John Sharp, who’s deep in the Web2.0 in health care world for HIMSS on behalf of Cleveland Clinic and writes the eHealth blog, has a pretty comprehensive overview about Health2.0 out that he gave to his local HIMSS group. (It was a couple of weeks back, but I’ve been underwater as you can all guess!) Here’s the presentation and he covers a lot of ground, and gives a nice plug to the Health2.0 Conference.
Above the Fold
POLICY: Sicko and Healthcare Reform by Maggie Mahar with UPDATE
Michael Moore’s “Sicko” does two things very well.
First, the film makes it clear that in the U.S., even if you have health insurance, this does not mean that you are “covered.” Everyone knows that many Americans are uninsured. But now, millions of middle-class Americans are beginning to realize that they are UNDERinsured, and Moore drives that point home.
For-profit-insurers spend a great deal of time designing policies that will limit their “losses”—i.e. limit the amount that they have to pay out. These “Swiss cheese” policies are filled with holes: for example, a policy may pay for surgery, but not rehabilitation after surgery. And this omission is deliberate. As a former claims adjuster tells Moore, when an insurer denies payment, “You’re not slipping through the cracks. They made the crack and are sweeping you toward it.”
Secondly, “Sicko” underlines the signal difference between healthcare in the U.S. and healthcare in other countries: the citizens of other countries take a collective view of the problem. Or as Moore puts it, they realize that when it comes to sickness and dying, all of us are vulnerable. “In the end, we truly are all in the same boat . . . they live in a world of ‘we’ not ‘me.’”
Of course people in the U.K. Canada and France know that healthcare is not free. (And contrary to what some of Moore’s critics say, he does not pretend that it is.) But since they think of healthcare as a right—something we all deserve simply because we are human—it seems to them fair that, “You pay according to your means [through taxes] and receive according to your needs.” In this, national health programs that are funded by taxes resemble Medicare: the higher your salary, the more you pay into Medicare. The sicker you are, the more you will take out in benefits. If you’re lucky, you put in more than you take out.
What “Sicko” doesn’t do is focus on the waste in our system. As Jonathan Weiner observes below, we can’t afford to pay for everything that someone might possibly want. We need to be sure that we are getting value for our healthcare dollars. In one case, Moore tells the story of a man dying of kidney cancer. Desperate to save him, his wife valiantly tries to persuade insurers to pay for new treatments –including a bone-marrow transplant that the insurance company calls “experimental.” But the insurer refuses, and a few weeks later her husband dies. This is one of the saddest moments in the film—both husband and wife are very appealing.
Yet it is not clear that the insurer was wrong to refuse the cover the bone-marrow transplant. It is very difficult to tell from the few details given in the film whether it might have helped—but advanced kidney cancer is not curable. Even the newest drugs give the patient, at most, a few more weeks of life. At the same time, it is understandable that both the husband and the wife (and apparently Moore) assume that the insurer was merely trying to save money.
After all, when it comes to making coverage decisions based on medical evidence, for-profit insurers have a pretty spotty record. In the 1990s, when insurers said they were trying to “manage care,” many were simply “managing costs.” For example, some decided which drugs to include in their formularies based simply on whether the manufacturer would give them a deep discount. In return for the discount, the insurance company would assure the drug-maker that it would not cover a competing product.. This had nothing to do with which drug was more effective.
As I suggest below (see my most recent post on MedPac ) the public will always be suspicious of decisions made by for-profit insurers—even when their decisions are based on sound medical evidence. For-profit insurers just don’t have the political or moral standing to make these judgments. (By contrast, most patients are much more comfortable with Medicare’s coverage decisions—which is why we need a federal agency testing and comparing the effectiveness of new treatments. )
But if Moore skips over the problems of overt treatment it may be because he knows that this at this point more Americans are worried about undertreatment. And to be fair, no one could examine all of the problems in our dysfunctional healthcare system in a single film. What is important is that Moore says what he says loudly and clearly. He tells a vivid, memorable story—and in the process, he has managed to spur the national conversation about healthcare reform.
This is what scares people like Peter Chowka. If people begin talking about health care, they may begin to think about it. It may even occur to them that perhaps it wouldn’t be so terrible to borrow a few ideas from other countries. As Moore points out, “If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what’s our problem? “
"It’s conceivable, Moore suggests, that we might even learn something from Cuba, a country that spends 1/27 of what we do on care. Of course the film’s Cuban adventure is controversial—and purposefully so. I’ve written about it here on TPM café where I recount a very funny story Moore tells about his experience with Standards & Practices at NBC– a tale which shows that he knew exactly what he was doing when he took part of “Sicko’s” cast to Cuba.)
Looking back on “Sicko” Moore says, “I could have played it safe, I know. I could have gone to Ireland. . . . Everyone loves the Irish …. But you know you have to get people’s attention.”
And, as usual, Michael Moore has succeeded in doing just that.
UPDATE: A couple Moore on Sicko. A balanced enough review in the NY Times from Philip Boffey, and an interesting one (sadly firewalled) by Timothy Egan about whether Americans live better than Italians (My take has always been that rich Americans live better than rich Italians) — Matthew
TECH: This sounds like deliberate trouble..
I was sent an email about a Global Competition Seeks Disruptive Innovations in Health and Health Care. Some of you like this kind of thing. The rest may be a touch cynical & I’m not sure $5,000 is going to change the world. but it might…
"Disruptive Innovations in Health and Health Care" is an open source competition to identify ways in which the health and health care marketplace can offer services, tools and choices that consumers want but are currently out of reach because of cost, complexity or because the right idea hasn’t come along. Changemakers is looking for entrepreneurs both within and outside of the health care field with ideas for new products, services, technologies, business models-or some combination thereof-that enable consumers to manage health and receive care in ways that are more affordable, accessible, simple and convenient. The “Disruptive Innovations” competition is running until July 18. Approximately twelve competition finalists will be selected by a distinguished panel of judges, then a global network of social entrepreneurs will then vote for three winners from anywhere in the world—each of whom will receive a $5,000 cash prize from Changemakers. The Finalists will attend a Change Summit to stimulate future collaborations and insights from thought leaders in the field. Enter the competition
JOB POST: Medical Director
A.D.A.M.
(Nasdaq: ADAM) is a leading provider of online consumer health
information solutions to healthcare organizations, employers,
consumers, and educational institutions. A.D.A.M.’s goal is to empower
consumers to get smart about their health and wellness, while reducing
the costs of healthcare and benefits administration. This position is based in Atlanta, Georgia.
JOB POST: National Guidelines Project Manager
Kaiser Permanente’s Care Management Institute (CMI) is a unique,
pioneering institution with a mandate to drive, fund, and catalyze care
management activities throughout our non-profit HMO. CMI strives "to
make the right thing easier to do. The Center for Health Care Delivery is creating a new Knowledge Service/Evidence unit. The National Guidelines Project Manager is responsible for leading and
making significant contributions, and/organizes the development, revisions,
production and dissemination of National, evidence-based guidelines
and practice resources across the organization. Responsibilities include
all aspects of project management. Interfaces regularly with management
to produce timely and valuable results. Responses to: Ca**********@**.org.
PLEASE remember to include THCB JOB BOARD in the subject of your email.
TECH/HEALTH2.0: Vince Kuratis Connecting the Dots…on Google Health
Vince Kuratis, who knows rather more than he should about DM and eHealth, and maybe knows rather too much to be as optimistic as he is—given all that he knows—has a long and excellent article on Connecting the Dots…Google Health Promises to Create AND Dominate Next Generation PHRs.
Briefly Vince’s analysis is that Google Health will allow a personal URL that will be a place that a consumer can store data from all over the health system and link it to their own “soft” data such as Google searches, and then run applications over the top—presumably to do things like diagnose diseases.
You should go read Vince’s analysis, which is pretty close to my own, and irons out a lot of the details.
The only way that I’d differ from Vince (other than I was too lazy to write mine out fully) is that that I’d add in the one interesting VC investment Google has made. It’s in 23andme. Aside from the fact that the CEO is Larry or Sergey (I can’t tell those two apart)’s wife—bet that made the pitch easier!— and that Esther Dyson has her hooks into it as well, the interesting thing about 23andme is that it’s a genetic testing company. And it seems pretty logical that genetic information is going to be mixed into PHRs in the near future….so it doesn’t take a rocket genome scientist to make the link between 23andme and the not yet unveiled Google PHR/personal health URL.
They key question is whether Google (and more importantly American consumers using Google as a vehicle) has the clout to make the health care system willingly and easily give up its data….
We shall see.
POLICY: Tom Tomorrow disses the conservative straw men
The best political cartoonist in America is at it again–This Modern World
PHYSICIANS: Medicare and the AMA–here we go again
Physician fees would be cut by 9.9 percent in the coming year under a payment plan proposed Monday by Medicare <SNIP> Congress has stepped in to prevent similar cuts in the past, and doctors’ groups are urging lawmakers to intervene once again this year.
Not very likely….
HEALTH PLANS: From the AHIP fields (Ignagni loves Shalala and vice versa–Newt’s just watching!)
AHIP’s annual conference last week, and Karen Ignagni was recently spotted in USA Today slagging off Michael Moore as part of that newspaper’s “fair and balanced” look at the topic, and telling yet more lies about “Canadians coming to the US for health care.” Apparently her research team doesn’t subscribe to Health Affairs. I meanwhile was at Meditech having way more fun (more about that anon). But an anonymous THCB reader did indeed make it to Vegas. And considering AHIP’s somewhat risky current political tactics, I’d think Vegas was an appropriate place for them to have the show! Here’s his report:
The AHIP (America’s Health Insurance Plans) conference was everything that you would expect from a group of health insurance executives and the people who want to sell them stuff. Held at the posh Wynn resort in Las Vegas, it brought together the who’s who in health insurance, although fewer CEO-level folks than the World Health Care Congress. Unlike HIMSS, which is both much larger and pushing to include payers, purchasers and health information exchanges, AHIP doesn’t seem to be pushing such democratization. This is the business of health insurance.
Of course the triple 800-pound-gorillas in the room were the release of Michael Moore’s “Sicko,” the public awareness that CDHP wasn’t panning out to be the panacea that it was positioned to be, and the Democratic takeover of Congress.
Karen Ignagni, AHIP’s fearless leader, opened the conference with a less than rousing invitation for the assembled attendees to pat themselves on the back for all of the good work that they are doing to improve healthcare…and to consider themselves among “the patriots” on July 4. Maybe it was the early hour, but I believe that I counted exactly twelve people clapping.
Ignagni introduced her “close personal friend” former Secretary of Health and Human Services Donna Shalala (under President Clinton) and current president of University of Miami. I think that Shalala was chosen as a way of demonstrating that AHIP has connections with Democrats as well as Republicans. Shalala told the audience to support AHIP because Ignagni is among the most connected people in Washington on health issues…and – again to a smattering of applause – echoed the sentiment that those in the audience were somehow “patriots” in the cause of improving healthcare. Shalala continued about her co-chairmanship (with Senator Bob Dole) of the commission looking into the mistreatment of troops at Walter Reed. It’s a very difficult problem because there are very few experts on the military health system. But, she told us, that it was an example of a single payer, government run system…and look, look…at all of the problems, especially in transitions of care (that I’m sure have nothing to do with the rivalries that exist between military branches and are all about the MHS being “single payer” and government run). She went on to speak about how unlikely it was that there would be transformational change anytime soon because while there is widespread agreement that healthcare needs reform that there is not widespread agreement on how to fix it. We could expect incrementalism or worse, and that she (and the Clintons) had mis-read the public’s desire for change in 1993. (Ed’s note: It appears that the time and options Shalala has acquired on the United HealthGroup board have softened her liberal credentials somewhat!)
Next up was Newt Gingrich, who began by recommending Nicholas Sarcozy’s new book and focused on the new French President’s admission that the French people need to “work harder”. He said that he might run for President but was waiting for the current group of those “interviewing” for the position to narrow a bit. He declared the Medicare drug benefit and the sign-up process a success because of the power of consumer choice. Using a metaphor he dubbed “Medi-Cruise” for government run or single payer healthcare, he likened the ability of senior citizens to navigate the complexities of choosing vacation cruises with their abilities to choose optimal drug benefits. Seniors – according to Newt – did a much better job of choosing a benefit than if the government had chosen a one-size-fits-all benefit: Just imagine if the government chose your cruise for you – “Medi-Cruise”…and if everyone was forced to have the same-type room! As if a cruise – paid for on a voluntary basis by people themselves and health benefits – necessary and paid for by the government – are the same thing. Gingrich – on a positive note – said that the National Health Information Network (including digitization of individual providers) should be viewed on the same importance and scale as the national highway projects under Eisenhower. He rationalized this huge government project because it was for national security. He also focused on ferreting out fraud and abuse instead of making wholesale rate cuts. Ultimately, Gingrich is among those who believe that transparency of cost and quality information and consumer incentives will make healthcare a functioning market. He expects consumers to lead transformative changes in healthcare. There was no mention of the recent CDHP story in the WSJ.
Possibly fearing disruption or protest, Q&A at both sessions was short, seemed tense, and required clear identification by name and affiliation…not unreasonable…I had the feeling that any overtly accusatory questioner would be cut off, ushered out, and pilloried by the crowd. Ignagni seemed loaded for bear.
HEALTH2.0/PHARMA:Drug Companies & Social Media
The ever wonderful Jane Sarasohn Kahn has a great article up at IHealthbeat on the use of Social Media and Health2.0 by drug companies. Her conclusion is that Drug Companies Lag in Adopting Social Media To Communicate With Consumers but that there’s great opportunity to go after compliance and adherence via social media. These BTW are good things for drug companies and patients. Read her article.
And if you can’t get enough JSK (and who can?) Jane will be moderating the kick-off panel with the likes of Google, Yahoo, WebMD and Microsoft explaining their take on Health2.0 at the conference of the same name on September 20th. But she’ll also be talking about social media (along with another "veteran" of that world Joyce Flory) at Dimtriy’s Blogging & Social Networking track in the Marketing to the Health Care Consumer Summit in Chicago earlier that same week.
