to continue doing so?

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TECH: Does Asset Tracking Live Up to the Hype?

My latest piece for Digital Healthcare and Productivity is up. It’s called Does Asset Tracking Live Up to the Hype? By and large I think that it will while the folks at ECRI are not so sure.

Meanwhile asset trackers PanGo who got a brief mention in my piece yesterday merged with Innerwireless, a company that has its own (non-WiFi) tracking technology and provides (as the name suggests) wireless networks inside hospitals. What this does to PanGo’s partnership with Cisco, which also provides the odd network, someone cleverer than me will hopefully tell me.

PODCAST/CONSUMERS/TECH: Interview with MaryAnn Stump CEO, Consumer Aware–HealthFacts.org

This is the transcript of my interview last month with MaryAnn Stump CEO, Consumer Aware. Consumer Aware is the BCBS Minnesota subsidiary that puts out the web site HealthCareFacts.org which ranks and rates hospitals and clinics. Unfortunately I had some technical problems with this podcast recoding, but 95% of what Mary Ann was saying is here—and she said a lot! The original audio podcast is here

Matthew Holt:  This is Matthew Holt with The Health Care Blog, and I’m back with another podcast on the blog. Today I’m very excited that I’m talking with Mary Ann Stump, who is, among her many other titles, the president of Consumer Aware. Which, Mary Ann, you’ll explain to us, is a subsidiary of Blue Cross of Minnesota. Tell us a bit more about what you do, and about what else you’re doing at Blue Cross of Minnesota.

Mary Ann Stump:  Ok. Well first of all, good to talk with you Matthew. I appreciate the opportunity. About a year and a half or so ago…I’ve been working with Blue Cross/Blue Shield of Minnesota for about 16 years now. About a year and a half ago, when I had been working diligently in this whole space of consumer information‑‑that became known more formally as "transparency"‑‑our CEO and I were talking one day. I said, "You know, I think we really need a team. Sort of a garage type of situation, a learning laboratory where we can really start devoting‑‑with a particular number of people that have an interest in advancing a whole vision around effective and useful consumer information‑‑ someplace where we can sort of work on this in addition to thinking about the business the way that it is today."

We had an affiliate organization that essentially was doing managed‑care tools. Really as you know, the whole managed‑care movement is not only changing significantly, but I think the kinds of things we were doing historically are not the kinds of things that we’re going to need as far as the future is concerned.What he suggested was: Why don’t we take that particular affiliate organization‑‑that I like to think about as a garage so to speak‑‑and say let’s set off deliberately to start to look at how we were going to do things differently as far as consumer information is concerned. Based not only on what we know but where we want to start to see people moving. From being the usual recipient approach to health care and really with the consumer at the center, being customers of care. What are the kinds of tools we would develop in that regard? I’d already been working on a couple things, and so essentially we formalized not only the expectations but the opportunity to be able to accelerate that. So Consumer Aware was born.

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PODCAST/TECH: Glen Tullman, CEO Allscripts interview–What’s the future for eRx and EHR?

This is the transcript of my HIMSS interview with Glen Tullman, the CEO of Allscripts. it includes some comments from Jim Morrow, an MD from Georgia who is HIMSS doc of the year too. The original audio podcast is here.

Matthew Holt:  …It’s Matthew Holt with The Health Care Blog. It’s another of my HIMMS podcasts, and this one’s really exciting. I have not only Glen Tullman, who is the CEO of Allscripts, which is one of the dominant players in the EMR market for ambulatory care, and moving to other areas, but I also have Jim Morrow who is a doc from…Where in Georgia, Jim?

Jim Morrow:  From Cumming Georgia, North Fulton Family Medicine.

Matthew:  Ah. From a medium‑sized practice, a family medicine practice in Georgia. He is an Allscripts user. Jim isn’t going to be prepared for this, but we brought him here anyway. Anyway. Good morning, Glen.

Glen Tullman:  Good morning. It’s good to be here.

Matthew:  We do this thing‑‑as my listeners are now familiar with‑‑with the mike, so it will fade in and out because it’s not very professional. [laughs]. Anyway, first off Glen, you’ve been CEO of Allscripts since what? 1997, 1998, something like that?

Glen:  I’ve been with Allscripts for nine years now.

Matthew:  Right, so ’98. And you had the joy of being the head of a public company, which went from a stock price of what, seventy‑eight or seventy‑nine in 2000, to two, or three, or something in 2002? And yet, you’re still there. I can’t think of any other health care CEO who’s gone through that experience. Luckily the stock has been at more than two these days. So how did it feel in those dark days…

Glen:  Well, we’ve been…I’m fortunate, this is the third public company that I’ve run, two in health care, one in the property and casualty insurance business. We were the beneficiaries of the Internet "craze", if you will and the stock price ran up. I continued to tell our people that we hadn’t accomplished our mission, but the market put a high valuation on us and the stock ran up to $89. Then it actually came down.Our investors were fortunate that someone called us "the last man standing." It came down slower than most Internet stocks that collapsed; because we had a real business and a real vision. And I think, today we’ve continued over the years to execute on the vision, to build the infrastructure that you see working today. The stock market seems to be rewarding us for it.

Matthew:  Well, you guys made what, nine million bucks last year in profit? What are you scheduled for this year?

Glen:  Well, I’d like to talk about what we’re accomplishing. I think the accomplishment is that the product is working for physicians. We have over 30, 000 physicians today, over 400 hospitals. When you do things right, when you deliver for your customers, the end result is profitability. So we’re seeing a nice growth in our profitability. The analysts have put a number of different numbers on what we’ll look like next year.I think another key point I’d make is: We are actually reinvesting in software development, and other processes, more money than anyone else in the ambulatory sector. So we’re able to provide a great return on products that are well priced. And also invest in the market. Things like the NEPSI initiative, which is a 30 million dollar investment for us over five years.

Matthew:  Let’s move on to NEPSI.

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