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PODCAST/TECH: Jeff Rose, Health Alliant Interview

For those of you who don’t want to listen to the podcast, here’s the transcript of my conversation last week with Jeff Rose from Health Alliant.

Matthew Holt: So it’s Matthew Holt from the Health Care Blog and we are doing another podcast and this one is from Jeff Rose from Health Alliant. Jeff, thanks for taking the time to speak to me.

Jeff Rose: Thank you, it’s nice to be here.

Matthew: Well let me briefly introduce Health Alliant for those of you who don’t know it. I think pretty much without question Health Alliant has created a niche for itself in being a consulting company that is helping RHIOs get off the ground. As many of the folks that read The Health Care Blog know, we’re somewhat cynical about the prospects of RHIOs here, and full disclaimer, back I think about eleven, twelve years ago I wrote a report on something called CHINs, which were in some ways precursors to RHIOs, saying that they faced a pretty bleak future and that actually came to pass. But a lot of things are different now.So for most of this conversation I’m going to speak with Jeff about the evolution of RHIOs and what he thinks they’re doing. But to start off with I’m going to ask Jeff a little bit about Health Alliant and a little bit about his background. So Jeff, can you just tell me a little bit about what you did before you got to Health Alliant, and then a little, just a thumbnail sketch about the sort of service Health Alliant is providing and for whom.

Jeff: Yes Matthew. I’ve spent all of my career in healthcare, principally between healthcare services and information technology. I began my career in information technology for Coopers & Lybrand and then Foster Medical Corporation and from there started a company in healthcare services called NovaCare, which was a very large medical rehabilitation provider.

Matthew: Sure.

Jeff: Then I’ve been involved in other healthcare service and IT related businesses, coming on close to thirty years now.

Matthew: You sound young though [laughter], haven’t been beaten up to much by the experience. So give me a quick thumbnail of Health Alliant, what it does and also it has a somewhat unusual structure for a typical consulting company.

Jeff: Yes, we do have an unusual structure. We began as a non-profit on a mission to improve the US healthcare system. Our founders included Molly Coye, David Brailer, Blackford Middleton, Bill Bernstein and myself. And then when David Brailer went to Washington as the National Coordinator for Health Information Technology had to resign from the board, and Scott Wallace of the National Alliance for Health Information Technology came on the board. I say we began as a non-profit as recently we’ve heard from the IRS that they’re questioning whether RHIOs need to be non-profits and also whether firms that serve them need to be non-profits. So we’re in discussions with them. It’s not clear what the outcome from that will turn out to be.

Matthew: Well that’s actually non-coincidental because as you probably know there was that report out today about the role of non-profit hospitals and that’s the main question and if you go back to the – full disclosure here, I used to work for IFTF which is the organization which incubated HealthTech where Molly Coye ended up and where David Brailer was working, although I wasn’t with IFTF at that time. So IFTF is also a non-profit and was constantly walking that line between what’s a non-profit organization doing consulting for non-profits and for-profits, and there’s always a sort of question in American business about what the role of non-profits is. I think that’s an ongoing question.

Jeff: I would just say that when we started this, now four and a half years ago, it was in response to what we perceived as a market failure – a market failure in healthcare in that the costs here are significantly higher than around the world. Health status is not as good as elsewhere around the world and there’s certainly questions about the quality and access to care and so what we saw was an industry that needed different kinds of support in order to move forward, to progress. And we characterized this as a market failure, and usually when there’s a market failure either non-profits step in to fill the breach or the government acts. And so we thought this was an appropriate role for a non-profit and we weren’t trying to do this as a for-profit venture.

Continue reading…

TECH/HEALTH PLANS: Quick recap on PHRs and consumer health care

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Yesterday I ran a panel at Teradata’s partner conference in MickeyMouseville, FL. On the panel were Liz Dudek from Medstat, Jill Burrington-Brown from AHIMA and David Cochran from Harvard Pilgrim health plan.

Pretty interesting conversation. David is particularly fun and funny. He thinks that consumers are being driven to the CDHP and have no real interest in it. Liz thinks that PHRs based on claims are going to be introduced by many more employers this fall. Jill is out educating anyone who listens about PHRs, but we all agreed that a unified consumer view of all their data is far away.

Funnily enough I was the most optimistic—I think that PHRs will be relatively common (15–20% uptake in 5–7 years?). Harris apparently said that it’s now 7% but I don’t believe that number. But after Wellpoint and United started providing it to their members

David had an interesting parsing out of the functions being lumped in a PHR

a) Communication transactions with physicians (appointment setting, refills, online visits)b) Information relevant to individuals health (Rx, Healthwise et al)—the Information therapy piecec) Financial transactions (EOB, related accounts)d) One other that I’ve forgotten!

His point is that not all organizations can do all pieces. The physician transaction piece is tough for a health plan, but is the most popular part of the PHRs run by Group Health, Caregroup, PAMF et al. So as in much of health care, expect spotty and varied implementation.

I agree, but I think that if the plans get serious about this it’ll force the providers to get involved. We shall see.

TECH: Search engines revving up–Healia review

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Got a press briefing from Healia, which is a new search engine focusing on health care. Their goals is to improve the quality and personalization level of the search, and cut out the spam results.

The approach is well thought out. Their engine also allows filtering by age/race/reading level/gender via a column on the left. They automatically behind the scenes assess quality by looking at the documents to
assess the page (rank by both relevancy and quality), and they assign it something called Healia’s Quality
Index Score. Finally they detect the general semantics of the
search term–drug searches will include dosages and side effects.

None of this makes much sense without using it, so you should go test drive it. You’ll see that results for standard medical terms bring back results from a more "authoritative" bunch of sites than a standard Google search, and if you search on specific disease terms (like diabetes) you get a series of tabs that divide the response up into categories like prevention, treatment, etc. You can also turn on or off the filters on the left that give you another range of result choices  or vary the font size right from the top.

So far the VA has licensed the technology, and they’re going both the licensing and portal rout. At the moment it’s small with only a few employees, but they’ve clearly done a lot of formal usability testing and lots of research and thinking about what would be  useful health search engine.
Healia’s founder is Tom Eng, Chairman. Craig Husa is the CEO. Marcos Athanasoulis who runs their tech of happens to be an old friend of mine and I used to work with his wife Monika, but I didn’t realize he was on board until this call!I’ll hopefully soon be getting a look at another major new search engine for health care, Healthline, (for which Enoch Choi appears to be blogging) shortly. But clearly in the post Google IPO world, there is now interest in figuring out the future of  consumer web search for health care once again.

CODA: Meanwhile. Tommy Thompson is pitching new health care software. It’s a self diagnosis tool. May well be very clever n’all, but I dont think it’s going to find a self-pay market at $30 a year. I might though be wrong!

AND: Another sorta health-specific search engine that’s supposed to help you find insurers and doctors that was called Healthia (not that that was confusing it with Healthline or Healia in anyway!) has changed it’s name to Vimo.

PODCAST: Jeff Rose on the reality of RHIOs

Yet another excuse to see if you believe in RHIOs. Here’s an interview with Jeff Rose who runs Health Alliant, probably the only consulting company focusing exclusively
on RHIOs–which he views as a partial solution to health care’s market failure.

Jeff thinks that there is a business model for RHIOs, and that they’ll be doing much more than moving lab results about. A very interesting interview you can download or listen to here  (transcript to come).




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			TECH: Williams not impressed by Bush		
	






	


David Williams at The Health Business Blog tries vainly to interpret Mr. Bush. No not that Bush, Jonathan Bush from AthenaHealth. But it’s clear that Jonathan shares similar skill with the English language as his more famous cousin. If you know what this means, please feel free to let me know.




Q: So what do you think about the Massachusetts eHealth Collaborative [MAeHC] experiment to build full electronic patient records in three communities [North Adams, Newburyport, and Brockton, in a $50 million project funded by Blue Cross and Blue Shield of Massachusetts]?


A: That’s way off on the wrong track. If you could just pay for results, rather than pay for inputs, you’ll probably do better. Markets work better. We changed AthenaHealth 100 times. We had certified nurse midwives on salary and I had no browsers. Now we’re a Web-native, dot-communist bunch of MIT guys, analysts, and recovering Fleet Bank people working together to form this integrated clinical, financial, paper, analog, digital process.




I had no browsers? Maybe he meant he had no trousers? Or maybe he wasn’t able to get on the Internets? To be fair to Bush, several of his comments in the interview about automating the peripheral information floating around in the system such as lab results rather than starting with the clinical workflow of doctors make some sense. But given that significant majorities of primary care docs in many other nations do use EMRs in the office, it seems unreasonable to suggest that American doctors can’t do it. Which leads to David’s suspicions about Bush’s motivations:




So why is Bush badmouthing MAeHC?Bush’s company, athenaHealth receives a substantial cut of physicians’ revenues in exchange for assuming the hassles of billing and collection. In the arcane world of coding and billing, where each payer maintains arbitrary, changing, and unpublished rules, and where clinical practice and billing are disconnected and paper-based, athenaHealth’s revenue cycle management approach offers a strong value proposition.I wonder if Bush is worried that MAeHC’s promotion –with payer backing– of integrated EHR and PMS systems such as eClinicalWorks will obviate the need for athena’s services and blunt the entry of athena’s new athenaClinicals.




I took part in an study (as a respondent) recently and it’s clear from the (unpublished) results that the EMR and Practice management app vendors are on a collision course in the smaller physician space. So perhaps Bush is marking his territory and is nervous about eClinicalWorks et al. if I was anywhere in that space I would be. One interviewee called eClinicalWorks the Southwest of the industry!

	






	

		
			TECH: Data storage–what to do for home office use?		
	






	


The NY Times tells us that we shouldn’t keep all our data in one stash.


They’re right. I have everything important at least in two places, but it’s still a struggle to manage.


You can buy online back up, but at the moment it’s just not worth it. Apple charges $100 a year for a gig?  That’s a hell of a markup. You can buy a gig of storage for less than a dollar if you buy more than 100Gs in an external hard drive–-which is what you’ll need if you have movies or much music or lots of photos. Moving it over the net is too slow for those big quantities for now (although it’s getting faster). Moving a gig up or down takes several hours (as those of us who share soccer torrents know)  So that’s the issue for storage.


But what about disaster recovery? I came up with a low tech solution but one with other uses. For less than $200 I bought a fireproof, drop-proof safe that is big enough for all my meager valuables and two external hard-drives. My hard drive lives in the safe if I’m not using it.  Yes of course there’s a chance that either I won’t put it in the safe or that the effect of an earthquake would destroy the disk drive, but it’s not a bad option as it’s something I use anyway for my other valuables, such as passports.


But as the price points change, what I’ll probably end up doing is going with one of the services that the NY Times is talking about. Already one company (Fabrik) is down to 50 cents a month for a gig of storage. That’s still way more than my solution—I’m storing around 100 Gigs (5 of which I really need). So I might be persuaded to put 5–10 of it online for $100 a year. Xdrive will soon introduce something similar (5 gigs for $120 a year) But the ideal solution is a someone selling me 100 Gigs of back up for a little more than than I pay for my external hard drive—say $100.


We’ll get there as storage costs fall. And in about 5 years it’ll be another monthly bill we don’t even think about. But for now the price needs to fall a lot before it’s a mass consumer or even small business market.


And then consumers will start putting lots more online…think banking records and medical records. Perhaps a few tech companies are starting to think about that, eh?

	





	

		
			TECH: Do you believe in RHIOs?		
	






	


Friend of THCB Matt Quinn does, if people can just trust each other—apparently they’ve got some trust going in Ohio. Well worth a read, althought the main purpose of a RHIO needs to be a central ASP providing applications for smaller practices; and that has some of the same problems of the back-up storage issue I’m writing about elsewhere on THCB today.


Anyway to figure out what’s going on in Ohio, read Matt’s letter to Hospitals & Health Networks.


 

	





	

		
			PHYSICIANS/PHARMA/TECH: A take on the news, sort of		
	



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Things we already knew:


Doctors are poor at judging their own abilities. It’s a bit like everyone says they’re a good driver, but that 75% of drivers are terrible.


Merck earnestly believes that it was as pure as the driven snow over Vioxx and never knew that it was dangerous until it took it off the market(who knew about Dodgeball, eh — let alone what Kaiser knew several months earlier).


Little girls don’t really cry tears of stone


Things that I don’t think we did know


Online PHR use is up to 7% by July. Which is about 6% higher than they said it was 2 years ago.




According to the survey, commissioned by UnitedHealth Group and conducted by Harris Interactive ® , only 7 percent of U.S. adults use online personal health records and 35 percent of people surveyed were not even aware this resource technology exists.



	



	
	

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