By JOHN HALAMKA

This Thursday I gave a presentation to the National Committee on
Vital and Health Statistics (NCVHS) about measuring quality using
“traditional” and emerging, novel sources of healthcare data.

My
definition of traditional data sources that are currently used to
measure quality includes administrative claims data aggregated from
hospital-based claims databses (for example, BIDMC has an Oracle
respository called Casemix), payer-based databases (all have a claims
warehouse to support disease management), physician organizations (Beth
Israel Deaconess Physicians Organization has worked with Heathcare Data Services to create all payer business intelligence tools ) and health data consortia (such as the Massachusetts Health Data Consortium offers de-identified aggregated claims to enable institutional comparisons)”

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By ROGER COLLIER

Part 1 of this two-part piece asked why Adam Smith’s “invisible hand” seems to be affected by a palsy that causes health care price competition to fail, especially when employers and employees select health plans. This part focuses on a second failure of price competition: when insurers build their networks. Our hearts don’t often bleed for health insurers, but it’s possible to feel a little sympathy as they struggle to assemble networks of the most cost-effective providers.

The insurers’ first problem is the data used to pick their preferred providers. Few carriers or PPOs have the analytical capability or the data base of the Dartmouth Atlas Project; most will be drawing conclusions from their own more or less limited claims data, along with possibly anecdotal perceptions of quality.

The insurers’ second problem is the need to include in their networks “essential” providers, like prestigious or sole community hospitals, or major specialist groups. These key providers are well aware that insurers will not want to alienate employers—or have gaps in their networks—and will set their prices accordingly. In the early days of managed care, insurers drove down prices by negotiating with subsets of providers, offering higher patient volumes in exchange for lower prices. It worked, right up until the big provider push-back against managed care in the 1990’s, when hospital mergers and amalgamation of specialist practices created quasi-monopolies that insurers are now unable to circumvent.

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By Matthew Holt

The Dartmouth Atlas releases this afternoon a really cool interactive atlas showing the disparity in Medicare spending between states AND showing the relative growth rates in spending between metro areas. Fabulous graphics, fantastic research and much much more grist for the mill — why was annual average growth  in Medica spending from 1992 to 2006 in Miami, FL, 5% while it was only 3% in Los Angeles, California?

And don’t forget what Einstein said about compound interest.

By ANDRE BLACKMAN

So I just got back from a very informative & interactive event
where I learned about the application of 
mobile technologies in
creating social change. It’s here at this meeting of the
socially-conscious minds and the focus of impact creating technology,
that I began thinking about the real ways in which cutting edge tools
are being used in the public health world.Let’s face it, we’re living in the year 2009 and whether you are a young kid or much older,
technology has been integrated into our lives – both for work and play.
Several industries and disciplines have been traditionally linked with
technology (e.g. science, engineering) however in recent years with the
advent of  the Internet and social media, fields such as PR/marketing and education have latched onto emerging technologies and have been making quite a bit of use of them – making things better.

How are they making things better you ask? Well, they are doing a couple things:

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By e-Patient Dave

Unless you’ve been offline since last week, you know that Medpedia
has gone into public 
beta. I
have a concern about the reliability of
their model, based on my personal experience and the self-education
I’ve been doing for the past year. I want to lay out the concern, my
reasons, and a proposal.

It was a year ago that I first learned of the e-patient white paper, E-Patients: How They Can Help Us Heal Healthcare (available free in PDF or wiki), which lays out the foundational thinking for what we’re now calling participitory medicine. The Wikipedia definition of the term includes this:

"Participatory medicine is a phenomenon similar to citizen/network
journalism where everyone, including the professionals and their target
audiences, works in partnership to produce accurate, in-depth &
current information items. It is not about patients or amateurs vs.
professionals. Participatory medicine is, like all contemporary
knowledge-building activities, a collaborative venture. Medical
knowledge is a network."

In this context, I’ll lay out my concerns.

First, I understand the need for evidence and the desire to to filter out flaky assertions.

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By Sarah Arnquist

If the goal of health reform is to improve Americans' health, then the debate needs to broaden to focus on issues outside the medical system that often play a greater role in determining health.

That’s the message Susan Dentzer, editor-in-chief of the health policy journal Health Affairs, gave to an audience Monday at the Johns Hopkins Bloomberg School of Public Health.

Dentzer began her talk by quoting New York Times Columnist David Brooks, who wrote in a column last fall about a “tide of research in many fields, all underlining one old truth — that we are intensely social creatures, deeply interconnected with one another and the idea of the lone individual rationally and willfully steering his own life course is often an illusion.”

Her point was that communities and social networks play a huge role in
setting social norms and determining health status of the population. And Improving population health should be the goal of any national health
reform effort, she said, and accomplishing that requires a focus on determinants
of health outside the medical care system, such as smoking, obesity,
poverty and social networks.

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By Wendy Everett

As the health reform debate intensifies, the rightful role of medical technologies is stuck squarely in the
middle, caught in a simplistic tug-of-war over whether these innovations raise or lower health care costs. Instead of this argument, we should be focused on how to best identify the truly valuable technologies – those with potential to save both lives and money – and get them into the health care marketplace.

So how can we ensure that the U.S. is making smart investments in innovative technologies that pay dividends for patients and the system, something Europe, Canada and many other countries are already doing?

Answering this question would give us a shot at fixing some of the most broken parts of health care. Technologies can play a key role in the redesign of the ailing primary care system by providing quality patient data, assisting in preventive practices, and taking the burden off the backs of primary care physicians. Similarly, technologies can help combat and manage the massive burden of chronic disease, and they can help reduce the costly clinical waste and inefficiency plaguing the system.

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By ROGER COLLIER

Wall Street Journal editorial writers and other folk with touching faith in classic economic theory wonder from time to time why competition doesn’t work better in the health care system. (Actually, the WSJ people are sure that it could, if it were not for government bureaucrats and their spendthrift liberal friends).

It does seem as if Adam Smith’s “invisible hand” is affected by a strange palsy as it nears the realm of health care. But why, given the legions of insurers and providers all apparently eager to edge each other out in the race for our dollars?

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By Bonnie Washington

After years of relative consumer inertia in the Medicare drug  benefit plan selection process, the economy
created the first real test of Medicare drug plans' stickiness.  Would seniors stay loyal  to their last drug plan choice, or would they be more willing to shop around to chase savings?

New data released today by Avalere Health shows that 1 of every 3,  or more than 9 million, Medicare beneficiaries has picked a Medicare  Advantage plan with prescription drug coverage (MA-PD plans) as their way to access medications.  Growth in MA-PDs far outpaced enrollment in standalone drug plan, or PDPs, for 2009.  MA-PDs; picked up about 730,000 people relative to mid-2008 levels, while  total enrollment in standalone prescription drug plans, or PDPs, increased by about 140,000 individuals over the same period.

How to explain MA-PDs newfound popularity?  It's the economy, of course.  

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