Tag: Uncategorized

Health 2.0 Meets Ix–The Great Debates

On April 22–23 in Boston, two ideas are going to come together. Health 2.0 has been defined in different ways, but is most often considered to be the use of lightweight online technologies which allow consumers to access and exchange health information via the now familiar search, communities and tools. Information therapy (Ix or information prescriptions) involves the proactive delivery of the right information to the right person at the right time, usually as part of the care delivery process.

However, while both Health 2.0 and Ix are focused on improving patients’ participation in care, they tend to come from different backgrounds. Ix tends to be “prescribed” to the patient, often by a clinician (although system-triggered Ix and  consumer-prescribed — either “self-prescribed” or recommended by a peer, caregiver, etc. is also part of the definition). Ix innovations have had the greatest penetration in organized systems of care with robust provider and patient HIT applications like Kaiser Permanente and Group Health Cooperative in Seattle.

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CLASSIFIED: Yale School of Management’s Healthcare Conference 2009

 “Where is the Value? Managing Cost and Quality in a Healthcare System Facing Reform.” April 3rd at the Omni Hotel in New Haven, CT. A full-day summit of industry leaders, students, and academics discussing current topics of industry concern as Obama attempts to usher in reform. Our 16 breakout sessions will focus on answering how to unlock additional value in the current system. Our 2 keynote addresses will feature Samuel Nussbaum, MD, Chief Medical Officer of WellPoint, and Helen Darling, President of the National Business Group on Health. Registration and further details can be found at:


PharmaSURVEYOR is The Most Advanced Drug Safety Utility for consumers
and professionals alike.  PharmaSURVEYOR offers a personalized drug assessment tool designed to
show users not only drug-drug interactions but the much more common and
often dangerous adverse drug side effects making it a valuable tool for Medication
Therapy Management and Medication Reconcilliation. By partnering with
other healthcare sites and services such as Electronic Health Records
(EHRs) and Personal Health Records (PHRs), it can automatically
bring in a patient's medication list from a partner, run a Drug Safety
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Two Birds With One Stone: Covering the Uninsured by Fixing Medicare

Victor Sandler

As a nation, we are in a heap of trouble. Our medical system is a
disaster—overly expensive and ineffective. On average, we spend two to
three times more per capita on health care than other developed
countries. Yet on measures of quality, we rank 22nd out of 23 among
those same countries, according to the World Health Organization. Not
only that, Medicare, our national insurer for the elderly and disabled,
is facing more than $30 trillion in unfunded liabilities over the next
40 years. We have 50 million people who are uninsured in this country
and millions more who are underinsured because employers have shifted a
larger percentage of premium costs to them and increased deductibles
and coinsurance payments, causing some to forgo medical treatment
because of the expense.

The bad news is that we are on a path that is much too costly and
clearly not sustainable. The good news is we can get off that path by
cutting medical costs dramatically without negatively affecting
quality. The way to start is by acknowledging the fact that we don’t
have the best health care in the world, as former President George W.
Bush and others have touted.

What we have is the most health care in the world.

The Causes of Medical Waste
The factors that feed our obese medical system are manifold. But three
are especially troublesome. First, there is an unfortunate ethos within
American medicine and society at large called “heroic positivism.”1
Essentially, it is the idea that the more we do to and for our
patients, the more they gain.

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A Healthcare IT Primer

HalamkaNow that Healthcare IT is part of the stimulus and newsworthy, I
receive many questions from reporters 
about the fundamentals of healthcare IT. Here's a primer with the Top 10 questions and answers:

1. Can you define EHR, EMR, PHR and PM in simple terms?

Electronic Medical Record – An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by
authorized clinicians and staff within one health care organization.

Health Record – An electronic record of health-related information on
an individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by authorized
clinicians and staff, across more than one health care organization.

Health Record – An electronic record of health-related information on
an individual that conforms to nationally recognized interoperability
standards and that can be drawn from multiple sources while being
managed, shared, and controlled by the individual.

Management – An application used to manage the physician business
operations including scheduling, registration, and billing …

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Health Care Reform: Ideology, Self-Interest and Rhetoric

Thirty years ago, one of us asked the retiring CEO of one of the largest drug companies what was the worst mistake he had made as CEO.  Without hesitating he said, “Opposing Medicare.  We were so ideologically hostile to a big new government program that we lost sight of our own self-interest. All the major drug companies except Syntex opposed it.  Luckily we lost.  We have made billions of dollars because of Medicare.”

The White House “summit” on health care reform was a nice start but as the as the reform debate unfolds, public and congressional opinion and the positions of the powerful interests involved – pharmaceuticals, insurers, device manufacturers, physicians, large and small employers, and technology companies – will be swayed by their ideology, perceptions of self-interest and the rhetoric used in the debate.

At one level, there is a broad consensus in America that we need to reform healthcare to expand coverage, improve quality, and make healthcare affordable.  Public opinion polls show broad agreement and large majorities in favor of fundamental change.  Even among specific stakeholder groups, from employers to hospitals and doctors, there seems to be widespread agreement that healthcare needs to change. But, the combination of a deep ideological divide, self-interests that are mutually exclusive, and rhetoric that is capable of turning public opinion against change may end up creating an environment of inaction.

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Drug war lunacy–Connecting the Dots

Next month the Supreme Court will be given the chance to redress one minor the lunacy of the last thirty years of the so-called “war on drugs”. It will get to decide whether in the name of "zero tolerance" a thirteen year old girl can be strip searched in the quest to find some OTC ibuprofen. Oh, and she was an honor student falsely accused by a former "friend". Given the current make-up of the Supreme Court—yes Clarence Thomas still gets a vote—we can probably expect nothing sensible.

On the other hand nothing sensible, and much worse, is going on south of the border. My former colleague Paul Saffo points out that Mexico is on the verge of collapse. He notes a major signal—the cops are wearing masks while a major drug dealer stands proud.

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Narrow Networks – Part II

For the past six years, Harvard Pilgrim has offered a limited
network product to our New Hampshire members called “New Hampshire
NetOption.”  Simply put, all New Hampshire providers are Tier One
providers – lowest co-pays – and so are all Massachusetts community
hospitals.  Tier Two providers are MA-based teaching hospitals (members
have a higher co-pay for services there).  That’s it.  Two tiers – one
for NH hospitals and MA community hospitals, and a different one for
MA-based teaching hospitals.

There is, however, one catch.  All NH hospitals and their physicians
and all MA hospitals and their physicians are “in network” for this
product – except Partners.  When we set the product up, Partners chose
not to participate because the plan design treated teaching hospitals
differently than it treated community hospitals.  That’s their call. 
NBD, as my kids would say.

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The Public Program Impasse: A Proposal

Health care reform proponents could find encouragement in recent Obama administration comments on the issue of taxing health care benefits. The President, having adamantly rejected the concept during last year’s campaign (thereby violating a cardinal rule of politics: “never say anything you can’t later on claim was misinterpreted by your enemies”) indicated through White House budget director Peter Orzsag that he considered the issue very much on the table.

Since passage of health care reform is likely to require almost unanimous support by the fifty-eight Senate Dems—or maybe fifty-nine, depending on the eventual emergence of a winner from the long Minnesota winter—the President’s willingness to back down is a positive step (although sophisticated financial thinkers will note that shuffling funding sources will do nothing to reduce total costs).

What the administration’s openness to compromise also does, however, is move the spotlight onto another issue with the potential of sinking health care reform: the inclusion or otherwise of a public program option in a reform structure.

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