My erudite tones from the YourCall radio show on Monday–available streaming or in MP3 for download
PODCAST/TECH: Health Communities 2dot0
This is the transcript from the recent Health 2.0 Communities podcast–original post here.
Matthew Holt: Welcome to another podcast here at the Health Care Blog. This is Matthew Holt, and with me today are two more leaders of what we’re starting to call the Health 2.0 Movement. They are Daniel Palestrand, founder and CEO of Sermo, a community-focused site that focuses on physicians, and Unity Stoakes, President & COO of Organized Wisdom, which is a community site focused on patients and consumers. Good afternoon, both of you.
Daniel Palestrand: Thank you very much. Nice to be here.
Unity Stoakes: Likewise, Matthew. Thank you for setting this up.
Matthew: Let’s start off by getting right into it. I suspect that a lot of people reading the blog haven’t heard of Sermo or Organized Wisdom, and you guys are on different sides of the same coin. This is all to do with the open health care issue, and the idea of getting many more voices online. Daniel, why don’t you start off? Tell us a bit about the core idea behind Sermo, what it does, and what kind of activities are going on on your side?
Daniel: Sure. Up until about fifteen months ago, I was a surgical resident at one of the hospitals here in Boston. I had done some startups in ’98 and ’99, but really had no near-term plans to go back to the business world.
I started seeing a trend more and more with my colleagues, where we would be talking about cases or recent news in the mainstream press — perhaps a new revelation about a new approach to treating a disease, or a problem with a drug or device, or a new resistant form of bacteria. What we were remarking on was that we had inklings of this — it had come up in conversation weeks or months ago — that there was an idea there. We realized that this wasn’t a fluke event. So often in the trenches of medicine, at the bedside, in grand rounds, physicians were talking about these phenomena long before it appeared in the conventional press. That set me about thinking: what would you have to do to capture these clinical insights and make them useful?
My starting point was coming up with a business model. I had done other startups that involved physicians and health care IT, and I knew that trying to get people to part with money is particularly difficult in health care IT. So from the start, we had a model where we would not have physicians paying for anything. We would look to get the parties who find value in the information to pay — to underwrite the business model.
My second thought was, assuming we could get physicians to make these insights, how would we distinguish the signal from the noise? I had had enough experience with my early work with the CDC and Device Registry to know that getting the initial observations isn’t the challenge. The real challenge is separating the signal from the noise in the background. What I wondered was, could you create a model whereby the valuable information would be determined by the users themselves — in other words, the people on the front line.
That was really when Sermo was born. In our model, we have a system where any licensed and credentialed physician can submit an observation, but what really distinguishes the value of that observation is the degree of corroboration that it gets from other physicians. It started out with a very simple, basic idea. We were thrilled to see that it was a very patentable and fundable idea, and has now turned out to be extremely scalable. We are seeing an incredible torrent of information coming out of our system.
We’re now a thriving young startup company, part of what we’ve realized is a much broader trend, variously called social media, Web 2.0, or prediction markets. We’re very excited to see other companies, like Organized Wisdom, tapping into the same trends.
Unity: I’m actually the president and co-founder of Organized Wisdom. We’re a health-focused social networking site. The easy way to think about what we’re doing is that we’re a mash-up between WebMD and Myspace.com. We’re really focused on integrating expert content with user-generated content, and eventually flaring in industry content and research from health organizations as well.
We got started… actually, my partner Steven Krein and I have been in the online space for the last twelve years. We took a company called Promotions.com public in the late ’90s. It was an online marketing company that was later acquired by iVillage. So we spent many years seeing a lot of these community trends taking shape in other industries, but we didn’t see a lot of progress being made with online health. At the same time, over the last couple of years, we’ve seen eight out of ten people going online to search for health information. We’ve also seen a lot of research indicating that people are turning to their friends and family to get health information. So we got the idea to combine the two and really try to create a community for consumers, patient experts and leaders of health organizations to come together and share their wisdom and knowledge in an organized, structured way… to build a very useful, helpful knowledge base covering thousands of health topics, conditions and diseases, so that any consumer needing health information could easily come in and find the information that they need.
BLOGS: Fox News touts THCB?
Fox News? Likes a commie site like this? Believe it baby!
PHYSICIANS/POLICY: NY Times is surprised about its Ps and Qs in Prostate Cancer Therapy
So there are three treatments for prostate cancer. Medicare pays physicians a whole lot more for one (new snazzy non-invasive one that patients prefer too) than the other two. So they rush off to get the necessary equipment and staff-up to perform the new procedure. Then they start doing that rather more than they others. And the NY Times is surprised!
Wow. Just wait till they hear about chemotherapy, and how much of that treatment “choice” is based on incentives to physicians. (Cue Greg to tell us!)
Just another reminder why non-globally budgeted FFS in a system with no mandated technology cost-effectiveness assessment does not work. And that’s roughly what Medicare provides. Instead we should be trying to figure out what is the best patient long-term outcome is for a pre-determined amount of spending.
PHARMA: That can’t have been a fun management call, with UPDATE
Pfizer’s next big drug for heart disease (torcetrapib which was slated to replace Lipitor) has bombed in trials, causing sufficient deaths that the trials have been ended early and development has been stopped. This is obviously dreadful news for Pfizer, and I assume that the stock will be well done on Monday. But that’s how the pharma business is supposed to work—big bets on new blockbusters may not pan out, but others will do so.
But beyond that it is also a pointer that some of the easy “targets” such as heart disease and diabetes may be nearing their natural limits for medication therapy, and that lifestyle changes, the old “diet and exercise” may really be the best way to deal with them—allied of course with the generics which were the blockbusters of yesteryear. Almost all the growth in the drug business in the last few years seems to be in niche and very expensive biologics for virtually orphan diseases.
Which all means that the cuts in the sales-force that Pfizer announced last week are likely to be the first of many. Big Pharma is going to have to figure out how to get to a model beyond hitting every doctor and every patient on behalf of a few big blockbusters. The challenge for the rest of the system is to figure out how to use both the new niche drugs and the old blockbusters in the most effective manner.
UPDATE: Pfizer stock is off 12% in relatively early going, down to $23 and change. Ouch! Although it’s still above the lows of a year ago (Just). If you are a bitter shareholder this morning, you should thank the lobbying dollars sunk into Part D’s passage in 2003 for the industry profit recovery that’s kept it afloat this far in 2006. You should also worry about what comes next on that score!
HEALTH PLANS/POLICY: John Igleheart is a pussy

In a Conversation With Larry C. Glasscock, the CEO of Wellpoint, John Igleheart has either been massively restricted by Glasscock’s PR handlers or has revealed himself to be a complete pussy.
A little history: having been a senior exec at CareFirst (Blues of DC), Glasscock took over the fast growing regional Blues plans based around Anthem BCBS in Indiana, took them for-profit and made himself a fortune. A great American success story.
He then merged Anthem with the big other for-profit Blues agglomeration, Wellpoint which was run by Len Schaeffer, in 2005. I’ve had a fair bit to say about the variance between Len Schaeffer’s high-fallooting rhetoric and the actual on the ground performance of his company. Glasscock appears no better. And in many ways, he’s been much worse.
I’m not saying that Igleheart should necessarily have gone after him for the fact alone that he made $25m last year (not to mention the millions more in stock)—after all Wellpoint stock has done very well. But given that certain other health plan CEOs are in some hot water for their outright greed and fraudulent behavior, it might just have come up.
POLITICS/TECH: Fame and fortune and everythingthat goes with it
Today, (Monday) I’ll be on local NPR in San Francisco talking about what the Democrats may (or more likely, may not) do about health care in the new Congress. It’s on the Your Call show on 91.7 KALW at 10am and yes it has the politics you’d expect of a San Francisco NPR station, so I’ll be the right winger on the show! You can tune in or listen here.
And on Tuesday I’ll be talking at the Northern California Chapter of HIMSS in San Ramon about the PHR. It’s a good line-up and I’ll be reporting back on the smell of sulphur!
POLICY/HEALTH PLANS: Yet more debatable data on CDHPs
HSC’s John Gabel (kind of a “neutral” in the debate) is out with a new study suggesting something that I think is true. The take up of CDHPs by workers offered them in a choice with other products (HMOs. PPOs) is slow. And that’s because they’re not being appropriately compensated with premium reductions in their take-home pay to off-set the much higher-deductibles.
And of course this goes back to how employees buy their health care in the first place—mostly unconsciously via their employers, not knowing the actual cost of their premiums. If you want a long lecture on why this makes employees poor purchasers of insurance, attend any Alain Enthoven Stanford Business School class.
The likely evolution of all this is that workers will find the deductibles and co-pays for their PPO and HMO products increasing to the level of the HDHPs pretty soon. That’s how employers will “get out” of health care benefits—until the possible day when they all look at each other and say “OK let’s drop them totally and let the government take over.” Which is what they all want, but no one is quite ready to make the first move.
But because the HDHP is becoming an evolution of the PPO product that already exists, the argument will about choice will soon be moot. Karen Ignagni may well say that all (or actually 30%) the new small employer HDHP buyers were uninsured, but it’s pretty obvious that most (70%) of the new HDHP wielding employees were people with PPOs before who are being forced into HDHPs by their employers. And that’s certainly what’s happening with Intel and other larger employers who are “offering” HDHPs.
However this news release is most remarkable for this quote from Ignagni: “Ignagni said the plans are popular in certain niches but that it was too soon to say if they will gain wide acceptance.” She’s actually telling the truth! Mark that one down in your diary.
POLICY/POLITICS/HEALTH PLANS: A Stark future for private health plans in Medicare?
Here’s the SF Chronicle on Pete Stark’s opinion about Medicare Advantage
Boiled down, Stark’s contention — based on a new Commonwealth Fund foundation study — is that the private firms are being paid 12.4 percent more per patient than government-run Medicare to provide the same level of services. In 2005, Medicare Advantage plans, originally created based on the contention that private industry could provide service for less than the government, were overpaid an average of $922 per enrollee, for a total cost to taxpayers of $5.2 billion.The payments “are not a mistake,” Stark charged. “Republicans are overpaying Medicare HMOs as part of a deliberate effort to shift beneficiaries into private plans. The Republicans’ ultimate goal is the privatization of Medicare, complete with a voucher system that leaves seniors to fend for themselves,” he added.The industry questioned the methodology of the study Stark used to make his charge and said that Medicare Advantage plans actually save money by injecting competition into the Medicare system, which covers about 43 million Americans. Figures from the America’s Health Insurance Plans trade group estimate that Medicare Advantage participants save on average $82 a month, compared to what they would pay in the traditional Medicare program. That comes to total savings of more than $6.8 billion annually, the group estimates.
And like the good politicians they are AHIP just changes the subject (See the release for a typical piece of Karen Ignagni’s tenuous relationship with the truth)..
Err, guys, it’s not whether the enrolled seniors are paying less in deductibles and co-pays that Stark is worried about. He knows that the private plans are cross-subsidizing those beneficiary costs (along with gym memberships et al) from the vast profits they’re making on them. It’s the taxpayer who’s paying more, as way too many GAO reports have shown (and now the somewhat more biased but no less true Commonwealth Fund report shows).
So the key question that the private plans need to be focusing on, especially as they are staring risk adjustment in the face anyway is, can they genuinely save money over the FFS on a non-risk selection basis by improving the efficiency and quality of the care they manage? Currently as the details of the report make clear, the risk adjustment has been hidden by an overall increase in the payments, and by the double inclusion of some other technical payments, such as the indirect amounts Medicare pays for medical education.
But surely that can’t last under any scenario. Logically in the high cost states like New York and Florida, making genuine savings over Medicare FFS—given the huge unnecessary care delivered and reported on by the Dartmouth crowd—must be achievable. Those savings should include decent profits for the private plans. They shouldn’t need extra payments to make it worth their while being in the market. If the private plans cannot prove that pretty damn quick, then they need to be prepared to get out—in a replay of the early 2000s. And Stark may want some of his (our!) money back!
POLICY: For Make Benefit Glorious Nation of California By John Irvine
The first shots in the fight over California Gov. Arnold Schwarzenegger’s health care reform proposal were fired last week. The Los Angeles Times reported that a team of advisers is working to develop the proposal, which will probably be unveiled during Schwarzenegger’s state of the state address in January. The news had led to a pretty serious hoo ha. Liberals are worried that the plan will look a lot like the helpful proposal drafted by America’s Health Insurance Plans. Conservatives, on the other hand, are concerned that Schwarzenegger could get carried away in his enthusiasm to appeal to moderate voters and end up producing something that could hurt California’s businesses.
What should we expect? The backgrounds of the advisers who are helping Schwarzenegger produce the plan may give us some hints. As it turns out, three of the four are Democrats. One recently left his position at McKesson government relations. In his piece this week, the California Health care Foundation’s George Lauer described the makeup of the team:
Richard Figueroa, former
legislative director for Insurance Commissioner John Garamendi and
former aide to former Gov. Gray Davis (D).John
Ramey, former executive director of the Managed Risk Medical Insurance
Board, deputy secretary and assistant secretary of the Health and
Welfare Agency, and chief of staff for the Department of Health
Services. Since 2000, Ramey, a Republican, has been principal and
partner of Ramey, Macomber & Associates a Sacramento firm
specializing in health care and health insurance contracts.Herb
Schultz, former deputy director of the state Department of Managed
Health Care, most recently vice president of government programs at
McKesson Health Solutions. Schultz also served as acting director of
the California Employment Development Department and acting secretary
and undersecretary for the Labor and Workforce Development Agency.Daniel Zingale, chief of staff for first lady Maria Shriver and former director of the Department of Managed Health Care.
A lot of people have focused on the possibility that the plan will look a lot like the proposal produced by former Massachusetts Gov. Mitt Romney. The critics say the idea probably wouldn’t replicate well in California for many reasons. (Short explanation: California is a lot bigger than Massachusetts.) Adopting a variant of the Romney proposal would also be a form of endorsement for Romney, who plans to run for the White House in 2008.
