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
Above the Fold
POLICY: Hoggy on Reggie
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.
TECH: A good use of Twitter?
I am really struggling to understand the point of Twitter. But maybe there is some use to it. Via #1 blogger Amy Tenderich, here’s a diabetic recording his life on Twitter.
Amy, will of course be at Health2.0. Maybe we’ll Twitterize that event?
POLICY/POLITICS: Clinton gets a little more specific
Hillary Clinton made a major speech on health care yesterday. (Here’s the full text). Her quick points. Pay for preventative services (although what she’s talking about you’d recognize as DM), use IT and EMR, use the primary care “medical homes model” (the AAFP’s got to her!). Those are all strategies to save money—suspend your disbelief for a moment. Her other points are about changing malpractice and beating up drug companies on pricing. All very worth and all that but mostly rhetoric I guess.
Then more interesting stuff. Basically she wants a re-run of 1993–4. Big purchasing pools for small business. Guaranteed issue at community rating. Ending risk selection and underwriting. Unfortunately she uses a bad example by conflating cherry picking with insensitive network management/UR which are NOT the same thing:
In fact, according to a recent McKinsey report, insurance companies in America spend tens of billions a year figuring out how not to cover people — doing complicated calculations to figure out how to cherry pick the healthiest persons, and leave everyone else out in the cold. That is how they profit: by avoiding insuring patients who will be "expensive" — and then trying to avoid paying up once the insured patient actually needs treatment.
I see this all the time. My office spends countless hours arguing with insurance companies to get my constituents the health care they have paid for. For example, a father called me from northern New York — his son had a rare illness. Now he and his son were well insured. He’d worked for many years for the same employer who provided a good policy. But when his son needed a special operation — that could only be performed at one place in the country — the insurance company said, sorry, that’s out of network, we’re not going to send you to have that done. So my office intervened. And in the end they got permission for the operation. But I don’t think people should have to go to their United States Senator to get their insurance company to give them what they’ve paid for.
As President, I will end the practice of insurance company cherry-picking once and for all by allowing anyone who wants to join a plan to do so and prohibiting insurance companies from carving out benefits or charging higher rates to people with health problems.
She needs to find a new example to educate people as to what cherry picking is. Perhaps she should take Jon Cohn tour with her…. In any event that coverage denial piece will come back to bite her because her most interesting issue is her desire to establish a NICE type cost effectiveness institute which she calls the Best Practices Institute, and she gives a strong hint that it’ll not just be vetting new drugs for cost-effectiveness but also be using Wennberg/Dartmouth-type analysis as well as standard cost-effectiveness analysis to direct P4P. So of course there will be coverage decisions which may impact that constituent of hers with a rare illness…
It seems to me that she’s trying to get on the wave of employer discontent and then cut a deal with the larger insurers to let them stay in the game, and also let them blame the government (the new Best Practices Institute) for restrictions on coverage decisions. Not a bad political compromise perhaps. Of course the devil is in the details of the pools and the uniformity of benefits that insurers must provide.
And of course the real thing that needs discussion is the one thing she left out. How does this plan get the uninsured insured? It keeps the same employer payment format in place, and seems to have no mandate. Hillary is many things but dumb is not one of them. She must be focus grouping this next element to death, because ignoring it isn’t an option, even for as corporate a Democrat as she’s become.
Still, she’s revealed more than I expected her to, and there’s plenty here for her opponents on the right as well as on the left to latch onto. This is getting fun!
TECH/CONSUMERS: Musings on IFTF, Health2.0 and social networking
I sat in a meeting today put on by my old colleagues at IFTF. (There are some other bloggers here, so there’ll be more about the meeting elsewhere). The room is filled with an interesting mix of techies, health care people, non-health care people, foundations, drug companies et al.
IFTF is fixated on the concept of biocitizenship. They’re interested in how wider communication tools (of which the Web2.0 tools are one) are allowing social movements to spread, and how this has enabled much more activism. I’m not convinced that this combination is as true or as new as they think, but it’s an interesting lens with which to view these emerging communities. For more on the biocitizen, look here — or contact Jody Ranck. I’m not going to detail IFTF’s research here. They’ve done some cool scenarios (including one with Howard Rheingold’s daughter acting as a “not LonelyGirl” faux youtube video as a very new health care consumer) in progress plus they sell their research for money (and if you’re a corporation it’s probably worth buying).
We also heard from the CDC, Revolution Health and DailyStrength.org. They are combining new tools, new communities and new techniques at a staggering rate. They’re also seeing some real growth. Revolution has been seeing big growth and although they didn’t give the numbers, DailyStrength seems to have 4–5,000 people per discussion group. It seems that better, more personalized search, and mapping your personal situation to that of others is the future to handle all this new information. I think that Natural Language Recognition based processing and search is going to be very important (which is why I’m so high on Enhanced Medical Decisions). However, much more of this will be dependent on what IFTF calls computing “sensemaking” (Computing has gone from processing to communicating, to sensing and on to “sensemaking”). That’s going to match patterns and heuristics to match your data. So that you get exactly what you need from all the stuff out there about you—and then that will get combined with the sensor information from medical devices et al. And then put that all in context-which may be done by computers or humans with computers.
All interesting stuff, but there’ll need to be much more unpacking of these tools and the business models for them in the next little while….
TECH/HEALTH2.0: The trademark for Health2.0
I’m at IFTF’s meeting today with a group discussion health new media. The Health2.0 term has been used alot and at Dmitriy’s urging I thought I’d clarify something.
Yes I’ve trademarked Health2.0. No, I will not stop anyone using it. I’ll be giving control over the trademark to the collective advisory board for the Health2.0 Conference. All I want to make sure is that no one uses the trademark offensively (pun intended) as for instance has happened with the term eRx.
More from IFTF later…
TECH/PODCAST: Interview with Bob Fisher, CEO of Foresight
Foresight is a highly focused tech company working (mostly) deep in the transactional guts of payers and plans providing claims editing tools, business intelligence and a variety of other services. Recently they had a very convivial user conference in Carefree, AZ and were nice enough to invite me to give a keynote. I also got into a little contention (but not too much!) with Foresight’s CEO Bob Fisher about what’s wrong with health care in the US. So I thought I’d return the favor and have Bob on the blog to explain what Foresight does, and we got to talk a little about the wider issues in health care too. Anyone who has any interest in how health insurers actually work (which should be all of you!) should listen to this.
HEALTH2.0/TECH: And in your Health2.0 moment of zen
I’ll be at an IFTF meeting today where they too are talking about Health2.0 but in the much wider context of a shift in bio-citizenry. Hey, they’ve got way high fallotin’ since my days there as a grunge health care consultant in the 1990s. Of course if I didn’t plug the Health2.0–User Generated Healthcare conference in this post, you’d be disappointed, right?
But one interesting nugget arrived in my email courtesy of Today in E-Health Business. Comscore thinks that the “newbies” in the consumer health space are growing—look especially at Healthline’s increases.
More consumers are turning to the Internet to learn about various health issues, with some smaller Web sites gaining traction in the booming online health information category, says a new study by comScore, Inc., a company that measures Web usage. During the first quarter of 2007, an average of 55.3 million monthly U.S. visitors accessed online health information resources, according to the study released May 21. This figure represents 31% of the total U.S. Internet audience, an increase of 12% from the same period last year, it adds. WebMD Health led the online health information category with an average of 17.1 million unique visitors per month in the first quarter (up 25% from the year-ago period), followed by NIH.gov with 9.8 million visitors (up 8%), MSN Health with 8.1 million visitors (up 1%), and Yahoo! Health with 6.7 million visitors (up 83%). Several smaller players also have grown significantly in the category, the study finds. For example, Healthline.com attracted an average of 2.7 million visitors in the first quarter, up 269% from the same period last year, while QualityHealth.com jumped 114% to 2.6 million visitors in the quarter, compared with the same period a year ago, according to comScore. Meanwhile, recent market entrant RevolutionHealth.com has seen its traffic more than double from 239,000 visitors in January to 486,000 visitors in March. “While the larger and more established health portals are continuing to grow, the category is being shaken up by a few upstarts,” says Carolina Petrini, vice president of pharmaceutical solutions at comScore.
TECH/PODCAST: Generic Medical Devices, really? The interview with Richard Kuntz, CEO
This is the transcript of the interview with Richard Kuntz, the CEO of Generic Medical Devices—a start up making, well, generic medical devices. The audio is here
Matthew Holt: This is Matthew Holt with the Health Care Blog, and this morning I’m back with another podcast and I’m talking to Richard Kuntz. Richard is the CEO of GMD, Generic Medical Devices, which is a company which is, as the name suggests, developing generic versions of medical devices. That’s a pretty interesting approach, and I don’t think it’s been done before.There’s actually a pretty big generic drug industry, which has a pretty interesting place in the panoply of pharmaceuticals, but we don’t know much about generic medical devices. And to find out a bit more, I’ve got Richard on board for a podcast this morning. So, Richard, how are you?
Richard Kuntz: Excellent. Yourself, Matt?
Matthew: I’m doing okay so far. As I told you just now, we’re testing out this new device. Hopefully it’ll work and we’ll have an error-free podcast! [laughs]So let’s start at the beginning. We know that medical devices come in different flavors, but probably the ones that have caused most controversy in recent years, in the press and elsewhere, have been medical devices, the expensive ones that are used in surgeries and procedures. We’re talking about stents and artificial hips and that kind of stuff, and there’s been a lot of controversy about both how those are solved and also the margins that are made on those devices. And some of these, there have been a lot of controversy around that.But just give us an overall view of this. You decided to go into this business with the goal of looking at medical devices and creating, presumably, an equally high quality but lower cost version. But what kind of medical devices have you looked at, where is the market that you think is the opportunity, and what is your approach to the market?
Richard: Certainly the pacemakers, ICs, orthopedic hips, stents, are probably the four items that receive most of the press and discussion in general public, but there are literally thousands of other products that go into the hospitals as far as other implants, surgical instrumentation, and supplies.We’re focusing as the first company to begin developing products that are off-patent, that have proven safety and efficacy, that have existing reimbursement to reduce health care costs and help save Medicare. Every time we pick up the newspaper they’re talking about the impending bankruptcy of Medicare, and we intend to remove cost from those devices in the $120 billion device marketplace.There are literally thousands of products that the large companies have enjoyed a long run on, where the patents have expired; yet the prices continue to ratchet up each and every year. So we’re focusing on those products that do have patents that have expired, and truly, the only thing generic about our products is the price.
POLICY: Cynical quickie
Apparently the Brits are short of entrepreneurs in their health care sector. I’m sure Pete Stark thinks we’ve got a few extra here we can send them.
