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TECH: Search engines revving up–Healia review

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Got a press briefing from Healia, which is a new search engine focusing on health care. Their goals is to improve the quality and personalization level of the search, and cut out the spam results.

The approach is well thought out. Their engine also allows filtering by age/race/reading level/gender via a column on the left. They automatically behind the scenes assess quality by looking at the documents to
assess the page (rank by both relevancy and quality), and they assign it something called Healia’s Quality
Index Score. Finally they detect the general semantics of the
search term–drug searches will include dosages and side effects.

None of this makes much sense without using it, so you should go test drive it. You’ll see that results for standard medical terms bring back results from a more "authoritative" bunch of sites than a standard Google search, and if you search on specific disease terms (like diabetes) you get a series of tabs that divide the response up into categories like prevention, treatment, etc. You can also turn on or off the filters on the left that give you another range of result choices  or vary the font size right from the top.

So far the VA has licensed the technology, and they’re going both the licensing and portal rout. At the moment it’s small with only a few employees, but they’ve clearly done a lot of formal usability testing and lots of research and thinking about what would be  useful health search engine.
Healia’s founder is Tom Eng, Chairman. Craig Husa is the CEO. Marcos Athanasoulis who runs their tech of happens to be an old friend of mine and I used to work with his wife Monika, but I didn’t realize he was on board until this call!I’ll hopefully soon be getting a look at another major new search engine for health care, Healthline, (for which Enoch Choi appears to be blogging) shortly. But clearly in the post Google IPO world, there is now interest in figuring out the future of  consumer web search for health care once again.

CODA: Meanwhile. Tommy Thompson is pitching new health care software. It’s a self diagnosis tool. May well be very clever n’all, but I dont think it’s going to find a self-pay market at $30 a year. I might though be wrong!

AND: Another sorta health-specific search engine that’s supposed to help you find insurers and doctors that was called Healthia (not that that was confusing it with Healthline or Healia in anyway!) has changed it’s name to Vimo.

QUALITY/HOSPITALS: Odd hospital stay ratings–only the good get mentioned?

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In a vox populi column the SF Chronicle asked readers, How would you rate your last hospital stay? Funnily enough in every case when they had a good experience they mentioned the name of the hospital. If they had a bad experience, they didn’t call out its name.

Do people with bad experiences really tend to keep quiet about who did the dirty on them? Or is the Chronicle scared of pissing off advertisers? We report, you decide!

HEALTH PLANS: The individual insurance market sucks; did I just catch AHIP in yet another lie?

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You’re not exactly surprised are you? A Commonwealth Fund Study Says Individual Insurance Too Costly

The overwhelming majority — 89% — of working-age adults who shopped for health coverage in the individual market over the last three years were rejected for health reasons or found it too expensive <SNIP> Coverage was not affordable for 58% of the applicants, and 21% who had a medical condition were turned down, charged a higher premium or sold a policy that excluded the existing problem from coverage, the report said.

But don’t worry—that bastion of pure unadulterated research AHIP has its own study:

America’s Health Insurance Plans, an industry group, took issue with the study and its methodology — a telephone survey of more than 4,000 consumers — saying their impressions were not as reliable as the trade organization’s survey of insurance companies last year. The group also pointed out that its survey showed that 16 million people had individual health insurance and that the policies they purchased were more affordable than the Commonwealth report suggested and with richer benefits than employer-sponsored coverage.

Are they really saying that “individual health insurance policies are more affordable” AND have“richer benefits than employer-sponsored coverage.” Even on an acid trip there’s no way that Karen Ignagni and her lackeys can keep those two thoughts in their head at the same time without smoke coming out of their ears. I mean I know they’re well versed in lying but that one is about as stupid as possible. If only because by definition the distribution costs of selling individual policies massively exceed those of group policies. If they’re “more affordable,” it’s because their benefits are lower. And yes the benefits of most individual policies are worse than those of group policies, and most of them are consequently cheaper on an absolute dollar basis. But on a “dollar per benefit” scale they cost more. . Just one tiny study from Gabel and co in 2002 proving this is here

And that’s not even counting the fact that insurers underwrite the crap out of the individual market. AHIP’s own release confirms that  “Of those applicants offered coverage in the individual market, more than three-quarters received their requested coverage at standard rates, while 22 percent were offered full coverage at higher initial premiums.  Only 1 percent of offers included a coverage exception for a specified condition.” In other words the 20% of people who were potentially sick were underwritten. Duh! (And of course they don’t count people who were completely rejected, so their not bothering with the relevant denominator).

But back to the LA Times article. Please, please tell me AHIP’s being misquoted (and to be fair their own press release doesn’t quite say what the Post says they say), and that they meant “or” not “and”? Well let’s see—in a riposte to the paper I linked to in the previous paragraph which suggested that the individual market was poor value in Health Affairs back in 2002, this was written:

Administrative expenses are much higher for individually purchased insurance. Since each dollar of health insurance protection costs more in the individual market, it is not surprising that consumers in that market buy less of it

This is logical. It also would appear to completely agree with my point and rubbish the quote from the AHIP lackey research director in the LA Times. So who came up with this powerful and insightful analysis? It was Donald A. Young and Thomas F. Wildsmith. And who were they?

Donald Young is president and Thomas Wildsmith is a policy research actuary at the Health Insurance Association of America in Washington, D.C.

HIAA merged with GHAA to form AHIP shortly after that was published. Pity they didn’t bring their research team with them. At least they had some vague standards of honesty when they debated their corner back then.

CODA: By the way, I’m not exactly thrilled with any study done on the individual market. Even the massive RAND one in California had several flaws as I pointed out here, but no one in their right mind should trust anything AHIP says on the subject.

PODCAST: Jeff Rose on the reality of RHIOs

Yet another excuse to see if you believe in RHIOs. Here’s an interview with Jeff Rose who runs Health Alliant, probably the only consulting company focusing exclusively
on RHIOs–which he views as a partial solution to health care’s market failure.

Jeff thinks that there is a business model for RHIOs, and that they’ll be doing much more than moving lab results about. A very interesting interview you can download or listen to here  (transcript to come).




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			HOSPITALS/POLICY: Another hospital CEO calls for single payer		
	






	


I put this up because you guys love this type of thing as an open thread. Albany Medical Center chief calls for hospital reform and single-payer system.  Albany Med Center is a monopoly non-profit provider, so it’ll do fine under single payer, but maybe not quite as well as it does now—but it’ll save a bundle not cahsing up its uninsured and charity care.


Oh, and by the way, just in case you were surprised the Senate Finance Committee has found that non-profit hospitals don’t really deliver any more charity care than for-profit ones, and as the list of Boston Hospital CEO salaries makes clear, their senior executives aren’t exactly beggaring themselves working there. Which confirms my conclusion that there’s little difference between them and that we should get rid of the distinction one way or another—and make them look like old fashioned public utilities. (Maggie Mahar is slightly more charitable about the non-profits, but not much)


 

	





	

		
			TECH: Williams not impressed by Bush		
	






	


David Williams at The Health Business Blog tries vainly to interpret Mr. Bush. No not that Bush, Jonathan Bush from AthenaHealth. But it’s clear that Jonathan shares similar skill with the English language as his more famous cousin. If you know what this means, please feel free to let me know.




Q: So what do you think about the Massachusetts eHealth Collaborative [MAeHC] experiment to build full electronic patient records in three communities [North Adams, Newburyport, and Brockton, in a $50 million project funded by Blue Cross and Blue Shield of Massachusetts]?


A: That’s way off on the wrong track. If you could just pay for results, rather than pay for inputs, you’ll probably do better. Markets work better. We changed AthenaHealth 100 times. We had certified nurse midwives on salary and I had no browsers. Now we’re a Web-native, dot-communist bunch of MIT guys, analysts, and recovering Fleet Bank people working together to form this integrated clinical, financial, paper, analog, digital process.




I had no browsers? Maybe he meant he had no trousers? Or maybe he wasn’t able to get on the Internets? To be fair to Bush, several of his comments in the interview about automating the peripheral information floating around in the system such as lab results rather than starting with the clinical workflow of doctors make some sense. But given that significant majorities of primary care docs in many other nations do use EMRs in the office, it seems unreasonable to suggest that American doctors can’t do it. Which leads to David’s suspicions about Bush’s motivations:




So why is Bush badmouthing MAeHC?Bush’s company, athenaHealth receives a substantial cut of physicians’ revenues in exchange for assuming the hassles of billing and collection. In the arcane world of coding and billing, where each payer maintains arbitrary, changing, and unpublished rules, and where clinical practice and billing are disconnected and paper-based, athenaHealth’s revenue cycle management approach offers a strong value proposition.I wonder if Bush is worried that MAeHC’s promotion –with payer backing– of integrated EHR and PMS systems such as eClinicalWorks will obviate the need for athena’s services and blunt the entry of athena’s new athenaClinicals.




I took part in an study (as a respondent) recently and it’s clear from the (unpublished) results that the EMR and Practice management app vendors are on a collision course in the smaller physician space. So perhaps Bush is marking his territory and is nervous about eClinicalWorks et al. if I was anywhere in that space I would be. One interviewee called eClinicalWorks the Southwest of the industry!

	





	

		
			PHARMA:  Peter Rost’s confessions of a healthcare hitman		
	



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Rost_smallSo the book that Rost has been working on is out. (Here’s a very quick summary of his story I wrote back in March). It’s called The Whistleblower: Confessions of a Healthcare Hitman. 


In contrast to John Mack’s review which calls it a little dull, I think it’s a very, very interesting tell-all and much more interesting than a fictionalized version would have been. It’s 200 pages and I devoured it in 2 hours. I am of course bitter that he stole my title, but we’ll let him off!


There are some problems with the book. First, Rost is a little late to the game on the series of corrupt practices that big Pharma has been involved in over the years. Marcia Angell did it better, and John Abramson gets better into the details. Rost’s chapter on that corruption (ch 19) is a big mess, because it presents several different types of malfeasance as being the same thing, whereas there are activities within big pharma that are way over the line, and others where the line may been approached but not crossed. In the latter case a pharma company may settle because it didn’t want to run the “death penalty risk” of not settling with an aggressive prosecutor and potentially being banned from government programs. The key point of that chapter gets a little lost—and that point is that breaking the law is a considered business risk for pharma and many other health care entities; more so when the “law” is unclear—which it often is. 


However, the rewards are worth it and not just in pharma. After all St Barnabas paid a Medicare fine recently of $265m odd when it acknowledged overcharging some $630m! So crime does pay, and it pays in the health care world to fuzz up the notion of “crime”. (There is one great catch, which is that the front organization that nominated Rost for whiny whistleblower of the year was headed by a guy who’d done Federal time for Medicaid fraud). But I think the whole chapter could have been cut.


The other frustration with Rost’s book is that we don’t learn much about some key issues that are ongoing in the Genotropin suit and he hid the whole existence of the suit from the narrative, whereas I think it would have been better done to introduce it with everything else he was up to chronologically, as the rest of the book is organized. However, some of the lack of details is inevitable as that one has some while to play out…and at the moment it looks like Rost is facing an uphill battle. We do learn that there is or at least was an ongoing criminal investigation into the the Genotropin issue as well as Rost’s civil Qui Tam suit. That may have been public information but I didn’t know about it. But it’s a little like Wayne Rooney writing his autobiography aged 20!


Finally, Rost spends much time going on about how tough it is to be poor–but he was earning $500K a year until recently and must have some stashed away. He also doesn’t tell us how much he got out of Wyeth (and maybe he can’t under that settlement) even though he details in the book that apparently many Wyeth execs had to settle with their local tax authorities at great personal pain.


But in any event the book is mostly about what happened when Pfizer took over Pharmacia, and has some interesting revelations about how Pharmacia may have juiced its earnings to indue Pfizer to overpay. That, of course, wouldn’t exactly have been an unknown act (Enron? Worldcom?)—although Pfizer today is at pains to say that the SEC has already investigated this and found it baseless. Not that corporate America has any sway over the SEC, the DOJ or anything, unless your name is the same as the leader of the Senate’s, or the current President’s!


Other than those quibbles I genuinely found this a terrific page turner. For sure it’s written in a self-sympathetic manner. Well what did you expect? There’s no doubt that Rost enjoys pissing people off, and knows his way around some Internet tracking tools that few corporate suits understand. We also of course don’t hear Pharmacia/Pfizer’s side of the story—but it’s going to be very interesting if they try to explain that Rost was behind the Genotorpin scheme himself. Because their defense must be either that or he’s made the whole thing up. (And if they really are withholding a database of contracts from the DOJ, as Rost says, I assume that they’ll be found out one way or another).


But it’s a great read straight from the horse’s mouth of a guy fighting a massive corporation with the weapons he has at his disposal. And very entertaining too. I know that it will be read alot, especially in the pharma business! And it’s yet more embarrassment for a big corporation that had a knee-jerk reaction to a problem that it could have solved easily by a) coming clean and b) buying off the squeaky wheel. 


It reminds a great deal of the Thatcher government that could have got rid of the whole Spycatcher scandal by paying the ex-spy his pension, and instead landed itself in deep doo-doo, while helping the ex-spy turned author Wright sell a ton more books!

	




	
		

	



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