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PODCAST: Lonny Reisman of Active Health Management

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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.

Unh

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/POLICY: McCall gets off the Scrushy way

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Want to be a fraudulent gazillionaire running a public company? Get your CFO (or in Scrushy’s case a plethera of them) to commit fraud, blame it all on them when it gets discovered, and suggest that as CEO it’s got nothing to do with you, and who were you to know anyway—after all you were just the CEO?

OK, so it didn’t work for the Enron guys, but then again everyone in Houston knew someone who lost their job or life savings. Most San Franciscans haven’t got a clue what McKesson does, or that it’s one of the biggest companies in town. So when the Jury Acquits, Hangs in Trial of McKesson’s Former CEO and GC, it shows that McCall gets off the Scrushy way. Well done. Now will some one give me a big public company to run?

POLICY: Morrison, Klepper & Enthoven–radical communists or mercantilist capitalist apologists?

You be the judge!

Ian Morrison is trying to point out  to the upper echelon of America’s body politic (i.e. the rich bit of its health care system) that some compromise may be reasonable in order to avoid single payer.

Brian Klepper and Alain Enthoven are pointing out why that compromise is necessary now — not something that a random walk through the unthinking business columns of the NY Times might suggest.

Of course they’re all optimists. As I’ve told all three (all of whom I know and greatly admire), I think the systems will trundles on till the middle of next decade when at the behest of the China central bank (or whoever controls economic policy then) the President will be forced to put AHIP, the AHA, the AMA, PhRMA and their Congressional lackeys in a room and offer them two choices. And single payer will be the more acceptable one.

TECH/HEALTH PLANS: Gadfly tells me I’m MIA on Kaiser

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Gadlfy has been telling me that I’m MIA on the big Kaiser story, but luckily MrHISTalk has picked up the slack and has printed the Internal E-Mail Criticizing Kaiser’s HealthConnect Lands Employee in Hot Water. In addition in a presumably related move CIO Cliff Dodd has quit. Gadfly also tells me that the 25yr old malcontent Justen Deal (who I’d never heard of before yesterday) was previously a Kaiser cheerleader. Well nothing like a convert to preach a new religion. And his new faith is that Epic sucks, HealthConnect is a disaster responsible for a forthcoming financial crisis at KP, and that Halvorson is incompetent/a crook (take your pick)

I have no idea whether the Epic solution will or won’t work in the long run, but I suspect that it was rather better than the IBM/Colorado solution, given a conversation I had  a while back with some internal KP tech savvy docs about the state of that code. The truth is presumably somewhere in the middle. Unless Halvorson actually has secret stock in Epic or is being paid off into some Swiss bank account, something that’s rather unlikely given the way Judy Faulkner runs that private company, then there doesn’t seem to be any direct conflict of interest. Lots of big IT projects don’t work as advertised—in fact few do! And Kaiser is a highly fragmented and political organization (always has been, always will be), so betting the farm on a one-stop EMR solution probably did require getting most of the board to leave. I’m amazed Halvorson got it done at all.

And I cannot believe that HealthConnect is by itself responsible for all the anticipated losses—the move towards HDHPs is far more likely to hurt KP’s bottom line, as they are just not set up for that type of an environment (in which the risk pools is destroyed). It’s just not in their nature.

And at least the attempt behind HealthConnect is to improve care. Much more concerning is the organization’s reaction to the kidney transplant scandal, which as some of my commenters mentioned at the time called into question the financial ethics of TPMG.

But I guess this new little outburst doesn’t help! And I have heard quite a few KP docs bitching about the new system. Any more want to chime in pro or con or neutral?

….and of course much more from a not exactly neutral source at Gadfly’s blog

 

PODCAST/TECH/QUALITY: Don Kemper podcast

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Here’s the transcript from the recent podcast with Don Kemper. Interesting stuff from a real pioneer.

Matthew Holt: So welcome to another THCB podcast. Today we’re very lucky to have Don Kemper, who is the President, CEO and certainly the joint founder of Healthwise, and also, although he’d be too bashful to say it, probably the main individual in America who has been behind the information therapy movement, which now has its own separate Center for Information Therapy, the one that Don I believe founded. So Don, welcome to The Health Care Blog.

Don Kemper: Thank you, Matthew. I’m pleased to be here. You’re very kind.

Matthew: Those of you who’ve been reading the blog have noticed that over the years I’ve both been to a couple of information therapy conferences, partly because they’re held in Park City, Utah, which is a beautiful and lovely place to go where I have friends (even though I left most of my left knee there in the trees some years ago and am just steadily getting it put back together) but also because I’m pretty convinced and a firm believer that the concept of information therapy is one that is going to be of significant importance no matter what happens in the future health care reform debate. And it’s something that, as people are developing new and different forms of information technology to support those patients and physicians, information therapy is going to be an important part of that.

So, with that, Don, why don’t you take us back to the early days. Tell us a little about what Healthwise does, how that started, how the Healthwise Handbook got going, and then perhaps just tell us a bit about Information therapy to start off with.

Don: It all started, Matthew, when I was a lieutenant in the U.S. Public Health Service back in 1970, and I heard a talk by the assistant secretary for health education and welfare in those days, Vern Wilson. He said the greatest untapped resource in health care is the consumer. And that was at a time when nobody was thinking about what a patient could do for themselves, and I though, "That’s a good idea." I had a little baby at home and somebody had given me a Dr. Spock, and I thought, "Well, what the world needs is a Dr. Spock for the whole family," and began to try to get the federal government to write a basic self-care book that they could give to every family in America.

That idea didn’t get very far in my two year tenure with the Public Health Service, but I held onto the idea, and a few years later landed in Boise, Idaho with a pretty open book on what I could do, and we started to develop that idea. And so Healthwise was formed in 1975. We published the first copy of the Healthwise Handbook through Doubleday in 1976. And we have been growing toward the same mission that we established right then, which was to help people make better health decisions.

So over the last 31 years, we have been continually looking for ways to enrich this mission of helping people make better health decisions by giving them books, giving them workshops, giving them good web based information, and now finding ways to prescribe information to meet their specific needs in every moment of care.

Do you want to know more?

Matthew: Sure. Let me ask you some more specific questions. Healthwise is founded as a non-profit, and I guess that perhaps the first time I ran into Healthwise was back in early ’90s. Somewhere around that time you convinced the folks at Kaiser Permanente to give that book to every member, I believe. Maybe that was just Northern California. The thing that I as a health care economist policy guy that I sort of sat up and took a notice, was that actually, they showed that emergency room visits declined dramatically amongst people who had these books.

So tell me a little bit about how that evolved, and how, apart from being sort of a worthy organization giving out information to people, Healthwise started evolving into being a place where the health care system realized it could start having a positive impact on savings, as well as outcomes.

Continue reading…

POLICY: Healthcare crisis countdown

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The Christian Science Monitor has a pretty interesting article about how the healthcare crisis countdown may lead to a big debate in health care politics either 2008 or later. My guess is much later, but it’s a matter of timing. And the later the system players leave it to sort themselves out, the more likely it’ll be that we get an unthinking single payer solution (as opposed to a thinking one).

Meanwhile John Abramson has joined the hate America crowd. Just because he has data and evidence on his side, he thinks he can get away with that stuff?!

TECH: McKesson Buys Per-Se Technologies

McKesson is buying Per-Se Technologies . Per-Se was the result of a series of roll-ups in practice management and hospital billing companies, which bought the “switch” part of NDC two years ago. McKesson itself has quite some experience buying technology companies that are roll-ups of others! (And not all of that experience was good!).

More later on the impact.

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