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PODCASTS/HEALTH PLANS/TECH: Interview with Stan Nowak, CEO of Silverlink

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Here’s the transcript of my interview with Stan Nowak of Silverlink. The original audio is here.

Matthew Holt:  Hi, it’s Mathew Holt of THCB and I’m back with another podcast. And this time I am talking with Stan Nowak, who is the CEO and President of Silverlink. You may not be familiar with Silverlink; they are a company that relatively new and relatively small. But they have a big client base doing, primarily outbound automated phone calls. We spend a lot of time on THCB talking about the Internet, the web, Health 2.0, and all these kind of new ways that people are using computer technology to communicate with each other. But what we obviously we don’t realize, well we do realize but don’t think much about it, is that in healthcare; a lot of the activity is in phone calls. And there is a big market in trying to do the phone call better and to gain more information from that.So, I chatted with Stan a couple of week back and I thought it would be interesting have him on a podcast because Silverlink has introduced some new initiatives. But they also have been doing a lot of stuff that probably is not familiar with people. It has sort of been under the radar, both in terms of working for PBMs if you have Medicare Part D and working with many health plans. So, first off, Stan, good afternoon. How are you doing?

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POLICY/HEALTH PLANS: Has George changed his tune?

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Found this Interview with KP CEO George Halvorson put out in January. Here he is talking about single payer

PwC: Are there other practices you see overseas that you think are importable?George Halvorson: One of the nice things about almost every other country, particularly the ones with single-payer systems, is that they focus very heavily on primary care. Most health-care costs come from a very small number of people: 1% of the population represent 40% of the costs; 10% of the people represent 80% of the costs, etc. So the largest potential you have for changing the total cost of health care is to focus on that small group of people and take care of them appropriately. And the only really effective way to focus on those people is with primary care. You need to intervene medically with those people before diseases progress to the point where they’re extremely expensive. And that requires a primary-care model.Countries with single-payer systems all have put in place extensive primary care, and employ much less expensive specialty, secondary and tertiary care. That’s actually not a bad model, because what you end up with is fewer people needing a heart transplant. If you need a heart transplant, you may be less likely to get it in those other countries. But if you have really good primary care, you’re much less likely to actually need the heart treatment.PwC: Does that mean there are trade-offs regarding care?George Halvorson: Only if you have to decide where you’re going to invest. If you decide to invest in the primary care part of the equation, then you eliminate the need for some of those very expensive treatments. On the other hand, if you don’t invest in the prevention part of the agenda, then you have to invest much more heavily on the tertiary side of the equation. It’s a cost trade-off for the system. For the patient, think of the quality-of-life perspective: Would you rather have a massive heart attack, or would you rather be treated by a primary care doctor? It makes more sense to focus on early prevention and not on the tertiary care rescue model.

It’s a sensible and pretty accurate description. But that’s not exactly the terms he was using about single payer more recently at the Commonwealth Club when his description of single payer used the terms “rationing”, “Canadians coming to the US” and he alluded to single payer being like the prison health care system. I wonder what changed his tune? Was his body invaded a la Harry Potter movies by Sally Pipes?

BOGS: Worldhealthcareblog

The WHCC Europe edition has it’s own blog at  Worldhealthcareblog.org. Very detailed recounting of what’s going on at the conference. I did it for them at Washington Dc last year and will be doing so again next month.  No one told me that I could have gone to Barcelona too!

PODCASTS/HEALTH PLANS/TECH: Interview with Stan Nowak, CEO of Silverlink

Stan Nowak is President and CEO of Silverlink which does automated phone calls on behalf of health plans. It’s a lot more complex and much more interesting than you might think, and it really is closing the loop for those health care consumers who don’t use the web. Plus Stan is an interesting and fun guy, even though he had to suffer through that awful Cambridge, Mass based business school!

Listen to the podcast. The transcript will be up in a few days.

HEALTH PLANS/POLICY: Individual association problems

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Nothing really new here, but a nice piece from Lisa Girion in the LA Times about how because of the haste of insurers to avoid association groups and insure the young healthies, said groups are going into death spirals. And of course being kicked out by their plans if they can possibly figure out a reason in the fine print to do so. Today’s bete noir is Blue Shield of California which is kicking out the Association of Realtors on a technicality, but they’re obviously all at it.

Which of course means that if you’re in one of those association groups and yours get terminated and you’re sick, you’re screwed. I thank my lucky stars that when this happened to me, I was able to fool one plan into thinking that I’m healthy enough to be worth having. So far, one year later I have no claims, so they’re up!

POLICY/POLITICS: Up at The Grauniad

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My father would rolling in his grave if he wasn’t still alive. I, yup the guy who voted for Thatcher twice, have been given a column on the venerable web site of The Guardian–the paper of the wet liberal lefty chattering classes in the UK. I’m up explaining the Democratic Presidential candidate’s health plans or lack of them.

This past week saw the first debate among the Democratic candidates
for president about what has become the most important domestic issue
in American politics: the country’s failed healthcare system.
To serious students of policy, America’s healthcare is the most obvious
feature of its society and economy that needs correction. However, to
serious students of American politics, reforms to the
healthcare system are the most difficult problems. Case in point: the
Democrats lost control of Congress in 1994 in large part because of
opposition to the Clinton healthcare plan.

The problem is that healthcare system reform will necessitate
controlling the system’s huge and growing costs – currently 17% of GDP
in the US against less than 10% in most of Europe. But those reforms
will need to cover the 45 million people who now lack insurance, as
well as reassure middle America that they will keep their coverage, and
not upset upper-income Americans and the senior lobby who are generally
happy with their doctors. And of course then there is the problem of
dealing with a powerful $2,000bn industry which has little interest in
seeing its bumper profits diverted.

TECH/QUALITY: Stents–it’s even worse than we thought, WITH UPDATE from The Industry Veteran

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Note: I put this up late last night–but it’s such a huge story (and as one emailer says, can you think of a recent study that so blatantly points out all the flaws in the health care industry better than this?) that I’ve moved it to the top today

Man. This is no fun for Boston Scientific and the rest. Most angioplasties unneeded, study finds. This is even worse than was thought. Non-emergency angioplasties with stents are not even any good at reducing chest pain (angina) compared to drugs over 5 years:

The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients. An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done. "By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

<SNIP>

About 1.2 million angioplasties are done in the United States each year. Through a blood vessel in the groin, doctors snake a tube to a blocked heart artery. A tiny balloon is inflated to flatten the clog and a mesh scaffold stent is usually placed. The procedure already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later. The new study shifts the argument from which type of stent to use to whether to do the procedure at all. It involved 2,287 patients throughout the U.S. and Canada who had substantial blockages, typically in two arteries, but were medically stable. They had an average of 10 chest pain episodes a week — moderately severe. About 40 percent had a prior heart attack.

Live by the stent and potentially die by it. BSX was down around 6% at the close. And it would be un-THCB like to say “I told you so”, but I told you so.

UPDATE: Meanwhile, all the analysts MarketWatch polled don’t think that this study will make any difference, even though BSX barely got a dead-cat bounce today after its mauling yesterday. And then, well you knew this was coming….here’s what The Industry Veteran thinks about my pussyfooting around the issue:

The NEJM study on stents versus medical therapy, publicized this week in connection with the American College of Cardiology meeting, is not really “worse than what we thought” in terms of what it reveals about the larger health care system. It demonstrates exactly what we thought and what I’ve made explicit on this site several times. Ed Silverman over at Pharmalot nails it squarely when he writes that a large segment of cardiologists feel threatened by the study’s results because there are financial incentives for them to insert stents. In other words, the big problems facing health care will not be adequately addressed by digitalizing medical records, adopting treatment algorithms or any other technical tweaks. As long as the public remains hostage to obsessively greedy manufacturers, equally greedy physicians and third-party payers that are capital aggregators, we will continue to pay more than the rest of the world for our health care and, for the population as a whole, derive fewer benefits. Too many middlemen are allowed to extract too much economic rent from the health care system.

As the ACC meeting in New Orleans winds down, I’m reminded of a conversation I had at a previous meeting with a cardiologist from Westchester County, New York. American society, in his considered opinion, must guarantee practitioners who choose to start in his field a minimum yearly salary of $250,000 in return for their willingness to “give up the decade of their twenties.” Until then I still held the naive notion that while nationally acclaimed investigators working in academic medicine are exalted whores and crooks, the garden variety specialists in solo offices maintain genuine concerns for their patients as they work to obtain a secure but not unconscionable livelihood. In a pig’s eye!! Specialty practice in the United States today attracts people with the souls of Tony Soprano or “Chainsaw” Al Dunlop and it refines their predatory instincts through an arduous indoctrination process. Debating whether they or the pharma and stent companies do more to corrupt the system remains pointless, similar to arguing whether local politicians or the road contractors who bribe them are worse crooks.

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