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Tag: The Insider’s Guide To Health Care

CONSUMERS/POLICY: Real people really travelling

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Via HISTALK, a really interesting column about people traveling to India for surgery. Essentially the total cost slightly exceeds the co-insurance for those with insurance and of course the cost is remarkably lower for the uninsured. The people featured are those in the 50-65 age group who are pre-Medicare and finding it harder and harder to get health insurance are the obvious candidates.

And of course they are the ones for whom the health insurance crisis is biting home, and the ones who will be the swing voters about this issue. I for one cannot believe that this group of Americans will accept that they all need to travel to India and pay out of pocket, over and above whatever catastrophic coverage they are also buying. So when a politician comes up with a believable universal solution, this type of story will be behind what gets it through the Congress.

PODCASTS/TECH/CONSUMERS: Health2.0 roundtable

Here’s the transcript from last weeks podcast. It gives you a window into one of the hot areas at the moment, Health2.0 (perhaps I should trademark that quick!). The participants are three leaders of new online health focused companies, all of whom are relatively new and very ambitious. The original podcast post is here.

Matthew: Welcome to another THCB podcast. I’m Matthew Holt. Today is pretty exciting. I have got three of the leaders in what’s starting to be called the Health 2.0 movement. Those of us who were around the first time when things got crazy in Silicon Valley in the late 90’s when Netscape and Healtheon came on the scene are somewhat nostalgic for the days when you would go to parties and people would try to recruit you for a job just because you were standing around drinking. And those of us who have lived through the e-health bust are particularly upset about what happened next!But it looks like in the last couple of years, mostly in the last year or so, there’s a lot more interest in health care online, health care search, and health care information. And a lot of that has to do with what’s happened with the Google IPO and how successful Google has been creating a business out of search. Obviously a lot of the buzz in Silicon Valley and on the Internet in general has to do with that.But what I thought we’d do today is take a look at this Health 2.0 movement. So I’ve assembled three individuals who are leaders of companies, all of them at this stage relatively small companies, and all relatively new companies. But all of them are doing something very interesting in a slightly different segment of health care and health care online, or as it’s now starting to be called, Health2.0.And just before I introduce them, I’d also point out that just yesterday Dmitriy Kruglyak at HealthVoices started a manifesto called the Health Train, The Open Healthcare Manifesto, which is a new sort of manifesto promoting the idea of open health care. I’m one of the people who signed that, and I think it’s quite an exciting time in general for the concept of new types of open online heath care.So with that, let me tell you who I’ve got on the conference call with me. I have

  • Dean Stephens, who is the president and CEO of Healthline, based in San Francisco,
  • Tom Eng, who is the Chairman of Healia, based up in Seattle, and
  • Chini Krishnan, who is the CEO and founder of Vimo.

And the good news here is that Vimo was until very recently called Healthia, but for the context of this conversation, thank God, changed it’s name. [laughter] And I had to let Chini come in because when I went to visit Vimo they gave me a T-shirt. And I’ll be expecting the other two of you guys to be sending one along soon. [laughter]Now with that, I want you each to give a brief introduction to your company.

Continue reading…

QUALITY/CONSUMERS: Wallace and some patient advocates

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Information Therapy center chair Paul Wallace is from Kaiser Permanente, who quite logically would be interested in Ix.

He notes that the medical care cost, and the costs of poor health to employers far exceed the medical cost. (Absenteeism. etc)

He also notes that no consumer is involved in designing consumer directed health care. How do we get “skin in the game” not to be a blunt tool like managed care? And he explains that the revenue that would pay for the care of the 20% has left the system. let’s not use blunt tools to solve complex problems. That means using co-pays to access selective care, but not for pharmacy, well baby care, etc. And are there incentives to use information therapy in those decisions?

He has a vision of putting the patient centered care integrating this around patients not their diseases.

Then it’s on to two patient advocates. Sue Sheridan (who gave a harrowing speech last year that’s well worth re-reviewing) and Jesse Gruman from the Center from Advancement of Health. Sue has got the CDC to engage consumers in telling mothers about the risk that jaundice can cause brain damage. So eventually this fall they are putting out information that are right for new mothers—not about the disease but “how can my baby get hurt and how can I do something about it. Sue thinks fear is a gift that will motivate. Jesse is not so sure, but know that we need to arouse the anxiety just enough to give them something productive to do. Last year Jesse told us about “blunters and monitors.” In other words some people want the second opinion, want to know everything, but others want the doctor to tell them what to do. But there is no neutral health information. So the people trying to engage patients in health information have a major challenge. But Sue thinks that we should create the demand for patients to be engaged because if they’re more involved they’ll have better outcomes.

Jesse thinks that using marketing methodologies that retail et al use to make people buy stuff they don’t really want/need (e.g. data mining connections) needs to be used to deliver information therapy and make people integrate it in their life. We also need to tell people what we expect them to do.

One of the most interesting questions is from a Canadian who is telling about how consumer health information in his hospital (McMaster, in Hamilton Ontario) is worked out in conjunction with marketing academics. In the US he says that this stuff seems to be part of the marketing department, and be kept as proprietary information.

CONSUMERS/TECH: Technology in health in the next decade

Tech trends….

EMR is now banal, aparently its happening, and there’s congestion in hospitals on traffic over WiFi networks.

Personal products Nike has systems that track your health conditions as you run—your new buzz word is the “Body Area network”. Now we have the development of wearable and implantable biosensors. These sensors will be intergrated with sensors in the environment (Matthew’s Note—Intel has several prototype houses where there are sensors checking in on the occupants all the time). He showed us a list of a huge number of sensors announced in the consumer market place in both persona and ambient information over the last 6 months. Plus there’s also gathering more adn more data from “lifesensing”—capturing images and data from every moment of daily life.

Sensemaking is the process of putting all this data together and synthesizing it into results that can be used.

Abundant computing is going to provide the power to put this all together…so one of the most interesting applications is to take all of life data and synthesise it for new resutlts. Accenture labs has designed a persuasive mirror that is designed to change your behavior (eat too much food, get fat, etc—and show you a picture)

Medical telepresence—at “arms length future” we’ll have a critical care facilty at home—doctors can operate robotically on patients at home. He says this is a reach, (My note: actually I dont think so. We already have robotic surgey and we’re slowly seeing the separation of diagnoses and treatment, and the separation of the hands on/therapeutic process).

 

CONSUMERS/HEALTH PLANS/HOSPITALS/TECH: Consumer comparison tools, not exactly wowing the world as yet

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There’s a new report from CHCF, written by Katy Hendrickson at Forrester, it’s called  (pdf) Health Care Cost Comparison Tools: A market under construction. I’ve read it and it does suggest that something is slowly happening in the Submio/Health Grades world, but that it’s mostly about a few plans trying to steer consumers around based on quality….we are a long, long way from price transparency. Stll def worth a read if you’re all interested in consumerism, transparency or health care cost and quality. And apparently some of you are

There’s also a companion report out called Consumers in Health Care: Creating Decision-Support Tools That Work . I haven’t read that one yet. Comments please from anyone who does.

 

INTERNATIONAL/CONSUMERS: Consumerism meets single payer

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So do the tappings of consumerism in health care need American-style CDHC? Apparently not, as in the UK the latest is that doctors are to be graded for quality of service

Every doctors’ surgery (surgery = office in Brit talk, not what it means in Yank-sih) is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance, The Times has learnt. Expert panels will give family doctors one of three gradings in a move backed by ministers desperate to show that patients are getting value for money from huge GP pay rises. The scheme, being drawn up by the Royal College of General Practitioners, will run alongside government plans to publish detailed patient surveys of each surgery’s performance.

Of course the huge pay rises for GPs were as part of a pay-for-performance scheme…something their American colleagues might be a little envious about!

QUALITY/CONSUMER/TECH: Health — On Demand by Pat Salber

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Pat Salber writes The Doctor Weighs In, and she has some pretty interesting thoughts about this consumer health schtick. I cross-posted here but go check out her blog too!

The Internet has changed the way we do so many of life’s routine activities. We shop on-line for clothes, food, birthday presents (thank heavens–no more going to the post office), insurance, dates, and new friends. The list of things we can do and get on the net just goes on and on. PEERtrainer (www.peertrainer.com) has joined many other websites as a convenient, fun way to meet people with common interests and goals. It offers peer support and accountability with 24/7 convenience, and if desired, anonymity. And the Internet is changing the face of health care as well. I belong to Kaiser Permanente, an integrated health care system that makes it easy to make appointments on-line as well as to refill and have my medications mailed to me. I can get my lab results via a secure website and I can communicate with my physician via email.

But I never thought I would be able to get health and wellness services on the web. This weekend, I was at a medical conference and learned about an amazing new website: www.keepyoursight.com. A young ophthalmologist, Sean Ianchulev, described how his company, Peristat Group, has developed a way to screen for glaucoma on-line. Now, I guess I am a little out of date. My first thought was, "How are they going to deliver that little puff of air to my eye via the web?" Of course, that is not the only way to screen for glaucoma anymore. Rather, machines that test your peripheral vision have replaced the air puffs in many health care settings. This type of testing is called perimetry. The Peristat Group has figured out how to mimic what on-site perimetry machines do — on-line. That means, anyone can get screened for glaucoma in the privacy of their home anytime they want. It’s a bit complicated and takes some practice, but the site takes you through some simple instructions and then allows you to practice until you get the hang of it. Dr. Ianchulev tells me they built algorithms into the on-line test that help them weed out tests that are not performed properly. He also tells me they are developing an on-line test for macular degeneration, one of the leading causes of blindness in the US. Imagine, as this technology gets better and better and the test-taking gets easier and easier, glaucoma testing, testing for macular degeneration, and who knows what else, will be available to people “On Demand.”

As we move into an age where consumers are being asked to shoulder more and more of the financial burden of health care, I suspect we will see even more innovation in the delivery of services. The FDA recently turned down the request to have statins, very effective cholesterol-lowering drugs, available over-the-counter (OTC). Opponents of OTC statins worried that consumers would not recognize the rare, but serious side effects of these relatively safe medications. However, such dangerous drugs as aspirin and acetaminophen (e.g., Tylenol) have been available OTC for decades. I can’t tell you how many people I treated for overdoses of these benign drugs during the years I practiced emergency medicine. I think the argument of having to protect the public is one that will not hold up in the long run. Combine the use of home testing electronic devices with great interactive web-based programs, OTC availability of cholesterol-lowering drugs and blood pressure-lowering drugs, and on demand lab testing (available in many states) and you now have a way to get treatment of these common conditions to millions of people who are now untreated or undertreated…and for a fraction of the cost.

I think innovations in health care delivery, such as these, are very exciting, but also threatening to the same folks who have been promoting "Consumer Directed Health Plans" as the way to save the disintegrating American health care "system." But, hey, if I have to pay for it out of my pocket, I am going to get what I want, how I want it and when I want it. If I can get it for free on the net in the middle of the night, I say, bring it on. “Health On Demand,” — now this will usher in the age of real consumer directed health care.

TECH/CONSUMERS: It’s care delivery that matters most

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Here’s my FH editorial today….

This week two very different healthcare conferences rolled through San Francisco. One was about Consumer-Directed Health Care and was a cross between a capitalist land-grab and a political pep rally for HSA-backers and Canada-bashers. There are clearly interesting ideas from many start-ups as to how to better serve consumers , and plenty of new initiatives from bankers wanting to get at the new accounts being set up within health care. Google’s announcement of its new “Co-op” service that includes a “Health” component, and Intuit’s deal with Ingenix show that big time consumer companies are viewing this movement seriously.

Later in the week the National Patient Safety Conference saw clinicians discussing the issues of medial errors, nursing and clinical efficiency, and how to use technology to turn around provider performance. That is clearly a much bigger and even more intractable problem than making health care more consumer friendly. It’s also a movement that has been going on for more than twenty years, and we are really only seeing marginal improvements. Health care has many problems, but clearly the care delivery coal-face is where most health care money is spent, and where we have the most to change.

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