Those of you who like your reality dressed up as fiction might like this new book, which Greg Pawelski recommends as telling lots of truth about the oncology-industrial complex. It’s called A Test of Survival and the web site is worth exploring at least.
I’m up over at Spot-on about the health benefits system, and how it’s heading for long-term collapse, focusing on this time a wealthy company that’s not from Arkansas: Inside Intel’s Health Care System.
Meanwhile, I wrote a little about HIMSS, technology and why we’re falling behind over at TPMCafe’s excellent ongoing blog on Medicare Part D (which is fast becoming an excellent group health policy blog).
So go there and come back here for extensive HIMSS dump downloads next week….
Even though I saw him and I was wearing “his” badge, so his whining is a little out of order….MrHISTalk’s write up of HIMSS is fantastic. He must have had a long flight home with a power converter. He’s wasted at whatever his day job is, and they should give him the mini-cooper.
I had a dead battery and a short hop, so I will be dribbling back and forth with more from the 15 interviews I did at HIMSS over the next few days when I convert my “notes” into something resembling English….
Your correspondent had the somewhat out of body experience of discussing HSAs and “cherry picking” with a Singaporean health minister, followed by eventually getting a back to my grotty motel, and being told that I had to go to another motel, driven there by a very chatty young Indian man who was very interested in discussing optical networking, and hospital automation at 2 am…
Meanwhile, the check in for the conference is at the other end of the center from the press room, which doesn’t have enough power cords.
So you wonder why no HIMSS update….just wait. Patience, patience
A new study states the obvious about health policy and the HSA
The analysis, conducted by Jonathan Gruber of M.I.T., projects that while 3.8 million previously uninsured people would gain health coverage through HSAs as a result of the President’s proposals, 4.4 million people would become uninsured because their employers would respond to the new tax breaks by dropping coverage and they would not secure coverage on their own. The net effect would be to increase the number of uninsured Americans by 600,000.
HIMSS appears to be getting bigger and bigger. There are 23,500
people here and over 800 exhibitors, but segregation is the watchword.
The big guys are downstairs in the main exhibit hall, while the smaller
companies are in an upstairs gulag. Cerner has perhaps the most
interesting approach,
taking a huge space in the middle of the hall, but featuring its
clients rather than itself. Several other big companies are hosting
smaller ones, with Microsoft devoting seemingly all its space to lots
of vendors who use Windows, and maybe one day Vista. Meanwhile, the
other Vista, as in the VA’s
system, is the core of Medsphere’s new offering for the mid-range
hospital market. CMO Scott Shreeve told me that "Epic is a Jaguar, but
not everyone can afford a Jaguar."
I’ll report more this week on wireless tracking, ePrescribing,
RHIOs, and interoperability–the IHE has a large part of the gulag
showing its interoperability forum. Brailer’s keynote yesterday
continued the inter-operability message.
Not exactly health care tech, but I find this pretty cool. GotVoice takes messages out of your cell phone or home/office voice mail (It actually leaves them in the saved queue) and emails them to your email inbox as Mp3 files. You can either set it up on a schedule (twice a day) to go get them, or you can download their little application that sits in that little tray at the bottom right of windows, and you can send it to get your messages. So then you can basically turn your cell phone off, and of course you can now forward the message attached to an email.
The messages are still in your “saved” queue if you want to get them by phone, and you can even set it up so it will delete old saved messages (that are now in your email box) on schedule, and if you want to keep a message forever, then you can store it as an MP3 forever.
Neat, free technology, that doesn’t take much effort to set up. Very convenient if you have a more reliable computer than phone connection. The only pain for me is that when I play the message in iTunes, after it stops iTunes plays the next thing on my list which happens to be Joe Walsh’s Rocky Mountain Way….all together now: Dun dun dun nun dun der
I’’m on my way to HIMSS today but in the meantime, more on my ongoing personal struggle to get health insurance…..
Remember that I was kicked out (or the association that I bought my insurance through was kicked out) from the PacAdvantage buying group? So my choices are to go back to the individual market or, luckily as I’m now “domestic partnered”, to pay some $450 a month for the rich benefit plan on my partners insurance.
So I finally got around to fixing myself short-term insurance while I’m being underwritten by Blue Shield and Health Net for standard individual insurance. For the short term insurance from Blue Shield the application I initially started last year puzzled me because the common generic medication I take for gout wasn’t on the approved drug list (It costs $40 a year!!) but a whole bunch of much worse medications were! I’d saved my application from last year because it itself didn’t enable you to change the desired date of coverage but you could restart it and it would start on the next effective date. But if you went “back” to change the date, you lost all you’d put in. A stupid UI screw-up which I wrote about when it happened last year. When I re-continued my “saved application” it denied me. But I had in between talked with the Blue Shield people who told me that the drug list had been discontinued as part of the short-term program. So I started a new application (start counting how many I end up filling in) on eHealthinsurance, and got approved — or at least got accepted and later (with no new email informing me) got a form in the mail saying I was approved. Oh, and for the short term coverage, you can’t set up automated payment or credit card even thought you pay for the first month in advance online with a credit card. Instead, you have to send a check. Pathetic.
Then I started the next application for normal individual HDHP insurance with HealthNet, also on eHealthinsurance. It asked me a bunch of the same questions, none of which carried over from page to page. It even asks you to fill in the same doctor’s information on 3 different pages (it asks about conditions, then drugs, then visits — all were the same one shot visit to one doctor for me!!) It never gives you the chance to carry over the information or tick a box saying “same”. And of course nothing came over from the short-term application I’d just filled in, even though it’s all in eHealthinsurance’s database. The UI on the form and the user experience is pathetic.
Now of course I get an email from eHealthinsurance saying that HealthNet needs more info, and will be mailing me a form to fax back! So much for the “e” in their name.
As this was going on I’d called Blue Shield to ask about their guaranteed issue plan (Over $400 a month for dreadful coverage). Later on Blue Shield had a different agent call me to direct me to her website where I could download a PDF application, fill it in bt hand and fax it back. Don’t forget, AHIP tells us that this is one of America’s most technologically advanced health plans! Ten years ago they allegedly did a deal with Healtheon to help their customers apply and manage their benefits online—oh, how far we’ve come! Oh, and the PDF crashed my system because I didn’t have the latest version of Acrobat, so I had to download that too. Pathetic
And of course the joke is I am already a Blue Shield customer via the group plan (or was till the end of January) and am on the short-term product right now! And I was a customer on their short-term product back in 2004 when I last had surgery. So I’ve been constantly covered by them since 2003. They could look in the claims database for everything that I’ve had in the past 3 years. But none of that information appears to be available. Pathetic
In the end I thought that I’d go back to eHealthinsurance rather than fill in a paper form. So I find the same plan and the same price as Blue Shield offered me direct, and applied for that. They of course wanted all the exact same information that HealthNet wanted. Of course all that information is in the eHealthinsurance system. The eHealthinsurance customer rep told me that it was fine to apply for multiple plans at once. I asked her if, when I gave the same information to a different health plan, would they underwrite me the same way and come back with the same price? She said, no they vary greatly.
BUT I could not transfer the information from the HealthNet form to the Blue Shield form even though it’s all in the same damn database! So I had to re-key it in. She told me that I wasn’t the first person to ask for that function by a long chalk. And once again I couldn’t even carry physician information over from page to page of the application, even though you can go via eHealthinsurance to HealthNet’s electronic provider directory to find out information on the exact physician. But you cannot import it into the application form. Pathetic.
Now the interesting part will be figuring out a) what else the plans think they need to know and b) what rates they will charge once they figure out that I had knee surgery in the past — even though it’s only a minor indicator of whether I’ll need it in the future.
Meanwhile, eHealthinsurance says that when you look at its plans it gives you a comparison between them, but it doesn’t even put the most important single feature of a HDHP on the front page— that is the maximum out of pocket (i.e. your maximum exposure if you have a catastrophic event). And it doesn’t even define the maximum out of pocket the same way when you click through to it — for some plans the number includes the deductible, sometimes it doesn’t.
I had an email conversation with the preeminent medical director working in the corporate benefits world about this exact topic. He told me that he came to realize what a mess this all was when he was unable to figure out what was the best option for his mother among the multiple competing plans with different premiums and benefits in Medicare Part D. If I’m in the top 1% of Americans on this topic he’s in the top one or two period. And he can’t figure it out.
This is a world of deliberately confusing plans and benefits, presented in a deliberately confusing way, taking advantage of none of the technology that makes our lives easier in other areas of business. Pathetic. pathetic, pathetic.
And it’s a world that many many more people will be heading for.
Ian Morrison said in his talk at the P4P conference the other day that no Canadian had ever had an MRI. As a sweeping generalization that’s true. But in actual fact a few of them have had one, and they use their machines a lot more efficiently.
(BTW Ian was joking, for you literal conservatives out there).
Over at Spot-on, I’m musing about whether or not I’m a Health Care Hitman. Peter Rost, late of Pfizer, is more or less singing the same tune.
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