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TECH/PODCAST: Interview with Bob Fisher, CEO of Foresight

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Here’s the transcript of the recent podcast with Bob Fisher from Foresight. The original interview is here and a 7 minute cut down version is up on Foresight’s site too.

Matthew Holt:  This is Matthew Holt with the Health Care Blog. This morning I’m talking with Bob Fisher. Bob is the founder, president, and CEO of Foresight Corporation, which is an Ohio based technology company that works primarily with health plans. I had the great fortune of being a speaker at Foresight’s recent customer meeting down in lovely Phoenix, Arizona, where I very much enjoyed meeting with Bob and the rest of his crew.  It was really quite an interesting meeting because after I did my song and dance about the future of the health care system, the folks there really got into some of the nitty-gritty. It was almost a chance for Bob to pick his customers’ brains, I think, about what they’re seeing. He’s come back with a wide wealth of information, not only about what Foresight’s up to but also what some of America’s leading health plans are up to. So deep in the engine room, as it were. So, Bob, good morning, or I should say good afternoon to you. 

Bob Fisher:  Good afternoon, Matthew. I appreciate the opportunity. 

Matthew:  How are you doing? Have you been keeping well since the last time we were together only a few weeks back? 

Bob:  I came back with a head full of knowledge and a little bit of a tan, and today I have a head cold, but I’ll try and keep it out of the interview.

Matthew: So let’s start at the beginning. Foresight’s a pretty small company. You’ve been around since the very end of last century. 

Bob:  In 1990. 

Matthew:  Sorry. 1990? Boy, you’re a bit older than I remember. 

Bob:  Yeah, 17 years. 

Matthew:  Seventeen years. Actually you’re almost an old company in technology terms in that case. So, but for the average THCB reader, I suspect that you’re pretty much an unknown quantity. I mentioned you work with health plans. What do you guys do? What are your core missions, core business functions? 

Bob:  Matt, we work with health care organizations, providers, and especially payers as you mentioned, and we use technology to help them streamline their operations. That is in the areas of claims, payments, eligibility, that sort of thing. We call it transaction lifecycle management. Now, we have a decent chance of actually being known perhaps by some of The Health Care Blog readers because actually most large payers in the US today, including the majority of Blue Cross organizations, are using Foresight technology. They’re using it to reduce the claims rework, to assure accurate and timely payments, to provide any level of management reporting on an ad hoc basis, and to improve provider relations.

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HEALTH2.0: PR slop busted, but not really!

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Over at NDDB.net, which is in the physician rating game, there’s a rather grumpy post about Steve Case from RevolutionHealth on Good Morning America. Other that they’re competitors, I’m not quite so sure why NDDB is so grumpy. I think that Revolution’s helping to define the Health2.0 rating, community, tools et al market and that’s very helpful for all the companies involved. A rising tide will potentially lift all boats.

But they do have one fun “gotcha”. Seems that Revolution’s PR guys/gals have left an old press release draft out on the web that they should have sent to the trash. and it contains this quote:

“While there are many sites that offer health information, none is as exhaustive and user friendly as RevolutionHealh.com,” said XYZ Expert. “The site offers something for everyone. Whether you’re looking to research a recent diagnosis, lose weight or connect with others who share similar health issues, you can find it all on RevolutionHealth.com.”

Now we all know that press release quotes aren’t actual quotes. So playing gotcha is a little unfair. But I went the extra step to see what happened in the actual press release. And here’s what it said:

"Reliable and useful information about health is a precious commodity. RevolutionHealth.com can help consumers take greater control of their health," said David A. Kessler, M.D., former Commissioner of the Food and Drug Administration; Kessler consulted with Revolution Health on the development of the site.

See, they got an XYZExpert (David Kessler) and he made up his own quote! If he’d used the one the PR firm gave him, then it wouldn’t have been so clever (and it would have been rather more fun!). But PR guys, you should take the old one off the web, already.

POLICY: OMG–WalMart are the good guys!

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Forget anything you ever knew about health benefits. WalMart are the good guys!

In fiscal year 2006, Wal-Mart spent about $4.8 billion on employee benefits – a cost made higher because many hires arrive with unattended health needs, according to Mr. Emerick. The expense was far too much, given Wal-Mart’s $11.2 billion in profit that same year, he said. Many employers, especially in retail, have increased part-time employment and made it harder for their workers to qualify for benefits as a way to manage costs, Mr. Emerick said. Employees eligible for coverage stood at 59 percent in 2006, down from 62 percent in 2004, according to a Kaiser Employer Health Benefits Survey. In comparison, Wal-Mart’s eligibility is 76 percent, up from 72 percent in 2004, Mr. Emerick said. "In many respects, we believe that eligibility is much more important than the scope of coverage," he said.

And given that all rational people want the employer-based system to be replaced with something better, let’s not mention how WalMart’s rampage through the grocery and retail business has caused a significant decrease in the number of employees of other company’s receiving health benefits, nor anything about their suggestions to their staff about how to go on Medicaid. And given that they favor high-deductible plans, let’s also not ask how many WalMart employees can take a $1,000 deductible in their stride. After all this is about empowering consumers, right?

At some point WalMart the company will figure out that a national tax-based coverage system is way better for its employees and somewhat better for it. Then of course Lee Scott will have to explain to the richest family in the world why they may have to pay just a little more tax. Something they’re not too keen on usually. Do you think he’ll keep his job after that? He’s already in a little bit of trouble as it is.

PHYSICIANS/CONSUMERS List prices for doctors?

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Healthcare Partners, the biggest physician group to emerge from the carnage of Southern California physician group implosion in the late 1990s is now putting a list price out for some procedures. Why?

"It feels like the right thing to do," said Robert Margolis, a founding physician and chief executive of the medical group.

OK This is a little curious, and that explanation won’t win Bob too many prizes in his MBA or logic class but given that he kept his ship afloat while the rest of southern California’s physician groups imploded, it’s not wise to think he’s crazy. So what’s going on? This is perhaps a preemptive strike on the retail store clinics, which are not yet big in California. It’s also perhaps a play for the dollars of the worried-well uninsured. So there may be logic behind it if it’s really an attempt to grab market share.

But there’s probably less to it than that. If you look at the actual prices, the only ones quoted are for wellness visits, immunizations and physicals—the kinds of things that are often not covered by insurance and usually aren’t that big a part of a physician’s revenue. Furthermore the price bands are very, very broad. An office visit for a repeat customer is $55 to $170. Well $55 may undercut a retail clinic but $170 won’t. So how is the consumer supposed to make a buying choice between them? And of course the prices are not anything like as detailed as say what Aetna’s releasing in certain markets. This leads me to believe that they’re way above the rates that HealthCare Partners has contracted with the local health plans.

So at best this is a tentative step in the water. And the best evidence from that comes from Margolis himself. He’s veteran of the global capitation days and he knows that this front end stuff doesn’t matter much in the big picture.

Many healthcare professionals, including HealthCare Partners’ Margolis, believe that consumerism has its limitations and is no cure-all for escalating healthcare costs. That’s because the biggest cost drivers are the chronically ill, who are often unable to comparison shop and quickly reach even the highest commercial deductibles every year, or are so impoverished by medical expenses that they are on government programs. Consumerism "has a nice ring to it," Margolis said. "But it’s very shallow in its effect, in my view."

There is of course a way of creating price competition that helps consumers decide what health care services they should be buying, and will actually create a rational market in health care. But it ain’t at the individual service level, and to get there will of course mean running roughshod over all the ideals that the wackier promoters of consumer transparency espouse. But more of that another time….

CODA: And for your amusement…NPR’s Marketplace called me for a rent-a-quote about this story but I went to walk the dog, and in the meanwhile they secured some other pundit. Someone else gets their name in lights and I’m left picking up dog poop. Fame is fleeting, eh?

HOPSITALS/POLICY: Spending on health care is good for the economy, really!

Hospital boom adds billions to Arizona economy

Arizona’s hospital construction boom will create a windfall for the state’s economy by creating 14,900 jobs each year and add $2.6 billion in wages over that five-year period, according to a study commissioned by the hospital association.

And digging holes is equally good for it–4,000 in Blackburn, Lancashire I believe. Of course given the funder of the study, what was it going to say?

OFF-TOPIC: Wanna be ethnographed?

IFTF is looking for some volunteers to be ethnographed. Not as painful as it sounds—actually rather fun I did it a few years back.. They are currently recruiting for a new research study called "Boomers in the Next 20 Years". If you’re interested read on

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POLICY: Hoggy on Reggie

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For your weekend fun read—soon to be featured in THCB conservative—David Hogberg’s review of Reggie’s new book Who Killed Healthcare in The American Spectator. Hoggy of course thinks she’s too left-wing  in that she’s in favor of an individual mandate. Of course I haven’t ready this book yet although I’m prepared to guess what’s in it. Let’s just hope that Reggie’s next forecast is a little more accurate than this one she made in 1998.

As my book describes, the market forces that revolutionized the once-bloated U.S. economy are now reshaping health care. Activist consumers’ demands for accountability, convenience, and control are making the system more informative and accessible. The focused-factory concepts that revived the nation’s manufacturing sector and fashioned its world-class service sector are now shaping high-quality, cost-controlled health care delivery systems. And the sort of technological innovations that have increased productivity since the Industrial Revolution are improving the quality of health care while controlling costs. Brilliant entrepreneurs are using the managerial lessons learned from successes such as SamWalton to create a better, cheaper,more accessible health care system.

And just to be fair and a good sport this prediction stuff is very hard. So to prove it I’ll  lay some of my ghosts. The 1997 IFTF 10 Year Forecast for which I wrote the relevant part suggested rather more success in cost containment …although I had rather different reasons for thinking that was coming about. Here’s the most wrong part of the whole IFTF 10 Year Forecast:

The biggest change in the health insurance market over the past 10 years has been the fast growth of HMO enrollment. In 1998, more than 76 million Americans were enrolled in HMOs, and a majority were in some kind of a managed care plan. By 2005, HMOs will capture the majority of the commercial market and more than 25 percent of the Medicare market. Sixty percent of Medicaid recipients will be in some form of HMO by the year 2010.3 Among this plethora of new products, it will be increasingly difficult to distinguish one health plan from another. They’ll all offer similar—and often the same— providers and pay those providers through a mixture of discounted FFS and capitation (a flat fee per patient). By 2005, more than 100 million people will be in these “HMO descendants.”

The health insurance market will evolve into a mix of different health plan models, many of which will spend the next several years in a constant flurry of reorganization and mergers. Four dominant “intermediary” models will emerge by 2005: the case manager, the provider partner, the high-end FFS broker, and the safety-net funder. As a result, in 2007 close to 50 percent of the population will be in health plans for which cost containment is a key issue. Despite all the pressures toward increasing costs in the system, these new strategies will be successful enough to keep costs from exploding again as they did from 1960 to 1990.

 

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