Jane Sarasohn Kahn brings you up to date on Being Transparent About Privacy.
Above the Fold
BLOGS: PRSA Health Academy Panel
Dimitriy has a report on the PRSA Health Academy Panel that we were both on last week. Fun panel, but a little too early in the morning for my taste!
PHARMA/POLICY/POLITICS: November comes after September
Interesting article in the WaPo about the impact of the donut hole in Part D on the Senior vote. I think it will matter, it will hurt the Republicans and the signs seems to be point that way in one House race in Florida. Of course whether it will matter enough to push the House over to the Democrats is another matter. But the most interesting stat in the article is buried on the second page.
Perhaps playing in Klein’s benefit: More seniors are finding themselves
in the doughnut hole as the election approaches. The Institute for
America’s Future, a group calling for the closure of the gap,
calculated that, on average, seniors who enrolled in the benefit at the
beginning of the year would have fallen into the doughnut hole on Sept.
22.
So this problem will get worse all the way up to election day, and the greed fest known as the Medicare Modernization Act (of which to be fair the greed of big Pharma was only one small part) may play a factor. And if it does, the obvious change that the Democrats would now put in the bill would be negotiated pricing.
That was not what Pharma wants, but of course it’s a maybe and the CEOs of big Pharma who pushed the bill through are leaving their posts and leaving the potential consequences to their successors. My guess is that those successors will wise up and figure out how to cut a more reasonable deal so that they are not so squarely in the gun sights when the nation has a real debate about health care costs in a few more years.
TECH/INDUSTRY/POLICY: Out with the trash
Just some quick Friday cleaning up of stuff I never got to but you should look at.
- Intuit’s Dan Levin on how they’re going to fix the mess of medical billing et al.
- The head of the AMA bitching (with no little justification) about Health Insurers Profits
- Craig Barret CEO of Intel, bitching about the cost of health care in the US
- And the continuing irrational belief that a patchwork of state-based solutions can fix any national health care problem, this time in relation to the EMR infrastructure. Goal Is Electronic Health Records. Path Is State by State
As you may have gathered I was crazy busy yesterday and am playing ubber catch-up on about 5 fronts today. Hopefully will have a little more insight for you on Monday. Have a good weekend!
POLICY: How dumb is the NY Times?
Like a dog licking an open sore, the NY Times again returns to the "we spend so much on health care because it’s worth it" meme in a ridiculous article called The Choice: A Longer Life or More Stuff. (This post was about a different NY Times author’s stupid article on the same subject last month). They then print a bunch of reader responses, sadly few of which point out the fact that compared to countries who spend less money we’re not getting "longer life" (although the first one does).
But none of them point out the simple truth. We spend that much because the system has been politically rigged so that it’s virtually impossible not to. There is no causal connection between the vague desire for increased life expectancy on behalf of the public, and the increase in health care system spending. But there is a huge causal connection between the desire for greater health care system revenue on behalf of the system stakeholders and the increase in health care spending– because we have a funding system set up on their behalf. Has the NY Times not heard of, say, Medicare Part D? Have they not heard of 30 years of Wennberg’s Dartmouth works which proves that high cost care has bugger-all to do with improved outcomes? This is like saying we need 5,000 nuclear warheads or a brand new attack fighter 15 years after the end of the cold war, or that the drug war is effective. It’s patently not because we need those things, but it’s because there are strong interests that have gotten them funded!
Why can the NY Times, which does occasionally notice the rape and pillage of the ecoonomy by the health care system (though not as well as the WSJ does), not leave this open sore alone? Perhaps Judy Miller has been reassigned to the health beat and is ghost writing all their stuff, being fed lines by the health care equivalent of the Iraqi National Congress. What other explanation makes sense?
QUALITY/POLICY: Futurist’s forecast from Clem Bezold
Clem Bezold from Institute for Alternative Futures (kind of the alternative IFTF) gave an overview of the conference and an optimistic 2016 forecast for the availability of broadband to the home, better knowledge and personalized tools that will work on that information. Then he gets a little more controversial, including personal values, need for universal coverage, end of life care in context, etc — all as part of care in 2016
His main talk is about accelerating Disparity Reducing Advances project—wants to accelerate the technologies and process that reduce the social disparities in health care. They are not looking at the bigger picture of employment, education, etc, (consciously) and its impact on health, but they think that they can make a difference in the health care provision and tech part. They’re trying to pick their targets. And the first one is:
—Prevent obesity in poor populations. That leads to different levels of action in diff government and social programs. but we need to change the social environment, including getting the right foods into the right neighborhoods, as well as doing the health care screening and pre-diabetes initiatives. So there are a whole variety of factors you;d get to for any diseases, and information therapy is a big part.
Some things they’re trying—working with cell phones (LG has launched a diabetes phone this month which has a built in test strip reader. Also looking at biomonitoring activity, all connected to cell phones infrastructure. But needs to be connected to services. There are proposals to say that spectrum should not be auctioned off, but instead should be free (internet telephony over free wiMax?). That will be all added to patient and care giver “navigation”.
His forecast for monitoring. By 2008 standards for biomonitoring; by 2012 reimbursement has changed so it gets pay for; by 2016 common in us for monitoring the chronically ill and elderly. My feelings that this is about right, but it’ll require a whole hell of a lot of changes in the system…and of course there are huge infrastructure issues for the lower income providers (tech access, language, etc) which Clem spelled out clearly (and far too quickly to note down easily!)
Clem is an “aspirational” futurist who’s trying to change the future as much as explain it. At IFTF we were “analytical” futurists, and we derided the aspirational guys as the “personal helicopters by the year 2000” school of futurist — but his talk was really interesting, and frankly alot of analytical futurism is by definition wrong. So hopefully Clem provoked some big goals that we should all be going after.
I asked him about the norms of advertising for food and obesity—he thinks policy things can be done. And also about the system change required for home monitoring? How can the system change? He thinks that health care will be redesigned the hard way, otherwise it’s a perfect storm. It’ll get worse before it gets better. How do you get the patients and care-givers in the right place within the system. We will re-torque our use of health care providers to make that change.
Josh Seidman put up the Ghandi mantra “First they ignore you, then they laugh at you, then they fight you, then you win.” I think Ix is still being ignored, but soon it’ll be heading to the “fighting” part—and that is when it’ll get brutal.
Meanwhile in a moment of Ghandi zen, here’s a photo of a balloon over the canyons this morning
QUALITY/TECH: Intel’s Dishman wants a proactive health system
He’s been running the R&D for Intel’s health group, which basically means ethnographic research about over 500 households. They largely focused on using “caring machines” to monitor and support the care of the elderly in home, and the chronically ill. In his view care needs to be pro-active, needs to be personalized, connected (across the care network), continuous across conditions, and bionic. His other view beyond Intel is CAST has 500 companies doing major demo days like the White house conference on aging. The commission for aging in place technologies…
The current hospital system is what he calls “mainframe technology” — as people get old, that’s not going to scale. the same metaphor is true for health care—the power of the mainframe goes to the PC to the cell phone. And of course going from point intervention to continuous monitoring.
Sidebar: cool to hear a business executive telling his audience to read Michel Foucault
Dishman showed a prototype PHR/life management system that connects, which includes daily schedule, a “presence lamp” showing when other care-givers, family are in their houses, via sensor network. It includes a “social health” world which shows how close family members are to the person at the center, because it measures by phone sensors, and activity sensors (the more contact the closer people get to the middle). See the photo below for a poor representation of what the hell he’s talking about) This has been called “making the invisible visible”.
They’ve added photos of people calling and social network diagrams on the phone for those with memory loss (caller ID on steroids)
Intel also has a Parkinsons assessment box, which integrates the clinical tests done for parkinsons (moving pegs on a board), tracks motor skills, tremors etc….and then will titrate the drugs best on how people are doing.
Interesting stuff…but then he notes we’re working out how to pay for all this stuff……
BLOGS: Starring moi!
Tomorrow I am on two unrelated panels on the same topic!
Firs at 8 am PST at Jack Morton Worldwide (PR agency) (at 560 Pacific Ave San Francisco, CA) there is a panel on Engaging Blogs and New Media from the PRSA Health Academy. Dimitry will be the other blogger there along with Amy Hughes from Cisco and Dr. Harold Itskovitz
Then immediately afterwards Bulldog reporter is having an online audio conference called Advanced Secrets of Pitching Blogs: Influential Online Journalists Reveal How to Tap the Blogosphere to Protect and Promote Your Brand Online. On that one will be real blog stars including Tom Foremski, Eric Alterman & Jeremy Pepper. I hope I don’t look too foolish in their company!
Click on the links for details.
TECH/QUALITY: More quick hits from Ix conference
Deborah Bell—Runs ovarian cancer listserv and became an in-depth patient
Alan Greene, the pediatrician who runs DrGreene.com, and gets 50 million hits a month from 2 million unique users—Money quote for doctors online and off – “You have to get to the spot where you are OK that you patient knows more than you do.” He rewrote the Hippocratic oath because it said that physicians should NOT share information with patients! But doctors should still take a stand and tell patients what they really think.
Don Kemper, Healthwise—Infrastructure change saves lives for average people. Water quality; seatbelts in carsthey worked for the 20th century. What about the new century? How about message systems to tell you about immunization for kids? Information to cut out unnecessary surgery? Medication adherence protocols and information for everyone? Personalized wellness, prevention and screening for everyone? An appreciative approach to the end of life? We need to change the infrastructure so that the average person cannot avoid the Ix infrastructure!
TECH: MedEncentive–a “commonsense” P4P program
MedEncentive’s system allows doc and patient to declare their compliance and then agree to let the other patient confirm the compliance. And their study shows that it works. Here’s the press release on the study and here’s the study in full. (BTW Here’s their agreement with Healthwise).
Jeff Greene the CEO of MedEncentive thinks that he’s got around all the issues that block the intro to P4P (more work, no more money, transparent info they don’t trust, etc). He doesn’t approve of the stratification. “We’ve got to make the bad docs better and the good docs faster”. He thinks that we don’t need to beat up on docs, when the real increases are going to pharma and hospitals.
P4P works if docs accept it, patients are involved, and there is a positive ROI.
How do they do it? Both docs and patients get rewarded immediately when do they something good. Here’s how it works from their release:
Physicians were compensated for accessing MedEncentive’s website to declare compliance to or provide a reason for deviation from evidence-based medicine guidelines and for prescribing information to their patients for each office visit. Patients were instructed to go online to receive the prescribed information about their diagnosis and treatment and to confirm they followed the doctor’s advice in exchange for reimbursement of their office visit co-pay. Both parties were also asked to confirm the others declarations, thus creating a powerful interactive check and balance.
MedEncentive gets a PMPM payment for their service. They authenticate that EBM was used, and when they authenticate that EBM and IX were used, then they pay a spiff to the docs (20% more than standard fee) and they rebate the co-pays to the patients. And it makes overall costs go down (as it reduces hospital and pharma costs).
There’s an ability to deviate off the guideline if they have a good reason, and then they show the patient why later and let the patient comment. (The docs will soon be asked about patient compliance). The patients used computers to access the IX, and the customer (a municipality) set up computers for retirees. The consumers get $30 for reading the Ix material (which is a study and a questionnaire—like online traffic school) and then they ask them to rate the doctor. They aggregate the patients rating per doc and show them the overall score (not individual patients rating).
The docs say that it improves their productivity, as their patients are more informed. And chronically ill patients don’t want their patients to think they’re not compliant.
Jeff thinks that HMOs failed because we put all the incentives on the provider side. Now HSAs are going to put it all on the patient side. He thinks that responsibility needs to be shared and they’re calling it Interactive Accountability.
Results of the study—In Duncan OK, town of 22,000. Set it up for 60 days. Patients told, “ask doc for the info therapy Ix and get money back”, and they hand out Ix pads for docs. They then take the claims data from the employer TPA, and analyze what happened. And of course almost all the savings came from a big reduction in hospital costs. There was also a big reduction in radiology costs (that’s the only specialty that saw a reduction)! The city saw a reduction in overall costs—the city saw a reduction of 11.5% from baseline year to intervention year.
