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What About Health Plan Transparency? – Brian Klepper

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As you might have noticed, Matthew has been a little preoccupied lately. He and Indu are putting the finishing touches on the Health 2.0 conference. This meeting will be 4 times the size they originally conceived, with content that describes a good portion of how health care will undoubtedly be shaped in the future. I’ll be there, typing furiously, trying to capture the blow by blow for THCB.

In any case, while Matt’s energies are elsewhere, I thought I’d float a topic that’s been on my mind recently.

Senator Clinton plans to roll out her health plan tomorrow, but in the roll-up last week she pointedly singled out the health plans as a big part of the problem.

"I intend to dramatically rein in the influence of the
insurance companies. They have worked to the
detriment of our economy and of our health-care system."

There has been a lot of discussion and progress lately on the transparency of doctor and hospital pricing and performance. But health plans are also very important, costly system players. What about the transparency of their pricing and performance? At this point, nearly all health plan costs and performance are opaque to the purchasers who buy coverage and to the vendors whose services they broker.

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HEALTH2.0: User Generated Healthcare, Health2.0FAQ (by Matthew) with UPDATE

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Q. What is Health2.0 and why are we running a conference about it?

The term Web2.0 has been around since 2003. The O’€™Reilly organization both coined the term and created a definition that year, and then they went on to create the Web2.0 Conference. Meanwhile over at The Health Care Blog and in his by now relatively long consulting career, Matthew Holt (your author–€I’€™ll be switching to "€œI & we" from now on) has been following technology in health care since the early 1990s. Some of my eHealth era reminisces were relatively poignant…

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Best of: The AMA goes 2.0

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Most of you reading about Health2.0 will be bored by now of me talking about Sermo and how they’ve become the quickest growing physician online community in well under a year–although there’s now competition in that space from the  likes of Within3. You’ve also probably got bored of me saying that the big question about Health2.0 technologies is whether "the health care establishment" is going to adopt them.

However, you’d probably be a little surprised to find that one of the bastions of America’s health care establishment–and one that doesn’t get much good press on THCB–has decided that it needs to jump on board the Health2.0 bandwagon. Today Sermo announces a deal with the AMA that allows the AMA to see what doctors are talking about on Sermo, and gets its user docs free access to all the AMA’s journals, as well as starts making Sermo’s ranking and discussion tools part of those journals.

This is a coup for Sermo and a big move for the AMA. Not to mention a validation of the impact of at least one part of the Health2.0 movement. Want to know more? I thought you did–which is why I interviewed Sermo CEO Daniel Palestrant about the deal yesterday. Listen to the interview.

And yes, Daniel and Sermo (and the Within3 folks) will all be at the Health2.0-User Generated Healthcare conference. But you all knew that too!

HEALTH 2.0: It’s a sell out!

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I remember first discussing the Health2.0 Conference with my partner Indu Subaiya and saying, "do you think we can get 100 people to come?" Well apparently we misunderestimated ourselves. As of yesterday the Health2.0 Conference has sold out. There’s a waiting list and some final adjustments to be done, but we’re expecting 400 people plus to be there on September 20th.

Thanks to all the speakers, advisory board members, moderators, sponsors, and of course my colleagues Indu, John and Sara, Patrick and Adrienne who have been working their tails off.

If you’re coming we’re really looking forward to seeing you. And if you can’t make this one, we’re already planning the next one in 2008.

POLICY/INTERNATIONAL: The Dutch–Better than the US at football, drug-laws and health care organization

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The Netherlands is a small nation of only 16 million, and yet they have a record in International soccer that’s better than many three times their size. laws about drugs and prostitution that reduce crime, violence and embody toleration, and now they probably have the most advanced health care financing system in the world.

How so? It’s essentially Enthoven’s original managed competition idea in action (circa 1987). Even the Wall Street Journal thinks good things. The key is you need to ban underwriting, and implement risk adjustment (not that it’s easy but it is doable) between plans. Then you have to give the insurer and the insured incentives to realize that the way that population health is managed has ramifications for both the population’s health and its wealth. Then you get rational trade-offs made at a population level.

Can it happen here? I think so, unless you think that Americans cannot handle rational choice. Of course the people who claim to value choice in health care here can’t abide by the concept of the rational structure that the Dutch have put in place which allows choice to be made about the right things. So "choice" here in health care financing means, as the WSJ put it:

In the U.S., competition among insurers often means competition to find
the healthiest customers, especially in the individual market.

But of course if you don’t allow individuals to make the choice of what they spend collectively on a monthly basis to be the point of decision on how much is spent on health care (and put those intermediaries in the middle in the position of benefiting from lowering that amount in the "right" way), then the only other rational allocation is to have the government do it via the tax system.

CODA: I wrote extensively earlier this year on my comparison between the two and how different they both are from typical American notions of competition.

BLOGS: Health Wonk Review up

Brain Klepper has defected back to Pat Salber’s blog to host a great edition of Health Wonk Review. But don’t worry Klepper fans….we’ll have him back here shortly. In fact he’ll be running THCB during the Health2.0 Conference. But if you’re a Pat Salber fan (and why wouldn’t you be?) don’t fret. She’ll be blogging from Health2.0 too.

POLICY: What the lumenati are saying may surprise you

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Forbes has one of those “pics and words” articles about healthcare, with quotes from lots of smart and not-so-smart commenters. But I just thought it would be fun for you to read the quotes and then play the “who really said that” game.  Here are some quotes I picked, not quite at random. After the jump, I reveal who said them with a little commentary

1) We want to get to 100% insurance coverage so the whole country is in the risk pool, which eliminates cherry picking.

2) The old managed competition idea from the Clinton years is still a pretty good one. The idea was to have some entity–employer, private or possibly a public sponsor–set up a menu of choices for people and give them a lot of information about each choice. Then give people a set of choices that range from basic coverage to highly generous, expensive coverage and let them decide how much money they want to spend. Subsidize lower-income people in some way, like refundable tax credits, to ensure people have money to buy good basic coverage, but then they’d have to add their own money if they wanted something more extravagant.

3) We have turned over $2.2 trillion of our money to those who manage our health care, without holding them accountable. Not surprisingly, these folks–hospitals, insurers, governments–used the money to benefit themselves

4) All of the incentives are pointed in the wrong direction.

5) The Medicare program needs to focus on being a more active purchaser. We need to consider an entire episode of care from start to finish to ensure a patient gets care in the most appropriate location … We don’t, at the moment, have a rational reimbursement structure for health care. You may pay more for a procedure at one location, and the quality of care may not be higher. Part of fixing that will take legislation.

6) Spend money on an information infrastructure. Then it would technically be quite possible to track what different hospitals actually spend on health care and what happens to these patients that get treated. Put that information on the web and let people see it to hold doctors and hospitals accountable for how they practice.

7) You need to have a private marketplace rather than have government control in the health care sector, and that means fixing the federal tax code.

You want to know who really said that? Read on:

Continue reading…

HEALTH2.0: Billing and administrative technologies get some publicity

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In yesterday’s WSJ article about billing and admin systems Christopher Parks’ MedBillingManager, RevolutionHealth’s Expense Manager and Intuit’s new Quicken Health got some publicity. As did a service I’d never heard of called Smart Medical Consumer which seems to help you beat up providers and insurers who aren’t playing fair. (If you can’t get into that WSJ site, and it should be free, there’s a summary here)

Of course (plug plug) two weeks from tomorrow Revolution & Quicken are on the "Consumer Tools" panel at Health2.0: User-Generated Healthcare, and Christopher from MedBillingManager will be in the  crowd and we’ll try to remember to give him a shout-out!