Long term care gets kind of short shrift in our health care system, and on this blog too. Which is a pity as it’s really important. Joe Anglelli from The Pioneer Network writes to me telling us about a new report by two Brown University professors about the issues.
Above the Fold
TECH: Big practices using IT, less so in smaller ones
Another incomplete but useful study from HSC on physician technology use. Essentially the investments made by big groups in EMRs are showing up in the data, with nearly half those in groups of 50 and above using ePrescribing—perhaps the key indicator of whether a doc is using a computer for a basic clinical function.
But for those in the 1–9 sized group the number went from 8% in 2001 to 13% in 2005. A big increase in percentage terms, but not exactly setting the world alight.
TECH/QUALITY: Reason why health care costs keep exploding, #469
The number of CT studies is growing at 8% annually.
PODCASTS/TECH/CONSUMERS: Health2.0 roundtable
Here’s the transcript from last weeks podcast. It gives you a window into one of the hot areas at the moment, Health2.0 (perhaps I should trademark that quick!). The participants are three leaders of new online health focused companies, all of whom are relatively new and very ambitious. The original podcast post is here.
Matthew: Welcome to another THCB podcast. I’m Matthew Holt. Today is pretty exciting. I have got three of the leaders in what’s starting to be called the Health 2.0 movement. Those of us who were around the first time when things got crazy in Silicon Valley in the late 90’s when Netscape and Healtheon came on the scene are somewhat nostalgic for the days when you would go to parties and people would try to recruit you for a job just because you were standing around drinking. And those of us who have lived through the e-health bust are particularly upset about what happened next!But it looks like in the last couple of years, mostly in the last year or so, there’s a lot more interest in health care online, health care search, and health care information. And a lot of that has to do with what’s happened with the Google IPO and how successful Google has been creating a business out of search. Obviously a lot of the buzz in Silicon Valley and on the Internet in general has to do with that.But what I thought we’d do today is take a look at this Health 2.0 movement. So I’ve assembled three individuals who are leaders of companies, all of them at this stage relatively small companies, and all relatively new companies. But all of them are doing something very interesting in a slightly different segment of health care and health care online, or as it’s now starting to be called, Health2.0.And just before I introduce them, I’d also point out that just yesterday Dmitriy Kruglyak at HealthVoices started a manifesto called the Health Train, The Open Healthcare Manifesto, which is a new sort of manifesto promoting the idea of open health care. I’m one of the people who signed that, and I think it’s quite an exciting time in general for the concept of new types of open online heath care.So with that, let me tell you who I’ve got on the conference call with me. I have
- Dean Stephens, who is the president and CEO of Healthline, based in San Francisco,
- Tom Eng, who is the Chairman of Healia, based up in Seattle, and
- Chini Krishnan, who is the CEO and founder of Vimo.
And the good news here is that Vimo was until very recently called Healthia, but for the context of this conversation, thank God, changed it’s name. [laughter] And I had to let Chini come in because when I went to visit Vimo they gave me a T-shirt. And I’ll be expecting the other two of you guys to be sending one along soon. [laughter]Now with that, I want you each to give a brief introduction to your company.
HEALTH PLANS: Matthew Holt, stock trading pussy
Sector Wrap: Health Insurers Fall. UNH is down $5 or close to 10% from its high on Tuesday with Allen’s conecession in VA giving the Dems the Senate being probably the clincher today.
And was I short, like I said I would be on Monday? Back then the 45 Nov puts were trading at 20 cents, today they’re 55. So how many did I load up with? (no need to add the next sentence!)
HEALTH PLANS: A little more on KP
Here’s a piece from veteran SF Business Times health care reporter Chris Rauber on the Kaiser saga. I still basically stay where I was, but it’s worth noting that the presumed reason that Cliff Dodd resigned on such short notice (i.e. was canned) is not because HealthConnect (Epic) doesn’t work—it’s because the story that he was a director of the consulting company paid $1m in fees by KP while he was CIO is presumably true! That’s such a visible conflict of interest, it’s bizarre that he and the rest of the board thought they could get away with it. So I suspect that he never told them and no one bothered to ask until Justen Deal dug it out of various filings. Of course you may have your own opinions. I also just noticed that Dodd’s sole academic qualifications were that he has a BA in Sociology. I’ve got one of those (well, sort of)—perhaps they should give me the job!
However, there is no evidence that any other major EMR system works better than Epic, or is written on a more sophisticated, more modern code than MUMPS. The only real competitor in existence when the decision was made was Cerner’s Millenium—not known for its drop dead gorgeous implementations, and lacking an outpatient function at that time. The others, Soarian (Siemens), Eclipsys, McKesson did not have proven ambulatory and in-patient systems.
Why didn’t KP just buy Epic, as has been suggested? Perhaps you should ask the folks at Phillips about how easy Judy is to work with, and how willing she is to sell.
While we can all snipe from the sidelines, there is no question that getting clinicians to use process automation software of any type is really, really, hard. So I’m not surprised that this isn’t all smooth sailing.
Finally, the real scandal at Kaiser this year has not been about the IT system, or even about the pecadillos of various Kaiser executives. The real scandal has been the opaqueness of the management of the kidney transplant program’s collapse, even though that’s stayed out of the national press (beyond the LA Times and Chris Rauber’s work).
At a meeting about PR for blogging that I spoke about, Kaiser’s new press rep (didn’t catch her name) said that they were going to behave differently in the future. At least Halvorson wrote an email about this latest brou-ha-ha. We heard zip from him or TPMG about the kidney scandal.
QUALITY/PHYSICIANS: OBGYNs are scientists, scientists I tell you
Interesting long article in the New Yorker by Atul Gawande about How childbirth went industrial. Briefly it’s about how we stopped using all kinds of techniques for getting kids out that required a lot of skill because we started measuring the results on a universal scale. And the result is a lot, lot more C-Sections. In the UK they don’t use so many C-Sections, so I asked a recently retired British OBGYN I know rather well for his opinion. Here’s what my dad has to say about the article:
It shows yet again that the worst way to deliver a baby is by C/S following a long failed labour. If you could guarantee a normal labour then that would probably be best for mother and baby, at least at the time. This doesn’t allow for the increase in prolapse and Sphincter Weakness Incontinence (Stress incontinence)in later life. It also shows that female doctors are the poorest judge of how they should deliver!
PODCAST: Lonny Reisman of Active Health Management
Lonny Reisman is a physician who came up with what he believes is a way to improve medical care and patient outcomes by tracking data and feeding it back to practitioners in close to real time. Aetna liked the idea so much they bought the company, Active Health Management, for $400m big ones last year. More importantly, it might be one way that population care management can become real in the continuing absence of the EMR.
Here’s the podcast.
It’s really interesting stuff and rather better sound quality than some of the recent ones–there’ll be a transcript up soon.
HEALTH PLANS: Are we finally at the top?
I was going to do a post election special, but Joe Paduda beat me to it over at Managed Care Matters. I was also going to short United Healthcare, given that the Dems win will likely make it rough on those who feed at the trough of Medicare managed care. But of course I failed to do so, mostly because I’m spending all my money on putting in a new kitchen. And of course had I done so, I’d have made out, but again for a different reason. As it turns out, the stock rallied up on Tuesday and then fell Wednesday because the company released news that its problems with the options back dating scandal would be worse than were originally thought.
But longer term, the value health plans contribute when they’re not putting their heads into the Medicare trough seems to be diminishing, and employers seem to be getting wise. If the government (or at least Henry Waxman and Pete Stark) start really asking tough questions, and if Dick Cheney is not the deciding vote in the Senate, which is looking more and more likely, well perhaps the six year bull market in health insurer stocks is over. But I’ve been saying that for a while.
On the other hand, health plans do have some potential to do good. See my podcast with Lonny Reisman of Active Health Management to see what that might be.
TECH: RHIOs as ASPs?
My piece about RHIOs as ASPs is up at Digital Healthcare and Productivity
