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CONSUMERS/BLOGS: CDHC Conference

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Dmitriy did a nice job at his talk at the CDHCC meeting yesterday. You can see his slides here

I was the skunk in the room on a couple of panels. I asked a “question” at the payments and financial services panel, which basically said that HSAs were going to turn doctors into collections agencies….and got surrounded by lots of people afterwards who either agreed with me, or who told me that they were on the point of building the real-time credit guaranteeing, deductible adjudication network that was going to save physicians, and guarantee them that the patients with HDHPs actually pay their bills. They’d better be right, or else the doctors will start thinking that single payer, but one that at least guarantees to pay, is a pretty good alternative!

I was not the only skunk in the room on the Sally Pipes/Grace-Marie Turner debate (!) which I pointed out was as much of a  debate as the Republican Convention. One questioner stood up and said that the pro-HSA crowd (which he was on) would have to prove that they weren’t just about employers cost shifting to employees, or they’d lose the ideological battle. Too bloody right—unfortunately the data is in and that is exactly what’s going on. The PRI guys (Graham and Pipes) want to go to meetings to combat State Senator Sheila Kuhl’s call for single payer—what they are confused about is why the single payer guys think that HSAs are a godsend for their cause. Apparently they think everyone wants to have an HSA and take part in health care “ownership”.

I tried to be a moderate and merely pointed out that the ideologues in the HSA movement are treading on very dangerous ground as Americans love their employer-based insurance and know that there’s not much to replace it with. Just wait till they find out how dreadful life is in the individual market!

HEALTH PLANS/POLICY: RAND study on the individual market puzzles me a little

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Here are my longer comments on the RAND study about Consumer making in the individual insurance market published on the web last week by Health Affairs. Somewhat ironically I was interviewed and fairly extensively quoted in this Olga Pierce UPI story (yup, the Moonies got to me!) before I’d read the whole study, so I was mostly venting my prejudices about the individual insurance market as a whole in my comments there. This is a little long, so I’ve put it below the jump — but I think it’s very important.

Continue reading…

TECH: CDHCC Conf. Report Esther Dyson on start ups

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I’ll be dipping in and out of the CDHCC conference. Yesterday I popped in to remind Esther Dyson that we’d met 10 years ago, but now just know each other via email. (She emailed me during someone else’s talk to tell me to pay attention to it!) Esther didn’t really have a prepared talk—she’d been spending her time going weightless like one of those astronauts in training. She basically said that start-ups had to be realistic and very focused.

I asked her what VCs should be investing in. She suggested management of the chronically ill, such as compliance reminders, and products for women and family aimed at pregnant women and those with newborns.

Given that she’s spending a lot of time holding conferences on personal health records, Esther was asked about her vision for them….but more interesting was who was going to win. She said health plans were not trusted. We need something like banking system. She thinks that employers might be the driver of this. They’re well positioned to be the key. In the end its the consumer who has access, they’ll assign permission to providers and insurers to access that record. Each patient will have broad records, that will cut out lots of inefficiency, and pay up quicker. Then add data for researchers which will improve health care, even without changes in legislation.

Other interesting mentions; she’s getting involved in the open genome project. Genetic information is being put online. Esther will be one of the first to put her genes online. Esther realizes that this is a big political mess. (Perhaps we need an ICANN for health care). She said that we need to be clearer about how we ration things. But she didn’t really follow up on that.

Other talks—CEO of Healthline, the reborn Yourdoctor.com, and Intermap systems spent a while telling us how his search engine was better than everyone else’s. He might have noted that his site is only #7 when you do a Google search on the name, so perhaps the bug guys are scared of him! This is a third time restart for this technology and it’s pretty interesting, so maybe this will work out now. $42m in so far, though!

Ryan Phelan, ex Direct Medical Knowledge (which was basically PlaneTree online) had $5m investment in that and sold it to WebMD for $65m about 25 minutes later….instead of lying around on the beach drinking Krug (well maybe after a few years of that), she’s now started DNA Direct, which is aiming to be a consumer friendly hub for genetic testing. I thought that the presentation was succinct and that she may well have a real long term business model.

Today I’ll be dipping in some more. Pity Reggie is on before I get out of bed!

TECH: Oops! Hospital loses 5,000 X-rays in hard-drive crash

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Ore. hospital loses 5,000 X-rays in hard-drive crash. Apparently 4 out of 5 hard drives failed, and the back-up wasn’t backed up. Still that’s nothing—I lost a whole year of downloaded soccer videos when I knocked over my external hard drive. And I still was too cheap to buy a back-up to the back-up.

Of course some of you might think that the radiology images are slightly more important than say Chelsea’s game with West Brom….

PHARMA/POLICY: Yet more revisionism in Part D

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It’s incredible how a couple of bullshit surveys, dishonestly conducted have changed the rhetoric a little on Part D. Now there’s a very odd article about Part D in The LA Times, which has been speaking truth to one power (Kaiser Permanente) all last week. Apparently it’s all going swimmingly well.

By the May 15 deadline, federal officials expect to have more than 20 million seniors enrolled in plans under Medicare Part D, as the benefit program is called. That would include at least 7 million who previously lacked insurance for outpatient prescriptions. Of the millions who have signed up, many are enjoying significant savings, sometimes $1,000 a year or more. That’s a considerable achievement for a government that has not tried to roll out such an ambitious entitlement program since the days of Lyndon B. Johnson. It’s especially so for President Bush, who is no fan of big government.

And read on because it quotes lots of dinisterested parties like everyone’s favorite lobbyist and truth-teller Karen Ignagni, and the flack from the AEI, before it gets to the real triumph of Medicare Part D. It’s cheap, much cheaper than we were told!

Mike Leavitt, HHS secretary was happy to point that out:

As proof that privatization is already working, Leavitt points to estimates that the program’s net cost to the federal government will be $678 billion over 10 years, instead of the $737 billion projected last year.

Funny that because this is what the PBS Newshour reported in March 2004

When the Medicare law was passed last November, Congress’s scorekeeping arm, the Congressional Budget Office, pegged the cost at $395 billion over ten years. Contrast that with the $534 billion estimate from HHS’ Centers for Medicare and Medicaid Services, or CMS. The Bush administration released that estimate last month as part of its 2005 federal budget request.

So we’re not yet hitting some of the wilder estimates of the program cost, and we’re only going to be (maybe) $280 billion over the original budget promised, or a mere $140 billion over the real estimate that was deemed so explosive that it was forcibly hidden from Congress by Tom Scully, the Bush flack then running CMS. That must mean that the whole thing is cheap and shows that the market is working!  And of course we can trust everything that these guys say, as in every other aspect of their performance.

Pity that if we just paid the prices the VA gets we could cover all seniors with no donut hole for less money, but at least we’re helping out with private enterprise and promoting choice! Because that’s such a great thing.

Martha Straub, 86, a retired secretary from Woodland Hills, gives her new drug benefit an A and the signup ordeal a D. That averages out to a C+. "It’s very hard for an individual to dial in the plan that’s going to be most beneficial to you," said Straub’s daughter, Lorna Bashara, who helped her mother. "It was like looking for a needle in a haystack."

(Cross posted over at TPMCafe, who’s blog on the subject is somewhat quietening down)

HEALTH PLANS/HOSPITALS: Kaiser needs to set up a major external review

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Here’s the latest LA Times article in the series on an issue for Kaiser Permanente that is clearly not going away: Kaiser Transplant Patients Express Their Fear and Fury

And up from the comments from Harvey Frey MD, is the core issue that KP must deal with now before they get put in the "just like the rest of the egregious bastards" category: Harvey says:

Kaiser-Permanente is emphatically a for-profit organization. 50% of
Kaiser’s annual billion dollar profit is paid to the Permanente Medical
Group, and thence into the doctors’ retirement accounts. Fifty cents of every dollar NOT spent on health care directly benefits
the doctors. Money paid to outside contractors comes right out of their
pockets. The motivation behind the Kaiser denial of kidney transplants is clear.

As for cooking their statistics, according to an ER doctor friend of
mine who has worked there, they drive up their heart treatment
statistics by referring out the riskier cases. They get away with their poor care by forcing patients into their
mandatory arbitration system, and blackballing arbitrators who find big
for patients. The only excuse for being a Kaiser supporter is ignorance of what they actually do!

I don’t know if this little blog has any influence, but here’s what I’m calling for. Kaiser needs to set up not an internal inquiry as they’ve started, but a major league external investigation headed by a serious independent medical heavyweight. They must also agree to abide by its recommendations for insulating the (largely salaried) Permanente physicians from the suspicion (as voiced by Harvey), and I hope not the actuality, that they are making medical decisions for their own personal profit.

Don’t forget that capitation as a movement died because the public felt that doctors were withholding care for their own financial advantage. The same thing is becoming understood about FFS–or rather that doctors/the system does too much for their own advantage not for the best care of patients. KP or more accurately The Permanente Medical Group needs to get itself out of that similar ethical hole, and given that it largely pays it physicians with salaries, it ought to be able to make sure that, not only in perception but also in reality, it is working for patients’ best interests.

Because, as I said in a private email exchange last night, if we can’t trust salaried physicians at what has been–to those of us in the  health policy world at least–one of the few institutions that has been an innovator in care and care management on a population basis, who can we trust?

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