On Tuesday, Ron Pollack of Families USA led a call with bloggers — unfortunately, I couldn’t be on it — to discuss Harry and Louise Return — the new health reform campaign sponsored by five prominent organizations: the American Cancer Society’s Cancer Action Network (ASC CAN), the American Hospital Association (AHA), the Catholic Health Association (ACHA), Families USA and the National Federation of Independent Business (NFIB).
Two direct-to-consumer genetic testing firms, 23andMe and Navigenics gained approval from California regulators this week to continue providing clients access to and interpretations of their personal DNA.
The NY Times reports this morning that, "The licenses, granted to Navigenics and 23andMe, should help defuse a
controversy that began in June when the California Department of Public
Health sent “cease and desist” letters to the two companies and 11
others that offer genetic testing directly to consumers."
The news sparked a heated summer debate over whether consumers should have unbridled access to their DNA or whether a doctor should lead the process.
People have begun to ration themselves off of medical visits and prescription drugs, according to the National Association of Insurance Commissioners (NAIC).
One in 5 Americans said they reduced visits to the doctor due to the slowing economy. One in 10 have reduced their prescription drug intake.
The NAIC found that 85 percent of Americans have made a change to their health insurance policy.
In related news, Take Care Clinics, part of Walgreens, is offering school and sports physicals for $25 to patients 18 months of age and older. The clinics will also certify that kids’ immunizations are up-to-date. The launch of this targeted service is well-timed for back-to-school physicals when pediatricians’ offices can be very busy in the weeks leading up to school starts. Take Care’s press release has been quick to point out that, "School and sports physicals at a Take Care Clinic do not take the place of a child’s yearly routine health exam and complete developmental assessment." Take Care has about 200 clinics in 14 states.
Something profound is happening in buyers’ and the public’s attitudes towards primary care and the health system. With inexorable rises in costs and corresponding decreases in access to primary care doctors, buyers and the public are mad as hell, and they’re deciding they’re not going to take it anymore. Something is badly and sadly wrong, and corrective measures are being put in place.
Signs of Paradigm Shift
Signs of a paradigm shift – a change in assumptions about the system’s basic structure – are everywhere. No longer do we accept the notion every patient should have a specialist for every disease, every life-improvement procedure, every orifice, and every organ. Care, it’s now assumed, must be coordinated to prevent people from falling through the cracks. We must stop wasting time and resources for patients and the system as a whole.
The U.S. system lacks timely access to primary doctors who oversee care. And specialty services are overused. Yet the U.S. has fewer primary care physicians per capita than any other country in the developed world. On the other hand, we have more specialists per square mile than other countries.
What’s Driving the Paradigm Shift?
• Major corporate buyers, led by IBM, which spends $1.7 billion on health care, have created an activist organization, The Patient-Centered Primary Care Collaborative. Paul Grundy, MD, MPH, IBM’s Director of Health Transformation, chairs the Collaborative. It is based partly on IBM’s experience in Denmark, where it owns a company, and where patient satisfaction with care is 97% versus 50% in the U.S. Grundy believes every citizen should have a personal physician, and every physician should be rewarded for offering same day access, managing a patient panel, and be compensated for telephone and email consultations.
• A vibrant movement is underway to “disintermediate” health plans. “Disintermediation” occurs when access to information or services is given directly to consumers. In the process, “middlemen” in the form of health plans may be ended, or their services transformed. That’s what consumer-driven health care is about, that’s why their existence in their present form is threatened, and that’s why health plans are moving rapidly to high deductible plans linked to health savings accounts.
• The “medical home” concept is gaining traction. This concept hinges on two ideas: 1) placing the primary care physician at the center of care by having him/her coordinate overall care; 2) giving primary care doctors “ownership” control of specialty care referrals. America wants a health system in which the primary physician uses a secure computer platform to coordinate efforts of specialists, pharmacists, therapists, and others. Increasingly patients don’t appreciate why they must fill out a new form at each doctor’s office, why doctors don’t communicate with each other, and why doctors duplicate tests and don’t know what other doctors do. A number of medical home pilot studies are now being conducted. To make medical homes happen, doctors will need financial incentives and support to introduce technology, and coordinate care. Payers will need to step up the payment plate to help medical homes become real.
• New business models to reduce cost and offer convenience are fast evolving. These include retail clinics, medical offices at the worksite, specialty clinics, urgent care clinics, elective surgical centers, and ambulatory facilities offering imaging, multiple specialty services, and one-stop care. Most of these are outside expensive hospital settings. Some are currently beyond the control of primary care physicians. At last count, there were over 1000 retail clinics, 500 worksite clinics, and roughly 3,000 urgent care facilities.
• The physician empowerment movement is growing. The Physicians’ Foundation for Health System Excellence, which represents state and local medical societies, has completed a survey of 300,000 primary care physicians to highlight their problems, to educate the public, and to persuade policy makers to take steps to enhance the supply of primary care doctors, to pay them better, and to give them tools to offer comprehensive coordinated care. Sermo, a physician social networking site, has 75,000 members and will soon issue an “Open Letter to the American Public,” signed by 10,000 doctors to reflect physician grievances and to indicate how the system can be improved. These efforts, coupled with the Patient-Centered Primary Care Collaborative, are designed to improve the lot of primary care physicians.
Conclusion: A new primary care paradigm is upon us and will fundamentally change how the U.S. delivers care.
Charlie Baker is the president and CEO of Harvard Pilgrim Health
Care. This post first appeared on his blog, Lets Talk Health Care.
A few months ago, the New England Healthcare Institute (NEHI) issued a report on non-urgent use of Emergency Departments. It didn’t get that much public attention, which is too bad. It offered some interesting insights.
First of all, inappropriate — or non-urgent — use of the Emergency Room was not limited to uninsured populations. It showed up across the board. People covered by private insurance, Medicaid and Medicare were just as likely to use the ER for non-urgent care as people without health insurance. About 20 percent of all ER visits by privately insured and Medicare patients were for non-urgent purposes. About 24 percent of all ER visits by Medicaid beneficiaries and people without any insurance were for non-urgent purposes.
Second, another 25 percent of all ER visits for each group were for primary care treatable/preventable maladies. In other words, almost half of all ER visits were either for conditions that could have waited at least 24 hours to be addressed, or could have been solved in a doctor’s office.
PharmaLive, the website that bills itself as the "Pulse of the Pharmaceutical Industry," recently ran this press release from PeopleMetrics, a marketing research firm. The group surveyed physicians to measure the effectiveness of sales representatives pushing atypical antipsychotics for five leading US-based pharmaceutical companies: AstraZeneca, Bristol Myers Squibb, Janssen, Lilly and Pfizer.
The survey’s questions measured physicians’ response to the salespersons who visit their offices. Depending on the answers, the docs were categorized as either Fully Engaged, Engaged, On The Fence and Disengaged. "Overall, 31% of physicians were Fully Engaged or Engaged, while the largest proportion of physicians (53%) were On The Fence," the research showed.
"Sales representatives must develop personal relationships with their
physicians to achieve the highest levels of engagement," the survey
concluded. "In fact, emotional components such as friendship with the
reps are the strongest indicators of Fully Engaged physicians. . . We
find that this emotional dimension is key in understanding physicians’
perceptions toward their reps and the pharmaceutical company as a
whole" and will be "the most impactful drivers of physicians’
Gee, and I thought it was the peer-reviewed literature they dropped off showing how well the drugs work. Silly me.
This post first appeared on Merrill Goozner’s blog, Gooznews.
Leave it to Wal-Mart to continue to grow its franchise in health through yet another
revenue center. This time it’s telemedicine.
The company will pilot telemedicine through retail clinics in Houston, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach.
Instead of employing nurse practitioners, the medical model for this program will use paramedics working under the supervision of physicians via various scopes technologies — electronic stethoscopes and beyond. NuPhysicia describes this process as, "interactive physician visits."
Jane’s Hot Points: While the retail clinic business may be flat, as I wrote on July 25, this new model will enhance patient choices on the retail health front beginning in Houston. If this program pans out in terms of process and outcomes measures, you can be sure Wal-Mart will replicate it in other metropolitan markets. Telemedicine in retail health clinics could differentiate Wal-Mart’s offering from other emerging clinic brands such as Minute Clinic, RediClinic, Take Care, and the many other storefronts among the 900+ clinics currently operating across the U.S.
Last week, The Health Care Blog ran two articles about new wiki sites
that will develop
and continuously update medical information. A wiki
is a “content collaborative” that allows anyone (or anyone authorized
by the site) to contribute or modify content; Wikipedia is the best
In Medicine Meets Wiki, Jane Sarasohn-Kahn brought our attention to MedPedia, a
collaboration between major academic institutions and governmental
agencies to clearly describe the entirety of current medical knowledge.
Then Bob Wachter described Google’s new Wikipedia competitor, Knol, and
suggested sites like this could threaten the stranglehold that
traditional medical journals have had on emerging information.
Joshua Seidman is the president of of the Center for Information Therapy
that aims to provide the timely prescription and availability of evidence-based health information to meet individuals’ specific needs and support sound decision making.
I had a fun meeting recently with some smart folks from the Robert Wood Johnson
Foundation that raised questions about Ix that could use some clarification. When we talk about information therapy (Ix), we often drift into “evidence-based information” to help with some specific health condition.
That certainly is an important component of Ix, but it’s too limiting in many circumstances. When we talk about the “proactive delivery of the right information to the right person at the right time,” that has to encompass whatever the information needs of the consumer are.