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An Analysis of Senator Hillary Clinton’s Health Plan Proposal by Robert Laszewski

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This is nothing like the Clinton Health Plan from 1993.

Senator Clinton has so far been running a smart campaign for President — at least on the policy side — and her health care reform strategy is no exception. She waited until after all of the leading Democratic, and most Republican, candidates had announced their plans and then stuck her plan right in the ideological middle of where her Democratic opponents put theirs. It also looks a great deal like a bipartisan plan enacted in Massachusetts and a bipartisan compromise in the works in California. So on the day it was released, it was correctly identified as being relatively centrist.

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TECH: Fred Trotter meets Dr. Peel

I was on my way to see Deborah Peel’s talk yesterday when I was waylaid by a previous engagement that I’d mischeduled in my calendar. Given I had 4 people waiting for me I couldn’t break it but I was very disappointed to not be there.

Fred Trotter was there and had some of his questions answered. Unfortunately he didn’t ask the ones that I am getting so worked up about.

Now I’m off to see Newt Gingrich. Perhaps I’ll get a chance to ask him about his views on it. (And for the record the Google party was fabulous!)

TECH/PODCAST: ICW’s Jeremy Coote

ICW is a German-based  consumer facing record company, that is dominant in Germany and several Eastern European countires. Over here they decided that their skills lie in integrating data from disparate systems, very much a Health 2.0 trend (which is why they’re a Health 2.0 Conference sponsor).

They also announced a major open source initiative with Agfa and Sun this morning–which will hopefully give a boost to open source in health care (which thus far has been a somewhat small and lonely community)

I spoke to ICW America CEO Jeremy Coote today.

PODCAST/TECH: The new Virtual Palomar West

My first interview at HIMSS is with Orlando Portale, CIO and Michael Covert, CEO of Palomar Pomerado Health in the San Diego area. They’re planning a new hospital and are working with Cisco and have put together a fun video about their new Virtual Palomar West in Second Life. They both had some really interesting things to say about how to build a large new hospital and how to plan for its use for a long, long time ahead. Here’s the interview.

(FD, Orlando and I are both on the advisory board for HIMSS Community for Connected Health, sponsored by Cisco, and I have done consulting work for Cisco in the past).

Health 2.0 – Patient-oriented Health Care, by Dan Kogan

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Dan Kogan is a veteran IT developer who built some matching systems now prevalent in financial institutions. He’s now turned his attention to healthcare and has started Health World Web. I (Matthew that is) have been advising him as he gets going, and have therefore (as I allways want good material) bullied him into writing about his view of why health care is ripe for this technology and a little about what his company plans to do. (Don’t forget that the same offer is open to anyone who wants to write on the Health 2.0 Blog)

When exactly did the power of healthcare move out of the hands of the people and into the hands of the doctors? Historically, patients do not take the upper hand when it comes to choosing the proper healthcare. Choosing the right doctor becomes a nerve wrecking game of cross referencing the insurance listings with yellow pages, the general listings of a Google search inquiry with proprietary knowledge or word of mouth. Finding a good doctor often reminds a patient of a game of dice. The chances of rolling two 6’s are equal to 1/36 or about 3%. What comes into the equation is the patient’s insurance, the insurance a doctor will accept, the potential path to the specialist through the gatekeeper (if one is required), locale and then, just pure randomness in getting to one of the more than 700K licensed MDs.

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More on Google and the Cleveland Clinic

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For a start, as I said in my last post  and many times, and at least one of these commenters has written at length, the benefits of sharing health data in clinical situations massively outweigh the risk. So that should be the focus of the discussion.

I am NOT saying that there shouldn’t be privacy protections and there is no reason in my mind why, for all HIPAA’s flaws, it cannot be extended to PHR providers as covered entities.

However, as far as I can tell nothing that is happening here violates HIPAA. Showing you keyword based advertising may not to everyone’s taste, but it does not mean your private health data is being transferred to anyone. And presumably your data will only end up in these services if you give them permission to accept it, which will include consent to provide whatever services and advertising you’ll see.

And that’s assuming that either company does advertising based on records rather than search terms (which is Google make that 98% of their money).

But exactly where are Microsoft and Google suggesting that they’re going to be selling private identified data? Nowhere. Microsoft has bent over backwards to demonstrate that they have no intention of allowing themselves or anyone else to access your health records without permission. And Google will likely do the same when it announces its plans officially.

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TECH: HIMSS Today

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Today it’s HIMSS. Yesterday I spoke to the CHIME CIOs and had a good time. Today I’m talking to the Cisco Community for Connected Health and the rest of the time I’ll be accosting people with a microphone. Come back over the days to come to see.

Google, the Cleveland Clinic and the Privacy Zealots

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So Modern Healthcare‘s Joseph Conn has a whole page to write about the Cleveland Clinic and he writes just about HIPAA and the fact that this pilot is not going to be covered by it. Writing in the San Francisco Chronicle Victoria Colliver talks about not a lot more, but at least she has someone stating the bleedingly bloody obvious—

"If it’s made convenient
enough and easy enough, people will be no more concerned about privacy
with these systems than they are with their financial information," he
said. "Far more people die because health information is not released
or difficult to get … than anybody’s ever been harmed because the
information has been inadvertently released."

OK so it was me she quoted, but someone needs to give Deborah Peel
and whoever the hell the World Privacy Forum is a big shake. I say this
as a card-carrying member of the ACLU and Amnesty International who is
deeply concerned about anyone’s private information and what use is
made of it.

And the shake is, if a government overhears your private information
illegally (or quasi-legally) it can use that information to take away
your freedom and worse. So the standard for their ability to access
that information should be an awful lot higher than it is in virtually
every country—including this one.

If a private corporation unwittingly lets slip your private health
data, or even uses some aspect of it knowingly to target you for
marketing, the chances of you suffering much from it are very, very low.

These are vastly different things, and conflating the two does not help in the least.

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Where have all the savings gone, long time passing? by Eric Novack

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Where have all the savings gone, long time passing?

I am not the first to comment on this New England Journal of Medicine article, but it does deserve a place here at THCB. 
It has been the dogma of many at THCB that prevention = savings, and substantial ones at that!Put in the context of this study from the Netherlands, also published this month, is it time for some health care reformers to change their tune on how the health care reforms they promote will save money?

And before simply putting the savings to ‘pay’ for this on the elimination of administrative costs, please see my previous post.

And before saying that electronic medical records will, by themselves save 80 billion dollars per year (as I heard former President Clinton say at a Wisconsin rally this weekend- as an aside, I love XM radio for unlimited access to C-SPAN), consider the $4 billion struggle at Kaiser Permanente to get medical records for a measly 8.6 million patients… Now, with over 300 million in the country, that might mean an investment of well over $120 BILLION (with a B) to TRY to computerize the electronic medical records of the country.
 

Do not misread me to claim I am a proponent of the status quo, nor that I am not in favor of the WORD OF 2008—change— it is simply that I would like to hear more from those who want to institute certain kinds of change— how will they really ‘save money’ while simultaneously increasing access without severely impacting my liberty as a patient.

HEALTH PLANS: $9 million? OK, We’ll change our tune

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On Thursday HealthNet was being sued by the LA City attorney’s office and saying that it was doing nothing wrong and would keep on trucking:

Health Net’s Olson said the company’s application had been approved by regulators and didn’t need to be changed.”There are 110,000 Californians who figured it out and were able to fill out the application in a way that got them low-cost, high-quality coverage,” he said. “It’s fine and it’s working.”

Presumably they had faith that the arbitration process that many health plan policyholders have to go through would mitigate any risk.

What a difference a day makes.

Friday, the arbitrator in the case of the cancer patient whose insurance was retroactively terminated—this was the case which revealed the bonuses paid to staff who cancelled policies— awarded $9 million in punitive damages to the patient. This isn’t quite the $89 million that was awarded against HealthNet in 1993 in the Fox-Hipple case, but the difference is that in arbitration there’s usually no appeal (that $67m was never paid in full).

Jay Gellert, HealthNet’s CEO immediately announced that they would stop retroactive cancellations. But of course with lawyer William Shernoff now smelling blood, and with Blue Shield still fighting for the “right to recission” in the courts, the damage isn’t over.

Hopefully this will eventually mean that the companies will accept real regulation and real reform in the individual market, which essentially means ending it. 

(FD I am a HealthNet individual policy holder and they haven’t “recivved” me yet. Then again I haven’t had a claim in 3 years!)

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