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Tag: The Insider’s Guide To Health Care

TECH/CONSUMERS: Ix Therapy time again!!

Today Indu and I are at the Ix Therapy Conference in Park City, UT. I’m here as a guest of Josh Seidman, Dorothy Jeffress and the crew at the Center for Information Therapy

David Kibbe is up first. His talk is called "Google. Then Gargle." He’s talking about 4 disruptions:

1. EMR, and spread of electronic health records

2. MinuteClinic, and retail medicine from NPs
3. Medical Tourism, drugs and surgery abroad
4. Health2.0

He’s very interested in Microsoft’s HealthVault (although like me he notes that creating a "strong password" for HealthVault is pretty annoying–I also think HealthVault needs a tutorial PDQ too). But nonetheless the option of moving data around easily between multiple entities and providers is pretty disruptive.

HEALTH2.0/CONSUMERS/TECH: Patient groups online are a source and a force

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We know that patients have been organizing online and Laura Landro (who’s been there herself) confirms it in a fascinating article. Go read it. Of course this is making some people nervous.

Of course, the rush to link communities and researchers and the move by patient groups to conduct their own research raises some thorny new issues. While the nonprofit, patient-run online groups have no financial interest in research or recruiting for trials, some for-profit health Web sites see their online communities as a way to make money. Such sites, supported by drug-company advertising, may seek to recruit patients for drug-company clinical trials, often without going through physicians who may advise patients about the pros and cons of such trials. Also, the research organized by online patient communities makes some scientists nervous because such efforts don’t use the gold standard of randomized controlled clinical trials.

So you might argue that the for-profit status of Yahoo or DailyStrength raise that thorny issue. But of course the non-profit groups are starting to use for-profit start-ups like Clinicahealth and Solos to supply their online services. And the mix between patient groups, disease groups and big Pharma continues to be a matter of controversy. Meanwhile there’s plenty of evidence that clinical trials per se are not that helpful, and all the data generated online will be very important no matter what the nervous scientists think.

We are on the cusp of a big change here, and everyone’s roles are changing in uncertain ways.

TECH/CONSUMERS: Mental Health–Bloggers Prefer Web Over Therapist by James Harris

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James Harris a marketing consultant for WebTribesInc.com, an operator of MySpace-style websites for individuals with mental health concerns. wrote to me about the results of a new survey the company made of its members. Now it’s a small survey of current users, so strictly speaking it may not be too generalizable, but it confirms a lot of other research saying that patients prefer talking to computers rather than humans about sensitive health topics. The survey was made available to 1,600 members of the company’s websites in April 2007. Seventy-eight members, or 5%, responded to the questionnaire. Founded in 2006, WebTribesInc.com now has 8,100 registered members on its four sites. WebTribesInc.com operates four MySpace-type sites: DepressionTribe.com, OCDTribe.com, AnxietyTribe.com and Addiction.Tribe.com. You can see more at the WebTribesInc.com home page. Here’s James’ take:

Can the Internet play a positive role in addressing an individual’s mental health needs? A new survey of members of three popular social networking websites suggests that many bloggers prefer these online communities to seeking professional therapy. WebTribesInc.com recently surveyed members of its sites about their preferences when sharing thoughts and feelings. The survey found that members feel more comfortable discussing their conditions with their online community rather than with a private therapist. In the survey, members were asked "Where do you feel most comfortable expressing your issues?"

The survey found:

–68% said "an online community;"–23% said "my therapist;"–9% said "family and friends;"

According to Ryan Fitzgerald, president of WebTribesInc.com, "Although a number of celebrities including Brooke Shields and Tipper Gore have shared their stories of coping with depression, there is still a very large stigma attached to seeking formal treatment for mental health conditions." Fitzgerald said many of the site members have reported avoiding seeking professional help because they are afraid of being diagnosed as depressed or anxious and are worried the information will be shared with their employer or health insurer. "A safe online mental health community site offers anonymity and sharing in a nonjudgmental atmosphere. Journaling about troubling thoughts and feelings has been shown to be therapeutic. Online communities are also a welcome option for individuals who can’t afford professional treatment or live in remote areas," said Fitzgerald.

CONSUMERS: Diabetes Mine: Would You Believe… Doug Burns Going to Trial? WITH UPDATE

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#1 healthcare blogger Amy Tenderich is hopping mad about a diabetic arrested for being hypoglycemic, and she’s rallying the Type 1 diabetics to the cause. Go over and read it —  Diabetes Mine: Would You Believe… Doug Burns Going to Trial?. It’s another case of the police being boneheaded and a DA too scared to admit that they’re wrong–presumably in the police associations pocket come reelection time. But to force this to trial? Idiotic.

I have a great friend at college who went hypoglycemic and ended up falling into a river, and nearly drowned — until a medical student figured out what was happening and gave her some coke. I read a book by a Brit called “Metal jam” which showed the experiences of a Type 1 Diabetic going hypo. The rough answer is to figure out what’s up and get them sugar OR insulin (depending on whether they’ve had too much insulin or not enough!) But it’s a very dangerous situation that not enough people know about. Here’s Amy on one nasty time it very nearly happened to her.

And here’s Amy on ways to help Doug. I am very interested to see the power of the social networking in this case. And good luck to Doug.

UPDATE: I guess the Redwood City DA didn’t fancy having Amy sic a few hundred mad diabetics on him, so the charges have been dropped.

PHYSICIANS/CONSUMERS List prices for doctors?

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Healthcare Partners, the biggest physician group to emerge from the carnage of Southern California physician group implosion in the late 1990s is now putting a list price out for some procedures. Why?

"It feels like the right thing to do," said Robert Margolis, a founding physician and chief executive of the medical group.

OK This is a little curious, and that explanation won’t win Bob too many prizes in his MBA or logic class but given that he kept his ship afloat while the rest of southern California’s physician groups imploded, it’s not wise to think he’s crazy. So what’s going on? This is perhaps a preemptive strike on the retail store clinics, which are not yet big in California. It’s also perhaps a play for the dollars of the worried-well uninsured. So there may be logic behind it if it’s really an attempt to grab market share.

But there’s probably less to it than that. If you look at the actual prices, the only ones quoted are for wellness visits, immunizations and physicals—the kinds of things that are often not covered by insurance and usually aren’t that big a part of a physician’s revenue. Furthermore the price bands are very, very broad. An office visit for a repeat customer is $55 to $170. Well $55 may undercut a retail clinic but $170 won’t. So how is the consumer supposed to make a buying choice between them? And of course the prices are not anything like as detailed as say what Aetna’s releasing in certain markets. This leads me to believe that they’re way above the rates that HealthCare Partners has contracted with the local health plans.

So at best this is a tentative step in the water. And the best evidence from that comes from Margolis himself. He’s veteran of the global capitation days and he knows that this front end stuff doesn’t matter much in the big picture.

Many healthcare professionals, including HealthCare Partners’ Margolis, believe that consumerism has its limitations and is no cure-all for escalating healthcare costs. That’s because the biggest cost drivers are the chronically ill, who are often unable to comparison shop and quickly reach even the highest commercial deductibles every year, or are so impoverished by medical expenses that they are on government programs. Consumerism "has a nice ring to it," Margolis said. "But it’s very shallow in its effect, in my view."

There is of course a way of creating price competition that helps consumers decide what health care services they should be buying, and will actually create a rational market in health care. But it ain’t at the individual service level, and to get there will of course mean running roughshod over all the ideals that the wackier promoters of consumer transparency espouse. But more of that another time….

CODA: And for your amusement…NPR’s Marketplace called me for a rent-a-quote about this story but I went to walk the dog, and in the meanwhile they secured some other pundit. Someone else gets their name in lights and I’m left picking up dog poop. Fame is fleeting, eh?

TECH/CONSUMERS/THCB: Health2.0 Agenda Announcement!

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I am delighted to announce the line-up and agenda for Health2.0–User Generated Healthcare, which will be held on September 20th in San Francisco.

After an introduction and summary of the Health2.0 report (from little ol’ me and my colleague Indu Subaiya) we move into a panel looking at the view from the big consumer aggregators in online health care. Who are of course with one exception the big general aggregators—Google, Yahoo, Microsoft & WebMD.

Then we move into the 4 categories of Health2.0. Search, Social Media for Patients, Tools for Patients/Consumers, and Social Networking for and about Providers. You’ll see really focused demos of communities and tools that are already existing. All delivered in a focused manner that will really hit the high points

We also have a stellar group of industry luminaries to react to what they’ve seen including leaders from Kaiser Permanente, Cisco, Regence BCBS, RelayHealth/McKesson, the view from financial/Internet veterans like Marty Tenenbaum from Commerce.net & Esther Dyson, and other industry players from providers, pharma and plans.

This is also going to be a highly interactive day, with an “unconference” topic tables at lunch, exhibits and demos in the breaks, networking on speed, and interaction with the audience in every panel.

We know that you’ll have seen nothing in health care like Health2.0–User Generated Healthcare and we’d love to see you there. For more information and to register go to www.health2con.com

UPDATE: Download a PDF copy of the agenda and announcement here.

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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